systemor bring the client out of a deep relaxation. There are several variations of this technique and it can be applied with either the fingers, fists, palms, or the edge of the hands. Cupping the hands and striking the chest or mid-back, for example, may have the effect of loosening mucous from the lungs of a client with respiratory difficulties. Other variations include pounding, diffused, pincement, pecking, slapping and hacking. Take care not to strike the lumbar region or spine with too much force as the kidneys may become bruised. Also note that when using any variation of tapotement, do not prolong its use for clients using anti-anxiety medicines; too much tapotement may induce more stress. Vibration This is the general term used for any application of rocking, shaking, or trembling muscles or joints. Vibration , typically used at either the beginning or end of a massage or as a transitional tool, can be soothing and is suited for clients suffering from stress. Variations such as shaking or trembling can be done gently but with a more vigor pace. When vibration is used for relaxation purposes, it should be performed for no more than 10-15 seconds. Prolonging vibration is often included in Sports Massage since sustained shaking is generally stimulating to the nervous system. As with tapotement, do not use prolonged vibration for clients or patients using anti-anxiety medicines. Vibration should also not be used on the abdomen for clients on certain medications (see Medications, above) as it may induce nausea. Stretching This is used to lengthen muscles and increase a client’s range-of- motion (ROM). There are two methods of stretching a therapist is likely to use during the session; passive (or static) stretching and Proprioceptive Neuromuscular Facilitation (often referred to as a PNF stretch). With passive stretching, a muscle is pulled away from one of it boney attachment sites by the therapist so that it is at its maximum length. This stretch should be held for seven to ten seconds, which is the time it takes for receptors in a muscle to relax into a greater length. More effective than passive stretching is Proprioceptive Neuro-muscular Facilitation. This technique actively takes a client through several rounds of contracting and relaxing target muscles while the therapist resists the client through their full ROM. There are several variations or methods to conducting PNF stretches, though it is usually conducted by resisting a client’s movement with the target muscle held half way through its ROM. PNF stretches tend to have a larger effect than passive stretching. Compressions These are usually performed with the entire palm of the hand but can also be done with forearms, knees or feet to push muscles down into or down and away from the body. Since this technique uses broad pressure, it can be used with medium to firm pressure and will affect a larger area. Compressions can increase blood and lymphatic flow and help initiate the stretching of a muscle. Fast-paced compressions may also release acetylcholine (ACh), a chemical messenger that helps muscles contract more quickly by exciting the nervous system. Compressions are normally performed before lubricants are applied to the client or as a preparatory and transitional technique as the therapist moves to a new area of the client’s body. Compressions should not be used over the thorax (upper back and chest area) if the client has difficulty breathing, when the client has spider- or varicose veins in their lower limbs, or over bruises. Feathering This is a technique of very light pressure commonly used on the skin to calm and sooth nerves. This technique is also sometimes associated with lymphatic massage or can be used to reduce edema. To affect the lymph flow or to reduce edema, light force is applied by stroking towards the heart from areas closest to the heart and working away from the upper chest to either the top of the head, towards the feet, or towards the hands or feet.
Feathering can also reduce the appearance of bruising when applied in a circular fashion for one to three minutes. Since feathering can be ticklish to the client, the therapist should monitor the client’s reactions when proceeding. Hot stones or hot compresses These may be used to increase the blood flow to an area of the client’s body. This is often done because increasing the blood flow to injured tissues brings the tissue nutrients while simultaneously carrying cellular waste away. Using heat therapy has the tendency to loosen hypertensive muscles by soothing the nervous system; heat has the simultaneous effect of softening muscles for deeper work as well as reducing the stress of a client. Stones should be between 118 and 130 degrees when applied directly to the skin to be effective for most clients. Note that hot stones are contraindicated for clients that have areas of edema (diabetic clients often have swollen limbs) or inflammation, a fever, taking vasodilatation medicine (a drug that increases blood flow), and for pregnant women. Cold stones or cold compresses These may be used to decrease edema or inflammation and to reduce sensitivity to pain. Cold therapy is typically applied in instances where edema, inflammation or pain, limit a therapist’s ability to massage a part of the client’s body. Unlike heat therapy, cold therapy is stimulating to the nervous system and can be used to tone up hypotensive muscles. Note that cold therapy should not be used if a client has edema or inflammation within 72 hours of an injury because such inflammation is normal for the body when tissues have been damaged. Cold therapy should also not be used with clients on vasoconstriction medicine (drugs that narrow blood vessels, usually prescribed to clients with low blood pressure to increase their blood pressure). Trigger point therapy This is associated with myofascial trigger points (often indicated by tender points or painful knots in a client’s muscles). Trigger points, in which stands of muscle tissue become hypertensive and lead to a build-up of metabolic wastes in the tissue which in turn cause pain either at all times for the client or when the client’s tissues are palpated. Typically, the pain of a trigger point induces muscle strands to continue being hypertensive; this leads to a cycle of hypertensive muscle and pain that continues until the trigger point is deactivated. Trigger points are normally deactivated with medium to firm pinpoint effleurage with the fingers or thumbs, also known as acupressure . In this technique, pressure is applied until the trigger point begins to twitch, spasm or throb and held until the response subsides and tissue density decreases. Trigger points may form for any number of reasons, the most common being direct trauma to the tissues and overuse and repetitive motions. When the latter is the case, when a client’s trigger points are deactivated, they may need to be advised not to repeat the movement that caused the trigger point(s). But trigger points may also form as a compensation issue for muscles near them that are weakened. When this is determined to be the case (perhaps discovered by performing some of the assessments listed in the Assessments for Treatment Planning section), it may be the best course of action to leave trigger points alone until weakened muscles are strengthened. Balms and analgesics These are also within the scope-of-practice for massage therapists to apply. Balms can have a wide range of effects and may be manufactured with a broad spectrum of ingredients, meaning once again it is important to make a note regarding a client’s allergies. When cold therapy is not available, an analgesic may be applied locally to reduce pain. As with balms, analgesics may be manufactured with a wide range of ingredients thus leading to similar considerations of a client’s allergies.
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