Therapeutic massage is used as an adjunct in the treatment of various injuries and conditions. Its techniques are adapted to the nature of the functional disturbance in the body. It has its own methodology, indications and contraindications. Therapeutic massage can be either full-body or local, and it is best carried out on a doctor's recommendation and in cooperation with them.
Five basic techniques can be distinguished in therapeutic massage:
• stroking,
• compression,
• rubbing,
• kneading,
• vibration,
together with active-passive movements.
Rehabilitation massage is used in functional treatment and in restoring physical working capacity after long breaks in training or after surgery (meniscus removal, Achilles tendon operations and so on). It is combined with therapeutic exercise, mechanotherapy and other methods. It may be full-body (2-3 times a week) or local (daily, and in the first stage of treatment 2-3 times a day).
After injuries and during illness, massage is best started as early as possible, in order to support blood and lymph flow, ease pain, help swelling and haematoma resorb, and assist tissue repair and the normalisation of metabolic processes. The exact timing and intensity are determined by the treating specialist.
In the first stage of treatment massage is often combined with cold, and in the second stage with heat procedures.
In the first 24 hours after an injury, ice massage (applications) is usually used. Later, cold massage is alternated with warm.
Ice massage
Cold applied to the tissues has a pain-relieving and anti-inflammatory effect. This happens because cold reduces the sensitivity of the nerve endings, which in turn reduces the sensation of pain. After ice massage the range of movement in the treated joint usually increases and tissue swelling decreases. Ice massage may improve blood flow in the muscles, help clear metabolic by-products and support tissue recovery.
This kind of massage is fairly simple to do. An ice bag or a plastic bag of ice can be used. To make the ice, fill them with water and put them in the freezer for 30-60 minutes.
In winter, snow can serve the same purpose. Ice massage is used in the first hours after a musculoskeletal injury, and in chronic musculoskeletal conditions in combination with physical exercise. Ice should not be held directly against the skin for long, to avoid a cold burn.
Ice massage is usually done after training or competition. It works like this: the injured (or affected) area is massaged with ice for 2-3 minutes, after which the athlete swims in a pool or a large bath, or, if that is not available, performs simple exercises. The procedure is repeated several times.
In addition - for example in shoulder periarthritis - a series of exercises on machines, with an elastic band or in an isometric mode can follow the ice massage. Ice massage lasts 3-5 minutes. The duration depends on the location of the injury (or the stage of the condition), sex, age and the athlete's general well-being.
Cupping (vacuum) massage
In colds and respiratory illness (bronchitis, pneumonia and the like), cupping massage is sometimes used during the first 2-5 days, later percussion massage combined with inhalation, and a warming massage at night. Such procedures do not replace treatment and are acceptable only as a supplement on a doctor's advice; pneumonia always requires medical supervision.
The action of cupping massage is based on a reflex mechanism (of the motor-visceral reflex type). The vacuum created inside the cup stimulates the skin receptors. Before cupping massage, the area being worked is coated with warmed petroleum jelly oil.
Percussion massage
Percussion massage is used in bronchitis and pneumonia to support blood and lymph circulation and improve lung ventilation. It is performed lying down or seated. The palm of one hand is placed on a particular part of the chest and rhythmic blows are delivered onto it with the fist. The same is then repeated on other symmetrical areas.
Percussion massage is done first on the front of the chest and then from the back. At the front, the blows are applied below the collarbone and at the lower costal arch; at the back, above, between and below the shoulder blades. Compression of the chest with both hands follows. The therapist's hands rest on the lower lateral part of the chest, closer to the diaphragm. On the in-breath the hands slide towards the spine, on the out-breath towards the breastbone (with the chest compressed at the end of the exhalation). The therapist then moves both hands to the armpits and repeats the same movements.
Next comes an oblique chest massage: one of the therapist's hands (the right) is in the client's armpit area, the other (the left) on the lower lateral surface of the chest closer to the diaphragm, and again the chest is compressed at the peak of the exhalation. The position of the hands is then swapped. These techniques are performed for 2-3 minutes.
So that the person does not hold their breath, they are given the cue "breathe in" (as the hands slide along the spine) and then "breathe out" (as the hands slide towards the breastbone). At the end of the exhalation the chest is compressed, which activates breathing.
Percussion massage creates extrapulmonary conditions that make breathing easier. The mechanical stimulation encourages breathing and helps bronchial secretions (phlegm) clear. Compression of the chest stimulates receptors in the alveoli, the root of the lung and the pleura, which raises the excitability of the respiratory centre and supports an active in-breath. Working on the intercostal breathing muscles has a reflex effect on the respiratory centre and stimulates the act of breathing.
Therapeutic massage should only be performed by a trained specialist, and a doctor should be consulted before starting a course - especially in cases of acute inflammation, fever, thrombosis, skin conditions, pregnancy or an oncological diagnosis.