Medical Stress Management Massage Therapy

by: Boris Prilutsky

The reputation of massage therapy as a medical therapeutic tool has taken a strong stance in the modern healthcare arsenal. But for some reason, the massage therapeutic community and other health care practitioners underestimate the therapeutic power and importance of full body stress management massage. Nowadays, modern society is suffering significantly from the negative effects of stress. Stress-related illnesses include heart attack, stroke, high blood pressure, diabetes, anxiety, clinical depression, and more.

In the recent years, many statistical and survey data indicate that severe side effects of stress are gradually debilitating more and more people. It should be noted that the U.S. economy is losing $300 billion dollars annually in costs arising from stress-related illnesses.

With such a need for ways to address these stress-related pathologies, the stress management massage therapist should be a well-respected professional. But in our community, massage therapists who choose to perform only full body stress management massage tend to be looked upon as second rate or as having only basic skills compared to those therapists trained in modalities such as orthopedic massage therapy, who are capable of relieving lower back or neck and upper back pain.

Not that I am a proponent of crippled education – I believe massage therapists ought to be educated in vast variety of applicable disciplines. It’s just that favoring one massage discipline over another, to underestimate and downplay the value of stress management massage is erroneous.

It is important for us to remember that the genesis of many back and limb disorders is stress-related. For example, most of us carry stress in the muscular structures of the upper back and neck, lower back, or abdominals. The increased tonus of the muscles can produce not only local aches and pains, but also general biomechanical imbalances. Biomechanical imbalances are always expressed in compensatory movement, which in many cases causes the development of intervertebral disc herniation, initiation and acceleration of arthritic condition, or muscular pathology, etc. Thus, weekly or bi-weekly full body stress management massage not only helps eliminate the side effects of stress, but is also a great preventive medicine effort in avoiding back and limb disorders.

In order to have a profound understanding of the power of full-body stress management massage, it is important to know and understand the mechanism of the negative side effects of stress on the human body. Imagine being confronted by a dog ready to attack you. The human body response to such a shocking stress is the “fight or flight” phenomenon, expressed by a sharp increase in respiratory/breathing rate, heart rate, blood pressure, and stress hormone production. The above-mentioned processes are results of over-activity of the sympathetic division of the autonomic nervous system.

The balance of the activities between the sympathetic and parasympathetic nervous systems is the mark of very good health. Oppositely, imbalance of activities of these nervous systems is equal to illnesses. In our stressful daily life routine, stress-causing factors (not only those such as the attack dog example, but also small things like the news headlines of tragedies and disasters) little by little increasingly impinge on our health, resulting in high blood pressure (70 million Americans suffer from high blood pressure), clinical depression, anxiety, diabetes, heart attack (60 million Americans suffer from episodes), etc. Full body stress management massage is the most powerful method in healthcare concerning the capability to balance the activities of the sympathetic and parasympathetic nervous system.

Stress and Cardiovascular Abnormalities

Arteries carry a sufficient quantity of smooth muscles and nerve supply to contract as well as dilate. As I stated before, stress factors cause elevated activities of the sympathetic nervous system, which result in vasoconstriction. Constricted vessels cause an increase in blood pressure and significant amplification of peripheral vascular resistance, which is the main opposition to cardiac work. This means the heart must not only perform its non-stop duty of pumping blood to all body systems, but it must also work extra hard to overcome the added peripheral vascular resistance.

With time, this overload of cardiac work leads to heart attack and other heart diseases related to exhaustion of the cardiac muscle/connective tissue. Also, elevated levels of cardiac work demand a greater amount of arterial blood supply, which is unavailable in the presence of vasoconstriction. Constant vasoconstriction and high blood pressure accelerates the development of arteriosclerosis. In turn, arteriosclerosis can be the main cause for heart diseases, kidney diseases, and strokes. Further, in my article I will explain in details how full-body massage depresses sympathetic nervous activities causing vasodilation, reduction of blood pressure, and decrease in cardiac work.

Stress and clinical depression

Additional stress related phenomenon that supports all negative reactions of our body to stress is an increased production of stress hormones. Constantly being overstressed, the central nervous system is excited sometimes to a point when it cannot take anymore. At this point, as an act of defense, the centers cause a reduction of the amount and activities of serotonin within the brain. One of the twelve neurotransmitters, serotonin is largely responsible for our waking state. Reduction of the quantities and activities of serotonin in the brain is clinically expressed as depression.

Full body stress management massage causes multiple positive changes in the functions of organs and systems, cutting back stress hormone production. With time, this will allow the serotonin activities to be restored and the depressed condition will improve. It is very important to understand that massage therapy tremendously helps to prevent the development of clinical depression. From the very first treatment, the positive changes occurring in the functions of organs and systems include reduction of the factors that constantly bombard/excite the central nervous system.

We know that fibromyalgia patients often suffer from clinical depression in addition to their pain symptoms all over the body. Clinical depression (reduction in quantities and activities of serotonin in the brain) results because of constant bombarding of central nervous system by low-grade pain and in such a case, as an act of defense, the serotonin levels and activities are reduced, but many people suffer from clinical depression with no pain all over the body. This example of fibromyalgia I mention here for better understanding of the mechanism of development of clinical depression as the body’s own act of defense.

The matter of fact is that by applying full body medical massage therapy techniques, we are breaking the vicious cycle that leads to the developments of illnesses related to stress. In the next issue, I will explain in detail the mechanism of the physiological effect of massage on the human body as well as with the help of pictures, I will propose to you step by step techniques for full-body stress management massage.

Medical Stress Management Massage Therapy (continuation)

By Boris Prilutsky, MA

The protocol of full-body stress management massage was initially proposed by Russian physician, Prof. Anatoli Sherbak. In the early 60s, this method was perfected in former city of Leningrad Lesgafte School of Physical Rehabilitation. Initially, scientists tried to develop a protocol that would be most effective for the rehabilitation of overstrained Olympian athletes. What they found out was that the ultimate set of technical approaches, the same that I will propose to you, could be a significant effort for stress management. In 1964, a group of scientists finally proposed an optimal protocol for stress management. 140 professional athletes participated in this study. The research scientists took and analyzed data from hemodynamics studies, which include reflections of left cardiac work, degree of vasoconstriction, electroencelography, EMG (electromyography studies), hematocrit, etc. It is likely that many of the techniques I will propose, many of you are already using today in addition to other wonderful techniques. I highly recommend all to adopt these protocols of techniques and steps sequence as they have been selected through research as the most effective for stress management.

Relaxation versus stress management

Stress management means more than simple relaxation. In my opinion, a sense or feeling of relaxation is only one of the expressions of stress management. For example, an overstressed person (who under pre-session hemodynamic studies will demonstrate higher blood pressure, faster heart rate, increased peripheral vascular resistance & left cardiac work), can sit in a dark room with a peaceful, soothing, ambience and soft relaxing music for one hour, after which, he/she will report a nice relaxed feeling. But post-session hemodynamics study will show the effects of this relaxation session to be only a small reduction of peripheral vascular resistance, blood pressure, heart rate, etc. On the other hand, stress management massage causes measurably significant positive changes in functions of organs and systems (as I mentioned previously) and the client will experience and report the relaxation sensation as well.

Physiological effect of massage on the human body

Two factors define the physiological effect of massage on humans.

1. Local, mechanical factor – expressed by mechanical acceleration of venous blood drainage, some degree of lymph drainage acceleration, passive exercise for soft tissues, and breaking down deposits of calcium in soft tissue and stimulation of its removal from the body.

2. Reflex factor – the main power of massage therapy is its reflexive therapy. By mobilizing skin, connective and muscular tissue, we deform the proprioreceptors, which in turn creates action potentials (electrical activities) that through neurological pathways reaching motor and vasomotor centers. As a reflex (involuntary reaction of organs and systems to original stimuli) the body responds by expressing all positive changes that I mentioned earlier. In order to reach these results we must perform all sets of therapy in the inhibitory regime.

Inhibitory Regime

How much pressure should be applied?

In order to reach results, and to avoid injury from applying vigorous pressure, we must utilize the following definition. 1. Pressure has to be significant (gradually increasing to the maximum extent) but must avoid activating the pain analyzing system. Given the fact that pain is a somewhat subjective sensation and cannot be measured like weight, or blood, we have to design the pressure by consulting our client. The moment when the individual’s threshold of pain is determined, the therapist can properly increase pressure to the determined level. 2. If the applied pressure causes protective muscular contraction reflex, and even if the client encourages you to continue or increase it, you must reduce the pressure and restart the process of gradually increasing pressure to the maximum point that will avoid muscular reflex contraction.

Technical steps for full body stress management massage


1. Client position: Face up. Spread the lubrication effleurage manner over all areas of foot

2. Squeeze each toe between fingers and thumbs while continue to massage toes under pressure. (perform 3-5 strokes for each toe)

It is very important to start the full-body stress management massage session from the toes. Toes are the most distal parts of the body from the centers (brain and heart) and they are the very ends of the capillary network. Therefore, by massaging only the toes we cause significant reduction of sympathetic activities.

3. As tightly as possible surround the foot with both hands and squeeze down the foot, 3-5 strokes from the toes towards the ankle. Please be aware that all strokes are performed exclusively towards the heart and dragging the hands back to the start position is not appropriate.

4. With one hand, support the lateral side of foot. With the thenar area of other hand, massage in-soles/arch area of foot 3-5 strokes from just under the ball of the foot down towards the table

5. While compressing the tendon channels between fingers and thumbs, under pressure, massage each channel 3-5 times (towards the ankle)

6. With the tips of fingers, under pressure, massage around the malleolus (ankle bone) 3-5 times.


1. Spread the lotion in a hand after hand effleurage manner on all areas of shin (3-5 movements)

2. While surrounding the shin and squeezing tighter, continue 3-5 strokes in a hand after hand Freccion

3. With both thumbs, under pressure, initiating from the ankle area and finishing approximately at the knee, massage the soft tissues on each side of the tibia bone 3-5 times

4. Place both thenars on either side (lateral and medial sides) of the shin. While squeezing between thenars, under pressure in a hand after hand circular motion, massage the lower leg from bottom up 3-5 times.

5. Change position to stand in front of the shin. While surrounding shin with both hands, perform hand after hand effleurage (arms will criss cross during this techniques) 3-5 times

6. While squeezing shin by surrounding hands, proceed from the bottom up in the manner that one hand will perform a circular motion while the other hand trails after in a straight squeeze from the bottom up. Perform this 3-5 times

7. Turn back to initial position toward the face of client. Under pressure, with both thumbs, massage around the patella.

Front Thigh:

1. Spread the lotion in a hand after hand effleurage manner on all areas of thigh (3-5 strokes)

2. Continue with hand after hand Freccion (3-5 strokes)

3. Keeping wrists and arms extended, apply pressure with the dorsal part of the fingers in a hand after hand manner 3-5 strokes. (Make sure to massage the proximal, middle, and lateral portions of the quadriceps)

4. With both thumbs under pressure, starting from just proximal to the knee, massage each portion of the quadriceps area 3-5 strokes.

5. Change position to stand in front of the thigh. While surrounding thigh with both hands, perform hand after hand effleurage (arms will criss cross during this techniques) 3-5 times

6. Place hands on thigh so that the fingers and thumbs form a diamond shape. Apply initial pressure with the fingers, and perform Petrissage #1 kneading techniques. Fingers grab the tissues first circling in towards the thumbs and then pushing back away from the thumbs under pressure. Make sure to knead 3-5 times in each area of the thigh.

7. Continue with Petrissage #2. The motion of the fingers is the same, but hands move one after the other in an oscillating manner.

8. Place hands flat (thumbs closed next to fingers) on either side (medial and lateral) of the thigh just proximal to the knee. Apply initial pressure, and perform Freccion action pulling with the one hand and pushing with the other. (the hands cross over 3-5 times)

9. Turn your back to the patient’s/client’s head, beginning on the medial side of the knee, ending at the client’s hip, brush/comb the thigh hand after hand 3-5 times

10. Turn back to initial position toward the face of client. Keeping fingers slightly spread, and tilt fingers at an angle to the body. Begin lightly bouncing hand after hand, perform ax technique over all areas of thigh.


1. Confirm that at least 2 hours has passed since the last time the client has eaten. In the case that the client is female, confirm that she is not pregnant. Ask the client to draw up his/her knees, feet flat on table. Stand in front of the stomach, feet apart

2. Keep hands flat on the stomach and at all times across from each other. Effleurage in a clockwise motion, with left hand sliding over the top of the right arm as the hands circle around the stomach.

3. Continue this motion with Freccion pressure.

4. Spiral Iron – Left hand on top of the four fingers of the right hand. Begin at the navel, spiral motion larger to the edges of stomach area, then spiraling smaller back to the navel.

5. Tuck thumbs under the palms of the hands and perform cross freccion across the abdominals.

6. Stand facing towards the client’s feet. Use the ulnar edge of the right palm and the fingers of the left hand to slice and grab diaphragm muscle under the left side of client’s rib cage in a hand after hand manner 3-5 times. For the right side, use ulnar edge of the left palm and the fingers of the right hand.

7. Stand in front of stomach and perform final effleurage. Return the client’s legs to the extended position.

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