# Massage - Synergistic Techniques

This book is created to explain and summarize a style of massage incorporating many aspects of international massages into a massage that aims to relieve all types muscle tension. This style is designed to cater to athletes or individuals with significant muscle tension. This book is designed to provide massages that relieve a specific type of muscle tension and should not be confused with massages that try to "provide a general feeling of relief".
(To readers: Please note this is my first book, and I am trying to create a concise outline of various topics to be covered. I realize the tone of voice may be very forceful and I aim to revise this in future edits. This forceful tone is aimed to keep me on track to follow my vision of what concepts need to be covered properly.)
This book aims to be a technical howto massage manual (readable for beginners), with referencing of specific groups of muscles (with technical names), by providing a specific set of solutions to relieve muscles pain. Ideally this book will try to provide a set of massage solutions that only the best physio-therapists can currently provide. Solutions will try to never be vague or provide "new-age" remedies (without explicit noting of unknowns).

## Introduction

It is my belief that there is no style of massage that is better than other styles of massages. This style aims to increase the effectiveness of massage in general by combining my first hand experience with different massage techniques including; fingertip, pressure point/reflexology, chiropractor, and stretching.

## General Massage Theory

Massage with your fingertips. The human fingertips have the most nerves in the human hand allowing a greater feel for the muscle tension in your massage subject. This is not as easy as it sounds as the pressure of the massage must be from the inside of the finger away from the fingernail. The fingernail should touch the subject as little as possible.
As such, I find rock-climbers and basketball players have the best hands for this massage as fingertip strength is used extensively in their sport. Professions who grip bars or handles for a living will find proper massage technique incredibly difficult (they tend to want to dig their fingernails in and lack fingertip strength vs grip strength).
The human body has many different types of muscles that serve to extend, retract, and rotate limbs. Muscles and tendons are often laid in a way that makes massage impossible on the inner muscles until the outer layers of muscle are relaxed.
Injuring muscles is a common side effect of deep-tissue massage and massaging very stiff muscles. Knowing which techniques cause the least damage allows the massuese to give an effective massage while minimizing the negative effects. This is especially important for athletes that want to compete and retain their balance/speed/strength.

### Stroking technique

    Often done with oil, this involves stroking the muscle along the length of the muscle. This technique works best with muscles located on the surface uncovered by other muscles.
    Cross-stroking refers to the stroking of muscles across its axis to make the muscle "snap". This is much like plucking the string of a guitar on an instrument and should be avoided as much as possible. Extensive cross-stroking of muscles leads causes unnecessary wear and tear compared to other techniques. Note: this technique does often lead to a quicker relief of pressure but often leaves the muscle severely weakened. My experience has shown that the "pure pressure" technique is preferrable to Cross-stroking.
    Cross-stroking should not be used as a massage technique so much as to locate tendons/muscles that are stiff.

### "Pure pressure" techinique (Chiropractor based)

    Many muscles, including most large muscles and many muscles located deep under layers of other muscles respond best to this technique. Stroking deep muscles often leads to the "cross-stroking" of larger muscles on top which damages the muscle ontop.
    Simply done, the "pure pressure" is commonly done using the knuckles or elbow. The masseuse leans on and compresses the muscle at pressure points for 30+ seconds. Often this may take minutes per muscle (especially for larger muscles). Eventually the muscle will soften and releasing the pressure will give the subject a feeling that blood and relief is gushing into the muscle. (there should be only limited numbness associated with this technique, you should NOT be cutting off the blood supply)
    "Pure Pressure" should be applied at an angle that generates some cross-stroking. That is, as the muscle relaxes, you should be able to feel the muscle gently slide by your elbow/knuckle. If it snaps past your elbow/knuckle, your angle is not correct.

### "Tapping"

    Basically just shaking the muscle by various means; chopping at the area, mechanical (ultrasound or consumer vibration devices), jacuzzi water-jets/bubbles. Of these, water-jets seem the most effective (possible due to the use of warm water often associated with jacuzzi's). Overuse of tapping techniques will definitely result in noticeable muscle damage including bruising. This technique should be used lightly and only as a supplement to other techniques.
    Novices without enough fingertip strength to massage larger muscles will often revert to this technique. Note: Larger muscles often can take more abuse than smaller muscles and Tapping is a very effective technique if used sparringly.

### Stretching

    Although not strictly a massage. This is often the most effective way to relieve stress in large muscles or deep muscles (eg. rotator cuff). Effective stretching should last 30+ seconds and may last minutes depending on circulation and stiffness.
    Do not bounce when stretching (this may result in injury and is not as effective). Constant pressure should be applied when stretching. Pressure will need to be periodically increased as the muscle relaxes during the stetch.

### Promoting circulation (Heat/Ice Contrast baths)

    Note: Although related, this is not a guide to sports injury and will not go extensively into RICE (Rest Ice Compress and Elevate) techniques that are used to treat sports injury.
    I find my experience with Ice and Constrast baths (alternating 5min hot and cold water baths) to be a very effective technique to help deal with swelling and injuries. However, for general muscle stiffness, this does not help enough to be considered a technique.
    Assuming your source of muscle tension is not an injury that is swollen and may worsen with heat, heat is a masseuses best friend. If you are very stiff, the subject should take a long 15min+ hot bath/jacuzzi to loosen up the muscles. This will make the massage less painful, less damaging, and more effective overall.
    After a very physical massage which has released a lot of stress, another hot bath will help circulation and help clear the lactic acid from your muscles.

## Shoulder stiffness - Rotator Cuff

The most common muscle tension state that baffles subjects and massagers. This is caused by either of the rotator cuff muscles (lookup name) located deep within the shoulder blade. This deep location means it is impossible to massage these muscles effectively without first relaxing the very large shoulder and back muscles that cover it up.
The pressure points for the shoulder and back muscles are quite far from the source of pain caused by the stiff rotator cuff. This causes the subject and massager to be often be misguided by the pain and stiffness which they are unable to release.

### Locating the problem

Subject will often be seen moving their shoulder blade and swinging their upper arm(lookup technical name) trying to find relief.
Exact location: Betweent the lats (back muscle) and the rear deltoids (shoulder muscle) just below and behind the armpit.

### Solution

* Relax the shoulder muscle (lookup name of specific group of muscles). The rotator cuff will to be totally inaccessible to massage if the shoulder or back is stiff.
* Stretching - Often the best way to provide relax the rotator cuff is to stretch it. The shoulder rotator cuff serves to rotate your forearm forward/backward.

#### Stretch forward rotator cuff (lookup techinical name)

    Find a pole (at least body height, need a diagram); with your right hand hold pole with palm facing forward, make a ~90degree bend in an "L" shape with your arm so you forearm is parallel with the pole. Place your elbow infront of the pole and lean forward with your body as if you wanted to snap off your forearm (don't actually do it, but it illustrates what this is trying to stretch).
    Feel free to fidget and alter to angle of the stretch as it stretches different parts of the rotator cuff. Changing the angle of your elbow from 45degrees to 135 degrees also helps stretch all parts of the rotator cuff.
    (This seems to be by far the most common baffling source of muscle tension in sports and in the workplace. The reverse rotator cuff doesn't seem to be as common or major a problem.)

#### Stretch rear rotator cuff

    Totally different stretch from the forward rotator cuff. Find a long flat table, place your right arm on top of the table in an "L" shape with your palm facing down and pointing to the left. Hold the edge of table with your right hand and, keeping your elbow on top of the table (and near the edge of the table), lean down and try to take your shoulders and hand as far down to the ground as you can.
* "Pure pressure" and Stroking - After stretching, either of these techniques can help fully relax the muscle (stretching usually helps the most). Applying these techniques, massage the rotator cuff using the 2 mentioned techniques (ideally with the subject lying face down). You may find the rotator cuff hard to locate due to a layer of stiff larger muscles on top. Go to step 1 to relax related muscles.

### Common Problems

You may find the rotator cuff is hard to locate due to the following:
Small size of muscle - In non-muscular/athletic people, the rotator cuff muscle often feels more like a thin stiff tendon only a couple mm wide. It will be impossible to locate if the latizoids or deltoids are too stiff.
Lack of response to massage techniques - This muscle is very deep and will not respond to tapping techniques well. You must relax surrounding muscles first. As surrounding muscles may be difficult to fully relax in one massage session, always remember to stretch the subject as stretching will always provide a large amount of relief for this condition.

## Prevention

Regular person: This stiffness is usually caused by bad posture in the workplace.
Athlete person: The rotator cuff is extremely useful in many contact sports (eg. basketball, rugby, wrestling, judo...) and sports involving the upper body. My personal experience has shown, even with years of extensive training, the rotator cuff is almost never strong enough and can always stand from having extra strength. Please refer to a sports trainer for specific exercises on improving the strength of this muscle.
My experience has also shown athletes not involved in contact sports will not readily understand how to provide training of the intensity necessary to create a really strong rotator cuff. Basic rotator cuff training should suffice for several months but finding a athelete with contact sport experience will help to create a rotator cuff strong enough to minimize future injury.

## Areas for expansion

* Neck stiffness - left/right tilt
* Neck stiffness - rotating
* Neck stiffness - forward/back tilt
* Shoulder blade (trapezoids) stiffness - pain shugging shoulders rearward
* Shoulder blade stiffness - pain shugging shoulders forward
* Knee pain - below kneecap - usually stiff tibia
* Knee pain - above kneecap - usually stiff quads
* Lower back pain - spinal massage
* Outer shoulder stiffness (deltoids)
* Chest stiffness (pectorals)
* Foot pain
* Forearm pain
* Hand massage

## Medical Disclaimer

Wikibooks contains books on many medical topics; however, no warranty whatsoever is made that any of the books are accurate. There is absolutely no assurance that any statement contained or cited in a book touching on medical matters is true, correct, precise, or up-to-date. The overwhelming majority of such books are written, in part or in whole, by nonprofessionals. Even if a statement made about medicine is accurate, it may not apply to you or your symptoms.
The medical information provided on Wikibooks is, at best, of a general nature and cannot substitute for the advice of a medical professional (for instance, a qualified doctor/physician, nurse, pharmacist/chemist, and so on). Wikibooks is not a doctor.
None of the individual contributors, system operators, developers, sponsors of Wikibooks nor anyone else connected to Wikibooks can take any responsibility for the results or consequences of any attempt to use or adopt any of the information presented on this web site.
Nothing on Wikibooks.org or included as part of any project of Wikimedia Foundation Inc., should be construed as an attempt to offer or render a medical opinion or otherwise engage in the practice of medicine.