Hartvig Nissen.

Practical massage and corrective exercises online

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come under my notice have been combined with crural
neuralg'ia as well, I think it best to consitler these two
conditions together. It seems advisable, also, to dis-
cuss the treatment according to a plan which may, with
suitable modifications, be applied tO' each special case,
and yet one which will embrace the details gleaned
from numerous observations. Let us take a case: —

"A patient suffering from well-UTarked sciatica and
crural neuralgia of the right side applies for relief, after
having been under treatment by others for many years
in vain. He has used veratria, aconite, and belladonna
ointnients, moq^hine injections, electricity, sinapisms,
and vesicants. We may assume, also, that for a con-
siderable period he took arsenic, quinine, and potas-
sium iodide and bromide, that he has l>een to a number
of springs, like Gastein, Wiesbaden, Teplitz. and
Ragaz, and also that neither sea-bathing nor hydro-
therapy has had any effect upon his obstinate malady.
He is only able to drag himself painfully along by the



use of a cane, and every step causes acute suffering.
Rising and sitting down can only be accomplished by
aid of the anns, while for g'oing upstairs or getting
out of bed the assistance of an attendant is necessary.
He is never entirely free from pain, and there is gen-
erally a daily exacerbation lasting often several hours,
and preventing much-needed rest.

"Examination shows no other functional disturb-
ances. There is great sensitiveness in the buttock, at
the point of exit of the sciatic nerve, and many painful
points exist along the outer and inner aspects of the
thigh. The limb, furthermiore, will be seen to be held
in a characteristically pathognomonic position, namely,
the thigh rotated inward and adducted, the knee
slightly bent, and the foot not resting on the groiuid
with the sole, but touching it with the toe only.

*'0n sitting down, the patient supports himself by
his left arm, and lets himself fall, as it were, upon his
left buttock, instead of perfonning the usual move-
ments of flexion with knees and hips. The involve-
ment of the semitendinosus and semimembranosus
muscles causes great sensitiveness to pressure over
their tendons. Voluntary abduction of the affected
thigh is impossible, and abduction of even the well
extremity cannot be performed on standing erect, on
account of inability of the patient to support himself
upon the affected limb. External rotation is also im-
possible. Hence it appears that the glutei, the pyri-
formis, the internal obturator, and the gemelli (ex-
ternal rotators) are all affected. Nor can the patient


flex the thigh (involvement of the ihac and psoas
major), nor can he addiict it after it has once been
passively abducted (involvement o-f the sartorius, in-
ternal rectus, adductors longus, brevis and mag-nus, and
pectineus). But the greatest pain of all is caused by
rotating the thigh outward, as the sciatic is thus made
to glide upon and rub against the quadratus femoris.

"I have purposely selected a case in which all the
muscles of the buttock, alxDUt the hip-joint, and of the
thigh have become involved, and hence almost entirely
deprived of function. Many years of experience and
many trials have convinced me that the cure of these
forms of sciatica will be most rapidly effected when, in
addition to the mechanical interferences, passive and
active motions of all the affected muscles are employed.
It has also seemed to me best to begin the daily treat-
ment with the passive and active movements, leaving
the mechanical manipidations, which are very painful,
till the last. They cause so much exhaustion, as a rule,
that the patient is anxious only for rest, and will hardly
have the energy necessary for performing acts which
he kno'ws must only increase his suffering."

If the cause of the neuralgia is a pressure, as froin
a tumor, etc., it is of no use to try this treatment, but
otherwise it will generally effect a cure. At the end of
each day's trea.tment the patient will generally complain
of much pain and fatigue, which usually diminishes
considerably in about half an hour, although it some-
times lasts for hours after^^^rd. In the beginning,
too, the night's rest may be more broken than before.


In six to twelve days usually a changfe for the better
occurs, the night's rest becomdng more tranquil, the
pain less, and the first signs of approaching conva-
lescence begin to appear.

Dr. Schreiber says : "It is almost a matter of course
that the physician will be confronted with every kind
of doubt on the part of the patient regarding the ulti-
mate results of treatment, but, as failures are rare
where sufficient perseverance and the requisite skill
have been employed,- he may confidently combat these
miisappirehensions. The duration of the treatment will
depend on the following various factors : —

"i. On the previous length of the illness.

"The longer the disease has existed the more pro-
tracted will have to be the treatment. Eight weeks
will, as a rule, be the limit ; at least, that was the limit
needed to cure one of my cases of a previous four
years' duration. Cases of only a few months' standing
often need but ten or twelve days for a cure.

"2. On the extent of the disease.

"The greater the number of muscles involved the
more numerous must the number of corresponding ex-
ercises be, and hence the longer the time required.
"3. On idioisyncrasy. Individual peculiarity.

*Tn sensitive individuals it is often necessary to pro-
ceed very cautiously and gently at first. More time is,
therefore, required in these cases than where the pa-
tient is not of a timorous or complaining dispo'sition.

"4. On the skill, the experience, and the persever-
ance of the physician.


"Familiarity with the methods frequently enables
a practised hand to employ many devices which an in-
experien.ccd i)erson veiy pnii)erly avoids.

"5. On the age and general nutrition of the patient."

Two very interesting cases are illustrated by Dr.
Schreiber, and he claims to have cured numerous per-
sons of very bad sciatica. His mode of treatment is
in its character the same as I have been; using, but as
Dr. Schreiber already, the first day of treatment, uses
some kind of apparatus, the dcscrii).tion l>elow given
shows the method found by me to be the best where
the patient is confined to his room, as in a case of
sciatica of the rig"ht leg.

The first day the treatment must be very gentle and
of short duration, the patient lying down.

1. Right leg flexion and extension — passive — four
to teil times, according to his strength.

2. Right leg nerve compression and rolling.

3. Breech beating.

4. Right leg (back of the thigh) percussion and

The second day the same treatment with more

The third day the following is applied: — ■

1. Right leg flexion and extension — passive.

2. Right leg nerve compression and rolling.

3. Right thigh rotation.

4. Right leg vibration.

5. Breech beating.

6. Right leg nerve compression, percussion, and


The fourth day give: —

1. Right thigh rotation.

2. Right leg flexion and extension — resistive.

3. Right leg nerve compression and rolling.

4. Right leg sq>aration and closing — passive.

5. Right foot flexion and extensioii — resistive.

6. Right leg vibration.

7. Breech beating.

8. Right leg nerve compression, percussion, and

The fifth, sixth, and src'cnth days we may apply
deep kneading of all the muscles of the buttock and
thigh, just before "breech beating" and "sciatic nerve
stretching," in connection with the former prescription.

The next four or five days the following move-
ments should be used : — '

1. Thigh rotation' — both legs — passive.

2. Right leg flexion and extension — resistive.

3. Right leg nerve compression and rolling.

4. Right leg torsion — passive.

5. Right leg separation and closing — resistive.

6. Kneading and beating of right leg andj buttock.

7. Right knee upward traction — resistive.

8. Right foot flexion and extension — resistive.

9. Right leg vibration.

10. "Sciatic nen^e stretching."

11. Right leg nerve compression, rolling, and fric-

The last prescription, which ma}^ be continued till
the patient is well, has a more all-sided effect.


1. Thigh rotation — Ijoth legs — passive,

2. Right leg iicrve C()ini)ressi(jn, rolling, and fric-

3. Trnnk rotaticni — astride sitting — passive.

4. Right leg llexiun and extension — resistive.

5. Kneading- and beating- of right leg- and buttock.

6. Forward trunk flexion and extension — sitting —

7. Bent-knee separation and closing- — resistive,

8. Right leg- percussion.

9. Right leg torsion — resistive.

10. Breech beating.

11. "Sciatic nen-e stretching."

12. Right leg nerve compression, rolling, and fric-

In connection with this it will be of great advantage
to let the patient walk and run on tiptoe, and to go up
and down a few steps, or stairs. There should also be
taken good care that the patient always sits straight
and rests e\'enly on both buttocks.

Of the many cases of sciatica which the writer has
treated, the following one was cured in the shortest
time, considering the previous duration of the dis-
ease : —

A lady, 29 years old, suffered from sciatica for ten
months. She had been in bed most of the time, and
all kinds of treatment had been tried without any re-
lief. One, day she felt well enough to be taken in a
carriage and carried into the writer's Institute, where
the movement treatment was applied. It pained her


a great deal, but after awhile it gavel her relief, and
she returned the next day. The fifth day she walked
alone to the Institute, and after three weeks' treatment
was cured. She has not had any return of the dis-
ease since.


Diseases of the Organs of the Circulation',
chronic heart disease.

Dr. Gu.staf Zander, of the ]\Icchanico-Therapeu-
tic Institute in Stockholm, says: "In heart diseases,
movement treatment is an uninterrupted necessity, at
least during the winter. It is a pity when in such
cases the patients have no opportunity to use this treat-
ment. It is astonishing what excellent effects regular,
gentle, but many-sided muscular exercises have on dis-
eases of the heart. Some of these, when not too far
gone, can be entirely cured ; others can be stopped
from further development, and all can be relieved."

From Dr. Hartelius, the Principal of the Royal
Central G^nnnastic Institute, in Stockholm., we quo'te
the following : —

"A lady, 30 years old, with a dangerous organic
heart disease — stenosis of left osfiuiii afriozrnfricular,
zcith insufficiency of mitralis. The action of the heart
was very weak. The patient suffered with great short-
ness of breath and painful palpitations; a great deal of
subcutaneous effusion in the lower extremities and also
considerable effusion in the peritoneum. Her aspect
was cyanotical.

"Mild chest liftings and vibrations were given to
produce strong inspirations, also rotation of the arms



and legs to increase the circulation, gentle rotation and
torsio'n of the trunk to act on the portal system, and
centripetal stroking on the lower extremities tO' pro-
mote resorption of the suljcutaneous effusion. In the
beginning the movements were very mild, but gave
relief for a few hours at a time. Later the movements
were applied several times daily, and then more lasting
effects were produced. Patient received great relief,
more strength, and the effusion was lessened, but her
organic trouble could not be cured.

"Experience tells us that each difficult heart disease
must nearly always be under the influence of move-
ment treatment in order to secure permanently good

A weakened circulation is the necessary consequence
oif every heart disease, and the object of the nuassage
treatment is therefore to facilitate the work of the
heart by improving the circulation. Movements must
be given which shall diminish the pressure of the blood
and decrease the activity of the heart.

Centripetal massage and rotations further the cir-
culation, especially in the more peripheral parts of the
body; and respiratory movements do' the same in the

Inspiration acts as a pump on the circulation toward
the heart. Muscle-contractions produce aj pressure on
the walls of the blood-vessels, whereby the blood is
forced toward the heart ; hence, respiratory and circu-
latory movements are here of great value.

As before said, every pressure of a muscle causes


the blood to be squeezed out of the veins of the mus-
cles in the direction toward the heart. It should be
remembered that kneadings and strokings are suffi-
ciently strong- to press together the veins, and thus
further the flow of blood to the heart; but, on the
contrary, they do not offer any hindrance toi the free
course of the arterial blood.

It is known that the veins hold more when they are
lengthened. In rotations of a joint a frequently re-
peated elongation and shortening of tlie numerous
veins take place; each time a vein is elongated the
blood is sucked up from the peripherally situated tribu-
taries, which, in their turn, react in a circvilato^ry
furthering manner on the capillaries. On the shorten-
ing of the veins, which immediately follows, they
empty their contents in a centripetal direction. Of
special importance are the thigh rotations and arm ro-
tations, because a strong suction arises in the great
veins lying near these joints.

Trunk rotations have especial influence on the in-
ferior vena cava, but to a slight extent also^ the suj^erior
vena cava.

Respiration is to oxidize the blood, and in heart
disease the oxidization of the blood is incomplete.
Therefore, it is of the greatest importance to give fre-
quent respirator}'- movements to these patients.

But the chest also ser\'es as a blood-pump, because
deep respirations further the circulation. Inspiration
increases the negative pressure in the chest, by which a
strong attraction of blood to the heart arises in both


of the venae cavse. Further, the diaphragm., in con-
tracting during respiration, expands the inferior vena
cava and, by simultaneously exercising pressure on the
abdominal organs, presses the blood from these into
the veins.

Dr. Anders Wide says: "Since the action oif the
heart is facilitated through medical gymnastics, a dis-
eased heart should, to a certain extent, be improved by
the treatment. This ought especially to be the case in
diseases of the muscles of the heart, which latter are
strengthened by the treatment. But even in, valvular
lesions symptoms of failing compensation can be dimin-
ished by the gradually increased work given the heart.
Heart dilatation should also be diminished by facilitat-
ing the work of the heart-muscle. But even if a medi-
cal gymnastic treatment cannot free the patient from
heart disease itself, and only in few cases improve it,
still I dare assert that every patient with heart disease
will obtain relief from the troublesome symptoms of
palpitation, shortness of breath, pain and oppression
over the heart, with other symptoms that always ac-
company heart disease; and even this is much to be
thankful for. It is true that the improvement will not
be lasting in every case, l>ut that it must be often re-
peated and for long periods ; but it should also be
rememibered that the disease is chronic and that no
other treatment gives better results."

It is clear that the same kind of treatment may be
used for nearly all kinds of heart disease, because the
object in every case is to facilitate the work oi the


heart. Passive moA^ements are of the greatest impor-
tance in this treatment, but some resistive movements
are also of great value.

In arranging a treatment for heart disease, passive
movements only should be used to begin with, and
gradually, as the patient Ijecomes stronger, some few
resistive exercises may be added.

Prescription I.

1. Chest lifting and vibration.

2. Foot rotation, double.

3. Arms — centripetal stroking, kneading, and fric-

4. Legs — centripetal stroking, kneading and fric-

5. Hand and finger rotation, flexion, and extension
— passive.

6. Thigh rotation.

7. Chest percussion.

8. Loin traction.

9. Leg vibration.

10. Back percussion and friction.
This should be gradually increased to the follow-

Prescription 11.

T. Shoulder rotation and chest lifting — sitting —

2. Thigh rotation — reclining — passive.

3. Leg flexion and extension — reclining — resistive.


4. Arm nerve compression, muscle rolling, slap-
ping, and friction — sitting.

5. Forearm flexion and extension — sitting — resis-

6. Trunk torsion — sitting — resistive.

7. Chest lifting and vibration — reclining — passive.

8. Foot rotation — double — reclining — passive.

9. Leg nerv'e compression, muscle rolling, slapping,
and friction — reclining.

10. Arm rotation — single — sitting — passive.

11. Hand and finger flexion and extension — resis-

12. Trunk rotation — astride sitting — passive.

13. Chest slapping — standing.

14. Shoulder rotation and cliest lifting — sitting —

A short rest should be taken between every exercise.

The so-called "Schott" treatment by exercise is a
century old and has been used by Ling and all his fol-
lowers ever since. I myself have been using the same
method for over forty years. But the medical profes-
sion in the L'nited States did not wake up to the fact
before ''Schott" was thrown at them in medical jour-
nals. Up to twenty 3^ears ago the advice to people
with heart troubles in this counry was always "rest,"
"don't move." and so on. Now it is "exercise," "play
gO'lf" ; but that should l>e done with great care. A
course of medical gymnastics by an expert would be
better and safer.



the following moveni/ents are very useful: —

1. Forward arm rotation — sitting — passive.

2. Foot rotation, (loul)le — reclining — passive.

3. Vertical arm flexion and extension — sitting — ■

4. Leg flexion and extension — reclining — resistive.

5. Trunk rotation — astride — passive.

6. Hand and finger flexioii and extension — resis-

7. Foot flexion and extension — resistive.

8. Arm nerve compression, rolling, slapping, and

9. Leg nerve compression, rolling, slapping, and

10. Arm vibration.

11. Foot-sole slapping and friction.

12. Back percussion and friction.

Diseases of the Respiratory Organs.

Catorrli of the larynx, caforrh of the. lungs, conges-
tion of the lungs, 'emphysenia of the lungs, spasmus
hronchialis, and e\'en tuberculosis have all been treated
with success at different establishments by movements,
but each of them requires quite a special treatment by
a skillful and experienced gymnast, and therefore, only
a prescription for rrrovements to be used where there is
a disposition to a lung trouble, showing a narrow chest,


round and stooping shoulders, and lack of muscular
power, is here given : —

1. Shoulder rotation and chest lifting — sitting.

2. Foot flexion and extension — resistive.

3. Trunk torsion — sitting — resistive.

4. Forward ami rotation — sitting.

5. Leg: flexion and extension — reclining — resistive.

6. Horizontal ami separation and clo'sing — resis-

7. Neck flexion and extension — standing — resis-

8. Forward trunk flexion and extension — sitting
— resistive.

9. Lateral arm elevation and depression — sitting —

10. Chest slapping.

In connection with these exercises, or as a single
treatment, should be used

Throat massage, and

Chest and back massage,
and also freciuent breathing exercises in open air.

There is probably nothing better for lung troubles
than the methods now in use: Cleanliness, good and
wholesome food, sleep with open windows, and be out
of doors and take deep breathing exercises.


Diseases of the Organs of Digestion.

The following prescriptions are given only iur the
most frequent cases, as dyspepsia, constipatioii, and
hyperemia of the liver. The treatment in these cases
should be directed to strengthen the whole system, as
well as to act locally on the diseased organ.


If the patient is very weak it will be necessary to
give him a light treatment for the first two or three
weeks, viz. : —

1. Arm nerve compression, rolling, slapping, and

2. Legs the same.

3. Stomach vibration and friction.

4. Thigh rotation.

5. Armi vibration.

6. Chest lifting and vibration.

7. Stomach kneading (circular) and frictio'n.

8. Leg vibration.

9. Back percussion and friction.

When the patient is improved and has gained some
strength, not confined' to bed, the following should be
applied : —

I. Forward arm rotation — sitting — passive.



2. Stomach kneading, vibration, and friction.

3. Upward knee traction-^ — reclining — resistive.

4. Trunk rotation — astride sitting — passive.

5. Stomach concussion and friction — lying.

6. Leg elevation — lying — resistive.

7. Vertical arm rotation — sitting — passive.

8. Loin traction — lying.

9. Leg flexion and extension — reclining — resistive.
10. Back percussion and friction.


If the patient is in bed a local manipulation for
about five to ten minutes twice a dav will be most
effective, viz. : —

1. Stomach kneading, vibration, concussion, and
friction — five to ten minutes.

2. Breech beating.

3. Loin traction.

If the disease is of long standing it is necessary to
apply strong muscular nrovements, as: —

1. Forward trunk flexion and extension — sitting
— resistive,

2. L^pward knee traction — reclining — resistive.

3. Bowel vibration — standing — passive.

4. Trunk elevation — lying — active.

5. Trunk rotation — astride sitting — passive.

6. Stomach kneading and friction — reclining.

7. Trunk torsion — kneeling — resistive.

8. Forward arm traction — lying — resistive.

9. Loin vibration — sitting — passive.


10. Breech beating-^-standing — passive.

11. Stomach kneading, concussion, and friction.

12. Shoulder rotation and chest lifting — sitting —

In connection with this treatment, the patient should
l)e taught to take some active exercise by himself every
day, separate from the time of the massage treatment.

1. A breathing exercise.

2. Chopping movement.

3. Harvesting movement.

4. Lie on the back and raise both legs.

5. Breathing.

I ha^■e had some of my greatest success in treating
these diseases. Some years ago the German ambas-
sador at A\'ashington came to me for treatment directly
from Dr. IMezger, and he wasi so greatly pleased with
the success of my treatment that he soon brought me
a number of foreign ministers and the United States
high officials.

But of all cases one was especially remarkable. A
gentleman, abo-ut 40 years of age, came to me in Bos-
ton some years ago. He told me a pitiful story. He
had been in a good business, but commenced to drink,
as he said hiuTself, one bottle French Cognac during
the day and half a bottle at night. After a couple of
years his business was gone and he himself a wreck.
W^hen he came to me he had not been drinking for
three years, but he had stuffed his stomach with every
kind of pills and medicine to get relief for his consti-
pation. Nothing would help him any more ; he would


go two and three weeks without an operation, and he
looked worse than any man I had ever seen. After
five days' massage he had his first natural operation
for many years, and he gradually gained in health.
Four months later he was entirely changed, had
gained flesh and strength, had good appetite and daily
movements of the bowels, and he is today a prosperous
and healthy business man.


The following-cited case of this disease will be

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Online LibraryHartvig NissenPractical massage and corrective exercises → online text (page 9 of 11)