A large guide to Vasechkin massage. Vasichkin V.I. All about massage (1). General guidelines
Vladimir Vasichkin
Great guide to massage
Introduction
“My work is dedicated to my neighbors - the Shvedov family Vladimir and Alena”
This book with such a famous title was published about twenty years ago. At that time, the leaders of the publishing house “Medicine” in St. Petersburg (then still in Leningrad) suggested that the author, in a more concise and succinct way, specifically touch on all the most important topics on the use of types of massage and self-massage for diseases and disorders in human health.
Having withstood all the main presentations in the literature of famous authors of the Russian old school (1887–1911) - I. V. Zabludovsky, E. N. Zalesova, M. Ya. Mudrova, N. V. Sletov, M. A. Mukharinsky and many others . others, as well as more modern ones (1922–1985) - A. F. Verbova, L. A. Kunicheva, N. A. Beloy, A. A. Biryukova and others, taking into account the “newest” interpretation and accumulated experience in the application and scientific study of the effects of massage manipulations on humans, of course, with the practice of conducting numerous training courses on types of massage: therapeutic, sports, recreational, segmental, acupressure, etc. - the author strived for perfection of presentation in the relevant sections of the book “Handbook of Massage” "
In the 20th century, under this name, this book was published in many cities of the country: St. Petersburg - publishing houses "Medicine", "Hippocrates", in Tyumen - publishing houses "Zhenmars" and "Kormez Ltd", Kharkov - "Medicine", in Minsk - " Medicine,” etc. The circulation reached 300 thousand copies, the book was very popular, especially in secondary medical institutions, because there the basics of massage were studied in more detail and thoroughly.
In the 21st century, the book was published in the publishing houses “Nevskaya Book”, “LAN” - St. Petersburg, in Moscow - EKSMO-PRESS, etc., and was reprinted several times over several years.
The author consistently presented complex material, maintaining simplicity and accessibility in the study, both in practical and theoretical application. The technique and methodology for performing types of manipulations performed during massage and self-massage has been tested through extensive practical experience during training courses and complex medical practice. Thanks to a timely and competent course of massage, many unnecessary problems that arise with our health can be avoided and prevented. This book is intended for a wide range of readers who are constantly interested in the use of massage and self-massage in everyday life. The author wishes everyone good health, and that massage manipulations become a companion in improving and maintaining health.
Basic principles of massage
Massage originated in ancient times. The word “massage” comes from the Greek word “?????”, which means “knead”, “knead”, “stroke”.
Massage as a method of treatment was used already in the third millennium BC. e. in China, then in Japan, India, Greece, Rome. Records of massage also appear among Arabs. From the depths of centuries, a description of the therapeutic methods of acupuncture, acupressure - pressure on certain points of the body has come down to us. Ancient monuments, such as preserved alabaster bas-reliefs and papyri, which depict various massage manipulations, indicate that the Assyrians, Persians, Egyptians and other peoples knew well and used massage and self-massage techniques ( rice. 1).
Rice. 1. The location of the lines of greatest resistance to stretching of individual areas of the skin according to Benninghoff
In Europe in the Middle Ages, massage was not used due to persecution by the Inquisition. It was only during the Renaissance that interest in body culture and massage arose again. In Russia in the 18th century. massage was promoted by M. Ya. Mudrov. In the 19th century The development of massage was facilitated by the work of the Swedish specialist P. Ling, the creator of “Swedish massage”. Much credit for the spread of massage belongs to I.V. Zabludovsky. The massage technique he proposed has retained its significance to this day. Among the founders of therapeutic and sports massage in our country, mention should be made of A. E. Shcherbak, A. F. Verbov, I. M. Sarkizov-Serazini and others.
Nowadays in Russia, massage is used in almost all medical and health institutions. The technique of massage and self-massage, built taking into account clinical and physiological, rather than anatomical and topographical principles, is an effective means of treatment, restoration of performance, relieving fatigue, and most importantly, serves to prevent and prevent diseases, being an active means of healing the body.
Types of massage
Massage is a dosed mechanical and reflex-conscious irritation of the surface of our body for the purpose of pleasure, healing and healing of ailments.
Massage can be general and local. Depending on the tasks, the following types of massage are distinguished: hygienic (cosmetic), therapeutic, sports, self-massage.
Hygienic massage
This type of massage is an active means of preventing diseases and maintaining efficiency. It is prescribed in the form of a general massage or massage of individual parts of the body. When performing it, various manual massage techniques, special devices are used, self-massage is also used (in combination with morning exercises) in a sauna, in a Russian bath, in a bath, under a shower. One of the types of hygienic massage - cosmetic - is used for pathological changes in facial skin and as a means of preventing its aging.
Massotherapy
This type of massage is an effective method for treating various injuries and diseases. The following varieties are distinguished:
Classic – used without taking into account the reflex effect and is carried out near the damaged area of the body or directly on it;
Reflex – it is carried out with the aim of a reflex effect on the functional state of internal organs and systems, tissues. In this case, special techniques are used to influence certain areas - dermatomes;
Connective tissue - with this type of massage, the effect is mainly on the connective tissue, subcutaneous tissue. The main techniques of connective tissue massage are carried out taking into account the directions of the Benninghoff lines ( rice. 2);
Rice. 2. Massage devices: a – general view of PEM-1: 1 – vibrating platform; 2 – vibration frequency regulator; b – electric vibration massager ELVO: 1 – additional handle; 2 – body; 3 – switch; 4 – main handle; 5 – suction bells; 6 – spherical protrusions; 7 – spike attachment; 8 – flat nozzle
Periosteal - with this type of massage, by influencing points in a certain sequence, they cause reflex changes in the periosteum;
Acupressure is a type of therapeutic massage, when a local effect is applied in a relaxing or stimulating manner on biologically active points (zones) according to the indications for a disease or dysfunction, or pain localized in a certain part of the body;
Hardware - carried out using vibration, pneumatic vibration, vacuum, ultrasonic, ionizing devices; types of baroelectric stimulation and other types of massage are also used (aeroion, various applicators);
Therapeutic self-massage - performed by the patient himself, can be recommended by the attending physician, nurse, massage specialist, exercise therapy. The most effective techniques for influencing a given area of the body are selected.
Sports massage
This type of massage was developed and systematized by prof. I. M. Sarkizov-Serazini. According to the tasks, the following types are distinguished: hygienic, training and recovery, preliminary.
Hygienic massage usually done by the athlete himself daily along with morning exercises and warm-up.
Training massage is produced to prepare the athlete for the highest sporting achievements in a shorter time and with less psychophysical energy. Used in all periods of sports training. The training massage technique depends on the tasks, characteristics of the sport, the nature of the load and other factors ( table 1).
During a general training massage, the athlete is massaged in a certain sequence ( rice. 3). The duration of manual massage of individual areas and parts of the body is approximately as follows: back, neck, shoulder girdle, gluteal (lumbar) region - 8 minutes; hips, knee joints, shins, ankle joints, feet – 16 minutes; shoulder, elbow joints, forearm, wrist joints, hand, fingers – 14 minutes; chest, abdomen – 7 min.
Table 1
Approximate duration (min.) of a general training massage depending on the athlete’s body weight
General massage start with the preliminary. It is used to normalize the condition of various organs and systems of an athlete before upcoming physical activity. Depending on the tasks, the following types of preliminary massage are distinguished:
Warm-up - performed before a training session or performance at a competition, when it is necessary to maintain and increase the tone of the body by the time the exercise is performed, taking into account the specifics of the sport;
Warming – used to cool the body or individual parts of the athlete’s body, using various rubbings and ointments (finalgon, dolpic, sloans, efkamon, nicoflex, etc.);
Mobilizing - used to mobilize all the resources of the athlete’s body - physical, mental, technical, etc. - in combination with verbal “suggestion”.
Restorative massage – a type of sports massage that is used after various types of stress (physical, mental) and at any degree of fatigue, tiredness to restore various functions of the athlete’s body as quickly as possible and increase his performance.
A short-term restorative massage is carried out during a break lasting 1–5 minutes. – between rounds, during substitutions in sports games, during rest between attempts (approaches to apparatus).
The main objectives of short-term restorative massage are:
Relieve excessive neuromuscular and mental tension;
Relax the neuromuscular system and create conditions for optimally rapid recovery of the body;
Eliminate existing pain;
Increase general and special performance of both individual parts of the body and the entire organism.
Rice. 3. The sequence of general training massage (on the front and back surfaces of the body, according to the digital indicators)
Restorative massage during a break of 5–20 minutes. It is carried out between halves for football players, wrestlers, gymnasts, and track and field athletes. At the same time, massage techniques are performed taking into account the specifics of the sport, the time until the subsequent load, the fatigue of the body, and the mental state. The greatest effect can be obtained from a restorative massage for 5–10 minutes. in combination with a contrast shower.
Restorative massage during a break of 20 minutes. up to 6 hours, used in divers, wrestlers, gymnasts, track and field athletes and other athletes. Depending on the athlete’s condition, it is advisable to carry it out in 2 sessions: the 1st lasts 5–12 minutes, while those muscle groups that bore the main load in this sport are massaged. 2nd session – from 8 to 20 minutes, during which not only the muscle groups that bear the maximum load are massaged, but also the parts of the body located above and below these muscles.
During multi-day competitions, restorative massage is used in sports such as wrestling, boxing, skiing, figure skating, chess, etc., when passive rest does not relieve accumulated fatigue and does not provide the desired recovery effect. This type of restorative massage is carried out in sessions. Its tasks include: relieving neuromuscular and mental tension; restore and improve the athlete’s performance in an extremely short time; help normalize night sleep.
On weekends and days off from competition, athletes strive to restore their strength and improve performance using restorative massage (1–3 sessions). After the completion of the competition, the complex of medical and biological means of recovery includes types of restorative massage (manual, vibration, ultrasound) in combination with a bath, hydromassage, aeroionotherapy and other types of influences.
Self-massage
In everyday conditions, it is not always possible to use the services of a massage specialist. In such cases, you can use self-massage. When starting to master the technique of self-massage, you must follow the following rules:
Make all movements with the massaging hand along the flow of lymph to the nearest lymph nodes;
Massage the upper limbs towards the elbow and axillary lymph nodes;
Massage the lower limbs towards the elbow and inguinal lymph nodes;
Massage the chest in front and to the sides towards the armpits;
Massage the neck downwards towards the supraclavicular lymph nodes;
Massage the lumbar and sacral areas towards the inguinal lymph nodes;
Do not massage the lymph nodes themselves;
Strive for optimal relaxation of the muscles of the massaged body parts; hands and body must be clean; in some cases, self-massage can be performed through thin cotton or woolen underwear.
It should be noted that self-massage requires significant muscle energy from the massager, creates a large load on the heart and respiratory organs, like any physical work, causing the accumulation of metabolic products in the body. In addition, when performing it there is no freedom in movement, and individual manipulations are difficult. This limits the reflex effect of massage on the body. Self-massage can be performed at any time of the day, in any comfortable position - at a desk, in a car seat, in the forest during a hike, on the beach, in a bathhouse, etc. Knowing the basics of acupressure, you can effectively prevent various dysfunctions of the body and diseases.
Hygienic basics of massage
The room for massage should be dry, bright (illumination 120–150 lux), equipped with supply and exhaust ventilation, providing 2–3 air exchanges per hour. It is advisable to have a separate massage room with an area of about 18 m2. It should contain:
Stable, upholstered in leatherette, lined with foam rubber or a layer of sea grass, a massage couch (if possible with three moving planes and electrically heated) 1.85–2 m long, 0.5–0.6 m wide, 0.5–0 m high 7 m ( rice. 4);
Rice. 4. Massage couches: a – regular; b – with electric heating
Round cushions covered with leatherette, 0.6 m long, 0.25 m in diameter;
Massage table, upholstered in leatherette, dimensions 0.8 x 0.6 x 0.35 m;
A cabinet for storing clean sheets, bathrobes, towels, soap, talcum powder, massage devices, apparatus, Sollux lamps and other necessary equipment used in massage;
First aid kit, which contains: cotton wool, sterile bandages, alcohol solution of iodine, adhesive plaster, boron petroleum jelly, disinfectant ointment, ammonia, camphor-valerian drops, ointments, rubbing, powders, elastic bandage;
Sink with cold and hot water supply.
The floor in the office should be wooden, painted or covered with linoleum, the air temperature should be from +20° C to +22° C, and the relative humidity should not be higher than 60%. In the office it is advisable to have an hourglass or procedure clock, a device for measuring blood pressure, a stopwatch, a wrist dynamometer, and a tape recorder.
More detailed operating rules and a list of equipment for massage rooms are set out in the Handbook of Occupational Safety and Health for Health Care Workers (M.: Medicine, 1975).
Requirements for the massaged
Before the massage, it is advisable to take a warm shower or wipe yourself with a damp towel, wipe yourself dry, and expose only the part of the body being massaged so that clothing does not interfere with the massage. If there is significant hair growth, you can massage it through your underwear or use creams and emulsions. Abrasions, scratches, scratches and other skin damage must be pre-treated. For the greatest effect of massage, it is necessary to achieve complete relaxation of the muscles of the massaged area. This condition occurs in the so-called average physiological position, when the joints of the limbs are bent at a certain angle ( rice. 5).
Rice. 5. Average physiological position of the limbs during massage
Requirements for a massage therapist
In the rules of behavior of a massage therapist, it is necessary to highlight 2 main aspects of mastering massage - psychological and technical. Psychological factors include attentiveness, patience, tact, friendliness, calmness and confidence in the correct implementation of the massage session plan, taking into account the condition of the person being massaged. Technical – the ability to perform any type of massage, choose the most effective techniques, observe a rational sequence of basic and auxiliary massage techniques, take into account the adequacy of the patient’s response to a massage session or course.
Rules for working as a massage therapist
It is necessary to establish a relationship of trust between the person being massaged and the specialist, which is achieved by the latter’s ability to establish good contact with the patient. The success of treatment often depends on this.
The work of a massage therapist involves a lot of physical activity, so you need to pay attention to preventing pathological changes in the cervical and lumbar spine, the appearance of congestion in the lower extremities, in order to prevent the occurrence of occupational diseases (humeral periarthritis, flat feet, varicose veins, tendovaginitis, myositis, radiculitis). To do this, you need to perform special relaxation exercises. You should rest while sitting.
The massage therapist must have a good knowledge of anatomy, the physiological effects of individual massage techniques, be able to conduct a diagnostic palpation examination, and have a developed sense of touch. It is necessary to comply with hygienic requirements, cut your nails short, for oily hands use nourishing creams “Tomato”, “Victoria”, etc., for dry skin (peeling) use creams “Velour”, “Peach”, “Morning”, “Nectar” . When washing hands, the water should have a temperature of 18–20°C. If the skin of your hands becomes dry from frequent washing, then you should use “Cosmetic”, “Spermaceti”, “Glycerin”, “Vaseline”, “Amber” soaps. Clothes should be loose, there should be no objects on the hands that could injure the skin of the person being massaged, it is better to have low-heeled shoes.
You should choose the most comfortable working position, maintain the correct breathing rhythm, work with both hands, involving only those muscles that perform this massage technique. After clarifying the patient’s complaints and determining the condition of his tissues, it is necessary, together with the doctor, to determine the massage technique, taking into account the clinical forms of the lesion, the characteristics of the underlying and concomitant diseases. If, during the course, the massage therapist considers it necessary to make any adjustments to its implementation, which may be caused by the patient’s negative reactions to certain manipulations or the appearance of new clinical signs of the disease, it is necessary to consult with the attending physician.
There should be absolute silence in the massage room, and only at the request of the person being massaged can you turn on music or carry on a conversation, taking into account the patient’s condition, trying not to cause negative emotions in him, not to tire him, and to listen to all the patient’s responses to various manipulations. The person being massaged can be in a sitting position, lying on his back, stomach, on his side, sometimes standing ( rice. 6).
Rice. 6. Postures of the person being massaged during the massage: a – lying on his stomach; b – lying on your side; c – lying on your back; g – sitting
When performing a massage, the patient's muscles must be completely relaxed, firm support must be provided for the massage therapist, the massage therapist and the patient must be in comfortable positions.
table 2
Position of the person being massaged and the massage therapist during massage
Methodology
Massage can be performed directly in the affected area or above it in case of swelling, sharp pain, and also symmetrically to the lesion if it is impossible to carry out direct manipulations in this area (plaster, fixing bandage, violation of the integrity of the skin).
Massage procedure just like self-massage, it consists of 3 stages: 1) introductory – for 1–3 minutes. using gentle techniques, prepare the person being massaged for the main part of the procedure; 2) main – for 5–20 minutes. and more differentiated targeted massage is used, corresponding to the clinical and physiological characteristics of the disease; 3) final – within 1–3 minutes. reduce the intensity of the special effect, while all body functions are normalized, breathing exercises are carried out, if necessary (in the treatment of neuritis of the facial nerve, the presence of a plaster cast), ideomotor movements are used with the sending of volitional impulses, articular gymnastics ( Fig.7).
Massage should not cause increased pain. After it, you should experience feelings of warmth, comfort, relaxation in the massaged area, improved overall well-being, increased joint mobility, drowsiness, and breathing may become easier and freer. The duration of the session, depending on the indications, can be from 3 to 60 minutes.
Rice. 7. The sequence of a general classical massage session: 1 – back; 2 – neck; 3 – pelvis; 4, 6 – foot; shin (on the back surface); 5, 7 – thigh (on the back surface); 8, 11 – foot, lower leg (along the front surface); 9, 12 – thigh (along the front surface); 10 – left hand; 13 – right hand; 14 – front chest; 15 – belly. The patient lies first on his stomach, then on his back,– location of the massage therapist during the massage session
Massage is prescribed daily or every other day, depending on the age and condition of the patient, as well as the area of the body being massaged. According to indications, massage is carried out 2-3 times a week, combined with baths, ultraviolet irradiation and other types of complex treatment.
Massage course includes from five to twenty-five procedures depending on the severity of the disease and the condition of the person being massaged. Breaks between courses can last from ten days to 2-3 months, in each case this is decided individually. The number of procedures after the break, depending on the patient’s condition, can be reduced or increased.
The massage course is divided into 3 periods: 1) introductory – 1–3 procedures necessary to determine the body’s response to massage (reduction of pain, drowsiness, ease and freedom of movement). During this period, the tolerance of individual massage manipulations is determined, they strive to influence the entire body as a whole, without highlighting reflex areas; 2) main - starting from the 3-4th and up to the 20-23rd procedure, a strictly differentiated massage technique is used, taking into account the clinical picture, the physiological state of the person being massaged and the characteristics of his disease, while paying attention to functional changes in the massaged areas of the body. During this period, the intensity of exposure is gradually increased from procedure to procedure; 3) final - consists of 1-2 procedures, if necessary, you can teach the patient self-massage, showing a rational complex and sequence of techniques for individual areas of the body, performing breathing exercises, and also recommend physical exercises for independent exercise using massagers, massage devices and balneological procedures. The time limit for a massage is determined by the duration in minutes or by the number of massage units for a given procedure ( table 3).
Table 3
Number of standard units for performing massage procedures
NOTES: 1. For 1 conventional massage unit (m.u.) a massage procedure (direct massage) is taken, which requires 10 minutes to complete. 2. The time of transitions (moving) to perform massage procedures outside the office is taken into account in conventional massage units at actual costs. 3. The specified standards cannot serve as the basis for establishing staffing levels and wage calculations, except for cases specifically stipulated in the current staffing standards and conditions of remuneration for massage nurses.
Indications and contraindications for the use (prescription) of massage
Massage and self-massage are indicated for all healthy people; they are also used for various diseases. Massage and self-massage can be used either separately or in combination with other types of treatment. Indications for prescribing massage during various periods of a person’s illness or condition are wide. General indications are given here. The relevant sections provide a complete description of the types of massage for various diseases.
Indications
Diseases of the cardiovascular system : coronary heart disease, myocardial infarction, including after surgical treatment, post-infarction cardiosclerosis, hypertension and arterial hypotension, functional neurogenic disorders of the cardiovascular system, myocardial dystrophy, infectious-allergic myocarditis, heart defects, diseases of the arteries and veins.
Respiratory diseases : sore throat, pharyngitis, laryngitis, vasomotor and allergic rhinitis, chronic nonspecific lung diseases, chronic pneumonia and bronchitis, emphysema, pneumosclerosis, bronchial asthma without an exacerbation stage, pleurisy.
Injuries, diseases of the musculoskeletal system : rheumatoid arthritis and other damage to the ligamentous apparatus of the joint, dislocations, tendinitis, tenosynovitis, paratenonitis, periostitis, degenerative processes in the joints, ankylosing spondylitis, osteochondrosis of various parts of the spine, bruises, sprains, spinal curvatures, flat feet, disorders posture.
Diseases and damage to the nervous system : trauma to the nervous system, consequences of cerebrovascular accident, residual effects of poliomyelitis with spastic and flaccid paralysis, cerebral atherosclerosis with chronic cerebral circulatory failure, cerebral palsy, neuralgia, neuritis, plexitis, radiculitis with degenerative processes in the intervertebral discs, parkinsonism, diencephalic syndromes, solarites, polyneuritis.
Diseases of the digestive system outside the acute phase : colitis, intestinal dyskinesia, gastritis, prolapse of the stomach (gastroptosis), peptic ulcer (without a tendency to bleeding), diseases of the liver and gall bladder (gall bladder dyskinesia), as well as conditions after cholecystectomy and operations for peptic ulcer of the stomach and duodenum.
Inflammatory diseases of male and female genital organs in subacute and chronic stages : chronic urethritis, prostatitis, vesiculitis, incorrect positions and displacements of the uterus and vagina, anatomical inferiority of the uterus (congenital and acquired), its functional inferiority, anatomical and functional insufficiency of the pelvic floor ligamentous apparatus, pain in the sacrum, coccyx, in the uterus and ovaries during the intermenstrual period.
Skin diseases : seborrhea of the scalp, acne of the face and torso, psoriasis, lichen planus, scleroderma, ichthyosis, hair loss, neurodermatitis.
Diseases of the ear, nose and throat : sore throat, pharyngitis, laryngitis, rhinitis, nosebleeds.
Eye diseases : glaucoma, keratitis, conjunctivitis, optic neuritis.
Metabolic disorders : excessive obesity, diabetes, gout.
Massage is also used for headaches and sleep disturbances, sexual weakness, dental diseases and increased irritability. The use of massage and self-massage is widely indicated for various ailments.
Contraindications
Massage and self-massage are contraindicated in acute febrile conditions, acute inflammatory processes, bleeding and a tendency towards it, blood diseases, purulent processes of any location, various skin diseases (infectious, fungal etiology), gangrene, acute inflammation, thrombosis, significant varicose veins, trophic ulcers, atherosclerosis of peripheral vessels, thrombangitis in combination with atherosclerosis of cerebral vessels, vascular aneurysms, thrombophlebitis, inflammation of the lymph nodes, active form of tuberculosis, syphilis, chronic osteomyelitis, benign and malignant tumors of various locations (before surgical treatment). Contraindications to massage are also unbearable pain after injury (causalgic syndrome), mental illness, circulatory failure of the 3rd degree, hypertensive and hypotensive crises, nausea, vomiting, pain of an unknown nature on palpation of the abdomen, bronchiectasis, pulmonary, cardiac, renal, hepatic failure. It must be emphasized that in some cases, contraindications to massage and self-massage are temporary and occur in the acute period of the disease or during an exacerbation of a chronic disease.
Issues related to the appointment of massage require adherence to medical ethics and tact. When prescribing a massage, the doctor must indicate in what combination with other procedures its types should be used, must constantly monitor the patient, and the massage therapist must inform the doctor about all deviations. This approach to the use of massage makes this method the most effective in treating various diseases and injuries.
The effect of massage on the body
The covering of the human body, deep tissues (subcutaneous tissue, muscles, periosteum), as well as internal organs form a single functional whole. In this regard, a massage specialist needs to know the structure, functions of tissues and systems of the human body.
The skin is in direct contact with the external environment and actively participates in the life of the body. This is a huge receptive field. The skin contains nerve fibers and their endings, blood vessels, muscles, sweat and sebaceous glands and other formations.
Clean, healthy skin is involved in breathing, blood circulation, heat regulation, metabolism, production of enzymes and mediators, cleansing the body of harmful toxins and excess water, i.e. the skin functions as auxiliary lungs, heart, liver, kidneys; per day, the skin secretes 650 g of sweat (this is 27% of the daily volume of water released from the body), a large amount of salts and about 10 g of carbon dioxide. When stressed, the skin can produce up to 3.5 liters of sweat in 1 hour.
Under certain conditions, dilated skin vessels are capable of accommodating an additional volume of more than 1 liter of blood (the volume of blood circulating in the body is about 5 liters).
The skin is a complex sensitive system. It contains over 3 million pain receptors. It is estimated that on average per 1 cm 2 of skin there are 2 thermal, 12 cold, 25 tactile and 150 pain points.
The skin consists of 3 layers: the epidermis, the skin itself (dermis) and subcutaneous tissue ( rice. 8).
Rice. 8. Schematic representation of the structure of the skin: 1 – nerve receptors; 2 – hair; 3 – muscle that lifts the hair; 4 – sweat gland; 5 – hair papilla; 6 – hair follicle; 7 – sebaceous gland; 8 – blood vessels
The epidermis is the outer layer of the skin, which directly connects the body with the external environment and consists of 5 layers.
Its lower layer, the bezel, consists of epidermocytes, dividing cells. The cells of subsequent layers are derivatives of these cells. In addition to them, this layer contains cells that produce the pigment melanin, the content of which determines the color of the skin.
Above it is the spinous layer, in which there are several rows of cubic and diamond-shaped cells. Above it is a granular layer, consisting of one or several layers of cells with smooth contours. On the palms and soles, the granular layer is significantly thickened and contains 4–5 rows of cells.
The first 2 layers of the epidermis (basal and spinous) are called the mucous (malpighian) layer. Above the granular layer there is a shiny layer, consisting of 2-3 rows of flat cells; it is well developed on the palms and soles, but is not visible on the red border of the lips and on the foreskin of the penis. The most superficial layer of the epidermis, the horny layer, contains completely keratinized anucleate cells - horny plates.
The dermis is poor in cells and is a dense connective tissue rich in elastic and collagen fibers, which gives the skin elasticity and strength. This layer contains a large number of blood vessels, forming 2 networks - deep and superficial, which provide nutrition to the epidermis.
Subcutaneous adipose tissue is a loose network of numerous connective tissue fibers in which fat cells are located. This layer has different thickness depending on its location. So, on the abdomen, buttocks, palms, soles it is well developed, but on the foreskin of the penis, ears, border of the lips - weakly.
Subcutaneous adipose tissue protects the body from bruises and hypothermia. Blood and lymphatic vessels, nerve endings, hair follicles, sweat, sebaceous glands, muscles are located in the dermis and subcutaneous adipose tissue.
Arterial vessels go to the skin in 3 rows: some feed the subcutaneous fat layer and the mobile area of the skin, others feed the fatty tissue and sweat glands, and others feed the papillae, hair follicles and sebaceous glands. Then the blood flows through the capillaries into the veins, which form 4 networks: 2 are located under the papillae, the 3rd is in the deep layer of the skin, the 4th is in the subcutaneous tissue.
The lymphatic system of the skin consists of 2 networks of lymphatic capillaries and 2 sections of efferent lymphatic vessels. The draining lymphatic vessels of the skin drain into the regional lymph nodes. The skin contains many nerve endings and nerves. The skin glands, despite their small size, perform important functions.
Sweat glands (mostly on the palms and soles) secrete a secretion (sweat), which is a liquid containing about 1% dry matter (salt, etc.) and 99% water.
Sebaceous glands are small sacs located in the hair follicle area. Each hair has several sebaceous glands, their ducts open into the upper expanded part of the hair follicle - the funnel. Sebaceous glands are located in the upper third of the skin itself and are not found on the soles and palms.
During the day, the sebaceous glands secrete up to 2-4 g of fat, which is distributed over the surface of the skin, which ensures softness, elasticity of the epidermis and protects hair and skin from drying out and at the same time does not allow fluid to pass through. Fat serves to lubricate the skin, protects it from cracks, dryness and reduces friction between the folds of the skin.
The hair on the skin is long, bristly, vellus, they protect one or another part of the body from pollution, thermal, chemical and other influences.
The permeability of the skin in its different layers is not the same. Thus, the horny, lucid and granular layers are less permeable, but in the skin itself and in the subcutaneous adipose tissue, due to the presence of a network of blood vessels, the skin’s ability to absorb is significantly increased.
Skin massage not only affects its various structural layers, but also affects the central nervous system through numerous extero- and interoreceptors. During massage, dead cells are mechanically removed from the skin, which significantly improves skin respiration and enhances the release of decay products. During massage, the skin vessels dilate, blood circulation improves, skin nutrition and the activity of the glands embedded in it are activated (histamine and acetylcholine are released, which dilates the skin vessels and increases blood flow). The skin tone increases, it becomes smooth, elastic, elastic, pink, clean.
The variety of receptors embedded in the skin makes it possible to achieve positive results in the treatment of various diseases by directly influencing certain local areas of the skin, the corresponding projection areas of individual internal organs.
Muscular system
Skeletal muscles ( rice. 9–1 and 9–2), of which there are more than 400, constitute the active part of the human movement apparatus. In general, they make up about 1/3 of the total body weight.
The mass of muscles located on the limbs is equal to 80% of the total mass of the muscular system. The functions of muscles are strictly defined, each muscle has a known size, shape, is in certain topographic relationships with the tissues surrounding it, and performs work that is completely dependent on the conditions of blood circulation and innervation. The muscle contracts under the influence of impulses that are transmitted to it along efferent motor (centrifugal) pathways from the central nervous system.
The muscle is also innervated by centripetal, sensory (afferent) nerves, the endings of which are proprioceptors. Depending on the state of the muscle fibers (contraction, stretching), the excitation of proprioceptors changes. A motor neuron (motor, efferent nerve), approaching a muscle, branches into many endings - synapses, through which each muscle fiber is connected to the central nervous system.
Muscles have the ability to shorten, stretch, and also have viscosity, which is caused by internal friction of muscle tissue particles. A numerous group of muscles originate from the bones (sometimes from the fascia) and are attached to the bones.
Rice. 9–1. Human muscles: a – front view: 1 – pectoralis major muscle; 2 – serratus anterior muscle; 3 – rectus abdominis muscle; 4 – white line of the abdomen; 5 – external oblique abdominal muscle; 6 – inguinal ligament; b – rear view: 1 – trapezius muscle; 2 – latissimus dorsi; 3 – rhomboid major muscle; 4 – gluteus medius muscle; 5 – gluteus maximus muscle; 6 – sternocleidomastoid muscle
There are muscles of the trunk, head, and limbs. The muscles of the body are divided into posterior (muscles of the back, neck) and anterior (chest, neck, abdomen).
Large muscle groups can be exposed to massage. Under the influence of various massage manipulations, the electrical activity of the muscles increases, their elastic-viscous properties change, redox processes change significantly, the flow of oxygen increases, the massage of the massaged muscles becomes larger, gas exchange increases, and the release of carbon dioxide and nitrogen increases.
Rice. 9–2. Human muscles: c – muscles of the lower limb: 1 – biceps femoris; 2 – semitendinous muscle; 3 – semimembranosus muscle; 4 – calf muscle; 5 – calcaneal tendon; 6 – quadriceps femoris muscle; 7 – proper patellar ligament; 8 – tibialis anterior muscle; 9 – extensor digitorum longus; 10 – long peroneal muscle; d – muscles of the upper limb: 1 – teres minor; 2 – teres major muscle; 3 – biceps brachii; 4 – triceps brachii muscle; 5 – brachialis muscle; 6 – brachioradialis muscle; 7 – superficial digital flexor tendon; 8, 10 – superficial flexor of the fingers; 9 – flexor carpi radialis; 11 – flexor carpi radialis; 12 – flexor carpi radialis tendon; 13 – elbow muscle; 14 – short extensor pollicis
Circulatory system
Serves to ensure constant circulation of blood and lymph, through which organs and tissues are supplied with nutrients and oxygen, the release of metabolic products from them, humoral regulation of others. Circulatory system ( rice. 10) consists of the heart's blood vessels (arteries, capillaries, veins).
Rice. 10. Circulatory system: 1 – superficial temporal artery; 2 – facial artery, 3 – vertebral artery; 4 – common carotid artery; 5 – subclavian arteries and vein; 6 – axillary artery and vein; 7 – root of the lung, 8 – arteries supplying the humerus; 9 – hepatic veins, 10 – brachial artery; 11 – celiac trunk; 12 – deep artery of the shoulder; 13 – superior mesenteric artery; 14 – abdominal part of the aorta, 15 – inferior mesenteric artery; 16 – inferior vena cava; 17 – radial artery; 18 – ulnar artery; 19 – deep artery, circumflex ilium, 20 – lateral artery, circumflex femur, 21 – femoral artery and vein; 22 – deep femoral artery; 23, 24 – popliteal artery; 25 – anterior tibial artery; 26 – posterior tibial artery, 27 – peroneal artery; 28 – dorsal artery of the foot, 29 – superficial temporal vein, 30 – facial vein; 31 – external jugular vein; 32 – internal jugular vein; 33 – superior vena cava; 34 – aortic arch, 35 – pulmonary trunk; 36 – pulmonary veins; 37 and 41 – lateral saphenous vein of the arm; 38 and 44 – medial saphenous vein of the arm; 39 – renal veins and arteries; 40 – intermediate vein of the elbow; 42 – common iliac artery and vein; 43 – intermediate vein of the forearm; 45 – superficial veins of the thigh and leg; 46 – dorsal venous network of the foot, elbow
The heart is a 4-chambered hollow muscular organ that produces rhythmic contractions (systole) and relaxations (diastole), due to which blood moves through the vessels. The heart is the central “pumping station” of the blood circulation. With each beat, 50–70 ml of blood is ejected into the aorta. At a contraction frequency of 70 per minute. this amounts to 4–5 liters. The heart has 2 atria and 2 ventricles. Venous blood flows in the right half (right atrium and right ventricle), and arterial blood flows in the left half. The work of the heart occurs in 3 phases: 1) contraction of both atria, as a result of which blood from the atria enters the ventricles; 2) contraction of both ventricles, with blood from the left ventricle entering the aorta, from the right ventricle into the pulmonary trunk, and the atria relaxing and receiving blood from the veins entering them; 3) a pause during which the heart muscle rests.
The superior and inferior vena cava, coronary sinus (sinus) and small venous vessels flow into the right atrium - the smallest veins of the heart. When the ventricles contract, blood is expelled from the right ventricle into the pulmonary trunk. 4 pulmonary veins flow into the left atrium (2 each on the right and left sides). Through these veins, the aorta originates in the atrium, from which, in turn, arteries arise.
Arteries are vessels through which blood flows from the heart to the organs. All arteries, depending on their diameter, can be divided into large, medium and small. In relation to the organ, they are distinguished: extraorgan and intraorgan arteries. The thinnest arterial vessels are called arterioles, they pass to capillaries.
Capillaries are the smallest blood vessels through the walls of which all metabolic processes between blood and tissues take place. They are located in the form of networks in the tissues of all organs and connect the arterial system with the venous system. The number of capillaries in different organs is not the same and ranges from several tens to several thousand per 1 mm 2 of organ tissue.
It should be noted that not all capillaries function simultaneously, but only 1/20–1/50 of them. The number of functioning capillaries depends on the condition of the organ. The capillaries that are not functioning at the moment are narrowed and do not allow the formation of blood elements (erythrocytes, leukocytes, etc.) through.
Blood capillaries turn into venules. Between arterioles and capillaries there are transitional vessels - precapillaries, and between capillaries and venules - postcapillaries. Vessels (arterioles, precapillaries, capillaries, postcapillaries and venules) make up the microvasculature, the movement of blood in which is called “microcirculation”.
Veins are vessels through which blood flows from organs to the heart. Compared to arteries, in veins blood flows in the opposite direction, that is, from smaller vessels to larger ones. In each organ, the smallest venous vessels - venules - give rise to an intraorgan system of veins, from which blood flows into extraorgan veins, collecting blood from different organs and areas of the body into the largest veins - the superior and inferior vena cava, which flow into the heart. The pulmonary veins also drain into the left atrium.
Unlike arteries, most veins are equipped with valves that prevent blood from flowing back. The walls of arteries and veins are supplied with nerves (sensory and motor) and nerve endings. All blood vessels are united into the systemic and pulmonary circulation. The systemic circulation begins with the aorta, which emerges from the left ventricle and carries arterial blood through its branches to all organs of the body ( rice. eleven) and ends with the vena cava. The lesser circle (pulmonary) begins with the pulmonary trunk, which emerges from the right ventricle and delivers venous blood through its branches (pulmonary arteries) to the lungs. When passing through the blood capillaries of the lungs, venous blood turns into arterial blood, which flows through the four pulmonary veins. The pulmonary circulation ends with these veins flowing into the left atrium.
Rice. eleven. Circulatory organs (diagram): 1 – heart; 2 – arteries; 3 – veins; 4 – capillaries; 5 – left ventricle; 6 – right atrium; 7 – superior vena cava; 8 – inferior vena cava; 9 – aorta; 10 – right ventricle; 11 - pulmonary trunk; 12– capillaries of the lungs; 13 – pulmonary veins; 14 – left atrium
A massage specialist needs to know that the pulmonary trunk is located in the anterior mediastinum and carries venous blood. As it exits the right ventricle under the aortic arch, it divides into the right and left pulmonary arteries. Each pulmonary artery goes to the gate of the corresponding lung, where it is divided according to the number of pulmonary lobes, then the vessels are divided into smaller ones.
The pulmonary veins leave two of each lung through their gates and empty into the left atrium. They carry arterial blood, which flows from the capillaries adjacent to the pulmonary alveoli through venules and larger intraorgan venous vessels. In addition to the pulmonary arteries, pulmonary veins and intraorgan (intrapulmonary) branches, there are bronchial arteries, veins and their branches inside the lungs, related to the systemic circulation.
Large branches depart from the aortic arch: the brachiocephalic trunk, the left common carotid artery and the left subclavian artery. These vessels carry blood to the anterior chest wall. The brachiocephalic trunk is divided into the right common carotid and right subclavian arteries. The common carotid artery is a steam artery and is divided into the external and internal carotid arteries. Numerous branches depart from the external carotid artery (facial, occipital, sternocleidomastoid, maxillary, superficial temporal, and many others).
The internal carotid artery gives off the ophthalmic artery and then divides into the anterior and middle cerebral arteries, the posterior communicating artery, and the choroid plexus artery. The right subclavian artery is a branch of the brachial trunk, and the left one is a branch of the aortic arch, passing in the neck above the dome of the pleura. The vertebral, internal thoracic, transverse cervical arteries, etc. depart from it.
The arteries of the upper limb begin with the largest axillary artery, which continues into the brachial artery and is divided into the ulnar and radial, which form 2 palmar arches on the hand - superficial and deep.
The thoracic aorta is a continuation of the aortic arch; Having passed through the arterial opening of the diaphragm, it continues into the abdominal aorta. Next to the thoracic aorta are the hemizygos vein (left), azygos vein and thoracic lymphatic duct (right), and the esophagus. The branches of the thoracic aorta supply blood to the walls of the chest and all organs of the chest cavity (except for the heart) and are divided into parietal and intramural. The parietal branches are: posterior intercostal arteries in the count. 10 pairs The superior phrenic arteries, two in number, go to the diaphragm. The organ branches of the thoracic aorta are bronchial, esophageal, mediastinal and pericardial.
The abdominal aorta at the level of 4–5 lumbar vertebrae is divided into the right and left common iliac arteries. On its way, the abdominal aorta gives off branches to the walls and to all organs of the abdomen. The common iliac arteries, right and left, are the terminal branches of the abdominal aorta. At the level of the sacroiliac joint, the common iliac artery is divided into internal and external. The internal iliac artery is divided into anterior and posterior trunks, which give off branches that supply organs and the walls of the pelvis.
The arteries of the lower limb originate from the external iliac artery. The femoral artery, passing under the inguinal ligament, goes down and medially, reaching the popliteal fossa, continues into the popliteal artery. The popliteal artery gives off 5 branches to the knee joint, it passes to the back surface of the leg and immediately divides into 2 terminal branches - the anterior and posterior tibial arteries.
The anterior tibial artery passes on the anterior surface of the leg, then continues into the dorsal artery of the foot. On its way, the anterior tibial artery gives branches to the knee joint and the anterior muscles of the leg. The branches of the dorsal artery of the foot are the tarsal arteries, arcuate artery, etc. The posterior tibial artery runs along the back surface of the leg, emerging from under the calcaneal tendon to the medial malleolus; bending around it, it passes to the plantar surface of the foot, where it divides into 2 terminal branches - medial (inner) and lateral (outer). The medial and lateral plantar arteries give off branches that supply blood to the bones, muscles and skin.
Many veins are located next to arteries. However, there are also veins that are not topographically connected to arteries, such as superficial cutaneous veins. More often, an artery is accompanied by 2 companion veins, and therefore the total number of veins is much greater than arteries. The peculiarity of veins is that they have valves that prevent the reverse flow of blood, but, in addition to this factor, blood from the capillaries enters the venous system under negligibly low pressure, unlike the arterial one.
When muscles contract, the veins mechanically either expand or contract ( rice. 12). When a vein expands, blood is sucked into it, and when it collapses, it rushes to the heart. The filling of the veins with blood is influenced by the position of the limbs, head, torso, as well as the act of inhalation, during which the suction action of the chest accelerates the flow of blood. The venous bed is represented by two systems - the hollow and portal veins. The vena cava includes 2 large trunks (the superior and inferior vena cava, which receive the own veins of the heart, veins of the head, neck of the extremities, walls of the chest and abdominal cavities and pelvis, internal organs, with the exception of the veins of the gastrointestinal tract and spleen).
Rice. 12. Cutaneous veins of the lower limb (front and back views) and diagram of the “muscle pump”: 1 – superficial vein surrounding the ilium; 2 – place of confluence of the great saphenous vein; 3 – great saphenous vein of the lower limb; 4 – venous plexus of the dorsum of the foot; 5 – superficial epigastric vein; 6 – external genital veins; 7 – small, or posterior, saphenous vein of the leg; 8 – venous plantar network
The portal vein system collects blood from the stomach, intestines, pancreas and spleen and sends it to the liver, where, after passing through the capillary bed of the hepatic lobules, the blood then enters the inferior vena cava.
Massage manipulations affect the condition of the skin capillaries, helping to accelerate capillary blood flow, increase blood supply to the massaged area, and improve tissue trophism (nutrition). The reflex mechanism of massage is also widely known, when certain remote areas of the body are massaged, and the effect of increasing skin temperature and increasing blood flow is observed in the non-massaged limb. It is noted that the regulation of vascular tone in the periphery involves not only mechanical effects, but also substances such as acetylcholine and histamine, which also confirms the neurohumoral effect of massage on the circulatory system.
Lymphatic system
Closely related to the circulatory system. The supply of tissues with nutrients and oxygen from the blood occurs through tissue fluid. 1/4 of the total body mass is tissue fluid and lymph. Penetrating into the lumen of the lymphatic capillaries, tissue fluid changes its chemical composition, is enriched with formed elements and, thus, turns into lymph. Lymph contains lymphocytes, a small number of eosinophils, and monocytes.
The lymphatic system includes vessels of different diameters, lymph nodes, as well as lymphatic organs - tonsils, lymphatic follicles (nodules) of the mucous membranes. Lymph moves in one direction - from the organs to the heart - and pours into the venous bed.
All massage manipulations are better and even sometimes necessary to be carried out along the lymphatic vessels, thereby accelerating lymphatic drainage from organ tissues. Lymph nodes perform hematopoietic and protective (barrier) functions. Lymphocytes multiply in them and pathogenic microbes are phagocytosed. Immune bodies are also produced in the lymph nodes.
The lymphatic system begins with lymphatic capillaries. They are a closed system of tubes. From the capillaries, lymph enters the lymphatic vessels. The direction of lymph flow is ensured by a large number of valves, which are mainly located in pairs. Larger lymphatic vessels accompany the blood vessels, entwining them. All lymph passes through the thoracic lymphatic duct 6 times a day, and a complete blood circulation is completed in 20–25 s. Along the path of the lymphatic vessels, nodes are located in certain places - these are formations of dense consistency, of various sizes and shapes. Lymph nodes are biological filters for lymph flowing through them; under pathological conditions, the lymph nodes can suddenly enlarge.
Lymph nodes are located in groups in certain places, often along the blood vessels, and are shrouded in loose connective tissue. The most permanent and numerous groups of nodes are located in the neck, chest (near the trachea and bronchi), abdomen, groin area, in the axillary cavity, etc.
Each lymph node receives several lymphatic vessels. The flow of lymph in the nodes slows down, and enrichment with cellular elements occurs here. Lymph flows through the efferent lymphatic vessels into the lymphatic ducts. The main one is the thoracic duct, which collects lymph from almost the entire body, with the exception of the right half of the head and neck, the right upper limb, the right half of the heart and part of the diaphragm and liver. From the listed areas of the right side, the right duct receives lymph.
The thoracic duct begins in the abdominal cavity at the level of the 2nd lumbar vertebra from the confluence of the right, left lumbar and intestinal trunks. Lymph flows from the lower extremities, pelvis and abdominal walls along the lumbar trunks into the thoracic duct. Along the intestinal trunk - from the abdominal organs. From the abdominal cavity, the thoracic duct passes through the aortic opening of the diaphragm into the chest cavity. At the level of 4–5 thoracic vertebrae, the duct shifts to the left, exits the neck and flows into the left venous angle, formed by the connection of the subclavian and internal jugular veins.
Three trunks flow into the terminal part of the thoracic duct: left bronchostinal, left jugular, left subclavian. The right lymphatic duct is very short (only up to 1.5 cm), it flows into the right venous angle. Lymph flows from the right half of the chest, the right half of the head and neck, and the right upper limb through the right lymphatic duct into the venous blood.
Lymphatic vessels and nodes of the lower limb are divided into deep and superficial ( rice. 13, a).
Superficial veins begin from the lymphatic network in the skin and subcutaneous tissue, located on top of their own fascia, and accompany the superficial veins.
Deep lymphatic vessels collect lymph from bone tissue, bone marrow and periosteum of the bones of the foot, leg, thigh, from capsules and ligaments of joints, from muscles, nerves, fascia, intermuscular tissue. They run everywhere next to deep blood vessels, starting on the back of the foot and on the sole. Most of the vessels carry lymph to the popliteal nodes, then they rise along with the femoral artery and reach the deep inguinal nodes.
Lymphatic vessels and nodes of the upper limb are also divided into deep and superficial ( rice. 13, b). Superficial ones begin from the lymphatic networks of the skin and the palmar surface of the fingers, then the vessels flow into the ulnar nodes, and through the efferent vessels from these nodes the lymph flows into the axillary nodes. Deep lymphatic vessels begin on the fingers and hands, collect lymph from bones, joints, muscles, go along with the main arteries of the forearm and reach the axillary nodes.
Rice. 13. Superficial lymphatic vessels of the lower limb (a) and upper limb (b)
The axillary nodes lie superficially and receive lymph from the superficial lymphatic vessels of the arm, chest wall, back and mammary gland.
The central nervous system does not have lymph nodes. In the head area ( rice. 14) there are occipital, postauricular, cervical (parotid), mandibular, mental and other lymphatic vessels and nodes. There are also deep and superficial lymphatic vessels on the head and neck. Deep cervical lymph nodes accompany the jugular vein in large numbers, and superficial ones lie near the external jugular vein. It is into these nodes that lymph flows from almost all the lymphatic vessels of the head and neck, including the efferent vessels of other lymph nodes in these areas.
Rice. 14. Superficial lymphatic vessels of the face, head and neck (according to V. A. Stange)
Lymphatic vessels and nodes of the chest cavity are also divided into superficial and deep, which accompany the blood vessels at the hilum of the lungs. From here, the lymphatic vessels are directed to numerous large bronchopulmonary nodes located along the bronchi and especially at the tracheal bifurcation. Lymphatic vessels of the esophagus, diaphragm, liver, back, intercostal, pectoral muscles, mammary gland flow into the lymph nodes of the mediastinum, diaphragmatic, intercostal nodes ( rice. 15, a).
Lymph nodes and vessels of the abdominal cavity are located along the blood vessels. It is along the course of the abdominal aorta and inferior vena cava that the lumbar nodes are located. The celiac nodes are located in the abdominal cavity. In the pelvic area, all lymph nodes passing along the blood vessels have similar names ( rice. 15, b).
Rice. 15. Superficial lymphatic vessels: a – front surface of the body; b – posterior surface of the body
The external iliac, internal iliac and common iliac lie near the arteries of the same name, and the sacral nodes lie on the pelvic surface of the sacrum near the median sacral artery. Lymph from the organs flows mainly into the internal iliac and sacral nodes. Lymph flows into the lymph nodes of the abdominal cavity from the organs of this cavity and partially from its walls. The lumbar lymph nodes also receive lymph from the lower extremities and pelvis. Massage manipulations significantly accelerate the movement of lymph. Considering the importance of lymph flow in eliminating residual effects of inflammation, massage manipulations should always be carried out from the periphery to the center, i.e. in the direction of lymph flow along the lymphatic pathways to the lymph nodes. Massage can regulate lymph flow, which is very important for injuries and diseases.
Nervous system
The vital activity of all body systems and their parts is regulated and coordinated by the nervous system. Its essential role is to ensure the functional unity and integrity of the body. It determines the interaction between the body and the external environment, regulates physiological processes occurring in cells, tissues, organs, and also controls the work of skeletal muscles, regulating the degree of tension, muscle relaxation, their strength, and the speed of muscle contraction.
I.P. Pavlov, noting the functions of the nervous system, emphasized that its activity is aimed both at unifying, integrating the work of all parts of the body, and at connecting the body with the environment.
The unified nervous system is conventionally divided into 2 main parts - animal (somatic) and autonomic.
In the animal and autonomic parts of the nervous system, a central division is distinguished (brain and spinal cord) and peripheral (cranial and spinal nerves, the border sympathetic trunk, its branches and numerous autonomic ganglia in the walls of the internal organs and near them). The autonomic nervous system innervates primarily internal organs (digestive, respiratory, excretory, circulatory and endocrine glands). It also takes part in the innervation of skeletal muscles, regulating metabolism in the muscles. The somatic nervous system provides innervation to the musculoskeletal system (bones, joints, muscles), skin, and sensory organs.
The central nervous system consists of the brain and spinal cord. It is built from a huge number of nerve cells (neurons) and their processes (nerve fibers). Bundles of nerve fibers connect one part of the brain and spinal cord with others and perform a conductor function - nerve impulses are transmitted through them. Through the branches of the nerves, the central nervous system communicates with the organs. The brain is located in the cranial cavity and includes 2 hemispheres and 5 sections: medulla oblongata, posterior, middle, intermediate, terminal. 12 pairs of cranial nerves extend from them to the periphery. All cranial nerves, with the exception of the vagus, innervate the organs of the head and neck.
The human spinal cord is located in the spinal canal from the upper edge of the 1st cervical vertebra to the lower edge of the 1st lumbar vertebra. Along the entire length of the spinal cord, corresponding to the segments of the body, 31 pairs of spinal nerves depart from it, which leave the spinal canal through the intervertebral foramina. The spinal cord has signs of a segmental structure. A segment of the spinal cord is understood as a section of its gray matter corresponding to the position of a pair (both left and right) of spinal nerves innervating certain segments of the body (dermatomes).
There are 7 cervical, 12 thoracic, 5 lumbar, 5 sacral and 1 coccygeal segments ( rice. 16). The anterior branches of the thoracic spinal nerves are called intercostal nerves. They innervate the intercostal and other muscles of the chest and abdomen, and the cutaneous branches innervate the anterior and lateral surfaces of the chest ( rice. 17).
Rice. 16. Segmental division of the spinal cord: CI – VII – cervical region; T(D)I – XII – thoracic region; LI – V – lumbar spine; SI – V – sacrococcygeal region
Rice. 17. Cutaneous nerves: a – in front: 1 – frontal (I branch of the trigeminal nerve); 2 – infraorbital (II branch of the trigeminal nerve); 3 – mental (III branch of the trigeminal nerve); 4 – anterior and lateral cutaneous branches of the intercostal nerves; 5 – musculocutaneous nerve of the shoulder; 6 – medial external cutaneous nerve of the shoulder; 7 – external cutaneous branches of intercostal nerves; 8 – medial cutaneous nerve of the forearm; 9 – anterior cutaneous branches of the intercostal nerves; 10 – external cutaneous nerve of the forearm; 11 – external cutaneous nerve of the thigh; 12 – cutaneous branch of the iliohypogastric nerve; 13 – genital branch of the femoral-genital nerve; 14 – cutaneous branch of the femoral nerve; 15 – cutaneous branch of the obturator nerve; 16 – medial saphenous nerve of the calf; b – posterior: 1 – posterior branches of the thoracic nerves; 2 – posterior cutaneous nerve of the shoulder; 3 – posterior cutaneous nerve of the forearm; 4 – superior gluteal nerve; 5 – piriformis nerve; 6 – lower gluteal nerve; 7 – posterior cutaneous nerve of the thigh; 8 – lateral cutaneous nerve of the calf
The peripheral nervous system includes nerves and their branches, together with terminal devices that innervate various organs and tissues. Each segment (metamere) belongs to a specific pair of nerves, which have two symmetrical roots - sensory and motor.
The spinal nerves form several large plexuses - cervical, brachial, lumbar, sacral. The nerves emerging from each plexus innervate a specific area.
The cervical plexus is formed by the anterior branches of the four cervical nerves. It lies in the deep muscles of the neck and gives rise to nerves that innervate the skin of the lateral part of the occipital region, the auricle, the skin of the anterolateral region of the neck, clavicle, deep muscles of the neck, diaphragm, etc.
The brachial plexus is formed by the anterior branches of the four lower cervical nerves and most of the anterior branch of the first thoracic nerve. It is located in the lower neck behind the sternocleidomastoid muscle. There are two parts: supraclavicular and subclavian. The supraclavicular part gives off numerous branches to the deep muscles of the neck, to the muscles of the shoulder girdle and to part of the muscles of the chest and back. The subclavian part consists of the axillary nerve and a number of long branches - the musculocutaneous, median, ulnar, medial cutaneous nerve of the shoulder and forearm. All long branches innervate the free upper limb; the axillary nerve innervates the deltoid muscle, the capsule of the shoulder joint and the skin of the outer (lateral) surface of the shoulder.
The lumbar and sacral plexuses (the name “lumbosacral plexus” is more often used) form branches of the 12th thoracic and 1st–4th lumbar nerves. The nerves of this plexus innervate the muscles of the lower extremities, psoas muscles, abdominal muscles, iliacus muscle and skin.
The sacral plexus is formed from the 5th lumbar and the connections of all the sacral and coccygeal nerves. The nerves of the plexus innervate the muscles and partly the skin of the perineum, gluteal region, pelvic muscles, posterior thigh, all tissues, bones, joints, muscles, skin of the lower leg and foot. The branches of the sacral plexus, both superior and inferior, are the gluteal nerves, the pudendal nerve, the posterior cutaneous nerve of the thigh, the sciatic nerve, the tibial nerve, and the peroneal nerve.
Under the influence of massage manipulations, mechanical energy is transformed into the energy of nervous action, which gives the most complex reflex reactions. By changing the nature, strength, duration and areas of influence, it is possible to change the functional state of the cerebral cortex depending on the tasks facing the massage specialist - increase or decrease general nervous excitability or restore lost reflexes, improve tissue trophism, the activity of individual internal organs and tissues. If the massage is carried out incorrectly or incorrectly, a deterioration in the general condition may occur, nervousness, overexcitation, increased pain, and unpleasant sensations emanating from internal organs and tissues may appear. Reflex dosed effects can increase muscle tone, blood pressure, increase the content of adrenaline and sugar in the blood, increase blood clotting and cause other beneficial changes.
Massage and self-massage affect respiratory function, which can be observed in patients after surgical interventions in both the thoracic and abdominal cavities. At the same time, the function of external respiration significantly improves. In case of pneumonia and bronchial asthma, the effect of broncho-spasmolytics is significantly enhanced. The saturation of arterial blood with oxygen increases, as well as the release of carbon dioxide and oxygen consumption.
Under the influence of massage manipulations, substances such as histamine and acetylcholine are formed in the skin, which are carried throughout the body by the blood stream. A beneficial effect of massage on the indicators of blood coagulation and anticoagulation systems, lipid metabolism in patients with hypertension was noted. Indicators of the acid-base state of the blood, oxidation of lactic acid after muscular work (load) are normalized, and the urea content in the blood serum decreases.
Massage techniques
The technique of classical massage is described in various manuals. Many authors noted the need to preserve already established massage techniques, warning against the unreasonable desire of some specialists to change the technique of manipulation, complicating them and changing existing names. What is important is not the invention of new manipulations, but the development, based on long-existing techniques of classical massage, of private techniques used differentially in accordance with indications and taking into account the nature of the disease at a given stage of treatment.
In practice, there are 9 main massage techniques (stroking, squeezing, kneading, shaking, rubbing, active and passive movements, movements with resistance, percussive techniques, shaking), suggesting that their sequence be strictly observed when conducting a massage session. Other experts consider it advisable to distinguish 4 main techniques (stroking, rubbing, kneading, vibration), using them differentially, taking into account the clinical picture of the disease or the general condition of the person being massaged.
Massage techniques are sometimes divided according to their physiological effects: on the skin (stroking, rubbing, percussive techniques), on muscles (squeezing, kneading, felting, shaking, shaking, percussive techniques, movements), on joints, ligaments, tendons (movements, rubbing) . At the same time, A.F. Verbov, instead of the concept of “concussion,” introduced the term “vibration,” which combined all the techniques (tapping, shaking, chopping, shaking, shaking, patting).
Most authors believe that the main techniques of manual massage include stroking, rubbing, kneading, vibration and passive movements. When describing the technique of massage manipulations, some names of techniques make it possible to more accurately and easily understand their effect on the person being massaged. But before studying the technique of performing massage techniques, it is necessary to determine the main “tool” of influence - the massage therapist’s brush ( rice. 18). There are 2 main areas on the palmar surface of the hand: the base of the palm and the palmar surface of the fingers.
Rice. 18. Palmar and dorsal surfaces: 1 – elevation of the 5th finger; 2 – terminal phalanges of the fingers; 3 – elevation of 1 finger; 4 – base of the palm; 5 – radial edge of the hand; 6 – ulnar edge of the hand
Each finger (except 1) has 3 phalanges: terminal (nail), middle and main. On the palmar surface there are elevations of the 1st and 5th fingers.
In addition, in practice the terms “ulnar and radial edges of the hand”, “distal, middle and proximal phalanges of the fingers” are used.
When performing individual massage techniques, the specialist uses not only the palm, but also the back surface of the hand, either using fingers bent at a right angle, or using the entire back surface of the hand or the protrusions of the fingers bent into a fist - ridges.
Below are the main and auxiliary types of individual massage techniques.
Stroking
Stroking is a manipulation in which the massaging hand glides over the skin without moving it into folds, with varying degrees of pressure.
Physiological influence
When stroking, the skin is cleansed of horny scales, residual secretions of the sweat and sebaceous glands, skin respiration improves, and the secretory function of the skin is activated. The trophism of the skin changes significantly - metabolic processes intensify, musculocutaneous tone increases, the skin becomes smooth, elastic, firm, microcirculation increases due to the opening of reserve capillaries (hyperemia). Stroking has a significant effect on the blood vessels, toning and training them. When stroking, the outflow of blood and lymph is facilitated, which also contributes to the rapid removal of metabolic products and decay.
Depending on the technique and application of the technique and its dosage, stroking can have a calming or stimulating effect on the nervous system. For example, superficial flat stroking calms, deep and intermittent stroking excites. Using stroking in the area of reflexogenic zones (cervico-occipital, upper thoracic, epigastric), it is possible to have a reflex therapeutic effect on the pathologically altered activity of various tissues and internal organs. Stroking has an analgesic and absorbable effect.
Technique of basic techniques
At flat stroking the hand, without tension, with the fingers straightened and closed in one plane, makes movements in different directions (longitudinal, transverse, circular, spiral, both with one hand and with two). This method is used to massage the back, abdomen, chest, limbs, face and neck ( rice. 19). Planar deep stroking is performed with one palm weighed down by the other, with varying degrees of pressure, the movements go to the nearest lymph nodes. It is used for massage of the pelvis, back, chest, and limbs.
Rice. 19. Planar stroking
Embracing stroking – the hand and fingers take the shape of a groove: 1 finger is maximally abducted and opposed to the rest of the closed fingers (2–5). The brush grips the massaged surface and can move either continuously or intermittently, depending on the tasks assigned to the massage therapist. It is used on the limbs, lateral surfaces of the chest, torso, buttock area, and neck. The reception is carried out in the direction of the nearest lymph node; it can be carried out with weights for a deeper effect ( rice. 20).
Rice. 20. Comprehensive stroking to the nearest lymph node: a – e – sequence of the technique
Auxiliary stroking techniques
Pincer stroking performed with pincer-shaped fingers, more often - 1-2-3 or only 1-2 fingers. Used for massaging fingers, toes, tendons, small muscle groups, face, ears, nose ( rice. 21).
Rice. 21. Pincer stroking
rake-shaped – performed with the fingers of one or both hands placed in a rake-like manner, possibly with weights, the hand at an angle of 45°. It is used in the area of the scalp, intercostal spaces, in areas of the body when it is necessary to bypass areas with skin damage ( rice. 22).
Rice. 22. Rake stroking
Rice. 23. Ironing with two hands
Comb-shaped - performed by the bony protrusions of the main phalanges of the fingers of one or two hands, bent into a fist. It is used on large muscle groups in the back, pelvis, on the plantar surface of the foot, palmar surface of the hand and where the tendon sheaths are covered with a dense aponeurosis.
Ironing – performed with the dorsal surfaces of the fingers of the hand bent at a right angle at the metacarpophalangeal joints, with one or two hands. Used on the back, face, abdomen, sole, sometimes with weights ( rice. 23).
Rice. 23. Ironing with two hands
General guidelines
1. Stroking is carried out with well-relaxed muscles and a comfortable position for the person being massaged.
2. The technique is carried out both independently and in combination with other techniques.
3. The massage procedure most often begins with stroking, is used during the massage process, and ends the procedure with this technique.
4. Stroking is carried out slowly (24–26 movements per minute), smoothly, rhythmically, with varying degrees of pressure on the massaged surface.
5. First use superficial stroking, then deeper.
6. Planar surface stroking can be carried out both along the lymph flow and against it, and all other types of stroking can only be carried out along the lymph flow to the nearest lymph nodes.
7. In case of circulatory problems (swelling, edema), all stroking is carried out using a suction method: they start from the areas located above, for example, when working on the ankle joint - from the thigh, then massage the lower leg and only then the ankle joint, all movements - towards inguinal lymph node.
8. When performing a massage, it is not at all necessary to use all types of basic and auxiliary stroking techniques; it is necessary to choose the most effective and most applicable for a given area.
9. On the flexor surface of the limbs, techniques are carried out more deeply.
1. The fingers spread apart, and their loose fit to the massaged surface during planar stroking leads to uneven impact and unpleasant sensations.
2. Strong pressure during the technique, causing discomfort or even pain in the patient.
3. Very fast pace and sharp execution of the technique, shifting the skin instead of sliding along it.
Trituration
Rubbing is a manipulation in which the massaging hand never slides over the skin, but displaces it, shifting and stretching in different directions.
Physiological influence
Rubbing is much more energetic than stroking and helps to increase the mobility of the massaged tissues in relation to the underlying layers. At the same time, the flow of lymph and blood to the massaged tissues increases, which significantly improves their nutrition and metabolic processes, and hyperemia appears. The technique promotes loosening and crushing of pathological formations in various layers of tissue, increases the contractile function of muscles, improves their elasticity and mobility, so rubbing is often carried out on joints. Vigorous rubbing along the most important nerve trunks and in places of nerve endings on the surface of the body causes a decrease in nervous excitability.
Technique of basic techniques
Straight-line rubbing performed by the end phalanges of one or more fingers. This technique is used when massaging small muscle groups in the area of joints, hands, feet, the most important nerve trunks, face ( rice. 24).
Rice. 24. Straight rubbing: a – c – sequence of the technique
Circular – performed with circular displacement of the skin by the end phalanges with support on 1 finger or on the base of the palm. This technique can be carried out with the back of half-bent fingers or with individual fingers, for example 1. You can rub with weights with one or two hands alternately. The technique is used on the back, chest, abdomen, limbs - on almost all areas of the body ( rice. 25, 26).
Rice. 25. Circular rubbing with fingertips: a – initial phase; b – final phase
Rice. 26. Circular rubbing: a – with both hands; b – with weights
Spiral – performed with the base of the palm or the ulnar edge of the hand clenched into a fist, one or both hands are involved alternately depending on the area being massaged, it can be used with one hand weighing the other. Used on the back, abdomen, chest, pelvic area, limbs ( rice. 27).
Rice. 27. Spiral rubbing with the base of the palms
Hatching produced by the pads of the terminal phalanges of 2–3 or 2–5 fingers. At the same time, they are straightened, maximally extended and located at an angle of 30° to the massaged surface, pressing with short translational movements, displacing the underlying tissues, moving in a given direction both longitudinally and transversely. Used in the area of skin scars, atrophy of individual muscle groups, skin diseases, flaccid paralysis ( rice. 28).
Rice. 28. Hatching
Planing performed with one or two hands. The brushes are placed one after another and, with progressive movements reminiscent of planing, they are immersed in the tissue with the pads of the fingers, stretching and displacing them. It is used on extensive scars and for skin diseases (psoriasis, eczema), when it is necessary to exclude exposure to the affected areas of the skin, with atrophy of individual muscles or muscle groups (atrophy of the quadriceps femoris, with arthrosis of the knee joint) in order to stimulate ( rice. 29).
Rice. 29. Planing
Sawing performed with the ulnar edge of the hand or both hands. When sawing with both hands, the hands should be positioned so that the palm surfaces are facing each other and are at a distance of 1–3 cm, and they should be used to make sawing movements in opposite directions. A roll of massaged tissue should form between the brushes. If this technique is carried out with the ray edges of the brush, then this is called intersection. Both of these techniques are used in the area of large joints, back, abdomen, hips, cervical spine ( rice. 30, 31).
Rice. thirty. Sawing
Rice. 31. Crossing
Pincer-shaped – performed by the terminal phalanges of 1–2 or 1–3 fingers; movements can be linear or circular. It is used for massaging tendons, small muscle groups, auricles, nose, face for local effects, and for massaging teeth.
Guidelines
1. Rubbing is a preparatory technique for kneading.
2. When using the technique on the face, you must use stepping.
3. To enhance the effect of the technique, you should increase the angle between the massage therapist’s fingers and the massaged surface or perform the technique with weights.
4. Movements when rubbing are carried out in any direction, regardless of the direction of lymph flow.
5. Unnecessarily, when rubbing, do not linger on one area for more than 8–10 seconds.
6. Take into account the condition of the patient’s skin, his age and responses to techniques.
7. Alternate the rubbing technique with stroking techniques and others, performing 60–100 movements per minute.
Most common errors
1. Rough, painful execution of the technique.
2. Rubbing movements are carried out while sliding along the skin, and not with it.
3. Rubbing with straight fingers, not bent at the interphalangeal joints. This is painful for the patient and tiring for the massage therapist.
4. When performing the main types of techniques, do not do the phases with both hands simultaneously, but alternately.
Kneading
Kneading is a technique in which the massaging hand performs 2-3 phases: 1. Fixation, grasping the massaged area. 2. Compression, squeezing. 3. Rolling, crushing, actually kneading.
Physiological influence
Kneading has a major effect on the patient’s muscles, due to which their contractile function increases, the elasticity of the bursal-ligamentous apparatus increases, and shortened fascia and aponeurosis are stretched. Kneading helps increase blood and lymph circulation, improves tissue nutrition, increases metabolism, reduces or completely relieves muscle fatigue. Increased muscle performance, tone, and contractile function. It should be noted that kneading is a technique by which one can judge the technical capabilities of a massage therapist. Kneading is passive gymnastics for muscles.
Technique of basic techniques
Longitudinal kneading produced along the muscle fibers, along the muscle axis. Straightened fingers are positioned on the massaged surface so that the first fingers of both hands are on the front surface of the massaged segment - this is the first phase (fixation). Then the brushes alternately perform the remaining two phases, moving over the massaged area. It is used on the limbs, pelvis, back, sides of the neck ( rice. 32, 33).
Rice. 32. Longitudinal kneading of the shoulder muscles
Rice. 33. Longitudinal kneading of the thigh muscles
Transverse – the massage therapist places his hands across the muscle fibers so that the first fingers are on one side of the massaged area, and the rest are on the other. When massaging with two hands, it is more effective to place the hands from each other at a distance equal to the width of the palm, and then simultaneously or alternately perform all 3 phases. If this is done alternately, then one hand moves the muscles, performing the 3rd phase away from itself, and the other at the same time performs the 3rd phase towards itself, i.e. in different directions. Used on the back, limbs, pelvis, cervical region and other areas, possibly with weights ( rice. 34, 35, 36, 37).
Rice. 34. Transverse kneading with one hand (with weights)
Rice. 35. Cross kneading with two hands (multi-directional)
Rice. 36. Cross kneading with two hands (unidirectional)
Rice. 37. One-handed cross kneading: a – fixation phase; b – compression phase; c – crushing (rolling)
Technique of auxiliary techniques
Wallow performed most often on the limbs. The massage therapist's hands, with palmar surfaces, clasp the massaged area on both sides, fingers are straightened, hands are parallel, movements are made in opposite directions, moving along the massaged area. Used on the thigh, lower leg, forearm, shoulder ( rice. 38).
Rice. 38. Wallow: a – initial phase; b – final phase
Rolling – having grabbed the massaged area with one brush, make rolling movements with the other, moving nearby tissues onto the fixing brush, and so move along the massaged area. Rolling movements can be performed on individual fingers or a fist. Used on the abdomen, chest, sides of the back ( rice. 39).
Rice. 39. Rolling
shift – having fixed the surface being massaged, make short rhythmic movements, moving the tissues towards each other. The opposite action is called stretching. They are used for scars, in the treatment of skin diseases (psoriasis, etc.), for adhesions, paresis, on the face and other areas. Most often performed with two hands, two fingers or several fingers ( rice. 40).
Rice. 40. Shifting, stretching
Pressure performed with a finger or fist, the base of the palm, or with weights. It is used in the back area, along the paravertebral line, in the buttocks area, at the ends of individual nerve trunks (in the area where the BAP is located) ( rice. 41).
Rice. 41. Pressure
Pincer-shaped – performed with 1–2 or 1–3 fingers (pinching on the face), grasping, pulling, kneading local areas, using 2–3 phases of reception. Used on the neck, face, at the locations of the most important nerve trunks, in the back, chest.
Guidelines
1. The muscles should be as relaxed as possible, with comfortable and good fixation.
2. Perform the technique slowly, smoothly, without jerking, up to 50–60 movements per minute.
3. Make movements both in an upward and downward direction, centrifugal and centripetal, without jumping from one area to another, taking into account the nature of the pathological process.
4. The intensity of the massage is increased gradually from procedure to procedure so that there is no adaptation (habituation).
5. Start the technique from the place of transition of the muscle into the tendon and place the hands on the massaged surface, taking into account its configuration.
Most common errors
1. Strong pressure from the end phalanges of the fingers, causing pain.
2. Massaging with a tense hand and fingers, which tires the massage therapist.
3. Insufficient muscle displacement in the 3rd phase (crushing), which leads to abrupt execution of the technique.
4. Flexion of the fingers at the interphalangeal joints in the 1st phase (fixation). At the same time, the massage therapist begins to “pinch” the patient.
5. Sliding of fingers over the skin in the 2nd phase (compression), which is very painful and unpleasant, in addition, the massage therapist loses muscle, and a gap is formed between the massaged surface and the hand. In this case, complete kneading is not performed.
6. Simultaneous work of the hands during longitudinal kneading, the massage therapist seems to tear the muscles to the sides, which is very painful, especially for the elderly.
Vibration
When vibrating, a massaging hand or vibration device transmits oscillatory movements to the body of the person being massaged.
Physiological influence
Varieties of the technique have a pronounced reflex effect, causing increased reflexes. Depending on the frequency and amplitude of vibration, the expansion or contraction of blood vessels occurs. Blood pressure drops significantly, heart rate decreases, and the secretory activity of individual organs changes. The time required for callus formation after fractures is significantly reduced.
Technique of basic techniques
Continuous vibration is performed with the end phalanx of one or several fingers depending on the area of influence, if necessary - with one or both hands, the entire palm, the base of the palm, or a fist. This technique is used in the area of the larynx, back, pelvis, on the muscles of the thigh, lower leg, forearm, shoulder, along the most important nerve trunks, at the exit point of the nerve, BAP, BAZ ( rice. 42, 43).
Rice. 42. Continuous vibration (labile)
Rice. 43. Continuous vibration (stable)
Intermittent (percussion) - consists of delivering blows one after another with the tips of half-bent fingers, the edge of the palm (elbow edge), the back surface of slightly spread fingers, the palm with bent or clenched fingers, as well as the hand clenched into a fist. Movements are performed with one or two hands alternately ( rice. 44). Used on the upper and lower extremities, back, chest, pelvis, abdomen, fingers - on the head, face.
Rice. 44. Intermittent vibration (“finger shower”)
Technique of auxiliary techniques
Concussions are performed with separate fingers or hands, movements are made in different directions and resemble sifting flour through a sieve ( rice. 45). Used on spastic muscle groups, larynx, abdomen, individual muscles.
Rice. 45. Shake
Shaking performed with both hands or one with fixation of the hand or ankle joint being massaged. This technique is performed only on the upper and lower extremities. When using it on the upper limbs, a “handshake” and shaking in the horizontal plane are performed. On the lower extremities, shaking is performed in a vertical plane with fixation of the ankle joint. In this case, the knee joint should be straightened ( rice. 46).
Rice. 46. Shaking
Chopping It is performed with the ulnar edges of the hands, with the palms located at a distance of 2–4 cm from each other. The movements are fast, rhythmic, along the muscles ( rice. 47).
Rice. 47. Chopping
Pat carried out by the palmar surface of one or both hands, with the fingers closed or bent, forming an air cushion to soften the blow to the body of the person being massaged ( rice. 48). Used on the chest, back, lumbar region, pelvis, upper and lower extremities.
Rice. 48. Pat
Effleurage performed with the elbow edge of one or both hands bent into a fist, also with the back of the hand. Apply tapping on the back, in the lumbar and gluteal regions, on the lower and upper extremities ( rice. 49).
Rice. 49. Effleurage: a – ulnar edge of the hand; b – the back of the bent fingers
Puncturing performed with the end phalanges of 2–3 or 2–5 fingers, similar to beating a shot on a drum. You can use one brush or two – “finger shower”. Used on the face, at the exit points of the most important nerve trunks, in the abdomen, chest, back and other areas of the body, as well as in the BAP, BAZ.
Guidelines
1. The treatment should not cause pain in the person being massaged.
2. The strength and intensity of the impact depend on the angle between the massaging brush and the body - the closer it is to 90 degrees, the stronger the impact.
3. Long-lasting, small, low-amplitude vibrations cause calm and relaxation in the massaged person; short-term, intermittent, high-amplitude vibrations cause the opposite state.
4. The duration of performing striking techniques in one area is no more than 10 s; it should be combined with other techniques.
5. Do not perform intermittent vibrations (tapping, chopping) on the inner surface of the thighs, in the popliteal region, in the places of projection of the internal organs (kidneys, heart), especially in the elderly.
6. Vibration is a tedious technique for a massage specialist, therefore, if possible, hardware vibration should be used.
Most common errors
1. Apply intermittent vibration (chopping, tapping, patting) on tense muscle groups, which causes pain in the person being massaged).
2. During a two-handed technique, the “weakest” hand gets tired; with intermittent vibration, the blows are applied simultaneously and not alternately, which also causes pain.
3. When performing the shaking technique on the lower or upper extremities, the direction of movement is not taken into account; when the leg is bent at the knee joint, the ligamentous apparatus of the knee joint can be disrupted, and movements in the upper extremities not in the horizontal plane lead to damage and pain in the elbow joint.
4. The treatment is carried out with great intensity, which causes resistance from the person being massaged.
Massage of specific areas of the body
Scalp massage
The skin of the scalp is quite dense, but moves freely, and contains a significant number of sebaceous and sweat glands.
The blood supply to the scalp is carried out by arteries that are part of the system of the internal and external carotid arteries. The lymphatic vessels of the scalp pass from the crown down, back and to the sides to the lymph nodes located near the ears and on the back of the head ( see fig. 14).
Massage of the scalp can be performed on top of the hair and exposing the skin.
The position of the person being massaged is sitting, lying down. The massage therapist sits or stands behind the person being massaged.
Massage over hair. It is carried out by stroking from the forehead to the back of the head, from the crown to the ears, from the crown down radially in all directions. The direction of massage movements should correspond to the direction of hair growth and excretory ducts of the glands (do not carry out massage techniques against the direction of hair growth) - plane, grasping, rake-shaped, ironing; rubbing – straight, circular, spiral; shading – intermittent pressure, shifting, stretching, pinching (pincer-like); vibration – puncturing (“finger shower”), labile continuous, point local, linear.
Indications
Diseases of the circulatory system, consequences of injuries, skin diseases, mental fatigue, colds, cosmetic disorders, hair loss.
Guidelines
1. Alternate all techniques with stroking.
2. Duration of the procedure – from 3 to 10 minutes.
3. Before massaging the scalp, perform a light circular rubbing of the frontal, temporal, and occipital areas of the head to improve blood flow in the venous vessels.
4. After massaging the scalp, massage the collar area.
Massage of the scalp with skin exposure. It is carried out along the partings, the first parting is combed in the sagittal direction from the middle of the hairy border of the forehead to the back of the head, stroking with fingers flat from front to back, 3-4 passes. Rubbing, shading, linear, circular. Kneading - pressing. Shifting - stretching. Vibration – puncturing (with the end phalanges of 2–5 fingers) along the parting, linear and local acupressure techniques.
Indications
Dry seborrhea, scarring of the skin after burns, injuries, premature hair loss.
Guidelines
1. After massaging one part, comb the second part in the sagittal direction at a distance of 2–3 cm.
2. The duration of exposure to each parting is 1–2 minutes, the entire procedure takes up to 20 minutes. depending on the disease and the tasks facing the massage specialist.
3. Make up to 16–18 partings in the sagittal direction.
4. Make up to 10–12 partings in the transverse direction.
Face massage
Facial massage is divided into massage of the forehead, eye sockets, nose, cheeks, nasolabial folds, ears, according to indications. The person being massaged often sits, but can also lie on his back. The massage therapist stands behind the person being massaged or to the side of him (to improve visibility of the massage area, place a mirror in front of the person being massaged).
Frontal area massage. Planar stroking is performed, ironing in the direction from bottom to top from the superciliary arches to the line of the beginning of hair growth, the middle of the forehead to the temporal areas; rubbing – straight, circular, spiral; hatching, all techniques are carried out by “stepping” in all directions; kneading - intermittent, forceps-like pressure, pinching with 1-2 fingers over the entire surface of the frontal region; vibration – puncturing, “finger shower”, local acupressure and linear massage techniques. Alternate all techniques with stroking, performing 4–5 passes.
Massage of the orbital area. Stroking is performed in the upper part of the orbit towards the temporal regions, in the lower part of the orbit - towards the bridge of the nose, towards the inner edge of the eye, flat, pincer-shaped; rubbing – straight, circular; shading - along the same lines; kneading - forceps-like pressure in the upper part of the orbit, in the lower part - towards the bridge of the nose; vibration – puncturing, finger tapping, acupressure techniques.
Cheek massage. Stroking is carried out towards the ears, flat, pincer-shaped, ironing; rubbing circular, rectilinear, spiral, shading, sawing; kneading - forceps, pressing, sliding, stretching; vibration – puncturing, “finger shower”, acupressure.
Massage of the nose area. Planar, forceps-shaped stroking is performed; rubbing - straight, circular, forceps, hatching; kneading - pressing, forceps - puncturing, shaking with the end phalanges of 1-2 fingers, acupressure techniques. All movements should be made from the tip of the nose to the bridge of the nose.
Massage of the mouth and chin area. It is performed by stroking from the midline along the lower edge of the jaw to the behind-the-ear areas, from the wings of the nose to the earlobe, from the corners of the mouth to the auricles, flat ironing, pincer-shaped; rubbing - circular, straight, spiral, hatching, forceps; kneading – pincer-like pressure, stretching, sliding; vibration – puncturing, “finger shower”, patting, acupressure techniques. Alternate all techniques with stroking; when massaging the nasolabial folds, carry out movements from the lower part of the middle of the chin to the nasolabial folds to the wings of the nose.
Indications
Facial massage is prescribed for diseases and injuries of the trigeminal and facial nerves, damage and injuries to soft tissues, as well as skull bones, diseases and injuries to the skin, after surgical interventions and for cosmetic, hygienic purposes, to prevent facial aging.
Guidelines
1. Duration of massage – from 5 to 15 minutes.
2. The massage therapist must have special knowledge and experience in performing massage manipulations on the facial area.
3. The neck area should be bare when massaging the face, since massage of this area is mandatory.
4. A cold face must first be warmed with a compress, the massage therapist’s hands must be warm.
Ear massage. The earlobe is stroked, flat, sequentially, moving from the earlobe to the lower, middle upper recesses, after which the back surface of the auricle is massaged; rubbing – straight, circular, forceps; kneading - forceps-like pressure; vibration, mainly acupressure techniques using devices (sticks, rods, needles of various diameters with spherical ends).
Indications
Unilateral effect for neuritis, radiculitis. Auricular points are microzones of projections of individual organs; influencing them is widely used in the treatment of diseases of the nervous system and to relieve pain syndromes.
Guidelines
1. To identify areas of pain in the auricle, apply compression between 1 and 2 fingers 8–10 times, recording the response.
2. When choosing an effect, it should be noted that the right ear corresponds to the right half of the body, the left - to the left.
3. To achieve a therapeutic effect, a detailed study of the structure and location of the points of influence is necessary (cartography of the outer ear).
4. Having localized the point on the outer outer side of the auricle, it is “projected” onto the inner (facing the skull) side of the auricle. The fingers of the right hand are used to massage, and the auricle is supported with the left hand.
5. During the massage of the auricle, local pain in the ear first increases, then sensations of warmth and burning appear, peripheral pain subsides, and a therapeutic effect occurs.
6. Massage in a clockwise direction strengthens, stimulates body functions, and gives a tonic effect. Counterclockwise – inhibitory, calming effect.
Neck massage
The skin of the anterior and lateral parts of the neck is tender and easily removable. In the area of the back of the head, the skin is thicker and less mobile. By palpation while turning the head, it is easy to identify the sternocleidomastoid muscle. Between this muscle and the trachea, you can feel the pulsation of the common carotid artery, and in the subclavian fossa - the pulsation of the subclavian artery.
Lymphatic vessels passing in the neck area empty into lymph nodes located in groups at the border of the head and neck (occipital, postauricular, parotid, mandibular, lingual, retropharyngeal, buccal, chin). Stroking is performed (the patient sits or lies on his stomach, resting his forehead on his hands) flat, grasping, comb-shaped, forceps-shaped, the direction of all movements is from top to bottom; rubbing straight, circular, sawing, crossing, hatching; kneading - transverse, longitudinal, pressing, forceps, shearing, stretching; vibration - puncturing, tapping, patting, shaking with individual fingers.
Indications
Diseases of the cardiovascular system, central and peripheral nervous system, respiratory organs, internal organs, injuries and diseases of the spine, skin diseases and damage after surgery, as well as for cosmetic or hygienic purposes.
Guidelines
1. Neck massage lasts from 3 to 10 minutes. according to indications.
2. Alternate each massage with stroking.
3. Be careful when massaging the front surface of the neck, the area of the carotid arteries.
4. During a massage, the patient should not hold his breath.
Upper limb massage
The shoulder girdle (scapula and collarbone) and the free upper limb (humerus, bones of the forearm, hand) are interconnected during various movements. The blood supply to the upper limb is provided by the subclavian artery, and venous drainage occurs through the subclavian vein. Lymphatic vessels on the fingers on the back side run transversely to the lateral and palmar surfaces, from here they are directed to the palm, to the forearm and further to the shoulder, to the axillary and subclavian lymph nodes. The upper limb is innervated by the brachial plexus nerves.
Massage technique
The position of the person being massaged is sitting or lying down. The massage is performed with one or two hands. When massaging with one hand, the other fixes the limb being massaged and helps to grasp the muscles that are being affected. Massage movements should be carried out along the lymphatic vessels towards the lymph nodes (elbow area, armpit). Along the radius, along the back surface of the shoulder and through the deltoid muscle, complete the grasping stroking in the area of the supraclavicular lymph node, then grasping stroking along the ulna, along the anterior surface of the shoulder and complete the movements in the area of the axillary lymph node.
Hand massage. Planar, pincer-shaped stroking is performed on the dorsal surface of the hand, starting from the fingertips to the middle third of the forearm, then each finger is massaged separately towards its base along the dorsal, palmar and lateral surfaces. Rubbing – on the palmar and lateral surfaces of each finger and hand, circular, straight, hatching, sawing, comb-shaped; kneading - forceps, pressing, sliding, stretching; vibration – puncturing, tapping, shaking, acupressure techniques; passive and active movements.
Forearm massage. The area of the elbow bend is stroked, flat, grasping, comb-shaped, forceps-shaped, rake-shaped, ironing; rubbing - straight, circular, spiral, sawing, crossing, hatching, planing; kneading longitudinal, transverse, felting, pressing, shifting, stretching; vibration - patting, continuous, labile, stable, linear and local acupressure techniques.
Elbow joint massage. Circular and planar stroking is performed; rubbing – straight, circular, spiral, shading, pressing; vibration – point, puncturing; kneading - pincer-shaped, sliding; stretching, pressing; movements are passive and active.
Shoulder massage. Stroking is performed in the direction of the axillary fossa - planar, grasping, forceps-shaped; rubbing - straight, circular, spiral, crossing, sawing, hatching, planing; kneading - felting, transverse, longitudinal (flexors and extensors are kneaded separately), stretching, shearing, pinching, pressing; vibration – shaking, puncturing, tapping, patting, chopping, shaking, acupressure.
Shoulder massage . Stroking is performed - flat, grasping, tong-shaped, ironing, rake-shaped; rubbing - circular, straight, spiral, hatching; kneading - pressing; vibration – point, puncturing.; movements – passive, active.
First massage the deltoid muscle, and then the shoulder joint. If the massage therapist is in front of the patient, then for better access the massaged person is asked to put his hands behind his back; if behind, then the patient puts his hand on the other shoulder. The lower surface of the joint capsule becomes more accessible to the massage therapist when the hand is moved to the side or placed on the massage therapist’s shoulder ( rice. 50).
Rice. 50. Direction of basic massage movements on the upper limbs
Indications
Diseases and injuries of soft tissues, bones, joints; diseases of blood vessels, peripheral nerves; skin diseases.
Guidelines for massage of the upper limbs
1. Before the massage, it is good to relax the patient’s muscles.
2. When massaging individual areas, perform a preparatory massage of the entire arm.
3. Do not massage the hand and forearm separately (when massaging the forearm, you need to work on the hand as well).
4. When massaging the shoulder, massage the entire shoulder girdle.
5. When massaging the shoulder muscles, do not act on the internal groove of the biceps muscle.
6. In case of injuries, start the massage from the overlying area or with a preparatory massage of the entire limb.
7. The duration of the procedure depends on the purpose of the massage and can be 3–10 minutes. when massaging individual areas and 12–15 min. – when massaging the entire limb.
Lower limb massage
The lower limb is divided into the pelvic girdle and the free lower limb. The blood supply to the lower limb is provided by the iliac artery system. Lymphatic vessels are located along the blood vessels; starting from the dorsum of the foot and sole, they go from the distal parts to the proximal parts of the limb.
Massage technique
The patient's position is lying on his stomach, on his back. Massage movements are carried out along the lymphatic vessels towards the popliteal and inguinal lymph nodes.
Foot massage. Stroking is performed - from the toes along the dorsum of the foot, along the front surface of the shin to the popliteal lymph nodes, planar, grasping, along the plantar surface, comb-shaped, stroking from the toes to the heel; rubbing - circular, straight, comb-shaped, hatching; kneading - forceps-shaped, pressing on the sole; vibration - puncturing, tapping, patting, shaking; passive movements.
Ankle massage. Stroking is performed - circular, planar; rubbing - straight, circular, spiral, hatching; kneading - pressing; vibration is point, movements are passive.
Calf massage . Stroking is carried out - planar, grasping, along the front and back surfaces, comb-shaped; rubbing - straight, circular, spiral, sawing, crossing, planing, hatching; kneading - longitudinal, transverse, pressing, felting, stretching, sliding; vibration – shaking, puncturing, tapping, patting, chopping, puncturing.
Knee massage . Stroking is performed - circular, planar; rubbing – linear, circular, shifting of the patella; kneading - pressing; point vibration, passive movements.
Thigh massage . Stroking is carried out - along the front, side, back surfaces, flat, grasping, comb-shaped, ironing; rubbing - straight, circular, spiral, sawing, crossing, planing, hatching; kneading - stretching, felting, longitudinal, transverse, pressing, shifting (carry out separately in the area of the anterior, external and internal muscle groups); vibration - shaking of individual muscle groups, puncturing, tapping, patting, chopping, shaking, puncturing, shaking.
Gluteal muscle massage. Stroking is performed - from the sacrum, coccyx and iliac crests to the inguinal lymph nodes, flat, grasping, with weights; rubbing - straight, circular, spiral, comb-shaped, hatching, planing, sawing, crossing; kneading – longitudinal, transverse, pressing, shifting, stretching; vibration - shaking, puncturing, patting, shaking, chopping, tapping, punctate.
Hip massage. First, the pelvic area is stroked, and then - in the area between the ischial tuberosity and the greater trochanter - circular stroking and rubbing, shading; passive movements ( rice. 51).
Rice. 51. Direction of basic massage movements on the lower extremities
Indications
In the treatment of diseases of the cardiovascular system, injuries of soft tissues, bones, joints, peripheral nerves, central paralysis.
The objectives and techniques of massage are determined in combination with other treatment methods.
Guidelines
1. Massage of individual limb segments should be preceded by a preparatory massage of the entire limb.
2. You should not massage the foot or lower leg separately.
3. When massaging the thigh, you also need to massage the pelvic muscles.
4. When massaging in the popliteal cavity, movements should not be vigorous.
5. On the inner surface of the thigh, especially in the groin area, avoid shock techniques and intermittent vibration.
6. The duration of the massage can be from 3 to 15 minutes. when massaging individual segments and from 5 to 20 minutes. – when massaging the entire limb.
Massage of the back, lumbar region and pelvis
When examining and palpating the back, the spinous process of the 7th cervical vertebra, ribs, scapular axis with acromion, the medial edge of the shoulder blades and their lower angle are clearly visible protruding under the skin. Lymph from the vessels located in the back area is received by the axillary and inguinal lymph nodes.
Massage technique
The position of the person being massaged is lying on the stomach, arms slightly bent at the elbow joints and located along the body. Rollers or pillows are placed under the frontal area, chest and abdomen.
The massage begins with superficial stroking, then flat, deep and grasping - with both hands.
The direction of movement is from the sacrum and iliac crests upward to the supraclavicular fossa, first parallel to the spinous processes of the vertebrae, and then, retreating from the spine, moving upward from the iliac crests to the axilla.
When massaging the pelvic area, stroking, rubbing from bottom to top, auxiliary techniques are performed - stroking with weights, comb-like, ironing; further rubbing - circular, with weights, comb-shaped, sawing; kneading - with both hands, longitudinal and transverse, ascending and descending; vibration - chopping, tapping, intermittent vibration, patting, point ( rice. 52).
Rice. 52. Direction of the main massage movements in the back, lower back, neck and pelvis
Guidelines
1. When rubbing in the area of the C 4 – D 4 segment, you need to loosen your efforts.
2. Perform vibration in the interscapular area by reducing the force of impact.
3. It is necessary to spare the projection of the area of the kidneys, lungs, and heart on the back.
4. Finish the back massage with stroking.
Breast massage
The anterior chest wall is supplied with blood through the internal mammary artery and its branches, the side walls - through the branches of the axillary artery. Innervation is carried out by spinal nerves from the subclavian part of the brachial plexus. The lymphatic vessels of the breast are directed to the supraclavicular and axillary lymph nodes.
Massage technique
The position of the person being massaged is lying on his back or on his side, as well as sitting. First, a preparatory massage is carried out - stroking (superficial, plane, then grasping from the bottom up and outwards to the armpits), then a selective massage - the pectoralis major, serratus anterior, external intercostal muscles are massaged, at the level of the diaphragm. Massage movements are carried out in the direction from the collarbone and sternum to the armpits and shoulder joint ( rice. 53). Apply stroking, circular rubbing, transverse kneading, chopping in the area of the pectoralis major muscle; vibration - shaking, point vibration - according to indications.
Rice. 53. Direction of basic massage movements in the chest and abdomen
Massage of external intercostal muscles. Stroking, rubbing, and intermittent vibration are performed in the direction from the sternum along the intercostal spaces to the spine.
Diaphragm massage. A stable, continuous vibration is produced, fingers 2 to 5 are inserted into the right and left hypochondrium and they produce vibration, acting only indirectly. Completing the massage, carry out (with the massaged person lying on his back) planar stroking, grasping, from bottom to top, shaking, compression; movements should be rhythmic and painless.
Intercostal nerve massage. Stroking, rake-like rubbing, and vibration are performed.
Notes
According to E. A. Zakharova with additions by N. A. Belova, 1974.
Part of the section is quoted from V.I. Dubrovsky, 1986.
Tabeeva D.M., Klimenko A.M. Ear acupuncture. M., 1976.
End of free trial.
Introduction
“My work is dedicated to my neighbors - the Shvedov family Vladimir and Alena”
This book with such a famous title was published about twenty years ago. At that time, the leaders of the publishing house “Medicine” in St. Petersburg (then still in Leningrad) suggested that the author, in a more concise and succinct way, specifically touch on all the most important topics on the use of types of massage and self-massage for diseases and disorders in human health.
Having withstood all the main presentations in the literature of famous authors of the Russian old school (1887–1911) - I. V. Zabludovsky, E. N. Zalesova, M. Ya. Mudrova, N. V. Sletov, M. A. Mukharinsky and many others . others, as well as more modern ones (1922–1985) - A. F. Verbova, L. A. Kunicheva, N. A. Beloy, A. A. Biryukova and others, taking into account the “newest” interpretation and accumulated experience in the application and scientific study of the effects of massage manipulations on humans, of course, with the practice of conducting numerous training courses on types of massage: therapeutic, sports, recreational, segmental, acupressure, etc. - the author strived for perfection of presentation in the relevant sections of the book “Handbook of Massage” "
In the 20th century, under this name, this book was published in many cities of the country: St. Petersburg - publishing houses "Medicine", "Hippocrates", in Tyumen - publishing houses "Zhenmars" and "Kormez Ltd", Kharkov - "Medicine", in Minsk - " Medicine,” etc. The circulation reached 300 thousand copies, the book was very popular, especially in secondary medical institutions, because there the basics of massage were studied in more detail and thoroughly.
In the 21st century, the book was published in the publishing houses “Nevskaya Book”, “LAN” - St. Petersburg, in Moscow - EKSMO-PRESS, etc., and was reprinted several times over several years.
The author consistently presented complex material, maintaining simplicity and accessibility in the study, both in practical and theoretical application. The technique and methodology for performing types of manipulations performed during massage and self-massage has been tested through extensive practical experience during training courses and complex medical practice. Thanks to a timely and competent course of massage, many unnecessary problems that arise with our health can be avoided and prevented. This book is intended for a wide range of readers who are constantly interested in the use of massage and self-massage in everyday life. The author wishes everyone good health, and that massage manipulations become a companion in improving and maintaining health.
Basic principles of massage
Massage originated in ancient times. The word “massage” comes from the Greek word “?????”, which means “knead”, “knead”, “stroke”.
Massage as a method of treatment was used already in the third millennium BC.
e. in China, then in Japan, India, Greece, Rome. Records of massage also appear among Arabs. From the depths of centuries, a description of the therapeutic methods of acupuncture, acupressure - pressure on certain points of the body has come down to us. Ancient monuments, such as preserved alabaster bas-reliefs and papyri, which depict various massage manipulations, indicate that the Assyrians, Persians, Egyptians and other peoples knew well and used massage and self-massage techniques ( rice. 1).
Rice. 1. The location of the lines of greatest resistance to stretching of individual areas of the skin according to Benninghoff
In Europe in the Middle Ages, massage was not used due to persecution by the Inquisition. It was only during the Renaissance that interest in body culture and massage arose again. In Russia in the 18th century. massage was promoted by M. Ya. Mudrov. In the 19th century The development of massage was facilitated by the work of the Swedish specialist P. Ling, the creator of “Swedish massage”. Much credit for the spread of massage belongs to I.V. Zabludovsky. The massage technique he proposed has retained its significance to this day. Among the founders of therapeutic and sports massage in our country, mention should be made of A. E. Shcherbak, A. F. Verbov, I. M. Sarkizov-Serazini and others.
Nowadays in Russia, massage is used in almost all medical and health institutions. The technique of massage and self-massage, built taking into account clinical and physiological, rather than anatomical and topographical principles, is an effective means of treatment, restoration of performance, relieving fatigue, and most importantly, serves to prevent and prevent diseases, being an active means of healing the body.
Types of massage
Massage is a dosed mechanical and reflex-conscious irritation of the surface of our body for the purpose of pleasure, healing and healing of ailments.
Massage can be general and local. Depending on the tasks, the following types of massage are distinguished: hygienic (cosmetic), therapeutic, sports, self-massage.
Hygienic massage
This type of massage is an active means of preventing diseases and maintaining efficiency. It is prescribed in the form of a general massage or massage of individual parts of the body. When performing it, various manual massage techniques, special devices are used, self-massage is also used (in combination with morning exercises) in a sauna, in a Russian bath, in a bath, under a shower. One of the types of hygienic massage - cosmetic - is used for pathological changes in facial skin and as a means of preventing its aging.
Massotherapy
This type of massage is an effective method for treating various injuries and diseases. The following varieties are distinguished:
Classic – used without taking into account the reflex effect and is carried out near the damaged area of the body or directly on it;
Reflex – it is carried out with the aim of a reflex effect on the functional state of internal organs and systems, tissues. In this case, special techniques are used to influence certain areas - dermatomes;
Connective tissue - with this type of massage, the effect is mainly on the connective tissue, subcutaneous tissue. The main techniques of connective tissue massage are carried out taking into account the directions of the Benninghoff lines ( rice. 2);
Rice. 2. Massage devices: a – general view of PEM-1: 1 – vibrating platform; 2 – vibration frequency regulator; b – electric vibration massager ELVO: 1 – additional handle; 2 – body; 3 – switch; 4 – main handle; 5 – suction bells; 6 – spherical protrusions; 7 – spike attachment; 8 – flat nozzle
Periosteal - with this type of massage, by influencing points in a certain sequence, they cause reflex changes in the periosteum;
Acupressure is a type of therapeutic massage, when a local effect is applied in a relaxing or stimulating manner on biologically active points (zones) according to the indications for a disease or dysfunction, or pain localized in a certain part of the body;
Hardware - carried out using vibration, pneumatic vibration, vacuum, ultrasonic, ionizing devices; types of baroelectric stimulation and other types of massage are also used (aeroion, various applicators);
Therapeutic self-massage - performed by the patient himself, can be recommended by the attending physician, nurse, massage specialist, exercise therapy. The most effective techniques for influencing a given area of the body are selected.
Sports massage
This type of massage was developed and systematized by prof. I. M. Sarkizov-Serazini. According to the tasks, the following types are distinguished: hygienic, training and recovery, preliminary.
Hygienic massage usually done by the athlete himself daily along with morning exercises and warm-up.
Training massage is produced to prepare the athlete for the highest sporting achievements in a shorter time and with less psychophysical energy. Used in all periods of sports training. The training massage technique depends on the tasks, characteristics of the sport, the nature of the load and other factors ( table 1).
During a general training massage, the athlete is massaged in a certain sequence ( rice. 3). The duration of manual massage of individual areas and parts of the body is approximately as follows: back, neck, shoulder girdle, gluteal (lumbar) region - 8 minutes; hips, knee joints, shins, ankle joints, feet – 16 minutes; shoulder, elbow joints, forearm, wrist joints, hand, fingers – 14 minutes; chest, abdomen – 7 min.
Table 1
Approximate duration (min.) of a general training massage depending on the athlete’s body weight
General massage start with the preliminary. It is used to normalize the condition of various organs and systems of an athlete before upcoming physical activity. Depending on the tasks, the following types of preliminary massage are distinguished:
Warm-up - performed before a training session or performance at a competition, when it is necessary to maintain and increase the tone of the body by the time the exercise is performed, taking into account the specifics of the sport;
Warming – used to cool the body or individual parts of the athlete’s body, using various rubbings and ointments (finalgon, dolpic, sloans, efkamon, nicoflex, etc.);
Mobilizing - used to mobilize all the resources of the athlete’s body - physical, mental, technical, etc. - in combination with verbal “suggestion”.
Restorative massage – a type of sports massage that is used after various types of stress (physical, mental) and at any degree of fatigue, tiredness to restore various functions of the athlete’s body as quickly as possible and increase his performance.
A short-term restorative massage is carried out during a break lasting 1–5 minutes. – between rounds, during substitutions in sports games, during rest between attempts (approaches to apparatus).
The main objectives of short-term restorative massage are:
Relieve excessive neuromuscular and mental tension;
Relax the neuromuscular system and create conditions for optimally rapid recovery of the body;
Eliminate existing pain;
Increase general and special performance of both individual parts of the body and the entire organism.
Rice. 3. The sequence of general training massage (on the front and back surfaces of the body, according to the digital indicators)
Restorative massage during a break of 5–20 minutes. It is carried out between halves for football players, wrestlers, gymnasts, and track and field athletes. At the same time, massage techniques are performed taking into account the specifics of the sport, the time until the subsequent load, the fatigue of the body, and the mental state. The greatest effect can be obtained from a restorative massage for 5–10 minutes. in combination with a contrast shower.
Restorative massage during a break of 20 minutes. up to 6 hours, used in divers, wrestlers, gymnasts, track and field athletes and other athletes. Depending on the athlete’s condition, it is advisable to carry it out in 2 sessions: the 1st lasts 5–12 minutes, while those muscle groups that bore the main load in this sport are massaged. 2nd session – from 8 to 20 minutes, during which not only the muscle groups that bear the maximum load are massaged, but also the parts of the body located above and below these muscles.
During multi-day competitions, restorative massage is used in sports such as wrestling, boxing, skiing, figure skating, chess, etc., when passive rest does not relieve accumulated fatigue and does not provide the desired recovery effect. This type of restorative massage is carried out in sessions. Its tasks include: relieving neuromuscular and mental tension; restore and improve the athlete’s performance in an extremely short time; help normalize night sleep.
On weekends and days off from competition, athletes strive to restore their strength and improve performance using restorative massage (1–3 sessions). After the completion of the competition, the complex of medical and biological means of recovery includes types of restorative massage (manual, vibration, ultrasound) in combination with a bath, hydromassage, aeroionotherapy and other types of influences.
Self-massage
In everyday conditions, it is not always possible to use the services of a massage specialist. In such cases, you can use self-massage. When starting to master the technique of self-massage, you must follow the following rules:
Make all movements with the massaging hand along the flow of lymph to the nearest lymph nodes;
Massage the upper limbs towards the elbow and axillary lymph nodes;
Massage the lower limbs towards the elbow and inguinal lymph nodes;
Massage the chest in front and to the sides towards the armpits;
Massage the neck downwards towards the supraclavicular lymph nodes;
Massage the lumbar and sacral areas towards the inguinal lymph nodes;
Do not massage the lymph nodes themselves;
Strive for optimal relaxation of the muscles of the massaged body parts; hands and body must be clean; in some cases, self-massage can be performed through thin cotton or woolen underwear.
It should be noted that self-massage requires significant muscle energy from the massager, creates a large load on the heart and respiratory organs, like any physical work, causing the accumulation of metabolic products in the body. In addition, when performing it there is no freedom in movement, and individual manipulations are difficult. This limits the reflex effect of massage on the body. Self-massage can be performed at any time of the day, in any comfortable position - at a desk, in a car seat, in the forest during a hike, on the beach, in a bathhouse, etc. Knowing the basics of acupressure, you can effectively prevent various dysfunctions of the body and diseases.
Hygienic basics of massage
The room for massage should be dry, bright (illumination 120–150 lux), equipped with supply and exhaust ventilation, providing 2–3 air exchanges per hour. It is advisable to have a separate massage room with an area of about 18 m2. It should contain:
Stable, upholstered in leatherette, lined with foam rubber or a layer of sea grass, a massage couch (if possible with three moving planes and electrically heated) 1.85–2 m long, 0.5–0.6 m wide, 0.5–0 m high 7 m ( rice. 4);
Rice. 4. Massage couches: a – regular; b – with electric heating
Round cushions covered with leatherette, 0.6 m long, 0.25 m in diameter;
Massage table, upholstered in leatherette, dimensions 0.8 x 0.6 x 0.35 m;
A cabinet for storing clean sheets, bathrobes, towels, soap, talcum powder, massage devices, apparatus, Sollux lamps and other necessary equipment used in massage;
First aid kit, which contains: cotton wool, sterile bandages, alcohol solution of iodine, adhesive plaster, boron petroleum jelly, disinfectant ointment, ammonia, camphor-valerian drops, ointments, rubbing, powders, elastic bandage;
Sink with cold and hot water supply.
The floor in the office should be wooden, painted or covered with linoleum, the air temperature should be from +20° C to +22° C, and the relative humidity should not be higher than 60%. In the office it is advisable to have an hourglass or procedure clock, a device for measuring blood pressure, a stopwatch, a wrist dynamometer, and a tape recorder.
More detailed operating rules and a list of equipment for massage rooms are set out in the Handbook of Occupational Safety and Health for Health Care Workers (M.: Medicine, 1975).
Before the massage, it is advisable to take a warm shower or wipe yourself with a damp towel, wipe yourself dry, and expose only the part of the body being massaged so that clothing does not interfere with the massage. If there is significant hair growth, you can massage it through your underwear or use creams and emulsions. Abrasions, scratches, scratches and other skin damage must be pre-treated. For the greatest effect of massage, it is necessary to achieve complete relaxation of the muscles of the massaged area. This condition occurs in the so-called average physiological position, when the joints of the limbs are bent at a certain angle ( rice. 5).
Rice. 5. Average physiological position of the limbs during massage
In the rules of behavior of a massage therapist, it is necessary to highlight 2 main aspects of mastering massage - psychological and technical. Psychological factors include attentiveness, patience, tact, friendliness, calmness and confidence in the correct implementation of the massage session plan, taking into account the condition of the person being massaged. Technical – the ability to perform any type of massage, choose the most effective techniques, observe a rational sequence of basic and auxiliary massage techniques, take into account the adequacy of the patient’s response to a massage session or course.
It is necessary to establish a relationship of trust between the person being massaged and the specialist, which is achieved by the latter’s ability to establish good contact with the patient. The success of treatment often depends on this.
The work of a massage therapist involves a lot of physical activity, so you need to pay attention to preventing pathological changes in the cervical and lumbar spine, the appearance of congestion in the lower extremities, in order to prevent the occurrence of occupational diseases (humeral periarthritis, flat feet, varicose veins, tendovaginitis, myositis, radiculitis). To do this, you need to perform special relaxation exercises. You should rest while sitting.
The massage therapist must have a good knowledge of anatomy, the physiological effects of individual massage techniques, be able to conduct a diagnostic palpation examination, and have a developed sense of touch. It is necessary to comply with hygienic requirements, cut your nails short, for oily hands use nourishing creams “Tomato”, “Victoria”, etc., for dry skin (peeling) use creams “Velour”, “Peach”, “Morning”, “Nectar” . When washing hands, the water should have a temperature of 18–20°C. If the skin of your hands becomes dry from frequent washing, then you should use “Cosmetic”, “Spermaceti”, “Glycerin”, “Vaseline”, “Amber” soaps. Clothes should be loose, there should be no objects on the hands that could injure the skin of the person being massaged, it is better to have low-heeled shoes.
You should choose the most comfortable working position, maintain the correct breathing rhythm, work with both hands, involving only those muscles that perform this massage technique. After clarifying the patient’s complaints and determining the condition of his tissues, it is necessary, together with the doctor, to determine the massage technique, taking into account the clinical forms of the lesion, the characteristics of the underlying and concomitant diseases. If, during the course, the massage therapist considers it necessary to make any adjustments to its implementation, which may be caused by the patient’s negative reactions to certain manipulations or the appearance of new clinical signs of the disease, it is necessary to consult with the attending physician.
There should be absolute silence in the massage room, and only at the request of the person being massaged can you turn on music or carry on a conversation, taking into account the patient’s condition, trying not to cause negative emotions in him, not to tire him, and to listen to all the patient’s responses to various manipulations. The person being massaged can be in a sitting position, lying on his back, stomach, on his side, sometimes standing ( rice. 6).
Rice. 6. Postures of the person being massaged during the massage: a – lying on his stomach; b – lying on your side; c – lying on your back; g – sitting
When performing a massage, the patient's muscles must be completely relaxed, firm support must be provided for the massage therapist, the massage therapist and the patient must be in comfortable positions.
table 2
Position of the person being massaged and the massage therapist during massage1
According to E. A. Zakharova with additions by N. A. Belova, 1974.
Methodology
Massage can be performed directly in the affected area or above it in case of swelling, sharp pain, and also symmetrically to the lesion if it is impossible to carry out direct manipulations in this area (plaster, fixing bandage, violation of the integrity of the skin).
Massage procedure just like self-massage, it consists of 3 stages: 1) introductory – for 1–3 minutes. using gentle techniques, prepare the person being massaged for the main part of the procedure; 2) main – for 5–20 minutes. and more differentiated targeted massage is used, corresponding to the clinical and physiological characteristics of the disease; 3) final – within 1–3 minutes. reduce the intensity of the special effect, while all body functions are normalized, breathing exercises are carried out, if necessary (in the treatment of neuritis of the facial nerve, the presence of a plaster cast), ideomotor movements are used with the sending of volitional impulses, articular gymnastics ( Fig.7).
Massage should not cause increased pain. After it, you should experience feelings of warmth, comfort, relaxation in the massaged area, improved overall well-being, increased joint mobility, drowsiness, and breathing may become easier and freer. The duration of the session, depending on the indications, can be from 3 to 60 minutes.
PREFACE
The author strived to ensure that the reader could quickly find in this book information about the types of massage, the mechanism of its action on the body, as well as a definition of massage techniques and methods of their technical execution, recommendations for the use of massage manipulations on certain areas of the body, methodological instructions and errors, most often encountered when performing massage and self-massage. The reference book contains the latest information, mainly of an applied nature, related to common diseases. The author's many years of practical work in training specialists in sports and therapeutic massage determined the structure of the reference book.
LIST OF REFERENCES USED
Benediktov I. I. Gynecological massage and gymnastics. - Sverdlovsk, 1990.
Biryukov A. A. Sports massage. - M.: FiS, 1972.
Biryukov A. A. Massage. - M.: FiS, 1988.
Biryukov A. A. Bath and massage. - Minsk: Polymya, 1989.
Biryukov A. A., Burovykh A. N. Workshop on sports massage. - M.: FiS, 1983.
Bortfeld S. A., Rogacheva E. I. Exercise therapy and massage for cerebral palsy. - L.: Medicine, 1986.
Burovykh A.N., Zotov V.P. Restorative massage. - Kyiv: Health, 1981.
Burovykh A.N., Fain A.M. Restoring performance through massage and baths. - M.: FiS, 1985.
Velkhover E. S., Kushnir G. V. Exteroceptors of the skin. - Chisinau: Shtiintsa, 1984.
Velkhover E. S., Nikiforov V. G. Fundamentals of clinical reflexology, - M., 1984.
Verbov A.F. Basics of therapeutic massage. - M., 1966.
Glezer O., Dalikho V. A. Segmental massage. - M., 1982.
Goydenkov V. S., Norkina T. E. Metamorphoses of the healing needle. - M., 1987.
Goldblat Yu. V. Acupressure and linear massage in neurology. - L.: Medicine, 1989.
Gotovtsev P. I., Dubrovsky V. I. Athletes about recovery. - M.: FiS, 1981.
Dubrovsky V.I. The use of general massage in the early postoperative period in order to prevent some postoperative complications (methodological letter). - M., 1971.
Dubrovsky V.I. Basics of segmental reflex massage. - M., 1982.
Dubrovsky V.I. Acupressure, - M., 1986.
Dubrovsky V.I. The use of massage for injuries and diseases in athletes. - L.: Medicine, 1986.
Ibragimova V.S. Acupressure. - M.: Medicine, 1984.
Ibragimova V.S. Dot, dot, dot. - M... 1988.
Ivanchenko V. A. Secrets of your vigor. - M., 1988.
Kramarenko V.K. Hygienic, sports and therapeutic massage. - Kyiv, 1953.
Brief notes on segmental massage. - Sverdlovsk, 1968.
Kreimer A. Ya. Vibration as a healing factor. - Omsk, 1972.
Kunichev L. A. Massotherapy. - L.: Medicine, 1983.
Luvsan G. Essays on Eastern reflexology. - Novosibirsk, 1980.
Peterson L., Renström P. Injuries in sports. - M.: FiS, 1981.
Praznikov V.P. Hardening of preschool children. - L.: Medicine, 1988.
Sarkizov-Serazini I. M. Sports massage, - M.: FiS, 1963.
Tykochinskaya E. D. Basics of acupuncture. - M.: Medicine, 1979.
Tyurin A. M... Vasichkin V. I. Massage technique. - L.: Medicine, 1986.
Tyurin A. M. Nonspecific means of training ballet dancers. - L., 1981.
Shenk N.A. Exercise therapy and massage for infantile paralysis. - M., 1956.
Vogler P., Krauss H. Periostbehandlung, Kolonbehandlung. - Leipzig, 1975.
Dicke E., Schliack H., Wolff A. Bindegewebsmassage. - Stuttgart, 1979.
BASIC PRINCIPLES OF MASSAGE
Massage originated in ancient times. The word “massage” comes from the Greek word “μασσω”, which means to knead, knead, stroke.
Massage as a method of treatment was used already in the third millennium BC. e. in China, then Japan, India, Greece, Rome. Records of massage appear among the Arabs. From the depths of centuries, a description of the therapeutic methods of acupuncture, acupressure, and pressure on certain points has reached us. Ancient monuments, such as preserved alabaster bas-reliefs and papyri depicting various massage manipulations, indicate that the Assyrians, Persians, Egyptians and other peoples knew massage and self-massage well (Fig. 1).
Rice. 1. Image of massage techniques on Egyptian papyrus.
In Europe, massage was not used in the Middle Ages due to persecution by the Inquisition. It was only during the Renaissance that interest in body culture and massage arose again.
In Russia in the 18th century. massage was promoted by M. Ya. Mudrov. In the 19th century The development of massage was facilitated by the work of the Swedish specialist P. Ling, the creator of “Swedish massage”. Much credit for the spread of massage belongs to I.V. Zabludovsky; The massage technique he proposed has retained its significance to this day. Among the founders of therapeutic and sports massage in our country, mention should be made of A. E. Shcherbak, A. F. Verbov, I. M. Sarkizov-Serazini and others.
Nowadays in the Soviet Union, massage is used in almost all medical and health institutions. The technique of massage and self-massage, built taking into account clinical-physiological, rather than anatomical-topographical principles, is an effective means of treatment, restoration of performance, relieving fatigue, and most importantly, serves to prevent and prevent diseases, being an active means of healing the body.
TYPES OF MASSAGE
Massage is a set of mechanical dosed effects in the form of friction, pressure, vibration, carried out directly on the surface of the human body, both with hands and with special devices through air, water or other media. Massage can be general and local. Depending on the tasks, the following types of massage are distinguished: hygienic (cosmetic), therapeutic, sports, self-massage.
Hygienic massage. This type of massage is an active means of preventing diseases and maintaining efficiency. It is prescribed in the form of a general massage or massage of individual parts of the body. When performing it, various manual massage techniques, special devices are used, self-massage is used (in combination with morning exercises) in a sauna, in a Russian bath, in a bath, under a shower. One of the types of hygienic massage - cosmetic - is used for pathological changes in facial skin and as a means of preventing its aging.
Massotherapy. This type of massage is an effective method for treating various injuries and diseases. The following varieties are distinguished:
Classic - is used without taking into account reflex effects and is carried out close to the damaged area of the body or directly on it;
Reflex - it is carried out with the aim of a reflex effect on the functional state of internal organs and systems, tissues; at the same time, special techniques are used, affecting certain areas - dermatomes;
Connective tissue - with this type of massage, the effect is mainly on connective tissue, subcutaneous tissue; the basic techniques of connective tissue massage are carried out taking into account the direction of the Benninghoff lines (Fig. 2);
Rice. 2. Location of the lines of greatest resistance to stretching of individual areas of the skin according to Benninghoff (front and back views).
Periosteal - with this type of massage, by influencing points in a certain sequence, they cause reflex changes in the periosteum;
Acupressure is a type of therapeutic massage, when locally a relaxing or stimulating effect is applied to biologically active points (zones) according to the indications for a disease or dysfunction, or pain localized in a certain part of the body;
Hardware - carried out using vibration, pneumatic vibration, vacuum, ultrasonic, ionizing devices; types of baro-, electrical stimulation and other types of massage are also used (aeroion, various applicators - Fig. 3);
Rice. 3. Massage devices. a - general view of FEM-1: 1 - vibrating platform; 2 - vibration frequency regulator; b - electric vibration massager ELVO: 1 - additional handle; 2 - body; 3 - switch; 4 - main handle; 5 - suction bells; 6 - spherical protrusions; 7 - spike attachment; 8 - flat nozzle.
Therapeutic self-massage - performed by the patient himself, can be recommended by the attending physician, nurse, massage specialist, exercise therapy. The most effective techniques for influencing a given area of the body are selected.
Basic principles of massage
Massage originated in ancient times. The word “massage” comes from the Greek word rasaso, which means “knead”, “knead”, “stroke”.
As a method of treatment, massage was used already in the third millennium BC in China, Japan, India, Greece, and Rome. Records of massage appear among the Arabs. From the depths of centuries, a description of the therapeutic methods of acupuncture, acupressure, and pressure on certain points has reached us. Ancient monuments, such as preserved alabaster bas-reliefs and papyri, which depict various massage manipulations, indicate that the Assyrians, Persians, Egyptians and other peoples knew massage and self-massage well (Fig. 1).
Rice. 1. Image of massage techniques on Egyptian papyrus
In Europe, massage was not used in the Middle Ages due to persecution by the Inquisition. It was only during the Renaissance that interest in body culture and massage arose again.
In Russia in the 18th century. massage was promoted by M. Ya. Mudrov. In the 19th century The development of massage was facilitated by the work of the Swedish specialist P. Ling, the creator of “Swedish massage”. Much credit for the spread of massage belongs to I.V. Zabludovsky; The massage technique he proposed has retained its significance to this day. Among the founders of therapeutic and sports massage in our country, mention should be made of A. E. Shcherbak, A. F. Verbov, I. M. Sarkizov-Serazini and others.
Nowadays, massage is used in almost all medical and health institutions. The technique of massage and self-massage, built taking into account clinical-physiological, rather than anatomical-topographical principles, is an effective means of treatment, restoration of performance, relieving fatigue, and most importantly, serves to prevent and prevent various diseases.
Types of massage
Massage is a set of mechanical dosed effects in the form of friction, pressure, vibration, carried out directly on the surface of the human body, both with hands and with special devices through air, water or other media. Massage can be general and local. Depending on the tasks, the following types of massage are distinguished: hygienic (cosmetic), therapeutic, sports, self-massage.
Hygienic massage. This type of massage is an active means of preventing diseases and maintaining efficiency. It is prescribed in the form of a general massage or massage of individual parts of the body. When performing it, various manual massage techniques, special devices are used, self-massage is used (in combination with morning exercises) in a sauna, Russian bath, bath, and shower. One of the types of hygienic massage - cosmetic - is performed for pathological changes in facial skin and as a means of preventing its aging.
Massotherapy. This type of massage is an effective method for treating a variety of injuries and diseases. The following varieties are distinguished:
✓ classic – used without taking into account reflex effects and carried out near the damaged area of the body or directly on it;
✓ segmental-reflex – performed for the purpose of a reflex effect on the functional state of internal organs and systems, tissues; in this case, special techniques are used, affecting certain areas - dermatomes;
✓ connective tissue – affect mainly connective tissue, subcutaneous tissue; the basic techniques of connective tissue massage are carried out taking into account the direction of the Benninghoff lines (Fig. 2);
Fig. 2 Location of lines of greatest resistance to stretching of individual areas of the skin according to Benninghoff
✓ periosteal - with this type of massage, by influencing points in a certain sequence, they cause reflex changes in the periosteum;
✓ acupressure – a type of therapeutic massage, when a local effect is applied in a relaxing or stimulating manner on biologically active points (zones) according to indications for illness or dysfunction or for pain localized in a certain part of the body;
✓ hardware – carried out using vibration, pneumatic vibration, vacuum, ultrasonic, ionizing devices; Varieties of baro-, electrical stimulation and other types of massage are also used (aeroionic, various applicators - Fig. 3);
Rice. 3. Massage devices: a – general view of PEM-1:
1 – vibrating platform; 2 – vibration frequency regulator,
b – electric vibrating massager ELVO:
1 – additional handle; 2 – body; 3 – switch; 4 – main handle; 5 – suction bells; 6 – spherical protrusions; 7 – spike attachment; 8 – flat nozzle
✓ therapeutic self-massage - used by the patient himself, can be recommended by the attending physician, nurse, massage specialist, exercise therapy. The most effective techniques for influencing this area of the body are selected.
Sports massage. This type of massage was developed and systematized by prof. I. M. Sarkizov-Serazini. According to the tasks, the following varieties are distinguished: hygienic, training, preliminary and restorative.
Hygienic The massage is usually done by the athlete himself along with morning exercises and warm-up.
Table 1
Approximate duration of a general training massage depending on the athlete’s body weight
Training massage is carried out to prepare the athlete for the highest sporting achievements in a shorter time and with less psychophysical energy. Used in all periods of sports training. The training massage technique depends on the tasks, characteristics of the sport, the nature of the load and other factors (Table 1).
During a general training massage, the athlete is massaged in a certain sequence (Fig. 4). The duration of manual massage of individual areas and parts of the body is approximately as follows: back, neck, shoulder girdle, gluteal (lumbar) region - 8 minutes; hips, knee joints, shins, ankle joints, feet – 16 minutes; shoulder, elbow joints, forearms, wrist joints, hands, fingers – 14 minutes; chest, abdomen – 7 min.
Preliminary massage is used to normalize the condition of various organs and systems of an athlete before upcoming physical or psycho-emotional stress.
Rice. 4. Sequence of general training massage
Depending on the tasks, the following types of preliminary massage are distinguished:
✓ warm-up – before a training session or performance at a competition, when it is necessary to maintain and increase the tone of the body, taking into account the specifics of the sport;
✓ warming – when cooling the body or individual parts of the athlete’s body, using various rubbing, ointments (finalgon, dolpic, sloans, efkamon, nicoflex, etc.);
✓ mobilizing – to mobilize all the resources of the athlete’s body – physical, mental, technical, etc. – in combination with verbal suggestion;
✓ tonic (stimulating, stimulating) – if necessary (depressed, inhibited state, apathy);
✓ calming (sedative) – when athletes are in a state of increased excitability or pre-race fever.
Restorative massage is a type of sports massage that is used after various types of stress (physical, mental) and at any degree of fatigue, tiredness to restore various functions of the athlete’s body as quickly as possible and increase his performance. A short-term restorative massage is carried out during a 1-5 minute break between rounds, during substitutions in sports games, during rest between attempts (approaches to apparatus).
The main objectives of short-term restorative massage are:
✓ relieve excessive neuromuscular and mental tension;
✓ relax the neuromuscular system and create conditions for optimally rapid recovery of the body;
✓ eliminate existing pain;
✓ increase general and special performance of both individual parts of the body and the entire organism.
Restorative massage during a break of 5-20 minutes is used between halves for football players, wrestlers, gymnasts, and track and field athletes. At the same time, massage techniques are performed taking into account the specifics of the sport, the time until the subsequent load, the degree of fatigue of the body, and the mental state. The greatest effect can be obtained from a restorative massage for 5-10 minutes in combination with a contrast shower.
Restorative massage during a break of 20 minutes to 6 hours is used for divers, wrestlers, track and field athletes and other athletes. Depending on the athlete’s condition, it is advisable to carry it out in 2 sessions: the 1st lasts 5-12 minutes, massage those muscle groups that bore the main load in this sport; 2nd – from 8 to 20 minutes, during which not only the muscle groups that bore the maximum load are massaged, but also the parts of the body located above and below these muscles.
During multi-day competitions, restorative massage is used in sports such as wrestling, boxing, skiing, figure skating, chess, etc., when passive rest does not relieve accumulated fatigue and does not provide the desired recovery effect. This type of restorative massage is carried out in sessions.
His tasks include:
✓ relieve neuromuscular and mental tension;
✓ in an extremely short time, restore and improve the athlete’s performance;
✓ help normalize night sleep.
On weekends and days off from competition, athletes strive to restore strength and improve performance using restorative massage (1–3 sessions). After the completion of the competition, the complex of medical and biological means includes types of restorative massage (manual, vibration, ultrasound) in combination with a bath, hydromassage, aeroionotherapy and other types of influences.
Self-massage. In everyday conditions, it is not always possible to use the services of a massage specialist. In such cases, you can use self-massage. When starting to master the technique of self-massage, you must observe the following:
✓ make all movements of the massaging hand along the flow of lymph to the nearest lymph nodes;
✓ massage the upper limbs towards the elbow and axillary lymph nodes;
✓ massage the lower limbs towards the popliteal and inguinal lymph nodes;
✓ massage the chest in front and to the sides towards the armpits;
✓ massage the neck downwards towards the supraclavicular lymph nodes;
✓ massage the lumbar and sacral areas towards the inguinal lymph nodes;
✓ do not massage the lymph nodes themselves;
✓ strive for optimal relaxation of the muscles of the massaged areas of the body;
✓ hands and body must be clean;
✓ in some cases, self-massage can be carried out through thin cotton or woolen underwear.
It should be noted that self-massage requires significant muscle energy from the massager, creates a large load on the heart and respiratory organs, like any physical work, causing the accumulation of metabolic products in the body. In addition, when performing it there is no freedom in movement, and individual manipulations are difficult. This limits the reflex effect of massage on the body.
Self-massage can be performed at any time of the day, in any comfortable position - at a desk, in a car seat, in the forest during a hike, on the beach, in a bathhouse, etc. Knowing the basics of acupressure, you can effectively prevent various dysfunctions and diseases .
Hygienic basics of massage
The room for massage should be dry, bright (illumination 75-150 lux), equipped with supply and exhaust ventilation, providing 2-3 air exchanges per hour. It is advisable to have a separate massage room with an area of about 18 m2. It should contain:
✓ stable, upholstered in leatherette, lined with foam rubber or a layer of sea grass, a massage couch (if possible with three moving planes and electrically heated) 1.85-2 m long, 0.5–0.6 m wide, 0.5–0 m high .7 m (Fig. 5);
✓ round cushions, covered with leatherette, 0.6 m long, 0.25 m in diameter;
✓ massage table, upholstered in leatherette, dimensions 0.8 x 0.6 x 0.35 m;
✓ a cabinet for storing clean sheets, bathrobes, towels, soap, talcum powder, massage devices, apparatus, Sollux lamps and other necessary equipment used in massage;
✓ first aid kit, which contains: cotton wool, sterile bandages, alcohol solution of iodine, adhesive plaster, boric petroleum jelly, disinfectant ointment, ammonia, camphor-valerian drops, ointments, rubbing, powder, elastic bandage;
✓ sink with cold and hot water supply. The space in the office should be wooden, painted or covered with linoleum, the air temperature in it should be from 20 to 22 °C, the relative humidity should not be higher than 60 %. In the office it is advisable to have an hourglass or procedure clock, a device for measuring blood pressure, a stopwatch, a wrist dynamometer, and a tape recorder.
Rice. 5. Massage couches: regular; 6 – with electric heating
More detailed rules for the operation and equipment of massage rooms are set out in the Handbook on Occupational Safety and Health for Healthcare Workers (M.: Medicine, 1975).
Rice. 6. Average physiological position of the limbs during massage
Requirements for the massaged. Before the massage, it is advisable to take a warm shower or dry yourself with a damp towel, then wipe dry and expose only the necessary part of the body. Clothes should not interfere with the massage; if there is significant hair growth, you can massage through underwear or use creams and emulsions. Abrasions, scratches, scratches and other skin damage must be pre-treated.
For the greatest effect, it is necessary to achieve complete relaxation of the muscles of the massaged area. This condition occurs in the so-called average physiological position, when the joints of the limbs are bent at a certain angle (Fig. 6).
Requirements for a massage therapist. In the rules of behavior of a massage therapist, it is necessary to highlight 2 main aspects - psychological and technical. TO psychological include attentiveness, patience, tact, friendliness, calmness, confidence in the correct execution of the massage session plan, taking into account the patient’s condition; To technical– the ability to perform any type of massage, choose the most effective techniques, observe a rational sequence of individual basic and auxiliary massage techniques, take into account the adequacy of the patient’s response to a massage session or course.
Rules of work for a massage therapist. It is necessary to establish a relationship of trust between the specialist and the person being massaged, which is achieved by his ability to establish good contact with the patient; The success of treatment often depends on this.
The work of a massage therapist involves a lot of physical activity, so he must prevent the occurrence of pathological changes in the cervical and lumbar spine, the occurrence of congestion in the lower extremities, which will help prevent the development of occupational diseases (scapulohumeral periarthritis, flat feet, varicose veins, tendovaginitis, myositis, radiculitis). To do this, you need to perform special relaxation exercises and rest while sitting.
The massage therapist must have a good knowledge of anatomy, the physiological effect of individual massage techniques, conduct diagnostic palpation examinations, and have a developed sense of touch.
It is necessary to comply with hygienic requirements, cut your nails short, use nourishing creams “Tomato”, “Victoria” for oily hands, and use creams “Velour”, “Peach”, “Morning”, “Nectar” for dry skin (peeling). You should wash your hands with water at a temperature of 18–20 °C. If the skin of your hands becomes dry from frequent washing, use “Cosmetic”, “Spermaceti”, “Glycerin”, “Vaseline”, “Amber” soaps. Clothes should be loose, hands should not be worn with objects that could injure the patient's skin, and shoes should be worn with low heels. Try to choose the most comfortable working position, maintain the correct breathing rhythm, work with both hands, involving only those muscles that perform this massage technique.
After clarifying the patient’s complaints and determining the condition of his tissues, together with the doctor, it is necessary to determine the massage technique, taking into account the clinical forms of the lesion, the characteristics of the underlying and concomitant diseases. If a massage therapist, when conducting a course of massage, considers it necessary to make any adjustments to its implementation, which may be caused by the patient’s negative reactions to certain manipulations or the appearance of new clinical signs of the disease, then it is necessary to consult with the attending physician.
Rice. 7. Patient positions during massage
There should be absolute silence in the massage room, and only at the request of the person being massaged can you turn on music or have a conversation, taking into account his condition, without causing negative emotions, without tiring and listening to all the responses of the patient’s body to various manipulations. The patient can be in a sitting position, lying on his back, stomach, side, sometimes standing (Fig. 7).
During the massage, the patient completely relaxes his muscles, the massage therapist provides himself with solid support, and both are in a comfortable position.
table 2
Areas of massage and positions of the patient and massage therapist
(according to E. A. Zakharova with additions by N. A. Belaya, 1974)
Methodology
Massage can be done directly in the affected area or above it in case of swelling, sharp pain, and also symmetrically to the lesion when direct manipulation in this area is impossible (plaster, fixing bandage, violation of the integrity of the skin).
Massage procedure, just like self-massage, it consists of three stages: introductory – within 1–3 minutes, the patient is prepared for the main part of the procedure using gentle techniques; main – differentiated targeted massage is used for 5-20 minutes or more, corresponding to the clinical and physiological characteristics of the disease; 3) final - within 1-3 minutes the intensity of the special effect is reduced, while all functions of the body are normalized, breathing exercises, passive movements are carried out, if necessary (in the treatment of neuritis of the facial nerve, the presence of a plaster cast), ideomotor movements are used with the sending of volitional impulses , articular gymnastics (Fig. 8).
Fig. 8 Sequence of a general classical massage session: 1 – back, 2 – neck, 3 – pelvis, 4, 6 – foot, lower leg (on the back surface), 5, 7 – thigh (on the back surface), 8, 11 – foot, shin (on the front surface) 9, 12 – thigh (on the front surface) 10 – left arm, 13 – right arm, 14 – front chest, 15 – stomach
The patient lies first on his stomach, then on his back
location of the massage therapist during the massage session
Massage should not cause increased pain. After it, you should expect a feeling of warmth, comfort, relaxation in the massaged area, improved overall well-being, increased joint mobility, drowsiness, easier and freer breathing. The duration of the session, depending on the indications, can be from 3 to 60 minutes. Massage is prescribed daily or every other day, depending on the age and condition of the patient, as well as the area of the body. According to indications, massage is carried out 2-3 times a week, combined with baths, ultraviolet irradiation and other types of complex treatment.
Table 3
Massage procedure and the number of conventional units for its implementation (recommended by the USSR Ministry of Health)*
Notes 1. One conventional massage unit is a procedure (direct massage), which requires 10 minutes to complete. 2 The time of transitions (moving) for performing massage procedures outside the office is taken into account in conventional massage units at actual costs. 3 These standards cannot serve as the basis for establishing staffing levels and payroll calculations, except in cases specifically stipulated in the current staffing standards and conditions of remuneration for massage nurses
A massage course includes from 5 to 25 procedures, depending on the severity of the disease and the patient’s condition. Breaks between courses can last from 10 days to 2-3 months, in each case this is decided individually. The number of procedures after the break, depending on the patient’s condition, can be reduced or increased.
Massage course conditionally divided into 3 periods: 1) introductory – 1–3 procedures necessary to determine the body’s response to massage (reduction of pain, drowsiness, ease and freedom of movement); during this period, they determine the tolerance of individual massage manipulations, strive to influence the entire body as a whole, without highlighting reflex areas; 2) main - starting from the 3-4th and up to the 20-23rd procedure, a strictly differentiated massage technique is used, taking into account the clinical picture, the physiological state of the patient and the characteristics of his disease, while paying attention to functional changes in the massaged areas of the body; during this period, the intensity of exposure is gradually increased from procedure to procedure; 3) final – consists of 1–2 procedures; if necessary, you can teach the patient self-massage, showing a rational complex and sequence of techniques for individual areas of the body, performing breathing exercises, and also recommend physical exercises for independent practice using massagers, massage devices and balneological procedures.
The time limit for massage is determined by the duration in minutes or by the number of massage units for a given procedure (Table 3).
The book is intended for both initial and in-depth study of the art of massage. It describes all types of massage, the mechanisms of its action on the body, and provides recommendations for the use of massage and self-massage for the most common diseases. The diagnostic signs of diseases and the principles of their treatment are considered, the ethnology and pathogenesis of diseases that a massage therapist encounters in his practice are briefly outlined.
For massage specialists, physical therapy methodologists, nurses in medical, health and preventive institutions, as well as for everyone interested in the use of massage and self-massage.
Massage originated in ancient times. The word "massage" comes from the Greek word meaning "to knead", "to knead", "to stroke".
Massage as a method of treatment was used already in the third millennium BC. e. in China, then in Japan, India, Greece, Rome. Records of massage appear among the Arabs. From the depths of centuries, a description of the therapeutic methods of acupuncture, acupressure, and pressure on certain points has come down to us. Ancient monuments, such as preserved alabaster bas-reliefs and papyri, which depict various massage manipulations, indicate that the Assyrians, Persians, Egyptians and other peoples knew massage and self-massage well (Fig. 1).
In Europe, massage was not used in the Middle Ages due to persecution by the Inquisition. It was only during the Renaissance that interest in body culture and massage arose again.
In Russia in the 18th century. massage was promoted by M.Ya. Mudrov. In the 19th century The development of massage was facilitated by the work of the Swedish specialist P. Ling, the creator of “Swedish massage”. Much credit for the spread of massage belongs to I.V. Zabludovsky; The massage technique he proposed has retained its significance to this day. Among the founders of therapeutic and sports massage in our country, mention should be made of A.E. Shcherbaka, A.F. Verbova, I.M. Sarkizova-Serazini et al.
Nowadays, massage is used in almost all medical and health institutions.
Rice. 1. Image of massage techniques on Egyptian papyrus
The technique of massage and self-massage, built taking into account clinical and physiological, rather than anatomical and topographical principles, is an effective means of treatment, restoration of performance, relieving fatigue, and most importantly, serves to prevent and prevent various diseases.
Massage is a set of mechanical dosed effects in the form of friction, pressure, vibration, carried out directly on the surface of the human body, both with hands and with special devices through air, water or other media. Massage can be general and local. Depending on the tasks, the following types of massage are distinguished: hygienic (cosmetic), therapeutic, sports, self-massage.
Hygienic massage. This type of massage is an active means of preventing diseases and maintaining efficiency. It is prescribed in the form of a general massage or massage of individual parts of the body. When performing it, various manual massage techniques, special devices are used, self-massage is used (in combination with morning exercises) in a sauna, Russian bath, bath, and shower. One of the types of hygienic massage - cosmetic - is carried out for pathological changes in facial skin and as a means of preventing its aging.
Massotherapy. This type of massage is an effective method for treating a variety of injuries and diseases. The following varieties are distinguished:
- classic - used without taking into account reflex effects and carried out near the damaged area of the body or directly on it;
- segmental-reflex - performed for the purpose of a reflex effect on the functional state of internal organs and systems, tissues; at the same time, special techniques are used, affecting certain areas - dermatomes;
- connective tissue - affect mainly connective tissue, subcutaneous tissue; the basic techniques of connective tissue massage are carried out taking into account the direction of the Benninghoff lines (Fig. 2);
- periosteal - with this type of massage, by influencing points in a certain sequence, they cause reflex changes in the periosteum;
- acupressure - a type of therapeutic massage, when a local effect is applied in a relaxing or stimulating manner on biologically active points (zones) according to the indications for a disease or dysfunction or for pain localized in a certain part of the body;
- hardware - carried out using vibration, pneumatic vibration, vacuum, ultrasonic, ionizing devices; Varieties of baro-, electrical stimulation and other types of massage are also used (aeroionic, various applicators - Fig. 3);
therapeutic self-massage - used by the patient himself, can be recommended by the attending physician, nurse, massage specialist, exercise therapy. The most effective techniques for influencing this area of the body are selected.
Rice. 2. Location of lines of greatest resistance to stretching of individual areas of the skin according to Benninghoff (front and back views)
Fig.3. Massage devices: A-general view of PEM-1: 1-vibrating platform, 2-vibration frequency regulator; b-electric vibration massager ELVO: 1-additional handle, 2-body, 3-switch, 4-main handle, 5-bell suction cups, 6-spherical protrusions, 7-spike nozzle, 8-flat nozzle
Sports massage. This type of massage was developed and systematized by prof. THEM. Sarkizov-Serazini. According to the tasks, the following varieties are distinguished: hygienic, training, preliminary and restorative.
Hygienic massage is usually done by the athlete himself along with morning exercises and warm-up.
Training massage is carried out to prepare an athlete for the highest sporting achievements in a shorter time and with less psychophysical energy. Used in all periods of sports training. The training massage technique depends on the tasks, characteristics of the sport, the nature of the load and other factors (Table 1).
Table 1
Approximate duration (min) of a general training massage depending on the athlete’s body weight
Body weight, kg |
General massage |
Massage in a bathhouse |
During a general training massage, the athlete is massaged in a certain sequence (Fig. 4). The duration of manual massage of individual areas and parts of the body is approximately as follows: back, neck, shoulder girdle, gluteal (lumbar) region - 8 minutes; hips, knee joints, shins, ankle joints, feet - 16 minutes; shoulder, elbow joints, forearm, wrist joints, hand, fingers - 14 minutes; chest, abdomen - 7 min.
Preliminary massage is used to normalize the condition of various organs and systems of the athlete before the upcoming physical or psycho-emotional (on the front and back surfaces of the body according to digital indicators) load.
Rice. 4. Sequence of general training massage (on the front and back surfaces of the body according to the digital indicators)
Depending on the tasks, the following types of preliminary massage are distinguished:
- warm-up - before a training session or performance at a competition, when it is necessary to maintain and increase the tone of the body, taking into account the specifics of the sport;
- warming - when cooling the body or individual parts of the athlete’s body, using various rubbing, ointments (finalgon, dolpic, sloans, efkamon, iikoflex, etc.);
- mobilizing - to mobilize all the resources of the athlete’s body - physical, mental, technical, etc. - in combination with verbal suggestion;
- tonic (exciting, stimulating) - if necessary (depressed, inhibited state, apathy);
- calming (sedative) - when athletes are in a state of increased excitability or pre-race fever.
Restorative massage is a type of sports massage that is used after various types of stress (physical, mental) and at any degree of fatigue, fatigue to quickly restore various functions of the athlete’s body and increase his performance. A short-term restorative massage is carried out during a 1-5 minute break between rounds, during substitutions in sports games, during rest between attempts (approaches to apparatus).
The main objectives of short-term restorative massage are:
- relieve excessive neuromuscular and mental tension;
- relax the neuromuscular system and create conditions for optimally rapid recovery of the body;
- eliminate existing pain;
- increase the general and special performance of both individual parts of the body and the entire organism.
Restorative massage during a break of 5-20 minutes is used between halves for football players, wrestlers, gymnasts, and track and field athletes. At the same time, massage techniques are performed taking into account the specifics of the sport, the time until the subsequent load, the degree of fatigue of the body, and the mental state. The greatest effect can be obtained from a restorative massage for 5-10 minutes in combination with a contrast shower.
Restorative massage during a break of 20 minutes to 6 hours is used for divers, wrestlers, track and field athletes and other athletes. Depending on the athlete’s condition, it is advisable to carry it out in 2 sessions: the 1st lasts 5-12 minutes, massage those muscle groups that bore the main load in this sport; 2nd - from 8 to 20 minutes, while not only the muscle groups that bore the maximum load are massaged, but also the parts of the body located above and below these muscles.
During multi-day competitions, restorative massage is used in sports such as wrestling, boxing, skiing, figure skating, chess, etc., when passive rest does not relieve accumulated fatigue and does not provide the desired recovery effect. This type of restorative massage is carried out in sessions.
His tasks include:
- relieve neuromuscular and mental tension;
- restore and improve the athlete’s performance in an extremely short time;
- promote normalization of night sleep. On weekends and days off from competition, athletes strive to restore strength and improve performance using restorative massage (1-3 sessions). After the completion of the competition, the complex of medical and biological means includes types of restorative massage (manual, vibration, ultrasound) in combination with a bath, hydromassage, aeroionotherapy and other types of influences.
Self-massage. In everyday conditions, it is not always possible to use the services of a massage specialist. In such cases, you can use self-massage. When starting to master the technique of self-massage, you must observe the following:
- make all movements of the massaging hand along the flow of lymph to the nearest lymph nodes;
- massage the upper limbs towards the elbow and axillary lymph nodes;
- massage the lower limbs towards the popliteal and inguinal lymph nodes;
-massage the chest in front and to the sides towards the armpits;
- massage the neck downwards towards the supraclavicular lymph nodes;
- massage the lumbar and sacral areas towards the inguinal lymph nodes;
- do not massage the lymph nodes themselves;
- strive for optimal relaxation of the muscles of the massaged areas of the body;
- hands and body must be clean;
- in some cases, self-massage can be carried out through thin cotton or woolen underwear.
It should be noted that self-massage requires significant muscle energy from the massager, creates a large load on the heart and respiratory organs, like any physical work, causing the accumulation of metabolic products in the body. In addition, when performing it there is no freedom in movement, and individual manipulations are difficult. This limits the reflex effect of massage on the body.
Self-massage can be performed at any time of the day, in any comfortable position - at a desk, in a car seat, in the forest during a hike, on the beach, in a bathhouse, etc. Knowing the basics of acupressure, you can effectively prevent various dysfunctions and diseases .
The room for massage should be dry, bright (illumination 75-150 lux), equipped with supply and exhaust ventilation, providing 2-3 air exchanges per hour. It is advisable to have a separate massage room with an area of about 18 m2. It should contain:
- stable, upholstered in leatherette, lined with foam rubber or a layer of sea grass, a massage couch (if possible with three moving planes and electrically heated) 1.85-2 m long, 0.5-0.6 m wide, 0.5-0 high .7 m (Fig. 5);
- round rollers, covered with leatherette, 0.6 m long, 0.25 m in diameter;
- massage table, upholstered in leatherette, dimensions 0.8 x 0.6 x 0.35 m;
- a cabinet for storing clean sheets, bathrobes, towels, soap, talcum powder, massage devices, apparatus, Sollux lamps and other necessary equipment used in massage;
- first aid kit, which contains: cotton wool, sterile bandages, alcohol solution of iodine, adhesive plaster, boron petroleum jelly, disinfectant ointment, ammonia, camphor-valerian drops, ointments, rubbing, powder, elastic bandage;
Rice. 5. Types of massage couches: a - regular couch; b - electric heated couch
Sink with cold and hot water supply. The floor in the office should be wooden, painted or covered with linoleum, the air temperature in it should be from 20 to 22 ° C, and the relative humidity should not be higher than 60%. In the office it is advisable to have an hourglass or procedure clock, a device for measuring blood pressure, a stopwatch, a wrist dynamometer, and a tape recorder.
More detailed rules for the operation and equipment of massage rooms are set out in the Handbook on Occupational Safety and Health for Healthcare Workers (M.: Medicine, 1975).
Requirements for the person being massaged. Before the massage, it is advisable to take a warm shower or dry yourself with a damp towel, then wipe dry and expose only the necessary part of the body. Clothes should not interfere with the massage; if there is significant hair growth, you can massage through underwear or use creams and emulsions. Abrasions, scratches, scratches and other skin damage must be pre-treated.
For the greatest effect, it is necessary to achieve complete relaxation of the muscles of the massaged area. This condition occurs in the so-called average physiological position, when the joints of the limbs are bent at a certain angle (Fig. 6).
Rice. 6. Average physiological position of the limbs during massage
Requirements for a massage therapist. In the rules of behavior of a massage therapist, it is necessary to highlight 2 main aspects - psychological and technical. Psychological include attentiveness, patience, tact, friendliness, calmness, confidence in the correct implementation of the massage session plan, taking into account the patient’s condition; to the technical level - the ability to do any type of massage, choose the most effective techniques, observe a rational sequence of individual basic and auxiliary massage techniques, take into account the adequacy of the patient’s response to a massage session or course.
Rules of work for a massage therapist. It is necessary to establish a relationship of trust between the specialist and the person being massaged, which is achieved by his ability to establish good contact with the patient; The success of treatment often depends on this.
The work of a massage therapist involves a lot of physical activity, so he must prevent the occurrence of pathological changes in the cervical and lumbar spine, the occurrence of congestion in the lower extremities, which will help prevent the development of occupational diseases (scapulohumeral periarthritis, flat feet, varicose veins, tendovaginitis, myositis, radiculitis). To do this, you need to perform special relaxation exercises and rest while sitting.
The massage therapist must have a good knowledge of anatomy, the physiological effect of individual massage techniques, conduct diagnostic palpation examinations, and have a developed sense of touch.
It is necessary to comply with hygienic requirements, cut your nails short, use nourishing creams “Tomato”, “Victoria” for oily hands, and use creams “Velour”, “Peach”, “Morning”, “Nectar” for dry skin (peeling). You should wash your hands with water at a temperature of 18-20 °C. If the skin of your hands becomes dry from frequent washing, use “Cosmetic”, “Spermaceti”, “Glycerin”, “Vaseline”, “Amber” soaps. Clothes should be loose, hands should not be worn with objects that could injure the patient's skin, and shoes should be worn with low heels. Try to choose the most comfortable working position, maintain the correct breathing rhythm, work with both hands, involving only those muscles that perform this massage technique.
After clarifying the patient’s complaints and determining the condition of his tissues, together with the doctor, it is necessary to determine the massage technique, taking into account the clinical forms of the lesion, the characteristics of the underlying and concomitant diseases. If a massage therapist, when conducting a course of massage, considers it necessary to make any adjustments to its implementation, which may be caused by the patient’s negative reactions to certain manipulations or the appearance of new clinical signs of the disease, then it is necessary to consult with the attending physician.
Rice. 7. Patient’s postures during massage: a-lying on his stomach; b-lying on your back; c-lying on your side; g-sitting
There should be absolute silence in the massage room, and only at the request of the person being massaged can you turn on music or have a conversation, taking into account his condition, without causing negative emotions, without tiring and listening to all the responses of the patient’s body to various manipulations. The patient can be in a sitting position, lying on his back, stomach, side, sometimes standing (Fig. 7).
During the massage, the patient completely relaxes his muscles, the massage therapist provides himself with solid support, and both are in a comfortable position.
Massage can be done directly in the affected area or above it in case of swelling, sharp pain, and also symmetrically to the lesion when direct manipulation in this area is impossible (plaster, fixing bandage, violation of the integrity of the skin).
The massage procedure, as well as self-massage, consists of three stages: 1) introductory - within 1-3 minutes, the patient is prepared for the main part of the procedure using gentle techniques; 2) main - for 5-20 minutes or more, differentiated targeted massage is used, corresponding to the clinical and physiological characteristics of the disease; 3) final - within 1-3 minutes the intensity of the special effect is reduced, while all body functions are normalized, breathing exercises, passive movements are carried out, if necessary (in the treatment of neuritis of the facial nerve, the presence of a plaster cast), ideomotor movements are used with the sending of volitional impulses , articular gymnastics (Fig. 8).
Massage should not cause increased pain. After it, you should expect a feeling of warmth, comfort, relaxation in the massaged area, improved overall well-being, increased joint mobility, drowsiness, easier and freer breathing. The duration of the session, depending on the indications, can be from 3 to 60 minutes. Massage is prescribed daily or every other day, depending on the age and condition of the patient, as well as the area of the body. According to indications, massage is carried out 2-3 times a week, combined with baths, ultraviolet irradiation and other types of complex treatment.
A massage course includes from 5 to 25 procedures, depending on the severity of the disease and the patient’s condition. Breaks between courses can last from 10 days to 2-3 months, in each case this is decided individually. The number of procedures after the break, depending on the patient’s condition, can be reduced or increased.
The massage course is conventionally divided into 3 periods: 1) introductory - 1-3 procedures necessary to determine the body's response to massage (pain reduction, drowsiness, ease and freedom of movement); during this period, they determine the tolerance of individual massage manipulations, strive to influence the entire body as a whole, without highlighting reflex areas; 2) main - starting from the 3-4th and up to the 20-23rd procedure, a strictly differentiated massage technique is used, taking into account the clinical picture, the physiological state of the patient and the characteristics of his disease, while paying attention to functional changes in the massaged areas of the body; during this period, the intensity of exposure is gradually increased from procedure to procedure; 3) final - consists of 1-2 procedures; if necessary, you can teach the patient self-massage, showing a rational complex and sequence of techniques for individual areas of the body, performing breathing exercises, and also recommend physical exercises for independent practice using massagers, massage devices and balneological procedures.
Rice. 8. The sequence of a general classical massage session: a - behind, b - front; 1 - back, 2 - neck, 3 - pelvis, 4, 6 - foot, lower leg (on the back surface), 5, 7 - thigh (on the back surface), 8, 11 - foot, lower leg (on the front surface), 9 , 12 - thigh (on the front surface), 10 - left arm, 13 - right arm, 14 - front chest, 15 - stomach. The patient first lies on his stomach, then on his back indicates the location of the massage therapist during the massage session
Massage and self-massage are indicated for all healthy people; they are also used for various diseases. Massage and self-massage can be used either separately or in combination with other types of treatment. Indications for prescribing massage during various periods of a person’s illness or condition are wide. General indications are given here. The relevant sections provide a complete description of the types of massage for various diseases.
Diseases of the cardiovascular system, coronary heart disease, myocardial infarction, including after surgical treatment, post-infarction cardiosclerosis, hypertension and arterial hypotension, functional neurogenic disorders of the cardiovascular system, myocardial dystrophy, infectious-allergic myocarditis, heart defects, diseases of the arteries and veins.
Respiratory diseases: sore throat, pharyngitis, laryngitis, vasomotor and allergic rhinitis, chronic nonspecific lung diseases, chronic pneumonia and bronchitis, emphysema, pneumosclerosis, bronchial asthma without an exacerbation stage, pleurisy.
Injuries, diseases of the musculoskeletal system: rheumatoid arthritis and other damage to the ligamentous system of the joint, dislocations, tendonitis, tendonitis, paratenonitis, periostitis, degenerative processes in the joints, ankylosing spondylitis, osteochondrosis of various parts of the spine, bruises, sprains, curvatures spine, flat feet, poor posture.
Diseases and injuries of the nervous system: trauma to the nervous system, consequences of cerebrovascular accidents, residual effects of poliomyelitis with spastic and flaccid paralysis, cerebral atherosclerosis with chronic cerebral circulatory failure, cerebral palsy, neuralgia, neuritis, plexitis, radiculitis with degenerative processes in the intervertebral discs, parkinsonism, diencephalic syndromes, solaritis, polyneuritis.
Diseases of the digestive system outside the acute phase: colitis, intestinal dyskinesia, gastritis, prolapse of the stomach (gastroptosis), peptic ulcer (without a tendency to bleeding), diseases of the liver and gallbladder (gallbladder dyskinesia), as well as conditions after cholecystectomy and operations for peptic ulcer diseases of the stomach and duodenum.
Inflammatory diseases of the male and female genital organs in the subacute and chronic stages: chronic urethritis, prostatitis, vesiculitis, incorrect positions and displacements of the uterus and vagina, anatomical inferiority of the uterus (congenital and acquired), its functional inferiority, anatomical and functional insufficiency of the pelvic floor ligaments, as well as pain in the sacrum, coccyx, uterus and ovaries during the intermenstrual period.
Skin diseases: seborrhea of the scalp, acne of the face and body, psoriasis, lichen planus, scleroderma, ichthyosis, hair loss, neurodermatitis.
Diseases of the ear, nose and throat: sore throat, pharyngitis, laryngitis, rhinitis, nosebleeds.
Eye diseases: glaucoma, keratitis, conjunctivitis, optic neuritis.
Metabolic disorders: excess weight, diabetes, gout.
Massage is also used for headaches and sleep disturbances, sexual weakness, dental disease and increased irritability. Massage and self-massage are widely indicated for various ailments.
Massage and self-massage are contraindicated in acute febrile conditions, acute inflammatory processes, bleeding and a tendency towards it, blood diseases, purulent processes of any location, various skin diseases (infectious, fungal etiology), gangrene, acute inflammation, thrombosis, significant varicose veins, trophic ulcers, atherosclerosis of peripheral vessels, thromboangiitis in combination with atherosclerosis of cerebral vessels, vascular aneurysms, thrombophlebitis, inflammation of the lymph nodes, active form of tuberculosis, syphilis, chronic osteomyelitis, benign and malignant tumors of various locations (before surgical treatment).
Contraindications to massage are also unbearable pain after injury (causalgic syndrome), mental illness, circulatory failure of the third degree, hypertensive and hypotensive crises, nausea, vomiting, pain of an unknown nature on palpation of the abdomen, bronchiectasis, pulmonary, cardiac, renal, and liver failure. It must be emphasized that in some cases, contraindications to massage and self-massage are temporary and occur in the acute period of the disease or during an exacerbation of a chronic disease.
Issues related to the appointment of massage require adherence to medical ethics and tact. When prescribing a massage, the doctor indicates in what combination with other procedures its types should be used, constantly monitors the patient, and the massage therapist must inform the doctor about all deviations. This approach to the use of massage makes this method the most effective in treating various diseases and injuries.
The technique of classical massage is described in various manuals on massage and self-massage. Many authors noted the need to preserve already established massage techniques, warning against the unreasonable desire of some specialists to complicate the technique of manipulation. What is important is not the invention of new manipulations, but the development, based on long-existing techniques of classical massage, of private techniques used in differentiation in accordance with indications and taking into account the nature of the disease at a given stage of treatment.
In practice, there are 9 main massage techniques (stroking, squeezing, kneading, shaking, rubbing, active and passive movements, movements with resistance, percussive techniques, shaking), suggesting that their sequence be strictly observed when conducting a massage session. Other experts consider it advisable to distinguish 4 main techniques (stroking, rubbing, kneading, vibration), using their differentiation taking into account the clinical picture of the disease or the general condition of the patient.
Massage techniques are sometimes divided according to their physiological effect: on the skin (stroking, rubbing, percussive techniques), on muscles (squeezing, kneading, felting, shaking, shaking, percussive techniques, movements), on joints, ligaments, tendons (movements, rubbing) . At the same time, A.F. Verbov, instead of the concept of “concussion,” introduced the term “vibration,” which combined all the techniques (tapping, shaking, chopping, shaking, shaking, patting).
Most authors believe that the main techniques of manual massage include stroking, rubbing, kneading, vibration and passive movements. When describing the technique of massage manipulations, some names of techniques make it possible to more accurately and easily understand their effect on the person being massaged. But before studying the technique of performing massage techniques, it is necessary to determine the main “tool” of influence - the massage therapist’s brush (Fig. 9). There are 2 main areas on the palmar surface of the hand: the base of the palm and the palmar surface of the fingers.
Rice. 9. Palmar (a) and dorsal (b) surfaces of the hand: 1- eminence of the fifth finger; 2 - terminal phalanges of the fingers; 3 - elevation of the first finger; 4 - base of the palm; 5 - radial edge of the hand; 6 - ulnar edge of the hand
Each finger (except I) has 3 phalanges: terminal (nail), middle and main. On the palmar surface there are elevations of the 1st and 5th fingers.
In addition, in practice the terms “ulnar and radial edges of the hand”, “distal, middle and proximal phalanges of the fingers” are used.
When performing individual massage techniques, the specialist uses not only the palmar surface, but also the back surface of the hand, either using fingers bent at a right angle, or using the entire back surface of the hand or the protrusions of the fingers bent into a fist - ridges.
Below are the main and auxiliary types of individual massage techniques.
Stroking is a manipulation in which the massaging hand glides over the skin without moving it into folds, with varying degrees of pressure. The following types of stroking techniques are distinguished.
Physiological influence. When stroking, the skin is cleansed of horny scales, residual secretions of the sweat and sebaceous glands, skin respiration improves, and the secretory function of the skin is activated. The trophism of the skin changes significantly - metabolic processes intensify, musculocutaneous tone increases, the skin becomes smooth, elastic, firm, microcirculation increases due to the opening of reserve capillaries (hyperemia). Stroking has a significant effect on the blood vessels, toning and training them. When stroking, the outflow of blood and lymph is facilitated, which helps reduce swelling. This technique also helps to quickly remove metabolic products and decay.
Depending on the technique used and its dosage, stroking can have a calming or stimulating effect on the nervous system. For example, superficial flat stroking calms, deep and intermittent stroking excites.
By stroking in the area of reflexogenic zones (cervico-occipital, upper thoracic, epigastric), it is possible to have a reflex therapeutic effect on the pathologically altered activity of various tissues and internal organs. Stroking has an analgesic and absorbent effect.
Technique of basic techniques. During planar stroking, the hand, without tension, with straightened and closed fingers, located in the same plane, makes movements in different directions (longitudinal, transverse, circular, spiral, with one hand or with two).
This technique is used to massage the back, abdomen, chest, limbs, face and neck (Fig. 10).
Rice. 10. Plane stroking
Planar deep stroking is performed with one palm weighed down by the other, with varying degrees of pressure; movements go to the nearest lymph nodes. Used for massage of the pelvis, back, chest, limbs, and abdomen.
Enveloping stroking - the hand and fingers take the shape of a groove: the first finger is retracted as much as possible and opposed to the rest of the closed fingers (II-V). The brush grips the massaged surface and can move either continuously or intermittently, depending on the tasks assigned to the massage therapist. It is used on the limbs, lateral surfaces of the torso, gluteal region, and neck. And always in the direction of the nearest lymph node, possibly with weights for a deeper effect (Fig. 11).
Rice. 11. Enveloping stroking to the nearest lymph node: a, b, c, d, e, f - sequence of the technique
Auxiliary stroking techniques. Pincer-shaped - performed with pincer-shaped fingers, usually I-II-III or only I-II fingers, when massaging the fingers, toes, tendons, small muscle groups, face, ears, nose (Fig. 12).
Rake-shaped - carried out with the fingers of one or both hands placed in a rake-like manner, possibly with weights, the hand at an angle to the massaged surface from 30 to 45°. It is used in the area of the scalp, intercostal spaces, and on areas of the body when it is necessary to bypass areas with skin damage (Fig. 13).
Comb-shaped - performed by the bony protrusions of the main phalanges of the fingers of one or two hands, bent into a fist. It is done on large muscle groups in the back, pelvis, on the plantar surface of the foot, palmar surface of the hand and where the tendon sheaths are covered with a dense aponeurosis.
Ironing is carried out with the dorsal surfaces of the fingers bent at right angles at the metacarpophalangeal joints, with one or two hands. Used on the back, face, abdomen, sole, sometimes with weights (Fig. 14).
General guidelines
1. Stroking is performed with well-relaxed muscles and a comfortable position for the person being massaged.
2. The technique is carried out both independently and in combination with other techniques.
3. The massage procedure most often begins with stroking, then it is used during the massage process and ends with it.
4. First, apply superficial stroking, then deeper strokes.
5. Planar surface stroking can be carried out both along the lymph flow and against it, and all other types of stroking can only be carried out along the lymph flow to the nearest lymph nodes.
6. Stroking is done slowly (24-26 movements per minute), smoothly, rhythmically, with varying degrees of pressure on the surface being massaged.
7. In case of circulatory problems (swelling, edema), all stroking should be carried out using the suction method, i.e., start from the areas located above, for example, in the case of a pathological process in the ankle joint - from the thigh, then massage the lower leg and only then the ankle joint, all movement - towards the inguinal lymph node.
8. During a massage session, it is not necessary to use all types of basic and auxiliary stroking techniques; you should choose the most effective for a given area.
9. On the flexor surface of the limbs, the massage is made deeper.
Most common errors
1. Strong pressure during a technique, causing an unpleasant sensation or even pain in the patient.
2. Fingers spread apart; their loose fit to the massaged surface during planar stroking leads to uneven impact and unpleasant sensations.
3. Very fast pace and sharp execution of the technique, shifting the skin instead of sliding along it.
4. When performing variations of the technique, instead of sliding over the surface of the skin with varying degrees of pressure, it is shifted in different directions, which causes damage to the hairline, up to the appearance of irritation.
Rubbing is a manipulation in which the massaging hand never slides over the skin, but displaces it, shifting and stretching in different directions. The following types of “rubbing” techniques are distinguished.
Physiological influence. Rubbing is much more energetic than stroking and helps to increase the mobility of the massaged tissues in relation to the underlying layers. At the same time, the flow of lymph and blood to the massaged tissues increases, which significantly improves their nutrition and metabolic processes, and hyperemia appears. The technique promotes loosening and crushing of pathological formations in various layers of tissue, increases the contractile function of muscles, improves their elasticity and mobility, and therefore rubbing is often carried out on joints. Vigorous rubbing along the most important nerve trunks and at the site of nerve endings on the surface of the body causes a decrease in nervous excitability.
When massaging healthy or diseased joints, variations of the “rubbing” technique help increase or decrease mobility in the joint, help reduce hemarthrosis, swelling, rashes and pain in the joint area.
Technique of basic techniques. Straight-line - performed by the end phalanges of one or more fingers. It is used for massaging small muscle groups in the area of joints, hands, feet, the most important nerve trunks, and face (Fig. 15).
Rice. 15. Straight-line rubbing with fingertips: a, b, c - sequence of technique
Circular - carried out with a circular displacement of the skin by the end phalanges with support on the first finger or on the base of the palm; can be done with the back of half-bent fingers or with individual fingers, for example I. Rubbing with weights - with one or two hands alternately. Used on the back, chest, abdomen, limbs - on almost all areas of the body (Fig. 16, 17).
Spiral - carried out with the base of the palm or the ulnar edge of the hand bent into a fist; one or both hands are involved alternately and, depending on the area being massaged, it can be used with weights from one hand to the other. It is used on the back, abdomen, chest, pelvic area, and limbs (Fig. 18).
Auxiliary techniques. Shading is performed with the pads of the end phalanges of the II-III or II-V fingers, which are straightened, maximally extended and at an angle of 30° to the massaged surface. By pressing with short translational movements, the underlying tissues are displaced, moving in a given direction both longitudinally and transversely. Used in the area of skin scars, atrophy of individual muscle groups, skin diseases, flaccid paralysis (Fig. 19).
Rice. 18. Spiral rubbing with the base of the palms
Planing is done with one or two hands. The brushes are placed one after another and, with progressive movements reminiscent of planing, they are immersed in the tissue with the pads of the fingers, stretching and displacing them. It is used on extensive scars and skin diseases (psoriasis, eczema), where it is necessary to exclude exposure to the affected areas, with atrophy of individual muscles and muscle groups (atrophy of the quadriceps femoris, with arthrosis of the knee joint) for the purpose of stimulation (Fig. 20).
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| Rice. 19. Hatching | Rice. 20. Planing |
Sawing - performed with the elbow edge of the hand or both hands. When sawing with both hands, the hands should be positioned so that the palm surfaces face each other and are at a distance of 1-3 cm; Sawing should be done in opposite directions. A roll of massaged tissue should form between the brushes. If the massage is carried out with the radial edges of the hand, then this is called crossing. Both techniques are used in the area of large joints, back, abdomen, hips, and cervical spine (Fig. 21, 22).
Pincer-shaped - done with the terminal phalanges of the I-II or I-III fingers; movements can be linear or circular. It is used for massaging tendons, small muscle groups, auricles, nose, face, for local effects, and for massaging teeth.
Guidelines
1. Rubbing is a preparatory technique for kneading.
2. When rubbing on the face, you must use stepping.
3. To enhance the effect of the technique, you should increase the angle between the massage therapist’s fingers and the massaged surface or use a technique with weights.
4. Rubbing movements are carried out in any direction, regardless of the direction of lymph flow.
5. Unnecessarily, when rubbing, do not linger on one area for more than 8-10 seconds.
6. Take into account the condition of the patient’s skin, his age and responses to the techniques performed.
7. Alternate rubbing techniques with stroking techniques, etc., performing 60-100 movements per minute.
1. Rough, painful execution of the technique.
2. Rubbing movements sliding along the skin, and not with it.
3. Rubbing with straight fingers, not bent at the interphalangeal joints. This is painful for the patient and tiring for the massage therapist.
4. When performing the main types of techniques, do not do simultaneous phases with both hands (like swimming instead of crawl style with breaststroke style), but alternately.
5. The technique is performed in an unsupported position of the hand (at the base or the first finger, when massaging with bent fingers), which significantly increases the energy consumption of the massage specialist, causing excessive muscle strain, pain, fatigue, and myositis.
Kneading is a technique in which the massaging hand performs 2-3 phases: 1) fixation, grasping the massaged area; 2) compression, compression; 3) rolling, crushing, kneading itself. The following types of “kneading” technique are distinguished.
Physiological influence. Kneading has a major effect on the patient’s muscles, due to which their contractile function increases, the elasticity of the bursal-ligamentous apparatus increases, and shortened fascia and aponeuroses are stretched. Kneading helps increase blood and lymph circulation; at the same time, tissue nutrition is significantly improved, metabolism is increased, muscle fatigue is reduced or completely eliminated, muscle performance, their tone and contractile function are increased. Depending on the tempo, strength, and duration of execution of the variations of the technique, the excitability of the cerebral cortex and the tone of the massaged muscles decrease or increase. It should be noted that kneading is a technique by which one can judge the technical abilities of a massage therapist. Kneading is passive gymnastics for muscles.
Technique of basic techniques. Longitudinal - carried out along the muscle fibers, along the axis of the muscles. Straightened fingers are positioned on the massaged surface so that the first fingers of both hands are on the front surface of the massaged segment, and the remaining fingers (II-V) are located on the sides of the massaged segment - this is the 1st phase (fixation). Then the brushes alternately perform the remaining 2 phases, moving over the massaged area. It is used on the limbs, in the pelvis, back, and side surfaces of the neck (Fig. 23, 24).
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| Rice. 23. Longitudinal kneading of the shoulder muscles. | Rice. 24. Longitudinal kneading of the thigh muscles. |
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Rice. 25. Transverse kneading with one hand: a-phase of fixation; b-compression phase; c-crushing (rolling) |
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Rice. 26. Cross kneading with two hands (unidirectional) |
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| Rice. 27. Cross kneading with two hands (multi-directional) | Rice. 28. Transverse kneading with one hand (with weights) |
Transverse - the massage therapist places his hands across the muscle fibers so that the first fingers are on one side of the massaged area, and the rest are on the other. When massaging with two hands, it is more effective to place the hands from each other at a distance equal to the width of the palm, and then simultaneously or alternately perform all 3 phases. If alternately, then one hand moves the muscles, performing the 3rd phase away from itself, and the other at the same time performs the 3rd phase towards itself, i.e. in different directions. Maybe one with weights. Used on the back, pelvis, cervical region, limbs and other areas (Fig. 25-28).
Technique of auxiliary techniques. Felting is often performed on the limbs. The massage therapist's hands, palm surfaces, clasp the massaged area on both sides, fingers are straightened, hands are parallel to each other, movements are made in opposite directions, moving along the massaged area. Used on the thigh, lower leg, forearm, shoulder (Fig. 29).
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Rice. 29. Felting: a - initial phase; b - final phase |
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Rice. 30. Rolling |
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| Rice. 31. Shifting, stretching | Rice. 32. Pressure |
Rolling - having grabbed or fixed the massaged area with one brush, the other carries out rolling movements, moving nearby tissues onto the fixing brush; and so they move around the massaged area. The rolling movement can be performed on individual fingers or a fist. It is used on the stomach, chest, and sides of the back (Fig. 30).
Shifting - having fixed the massaged surface, make short, rhythmic movements, shifting the tissues towards each other. The opposite movement is called stretching. They are used for tissue scars, in the treatment of skin diseases (psoriasis, etc.), for adhesions, paresis, on the face and in other areas. More often it is performed with two hands, two fingers or several fingers (Fig. 31).
Pressure - carried out with a finger or fist, the base of the palm, or with weights. It is used in the back area, along the paravertebral line, in the buttocks area, at the ends of individual nerve trunks (in the area where the BAP is located) (Fig. 32).
Pincer-shaped - carried out with I-II or I-III fingers (pinching on the face), grabbing, pulling, kneading local areas, using 2-3 phases of reception. It is used on the face, neck, at the locations of the most important nerve trunks, in the back and chest.
Guidelines
1. The muscles should be as relaxed as possible with comfortable and good fixation.
2. Massage slowly, smoothly, without jerking, up to 50-60 movements per minute.
3. Carry out movements in both upward and downward directions, centrifugal and centripetal, without jumping from one area to another, taking into account the nature of the pathological process.
4. Increase the intensity of the massage gradually from procedure to procedure so that there is no adaptation (habituation).
5. Start the technique from the place of transition of the muscle into the tendon and place the hands on the massaged surface, taking into account its configuration.
Most common errors
1. Flexion of the fingers at the interphalangeal joints in the 1st phase (fixation). At the same time, the massage therapist begins to “pinch” the patient.
2. Sliding of fingers over the skin in the 2nd phase (compression), which is very painful and unpleasant, and the massage therapist loses muscle; a gap is formed between the massaged surface and the brush and complete kneading is not possible.
3. Strong pressure from the end phalanges of the fingers, which causes pain.
4.Massage with a tense hand and fingers, which tires the massage therapist.
5. Insufficient muscle displacement in the 3rd phase (crushing), which leads to abrupt execution of the technique.
6. Simultaneous work of hands during longitudinal kneading; The massage therapist seems to tear the muscles in different directions, which is very painful, especially for older people.
When vibrating, a massaging hand or vibration device transmits oscillatory movements to the body of the person being massaged. The following types of vibration techniques are distinguished:
Physiological influence. Varieties of the technique have a pronounced reflex effect, causing increased reflexes. Depending on the frequency and amplitude of vibration, the expansion or contraction of blood vessels occurs. Blood pressure decreases significantly. The heart rate decreases, the secretory activity of individual organs changes. The time required for callus formation after fractures is significantly reduced. Varieties of vibration have a pronounced effect on the peripheral and central nervous system, acting as a tonic and stimulant, which is used for flaccid paralysis of the most important nerve trunks and atrophy of individual muscle groups.
Technique of basic techniques. Continuous vibration is performed by the end phalanx of one or several fingers, depending on the area of influence, and, if necessary, by one or both hands, the entire palm, the base of the palm, or a fist (fingers clenched into a fist). This technique is used in the area of the larynx, back, pelvis, on the muscles of the thigh, lower leg, shoulder, forearm, along the most important nerve trunks, at the exit point of the nerve, BAP, BAZ (Fig. 33, 34).
Intermittent vibration (shock) consists of striking one after another with the tips of half-bent fingers, the edge of the palm (elbow edge), the back surface of slightly spread fingers, the palm with bent or clenched fingers, and the hand clenched into a fist. The movements are performed with one or two hands alternately (Fig. 35). Used on the upper and lower extremities, back, chest, pelvis, abdomen; fingers - on the face, head.
Technique of auxiliary techniques. Shaking - done with separate fingers or hands, movements are made in different directions and resemble sifting flour through a sieve (Fig. 36). Used on spastic muscle groups, larynx, abdomen, individual muscles.
Rice. 33. Continuous vibration (stable)
Rice. 34. Continuous vibration (labile)
Shaking - performed with both hands or one with fixation of the hand or ankle joint being massaged. This technique is performed only on the upper and lower extremities. If it is used on the upper ones, a “handshake” and shaking in the horizontal plane are performed.
On the lower extremities, shaking is done in a vertical plane with fixation of the ankle joint with the knee joint straightened (Fig. 37).
Chopped - carried out using the ulnar edges of the hands, with the palms placed at a distance of 2-4 cm from each other. The movements are fast, rhythmic, along the muscles (Fig. 38).
Patting is carried out with the palmar surface of one or both hands, while the fingers are closed or bent, forming an air cushion to soften the blow to the body of the person being massaged (Fig. 39). Used on the chest, back, lumbar region, pelvis, upper and lower extremities.
Tapping - performed with the ulnar edges of one or both hands bent into a fist, as well as with the back of the hand. It is used on the back, in the lumbar, gluteal regions, on the lower and upper extremities (Fig. 40).
Puncturing is carried out by the terminal phalanges of the II-III or II-V fingers, similar to beating out a shot on a drum. You can use one brush or two - a “finger shower”. Used on the face, at the exit points of the most important nerve trunks, in the abdomen, chest, back and other areas of the body, as well as in the BAP, BAZ.
Guidelines
1. The treatment should not cause pain in the person being massaged.
2. The strength and intensity of the impact depend on the angle between the massaging brush and the body - the closer it is to 90°, the stronger the impact.
3 The duration of performing striking techniques in one area is no more than 10 s; it should be combined with other techniques.
4. Long-lasting small vibrations with a small amplitude cause calm and relaxation in the massaged person, while short, intermittent vibrations with a large amplitude cause the opposite state.
5 Do not use intermittent vibrations (effleurage, chopping) on the inner surface of the thighs, in the popliteal region, in the areas of projection of the internal organs (kidneys, heart), especially in elderly and senile people.
6. Vibration is a tedious technique for a massage specialist, so if possible, hardware vibration should be used.
Most common errors
1. Intermittent vibration (chopping, tapping, patting) on tense muscle groups, which causes pain in the patient.
2. During a massage with both hands, the “weakest” hand gets tired; with intermittent vibration, the blows are applied simultaneously, and not alternately, which is painful.
3. When performing the shaking technique on the lower or upper extremities, the direction of movement is not taken into account and when the leg is bent at the knee joint, the ligamentous apparatus of the knee joint can be disrupted, and movements in the upper extremities not in the horizontal plane lead to damage and pain in the elbow joint.
4. Massage with high intensity, which causes resistance from the patient.
5. Perform varieties of striking techniques through movements in the elbow and even shoulder joints.
6. When performing a concussion technique in certain areas of the body, the movement is not made across the muscle fibers, but in other physiologically unfounded directions.
Movement is elementary motor acts characteristic of a particular joint depending on its physiological mobility. Based on the number of articular surfaces involved in the formation of joints, they are divided into simple (two articular surfaces) and complex (more than two), as well as complex (between the articulating surfaces there is a disc, meniscus) and combined (several joints function together independently). The volume of movement in a joint depends on its structure and the difference in angular dimensions of the articular surfaces: around the frontal axis - flexion and extension; sagittal - adduction and abduction; longitudinal - rotation; with combined movement around all axes - circular motion. The following types of movement techniques are distinguished.
Physiological influence. All movements have a beneficial effect on the human musculoskeletal system. Movements performed at a slow pace have a calming effect on the central nervous system. Movement is the best remedy for the treatment of physical inactivity; under their influence, the trophism of internal organs improves, metabolism and digestion intensity increase, and the protective properties and resistance of the body as a whole increase. Movements are of great importance in cases of stiffness (contractures, ankylosis), wrinkling and shortening of the bursa-ligamentous apparatus, as well as microtraumas and hemarthrosis.
Technique of basic techniques. Active movements are performed by the patient himself in a dose determined by a massage therapist or exercise therapy specialist. Options for active movements are widely presented in the relevant literature on exercise therapy and in other sources that recommend active movements for the treatment of a particular pathology.
Passive movements are performed by a specialist without the participation of the person being massaged. The patient's position is lying on his back. The following rules must be observed:
a) the massage therapist stands on the side of the diseased joint;
b) with the same hand (the right hand fixes the right arm or leg of the person being massaged) perform all the necessary movements in this joint;
c) the other hand of the massage therapist fixes, presses, presses on the most effective point when developing a given joint (shoulder - jian-yu; elbow - qu-chi; wrist, flexion-extension - da-lin + yang-chi, circular movement - nei -gu-an + wai-guan, abduction-adduction - yang-gu + yang-si; movements in the interphalangeal joints of the hand - he-gu + lao-gong + e-men, shi-xuan for the fingers of the hand; hip - huan- tiao; knee - yang-ling-quan; ankle - jie-si + kun-lun, in the interphalangeal joints of the foot - yong-tsiktan);
d) before performing passive movement, you need to ask the patient to show active movement in the joint and during the first procedures not to go beyond the limits of possible movement, and then gradually increase the amplitude of the effect;
e) at the moment of restoration of the missing range of motion in this joint, increase the pressure on the pressed point to 5-10 kg; when performing the technique, constantly fix the pressed point with the opposite hand;
f) increase the dosage, number of times and amplitude of exposure gradually from procedure to procedure.
Guidelines
Varieties of passive movements can be performed if it is necessary for the patient to lie on his stomach. Passive movements include traction, traction, stretching, stretching, and postural treatment.
Technique of auxiliary techniques. Movements with resistance. The person being massaged provides resistance when performing a movement in one or another joint, or, conversely, the patient performs an active movement, and the massage therapist gradually helps to perform this movement in the joint.
Isometric movements are based on the fact that the person being massaged fixes the corresponding angle of mobility in a certain joint for 5-10 seconds, repeating the movement several times. In this case, the angle of development of joint mobility gradually increases or decreases depending on the tasks.
Idiomotor movements consist in the fact that the person being massaged sends impulses to a separate muscle group or joint to imitate movement; These movements are performed with plaster immobilization or skeletal traction. Athletes use such movements together with auto-training.
Articulatory movements are often performed in cases of damage to the facial nerve, neuritis, neuralgia, to improve diction, pronunciation of individual words and combinations during stuttering, etc. Voiced consonants or hissing letters are pronounced in a certain sequence (as in patients who have suffered a stroke).
Facial movements are mainly used for asymmetry of the muscles of the face and neck. They use various forms of imitative grimaces. Most often the movements are performed in front of a mirror. Dosage and recommendations for performing the above movements are set out in the relevant sources [Syromyatnikova I.S., 1991, etc.].