Beauty of the Basics

 By Donna Shryer, November 1, 2022

Butter, sugar, eggs, flour and a splash of vanilla. Five ingredients for a basic white cake. It’s how you choose to combine these ingredients that separates a rubbery, cellophane-wrapped, mini-mart purchase and a sinfully rich confectionary created just moments ago in a fine pâtisserie.

It’s a fair comparison when considering the five basic massage techniques: effleurage, petrissage, friction, vibration and tapotement. Just like the trained pâtissier, massage therapists can use hands-on experience to refine their expertise, learn new viewpoints on soothing combinations and identify ways to complement the basics to provide clients the most benefit for their massage buck. 

Elevating basics to extraordinary comes down to routinely reviewing the fundamental techniques—with a focus on less frequently used techniques, explains Bruce A. Morgan, LMT, owner of Bodyworks by Bruce, Iowa City, IA. “If all you have is a hammer, everything looks like a nail. In the same way, if petrissage is the main technique in your toolbox, everything will look like a muscle knot. You need all five basic techniques in your toolbox, and you need to know how each one works in different situations and in different combinations.”

To keep his basic techniques sharp, Morgan routinely takes continuing education courses, and he credits even the most basic courses for new viewpoints. He also exchanges massage sessions with different therapists several times a year. “It’s good to see how somebody else approaches issues,” he says. 

Let’s review the five basic massage therapy techniques, reexamine how each technique can be used to provide both physical and mental health benefits to your clients, and discuss a few pearls of wisdom about each technique that can be easily overlooked. 

Effleurage

Effleurage, which traces back to the French word for “to skim” or “to touch lightly,” is defined as long, gliding strokes and gentle pressure. Massage therapists often perform the technique with open palms or thumbs to apply a lubricant and warm up the client’s body for the deeper pressure work to come, which is often petrissage. Effleurage is also used as a gentle transition between massage techniques during a session, and the stroke’s relaxing touch also makes it an ideal finishing technique.

Effleurage is often credited in helping reduce stress, anxiety and depression, and is believed to improve circulation and reduce pain.

Specific to clients who are sensitive to touch, Martin Scott, LMT, owner of Wake Massage in Portland, OR, says effleurage is his go-to technique. “This could mean sensitivity from an injury, post-surgery pain or chronic disease, like fascial pain, fibromyalgia or inflammation,” Scott says. Pressure, he adds, is key to fine-tuning effleurage to the individual client. 

Investigating effleurage’s effect on anxiety and pain, a study explored if performing the technique on the back, neck, hands, arms, legs and feet prior to gynecological examinations and procedures could reduce associated pain and anxiety.¹

When asked to score their gynecological experience after first receiving a massage, the women reported a 1.9-point decrease in pain intensity and a 4.3-point increase in relaxation. 

A 2022 report from the American Psychiatric Association says that 87 percent of Americans are “anxious or very anxious about inflation,” which is up 8 percentage points from the previous month.²

These numbers jive with what Katie Kozik, LMT, owner of K.K. Massage Therapy & HC LLC, in Traverse City, MI, sees. “I think because of the pandemic and now the additional stressors, I’ve had people swarming my office for calming relaxation,” Kozik says. To increase comforting calm, she often extends time spent on effleurage at the start and end of a massage session. She also spends more time with petrissage, the technique that often follows effleurage.

Petrissage

Petrissage comes from the French verb meaning “to knead.” As implied, the massage therapist uses their palms, fingertips, knuckles and/or forearms to create slow, rhythmical movements associated with kneading—such as rolling, wringing, lifting and squeezing—to work the muscles and fascia. 

The resulting compression releases tension in tight muscles and soft tissues beneath the skin. Petrissage can also help increase blood and lymphatic flow to the area being worked on, which according to a 2022 study, speeds up the healing process from muscle stiffness and perceived limb fatigue.³

Petrissage typically follows effleurage and after the massage therapist has identified areas tender to the touch. In 2021, the American Chiropractic Association (ACA)4 polled its members and learned that 92 percent of respondents reported an increase in musculoskeletal (MSK) conditions such as back pain and neck pain or knew of people who were having these issues as a result of working from home.⁴

Clidlin Augustin, LMT, headquartered in Orlando, FL, sees a similar increase in clientele with MSK-related pain in the lower back and neck, which has him concentrating more than ever on petrissage. 

“For tight low back and neck muscles, I often find that petrissage can be even more effective when I combine it with the friction technique,” he adds. “It’s my go-to combination these days to break muscle adhesion and release tight areas.” 

Augustin finds that petrissage is much more than the technique that typically follows effleurage. “I’ve learned that compression is amazing to help release muscle guarding and bring a client to a state of homeostasis and comfort so they can relax on the table.”

He also discovered that petrissage is “surprisingly” effective for sciatica. “Experience taught me that kneading the calves can help back pain that trickles down from the hamstrings to the calves,” he says. 

Friction

Friction encompasses short, brisk circular movements that the massage therapist produces with their palms, thumbs and finger pads. Since the goal is to create surface tension and draw heat to the tissues, friction requires more pressure than effleurage or petrissage and only a minimal amount of lubricant. 

“Friction is hard to define since the technique changes depending on the amount of pressure you apply and what tissue you’re working on,” Morgan says. “There’s also overlap between friction and petrissage since both techniques move across the skin to relax the underlying subcutaneous tissues. In my opinion, friction is concentrated petrissage in a certain area.”

For Scott, friction achieves noticeable results when working on the tendons and ligaments. “The technique is also good for mobilizing the fascia on the surface, which can help with joint mobility and desensitizing areas that are tender to touch but definitely not injured,” he adds. “So, for example, friction is more for a chronic pain situation, like pain connected to scar tissue.” 

A 2020 meta-analysis studied the status of various physical scar treatments on pain, pigmentation, pliability, pruritus,

scar thickening and surface area. Intervention methods included massage (effleurage, friction and petrissage), extracorporeal shockwave therapy (ESWT), occlusion and hydration therapy, and light therapy.

The authors concluded that massage, ESWT, and high-intensity light therapy are the most effective agents in reducing pain associated with burn scars. The study further reveals that scar thickness is positively treated with massage therapy.⁵ 

Vibration

Vibration relies on a massage therapist using their fingertips to create rapid back-and-forth trembling movements with light pressure. The technique originates in the massage therapist’s forearm muscles and is performed for short bursts of time, typically no more than 20 seconds on any one spot. 

When done correctly, Scott describes vibration as a fast version of friction. He emphasizes, however, that the technique requires intense energy to perform and can be exhausting for the massage therapist.

That said, vibration can help improve circulation, relieve muscular tension, decrease stress, improve lymphatic flow, and, if used along with friction techniques, loosen scar tissue. 

Speaking to muscle tension, a study compared the effect of vibration massage and passive rest on accelerating the process of muscle recovery after short-term intense exercise. The results report that characteristics of the vibration technique “can be an effective method in accelerating recovery and regaining lost motor capabilities of muscle groups fatigued by exercise. This offers the potential to shorten rest periods between sets of repetitions in training or between training units.”⁶

Augustin questions why vibration is rarely used. “I think it’s a good transition move after petrissage. For example, when I’m doing petrissage on the traps, and if the technique causes muscle guarding, I find that doing vibration in that same area—after petrissage—eases the muscle guarding and brings the client back into a relaxed state.”

Tapotement

Tapotement, sometimes called percussion, involves rapid, rhythmic movements, such as tapping, patting, clapping, beating, pounding or knocking the body—as opposed to gently stroking soft tissue structures. The massage therapist often performs this technique with cupped hands or with the outside edge of their hands.

While studies that look at tapotement’s effectiveness alone are rare, one study reports that combining effleurage, petrissage and tapotement for 15–30 minutes up to 2 hours after exercise can reduce the symptoms of delayed onset muscle soreness (DOMS) and improve range of motion.⁷

Based on personal professional findings, Scott feels that tapotement helps soft tissue open and stretch without necessarily targeting one trigger point. 

Augustin not only feels that tapotement helps the nervous system “calm down” and helps muscles release tension, but he also discovered that tapotement has a soothing rhythmic sound that many of his clients like. “It seems like this is a great auditory thing. Clients get lost in the calming rhythmic sounds—and it seems to deepen their relaxed state.”

Morgan emphasizes that no single technique is better than the other, and they each have a purpose. “The problem is, you only have an hour or so to work on the client, and that doesn’t leave time to figure out what techniques will work best,” he says. “That’s why it’s essential to stay up on what these techniques can do and avoid going into autopilot. It’s the only way you can bring about the best results for the client.” 

References