Facilitation Technique Category: Therapeutic Massage

Activity Title: Petrissage technique: Kneading procedure.

Source: Institute for Integrative Healthcare. (n.d.). Retrieved from
http://www.integrativehealthcare.org/mt/archives/2010/05/massage_stroke_1.html
Equipment: Standard bed lines, pillows, foam, towels, blankets, bolsters, lubricant, and massage
table.
Activity description: Massage is a physical therapeutic modality that improves physiologic
properties through several types of pressure, stroking, and rubbing. Therapeutic massage in
general provides many benefits including: improving circulation and tissue warm up, decreasing
muscle spasm and atrophy, stimulating reflective effects and healing, etc. Petrissage technique is
described also as kneading procedure in which the muscle is pressed and roller under the
professionals hands. The purpose of this activity is to lose adhesions, to improve flow of the
lymphatic system, and to assist removal of the metabolic waste. First, the instructor will obtain
prior to initiate massage the approval or consent from the client/participants. Second, instructor
will explain a detail description about the massage modality with the particular risks and
benefits. Third, the instructor will explain the expectations/sensations during the technique.
Fourth, have the client comfortably situated including sitting lying forward or prone lying down
with a room temperature between 72-75 degrees in order to promote relaxation. Fifth, client
should be properly cover using standard bed lines and having exposure only the area to be
treated. Six, the instructor will apply the lubricant on hands and it will be warm up by gentle
rubbing of bilateral hands before direct contact with the client. Seven, the instructor will always
start with effleurage technique and then proceed to petrissage. Eight, instructor will start with the
proper direction from distal to proximal and will be performed using both upper extremities over
large muscle sets or just two fingers for small muscles group. Nine, the session will require 15
minutes for big areas and 8-10 minutes for small muscle groups with an specific intensity that
should increase and decrease. Ten, the instructor will conclude the session by asking for
feedback and reviewing all steps.
Leadership considerations: CTRS will be the instructor in this activity with a minimum
requirement of courses of continuing education regarding therapeutic massage. Also, staff
/volunteers, recreational therapist students can support/guide participants during the activities.
The staff to participants ratio should be 1:1 since this exercise is direct-contact between
client/therapist. Instructions/education regarding all safety issues include: fall precautions during
transfers excs , proper body mechanics, energy conservation techniques and breathing excs ( in
supine and sitting position) to promote relaxation, transfers techniques requiring dependent
transfers or assistive transfers, postural awareness, etc. Some contraindications should be taken
into consideration including: acute injury, infection, cellulitis, thrombus, cancer, etc. All
participants are allowed to ask questions at any time of the activity.

Adaptations: Participants with Cerebrovascular Accident: According to Guiles,

cerebrovascular accident (CVA) results from a disturbance of cerebral circulation that results in
cerebral insufficiency and consequently it will destroy the surroundings areas into the brain.
Some of the symptoms include difficulty ambulating, paralysis with weak muscles, synergistic
patterns (upper/lower extremities contractures), sensory impairments, etc. Some good
adaptations while working with clients with stroke it is placing them in positions of opposite
direction of the synergistic pattern. For example, if the client is lying down to receive the
massage on bilateral lower legs a good position will be placing them facing down because it will
prevent further flexion of hip/knee due to gravity. The use of two-step stair to get on the massage
table due to unilateral paralysis to facilitate transfer will be appropriate. Also, the use of long
pillows by the weak side of the client in order to prevent falls during massages tx (The Internet
Stroke Center).
Adaptations: Participants with Duchenne Muscular Dystrophy: According to MDA for
Strength Independence and Life, Duchenne muscular dystrophy (DMD) is a genetic condition
categorized by progressive neuromuscular deterioration and weakness. The disorder manifests
with symptoms such as waddling gait, excessive lordosis, proximal muscle weakness, toe
walking, and difficulties during stairs climbing. This disorder usually appears at the age of three
mainly in boys. Massage therapy is a great effective management because this population
requires prevention of contracture/deformity as well as emotional well-being for the child.
Adaptations should include the use of the hoyer lift for transfers since these children are no
longer able to ambulate after the age of seven (while using massage table). Also, the use of mat
on floor if there is not a hoyer lift to transfers. Also, schedule bathroom breaks during the session
in order to promote hygiene. Others adaptations include: encouraging communication during
massage session, allowing more time for repositioning while being on massage table (Mayo
Clinic).
Adaptations References
Giles, S. M. (n.d.). PTA Exam. In The complete study guide.
Institute for Integrative Healthcare. (n.d.). Retrieved from
http://www.integrativehealthcare.org/mt/archives/2010/05/massage_stroke_1.html
Mayo Clinic. (n.d.). Retrieved from http://www.mayoclinic.org/healthy-lifestyle/stressmanagement/in-depth/massage/art-20045743?pg=2
MDA for Strength, Independence and Life. (n.d.). Retrieved from https://www.mda.org/
The Internet Stroke Center . (n.d.). Retrieved from http://www.strokecenter.org/