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Following completion of this chapter, the student will be able to:

  • Discuss the physiologic effects of massage differentiating between reflexive and mechanical effects.

  • Apply specific treatment guidelines and considerations when administering massage.

  • Demonstrate the various strokes involved with Classic Swedish (Hoffa) massage.

  • Discuss the appropriate use of deep friction massage.

  • Describe connective tissue massage.

  • Explain how trigger point massage is most effectively used.

  • Describe dry needling as a technique for treating active trigger points.

  • Explain now myofascial release can be used to restore normal functional movement patterns.

  • Explain how strain–counterstrain, positional release, active release technique®. Graston®, Rolfing (structural integration), Trager cupping, and percussive massage techniques can be used for soft tissue mobilization.


Massage is a mechanical stimulation of the tissues by means of rhythmically applied pressure and stretching.1 Over the years many claims have been made relative to the therapeutic benefits of massage in the patient population, although few are based on well-controlled and well-designed studies.2–11 Patients have used massage to increase flexibility and coordination as well as to increase pain threshold; decrease neuromuscular excitability in the muscle being massaged; stimulate circulation, thus improving energy transport to the muscle; facilitate healing and restore joint mobility; and remove lactic acid, thus alleviating muscle cramps.3,6,12–16,110,112,114 Conclusive evidence of the efficacy of massage as an ergogenic aid in the physically active population is lacking, however.17

How these effects may be accomplished is determined by the specific approaches used and how massage techniques are applied. Generally, the effects of massage may be either reflexive or mechanical.18 The effect of massage on the nervous system differs greatly according to the technique employed, pressure exerted, and duration of applications. Through the reflex mechanism, sedation is induced. Slow, gentle, rhythmical, and superficial effleurage may relieve tension and soothe, rendering the muscles more relaxed. This indicates an effect on sensory and motor nerves locally and some central nervous system response. The mechanical approach seeks to make mechanical or histologic changes in myofascial structures through direct force applied superficially.18

Reflexive Effects

The first approach in massage therapy involves a reflexive mechanism. The reflexive approach attempts to exert effects through the skin and superficial connective tissues. Mobilization of soft tissue stimulates sensory receptors in the skin and superficial fascia.18 If hands are passed lightly over the skin, a series of responses occur as a result of the sensory stimulus of cutaneous receptors. This reflex mechanism is believed to be an autonomic nervous system phenomenon.19 The reflex stimulus can occur alone (unaccompanied by the mechanical mechanism). Mennell calls this the “reflex effect.”20 In itself, it is not an effect but the cause of an effect (i.e., it causes sedation, relieves tension, and increases blood flow).

Physiologic Effects ...

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