By Aubrey Gowing

Many Professionals have there own language and terminology that describe specific terms relevant to their field. Massage is no exception. Some of this language can be confusing to those new to this area. Our web site contains many of these terms, so to facilitate understanding we have produced a short glossary to explain some of these specialist terms.

Effleurage (stroking movements): Effleurage is used at the beginning of each body part to warm-up and prepare the tissues for subsequent strokes. It is also used at the end of each body part to drain the tissues and relax the client. It may be used throughout the treatment as a transition stroke to link movements or to warm-up the client.

Petrissage (compression and kneading movements): To compress and lift tissues from underlying structures and release alternately to give an intermittent pressure. Petrissage is very beneficial over areas of muscular tension.

Percussion (tapping): To stimulate and tone the tissues locally. Percussion movements increase circulation, improve muscle tone and stimulate sensory nerve endings.

Friction (rub one surface over another): To separate tissues by breaking down fibrous adhesions, scar tissue, fibrosis, and to break down fatty deposits and aid the removal of non-medical oedema.

Vibration (To cause a trembling or quivering motion): Vibration clears nerve pathways and produces a stimulating or sedating effect depending on the type of vibration used. Vibrations can be used when muscles are extremely tight and not responding well to petrissage or friction.

Marma points: Marma points are an integral part of Ayurveda (a traditional Indian medical system) and are the subtle pressure points, similar to points used in acupressure, that stimulate the life force or pranic flow in the body.

Dosha: The three Doshas of Ayurvedic medicine are energies that when balanced help maintain health.  These energies are known as Vata, Pitta and Kapha.

Chakra: Chakra is a Sanskrit word meaning wheel, often interpreted as wheel of light, referring to the spinning movement of local bio-energy.

C.P.D. – Continued Professional Development is the practice of actively increasing your knowledge and maintaining open lines of communication with your peers and industry providers after qualifying in your field. This keeps you up to date on new research and developments and current issues affecting your practice. It encourages an increase in skills to provide broader care to your clients.

C.P.D Points – Upon graduation from a massage, beauty or sports diploma course it is advisable to join a professional association. They will represent the interests of you and your fellow graduates. They generally provide reasonable insurance rates, maintain codes of ethics and enable voluntary self regulation.

To renew membership with your association you may be required to obtain a number of C.P.D Points. These are awarded for further research and study, attending seminars or undertaking further training.

I.T.E.C – The International Therapy Examination Council is based in London and is an internationally recognised awarding body offering vocational qualifications in complementary and sports therapy. It is regulated by the Qualifications and Curriculum Authority. The ITEC standard is the most widely recognised qualification for complementary therapies.

www.itecworld.co.uk

Connective Tissue Massage (C.T.M) – A form of massage focused on the treatment of fascia and Myofascial Dysfunction. It utilises slow, deep, stroking and stretching movements to release adhesion’s and lengthen fascia. This can help restore range of movement, relieve pain and improve overall health.

Soft Tissue Release (S.T.R) – A massage technique for treating adhesion’s and scar tissue. S.T.R. works by shortening the affected tissues, applying a “lock” below the adhered tissues using fingers, thumbs, heal of hand etc, and then lengthen the tissues to break down the adhesion.

Adhesions – Adhesions form when structures that should be separate become adhered, or stuck together. Typically in the body this is caused by fibrosis, an increase in the sticky quality of collegen fibres or the movement of the fascial ground substance to a more gel like state.

Fascia – Fascia is a loose, irregular connective tissue. It forms a three dimensional matrix providing a framework for the other soft tissues of the body. Like all connective tissues it consists of fibres, (collegen and elastin) cells (fibroblasts) and a ground substance (containing hyaluronic acid, giving fascia its ability to change from a liquid to gel state). Fascia is described as being in the immediate vicinity of every cell. Dr Ida Rolph who developed a form of fascial body work known as structural integration or Rolphing, described fascia as “the organ of posture”.

Bunching in fascia – This is a loose term that reflects fascias ability to migrate, thicken and become adhered in response to injury or postural imbalance.

Knots – This is a layman’s term that accurately describes the feeling of tension and restriction experienced with dysfunctional soft tissues. Knots are usually formed by adhesion, fibrosis and elevated levels of muscle tone.

Internal Scar Tissue – This is the result of our bodies repair mechanism laying down collegen fibres in response to injury, overuse or abuse. Internal scar tissue is formed when fibrosis is contained within a structure, typically a skeletal muscle and its surrounding fascial envelop, the epimysium. This affects the muscles ability to function as the scar tissue will inhibit both contraction and stretching.

External Scar Tissue – The formation of external scar tissue is similar to internal scar tissue except that in this case fibrosis takes place outside the fascial envelop and tethers or adheres separate structures (muscles, tendons, ligaments and periosteum) to each other. This can result in impaired movement, reduced local circulation, inflammation and pain.

Fibrosis – This is the formation of excessive amounts of fibrous connective tissue. Fibroblasts are the cells that produce and maintain our extracellular matrix. They produce the ground substance and fibres that make up fascia. Overload or repetitive load causes fibroblasts to produce more collegen fibres as it is collegen that gives connective tissue its tensile strength. The down side is this reduces elasticity. In massage it is fibrosis that is responsible for the formation of knots and the palpable matted feeling of dysfunctional soft tissues.

Muscle stripping – A deep kneading stroke that follow the muscle fibre direction. It is used to break down adhesion and fibrosis.

Cross fibre friction – This can be used as a friction or kneading technique. It works by traversing the fibre direction of the soft tissues. It is and effective tool for breaking down adhesion, fibrosis and scar tissue.

Elbow work – The use of the elbow to apply massage techniques. It is very effective when applying muscle stripping, cross fibre friction and compression to areas of dense musculature.

Surface anatomy – The use of bony landmarks and muscle contours to accurately locate and identify anatomical structures.

Palpation – The process of assessment through touch. Palpation is a skill used by massage therapists to locate areas of dysfunction within soft tissues.

Muscle Energy Technique (M.E.T) – This technique uses the nervous systems inhibitory action on muscular contraction to cause a temporary reduction in tone, to facilitate a lengthen or stretching of shortened tense muscles. There are two main approaches: Post-Isometric relaxation uses contraction of the agonist (prime mover) while reciprocal inhabitation uses contraction of the antagonist (opposing muscle). Typically contractions are gentle, using approximately 20 % of the muscle force. This technique is very effective when treating restricted range of motion.

Post-Isometric Relaxation (P.I.R) – A form of M.E.T. that works on the principal that after contraction there is a period of relative hypotonicity, during which a greater lengthening of the tissues can be achieved. In P.I.R the agonist is tensed, relaxed then brought to a new lengthened position.

Reciprocal Inhibition (R.I) – R.I is similar to P.I.R in that there is a contraction, relaxation and lengthening phase. However in R.I. it is the antagonist which is contracted. This results in a stimulation of the inhibitory reflex in the agonist resulting in a short period of relative hypotonicity in the agonist, allowing a greater stretch of the shortened tissues. This is mot beneficial when the agonist is injured or inflamed.

Proprioceptive Neuromuscular Facilitation (P.N.F) – This technique uses the contraction and relaxation of muscles to facilitate a lengthening of shortened, tight muscles. In this regard it is similar to M.E.T but there are a few subtle differences. P.N.F developed out of physical therapy practices in the U.S, where as M.E.T evolved out of osteopathic practice in Europe. P.N.F methodology typically uses high levels of contractive force whereas M.E.T uses low to moderate levels of contractive force.

Crepitus – A creaking sensation. This is often caused by scar tissue or adhesion.

T.M.J – The Temporomandibular Joint is formed by the mandible (jaw bone) and the temporal bone of the cranium.

T.M.J.D – Temporomandibular Joint Dysfunction.

Extra- oral – In the treatment of T.M.J.D this refers to working outside the mouth on the structures that effect jaw movement.

Intra- oral – This refers to work inside the mouth. In the treatment of T.M.J.D the therapist, wearing latex gloves, works the hard and the soft palate and the muscles of mastication (chewing) to address dysfunction.

Trigger Points – These are points of tenderness in muscles, tendons and fascia, which can be felt as fine nodules within a tense band of tissue. If active the client will experience pain either at the site of the Trigger point or more often in a specific referral area. If latent the client only experience pain when trigger point is compressed. This is a very effective technique for reducing pain and tension fast.

By Aubrey Gowing

In recent years interest in Complementary therapies has grown enormously worldwide. A recent study in the U.S showed that 18% of American adults received one or more treatments from a massage therapist in the last year compared to only 8% in 1997¹. In this country people are thinking more about their health and looking at the issue of ‘lifestyle’. Now when people feel stressed they recognise it as a negative factor, not just because they feel tense, but because they think of it as bad for their health and they are right. Stress is considered to be a major factor, if not the cause, in at least 75% of all illness². Stress is also known to contribute greatly to the ageing process³.

With these facts in mind it is not hard to see why therapies like Massage, Aromatherapy, Indian Head Massage and Reflexology have become popular in many settings, from maternity hospitals to hospices, from beauty clinics to drug rehabilitation centres. Massage has found a home in many caring environments like nursing homes and with home care groups. In the nursing home setting it is worth thinking about the simple physical contact used in therapies, and the hugely positive psychological effect it can have on the elderly. The later years of life are often a time of loss. There can be loss of spouse, family, friends, loss of work and independence. As Dawn Nelson points out in her book ‘Compassionate Touch’, “attentive nurturing touch can be a significant therapeutic factor in treating despondency in the aging and/or the ill because of its multiple psycho-social, mental, emotional and physical benefits” ⁴.

Massage is especially beneficial for people aged sixty-five and older, as it helps them maintain mobility and independence longer. Massage promotes healthy skin through the application of nourishing oils, many of which are proven to improve the suppleness of mature skin types. It stimulates the sebaceous glands in the skin to produce more of the body’s own natural moisturiser and stimulates the circulation in the superficial capillaries. Treatments also improve general blood circulation and lymph flow; this is of particular relevance to elders with poor mobility, as circulation in the extremities can easily become impaired. This can start simply as cold hands or feet, but can lead to cramp and pains, loss of sensation and loss of kinaesthetic awareness. By improving the suppleness of muscles and fascia, massage can also affect joint flexibility. This can have major implications on quality of living, for example improving hip and knee mobility could make the difference between being able to climb stairs or not. With declining peripheral vision, maintaining mobility in the neck allows the ability to turn the head to see our surroundings. If driving, this could literally be the difference between life and death. When dealing with arthritic joints in the chronic phase, when there is no inflammation, massage of the surrounding muscles can help ease the stress on the joints.

Massage treatments should always be tailored to suit the client’s needs. When working with elderly clients their physical condition is more relevant than chronological age. The Elderly can be divided into three categories regarding treatment:

1. Robust, who show few outward signs of impaired health, look younger than their age and are sharp mentally and physically active.
2. Age appropriate, who show some of the typical signs of aging.
3. Frail, people who look and feel fragile to the touch.

All three types will benefit from treatment but adaptations must be made, and in all cases a thorough medical history should be obtained.

It is helpful to think of the effects of massage as being similar to exercise. People in the robust category could engage in gentle to moderate exercise and so would benefit from gentle to moderate intensity massage. Whereas people in the age appropriate category may need to consult with the doctor and stick to gentle exercise, so with doctor’s permission gentle massage will be appropriate. People in the frail category will require the gentlest care, even with doctor’s consent. Issues such as tissue fragility and extremely low stamina must be taken into account. Very light massage for short durations can still be beneficial.

In a typical Holistic Massage treatment a variety of massage techniques are used, each with their own effects and benefits. Broad brushing movements described as Effleurage strokes are exceptionally good for warming up the area to be massaged. They enhance circulation, especially venous return. Kneading movements, described as Petrissage, usually follow. Kneading movements help keep muscles and connective tissues pliable and elastic. Gentle tapping and cupping movements, described as percussion, help improve muscle tone. The proportion of each type of stroke can be varied to suite the client’s needs at the time of the treatment.

In my own recent experience I treated an elderly client who would have described himself as robust all his life but now in his mid seventies was rapidly moving in to the age appropriate or even the frail category. He presented with stiffness in the legs and back. This was causing difficulty stepping over the high ledge getting in and out of the bath. After working on his back and legs over a six-week period I could feel a dramatic difference in the quality of the tissues. Muscle which felt almost totally rigid in the first session, now felt supple and flexible. The client said, “it’s like magic, not only can I get in and out of the bath, I feel like jogging down the street”. Then my client said “But I am still nervous standing up in the bath”. I asked why and the response surprised me, “Oh you know, I can’t feel anything through the soles of my feet so my balance isn’t that good”.

This lead into a discussion about Reflexology. There are many forms of Reflexology practiced. Treatment can be applied to reflexes on the feet, hand or the ear. In this case Foot Reflexology was the clear choice. We switched from weekly massage treatments to weekly reflexology sessions. From the first session the reason for the loss of sensation was obvious. The soft tissues of the foot were almost totally rigid they were so congested. The first two sessions were focused on regaining mobility. By the third session I felt like I was working a totally different pair of feet, the changes were so dramatic. On the day of the fourth session my client arrived with a big smile. He told me that after the last session he could feel the floor again. Now he had the confidence to stand in the shower for the first time in years, without fear of falling. “It’s a serious consideration at my age, I can’t afford to be falling”, he joked.

Once we had achieved a good level of suppleness in the tissues of the foot we began to focus on treatment of the reflexes. As every system, organ and gland is represented by a reflex point on the feet, we were able to address internal problems, like poor digestion and constipation. This lead to a discussion on the relevance of diet and the use of vitamin supplements. On his most recent visit the client said he was on “a real health buzz and feeling great”. Odd for someone in their seventies? Apparently not.

One of the biggest advantages of reflexology over other forms of bodywork is its ability to affect the internal structures of the body. A person with breathing difficulties and congestion in the lungs cannot have the lungs massaged. With reflexology, working the chest and lung reflexes can however stimulate a reflexive action in the lungs. I have over the course of my practice seen many dramatic results achieved, especially in relation to digestive, respiratory and sinus conditions.

Because of the extremely potent effect of reflexology, care and sensitivity must be used when approaching treatment of the elderly. Over stimulating the reflexes can place a strain on already struggling systems, leading to what is termed a healing crisis. This is simply due to too much happening too quickly, causing the recipient to feel less well. Light and gentle reflexology applied at regular intervals can achieve great results with conditions like constipation, loss of appetite, insomnia and poor immune function without any negative effects.

As with massage, the therapeutic touch used in reflexology helps elderly clients reconnect with themselves and others in a way that strengthens their social and emotional well being. People at all stages of life, be they infants, children, adults or elderly, need caring contact to thrive. Massage and reflexology make available this caring touch to those who would otherwise be deprived of the contact they need. This is especially true for the elderly who rely so much on caregivers to meet their needs. Many nurses and caregivers have trained with us over the years and have put their skills to use in precisely this way. They have found this enormously rewarding as it allows them to express the caring aspect of their occupation to the fullest. For most it was the desire to care for others that started them on their career path in the first place.

People giving massage benefit in much the same way as those they are massaging. One study conducted by the Touch Research Institute in the University of Miami had elderly retired volunteers provide massage to infants. After one month the elderly volunteers reported less anxiety and improved mood after giving the infants massage. Their pulse decreased and levels of cortisol, a stress hormone, also decreased. They reported improved self-esteem, fever visits to the doctor and more social contact⁵.

The many benefits of massage and reflexology can be experienced by receiving treatment or by giving treatment to someone else. So the only question is, would you like to receive treatment or are you someone who is prepared to give?

If you are interested in finding out more about treatment or training contact the Holistic Healing Centre, 38 Dame Street. Dublin 2. Ph 01-6710813

References.
¹Touch Therapy Institute. Los Angeles. www.touchtherapyinstitute.com
²Tucker, L. An introductory Guide to Massage (2001) Haddington, U.K.Scotprint
³Evans, W., & Rosenberg, E.H. (1991) Biomarkers. New York: Simon&Schuster
⁴Nelson, D. (1994) Compassionate Touch: Hands-on caregiving for the elderly, the ill, and the dying. Barrytown, N.Y. Stution hill press.
⁵Field, T., Hernandez-Reif, M., Quintino, O., Schanberg, S., & Kuhn, C. (1998) Elder retired volunteers benefit from giving massage therapy to infants. Journal of Applied Gerontology, 17, 229-239.