Hartvig Nissen.

Practical massage and corrective exercises online

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The movements in these cases should be stimulat-
ing and strengthening.

1. Chest Hfting and vibration — lying.

2. Leg nerve compression, rolling, slapping, and

3. Arm compression, rolling, slapping, and friction.

4. Head rotation — sitting.

5. Leg vibration — lying.

6. Arm vibration — sitting.

7. Stomach friction and circular kneading — lying.

8. Back percussion and friction.

9. Head percussion, kneading, vibration, and fric-


The treatment here is to avoid new attacks as well
as to improve the patient's condition, and foi-" this rea-
son the movements should not only be applied tO' the
paralyzed arm and leg, but to tlie whole body.

The following illustration of this mode of treat-
ment gives the best example of prescriptions for such
patients : —

.V gentleman, 64 years old, was stricken with apo-
plexy, resulting in a partial paralysis of the right side.
Forty-eight hours later the writer was called in by his
physician to try the massage treatment. The patient
was at this time still unconscious.


The first day the following- movements were ap-
plied very gently: —

1. Right ami nerve compression and friction.

2. Right hand ajidi finger rotation.

3. Right leg ner\-e compression and friction.

4. Right foot rotation.

5. Right leg muscle rolling and friction.

6. Right arm muscle rolling ajid friction.

The next day the patient seemed to know what was
going on, as he saw the operator and objected to have
a stranger alx)iit him. Xe^•ertheJess, by kind words
and cheerfulness, he consented to the treatment. There
was now a slight movement of the right leg, and there
was applied, in addition to the former prescription : —

Thigh rotation and leg flexion and extension, pas-
sive, to the right leg.

The third day the patient was glad to see the opera-
tor and delighted to show him his improvement, as he
now was able to draw his knee up, make a. slight mo-
tion of the foot, and of the arm.

His right hand and fingers were swollen and pain-
ful, and he could not see with his right eye, and he
spoke with difficulty.

Centripetal stroking and k)ieadi}ig was first applied
to the right fingers, hand, and arm, together w'ith the
following movements : —

Right hand and finger rotation and flexion — pas-
sive ;

Right arm rotation and flexion — passive '

Centripetal stroking and kneading of right leg;


Right foot rotation and flexion — passive;

Thigii rotation and leg" flexion — both legs — pas-

Both arms — nerve compression, rolling, and fric-
tion ;

Both legs — nerve compression, rolling and friction.

The fourth day no treatment was given.

The fifth day considerable improvement was
noticed in moving both the arnT and leg ; the swelling
and pain of the right hand were veiy much less. The
same movements were used as at the last time.

The sixth day no treatment was applied.

The se\"enth day the iuTprovement was astonishing:
the swelling of the right hand had disappeared, and
the patient was able to 'take me by the hand and to
move his foot and leg at will. Prescription was then
changed to the following: —

Chest lifting and vibration;

Thigh rotation of both, legs ;

Right arm rotation;

Foot rotation, double ;

Right hand and finger' rotation and flexion — pas-
sive ;

Right leg nerve compression, rolling, and friction ;

Right ami nerve compressiou, rolling, and friction ;

Right leg' vibration ;

Right arm vibration ;

Back kneading, percussion, and friction.

This treatrrrent was repeated the eighth, tenth, and
eleventh days after the first visit.


The twelfth day the patient was r.p and al)le to
\\alk a httle in his rcx^ni, and the follouini^- prescrip-
tion wa,s then given: —

Shoulder rotation and chest Hftinir — sittinjr;

Thigh rotation, both legs — reclining;

Right arm rotation — sitting;

Right foot flexion and extension — sitting — resis-
tive ;

Right ami nen-e compression, rolling, slapping, and
friction ;

Right leg nerve compression; rolling, slapping, and

Right arm flexion and extension — resistive ;

Forward trunk flexion- and extension — sitting — •
resistive :

Right knee flexion and extension — sitting — resis-

Right arm torsion — resistive;

Right arm vibration — sitting;

Trunk rotation — astride sitting — passive ;

Right leg torsion — resistive;

Right leg vibration — reclining;

Back percussion and friction — standing;

Head kneading and friction.

The improvement continued from day to day. The
eyesight came back, the speech was clearer, and the
patient gained more and more control over his lim^bs.
The treatment was continued every other day for two
weeks more, when the patient couTmenced to take out-
door walks.


The fifth week only two treatments were applied
and then entirely discontinued, the patient being able
to walk as well as before tha stroke, and having full
use of his arm.

This case was a very favorable, one, but there can
be no doubt that the movement treatment hastened the
improvement considerably, although the physician
must be careful not to apply this treatment too: soon,
and that it is done in a very gentle and judicious

When the physician does not feel sure that the
movements will have a good effect it will always be
best to wait from four to six weeks before they are
resorted to.

Abdominal massage shoidd not be applied tq these

Before resistive movemients can be used in these
cases it becomes necessary to- apply assistive move-
ments, then actiz'e, and finally resistizre, which fre-
quently must begin with "excentric" exercise before
the "concentric" ones.

For instance, in case of the right arm^ — support the
elbow and tell the patient tO' bend up his arm ; he can-
not do it — tell him again and again, and gradually
push his arm' up. Now tell him to; extend the ann,
which probably will have the same result, and you
must slowly stretch it out for him. Repeat this day
after day, and some day you will see the arm begin to
move. Then encourage the patient and command him
to reach for certain objects — your own hand in dif-


ferent positions. Gradually, the motor nerve centers
are jjeing trained, and some day the patient is able to
bend and stretch his arm at will, althouj,di it may be
jerky and imevenly and with very little strength. Now
begin to Ix^nd the ami, while you tell the patient to
keep it straight ; and again stretch the arm, while the
patient is told to keep it l>ent.

This is the "excentric" exercise, which will gradu-
ally make the muscles stronger and able to bend and
stretch "concentrically."

This mode of treatment should be given to any
part where it seems necessary — ann, hand, leg, foot,

Besides this, be cheerful and agreeable to the* pa-
tient; take him under the arm and walk with him,
tiying to make him lift both his legs and put the feet
squarely down on the floor without hesitating. Let
him try to hit you with his lame fist and, grab your
arm, and also tell him to spread out his fingers a cer-
tain number of times, several times daily, etc.

The most cases of paralysis are slow to recover,
and especially is the hand, as a rule, far l>ehind the
rest of the body in becoming well. The treatment is
agreeable to this kind of patients and it has a soothing
and cheerful influence on them.

Here it may be well to say that all persons w4io have
been troubled once with apoplexy ought never to stop
taking movement treatment, or at least only at short
intervals, unless they have plenty of other healthful
exercise, as it is the best means to prevent another


Local Diseases (Continued).


This disease has often been quickly inTproved by
a proper treatment of derivative movements, which
are herein set forth :—

1. Forward arm rotation — sitting — passive.

2. Foot rotation, double — reclining" — passive.

3. Vertical arm flexion and extension — sitting —

4. Leg flexion and extension — reclining — resistive.

5. Trunk torsion — astride sitting — resistive.

6. Bent knee separation and closing — reclining — •

7. Breech beating — standing — passive.

8. Knee flexion and extension — sitting — resistive.

9. Stomach friction— lying — passive.

10. Shoulder rotation and chest lifting— sitting.


Dr. Anders Wide, of Stockholm, says in his book
on "Medical and Orthopedic Gymnastics" : —

"A few cases of tabes dorsalis are treated with
gymnastics every year, and I dare assert that the treat-
ment has, in no case, been without result, as improve-


nient in certain symptoms has always been gained. It
is specially worthy of notice, that the unsteadiness in
Avalking and the inner paresis of the intestine and
bladder can be diminished or even, for a time, totally
disappear. I consider it, however, to be my duty to
point out here that, as far as I know, no return to
health has occurred in any case treated."

Patients with this disease are generally more hope-
ful of beneficial results than physicians, and the
knowledge that this affection frequently comes to a
standstill and improves, and that in some few instances
recovery has taken place, ought to inspire us with
more hope and zeal to co-operate with the sufferers.

This disease is characterized clinically by want of
power to co-ordinate voluntary movements, by violent
shooting pains, especially in the legs ; absence of knee-
jerk, atrophy of the optic nerve, paresthesia and anes-
thesia in certain parts, dysuria, and functional sexual
disorders; anatomically, by a sclerosis (hardening) of
the posterior columns of the spinal cord.

The treatment prescribed by Dr. ^^^ide and other
Swedish as well as German authorities consists merely
of passive movements and massage, and, of course,
they are useful and even necessary. But I firmly be-
lieve, with Dr. H. V, Barclay, of New York, that a
thorough course of educational gymnastics is what is
mostly needed in order to train the nerves and again
awaken the activity of the nerve-centers and make the
muscles obey the will.

Aly mode of treating these cases is as follows : —


1. Back percussion — standing.

2. Thigh rotation — recHning.

3. Arm rotation and forearm rotation — sitting.

4. Trunk rotation — astride sitting.

5. Abdominal massage — ^recHning.

6. Arms nerve compression, muscle rolling, slap-
ping and friction — sitting.

7. Legs — the same.

While the patient is lying down, he is told to
move his legs in certain directions. — pull one knee up
and slowly lower it ; bring- the leg outward and back
again; cross one leg over the other; bring one foot
toi touch the other leg, or knee, etc. At first these are
done assisfk'cly till the patient gradually is able to do
it alone. Later, tlie patient stands up and practises dif-
ferent exercises at my comniand, both with the lower
and upper extremities. These have been of very great

This is what has been called the "Frankel" sys-
tem, but has been practised by myself and otliersi long
before we heard of Frankel.

9. Full massage of the back and buttocks.

After this kind O'f treatment has been used for some
time — two to three months — rcsistwe exercises may
be used, always taking care not tO' overtax the patients'
strength, as they are generally very eager toi get well
and apt to do more than the}^ oug'ht to do.

Cures are rare, although there are some on record,
but great improvement is a frequent occurrence.


Infantile Paralysis,
roliomyelitis anterior.

This dreaded disease is nowadays treated almost
entirely with massage. At least our greatest medical
experts have frequently advised patients to try mas-
sage as the^ only remedy which probably will restore
the functions of the paralyzed parts, saying, at the
same time, that electricity will not do- it and m;ay even
do harm.

My experience with these cases fully agrees with
the physicians — but even massage may do harm, if
not applied carefully, and the patient constantly warned
not to overdo.

^^"e must by careful examination find the para-
lyzed muscles and their nerves, and apply mild muscle
kneading and percussion to them. Give' passive exer-
cises — flexion, extension, abduction, adduction, and ro-
tations: stretch contracted muscles and ti*y our best to
make the weak, paralyzed muscles contract and gradu-
ally begin to work.

Here again it is of value to apply assisfk'e exer-
cises and make the patient concentrate his will on the
nmscles to be used — always taking care not to do too
much. Of course, with a small child this is rather



out of the question ; but then we must nivent some
exercise which the child wih be interested in doing,
and which will have the same effect.

When we know the exact muscles involved we can
also find the ner\Ts and apply some vibratory pressure
on them at their outlet from the spinal cord, which
will have a stimulating effect.

Two interesting cases of mine may give an idea of
my method of treatment : —

I. Some years ago I was called to attend to a girl
Off 6 years of age; she had never been able to stand
on her feet ; and the parents asked me what I could
do. They had "been going to a doctor for electricity
one year, to an osteopath one year, and a lady had
applied massage every day for one year." I told them
that, although I might give some massage, it would
probably be different from what the girl had been
given, and that I would rely mostly on what I called
educational gymnastic training.

This child was in a rather feeble and nervous con-
dition ; so I did give her some massage — nerve com-
pression and frictions of amis and legs, stomach fric-
tion and circular kneading and full massage of the
back. Besides this, muscle kneading and percussion to
the weak muscles of the legs and passive exercises,
soon followed by assistive, and before one month
(treatment three times a week) the child began tO' re-
spond and "jerkingly" do several exercises. Now it
was to make the exercise even, and not toi allow any
movement without first being told, as, for instance:


"Give me that foot in my hand," which I held out-
side. She would do so, l)ut inimcdiatcly tiy to pull it
back again, which I checked by saying "Hold it"; and
after a short rest, "Now pull it back," and so' on in
different directions.

After three months' treatment the child could
stand and, holding on to somebody, take a few steps.
Then they went away for the summer, which was good
for her general health. In> September I began again,
but only twice a week. In the following spring one
of our first neurologists saw the child and told them
to continue my treatment, but every day and not twice
a week. Another summer vacation and, we continued
treatment three times a week. Now the child stood
up and I taught her tcy place the feet in different di-
rections and before the next summer she and I danced
a waltz together. Next year, treatment twice a
week and she walked back and forth tO' school, morn-
ing and afternoon; the abdominal muscles still w^eak,
so her gait w^as rather swaying, bending the body
backward wdth each step. But even that could have
been remedied if the parents had been willing to con-
tinue ; they think she will outgrow it by honre practis-
ing and, of course, much can be done if they stick to it.
II. In November, 19 14, I was called to a yoitng
married gentleman, 24 years of age. Two months be-
fore he had been stricken wdth infantile paralysis, very
high fever, and for a while given up by the physicians.
Now he w^as flat on his back, without being able to
mo've a single muscle in either leg or lower part of


the back. He had been constipated all his life and
had taken some physic every day to move his bowels.

The expert physician, who had been called in con-
sultation, said : "Massag-e, and nothing else, will do
yoii any good."

I began with massage of the stomach, then gentle
"combination" kneading, nerve compression and fric-
tion of both legs, and back massage.

Next day the same and passive movements.

In giving massage of the stomach I noticed some-
thing loosen in the ascending colon, and when I re-
turned I was told that without taking any medicine
the bowels had acted and he had passed a black, hard
lump, which probably had been lodged in his co'lon. a
long time and caused autotoxin. He has ne\'er taken
any physic since.

Gradually I led this patient to concentrate his will
on certain muscles, and already, at the end of the first
week, he could move the quadriceps and patella of his
right leg.

I found the nerves at the lumbar spine and applied
vibratory pressure, gave muscle kneading and percus-
sion to his weak muscles, and as I found that the
gastrocnemius was inclined to contract, I applied
stretching by bending the foot upward.

The adductors were next to begin to show life;
then we worked on the flexors of the thigh and the
abductors. Dr. Brown, orthopedic surg-eon of Boston,
came once a month, and he ordered hot tul>bath and,
while in the tub, trying tO' draw the knees up, which

iNl^ANilLh. i'AKALYblb. 157

worked very well. The patient was also lying- down
with a pillow under his lumbar and lower dorsal back,
and in this jx>sition made to draw in his abdominal
muscles. This also worked well, until I noticed that
he beg^an to have "backache" from the pressure of the
lumbar vertebrae, and the pillow was discontinued.

Treatments were given every day fo^r one month,
then six times a week, four times a week during the
third month, aud finally three times till the middle of
June. Already in March the patient had rig^ged up a
bar between two doors and, by taking hold of this,
would raise himself up and stand upright, gradually
beginning to move his body in different directions.
He would sit on a table and move his legs forward
and backward, and also sideways, etc.

All morning he was in a chair on. his piazza, in
sunshine and fresh air. His little wife was a wonder
of a helper to him ; they were all alone and I felt as
if they were my own children. By the end of April
we rigged up two long, parallel bars (ten feet) in the
parlor, and here he stood up and walked forward and
backward between the bars.

In J\Iay he was given braces and crutches, and he
soon learned to walk pretty well. Then the two went
in their own automobile to Canada, where the im-
provement steadily continued. He still uses the
crutches, but there is no doubt now that he will ulti-
mately recover, by rest and judicious exercises, tO' the
great astonishment of his physicians, who never ex-
pected to see him ou his feet again.


Of course, this young man was an intelligent fel-
low aiid eager to do his best, which* helped my treat-
ment greatly, but I had to caution him frequently and
even scold him for doing too much. I had to put the
check-rein on him as on a wild colt.

These two cases ought to give some idea of how
to treat patients with this malady.

Occupation Neuroses.

These generally occur during the best working
period of a man's life. The illness creeps upon one,
and its course is slow. Nctu'itis in any of the nerve-
roots of the arms or even in plexus brachialis is some-
times the cause of the illness. Often there is great
tenderness over the nerves of the arm; but more fre-
quently OA'er the muscles. Excess of work is the cause
oi the trouble, and therefore the first thing to do' is
to quit the particular work which has produced the
neurosis. Then passive movements oi the arm and
centripetal massage should be applied. But where the
nerve is sensitive and tender light circular kneading
should be gi\-en, and often the sore spot entirely
avoided while the centripetal massage is applied a,bo>ve.
This is especially the case with masseur neurosis and
other neuroses occurring after very hard work.

The prognosis is not always good in occupation
neurosis. The illness may follow the patient all
through life; although I believe that many failures to
cure it have come from too hard treatment. My per-
sonal experience is that moderate and even very light
massage will produce a cure.

Some tinie ago a gentleman, druggist, who used his
left hand frequently in the ice-basket while making ice-



cream was taken ill with neuritis of the median nerve

oi the left ami aiid. hand. P'oir seven) weeks lie was
treated by his physician with all sorts of rem^edies,
among them electricity and vibrator machine, but he
grew steadily worse and finally was unable to sleep,
and confined to his room. His friends had told him
to send for me, but his doctor said "No, — what could
massage do when electricity and) vibration made him
worse?" Nov/ he changed his doctor and he at once
sent for me. The patient told me about his experience
and that his first doctor had said massage would ag-
gravate the trouble, to which I said that probably the
iBost masseurs vrould do so, but I would undertake to
give him five treatments, and) if he by that time felt
no relief we would stop, and I should not charge him,
but if he was better he should continue the treatment.

The first treatment consisted of light friction from
the spine, over the shoulder and down the ami, and
slight pulling of the anm — six nuinutes in all. The
next day the same and nerve compression; third day
the same; fourth and fifth the same and some com-
bination kneading and singie anrr rotation.

After the fifth treatment the patient was entirely
well, and has not had any attack later.

writers' cramp.

These movements are useful : —

1. Back percussion.

2. Right arm centripetal stroking, kneading, circu-
latory friction.


3. Right arm rotcation.

4. Forward trmilv llexion and extension — sitting-

5. Right arm torsion — resistive.

6. Right hand and finger flexion and extension —

7. Right arm viljration.

8. Trunk rotation — astride sitting — passive.

9. Vertical ami flexion and extension — resistive.
10. Right arm nerve compression, rolHng, slapping,

and friction.

Cramp of the Legs.

1. Thigh rotation.

2. Leg vibration.

3. Foot flexion and! extension — resistive.

4. Trunk torsion — sitting — resistive.

5. Leg nerv^e compression, rolling, and friction.

6. Leg flexion and extension — resistive.

7. Trimk ele\'ation — lying — active.

8. Upward knee traction — resistive.

9. Breech beating.

10. Leg torsion — resistive.

TT. Leg nerve compression, slapping, and friction.

12. Back percussion and friction.


This disease has been treated with great success by
the Swedish movement.

M. Napoleon Laisne has applied this treatment to


hundreds of children at the "Hopital des Enfants
Malades," in Paris, with the greatest success. Dr.
Blache, the president of this hospital, addressed in 1851
an assembly of directors, and prominent physicians
upon the results of this treatment. He closed his re-
port by saying that in four yea,rs not one of the choi-eic
children thus treated had suffered a relapse.

Resistive mo\'ements followed with light friction
downward of the parts just treated, and also some
active exercises according to command, are the most

1. Horizontal arm separation and closing — sitting
— resistive.

2. Bent-knee separation and closing — reclining
— resistive.

3. Trunk torsion^ — sitting — resistive.

4. Foot flexion and extension — double — reclining
— resistive.

5. Neck flexion and extension — standing — resistive.

6. Vertical arm flexion and extension — lying — re-

7. Leg flexion and extension — reclining — resistive.

8. Arm torsion — sitting — resistive.

9. Back percussion — standing.

A regular course of Educational Gymnastics should
be given for several years.


Sciatic Neuralgia.

Of all writers on the treatment of this malady Dr.
J. Schreiber seems to have had the most cxi>erieiice and
to have been the most successful in his cures. Upon
this subject he says: —

"As the greater number of sciaticas which have

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Online LibraryHartvig NissenPractical massage and corrective exercises → online text (page 8 of 11)