In Workers' Comp, for example, it's common for the patients to begin with physical therapy, and then massage, chiropractic, and acupuncture may be gradually incorporated along with the continuing physical therapy.
Trigger points are defined as tender, small contraction knots that typically refer pain, called "active" trigger points. Active trigger points are often caused by injury, muscular strain, and overuse. Travell and Simons define a trigger point as "a highly irritable localized spot of exquisite tenderness in a nodule in a palpable taut band of muscle tissue." Common massage techniques include effleurage, gliding, petrissage, grasping, and friction. Over time, the "active" trigger points will relax and refer less pain, tingling, and numbness. They will become "latent" and perhaps only tender locally to the touch. Although myofascial trigger points may be found in the muscle tissue or muscle fascia, trigger points in general may also be present in cutaneous, ligamentous, periosteal, and non-muscular fascial tissues.
Trigger points can be so intense that they may elude to misdiagnosis. For example, "chronic jaw pain, toothaches, earaches, sinusitis, ringing in the ears (tinnitus), and dizziness may be symptoms of trigger points in the muscles around the jaw, face, head and neck." Neuromuscular therapy also addresses circulation, nerve compression, postural issues, and biomechanical problems that can be affected by specific injuries.
Long, firm stretching strokes are employed without the use of oils to release fascial restrictions in the soft tissue caused by trauma and injury, poor posture, or inflammation. Fascia is defined as "a band or sheet of connective tissue that attaches, stabilizes, encloses, and separates muscles and other internal organs." The three layers of fascia are termed superficial, visceral, or deep. Superficial fascia is on the lowermost layer of the skin in nearly all the regions of the body, such as on the face, nape of the neck, and overlying the breastbone. The superficial fascia primarily determines the shape of the body. Visceral fascia is mostly associated with the internal organs and the name of that fascia varies according to the anatomical location or structure. For example, the visceral fascia covering the heart is called the pericardium, and in the brain, they are known as meninges.
Deep fascia is mostly associated with the muscles, bones, nerves and blood vessels. It is a layer of deep connective tissue which surrounds individual muscle fibers, individual muscles, and groups of muscles. A helpful analogy to understand fascial restriction would be if you got a single snag or pull on a knit sweater, and the sweater bunches up and becomes disorganized. Deep fascia in the body works like this, and has an effect on the surrounding muscles, nerves, and soft tissue. This layer is richly supplied with sensory receptors and can benefit from myofascial release during a massage. Examples would be plantar fascia and thoracolumbar fascia.
Many of my favorite and most effective myofascial techniques for specific injury work have been developed by Til Luchau, former Rolfer and lead instructor and the Director of Advanced-Trainings.com. These techniques have been employed by many manual therapy practitioners, including structural integration therapists, physical therapists, massage therapists, osteopaths, chiropractors, acupuncturists, and more.
Til describes the two primary goals as (1): “Increase options for movement and mobility, ranging from subtle micro movement pulsations to gross range of movement”; and (2): “Refine the proprioceptive sense, meaning wanting the client to feel and perceive their bodies in new ways as a result of the work.” Myofascial work can have a deep effect on our bodies, musculature, and postural habits, while relieving pain and improving the patients' level of functioning and recovery.
As defined by the Medical Dictionary, Deep Tissue Massage is characterized by "a group of massage techniques designed to access multiple layers of muscle and fascia to improve alignment, reduce levels of resting tension, and create more efficient postural and movement patterns." It is a type of massage in which the "fingers, thumbs and elbows are used to release chronic muscle tension, using slow, deep strokes and friction; the therapist may work perpendicularly to the length of the fibers of the superficial muscles, with the intent of massaging muscle that lies underneath."
Deep tissue massage addresses fascial restrictions, relieves muscular and joint pain, and improves posture. It is known to decrease chronic back pain, decrease arthritic symptoms, aid muscle rehabilitation in athletes, alleviate fibromyalgia symptoms, and break down scar tissue.
- Effleurage- long, gliding, sweeping strokes administered with hands (both open palm and fists) and forearms
- Petrissage- kneading, rolling, wringing and lifting strokes which help free up knotted muscles and soft tissue, stimulate nerve endings, and aid in increasing circulation
- Friction- a warming stroke designed to quickly generate heat in preparation for deeper work and consisting of rubbing back and forth along the length of the muscle or across it by either using wringing motion or small circular movements
- Tapotement- a percussion stroke in which the hand action rhythmically stimulates nerves, muscles, and circulation; the hand position can be cupped or with palms flat, or it can be with fingers interlocked in either a palms together position or in soft fists
- Vibration- rocking, shaking and trembling movements applied to one limb or to the entire body to reverberate through the surrounding tissues in order to break postural holding patterns and to facilitate a momentary release of tension in the muscle tissue
“What is Myofascial Release?” Myofascial Release®: Treatment Centers & Seminars. Retrieved from www.myofascialrelease.com/about/definition.aspx
Luchau, Til. Advanced Myofascial Techniques: Shoulder, Pelvis , Leg, and Foot. Scotland: Handspring Publishing Limited, 2015. Print.
"Deep Tissue Massage". (n.d.) Segen's Medical Dictionary. (2011). Retrieved March 16 2018 from https://medical-dictionary.thefreedictionary.com/deep+tissue+massage
"Deep Tissue Massage". (n.d.) Medical Dictionary for the Health Professions and Nursing. (2012). Retrieved March 16 2018 from https://medical-dictionary.thefreedictionary.com/deep+tissue+massage
Swedish Massage. Retrieved from http://strictlytherapeutic.com/swedish.html
Photo by Harlie Raethel on Unsplash
Coviello, Jason. “Ranpreet Kaur, Massage Therapist.” 2015. Digital Photographs, http://www.jcartistry.com.