Massage Therapy (1).pdf

TOPIC 1: Basic Maneuvers in Massage Therapy Stroking ↑ * Analgesic (relieve pain) - - increase * - blood supply (shin turns red /pink * - * -locally and systematically swelling of - ↓ the legs malfunction of increase the C caused a reins * muscular tone (for by se intercostal muscles) * direction -...

TOPIC 1: Basic Maneuvers in Massage Therapy Stroking ↑ * Analgesic (relieve pain) - - increase * - blood supply (shin turns red /pink * - * -locally and systematically swelling of - ↓ the legs malfunction of increase the C caused a reins * muscular tone (for by se intercostal muscles) * direction - > to · Low angle of increase blood supply in a specific areal incidence. (delect loss thorax - and - addomen Chromobile) - L superficial remain muscles -1 vasodilation & ↑ > - * of heat) [ Stretches blood for scars and brises supply tissues Effect of compression :Is blood supply 00 2 · > - ↳ Manual Lymphatic per 3. VD. Analgesic effect 4 tension. /stretching (occurs at Lower trap , Temporalis, Marreters Hand , Slipoars subscapular , and same foot , time fransnatur in ,. Cr, Lat. Dossi Brachioradialin Masters Sternachdomastoid, Ericss , Cis like 7 ↳ schemis Compression :. , , stripping) -longitudinal for myofascial Liber. distalto proximal way , love angle , of incidence. B · > - - CANALGESIC) & Diagnosis E ↑ mobility ↑ Olax : Intense Tighten ↑Cone : ↑ Intensity ) + ↓ hythm for Impermobility of skin - mussler more force ↓ - > Depth) Intensity - frequency - ↑ intensity , * (make to mucus airways ↓ frequency more and : gives analgesic effect dunch" flumt being it then , expell it (o very e high frequency & = 90 °, z = 4510 900 + for very specific - area stroking - tear , contusion pneumonial , ↳ for bigger (distal to area proximal) ~ => => > - for several minst in a wide area. better than percussion > - = > = > > * ~ (several mine) ↳ ↑ mobility P de > - helps balancing the muscular cors between agonists and antogonists. Deep stroking ↑ muscle longitudinal tono · ↓ muscle tose : - - to Distal-proximal longitudinal Proximal to distal # O ↳ Skin/Underlying Dinne Internityfrequency TOPIC 2: MASSAGE EFFECTS O - Change - parameters (I , t , b) - - - - ~ CPNS) (VD) > - increase ~ Stand is mobility stick (VD - > reducing volume at are a. NS NS NS * * Exproprioceptive Visungung Streng > ↳ Static : Nervous system conditions Dumping ! Dynamis : Deep Stroking (careful with speed !! ) Wh. -~ ↳ Abdominal hyph Surgery =7 Scars Compression & ↳ Proximal > Distal Inbed immobilization to Distal to Bracimal nodes input -Fou speed - - - ↳ pressure /baroreceptors O & touch /contact-"Fight news En impulse - - type nociceptors neurotransmitters y -e ↑ Chistamine calm down zcetylcholima) ↑ activity body (noradrenaline increase part of inflamatory "Information" blood kept : O in one area. [ ↑ "I ⑳ Neurotransmiters soup * - # - Massage Manual Symphotic drainage ↑ Proprioceptive - permanent vasodilation * ↑ - (no static Creatment venous T system - compression) Lower lint ↓ higher risk 37 °. 5 C E in the entire body , is a sign of infection. ↑ & Locally - >↑ isk infection > - ↳ ↑ risk release of blood dat all indicate if inflammation on. medication # # ↳ disans that affect the > - You joints and soft can increase tissues the spred and. increase proliferation of tumoral cells. TOPIC 3: SKIN EXAMINATION The skin Entirely surrounds us as a natural barrier. Most ancient and sensitive organ Defines our individuality. Provides valuable information of our general health condition. Wrap membrane, alive, relatively waterproof, elastic and mobile. Continuity with the mucous membranes. Highly vascularised. Segmental Innervation Dermatome (EXAM QUESTION) Skin area innervated by a spinal nerve corresponding to a spinal segment. I.e. skin area that contains sensitive information related to a single spinal root Essential when assessing aesthetic impairment (neuro). Keep in mind… The dermatomes OVERLAP (overlapping is even greater for vibration and soft touch, pain and temperature) Skin assessment Visual inspection Palpation Mobilization (Active and passive mobilization) Instrumentation Visual Inspection Conditions for observation Respect the patient’s PRIVACY Quiet, well ventilated, nice-looking Light conditions ( DAYLIGHT ) Bilateral Bony prominences + orthopedic/prosthesis supporting areas. Cover the stretcher with a pad/sheet and the patient with towels. * > ↑P = - blood supply ↓ Mass 1. Skin coloration Redness: increase in temperature and if bright red send to emergency room. Purplish or bluish: there is a lack oxygen and reduced temperature Black: Death of cells and necrosis. Yellowing: Problem with the liver. Marble or pale skin: no blood supply and vasoconstriction. Orange - Brown areas: high pressure. Hyper-pigmentation: the skin remains the same Color but melanilocytes will produce more melanin. Hypo pigmentation 2. Hairiness 3.Volume 4. Skin appearance Scaly plated Cellulitis Stretch marks Wrinkled Atrophic 5. Secretion Normal skin —> No Signs of dryness or sweating Sudorative disorders (Dry and plated) —> Injured nervous plexus and/or peripheral nerve 6. Flexion Creases In Down Syndrome people Eczema 7. Hairs and nails RIngworm Fungical infection PALPATION AND MOBILIZATION 1. Skin mechanical properties # Tested through the skin fold Consistency —> force used to form and maintain the skin fold Thickness —> width Extensibility —> how much it can be pulled Flexibility —> how much the skin fold can be twisted. Mobility —> Skin rolling, how much of the skin rolled can be moved. Elasticity —> ability of returning to its original state 2. Trophism and blood supply ⑳ Temperature Hyper Vs Hypothermia Skin Skin Texture Trophism and blood supply Pulse ( Radial artery, Brachial artery, Subclavian, Tibial artery, Pedius artery, Temporalis artery, Facial artery) Oedema -Venous -Lymphatic # * -Combined lymphodoema -Fovea Sign test -Stemmer’s Sign test Humidity Sudoral secretion —>. Hyperhidrosis Vs Anhydrosis Sebaceous secretion —> Normal, dry or oily skin Scars Resting Skin Tension Lines Normal Keloid Hyper/Hypotrophic Instrumental Quantificaiton Oedema Centimetric measurement for perimeters Volumetric quantification Skin thickness —> Adipometer Skin Temperature —> Temperature probe Trophism and blood supply —> Moberg test Static posture —> Digital Photographic control Supporting areas —> Barometry (for pressure) Sensory Assessment Superficial (exteroceptive) Algesia (pain) Thermal (T) Tactile (touch) Deep (interoceptive) Baresthesia (pressure) Algesia (pain) Palesthesia (vibration) Proprioception (articular position) Cortical or combined Stereognosis 2 point Discrimination Graphestesia General basis Ensure proper understanding of orders and cooperation Restrict distractions Shealthy Bilateral * Eyes closed Don’t exceed 20 min side Surface sensitivity Exteroceptive, Protopathic or Thalamic sensitivity Normoesthesia: Physiologic functioning Hypoesthesia: Decreased sensitivity Hyperesthesia: Amplified sensitivity Anesthesia: Absence of perception Dysesthesia: Altered perception Paresthesia: Tingling, prickling, numbness, burning. Synesthesia (same path for senses): Visual-tactile, pain-colour, Auditory tactile (Scon tissue - & Above makes poin O Healthy C time Proprioceptive, Epicritic or Cortical Sensitivity —> Deep sensitivity Baresthesia Digital pressuring: trapezius, Gastrocnemius & Brachial biceps Semester-Weinstein monofilaments Palesthesia Turning fork Distal to proximal Hypoalesthesia, hyperalesthesia, a Palesthesia * Bathesthesia Combined or Cortical Sensitivity Sterognosis: Ability to identify the objects by touch. Graphesthesia: Ability to identify signs on the skin. Two point discrimination: Ability to differentiate 2 points applied in the skin at the same time. The skin Wrap membrane, alive, relatively waterproof, elastic, mobile. Continuity with the mucous membranes orifices. Highly Vascularized. Originated in 2 blastodermic layers: Ectoderm (Epidermis and appendages (hair and nails) Mesoderm (Dermis and Hypodermis) Layers of Skin Epidermis Stratum Corneum Stratum Granulosum Stratum Spinosum Stratum Básale Dermis Papillary Reticular Hypodermis Skin Annexes —> hair, nails, sweat and sebaceous glands Functions of the skin Protective Mechanical protection —> Hypodermis Antimicrobial protection —> Sweat glands Thermal protection —> Insulation (fatty tissue (Hypodermis) for passive, Active —> dermis/ blood vessels) Electrical protection —> fatty tissue (Hypodermis) + Sebaceous Glands (Active) Light protection —> Dermis (Melaninocytes) # Chemical protection * = Sensory Sensitivity = First skill to interact and protect our being. Sensory receptors Located in afferent neurons peripheral endings Respond to internal and external stimuli Triggered by specific stimulus (pressure, temperature, chemicals, injury) in a specific intensity range. Nerve signal transduction Somatic receptors Proprioception Located in peripheral tissues: -Skin + Superficial fascia -Tendons -Joint capsules and ligaments Functional types of skin sensory receptors A. Thermoreceptors (Low threshold) Krause (Heat loss) Ruffini (Heat > 45 degrees Celsius) B. Mechanoreceptors (Low threshold) According to the response time to the stimuli: Slowly adapting receptors —> Pressure (Soft tissue will have a decreased blood supply, Hard tissue will break) Rapidly adapting receptors —> Superficial touch/ tickling, movement and vibration. According to the covered surface area: -Type 1 —> Small and surface covering -Type 2 —> Wide and well defined surface covering. Materiel discs (type 1, slowly adapting) Sensitive to skin displacement and maintained pressure Reticular dermis Pacinian Corpsucles (type 2, rapidly adapting) Sensitive to skin displacement and vibration Papillary dermis, Hypodermis, periosteum, tendons, synovial membranes. Ruffini corpuscles (type 2, slowly adapting) Skin displacement and maintained pressure Reticular dermis and hypodermis Both hairless and hairy skin Krause end bulbs (type 2, rapidly adapting) Light touch Reticular dermis Mucocutaenous and synovial membranes Meissner’s corpuscles (type 1, rapidly adapting) Light and discriminatory touch, vibratory. Papillary dermis Located in thick hairless skin —> finger pads C) Nociceptors (low threshold) Triggered when the tissue is damaged Some emotions are brought along with the physical sensation. (Ex: anger (feel less pain as higher threshold, anxiety feel more pain as lower threshold or fear) Small non or lightly myelinated afferent neurons TOPIC 4: POSITIONING IN MASSAGE THERAPY * - ~ - NOThave E 4. 2 , , 3 o 1 - - ⑳ - D & A f - - & - ↑ Proprioception ↑ Exam -Stabilizers(endurance) -~ - ↑ Q -A Cype I Liber Cisometric ~ ~ to the - stabilizers and neutralizers ↓ Dynamic Expe I movement filers Cisotonic Contact ↑ Reinforce Concentric of bipbrah - force produced brachiradialis - from pelois I Knuckle de stroking O > Contrati Isometria y V- y U2 L 00-7 M & Vue ⑦ - Vol ↓ ACL & 7 ↓ ↑ Spina Erectors i port ↑ I I ↳ D Not stable focus O scometric head and , ↑↑ constant contraction neck extensors Ov - - meniscus > - - Injury * good ROM - ↑ - - Stability + F OO O ulnar border , O ~ - - Chumb O - => * - 1 - - ↑ Movement ↑ Stability - & E - see for longitudinal motion Jan back L > - · 00 Seale No active E menisc suffer Stretching ↑ slift & too close to treatment lighter ! good for as gives freedom mor weight ments O mech too tillid D> twisting in 9 - O die area O Of ar m trunk arm too don ON bendon perior old / O I g ABD f HYPER # > - & > -. EXT PRONATION Extension of wrist ↳ flexing first Of FA overload beautical 1 && - Erectora 7 extended T ↳ too far ① , needs to hurting trank by O set not same in direction as get closer maneuver twisting O uncomfortable for patient confidence in 2 and loses T too much flucion O - neck Have a of the seat - Final Recommendations Unappropriate corporal mechanics sustained in time and incorporated as a neuromotor scheme —> Both static and dynamic corporal biomechanics alteration. Relaxed Shoulders —> Avoids carniocervical overload + Ensure blood supply Deep diaphragmatic breathing —> 02 to the entire body —> Avoid fatigue. # Slow, smooth movements are less harmful and allow greater movement control. When bending the elbow —> Tendency to bend the waist and “get settled” in the lumbar region. Advantages of an appropriate corporal mechanics: -Control of direction, force and rhythm of the movements -Energy saving -Less biomechanic stress in the PT’s body # -Efficient breathing -Relaxation “extensible” to the patient. TOPIC 5: BASIS OF MASSAGE Massage Therapy Application of the different classic massage maneuvers with therapeutic purposes. Massage Techniques Superficial reflex techniques (skin; reflex effects) Superficial fluid techniques (skin, superficial fascia, subcutaneous tissue, deep fascia; mechanical effects) Neuromuscular techniques (muscles, connective tissue hydration, lymphatic return; mechanical + complex reflex effects) Connective tissue techniques (connective tissue; mechanical effects - hydration, extensibility & modeling) Passive movement techniques (tissue+joints, wide-ranging effects on fluid flow) Percussive techniques (tissues depending on the force applied; reflex NM effects + mechanical effects) Intelligent touch Attention ② Focus the awareness on selected aspects of the sensory field. Concentration Constantly analyze and organize all the information obtained. Discrimination Therapist’s ability to distinguish fine gradations of sensory information Identification (texture) Distinguish between different structures and healthy and dysfunctional tissue states Inquiry Ask yourself … What is it? How does it feel related to the patient’s history? How does it fit within the symptoms? How does it feel when compared contralaterally? Intention Aim of using massage techs, to normalise the tissue and body Therapists’ Psychological preparation for treatment Burnout Prevention Burnout Syndrome: “Exhaustion + loss of interest in work and personal life that can result from chronic stress. Pts often miss warning signs of chronic stress… Common signs of chronic stress 2. 1. 3. > - * O * Stress busters Main strategy —> decrease levels of destructive stress and maintain healthy levels of “good stress” Using STRESS BUSTERS, activities that can be used to control stress levels We can use: Personal support (keep in contact with others lifeforms) Spiritual (sense of direction) Organizational (build structure to personal life) Physical (aerobic ex. —> endorphins secretion) Emotional (acknowledge & express your emotions) Mental (portable and price; available anytime) Diversionary (take a break —> get a fresh perspective) I Considerations Patient-Physiotherapist Relationship Neither too formal nor too warm. Support your communication in the health professional field. Appropriate terminology when referring to condition and treatment. Empathy and Active listening. Transference and Countertransference Unconscious process involving arousal of the patient’s/PT’s past unresolved conflicts and transferring them to the PT/ patient. The patient/PT begins to see pT/patient in a personal instead of a professional perspective. Drift to the appropriate professional BE AWARE OF HIS PSYCHOLOGICAL PROFILE. Tools Hands “Are individual’s second brain” Correct using: -Warm, relaxed, well adapted —> Optimal palpation —> Effect transmission. -“Ask for permission” —> Respect the tissue and the patient. -Always maintain the touch Pressure with your body weight! Patient’s posture Prone For treating dorsal areas Uncomfortable for the face/neck region Wedges and pillows —> Under ankles and abdomen Supine Face to face Promotes active participation Wedges and pillows —> under knee Lateral decubitus For treating the flanks Stabilization —> Pillow between both lower limbs, upper arm and craniocervical region Sitting position For treatment of forearms and hands Everytime the patient is not able to be in any other position.