Manipulative Therapies

Swedish Massage:

• Swedish massage movements form the foundation of most therapists massage routine. Swedish Massage is also called as relaxation massage. It can be given with light, moderate and deep pressure for a variety of treatment outcomes. It includes 6 stroke techniques:

1. Effleurage
2. Petrissage
3. Friction
4. Tapotement
5. Vibration
6. Joint Movement( Range of Motion)

Swedish Massage Movements:

According to Per Henril Ling:

• Effleurage
• Petrissage
• Friction
• Vibration
• Tapotement
• Joint movement

According to J.H Jellog:

1.Touch

2.Stroking

3.Friction

4.Kneading

5.Vibration

6.Percussion

7.Joint movement

Now, let us go through the movements of Swedish massage one by one.

Touch:

• Touch of massage is not an ordinary touch or contact of hand with body. It is a professional touch. It is an intelligent, controlled movement done with a purpose and is capable of producing a desired physiological effects.
• It has 3 different forms of applications:

1. Passive touch,
2. Pressure touch,
3. Nerve compression

• Passive touch- This consists in lightly touching the part operated upon with one or more fingers, with the whole hands, or both hands.
• Pressure touch- This consists in making light or heavy pressure with the whole of one or both hands or with one or more fingers, upon the hand, a joint, or some swollen or irritated part, or upon any portion of the body.
• Nerve compression- In this procedure strong pressure is made upon a nerve trunk at some point in its course. The points usually selected for pressure are the so called motor points, which are located upon the surface where large nerve trunks are readily accessible, lying just beneath the skin

Stroking:

Touch + movement

This procedure is simply touch combined with motion. The tips of two or three or of all the fingers, or the entire palmar surface of one or both hands, should be moved gently over the skin with light contact.

• In gentle stroking, not even the full weight of the hand is allowed to rest upon the surface, the contact being made as light as possible.
• The wrist must be flexible, and the movement even and slow, and perfectly uniform in relation to pressure and time.

There are several forms of stroking

• With the finger tips- digital stroking.
• With the palm of one or both hands- palmar stroking.
• With the knuckles knuckle stroking.
• Reflex stroking.

1.Digital stroking- The tip of one finger may be used or the tips of all the fingers of one or both hands. Stroking with the finger tips is used chiefly for the forehead and spine.

2.Palmar stroking- In this procedure the whole or a part of the palm of both hands should be applied to the surface. It is used for broad, fleshy parts about the joints and for the soles of the feet.

3.Knuckle stroking- in this procedure the hand is closed, and the knuckles of the second joints of the fingers are applied to the surface. It is seldom used except in massage of the back.

4.Reflex stroking- The reflex is developed by gently stroking the sensitive part with the finger nail. Stroking on the reflex areas, with the end of a lead pencil, a wooden toothpick, or the head of a pin may also be employed.

Friction:

• It is the combination of touch + pressure + motion.
• Friction consists of small deep movements as compared to touch and stroking
• In this procedure whole part of the hand is moved over the surface with considerable degree of pressure with its full contact over the part operated upon.
• The rate of movement varies from 30-180strokes per minute.
• The amount of the pressure depend upon the application area which vary in different area like:
  • heavy/thick/fleshy surface– more pressure
  • light pressure- over thin and bony surface

 Types of Friction

1.Centripetal friction

2.Centrifugal friction

3.Spiral friction

4.Circular friction

5.Rotatory friction

1.Centripetal– it is a friction in which movement is in the direction of blood current. In veins chiefly applicable in the extremities, the movement is done from below upwards (towards the heart)

2.Centrifugal– it is the friction in which movement is opposite to blood current in veins or away from the heart towards the distal part of the body.

3.Circular– it is applicable to extremity. Limb is grasped by both hands which make an alternate wringing or twisting movement starting from  hand and extending upwards.

4.Spiral– it’s a combination of the preceding movement conducted by one hand and the support is given by other hand. It progresses from lower or distal to the upper or proximal end of the part with a sort of spiral movement.

5. Rotatory friction– Friction in which the hands are made to move over the broad surface in an circular, semi-circular, oval, direction, specially applicable to fleshy area such as hip and the portion of back over the spines of the scapula.

In applying rotatory friction it is often necessary from one hand to support the tissue and the other should conduct the movement.

Kneading:

• Kneading consists essentially in the application to the tissue of an alternate and intermittent compress by grasping the tissues or by compressing them against underlying bony surface.
• The hands are placed firmly on the skin so that the movement can take place in the deeper structure and not only over the skin.
• The different forms of kneading may be divided into 2 classes

1. Superficial/ fulling
2. Deep

The applying of superficial kneading is pinching or fulling.

Deep is classified as:

• Palmar
• Petrissage
• Rolling
• wringing
• chucking
• Fist, digital, elbow

1.Superficial kneading or fulling- In this procedure the skin is grasped between the thumb and the last two phalanges of the first finger. The skin is subcutaneously compressed between the thumb and finger and lifted from the underlying bone or muscle. The two hands are in alteration, one hand picking up the tissue as the other drops it, and so following along with the surface in a systematic manner

2. Deep kneading- In deep kneading the object is to act upon the muscles. Comparatively little pressure should be used in kneading thin tissues, thick firm tissues admit of much greater pressure.

• Palmar Kneading
  • this movement is executed either with the heels of the hand or the whole palm surface as may be required.
  • When much force is to be employed, the heels of the palm is to be used in a large mass like abdomen.
  • The movement is performed by making circle in opposite direction i.e. clockwise with right hand and anti-clockwise with left hand.
  • It is given in chest, back, abdomen, and thighs
• Petrisage
  • The petrissage is designated as that form of deep kneading in which the muscle structure is grasped by the hands as large as a portion is possible by the palmar aspect of the hand.
  • Great care should be taken to prevent slipping of the skin between the fingers.
  • In petrissage the parts should not be squeezed or compressed in the hand, but should be lifted from the bone or underlying tissues, rolled and stretched, always in an upward direction in operating upon the limbs, or from the point of insertion.
• Rolling:
  • In this procedure the tissues are compressed against the deep lying structures, and rolled by to and fro movement. In rolling, the fingers are extended and held close together.
  • Rolling may be applied with either one or both the hands. It is especially helpful in massaging the upper portion of the back, the hips, arms and legs.
• Wringing:
  • This procedure is executed by grasping the limb with the two hands placed on opposite sides and close together.
• Chucking:
  • In this procedure the limb is supported by one hand while the other firmly grasps the fleshy portion and drags it first upward and then downwards in the direction. This application is especially useful in overcoming muscular rigidity and in stretching contracted muscles.
• Fist Kneading:
  • This procedure is used only in kneading the abdomen. It consists in compression of the deep tissues by the knuckles of the closed fist. Pressure is made along the course of the colon, beginning from the right side.
• Digital Kneading:
  • In digital kneading, the ends of the fingers or thumb alone are employed, the tissues being rubbed and pressed against the underlying bony surfaces. It is chiefly used in massaging the joints, spine, the head and face, and the abdomen.

Vibration:

• This procedure consists of fine vibratory or shaking movements communicated to the body through the hand of the masseur. One or both the hands may be placed against the surface, or may grasp some part of the patient, as the hand, the foot or the head. Sometimes one hand or sometimes both the hands are employed.

Types of Vibration

Lateral vibration: The palmar surface of the hand being held upon the skin with sufficient firmness to prevent slipping, the hand is moved laterally to and fro.

Knuckle vibration: The knuckles of the closed hand are placed in contact with the skin, and moved slowly over the surface, a vigorous vibratory movement being executed at the same time.

Superficial vibration: One or both palms being placed upon the surface, they are made to move slowly over the area to be operated upon, a fine trembling movement being executed at the same time.

Deep vibration: The palm of the hand or the closed fist being placed firmly upon the surface of the part to be acted upon, the arm is held straight, and a fine trembling movement communicated to it.

Shaking: The part to be operated upon is grasped firmly by both hands and shaken with a rapid vibratory movement . This movement is especially applicable to the extremities and the head.

Digital Vibration: The end of the thumb or of one or more fingers being placed upon the part to be operated upon, the arm of the operator is thrown into violent vibrations, which are communicated through the thumb or fingers to the patient.

Percussion

This procedure consists of blows administered in various ways and with varying degrees of force. The two hands are used in alteration. The movement is always from the wrist joint, which gives to the blow the quality of elasticity.

• Tapping: This is a form of beating in which the tips of the fingers alone are employed. Either one or all the fingers of one or both hands may be employed. It is used for chest and head.
• Spatting: This consists of percussion with the palmar surface of the extended fingers held rigid. This is the form in which percussion is mostly employed. It is applicable to most parts of the body.
• Clapping: In this procedure, the whole hand is employed, the palmar surface being so shaped as to entrap the air as it comes in contact with the skin, producing a sort of explosive effect and a loud sound.
• Hacking: In this procedure the ulnar, or little finger, border of the hand alone comes in contact with the skin. The fingers are held slightly apart, but loosely so that they are made to come successively in contact by the force of the blow, thus gives a peculiar vibratory effect.
• Beating: In this procedure the body is struck by the palmar surface of the half- closed fist, the dorsal surface of the terminal phalanges of the fingers and the heel of the hand along coming in contact with the body. It is useful for application to lower part of the back and fleshy portion of the thighs. vii. Reflex percussion- Percussion movements on reflex areas.

Joint Movements

• They are movements of  various joints in the body which may be passively or actively done.
• Flexion, extension, adduction, abduction, pronation, supination, circumduction, stretching.

Physiological effects of massage:

• Increases the blood circulation.
• Improves the elimination of waste matter.
• Enhance the metabolism. Improves the lymphatic and venous drainage.
• Improves the supply of nutrients to all over the body.
• Relieves pain, stiffness and swelling.
• Improves lung efficiency.
• Strengthens the muscles and joints.
• Massage stimulates the parasympathetic nervous system, putting the body into a state of rest and healing.
• Dopamine, endorphin and growth hormone levels rise during a massage, while cortisol and epinephrin levels fall, all of which contribute to an individual’s well being.
• Increase flexibility and range of motion in joints.

Duration of the Massage:

• 45 minutes to 1 hour for full body massage.
• 15 minutes to 20 minutes for partial massage.

Characteristics of a Masseur/Masseuse:

• Have a great interpersonal skill (ability to communicate).
• Masseur should have knowledge of proper technique.
• The masseur must have great physical stamina.
• Masseur must maintain the hygiene.
• Knowledge of anatomy and physiology is must.

Precautions:

• Massage should be taken in empty stomach or 4-5 hours after meals.
• Physical hygiene of masseur should be maintained.
• Pressure should be according to the built of the person.
• Heavy massage movements should be avoided over the chest and abdominal region.
• Massage movements should be done from wrist not from elbow.
• Masseur should maintain the correct body posture throughout the massage therapy.
• Massage should not be given in inflamed area.

Indications:

• Obesity.
• Insomnia.
• Constipation.
• General detoxification.
• Paralysis.
• General malaise.
• Painful conditions.
• Infants
• Arthritis
• Diabetes mellitus
• Stress
• Asthma
• Post surgical rehabilitation
• Aging problems
• Positive promotion of health

Contraindications:

• Fever.
• Open wounds.
• Skin diseases.
• Cancer.
• Fracture.
• Acute Inflammation
• Eczema
• Fungal infection
• Osteoporosis

General sequence  of the movements to be followed:

1.Touch

2.Friction

3.Kneading

4.Percussion

5.Joint movements

6.Vibration

7.Stroking

Sequence to be followed in while giving full body massage:

• Supine:
  • Legs
  • Arms
  • Chest
  • Abdomen
• Prone:
  • Legs
  • Back and hips
• Sitting:
  • Head and neck
  • face