In the professional world of massage therapy, the combination of diverse therapeutic modalities like IASTM, tape and movement can magnify the impact of the session and enhance the benefits — from short-term to long-term.
I have long combined the benefits of various modalities into my massage therapy to create a therapeutic experience that not only addresses the immediate challenges of pain and discomfort, but also, more importantly, identifies and addresses those factors that contribute to the cause.
I use a combination of three modalities with my massage therapy work: scraping, kinesiology taping and movement stretch (affectionately known as Scrape, Tape and Move). I call this combination a massage care triad: The inclusion of a diverse combination of therapeutic interventions can improve the experience and the outcome of the massage therapy session.
I begin all massage therapy sessions with traditional and standard massage strokes. Touch with your hands is a powerful vehicle for delivering therapeutic hope to the recipient. When we, as massage therapists, master the fundamentals of touch by mastering the basic strokes of Swedish massage, we allow ourselves to access our therapeutic intuition.
Intuition is not a random celestial series of events, but is a reliable form of delivering massage by integrating your knowledge of science, massage technique training and touch experience combined with listening carefully to the client. Listen to your client with your ears, eyes, nose and hands.
Above all else, believe what your clients share with you.
Scraping is a term used in massage therapy to describe gua sha, or instrument assisted soft tissue mobilization techniques (IASTM). The latter term is an invention of the physical therapy profession in the U.S. and its insurance payers. The goal of the terminology, in my opinion, is to create a perception of medical complexity above and beyond the simplicity of what scraping the skin really is.
Scraping techniques defined by the term gua sha are used throughout Asia and other parts of the world as a common folk medicine remedy for a wide range of annoying ailments ranging from tight neck muscles and low back pain to chest cold congestion.
Back in 2008 when I was working as a massage therapist with the USA Olympic Track and Field Team in Beijing, China, I easily found traditional gua sha tools made of jade in the marketplace and in pharmacies available to any customer who wanted to purchase one for their self-care and family use.
Conversations I had with shopkeepers in China pointed to traditional Chinese medicine as the origin of gua sha. The term gua, in translation, means “scraping” and sha means “bruises.” However, I personally do not use the term “bruising” with my clients when I incorporate IASTM into my modality selection for a successful massage therapy strategy.
After I complete my massage strokes, I apply scraping techniques using a range of tools.
When choosing an instrument, however, there are multiple factors I take into consideration: The tool must have a comfortable weight that gives good feedback to the hands when working, a textured grip on the tool to control the tool even when my hands have residual massage cream or oil on them, and lastly, multiple technical edges that let me customize the contact point on the skin for any region of the body that I wish to work on.
If all of these factors align, I am confident that the instrument will aid me in providing quality and effective instrument assisted soft tissue mobilization for my clients.
After the massage techniques have been applied, followed by and integrated with the scraping techniques, I move next to kinesiology taping: A modality of choice to enhance the positive results of the massage and scraping.
Before I begin taping, I assure the skin is cleaned of any residual massage cream. This can be done with a warm wet washcloth and dried before applying the kinesiology tape. I then apply the kinesiology tape in a manner to support the therapy session goals.
The goals of my massage therapy session are normally to reduce or eliminate pain, to enhance muscle and fascia mobility or to address those known factors that interfere with movement potential such as adhesions, spasms and tight joint capsules.
When applying the kinesiology tape, the key to best results is determining the amount of tension to apply to the tape before contact with the skin. Kinesiology tape works best when the amount of tension of the tape matches the goals of the massage therapy session.
I divide the goals of kinesiology tape into two sections: You either want to enhance muscle and fascia movement and reduce pain, or you want to inhibit micro muscle spasms and reduce pain. Enhance or inhibit are the keys to determining the direction and skin area placement of the kinesiology tape and how much tension to apply to the tape before contact onto the skin.
Applying the kinesiology tape onto the skin with too much tension can most likely lead to skin blisters after several hours of movement. This reaction is highly probable during athletic activity when movement repetition cycles generate muscle contraction power and heat.
Choose a tape that takes the guesswork out of determining how much tension the massage therapist has in the tape. One tape is printed with creative and ingenious geometric hexagon figures that change size when the kinesiology tape is stretched. By stretching that tape until either the small hexagon (indicating 25 percent tension) or the large hexagon (indicating 50 percent tension) appear with even sides, massage therapist can achieve the exact percentage of stretch tension required, each time, for repeated applications to ensure predictable outcomes of this therapeutic intervention.
This technology is helpful in cases where the kinesiology tape tension must be repeated and perhaps sometimes applied by a massage therapist colleague or the client themselves as part of the self-care suggestions from the massage therapist. The desire to maintain the exact tension of the tape allows for optimal therapeutic results to be accomplished.
Lastly, movement is the key to the successful resolution of many minor muscle-tendon complaints presented to the massage therapist. The goal of the massage therapy session and the massage care triad is to combine diverse modalities to enhance the benefits of massage therapy.
With the movement phase of the massage session being final, the goal is to integrate and reprogram movement patterns in the nervous system to allow motor patterns once affected by pain to reset for improved range of motion and muscle lengthening.
What makes the movement portion of the massage care triad work well is to focus on the anatomy of movement. Movement is first and foremost dependent on how well the joint and joint capsule move freely.
We live on a planet with gravity, where the compression of joints is a constant. When joints reach a point of repeated and constant compression, where movement patterns become inhibited due to structural and neurological implications, the body adapts.
This biomechanical adaptation can lead to uneven wear and tear on all body structures. This is especially evident with weight bearing joints such as hips, knees and ankles. However, shoulder joint mobility issues occur frequently, not from weight bearing, but from reduced shoulder joint capsule mobility and flexibility of rotator cuff muscles.
The most efficient way to enhance movement is to apply controlled constant stretch tension to the target joint and its related muscle and fascial attachments. I apply passive stretching using timed holding patterns of 30, 60 and 90 seconds. I limit the total amount of stretch tension on a joint and related muscles to 90 seconds.
In my experience, what works well is to focus on static gentle stretch of the joint capsule first before focusing on additional myofascial structures of concern. The results of static gentle joint capsule stretch are readily observed with hip joints and shoulder joints by immediate enhanced mobility.
All the standard contraindications for stretching movement should be observed such as history of joint dislocations or subluxations, joint disease, post-surgical restrictions, joint replacements and any medical contraindications discovered during history taking phase of massage session visit.
Implement the Massage Care Triad Today
When massage therapists combine scrape, tape and move into their paradigm of successful massage therapy care, the results last longer and have a better chance of improving the client’s relationship with gravity when they move.
By reducing or eliminating myofascial causes of pain and enhancing mobility and movement potential, the massage therapist continues to play an essential role in optimizing the quality of structural wellness for active people.
About the Author:
Benny Vaughn, LMT, ATC, BCTMB, LAT, CSCS, MTI, has been a clinical orthopedic massage therapist for 45 years and still sees, on average, 35 cases a week at his athletic therapy center in Fort Worth, Texas. He is also a Certified Athletic Trainer with 32 years of experience in the treatment, prevention and care of athletic injuries.