Many people enter into the massage therapy profession with enthusiasm and vigor, determined to help make a difference in other people’s lives. We learn various methods and techniques for addressing client issues, which is an ongoing process. As time passes, therapists’ careers may be cut short, as aches and pains start to present themselves if they are not conscious of body mechanics and proper application of learned techniques.
This concern about longevity, strain on the body and the need to minimize effort with lasting results was the starting point for me. These were my initial thoughts when starting my search for a treatment technique or method that would combine many modalities simultaneously when addressing client issues. Combining transferable skills and integrating already learned massage techniques and methods can be quite powerful in addressing client issues.
Dynamic Angular Petrissage (DAP) calls upon a therapist’s learned skills and requires that the therapist employ them when implementing a treatment plan. Assessment is vital to confirming your hypothesis and to providing a rationale for the choice of modalities and treatment techniques employed. When a client presents with an issue or an injury, it is necessary to look not only at the area of referred pain, but also at related structures that may indirectly contribute to their symptoms or underlying cause of injury. The cause could be skeletal, muscular, neurological, or a combination of the three.
What is DAP?
DAP is a treatment method. It is a way of addressing patient issues that can be quite detailed in its application, but quite simple in its philosophy.
It provides a quick and gentle way of restoring the pliability and functionality of the tissue, with the therapist taking the client’s joint through various ranges of motion. However, there two factors that are difficult for therapists to grasp, at first: Until the technique is experienced or felt by the therapist, the fact that little pressure is being used in the treatment may not seem plausible. Combining the arm movements with body mechanics to support the movement of the client may seem tricky, but this combination of passive movement and muscle-specific petrissage allows for the technique to make the work more effective and less strenuous on the therapist.
At its simplest level, the technique involves using one hand to gently knead the muscle while using the other hand to take the limb through passive or assisted ranges of motion according to the muscle’s line of pull, restrictions and changing angles, not only to simulate the action of the muscle, but also to help refine the client’s movements. The other hand gently adapts to the tissue’s texture, tone, tenderness and temperature while kneading the tissue. Those muscles that are restricting the joints’ range can be worked on gently and thoroughly without having to resort to “muscling” techniques to get the job done. The kneading technique and limb movement applied are determined by what the therapist is palpating, detecting and feeling during the treatment.
There is no customized massage routine when using DAP but rather a method of applying petrissage in order to help achieve the goals of the treatment plan. A treatment is customized for the individual client based on presenting symptoms. The therapist’s palpation skills, along with knowledge of skeletal and muscular anatomy and innervation, are crucial in providing a safe and effective treatment.
Research shows that people’s bodies react differently even when receiving the same stimuli, such as with a cold or headache medicine. I believe this concept holds true when treating various clients with similar symptoms. If a similar treatment technique is applied to different individuals, as expected, each client may elicit differing responses and experiences from the treatment. Application of DAP can be used to help with client issues, such as pain, altered sensation and limited range of motion. Each client may desire the same outcome “to be issue-free,” but the road to being issue-free will be different for each client and may be a bumpy one for some.
Not deep, rather detailed
DAP is not a deep pressure treatment but because of the detail work involved, the client may feel as if it is. Each client may interpret and feel different based on their own response to touch. For example, a post-surgical mastectomy client from North Carolina writes:
“This method of massage that I have never experienced before uses your own body for resistance and movement to work muscles and goes deep into muscle groups for optimum results. While his methods are painful at times, the end result is well worth the discomfort. In the course of two sessions, my range of motion improved and level of pain decreased. This method should be a must for all massage professionals who work with surgical patients to get them on their feet and moving sooner than later.”
How does it work?
DAP is comprised of combinations of established techniques, which if administered skillfully, can result in a powerful method of treatment that is gentle on the therapist and can produce positive results for the client.
The fundamental idea behind this form of treatment is using light petrissage techniques, muscle stripping, segmental stretching or myofascial release techniques in combination with the use of levers to change angles, lengthen and shorten the muscles. It can be extremely gentle and helpful for clients with varying levels of complication, from leg lengthening, Guillain-Barre syndrome (GBS), frozen shoulder, mastectomy, breast augmentation and reductions, whiplash, thoracic outlet syndrome, carpal tunnel syndrome, hip and knee replacements, and more.
We cannot prevent conditions like GBS, frozen shoulder or carpal tunnel from occurring; however, given the massage therapist’s scope of practice, we can maintain, rehabilitate and augment physical function in a person who is rendered dysfunctional by a condition. I have used DAP in these aforementioned situations with positive results.
The reasoning for movement during the treatment is to not only lengthen, increase and decrease the tension on specific muscles, but also to help assess while treating the soft tissue. In order to lengthen the muscles or perform muscle stripping, one needs to be able to simultaneously change the resting tension by using a lever to lengthen or shorten a muscle.
Lets look at a simple example of using DAP on a bicep that has a nonreferring trigger point and high resting tension, resulting in an inability to fully extend the elbow. Also, the end feel is soft tissue inhibiting full flexion, which you have determined through your clinical/orthopedic assessment.
With the client in a supine position, elbow resting on the table, the therapist’s one hand pincer grasps the bicep while the other hand passively moves the client’s supinated forearm from a flexed position to eccentrically lengthen, allowing the bicep to myofascially glide beneath and between the pincer grasp. Repeat the eccentric movement changing from pincer to muscle stripping, effleurage, c-scooping, segmental stretching—any desired pertrissage. You can work on specific segments of the muscle or the available complete muscle depending on your intention and accessibility.
This example is linear in appearance, and DAP is far from linear. The therapist can quickly and simply change to a multidimensional approach by adding gradients of pronation and supination, as you eccentrically lengthen the tissue with one hand and simultaneously knead the tissue with the other.
Paul Lewis, R.M.T., is an international presenter and therapist. He has taught this treatment method in Japan, Canada, Europe and the U.S. His instructional DVD highlighting Dynamic Angular Petrissage (DAP) won a bronze Telly award at the 33rd annual Telly Awards, and he believes that DAP techniques and its many applications can help to augment a therapist’s current treatment protocols. For more information, visit www.paullewis.ca.
Read Lewis’ blog, “Therapeutic Massage: Bringing it all Together,” here.
Lewis, Paul. Dynamic Integrative Massage Techniques for the Upper Body DVD, Vol. 2. Toronto, ON, Canada: Paul Lewis Services Inc., 2010.