Massage

Definition
Massage is the scientific manipulation of soft tissues of the
body with the palmar aspect of hands(s) and or fingers.

 Massage is a tern applied to certain manipulation of the soft
tissues.

Superficial stroking
 the rhythmic movement of hand or parts of hand, over
the skin the lightest amount of pressure in order to
obtain sensory stimulation.
 Strokes can be applied from proximal to distal part or
vice versa. (Centrifugal of Centripetal) .
 Every massage should begin and end with strokes.
 It can also be used between every other technique.
 It is best performed with palm of hand or pulp of fingers.

 This “just ‘’ touch no pressure contact should be
maintained throughout the stroke.
 The hands should work in alternate motions, so that there
is no loss of contact with patients Skin.
 At a time only one hand should slide over the pt’s skin.
 The stroke should end with a smooth lift of hand.
 Slower strokes (12-15/min) are more sedative.
 Faster strokes (30-40/min.) are stimulating in nature. PHYSIOLOGIC EFFECT
 Soothing & sedative
 Stimulates cutaneous touch receptors.
 Indirectly improves circulation by activating the axon
reflex.
 Facilitates contraction of muscles. effects. THERAPEUTIC EFFECT.
 Reduces anxiety, tension & psychological stress.
 Decrees hyper sensitivity
 Fast stroking elicits contraction in hypotonic
muscles. *Deep stroking / Effleurage
 It is the movement of the palmar aspect of hand over the external
surface of the body With constant moderate pressure, in the
direction of venous and lymphatic drainage.
 Each stroke begins from the distal end of the segment and is
completed at the proximal end usually at the site of a group of
lymph nodes.
 Direction of movement of hand is always from distal to proximal.
 Contact and Continuity must be even throughout the stroke.
 Depending on area, one or both hands may be used.  Pressure is applied by transfer of body weight to the
subject skin through the upper extremity of therapist.
 Return stoke is usually superficial.
 Rate of stroking is usually slow (10-12/min) to allow
refilling of venous & lymphatic Channels.
 In babies with “C” grasp effleurage is done from
proximal to distal. Therapeutic uses
 Removal of edema.
 Removal of metabolites & inflammatory
products.

Pressure Manipulation
Kneading
• Palmar, Digital, Ironing.
Petrissage
•Picking-Up, Wringing, and Skin rolling.
Friction
Circular, Transverse

Kneading
 It is a pressure manipulation
 It is a technique in which tissues is pressed down on to the
underlying structures.
 Pressure is applied in a circular way along the long axis of
underlying bone.
 The Pressure is Increase and Decrease in gradual manners.
 Hands are placed over the skin and tissues are
compressed against the bone and hands are moved in a
circular direction.

 Several small concentric circles are performed to the body surface
and each circle overlaps the previous one.
 ½ the circle Pr. is Increase and ½ it is Decrease.
 Thus each circle has 2 phases.
 (i) Phase of compression
 (ii) Phase of relaxation
 Increase Pr. should always be proximal to distal.
 Kneading can be applied with part of fingers, thumb or palm of
one or both hands.

Palmar Kneading
 Performed with whole of palmar or with heel of hand.
 Usually performed over larger areas such as thigh, calf, arm etc.
 Both the palms are placed on opposite aspects of limb segment (medial and
lateral)
 Fingers & thumb not in a contact with the skin.
 Both hands should perform co-ordinate circular movement, in opposite
directions.
 ½ Cycle pr Increase and ½ cycle it decreases.
 Slow rates of kneading allow deeper penetration.

Digital Kneading (Finger / Thumb)
Finger kneading
 palmar aspect of whole finger or part of it may be used.
 Whole finger kneading, finger pad kneading & fingertip kneading
can be used.
 One finger or 2-3 fingers may be used. To increase contact area.
 Thumb & little finger should have no contact the skin.

Thumb Kneading
 The tip of one or both the thumbs are used depending on the
side of area .
 One thumb may be placed over the other to reinforce the
movement.
 Thumb pad and thumb tip kneading techniques are used.
 Thumb pad – smaller muscular areas such as thenar eminence.
 Thumb tip- Narrow area such as interosseous spaces.

Reinforced kneading / Ironing
 Utilizes both the hands for kneading
 Used when greater depth is required.,
 Most commonly used over back.
 Hands placed over each other on the skin.
 Elbow of therapist in extension.
 Intermittent circular Pr. is transmitted to the body.

Petrissage or working
 Derived form French word “Petrir’’ meaning to “knead’’.
 The direction of application of Pr. differentiates petrissage from
Kneading
 Kneading exerts vertical compression of soft tissues over underlying
bone and petrissage involves picking up movement of soft tissue with a
lateral compression.
 Intermittent Pr. is applied at right angles to the long axis of bone.
 Picking up, skin rolling & wringing are the petrissage techniques.

Picking Up
 Involves lifting of the tissue up at right angles to the
underlying bone, squeezing and Releasing it.
 The web space between thumb and index finger lies across
the central line of the muscle bulk and skin to be lifted.
 The thumb and thenar eminence are placed on one side and
index, middle finger placed over the other side of the central
line.

 Transfer of body weight to skin through upper extremity to apply compressions
initiates the technique.
 Same time grasp of hand is tightened along with little extension of wrist.

Skin Rolling
 Involves lifting and stretching of the skin between the thumb and the fingers as
well as moving the skin over the subcutaneous tissue.
 Therapist lifts up and moves the skin and superficial fascia with both the hands
keeping a roll of the skin raised continuously ahead of the moving thumb.
 Thumb is abducted in such a way that the tip of thumb and index fingers of both
hands touch each other maintaining a full palmar contact with the skin.
 Pull the finger backwards with sufficient pressure so that skin is pulled up.
 At the same time thumb is adducted and opposed with downward pressure over
the underlying skin.

 The coordinated motion of thumb and fingers lifts off a roll of skin from
the underlying structures.
 Palm is gradually lifted off the skin so that lifted roll of skin remains
between tip of fingers and thumb.
 Move the thumb forward to roll the lifted skin against the fingers.
 Main effect of this technique is to stretch the cutaneous and subcutaneous
tissue and induce relaxation.
 Usually performed over the back.
Skin Rolling.

Muscle Rolling
 Applied over arm, calf thigh muscles.
 Whole muscle is lifted between the tip of thumb and fingers,
using similar grasp
 Alternately apply and release pressures with thumb and fingers
which rolls muscle fibers from side to side.

Wringing
 Grasp and placement of hand similar to picking up.
 Both hands are used in opposite aspects of the limb.
 Lifting up the skin is done and both hands move in opposite
directions.(Forward & backward)
 Useful for mobilization of adherent skin.

Physiologic & Therapeutic uses
(Kneading & petrissage)
 Mainly break down of adhesions.
 Reduce edema.
 Increase mobility of adherent structures.

Friction or Rubbing
 It consists of small range oscillatory movement which is applied
to the deeper structures Pressure by thumb or fingers.
 According to direction of movement it grouped as.
 (i) Circular Friction
 (ii)Transverse friction.

Circular friction
 Advocated by wood in1974. Resembles digital kneading.
 Only difference is continuous Pressure is applied during whole
procedure no phase of Relaxation.
 Movement in circular direction. Increase Pressure when superficial
Structures become relaxed.
 Applied around localized area (joints, muscle attachments fibrocytic
nodules.)
 Used in case when nerve trunk is imbedded in consolidated edema
fluid. Localized effects on muscles are in prolonged state of tension.

Transverse friction
 Movement is transverse (i.e.) across the long axis of the structure to be
treated.
 Performed with tip of the thumb, index or middle finger, which can be
reinforced, 2 or 3 fingers.
 Ligaments to be treated should be in taut position.
 Muscles to be treated should be in relaxed position.
 It is a painful procedure and patient is to be informed about it priorly.

Physiologic and therapeutic effects
❖ Breaks down intra-fibrillary adhesions.
❖ Smoothens the rough gliding surfaces.
❖ Ensures pain free mobility.
❖ Useful in traumatic muscular lesions, tendonitis, tenosynovitis and
ligament sprain.
❖ Much useful in localized pain (trigger points).

Percussion or Tapotement
 French word which means striking of two objects against each
other.
 Utilizes controlled movement of wrist and forearm to strike the
patients body surface Rhythmically.
 Mild blows are applied with various pressure and in different
manners.

Clapping or Slapping
 Used in management of chronic respiratory disorders which
leads to sputum retention
 Slightly cupped hands strike the chest wall alternately in
predetermined rate.
 Fingers and thumb are adducted and M.P. joints of fingers are
slightly flexed in position.
 Palm should not come in contact with patient’s body during
striking.

 No movement at elbow, only wrist flexion and extension should be
done rapidly.
 Hand should create air cushion between the hand and the chest
wall on impact.
 Performed during both inspiration and expiration.
 Manual percussion normally 100 – 480 times / Min.
 Clapping is performed over chest wall, with a blanket or towel
covering it.
Clapping or Slapping.

Hacking
 The ulnar border of medial 3 fingers is used to strike the skin.
 This produces a peculiar sound
 Alternate supination and pronation of forearm combined with
radial deviation of the wrist respectively produce hacking.
 Applied over larger areas such as back and thigh etc.

Tapping
 Useful when intermittent touch and pressures are to be applied over a
small area.
 Only the pulp of fingers strikes the body part.
 One of both hands may be used.
 Alternate flexion and extension of the MCP joints produce the tapping.
 No movement should be at wrist and elbow.
 Commonly used over face, neck and other smaller areas.
 Conveniently used on children.

Beating
 Anterior aspect of the clenched fist strikes the body part.
 In making fist, fingers are flexed at MCP and PIP joints but DIP is
kept extended to produce a flat surface, which is used for beating
 Beating is produced by alternate flexion and extension of wrist.
 No movement at elbow.
 Used over back, thigh and other fleshy and broad area of body.

Pounding
 Fingers are flexed at all the joints to make a fist.
 Thumb rests over the index finger.
 Supination and pronation of forearm combined.
 Ulnar and radial deviation of wrist respectively produces the pounding
 Used over back, thigh and other fleshy and broad areas of the body.
 Ulnar border of clenched fist strikes the body.

Tenting
 It is a modification of clapping.
 Here concavity is produced between the index and the ring finger with the
middle finger slightly elevated and placed over them.
 For loosening secretions in the smaller chest of newborn or a premature infant.

Contact Heel percussion
 It is a modification of clapping.
 Concavity is produced between thenar and hypothenar
eminences.

Thumping
 Apply pressure over the body surface with dorsal aspect of clenched fist.
 Usually applied over back and chest.
 Helps in increase exhalation.
 Helps in coughing up material from bronchial emphysema.

Vibration
 Involves constant touch of therapist hand and application of rapid intermittent
pressure with out changing the position of hand.
 Usually used over chest wall.
 Can be produced by one fingertip or palm.
 The therapist should produce isometric contraction of all the muscles of upper
extremity which are transmitted to the patient’s body surface through his hands.
 This produces oscillatory movements of his hand in upward and downward
direction and
 Transmits the mechanical energy to the patient’s chest.

Shaking
 Oscillation is coarse compared to vibration.
 Fore arm in midprone position.
 Oscillation occurs in side ways movement
 Patients in supine lying, Place both hands on each side of anterior Chest
wall or antero posteriorly on same side.
 Patient’s in side lying , place both hands on the upper lateral chest wall
or antero posteriorly on the upper side chest wall .

 Shaking is done during expiratory phase.
 Therapist tends to produce upward and down ward movement of upper extremity.
 This shakes chest wall vigorously .
 While shaking is done for extremities , they should be raised to encourage venous
and lymphatic return .