Medical Massage Therapy Modalities

The difference between Medical and Orthopedic Massage

Orthopedic massage involves therapeutic assessment, manipulation and movement of locomotor soft tissue to reduce pain and dysfunction. Restoring structural balance throughout the body allows us to focus on both prevention and rehabilitation of musculoskeletal dysfunctions. 

A medical massage therapist is a Certified massage therapist (CMT) who treats health conditions diagnosed by a doctor. Massage therapy in medical settings is growing because the practice of combining traditional and alternative medicine is increasing. More hospitals and medical centers are offering these types of treatments and more health insurance companies will cover the cost.

Medical massages help reduce pain and stress, especially for cancer or fibromyalgia patients or for patients in hospice.

Scope of practice

A medical massage therapist works closely with doctors to treat patients who are affected by pain, illness, or injury. Their typical day-to-day roles and responsibilities include:

• Providing massages to patients for a variety of lengths
• Using various massage techniques to manipulate muscles and soft tissue to treat chronic pain and injuries
• Listening and explaining various aspects of medical massage to patients

Their work has the specific goal to alleviate pain and treat health conditions such as neuropathy, cancer, fibromyalgia, sports injuries, or even high blood pressure.

Medical massage therapist vs. general massage therapist

The work of a medical massage therapist differs from that of a general massage therapist. Medical massage therapists have advanced training and experience that allows them to provide care focused on healing injuries, improving function, or increasing circulation. They typically work in hospitals or clinics, may receive orders from a physician as to the type of massage treatment they should give their patients, and can even be paid through the patient’s health insurance.

On the other hand, general massage therapists typically work in spas with the main goal to provide relaxation for their clients. They may use similar techniques as a medical massage therapist, and they may even be able to alleviate some pain, too. However, a general massage therapist’s main goal is not treating a medical condition, but rather reducing stress and promoting relaxation for their client.

Orthopedic:

First, an assessment of the injury or issues will be made.

The therapist in charge of your massage therapy will look at the range of motion, flexibility, and rotation of the tissues. This will help them determine what muscle groups and tendons are involved and which techniques would be best.

Your massage therapists will use an assortment of soft-tissue techniques to loosen muscles and tendons.

These techniques include:

• Active engagement – Used to reach deep, hard to access muscles by compressing muscles and stroking lengthwise in a perpendicular motion. It is especially helpful with whiplash or lumbar pain.
• Positional release – A gentle treatment safe for inflamed muscles and tissues that are too sensitive for other techniques. Soft tissues are manipulated into comfortable positions and held in the correct place for a minute or longer. This lengthens and softens tissues promoting pain relief.
• Nerve mobilization techniques – Also known as neurodynamics and neural mobilization, this method is used to locate strained nerves and sources of pain.
• Muscle energy technique – Therapist provides resistance while you voluntarily contract certain muscles. Especially helpful with lumbar pain.
• Trigger point therapy – Uses intervals of pressure on trigger areas to release lactic acid and promote circulation.
• Myofascial release – Gentle pressure applied to the body to stretch fascia tissues.

Orthopedic massage can benefit patients with many symptoms and conditions. It is shown to greatly help after orthopedic surgery such as ACL, knee or hip replacement.

Soft tissue injuries like sprains, pulled muscles or torn ligaments are also greatly benefited by this massage.

Other conditions that benefit are:

• Carpal-tunnel syndrome
• Frozen shoulder
• Tennis elbow
• Tendinitis
• Sciatica
• Bulging discs

Pre/Post - Surgical Manual Lymphatic Drainage 

What is/is not manual Lymphatic drainage (MDL)?

Pre/Post-surgical Manual Lymphatic Drainage is a gentle yet powerful form of bodywork that is intended to stimulate and encourage the natural movement of the lymph, which carries waste products away from the tissues back towards the heart. It is a technique based on gentle, rhythmic and constant movements that mimic the rhythm of the body’s lymphatic system. During a post-surgical manual lymphatic drainage session, the therapist gently massages the lymph nodes and then guides post surgical edema towards those correlating lymph nodes.

*Post-surgical Manual Lymphatic Drainage is NOT deep tissue massage.  MLD should NEVER hurt to receive.  MLD is also NOT opening up incision wounds to push edema out of the body.

Why should you receive MLD before or after your cosmetic or orthopedic surgery?

Oftentimes after surgery, the body will swell with excessive edema both at and proximal to the surgical site.  This post-operative swelling, while completely normal, can be quite uncomfortable.  Sluggishness, decreased range of motion, increased sensitivity, inability to sleep comfortably, and an overall feeling of puffiness can often occur during the surgical recovery process.

Reducing post-surgical swelling is one of the most common ways that Manual Lymphatic Drainage is used.  Because of its ability to directly move excessive post-surgical edema while using the most gentle of touch, Manual Lymphatic Drainage is frequently regarded as an imperative part of the surgical recovery process by surgeons worldwide.

Postoperative MLD to clients recovering from wide range of surgeries include:

• Brazilian Butt Lift (BBL)
• Tummy Tuck/Abdominoplasty
• Liposuction
• Fat Transfer
• Arm/Leg Lift
• Facelift
• Breast Implant
• Chin Liposuction
• Mastectomy/Breast Reconstruction

Do you have tissue fibrosis or lumps and bumps after surgery?

Fibrosis is a build up of scar tissue that can occur as a result of cosmetic surgery which can cause lumps and bumps in the subdermal tissues.  It can sometimes be found in the lateral torso, lower abdomen, and back after liposuction.  While this consequence of liposuction is not ideal, not to worry.  Fibrosis can be treated!

Through various techniques, fibrosis and scar tissue can be gently treated causing any lumps and bumps that may have settled during the recovery process to get smoothed out.  Using warm oil and lymphatic cupping, myofascial decompression allows for scarring and edema build-up to gently be reduced allowing the patient to feel more comfortable and confident in their new body.

Acupressure (the use of pressure to stimulate the acupoints) remove blockages and promote balance of energy throughout the body. ... Trigger point therapy works to release muscle tension, acupressure work to balance vital energy, or chi.

What is Trigger Point Therapy?

Myofascial Trigger Point Therapy, also known as " Trigger Point Therapy ", refers to the treatment of myofascial trigger points (MTrP) or 'trigger points' (TrP) that are found in muscles and fascia. Myofascial trigger points are painful, tense areas that are found in muscles. MTrPs affect muscles and fascia.

What is Trigger Point used for?

In alternative medicine, trigger point therapy is used to treat a number of chronic pain conditions, including:

• headache
• temporomandibular joint pain (TMJ)
• low back pain

In addition, some people use trigger point therapy as a treatment for osteoarthritis, carpal tunnel syndrome, tinnitus, migraines, sciatica, and sports injuries.

What is Acupressure Massage?

Acupressure is a thousands-year-old form of massage therapy that involves applying pressure to certain points on the body to address ailments. According to traditional Chinese medicine, people have meridians or channels throughout the body. Qi, which is understood as a life-sustaining energy force, runs along those meridians. Qi can become stuck at some points along the meridians, and the goal of acupressure is to keep the energy flowing using pressure at specific points. Western medicine doesn't include the existence of the meridians, so acupressure isn't part of mainstream medical treatment here. 

What is Acupressure used for?

There are hundreds of acupressure points on the body, corresponding to other parts of the body. (For example, there's a point on your hand for your kidney.) So, naturally, the practice has many associated benefits. As with any form of massage, a huge perk of acupressure is relaxation, one that you can get behind even if you doubt the existence of meridians. Acupressure is often used for pain relief, and studies have suggested it may help fight back pain, menstrual cramps, and headaches. The practice is used for many other purposes that have been studied less, including immune system and digestion support.

Cranial sacral therapy (CST) is sometimes also referred to as craniosacral therapy. It’s a type of bodywork that relieves compression in the bones of the head, sacrum (a triangular bone in the lower back), and spinal column.

CST is noninvasive. It uses gentle pressure on the head, neck, and back to relieve the stress and pain caused by compression. It can, as a result, help to treat a number of conditions.

It’s thought that through the gentle manipulation of the bones in the skull, spine, and pelvis, the flow of cerebrospinal fluid in the central nervous system can be normalized. This removes “blockages” from the normal flow, which enhances the body’s ability to heal.

Many massage therapists, physical therapists, osteopaths, and chiropractors are able to perform cranial sacral therapy. It can be part of an already-scheduled treatment visit or the sole purpose for your appointment.

Depending on what you’re using CST to treat, you may benefit from between 3 and 10 sessions, or you may benefit from maintenance sessions. Your healthcare provider will help you determine what’s right for you.

Benefits and uses

CST is thought to relieve compression in the head, neck, and back. This can soothe pain and release both emotional and physical stress and tension. It’s also thought to help restore cranial mobility and ease or release restrictions of the head, neck, and nerves.

Cranial sacral therapy can be used for people of all ages. It may be part of your treatment for conditions like:

• migraines and headaches
• constipation
• irritable bowel syndrome (IBS)
• disturbed sleep cycles and insomnia
• scoliosis
• sinus infections
• neck pain
• fibromyalgia
• recurrent ear infections or colic in infants
• TMJ
• trauma recovery, including trauma from whiplash
• mood disorders like anxiety or depression
• difficult pregnancies

There’s plenty of anecdotal evidence that CST is an effective treatment, but more research is needed to scientifically determine this. There’s evidence that it can relieve stress and tension, though some research suggests that it may only be effective for infants, toddlers, and children.

Other studies, however, indicate that CST may be an effective treatment — or part of an effective treatment plan — for certain conditions. One 2012 Trusted Source study found that it was effective at reducing symptoms in those with severe migraines. Another study found that people with fibromyalgia experienced relief from symptoms (including pain and anxiety) thanks to CST.

Myofascial release therapy is a massage technique that focuses on relieving pain in your myofascial tissues. These are the thick connective tissues that support your muscles.

About Myofascial Tissue

Your myofascial tissue is a network of tissue that spreads throughout your entire body. It connects your muscles, joints, and bones. It also provides support to your organs, helping to keep them in place.‌

If you could see it, your fascia would look like a single sheet of tissue. However, there are multiple layers that work together. In between these layers is a liquid called hyaluronan that provides stretch and encourages free range of movement. When this liquid becomes thick, sticky, or dries up, it can impact the surrounding body parts.‌‌

When you feel stiffness or pain in your body, it can originate from different tissues in your body. Myofascial pain is different from other types of pain because it occurs in places where your myofascial tissue meets or crosses. Myofascial pain may be difficult to identify because it can radiate from the area and spread.

Usually this tissue feels more elastic and movable. Tight myofascial tissue can restrict movement in your muscles and joints. As you move differently to make up for the loss in movement, you can cause additional tightness without realizing it. This can lead to widespread pain and discomfort.

Understanding Myofascial release therapy

During a myofascial release massage, your therapist spends time feeling your myofascial tissue for areas that are particularly stiff and tight. These are the places that cause you to feel pain, even if it's radiating to other areas. It's important that you seek help from a trained specialist who knows how to identify myofascial tissue issues. A myofascial massage is different from other types of massage and techniques will vary from therapist to therapist.‌

Other types of massage may be relaxing, but myofascial release therapy is often intense and painful. Your therapist will use their hands to massage and stretch your myofascial tissue and eliminate knots. ‌

In some cases, a therapist will use additional tools like a foam roller or ball to aid in separating the tissue. You may feel sore immediately following a myofascial massage, but the results often include an increased range of motion and less pain and stiffness.‌

Myofascial tissue will often become tight in the following areas:

• Arms
• Calves
• Feet
• Head
• Hips
• Jaw
• Lower back
• Neck
• Quads‌
• Shoulders

Benefits of Myofascial Release therapy

A single myofascial massage won’t offer long-term relief. However, regularly receiving myofascial release therapy can:

• Improve range of motion
• Reduce soreness
• Increase your body’s natural recovery process
• Helps with overall relaxation 
• Improve circulation‌
• Relieve stress

Ultrasound therapy is a noninvasive treatment in which sound waves are used to penetrate soft tissues, increasing blood flow. This can help relieve pain, improve circulation, and promote tissue healing. As such, ultrasound therapy is often used to treat injuries and muscle spasms, as well as chronic issues like neck or back pain.

Helps individuals manage pain and improve mobility,

Ultrasound therapy is also called therapeutic ultrasound or focused ultrasound.

Studies suggest that ultrasound therapy can be used effectively for treating certain chronic pain conditions as an early stage, non-invasive option. It is also used as an alternative treatment option, or as a complement to more invasive methods such as surgery.2

Ultrasound therapy may be potentially helpful in treating pain associated with several conditions:

• Neck pain3
• Chronic back pain4
• Myofascial pain syndrome, which describes recurring pain and spasms in an area of the body 5
• Osteoarthritis, often referred to as "wear-and-tear" arthritis of the joints1
• Bone fractures6
• Painful bone cancer2
• Nerve pain2
• Pain due to non-cancerous tumors2
• Tendinitis, or when the tissue that connects the bones to the muscles becomes irritated7
• Bursitis, or when the fluid-filled sacs in the joints become inflamed7
  

While the FDA has approved ultrasound therapy as a treatment modality for many chronic pain conditions, more research is still being done for other possible uses.

There are two types of ultrasound therapy that your provider may administer. The one you get depends on what condition you're looking to treat:

• Mechanical: This type of therapy relies on mechanical vibrations to penetrate the soft tissues. This creates cavitation, tiny gas bubbles that quickly expand/contract and are thought to reduce swelling and inflammation. Mechanical ultrasound is also believed to help break down scar tissue and deposits such as painful kidney stones.
• Thermal: This type of therapy warms the skin and muscles, which may help with pain. It is typically used to treat minor injuries, such as strains and sprains.
  

There are a number of benefits to including ultrasound therapy as a part of your physical therapy treatment for these conditions. For example:

• It may eliminate or reduce dependence on pain medication.
• It is easy, painless, and non-invasive.
• When correctly performed, there are no known side effects.
• It is generally considered safe for most people.

That said, ultrasound therapy is not safe to use:

• If you are pregnant
• Over the spine or eyes
• On parts of the body where there is an active infection
• If you have a pacemaker, or a device that helps regulate your heartbeat
• Over broken bones
• Over any areas with implanted medical devices
• Over or near areas with cancerous tumors
  

Before starting your treatment, your therapist will check to make sure you don't have any burns, infections, or other problems that might contraindicate the therapy.

Your therapist will then select a small surface area to work on based on your specific condition and apply a gel either to the transducer head, the wand that emits the sound waves, or to your skin. This helps distribute the sound wave energy and prevents the transducer from getting too hot.8

During your ultrasound therapy treatment, your therapist will continually move the transducer head over and around the selected area to deliver the sound waves where needed.

Treatments may last for five to 10 minutes, but this can vary depending on your needs.8

Ultrasound therapy is not painful if the therapist keeps the wand moving continuously. However, if the wand is held in one spot for more than a few seconds, it can become uncomfortable.8

Don’t be surprised, however, if you feel nothing at all, apart from the cold gel on your skin. If the area being treated is especially sensitive to touch, you could possibly feel discomfort as the transducer head passes over.

Let the therapist know if you experience any discomfort.

      Vacuum Cupping Therapy is an ancient form of alternative therapy in which a therapist puts special cups on your skin for a few minutes to create suction. People get it for many purposes, including to help with pain, inflammation, blood flow, relaxation and well-being, and as a type of deep-tissue massage. Cupping increases blood circulation to the area where the cups are placed. This may relieve muscle tension, which can improve overall blood flow and promote cell repair. It may also help form new connective tissues and create new blood vessels in the tissue.
Avoid showering or swimming the rest of the day after your treatment. If you have any soreness post-session or if your cupping marks are very dark, massaging gel, cream, or oil into the area can help promote healing and reduce any discomfort.

• How does kinesiology tape work?

Kinesiology tape is really stretchy.

Kase created Kinesio tape with a proprietary blend of cotton and nylon. It’s designed to mimic the skin’s elasticity so you can use your full range of motion. The tape’s medical-grade adhesive is also water-resistant and strong enough to stay on for three to five days, even while you work out or take showers.

When the tape is applied to your body, it recoils slightly, gently lifting your skin. It is believed that this helps to create a microscopic space between your skin and the tissues underneath it.

One small study with 32 participants showed that when kinesiology tape was applied over the knee, it increased the space in the knee joint.Trusted Source A similar study showed kinesiology tape also increased the space in the shoulder joint.Trusted Source Even though the increase in space is slight, it helps reduce the chance of joint irritation.

Some physical therapists think the tape changes the information your sensory nervous system is sending about pain and compression in your body.

Dr. Megann Schooley, board-certified clinical specialist in sports physical therapy and certified strength and conditioning specialist, explains it this way:

“All of your tissues — skin, connective tissue, fascia, muscles — contain sensory receptors that feel pain, temperature, and touch. Those receptors all contribute to proprioception—your brain’s sense of where your body is and what it’s doing. Kinesiology taping creates a lift that unloads the underlying tissues. Decompressing those tissues can change the signals going to the brain. When the brain receives a different signal, it’s going to respond differently,” Schooley says.

Trigger points are a good example. Physical therapists have used kinesiology tape to lift the skin over these tense, knotted muscles. When the area is decompressed, pain receptors send a new signal to the brain, and tension in the trigger point decreases.

A 2015 study showed that trigger point pain was reduced and flexibility increased for people when kinesiology tape and manual pressure were used together.Trusted Source

If you’ve been injured, kinesiology tape might help improve circulation and reduce swelling in the area where you’re hurt.

A 2017 study showed that kinesiology taping can improve blood flow in the skin.Trusted Source It may also improve circulation of lymphatic fluids. Lymphatic fluid is mostly water, but it also contains proteins, bacteria, and other chemicals. The lymphatic system is the way your body regulates swelling and fluid buildup.

The theory is that when kinesiology tape is applied, it creates extra subcutaneous space, which changes the pressure gradient in the area underneath your skin. That change in pressure enhances the flow of lymphatic fluid.

Studies have had mixed results. In two recent studies, kinesiology tape reduced fluid buildup in women who underwent breast cancer treatment and people who had total knee replacements.Trusted SourceTrusted Source

Changing the flow of lymphatic fluid could help bruises heal faster. Although there are few studies to confirm this effect, anecdotally some people report that when they’ve removed tape from bruised body parts, the areas under the tape were a different color than the un-taped areas.

What is Kinesiology Tape for:

• Treating injuries
• Supporting weak zones
• Re-educating muscles
• Enhancing performance
• Managing scars

Does it really work?

The answer for some people is: yes. But we need more research — what exists currently is inconsistent. Some studies indicate no difference in outcomes between kinesiology tape and placebos or “sham taping.”

Some studies show minimal or moderate gains.

Many studies indicate that kinesiology taping is most effective when used together with conventional treatment methods.

Will The tape harm the skin?

The adhesive on major brands is latex-free and hypoallergenic, so it shouldn’t cause an allergic reaction if it’s applied properly and if you don’t have sensitivities. It’s probably a good idea to apply a test strip first, just to be on the safe side.