Hartvig Nissen.

Practical massage and corrective exercises online

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(Fig. g, A) on and. around the fleshy part- of the limb
with a loose and light movement of the wrist-joint.



(Fig. 9, B.) The blow must be firm and deep, and
one a second.

These two motions stand foremost among the
manipulations which aim at mechanical excitation.

Fig. 9. — Beating.

A blow calls forth a local contraction which is inde-
pendent of any nervous stim'ulus by reason of the
independent irritability of the muscle itself. This is
a particularly effective way of stimulating a muscle,



and often so when other forms of stimuli have gi\cn
out. The contraction itself furnishes the conditions
for a quicker access of blood and interchanj^e of
material, increase of temperature, and nutritional

Fig. 10. — Arm Vibration.

Percussion and heating are very important parts
of massage, and are extremely serviceable in counter-
acting muscular atrophy and in restoring normal size
and functional power to groups of thin and weak

These manipulations applied gently across the
muscles cause contraction of muscles and blood-


vessels; while applied forcibly, muscles and tendons
will loosen and thereby overcome contractons, and
cause dilatation of the blood-vessels.

9. Vibration. — The operator takes hold of the
patient's hand and makes a slight pull and a very
rapid vibration (shaking) of the whole arm. Re-
peated five to ten times. In order to apply this
effectually it is necessary for the operator to make
himself as rigid and tense as possible. (Fig. 10.)

This has a stimulating and strengthening effect
on the nerves and also on the respiration ; and it can
be given with excellent results in nervous affections
and fatigue.


Rotations or Circumduction of Arm,
Hand, and Fingers.

10. Finger Rotation. — The joint between the
finger and hand, metacarpal joint, is fixed by the
operator's one hand, and with the other the finger is
rotated (or circumdncted) in its joint; at the same
time a "piull" is appHed to the fingers; rotated ten to
twenty times each way, and abotit twenty-five rota-
tions in ten seconds, unless the finger-joint is very
stiff. In such case the joint must first be flexed
(bent) and extended, and then the rotation per-
formed in as big a circle as the joint will allow.

11. Hand rotation is performed by taking hold
of the wTist with one hand and of the fingers wdth
the other hand, and describing a circle in the wrist-
joint from ten to twenty times each way — alx)ut
twelve rotations in ten seconds, with a piill of the

12. Forearm Rotation. — The patient's elbow
is fixed in the operator's one hand, who, with the
other hand, takes hold of the patient's w^rist (Fig.
it) and moves the foreami, which is kept on an
angle, in a circle in the elbow-joint, from ten to
twenty times each w^ay — about eight times in ten



13. Arm Rotation (Single). — The operator
takes hold of the patient's shoulder with one hand
and of his elbow with the other hand, moves the
arm forward, upward, backward, and down so as to
describe a circle of the shoulder-joint, from five to

Fig. 11. — Forearm Rotation.

ten times one way and reverse as many times — about
five times in ten seconds, with a pull of the arm.

The arm, forearm, hand, and finger rotations are
very useful in stiffness of the joints. The contracted
muscles and tendons are forcibly but gradually
elongated, and any existing exudations within the
joints are disintegrated and absorbed. But these


movements are also of great value in general )iias-
sagc and in all cases where it is desired to quicken
circulation or to draw the blood away from the chest
and head. On account of the bent position of the
axillary artery, the raising of the arm in rotation
stretching it out, the arterial l)l()od-currcnt is very
much increased at the same time that the pressure
of the muscles on the veins drives the venous blood
to the heart, and a very rapid flow of blood to the
arm and hand is the result. The movements should
always begin with the arm and end with the fingers;
and if done well, these few exercises will, as a rule,
make the coldest hand warm.

Arm rotation (single), is an Excellent movement
in cases of congestion or too much blood in the

14. "Flexion" (passive) of onn, hand, and
finger is also a ^•ery valuable and necessary move-
ment to break up adhesions within the joints ; and
sometimes great force must be applied when the
shoulder- or elbow- joints are stiff from dislocations,
fractures, etc.

In raising the ami vertical the big chest and back
muscles — the pectoralis and latissimus dorsi — are
being stretched, which in many of these cases is
highly necessary. If the forearm is bent the exten-
sors of the arm — especially the triceps — are stretched ;
and when the arnn is extended the flexors — the bi-
ceps and brachialis — are stretched, and so on. These
passive stretchings of antagonistic muscles are of



great importance in many cases : besides, they are
also beneficial in stretching nerves and blood-vessels.
15. Vertical Arm Rotation (Sitting). — The
patient sits with his arms extended over his head ;
the operator standing behind, supporting the patient's

Fig. 12. — Vertical Arm Rotation.

back with his knee, takes hold of his hands (.Fig.
12), and while stretching the arms well, he moves
them in a small but ^'ery rapid circle fonvard, out-
ward, backward, inward, taking care not to strike
the anns against the head. This is not reversed,
but repeated three to six times, and between each



quick rotation of twenty to thirty circlings the arms
should be gently lowered a little in front and pulled
backward while a pressure is made with the knee on
the patient's back; then the arms are again raised
and the quick rotation repeated.

Forward Arm Rotation.

This makes a great expansion of the chest and
stretches out the pectoral muscles ; the blood is
drawn out of the arms, and the apex of the lungs is
brought into vibration ; an increase of pulmonary
circulation and bronchial absorption follows; the
flow of the blood to the chest causes a diminution of


blood-pressure, especially in abdominal and pelvic

i6. Forward Arm Rotation (Sitting). — The
operator, standing behind the patient, the latter rest-
ing his back against the operator's chest, then takes
hold of his amis just below the elbows and moves
them in a circle forward, upward, sideways, and
down, but not reverse, from ten to twenty times
(Fig. 13) — about twelve to fourteen movements in
a minute.

This expands the chest and has a great effect on
the respiration and the circulation.

17. Shoulder Rotation and Chest Lifting
(Sitting). — The patient sits on a stool, and the
operator, standing behind, takes hold under and in
front of the patient's shoulders, moves them up-
ward, backward, and down, at the same time press-
ing his chest against the patient's back. Repeated
ten to twenty times, but not reversed. (Fig. 14.)
About twelve to fourteen times in a minute.

This is a mild but effective movement in weak-
ness of the lungs and heart, as it deepens the in-
spiration followed by a stronger expiration, thereby
stimulating the flow of venous blood to the heart.

Forward arm rotation and shoulder rotation are
most effective respiratory movements, and should
be given frequently to patients who are able to sit
up, so as to increase the quantity of oxygen and
purify the blood, which, during the treatment, is
forced to- flow rapidly. But, aside from this, the
deep inspiration draws the venous blood to the



heart, and is therefore of great vakie in diseases of
the heart i\s well as in cases of congestion of the
brain and in all nervous affections which produce
flushHig of the head and face. In lung troul)les
these breathing exercises are invaluable, and I have

Fig. 14. — Shoulder Rotation and Chest Lifting.

often with a single application brought a man's
respiration from 34 in a minute down to 20.

Persons who have been diving or swimming
under water frequently compilain of headache and
their eyes are bloodshot from congestion as a result
of "holding the breath" ; six to tw^elve deep breath-
ings will quickly give relief to those cases.

Manipulations of the Legs.

i8. Centripetal stroking, kneading, and
CIRCULAR friction shoulcl all be applied in the same
manner as to the arms, beginning with the toes and
gradually proceeding toward the hip. (Figs, i, 2,
3, 4, and 5.)

In stroking the foot use your right hand on the
patient's right sole from the toes toward the heel a
few times, and also up along the instep; use the
left hand on the front and outside of the right foot,
and both hands alternately from the ankle to the

The uiitsclc kneading of the foot is done by an
alternate squeezing with both hands.

The rest of the manipulations are the same as to
the arnii,

19. Nerve compression, muscle rolling, slap-
ping, and friction from the hip toward the foot
are similar to those movements given the arms, as
described in Chapter III. (Figs. 6 and 7.)

20. The combination kneading, as applied to
the arms.

21. Percussion, as applied to the amis.
(Fig. 8.)

22. Beating, as ai^plied to the arms. (Fig. 9.)


23. Vibration. — The operator, taking hold of
the patient's heel and ankle, makes a slight pulling
and very rapid shaking movement of the whole

This has a stimulating effect on the nen-es.

24. Stretching the Sciatic Nerve and the
Hamstrings. — The patient reclines on a bed or
chair, etc. ; the operator bends the patient's knee and
raises the leg, resting the patient's heel on his
(operator's) shoulder. Now he makes a strong
pull upward on the toes (flexing the foot) and at
the same time stretches the knee by pulling on the
thigh, just above the knee, with the other hand.

This is an excellent way to stretch the nerve and
very valuable in sciatic neuralgia. The higher the
patient sits up, the more forcible is the exercise.

Rotations or Circumductions of Leg and Foot.

25. Foot Rotation (Single). — The operator
fixes the patient's ankle with one hand, and, taking
hold around the toes, without pinching, moves the
foot around in a circle ten to twenty times one way,
and reverses. About fifteen times in ten seconds.

This is useful to break adhesions in stiff ankle-
joints, to limber the joints, and to bring the blood
into a better circulation.

26. Foot Rotation (Double). — The patient,
in a lying or reclining position, rests the back of
his heels against a cushion. The operator, sitting


in front of the patient, takes hold of his toes
(Fig. 15) and moves both the feet in a quick circle
— the quicker the better — twenty to thirty times one
way, and reverses. The legs should be kept straight
but passive during the motion, so as to allow a
vigorous shaking of the whole limb.

This has a very good effect on the circulation,
and, by increasing the flow of blood to the feet, acts
as a good derivative from other parts.

Fig. 15. — Foot Rotation (Double).

27. Foot and toe flexion, passive, whereby the
muscles and nerves are put on a full stretch, are
very useful movements. Especially in paralysis or
other cases when some set of muscles are contracted
— these should be passively stretched.

28. Thigh Rotation (Receining). — The oper-
ator takes hold of the patient's foot — right foot
with right hand, so as the thumb comes on the
instep — and of his bent knee with the other hand
(Fig. 16) ; the knee is now pressed upward, then



moved outward and downward (without Ix^ing
straightened) so as to descril)C a circle in the hip-
joint; the knee should not be moved to pass the
middle line of the Ixuly, and the movement should
be firm and e\en, with a good pressure of the knee
upward. The pressure is done at the foot, while
the hand at the knee simply steers the miotion. The

Fig. 16. — Thigh Rotation.

foot must be kept in line with the knee and not be
twisted outward. The rotation is done from six to
fourteen times in one direction, then as many times
reversed. About three tO' five times in ten seconds.

This is one of the best exercises for equalizing
the circulation, and as a derivative from diseases in
the pelvis and abdomen, as well as to limber the hip-
joint. It is considered a delightful movement by


almost every patient, and may be used frequently in
general massage, as well as in local troubles.

29. Hip Rotation (Lying). — The patient lies
flat on his back with the lower extremities outside
the bench or couch. The operator, taking hold of
the ankles, moves both legs around in a big circle
eight to twelve times in one direction, then as many
times in the other.

This is very effective in affections of the abdo-
men and pelvis.

Passive rotations alternately shorten and lengthen
the blood-vessels, and are more especially effective
with the bigger veins. When they are stretched they
carry more blood than when they are shortened, and,
therefore, movements which alternately shorten and
lengthen these vessels act as a sucking power on the
venous circulation toward the heart, as the blood
cannot go backward on account of the valves.


Passive ^Movements of the Trunk.
(a) Mcniipitlafions of tJic Chest.

30. Chest Friction and Chest Kneading. —
The operator puts his hands on the patient's chest
with the finger-tips pointing at the throat and the
thumbs meeting at the sternum, then makes rapid
strokings with l3oth hands — one to each side — and
gradually moving his hands down, always begin*
ning at the middle of the chest. After the whole
chest has been treated this way a few times, the
iintsclc kneading is applied by picking up the skin
and muscles alternately with both hands, beginning
at the sternum and following the pectoral muscles
out to the side. First manipulate one side of the
chest, then the other.

The circular kiicadi>ig is next applied with one
hand on each side of the sternum, making the rotary
motions toward the side of the trunk.

31. Chest vibration should follow the knead-
ings by putting the hands, one on each side of the
chest, and pulling downward, making a rapid vibra-
tion, or shaking, with very tense hands and fingers.

The friction — sidew^ays stroking — should finish
these manipulations.

^ (49)


32. Chest Slapping (Standing). — The oper-
ator, standing" in front of the patient, brings his
hands on the back of the patient's shoulders and
slaps him over the region of the lungs, thus mov-
ing' forward under the amis tO' the chest and all
over the chest up to the shoulders in front. Re-
peated three to six times.

If the patient is lying down the slapping is done
by alternately using both hands rapidly all over
chest from side to side and gradually moving the
handsi upward to the shoulders.

The slapping should be done with the palm and
fing-ers and a lig'ht movement of the wrist, without
keeping the hands stiff.

The friction, kneading, vihrati -., and slapping
of the chest are frecpiently used in "general" mas-
sage as a fine exercise for the chest muscles and to
increase the circulation and tone up the nervous
system of the whole chest, lungs, and heart. They
are very useful in weakness and emphysema of the
lung's, organic diseases of the heart, and in nervous

33. Chest Lifting and Vibration (Reclin-
ing). — The operator, standing in front of the pa-
tient, puts his hands on each side and under the
shoulders of the patient, then lifts him slightly
(Fig. 17), and, by shaking his hands while he pulls
them forward under the patient's arms, eft'ects a
vibration of the whole trunk. Repeated four to
eight times. This stimulates the lungs and heart



and is a very good rcspiratoiy movement for a
patient who cannot sit up. 1 liax'e often gi\-en great
relief to asthmaiic patients with a few apphcations
of this movement.

(b) Abdoiiiiual Massage.

34. Stomach friction is made with both hands
all over the abdomen from the middle and out to

Fig. 17. — Chest Li f tins: and Vibration

the sides, beginning under the ribs and gradually
moving downward ; this is followed with an upward
stroke with the one hand on the right side, beginning
at the cecum and over to the left in the direction of
the ascending and transverse colon, and then a down-
ward stroke with the other hand on the left side in
the direction of the descending colon to the sigmoid
flexure. Repeated four to eight times.

This influences the activity of the intestines.


35. Muscle Kneading of the Abdomen. —
\\'ith both hands the operator ahernately kneads and
rolls the flesh and muscles of the abdomen in a circle
from the right upward, oxer to the left and down-
ward, in the direction of the ascending, transverse,
and descending colon. After a few treatments the
operator should be able to make very finn and deep
kneadings without any disagreeable feeling to the
patient ; the intestines will be forced to greater con-

Fig. 18. — Muscle Kneading of the Abdomen.

traction and activity, and fat and flabby abdominal
muscels will be reduced and made firmer. (Fig. 18.)

The muscle kneading of the abdomen is espe-
cially useful in constipation and obesity.

36. Knuckle Kneading of the Abdomen. —
With the slightly bent knuckles of th© fingers an
alternate pressure is made with both hands, begin-
ning at the middle line under the ribs, and grad-
ually and evenly moving the hands out to the sides,
taking care not to press on the hip-bones ; then the


knuckles are again placed at the middle line a little
lower than fn'st time, and so on till the whole ahdo-
men has been kneaded in this manner. ( h ig. 19.)

This is very useful in constipation and to make
the intestines more active.

T^y. Circular Kneading of the Abdomen. —
The operator places his three middle fingers, which
are held close together, upon the spot which is to be

Fig. 19. — Knuckle Kneading of the Abdomen.

manipulated — either in the gastric region or on the
stomach, or beginning at the cecum and following
the colon — and pressing lightly (Fig. 20) executes
circular kneading. After a thorough kneading on
one spot the fingers are lifted and placed on another
spot nearby and so on.

In case of constipation begin at the sigmoid
flexure, kneading thoroughly, then lift the fingers
and move a little higher up the descending colon,
again kneading well, and move higher up, then



across the transverse colon to the right and down
the ascending colon to the cecum, always making" the
pressure of the kneading in line of the normal
passage. This will help to loosen up hardened matters.
Then knead the colon from cecum to sigmoid flexure.

Fig. 20. — Circular Kneading of the Abdomen.

This kind of kneading is probably the mO'St
effectual of them all and acts very powerfully on the
glands and epithelium of the alimentary canal ; it
has a very stimulating effect on the abdominal
organs and their nerves. It increases the activity of



the stomach and the secretion of the juices, and
effects a l)etter mixture of the secreted juices and
the food substances. It is therefore of great vahie
in cases of inchgcstion, dysj^psia, constipation, etc.

38. Stomach Vibration. — The operator presses
his shghtly l>ent fingers under the patient's ribs on
the left side and apphcs a rapid vibration on the

Loin Vibration.

ventricle; the hands should be mo\ed so as to apply
the vibration all over the left hypochondriac. Re-
]:)eated three to six times, and followed by stomach

Useful in dyspepsia and chronic catarrh of the
stomach and to increase the appetite.

39. Bowel Vibration (Standing). — The oper-
ator, standing behind the patient, puts both hands on


the patient's abdomen, and by a rapid pushing and
pulhng motion of his hands an effective vibration is
applied tO' the whole bowel. Repeated three to six
times ; very useful in constipation.

40. Bowel Concussion (Lying). — The oper-
ator's hands are placed on the patient's abdomen,
and a pressure is made — deep- but evenly ; then the
hands are cjuickly taken off, allowing the abdomen
to spring back like a rubber ball. Repeated three
to five times.

This strengthens the abdominal muscles and the
digestive powers.

41. Loin Vibration (Sitting). — The operator,
standing behind the patient, who sits on a stool
slightly stooping forward, presses his hand with the
ulnar edge on each side of the patient just above his
hips (Fig. 21), and applies a very rapid alternate
pushing and pulling movement with his hands. The
hands must be firm and not glide on the flesh. Re-
peated three to six times at short intervals.

This has a very stimulating effect on the liver
and stomach and on the lungs and the diaphragm.

42. Loin Traction (Lying). — The operator
puts his hands on each side and under the small of
the back of the patient, and pulls his hands forcibly
forward, just above the hips. Repeated four to ten

This has a very soothing effect and is useful as a
finish to abdominal massaee.


Of all the different kinds of massage, the "ab-
dominal" has more special intluencc on blood-pres-
stn'e, which is increased considerably durino^, and for
a while after, these manipulations. Abdominal mas-
sag-e, therefore, should not be used in cases of recent
bleeding within the brain, in the lungs, or stomach.

Massage of the Back.

43. Back Friction. — The operator puts his
hands on the patient's neck with the finger-tips point-
ing upward and the thumbs meeting at the spine,
then makes rapid strokings simultaneously with both
hands, one to each side, gradually moving down-
ward to the buttocks, but always applying the strokes
from the spinal column outward and never toward
the spine, neither up the back. Repeated four to
ten times.

Has a soothing and quieting effect.

44. Back Muscle Kneading.— The operator
first manipulates the muscles of the neck and shoul-
ders and gradually proceeds downward to the but-
tocks, picking up the muscles with one hand and
squeezing with the other, from the spinal column
outward, following the course of the trapezius and
latissimus muscles, first on one side of the back, then
on the other. Repeated three to six times. (Fig.
22.) Increases circulation and the action of the
nerA'^esi and has a good effect on tired muscles.

45. Back Muscle Rolling. — The operator, put-
ting both his hands side by side on one of the pa-
tient's shoulders, makes an alternate, very rapid
pushing and pulling motion with hisj hands, gradually



moving' downward to the buttocks; the hands must
be so firmly on the patient as to move his muscles
from side to side, thereby causing- a quick stretching
and a vibration of them. First roll the muscles of
one side of tb.e back three to five times, then the
other side.

Increases circulation.

46. Back Circular Kneading. — The oper-
ator's middle three fing-ers of each hand begin at the

Fig. 22. — Back Muscle Kneading.

neck on each side of the spine and apply the circular
kneading outward, then begin a little lower and
work outw^ard, one hand on each side, and so on to
the end of the spine, thus kneading the buttocks and
hips thoroughly. Repeated three to six times.

Increases resorption and has a very soothing

47. Back ^^IBRATION. — The operator puts both
hands, with the fingers spread out, one on each side
of the patient's back up at the shoulders, then pulls
downward ■with a firm pressure and a rapid vibra-



tion of hands and fingers. Repeated three to five

Stimulates the nerves.

48. Spinal Nerve Compression. — The operator
presses with his middle and index fingers on each

Fig. 23. — Back Percussion.

side of the spinal column from the neck to the end

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Online LibraryHartvig NissenPractical massage and corrective exercises → online text (page 3 of 11)