Hartvig Nissen.

Practical massage and corrective exercises online

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while the same muscles on the right side contract "ex-
centrically" to hokl the bcxly, until, by shortening, they
raise the trunk to the original position and start the
movement to the right, when the muscles' on the left
beg"in to \vork.

Besides being a jxjwerful exercise for these mus-
cles, it also acts strongly on the floAv of blood through
llie inferior vena cava and the portal system, and
therefore is an excellent exercise for constipation and
Ii\'er troubles.

105. Trunk Torsion (Fig. 61). — The trunk is
turned (rotated) round its long axis alternately to the
left and right, without moving the hips, so as to make
the whole movement alx)ve the hips with the head
immovable with the shoulders.

This employs the whole range of rotation in the
thoracic spine, and a small amount in the lumbar
region, while the cerx^ical spine, the pelvis, the hii>-,
knee-, and ankle- joints reniain fixed in the funda-
mental position, by a strong muscular effort.

The oblique alxlominal and back muscles are di-
rectly concerned in this movement: and practically all
the muscles of the hips and lower extremities, includ-
ing the inverters of the feet, contract in the effort to
fix the pelvis and legs.

It is a strong abdominal exercise, and probably a


better "reducer" of obesity than any of the former;
and owing to the strong contraction of the tibiahs
anticus and posticus and plantar muscles, it is also
strengthening- to^ the arches O'f the feet.

io6. Trunk Circling (three to eight times).—
With the hands on hips and feet apart, bend the trunk
forward, then to) the left side, then backward, then to
the right and forward, describing as large a circle as
possible from the waist.

The trunk should not be twisted, but kept square
to the front throughout the whole movement, the chest
well expanded,, the hips, shoulders, and head steady,
and the legs straight. When the circling has been
done from three to eight times in one direction, it
should be repeated as many times in the other.

The effects of this movement are to strengthen the
muscles of the abdomen, the sides, and back ; limber
the back and loins, stimulate the spine and its nerves;
assist the action of the liver, stomach, kidneys, and
intestines, and to increase the oortal system of the

107. Trunk Elevation (Lying) (Fig. 62). —
The patient, lying on a lounge or bed, with his legs
hanging down, raise his body to a sitting position,
while somebody holds down his knees ; or it may be
practised sitting on the floor or a stool, Mnth the feet
held under a bureau, etc., and the body raised and
lowered according to the strength of the patient.

The movement should be done only at the hips,
without any lumbar hyperextension ; the back straight,
the head well back, and) the chest expanded.


The flexors of the hip-joint, viz., the ps^>as, ihacus,
sartorius, and pcctineus, are here stroni^ly contracted,
which again demand a vigorous contraction of the
abdominal muscles.

The upper back muscles nmst also be well con-
tracted in order to hold tlie 1)ack straight and chest
expanded; otherwise the upper part of the body will

Fig. 62. — Trunk Elevation (Lying).

be "curled," the shoulders and head drawn forward,
and the chest depressed, which would result in a very
faulty position.

When properly executed, this movement is one of
the most powerful abdominal exercises, and gives ex-
cellent training in the kind of muscular control required
for a good carriage of both the upper and lower parts
of the body.


Care should be taken to begin gently, and never
to allow "tremors" to appear.

io8. Body Horizontal on Toes and Hands
(Fig-. 63) or on the Bent Elbows and Toes. — •
Keep the whole body in one horizontal line for a few
seconds ; then rest by lowering the trunk to the floor,
and again raise up to the first position. Repeat two
to six times.

Elffects a muscular contraction of the front part of
the abdomen and pehis ; ^■iscera gravitate forward ;
the chest is expanded, and elevation of internal organs
results. The blood is drawn into the anterior portion
of the bo'dy, away from the spine.

Useful in prolapsus of the uterus, vagina, or rec-
tum, and in obesity.

Stiffness of Joints and Tendons.

From Dr. Schreiber the following is quoted: —

"It not infrequently happens that, after arthritis,
thickening of the periarthritic structures or even adhe-
sion of the articular surfaces themselves may occur,
leading to very considerable disability of motions.
Only by mechanical means can we then hope toi break
up the existing adhesions, to smooth the roughened
articular cartilages, and to restore tO' the ligaments
their fonner suppleness and elasticity.

"All the mechanical interferences used — pressing,
stroking, kneading — as well as the passive exercises —
must be performed with the greatest care, since it is
quite p<issible tO' initiate fresh inflammatoiy action by
injudicious treatment.

"The successful treatment of these cases affords one
of the most difficult problems of the niechano-therapist,
for it requires untiring perseverance and patience, as
well as nice judgment and all the fruits gained by ex-
perience, to tide the patient over the necessary pain
which for months he may be called upon to bear.

"The modus operandi in each case will be indicated
by the mechanism^ of the particular joint to^ be treated,
which sometimes will be found to l)e immovably fixed.
At first the tissues surrounding the joint are to l>e



gently rubbed, using' in the beginning the finger-tips
only; later, the force may be increased.

"As soon as the part has, in a measure, become
accustomed to the pain, the passive motions suitable to
the joint may be begun.

"The adhesions existing within and around the
joint may be of so firm and resistant a nature as to
readily lead to the belief in the existence of lx)ny
ankylosis. At first the amount of motion obtained in
the joint will be exceedingly small, but even with this
we will be bound to rest satisfied, for an increase of
mobility often does not begin for months ; in the mean-
while the patience of both physician and patient will
necessarily be put to a severe test. Nevertheless, keep-
ing in mind the old saying, .that 'constant dropping
wears away the rock,' troatment must be continued
steadily and systematically.

"The astonishing results which experienced me-
chano-therapists often obtain in cases declared incur-
able by others can often be explained by the consistent
and methodical treatment which they pursue.

"The knee-joint is very often the seat of extensive
synovial exudation in consequence of chronic' rheuma-
tism. Resorption is to be effected as in synovitis in
general, namely, by centripetal stroking, pressing, and

The following is an interesting case of stiffness, of
the right shoulder which I treated a few years ago^: —

A rather feeble lady, about 45 years of age, was
struck on her right forearm. There was no fracture


nor sprain, but the arm was kept in a sling for two
months. Then the lady found that she could hardly
move her arm at the shoulder-joint. The adliesions
were broken up. During the oi>eration the slioulder
was mechanically dislocated and reset. InHammatory
adhesions followed, and the operation was rei>eated
with no better result. The joint was stiff, with great
inflammation of the deltoid and the adjacent nerves
and tendons, and so tender and sore that it could not
be touched when the ph^-sician prescribed massage.

The patient being under the influence of an injec-
tion of morphine administered by the physician, the
writer was enabled to apply treatment consisting of
centripetal kneading and stroking. After a few days
the injection was discontinued and passive motions
were applied, in addition to the manipulations. Two
weeks later active and resistive movements were used.
After two months' treatment the patient was well.

My method now in treating- stiff joints is to put
the contracted nmscles on a passive, but strong ex-
tension and, while holding them in this position, apply
centripetal stroking, quite hard circular kneading, and
vigorous vibration on the extended contracted parts ;
also muscle kneading and percussion on the antagonists
so as to make them stronger. I have found that in
most of these cases — after the inflammation had left
— the more strength the operator can use in bending
and stretching the joint passively, thei quicker it wdll
be well ; but, of course, care must be taken not to over-
do it or to fracture some bone, ^^'e must find out


exactly which muscle or muscles are the contracted
ones and which are the weak ones, and treat themi ac-
cordingly. Sometimes we find, after we have been
treating- a joint-affection qnite roughly for weeks and
months, that neuritis has set in, and then the treat-
ment must be altered altogether, otherwise we shall
gO' from bad to worse. Neuritis, as will be seen later,
is to be treated very gently and not with centripetal
strokings and kneading^s.

As soon as the patient is able, he should be encour-
aged to move the jonit, and be given resistive exercises
for the weak muscles ; thereby he, himself, passively
stretches the contracted muscles.

One great mistake is often made by masseurs, viz.,
to apply massag-e too long- at a time. IMuch harm may
te and has been done by long treatment, while no hann
will ever occur by too short a treatment. It is safer
to make it tooi short than too long, especially if the
treatment is strong and vigorous. Ten to^ fifteen min-
utes suffice; sometimes even less will be better.
Remember that moderate muscle kneading and percus-
sion make muscles contract and become stronger, while
circular kneading — especially strong — and vigorous
vibration loosen the muscles, and still more so' when
the muscles are kept on the "stretch."

At times it is necessary to lift some muscles either
by one hand or by certain positions on the part of the
patient, and with the other hand, or fingers, knead
under and aronnd them to break up adhesions ; but all
these different manipulations must be seen or learned
by long experience.


I could give hundreds of cases which I have treated
with good success by thi's method ; but my success at
the chnic in Boston City Hospital, which has gained
the appnnal and praise of the head surgeons there,
must be enough to prove the merits of my metho<l.

Sprains, Synovitis, Hydrartriius (Water on
THE Knee), "Ctiarley-horse," etc. — In my opinion
such afllictions should be given massage as soon as
possible. Tliis I am also able to back, up with many
successful cases. One of my sons, as captain of M.
A. H. football team, one Saturday was badly injured,
and the coach looking at himi said : "You have water
on that knee; it will be the last of your playing this
season," at which the boy answered that he was not
so sure about that, as he was going to see "Dad."
\Xe\\, "Dad" just applied hot water on the knee for
about fifteen minutes; then gave light "combination"
kneading of the thigh, beginning at the hip all around
toward the knee. ])ut not touching it, followed by cen-
tripetal stroking from the knee and up the whole thigh,
especially the inside, where the big veins are; also
some stroking from the foot and up, avoiding the

This was done for ten minutes, three times a day
the first few days and then twice a day; and the fol-
lowing Saturday the boy played a winning game as
half-back. Some time later he was struck, and a
"Charley-horse" appeared. T gave the same treatment
and also circular kneading right oni the spot for three
davs, and all was well.


In sprains I have had hundreds of similar* cases.

Batlie the parts in hot water immediately after the
accident, then apply "combination" kneading from
above and gradually move down toward the sprain,
stopping before it is reached ; then centripetal stroking.
When the soreness has disappeared give gentle circu-
lar kneading all around the joint, followed by strok-
ing; also apply circular kneading with one hand while
centripetal stroking is applied with the other hand.

Provided no ligament is torn, a sprained ankle, if
treated at once, should be well in from two to six
days. If a ligament is tO'm the massage is still of
great help, but the sore spots must not l>e touched ;
all the massage is to be above and below.

Of course, there are cases when massage had better
not be used.

For instance, if a muscle is ruptured throug'h over-
work, it should be "plastered" up till it is healed; then
gentle kneading may be good.

The most cases of sprains which are treated with
massage stop too' soon. Especially is this the case
where the sprain is an old one. Here the muscles have
become very weak through the long inactivity. There-
fore, whenever a sprain is seemiingly well — that is,
pain is gone — passive rotations, flexions, and exten-
sions should be applied; and also' resistive movements
to make the muscles strong again, and even stronger
than before, so they will not allow of any more sprains
to that joint.

Persons who' frequently "turn" the foot do this


because the ligaments arc "slack," and as we cannot
niake tliein shorten, we must make the muscles strong
enough, to act for the ligaments as well.

Old sprains, when the inflammation has disap-
peared, are treated like stiff joints, often with great

Syjioz'itis is best treated with centripetal stnjking
above the diseased part and, better, ten minutes twice
a day; then not so frequently.

These different traumatic cases, when; no fractures
occur, if treated early and by an expert, will most
frequently be cured in quite a short time, while if they
have been allowed to go on for months and even years,
this treatment will still prove to be most effective, and
on the average in these old cases a cure may be ef-
fected in from one to three months.

Other joints are treated on the same plan.

The hip- and shoulder- joints are more difficult to
treat and require a much longer time in order to pro-
duce a cure.

The following-cited cases are especially note-
worthy : —

Ca.se I. — A gentleman, 36 years old, sprained his
right ankle by a fall, and had been on crutches for
eight months, when he came for treatment. There
was no flexibility of the ankle, which was very tender
and swollen. After six weeks' treatment once a day
the patient was cured.

Case IT. — A young lady had come to Washington
to attend the inauguration of one of the Presidents.


Three weeks before, she shpped on the icy pavement
and sprained her right ankle. She was laid up, and all
sorts of liniments, etc., were prescribed by her physi-
cian. After ten days he told her that there was noth-
ing more to do but to keep quiet for two or three
months, when she probably would be well. At this
point I was called in, and the young lady told m:e, with
tears in her eyes, why slie had come to the city, and
that now she was told that she would have to be cjuiet
in her room for months, and she implored me to do
my best. The ankle was still black and blue and very
m;uch swollen, and the pain did not allow of touching
the parts. After the examination she was informed
that she would pro1>ably be well in ten days if treat-
ment was applied twice a day. To this she was only
too glad to consent.

The treatment was given twice that day. The next
day the most of the discoloration had disappeared, and
now she was told to walk a little at a time in her room.
The improvement was remarkable from day to day.
The ninth day after, the seventeenth sitting, she was
cured, and went to the inauguration ball on the tenth

She had no relapse.

Case III. — About two years ago one of my assist-
ants sprained his left ankle in a gymnasium. He was
brought home by his friends and told to be quiet in
bed. He kept on all night bathing the leg with hot
and cold water, and came next mo'ming to> the Insti-
tute. The joint was slightly dislocated, the foot was


turned upward and inward, and twice as large as usual.
The patient was a strong young man, so that I at once
went to work and succeeded in getting the joint
straight, after which a full treatment was applied.

.Vfter four days' treatment, twice a day, the young
man was well.

Prof. Dr. J, Nicolaysen, of Christiania (in Norsk
Mag. for La-gczndenskab, 1874), communicates the
following case of hydrartJints ( water on the knee) : —

"A man, 32 years old, had suffered from hydrar-
tlirus for six and one-half years. Repeated punctures
and evacuation had ahvays been follow^ed by a re-
accumulation of the fluid.

"Massage was used for several months, and the
patient returned to his work. There was no relapse."

Another gentleman, 26 years old, had suffered from
hydrarthrus for two months, when he came to the
same professor, who sent him toi me, at that time in

After two w'eeks' treatment the collection of fluid
in the knee-joint disappeared, but the swelling of the
capsule continued.

After five weeks' treatment the patient was well.

AMienever massage is applied to a leg after an acci-
dent, it is best to begin with vigorous centripetal strok-
iugs at the inside of the thigh; or if it) be the arm.
make the same kind of strokings on the inside of the
upper arm, as this will, quicker than any other manipu-
lation, produce absorption through the big veins from
the diseased part.


I have always found that the quickest way to cure
sprains or bruises is to bathe with hot water immedi-
ately after the accident for half an hour or more, and
then apply the massage oboz'e the sprain, until it will
allow of being touched with gentle strokings, which
gradually should be increased in force ; then a circular
kneading on and around the sick parts with the fingers
of one hand, while the other hand is continuosly strok-
ing upward.

Even in fractures it will be of great value to use
the hot water, and centripetal strokings above the frac-
tured parts, which will reduce the swellings and enable
the surgeon to set the bones with more accuracy.



("Morbid condition of foot in ivhich the
arch is destroyed." )

This troii])le has grown very marked the last
twenty-odd years, iuid many theories are advanced, and
espe,cially have the orthopedic surgeons insisted that
the habit of standing and walking with the toes turned
out is the chief cause of this malady.

In this I cannot agree; and although I am not a
surgeon, I still believe I have some right to my opin-
ion — having taught gymnastics to hundreds of thou-
sands, boys, girls, and adults, and treated many hun-
dreds in the last forty years.

The surgeon says : "These patients come to me
invariably with the feet turned abnormally out; they
are fiat-footed, and I tell them to practice standing
and walking with their feet parallel — even turned
inward — which relieves them and helps to cure them."

Very well ; but supposing a physician orders a pa-
tient to take stiychnine, are we tO' understand that he
is tO' do so all his life, or even that other persons must
take it because it cures in some cases?

My theory is, that it was the broken-down arch
which made the foot turn abnormally outwird, not
the reverse.



Who are those who mostly suffer from fiat-foot?
They are saleswomen and nurses; and wdiy? Because
they have tO' be on their feet all day (most frequently
in poorly fitting- shoes) ; their feet tire, and they begin
to walk with stiff ankles^ — no- foot action ; consequently
all the muscles are weakened and cannot do their
work; they "give," and the pressure on the arch of
the foot being nO'W unbearable, the foot gradually
turns O'Utward. And this is what the surgeon sees;
but he did not see this patient before she was taken ilk
when her foot in ninety-nine out of a hundred cases
was normally turned.

Of course, if it was an abduction of the foot in the
ankle, which made us turn our feet outward in stand-
ing, I would- say "the surgeon is right;" but the gym-
nastic standing position with the toes turned out is
done by a rotation of the thigh at the hip^joint, and
we insist that the toes shall always be in line with the
patella, and there is no^ danger for the arch of the foot
as long as the muscles are kept strong and active.

There is another cause why women suffer so- much
more with the malady than men, namely, because they
are naturally "knock-kneed," this puts a heavier bur-
den on the arch of the foot.

If people would be careful about always keeping
the toes in line with the knee in walking and standing,
in g\Tnnastics and dancing, and exercise their ankles,
as well as having shoes comfortable and well-fitting,
we should see much less of these troubles.

The crusade which has been going on for several


years and whicli has resulted in nnsi^^litly. awkward
p()siti(Mis of the feet in many sehouls, in this eountry
will ultimately lead to a nation of l)ow-lei;"j:;"e(l men
and wonren.

( )ne argiiment nften used is, that the Indians st.and
a.nd walk with toes strait;ht ahead — iJicrcfovc it is

A\'ell, the mountaineers of Norway walk with their
feet abnormally out to Ijetter climl> the mountains.

In either case it is the condition which has made
them as they are.

We have alsoi been told that our "forefather." the
"monkey," keeps his feet (rather hands, th.ough )
turned inward — that it is natural and we must do the

There are very few people nowadays who care to
"ape" the monkey; we will rather keep a big distance.

Sometimes we find some girls in the gymnasiums
suffering with "flat-foot," and it is rather strange that
there are not many more of them. These voung ladies
ha^•e for many years been wearing hig'h shoes with
high heels, and now^ they are suddenlv forced to wear
gym. shoes without any heels for three to five hours
a day. No wonder that they suft'er. These people
shonld be given small heels inside their shoes.

I have had great success in treating /7o/-/oo/ with
massage and a few simple exercises, as follows : —

1. Centripetal stroking of foot and leg to knee.

2. IMuscle kneading of foot and up the inside of
the leg ; also percussion.


3. Foot rotation.

4. Foot flexion inward and upward, with resist-

5. Foot extension wnth resistance.

6. Again muscle kneading, percussion, and

This ought to be given every day, or at least every
other day ; and the patient should take some exercises
at home morning and night : —

1. Sit and rotate her foot actively.

2. Turn the foot inward and upward and resist
with her hand.

3. Stand and raise on tip-toes and at the same time
turn toes in and heels out.

4. Deep knee bending.

5. Sit or stand and try to pick up a marble with
the toes.

6. Centripetal stroking of foot and leg.


General ]\Iassage

has within the last thirty years become of such great
importance in the treatment of many kinds of ills that
I ^\•ish to take it up as a special branch of massage.
Thirty years ago it was hardly known in Europe, and
even to-day we hear the young masseuses, who have
recently come over from Sweden, saying that they
don't like to give "general" massage and don't care for
such cases.

The real reason is that; they have not learned that
kind of massage in Sweden. They have had a thor-
ough course in medical gymnastics and local massage,
but not in general massage, and because the American
people have come to look to every Swede as a natural
masseuse, \\hich, however, is a great mistake, these
inexperienced young ladies put on the air of authority
and knowledge and scorn the idea of giving general

My advice to all newcomers is to learn general
massage as quickly as possible, and also to learn how
American patients are treated, and even to take a sh(^rt
course of study here before they visit the physicians
with their cards.

There was a time when "graduated from Sweden"
was the best possible recommendation on a card, but



that time has passed, since we have just as good schools
right here, where the theory is broader and the practi-

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Online LibraryHartvig NissenPractical massage and corrective exercises → online text (page 6 of 11)