Chapter 7: Superficial Reflex Techniques Outcome-Based Massage: From Evidence to Practice © 2009 LWW.

ObjectivesObjectives

At the end of this presentation, you will have the information needed to:

• Describe 3 superficial reflex massage techniques

• Explain the outcomes they produce

• Know when to avoid them or modify their use

• Begin manual practice

DefinitionsDefinitions

• Superficial: pertaining to or situated near the surface

• Reflex: an involuntary reaction in response to a stimulus applied to the periphery and transmitted to the nervous centers in the brain or spinal cord

©2009 LWW

Reflex Effects of MassageReflex Effects of Massage

• Are mediated by the nervous system

• Peripheral receptors send impulses to centers in the brain or spinal cord, which then cause a local or systemic response.

• E.g., stroking a person’s hand at the right rate and rhythm can cause drowsiness.

Mechanical Effects of MassageMechanical Effects of Massage

• Are caused by physically moving tissues, by:

– Compressing

– Stretching

– Shearing

– Bending

– Twisting

• E.g., stretching scar tissue causes it to lengthen.

Superficial Reflex TechniquesSuperficial Reflex Techniques

• Engage the skin and affect level of arousal, autonomic balance, or perception of pain.

• Include:

– Static contact

– Superficial stroking

– Fine vibration

Static ContactStatic Contact

• Motionless contact of the therapist’s hands with the client’s body, performed with minimal force

• The least mechanically forceful of the massage techniques

• An important part of systems such as Therapeutic Touch, Reiki, and Polarity Therapy

Static Contact: Outcomes and UsesStatic Contact: Outcomes and Uses

• Increases rapport

• Decreases anxiety, improves relaxation

• Analgesia

• May improve growth of premature infants

• Is used to assist with client education

• May affect client’s electromagnetic field

Static Contact: Contraindications and CautionsStatic Contact: Contraindications and Cautions

• Contraindicated in areas of acute inflammation because of pain

• Clients who have much pain or distress may not tolerate touch at all.

• Be sensitive to the needs of frail, high-risk, or terminally ill clients.

• Even though static contact causes minimal mechanical effects, it can give rise to complex physical and emotional responses, including touch-triggered memory.

Performing Static ContactPerforming Static Contact

• Use a relaxed upright posture and fully relaxed hands.

• Breathe using your diaphragm.

• Encourage relaxation and diaphragmatic breathing in your client.

• Observe client for signs of relaxation.

• For a relaxation response, try applying static contact to the client’s occiput, sacrum, face, hands, or feet.

Static Contact Applied to the OcciputStatic Contact Applied to the Occiput

Static Contact Used to Teach BreathingStatic Contact Used to Teach Breathing

Superficial StrokingSuperficial Stroking

• Gliding over the client’s skin with minimal deformation of subcutaneous tissues

• Usually applied unidirectionally over large areas of the client’s body

• Often used at the beginning or end of a region or intervention

Superficial Stroking: Outcomes and UsesSuperficial Stroking: Outcomes and Uses

• Reduces pain

• Improves mood and reduces anxiety

• Changes level of arousal (alertness)

• Improves growth of premature infants

• May alter level of neuromuscular tone

Superficial Stroking: Contraindications and CautionsSuperficial Stroking: Contraindications and Cautions

• Contraindicated in areas of acute inflammation because of pain

• Clients who have much pain or distress may not tolerate touch at all.

• Be sensitive to the needs of frail, high-risk, or terminally ill clients.

• Recent myocardial infarction

• With bypass surgery, wait 48 hours.

• Ticklishness: use a broader contact, more lubricant, or more pressure

Performing Sedative StrokingPerforming Sedative Stroking

• Use:

– Relaxed contact with the entire palmar surface

– Slow, stable rate

– Caudal direction (down limbs and back)

Performing Stimulating StrokingPerforming Stimulating Stroking

• Use:

– Fingertip contact

– Fast irregular rate

– Multidirectional strokes

Superficial Stroking of the FaceSuperficial Stroking of the Face

Superficial Palmar Stroking of the BackSuperficial Palmar Stroking of the Back

Fine VibrationFine Vibration

• Fast oscillating or trembling movement produced on the client’s skin with minimal deformation of subcutaneous tissues

• Manual technique is hard to perform long enough to be effective.

• Perform using a machine that vibrates at 100 Hz

Fine Vibration: Outcomes and UsesFine Vibration: Outcomes and Uses

• Analgesia for both acute pain and chronic pain

• Improves ability of clients with neurologic problems to perform exercise (through temporarily raised neuromuscular tone)

Fine Vibration: Contraindications and CautionsFine Vibration: Contraindications and Cautions

• When pain is due to acute inflammation, the weight of a hand or of a machine may not be tolerated locally

Performing Fine VibrationPerforming Fine Vibration

• Analgesia is much greater when:

– Vibration is applied continuously for longer than 30 minutes

– Rate is 100+ Hz

• So use a machine! You can attach it to the client, freeing your hands to perform other manual techniques.

Using a Fine Vibration MachineUsing a Fine Vibration Machine

ReferencesReferences

• The references for the material in this PowerPoint presentation are found in Chapter 7: Superficial Reflex Techniques.