Massage Full Body - notes PDF

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MASSAGE CHECK: 1. CONTRAINDICATIONS 2. ANATOMICAL AREAS OF SPECIAL CONSIDERATION

ANKLE TO KNEE: (Calves) Patient Prone with Legs Elevated Towels and Pillows

Therapist – At feet facing cephalad

1.Effleurage      

Mould your palms to the limb contour Ankle to beyond popliteal space Think Heart shape cephalad Lightly caudad KEEP CONTACT Reduce pressure at the back of the knee

2.’Splitting The Gastrocnemius’  Build up pressure superficial to deep  PATIENT TOLERANCE  Pressure on, then move 3.Effleurage Facing cephalad 4.Petrissage      

Move to the side of the couch Lift/Coax “Donald Duck” Lift and Squeeze “Donald Duck” Lift and thumb roll – away Lift and thumb roll – towards Lift/circling wringing (figure of 8)

5.Effleurage  Facing cephalad  Patient prone/Knee Flexed  From heel to Popliteal Space – “Toothpaste Squeeze” 6. Tapotement      

Move to the side of the couch Cupping, (Clapping) Hacking (Ulnar Border) Beating (Closed Fist – Ulnar Border) Pounding (Closed Fist – Palmar Fingers) Thenar/Hypothenar eminences

KNEE TO BUTTOCKS (Hamstrings)

7. As above without ‘Splitting Gastrocnemius’  Split hamstrings into 3 areas  Medial – intermediate – lateral for Petrissage 8. Effleurage 9. Petrisssage 10. Tapotement MASSAGE OF THE BACK AND SHOULDERS Time: 20 mins (approx.) CHECK: CONTRAINDICATIONS ANATOMICAL AREAS OF SPECIAL CONSIDERATION CONSIDER RHYTHM Therapist  At side of couch facing cephalad  Patient Prone Arms initially hanging down over side of plinth  Towels and pillows Effleurage    

Lumbar lordosis to over shoulders Hands either side of Spinous Processes Think heart-shape for pathway Little fingers lead

 Heavy pressure forward lightly back Lateralising    

Thenar/Hypothenar eminences start together at Spinous Processes Medial to lateral incorporate sacrum Trace Latissimus Dorsi Alternate lateralising with effleurage

Frictions/Deep Pressure Mobilisations      

Start at dimple PSIS Circular frictions away from spine, either side, using thumb pads Left hand clockwise, right hand anti-clockwise Pathway to spine of scapula and across Pressure on first – start lighter then increase Alternate 2 or 3 friction pathways with effleurage

PATIENT: HANDS ONTO COUCH RETSING ON TOP OF ONE ANOTHER AND REST FOREHEAD ON DORSUM OF TOP HAND Effleurage  From occiput down over shoulders

Frictions/Deep Pressure Mobilisations    

Along occipital ridge From T4 to occiput either side of spine Alternate frictions with effleurage Finish at Neck/Shoulder juncture with effleurage

Patient  Return arms to patient’s side Petrissage  All movements to upper trapezius and upper back  Beware of fingers digging into clavicle anteriorly as you ‘pick up’ (Brachial Plexus) Effleurage  Finish in lumbar region

Petrissage  Do the same movements to low back area overlapping area covered in upper back Effleurage  To whole back incorporating neck and shoulders  Include sacrum Tapotement    

Cupping/Clapping Hacking – NOT OVER BONY PROMINENCES Beating – Ulnar border NOT OVER BONY PROMINENCES Pounding – Palmar finger NOT OVER BONY PROMINENCES

Effleurage  Whole back, neck and shoulder including sacrum ACTIVE R.O.M. MASSAGE – NECK and SHOULDERS Approx. Time – 15 -20 mins CHECK: 1. CONTRAINDICATIONS ANATOMICAL AREAS OF SPECIAL CONSIDERATION

TEST FOR: VERTEBRAL BASILAR ARTERY INSUFFICIENCY I. II.

Extension and Rotation Compression

Patient Sat/Leaning on Couch  Patient could be prone or supine but these are variations  Towels , pillows Therapist  Stood behind patient hands on shoulders  Legs wide  Back straight

Effleurage     

Start occiput Either side of neck down tracing upper trapezius Mould hands to contours of neck and shoulders Pressure downwards – lightly as returning Spine itself

Frictions/Deep Pressure Mobilisation      

Begin level with spine of Scapula (T4) Thumb pads either side of Spinous Processes Movement is synchronised Circular frictions away from spine as in back massage Cephalad and Caudad Be careful with fingers – DON’T STRANGLE

Effleurage  Neck/Shoulder  Upper Trapezius Petrissage    

As in initial calf massage ‘Ducks Beak’ All movements Beware of fingers in clavicle – Brachial Plexus “ Spocks Point”

Friction/Deep Pressure Mobilisation (Both Scapulae)     

Around Scapula Begin inferior angle Rest fingers on back to act as bridge Find axillary angle and A/C joint Rhythmical synchronised movement

Friction/Deep Pressure Mobilisation (Individual Scapulae)  Patients hand into small of back- lumbar lordosis  Therapist pushes anterior shoulder to highlight scapula

Friction/Deep Pressure Mobilisation (Shoulder Joint)  Place thumb and finger on A/C and slide anterior and posterior to locate

   

Variation1. - Lock thumbs and use finger pads Variation2- Thumb pads Variation3 -Combination of 1 and 2 BEWARE ANTERIOR SHOULDER

Tapotement     

Whole area Cupping, Clapping Hacking NOT OVER BONY PROMINENCES Beating – Ulnar Border Pounding – Palmar interphalangeal joint (Thenar/Hypothenar)

Effleurage  Whole area Variations  Patient lying prone then supine

ACTIVE AND PASSIVE  R.O.M. FULL RANGE

TURN PATIENT SUPINE Towel technique Pillows and towels FOOT and ANKLE TIME: 20 mins per foot CHECK: CONTRAINDICATIONS ANATOMICAL AREAS OF SPECIAL CONSIDERATION EXAMINE FEET – CHIROPODY/PODIATRIST REFERRAL MASSAGE TO LOWER LEG (Posterior Aspect) Therapist  Sat/Stand facing cephalad Patient

 Prone  Legs Elevated  Towels and pillows  Mould your palms to limb contour Effleurage  Ankle to beyond popliteal space  Think heart shape/heavy cephalad  Lightly back  Keep contact  Reduce pressure at back of knee “Splitting Gastrocnemius”  Build up pressure superficial to deep  Patient tolerance  Pressure on, then move Effleurage  Facing cephalad Petrissage      

Move to side of couch Lift/Coax “Donald Duck” Lift and squeeze “Donald Duck” Lift and thumb roll away Lift and finger roll towards Lift/circling wringing – think figure 8

Effleurage  Facing cephalad Therapist  Move to side of couch Tapotement  Cupping/Clapping  Hacking/Ulnar Border  Beating closed fist, palmar fingers, Thenar/hypothenar eminences. Effleurage Therapist

 Facing cephalad- Continue up to buttocks on final stroke MASSAGE TO FOOT

Effleurage Whole foot – 3 techniques 1. Envelope foot dorsum/plantar aspect  Stroke toes to heel 2. Trace tibialis anterior – insertion to tibia 3. “Stripping out” using thumb pressure to plantar aspect  Fingers rest on dorsum  Toes to heel Friction/Deep Pressure Mobilisation*  Sole of foot  Use finger and thumb pads  Balls of feet to heel and return.  Within patient tolerance  Work across the foot medial – lateral working logically. Friction/Deep Pressure Mobilisation*  Around malleoli  Use finger pads  Locate depressions and work into/within patient tolerance Friction/Deep Pressure Mobilisation*  Metatarsal heads/MTP joints  Squeeze between thumb/finger  Circular grinding motion  Each in turn * In Rx tendons/ligaments are placed on a stretch and fractioned using transverse cross fibre action. MTP Joint Rolling  As above but using the thenar eminences Effleurage  Whole foot Passive Movement    

Stretch each individual toe Plantar/Dorsiflex Plantar flex and dorsi flex each individual distal toe joint (DIP) Proximal (PIP)

 MTP  Circumduct each toe  Stretch and move in figure 8 Hallux  Stretch DF and PF metatarsals 2-5 Gliding  Shake, glide and slide metatarsal joints against each other.  Fingers on dorsum/thumbs plantar  Stretch connective tissue between MCJ –‘Kit Kat’ Inversion/Eversion  Grasp whole foot (sub talar) Ankle Joint  3 movements (i) Slide/glide ankle mortice (ii) Rock Calcaneum (iii) PF – DF Effleurage Whole foot ankle lower leg Tapotement Calf muscles ACTIVE ROM ANKLE TO KNEE (Tibialis Anterior) Facing cephalad 11. Effleurage/Petrissage  Ankle to knee  Pressure technique to Tibialis Anterior  Using Hypothenar eminence away from Tibia.

12. Effleurage  Move laterally and medially around Patella to cover thigh/quadriceps

KNEE TO INGUINAL CREASE/LIGAMENT (Quadriceps) 13. Effeurage  Start below the knee and move around the patella to effleurage thigh/quadriceps

 Pressure  Heart-shape  Little fingers lead

14. Petrissage  As before but only front of thigh/quadriceps

DO NOT MASSAGE INNER THIGH IN SUPINE 15. Effleurage 16. Tapotement (As before) 17. Effleurage

18. Other Techniques  Compression  Approximation  Jostling/Shaking  Vibrations

N.B. A. Consider the positioning of the limb to assist venous return and lymphatic drainage B. In treatment, the upper leg would be treated first. C. Taking the joints included in the massage through their full range of movement, after the massage is an integral part of the treatment

ARM and HAND Time- Approximately 15mins CHECK:  CONTRAINDICATIONS  ANATOMICAL AREAS OF SPECIAL CONSIDERATION Patient  Sitting either on couch or chair  Arm resting on couch or pillow  Towel technique – Roman Toga  Palm down  Pillow support –Lumbar and Popliteal Therapist  Stood or sat facing/at side  Support nearest arm of patient with your nearest arm WHOLE ARM Effleurage  Wrist to over shoulder  Medial aspect first then lateral  Squeezing/moulding palm to arm  Elbow to over shoulder  Squeezing as in fluid out of a tube UPPER ARM Petrissage      

Support bent flexed arm on therapist’s leaving both of therapist’s hands free Pick up biceps/triceps Pick up/squeeze triceps Pick up thumb roll/finger roll Pick upo wringing/circling Palmar/Thenar Hypothenar can be used to deep pressure mobilise deltoids

N.B. The arm hand can be rested on a pillow or patients lap for rolling, wringing, circling if therapist finds the positioning uncomfortable when supporting.

Squeezing

 As in fluid out of a tube Tapotement  Clapping cupping to bicep/triceps Frictions/Deep Pressure Mobilisation To:  Gleno-humeral joint  Elbow joint -humero-ulnar superior radial ulnar and humero – radial  Wrist – palm down (carpals) PALM – UP - Supinated To wrist – palm up (carpals) BEWARE CARPAL TUNNEL  Support on fingers use thumbs for friction  Thenar hypothenar eminence MCP JOINT BEWARE TENDERNESS  Thumb palmar/volar  Finger dorsum  Trap squeeze between thumb and finger  Circular grinding motion  Each in turn  MCP JOINT rolling as above using thenar eminences PALM-UP PASSIVE MOVEMENTS          

Stretch individual fingers } Alternative Start MCP Joint – “pull off” at end } to individual Hook 1st finger underneath dorsum } friction to P.I.P. Thumb on top- palmar } & D.I.P. Flex and extend each individual finger joint D.I.P. (distal) P.I.P. (proximal) and M.C.P. Shake slide and glide } Metacarpal joints against each other } Fingers on palmar, thumbs dorsum }Can do palm down Stretch connective tissue between “Kit Kat” }

 Handshake grip  Other hand support ulnar radius Flex, Extend, Radial and Ulnar Deviation, Circumduct

 Put fingers over wrist move other hand to support elbow Pronate/Supinate  Grasp wrist and upper arm Flex and Extend Elbow  Support whole arm, above and below elbow  Ab/Adduct at elbow with slight flexion – Valgus/Varus stress  Traction to wrist joint  Shake whole hand and arm Effleurage REMEMBER to improve R.O.M/E.O.M. take the joint through its full range WITHIN PATIENT TOLERANCE...