Counseling Sheet

Agatha M. Thrash, M.D.
Preventive Medicine

“And God said, Let us make man in our own image, after our likeness.... So God created man in his own image, in the image of God created he him; male and female created he them.” (Gen. 1:26, 27) Mankind has been fascinated with the form and function of the human body from the very beginning. For beauty and sheer simplicity of line, it is unmatched. As a machine, the human body is the pinnacle of God’s work, formed on the sixth day of Creation; after which God declared, “It is very good.”

“With its 206 bones, 639 muscles, 4 billion nerve cells, and 30 trillion cells in total, the human body is remarkably designed for life.” (Science and Religion - Jerry Bergman) “I will praise thee; for I am fearfully and wonderfully made: marvelous are thy works; and that my soul knoweth right well.” (Ps. 139:14)

Definition of Massage

Massage may be defined as the manipulation of the tissues of the body for therapeutic purposes, producing effects on the nervous, muscular, and respiratory systems and the local and general circulation of blood and lymph. These manipulations are most effectively performed with the hands.

Massage is an ancient remedy used both by man and animals. Animals instinctively lick their wounds, cleansing and massaging them at the same time. Man has doubtless used massage of a simple type from prehistoric times. It is known to have been employed anciently in China and India. It was described by Homer in 1200 B.C., and by Hippocrates in 460 B.C. It was used in the Greek and Roman baths. In more recent times, it was developed to a high degree by Ling of Sweden and Mezger of Holland. Later advocates were Weir Mitchell and Kellogg in the United States and Cyriax and Mennell in England.

The word massage is taken from a root meaning “to knead” or to “handle.”

Massage Movements

Stroking (effleurage)

Superficial—This consists of long, light, rhythmical stroking movements in which the effect is reflexive in nature (sedative). This stroke is also used to begin and end the massage routine; in applying lubrication; and to desensitize the area(s) to be massaged.

Deep—This stroke is much heavier, is usually centripetal (toward the heart), and is aimed primarily at emptying veins and lymphatics by mechanical pressure.‍

Kneading (petrissage)

Consists in grasping the muscle, picking it up, rolling, and squeezing it according to the contour of the muscle mass. Kneading is always applied across the muscle. The muscle should never be pinched with the tips of the fingers. This stroke improves the skin tone.‍

Friction

‍It is a deep circular movement in which the fingers do not glide over the skin but the skin moves with the fingers. It is not a rubbing motion as the name might suggest. It is intended to loosen superficial scar tissue or adhesions and break up fibrotic nodules in the muscles and connective tissues. This stroke is done with the palm or thumbs or fingers.

Percussion

This consists of a series of brief, brisk, rapid contacts of the hand or hands alternately—cupping, clapping, tapping, slapping, hacking, or beating the tissue being massaged. This is one of the less important massage movements. The effects are on deeper organs: for example, stimulating the adrenals, or in respiratory problems.‍

Vibration

This is a shaking impulse imparted to the patient's tissues by a continuous vibration of the operator's shoulder, arm, hand, and fingers. This is a difficult movement, which is tiring to the operator and has questionable therapeutic value, except in chest therapy where vibration is performed to dislodge mucous from the bronchial walls into the main tubes where this can be coughed up or suctioned.

Effects of Massage

Physiological Effects

• ‍‍Increases blood circulation (superficially).
• Increases lymph circulation.
• Increases RBC count and hemoglobin, which is transient but has a tendency to be more prolonged with repetition.

Neuromuscular Effects

• Relieves or decreases muscular spasm and twitching causing muscle relaxation.
• Helps maintain muscle tone and retards denervation atrophy.
• Keeps muscle supple and free from fibrosis.‍

Effects of Massage on Metabolism

‍There is an increase in the output of urine (diuresis) following abdominal massage—increase in excretion of nitrogen, inorganic phosphorus, and sodium chloride.

Effects on Abdominal Viscera

‍Kneading and deep stroking may increase peristaltic action to promote evacuation of flatus and feces from the large intestines.‍

Effects on the Lungs

‍Percussive and vibratory movements are used in combination with other measures of chest physical therapy in the prevention and treatment of acute and chronic lung conditions.

Psychological Effects (positive and negative)

• Soothing.
• Attention and physical sensation seem to establish a close and trusting personal relationship.
• Mennell warned "It is easier to rub a disability into a patient's mind than it is to rub it out of his limb." Care must be taken to reassure the anxious patient and to correct his misinterpretation of the reason for the reason(s) for his treatment.

Indications

Indications for Massage (Taken from Manual of Hydrotherapy and Massage by Moor, et al.)

The prescription for massage should be based on its physiological effects and the pathological condition for which it is given. Based on these considerations, it has many uses.

The following are the common indications for massage:

Musculoskeletal Conditions

• Osteoarthritis and rheumatoid arthritis
• Myositis, fibrositis, and fibromyositis
• Posttraumatic conditions such as sprains, strains, and contusions
• Postfracture care
• Muscle cramps, including writer's cramp
• Torticollis (neck spasm)
• Amputation stumps
• Coccygodynia by the intrarectal method of Thiele

Cardiovascular Conditions

• ‍‍Cardiac edema
• Intermittent claudication of peripheral vascular disease

Neurological Conditions

• ‍‍Hemiplegia (stroke or paralysis of half of the body)
• Poliomyelitis
• Multiple sclerosis
• Parkinson's disease
• Functional nervous disease
• Bell's palsy and other peripheral nerve lesions

Miscellaneous Conditions

• ‍‍General massage for secondary anemias
• Abdominal massage for constipation

Contraindications

‍There are some diseases in which massage should never be used because of the danger of spread of the disease to neighboring or distant tissues. The following is a list of the common contraindications:

• Known or suspected benign or malignant new growths. Massage of a malignant tumor would be likely to cause metastasis through the blood or lymph circulation.
• Acute phlebitis, thrombophlebitis, or phlebothrombosis. In these diseases, massage over the involved vein might dislodge a blood clot or embolus, which would lodge in the lung, causing infarction and possibly death.
• Lymphangitis is an infection which would be spread by massage.
• Acute inflammatory conditions of the skin, soft tissues, joints, or bones would be made worse by massage.
• Skin diseases such as eczema, acne, furuncles (boils), ulcerations, and wounds should obviously not be massaged.
• Hyperesthesia of the skin may render massage too painful to tolerate.
• Acute communicable disease would not ordinarily be benefited by massage and the operator would be in danger of contracting the disease and communicating it to others.
• Pregnancy is a contraindication for abdominal massage.

Basic Techniques to Remember‍‍

• Maintain evenness of rhythm.
• Establish correct rate of movement.
• Keep hands flexible—fitting contour of body.
• Maintain proper stance.
• Regulate pressure according to the kind of tissue being treated and the purpose of the treatment.

Massage is seldom prescribed alone, but is usually part of a complete prescription written by the physician according to his estimate of the patient's needs. It is usually preceded by some form of heat for its relaxing and analgesic effect. The best form of heat to produce relaxation of muscle is moist heat in the form of fomentations or immersion baths. Infrared radiation or ultrasound are second choices but are effective. Diathermy, although the heat of choice for some conditions, is not a good muscle relaxer. The paraffin bath is the most satisfactory form of heat for the hands of patients with rheumatoid arthritis; it is a very satisfactory preparation for massage. If exercise is indicated in the individual case, it is usually given following massage.

Massage should be given in a warm, quiet room. The patient should be placed in the most comfortable position possible on a firm table of proper height for the most effective treatment. Massage should never be attempted over the patient's clothing. The hands of the masseur should be kept free from calluses and roughness. The patient's skin is usually lubricated with a massage cream or oil or dusted with powder. These are removed at the end of the treatment.

The general type and dosage of massage should be indicated in the physician's prescription. However, in the administration of massage, much must be left to the judgment and experience of the masseur. The treatment should be long enough to be effective, and yet the patient should not be fatigued. The duration of massage to a local area may vary from 5 to 15 minutes. General massage may last 45 minutes to an hour. Frequency of treatment may range from daily to twice weekly. The dosage and frequency of massage is based entirely on the individual patient's condition as judged by the attending physician.‍

Quotations from E.G. White

‍"Natural means, used in accordance with God's will, bring about supernatural results. We ask for a miracle, and the Lord directs the mind to some simple remedy." 2SM 346

"We should neglect nothing that would serve to benefit a human being." MH 48

"The movement cure is a great advantage to a class of patients too feeble to exercise." 3T 76

"Every person should have a knowledge of nature's remedial agencies and how to apply them." MH 127

"The use of natural remedies require an amount of care and effort that many are not willing to give." MH 127