Front Matter

Chapter 6 Manual Therapy 123

restore circulation, inhibit the muscle, reduce
muscular tension, and promote healing.
Trigger point release/trigger point pressure release
techniques were popularized by Dr Janet
Travell in the early 1940s in conjunction with
her extensive work on myofascial pain.
Myofascial pain or myofascial pain syndrome
(MPS) is a musculoskeletal pain condition char­
acterized by deep, achy pain (local or referred)
and the presence of trigger points (TrPs;
Saavedra et al., 2014). Travell defines a TrP as a
hyperirritable point within a taut band of skel­
etal muscle (Travell & Simons, 1983). A TrP can

be active or latent. If active, it is tender to palpa­

tion and has a predictable pattern of referred

pain that often occurs “within the same dermat­

ome, myotome or sclerotome” as the muscle in

which it is embedded (Travell & Simons, 1983).

Figure 6.2 Effleurage to the gluteal muscles. Effleurage
consists of long slow strokes, generally light to moderate
pressure, usually parallel to the direction of the muscle
fibers.

Figure 6.3 Petrissage (skin rolling) of the paravertebral
muscles. Petrissage involves short, brisk strokes,
moderate to deep pressure, parallel, perpendicular, or
diagonally across the direction of the muscle fibers. It
may include kneading, wringing, or skin rolling.

Figure 6.4 Tapotement to the triceps muscle.

Tapotement is rhythmic, brisk percussion often

administered with the tips of the fingers, primarily used

as a stimulating stroke to facilitate a weak muscle.

Figure 6.5 Cross‐friction massage of the supraspinatus

tendon. Cross‐friction massage involves applying moderate

pressure perpendicularly across the desired tissue. Pressure

is maintained in such a way that the finger does not slide

across the skin, but rather takes the skin with it.