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96 Cards in this Set
- Front
- Back
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massage |
the rubbing or kneading of muscles or joints with the hands. certain manipulations of soft tissue, effects on NS, muscular system, RS, circiulation and lymph. masser-knead FR amassar- knead Portuguese, massa- dough |
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therapeutic massage |
use of variety of manual techs designed to promote stress relief and relaxation, mobilize structures, relieve pain and swelling, prevent deformity, promote functional independence in someone w/ specific health prob |
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recreation massage |
use of variety of manual techniques designed to relieve stress, promote relaxation and general wellness in a person with NO health prob. A lot of this |
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why massage |
foundation for principles of touch/palpation, also for principles of draping and client handling. Gateway modality, effective interventions |
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CV system massage effects |
Dilate superficial vessels via local reflexes, increase stroke volume via promotion of venour return. Decreased incidence of DVT via decrease in blood viscosity and hematocrite. Edema- inceases lymph flow via mechanical P |
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CT massage effects |
decrease pain and improve mobility. Cyriax friction- traumatic hyperemia, prevents/disrupts adhesions, temporary analgesia |
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muscle tissue and massage |
decrease spasm and hypertension |
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NS and massage |
decrease pain, possibiliy via gate theory and via increase an opiate production |
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indications for massage |
pain, edema, spasms, trigger points, insufficient circulation, contracted tissue, specific/general relaxation |
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contraindications for massage |
when increased circulation is not desired, severe distress (pain, febrile state), contagious skin condition,over foreign bodies or sharp bony prominences, acute conditions, areas of decreased sensation, over recent sx, systemic edema, areas of active bone growth, tuberculosis, pregnant |
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therapeutic relationship |
implicit agreeament regarding roles of PT and client. Informed conest (cannot consent w/o knowing what you will do), maintain boundaries. |
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role of touch |
physical and psychological, helps ID pt's state, can communicate your state of being wash hands before/after, hot water 15+ sec, warm/dry hands first, short fingernails, rings? |
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positioning of pt |
support natural joint curvatures- pillows, bolsters, towels. Limbs should be elevated to allow gravity to assist circulation. Pt should not be supporting any part of themselves. Comfort |
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draping |
expose area that you are tx, parts not tx should be covered |
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massage media |
purpose to avoid uncomfortable friction b/n hands and skin. Unscented, hypoallergenic. Avoid reqular lotions- many absorb too quickly, requires repeated pauses to apply more. Oils can go rancid, and stain |
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PT positioning |
monitor body mechanics, shift weight, when possible face persion during massage. Table height usually b/n PT wrist and end of fingers. Many vary, some use step |
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effleurage |
rhythmic, consistent, stroking. In any direction, info gathering, warming, calming Superficial- relax effect, calming. Deep- reflex and mechanical effect. |
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petrissage and compression |
intermittent keading. Pushing down. may be uni, bilateral or digital. Increases circulation, softens and lengthens tissue |
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friction massage |
sustained pressure w/ mov't. May be linear/parallel, cross fiber, circular. Cyriax cross fiber is particular tech. Applied w/ specificity, non gliding tech- not superficial |
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jostling massage |
rhythmic shaking of tissue/limb. Good for relaxing, decreases muscle guarding |
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percussion/tapotement massage |
hacking, beating, punching, chopping, slapping. Stimulating, good way to end session. High in sports massage |
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direct pressure massage |
sustained pressure w/o mov't. Trigger point is a type |
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stroke direction and duration |
linear, cross fiber, distal proximal. W/ or against. Lengthen or shorten. Anything but effleurage is distal to proximal, more leway on back. Adequate to achieve goal, no rx for times |
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stroke pressure and rate and rhythm |
varies based on goal, body region, pathology, pt tolerance. should be purposeful and consistent |
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principles of strokes |
work broad and light to specific and deep. Mold hands to pt body. Deep pressure- distal to proximal. Address entire length of muscle of interest. Minimize interruptions- leave hands on as you move around. |
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pain and massage |
painful musculoskeletal conditions. Good for back pain, general orthopedic conditions, post op conditions, fibromyalgia (may feel fine at time, horrible 48h later), degenerative joint conditions |
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edema |
swelling due to an increase in fluid in the interstitial, intra articular, or intracellular space. Massage helps reduce when caused by injury, illness, sx. |
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lymphedema massage |
manual lymphatic drainage: form of massage using really light P (30-40mmHg) and brush like strokes to encourage mov't of lymph through lymphatic vessels and nodes |
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contracted tissue and massage |
short tissue shortened or damaged in a way that decesaes its extensibility. After inury, sx adhension may develop- break up or reallign, scar massage. After neuro injury- muscle tone may be flasid (PNS) or spastic (CNS), useful for CNS more, keep ROM |
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muscle spasm and massage |
involuntary contraction due to inflammation, irritation. Often protective. Massage purpose: relax muscle spams, increase local BF, reduce assoc pain. Can help break pain-spams-pain cycle |
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pain spams pain cycle |
inury, altered BF, stiff, weak. Then pain, brace area, weaker, stiffer, more pain, more bracing |
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trigger points |
focus of irritibility in a tissue that when compressed is locally tender, will refer pain, sometimes referred to ANS and distort proprioception. Little area w/in, feels like taut bands/nodule. usually spasms as it releases. Ice, massage, digital/ischemic compression, PNF, TPPR |
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local edema |
edema is confined to an area |
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systemic edema |
occurs throughout the body. Congestive heart failure |
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massage and relaxation |
a nice side effect that can allow us to move to other tx. Not all find it this way |
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lymphedema |
edema resulting from compromise of lymphatic sysyem, tends to be regional. removal of cancerous lymph nodes |
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what makes up the lymph system |
lymph fluid, interstitial fluid, lymph nodes, lymph ducts, associated lymph tissues, capillaries, and vessels that produce and transport lymph fluid. From tissues to circulatory system |
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functions of lymphatic system |
remove excess fluid from tissues, abdorb fatty acids and subsequent transport of fat to the circulatory system, produce immune cells |
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when increased circulation is not desired |
System cannot manage increase. Systemic edema (Kidney, liver, Congestive heart failure- cannot increase volume out, into lungs), primary lymphedema, infections (local). Deep vein thrombosis (break off) |
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deep vein thrombosis |
redness, heat, pain, skin changes (shean), decreased hair. Calf common. Women on birth control, post sx. Leg most common. US confirms, not in our scope though |
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severe distress |
physically ill, fever (systemic process occuring), nauseated. Severe pain. Radiation- local |
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contagious skin conditions |
local. worsen, spread w/ P and rubbing. Rashes, boils, athlete's foot, ringworm, allergies- to certain oils and lotions, double check |
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over foreign bodies or sharp bony prominences |
massage can shear and compress tissues, massage over foreign bodies (nails, screws, shrapnel) or over sharp bony prominence (hypertonic bone) may damage tissue |
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acute conditions |
massaging damaged or leaking BV increase bleeding. wait 48h. Too early can damage cellular and fibrous network delaying healing. May work proximal to site of injury. Inflamm- redness, heat, swelling, pain. No itis |
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areas of decreseased sensation |
pt cannot give proper feedback. stroke, diabetes, SC injury, frostbite. Need to neuro check to be sure. |
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over recent sx or loss of strucutral integrity |
know MD protocol, special care taken with scar massage. Skin grafts may not accommadate shear forces |
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over active bone growth |
healing fx site, myositis ossificans, osgood- schlatter disease. If growing not a contraindication, just have extra dr. okay |
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myositis ossificans |
inflammation of muscle leading to bone formation. 9-20% quad contusions. When muscle bleed the cascade of cellular responses occur causing hetertropic bone formation |
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osgood schlatter disease |
in young athletes, soccer, basketball, ballet, figure skating. Atypical bone growth, lump below patella, painful |
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tuberculosis |
highly contagious bacterial infection that usually begins in lungs. Spreads to lymph nodes, kindeys, bones. S/s coughing, blood in sputum, fatigue, weight loss, night sweats. Goal is to avoif disturbing or spreading the infections |
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pregnancy |
Considerations for this: there is increased BV, DVT risk, soft tissue laxity, positioning considerations for comfort and circulation , increased training needed to perform massage over the abdomen. Specialty |
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massage precautions |
May need reduce P, avoid certain regions, or shorter time. Hematomes (chronic), non uniform fx, herniated discs, debilitated pt (children, elderly), malignancy, conditions w/ collagen weakening (steroid, diabetes, RA) |
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stroke order |
superficial stroking, deep stroking, kneading, compression/direct pressure, friction. Always make nice at end |
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friction massage purpose |
mobilize adherent tissue, reduce scar tissue, reduce/mobilize trigger points, increase local circulation, decrease pain |
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cross fiber parallel circular |
deep friction applied perpindicular to the direction of the fibers deep friction in same direcition as fibers repeated circular motion, distal to prox considered |
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deep transverse friction massage or cyriax friction |
small areas that are actively healing, pain/inflammation in musculoskeletal condtions, attempts to reduce abnormal adhesion, more mobile, realigning soft tissue, might help normal healing by preventing abnormal scarring. for subacute/chronic. Tendons. Contact is w/ index supported by others, a lot w/ thumb |
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deep transverse friction massage mechanical and physiological effects |
Mobilize and elongate fibers localized hyperemia (increased blood flow) |
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DTFM histology and neurological effects |
prevents, or slows scar formation, stim collagen orientation along lines of stress pain inhibition |
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DTFM indications |
promote healing of CT and contractile tissue, to retain or regain mobility, pain modulation healing, mobility, pain |
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DTFM contraindications |
acute inflammation, hematoma, conditions that increase bleeding (hemophilia, pt on anti coagulants, pt on steroids), debilitated/open wound |
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positioning for DTFM |
muscles: supported and relaxed. Tendons: position of tension. Ligaments: taut as far as ROM will allow |
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DTFM treatement protocol |
Initial 5-6 min, first 1-2 pain, by 2 min should be numbed, once pain has decreased, gradually decrease P, check every 1-2, increase session by 3 min each time 12-15min max, 48h b/n session |
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trigger points biopsied |
fibers are increased in diameter, darker, contraction knots |
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trigger point characteristics |
consistent referred pain upon compression, local twitch response elicited by palpation, may limit ROM, muscle weakness w/ no appreciable atrophy, possible autonomic phenomena. Worse w/ m activity, passive stretch, direct P, cold |
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types of trigger point |
Active- always tender, produce referred pain, assoc m may be weak w/ decreased motion, localized twitch response. Latent- painful only when palpated |
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potential trigger point causes |
acute conditions- fx, sprain, dislocation, muscle impact injuries. Stress from excessive/unusal exercise, articular dysfunction, overload on muscle from prlonged posture, immobilization, Nerve compressions |
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motor end plate hypo |
Dysfunction (pre, post, or synaptic) acquired or genetic. Continued Ach release. Compression of local sensory n and vessels, decreased Ach inhibitors and O2, depleting ATP, decreases Ach inhibition and Ca removal, increasing contractility, chem activate nociceptor |
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trigger point vs tender point |
localized point plus change in tissue texture, jump sign- involuntary m response, referred pain (may not always be there), can pick up depending on muscle, tender points usually have multiple points in an area |
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finding trigger points |
flat palpation- fingers pressing down pincer palpation- picking up that part of m |
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trigger point tx |
spray and stretch, ice and stretch, pressure release/digital compression, deep stroke massage, PNF |
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trigger point pressure release |
gentle digital P, aim to reduce ischemic effect to injured tissue. 1 finger palpated trigger point, then m is passively lengthened to point of tissue resistance. At this resistance P is slowly increased |
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digital compression |
applied to 1 point 10-45s and P released w/ resolution of pain. Effleurage, petrissage, digital compressions, effleurage, stretch. Getting ischemia to then get increase BF |
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Pressure/stretch hypo |
help to restpre contracted sarcomeres to normal resting length, mechanical P helps to separate myosin and actin |
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trigger point dry needling |
injecting needle directly into TrP. Controversial |
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when is compression used |
edema/lymphedema, venous stasis ulcers, residual limbs, hypertrophic scarring, preventative modality |
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compression (not massage) |
improves venous and lymph circulation- hydrostatic P increased and pushes fluid, intermittent c pumps fluid. Provides shape- shape and limit size of a residual limb. Increaes tissue temp-insulator, may help breakdown collagen (limit scar, aid in tissue mobilization) |
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edema |
increased fluid in intersitial space, typically balanced b/n osmotic and hydrostatic Ps. Venous/lymphatic insufficenecy, increased BF related to truama, sx, burn, infection, or pregnancy due to increased BV, baby position |
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lymphedema |
lymph collects in interstial space, usually processsed in kidneys. Primary- congenital. Secondary- infection, neoplasm, sx, arthritis, venous insufficiency... Common to cancer radiation and lymph removal, microscopic worms in vessels and nodes |
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lymphedema and PT |
Specialty- further training needed, measure and Rx compression garments, wrap to provide compression. use expert if one in area |
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venous statis ulcers |
caused by impaired venous circulation- not fully uderstood, elevated venous P impedes venous return, may lead to endovascular and inflammation changes. Multilayered comp most effective- more rigid surface. Be aware of gravity influence |
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residual limb shaping |
required to prepare limb for weight bearing. Swell due to sx, gravity. Weight bearing increases forces on it. compression shrinker or wrap. prepare for prosthetic |
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hypertrophic scarring |
comp can decrease height of scar and increase pliability. Not fully understood. May act as mold, decreas local edema, faciliate improves collagen orientation |
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compression pump info |
typically pneumatic. prevent pooling in lower limbs. may help prevent DVT by minimizing pooling of blood. Sleeves that inflate/deflate to move P- sequential to aid in fluid mov't proximal, 1 single chamberto increase overall compression |
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compression pump precautions |
impaired sensation/mentation, uncontrolled hypertension, cancer, stroke or cerebrovascular insufficiency, over superficial peripheral nn to prevent palsy |
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compression pump DVT prevention, edema, venous stasis ulcer |
inflammation time 80-100 seconds deflation time 25-50s P- 30-80mmHg, typically lower than diastolic BP UE 30-60, LE 40-80 2-3 hours per tx or time in hospital bed |
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compression pump residual limb reduction |
inflammation 40-60s deflation 10-15s P- 30-80mmHg typically lower than diastolic BP, UE 30-60 LE 40-80 2-3h per tx or time in hospital bed |
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compression pump documentation |
volume/diater of limb (tracked), mmHg of compression, garments OTC stocking, custom |
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OTC stocking Custom stocking |
16-18mmHG, TED hose anti-embolism stockings, JOBST compression stocking, lymphedema may have higher levels 30-40mmHg for edema, typically used in stages/level |
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compression device contraindications |
heart failure, pulmonary edema. recent DVT, thrombophlebitis, pulmonary embolism. obstructed lymph/venous return. severe peripherial arterial disease or ulcers due to insufficiency. acute local skin infection. hypoproteinemia (proteinlevels <2gm/dL). acute traume, fx. arterial revascularization. |
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hacking/chopping |
rhythm is key, fingers are loose, not used. wrists loose, hitting w/ 5th MCP, pretty light |
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cupping |
thumb to index finger, form cup, strike w/ entire circle, sound like rain, over lung lobes |
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beating |
lose fist with side of hand, glutes and legs, back |
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punching |
lose fist, hit w/ knuckles, more pressure |
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slapping |
really gentle, pulling toward self, loose hands and wrist, use whole hand |
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Tapping |
neck and head |
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vibrate |
P on an area, vibrate through arm, small areas |
