Massage Therapy Journal Spring 2024

56 • Massage Therapy Journal

AMTA Continuing Education

Orthopedic Massage Techniques to Use In Your Practice Muscle Energy Techniques. Muscle energy techniques (MET) is the name for a group of manual therapy techniques used by massage therapists, physical therapists, chiropractors and osteopathic doctors. The goal of these techniques is to improve joint mobility, reduce muscle tension and decrease musculoskeletal pain. METs involve active participation of the client. The concept of MET was developed by Dr. Fred Mitchell, Sr. in 1948. His goal was to increase musculoskeletal efficiency by reducing immobility of the joints and stretching tight musculature and fascia. In doing so, he found it to also be effective in reducing discomfort and improving circulation. 15, 16 Note: Massage therapists should concentrate on the fascia to stay within their scope of practice. Some common contraindications and cautions around METs include: • Joint dislocation • Local infection • Muscle strain • Joint sprain • Joint instability Some common MET protocols to use with your clients: Post Isometric Relaxation 1. The practitioner places the targeted muscle in a passive stretch where there is a barrier assessed in the tissue. The client may or may not be able to feel a subtle lengthening or restriction barrier. 2. Back off the barrier slightly. 3. The client then actively contracts the target muscle against the practitioner’s resistance for approximately 10 seconds at 10 percent strength. 4. After 10 seconds, the client takes in a deep breath, exhales and relaxes the contraction while the practitioner passively stretches the target muscle to the next barrier. 5. This lengthening stretch is held for at least 10 seconds. • Recent trauma • Bone fracture

6. Repeat the process three times. There should be a noticeable change in the range of motion of the joint and the flexibility of the targeted muscle. Reciprocal Inhibition 1. The practitioner places the targeted muscle in a passive stretch where there is a barrier assessed. Again, the client may or may not be able to perceive the lengthening or restriction barrier. 2. The client then actively contracts the antagonist of the target muscle against the practitioner’s resistance for approximately 10 seconds at 10 percent strength. 3. After 10 seconds, the client takes in a deep breath and exhales and relaxes the contraction while the practitioner passively stretches the target muscle to the next barrier. 4. This lengthening or stretch is held for at least 10 seconds. 5. Repeat three times. There should be a noticeable change in the range of motion of the joint and the flexibility of the targeted muscle. Cross Fiber Friction. Cross fiber friction, also known as deep friction massage, is a specific, deep, non-gliding soft tissue manipulation that employs a force that moves perpendicular to the fiber direction of a muscle or tendon. Generally, this technique is applied using either the fingers or thumbs. The goal is to break up denser tissue, increase joint range of motion, create a local inflammatory response or promote local blood circulation. Deep friction massage was developed by Dr. James Cyriax as a method of increasing muscle, tendon and ligament mobility. As a note of caution, after using this method, the client may have tenderness at the site of application for 24 to 48 hours. 17 Some common contraindications and cautions around cross fiber friction include: • Anticoagulant or antiplatelet medications • Local bacterial infections • Bruises • Local bursitis • Local skin diseases • Areas of decreased sensation • Fragile skin

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