Massage (meaning to knead or manipulate) is one of the oldest
therapeutic measures employed for the relief of disease. It is probable
that the Chinese used this method of treatment several thousand
years ago. The Japanese and the Greeks and Romans also were ancient
users of massage. To-day it is recognized as one of our most useful
adjuvants in the treatment of a great many disorders. Unfortunately,
like some other therapeutic measures, it has been misused for personal
gain by unscrupulous parties to the great detriment of this form of
treatment; because of this many physicians have hesitated to adopt its
use extensively for fear of being classed with the army of quacks and
charlatans who endeavor to guile the public with a pretended knowledge
of massage. It not being possible for all nurses to become proficient
in the art of massage while doing general nursing (as it requires time,
patience, and a great deal of experience to succeed), massage has
become somewhat specialized, and we find many nurses who devote their
time and attention exclusively to this work. Yet all nurses should have
a general knowledge of the physiologic effects of massage and how to
give it. The best results are obtained only when massage is given under
the direct supervision of a physician, as massage may influence the
function of almost every organ and tissue of the body.
Some general rules may be given as to the hour and duration of each
treatment. A great deal depends upon the nature of the disorder in
each individual case. In the treatment of neurasthenic patients
where insomnia is often a troublesome symptom, massage given one or
two hours before the patient quiets down for the night frequently
results in improved sleep. Again, other patients will do better to
have the treatment one or two hours after the morning meal. Individual
peculiarities must be considered always in giving massage. The room
should be of such temperature that the patient when exposed will not
feel chilly. Absolute quiet should be maintained during the treatment,
and after the treatment the patient should remain quiet in a recumbent
posture for an hour or two as the condition may require. The oft-used
expression “that a masseur or masseuse possesses a great deal of
electricity which is transferred during the treatment to the patient,”
should find no place in the intelligent mind in considering the effects
of massage. It is true that one operator by his method of administering
massage may please a patient and accomplish more than another, but this
is due only to the fact that one understands how it should be given,
and the other does not.
All the different movements in massage may be classed under the
following: First, stroking; second, friction; third, kneading; fourth,
vibration; fifth, percussion; sixth, joint movements.
=Stroking.=—This procedure may be given with two or three fingers
or the palmar surface of one or both hands. The movement should be
gentle, and the contact made as lightly as possible. Stroking should be
done always in one direction, and, as a rule, in the direction of the
blood currents in the arteries. The physiologic effects when properly
applied should be sedative, as the purpose should be to diminish
the blood-supply to the part. It produces a certain effect upon the
cutaneous nerves which is very quieting. It is often found useful when
applied about the forehead for sleeplessness. Nervous headache may be
relieved by the same procedure. Neuralgic pains and the vague, but
nevertheless uncomfortable, sensations complained of by neurasthenic
patients are often relieved by this measure.
=Friction.=—In this procedure the whole or part of the palmar surface
of the hand is moved over the surface of the body with considerable
pressure. The principal effect of friction is upon the superficial
blood-vessels and the lymphatics. In the lower extremities the movement
should be from below upward in the direction of the venous flow. The
same may be said of the upper extremities. The thumb may be made to
follow the course of the larger veins, in this manner stimulating the
venous circulation. Some patients object to friction applied by the
dry hand, in which case some lubricant may be used; pure vaselin,
cocoa-butter, and talcum powder are among the best for this purpose.
Friction should always be used in the beginning of massage, especially
if the surface of the body is cold.
It is not the intention here to give minute instruction as to the
methods of procedure with all the different parts of the body; only
general instructions can be here given, and those requiring further
information should consult text-books upon this subject.
_Physiologic Effects of Friction._—First, reflex effects upon the
vasomotor nerves producing dilatation of the peripheral blood-vessels
with increased circulation, aiding the venous and lymphatic
circulation. It is useful in all conditions accompanied by poor
peripheral circulation. It not only stimulates the circulation, but
aids materially in elimination and increased nutrition. It aids in the
relief of general dropsy and hastens the absorption of inflammatory
exudates resulting from sprains and various joint affections, etc.
=Kneading.=—Kneading is one of the most important procedures in
massage. It consists in the alternate compression and relaxation of
the tissues, the hand not being allowed to slip over the surface as
in friction. It may be administered in various ways, such as rolling,
wringing, and the use of the palm or fingers. Furthermore, it may be
deep or superficial. Superficial kneading stimulates all the functions
of the skin, increases superficial circulation in the blood-vessels and
lymphatics. In deep kneading the object is to influence the deep-lying
muscles, and care should be exercised in this procedure not to injure
the large blood-vessels and nerves. Here a knowledge of anatomy is
essential. In the beginning of deep kneading little pressure should be
exercised until tolerance is established; then greater pressure may
be exercised without discomfort to the patient. It is quite essential
that each muscle group be gone over carefully and thoroughly, so that
every muscle so far as possible shall be included in the treatment. The
physiologic effect of deep kneading is a stimulation of the functions
of the nerves, blood-vessels, lymphatics, and cellular metabolism of
the muscles. It is of especial benefit to patients who are unable to
take a sufficient amount of active exercise, such as those suffering
from neurasthenia, rheumatism, chronic neuritis, locomotor ataxia, and
from localized disturbances, such as fractures, sprains, etc.
=Vibration.=—This procedure consists of vibratory movements to the
body of the patient through the hand of the operator. It may be
given by using the palmar surfaces of the hand or the finger-tips.
This procedure stimulates the superficial circulation and acts as
a mild general stimulant. It may be used in conditions of poor
circulation from any cause, but is contraindicated in conditions of
hypersensitiveness.
=Percussion.=—This procedure consists of blows or taps with varying
degrees of force. The tips of the fingers may be used, the two hands
alternating, or the palmar or the ulnar surface of the hands may
be used for the same purpose. In any case, the force should not be
sufficient to bruise the tissues. The physiologic results of percussion
are stimulation for functions of the skin and a marked effect upon
the underlying structures, muscles, nerves, and blood-vessels. It is
useful in such conditions as sciatica, inactivity of the liver, chronic
constipation, poor circulation from various causes, and to produce
reaction after a cold bath, etc.
=Joint Movements.=—Under this procedure we may mention flexion,
extension, abduction, adduction, pronation, supination, circumduction,
and stretching. The movements may be passive or resistive. In passive
movements the exercise is almost entirely confined to the joint, the
patient offering no muscular resistance. With the resistive movements
a certain degree of muscular activity is enforced by the patient,
thus not only exercising the joints, but the muscles connected with
the joints. The physiologic effect of joint movements is to markedly
stimulate all the parts about the joint, and is indicated in various
joint disorders which may have resulted in the lessening of the normal
movements of the part, as in rheumatism, gout, chronic synovitis, and
the stiffness that follows immobilization of the joint in the treatment
of sprains, fractures, etc. Care should be exercised in the beginning
not to use too much force in the manipulation, otherwise the existing
condition may be aggravated, and more harm result than good. Increased
force may be exercised with each treatment, always bearing in mind the
necessities of each case.