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Chapter: The Massage Connection ANATOMY AND PHYSIOLOGY : Integumentary System

Massage Techniques and the Effects on the Body

The techniques used in the manipulation of skin and underlying tissue can be categorized as: 1. superficial reflex techniques 2. superficial fluid techniques 3. neuromuscular techniques 4. connective tissue techniques 5. passive movement techniques.


The mechanical, reflex, physiologic, psychological, and psychoneuroimmunologic effects of massage are related to the technique used. Mechanical effects are those caused by physically moving the tissues (e.g., compression, stretch, etc.) Reflex effects are changes in function caused by the nervous system. Physio-logic effects involve changes in body processes caused by nerves, hormones, and chemicals. Psycho-logical effects are emotional or behavioral changes. Psychoneuroimmunologic effects are those that alter hormone levels and function through stimulation of the neurohormonal system.

The techniques used in the manipulation of skin and underlying tissue can be categorized as:

1.        superficial reflex techniques


2.        superficial fluid techniques


3.        neuromuscular techniques


4.        connective tissue techniques


5.        passive movement techniques.


Superficial Reflex Techniques

When superficial reflex techniques are used, the re-flexes produce changes . No mechanical effects are produced. Therefore, the direction of the stroke is unimportant. These techniques primarily affect the level of arousal, perception of pain, or autonomic bal-ance and have been shown to have positive effects on the physiologic and psychological development of premature infants.1 Examples of superficial reflex techniques include static contact, superficial stroking, and fine vibration.

Static contact is synonymous with a resting posi-tion, passive touch, superficial touch, light touch, maintained touch, or stationary hold. In this tech-nique, minimal force is used and the therapist’s hands are still. This technique produces sedative ef-fects and reduces anxiety. It is often used at the be-ginning and end of massage.

Superficial stroking is also known as light stroking, feather stroking, or nerve stroking. In this technique, the therapist’s hands glide over the skin with little pressure on the subcutaneous tissue. It is used to alter arousal levels and to reduce pain. Pain is reduced by stimulation of large diameter touch nerve fibers, which, in turn, reduce the transmission of pain im-pulses to the brain. Local reflexes triggered by the strokes reduce muscle spasm and tension.

Fine vibration, also known as vibration, cutaneous vibration, transcutaneous vibration, mechanical vi-bration, and vibratory stimulation, is a technique in which rapid, trembling movement with minimal pres-sure is produced by the therapist on the client’s skin. Studies of the effects of vibration using mechanical vi-bration have shown that the pain threshold increases, causing reduction in pain.5 Such an effect is produced even if the stimulation is given at different sites— proximal to, distal to, or on the site of pain or in the contralateral region. An increase in muscular tone may be seen below the site of stimulation.

Superficial Fluid Techniques

Superficial fluid techniques are those that effect structures in the dermis and subcutaneous tissue. Su-perficial effleurage and superficial lymph drainage techniques are in this category. In superficial ef-fleurage—also known as effleurage—gliding, stroking, or deep stroking, gliding movements are used. In addition to producing reflex effects similar to those of superficial stroking techniques, these move-ments affect lymphatic and venous return in skin and deeper structures by mechanical compression. They are, therefore, particularly effective in reducing edema. These techniques also have psychological and other physiologic effects, such as reduced anxiety, in-creased relaxation, reduced muscle excitability, and increased intestinal movement.

The superficial lymph drainage technique uses short, rhythmic, nongliding strokes in the direction of lymph flow. The strokes result in gentle stretching of the skin and superficial fascia, together with the stimulation of contraction of lymph vessels. If per-formed over a large surface area of the body, it effec-tively increases lymph return to the veins. In addi-tion, these techniques reduce anxiety and pain, produce sedation, and improve immune function.

Neuromuscular Techniques

Neuromuscular techniques include broad contact compression (compression, pressure, pressing), petris-sage (kneading), stripping (stripping massage, deep stroking massage), and specific compression (focal compression, ischemic compression, digital compres-sion, digital pressure, direct pressure, static friction, and deep touch). These techniques affect both superfi-cial and deeper tissues, such as muscle. Broad contact compression has been shown to increase blood and lymph flow.6It may increase or decrease muscle rest-ing tension and have a stimulating or sedative effect, depending on the rate and pressure of strokes. Hence, it is commonly used in sports massage.

In petrissage, the tissue is repetitively compressed, dragged, lifted, and released against underlying struc-tures. These strokes relieve anxiety, improve immune function, and positively alter allergic responses. In ad-dition, petrissage has been shown to increase mobility of connective tissue and extensibility of muscle, reduce muscle tension, enhance muscle performance, and in-crease joint motion.7These effects may be caused by cutaneovisceral reflexes and mechanical compression.

In stripping, slow, gliding strokes are applied from one attachment of muscle to the other. It may be used to reduce the activity of myofascial trigger points (points on the surface of the body that are sensitive to touch and cause pain that travels or spreads when palpated). In addition to affecting trigger points, stripping may have the same effects as petrissage. Strokes performed in the direction of the natural flow result in emptying of veins and lymphatics. For this effect to occur, the muscles must be totally relaxed and the effects of gravity must be employed (e.g., limb elevation, recumbent position). It is important for proximal muscles to be relaxed while working on distal areas. If the pressure exerted is excessive, the arterial blood flow that occurs in the opposite direc-tion of veins and lymphatics may be impeded. Heavy pressure may also result in a protective reflex con-traction of muscles.

In specific compression, pressure is applied to a specific muscle, tendon, or connective tissue in a direction perpendicular to the tissue in question. This technique is used extensively by bodyworkers, either alone or in combination with other tech-niques (e.g., shiatsu, acupressure, and reflexology). It may help soften adhesions and fibrosis. The fact that it is used to reduce pain and produce physio-logic effects in regions far from the site of appli-cation suggests that it works by triggering complex somatovisceral reflexes.8

Connective Tissue Technique

Connective tissue technique uses palpation to help re-model and lengthen connective tissue. Friction (circu- lar friction, transverse friction, deep friction, deep transverse friction, cross-fiber friction, and Cyriax friction), skin rolling (tissue rolling, rolling), myofas-cial release (myofascial stretching), and direct fascial techniques (connective tissue technique, bindegeweb-smassage, myofascial massage, deep tissue massage, deep stroking, strumming, ironing, myofascial ma-nipulation, and soft-tissue mobilization) are some of the methods used. This technique is accompanied by reactive hyperemia and local increase in temperature. Hyperemia may result from release of histamine from mast cells and autonomic reflexes. It is claimed9 that these effects may last for several hours following ma-nipulation. Connective tissue techniques may have a powerful analgesic action that may be explained by the gate-control theory and release of natural painkillers.

Friction massage frees adherent skin, loosens scars and adhesions of deeper tissues, and reduces local edema. Repetitive, nongliding techniques are used in friction massage to produce movement between the fibers of connective tissue. In skin rolling, the tissue superficial to the deep fascia (the connective tissue layer investing muscles) is grasped and, using gliding strokes, lifted and rolled over in a wavelike motion. This stroke results in mechanical stretch of the con-nective tissue, releasing adhesions that may restrict mobility. In myofascial stretching or release, nonglid-ing traction is applied to muscle and the associated fascia. This technique, similar to direct fascial tech-niques, also results in mechanical lengthening of the fascia and is widely used in musculoskeletal condi-tions to increase mobility.

Passive Movement Techniques

Passive movement techniques use passive motion to treat various conditions. They include shaking (mus-cle shaking, course vibration, rolling friction, and jostling), rhythmic mobilization, and rocking (pelvic rocking, rocking vibration). These techniques have greater effects on muscles and joints. They produce sedation (possibly by stimulating vestibular reflexes) and decrease anxiety and pain perception.

Percussive Techniques

Percussive techniques alternatively deform and re-lease tissue at varying rhythms and pressure. Clap-ping or cupping, tapping, hacking, pounding, and tapotement are some examples. These strokes result in initial skin blanching as a result of contraction of arterioles from mechanical stimulation. Blanching is followed by redness brought about by vasodilation from overstimulation. The effects of this technique on muscle tone and alertness vary with the rate, vigor, and duration of strokes.

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