quadriceps, moving the muscle group in one direction while the client moves the femur in the opposite direction. Next, the technique is repeated along the length of the bone or to either extent beyond a joint, as massage therapists takes special precaution not to torque the injury site itself. This is a generally safe technique; the only precaution involves the client’s comfort upon the technique’s application. the various techniques described here, cross fiber friction is one of the more uncomfortable techniques and may result in soreness or inflammation of the targeted area after it is performed; icing the targeted area after using this technique can help reduce its after-effects. Massage therapists should not use cross fiber friction if inflammation is present at the injury site or until the inflammation has been treated with ice or NSAIDs (see below). Therapists should let a client who is unfamiliar with cross fiber friction know the purpose behind applying this technique and what may result from its use. and bones of the athlete and result in severe bruising. Instead, the applied pressure should move perpendicular to the bone or at as much of an angle away from the bone as possible. Massage therapists should check in frequently with the athlete for feedback about pressure and pain; some discomfort is normal during deep tissue work but sharp pain should be avoided. Therapists should avoid deep tissue massage when an athlete has a blood disorder or is taking medication that causes hemophilia (prevents blood from clotting), or, causes thrombophilia (increased blood coagulation) since the latter condition may lead to the development of a thrombosis (blood clot). is not experiencing sharp pain, therapists should continue the technique by slowly lifting fingers or thumbs out of the muscle and repositioning them one inch closer to the insertion; therapists should repeat the stroke until the origin is reached. Generally, massage therapists should make at least three passes from origin to insertion. Note that large or broad muscles such as the latissimus dorsi will take longer to treat than shorter muscles such as the infraspinatus, sometimes as long as 30 minutes. On occasion, this technique is more effective when moving from insertion to origin, so if working from origin to insertion proves ineffective for this technique, massage therapists should apply the technique in the opposite direction. effective temperature (less than 116 degrees; a therapist trained to utilize hot stones will know when a stone is too cool to be effective). In the careful placement of stones, stones may be placed directly on the skin, provided they are not more than 120 degrees. Hot stones at a temperature greater than 120 degrees should be buffered by a towel or blanket to prevent burns on the athlete. As with a deep tissue massage, an open channel of communication between the massage therapist and the athlete helps to establish the comfort zone regarding the heat of the stones. While often effective in loosening soft tissue and very relaxing for any client, there are cautions against using hot stones. A hot stone massage is generally contraindicated if the athlete has diabetes or takes blood thinners. Hot stones are also contraindicated for female athletes who are pregnant or experiencing menopausal hot-flashes, or if the athlete has a sunburn.
to the client) without lubricant, grasp the fleshy areas of a limb above and below the injury. Then, slowly rotate each hand in an opposite direction from the other hand around the axis of the bone (or in opposite directions around the axis of the elbow or knee joint) as far as each muscle or the client’s comfort will allow. This technique may also be performed with the client’s help, as massage therapists grasp an especially large area of muscle such as the Cross fiber friction When applied correctly, this technique can loosen tension at the joints by realigning muscle fibers and reducing the scar tissue that may affect a client’s range-of-motion (ROM). To perform this technique, massage therapists apply medium to firm pressure with the thumbs or fingertips at either the origin or insertion of a muscle, or a site of scar tissue formation, and then move quickly back and forth perpendicular to the affected tissue fibers. (Therapists may also work in a circular motion for variety, but should always start and finish with the perpendicular movement.) Among Deep tissue As its name implies, this technique typically involves the application of forearms and elbows with firm pressure to access deep layers of muscle tissue that are not readily accessible with thumb or finger pressure. (Therapists may use thumb or finger pressure, but it takes more time for them to reach deep tissue, because they cannot generate the greater pressure that forearms or elbows can.) The deep tissue technique is further characterized by slow and deliberate movements while the targeted muscle or muscles are minimally lubricated. When performing deep tissue work, massage therapists should not press muscle tissue down into bones, as this can damage both the muscles Directional massage This technique is similar to the Myofascial Release technique (see below); however, it is applied to muscles as opposed to the body’s fascia, is deeper, and is meant to be done during the acute phase of a muscle’s injury (24-48 hours after the initial injury) between applications of ice. Without using any lubricant, therapists begin this technique by placing the fingers or thumbs perpendicular to a muscle’s fibers near a muscle’s origin with light to medium pressure. After the fingers or thumbs make contact with the muscle tissue, therapists use a short, one-inch deep stroke to push the muscle towards its insertion. Massage therapists should check in with clients to see if they are experiencing any sharp pain; if so, massage therapists should stop. If a client
Hot stones
Warm-to-hot stones (120- 150 degrees) may be utilized to direct heat deep into muscles. The application of heat deep into the muscles can have a sedative effect on the nervous system and effectively treats hypertension and manages pain by dilating
blood vessels and loosening superficial muscles, thereby giving therapists quicker access to deeper layers of soft tissue. Hot stones can be utilized in one of two ways; either as an extension of the hands so that the stones are kept in motion or by careful placement. When used as an extension of the hands, stones are usually heated to a temperature of 120-130 degrees and kept in constant motion so that they do not burn the athlete’s skin. As the stones cool, the pace of the stones may slow until the stones are no longer at an
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