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Common massage techniques

This is an excerpt from Anatomy and Physiology of Sports Massage, The by Portia B. Resnick.

This section will discuss a variety of common massage techniques. Although many of these techniques fall under the categories described earlier (e.g., circulatory or myofascial), they are discussed here to highlight how they can be used separately and together to create a sports massage protocol.

When performing massage, body mechanics is of utmost importance (figure 3.1). Relying too much on just the thumbs or hands without using different tools or body weight to assist can result in injury to the clinician performing the treatment, especially when the clinician provides multiple treatments per day (Resnick 2024). General body mechanics for clinicians includes the following rules:

• Maintain a split stance: Your legs should be in a lunge position when you are alongside the table (figure 3.1a) and in a squat position when you are facing the table (figure 3.1b).
• Movement should be from your torso where the legs and hips move your upper body.
• Keep your back straight, avoiding excessive flexion.
• Adjust the table height as necessary to fit your own mechanics and the size of the client on the table (including if moving the client to a side-lying position).
• Keep your wrists in a neutral position, avoiding hyperextension.

The treatment area for massage should allow for appropriate body mechanics. There should be enough room for the clinician to move around the massage table. Otherwise, the patient's position should be adjusted for optimal reach. Because many techniques of sports massage are performed in an open clinic, the patient will typically be clothed; this is different from a traditional massage setting in which draping provides boundaries. By working around and over clothing, it is easier to change position with the patient on the table and to use movement in many of the techniques. (Note: Clothing is a boundary that should be respected, with the clinician working over clothing and never under clothing.)

Common Swedish Massage Techniques

Some common techniques typically fall under the category of Swedish massage; however, a few can be done in other types of treatment. Hallmarks of Swedish massage include the use of oils or lotions, the emphasis on circulatory system influences, and the promotion of relaxation. Some techniques, such as percussion and petrissage, can be done in conjunction with multiple types of treatments. Other techniques that I consider to be more of a crossover or a cousin to a technique, such as effleurage in Swedish massage and glides in myofascial treatment, can also be used.

EFFLEURAGE

Effleurage is a gliding stroke that is often used to introduce touch at the start of massage, to transition between strokes or body parts, and to apply any lubricant to the area (figure 3.2). Although effleurage is typically a superficial application, pressure, speed, and drag can be altered based on the intent of the session. When the effleurage is more superficial and slower, it can be soothing and promote parasympathetic activity. An effleurage with more pressure at a slow rate can also elicit a parasympathetic response. However, whether the effleurage is superficial or deep, the body responds with a more sympathetic response when a faster rate is used. Although effleurage is usually part of a Swedish massage and is used to promote parasympathetic dominance, a quicker-paced effleurage can be used in instances where more a sympathetic response is desired. In addition, clinicians should use caution in situations where emollient is not wanted; examples include for a wrestler before competition when it may be against the rules or for any athlete competing in an outdoor climate where they may have difficulty dissipating heat with lubricant on the skin.

Effleurage uses your entire hand, from palms to fingertips, with the pressure equally distributed throughout the hand. Your wrists should remain as neutral as possible (avoid hyperextension of the wrist). Pressure should not come from your hands or shoulders but from the weight of the body behind the hands.

PETRISSAGE

Petrissage is a kneading technique that uses alternating and squeezing to lift the tissue, typically focusing on the muscle belly (figure 3.3). When the muscle belly is squeezed, the muscle spindles are activated and lifting of the muscle puts a stretch on the tendon, activating the Golgi tendon organs. The result is relaxation of the muscles. Compression and heat of the hands on the tissue leads to a softening of the fascial layers, starting with the superficial fascia. Like with effleurage, the pace of the petrissage influences the intent. A slower petrissage will create a more parasympathetic state, whereas a quicker pace with a deeper grasp of the tissue will have a more sympathetic influence. Petrissage can be done with or without emollient and also over clothing.

To execute the petrissage technique, your full hand and fingers should be in contact with and compress the tissue while you move along the muscle belly. Squeezing should occur from your palms to fingertips (think of squeezing toothpaste down the length of a tube, rather than compressing a plastic water bottle). Combine the squeezing with a lifting of the tissue. When performing petrissage, your body should face the table, your legs should be in a plié squat position, and your hips should rock back and forth in time with your hands to create the rhythm of the movement.

JOSTLING OR SHAKING

Jostling or shaking is a vigorous movement of the tissue (figure 3.4). You can pick up the tissue from the bone (e.g., the quadriceps), shake the limb (e.g., the arm), or move the muscles from side to side (e.g., the erector spinae group of the spine). The technique should be performed as a rhythmic movement of the tissues, with the intent of stimulating the mechanoreceptors. When the full limb is involved, the mechanoreceptors in the joint capsule are also stimulated. Before you perform this technique, it is important to know whether the client has a history of instability in the joint, especially the glenohumeral joint.

Mechanics for the jostling or shaking technique involve you utilizing the lunge stance of your legs. Your full hand should be used to pick up the tissue. This technique is intended to be done at a quick pace, meaning it will have more of a sympathetic influence. Like all techniques, jostling or shaking takes practice; it may feel awkward to you until you have mastered it.

FRICTION

Friction is used to move the tissue underneath the skin and can be applied transversely or parallel to the fibers (figure 3.5). Superficial friction done quickly and with little pressure can be used to warm the area. With increased pressure, friction will both compress and stretch the tissues. Friction is another technique that can be done with or without emollient, keeping in mind that the stretch is enhanced without emollient because it is easier to engage with the tissue. Although friction can be used as a general technique over an area, most people associate friction with cross-fiber friction, which is a more specific technique used to address a specific area. Cross-fiber friction is effective for specific areas, such as with postoperative surgical scars, but may be too specific for many of the sports massage scenarios presented here.

COMPRESSION

Compression involves pushing down into the tissue with varying force, followed by release of the tissue (figure 3.6). Pushing into the muscle and the subsequent release can stimulate the release of histamine, keep blood flowing in the muscles, and stretch the muscle. This technique does not use emollient and thus is a good way to warm up the tissue before a sports massage treatment that does not rely on any lubricant. Compression can be used similar to effleurage in examining and preparing the tissue for treatment; however, unlike effleurage, compression can be done over clothing. Compression also creates more of a sympathetic response, making it appropriate to prepare the body for activity.

The most ideal hand position for applying compression uses a loose fist. This position is preferred because it allows you to maintain a neutral wrist. It is also less invasive because open hands and flat palms should be avoided on areas such as the gluteal region, where compression is an effective technique. You should use the split stance or lunge technique when positioned alongside the table, or you should use a squat stance if you are facing the table.

PERCUSSION (OR TAPOTEMENT OR VIBRATION)

Percussion, also referred to as tapotement or vibration, involves application of mechanical vibration to the myofascial system (figure 3.7). Percussion is purported to influence the stretch receptors in the muscles, creating relaxation using similar mechanisms to reciprocal inhibition. In addition to reducing muscle tension, the vibratory effect also alters fascial mobility via changes in viscoelasticity. The vibration also causes the release of histamine, which is noted by the red color of the skin over the area of application and may allow for greater pain tolerance. Percussive techniques increase blood flow to the area, possibly because of muscle ­contraction and ­relaxation allowing for greater blood ­perfusion (Ferreira et al. 2023).

The application of percussive techniques in manual therapy includes the ­following:

• Hacking involves using the ulnar border (pinky side) of an open hand. Hacking should be done parallel to the muscle fibers.
• Beating or drumming involves using the ulnar side of a loose fist.
• Cupping involves using a cupped palm of the hand, with the borders of the hand used to make contact.

Changing the speed, tempo, and force of the movement will alter the body's response.

Myofascial Techniques

Myofascial techniques are designed to engage the myofascial system. As discussed in chapter 1, fascia surrounds the entire body, so the techniques described next may be more general. However, once clinicians understand the basic types of techniques, they can adjust them to the specific muscle properties in creating a treatment. The specifics of how to apply myofascial techniques to the muscles are outlined in chapters 6 to 10.

SPIRALING

Spiraling engages some of the relevant fascia structures surrounding the thigh, the upper arm, and the torso as well as the fascial layers below (figure 3.8). It is important to note that spiraling is done only in areas where the muscles form more of a cylinder (e.g., muscles of the abdomen and low back) or those surrounding a bone (e.g., muscles of the thigh). Spiraling cannot be done on the lower leg or the forearm where the muscles are attached between the two bones. The technique is a good way to initiate warming and mobilizing the fascia surrounding the body part prior to further treatment.

For the leg and torso, spiraling is performed with the patient lying supine and you facing the table in a squat stance. Reach one hand under the area as far as possible (e.g., the most medial and anterior aspect of the thigh) and start the other hand closer to your body (e.g., on the posterior lateral aspect of the thigh). To initiate the spiral, stand up out of the squat while your bottom hand pulls the tissue more laterally and your top hand pushes the tissue medially, spiraling the tissue. The push and pull creates a unique fascial stretch to the area.

MYOFASCIAL GLIDES

As noted earlier, myofascial glides are similar to effleurage, but no emollient is used on the skin and the goal is to engage with the fascia. One difference between the two techniques is that myofascial glides are meant to be slow, with you allowing the melting or release of the fascia to guide your hand, as opposed to using your hand to guide the movement over the skin as done with effleurage. The stance is similar: Use a split-lunge stance to the side of the table and move your torso as the hand glides. The entire heel of your hand, a loose fist using the proximal phalanges, or even the forearm can be used to provide the glide. When you are using the forearm, your legs will need to drop to a lower lunge, but the advantage is the forearm is able to cover more surface area of the body. The key to an effective glide is patience. See chapter 7 (trapezius section) or chapter 8 (low back section) for examples of glides.

SKIN ROLLING

Skin rolling involves lifting the skin to warm and release the superficial fascia (figure 3.9). Skin rolling is a form of petrissage, which is not as deep because it does not pick up the muscle. For those who may be familiar, the technique is similar to picking up the skin to measure a skin fold during a body fat ­assessment. Grasp the tissue between the thumb and the rest of the fingers. Your thumb guides the roll; like the ­myofascial glides, the roll should not be forced. Your body should be positioned appropriately in the direction of the roll, which is dependent on the direction of the fascia.

There are several situations in which skin rolling can be difficult to perform. When the client is not well hydrated, the superficial layer will adhere to the structures below. It will also be difficult to lift the skin if there are adhesions. Skin rolling might be more difficult after an endurance event or maximal lift. When the muscles are energy depleted, often the fascia can be adhered. Depending on the sport or the patient's stressors, certain areas of the body may be difficult to roll. Also, of all the techniques listed, skin rolling has the most variability among patients. Some people just do not like this technique; therefore, it should be avoided based on patient preferences. Other techniques can be used to elicit the same response.

LIFT AND SHIFT

Lift and shift combines petrissage (lifting the muscle) with compression and stretch. In this technique, the entire muscle is grasped between the thumb and fingers. From there, it can be lifted or shifted, pulling away from the origin or insertion. For example, the latissimus dorsi can be grasped and then distracted from the origin at the ribs and thoracolumbar fascia or from the humerus (see chapter 6, figure 6.17b). Additionally, movement can be added where the latissimus dorsi is distracted from the humerus while the patient attempts to bring their hand above their head into flexion. This technique creates a stretch in the muscle and can be used effectively for postural muscles.

PIN AND STRETCH

Pin and stretch is a type of compression that can add either passive or active movement. The technique is performed by shortening the muscle passively (performing the action), holding a spot on the muscle or tendon, and then slowly lengthening the muscle (performing the opposite motion of the muscle's action). When the muscle is passively lengthening, it allows for a unique stretch to the area between the spot of the pin and the insertion of the muscle. The pin and stretch can be done multiple times from the insertion toward the origin of the muscle. Ideally, no emollient should be used with this technique because it allows for deeper engagement of the tissue. Specific examples of how to perform the pin and stretch will be addressed in the individual muscle chapters; for an example of the pin and stretch of the hamstrings, see chapter 9, figure 9.8a-b.

If the technique is adjusted to passively pin and have the patient actively contract the antagonist, it becomes more of an active technique. Because fascia and muscle like movement, the patient may feel even more of a stretch. The pin and stretch is also an example of reciprocal inhibition (contraction of the antagonist), allowing for a greater stretch of the agonist. This technique can also be applied using a myofascial glide during the stretch. The patient actively goes through the range of motion while you glide proximally. This technique adds an additional element of gliding during the active movement. The order of application would be to start passively, then change to active movement, and then use active movement with a glide.

More Excerpts From Anatomy and Physiology of Sports Massage, The

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