Top 3 Don’ts
THERAPEUTIC MASSAGE
1. The everyday massage routine a therapist develops is a personal signature, a foundation for professional success and should be used daily.
Wrong: A massage routine must be changed daily or at least weekly to overcome the phenomenon of adaptation, which is one of the greatest obstacles to building a successful practice. (LINK TO ADAPTATION ARTICLE)
2. The commonly suggested posture during massage: the therapist slightly bends knees, keeps upper body straight and doesn’t have contact with table.
Wrong: These body mechanics kill the therapist’s lower and upper body while greatly reducing his or her technical potential. (LINK TO BODY MECHANICS ARTICLE)
3. Some therapists prefer to start a massage session with the client positioned on the stomach.
Wrong: To fully take advantage of the stress reduction effect of massage therapy, the session must start with the client positioned on the back. (LINK TO FACE UP OR FACE DOWN ARTICLE)
MEDICAL MASSAGE
1. Taking classes, getting certified and practicing one modality (e.g. Myofascial Release or Neuromuscular Therapy) constitutes the practicing of Medical Massage.
Wrong: Medical Massage is a concept where different modalities including Myofascial Release or Neuromuscular Therapy are only components of the treatment session. The more tools the practitioner has at his or her disposal the more clinically successful a Medical Massage session will be. (LINK TO MEDICAL MASSAGE ARTCILE)
2. Deep Tissue Massage with a ‘no pain, no gain’ approach has clinical benefits.
Wrong (except for Periostal Massage): Excessive application of pressure without efficient control of the pain analyzing system hurts the patient in the long run by triggering the formation of myogelosis in the damaged muscles, despite producing an immediate but short lived sense of improvement. In the latter case the deep pressure works as a simple counter-irritant without significant clinical benefits. (LINK TO BORIS’S DEEP TISSUE ARTICLE)
3. During Trigger Point Therapy the therapist must enter and exit the trigger point slowly.
Wrong: This approach decreases the clinical effectiveness of Trigger Point Therapy and should be used only if the therapist doesn’t have enough tools to control the patient’s pain analyzing system. In the clinically correct approach to Trigger Point Therapy, after the therapist is able to control the pain-analyzing system he enters the trigger point slowly and exits it as quickly as possible.
(LINK TO TRIGGER POINT ARTICLE)
Top 3 Do’s
THERAPEUTIC MASSAGE
1. The pressure during effleurage strokes must be directed only along venous and lymphatic drainage. The coming back part of the stroke must be without any pressure, almost like feathering just to maintain physical contact with the client’s body. Otherwise, the practitioner ruins his or her efforts to stimulate drainage from the tissue before more sophisticated techniques are used.
2. If a therapist wants a therapeutic massage session be clinically effective he or she should spend at least 40% of treatment time applying various kneading techniques. They are the cornerstone of the therapeutic and stress reduction session.
3. Before starting a massage session the therapist should clearly understand the treatment goals and accordingly adjust the set of massage techniques used for this particular client. For example, if treatment session has stress reduction as the goal, slower and more inhibitory massage techniques (e.g., effleurage, slow kneading) must be used. However, if the client has to return to work after the massage session and has an important task to finish, the therapist should completely change the session protocol, adding various stimulating techniques (fast kneading, percussion, vibration).
MEDICAL MASSAGE
1. If a therapist follows the pain pattern exhibited by a patient, he or she chases a ghost. Pain isn’t a pathology, but is the consequence of it. If the patient didn’t have trauma as an initial trigger, the location of the pain isn’t where the practitioner must work. To be clinically effective the practitioner must find the origin of pain and start treatment there. Thus the correct evaluation of the soft tissue becomes the first critical step in formation of an effective MEDICAL MASSAGE PROTOCOL.
2. For Periostal Massage to be clinically effective the applied pressure on the inflamed periosteum must greatly exceed the patient’s pain threshold. Periostal Massage is the only instance in Medical Massage when the practitioner would like to elicit as much as possible local damage to the periosteum to trigger controlled inflammation.
3. Before applying ischemic compression as part of Trigger Point Therapy, the practitioner must detect ‘entrance’ into the trigger point. It dramatically increases clinical outcomes of the therapy while saving tissue from excessive damage and it decreases pressure on the therapist’s hands.