Counseling Sheet

Agatha M. Thrash, M.D.
Preventive Medicine

Definition

The scientific manipulation of the tissues of the body for therapeutic purposes.

History

‍Massage 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 has been developed to a higher degree by Ling of Sweden and Mezger of Holland. Later advocates have been Weir Mitchell and John Harvey Kellogg in the United States, and Cyriax and Mennell in England.

Movements of Massage

• Effleurage: Effleurage may be superficial or deep. Superficial effleurage, or stroking, consists of long, rhythmical stroking movements. Deep stroking is much heavier, is usually centripetal, and is aimed primarily at emptying the veins and lymphatics by mechanical pressure. Effects are reflexive in nature, bringing relaxation and relief of spasm.
• Centripetal: A motion toward the center from the periphery (most massage movements are of this variety).
• Centrifugal: A motion away from the center toward the periphery (used only for race horses and athletes to slow down blood flow).
• Petrissage: Petrissage consists in grasping the muscle, picking it up, rolling it, and squeezing it in one continuous action, according to the contour of the muscle mass. Also known as kneading, it is always applied across the muscle. The muscle should never be pinched with the tips of the fingers. The effect is a mechanical stimulation of deep structures, primarily muscle.
• Friction: Friction is a deep circular movement in which the fingers do not rub over the skin, as the name might suggest, but the skin moves with the fingers. Its purpose is to loosen the superficial scar tissues or adhesions and break up fibrositic nodules in the muscles and connective tissue.
• Tapotment: Tapotment consists of percussive clapping, tapping, hacking, or beating of the tissue being massaged.
• Vibration: Vibration is a vibratory or shaking impulse imparted to the patient's tissues by a continuous vibration of the operator's shoulder, arm, hand, and fingers or by some mechanical device. It relieves pain on the nerve trunk and soothes and relaxes reflexively.

Qualifications of the Operator

‍The operator should have a basic knowledge of physiology and the underlying muscle structures, should have strength and good manual dexterity, and should be well cultured and orderly. He should keep his hands soft, without calluses, and his fingernails short.‍

Lubricants

Use massage cream or oil and powder for hairy arms.‍

General Considerations

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 the proper height (approximately 30 inches) for the most effective treatment. Massage is seldom prescribed alone, but is usually part of a complete prescription. 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. The treatment should be long enough to be effective, and yet the patient should not be fatigued. The duration of the massage to a local area varies from five to fifteen minutes. General massage may last 45 minutes to one hour.‍

Technique

• Effleurage (Stroking)
• Superficial effleurage: Apply just enough pressure to avoid tickling. Strokes may be given in either direction, usually centripetal, in a slow and rhythmical fashion, about 10 to 15 per minute. They should be given in only one direction in any particular treatment.
• Deep-stroking effleurage: Give in the centripetal direction or in the direction of the venous and lymph flow, with just enough pressure to collapse the superficial veins, about 15 to 20 times per minute, slow enough to permit refilling of the veins.
• Petrissage (Kneading)
• A combination of intermittent pressure and relaxation to the deep-lying structures, petrissage is performed by grasping the muscle, picking it up, rolling it, and squeezing it. Remember that this movement is always applied across the muscle and that the muscle should never be pinched. Petrissage is generally followed by deep stroking movements.
• Friction
• Apply heavy local pressure, usually with the thumb, fingertips, or hypothenar eminence of the palm. Use a deep circular movement, not gliding over the skin, but moving the skin with the fingertips. Friction is usually followed by stroking.
• Tapotment (Percussion)
• With the wrists relaxed, clap, hack, tap, or beat the tissues with rapid, alternating blows. You may omit this movement with nervous patients.
• Vibration
• If done with a mechanical device, apply with constant pressure.

Physiological Effects

The effects of massage are largely reflexive, rather than direct. Vasomotor nerves are stimulated by massage and there is dilation or constriction of distant blood vessels. Massage increases the number of both red and white blood cells in the peripheral bloodstream. Both light stroking and friction cause a brief contraction of the capillaries, followed by a dilation of these same blood vessels. Petrissage may cause a dilation of the deeper blood vessels.‍

Circulatory Effects

• Increases superficial blood and lymph flow.
• Increases red blood cells and hemoglobin.
• Relieves congestion as in sprains.

Neuromuscular Effects

• Relaxes muscle spasms.
• Soothes the nerves.
• Helps keep paralyzed muscles in a better condition until neuromuscular function is restored.
• Relieves physical and mental stress.

Metabolic Effects

• Increased circulation with the dilation of the blood vessels increases the absorption of wastes and by-products of fatigue, increasing recovery rate from fatigue.
• Increased circulation increases nutrition to the muscles, producing no waste products while carrying out these activities.
• Massage does not increase strength (except to the one giving the massage) and does not rub away fat.

Skin Effects

Over a period of time the skin becomes tougher, denser, more elastic and supple due to an increase in the following:

• Nutrition
• Secretions in the skin
• Insensible perspiration
• Sebaceous gland activity

When Massage Is Indicated

• ‍‍Excitement and overactivity
• Nervous conditions
• Peripheral nerve injuries (to prevent atrophy of muscle)
• Local muscle spasms
• Fractures
• Edema (as in dropsy, impending heart failure, venous congestion, sprains)
• Adhesions around joints
• Chronic inflammation such as arthritis, myositis, and fibrositis
• Following general heating activities, exercise with fatigue
• Circulatory collapse
• Secondary anemia
• Constipation (over abdomen)
• Amputation stumps
• Many convalescent conditions