Complete Your CE Test Online - Click Here peripheral and central nervous system, the autonomic nervous system (ANS), and neuroendocrine secretions. Rather than a one-to-one correspondence, the effects of massage are a combination of mechanical, neural, chemical and psychological factors (Crawford et al., 2016). Massage strokes Each massage stroke is associated with specific qualities of application that greatly influence its effects. In general, movements that are more rapid than the heart rate stimulate, while movements that are slower than the heart rate relax. Movements may be centrifugal, away from the heart and corresponding to arterial flow; centripetal, toward the heart and corresponding to venous flow; or cross-fiber, perpendicular to the direction of tissue fibers. Application also varies according to duration and frequency of treatment and the physical positioning of the body. Pressure can vary from light to deep, with varied rate of application (speed) and intervals of application (rhythm). Massage uses a variety of specific strokes (described below), including as many as five to eight categories. (Some massage therapists distinguish the following actions: Rocking from petrissage; shaking from vibration; and compression from friction.) ● ● Effleurage (gliding): This technique is carried out with long, gliding strokes toward the heart. May include nerve strokes or feathering (a very light stroke), and is typically performed to relax, stimulate, stretch and broaden tissue to increase circulation (lymph and blood movement) and reduce edema. ● ● Petrissage (kneading): This technique manipulates fleshy areas with actions including rolling (using both hands to compress the muscle against the bone, then rolling it), compressing, and chucking (using one hand to hold a limb while the other hand moves along the bone). Petrissage is primarily used to assist metabolic function and the removal of wastes; promote the movement of blood in deeper tissue; break up adhesions; stretch muscle fascia; increase blood and lymph circulation; and support weakened muscle. ● ● Friction: This technique includes a number of different types of vigorous, rhythmic actions that largely benefit the bony areas of the body. This stroke includes circular friction, which promotes circulation and stimulates muscle tissue and nerves; transverse friction, which is applied perpendicularly to muscle fibers to break up adhesion; parallel strokes, which stimulate deep tissue and reduce adhesion; and compression, or pumping. In each case, friction increases circulation, promotes flexibility of the joints, increases circulation and breaks down sediment in the fascia. ● ● Tapotement (percussion): This stroke uses pounding, tapping and other movements in rapid and alternating succession over primarily fleshy areas, avoiding any sensitive or injured area. The stroke is used to stimulate tissue, increase circulation, improve muscle tonus and loosen lung congestion. ● ● Vibration (shaking): Rhythmic shaking and manipulation of surface tissues used to soothe and calm or to stimulate, depending on the pressure and rate of the application. Action Strokes Results Local mechanical. Effleurage, petrissage, friction. Localized warming and softening of the tissue; increase in blood and lymph circulation to the targeted area; increasing cellular exchange of nutrients and wastes. Local (somatic) reflex. Vibration, friction. Massage action on the muscles and tendons activates nervous system feedback to contract or relax the targeted muscle fibers (tonus). Systemic mechanical. Effleurage, tapotement. Effleurage increases blood pressure, heart rate and blood/lymph flow; tapotement mechanically stimulates the central and peripheral nervous systems. Systemic reflux. Effleurage, friction, tapotement. Stimulation of the sensory receptors of the skin and deeper tissues activates neuroendocrine chemicals associated with relaxation or stimulation. Physiologic effects of massage therapy The physiological effects of massage are briefly reviewed in this table, and described at greater length below: General. ● ● Increase in local blood supply to soft tissues, muscles and joints, vasodilation. ● ● Increase in lymphatic and venous return (causing reduction of edema). ● ● Increases drainage and reduced swelling in soft tissue, muscles and periarticular areas. ● ● Prevention of adhesions and fibrosis in ligaments, muscles and associated tissues. ● ● Reduction in muscle atrophy during extended periods of disuse or immobility. ● ● Muscle relaxation and reduced muscle “guarding.” ● ● Increases flexibility and mobility, including joint range of motion. ● ● Pain reduction or interruption of pain cycle with increased mobility. ● ● Balances pH levels. ● ● Increases hormonal release with systemic results. ● ● Reduces pain and inflammation due to chemical release. ● ● Increases cellular metabolism, removes metabolic wastes. ● ● Promotes healing. Cardiovascular/circulatory system. ● ● Facilitates cell nutrition and oxygen supply. ● ● Removes metabolic waste. ● ● Increases vascular health. ● ● Changes heart rate and blood pressure. Lymphatic system. ● ● Facilitates movement of lymph through circulator system, increases flow, and reduces edema. ● ● Increases urine excretion. Integumentary system. ● ● Increased blood flow to skin, with increased skin temperature, perspiration and sebaceous secretions. Muscular system. ● ● Increases muscle tonus, relaxation and stretching. ● ● Reduces incidence of muscle spasm and cramping. ● ● Reduces pain and promotes healing. Nervous system. ● ● Reduces pain through chemical means and nervous response. ● ● Restores homeostasis in the parasympathetic and sympathetic systems. ● ● Releases natural pain killers. Respiratory system. ● ● Facilitates ease of breathing through relaxation of muscles and increased fluid removal (percussion stroke). Immune system. ● ● Increases production of T cytotoxic cells and reduces stress, with effects on the immune system and parasympathetic nervous system. Massage.EliteCME.com Page 33