Digging Deep into Physical Therapy Massage
The Role of Massage in Physical Therapy
There is nothing like a good massage, is there? Many people turn to massages regularly to address tight muscles, release stress and manage discomfort. Some people have them once a year while others make it a part of a regular wellness routine. Though licensed massage therapists are trained in the art of massage, many of our patients seek out this type of treatment when they first come to physical therapy. This article explores the role of massage as a treatment in physical therapy, how massage by a physical therapist differs from that of a massage therapist and why some physical therapists use this modality only for short periods.
DO PHYSICAL THERAPISTS MASSAGE?
Massage is the practice of using the hands or various tools to reduce general stress, pain and muscle tension. If you’ve had a massage in the past you will notice they tend to address large areas of the body. Most massages include work on the neck and shoulders, the arms and hands, the upper and lower back, hips, legs and feet. When requested, a massage therapist may focus on a specific area of the body but the goal usually remains to address pain and muscle tension in that area. Physical therapists are licensed healthcare professionals with extensive training in the anatomy and physiology of the musculoskeletal, integumentary and neuromuscular systems and who complete a doctorate or masters level of education. Physical therapists treat what are called body structure and function impairments and functional limitations by addressing specific anatomical structures and movement patterns. Typically a physical therapist is treating a specific injury or specific part of the body and their treatment is localized to that area.
When physical therapists perform “massage” it is called soft tissue mobilization as it better describes the practice of using tools or a therapist’s hands to assess soft tissue and then mobilize and manipulate it to restore normal function while also lessening tissue tension and pain. Some of the techniques may feel similar to how a massage therapist works on a specific area but the goals are different.
SOFT TISSUE MASSAGE (MOBILIZATION) IN PHYSICAL THERAPY
Physical therapists utilize their hands or other tools like cups or special instruments to target impairments in soft tissues. As mentioned above, the goal of soft tissue mobilization or massage in physical therapy differs from that of a massage therapist. Physical therapists use massage to restore overall function, reduce pain, reduce or soften scar tissue, reorganize fibers into a more aligned position for optimal tissue function, reduce swelling and edema and lengthen muscles.
Different types of soft tissue mobilization or massage accomplish different goals and target different layers of tissue. Your therapist may use their hands or special tools to push, pull or apply pressure to the muscles and soft tissue. They may use specialized techniques like strumming, direct oscillations, sustained pressure or unlocking spirals to achieve a reduction in tissue tension, promote blood flow and reduce pain.
Specially-designed instruments may be used to mobilize tissues in a practice called IASTM while another technique called strain-counterstrain uses a positional release technique to calm spasming muscles. Cross friction massage is a type of soft tissue mobilization wherein the therapist applies a deep, localized pressure across the direction of the disorganized or healing fibers. This promotes increased blood flow to the area which can help relieve pain and promotes tissue reorganization and remodeling.
Myofascial release techniques target the fascial layers while trigger point therapy uses sustained pressure to target an area of hypertonic muscle fibers. Finally, manual lymphatic drainage is a special type of massage that promotes drainage of lymphatic fluid. As you can see, the practice of massage in physical therapy is quite specialized and aimed at treating very specific impairments in soft tissue.
WHY MASSAGE ISN’T THE ONLY ANSWER
Now that we have spent time discussing all of the great benefits that massage or soft tissue mobilization can have on pain and tissue health, you may be wondering why physical therapists may hold their breath when a patient says that their previous therapist “massaged” them at every visit and it always helped their pain. There is no doubt that massage makes clients feel better. Whether it is the effect of therapeutic touch or modulation of nerve signals, most people feel better after a massage, but it is only one step in the rehabilitation process and not something we want our patients to rely on for long term symptom relief. Each physical therapist approaches treatment in their own way and massage or soft tissue mobilization has an important role to play in the rehabilitation of injuries or reduction in symptoms like pain or tightness, but its effects are also limited when the underlying problem is more complex than general stress or a hard workout over the weekend.
In physical therapy, the symptom reduction and changes in tissues like fascia or muscles caused by soft tissue mobilization or massage is important, but unless it is paired with appropriate loading of the tissues along with education on proper movement form and biomechanics, the effects are often short-lived. Massage is used more often early in the treatment of pain or injury when reducing pain, tightness or stiffness is needed to progress into more movement and to promote tissue healing. Once symptoms are under control or the tissues have responded appropriately to the massage, it is time to get moving and your therapist may not use massage any longer. Don’t despair though! Carefully prescribed exercises where tissues are stretched and loaded with gradual resistance is often what is needed to give you long lasting relief. Your physical therapist will prescribe individualized exercises and movement and possibly other manual therapy techniques like joint mobilizations to keep you moving in the right direction. Getting to this stage is a good sign that you are on your way to even better results.
MASSAGE AND OTHER TREATMENTS
If you are interested in working with one of our physical therapists and have had good success with massage in the past, we encourage you to let us know when we meet for the initial evaluation. This allows us to build an individualized treatment plan that is most likely to succeed in meeting your goals. If you are ready to start feeling better, call Evolve Physical Therapy today to set up an appointment.
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About EvolveNY-
Brooklyn's Premier Holistic Physical Therapy Clinics- There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better!
First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.
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