Features Practice Technique
Dynamic Angular Petrissage

What is DAP? Dynamic Angular Petrissage (DAP) is a treatment method. It is a way of addressing patient issues that can be quite detailed in its application, but is quite simple in its philosophy.

It is a quick way of helping to restore the pliability and functionality of the tissue by taking the patient’s joint through various ranges of motion. However, two factors make it difficult for therapists to grasp, at first: until the technique is experienced or felt by the therapist, the fact that very 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 patient may seem tricky, but this combination of passive movement and muscle specific petrissage makes the work more effective and less strenuous for 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 in reverse through passive or assisted ranges of motion according to the muscle’s line of pull, changing angles not only to simulate the action of the muscle but also to help refine the movements. The other hand is gently adapting 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 applied is determined by the therapist’s desired outcome.  

How does it work?
DAP comprises combinations of established ideas that, if administered skilfully, can result in a powerful method of treatment that is gentle on the therapist and can produce positive results for the patient. 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 patients having varying levels of complications from, for example, leg lengthening, Guillain-Barre Syndrome, frozen shoulder, mastectomy, breast augmentation and reduction, whiplash, thoracic outlet syndrome, carpal tunnel syndrome, or hip and knee replacements.

The reasoning for movement during the treatment is to lengthen, increase and decrease the tension on specific desired muscles in order to assess while treating the soft tissue. In order to lengthen the muscles or perform muscle stripping, one needs to be able to simultaneously subtly change the resting tension by using a lever to lengthen and shorten tissue.

Let’s look at a simple example of using DAP on a bicep that has a non-referring 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. Of course, you have determined this through your clinical/orthopedic assessment.

With the patient 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 patient’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 very linear in appearance, and DAP is far from linear. The therapist can quickly and simply change to a multi-dimensional 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. To further expand on this example, the therapist may decide to work distally or in the area of the bicipital groove by supporting the elbow and treating the bicep as though it is a single joint muscle, addressing the tissue from various angles of accessibility.  

Chair Massage
DAP techniques are universally applicable and can be adapted for use with both the massage table and massage chair. Treatment on the table and treatment on the chair differ in many ways – in the areas of the body that are supported, draped and not draped, for example.

The application of DAP on the chair differs from that on the table. In the chair, for example, the use of both passive and active assisted movement complements DAP well. As an example you may need to apply treatment to the shoulder area while requiring the patient’s head to rotate towards the left, all as their arm is being horizontally adducted towards the left. These movements would aid in the lengthening of tissue on the medial and superior angle of the scapulae. This method of treating is a combination of learned therapeutic modalities that I combine and apply in a way that allows the therapist to go beyond previously learned techniques.

Case Study: from the patient’s point of view
“I met Paul Lewis in May 2008 through a series of random occurrences. One of the first things that I learned about, and was intrigued by, was that Paul had actually read Janet Travell’s Myofascial Pain and Dysfunction, Vol. 1 and 2…. for pleasure! So I thought to myself, that he was either completely nuts or incredibly dedicated to learning about the body, and the art of healing.

“I was recently treated by Paul after I found myself nearly crippled by an acute onset of pain in my mid-thoracic spine that I could only describe as ‘an ice pick jammed between T3 and T4’. I admit, I was skeptical about seeing Paul, but after 24 hours’ of being unable to move or sleep comfortably, I took the opening in his schedule. After one session I could finally breathe, turn and drive more comfortably, and even got a few hours sleep. After the second session, I had nearly 80 per cent relief and after the third session, I could barely remember that I had suffered from any affliction a mere 72 hours previous!!

“Paul treated me supine and prone on the massage table as well as seated in his massage chair. His approach and diversity of techniques were similar to, and yet unique from, anything I had experienced in the past. I knew that his approach was somehow related to his combining the teachings of Aikido and massage therapy but I wanted to know more…

“Paul explained his unique approach to assessment and treatment. His approach, to me, is based on a detailed understanding of the body’s mechanics and movement patterns. ‘When I am treating,’ he said, ‘I look at the muscles and movement that has contributed to the symptom and start from there.’ Paul understands the complex balance and co-ordination required of the body’s muscles and joints to allow for fluid movement – that in order for fluid, co-ordinated, pain-free movement to occur, the ‘initiating’ muscles must contract, while the opposing structures must release and elongate, joints must slide, glide, roll, etc. Movement is never from activation of a structure in isolation. Disruption in a movement pattern, pain patterns, etc., can be related to any combination of issues in any combination of tissues.” (Jean Brown, PT, RMT)

Elicit different responses
Research shows that people’s bodies react differently although receiving the same stimuli, as is the case, for example, 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 of the patients’ treatments may elicit differing responses and experiences. Application of DAP can be used to help with patient issues such as pain, altered sensation and limited range of motion. Each patient may desire the same outcome – “to be issue-free” – but the road to being issue-free will be different for each patient and may be a bumpy one for some.

I believe that the DAP technique, and its many applications, can help to augment a therapist’s current treatment protocols and, therefore, deserves further review of its potential benefits to both patient and therapist.
 

Paul Lewis practises out of his clinic in Mississauga, Ontario, and will be presenting at various conferences and teaching engagements in Canada, Europe and the United States (CEUS). For more details please visit us at www.paullewis.ca .