Counseling Sheet

Agatha M. Thrash, M.D.
Preventive Medicine

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‍I. Sprains

• Heat should precede the massage for sprains.
• Soothing effleurage to the sprained area, interrupted with petrissage to more distant part of the sprained limb.
• By the third or fourth day, the petrissage can be given nearer to the sprained area.
• On the sixth or seventh day the sprained limb is usually supported by strappings or bandages and permitted to be used, if it has been immobilized to this point.

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II. Fractures

• Begin as early as gentle effleurage can be used without producing pain.
• Petrissage and passive and active joint movements are often not prescribed, until there is some union of the bone.

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III. Loosening scar tissue and contractures

• Friction and petrissage are the strokes used.
• Pain must be produced, usually, to break up adhesions.
• The massage should be preceded by heat.
• Digital friction interrupted with effleurage.
• Digital kneading or friction repeated.
• Joint movements and tendon stretching.

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IV. Procedure for constipation

• Deep breathing exercise: Take a full inspiration and hold for 20 counts, exhale fully and hold to the count of ten. Repeat 20-40 times. Do exercise 3 times daily when driving or working.
• The Mosher exercise: Lie on pad or floor on back. Three positions are assumed one after the other, continuing for 1-3 minutes. The positions are as follows: 1) Protrude the abdomen as high above plane as possible and hold for several seconds; 2) Relax abdominal muscles and assume “on plane" position; 3) Contract abdominal muscles to “hold in" abdomen for several seconds; 4) Relax and return to “on plane."
• Reflex effleurage: Lie on back and gently massage colon. Begin with left hand over the cecum in the right lower abdominal quadrant. Follow the outline of the colon around the hepatic flexure. Change hands smoothly and continue around the splenic flexure, sigmoid, and rectum. Repeat 8-10 times.
• Deep vibration to colon may be combined with reflex effleurage.
• Gentle percussion to colon, tapping, spatting, slapping.
• Digital kneading of colon, four times.
• Exercises: winging and bridging: To do winging, lie face down on the floor, lift both the lower and the upper extremities, shoulders and head, off the floor behind your back, supporting the weight entirely with the abdomen. This exercise should be maintained for 3 seconds only on the first day. If no discomfort arises from having done the exercise, the second day may be advanced from one to three seconds. Continue advancing the number of seconds daily up to one minute. To do bridging, lie on your back on the floor, support the entire weight of the body on the heels and the shoulders by lifting the hips and thighs, head and arms, off the floor. This exercise should be maintained for 3 seconds only on the first day. If no discomfort arises from having done the exercise, the second day may be advanced from one to three seconds. Continue advancing the number of seconds daily up to one minute.
• Enema of cold water. Use a bulb syringe that will hold about 1/2 cup of water. Use cold water and only one bulb full. Use after each meal. Gradually the colon will be trained to empty itself after meals if the exercise is continued many weeks on a very regular schedule.