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INTRODUCTION PHYSCIANS AND SURGEONS GIVE LIFE , PHYSIOTHERAPISTS ADD QUALITY TO IT . In the aid of adding quality to life of the patients, healing hands are required The soft tissue manipulation of soft tissues plays a very important role for Physiotherapists and yet is a challenge ,as many physiotherapists doesn’t like the word Massage . But physiotherapists today forgetting a warm touch to the patient is very important for complete rehabilitation of the patient which is possible with massage

General principles :

General principles The Soft tissue manipulation should always be practiced in a special room where proper ventilation is present It should never be practiced in a busy OPD Explain the entire procedure its effects and uses for the patient briefly and clearly Make the patient feel comfortable and relaxed

General principles :

General principles Prepare all the necessary things like powder ,towel ,creams etc Before ,starting the manipulation, stretch your fingers and wrist ,elbow . Rub your palms to get warmth which shall give a soothing effect to the patient It is very important to mind the contact of therapist hands with patient all through the massage, the contact should never be lost

General principles :

General principles After each manipulation ,effleurage is compulsory Hacking is avoided in Muscle spasm

Indications :

Indications Backache Cervical spondylitis Joint stiffness Insomnia Bells palsy Spasticity For hair growth and prevention of hair fall


Indications Cosmetics for face Improving for circulation Constipation Frontal headache Preventing pressure sores Constipation Scar mobilization Relieving spasm Relaxation


Contraindications Cardiac pacemakers Skin infections Open wounds Hyperpyrexia Myocardial infarction Thrombosis Embolism Osteoporosis

Contraindications :

Contraindications Renal failure Hypotension Osteomyelitis Varicose veins

Types of Manipulations :

Types of Manipulations

Stroking manipulations :

Stroking manipulations

Effects and uses :

Effects and uses Improves circulation Removes venous congestion Aids in lymphatic drainage Mechanical effect on proprioceptors Soothing effect It relieves insomnia Relieves Muscle spasm


SWEEPING CROSS FIBER Sweeping cross fiber is similar to effleurage in that it is primarily a gliding stroke, there is a superficial cross fiber component In effleurage the strokes are parallel to the primary fiber direction ,in sweeping cross fiber technique the stroke moves diagonally across fibers of the muscle treated. During the sweeping motion flex the thumb toward the palm and ulnar deviate the wrist . The primary pressure of the stroke is underneath the moving thumb


EFFECTS & USES OF SWEEPING CROSS FIBER It encourages tissue fluid flow It warms the soft tissue Enhance pliability and reduce tension in the muscle fibers

Compression Broadening:

Compression Broadening Compression broadening techniques are designed to mimic the natural broadening action of the whole muscle This technique is performed by applying the pressure to the target muscle while performing a broad cross fiber stroke {perpendicular to the muscle fiber direction}

Effects and Uses of Compression Broadening :

Effects and Uses of Compression Broadening This technique enhances elasticity and pliability in the muscle Releases spasm Provides relaxation Reduces adhesions

Pressure manipulations:

Pressure manipulations

Squeezing :

Squeezing The muscular area is gently lifted ,squeezed and relaxed It can be done stationery or along the length of the limb

Circular kneading :

Circular kneading It is performed with one hand or both hands working alternatively along the whole length of the limb The soft tissue is pressed against the underlying bone in a circular manner Soft palmer surface of the hand is used

Stationary kneading:

Stationary knead ing It is performed with one hand or both hands working alternatively along the whole length of the limb by pressing the soft tissue is against the underlying bone in a circular manner Soft palmer surface of the hand is used Each time the hands are lifted and placed

Ironing :

Ironing It is a form of kneading chiefly done on the back and gluteal region The body weight is used to get the maximum depth and moves the underlined thick structures on bone

Picking up :

Picking up This manipulation is performed with one or both hands The muscle is picked up with lumbrical grip and leaved The manipulation must be smooth ,slow rhythmic and continuous.

Wringing :

Wringing In this manipulation ,both hands are used to pick up soft tissues, manipulate them with thumb and fingers from side to side

Rolling :

Rolling This is a type of petrissage manipulation where the soft tissue is picked up and rolled on the underlying bone

Friction :

Friction These are small ,deep penetrating manipulations They are performed in a circular and lateral direction over a small area of joints The manipulation can be done with finger tips or pads The pressure varies according to need of the condition and site of manipulation

Effects and uses of Pressure Manipulations :

Effects and uses of Pressure Manipulations Accelerates circulation Prevents disuse atrophy Maintains Muscle properties Relieves edema Reduces cramps after exertion Helps in breaking down of adhesions Decreased localized pain as in acute lumbago Promotes luxurious growth of hair

Percussion Manipulations :

Percussion Manipulations

Hacking :

Hacking To perform this manipulation, the therapist arm should be abducted ,elbow flexed and wrist extended The movement consists of short and sharp blows with ulnar border of fingers with alternate pronation and supination

Clapping :

Clapping It is the manipulation used for limb, back and chest It is a mixture of alternate flexion and extension of wrist joint The whole hand is lifted and dropped on the part to be manipulated

Beating :

Beating In this manipulation ,the therapist stands at the side of the patient and the part is covered with a towel or blanket The manipulation is performed by lifting the arm and allowing to fall heavily onto the parts with fingers closely clenched The force is transmitted from the shoulder to the palm of the hand

Pounding :

Pounding The technique is same as beating but fingers are made into a fist .

Effects & uses :

Effects & uses Mechanical stimulation Improve muscle tone Improves circulation Breaks adhesions Relieves constipation

Shaking manipulations :

Shaking manipulations

Vibrations :

Vibrations Vibrations are performed with one or both hands placed on the part to be treated The vibrations can be achieved by strongly contracting upper limb muscles isometrically

Shaking :

Shaking The manipulation is analogous to vibrations and is performed with a relaxed hands or fingers

Effects & uses :

Effects & uses Increased activity of the cells of lung tissues and bronchi Increased circulation throughout the lungs to increase gaseous exchange Mucous is loosened and expectoration is facilitated


FACIAL MASSAGE Indications Contraindications Acne vulgaris Pyrexia Open wounds Unhealed scars Bell’s palsy Frontal headache Sinusitis Cosmetic purpose

Principles :

Principles Cover the part till the hairline with a towel , this is called DRAPING Ask the male patient to shave the beard to prevent friction Apply the lubricant evenly In case of Bell’s palsy cover the effected eye with a cotton pad

Procedure :

Procedure Stroking Effleurage Finger kneading followed by effleurage Hacking or tapping following effleurage Stationary vibrations followed by effleurage

Additional maneuvers :

Additional maneuvers Sweeping cross fiber Compression broadening

Neck & Upper back massage :

Neck & Upper back massage Indications Cervical spondylitis Trapezities Tenderness around scapular region Serratus anterior or Rhomboids Pain Torticolis NeuroMuscular Neck pains Contraindications Fractures Open wounds Hyperpyrexia Unhealed scars

Procedure :


Additional techniques :

Additional techniques Myofacial approach : Pulling the fascia in Multiple directions Place the hands lightly on patient neck where the Myofacial stretch is applied Pull the hands apart to take the slack out of the tissue and apply a light degree of pulling force between hands

Additional techniques :

Additional techniques Sweeping cross fiber Helps in reduction of tension in the superficial neck muscles . Use care with pressure level as there is sensitive vascular structures that are superficial in the anterior neck region

Pin & Stretch On sternocleidomastoid :

Pin & Stretch On sternocleidomastoid This technique allows direct pressure and stretching on SCM Place one hand underneath the client’s head in a position so that it can be moved in different directions Move the head into a position of flexion and contra lateral rotation Grasp the SCM muscle between thumb and fingers and then rotate the head into extension and ipsilateral rotation

Low Back Massage :

Low Back Massage INDICATIONS Lumbar spondylosis Lumbago Mechanical Back pain Paraspinal Muscle spasm CONTRAINDICATIONS Fractures Open wounds Bedsores Thrombosis Carcinoma Embolism

Procedure :


Additional techniques :

Additional techniques Sweeping cross fiber Myofascial approach Deep longitudinal stripping to spinal extensors Deep longitudinal stripping to quadratus lumborum Static compression Deep stripping in lamina groove Pin & stretch to quadratus lumborum

Upper limb massage :

Upper limb massage INDICATIONS Periarthritis Bicipital tendinitis Supraspinatus tendinitis Myalgia Elbow stiffness Gravitational edema CONTRAINDICATIONS Open wounds Myositis ossificans Unhealed fractures Dislocations Ligament sprains and strains Unhealed scars

Procedure :

Procedure Shoulder joint

Arm :


Elbow ,Forearm, Wrist & hand :

Elbow ,Forearm, Wrist & hand Elbow : same as Shoulder Forearm : same as arm Wrist :same as Shoulder Hand : Dorsal aspect : stroking - effleurage-skin rolling Palmar aspect :Finger kneading -effleurage Fingers : Spiral kenading -- effleurage

Additional techniques for Adhesive capsulitis /Periarthritis :

Additional techniques for Adhesive capsulitis / Periarthritis Myofascial stretching to anterior shoulder girdle muscles Sweeping cross fiber to anterior shoulder muscles Static compression to anterior shoulder Deep stripping of pectoralis major Static compression of subscapularis

Additional techniques for Tennis elbow :

Additional techniques for Tennis elbow Sweeping cross fibers to Wrist extensors Compression broadening of the wrist Deep stripping to extensor group Active engagement shortening to wrist extensors

Additional technique for Carpel tunnel syndrome :

Additional technique for Carpel tunnel syndrome Sweeping cross fiber to wrist flexors Deep longitudinal stripping to Flexor carpi ulnaris Ulnar neural mobilization

Lower limb :

Lower limb INDICATIONS Muscle spasm Quadriceps weakness Edema Knee pains Piriformis syndrome Trochanteric bursitis Ligament sprains Patellofemoral pain syndrome Chondromalacia patellae Iliotibial band friction syndrome CONTRAINDICATIONS Fractures Acute inflammations Open wounds Unhealed scars Varicose veins

PROCEDURE –thigh :


Knee joint :

Knee joint

Calf muscles :

Calf muscles

Foot :

Foot Dorsal aspect : stroking ,effleurage and skin rolling Plantar aspect : finger kneading Toes : spiral kneading

Additional techniques :

Additional techniques Sweeping cross fiber technique for Piriformis muscle in Piriformis syndrome Longitudinal stripping on Piriformis Pin & stretch technique on Piriformis

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