Registered Massage Therapists in B.C. are trained in various manual therapy techniques that they use according to the presenting pathology or patient complaint.
A thorough orthopaedic assessment can include any of the following: Postural assessment, joint range of motion, muscle strength and tendon reflex testing, and special testing. Special testing can include hundreds of directed tests designed to support or refute causes of symptoms or pathologies, helping the therapist choose appropriate techniques to use and outline an effective treatment plan.
The foundation of massage, Swedish massage includes strokes such as kneading, stripping, wringing, lifting, and jostling, either with elbows, palms, knuckles, fingertips or thumbs. They follow the principles of massage that encourage return of venous blood to the heart, that must start light and build pressure, that work out towards limbs from the torso, and that treat surrounding areas before treating the exact painful spot. Generally, Swedish massage has a relaxing effect as it decreases the firing of the sympathetic nervous system (“fight or flight” response), allowing the parasympathetic nervous system (“rest & digest”) to do its work. Swedish massage also includes “tapotement”, or short, fast stimulatory “tapping” techniques done with fingers, palms, or fists to increase local circulation, loosen mucus in respiratory tract, stimulate weak or hypotrophied muscles, and provide general stimulation to the sympathetic nervous system.
Myofascial Release (MFR)
Fascia is a connective tissue that is found throughout the body, at superficial and deep levels. Superficial fascia is found just beneath the skin and is loose and mobile when healthy, or restricted, adhered and shortened when it’s not healthy – often due to inflammation, trauma, surgery, pathology or a postural imbalance. Deep fascia is denser, tougher and tighter, compartmentalizing and surrounding organs and muscles to provide support. As an example, think of the white-silvery fiber in steak, or the delicate web produced when you pull apart raw chicken – that is fascia. Because fascia is thought to be continuously linked throughout the body, a pull or restriction at your wrist might have an effect all the way up your arm and into your neck. Therapists can use a variety of techniques to affect fascia, such as skin rolling or torquing to reduce surface adhesions, gentle cross-hands stretch or spreading to release restricted fascia, bowing of a shortened muscle or muscle group to lengthen the deep fascia, and even visceral manipulation to affect deep fascia surrounding the organs. This technique is often used at the beginning of a treatment before oil is applied so the therapist can grip the skin properly.
Joint Mobilization and Joint Play
These techniques include many variations, but they all target the joint, joint capsule and its surrounding muscles. Muscle shaking, full body rocking, and limb jostling all cause reflex muscle relaxation, decrease muscle tone and loosen the joint capsule. Traction (eg. pulling on the arm, leg or head) can be used for assessment and treatment of joints, testing stability and stimulating the proprioceptors (motion sensors) in the joints, causing muscle tone to decrease. It also encourages the exchange of lubrication fluids between the blood/lymph vessels and the joint space. Joint Play includes two main types; oscillation and sustained glide. They can be applied in different grades, up to grade 4 (grade 5 is what chiropractors do). Joint play techniques assess dysfunctions, increase range of motion, stretch tight joint capsules, and reduce adhesions, pain and spasm. It is useful for stiff joints, frozen shoulder and chronic injuries that cause a limited range of motion for that joint.
This technique uses static compression on a trigger point, with enough pressure to cause temporary local ischemia (decreased blood flow) within the patient’s pain tolerance. As the compression is held for 10sec up to one minute, the pain should decrease to almost none, as the muscle is forced to stop holding the contracted muscle fibres (hypertonicity and spasm). Heat applied post-treatment can help with any soreness that may follow that day or the next.
This technique uses static bowing, rhythmic pressure or muscle approximation on tendons and muscle attachment points to affect the Golgi Tendon Organs (GTOs). GTOs are nerve receptors that monitor muscle tension and if they detect excessive load or stretch, they will cause your muscle to relax so you do not tear a tendon or muscle. When applied during treatment, with firm pressure, your muscles relax to reduce tone and spasm. This technique works well if trigger points in a muscle are too tender for direct touch with muscle stripping or ischemic compressions. For example, we can bow the Achilles tendon to relax the calf muscles, or the IT band at the knee attachment, or Common Flexor and Extensor Tendons at the elbow for tight forearms.
Proprioceptive Neuromuscular Facilitation (PNF) Stretching
This stretching technique has several different combinations of active or passive stretching with submaximal muscle contraction of the patient. It takes advantage of “reciprocal inhibition”, meaning when you contract one muscle, the opposing muscle must relax and lengthen in order to accommodate the contraction. Using slight resistance with the contraction can also help fatigue the muscle to inhibit hypertonicity and spasm. It can achieve a greater increase in range of motion than regular, passive stretching.