Massage - contraindications and effects PDF

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Summary of the contraindications and physiological and psychological effects of massage ...

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Therapeutic Touch – Massage

CONTRAINDICATIONS OF MASSAGE DO NOT MASSAGE Absolute Contraindications – Situations affecting WHOLE body where intervention imposes high risk of harmful consequence -

Lack of informed consent Acute, unstable illness and/or severe undiagnosed pain Fever symptoms – influenza, TB, septic arthritis Septicaemia (infection) Possible undiagnosed cancer (consider the following)  Family history, unrelenting pain, generally unwell, night sweats, unexpected weight loss, lumps, heat/inflammation)

Regional Contraindications – Do not massage over these areas -

Fractures DVT Implants Skin wounds, bruising, burns, eczema Infected areas: fungal, bacterial, viral Inadequate circulation, fragile blood vessels

Relative Contraindications – special care required to decide potential risk of injury (case dependent) -

Acute, inflammatory conditions Moderate-severe irritability Osteoporosis Worsening condition – increasing pain, neurological deterioration Impaired peripheral sensation – diabetes, peripheral vascular disease

Precautions – Continue with care -

Fragile skin Oedema – pregnancy or lymphoedema Weakened CT – long term steroid use, osteoporosis, rheumatoid arthritis Blood clotting disorders – medications (massage may cause bruising) Poor mental health/MH disorder

Questions for the subjective assessment -

Do you have any health conditions, e,g, a heart disorder, skin condition or cancer? Have you had any sicknesses recently? And are you generally well? Do you experience night sweats or unrelenting pain? Are you on any medications and do you have any allergies? Have you had any surgeries, implants? Any major injuries I need to know about?

Therapeutic Touch – Massage

PSYCHOLOGICAL EFFECTS OF MASSAGE -

Decreased stress & anxiety Decreased depression Improved mood status (happier, relaxed) Increased self-efficacy Improved attention

Oxytocin - Non-noxious sensory stimulation (warmth, touch, stroking) - Promotes attachment and bonding - May produce sedative effects, increase pain threshold - Lowers BP - Influences CV and gastro-intestinal function, promotes weight gain, growth, healing The Calm and Connection Response – psychophysiological system complimentary to fight/flight response. Effects - Muscle relaxation - Decreased cortisol levels - Decreased CV activity - Improved digestion and anabolism in GI tract - Vagal parasympathetic system activated - HPA and SAM system shut down The Placebo Effect A substance, intervention or procedure that has no inherent power to produce an effect that is sought or predicted Relevance to massage: - Patient/therapist interaction - Power of suggestion - Patient Expectations - Patients experience of meaning - Optimism increases positive response to placebo effect - Nocebo: negative ‘effect’ of an intervention

PHYSIOLOGICAL EFFECTS OF MASSAGE

Therapeutic Touch – Massage

Structures we touch & influence -

Skin Subcutaneous tissue Connective tissue Muscle Blood & Lymph vessels Cutaneous mechanoreceptors Free nerve endings Musculoskeletal mechanoreceptors

Mechanoreceptors Stimulated by Massage Effleurage: Rapidly adapting receptors - located in superficial layers of skin - respond to light touch & changes in sensation Petrissage Slowly adapting receptors - located in deep layers of CT - respond to deep pressure Massage: Pain Reduction Local -

Reducing pressure on structures caused by local muscle tension or oedema Resolution of muscle spasm/tension Restoring blood flow, oxygenation, flushing Realignment of muscle fibres

Spinal Cord Level Effects - Pain gate control and counter irritant theories - Hormonal response – endorphin release in dorsal horn of spine PAIN-GATE Theory Pain Traveling up to the CNS – Transmission of noxious stimuli to the brain (Aδ and C fibres). Transmission of Pain Inhibited – Transmission of noxious stimuli to the brain may be reduced/blocked at the spinal cord by - descending inhibitory input from the brain - non-noxious stimulation of sensory receptors in periphery. Massage stimulates sensory receptors, blocking transmission of noxious stimuli. - Massage stimulates A beta fibres which inhibit pain transmission Global Effects (Central/Systemic) - ANS effects on tension and breathing - Descending inhibition from higher centres - Psychological effects on pain perception - Hormonal response – endorphin release from hypothalamus

Therapeutic Touch – Massage

Effects on the Fluid System - Blood coming from the heart and going to the heart: e.g. arteries, arterioles, veins. - Fluid movement out of vessels into the tissue; nutrients, maintain chemical balance around cells. - Normally an equilibrium is maintained; injury or pathology will upset equilibrium. - Natural pumping mechanism can be influenced by compression or movement of tissue as in massage. Lymphatics - Helps transport fluid back to the bloodstream (approx. 10%) - Reduce threat of toxic spread through the bloodstream. - Vessels have one-way valves empty into the lymph nodes (groin, armpits, neck, knee) - Drain into a single duct in a proximal direction (important to massage in a proximal direction) Muscle Stimulation of the muscle spindle with massage can ‘reset’ the spindle at a lower level. - General relaxation effect on muscle tone. - Certain techniques may have a stimulating effect and result in increasing muscle tone (activation of sympathetic nervous system).

MASSAGE TECHNIQUES

Therapeutic Touch – Massage

Effleurage Indications -

Improves blood flow (aids venous return) Aids lymphatic drainage Positively stretches muscle groups and has a relaxation effect on muscle (deeper strokes) Mental health, patients with body image issues, can provide sense of containment for patient’s sense of self. May increase tone, be stimulating and warming with faster strokes. Continuous effleurage leads to pain reduction

Petrissage Indications -

Improves blood flow (aids venous return) Aids lymphatic drainage (may reduce oedema) through pumping effect Warms and stimulates tissues Passively stretches muscle and fascia (connective tissue) increasing mobility and length. Helps release areas of adhesion and strengthens connective tissue. May promote relaxation response depending on pressure to muscle proprioceptors and reflex effect.

Deep Transverse Frictions (DTF) Transverse technique working across the line of collagen fibres (“against the grain”). Fingers move with skin, small amplitude, deep technique. Thorough knowledge of anatomy required. Uses: Partial muscle tear, Ligament sprain, Tenosynovitis tendonitis. Trigger Points: - “Discrete, focal, hyperirritable spots located in a taut band of muscle” Ischemic Compression Progressively stronger painful pressure applied to Trigger Point and held. Pressure within patient’s tolerance (5/10 pain). Feel for release of the TP (and cessation of referred pain)

ETHICS

Therapeutic Touch – Massage

Physiotherapy Board of NZ - Defines physiotherapy practice threshold competence required for initial and continuing registration - Ensures standards are met - Protects the profession - MUST be a member (legal requirement) - (declare gifts to them) Physiotherapy NZ - Regulatory authority - Organisation that protects practitioners - Involved in education, insurance, funding, advice (e.g. what to do in X situation) - Not compulsory Health Disability Commissioner (HDC) - Protects patients - Consumer rights - Investigates complaints Important Legislation - Privacy Act 1993: if in patient's best interest, can share info to the appropriate person e.g. informing GP of health issue - Code of Health and Disability Services Consumers Rights 1996 - NZ Bill of Rights  Right to refuse intervention and to have choice about participation in research (must refer person on)  Right to freedom from discrimination The Health Practitioners Competence Assurance Act 2003 - Governs what Physiotherapists are allowed to do - Provides framework for the regulation of health practitioners in order to protect the public where there is a risk of harm from professional practice - Obliged to report issues with other health practitioners if you are aware of them Steps to take if you injure patient – common exam question - Apologise - First aid - Inform of right to complaint - Tell supervisor - Incident report/ACC (if they need treatment) - TAKE NOTES of incident

Therapeutic Touch – Massage

Code of Ethics and Professional Conduct 1. Physiotherapists respect patient/clients and family 2. Physiotherapists act to promote the health and wellbeing of patient while acknowledging, respecting and facilitating patient autonomy. 3. Physiotherapists respect confidentiality, privacy and security of patient/client information. 4. Physiotherapists treat people fairly. 5. Physiotherapists practise in a safe, competent and accountable manner. 6. Physiotherapists act with integrity in all professional activities 7. Physiotherapists strive for excellence in practice 8. Physiotherapists communicate effectively and cooperative with colleagues, other health professionals and agencies, for the benefits of their patients/clients and the wider community 9. Physiotherapists take responsibility to maintain their own health and wellbeing 10. Physiotherapists accept responsibility for upholding the integrity of the profession...