Massage techniques were described in antiquity by the doctors of Greece, India, China and other countries. But since then, the technique of performing techniques has undergone a number of changes and improvements.

Today, in classical massage, there are 5 main techniques: stroking, kneading, rubbing, vibration and shock techniques.

The choice and combination of the above techniques depend on many factors. First of all, the nature and stage of the disease, as well as the gender, age of the patient and his condition at the time of the massage are taken into account. In addition, an important factor is the anatomical and physiological features of the massaged area.

When conducting a massage, one technique is rarely used. A massage session, as a rule, consists of a combination of several types of techniques. In order to achieve the maximum effect, it is necessary to alternate the main massage techniques and combine them with auxiliary ones.

Since the hands are the main tool of the massage therapist, it is first necessary to determine the working areas on them. On the palmar surface of the hand (Fig. 7) there are 2 main areas: the base of the palm and the palmar surface of the fingers and 2 elevations (I and IV fingers). Each finger (except I) has 3 phalanges: nail, middle and main. In addition, in practice, the ulnar and radial edges of the hand are also used.

Rice. 7. Palmar surface of the hand: 1 - elevation of the fifth finger; 2 - terminal phalanges of the fingers; 3 - elevation of the first finger; 4 - the base of the palm; 5 - radial edge of the brush; 6 - ulnar edge of the brush

In some cases, techniques are performed not only with the palm of the hand, but also with the back of the hand, fingers or finger combs bent into a fist.

Massage begins and ends with stroking. When it is performed, the hand glides over the skin without shifting it into folds, with varying degrees pressure.

This technique affects metabolic processes, increases muscle tone, enhances blood microcirculation; facilitates the outflow of lymph and blood, which leads to a decrease in edema; contributes to the rapid removal of metabolic products from the body, and also cleanses the skin of horny scales, remnants of the secretion of sweat and sebaceous glands.

In practice, two stroking techniques are used, one of which has a calming effect (superficial planar stroking), and the other is tonic (deep and intermittent). In addition, the reception has an analgesic and resolving effect.

In small areas of the body, as a rule, the reception is performed with the pad of the thumb or pads of the II-V fingers, and the large surfaces of the body are stroked with the base of the palm, fists, palmar and back surfaces of the hand.

Planar stroking used for massage of the limbs, chest, abdomen, back, neck and face. Reception is performed with a palmar surface tightly pressed to the skin. The brush should not be tense. Movements are made in various directions (longitudinally, transversely, circularly, spirally) both with one hand and with two (Fig. 8).

Rice. Fig. 8. Direction of hand movements during massage: a – rectilinear; b - zigzag; c - spiral; g - circular; e - hatching

Deep planar stroking most often used for massage of the pelvis, back, chest and limbs. The reception is performed with weighting one palm of the other, with varying degrees of pressure. In this case, the movements are carried out along the lymph flow towards the lymph nodes.

Embracing stroking perform a brush tightly adjacent to the massaged area, folded in the form of a gutter (I finger is maximally laid aside and opposed to the rest (II–V) closed fingers), directing all movements of the hand from the periphery to the center along the vessels. When performing an enveloping stroke (Fig. 9) the hand can move either continuously or intermittently.

Rice. 9. Embracing stroking towards the nearest lymph node

intermittent stroking, as a rule, they are used for massaging the limbs and small areas of the body. Hand movements should be rhythmic, while you need to grab your hand and squeeze, then let go.

Auxiliary stroking techniques include pincer-like, comb-like, rake-like, concentric stroking and ironing.

Forceps stroking used for massage of small joints (fingers and feet), tendons and individual muscles (face, ears, nose), palms, soles, lumbar region, dorsal surface of the leg. Reception is performed with thumb and forefinger or I–II and III with forceps folded fingers (Fig. 10). Having captured a muscle or joint with your fingers, they stroke along their entire length.

Rice. 10. Forceps stroking

Comb stroking used on muscle groups in the back and pelvis. Reception is performed with the main phalanges of bent fingers, while the thumb of the left hand is clamped with the right hand.

rake stroking used in the area of ​​the scalp, to massage the intercostal spaces and in those parts of the body where it is necessary to bypass the damaged skin. Reception is carried out with the fingers of one or two hands, arranged in a rake-like manner, sometimes with weights. The hand when performing this technique is located at an angle of 30 to 45 ° to the massaged surface (Fig. 11).

Rice. 11. Rake stroking

Ironing (Fig. 12) used for massage of the back, thighs, face, abdomen, soles. Reception is carried out with the fingers of one or two hands, which at the same time are bent in the metacarpophalangeal joints at a right angle to the palm, and with the back surface of the main and middle phalanges of the four fingers, and in the opposite direction, stroking with the pads of the straightened fingers (rake-like reception).

Rice. 12. Ironing

concentric stroking used for massage of the joints, limbs, muscles of the shoulder girdle and neck. Reception is performed by clasping the joint with both hands. In this case, the thumbs are located on one side, and the rest on the other. Circular stroking movements are made to the main lymph nodes in the direction of the lymph flow.

When stroking, it is necessary to follow the general guidelines:

1. Muscles massaged before the start of the massage should be in a relaxed state.

2. Massage begins and ends with stroking.

3. Stroking can be performed in combination with other massage techniques (rubbing, kneading and vibration).

4. Reception is performed slowly (24-26 movements per minute), rhythmically, gently, along the blood and lymph flow, and on the back - in both directions.

5. First use superficial stroking, then deeper.

6. In case of circulatory disorders (swelling, edema), stroking should begin from the areas located above, directing movements along the lymph flow.

7. During the session, it is not necessary to use all the options for stroking.

8. On the flexion surface of the limb, techniques are carried out more deeply.

During the reception, one should not apply too much pressure, as this can cause discomfort and pain for the person being massaged, and loose palms, spread fingers, too fast pace and abrupt execution of the reception can lead to skin displacement.

Rubbing is much more effective than stroking and has a deeper effect on the tissue. The reception is carried out along the blood and lymph flow, increasing the flow of blood and lymph to the massaged tissues, improving their nutrition and metabolic processes. Rubbing promotes loosening and grinding of pathological formations in various layers of tissue, increases muscle elasticity, and significantly reduces nervous excitability.

When rubbing, the hand moves the skin, making it shift and stretch in different directions, while the skin moves along with the masseur's hand.

Reception is carried out with the palmar surface of the hand, tubercles of the thumbs, pads of the index, middle and II–V fingers, the base of the palm, fists, the ulnar edge of the hand, bone protrusions of the phalanges of the fingers bent into a fist. It can be performed with one or both hands, making longitudinal, transverse, circular, zigzag or spiral movements.

When rubbing with the palms, the brush is pressed tightly against the massaged area, while the fingers are tightly pressed against each other, and the large one is set aside.

When massaging the back, buttocks, joints, intercostal muscles, the back of the foot and hand, the Achilles tendon, rubbing with the fingertips is used. The reception is carried out by pressing the thumb to the index finger, and the pads of the II–V fingers to the massaged area, producing a displacement of the skin and subcutaneous tissue. Reception can be done with weights.

On the back, in the area of ​​​​the shoulder girdle and hips, rubbing is performed with the elbow edge of the brush, tightly pressed to the massaged area, moving the hand in a straight line or in a circle.

On large groups of muscles of the back, hips, buttocks and others, rubbing with a fist is carried out. To do this, the fingers are clenched into a fist, and rubbing is done from the side of the bent fingers, as well as from the side of the little finger.

On the muscles of the back, joints, hips, anterior tibial muscles and others, rubbing is applied with the base of the palm, tightly pressed to the massaged area, and pressure is applied with displacement of the skin and subcutaneous tissue.

Rectilinear rubbing (Fig. 13) used for massage of small muscle groups in the joints, hands, feet, main nerve trunks, face. Reception is performed by the terminal phalanges of one or more fingers.

Rice. 13. Consistent execution of straight-line rubbing with fingertips

Circular rubbing used to massage almost all areas of the body: back, chest, abdomen, limbs. The reception is performed with a circular displacement of the skin with terminal phalanges based on the first finger or the base of the palm. It can also be done with the back of half-bent fingers or with individual fingers, with or without weights. (Fig. 14).

Rice. 14. Circular rubbing with two hands with weights

Spiral rubbing used to massage the back, abdomen, chest, pelvis and limbs. The reception is carried out with the base of the palm or the ulnar edge of the hand, bent into a fist, sometimes with burdening one hand with the other. When performing it, one or both hands are used alternately. (Fig. 15).

Rice. 15. Spiral rubbing with the base of the palm

Auxiliary rubbing techniques include hatching, planing, sawing, comb-like and tong-like rubbing.

Hatching used in the area of ​​scars on the skin, with muscle atrophy, skin diseases and flaccid paralysis. Reception is performed with pads of the terminal phalanges of the II–III or II–V fingers. In this case, the fingers should be straightened and be at an angle of 30 ° to the massaged surface. Movements in a given direction are performed progressively, tissues are displaced both longitudinally and transversely (Fig. 16).

Rice. 16. Hatching

Planing used on extensive scars and skin diseases in the event that it is necessary to exclude the impact on the affected areas, with muscle atrophy and for the purpose of stimulating them. When performing the reception, the hands are placed one after the other and with translational movements, reminiscent of planing, they are immersed in the tissues with the fingertips, stretching and displacing them. (Fig. 17).

Rice. 17. Planing

Sawing used in the area of ​​large joints, back, abdomen, hips, cervical. The reception is carried out with the ulnar edge of both hands, setting the hands so that the palmar surfaces are facing each other and are at a distance of 1-3 cm from each other (Fig. 18). During the reception, sawing movements are made with the hands in opposite directions, and between the palms there should be a roller from the massaged tissue.

Rice. 18. Sawing

If the sawing is carried out by the radial edges of the brush, then it is called crossing (Fig. 19).

Rice. 19. Crossing

Comb-shaped rubbing used to massage the muscles of the back, thighs, tibial muscles of the lower leg, soles, palms and abdomen. Reception is performed by bone protrusions of the middle interphalangeal joints.

Forceps rubbing used for massage of tendons, small muscle groups, auricle, nose, face. The reception is performed with the terminal phalanges of the I–II or I–III fingers, making rectilinear and circular movements.

When performing rubbing, you must adhere to the following guidelines:

1. Rubbing can alternate with stroking and other techniques.

2. To enhance the action of the reception, you can increase the angle between the fingers and the massaged surface or carry it out with weights.

3. Rubbing is carried out along the course of the blood and lymphatic vessels, and the back muscles are massaged from the lumbar to the cervical and from the lower corners of the shoulder blades to the lower back.

4. When rubbing, do not linger in one area for more than 8-10 seconds.

All techniques are performed carefully and gently, rubbing movements are performed with a shift of the skin, and not with sliding. The fingers should be straightened when performing the reception, since rubbing with bent fingers can cause discomfort for the person being massaged.

Kneading is one of the most technically difficult massage techniques, or rather, a set of techniques that first fix the massaged area, then squeeze it and knead it.

The main effect of kneading is directed at the muscles, which increases their elasticity, increases blood and lymph flow, significantly improves tissue nutrition, metabolism, relieves muscle fatigue and increases muscle tone, performance and contractile functions. There are two types of kneading: continuous and intermittent. Intermittent kneading is performed with one or two hands in the transverse or longitudinal direction, but the movements of the hands are not uniform, but intermittent.

Kneading with one hand, or ordinary, as a rule, is used to massage the limbs and back. It should be soft, smooth and pain-free. There are two ways to perform an ordinary kneading.

1st way. The massaged muscle is tightly grasped by the palm, and on one side of the muscle is the thumb, and on the other - all the rest, then it is lifted, squeezing between the fingers, and translational movements are made.

2nd way. The muscle is kneaded between the fingers, pressing on it on one side with the thumb, and on the other with all the others, moving along its entire length.

Kneading with two hands (double and circular) is performed in the transverse and lobar directions. Most often it is used to massage the limbs, pelvis, back and side surfaces of the neck.

Hand movements during longitudinal kneading (Fig. 20) directed along the muscle fibers, along the axis of the muscles. Reception is conditionally divided into 3 phases: in the first, straightened fingers are placed so that the thumbs of both hands are on the front surface of the massaged area, and the remaining fingers are located on the sides of the massaged segment; in the next two phases, the hands move over the massaged area.

Rice. 20. Longitudinal kneading of the thigh muscles

Cross kneading (Fig. 21) used to massage the back, pelvis, cervical region, limbs. To perform the reception, the hands are placed across the muscle fibers at a distance equal to the width of the palm. With transverse kneading, hand movements can be directed in one direction or in different directions. Reception can be performed with weights.

Rice. 21. Cross kneading with two hands (unidirectional)

Auxiliary kneading techniques are very diverse: felting, rolling, shifting, stretching, pressure, tong-like kneading, kneading with the base of the palm, kneading with the thumbs and kneading with the pads of the thumbs.

Felting (Fig. 22) most often used in massage of the limbs, thighs, shoulders. Reception is performed with palms, clasping them on both sides of the massaged area. The fingers are straightened, the hands are parallel. Movements are performed in opposite directions with movement along the massaged area.

Rice. 22. Felting

Rolling (Fig. 23) used for massage of the abdomen, chest and lateral surfaces of the back. The reception is carried out by capturing the massaged area with one brush, and with the other, rolling movements are made, moving the adjacent tissues to the fixing brush, and thus move along the massaged area. Rolling movements can be performed on a fist or individual fingers.

Rice. 23. Rolling

Sliding (Fig. 24) used for scars on tissues, in the treatment of skin diseases, with adhesions, paresis of the face and other parts of the body. As a rule, the reception is performed by making rhythmic movements and shifting the tissues relative to each other, having previously fixed the massaged surface. Shifting is performed with two hands or two or more fingers.

Rice. 24. Shift

stretching(traction) is used for adhesions, scars, muscle seals, etc. The reception is performed, as a rule, with the thumbs located opposite each other on the massaged area, exercising smooth stretching of the muscles.

Pressure (Fig. 25) used in the back, along the paraverbal line, in the buttocks, at the exit points of the nerve nodes (biologically active points), on the muscles of the face (paresis of the facial nerve, skin fading, etc.). Reception is carried out intermittently, with the ends of the index and thumb (or II-V fingers), fist, base of the palm, it is possible with weights.

Rice. 25. Pressure

Forceps kneading used for massage of the long muscles of the back, forearm, tibial muscles, face, neck, chest. Reception is performed with the thumb and other fingers folded in the form of tongs. First, the muscle is captured, pulled up, and then kneaded between the fingers. It can also be done with fingers I-II or I-III (pinching on the face), grabbing, pulling and kneading local areas.

Kneading with the base of the palm apply on the muscles of the back, thighs, anterior tibial muscles, large joints, firmly pressing the base of the palm to the massaged area and applying pressure on the tissues in various directions.

Kneading with thumbs carried out simultaneously on two lines. For example, the inside of the right calf muscle is massaged with the left hand, and the outside with the right. The kneading of the paraverbal zones (back muscles) is carried out both spirally and linearly. The reception is performed by applying the brush to the massaged muscle, the thumb is directed forward (along the line of the muscles), and they perform circular rotational (clockwise) movements forward, with pressure on the muscle.

Squeezing produce a tubercle of the thumb or its pads in a straight line with great pressure on the massaged muscles. When burdened, the thumb is pressed either with the base of the other palm, or with fingers II–V.

When carrying out kneading, the following methodological recommendations should be taken into account:

1. Kneading is carried out only on relaxed muscles.

2. The reception is performed vigorously, but gently, without jerking and without causing pain, making 50-60 movements per minute.

3. Receptions are carried out both in the upward direction, along the muscle fibers, and in the transverse and longitudinal directions, without jumping from one area to another, taking into account the pathological process.

4. The intensity of the massage increases with each session. For deep kneading, the muscles are pre-prepared (especially the muscles of the inner surface of the shoulder and thigh).

5. Techniques are carried out from the place where the muscle passes into the tendon, and the hands are placed on the massaged surface, taking into account its configuration.

When performing kneading, one should not bend the fingers in the interphalangeal joints in the first phase of the reception (fixation); slide your fingers over the skin, especially when squeezing the muscle in the second phase; press hard with the end phalanges of the fingers; massage with a tense hand; simultaneously work with your hands during longitudinal kneading in the third phase (crushing), as this causes pain in the person being massaged.

Vibration in technical performance is a fairly simple technique. During its execution, there is a transfer to the massed area of ​​the body of oscillatory movements produced evenly, but at different speeds and amplitudes, depending on the frequency of which, the vessels expand or narrow, decreases arterial pressure, the heart rate decreases, as well as the timing of callus formation after fractures.

Vibration is performed by the palmar surface, the terminal phalanx of one finger, thumb and index (or index, middle and ring), thumb and other fingers, palm and fist.

On the back, abdomen, chest, hips and other large muscle groups, the reception is carried out with the palmar surface. To do this, the palm is pressed tightly against the massaged area and oscillatory movements are performed (with pressure), moving forward.

In the region of the back, larynx, on the muscles of the limbs, vibrations are produced with the thumb and forefinger or with the thumb and all the other fingers, pressing them tightly against the massaged surface and conducting fast, rhythmic oscillatory movements.

In the area of ​​biologically active points, point vibrations are used with the pad of one finger. (Fig. 26), which is tightly pressed to the massaged point and make quick oscillatory movements.

Rice. 26. Point vibration

Depending on the method of conducting the reception, vibrations can be continuous (stable (Fig. 27), labile (Fig. 28)) and discontinuous.

Rice. 27. Continuous vibration (stable)

Continuous vibration is used in the region of the larynx, back, pelvis, on the muscles of the thigh, lower leg, shoulder, forearm, along the most important nerve trunks, at the exit points of nerve nodes (biologically active points and zones). Reception is performed with the terminal phalanx of one or more fingers, depending on the area of ​​​​impact. If necessary, it is carried out with both hands, the entire palm, the base of the palm or the fist.

Rice. 28. Continuous vibration (labile)

Intermittent vibration (shock), as a rule, is used when massaging the limbs, back, chest, pelvic region, abdomen, facial muscles and head (Fig. 29). It is characterized by a non-rhythmic effect on the massaged area. As a rule, the technique is performed by inflicting frequent blows with the tips of half-bent fingers, the edge of the palm, the back surface of slightly extended fingers, the palm with bent or clenched fingers, and also the brush clenched into a fist. Movements are performed with one or two hands alternately.

Rice. 29. Intermittent vibration

Shake(shaking) is used on the muscles of the limbs, buttocks, larynx, chest, pelvis, when exposed to internal organs. Reception is performed with separate fingers or brushes, while making movements resembling sifting flour through a sieve in various directions (Fig. 30).

Rice. 30. Concussion

shaking used for massaging the upper and lower extremities. Reception is carried out with both hands or one with fixation of the hand or ankle joint of the person being massaged (Fig. 31). Hands are shaken in a horizontal plane, taking it by the hand (“handshake”). Leg shaking is performed in a vertical plane with fixation of the ankle joint with the knee joint extended.

Rice. 31. Shaking the lower limb

crossing used for abdominal massage. The reception is performed with the brush of one hand with the thumb abducted on one side and II-III fingers zigzag from bottom to top (from the pubic region to the xiphoid process) on the other.

Guidelines for conducting vibration:

1. The strength and intensity of the impact during the reception depends on the angle of inclination of the fingers in relation to the massaged surface: the more it approaches 90 °, the stronger the impact.

2. Vibrations are exciting, and shaking is soothing.

3. On the inner surface of the thighs, in the popliteal region, in the places where the internal organs (kidneys, heart) are projected, intermittent vibrations (effleurage, chopping) are not carried out, especially in the elderly.

4. Vibration should not be performed on tense muscle groups.

Before applying massage techniques in practice, you need to learn the technique of massaging individual areas of the body. When massaging body parts, it must be taken into account that each muscle group, joint, limb, body segment is massaged taking into account the directions of the main massage movements. Performing a general massage for health purposes, first they massage the back and lumbar region, neck, chest, stomach, then the limbs (first the arms and then the legs) and finally the head and face.

In case of gastrointestinal diseases, mainly the abdomen, lower back, neck and trapezius muscles are massaged. However, performing self-massage or hygienic massage, you can massage all parts of the body. Consider first the massage of those parts of the body that are of interest to us in the first place (abdomen, lower back, neck and trapezius muscle), and then all the rest.

In gastrointestinal diseases, the focus is on abdominal massage. This procedure can be conditionally divided into two parts: massage of the anterior abdominal wall and abdominal organs and solar (celiac) plexus. Massage of the abdominal wall and intestines allows you to accelerate blood circulation, eliminate venous congestion and stimulate bowel function.

Abdominal massage is performed only in the absence of contraindications, no more than 8-10 minutes, 1-2 hours after eating. Receptions are performed in the position of the massaged person lying on his back with his head raised, a roller is placed under the knees.

When performing a massage, it is necessary to take into account the direction of the lymph flow and the location of the lymph nodes. The lymphatic vessels of the upper half of the anterior abdominal wall carry lymph to the axillary lymph nodes; the lower half - in the inguinal nodes; from the epigastric region, lymph enters the intercostal space; from the celiac to the lumbar nodes; from the hypogastric to the iliac lymph nodes.

At the beginning of the massage, planar stroking is carried out with the right hand (with the thumb being the supporting one), with which gentle circular movements are made, starting from the navel, clockwise, covering the entire surface of the abdomen. After that, they proceed to the main part of the massage: rubbing (crossing, sawing, shading), kneading with the fingertips (longitudinal, transverse, felting, rolling). Then they perform vibrations and finish the massage with stroking.

After the preparatory massage, the abdominal muscles should be completely relaxed.

In order to properly massage the stomach area, you need to know its location in the abdominal cavity well. As a rule, the fundus of the stomach reaches the 5th rib along the left midclavicular line, and the lower border is in the region of the anterior abdominal wall 1–2 cm above the navel in women and 3–4 cm in men.

Massage in the stomach area is carried out in two positions of the person being massaged: first, lying on the back, and then on the right side, using intermittent vibration with rake-like fingers in the epigastric region on the left, outside and inside, as well as shaking.

The area of ​​the large intestine is massaged from the right iliac region to the right hypochondrium and, bypassing it, descend to the left iliac region. Then, circular or spiral rubbing with weights, intermittent pressure, shaking are carried out and the procedure is completed by circular stroking and intermittent vibration with the tips of bent fingers and pressing with the palm or fingertips from right to left clockwise over the entire surface of the abdomen.

The liver area is massaged in the direction from the bottom left and right up, while the ends of the fingers penetrate under the right costal edge and produce spiral rubbing, vibration and shaking.

The gallbladder area is located on the lower surface of the right lobe of the liver. It is massaged with light planar stroking, semicircular rubbing and continuous vibration.

On the rectus abdominis muscles, forceps-like stroking, stroking, kneading from top to bottom and from bottom to top are used.

The kidney area is massaged with the right hand in the region of the projection of the right kidney, movements are directed from front to back, using circular rubbing, shaking and stroking.

The projection of the solar plexus is on the line between the xiphoid process and the navel. It is massaged with the fingers of one hand, making circular strokes, rubbing and intermittent vibration.

Neck massage is performed with the patient sitting or lying on his back. You can put a cushion under your head. Most often, stroking is used (planar, encircling, comb-shaped, tong-shaped); rubbing (rectilinear, circular, sawing, crossing, hatching); kneading (transverse, longitudinal, pressure, tongs, shearing, stretching); vibrations. Performing techniques, all movements are directed from top to bottom.

The sternocleidomastoid muscle is massaged using forceps-like stroking and rubbing, while directing all movements along the muscle fibers from the place of its attachment to the mastoid process to the sternoclavicular joint. Ring rubbing of the area of ​​the mastoid processes is performed with one or two hands. End the neck massage with stroking.

Since there are a large number of large blood and lymphatic vessels in the neck area and very thin delicate skin, its massage increases the outflow of venous blood and lymph from the cranial cavity and its integuments.

In gastrointestinal diseases, massage of the upper back is not carried out. Massage only the lumbar region and the sacrum. But since the back is massaged when doing a general massage, it will also be described.

Back massage is carried out taking into account the direction of the lymph flow and the placement of the lymph nodes located in the subclavian and supraclavicular areas, in the groin, the corners of the shoulder blades, etc. Therefore, it is recommended to massage the back in two directions: from top to bottom and from bottom to top (Fig. 32).

Rice. 32. The direction of the main massage movements in the back, waist, neck and pelvis

Back massage is performed with the patient lying on his stomach with arms extended along the body, arms slightly bent at the elbows.

Back massage begins with superficial stroking. Then, gradually increasing the pressure, a flat, deep and embracing stroking is carried out with both hands, while movements are directed from the sacrum and iliac crest upwards, parallel to the spinous processes of the spinal column, to the supraclavicular fossae. Further stroking is performed at some distance from the spinal column.

When massaging the back, a straight line is used (with pads and tubercles of the thumbs); circular (with pads of four fingers of one hand with weights or phalanges of four fingers); concentric (thumbs and forefingers, the base of the palm, phalanges of bent fingers without weight and with weight) rubbing.

The main part of the massage - kneading - is performed with both hands on each side of the back, both longitudinally and transversely, or circular kneading is used with the thumb pad of one or both hands.

The broad muscles of the back are massaged using single and double ring kneading and kneading with the base of the palm. The long muscles (from the sacrum to the back of the head) are kneaded by applying deep linear stroking with the palmar surface of the thumbs of both hands, directing movements from top to bottom and from bottom to top.

The trapezius muscle (nape, middle part of the back, subscapular and suprascapular regions) is massaged in accordance with the direction of the muscle fibers: in the lower part - up, in the middle - horizontally, in the upper - down, using all the basic techniques. Rubbing along the spinal column is carried out with circular movements of the thumb pads, fists and pads of the II-IV fingers, phalanges of bent fingers, the base of the palm, etc. The back massage is finished with stroking.

The pelvic area is massaged, directing movements from the bottom up, using stroking with weights, comb-like, ironing; circular rubbing with weights, comb-like, sawing; longitudinal and transverse, ascending and descending kneading with both hands; intermittent and point vibration.

Foot massage is most often required for soft tissue injuries, damage to bones and joints; treatment of cardio-vascular system, peripheral nervous system and central paralysis. In case of gastrointestinal diseases, the thigh and inguinal region are massaged.

When massaging the legs, it is necessary to take into account the direction of blood and lymph flow. The blood supply to the lower extremities is carried out by the iliac artery system. Along the course of the blood vessels are highly branched lymphatic vessels, and the lymph nodes are located in the groin, popliteal fossa and perineum. Lymph moves from the vessels of the buttocks and the inner surface of the thighs to the lymph nodes of the perineum, and from the back of the foot and sole rises to the inguinal and popliteal nodes.

Foot massage is carried out with the patient lying on his back, and special rollers are placed under the shins and knee joints.

Massage of the lower extremities begins with the foot, then moves on to the ankle and knee joints, hips and nerve trunks (Fig. 33).

Massage begins with light stroking of the fingers and the back of the foot, using comb-like, circular, straight and hatched rubbing; tong-shaped and pushing kneading; patting, shaking and puncturing vibration, as well as a series of passive soft movements.

The plantar and back sides of the foot are massaged, alternating stroking with semicircular rubbing, moving the hands along the lymphatic vessels towards the inguinal and popliteal lymph nodes, then encircling and flat rubbing the plantar surface, stroking the heel, rubbing and vibration of the entire sole. Finish the massage by rotating the foot clockwise. To do this, the leg is fixed with one hand, and with the other, having previously clasped the foot, rotation is performed.

The ankle joint is massaged using circular and planar stroking, some types of kneading, point vibration. Then proceed to the massage of the lower leg. First, it is stroked (possibly with weights) along the front surface, directing movements to the popliteal lymph nodes, and then a comb-like, circular, rectilinear rubbing, hatching, encircling rubbing along the front and back surfaces is performed; tongs and pushing kneading; vibration and shading.

The knee joint is massaged using circular and planar stroking; rectilinear and circular rubbing, shifting of the patella; pressure; point vibration.

When massaging the chest, not only the direction of blood and lymph flow is taken into account, but also the location of the muscles. In the chest area, the lymphatic vessels are directed to the supraclavicular, subclavian and axillary nodes, and in the lateral and lower parts of the chest - to the axillary cavity and axillary fossa, so massage movements are made from the lower ribs to the pectoralis major muscle in an arcuate upwards, massaging the pectoralis major, intercostal, anterior serratus muscles and diaphragm. The muscle fibers of the pectoralis major muscles are fan-shaped, so massage movements are carried out in the direction from the sternum to the armpits and shoulder joint.

Chest massage is performed with the patient lying on his back or side, as well as sitting. Massage begins with stroking (superficial, planar, covering from the bottom up and out to the armpits), and then the pectoralis major, anterior serratus and external intercostal muscles are arbitrarily massaged at the level of the diaphragm. Performing the main part of the chest massage, circular rubbing, transverse kneading and vibration are used. (Fig. 34).

Massage of the external intercostal muscles, as a rule, is performed with the fingertips in the direction from the sternum along the intercostal space to the spinal column, and is completed with an encircling planar stroking from the bottom up.

The serratus anterior muscle is massaged with the patient lying on his side, directing massage movements to the lower angle of the scapula and the spinal column, performing circular rubbing and longitudinal kneading in the intercostal spaces in the area from II to IX ribs alternately with stroking.

Massage of the mammary glands is performed only if there are medical indications. When massaging the breast, movements are directed from the nipple to the base of the gland, and with insufficient secretory activity, from the base of the gland to the nipple.

Anatomically, the upper limbs include the scapula, collarbone, humerus, bones of the forearm and hand. Particular attention should be paid to the location of the lymph nodes and blood vessels, since massage movements are always carried out along the lymphatic vessels, towards the lymph nodes. The arms are supplied with blood through the subclavian artery, venous outflow is carried out through the subclavian vein, and the lymphatic vessels cover the upper limbs from all sides. On the fingers, the lymphatic vessels run transversely to the lateral and palmar surfaces and from there they go to the palm, on the forearm and further to the shoulder, to the axillary and subclavian lymph nodes.

Lymph nodes are located in the elbow, axillary fossa, along the lower edge of the pectoralis major muscle, in the supraclavicular and subclavian regions.

Hand massage is performed in the patient's sitting or lying position, with one (in this case, the other is fixed to the massaged limb and helps to capture the muscles that are affected) or with both hands.

As a rule, massage begins with fingers and hands ( rice. 35). First, the back surface of the hand is massaged, from the fingertips to the middle third of the forearm, carrying out a flat, tong-like stroking (squeezing movements of the thumb and tightly closed other fingers of the massage therapist), circular stroking with one thumb, circular rubbing with the pads of all fingers and the base of the palm. The pressure of the massage therapist's hands should not be very intense, since the joints located on the back of the hand and in the elbow are covered with thin skin and can be damaged by strong pressure.

Then each finger is massaged separately towards its base along the back, side and palmar surfaces. When massaging the palmar and lateral surfaces of the fingers and hand, circular, rectilinear and comb-like rubbing, shading, and sawing are used. On the back of the hand, rectilinear and circular rubbing of the interosseous spaces with the pads of four fingers and spiral rubbing with the base of the palm are carried out.

When massaging the wrist joint, the brush is placed on the massage table or the massage therapist's thigh, first massaging the outer and then the inner side of the palm, performing circular soft rubbing with the thumbs.

After that, rising along the radius, along the posterior surface of the shoulder and through the deltoid muscle, an enveloping stroking is performed in the region of the subclavian lymph node. Then, making massage movements up the front surface of the shoulder, techniques are carried out in the area of ​​​​the axillary lymph node.

Forearm massage is carried out by fixing the patient's hand on the massage therapist's knee. During the reception, they wrap around the wrist and with circular stroking movements gradually move along the outer part of the forearm to the elbow bend. Then the inner side of the forearm is also massaged, paying special attention to the extensor and flexor muscles (biceps, inner shoulder and triceps).

When massaging the flexor muscles, stroking, rubbing and kneading (ordinary, longitudinal, double ring, transverse and forceps) can be used.

The extensor muscles are massaged while holding the patient's hand with the other hand. In the forearm area, semicircular rubbing, transverse kneading of the muscles of the shoulder from the radial and ulnar sides, light vibration with the base of the palm and fingertips are used.

The triceps muscle is rubbed with phalanges of bent fingers, a spiral movement of the base of the palm and crests of bent fingers; they knead, resting the thumb on the muscle, and the four others, pressing, move to the end of the deltoid muscle, where the fingers should converge.

The shoulder joint is massaged, given its anatomical structure. It consists of the head of the humerus and the articular cavity of the scapula. The tendon of the head of the biceps brachii passes through the cavity of the shoulder joint. The muscles surrounding this joint are attached to the small and large tuberosity of the humerus.

Massage of the shoulder and shoulder joint is carried out in the patient's sitting position, lowering the forearm on the table or thigh of the massage therapist, starting with rubbing and stroking the entire massaged area. After that, knead each muscle separately.

The deltoid muscle is massaged using a continuous encircling stroke, moving the hand in concentric circles towards the shoulder girdle. Since the muscle layer of the deltoid muscle is quite strongly developed, kneading is done with two hands with weights.

When massaging the shoulder, longitudinal and transverse kneading, semicircular rubbing, light patting and stroking are used. First stroke the deltoid muscle and the entire area of ​​the shoulder joint with fan-shaped movements. Then the joint is rubbed towards the neck with parallel circular movements of the thumbs, penetrating deeply into the muscles, and sliding movements along the front edge of the joint to the axillary fossa. The back of the shoulder joint is massaged with the thumb and, resting four fingers on the muscle layer, move towards the armpit.

The median nerve can be affected by massaging the palm, using vibration with the fingertips, which produce circular rubbing, longitudinal and transverse rubbing, light stroking and vibration of the shoulder joint, rising up. Massage of the shoulder muscles ends with active-passive movements and light stroking.

The lower part of the shoulder joint is massaged by placing the patient's hand on the shoulder girdle of the massage therapist, who at this moment fixes four fingers on the head of the humerus, and with his thumb presses into the armpit, feeling for the head of the humerus. When rubbing the armpit, the lymph nodes should not be affected. The sternoclavicular and acromial joints are massaged by rubbing and gently stroking.

Before massaging the anterior and posterior surfaces of the elbow joint, it is necessary to stretch the ligaments and joints of the arm. Between the supinator and the internal shoulder muscle is the radial nerve, and on the inside of the shoulder and the back of the elbow joint is the ulnar nerve. They are massaged using a slight vibration by drumming with the fingers on the arm bent at the joint.

The elbow joint is massaged with the patient sitting or lying down, the arm is slightly bent at the elbow, the muscles are completely relaxed. Stroking the elbow joint and adjacent muscles is performed by supporting the hand, using soft circular strokes with the thumb, circular rubbing with the pads of all fingers and the base of the palm, semicircular rubbing, transverse kneading of the muscles of the forearm, light vibration with the base of the palm and fingertips.

In order to act on the parts of the articular capsule located above the coronoid process and the inner edge of the articulation, it is necessary to penetrate the fingers deep into the joint. Massage of the elbow joint ends with light rubbing and stroking.

As already mentioned, with gastrointestinal diseases, the surface of the thigh is massaged. When performing the procedure, almost all classical massage techniques are used: stroking (planar, encircling, comb-like, ironing) on ​​the front, side, back surfaces; rubbing (rectilinear, circular, spiral, sawing, crossing, planing, hatching); kneading (stretching, felting, longitudinal, transverse, pressing, shifting); vibration.

When massaging the gluteal muscles, the same techniques are used as when massaging the thigh, directing movements from the coccyx, sacrum and iliac crests to the lymph nodes of the groin.

The hip joint is massaged in the pelvic region, conducting active circular stroking, and in the area between the ischial tuberosity and the greater trochanter, circular stroking, rubbing and shading are used. Massage of the lower extremities ends with stroking.

Head massage is used quite often as a separate procedure. There are quite a few indications for its implementation: after injuries, with skin diseases, cosmetic disorders, general fatigue, mental fatigue, hair loss and dysfunction of the circulatory organs.

Massage of the scalp is carried out in the position of the patient sitting or lying down. Massage movements are directed from the forehead to the back of the head, from the top of the head in all directions in the direction of the excretory ducts of the glands and hair growth. Performing techniques against hair growth can damage the hairline, worsen the general condition and cause a headache, since under the skin there are a large number of lymphatic vessels that descend from the crown of the head to the lymph nodes located on the back of the head and behind the auricles.

When massaging the head, a rake-like, planar stroking, ironing is used; encircling rubbing by circular and spiral movements of the hand and fingers; stroking, pressing, sliding, pinching, stretching and finger vibration.

Facial massage refers to cosmetic types of massage. It can be conditionally divided into several stages: massage of the forehead, eye sockets, nose, chin, cheeks, mouth, nasolabial folds and auricles. During the massage, the patient can sit or be in a horizontal position.

The frontal region is massaged, making planar stroking towards the place where hair growth begins from the superciliary arches; circular, rectilinear and spiral grinding; kneading and stroking, pinching and finger vibration. All techniques alternate with stroking, conducting 4-5 passes.

In the eye area, the skin is the thinnest, so it is recommended to lightly stroke in the direction of the temporal lobes from the bridge of the nose and superciliary arches and circular strokes; gentle rubbing with fingertips with vibration with fingertips; concentric stroking with the thumb. Light movements along the periphery of the eyeball can be alternated with gentle friction of the eyelid. A significant therapeutic and cosmetic effect can be achieved by applying acupressure.

Cheeks are massaged towards the neck and auricles, using stroking (flat, tongs, ironing); rubbing (circular, straight, spiral, hatching, sawing); kneading (forceps, pressing, shifting, stretching); vibration (puncture, "finger shower", acupressure).

The nose area is massaged light movements fingertips from the tip of the nose to the bridge of the nose, using the following techniques: stroking (planar, forceps), rubbing (circular, straight, forceps, hatching), kneading (pressure, forceps) and vibration (puncturing, shaking, point).

In the area of ​​​​the chin and mouth, hand movements are directed from the lower part of the jaw and corners of the mouth to the auricles and from the nose to the earlobe, using stroking (flat, ironing, forceps); rubbing (circular, rectilinear, spiral, hatching, tongs); kneading (forceps, pressure, stretching, shifting); vibration (puncturing, "finger douche", patting); acupressure techniques. All the techniques carried out necessarily alternate with stroking.

The nasolabial fold is massaged from the lower part of the middle of the chin to the nasolabial folds to the wings of the nose.

Facial skin is the most sensitive to external influences, and this should be taken into account during massage.

For the first time in a systematic visual form, all information on preventive and therapeutic massage is professionally presented. Optimal mastering of practical massage techniques is achieved through large photographs and diagrams.

The necessary basics of human anatomy, diagnostics of the musculoskeletal system are given in a basic, brief summary. The text fragments of the book substantiate the use of massage for various diseases, explain the indications and contraindications for its use.

Extensive illustrative material, conciseness and accessibility of presentation make the atlas an indispensable visual aid, combining the advantages of an atlas and a reference book. Atlas will become indispensable for massage therapists, manual therapy doctors, sports doctors, as well as doctors and methodologists of modern fitness centers. The book will be useful to students of medical schools and students of the postgraduate education system specializing in the field of restorative medicine, as well as to everyone who is interested in improving health without drugs.

The lymphatic vessels of the fingers are located transversely on the lateral surfaces and longitudinally on the palmar surface, then they are directed to the forearm and shoulder. The largest lymphatic vessels are located on the side of the flexors of the shoulder and forearm. Features of the lymphatic flow on the upper limb determine the appropriate direction of massage movements.

In the massage of the upper limb, massage of the hand and fingers, wrist joint, forearm, elbow joint, shoulder, shoulder girdle and shoulder joint are distinguished. Separately, three muscle groups are massaged: the flexor muscles of the forearm (biceps and internal shoulder), the extensor muscles of the forearm (triceps muscle of the shoulder) and the deltoid muscle. Massage starts from the inside of the shoulder.

Indications for use: diseases and injuries of the musculoskeletal system, vascular diseases, central and peripheral diseases of the nervous system.

Massage technique

Patient position: when massaging the anterior surface of the upper limb - lying on the back, a small pillow is placed under the patient's head, the arm is along the body; it is possible to perform a massage while sitting, the patient's hand is on the massage table; when massaging the back surface of the upper limb - lying on the stomach, the arm along the body.

Massage is carried out with one or two hands. When massaging with one hand, the other hand fixes the limb.

Direction of travel the hands of the masseur corresponds to the course of the lymphatic vessels, from bottom to top, from the periphery to the center, towards the elbow and axillary lymph nodes. Along the radius, along the back of the shoulder and through the deltoid muscle - to the supraclavicular lymph nodes. On the ulna, the front surface of the shoulder - to the axillary lymph nodes.

Brush massage

Patient position: lying or sitting. Massage of the palmar surface is carried out in the position of supination of the hand, the palm and fingers are half-bent.

The main techniques are stroking and rubbing, first stroking the fingers and hand at the same time, then rubbing each finger separately with the pads of the thumb and second finger.

Massage movements on the fingers are carried out on the palmar, back and side surfaces. First massage the back, then the palmar surface.

Direction of travel: from the fingertips - to the base of the finger, then along the tendons - to the elbow bend. The massage therapist's hand is placed across the patient's hand.

Stroking - planar, circular, forceps-like on the back surface of the hand from the fingertips to the middle third of the forearm.

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; circular and rectilinear rubbing of the brush.

On the back of the hand - deep rubbing of the interosseous spaces: rectilinear, circular, zigzag rubbing with the fingertips, the thumb pad, the base of the palm. Additional techniques - tongs-like, comb-like rubbing, hatching in the longitudinal and transverse directions.

On the palmar surface - circular rubbing with the pad of the thumb, pads of all fingers, comb-like.

On the palmar surface - they specifically affect the muscles of the tenor and hypotenor: rubbing, kneading, pulling.

Kneading - forceps, shifting, stretching (pull the articular surfaces apart).

Vibration - puncturing, tapping, shaking.

Finish the massage with passive and passive-active movements in all joints of the hand and fingers.

ATTENTION!

The massage of the hand is not performed separately without a massage of the forearm, as the muscles of the hand pass and attach to the forearm.

Massage of the wrist area

Patient position: sitting; the hand and forearm lie on the massage table, the hand is bent. When massaging the palmar surface, it is necessary to bend the brush as much as possible, which will ensure penetration into the joint space. When performing a massage in the supine position, the brush is placed on the masseur's thigh.

Direction of travel: to the ulnar lymph nodes. One hand of the massage therapist fixes the patient's fingers, thereby holding the forearm; the other hand is placed with the palm transverse to the back surface of the hand and conducts the movement.

Stroking - superficial planar and embracing, circular from the back, and then the palmar surface of the hand to the elbow bend.

Rubbing - transverse and circular, forceps, with the pads of the thumb, pads of the II-IV fingers (with the thumb and little finger clasping the joint from the sides), hatching.

ATTENTION!

Massage techniques on the dorsum of the joint are performed less intensively than on the palmar, due to the superficial location of the joint space.

With swelling of the joint, exudate accumulates on the back surface, so massage movements should begin from the side surface of the joint.

With swelling of the hand, massage begins with the overlying segments of the limb.

Forearm massage

Two muscle groups are massaged in isolation: wrist flexors and pronators - on the front surface of the limb; extensors of the hand and pronators - on the back surface of the limb.

First, a general massage of the forearm is performed with the same effect on the flexors and extensors, followed by a selective muscle massage.

Direction of travel: from the fingertips to the ulnar lymph nodes with the capture of the lower third of the shoulder.

Patient position: the forearm is bent at an angle of 110° to the shoulder. One hand of the massage therapist fixes the brush, the other massages. During extensor massage, the forearm is fixed in the pronation position. When massaging the flexors, the hand is transferred to the supination position.

When massaging the flexors, the massage therapist's thumb is placed along the radius, moving along the groove between the flexors and the long arch support, the remaining fingers along the ulna, the palm slides along the forearm, the movement is carried out to the inner condyle of the humerus.

When extensor massage - the thumb is located along the inner edge of the ulna, and the remaining fingers - along the line separating the flexor and extensor muscles, the movement is carried out to the outer condyle of the humerus.

Stroking - planar, embracing continuous and intermittent, ironing, tong-shaped, rake-shaped, comb-shaped.

Rubbing - rectilinear, circular, with the pad of the thumb, pads of four fingers, sawing, crossing, hatching, planing, semicircular with both hands.

Kneading - longitudinal and transverse with the pad of the thumb, pads of four fingers, felting, pressing, stretching, shifting.

Vibration - continuous labile and stable, chopping, shaking.

Massage of the elbow joint

The elbow bag is most accessible to massage from behind. Joint massage is carried out from the radial and ulnar sides, front and back. One hand of the massage therapist fixes the forearm or hand, the other massages.

Patient position: lying or sitting with your hand on the massage table; the arm is bent at the elbow joint at an angle of 90–110°.

Stroking - planar circular thumbs of both hands.

Rubbing - with the pads of the thumbs of both hands from the lateral surface of the joint; rectilinear, circular, hatching - on the back surface of the joint.

Kneading - forceps, pressure, stretching, shifting.

Finish the massage with passive and passive-active movements in the joint.

Shoulder and shoulder area massage

Two groups of muscles are distinguished on the shoulder: the muscles of the anterior surface - flexors (biceps and shoulder muscles) and the muscles of the posterior surface - extensors (triceps muscle).

First, an undifferentiated massage of all the muscles of the shoulder is performed: embracing continuous stroking, semicircular rubbing, felting. Next, the flexor muscles are selectively massaged first, and then the extensor muscles. With one hand, the masseur supports the patient's hand in the elbow area, with the other he moves.

Direction of travel: from bottom to top to the axillary lymph nodes.

When massaging the biceps of the shoulder movement begins below the elbow joint up to the anterior edge of the deltoid muscle. The thumb moves along the outer groove of the muscle, the other four fingers move along the inner groove, the palm is tightly pressed to the shoulder, the fingers meet in the armpit.

When massaging the triceps muscle of the shoulder direction of movement is the same. The thumb moves along the outer groove of the biceps muscle, then along the posterior edge of the deltoid muscle, the other four fingers move along the inner groove of the biceps muscle and the inner edge of the deltoid muscle.

Stroking - planar, embracing, tongs.

Rubbing - rectilinear, circular, sawing, crossing, hatching, planing.

Kneading - longitudinal and transverse in the direction up and down, with the pad of the thumb, pads of four fingers, tongs, felting, stretching.

Vibration - shock techniques, shaking, shaking.

ATTENTION!

Massage techniques on the inner surface of the shoulder should not be intense, since in the groove that separates the biceps muscle from the triceps, there is a neurovascular bundle.

When massaging the shoulder, it is also necessary to massage all the muscles of the shoulder girdle, which is due to the anatomical and topographic features of the muscles.

Deltoid muscle massage

With a sufficiently pronounced musculature, they affect the anterior and posterior portion of the deltoid muscle. With an underdeveloped muscle, separate portions are not isolated.

When massaging the anterior portion of the muscle, the massage therapist's thumb moves through the middle of the deltoid muscle in the direction of the acromial process of the scapula, the remaining fingers move along the anterior edge of the muscle with a tightly pressed palm.

When massaging the posterior portion of the muscle, the palm moves along the posterior edge of the deltoid muscle.

Stroking - embracing continuous stroking of the entire muscle, forceps - on individual parts of the muscle.

Rubbing - sawing.

Kneading - longitudinal and transverse in parts of the muscle.

Vibration - percussion techniques, hacking.

Shoulder joint massage

The joint is surrounded by powerful muscle groups, so it is most accessible for massage from the side of the armpit. First, the deltoid muscle is massaged, then the shoulder joint.

Direction of travel: from bottom to top, from the forearm area, a fan-shaped movement is carried out over the entire surface of the joint to the axillary lymph nodes.

Position of the massage therapist: standing behind the patient.

Patient position: while sitting, to provide better access to all surfaces of the joint, the following positions of the patient's hand are applied:

To access the anterior surface, the patient's hand is placed behind the back, the back of the hand lies on the lumbar region.

For access to the back surface, the patient's palm is on the opposite shoulder.

To access the lower surface, the patient's straight arm rests palm down on the massage therapist's forearm.

Known basic and additional techniques are used.

Stroking - planar, embracing, tong-like, ironing, rake-like.

Rubbing - rectilinear, circular, thumb pad, pads of four fingers, shading.

Kneading - pressure.

Finish the massage with passive and passive-active movements in the joint. With a pronounced limitation of mobility in the shoulder joint, one hand fixes the outer edge of the scapula, the other - fixing the distal shoulder, performs circular movements.

ATTENTION!

Massage techniques on the upper limb can be carried out without differentiated selection of individual muscles and joints.

In case of injuries and swelling of the limb, massage should be started from the proximal segment to facilitate the release of exudate.

Axillary lymph nodes are never massaged.

In the armpit area, the intensity of massage techniques is reduced.

Guidelines

1. Before the massage, the patient's muscles should be relaxed as much as possible by comfortable laying of the limb.
2. When massaging individual areas, carry out a preparatory massage of the entire arm.
3. Do not massage the hand and forearm separately (when massaging the forearm, the hand must also be affected).
4. When massaging the shoulder - massage the entire shoulder girdle.
5. When massaging the muscles of the shoulder, do not act on the internal groove of the biceps muscle.
6. In case of injuries, start the massage from the overlying area or from 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 minutes when massaging the entire limb.
8. Massage of the hand is carried out in the position of the patient lying on his back or on his stomach

9. Indications for massage of the upper extremities: diseases and injuries of soft tissues, bones, joints; diseases of vessels, peripheral nerves; skin diseases.

Shoulder massage. Massage begins with the trapezius and deltoid muscles. Use the techniques of deep stroking, intense rubbing and light kneading. The direction of movement is from the VI-VII cervical vertebrae (if you bend your head, the VII vertebra will protrude more than the rest) to the end of the deltoid muscle. The deltoid muscle should be well rubbed and kneaded.

Next, massage the triceps muscle, which is the extensor of the forearm. Apply techniques of superficial and deep stroking, vigorous rubbing and light kneading. Movements go from the elbow joint along the outer back surface of the shoulder to the shoulder joint.

Then they move on to massage the biceps muscle, which is the flexor of the forearm and shoulder. Movements are performed from the cubital fossa along the inner front surface of the shoulder to the armpit. The brachial artery, veins and nerves pass along the inner surface of the shoulder (on the inner groove). Therefore, when performing a massage, one must be especially careful and in no case exert any pressure on this surface.

Stroking in the direction of the axillary fossa - planar, encircling, forceps; rubbing - rectilinear, circular, spiral, crossing, sawing, hatching; kneading - felting, transverse, longitudinal (flexors and extensors are kneaded separately), stretching, shifting, forceps, pressure; vibration - shaking, puncturing, tapping, patting, chopping, shaking,

Forearm massage.

Stroking from the wrist joint to the area of ​​the elbow, planar, wrapping, forceps, ironing; rubbing - rectilinear, circular, spiral, sawing, crossing, hatching; kneading - longitudinal, transverse, felting, pressing, shifting, stretching, squeezing to the elbow; vibration - tapping, patting, chopping, shaking, shaking

Massage of the hand and fingers.

Massage starts from the back of the fingers, then moves to the back of the hand. Stroking is planar, then pincer-like on the back of the hand, starting from the fingertips to the middle third of the forearm, then massage each finger separately towards its base along the back, palmar and lateral surfaces. Rubbing - along the palmar and lateral surfaces of each finger and hand is circular, rectilinear - along the inter-metacarpal spaces; kneading - tongs, pressure, stretching; vibration - puncturing, shaking, passive and active movements

Anatomical features of the lower limb

The lower limb is divided into the pelvic girdle and the free lower limb. The areas of the lower limb include: 1) the gluteal region, which passes into the back of the thigh. Its upper border is the iliac crest, the lower one is the gluteal groove, or crease; 2) thigh area: a) the anterior thigh area corresponds to the location of the quadriceps femoris and sartorius muscles. The lower border runs 4 cm above the patella; b) the posterior region of the thigh corresponds to the space bounded at the top by the gluteal fold and at the bottom by a transverse line drawn 3-4 cm above the base of the patella; 3) areas of the knee: a) the anterior area of ​​the knee is located on the anterolateral surfaces of the knee. This area includes the area of ​​the patella, corresponding to the contours of the patella and condyles of the thigh; b) the back of the knee is located on the back of the knee. This area includes the popliteal fossa; 4) region of the lower leg: a) the anterior region of the lower leg extends from the tuberosity of the tibia to the level of the base of the ankles and occupies the anterior surface of the lower leg; b) the posterior region of the lower leg, which includes the so-called calf, the most protruding upper part of the posterior region of the lower leg; 5) areas of the foot: a) the rear of the foot is located on the dorsal and lateral surfaces of the foot, ranging from the fold of the ankle joint to the proximal phalanges of the fingers; b) the sole of the foot is located on the plantar surface of the foot, ranging from the distal sections of the calcaneal tuber to the proximal phalanges of the fingers; c) the calcaneal region corresponds to the calcaneal tuberosity.

Figure 106. Bones of the lower limb 1. Pelvic bone 2. Patella 3. Fibula 4. Tibia 5. Tarsus 6. Metatarsus 7. Fingers 8. Foot 9. Lower leg 10. Knee 11. Femur 12. Femur 13. Pelvis.

A - front view

B - rear view

Figure 107. Muscles of the lower limb. A is a front view. B - rear view.

Figure 108. Muscles of the foot.

The muscles of the lower limb (Fig. 107, 108) are divided into the muscles of the pelvis and the muscles of the free lower limb. Among the latter, the muscles of the thigh, lower leg and foot are distinguished.

The muscles of the pelvis (pelvic girdle), in connection with the upright posture of a person, form a powerful muscle mass into which the hip joint is immersed. They implement the most important functions of the body, providing both the possibility of a vertical position of the body and movement in space. With wide ends, they begin on the bones of the pelvis or spine, and with narrowed tendons, they are attached to the upper part of the femur. The complex complementary work of these muscles allows you to fix the hip joint in different modes and positions.

Some of these muscles originate on the inner surface of the pelvic bone or from the lumbar vertebrae. Among them is the iliopsoas muscle, which extends into the upper part of the anterior surface of the thigh. Most of the muscles of the pelvic girdle are located in the gluteal region (large, middle and small gluteal muscles; piriformis, external and internal obturator; twin; quadratus femoris).

The thigh muscles are unequal in length. Some of them extend from the pelvis to the bones of the lower leg and act on both the hip and knee joints, others, shorter ones, only on one of them. They all make up three groups.

The anterior group includes the tailor and quadriceps muscles. The latter is one of the strongest human muscles and consists of four parts, which are connected at the bottom into a common tendon that contains the patella. This is the only muscle that extends the leg at the knee. Its parts (the rectus femoris, the external, internal and intermediate wide muscles of the thigh) have different masses and lengths.

The internal group of muscles of the thigh provides mainly the adduction of the limb, acting on the hip joint (comb, long, short and large adductor muscles, thin muscle). The posterior group consists of the semitendinosus, semimembranosus and biceps muscles of the hip extensors and flexors of the knee joints. The primary importance of the lower leg muscles is that they provide fixation of the ankle joint when standing, orientation and support functions of the foot during movement (walking, running, etc.) . Among them there are relatively shorter muscles, the tendons of which do not go to the fingers (tibial, peroneal, three-headed). The flexors and extensors of the fingers, on the contrary, act on all joints of the foot.

The anterior leg muscles include the tibialis anterior, extensor digitorum longus, and extensor thumb longus. Their tendons run along the anterior surface of the ankle joint. These are the extensors of the foot and fingers (movement when the toe of the foot rises).

The back group is represented by two layers. The more superficial layer includes the gastrocnemius and soleus muscles, which are combined as the triceps muscle of the lower leg. They form one tendon, known to everyone as the Achilles tendon, which attaches to the calcaneal tuberosity. Deeper are the posterior tibial muscle, the long flexor of the fingers and the long flexor of the first finger. All these muscles act as foot flexors at the ankle joint, and they are especially stressed when standing on tiptoe. They are also involved in holding the arches of the foot, and those that extend to the toes, especially the first, provide, in addition, their supporting role when standing and walking.

The outer group consists of the long and short peroneal muscles, their tendons pass behind the outer ankle, these are also ankle flexors.

Fixing on the foot closer to its outer or inner edge, the leg muscles ensure its adaptation to the angle of inclination of the supporting surface, raising or lowering these edges.

Muscles of the foot. On the dorsum of the foot there is only a short extensor of the fingers with a separate part for the first toe.

The muscles of the sole are divided into the muscles of the first toe, little finger and middle group. The first two groups have almost the same set of muscles: finger abductor, short flexor. In the group of the first toe there is also a well-developed adductor muscle, which is important for strengthening the transverse arch of the foot. Yes, and other muscles of the sole, including the middle group (worm-shaped, interosseous muscles, short flexor of the fingers), despite their names, are of primary importance precisely in keeping the arch of the foot. In addition, by ensuring that the fingers are fixed in a certain position, they turn them into reference points when standing and moving. That is why the muscles of the big, supporting toe are so well developed.

Table 8. Muscles of the pelvis and lower limb

Continuation of table 8. Muscles of the pelvis and lower limb

Continuation of table 8. Muscles of the pelvis and lower limb

Continuation of table 8. Muscles of the pelvis and lower limb

Figure 109. Blood vessels of the leg.

Lymphatic vessels and nodes of the pelvis are concentrated along the iliac arteries and veins and collect lymph from the walls of the pelvis, from Bladder, uterus, vagina, rectum, and prostate. From the external genital organs, lymph enters the superficial inguinal lymph nodes

Figure 110. Iliac and inguinal lymph nodes.
Front view.

1 - superficial inguinal lymph nodes; 2 - wide fascia of the thigh; 3 - superficial lymphatic vessels; 4 - great saphenous vein of the leg; 5 - femoral vein; 6 - deep inguinal lymph nodes; 7 - external iliac vein; 8 - inguinal ligament; 9 - external iliac lymph nodes; 10 - common iliac lymph nodes; 11 - inferior vena cava; 12 - abdominal part of the aorta; 13 - lumbar lymph nodes; 14 - subaortic lymph nodes.

Figure 111. Lymphatic vessels and lymph nodes of the lower limb; right. Front view. 1 - inguinal lymph nodes; 2 - medial group of lymphatic vessels; 3 - lateral group of lymphatic vessels.

On the lower extremities are popliteal and inguinal lymph nodes, which are divided into superficial and deep. Lymphatic vessels carry lymph away from the skin (superficial vessels) and muscles, joints, bones, and nerves (deep vessels).

Superficial vessels are divided into two main groups, which are concentrated along the great and small saphenous veins.

The most noticeable accumulation of lymph nodes of the lower limb is localized in the upper part of the thigh under the inguinal fold. These inguinal nodes collect lymph from the thigh, lower leg and foot, as well as from the anterior abdominal wall (below the navel), the gluteal region, the external genital organs, the perineum and part of the pelvic organs.

Massage technique. The position of the patient - lying on his stomach, on his back; to relax the muscles, special rollers are placed under the knee and ankle joints. Massage movements are carried out along the lymphatic vessels towards the popliteal and inguinal lymph nodes.

Ankle massage. The ankle joint is a trochlear joint formed by the articular surfaces of the distal ends of the tibia and fibula and the articular surface of the talus block. Both tibias are interconnected by ligaments and form, as it were, a fork covering the upper and lateral surfaces of the body of the talus (Fig. 113). The articular bag is reinforced with ligaments.

The blood supply to the ankle joint is provided by the anterior and posterior tibial arteries. The pulsation of the first of them is determined on the front surface of the joint., And the second - behind the inner ankle.

Movements in the ankle joint are possible mainly in two directions - in the plantar (flexion) and in the back (extension). The amplitude of these movements in adults reaches 60-70°.

Figure 113. Ankle and foot.

Figure 114. Movements in the ankle joint.

The main landmarks of the ankle region are the medial malleolus (the bony prominence at the distal end of the tibia) and the lateral malleolus (the distal end of the fibula). The ankle ligaments attach to the ankles and bones of the foot. The powerful Achilles tendon attaches to the posterior surface of the calcaneus.

Movement in the ankle joint is limited by plantar and dorsiflexion. Supination and pronation of the foot are possible due to the subtalar and transverse tarsal joints.

It is possible to influence the ankle joint simultaneously from the front and side surfaces. Circular uninterrupted embracing stroking, rubbing is performed. The most commonly used rubbing options are: “toncers” are straight-lined, when four fingers rub the outer surface of the ankle joint, and the thumb rubs the inside; circular pads of four fingers on both sides; the base of the palm at the ankles; rectilinear with the base of the palm and tubercles of the thumbs; spiral base of the palm.

Massage of the ankle joint is done from the heel bone - the place of attachment of the tendon - to the place where the tendon passes into the calf muscle. The following rubbing options are used: rectilinear "forceps" - four fingers rub the outer surface of the ankle joint, and the thumb rubs the inner one; circular-shaped pads of four fingers at the same time; the base of the palm at the ankles; rectilinear pads and tubercles of the thumbs; circular pads of the thumbs. All of these techniques are carried out slowly and alternate with stroking and active-passive movements.

The ankle pouch is accessible in three places: on the anterior surface, where it is widest and lies fairly superficially under the foot and toe extensor muscles; on both sides under the ankles; on the back, covered by the Achilles tendon.

For rubbing, the leg is placed on the couch, the foot should be slightly unbent. Circular movements are made with the pads of all fingers (four fingers are alternately fixed, then one). First, the area under the outer ankle is rubbed, then the front of the bag, and finally the inner ankle. After that, the massage therapist moves the pads of the fingers down, beyond the ankles, and performs rubbing movements in the area of ​​the Achilles tendon. Rubbing ends with stroking.

Leg massage. The position of the patient - lying on his back or stomach, or sitting. Initially, a preliminary massage is performed: planar and embracing continuous stroking from the fingertips to the condyles of the thigh; semicircular or spiral rubbing in ascending and descending directions.

In the area of ​​the calf muscles, continuous vibration is applied in the form of shaking (shaking). Then the anterior muscle group is massaged - separately the tibial, the long common extensor of the fingers and the long extensor of the thumb. The following options are used: 1) stroking: rectilinear; "forceps"; the base of the palm; 2) kneading: with the pads of four fingers; phalanges of the fingers.

Massaging the back muscle group, the masseur should focus on the calf muscle - separately massage its outer and inner abdomen. When massaging the inner abdomen, it simultaneously affects the posterior tibial muscle and the flexors of the fingers. Longitudinal stroking with two hands, transverse and spiral, as well as kneading - ordinary (longitudinal and transverse), double ring, longitudinal with the pads of the thumbs, the base of the palm are also used. In addition, continuous vibration is made in the form of shaking. When massaging the left leg, the masseur's left hand fixes the foot, and vice versa.

If the massage is performed in the supine position, the thumb of the right hand (during the massage of the left leg) moves along the inner edge, and the remaining fingers along the tibia; the thumb of the left hand is along the tibia, and the rest along the inner edge of the gastrocnemius muscle. The Achilles tendon and the place of its attachment to the calcaneal tuber are especially carefully massaged.

Due to the fact that most of the muscles of the lower leg with their long tendons end on the metatarsal bones, as well as on the phalanges of the fingers, the massage of the lower leg should always cover the foot (starting from the fingertips). Massage only the foot or lower leg separately should not be.

Massage of the knee joint. The knee joint is a block and ball joint (Fig. 115), formed by the lateral and medial condyles of the femur, the upper articular surfaces of the tibia and the patella.

Figure 115. Knee-joint.

The patella (patella) is embedded in the tendon of the quadriceps muscle, the continuation of which is the ligament of the patella. The articular surfaces of the condyles of the femur, tibia and patella are covered with hyaline cartilage. The articular bag of the knee joint is extensive, its synovial membrane forms inversions, synovial bags and folds containing adipose tissue. The anterior section of the articular capsule is formed by the tendon of the quadriceps femoris muscle.

The main ligamentous apparatus of the knee joint consists of the lateral peroneal and tibial ligaments located on the lateral surfaces of the joint, as well as the cruciate (anterior and posterior) and transverse ligaments located in the cavity of the knee joint. Between the articular surfaces of the femur and tibia are two crescent-shaped cartilages - the inner and outer menisci. The main movements in the knee joint are flexion and extension. In a small range, rotation of the lower leg outward and inward in a bent position of the joint is possible.

The medial and lateral menisci are semilunar structures of cartilage located on the articular surface of the tibia. They act as cushion pads between the femur and tibia.

The blood supply to the knee joint is carried out by branches of the femoral and popliteal arteries, and the venous outflow occurs in the popliteal and femoral veins. The knee joint is innervated by branches of the lumbar and sacral plexuses. Movements in the knee joint: mainly flexion and extension. There may also be slight hyperextension beyond the neutral position, as well as rotation of the tibia relative to the femur.

.Figure 116. Movement in the knee joint.

The hip joint (Fig. 119) is formed by the acetabulum and the head of the femur. The acetabulum is located at the confluence of the ilium, ischium, and pubis. It is smaller than the head of the femur in size; it is increased by a fibrous cartilaginous rim that runs along the edge of the cavity - the acetabular lip. The head of the femur is covered almost over its entire surface with a thin layer of hyaline cartilage, and the acetabulum is covered only along the semilunar surface. The articular bag of the hip joint goes along the edge of the articular cavity, passes to the femur and is attached in front above the intertrochanteric line, so most of the femoral neck is in the joint cavity. The articular bag of the joint is very strong, ligaments are woven into it: in front - ilio-femoral, from below and from the inside - pubic-femoral, behind - ischio-femoral, in depth the bag is strengthened by a circular ligament. The ligament of the femoral head is located inside the joint, its mechanical significance is not great, but the vessels feeding the femoral head pass through its thickness.

The hip joint belongs to multiaxial joints, however, the range of motion in it is limited by the large depth of the acetabulum and a powerful ligamentous apparatus. In the joint, flexion and extension, abduction and adduction, as well as outward and inward rotation are possible. Flexion is produced by the iliopsoas muscle, the rectus head of the quadriceps femoris, the tailor and tender muscles. Extension is carried out by the semimembranosus and semitendinosus muscles, the long head of the biceps femoris; the gluteus maximus and the adductor maximus muscles of the thigh take part in extension. The thigh is abducted by the middle and small gluteal muscles, and the muscles of the adductor group are adducted. Blood supply - along the branches of the lower gluteal and obturator arteries. Venous drainage occurs through the deep vein of the thigh and the internal iliac vein. The outflow of lymph goes to the internal iliac lymph nodes. hip joint. Innervated by branches of the femoral, obturator and sciatic nerves.

Figure 119. hip joint.

Movements in the hip joint (fig. 120): flexion is possible in a larger volume with a bent knee. Rotation of the hip with a bent knee is difficult. In this case, when the femur is rotated inward, the lower leg moves outward. Outward rotation of the thigh is accompanied by a medial displacement of the lower leg. It is thanks to the movements of the thigh that the indicated movements of the lower limb are possible.

Since the hip joint is closed on all sides by large muscles, this makes massage difficult. Planar stroking, rubbing with the base of the palm, phalanges of bent fingers in various directions are used. The massage of the hip joint ends with active-passive movements.

Massage of the most important nerve trunks of the upper limbs. The lumbar plexus is formed by the anterior branches of the 1st-4th lumbar spinal nerves, it is located in the thickness of the muscles on the anterolateral surface of the lumbar vertebrae. Its branches penetrate the inner, anterior and outer surfaces of the thigh.

The sacral plexus is located in the small pelvis, it is formed by the connecting anterior branches from the 5th lumbar to the 4th sacral spinal nerves. The branches given to them go to the gluteal region. The largest of them - sciatic nerve.

The nerves of the lumbar and sacral plexuses innervate the skin and muscles of the pelvic girdle and the free lower limb, as well as the external genitalia. They provide sensory and motor innervation of the gluteal region, perineum, thigh, lower leg and foot.

Figure 120. Movements in the hip joint.

The sciatic nerve is massaged in the most accessible place: along the line from the lower edge of the ischial tuberosity to the middle of the popliteal fossa. Here, planar continuous deep kneading is used with the thumbs of both hands; rubbing with thumbs moving one after the other and describing semicircles in opposite directions; continuous and intermittent vibration at the tip of the thumb. The force of pressure during vibration increases gradually towards the sciatic tubercle, since as it moves away from the knee joint, the sciatic nerve is more and more covered with a layer of muscles.

The femoral nerve is massaged under the inguinal ligament in the femoral triangle along the anterior and medial surfaces of the thigh. Sparing techniques are used - stroking and rubbing.

The peroneal nerve is massaged at the head of the fibula. The same methods are applied.

The tibial nerve is massaged in the area of ​​the medial malleolus and popliteal fossa. Apply rubbing and vibration.

Indications: in the treatment of diseases of the cardiovascular system, injuries of soft tissues, bones, joints, peripheral nerves, central paralysis.

The tasks and methods of massage are determined in combination with other methods of treatment.

Upper limb massage

The lymphatic vessels of the fingers are located transversely on the lateral surfaces and longitudinally on the palmar surface, then they are directed to the forearm and shoulder. The largest lymphatic vessels are located on the side of the flexors of the shoulder and forearm. Features of the lymphatic flow on the upper limb determine the appropriate direction of massage movements.

In the massage of the upper limb, massage of the hand and fingers, wrist joint, forearm, elbow joint, shoulder, shoulder girdle and shoulder joint are distinguished. Separately, three muscle groups are massaged: the flexor muscles of the forearm (biceps and internal shoulder), the extensor muscles of the forearm (triceps muscle of the shoulder) and the deltoid muscle. Massage starts from the inside of the shoulder.

Indications for use: diseases and injuries of the musculoskeletal system, vascular diseases, central and peripheral diseases of the nervous system.

Massage technique

Patient position: when massaging the anterior surface of the upper limb - lying on the back, a small pillow is placed under the patient's head, the arm is along the body; it is possible to perform a massage while sitting, the patient's hand is on the massage table; when massaging the back surface of the upper limb - lying on the stomach, the arm along the body.

Massage is carried out with one or two hands. When massaging with one hand, the other hand fixes the limb.

Direction of travel the hands of the masseur corresponds to the course of the lymphatic vessels, from bottom to top, from the periphery to the center, towards the elbow and axillary lymph nodes. Along the radius, along the back of the shoulder and through the deltoid muscle - to the supraclavicular lymph nodes. On the ulna, the front surface of the shoulder - to the axillary lymph nodes.

Brush massage

Patient position: lying or sitting. Massage of the palmar surface is carried out in the position of supination of the hand, the palm and fingers are half-bent.

The main techniques are stroking and rubbing, first stroking the fingers and hand at the same time, then rubbing each finger separately with the pads of the thumb and second finger.

Massage movements on the fingers are carried out on the palmar, back and side surfaces. First massage the back, then the palmar surface.

Direction of travel: from the fingertips - to the base of the finger, then along the tendons - to the elbow bend. The massage therapist's hand is placed across the patient's hand.

Stroking - planar, circular, forceps-like on the back surface of the hand from the fingertips to the middle third of the forearm.

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; circular and rectilinear rubbing of the brush.

On the back of the hand - deep rubbing of the interosseous spaces: rectilinear, circular, zigzag rubbing with the fingertips, the thumb pad, the base of the palm. Additional techniques - tongs-like, comb-like rubbing, hatching in the longitudinal and transverse directions.

On the palmar surface - circular rubbing with the pad of the thumb, pads of all fingers, comb-like.

On the palmar surface - they specifically affect the muscles of the tenor and hypotenor: rubbing, kneading, pulling.

Kneading - forceps, shifting, stretching (pull the articular surfaces apart).

Vibration - puncturing, tapping, shaking.

Finish the massage with passive and passive-active movements in all joints of the hand and fingers.

ATTENTION!

The massage of the hand is not performed separately without a massage of the forearm, as the muscles of the hand pass and attach to the forearm.

Massage of the wrist area

Patient position: sitting; the hand and forearm lie on the massage table, the hand is bent. When massaging the palmar surface, it is necessary to bend the brush as much as possible, which will ensure penetration into the joint space. When performing a massage in the supine position, the brush is placed on the masseur's thigh.

Direction of travel: to the ulnar lymph nodes. One hand of the massage therapist fixes the patient's fingers, thereby holding the forearm; the other hand is placed with the palm transverse to the back surface of the hand and conducts the movement.

Stroking - superficial planar and embracing, circular from the back, and then the palmar surface of the hand to the elbow bend.

Rubbing - transverse and circular, forceps, with the pads of the thumb, pads of the II-IV fingers (with the thumb and little finger clasping the joint from the sides), hatching.

ATTENTION!

Massage techniques on the dorsum of the joint are performed less intensively than on the palmar, due to the superficial location of the joint space.

With swelling of the joint, exudate accumulates on the back surface, so massage movements should begin from the side surface of the joint.

With swelling of the hand, massage begins with the overlying segments of the limb.

Forearm massage

Two muscle groups are massaged in isolation: wrist flexors and pronators - on the front surface of the limb; extensors of the hand and pronators - on the back surface of the limb.

First, a general massage of the forearm is performed with the same effect on the flexors and extensors, followed by a selective muscle massage.

Direction of travel: from the fingertips to the ulnar lymph nodes with the capture of the lower third of the shoulder.

Patient position: the forearm is bent at an angle of 110° to the shoulder. One hand of the massage therapist fixes the brush, the other massages. During extensor massage, the forearm is fixed in the pronation position. When massaging the flexors, the hand is transferred to the supination position.

When massaging the flexors, the massage therapist's thumb is placed along the radius, moving along the groove between the flexors and the long arch support, the remaining fingers along the ulna, the palm slides along the forearm, the movement is carried out to the inner condyle of the humerus.

When extensor massage - the thumb is located along the inner edge of the ulna, and the remaining fingers - along the line separating the flexor and extensor muscles, the movement is carried out to the outer condyle of the humerus.

Stroking - planar, embracing continuous and intermittent, ironing, tong-shaped, rake-shaped, comb-shaped.

Rubbing - rectilinear, circular, with the pad of the thumb, pads of four fingers, sawing, crossing, hatching, planing, semicircular with both hands.

Kneading - longitudinal and transverse with the pad of the thumb, pads of four fingers, felting, pressing, stretching, shifting.

Vibration - continuous labile and stable, chopping, shaking.

Massage of the elbow joint

The elbow bag is most accessible to massage from behind. Joint massage is carried out from the radial and ulnar sides, front and back. One hand of the massage therapist fixes the forearm or hand, the other massages.

Patient position: lying or sitting with your hand on the massage table; the arm is bent at the elbow joint at an angle of 90–110°.

Stroking - planar circular thumbs of both hands.

Rubbing - with the pads of the thumbs of both hands from the lateral surface of the joint; rectilinear, circular, hatching - on the back surface of the joint.

Kneading - forceps, pressure, stretching, shifting.

Finish the massage with passive and passive-active movements in the joint.

Shoulder and shoulder area massage

Two groups of muscles are distinguished on the shoulder: the muscles of the anterior surface - flexors (biceps and shoulder muscles) and the muscles of the posterior surface - extensors (triceps muscle).

First, an undifferentiated massage of all the muscles of the shoulder is performed: embracing continuous stroking, semicircular rubbing, felting. Next, the flexor muscles are selectively massaged first, and then the extensor muscles. With one hand, the masseur supports the patient's hand in the elbow area, with the other he moves.

Direction of travel: from bottom to top to the axillary lymph nodes.

When massaging the biceps of the shoulder movement begins below the elbow joint up to the anterior edge of the deltoid muscle. The thumb moves along the outer groove of the muscle, the other four fingers move along the inner groove, the palm is tightly pressed to the shoulder, the fingers meet in the armpit.

When massaging the triceps muscle of the shoulder direction of movement is the same. The thumb moves along the outer groove of the biceps muscle, then along the posterior edge of the deltoid muscle, the other four fingers move along the inner groove of the biceps muscle and the inner edge of the deltoid muscle.

Stroking - planar, embracing, tongs.

Rubbing - rectilinear, circular, sawing, crossing, hatching, planing.

Kneading - longitudinal and transverse in the direction up and down, with the pad of the thumb, pads of four fingers, tongs, felting, stretching.

Vibration - shock techniques, shaking, shaking.

ATTENTION!

Massage techniques on the inner surface of the shoulder should not be intense, since in the groove that separates the biceps muscle from the triceps, there is a neurovascular bundle.

When massaging the shoulder, it is also necessary to massage all the muscles of the shoulder girdle, which is due to the anatomical and topographic features of the muscles.

Deltoid muscle massage

With a sufficiently pronounced musculature, they affect the anterior and posterior portion of the deltoid muscle. With an underdeveloped muscle, separate portions are not isolated.

When massaging the anterior portion of the muscle, the massage therapist's thumb moves through the middle of the deltoid muscle in the direction of the acromial process of the scapula, the remaining fingers move along the anterior edge of the muscle with a tightly pressed palm.

When massaging the posterior portion of the muscle, the palm moves along the posterior edge of the deltoid muscle.

Stroking - embracing continuous stroking of the entire muscle, forceps - on individual parts of the muscle.

Rubbing - sawing.

Kneading - longitudinal and transverse in parts of the muscle.

Vibration - percussion techniques, hacking.

Shoulder joint massage

The joint is surrounded by powerful muscle groups, so it is most accessible for massage from the side of the armpit. First, the deltoid muscle is massaged, then the shoulder joint.

Direction of travel: from bottom to top, from the forearm area, a fan-shaped movement is carried out over the entire surface of the joint to the axillary lymph nodes.

Position of the massage therapist: standing behind the patient.

Patient position: while sitting, to provide better access to all surfaces of the joint, the following positions of the patient's hand are applied:

To access the anterior surface, the patient's hand is placed behind the back, the back of the hand lies on the lumbar region.

For access to the back surface, the patient's palm is on the opposite shoulder.

To access the lower surface, the patient's straight arm rests palm down on the massage therapist's forearm.

Known basic and additional techniques are used.

Stroking - planar, embracing, tong-like, ironing, rake-like.

Rubbing - rectilinear, circular, thumb pad, pads of four fingers, shading.

Kneading - pressure.

Finish the massage with passive and passive-active movements in the joint. With a pronounced limitation of mobility in the shoulder joint, one hand fixes the outer edge of the scapula, the other - fixing the distal shoulder, performs circular movements.

ATTENTION!

Massage techniques on the upper limb can be carried out without differentiated selection of individual muscles and joints.

In case of injuries and swelling of the limb, massage should be started from the proximal segment to facilitate the release of exudate.

Axillary lymph nodes are never massaged.

In the armpit area, the intensity of massage techniques is reduced.