The next thing we will cover are the physiological effects of the massage strokes you may be using with a patient. I think what is most important thing to understand before you begin to treat a patient's complaint is that, for most of the common conditions we see like headaches, low back pain, joint pain or even specific conditions such as carpal tunnel syndrome, shin splints, golfer's elbow or sciatica, just to name a few, there is no "cure" for any of these, or at least one that has a universal consensus amongst doctors and professionals. If there was, there would not be the epidemic we see among the patient population of those who have been treated by various professionals, only to either end up in our clinic or worse, left with no answers.

My point is that we have all read, learned or perhaps, on occasion, had success treating some of the aforementioned conditions, but I assure you, no one has the "cure". If they did, there would be a line around their practice with people waiting to receive it. As it is with many approaches to life, we can all have our own 'lens of bias'. My mentor, Whitney Lowe, will often state, "We have who we see." In other words, if you see a chiropractor, they will recommend adjustments. Massage therapists will knead and rub. Surgeons will cut and Physical Therapists will prescribe exercises.

One of the most influential statements Whitney has ever taught me was; "The physiological effects of the application should match the desired physiological impact of the condition being treated." In other words, every stroke should have a purpose towards your overall objective.

Lets now take a look at how the basic/common massage strokes we mentioned in the previous section impact the body physiologically.

• Effleurage:This technique significantly affects the circulatory system and produces mechanical pressure on the veins so it should always be performed toward the heart, especially in the lower extremities
• Petrissage: Kneading, wringing, skin rolling and pick-up-and-squeeze are the petrissage movements that help to relax tissues and promote circulation
• Tapotement: primarily used to "wake up" the nervous system and is also used as a stimulating stroke which can release lymphatic build up in the back.
• Friction: back-and-forth friction movement is valuable because of its ability to break the cross linking bonds of fibrous scar tissue that have bound adjacent muscle, tendon or ligament fibers together
• Vibration: used to further relax the client and stimulate the blood flow once more before the recipient gets off the massage table. The vibration movement both relaxes the underlying muscles and creates a body-wide sense of relaxation.
• Sweeping Cross Fiber: Sweeping cross fiber techniques encourage tissue fluid flow, warm the soft tissues, enhance pliability, and reduce tension in the muscular fibers
• Compression & Broadening: The technique enhances elasticity and pliability in the muscle by using deep pressure perpendicular to the muscle fiber direction. Pliability is improved through the reduction of intramuscular adhesion among parallel fibers.
• Static Compression: focuses on neuromuscular effects of reducing hypertonicity and deactivating myofascial trigger points in muscle tissue.
• Deep Longitudinal Stripping: encourages tissue elongation and elasticity.
• Active/Passive Engagement: Performing movements with specific soft-tissue manipulation magnifies some of the physiological effects of the techniques we mentioned above
• Myofascial Approaches:increase tissue pliability by applying tensile force to the connective tissue. For many years descriptions of myofascial techniques focused on the mechanical response of the fascia to this pulling force. Proponents of these myofascial techniques emphasized the transformation of fascia from a thicker and gelatinous (gel) state to the more soluble or fluid (sol) state.

If you take the information we have covered in this chapter and apply it to our approach to massage, I am confident that you will not only get the results your patients are seeking, but you will also enjoy the work you do much more. When we can stand on solid ground about what it is that we are doing with massage therapy, we begin to build greater confidence in ourselves and our outcomes.