How to Massage: Principles of Massage
Have you ever set out to give a massage,
started the music, lubricated your hands, and then thought to yourself, “wow, I have no idea what I’m doing”?
I’m going to teach you the four Principles of Massage that all massage therapists use to make their treatments relaxing and also therapeutic.
The Four Principles of Massage are:
1. Superficial, deep, superficial
2. General, specific, general
3. Proximal, distal, proximal
4. Peripheral, central, peripheral
The first principle you need to know is
Superficial, deep, superficial.
You’ll want to start your massage with superficial pressure. The purpose of this principle is to warm up the tissues and increase circulation in the treatment area which will prepare the body for the deeper techniques that follow.
You want to begin to earn your patients’ trust and let them know that you aren’t going to hurt them. You want them to relax, and feel as though they are in good hands (pun intended).
Place your hands on the patient and take two or three audible deep breaths which will encourage your patient to breathe deeply as well.
Another reason to begin superficially is to allow your hands to familiarize themselves with your patient’s body. Starting superficially allows you to gain more information about what they are presenting with, and issues they haven’t vocalized in your initial interview.
Once you have familiarized yourself with the patients body and gained their trust, you can start getting more specific with your massage and treating to a greater depth.
This takes us to our next principle.
General, specific, general.
Similar to the first principle, general specific general is about getting to know the body, warming up the tissues and increasing circulation. It’s about gaining trust and also, learning about compensatory structures that might be involved or exasperating your patient’s chief complaint.
Make sure you treat your patient with broad, general strokes and superficially touch all the structures potentially involved before honing on your target. Once you’ve touched all the surfaces in the region that you are treating, you can begin to use more direct, pinpointed strokes as you get more specific to the structure that is affected.
Okay, you’ve treated generally and superficially, you’ve worked deeper and more specifically on the structures affected, now you’ve back out of the tissues slowly. Take the short, specific strokes you’ve been doing and make them longer and broader. Now, slowly make your broader strokes more superficial.
Great! Now that you’ve identified the structures and mastered your first two principles, let’s jump to the third principle.
Principle 3
Proximal, distal, proximal
Proximal means “closer to the centre”, or closer to the midline of the body. Proximal and distal are always used in relation to one another and never used on their own.
So, if we use the upper extremity, or the arm as an example, the shoulder is the most proximal and the fingertips are the most distal. Everything in between is a matter of relativity.
For example, The shoulder is more proximal to the elbow but the elbow is more proximal to the fingers. The fingers are more distal to the knuckles which are more distal than the wrist, elbows and shoulder.
Does that make sense?
When you’re treating, you always want to start at the MOST PROXIMAL region. Begin near the spine which is the most proximal region, then work towards the most distal region.
In the case of the upper extremity, that’s the tips of fingers. If we were to use the leg as an example, we would start with the back of the glutes as in the most proximal region, then move distally towards the tips of the toes.
This principle is important for two reasons.
The first reason is circulation. Blood comes from the left ventricle of the heart at the centre of your chest.
To increase circulation as a massage therapist you want to move oxygenated blood from the heart into the extremities at the beginning of your treatment, then, before you finish, push the deoxygenated blood back towards the heart.
Working with the direction of your patients’ circulatory system will help create a successful and pain-free session during and after your treatment.
The second reason that proximal, distal, proximal is important is because of the location of the spinal cord.
The spinal cord begins in the brain, travels through the spinal column where nerve roots exit the column and innervate other structures more distal in the body.
When you treat proximal to distal, you are also treating the nervous system and releasing muscles that might be compressing the peripheral nerves.
The fourth and final principle
Peripheral, central, peripheral
This principle refers to the injury as “the centre”.
As we learned in the previous principles, you don’t want to jump straight to the site of the injury. Begin generally, superficially and proximal to the injury site, then travel more distal, get to the specific structure at the centre of the injury and treat to a greater depth, once you have adequately treated the chief complaint, back out slowly, treat with broader strokes as you move away from the centre or the injury site and then use board strokes back to the peripheral edges of the injury. An instructor I had in massage school called this principle
“Surrounding the Dragon”.
You don't want to attack the dragon (or the injury site), right away. Use swirling techniques to move around the periphery of the site before bringing your strokes narrower and narrower towards the “dragon” or the injury site.
Now that you’ve learned how to “surround the dragon” or treat the periphery before the centre, take your treatment to the outskirts of the injury site - the periphery using broad and more general strokes.
Take your sweeping, superficial strokes first distal to the injury site and then bring it all back to the most proximal area.
Now you’ve learned the four principles of massage! Let’s apply this skill to an effleurage technique on the legs.
Imagine that your patient has a hamstring injury right in the middle of the posterior thigh. Here’s what we’re going to do.
Start the music. Lubricate your hands.
Think to yourself, what are the principles of massage?
Superficial deep superficial - apply broad strokes superficially down the muscle belly of the hamstring. Press deeper on the way down, and release your pressure slightly as you draw your arms back towards your body. Keep your hands on your patient the entire time but only use firm pressure in one direction. This way you don’t tire yourself out before the treatment is over.
Since your hands have quite a bit of lotion on them, take that lotion all the way down the back of the leg to the calf. Keep your hands moving with circular strokes.
Good! Now you’ve already applied the second principle “general, specific, general” and also the fourth principle “proximal, distal, proximal”. See how easy that was? Great.
Let’s take your circular strokes back up to the posterior thigh. Use general techniques to “surround the dragon” or work “peripheral, central, peripheral” and move towards the centre of the injury. Get closer and closer to the injury site using marginally deeper pressure with each stroke. Just enough pressure with each new stroke that the patient has time to adjust, and mentally prepare for a deeper and more specific technique. Don’t forget that each time you draw your hands toward your body, you are giving the patient and your hands a slight break.Amazing!
Okay, now that we’ve gotten specific and to the centre of the injury site, it’s time to move our hands away from the centre and towards the periphery.
Use broad and general strokes to finish up your treatment. Move from the distal region of the limb back towards the torso.
Great!
So now we’ve learned the four principles of massage.
Superficial, deep, superficial
General, specific, general
Proximal, distal, proximal
Peripheral, central, peripheral
And how to apply those techniques to a massage treatment.
We’ve learned how to conserve our strength and our energy by leading a stroke with firm pressure and finishing with superficial pressure.
These principles might seem very redundant to you as the therapist, but what the patient experiences is a slow, gentle, effective massage that is well thought out and methodically executed.
Capria Care Collective is taking new bookings, so if you’ve been looking for an RMT in Coquitlam who can help you up your training game, look no further!