Hartvig Nissen.

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IIHllll HI :i I.



Pkactioal Massage





Prrsidcnt of Posse Normal School of Gymnastics; Superintendent of
llosijital Clinics in Massage and Medical Gymnastics; For Twenty-
lour years Lecturer and Instructor of Massage and Swedish
Gymnastics at Harvard University Summer School; Late
Director of Physical Training at Boston and Brookliue
Public Schools: Former Instructor of Physical Training
at Johns Hopkins University and Wellesley College,
Former Director of the Swedish Health Institute,
Washington, D. C, etc.; author of "Swedish
Movements and Massage Treatment,"
"Practical Massage in Twenty Les-
sons," "A. B. C. of Swedish Edu-
cational Gymnastics," "Rational
Home Gymnastics," etc.




With 68 Original Illustrations, Including Several Full-
page Half-tone Plates,


F. A. DAVIS COMPANY, Publishers

English Depot

Stanley Phillips, London



Copyright, Great Britain. All Rights Reserved

Philadelphia, Pa., U. S. A.

Press of F. A. Davis Company

1914-16 Cherry Street


As years roll by there are constantly new theories
and methods coming up, and my own exjx^rience
teaches me, more and more, one is never too old to
learn ; so 1 have found it necessary to enlarge and im-
prove on my former books, and also to add the im-
portant "Corrective Exercises," with full description
of their effect and muscles used in the different

This new book, then, is what forty years O'f study
and experience, practice, and teaching have taught me ;
and I earnestly hope it will be of value to those who
wish to learn in a practical way to treat suffering hu-
manity v.'ith Mechanotherapy.

Hartvig Nissen.
Boston, Mass.




Since my book, "Swedish Movement and Mas-
sage Treatment," was piublished in May, 1889, I have
had many hundreds oif pupils as well as patients; and
during my thirty years of experience as a masseur and
teacher, I have been constantly studying and practis-
ing and broadening my views and ideas.

My first book was written on the authority of others
and the theory which they taught.

This book, which I hope will be found worthy of
its title, "Practical Massage," is the result of my life's

It is written just as I have been teaching "mas-
sage" for several years at Harvard University Summer
School and to my private pupils.

My method is a combination of what I have found
to be the best and most useful "manipulations" and
"movements" in other systems as well as original. I
trust this little book will be accepted as a practical help
in the treatment of the sick.

Hartvig Nissen.
Boston, Mass.




The History — Swedish Movement Treatment — A Word
to the Physician — Variety of Movements and Dura-
tion — How Often the Treatment Should be Repeated
— How to be Dressed — Physiological Effects of Move-
ments — Passive Movements — Active and Resistive
Movements 1-18

Active and Passive Movements — Resistive or Duplicate
Movements — The Positions — Manipulations of Arms
— Centripetal Stroking, Kneading and Circular Fric-
tion — The Effects of These Manipulations 19-29

Manipulations of Arms— Nerve Compression — Muscle
Rolling — Slapping — Friction— Combination Kneading
— Percussion — Beating — \'ibration 30-36

Passive Movements of Arms — Finger Rotation — Hand
Rotation — Forearm Rotation — Arm Rotation (Smgle)
— Flexion of Arm, Hand, and Finger — Vertical Arm
Rotation — Forward Arm Rotation — Shoulder Rota-
tion and Chest Lifting 37-43

Manipulations of Legs — Centripetal Stroking. Kneading,
and Circular Friction — Xerve Compression, Muscle
Rolling, Slapping, and Friction — Combination Knead-
ing — Percussion — Beating — ^\'''ibration — Stretching the
Sciatic Nerve — Passive Movements of Legs : Foot
Rotation (Single and Double) — Foot Flexion and

Extension — Thigh Rotation — Hip Rotation 44-48



Passive Movements of the Trunk: Manipulations of the
Chest- — Chest Friction and Kneading — Chest Vibra-
tion — Chest Slapping — Chest Lifting and Vibration —
Abdominal Massage : Stomach Friction — Muscle
Kneading of the Abdomen — Knuckle Kneading of the
Abdomen— Circular Kneading of the Abdomen — ■
Stomach Vibration — Bowel Vibration — Bowel Concus-
sion — Loin Vibration — Loin Traction 49-57

Massage of the Back : Back Friction — Back Muscle
Kneading, Muscle Rolling — Back Circular Kneading
— Back Vibration — Spinal Nerve Compression — Back
Percussion — Long Friction Down the Back — Breech
Beating 58-63

Head, Face, and Throat Massage — Head Percussion —
Vibration at the Base of the Skull — Kneading of the
Head — Head Vibration — Friction of the Forehead and
Temples — Facial Massage — Throat Massage — Head
Rotation — Head Flexion (Passive) 64-71

Resistive Movement of Arms : Finger Flexion and Ex-
tension — Hand Flexion and Extension — Arm Flexion
and Extension — Vertical Arm Flexion and Extension
— Horizontal Arm Flexion and Extension — Horizontal
Arm Separation and Closing — Lateral Arm Elevation
and Depression — Forward Arm Traction — Arm Tor-


Resistive Leg Movements : Foot Flexion and Extension —

Leg Flexion and Extension — Upward Knee Traction

— Knee Flexion and Extension — Leg Elevation and

Depression — Backward Leg Traction — Leg Separation




and Closing — Bent Knee Separation and Closing —

Leg Torsion 80-87


Passive and Resistive Movements of the Trunk : Trunk
Rotation — Trunk Torsion (Sitting and Kneeling) —
Forward Trunk Mcxion and Extension — Neck Flex-
ion and Extension 88-91

Corrective Active Exercises of Arms: Standing Position
— Shoulder Circling — Arm Circling — Arm Elevation —
Arm Flinging — Arm Rotation — Arm Flexion and
Extension 92-96

Corrective Active Exercises, of Legs: Leg Elevation,
Sideways — Leg Elevation, Forward — Leg Elevation,
Backward — Knees Bend — Heel Elevation — Charge, or
Fall Out, Forward — Horizontal Balance, Standing —
Back Curving — Leg Elevation, Lying 97-101

Corrective Active Exercises of Head and Trunk : Head
Bending, Backward — Trunk Flexion, Backward and
Forward — Chopping Movement — Harvesting Move-
ment — Trunk Flexion. Sideways — Trunk Torsion —
Trunk Circling — Trunk Elevation, Lying — Body Hori-
zontal on Toes and Hands 102-108

Stiffness of Joints and Tendons — The Modus Operandi —
The Knee Joint — My Method — Mistake to Apply Mas-
sage Too Long at a Time — Sprains, Synovitis —
Hydrarthrus 109-1 18

Flat-foot: "Morbid Condition of Foot in Which the Arch

is Destroved" 119-122



General Massage — My Advice to Newcomers — Neuras-
thenia — Prescription I — Prescription II — Prescription
III — "High Blood-pressure" — "Arteriosclerosis" 123-132

Hysteria and Hypochondria — Chlorosis and Anemia — In-
somnia — Diabetes Mellitus 133-142

Local Diseases: Diseases of the Brain, Spinal Cord, and
Nerve — Congestion of the Brain — Anemia of the
Brain — Paralysis as a Result of Apoplexy 143-149

Local Diseases : Congestion of the Spine — Locomotor

Ataxia , 150-152

Infantile Paralysis, "Poliomyelitis Anterior" 153-158

Occupation Neuroses — Writers' Cramp — Cramp of the

Legs — Chorea 159-162

Sciatic Neuralgia 163-170

Diseases of the Organs of the Circulation : Chronic Heart

Disease — Diseases of the Respiratory Organs 171-178

Diseases of the Organs of Digestion : Dyspepsia — Con-
stipation — Hyperemia of the Liver — Appendicitis —
Indigestion and Biliousness — Obesity — Diseases of
Urinary and Sexual Organs: Chronic Catarrh of the



Bladder — Chronic Catarrh of the Womlj — Displace-
ment of the Womb — Irrigularity and Painful Men-
struation 179-186


Diseases of the Organs of Movement: Scoliosis, "Lateral
Curvature of the Spine" — "Lordosis" — "Kyphosis" —
"Pigeon-breast" — "Round Shoulders" 187-196

Rheumatism, "Myitis" — Muscular Rheumatism, of the
Right Arm, of the Neck — Lumbago — Rheumatism of
the Joints, "Arthritis" 197-205



1. Centripetal Stroking 22

2. Muscle Kneading of Fingers 23

3. Muscle Kneading of Ann 24

4. Circular Kneading 25

5. Circular Friction 26

6. Nerve Compression 30

7. Muscle Rolling 31

8. Percussion 33

9. Beating 34

10. Arm Vibration 35

11. Forearm Rotation 3fi

12. Vertical Arm Rotation 4U

13. Forward Arm Rotation 41

14. Shoulder Rotation and Chest Lifting 43

15. Foot Rotation ( Double ) 46

16. Thigh Rotation 47

17. Chest Lifting and Viliration 51

18. Muscle Kneading of the Abdomen 52

19. Knuckle Kneading of the Abdomen S3

20. Circular Kneading of the Abdomen 54

21. Loin Vibration 55

22. Back Muscle Kneading 59

23. Back Percussion 60

24. Breach Beating 62

25. Veins of Head and Neck 68

26. Vertical Arm Flexion and Extension 73

27. Horizontal Arm Flexion and Extension 75

28. Horizontal Arm Separation and Closing 76

29. Lateral Arm Elevation and Depression 77

30. Forward Arm Traction (Lying) 78

31. Leg Flexion and Extension 80

32. Upward Knee Traction 81

33. Knee Flexion and Extension 82




34. Leg Elevation and Depression 84

35. Backward Leg Traction 85

36. Bent Knee Separation and Closing 86

ZT. Trunk Torsion (Kneeling) 89

38. Forward Trunk Flexion and Extension 90

39. Standing Position 92

40. Arm Circling 92

41. Arm Elevation (Forward. Upward) 92

42. Arm Flinging (Sideways) 92

43. Arm Rotation 92

44. Arm Flexion (and Extension) 92

45. Arm (Flexion) and Extension, Upward 92

46. Leg Elevation, Sideways 100

47. Leg Elevation, Forward 100

48. Leg Elevation, Backward 100

49. Knees Bend (Deep) 100

50. Charge, or Fall Out, Forward 100

51. Charge, or Fall Out. Forward (Side View) 100

52. Horizontal Balance ( Standing) 100

53. Back Curving 100

54. Leg Elevation (Lying) 100

55. Trunk Flexion (Backward) 104

56. Trunk Flexion (Forward) 104

57. Trunk Flexion (Forward) 104

58. Harvesting Movement 104

59. Harvesting Movement 104

60. Trunk Flexion (Sideways) 104

61. Trunk Torsion 104

62. Trunk Elevation (Lying) 107

63. Body Horizontal' 104

64-69. Curvature of the Spine 191-195



Massage is a very much misinterpreted word and
frequently erroneously used, sometimes intentionally,
but often 1)y mistake. It means kneading, or a me-
chanical action — a handling and manipulating — of the
flesh, as in stroking, pressing, kneading, percussing,
etc., for a therapeutical pui-pose.

In certain cases massage proper is all which is
needed, but very frequently it must be used together
with passive and resistive exercises, and in such cases
massage becomes a part of Medical Gymnastics,
Mechanotherapy, Swedish IMovements, or whatever
name one prefers to give; they all mean the same
thing'. The attempts made by certain authors to
separate massage from medical gymnastics, and espe-
cially, while doing so, attacking ''messieurs the
gymnasts" (Dr. Kleen) as overanxious to secure all
possible recogiiition, are rather ill-chosen, and prove
that those authors do not know gymnastics and only
a part of massage, viz., that small part which can
produce a cure without any exercises.



A first-class masseur noAvadays must necessarily
know gymnastics, and a medical gymnast surely
knows massage. '

In these lessons then we will consider massage
together with such gymnastic exercises as are neces-
sary in order to do the most good for the patient.

Let us, however, be frank and come to a full
understanding of what we are trying to do.

It would be impossible for anyone to gain a
thorough knowledge of this system, and how, under-
standingly, to give a full treatment, from a few
lessons or a brief manual.

But there are hundreds of cases where massage,
together with a few possiz'c and resistive movements,
and also active corrective exercises, will not only
give a great relief, but even effect a cure, wlien
applied judiciously and according to physiological

The object of these lessons is to describe, for the
use of the doctor himself, or for an operator under
the doctor's direction, such "movements" as may be
applied in the sick-room and without the use of
apparatus, and also to outline some simple, active,
corrective exercises which the patient may be taught
to practise.

First, let us look a little into


The History

of this curative agent. It is as old as mankind.
Nature early taught the man to knead his flesh, or
bend his body, to relieve him of certain ills. And
there are books as old as 3000 years B.C. written
alx)ut g}annastics, among them the Kong-Fu in
Chinese. We also know that the Persians, Phoeni-
cians, and Egyptians knew alx)ut massage as well as

The Greeks were the first to make a genuine
progress, however, in this branch, as in so many

yEsculapius, Apollo's descendant, is said to have
l)een the inventor of the art of grymnastics. Medea
l>rocured health and youth, by gymnastics.

It was four hundred to five hundred years before
Christ that Iccus, and, later, Herodicus, reduced
bodily exercises to a system, and Herodicus made it
a branch of medical science to preserve the health
and cure diseases by use of gymnastics, and among
his pupils was the famous Hippocrates.

Diodes, Praxagoras, Herophilus, Asclepiades,
Atheuceus, Celsus, and Galen recommended "move-
ment treatment," and gave rules for it.

Mercurialis in the sixteenth century wrote a
book, "De Arte Gymnastica," or the science of bodily
exercise, which he divided into "G\minastics for
Athletes, for the IMilitary, and for the Cure of Dis-


eases," to which, as used by the Greeks and Romans,
he gave especial attention, and pointed out the use
of the different movements in different diseases, and
also gave rules for their application in special cases.

Many a poor woman v/as burned at the stake
in northern Europe during the Middle Ages because
she knew a little more than other persons and cured
suffering men by massage, a magic which was looked
upon as a power of Satan.

It is interesting to read about Thomas Sydenham,
1624-1689, a noted English physician, called "the
English Hippocrates," who left the routine practice
and based his own upon the theory that there is in
nature a recuperative power wdiich ought to be aided
and not opposed ; also saying that, "if anyone knew
of the virtues of friction and exercise, and could
keep this knowledge secret, he might easily make a
fortune." There are many of these persons at the
present day in the United States claiming mysterious
and magical powers of curing diseases, setting bones,
etc., by the application of their hands.

Thomas Fuller, another English physician, pub-
lished in 1704 "Medicina Gymnastica," treating of
the power of exercise in preserving health and cur-
ing disease.

F. Hoffman, who was physician to the King of
Prussia in the first part of the eighteenth century,
wrote that exercise is the best medicine for the body,
and that we cannot imagine how salutary and favor-
able to health it is. "for it excites the flow of the


spirits, and facilitates tlic excretions iruiu ftlie

Clement J. Tissot, a iMxnch physician, who
several times gained the prize of the Academie
Royale de Chiriirgie for his lectures, Dublished in
Paris, 1781, "Gymnastic IMedecinale."

Gutsmuth, Jahn, Clias, and Spiess worked with
energy to spread the German gymnastics, but paid
no attention to gymnastics as used for the treatment
of diseases.

As Herodicus observed the curative effects of
gvmnastics on his own delicate health, and thereby
was brought to use movements in therapy, so did the
Swede, Pehr Henrik Ling, in the beginning of the
nineteenth century, study the movement treatment,
Ijccause he had cured himself of rheumatism in the
arm by percussions.

Ling formerly had been a) fencing-master and
instructor of gymnastics; but afterward, studying
anatomy and physiology, and the influence of the
movement and manipulations in different chronic
diseases, he founded a system of gymnastics cor-
responding with the knowledge of physiology, which
is universally known as "the Ling System," or the

"Swedish ^Movement Treatment,"

By ardent study and labor. Ling succeeded at
last in making his new ideas recognized, and in 18 13
the first college for pedagogical, military, and medi-


cal gymnastics, called the ''Royal Gymnastic Central
Institute," was established in Stockholm at the ex-
pense and under the supervision of the Swedish gov-
ernment, and Ling was its first president.

The principal studies for graduation are : Anat-
omy, Physiology, Pathology, Chemistry, Hygiene,
Diagnosis, Principles of the Movement Treatment,
and the use of exercises for general and local de-

In the rooms of this institute persons of every
condition and age, the healthy as well as the sick,
the wealthy as well as the poor, executed prescribed
movements. The number of those who adopted the
use of the therapeutic movements increased every
year, and among them were even physicians who in
the beginning had been the most opposed to Ling.

Ling died in 1839. His pupils, Brandting,
Geoi'gii, Liedback, and G. Indebeton, published
Ling's theories, and by this means and through the
many foreigners who studied at the Central Institute
of Stockholm, Ling's system soon became known in
a great part of the world.

Dr. Joseph Schreiber, of Vienna (in his "Man-
ual of Massage and Muscular Exercise"), says:
''The most powerful impetus, however, given to the
revival of mechanotherapy originated with a Swede,
the creator of the modern 'movement cure,' whose
doctrines, spreading to England and Germany, have,
after many decades, and in spite of l^eing marked by
some extravagances, gained universal recognition."

SWEDISH M()vi-:mi-:.\t tkkatmext. 7

De Ron, in St. Petersburg; Georgii, Indclxjton,
Bishop, and Roth, in London; Rothstein and Neu-
nian, in Berhn; Richter, in Dresden; Schreber, in
Leipzig; Melicher, in Vienna; Eulenburg, in Baden;
Laisne at the "Hopital dcs Enfants Malades," in
Paris; Taylor, in New York, and many others,
estabHshed special institutions for movement treat-
ment and published their results, partly in medical
papers, partly in books.

Dr. Douglas Graham, of Boston, has written
several articles, and also one "Practical Treatise on
Massage," in which he says: "Li 1844 the Supreme
Medical Board of Russia appointed twO' members of
the Medical Council to inquire into the merits of
the movement and manipulation treatment as prac-
tised by M. de Ron, one of Ling's disciples at St.
Petersburg, who had been using it then for a period
of twelve years. From the highly commendatory
report of the councillors we quote the following:
*A11 passive movements, or those which are executed
by an external agent upon the patient, as well as
active ones produced by the effort of the voluntary
muscles, and the different positions with the aid of
the apparatus or without it, are practised according
to a strictly defined method, and conducted ration-
ally, since they are based upon mechanical as well
as anatomical principles. Experience teaches us the
usefulness of the institution, as many patients thus
treated have recovered their health after having


suffered from diseases which could not be cured by
other remedies.' "

It was not, however, until after the middle of
the nineteenth century that massage became really
known and was considered by the medical profes-
sion as a scientific and valuable remedy in the
treatment of diseases.

Dr. Mezger, of Amsterdam, who was a famous
masseur in the early sixties, was the man who under-
stood how to win the confidence of the public, and
later, through his many pupils, exercised a powerful
influence upon the standing of massage in the medi-
cal world. The best known German and Austrian
physicians, as Langenbeck, Billroth, Esmarch, von
Mosengeil, GussinlMuer, and many others began to
employ it and scientifically publish its effects. And
soon the conviction gained gTound that massage was
a powerful curative agent which had been neglected
by the profession, and, therefore, had been abused
and overestimated by ignorant people. All o\'er
northern Europe massage was known and constantly
used, and Prof. W. S. Playfair, of King's College,
London, wrote, in 1883, "The Systematic Treatment
O'f Nerve Prostration and Hysteria," which greatly
encouraged the more general use of massage.

In the United States massage was hardly known
when I arrived here in the early eighties. The late
Dr. Lewis A. Sayre, of New York, prescribed it
frequently, and I had several cases from him during
my short stay in that city. Dr. Weir Mitchell, in


Philadelphia, prescribed "g^eneral massai^e" to his
jxitients, and he wrote, in i<S77, "l""at and IMood and
How to ]\Iake Them/' in which he advocates mas-
sage. But as a general rule the medical profession
here did not know massage and were not willing to
try it. A good illustration of their feeling toward it
is shown in the answer I received from one of the
oldest and best known physicians in \\'ashington,
D. C, in March, 1883, when asking for co-opera-
tion : "No, sir ; it would be the straight w'ay to get
the patients out of our hands."

Nevertheless, massage had come to stay. 1
opened an institute, "The Swedish Health Institute
for the Treatment of Chronic Diseases by Swedish
Movements and jMassage," in \\'ashington, where
the foreign diplomats assembled for treatment well
known to them, and they soon brought scores of the
great men and women of the United States to the
institute, and gradually the physicians of the city
came to inquire into the mode of treatment and
send their patients there. In INIarch, 1888, I read a
paper before the Clinical Society of ]\Iaryland, on
"Sw^edish INIovement and Massage Treatment,"
which appeared in several medical journals, result-
ing in numerous letters from medical men who
wanted to know more about it, and urging me to
write a manual and also give instructions on the
subject, and in 1889 my Ixvok, "Swedish Movement
and Massage Treatment," was published. In the
mean time massage had been introduced by reliable


men in many other cities, as, Dr. H. V. Barclay, in
New York, in the autumn of 1884; Baron Nils
Posse, in Boston, 1885, where, as before said, Dr.
Douglas Graham already had published a treatise
on massage, and the medical profession soon adopted
this mode of treatment as an excellent curative
agent. Still, it was rather amusing sometimes to
notice the fumbling of otherwise highly recognized
professional men. It has happened more than once
to the author of this book that he has been called
in by physicians to apply massage to patients who
were already suffering with a high fever, and he
invariably declined to do sO'. In one of these cases
the patient died the following day. Had the physi-
cian's request been acceded to, the massage treat-
ment would, no doubt, have been accredited with
hastening, or even causing", the sick man's death.

At other times the writer has asked the physician
in charge what the illness was, and has been told
that it was "none of his business."

A Word to the Physician.

Some physicians sccui to liavc iJie idea tJiat we
specialists are their riz'als and their opponents. Still
we have frequently repeated that ice do not practise

We are specialists, and, as such, necessarily

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Online LibraryHartvig NissenPractical massage and corrective exercises → online text (page 1 of 11)