Hartvig Nissen.

Practical massage and corrective exercises online

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physiologists^ and haz'e the practical experience


gaiiird by /lie fracticc of iiiaiiy years in this one

But it is co-operation bctii'coi the medical pro-
fession and the massage specialists which is desirable
ami necessary in order to produce the best results.

Therefore, it is the aim of this book to enhghten
those who want to know, and to show how the
treatment shoukl be applied in chfferent cases.

Massage is based on pkiin physiok3gical laws,
and has nothing in common witli ''magnetism," nor
is it "regular gymnastics," nor "rubbing."

\Mien the physician desires to have this treat-
ment applied to a patient, and does not want to
execute it himself, he should always take care that
the one employed thoroug'hly understands his

Much harm haS been done both to patients and
to the reputation of "massag'e," because physicians
have been too quick to accept the card of a "mas-
seuse" or "masseiu^" and send them cases without
looking" up their records. I know of several in-
stances where good-looking women and easy talkers
have obtained work, although they did not know the
first principles of massage, while others, wdio were
first-class masseuses, but did not look so well and
could not talk so well as their sisters, did not receive
any patients. As a natural result of this, in many
cases the treatment proved of no value whatever,
and in some instances actual harm was done.


As Dr. D. Graham says : "It is not to be
wondered at that many a shrewd, superannuated
auntie, and others who are out of a job, having"
learned the meaning of the word massage, imme-
diately have it printed on their card and continue
their 'rubbin,' just as they have always done."

Finally, it must be said that it is not our claim
to cure. all kinds of diseases by massage. Far from
that. Some diseases, it is true, can be cured quicker
by this method than by any other. In most cases,
however, it has to be used together with medical
treatment, for the same reason that electricity, baths,
etc., are very often employed to bring about a cure.
In other cases it should be resorted to only as an
after-cure, or as a means of exercise.

The Variety of Movements and Duration

of treatment is of great importance.

It is an utterly false idea that "massage" is
merely "rubbing," and needs only to be applied by a
strong hand and for an hour's time.

As Dr. Graham- says : "The argument, too often
used, that massage can do no harm, if it does no
good, is a dangerous one. When a man understands
one branch of the medical profession well, one of
the commonest errors is to suppose that he under-
stands all the rest equally well, as if our knowledge
of massage, like everything else, did not come
through experience."


For instance, in a case of synovitis or glandular
enlargement or sprains, etc., the manipulations
should always be directed cciitripctoUy — toward the
heart ; but in case of insomnia, or very painful
neuralgia, the manipulation should be directed down-
Avard, from the shoulder toward the fingers, from
the hips toward the toes, in order to ease and quiet
the nerves. In cases of congestion, movements must
be applied to drive the blo<:>d from the part ; in other
cases, as anemia, it is necessary to increase the flow
of blood to the parts.

Now% for instance, there are two patients, a
delicate, small woman and a strong, big man, Ixjth
sufYering with the same kind of illness. It might
be fair to treat the man for about an hour, but it
would surely be too much to let the woman undergo
the same treatment for the same length of time.
Ahvays bear in mind that the old maxim, "If a
little does good, more will do more good," is an
exploded thec^ry.

A good masseur can accomplish more in fifteen
minutes than a poor one in an hour.

"General" massage should nczrr hurt, and if
black and blue spots appear after the treatment, it is
a sure sign that the operator did not know his busi-
ness, although we often hear people talk al)out the
excellent and strong masseuse, who makes them
"black and blue all over."

"Local" massage, however, often has to hurt,
and if the patient is strong and, can stand it, the cure


will many times be hastened considerably by a strong
and vigorous treatment. But great care and tact
must be used by the operator in cases of weak and
delicate oatients.

How Often the Treatment Should
BE Repeated

is next to be considered, as the mistake is frequently
made by physicians to recomjinend their patients to
try massage treatment only two or three times a
week, "because they cannot stand it," or "they are
too weak to try it oftener."

The weaker a patient is the oftener he ought to
have the treatment. It should be applied at least
once a day, and sometimes twice, in order to derive
the most l3€nefit from it. The effect which is derived
from one treatment should not be lost before the
next treatment is applied.

It is the treatment which builds up the patient's
strength, but if only tried once in a while he will
feel tired and stiff a day or two afterward, and
naturally conclude that the treatment does him harm
— just as a man who takes a ten-mile horseback ride
once a week feels sore and stiff each time, and never
gets over it until he repeats the riding- several times

To a weak patient the treatment has to be given
very gently in the beginning, and, providing it is


applied reg'ularly, may soon 1k> increased in force,
and thus more vigor is given to the patient.

IIow TO BE Dressed

when under treatment is a frequent question. In all
cases where the manipulations ^re to be directed
ccntripctally, it is necessary to strip the body; but in
other cases it is preferred that it should be clothed,
as that will lessen the pain which sometimes is pro-
duced by the manipulations, and the skin (not being
the seat of the trouble) will te more protected.

The dress should be as light as possible, and all
tight clothing dispensed with.

Physiological Effects of Movements.

These may be divided into two groups : —
First. — Purely mechanical effects to secure the
removal of lymph, exudations, extravasations, etc.,
softening of exudations, and loosening of adhesions.
Second. — Increased circulation by stimulating the
muscular and nervous systems, causing molecular
changes, changes in sensation, and changes in the
nutritive functions.

By Passive Movements

the following results are obtained : —

I. Extravasations occurring about dislocated
joints are, by pressing and kneading the tendons and


ligaments in which they are imbedded, finally lique-
fied, and thus more quickly absorbed.

2. In stiffness of joints the contracted muscles
and tendons are forcibly but generally elongated, and
any existing exudations or vegetations within the
joints are disintegrated and absorbed.

3. By the forcible stretching of the muscles their
nen^es are likewise stretched, molecular changes
being thus set up in both.

4. Forced extension of the muscles causes pres-
sure on their blood and lymphatic vessels, thus
accelerating the circulation.

5. Finally, such muscles as have by rheumatic or
neuralgic pains been kept in a state of inactivity
have some of this much-needed exercise restored to
them. Passive movements thus form in certain dis-
eases, as in neuralgia and rheumatism, the introduc-
tion, as it were, for the more painful active motions
which have to follow.

The Active and Resistive Movements

cause an increased flow of blood to the muscles and
soft parts, increasing thereby the circulation and re-
moving accumulation of tissue waste. They cause
resorption of exudations, transudations, and infiltra-
tions, and a separation of adhesions in tendon-
sheaths and in joints. They increase the oxidizing
powers of the blood ; they relieve the congestion of


the brain, lungs, intestine^s, uterus, liver, and kidneys,
by increasing- the flow of blood to the muscles; they
stimulate directly the sympathetic ner^-oiis system,
thus increasing secretion, and reflexly the activity of
unstriped muscle-fiber, and so relieve various func-
tional derangements.

And they educate morbidly affected muscles to
convert abnormal into normal actions and to sup-
press useless movements.

Thus movement, or massage treatment, influences
the living organism : —

First, by increasing the circulation, respiration,
and temperature, improving the digestion, absorp-
tion, and nutrition, and facilitating excretion.

Second, the muscles become developed, the bones
and the whole human frame better proportioned.

Third, appetite is increased, and the food is taken
with greater relish.

Fourth, sleep is facilitated.

Fifth, the brain acts more vigorously and is freed
from psychical depression.

Sixth, relieves pain and removes congestion.

The Movements May be Spoken of as

"Strengthening" movements, such as flexion, ex-
tension, torsion, etc.

"Stimulating" movements, as percussion, vibra-
tion, etc.



"Quieting" movements, as rotation, friction, etc.

"Derivative" movements, with special move-
ments of the extremities.

"Purgative" movements, as kneading, pressing,
ajid active movements of the abdominal muscles.

Some movements have a special effect on the
"respiration," others on the "circulation," etc.


The next thing to be considered is the classifica-
tion of movements and their execution and effects.
First, let ns distinguish between

"Active" axd "Passive" Movemexts.

Active movements, l^eing such as the subject per-
forms entirely by voluntary muscular contraction,
without the aid of the masseur, belong to the regu-
lar g)nnnastic exercises, although some of them,
the "corrective" exercises, are used in medical

Passive movements are such as the patient takes
no part in beyond allowing the operator to move the
whole or any portion of his body — as Hexion, exten-
sion, and rotation — and to manipulate it, as in strok-
ing, k)ieadi)ig, percussing, etc. ; these latter are more
strictly what is meant by "massage."

But what is mostly used in medical gymnastics
are the

Resistive, or Duplicate ^Movements,

viz., "concentric duplex" movements, such as the pa-
tient makes while the operator resists. The patient
is contracting his muscles to the suitable resistance

(19) •


of the operator, and consequently the muscles in
activity are shortened.

This is the more frequently used form of resist-
ive movement, although the "excentric duplex"
movements, such as the operator makes while the
patient resists, are very useful in certain cases. The
patient's already contracted muscles are gradually
extended by the operator and consequently elon-
gated. This form' of resistive movements should be
used either in cases where the muscles are abnor-
mally contracted or where they are too weak to
contract against resistance, but still have strength
enough to resist excentrically. An illustration of
the last named is frequently seen in the gymnasium,
when the child is unable to pull himself up with his
amis and "chin the bar," while he may jump up to
it, hang in his bent arms and gradually extend them,
and thereby slowly develop his muscles to the desired
strength. Sometimes, as for instance in cases of
paralysis or locomotor ataxia, it becomes , necessary
to help the patient to do an exercise so as to train
the motor nerve to obey the patient's will and thereby
gradually gain strength and confidence to move the
muscles. These are assistiz'c vwi'cments.

The Positions

in which the movements are taken are numerous and
also of very great importance, as the same move-
ment often may have an entirely different effect in
one position' from that in another.


There are six fuiulanienlal positions, viz. : —

These are subdivided into a number of starting
positions with the arms, legs, trunk, and head, as: —
Standing — hands on hips,
arms horizontal,
arms vertical, etc.
Sitting — astride sitting,

forward bent sitting, etc.
Lying — reclining,
knees bent,
on back lying,
on front lying, etc.
Which, combined in various ways, make thousands
of positions in which the different movements may be
either taken or given. And so the number of move-
ments may be said to be endless, to suit each par-
ticular ailment.

\\'hatever the position is, care should be taken
that nothing interferes with the patient's breathing,
as he should nez'cr hold his breath, but always breathe
easily and as quietly as possible; therefore, the head
must not be allow'ed to "fall down on the chest,"
but be kept well up.



Passive Movements.
Manipulations of the Arms.

I. Centripetal stroking, kneading, and cir-
cular FRICTION are all to be given from the tips of
the fing-ers toward the shoulder.

In stroking, grasp the patient's finger with your
thumb and two first fingers, and make a finn pressing

Fig. 1. — Centripetal Stroking.

and stroking movement upward toward the hand ; at
the same time let your fingers glide in a circular
way round the patient's finger, describing the
motions of a screw. Let your fingers glide easily
back to the starting point (the tip of the patient's
finger), and repeat the motions fifteen to twenty
times in about ten seconds on each finger.

In treating the hand, use your fingers and the
palm and stroke first with your right hand, then



with your left on Ixjth the hack and pahn of the
patient's hand.

Grasp around the ami with your riglit hand and
make a firm stroking- in the screw motion from the
wrist to the ellxnv, ghding easily down again and
rei^ieat about eight times in ten seconds, then use
your left hand in the same manner. (Fig. i.)

Kncadiugs are of two kinds, viz., muscular and

Fig. 2. — Muscle Kneading of Fingers.

In muscle kneading of the fingers make an
alternate pressure with the thumb and index finger
of both hands, beginning at the tip of the pa-
tient's finger, about twenty pressures in ten seconds.
(Fig. 2.)

Then knead the muscles of the hands and fore-
arm toward the elbow by picking up each group of
muscles with the one hand (Fig. 3, x4), and when
releasing the grasp make an upward pressure with
the other hand (Fig. 3, 5). About fifteen kneadings
in ten seconds.



In circular kneading grasp the patient's finger
with your thumb and two first fingers and let each
of your fingers make a circular, or rotary, motion

Fig. 3. — Muscle Kneading.

while pressing so hard that the patient's skin is
moved and not your fingers rubbed over the skin;
gradually push your fingers upward to the hand.



Now put your tlirce middle fino^crs on the back
of the patient's hand and let them tog^ether make a
circular motion hard enough to move the underlying
tissues and gradually pushing upward (Fig. 4),
alx)ut twenty-five circular motions in ten seconds.
Then the same manipulation of the palnii of the
hand. Around the wrist use both your thumbs in
the same motions and knead well around and in the

Fig. 4. — Circular Kneading.

joint. Again use your three fingers or the whole
hand in the circular motion up the forearm and the

In circular friction grasp the hand with both of
yours, and make upward pushing movements alter-
nately with right and left, constantly moving the
hands and fingers, and especially the thumbs, in a
semicircular direction, letting the one hand push


upward while the other ghdes easily down, thereby
making a sideways friction together with the upward
stroke (Fig. 5), twenty-five motions in ten seconds.
Now repeat the same manipulations from the
elbow to the shoulders, and when the whole arm
has been worked OA'cr in this manner make firm
strokes from the fingers to the shoulders, clasping

•..,, • -^

Fig. 5. — Circular Friction.

the limb around with both your hands, from five to
ten times.

The Effects of These Manipulations

are as follows : —

Any pressure on the muscles must necessarily
exert pressure upon the underlying veins and drive
their contents away, and on account of the valves
which open toward the heart only, it is clear that the


contents of these vessels must be driven toward the
center, or the heart. Therefore, it would make no
difference if a pressure was begiin at the shoulder
and gradually worked down the arm — the circula-
tion of the blood would be accelerated either w'ay;
but a continual stroking- against the veins would
interfere very much with the venous circulation, and
even produce ruptures of the vessels.

Centripetal stroking quickens the circulation in
the blood- and lymph- vessels and even sucks the
blood from the vessels below, so that the arterial
stream is quickened through the faster outflow from
the veins and the diminution of the venous blood-
pressure. The strokings going in opposite direction
of the arteries do not interfere with the arterial
stream, because the position of the arteries is deeper
and more protected, and their walls are much more
resistant. Centripetal stroking brings alx)ut the re-
sorption and disappearance of all sorts of effusions,
prevents stasis as well as adhesions of the white
corpuscles to the walls of the vessels, and their sub-
sequent migration, and reduces inflammatory ten-
sion and the pain due to pressure. Strokings also
heighten the nutrition of the tissues, and are a
valuable procedure in many cases of traumatic
injur}% as w'ell as in some cases of delayed healing
from other causes; they \\\\\ also limit or prevent
a threatened mortification or gangrene in certain
cases. And, finally, it has the property of removing
fatigue, acting as a restorative to groups of tired


Fatigue results from the presence of carbonic
acid, lactic acid, acid phosphates, etc., due to the
consumption of oxygen and the lack of those sub-
stances that are oxidized during muscular contrac-
tions ; and the removal of these products, and the
access of fresh blood, rich in oxygen and oxidizable
substances, act as a restorative on the working
power of the muscles. Experiments have been made
flexing the arm at the elbow-joint, while raising a
weight, till exhausted ; then centripetal stroking has
been made for five minutes, immediately after which
the arm was able to perform even more labor than

Muscle kjicadiug and circular kneading are both
used to crush newly formed vessels and half-organ-
ized products of inflammation ; to stimulate the cir-
culation and further the resorption, and to separate
the exudations and infiltrations and force them out
in the lymph. The muscle kneading in lifting the
muscles up and again pressing them against the
bones acts mainly on the deeper tissues and also
helps to bring about contractions of the muscles,
and is therefore especially valuable in reducing
fatty degenerations and. make stronger muscles;
while the circular kneading is more useful to sepa-
rate foreign bodies and tO' licjuefy extravasations
and promote absorption.

Circular friction has a similar effect as the strok-
ing, but by moving the hands in a semicircular
direction we can easier reach all the capillaries and
small lymph-vessels.


Generally speaking: Centripetal stroking quick-
ens circulation and reduces inilammations ; muscle
kneading crushes settled and waste matters in the
deei)er tissues, while circular kneading does the same
to the tissues nearer the surface, thus separating
foreign material into small atoms, which again are
sent forth through the veins by the circular friction
and the last strokings.

Further, muscle kneading, rather quickly and
moderately hard, should be used on weak and
atrophied muscles to make them contract and grow
stronger; while circular kneading will loosen up
tense and hardened muscles.

For instance, suppose the flexor muscles of the
arm are contracted from some injury, circular knead-
ing and centripetal stroking under full extension of
the arm should be applied on the flexors, while
muscle kneading and "percussion" should be used on
the extensors, and also some resistive movements
to strengthen the extensor muscles so as to make
them able to overcome the contraction of the flexors.


2. Nerve Compression. — Grasping the limb
with both hands, a firm pressure is made around
and down the whole ami from, the shoulder to the
fingers. Repeated three to five times. (Fig. 6.)

Fig. 6. — Nerve Compression.

Both hands grasp simultaneously near the shoulder,
and the pressure should be evenly distributed by the
palm of the hand and all the fingers without pinch-
ing; when the grasp is released, the hands move a
trifle lower and around the arm and make another
pressure, and so' on tO' the fingers — five to six pres-
sures in teit seconds. A slow and even pressure is
most soothing to nervous patients.

This increases the circulation of the blood and
has a very quieting and soothing effect on the nerves.


In extreme nervous cases it is therefore a most
valuable manipulation.

3. Muscle Rolling. — Grasping the limb with
the palms of both hands (Fig. 7), and making a
(|uick, alternate pushing and pulling motion, and
gradually gliding downward from the shoulder, the
muscles of the arm will be rolled and squeezed
asfainst each other, whereby the circulation of the

Fig. 7. — Muscle Rolling.

blood is very much increased. Repeated three to
five times. There are hardly any manipulations
which will warm the arm and hand as quickly as

4, Slapping. — This is performed with the palms
of both hands, with a light motion of the wrist-
joint, and the whole arm is slapped from the shoulder
downward from three to five times. This stimulates
the action of the nerves and the circulation.

5. Friction is performed with the fingers and


palm of the hand from the shoulder and downward,
grasping lightly around the limb with both hands —
repeated ten to thirty times. This should be done in
slow time and very lightly sO' as not to interfere
with the venous circulation. Three to five frictions
in ten seconds.

This has a quieting effect on the nerves, and is
often sufficient to produce sleep in nervous and
sleepless patients.

Nerve compression, muscle rolling, slapping, and
friction are frequently used together as an excellent
way to increase the circulation of the blood and
quiet the nerv^es.

As before said, any pressure of the muscles must
necessarily send the venous blood in a quicker cur-
rent toward the heart, and as soon as the pressure
is relieved the underlying blood-vessels suck the
blood from veins and capillaries below, which again,
by the diminished blood-pressure, increases the flow
of arterial blood toward the parts; and it is a fact
that the manipulations working in a downward
direction have a much more soothing and quieting
effect on the nervous system. Therefore, in certain
nervous affections this mode of applying massage
should be preferred to the centripetal, and in other
cases follow it. In extreme nervous cases "nen^e
compression" and long, light "friction," downward
are most beneficial.

6. Combination Kneading. — Grasping the ami
near the shoulder with both hands and a firm pres-


sure, move each hand outward and upward hkc a
combined, imtscle-rolliiig, circular kneading, circular
friction, and centripetal stroking, not very rapid, so
as to stretch and knead the underhng muscles, and
gently move the hands dowmvard toward the wrist ;
all pressure, however, being in centripetal (upward)
direction. This procedure is very valuable to begin
the massage of an ami or leg before the other
centripetal strokings and kncadings are applied.

Fig. 8. — Percussion.

7. Percussion is performed with the edge of the
extended fingers (Fig. 8), which are kept loose, and
with a quick motion of the wrist-joint the fingers
are flung alternately across the muscles. The quicker
the better.

8. Beating is performed with the clenched fist

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Online LibraryHartvig NissenPractical massage and corrective exercises → online text (page 2 of 11)