Basic techniques of classical therapeutic massage. Basic massage techniques. Massage of legs and feet

Massage is a very popular and effective method of influencing human body used since time immemorial. Each developed culture and civilization has its own unique massage technique. This method of beneficial effects can be used for different purposes: to cure diseases, to heal and strengthen the body, or just for pleasure.

To achieve a certain goal, you need appropriate techniques. The following massage techniques are distinguished: stroking, rubbing, kneading, vibration, and the first one has a calming effect, and the remaining three tone up.

Massage should be started with stroking, thanks to which, due to pleasant sensations, the muscles are relaxed. After stroking, rubbing and squeezing are performed, then kneading and vibration. Between all massage techniques, stroking is done, with which the massage procedure itself ends.

When carrying out the massage procedure, it is necessary to alternate all the techniques, without taking breaks between them, one technique should smoothly transition into another. Also, do not massage the lymph nodes.

You need to start the massage gently and gently, then gradually intensify the techniques, and at the end of the procedure, repeat the relaxing, soft techniques again. The number of repetitions of certain massage techniques depends on the individual characteristics of the patient and other specific factors (health status, age). Some massage techniques need to be repeated up to 4-5 times, while others are much less frequent.

The dosage and strength of the massage are of great importance. Irregular, hasty, unsystematic and rough movements, as well as excessive duration of the massage can even cause pain, overexcitation of the nervous system, irritation of the cerebral cortex and convulsive muscle contractions. Such massage can only do harm.

It must also be remembered that all massage movements should be directed towards the nearest lymph nodes along the lymphatic tract.

Do not start the massage suddenly and end with sudden movements. The first massage sessions should not be too intense and lengthy, the muscles need special preparation for intense exposure. The patient's muscles should be relaxed as much as possible. It is important to carefully record the emerging sensations in the patient and periodically change the force of finger pressure on the body.

Stroking

Stroking is the main method of massage: the session begins and ends with it. Stroking is also performed when switching from one reception to another. The duration of stroking is 5-10% of the entire massage session.

Stroking is carried out along the lymphatic vessels from the periphery to the center, to the regional lymph nodes.

Stroking can be done with the palmar surface of the hand, the back of the hand, and the pads of the fingers.

When stroking with the palmar surface and fingertips, the hand should be relaxed and firmly attached to the patient's skin. In this case, the I finger is taken to the side, and the rest are closed. The masseur's hand should slide over the skin without moving it. The pressure of the hand on the skin is increased from the peripheral end of the muscle to its middle and decreased, approaching the proximal end.

Stroking is carried out with one or two hands separately (the hands are moved in parallel or sequentially when they end the movement with one hand, start with the other).

Types of stroking

☀ Surface-planar stroking - a gentle technique: the massage therapist's palm slides, lightly touching the skin.

☀ Embracing stroking - not intermittent - a deep impact technique, which is carried out along the lymphatic outflow. The masseur's hands are firmly attached to the patient's skin and move slowly. The fingers penetrate into the intermuscular spaces.

☀ Comb-like stroking: fingers are folded into fists, massage is carried out with bony protrusions.

☀ Ironing is performed with the back surfaces of the middle and terminal phalanx of the fingers, bent at a right angle.

☀ Rake stroking is carried out with the ends of straightened and spaced fingers.

☀ Cross stroking with both palms. The masseur fasten his fingers in a "lock", the patient's hand rests on the masseur's shoulder or rests on the table with a brush. Cruciform massage is indicated for the arms, back, and thighs in older children and adults.

Rubbing (massaging)

Distinguish between superficial and deep rubbing. At the first dose, the massaged part of the body is rubbed with the fingertips with one or two hands with vigorous pressure. In another case, rubbing is carried out using the elevations of the thumbs, an edge or the base of the palm. Movements are made in different directions, most often spiral. Rubbing is especially often used in the area of ​​the joints.

When rubbing, the body temperature can rise by 0.5 degrees, tissue processes in the massaged parts of the body can improve and pain can decrease; it promotes the resorption of indurations, various deposits, effusions, stretching of scars during adhesions, and the elasticity of the ligamentous apparatus increases.

Rubbing technique

Circular and straight rubbing

Rubbing (massaging) with the pads of the fingers or the pad of the thumb is done most often on the joints.

To apply more force when rubbing, press with the other hand on the massaging one, the massager's movements can be rectilinear and circular, which allows the rotational way to penetrate deeper into the joint. When pressed with the pad of the thumb, the rest of the fingers of the massager serve as a support.

Rubbing with the bumps of the thumbs

Rubbing can be carried out with the tubercles of the thumbs, for which they should be pressed tightly to the joint of both sides and made movements from the bottom up. Can be rubbed with "tongs". For this, the massaged part is captured, and the movement is carried out in a zigzag manner - spiral or rectilinear. This massage technique is typical for the Achilles tendon and ankle joint.

Rubbing with the base of the palm

Rubbing with the base of the palm is carried out with firm pressure on the massaged part of the body, movements are quickly zigzagged from the bottom up - this technique is most typical for back and lumbar massage.

Rake rubbing

A rake-like rubbing is carried out with the back of the hands of the massager (with a clenched hand into a fist); movement is directed up; back, the hands come back apart, like a rake and rub the body with the pads of the fingers.

Comb-like rubbing

Comb-like rubbing (massaging) is carried out with a hand clenched into a fist. It should be rubbed with the ribs of the phalanges. This technique is most typical for the massage of the legs and outer thighs.

Kneading

Kneading is the main technique with which muscles are massaged. Under its influence, the blood supply not only to the massaged one, but also to the nearby areas, especially those located below, improves.

This is very important, for example, in cases where it is necessary to "suck" spilled blood and lymph from the injured area - increased hyperemia caused by kneading, promotes vigorous resorption of edema and hematomas. Redox processes are activated, bone nutrition is improved. This "passive gymnastics" of muscles and blood vessels stimulates the receptors of muscle tissue, tendons, ligaments, fascia, periosteum, which also affects the state of the central nervous system.

All of these changes depend on the nature of kneading (depth, strength), as well as on the functional state of the muscles and the body as a whole. If the muscles are in a state of relative rest, kneading increases their tone, if the muscles are tired - lowers them. The stimulating effect of kneading on the central nervous system, as a rule, spreads to the entire body: breathing quickens somewhat, body temperature rises, and the number of heartbeats increases.

Kneading techniques

Ordinary kneading is the simplest technique. The technique of kneading it consists, as it were, of two cycles.

The first kneading cycle: with straight fingers, without bending them in the interphalangeal joints, you need to tightly grab the muscle across so that there is no gap between the palm and the massaged area; then, bringing the fingers together (the big one tends to the other four, and these four - to the big one), raise the muscle and make a rotational movement towards the four fingers to failure.

The second kneading cycle: without unclenching the fingers (it is important not to release the muscle when it is displaced to failure), return the hand together with the muscle to its original position; at the end of this movement, the fingers release the muscle, but the palm remains firmly pressed against it. Then the brush moves forward and captures the next area. The first kneading cycle begins again, and so gradually along the entire length of the muscle. For example, 4-5 full cycles are performed on the hip. The number of complete kneading cycles depends on the length of the area being massaged.

All kneading movements should be performed without jerking, rhythmically, without causing pain to the person being massaged. Otherwise, the muscles will reflexively tense, and the massage will not give the desired effect. Ordinary kneading is used in cases where the massage should be shallow and not too strong - immediately after heavy loads, with muscle pain, after prolonged bed rest.

Vibration

When vibrating, the massaging hand or vibrating apparatus transmits vibrational movements to the body of the massaged.

Physiological influence

Variations of reception have a pronounced reflex effect, causing an increase in reflexes. Depending on the frequency and amplitude of vibration, the vessels expand or contract. Blood pressure drops significantly. The heart rate decreases, the secretory activity of individual organs changes. The terms of callus formation after fractures are significantly reduced.

Variations of vibration reception have a pronounced effect on the peripheral and central nervous system, acting as a tonic, exciting, which is used for flaccid paralysis of the most important nerve trunks, atrophy of individual muscle groups.

Basic techniques

Continuous vibration is performed with the terminal phalanx of one or more fingers, depending on the area of ​​influence, if necessary, with one or both hands, the whole palm, the base of the palm, fist (fingers clenched into a fist). This technique is used in the area of ​​the larynx, back, pelvis, on the muscles of the thigh, lower leg, shoulder, forearm, along the most important nerve trunks, at the site of the nerve exit.

Intermittent vibration (shock) consists in applying successive blows with the tips of bent fingers, the edge of the palm (elbow edge), the back surface of slightly spread fingers, a palm with bent or clenched fingers, and also a hand clenched into a fist. Movements are performed with one or two hands alternately. Apply on the upper and lower extremities, back, chest, pelvis, abdomen; fingers - on the face, head.

Technique of auxiliary techniques

Shaking is done with separate fingers or hands, movements are made in different directions and resemble, as it were, sifting flour through a sieve. It is used on spastic muscle groups, on the larynx, abdomen, and individual muscles.

Shaking - performed with both hands or one with fixation of the massaged or ankle joint. This technique is carried out only on the upper and lower extremities. In the case of its application on the upper ones, a "handshake" and shaking in the horizontal plane are performed. On the lower extremities, shaking is done in a vertical plane with fixation of the ankle joint with a straightened knee joint.

Chopping is carried out with the elbow edges of the hands, while the palms are placed at a distance of 2-4 cm between themselves. Movements are fast, rhythmic, along the muscles.

Patting - is carried out with the palmar surface of one or both hands, while the fingers are closed or bent, forming an air cushion to soften the blow to the body of the person being massaged. Apply on the chest, back, lumbar region, pelvis, upper and lower extremities.

Beating - performed with the elbow edges of one or both hands, bent into a fist, as well as the back of the hand.

It is used on the back, in the lumbar, gluteal regions, on the lower and upper limbs.

Puncture - carried out by the terminal phalanges of II-III or II-V fingers, similar to knocking out a shot on a drum. You can take one brush or two - "finger shower". It is used on the face, in places where the most important nerve trunks exit, in the abdomen, chest, back and other areas of the body.

Each of these massage techniques is characterized by certain tasks, features of technical performance and physiological effect on the massaged tissues. Therefore, the use of certain massage techniques allows for a differentiated effect on individual tissues and organs - skin, subcutaneous fat, blood vessels, nerves, internal organs.

The book is intended for both initial and advanced study of the art of massage. It describes all types of massage, the mechanisms of its action on the body, gives recommendations on the use of massage and self-massage for the most common diseases. The diagnostic signs of diseases and the principles of their treatment are considered, the ethnology and pathogenesis of diseases that the massage therapist encounters in his practice are briefly outlined.
For massage specialists, methodologists physiotherapy exercises, nurses of medical, health-improving and preventive institutions, as well as for all those interested in the use of massage and self-massage.

Massage originated in ancient times. The word "massage" comes from the Greek word meaning "knead", "knead", "stroke".
Massage as a method of treatment was used already in the third millennium BC. NS. in China, then in Japan, India, Greece, Rome. Massage records appear among the Arabs. From time immemorial it came down to us, and the description therapeutic techniques acupuncture, acupressure, pressure on certain points. Ancient monuments, such as preserved alabaster bas-reliefs, papyri depicting various massage manipulations, testify that the Assyrians, Persians, Egyptians and other peoples knew massage and self-massage well (Fig. 1).
In Europe in the Middle Ages, massage was not used due to the persecution of the Inquisition. It was only during the Renaissance that there was a renewed interest in body culture and massage.
In Russia in the 18th century. massage was promoted by M.Ya. Mudrov. In the XIX century. the development of massage was facilitated by the work of the Swedish specialist P. Ling, the creator of "Swedish massage". The great merit in the dissemination of massage belongs to I.V. Zabludovsky; the massage technique proposed by him has retained its significance today. Among the founders of medical and sports massage in our country, A.E. Shcherbak, A.F. Verbova, I.M. Sarkizova-Serazini and others.
Nowadays, massage is used in almost all medical and health institutions.

Rice. 1. Image of massage techniques on Egyptian papyrus

The method of massage and self-massage, built taking into account the clinical and physiological, and not anatomical and topographic principles, is effective remedy treatment, restoration of working capacity, relieving fatigue, and most importantly - it serves to prevent and prevent various diseases.

Massage is a set of methods of mechanical metered action in the form of friction, pressure, vibration, carried out directly on the surface of the human body, both by hands and by special devices through air, water or other medium. Massage can be general or local. Depending on the tasks, the following types of massage are distinguished: hygienic (cosmetic), therapeutic, sports, self-massage.

Hygienic massage. This type of massage is an active means of preventing diseases, maintaining efficiency. It is prescribed in the form of a general massage or massage of individual parts of the body. When performing it, various methods of manual massage, special devices are used, self-massage is used (in combination with morning exercises) in a sauna, a Russian bath, a bath, under a shower. One of the varieties of hygienic massage - cosmetic - is carried out with pathological changes in the skin of the face and as a means of preventing its aging.
Massotherapy. This type of massage is effective method treatment of various injuries and diseases. There are the following varieties:
- classic - used without taking into account the reflex effect and carried out near the damaged area of ​​the body or directly on it;
- segmental-reflex - performed for the purpose of reflex influence on the functional state internal organs and systems, fabrics; at the same time, they use special techniques, affecting certain areas - dermatomes;
- connective tissue - affect mainly the connective tissue, subcutaneous tissue; the main techniques of connective tissue massage are carried out taking into account the direction of Benninghof's lines (Fig. 2);
- periosteal - with this type of massage, by acting on the points in a certain sequence, they cause reflex changes in the periosteum;
- acupressure - a type of therapeutic massage, when they act locally in a relaxing or stimulating way on biologically active points (zones) according to the indications for a disease or dysfunction or for pain localized in a certain part of the body;
- hardware - carried out using vibration, pneumatic vibration, vacuum, ultrasonic, ionizing devices; Varieties of baro-, electrostimulation and other types of massage are also used (aeroionic, various applicators - Fig. 3);
therapeutic self-massage - used by the patient himself, can be recommended by the attending physician, nurse, massage specialist, exercise therapy. The most effective techniques are selected to influence this area of ​​the body.

Rice. 2. Location of the lines of greatest resistance to stretching of individual skin areas according to Benninghof (front and back views)

Fig. 3. Massage devices: A-general view of FEM-1: 1-vibrating platform, 2-vibration frequency regulator; b-vibrating massager electric ELVO: 1-additional handle, 2-body, 3-switch, 4-main handle, 5-bells-suction cups, 6-spherical projections, 7-spike nozzle, 8-flat nozzle

Sports massage. This type of massage was developed and systematized by prof. THEM. Sarkizov-Serazini. According to the tasks, the following varieties are distinguished: hygienic, training, preliminary and restorative.
Hygienic massage is usually done by the athlete himself simultaneously with morning exercises, warm-up.
Training massage is carried out to prepare an athlete for the highest sports achievements in a shorter time and with less psychophysical energy consumption. It is used in all periods of sports training. The training massage technique depends on the tasks, the characteristics of the sport, the nature of the load and other factors (Table 1).

Table 1

Approximate duration (min) of general training massage, depending on the athlete's body weight

Body weight, kg	General massage	Bath massage

With general training massage, the athlete is massaged in a certain sequence (Fig. 4). The duration of manual massage of individual areas and parts of the body is approximately as follows: back, neck, shoulder girdle, gluteal (lumbar) region - 8 minutes; thighs, knees, shins, ankles, feet - 16 min; shoulder, elbow joints, forearm, wrist joints, hand, fingers - 14 min; chest, abdomen - 7 min.
Preliminary massage is used to normalize the state of various organs and systems of an athlete before the upcoming physical or psychoemotional (on the front and back surfaces of the body according to digital indicators) load.

Rice. 4. The sequence of the general training massage (on the front and back surfaces of the body according to digital indicators)

Depending on the tasks, the following types of preliminary massage are distinguished:
- warm-up - before a training session or performance at a competition, when it is necessary to maintain and improve the tone of the body, taking into account the specifics of the sport;
- warming - when cooling the body or individual parts of the athlete's body, using various rubbing, ointments (finalgon, dolpik, sloans, efkamon, iicoflex, etc.);
- mobilizing - to mobilize all the resources of the athlete's body - physical, mental, technical, etc. - in combination with verbal suggestion;
- tonic (exciting, stimulating) - if necessary (depressed, inhibited state, apathy);
- sedative (sedative) - when athletes are in a state of increased excitability or pre-start fever.
Rehabilitation massage is a type of sports massage that is used after various kinds of stress (physical, mental) and at any degree of fatigue, fatigue to restore the various functions of the athlete's body as quickly as possible and increase his performance. A short-term restorative massage is carried out in a break of 1-5 minutes between rounds, during substitutions in sports games, during rest between attempts (approaches to the shells).
The main tasks of a short-term restorative massage are:
- relieve excessive neuromuscular and mental stress;
- to relax the neuromuscular apparatus and create conditions for optimal rapid recovery of the body;
- eliminate the existing pain sensations;
- to increase the general and special performance of both individual parts of the body and the whole organism.
Restorative massage in a break of 5-20 minutes is used between halves for football players, wrestlers, gymnasts, athletes. At the same time, massage techniques are performed taking into account the specifics of the sport, the time before the next load, the degree of fatigue of the body, and the mental state. The greatest effect can be obtained from a restorative massage for 5-10 minutes in combination with a contrast shower.
Restorative massage in a break from 20 minutes to 6 hours is used by divers, wrestlers, athletes and other athletes. Depending on the condition of the athlete, it is advisable to carry out it in 2 sessions: the 1st lasts 5-12 minutes, massage those muscle groups that carried the main load in this sport; 2nd - from 8 to 20 minutes, while massaging not only the muscle groups that carried the maximum load, but also the parts of the body located above and below these muscles.
In multi-day competitions, restorative massage is used in such sports as wrestling, boxing, skiing, figure skating, chess, etc., when passive rest does not relieve accumulated fatigue and does not give the desired recovery effect. This type of restorative massage is performed in sessions.
Its tasks include:
- relieve neuromuscular and mental stress;
- in an extremely short time to restore and improve the performance of the athlete;
- to help normalize night sleep. On weekends, days of rest from the competition, athletes strive to restore strength, increase efficiency, using restorative massage (1-3 sessions). After the end of the competition, the complex of medico-biological means includes varieties of restorative massage (manual, vibration, ultrasonic) in combination with a bath, hydromassage, aeroionotherapy and other types of influences.
Self-massage. In everyday conditions, it is far from always possible to use the services of a massage specialist. In such cases, you can apply self-massage. When starting to master the self-massage technique, you must observe the following:
- all movements of the massaging hand should be performed along the lymph flow to the nearest lymph nodes;
- massage the upper limbs towards the elbow and axillary lymph nodes;
- massage the lower limbs towards the popliteal and inguinal lymph nodes;
- massage the chest from the front and to the sides towards the armpits;
- massage the neck downwards towards the supraclavicular lymph nodes;
- massage the lumbar and sacral regions towards the inguinal lymph nodes;
- do not massage the lymph nodes themselves;
- strive for optimal relaxation of the muscles of the massaged areas of the body;
- hands and body must be clean;
- in some cases, self-massage can be carried out through thin cotton or woolen underwear.
It should be noted that self-massage requires significant muscle energy from the massager, creates a great load on the heart and respiratory organs, like any physical work, causing the accumulation of metabolic products in the body. In addition, when performing it, there is no freedom of movement, and individual manipulations are difficult. This limits the reflex effect of massage on the body.
Self-massage can be performed at any time of the day, in any comfortable position - at a desk, on a car seat, in the forest during a hike, on the beach, in a bathhouse, etc. Knowing the basics of point effects, you can effectively prevent various dysfunctions and diseases ...

The room for the massage should be dry, light (illumination 75-150 lux), equipped with supply and exhaust ventilation, providing 2-3 times air exchange per hour. It is advisable to have a separate massage room with an area of ​​about 18 m2. It should contain:
- stable, upholstered with leatherette, lined with foam rubber or a layer of sea grass, massage couch (if possible with three movable planes and electric heating) 1.85-2 m long, 0.5-0.6 m wide, 0.5-0 high , 7 m (Fig. 5);
- round rollers upholstered with leatherette, 0.6 m long, 0.25 m in diameter;
- table for massage, upholstered with leatherette, dimensions 0.8 x 0.6 x 0.35 m;
- a wardrobe for storing clean sheets, bathrobes, towels, soap, talcum powder, massage devices, apparatus, sollux lamps and other necessary devices used during massage;
- first aid kit, which contains: cotton wool, sterile bandages, an alcohol solution of iodine, adhesive plaster, boric petroleum jelly, disinfectant ointment, ammonia, camphor-valerian drops, ointments, rubbing, powder, elastic bandage;

Rice. 5. Types of massage couches: a - an ordinary couch; b - a couch with electric heating

Sink with hot and cold water supply. The floor in the office should be wooden, painted or covered with linoleum, the air temperature in it is from 20 to 22 ° C, the relative humidity is not higher than 60%. In the office, it is desirable to have an hourglass or procedural clock, an apparatus for measuring blood pressure, a stopwatch, a wrist dynamometer, and a tape recorder.
More detailed rules for the operation and equipment of massage rooms are set out in the Handbook on Occupational Safety of Health Workers (Moscow: Medicine, 1975).
Requirements for the massaged. Before the massage, it is advisable to take a warm shower or wipe yourself off with a damp towel, then wipe dry and expose only the necessary part of the body. Clothes should not interfere with the massage; with significant hair, you can massage through linen or apply creams, emulsions. Abrasions, scratches, scratches and other damage to the skin must be pretreated.
For greatest effect it is necessary to achieve complete relaxation of the muscles of the massaged area. This state occurs in the so-called average physiological position, when the joints of the limbs are bent at a certain angle (Fig. 6).

Rice. 6. Average physiological position of the limbs during massage

Requirements for a masseur. In the rules of behavior of a massage therapist, it is necessary to highlight 2 main aspects - psychological and technical. The psychological include attentiveness, patience, tact, friendliness, calmness, confidence in the correctness of the massage session plan, taking into account the patient's condition; to technical - the ability to do any type of massage, choose the most effective techniques, observe a rational sequence of individual main and auxiliary massage techniques, take into account the adequacy of the patient's response to the session or massage course.
The rules of the massage therapist. It is necessary to establish a relationship of trust between the specialist and the massaged person, which is achieved by his ability to establish good contact with the patient; the success of treatment often depends on this.
The work of a massage therapist is associated with great physical activity, so he must prevent the appearance of pathological changes in the cervical and lumbar spine, the occurrence of congestion in the lower extremities, which will help prevent the development of occupational diseases (periarthritis, flat feet, varicose veins, tendovaginitis, myositis, radiculitis). To do this, you need to perform special relaxation exercises, you should rest while sitting.
The masseur should know well the anatomy, the physiological effect of certain massage techniques, carry out a diagnostic palpation examination, and have a developed sense of touch.
It is necessary to comply with hygiene requirements, cut nails short, when oily skin hands to use nourishing creams "Tomato", "Victoria", for dry skin (peeling), use creams "Velor", "Peach", "Morning", "Nectar". Hands should be washed with water at a temperature of 18-20 ° C. If the skin of the hands becomes dry from frequent washing, use the soaps "Cosmetic", "Spermacetic", "Glycerin", "Vaseline", "Amber". Clothing should be loose, no items that can injure the patient's skin should be worn on hands, and shoes are best worn with low heels. Try to choose the most comfortable working position, maintain the correct breathing rhythm, work with both hands, involving only those muscles that perform this massage technique.
After clarifying the patient's complaints and determining the state of his tissues, together with the doctor, it is necessary to determine the massage technique, taking into account the clinical forms of the lesion, the characteristics of the main and concomitant diseases. If the massage therapist, during the course of massage, considers it necessary to make any adjustments to its implementation, which may be caused by the emergence of negative reactions of the patient to certain manipulations or the emergence of new clinical signs diseases, it is necessary to consult with your doctor.

Rice. 7. Poses of the patient during the massage: a-lying on his stomach; b - lying on your back; in-lying on its side; g-sitting

There should be absolute silence in the massage room, and only at the request of the person being massaged, you can turn on music or conduct a conversation, taking into account his condition, without causing negative emotions, without getting tired and listening to all the responses of the patient's body to various manipulations. The patient can be in a sitting position, lying on his back, stomach, side, sometimes standing (Fig. 7).
During the massage, the patient completely relaxes the muscles, the masseur provides himself with firm support, both are in a comfortable position.

Massage can be done directly in the affected area or above it in case of edema, sharp pains, as well as symmetrically to the lesion focus, when direct manipulations in this area are impossible (plaster cast, fixing bandage, violation of the integrity skin).
The massage procedure, as well as self-massage, consists of three stages: 1) introductory - within 1-3 minutes, with gentle techniques, the patient is prepared for the main part of the procedure; 2) the main one - for 5-20 minutes or more, a differentiated targeted massage is applied, corresponding to the clinical and physiological characteristics of the disease; 3) final - within 1-3 minutes, the intensity of the special effect is reduced, while all body functions are normalized, breathing exercises, passive movements are carried out, if necessary (in the treatment of neuritis of the facial nerve, the presence of a plaster cast) ideomotor movements are used with the sending of volitional impulses , articular gymnastics (Fig. 8).
The massage should not increase the pain. After it, you need to expect a feeling of warmth, comfort, relaxation in the massaged area, an improvement in general well-being, an increase in joint mobility, drowsiness, and easier and more free breathing. The duration of the session, depending on the indications, can be from 3 to 60 minutes. Massage is prescribed daily or every other day, depending on the age and condition of the patient, as well as the area of ​​the body. According to indications, massage is carried out 2-3 times a week, combined with baths, ultraviolet radiation and other types of complex treatment.
The massage course includes from 5 to 25 procedures, depending on the severity of the disease and the patient's condition. Breaks between courses can last from 10 days to 2-3 months, in each case it is decided individually. The number of procedures after the break, depending on the patient's condition, can be reduced or increased.
The massage course is conventionally divided into 3 periods: 1) introductory - 1-3 procedures necessary to find out the body's response to massage (pain reduction, drowsiness, ease and freedom of movement); in this period, they find out the tolerance of individual massage manipulations, strive to affect the entire body as a whole, without highlighting reflex areas; 2) the main one - starting from the 3-4th procedure and up to the 20-23rd procedure, a strictly differentiated massage technique is used, taking into account the clinical picture, the physiological state of the patient and the characteristics of his disease, while paying attention to functional changes in the massaged areas of the body; in this period, gradually from procedure to procedure, the intensity of exposure is increased; 3) final - consists of 1-2 procedures; if necessary, you can teach the patient self-massage, showing a rational complex and a sequence of techniques for individual areas of the body, performing breathing exercises, as well as recommend physical exercises for self-study with the use of massagers, massage machines and balneological procedures.

Rice. 8. The sequence of the general classic massage session: a - behind, b - in front; 1 - back, 2 - neck, 3 - pelvis, 4, 6 - foot, lower leg (along the back surface), 5, 7 - thigh (along the back surface), 8, 11 - foot, lower leg (along the front surface), 9 , 12 - thigh (on the front surface), 10 - left hand, 13 - right hand, 14 - rib cage in front, 15 - belly. The patient lies first on his stomach, then on his back indicates the location of the masseur during the massage

Massage and self-massage are shown to everyone healthy people, they are also used for various diseases. Massage and self-massage can be used alone or in combination with other treatments. The indications for the appointment of massage in different periods of a disease or a person's condition are wide. Here are general indications. In the relevant sections, a complete description of the types of massage for various diseases is given.

Diseases of the cardiovascular system, ischemic disease heart, myocardial infarction, including after their surgical treatment, postinfarction cardiosclerosis, hypertension and arterial hypotension, functional neurogenic disorders of the cardiovascular system, myocardial dystrophy, infectious-allergic myocarditis, heart defects, diseases of arteries and veins.
Respiratory diseases: tonsillitis, pharyngitis, laryngitis, vasomotor and allergic rhinitis, chronic non-specific lung diseases, chronic pneumonia and bronchitis, pulmonary emphysema, pneumosclerosis, bronchial asthma without an exacerbation, pleurisy.
Injuries, diseases of the musculoskeletal system: rheumatoid arthritis and other injuries of the ligamentous apparatus of the joint, dislocations, tendonitis, tendova-ginitis, paratenonitis, periostitis, dystrophic processes in the joints, ankylosing spondylitis, osteochondrosis of various parts of the spine, contusions, sprains spine, flat feet, poor posture.
Diseases and injuries of the nervous system: traumas of the nervous system, consequences of cerebrovascular accident, residual effects of poliomyelitis with spastic and flaccid paralysis, cerebral atherosclerosis with chronic cerebrovascular insufficiency, cerebral palsy, neuralgia, neuritis, plexitis, radiculitis in degenerative disc disease parkinsonism, diencephalic syndromes, solaritis, polyneuritis.
Diseases of the digestive system outside the exacerbation phase: colitis, intestinal dyskinesia, gastritis, gastric emptying (gastroptosis), peptic ulcer (without a tendency to bleed), liver and gallbladder diseases (gallbladder dyskinesia), as well as conditions after cholecystectomy and operations for peptic ulcer diseases of the stomach and duodenum.
Inflammatory diseases of male and female genital organs in the subacute and chronic stages: chronic urethritis, prostatitis, vesiculitis, abnormal positions and displacements of the uterus and vagina, anatomical inferiority of the uterus (congenital and acquired), its functional inferiority, anatomical and functional insufficiency of the ligamentous apparatus of the pelvic floor, as well as pain in the sacrum, coccyx, uterus and ovaries during the intermenstrual period.
Skin diseases: seborrhea of ​​the scalp, acne of the face and trunk, psoriasis, lichen planus, scleroderma, ichthyosis, hair loss, neurodermatitis.
Diseases of the ear, throat, nose: tonsillitis, pharyngitis, laryngitis, rhinitis, nosebleeds.
Eye diseases: glaucoma, keratitis, conjunctivitis, optic neuritis.
Metabolic disorders: excessive obesity, diabetes, gout.
Massage is also used for headaches and sleep disturbances, sexual weakness, dental disease and increased irritability. Massage and self-massage is widely indicated for various ailments.

Massage and self-massage are contraindicated in acute febrile conditions, acute inflammatory processes, bleeding and inclination to them, with blood diseases, purulent processes of any localization, various skin diseases (infectious, fungal etiology), gangrene, acute inflammation, thrombosis, significant varicose veins, trophic ulcers, peripheral vascular atherosclerosis, thrombocyte in combination with cerebral atherosclerosis, vascular aneurysms, thrombophlebitis, inflammation of the lymph nodes, active form tuberculosis, syphilis, chronic osteomyelitis, benign and malignant tumors different localization (before surgical treatment).
Contraindications to the appointment of massage are also unbearable pain after trauma (causalgic syndrome), mental illness, III degree circulatory failure, hypertensive and hypotensive crises, nausea, vomiting, pain of an unexplained nature on palpation of the abdomen, bronchiectasis, pulmonary, heart, renal, liver failure. It should be emphasized that in a number of cases contraindications to the appointment of massage and self-massage are temporary in nature and take place in the acute period of the disease or with an exacerbation of a chronic disease.
Questions related to the appointment of massage require adherence to medical ethics, tact. When prescribing a massage, the doctor indicates in what combination with other procedures its varieties should be used, constantly monitors the patient, and the massage therapist must inform the doctor about all deviations. This approach to the use of massage makes this method the most effective in treating various diseases and injuries.

The classical massage technique is described in various massage and self-massage guides. Many authors noted the need to preserve the already established massage techniques, warning against the unreasonable desire of some specialists to complicate the manipulation technique. It is not the invention of new manipulations that is important, but the development of private techniques based on long-standing methods of classical massage, used differentiation in accordance with the indications and taking into account the nature of the disease at this stage of treatment.
In practice, there are 9 main massage techniques (stroking, squeezing, kneading, shaking, rubbing, active and passive movements, movements with resistance, percussion techniques, shaking), offering to strictly observe their sequence during the massage session. Other experts consider it advisable to single out 4 main methods (stroking, rubbing, kneading, vibration), applying their differentiation taking into account the clinical picture of the disease or the general condition of the patient.
Massage techniques are sometimes divided according to their physiological effect: on the skin (stroking, rubbing, percussion techniques), on muscles (squeezing, kneading, felting, shaking, shaking, percussion techniques, movements), on joints, ligaments, tendons (movements, rubbing) ... At the same time, AF Verbov, instead of the concept of "shaking", introduced the term "vibration", with which he combined all the techniques (tapping, shaking, chopping, shaking, shaking, patting).
Most authors believe that stroking, rubbing, kneading, vibration and passive movements should be attributed to the main methods of manual massage. When describing the technique of massage manipulations, some names of the techniques make it possible to more accurately and more easily understand their effect on the person being massaged. But before studying the technique of performing massage techniques, it is necessary to determine the main "tool" of exposure - the massage therapist's brush (Fig. 9). There are 2 main areas on the palmar surface of the hand: the base of the palm and the palmar surface of the fingers.

Rice. 9. Palmar (a) and dorsal (b) surfaces of the hand: 1- elevation of the V finger; 2 - terminal phalanges of the fingers; 3 - elevation of the first finger; 4 - the base of the palm; 5 - radial edge of the hand; 6 - ulnar edge of the hand

Each finger (except for I) has 3 phalanges: terminal (nail), middle and main. On the palmar surface there are elevations of the I and V fingers.
In addition, in practice, the terms "ulnar and radial edges of the hand", "distal, middle and proximal phalanges of the fingers" are used.
When performing certain massage techniques, the specialist uses not only the palmar, but also the back surface of the hand, acting either with fingers bent at a right angle, then with the entire back surface of the hand or the protrusions of the fingers bent into a fist - with ridges.
Below are the main and auxiliary types of individual massage techniques.

Stroking is a manipulation in which the massaging hand slides over the skin without moving it into folds, with varying degrees of pressure. There are the following types of "stroking" technique.

Physiological influence. When stroking, the skin is cleared of horny scales, residual secretions of sweat and sebaceous glands, skin respiration improves, and the secretory function of the skin is activated. Skin trophism changes significantly - metabolic processes are enhanced, musculocutaneous tone increases, the skin becomes smooth, elastic, elastic, microcirculation increases due to the opening of reserve capillaries (hyperemia). Stroking has a significant effect on blood vessels, toning and training them. Stroking facilitates the outflow of blood and lymph, which helps to reduce swelling. This technique also helps to quickly remove metabolic products and decay.
Depending on the method of using the technique and its dosage, stroking can have a calming or stimulating effect on the nervous system. For example, shallow, planar stroking is soothing, while deep and intermittent strokes are arousing.
By stroking in the area of ​​reflexogenic zones (cervico-occipital, upper thoracic, epigastric), it is possible to exert a reflex therapeutic effect on the pathologically altered activity of various tissues and internal organs. Stroking has an analgesic and absorbing effect.
Technique of basic techniques. When stroking flat, the brush without tension with straightened and closed fingers, located in the same plane, makes movements in different directions (longitudinally, transversely, circularly, spiraling, both with one hand and with two).
This technique is used to massage the back, abdomen, chest, extremities, face and neck (Fig. 10).

Rice. 10. Plane stroking

Plane deep stroking is performed with the burden of one palm with the other, with varying degrees of pressure; movements go to the nearest lymph nodes. It is used to massage the pelvic area, back, chest, extremities, abdomen.
Enveloping stroking - the hand and fingers take the form of a groove: the 1st finger is maximally retracted and opposed to the rest of the closed fingers (II-V). The brush grasps the massaged surface, can move both continuously and intermittently, depending on the tasks assigned to the massage therapist. It is used on the limbs, lateral surfaces of the trunk, gluteal region, on the neck. And necessarily in the direction to the nearest lymph node, it is possible with a burden for a deeper impact (Fig. 11).

Rice. 11. Grasping stroking to the nearest lymph node: a, b, c, d, e, f - the sequence of the technique

Auxiliary stroking techniques. Pincer-shaped - performed with pincer-like folded fingers, usually I-II-III or only I-II fingers, when massaging fingers, feet, tendons, small muscle groups, face, ears, nose (Fig. 12).
Rake-like - carried out with rake-like fingers of one or both brushes, it is possible with weights, brush at an angle to the massaged surface from 30 to 45 °. It is used in the area of ​​the scalp, intercostal spaces, on areas of the body when it is necessary to bypass places with skin damage (Fig. 13).
Comb-like - performed by the bony protrusions of the main phalanges of the fingers of one or two hands bent into a fist. It is done on large muscle groups in the back, pelvis, on the plantar surface of the foot, on the palmar surface of the hand and where the tendon sheaths are covered with dense aponeurosis.
Ironing is carried out with the back surfaces of the fingers bent at right angles in the metacarpophalangeal joints of the fingers of the hand, with one or two hands. Used on the back, face, abdomen, sole, sometimes with weights (fig. 14).

General guidelines

1. Stroking is performed with well relaxed muscles, a comfortable posture of the person being massaged.
2. Reception is carried out both independently and in combination with other techniques.
3. With stroking most often begin the massage procedure, then use it in the massage process and finish it.
4. First, a superficial stroking is applied, then a deeper one.
5. Plane surface stroking can be carried out both along the lymph flow, and against it, and all other types of stroking - only along the lymph flow to the nearest lymph nodes.
6. Stroking is done slowly (24-26 movements per 1 min), smoothly, rhythmically, with varying degrees of pressure on the massaged surface.
7. In case of impaired blood circulation (swelling, edema), all stroking should be carried out according to the suction technique, that is, start from the areas located above, for example, in the pathological process in the ankle joint - from the thigh, then massage the lower leg and only then the ankle joint, all movements - towards the inguinal lymph node.
8. During a massage session, it is not necessary to apply all types of basic and auxiliary stroking techniques; you should choose the most effective for a given area.
9. On the flexion surface of the limbs, massage is done deeper.

Most common mistakes

1. Strong pressure when performing a technique, causing an unpleasant sensation or even pain in the patient.
2. Fingers are spread, their loose fit to the massaged surface during planar stroking leads to uneven effects and unpleasant sensations.
3. A very fast pace and abrupt execution of the technique, displacement of the skin instead of sliding over it.
4. When performing a variety of techniques, instead of sliding on the surface of the skin with varying degrees of pressure, it is displaced in different directions, which causes a violation of the hairline, up to the appearance of irritation.

Rubbing is a manipulation in which the massaging hand never slides over the skin, but displaces it, making a shift, stretching in different directions. There are the following types of "rubbing" technique.

Physiological influence. Rubbing acts much more vigorously than stroking, helps to increase the mobility of the massaged tissues in relation to the underlying layers. At the same time, the flow of lymph and blood to the massaged tissues increases, which significantly improves their nutrition and metabolic processes, and hyperemia appears. Reception promotes loosening, crushing of pathological formations in various layers of tissues, increases the contractile function of muscles, improves their elasticity, mobility, and therefore rubbing is often carried out on the joints. Vigorous rubbing along the most important nerve trunks and in the place of nerve endings on the surface of the body causes a decrease in nervous excitability.
When massaging healthy or diseased joints, variations of the "rubbing" technique help to increase or decrease mobility in the joint, help reduce hemarthrosis, swelling, rashes and soreness in the joint area.
Technique of basic techniques. Rectilinear - performed with the terminal phalanges of one or more fingers. It is used for massage of small muscle groups in the area of ​​joints, hand, foot, the most important nerve trunks, face (Fig. 15).

Rice. 15. Rectilinear rubbing with fingertips: a, b, c - the sequence of the technique

Circular - carried out with a circular displacement of the skin by the terminal phalanges with support on the 1st finger or on the base of the palm; it is possible with the back of bent fingers or with separate fingers, for example I. Rubbing with weights - one or two hands alternately. It is used on the back, chest, abdomen, limbs - practically on all areas of the body (Fig. 16, 17).

Spiral - carried out with the base of the palm or the ulnar edge of the hand, bent into a fist; one or both hands are involved alternately and, depending on the area being massaged, can be used with the burden of one hand with the other. It is used on the back, abdomen, chest, pelvis, limbs (Fig. 18).
Auxiliary techniques. Hatching is performed with the pads of the terminal phalanges of the II-III or II-V fingers, which are straightened, maximally unbent and are at an angle of 30 ° to the massaged surface. Pressing with short translational movements, the underlying tissues are displaced, moving in a given direction both longitudinally and transversely. It is used in the area of ​​skin scars, with atrophy of certain muscle groups, skin diseases, flaccid paralysis (Fig. 19).

Rice. 18. Spiral rubbing with the base of the palms

Planing - done with one or two hands. The brushes are set one after the other and with forward movements resembling planing, they are immersed in the tissue with the fingertips, making them stretch, displacement. It is used on extensive scars and for skin diseases (psoriasis, eczema), where it is required to exclude the effect on the affected areas, with atrophy of individual muscles and muscle groups (atrophy of the quadriceps femoris muscle, with arthrosis of the knee joint) for the purpose of stimulation (Fig. 20).

Rice. 19. Shading	Rice. 20. Planing

Sawing - done with the elbow edge of the hand or both. When sawing with both hands, the hands should be set so that the palmar surfaces are facing each other and are at a distance of 1-3 cm; sawing should be done in opposite directions. A roller of massaged tissue should form between the brushes. If the massage is performed with the radial edges of the hand, then this is called crossing. Both techniques are used in the area of ​​large joints, back, abdomen, thigh, cervical spine (Fig. 21, 22).
Gable-shaped - is done by the terminal phalanges of the I-II or I-III fingers; movements can be straight or circular. It is used for massage of tendons, small muscle groups, auricle, nose, face, for local exposure, for massage of teeth.
Methodical instructions
1. Rubbing is a preparatory technique for kneading.
2. When rubbing on the face, it is necessary to use a step.
3. To enhance the effect of the technique, you should increase the angle between the masseur's fingers and the massaged surface or use a technique with weights.
4. Movement when rubbing is carried out in any direction, regardless of the direction of the lymph flow.
5. Without the need, when rubbing, do not linger in one area for more than 8-10 s.
6. Take into account the condition of the patient's skin, his age and responses to the techniques performed.
7. Reception of rubbing alternate with stroking techniques, etc., performing 60-100 movements in 1 min.

1. Rough, painful performance of the technique.
2. Rubbing movements with sliding on the skin, and not with it.
3. Rubbing with straight fingers, not bent at the interphalangeal joints. It is painful for the patient and exhausting for the massage therapist.
4. Performing the main types of reception, do not simultaneous phases with two hands (like swimming instead of crawl style with breaststroke style), but alternately.
5. Reception is performed in an unsupported position of the hand (on the base of it or on the 1st finger, during massage with bent fingers), which significantly increases the energy consumption of the massage specialist, causing excessive muscle strain, a feeling of pain, fatigue, myositis.

Kneading is a technique in which the massaging hand performs 2-3 phases: 1) fixation, capture of the massaged area; 2) squeezing, squeezing; 3) rolling, crushing, kneading itself. The following types of "kneading" techniques are distinguished.

Physiological influence. Kneading has the main effect on the patient's muscles, due to which their contractile function increases, the elasticity of the ligamentous apparatus increases, shortened fascia and aponeuroses are stretched. Kneading helps to increase blood and lymph circulation; at the same time, tissue nutrition is significantly improved, metabolism increases, muscle fatigue decreases or completely eliminates, muscle performance, their tone and contractile function increase. Depending on the pace, strength, duration of the performance of the types of reception, the excitability of the cerebral cortex and the tone of the massaged muscles decrease or increase. It should be noted that kneading is a technique by which one can judge the technical abilities of a masseur. Kneading is a passive exercise for muscles.
Technique of basic techniques. Longitudinal - carried out along the muscle fibers, along the muscle axis. Straightened fingers are positioned on the massaged surface so that the first fingers of both hands are on the front surface of the massaged segment, and the remaining fingers (II-V) are located on the sides of the massaged segment - this is the 1st phase (fixation). Then the brushes alternately perform the remaining 2 phases, moving along the massaged area .. It is used on the limbs, in the pelvis, back, lateral surfaces of the neck (Fig. 23, 24).

Rice. 23. Longitudinal kneading of the shoulder muscles.	Rice. 24. Longitudinal kneading of the thigh muscles.
	Rice. 25. Cross kneading with one hand: a-phase of fixation; b-phase of compression; c-crushing (rolling)
	Rice. 26. Cross kneading with two hands (unidirectional)
Rice. 27. Cross kneading with two hands (multidirectional)	Rice. 28. Cross kneading with one hand (with weights)

Transverse - the masseur sets the hands across the muscle fibers so that the first fingers are on one side of the massaged area, and the rest are on the other. When massaging with two hands, it is more effective to set the hands apart from each other at a distance equal to the width of the palm, and then simultaneously or alternately perform all 3 phases. If alternately, then one hand displaces the muscles, performing the 3rd phase away from itself, and the other at the same time performs the 3rd phase towards itself, that is, in different directions. You can do it alone with weights. Apply on the back, pelvic area, cervical spine, limbs and other areas (Fig. 25-28).

Technique of auxiliary techniques. Felting - performed more often on the limbs. The masseur's hands with palmar surfaces wrap the massaged area on both sides, the fingers are straightened, the hands are parallel to each other, the movements are made in opposite directions with movement along the massaged area. It is used on the thigh, lower leg, forearm, shoulder (Fig. 29).

	Rice. 29. Felting: a - initial phase; b - final phase
	Rice. 30. Rolling
Rice. 31. Shifting, stretching	Rice. 32. Pressure

Rolling - by capturing or fixing the massaged area with one brush, rolling movements are carried out with the other, moving the nearby tissues onto the fixing brush; and so they move along the massaged area. The rolling motion can be performed on individual fingers, fist. It is used on the abdomen, chest, and lateral surfaces of the back (Fig. 30).
Shifting - after fixing the massaged surface, they make short, rhythmic movements, shifting the tissues towards each other. Opposite movements are called stretching. They are used for scars on tissues, for the treatment of skin diseases (psoriasis, etc.), for adhesions, paresis, on the face and in other areas. It is often performed with two hands, two fingers, or several fingers (Fig. 31).
Pressing - carried out with a finger or fist, the base of the palm, it is possible with weights. It is used in the back, along the paravertebral line, in the buttocks, at the ends of individual nerve trunks (in the area of ​​the BAP) (Fig. 32).
Pincer-shaped - carried out with I-II or I-III fingers (tingling on the face), grabbing, pulling, kneading local areas, using 2-3 phases of reception. It is used on the face, neck, at the locations of the most important nerve trunks, in the back, chest.

Methodical instructions
1. Muscles should be as relaxed as possible with comfortable and good fixation.
2. Lead the massage slowly, smoothly, without jerking, up to 50-60 movements per minute.
3. Movements should be carried out both in ascending and descending directions, centrifugal and centripetal, without jumping from one area to another, taking into account the nature of the pathological process.
4. Increase the intensity of massage gradually from procedure to procedure, so that there is no adaptation (addiction).
5. Reception to start from the place of transition of the muscle into the tendon and place the hand on the massaged surface, taking into account its configuration.
Most common mistakes
1. Flexion of the fingers in the interphalangeal joints in the 1st phase (fixation). In this case, the masseur begins to "pinch" the patient.
2. Sliding fingers on the skin in the 2nd phase (compression), which is very painful and unpleasant, moreover, the massage therapist loses muscle; a gap is formed between the massaged surface and the brush and full kneading does not work.
3. Strong pressure with the terminal phalanges of the fingers, which causes soreness.
4. Massage with tense hand and fingers, which tires the masseur.
5. Insufficient displacement of muscles in the 3rd phase (crushing), which leads to a sharp implementation of the technique.
6. Simultaneous work of hands during longitudinal kneading; the masseur, as it were, tears the muscles in different directions, which is very painful, especially for the elderly.

When vibrating, the massaging hand or vibrating apparatus transmits vibrational movements to the body of the massaged. There are the following types of "vibration" reception:

Physiological influence. Variations of reception have a pronounced reflex effect, causing an increase in reflexes. Depending on the frequency and amplitude of vibration, the vessels expand or contract. Blood pressure drops significantly. The heart rate decreases, the secretory activity of individual organs changes. The terms of callus formation after fractures are significantly reduced. Variations of vibration reception have a pronounced effect on the peripheral and central nervous system, acting as a tonic, exciting, which is used for flaccid paralysis of the most important nerve trunks, atrophy of individual muscle groups.
Technique of basic techniques. Continuous vibration is performed with the terminal phalanx of one or more fingers, depending on the area of ​​influence, if necessary, with one or both hands, the whole palm, the base of the palm, fist (fingers clenched into a fist). This technique is used in the area of ​​the larynx, back, pelvis, on the muscles of the thigh, lower leg, shoulder, forearm, along the most important nerve trunks, at the site of the exit of the nerve, BAP, BAZ (Fig. 33, 34).
Intermittent vibration (shock) consists in applying successive blows with the tips of bent fingers, the edge of the palm (elbow edge), the back surface of slightly spread fingers, a palm with bent or clenched fingers, and also a hand clenched into a fist. Movements are performed with one or two hands alternately (Fig. 35). Apply on the upper and lower extremities, back, chest, pelvis, abdomen; fingers - on the face, head.
Technique of auxiliary techniques. Shaking is done with separate fingers or hands, movements are made in different directions and resemble, as it were, sifting flour through a sieve (Fig. 36). It is used on spastic muscle groups, on the larynx, abdomen, and individual muscles.

Rice. 33. Continuous vibration (stable)

Rice. 34. Continuous vibration (labile)

Shaking - performed with both hands or one with fixation of the massaged or ankle joint. This technique is carried out only on the upper and lower extremities. In the case of its application on the upper ones, a "handshake" and shaking in the horizontal plane are performed.
On the lower extremities, shaking is done in a vertical plane with fixation of the ankle joint with a straightened knee joint (Fig. 37).
Chopped - carried out by the elbow edges of the brushes, while the palms are placed at a distance of 2-4 cm between themselves. The movements are fast, rhythmic, along the muscles (Fig. 38).
Patting is carried out with the palmar surface of one or both hands, while fingers are closed or bent, forming an air cushion to soften the blow to the body of the massaged person (Fig. 39). Apply on the chest, back, lumbar region, pelvis, upper and lower extremities.
Beating - performed with the elbow edges of one or both hands, bent into a fist, as well as the back of the hand. It is applied on the back, in the lumbar, gluteal regions, on the lower and upper extremities (Fig. 40).
Puncture - carried out by the terminal phalanges of II-III or II-V fingers, similar to knocking out a shot on a drum. You can take one brush or two - "finger shower". It is used on the face, in places where the most important nerve trunks exit, in the abdomen, chest, back and other areas of the body, as well as in BAP, BAZ.

Methodical instructions
1. Reception should not cause painful sensations in the person being massaged.
2. The strength and intensity of the impact depend on the angle between the massaging brush and the body - the closer it is to 90 °, the stronger the impact.
3 The duration of percussion techniques in one area is no more than 10 s; it should be combined with other techniques.
4. Prolonged small, with a small amplitude of vibration cause the massaged person to calm down, relaxation, and short, intermittent, with a large amplitude - the opposite state.
5 Do not apply on the inner thighs, in the popliteal region, in places of projection of internal organs (kidneys, heart), intermittent vibrations (tapping, chopping), especially in elderly and senile people.
6. Vibration is a tedious trick for the massage therapist, so hardware vibration should be used if possible.
Most common mistakes
1. Intermittent vibration (chopping, tapping, tapping) on ​​tense muscle groups, which causes pain in the patient.
2. During the massage with two hands, the "weakest" hand gets tired; with intermittent vibration, shocks are applied simultaneously, and not alternately, which is painful.
3. When performing a shaking technique on the lower or upper extremities, the direction of movement is not taken into account and when the leg is bent at the knee joint, the ligamentous apparatus of the knee joint can be disrupted, and movements in the upper extremities not in the horizontal plane lead to injuries and pain in the elbow joint.
4. Massage with great intensity, which causes resistance from the patient.
5. Variety of percussion techniques are performed due to movements in the elbow and even shoulder joints.
6. When using a concussion in certain areas of the body, the movement is performed not across the muscle fibers, but in other physiologically unjustified directions.

Movement is elementary motor acts characteristic of a particular joint, depending on its physiological mobility. Based on the number of articular surfaces involved in the formation of joints, they are divided into simple (two articular surfaces) and complex (more than two), as well as complex (there is a disc, meniscus between the articulating surfaces) and combined (several joints function together independently). The range of motion in the joint depends on its structure and the difference in the angular dimensions of the articular surfaces: around the frontal axis - flexion and extension; sagittal - adduction and abduction; longitudinal - rotation; for combined movement around all axes - circular movement. There are the following types of movement reception.

Physiological influence. All movements have a beneficial effect on musculoskeletal system person. The movements performed at a slow pace have a calming effect on the central nervous system. Movement - best remedy in the treatment of hypodynamia, under their influence, the trophism of the internal organs improves, the metabolism, the intensity of digestion increase, the protective properties and resistance of the body as a whole increase. Movement is of great importance for stiffness (contractures, ankylosis), wrinkling and shortening of the ligamentous apparatus, as well as for microtrauma, hemarthrosis.
Technique of basic techniques. Active movements are performed by the patient himself in a dose determined by a masseur or exercise therapy specialist. Variants of active movements are widely presented in the relevant literature on exercise therapy and in other sources that recommend active movements for the treatment of a particular pathology.
Passive movements are performed by a specialist without the participation of the massaged one. The patient's posture is lying on your back. The following rules must be observed:
a) the masseur stands on the side of the sore joint;
b) with the same hand (the right hand fixes the right arm or leg of the person being massaged), perform all the necessary movements in this joint;
c) the other hand of the masseur fixes, presses, presses on the most effective point when developing this joint (shoulder - jian-yu; elbow - qu-chi; wrist, flexion-extension - da-ling + yang-chi, circular motion - nei -gu-an + wai-guan, abduction-adduction - yang-gu + yang-si; movements in the interphalangeal joints of the hand - he-gu + lao-gong + e-men, shi-xuan for the fingers of the hand; hip - huan- tiao; knee - yang-ling-chuan; ankle - tsie-si + kun-lun, in the interphalangeal joints of the foot - yun-tsktan);
d) before performing passive movement, you need to ask the patient to show active movement in the joint and in the first procedures not to go beyond the limits of possible movement, and then gradually increase the amplitude of the impact;
e) at the moment of restoration of the missing volume of motion in this joint, increase the pressure on the pressed point up to 5-10 kg; when performing the technique, the pressed point should be constantly fixed with the opposite hand;
f) increase the dosage, the number of times and the amplitude of the impact gradually from procedure to procedure.

Methodical instructions

Varieties of passive movements can be performed if it is necessary for the patient to lie on his stomach. Passive movements include traction, stretching, stretching, stretching, posture treatment.
Technique of auxiliary techniques. Movements with resistance. The massaged person resists when performing a movement in a particular joint, or, conversely, the patient performs an active movement, and the masseur gradually, with concession, helps to perform this movement in the joint.
Isometric movements are based on the fact that the massaged person fixes the corresponding angle of mobility in a certain joint for 5-10 s, repeating the movement several times. In this case, the angle of development of joint mobility gradually increases or decreases, depending on the tasks.
Idiomotor movements consist in the fact that the massaged person sends impulses to a separate muscle group or joint to simulate movement; These "movements are performed with plaster immobilization or skeletal traction. Athletes use such movements in conjunction with auto-training.
Articulatory movements are often performed with damage to the facial nerve, neuritis, neuralgia, to improve diction, pronunciation individual words and combinations for stuttering, etc. Voiced consonants or hissing letters are pronounced in a certain sequence (as in patients who have suffered a stroke).
Mimic movements are mainly used for asymmetry of the muscles of the face and neck. They use various forms of imitative grimaces. Most often, movements are performed in front of a mirror. The dosage and recommendations for the implementation of the above movements are set out in the relevant sources [Syromyatnikova IS, 1991, etc.].

It takes a lot of time to master the art of massage. Indeed, in addition to knowing the techniques and techniques, you need to study the structure of the body. Know where the lymph nodes are located, and how the blood moves through the body. Understand the location of energy centers and important biological points. In general, you need to thoroughly study the theory of classical massage. But for the first steps, as well as for home use, it is important to know at least the sequence of techniques and their meaning.

Principles of classical massage

For any of the schools of European massage has its own fundamental principles

The basics of classical massage are unchanged in any of the practice systems that branch off from the European school. They are based on the main techniques: stroking, rubbing, kneading and vibration. Swedish, Russian, Finnish systems are considered independent streams of European massage. But basically they have exactly these actions. The difference in these systems is only in the degree of impact, duration and intensity of therapy. There are basic provisions that are shown to be observed for the massage of any of the classical schools. Massage tips:

• The movements of half of the techniques are performed in the direction of the lymph to the lymph nodes. Exceptions are: vibration, tapping and rubbing
• Hands are massaged towards the elbow and axillary lymph nodes.
• Legs should be massaged towards the groin and knee hollows.
• From the front, massage is carried out "to the sides" along the intercostal lines and towards the axillary lymph nodes.
• The neck is massaged down towards the collarbones.
• The abdomen is massaged clockwise.
• The loin is massaged to the inguinal lymph nodes.
• Lymph nodes should not be massaged.
• The muscles in the area being massaged should be as relaxed as possible.
• The body and hands must be clean.
• For massage, be sure to use lubricants (ointments, oils, etc.).

For proper interaction with the skin, during stroking, lubricants are needed

Basic and auxiliary techniques

The classical massage technique consists in alternate use receptions, their timely inclusion in the session. Also, the technique is based on understanding how, how much and where to apply the techniques.

Classic techniques in pictures

The main methods of classical massage are:

• Stroking (pictures 1 to 5). The purpose of this technique can be called stimulation and improvement of skin elasticity, normalization of lymph circulation and blood circulation. Also, a decrease in pain, an improvement in vascular tone, a decrease in muscle tone.
• Rubbing (6th to 8th figure). Thanks to this technique in the body, the mobility of tissues improves, the work of the articular-ligamentous apparatus improves. The method of rubbing actively acts on vasodilation, enhances blood flow to tissues, and helps to strengthen the processes of eliminating stagnation in the body. Stimulates the regeneration of damaged organs, improves conductivity and sensitivity. Increases muscle tone, while reducing nervous excitability.

Reception multidirectional rubbing on the upper limb

• Kneading (from 9th to 11th figure). Increases muscle tone and contraction. A kind of muscle gymnastics is performed without the patient's efforts. Metabolic, excreting processes in the body are stimulated. The sensitivity to nutrients is improved. With injuries, regeneration processes are accelerated and enhanced. Helps in the resorption of deposits. Thanks to the contrasting effect, kneading is indicated for muscle failure, because it activates and strengthens muscle tone.
• Vibration (from 12th to 15th figure). The main effect on the body: vascular tone improves. Blood pressure rises or falls, depending on the desired effect. The vascular lumen expands or narrows. The myoneural apparatus is stimulated. It has an analgesic effect on muscles and the body as a whole. Tendon reflexes are enhanced. It helps to influence the deep layers, improves the functioning of internal organs. It is indicated for diseases of the gastrointestinal tract. In addition, the vibration technique acts far beyond the zone in which it is performed. The amplitude spreads over a larger surface of the body and, accordingly, affects a wider area.

Each of these techniques has its own variations. It may differ in the degree and intensity of exposure in each individual case. In addition, it can be performed with different parts of the hand.

Basic techniques and their variations in a convenient table

In addition to the main ones, there are also auxiliary techniques of classical massage, which are often performed only by experienced masters. In addition, they are considered not separate methods, but arising from the main ones. These include:

• Beating. It is often mistaken for a kind of "vibration" technique, but some experts identify "tapping" as a separate niche. Reception helps to improve the functioning of the nervous system and through it have a beneficial effect on the entire body. It is performed with the knuckles of the fingers with a series of light blows.
• Squeezing. This technique resembles stroking, but it is performed more intensively and rhythmically. Moreover, when it is used in practice, it goes after stroking and before rubbing. It helps improve blood circulation, blood flow and lymph drainage. At the same time, it relieves swelling and helps to remove stagnant deposits.

Many works and books have been written about how to do classical massage. It takes time and perseverance to learn all this. In addition, the art of massage has been studied for years. But for independent practice, for a start, the basic knowledge outlined above is also suitable. It is also important to know the sequence and duration of the receptions.

Sequencing

In any type of massage, the sequence and consistency of actions is important.

Before starting the session, it is useful to ventilate the room, turn on pleasant music and light incense. The classical massage techniques are in the sequence shown below.

An important point for the successful implementation of any technique is maximum muscle relaxation.

1. Stroking begins and ends with a massage session. It is also used after completing other techniques. At the beginning of the session, stroking is carried out with gentle, slow and gentle actions. In this case, the skin should not stretch, shrink or deform in any way. The movements are light and sliding. Stroking is divided into superficial and deep stroking, as well as flat and enveloping. The intensity, forces of influence, direction change depending on the type of stroking used and the individual clinical picture of the patient. Be sure to use oil or other means to help slip your hands. The technique can be done with one hand or two, with the pads and phalanges of the fingers, with the palm, the costal part of the hand. This technique is part of the basics of classic massage.
2. Squeezing. If this technique is used, then it follows the stroking. The movements are similar to the first technique, only they are done more intensively and rhythmically. With a deeper effect on the skin. It is performed with two hands.
3. Next comes the rubbing technique. It affects tissues more deeply. Moving, displacing, stretching the skin. The duration in one section does not exceed 10 seconds, the movements are neat and unhurried. Grinding is also divided into several subgroups: sawing, planing, alternating, comb-like and others. In addition, it happens: deep and superficial, interrupted and uninterrupted. The same is done with both hands.
4. The kneading technique is expressed in grasping the skin areas with your hands and working them out. Kneading can be: exciting, pulling, lifting, squeezing, lowering and squeezing. Just like rubbing, it can be superficial and deep, continuous and intermittent. It is carried out with two hands, with different direction and intensity. One of the irreplaceable classical massage techniques.
5. Vibration also includes tapping. Although sometimes it stands out as a separate one. The essence of the technique is different in amplitude and frequency of oscillatory movements. For execution use: one or both hands, pads or knuckles. Also the edge of the palm, the back and the inside of the hand. An important element in the classical massage technique.

The duration of each individual appointment depends on the individual characteristics of the patient and the clinical picture. The masseur must clearly see and understand where, with what intensity and duration it is necessary to perform the elements. To obtain a high-quality result, you need to contact professionals. After all, only they are fluent in all the techniques and basics of classical massage.

The massage technique consists of many different techniques which were described by doctors Ancient Greece, Egypt, India, China and other countries. Table 3 shows the main massage techniques and their varieties, which are used in both therapeutic and sports massage (V.I. Dubrovsky, 1999).

Table 3. Basic techniques of classical massage and their varieties

Basic techniques of classical massage	Varieties of basic classical massage techniques	Characteristics of massage techniques in the direction of their implementation	Which part of the hand does the massage technique (techniques)
Stroking	Ironing		Palm, back of the hand, index and thumb, thumb and palmar surface, II-V fingers, base of the palm
Comb-like
Gabled
Cruciform
Trituration	Sawing	Plane (longitudinal, transverse, spiral)	Palm, thumb (s), II-IV fingers, base of the palm, fist (s), phalanges of bent II-V fingers, ulnar edge of the hand, forearm, thumb and forefinger
Bias
Gabled	Enveloping (zigzag, ring, transverse)
Cruciform
Kneading	Felting, shifting, squeezing, gripping, squeezing, pressing, stretching (stretching)	Longitudinal	One hand (ordinary), two hands (double ring), thumb (fingers), base of the palm, phalanges of bent fingers, pads of II-IV fingers, elbow, etc.
Transverse
Ring
Spiral
Vibration	Shaking	Discontinuous (stable, labile)	Palm, thumb (s), thumb and forefinger, base of palm, forefinger and middle finger
Shaking
Shake	Intermittent
Crossing
Percussion techniques	Chopping	Longitudinal	Elbow edge of the hand, palm (s), fists, elbow edge of the hand with bent fingers, etc.
Beating	Transverse
Pat

In turn, techniques can be classified as medium-deep (stroking, rubbing, squeezing), deep (kneading) and shock (vibration).

When carrying out a massage, you need to alternate techniques without taking breaks between them. You should also not massage the lymph nodes during the massage.

Starting to master the techniques of massage, you can massage your leg, while at the same time you will learn and feel at the same time what sensations the person being massaged is experiencing.

The massage should begin gently and gently, then it should gradually intensify, and at the end, soft, relaxing techniques should be repeated. The number of repetitions of individual massage techniques is different and depends on the individual characteristics of the patient and some other factors (age, health status, etc.). Certain techniques have to be repeated up to 4-5 times, others less often.

The use of various massage techniques can be associated with the anatomical and physiological features of the massaged area of ​​the body, the functional state of the patient, his age, gender, nature and stage of a particular disease.

The technique of classical massage is based on a layer-by-layer effect on the connective tissue formations, taking into account the anatomical and physiological characteristics of the massaged area and segmental connections of the spine with internal organs and functional systems (V.I. Dubrovsky).

The strength and dosage of the massage go a long way. Rough, hasty, haphazard and irregular movements, as well as excessive duration of massage, can cause pain, muscle twitching, irritation of the cerebral cortex and overexcitation of the nervous system. This kind of massage can be harmful.

You should also not start the massage with sudden movements and break off suddenly. The first sessions should not be long and intense, the muscles need special preparation for intense exposure. The muscles of the person being massaged should be relaxed.

It is important to change the pressure of the fingers on the body and carefully record the sensations that arise. It is necessary to do such training massage sessions so that a sense of rhythm arises, in which the hands move continuously, changing one technique to another.

It must be remembered that massage movements should be directed along the lymphatic pathways towards the nearest lymph nodes. During massage upper limbs the direction of movement should go from the hand to the elbow joint, then from the elbow joint to the armpit.

When massaging the lower extremities, movements should be directed from the foot to the knee joint, then from the knee joint to the groin.

When massaging the trunk, neck, head, movements should be directed from the sternum to the sides, to the armpits, from the sacrum up to the neck, from the scalp to the subclavian nodes.

When massaging the abdomen, the rectus muscles are massaged from top to bottom, and oblique, on the contrary, from bottom to top.

Massage should start from large areas of the body, and then you need to move on to smaller ones, this sequence helps to improve lymph circulation and blood circulation in the body.

As a rule, during a general massage, not everything is affected, but only those parts of the body that most need massage. After all, massage of all parts of the body will take at least about two hours. With such a massage duration, a healthy person will get pretty tired, although the procedure is very pleasant. If the total mass-soot is “laid down” in 40-50 minutes, it will not bring even a small benefit. (For reference: correct massage of only fingers and toes takes 20-25 minutes.) Therefore, with a general massage, you must select the most important parts of the body and devote maximum time and attention to them.

A session of general massage begins from the back, neck and arms - from the side that is closer to the massage therapist. Then the massager goes to the opposite side and massages the other half of the back, neck and second hand. The head can be massaged after the back, neck and arms, or at the end of the entire session. Then the gluteal muscles and the sacrum are massaged alternately. Next - the thigh and knee joint closest to the masseur, then the second thigh and knee on the other side. After that comes the turn of the gastrocnemius muscle, Achilles tendon, heel and plantar surface of the foot - first on one side, then on the other.

Next, the massaged person lies on his back; breast massage begins on the opposite side from the masseur. Then the hand closest to the masseur is massaged (first its inner surface) in the following sequence: shoulder, elbow joint, pre-shoulder, wrist joint, hand and fingers. (Hands can also be massaged in the position of the massaged lying on the stomach.) After that, the massager goes to the other side and treats the other half of the chest and the other hand. The thighs, knee joints, shins, ankles and feet are also massaged alternately. Finish the procedure with a massage of the abdomen and head (Fig. 19) (A. Biryukov).

Figure 19. The sequence of massaging body parts.

1) it is necessary to firmly touch the palm of the masseur to the surface of the body when stroking and rubbing;

2) a full grip of the massaged muscle should be performed to avoid pinching;

3) kneading should be performed along the muscle fibers softly, smoothly, gently;

4) with percussion techniques, the hand should be relaxed;

5) the movements must be complete, i.e. continuous from the beginning of the muscle to its attachment;

6) kneading the muscle should be uniform throughout its entire length;

7) after each kneading technique, stroking, shaking should be performed.

Stroking. This technique is used at the beginning and end of the massage, as well as when changing one technique to another.

Stroking has a significant effect on the body. It cleanses the skin from keratinized scales and the remains of the secretion of sweat and sebaceous glands. As a result of this effect, skin respiration is cleared, the function of the sebaceous and sweat glands is activated. The metabolic processes in the skin are enhanced, the skin tone is increased, as a result of which it becomes smooth and elastic.

Promotes stroking and improves blood circulation, because as a result of the opening of the reserve capillaries, the volume of oxygen entering the tissues increases. This technique has a beneficial effect on the blood vessels, making their walls more elastic.

If there is edema, stroking helps to reduce it. helps outflow of lymph and blood. Promotes stroking and cleansing the body, because as a result of this exposure, decay products are removed. Stroking is used to relieve pain in trauma and other diseases.

The effect of stroking on the nervous system depends on the dosage and methods: deep stroking can excite the nervous system, while superficial stroking, on the contrary, soothes.

It is especially useful to perform stroking techniques for insomnia and increased excitability of the nervous system, after heavy physical exertion, with traumatic injuries, etc.

Stroking also helps to relax the muscles before subsequent massage sessions.

When stroking, the hands glide freely over the body, the movements are soft and rhythmic. These techniques never touch deep layers. muscle mass, the skin should not shift. The oil is first applied to the skin, and then, using wide, smooth movements, the oil is rubbed into the body, which at the same time relaxes and warms up.

Hands are relaxed when stroking, they slide along the surface of the skin, touching it very easily. You need to stroke in one direction, usually along the lymphatic vessels and veins. The exception is flat surface stroking, which can be carried out regardless of the direction of the lymph flow. If there is swelling or congestion, then stroking should be started from the overlying areas in order to facilitate the outflow of fluid.

You can use stroking yourself, as a separate massage effect. But most often stroking is used in combination with other massage techniques. Usually, the massage procedure begins with stroking. Stroking should be the end of each individual massage technique.

When performing the stroking technique, it should be remembered that first, surface stroking is always used, only after it can deep stroking be applied. Do not apply excessive pressure when stroking, which can cause pain and discomfort in the person being massaged.

Deeper should be stroking the flexion areas of the limbs, it is here that the largest blood and lymphatic vessels pass.

All stroking techniques are performed slowly, rhythmically, approximately 24-26 sliding strokes should be performed in 1 minute. Do not stroke with too sharp and fast movements, so that the skin does not shift. The surface of the palms should fit snugly against the surface to be massaged. When performing each stroking session, you should choose only those techniques that will most effectively affect this part of the body being massaged.

Receptions and techniques of stroking. The two most important stroking techniques are flat and wraparound strokes. They need to be produced with the whole brush, put it on the massaged surface.

Plane stroking is used on flat and extensive surfaces of the body, such as the back, abdomen, chest. With such stroking, the hand is relaxed, the fingers should be straightened and closed. The directions of movement can be different. You can perform movements transversely, longitudinally, in a circle or in a spiral. Stroking movements can be performed with one or two hands (Fig. 20).

Enveloping stroking is used to massage the upper and lower extremities, buttocks, neck, and lateral surfaces of the body. Grasping strokes are performed with a relaxed hand, while the thumb should be set aside, and the rest of the fingers should be closed. The brush should grip the massaged surface tightly (Fig. 20-21). The movements can be continuous, or they can be intermittent (depending on the goals set).

Figure 20.

Stroking can be done with one hand, or with two hands, while the hands must follow in parallel and in a rhythmic sequence. If stroking is performed on large areas in which excess subcutaneous fat is concentrated, you can increase the pressure by massaging with a weighted brush. In this case, one brush is superimposed on top of the other, thereby creating additional pressure.

Stroking movements can be shallow or deep.

Superficial stroking is distinguished by particularly gentle and light movements, has a calming effect on the nervous system, helps muscle relaxation, improves blood circulation and metabolism in the skin.

Deep massage should be done with force, while pressing is best done with the wrist. This stroking technique helps to remove metabolic products from tissues, eliminate edema and congestion. After deep stroking, the work of the circulatory and lymphatic systems of the body is significantly improved.

Stroking, especially flat stroking, can be performed not only with the entire inner surface of the palm, but also with the back of two or more fingers, with the lateral surfaces of the fingers - it depends on the area of ​​the body that is being massaged. For example, when massaging small areas of the facial surface, at the site of callus formation, as well as massaging the interosseous muscles of the foot or hand, stroking with the pads of the index or thumb can be used. Fingertip stroking is used to massage individual muscles and tendons, and to massage the fingers and face.

When massaging large surfaces of the muscles of the back, chest, thigh, you can use stroking with your palm or a brush folded into a fist.

Figure 21.

In addition, stroking can be continuous or intermittent. With continuous stroking, the palm should fit snugly against the massaged surface, as if sliding along it. Such stroking causes inhibition of the reaction on the part of the nervous system, calming it down. In addition, continuous stroking promotes the drainage of lymph and the elimination of edema.

Continuous stroking can be alternating, while the second hand should be brought over the first, which completes the stroking, and perform the same movements, but in the opposite direction.

When performing intermittent stroking, the position of the hands is the same as for continuous stroking, but the movements of the hands should be short, spasmodic and rhythmic. Intermittent stroking irritates the nerve receptors of the skin, so this massage stimulates the central nervous system. Thanks to this, intermittent stroking can activate tissue blood circulation, tones blood vessels and activates muscle activity.

Depending on the direction of stroking movements, stroking can be divided into the following types:

· Straightforward;

· Zigzag;

· Spiral;

· Combined;

· Circular;

· Concentric;

· Longitudinal stroking with one or two hands (Finnish version).

When performing rectilinear stroking, movements are made with the palm of the hand, the hand should be relaxed, and the fingers are pressed together, except for the large one, which should be taken a little to the side. The hand should fit snugly against the massaged surface of the body; movements should be made with the thumb and forefinger. They should be lightweight and glide.

When carrying out a zigzag stroking, the hand should make a quick and smooth zigzag movement directed forward. The zigzag stroking creates a feeling of warmth and soothes the central nervous system. This stroking can be done with varying pressure.

Spiral stroking is performed without tension, with light and sliding movements, like a zigzag stroke. The trajectory of movement of the hands should resemble a spiral. This stroking has a tonic effect.

You can combine straight, zigzag, and spiral movements into a combined stroking. Combined stroking should be performed continuously in different directions.

When massaging small joints, circular stroking can be performed. Movements should be made with the base of the palm, making circular movements towards the little finger. In this case, movements with the right hand will be directed clockwise, and movements with the left hand - counterclockwise.

To massage large joints, you can use another circular stroking - concentric. The palms should be placed on the massaged area, placing them close to each other. In this case, the thumbs will act on the outside of the joint, and the rest of the fingers on the inside. Thus, a figure-eight movement is performed. At the beginning of the movement, the pressure should be increased, and towards the end of the movement, slightly loosened. After that, the hands should return to their original position and repeat the movement.

To perform longitudinal stroking, the thumb should be taken as far as possible, then the brush should be applied along the massaged surface. Movements should be made with the fingertips forward. If longitudinal stroking is performed with two hands, the movements should be performed alternately.

When stroking, auxiliary techniques are also used:

· Comb-like;

· Rake-like;

Gabled;

Cruciform;

· Ironing.

Comb-like stroking is used to deeply massage large muscles in the dorsal and pelvic regions, as well as on the palmar and plantar surfaces. Such stroking helps to penetrate deep into massive muscle layers, and is also used for significant subcutaneous fat deposits. Comb-like stroking is performed using the bony protrusions of the phalanges of the fingers, bent into a fist. The fingers of the hand should be bent freely and without tension; they should not be pressed tightly against each other (Fig. 22). You can perform comb-like stroking with one or two hands.

Figure 22. Figure 23.

Rake stroking is used to massage the intercostal spaces, scalp, as well as on those areas of the skin where it is necessary to bypass damaged areas.

To perform rake-like movements, you need to place the fingers of the hand and straighten them. The fingers should touch the massaged surface at an angle of 45 degrees. Rake strokes should be carried out in longitudinal, transverse, zigzag, circular directions. You can perform them with one or two hands. If the movements are performed with two hands, the arms can move in parallel or sequentially.

To increase the pressure, rake-like movements can be done with weights (the fingers of one hand are superimposed on the fingers of the other hand) (Fig. 23).

Forceps are used to massage the tendons, fingers, feet, face, nose, auricles, and small muscle groups. The fingers should be folded with forceps, and, grasping a muscle, tendon or skin fold with the help of the thumb, index and middle fingers, perform rectilinear stroking movements (Fig. 24).

Figure 24. Figure 25.

Cross stroking is commonly used in sports massage and is used when massaging the limbs. Cross-shaped stroking is also carried out in the system of rehabilitation measures after serious illnesses and operations. In these cases, you can do cruciform strokes of the back, pelvic region, buttocks, back surfaces of the lower extremities. Cruciform strokes help in the prevention of pressure sores. When performing a cruciform stroking, the hands must be locked into the lock and grasped the massaged surface. Such stroking is performed with the inner surfaces of the palms of both hands.

Ironing is a gentle and gentle technique, so it is often used in children's massage (Fig. 25). Ironing is also used to massage the skin and muscles of the face and neck, as well as to massage the back, abdomen and soles. Weighted ironing is used to massage the internal organs.

Ironing with one or two hands. The fingers should be bent at the metacarpophalangeal joints at right angles. If ironing is to be done with weights, put the other hand on the fingers of one hand clenched into a fist.

1. When stroking, the muscles of the massaged area should be in a relaxed state.

2. Stroking is performed both independently (for example, with a fresh injury), and in combination with other massage techniques (rubbing, kneading and vibration).

3. Massage begins with stroking and ends with stroking.

4. Stroking is performed slowly, rhythmically, gently, along the blood and lymph flow (on the back in both directions).

5. In case of edema, lymphostasis and acute injuries, stroking begins from the proximal areas, and from the second day - from the injured area.

6. When performing stroking, the hand (palm) should tightly grasp the massaged area and slide to the nearby lymph nodes.

7. Stroking should be started from the proximal sections, and after several massage movements proceed to stroking the distal sections (to the nearest lymph nodes).

8. It is not necessary to use all stroking options in one procedure.

9. Stroking is the preparation of the massaged area for the following massage techniques.

The most common mistakes when stroking (according to V.I. Vasich-kin):

1) strong pressure on the skin, which can cause discomfort in the patient;

2) a very fast pace and sharp execution of the technique;

3) loose fit of the hand to the massaged surface, which leads to uneven effects and unpleasant sensations.

Trituration. After stroking, the next technique takes place, which has a deeper effect, since when it is performed, movement, displacement and stretching of body tissues occurs. When rubbing, fingers or hands should not slide over the skin, as when stroking.

Rubbing is widely used in almost all types of massage. Rubbing techniques dilate blood vessels and increase blood circulation, while the local skin temperature rises. This contributes to the better saturation of tissues with oxygen and nutrients, as well as the rapid removal of metabolic products.

Usually rubbing is used on areas with poor blood supply: on the outside of the thigh, on the sole, heel, as well as in the places where the tendons and joints are located.

Rubbing is used for neuritis, neuralgic diseases, since rubbing reduces the excitability of the nervous system, as a result of which the pain sensations characteristic of these diseases disappear.

Rubbing techniques help heal sore joints, restore them after injury and damage. Rubbing also has a beneficial effect on muscles, making them more mobile and elastic.

By rubbing, which increases tissue mobility, it is possible to avoid adhesion of the skin to the underlying surfaces. Rubbing helps to stretch adhesions and scars, helps to dissolve swellings and accumulations of fluids in the tissues.

Rubbing is usually done in combination with other massage movements. When rubbing surfaces with swelling and pathological deposits, rubbing should be combined with stroking. Rubbing is also used before kneading.

Rubbing should be done in a slow rhythm. In 1 minute, 60 to 100 movements should be made. Unless absolutely necessary, you cannot linger in one area for more than 10 seconds. Prolonged rubbing of the same area can cause pain in the person being massaged.

If you need to increase the pressure, rubbing can be done with weights. The pressure increases if the angle between the hand and the massaged surface increases.

When rubbing, it is not necessary to take into account the direction of the lymph flow, the direction of movement during rubbing depends only on the configuration of the massaged surface.

Techniques and techniques of rubbing. The main methods of rubbing are rubbing with your fingers, the edge of the palm and the supporting part of the hand.

Rubbing with fingers is used to massage the scalp, massage the face, intercostal spaces, back, hands, feet, joints and tendons, iliac crests. Rubbing is performed using the pads of the fingers or the back of the phalanges. You can rub with one thumb, while the rest of the fingers should rest on the surface to be massaged (Fig. 26).

Figure 26. Figure 27.

If rubbing is performed with all fingers except the thumb, the thumb or the supporting part of the hand performs the supporting function.

You can use only the middle finger when rubbing, performing straight, circular or dashed strokes with a pad. This method of rubbing is very convenient to use when massaging the intercostal and intercarpal spaces.

You can rub with the fingers of one hand or both hands. The other hand can be used for weights (Fig. 27), or rubbing movements can be performed in parallel.

As mentioned above, the choice of direction during rubbing depends on the configuration of the massaged surface, i.e. from the anatomical structure of joints, muscles, tendons, as well as from the location on the massaged area of ​​scars, adhesions, edema and swelling. Depending on this, rubbing can be carried out in the longitudinal, transverse, circular, zigzag and spiral directions.

Figure 28.

Rubbing with the elbow edge of the hand is used to massage large joints such as the knee, shoulder, and hip joints. Rubbing with the elbow edge of the hand can be used to massage the back and abdomen, the edges of the shoulder blades and the crests of the iliac bones (Fig. 28).

When rubbing with the ulnar edge of the hand, the underlying tissues should also be displaced, forming a skin fold when displaced.

On large muscle layers, such an intensive technique is used as rubbing with the supporting part of the hand. It is usually used to massage the back, thighs, buttocks. Rubbing with the support part of the brush can be done with one or two hands. With this technique, the movements are performed in a straight line or spiral. Depending on the direction of movement, rubbing is:

· Straightforward;

· Circular;

· Spiral.

Rectilinear rubbing is usually done with the pads of one or more fingers. Apply rectilinear rubbing when massaging the face, hand, foot, small muscle groups and joints.

Circular rubbing is done with the pads of the fingers. In this case, the hand should rest on the thumb or on the base of the palm. You can carry out a circular rubbing with the back of all bent fingers, as well as with one finger. This method of rubbing can be carried out with weights or alternately with two hands. Circular rubbing is used to massage the back, abdomen, chest, limbs and other parts of the body.

Spiral rubbing, used to massage the back, abdomen, chest, extremities and pelvic areas, is performed with the ulnar edge of the hand, bent into a fist, or with the supporting part of the hand. With this method of rubbing, you can use both brushes or one weighted brush.

When rubbing, auxiliary techniques are also used:

· Hatching;

· Planing;

· Sawing;

· Crossing;

· Gripping rubbing;

· Comb-like rubbing;

· Rake-like rubbing.

Hatching. Correctly performed shading technique helps to increase the mobility and elasticity of the tissues undergoing massage. This technique is applied

Figure 29. Figure 30.

in the treatment of post-burn skin scars, cicatricial adhesions after other skin lesions, postoperative adhesions, pathological seals. In certain doses, shading can reduce the excitability of the central nervous system, which contributes to the analgesic effect. Shading is performed with the pads of the thumb, index and middle fingers (each separately). You can stroke with the index and middle fingers together.

When performing hatching, straightened fingers should be at an angle of 30 degrees to the massaged surface (Fig. 29).

Hatching is done in short and straight-line movements. The fingers should not slide on the surface, the underlying tissues are shifted in different directions when performing the technique.

Planing. This auxiliary rubbing technique is used in the treatment of psoriasis and eczema, when it is necessary to exclude the effect on the affected areas of the skin, as well as in the rehabilitation treatment of skin with significant scar lesions. This technique is used to increase muscle tone, because planing has an exciting effect on the neuromuscular system. Positive action has planing and in the fight against increased fat deposits in some parts of the body. Planing is performed with one or both hands. When performing a massage with two hands, both hands should move sequentially, one after the other (Fig. 30). The fingers should be folded together, while they should be straightened at the joints. The fingertips apply pressure and then displacement of the tissue.

Sawing. The technique is used to massage the back, thighs, lower legs, abdomen, as well as those areas of the body where large muscles and joints are located.

Sawing should be done with one or both hands. Movements are made by the ulnar edge of the hand. Sawing with one hand should be done in a back and forth direction, while the underlying tissues move and stretch. If sawing is done with two hands, the hands should be placed on the massaged surface with palms facing each other at a distance of 2-3 cm. They should move in the opposite direction. It is necessary to perform the movement so that the hands do not slip, but shift the underlying tissues (Fig. 31).

Figure 31. Figure 32.

Crossing. The technique is used when massaging the muscles of the back and abdomen, limbs, cervical region, trapezius muscle. Crossing can be done with one or two hands. Movements are made by the radial edge of the hand, the thumb should be maximally set aside (Fig. 32).

If the crossing is done with one hand, you should make rhythmic movements from yourself and towards yourself. When performing a two-handed technique, the hands should be placed at a distance of 2-3 cm from each other. Hands should move in the direction away from you and towards you alternately, displacing the underlying tissue.

Pincer rubbing. The technique is used to massage the face, nose, ears, tendons and small muscles.

Perform gripping rubbing with the ends of the thumb and forefinger or thumb, forefinger and middle fingers. The fingers take the form of forceps and move in a circle or straight line.

Comb-like rubbing. This technique is used to massage the palms and plantar part of the foot, as well as in areas with large muscles: on the back, buttocks, outer thigh. A comb-like rubbing should be performed with a brush clenched into a fist, placing it on the massaged surface with the bony protrusions of the middle phalanges of the fingers.

Rake rubbing. The technique is used if it is necessary to bypass the affected areas on the massaged surface. It is used for varicose veins in order to massage the areas between the veins with spread fingers without touching the veins themselves.

A rake-like rubbing is also used when massaging the intercostal spaces, the scalp.

Movements are performed with widely spaced fingers, while the pads of the fingers perform rubbing movements in a rectilinear, circular, zigzag, spiral-like or shading pattern. A rake-like rubbing is usually performed with two hands, you can make movements not only with the pads of the fingers, but also with the back surfaces of the bent nail phalanges.

Rubbing with the edge of the palm. To perform the technique, place the edge of the palm across the massaged area (across the direction of the blood vessels), put the thumb on the index finger and move forward. The rest of the fingers should be slightly bent at the joints (Fig. 33).

Figure 33. Figure 34.

Rubbing with the base of the palm. The hand, palm down, should be placed on the massaged surface along the muscle fibers. The thumb should be pressed to the edge of the palm, moving the nail phalanx to the side (Fig. 34).

Pressure is applied to the massaged surface with the base of the thumb and the base of the entire palm. The rest of the fingers need to be slightly raised and taken to the side of the little finger.

Rubbing with two hands is performed with weights. This technique enhances the impact on the massaged area. If the resistance is performed perpendicularly, three fingers (index, middle and ring fingers should apply pressure on the radial edge of the thumb of the hand that is performing the massage (Fig. 35). If the burden is performed in the transverse direction, the other hand should apply pressure on the entire hand hands performing massage (fig. 36).

Figure 35. Figure 36.

In addition to the basic methods of rubbing, there is also an auxiliary method, which is called the coracoid. Beak rubbing is done in the following several ways:

· The elbow part of the hand;

· The radial part of the hand;

· The front part of the hand;

The back of the hand.

When performing coracoid rubbing, the fingers should be folded in the shape of a bird's beak, pressing the thumb to the little finger, the index finger to the thumb, put the ring finger on top of the little finger, and place the middle finger over the ring and index fingers. Performing coracoid rubbing with the elbow part of the hand, movements should be made with the edge of the little finger, pushing the hand forward (Fig. 37). When performing coracoid squeezing with the radial part of the hand, forward movements should be made with the edge of the thumb (Fig. 38).

Figure 37. Figure 38..

Beak-like rubbing with the face of the hand should be done with the little finger and thumb. The movement is made forward (fig. 39).

When performing a coracoid rubbing with the back of the hand, the movement should be made with the back of the hand (i.e., turning it away from you). With this method, the movement is directed in the opposite direction (Fig. 40).

Figure 39. Figure 40.

Fenning is rubbing with the pads of the thumbs. Reception is performed with two hands alternately. We set the brushes with a "dome", and the pads of the thumbs perform spiral movements to the sides (herringbone) from each other, displacing the skin.

Such types of rubbing as transverse rubbing with two palms, rubbing with the edge of the palm (sawing) are warming up and have a direct analgesic effect.

Drainage rubbing affecting the body fluids (blood, lymph, interstitial fluid) includes rectilinear rubbing with four-finger pads, “circular caterpillar”, rolling, fenning, rake-like and comb-like rubbing.

Methodical instructions (according to V.I. Dubrovsky).

1. Rubbing is shown before kneading and is, as it were, preparing fabrics for it.

2. Reception is slow; when it has the character of a prelaunch (preparatory) one, it is more energetic and fast.

3. To enhance the action of rubbing, it is often used with weights (one hand is placed on the other).

4. Rubbing is carried out along the blood and lymphatic vessels, and on the muscles of the back - from lumbar to the cervical and from the lower angles of the scapula to the lower back.

5. When rubbing, the brush (palm) must be firmly pressed to the massaged area.

6. Rubbing should be used with caution on soft tissues after injury (damage) and disease.

7. Rubbing is an important technique when acting on the tissues of the joints, various chronic muscle diseases. It can be combined with a sauna, physiotherapy and hydrotherapy. It should be used with great care for lymphostasis, edema, etc.

Typical errors when rubbing (according to V.I. Vasichkin):

1) rough, painful performance of the technique;

2) carry out rubbing movements with sliding on the skin, and not together with it;

3) rubbing with straight fingers, not bent at the interphalangeal joints. It is painful for the patient and exhausting for the massage therapist;

4) performing the main types of rubbing, do not simultaneous phases with two hands (like swimming instead of the crawl style with the breaststroke style), but alternately.

Kneading. This technique is one of the main ones in massage. In the general scheme of massage soot, kneading should take 60-75% of the total time allotted for the entire procedure. To make the kneading effect more noticeable, the muscles of the person being massaged should be relaxed as much as possible.

Kneading provides access to the deep muscle layers. When using it, you need to grab muscle tissue and press them against the bones. The capture of tissues is carried out with their simultaneous squeezing, lifting and displacement. The entire kneading process can be divided into three phases: grabbing the muscle, pulling and squeezing, and then rolling and squeezing.

The kneading technique should be done with the thumbs, fingertips, and the top of the palm. In this case, the movements should be short, fast and sliding.

When kneading, you need to strive to capture deeper layers of muscle tissue. To increase pressure, you can use your body weight and put one hand on top of the other. It is like squeezing and squeezing the skin of the massaged area.

Kneading should be done slowly, painlessly, increasing its intensity gradually. You should make 50-60 kneading movements per minute. When kneading, the hands should not slip, and sharp jerks and twisting of fabrics should not be made either.

The movements should be continuous, from the abdomen of the muscle to the tendon and back, while the muscle should not be released, jumping from one area to another. You need to start the massage from the place where the muscle passes into the tendon.

The positive effect of kneading is that it improves the circulation of blood, lymph and tissue fluid. This significantly increases the nutrition of the tissues of the massaged area, the saturation of tissues with oxygen, and improves muscle tone.

Kneading promotes the rapid removal of carbon dioxide and lactic acid from tissues, therefore kneading is necessary after heavy physical and sports exertion. Kneading significantly reduces muscle fatigue.

With the help of kneading, muscle fibers are stretched, as a result of this, the elasticity of muscle tissue increases. With regular exposure, muscle strength increases.

Kneading techniques and techniques. There are two main methods of kneading - longitudinal and transverse.

Longitudinal kneading. It is usually used to massage the muscles of the extremities, sides of the neck, back muscles, abdomen, chest, pelvic areas. Longitudinal kneading should be performed along the muscle fibers forming the abdomen (body) of the muscle, along the muscle axis, with the help of which the tendon of the beginning (head) and the tendon of attachment (tail) are connected (Fig. 41).

Figure 41. Figure 42.

Before carrying out longitudinal kneading, straighten fingers should be placed on the massaged surface in such a way that the thumb is on the side of the massaged area opposite from the rest of the fingers. Having fixed the fingers in this position, the muscle should be raised and pulled back. Then you need to make kneading movements directed towards the center. You cannot let go of the muscle even for a moment, your fingers should grasp it tightly. First, the pressure on the muscle should be towards the thumb, and then the thumb presses the muscle towards the rest of the fingers. Thus, the muscle is under pressure from both sides.

You can perform a longitudinal kneading with two hands, while all movements are performed alternately, one hand moves after the other. Movements are made until the entire muscle is completely flexed.

Longitudinal kneading can be carried out with intermittent movements, jumps. With this method, the brush massages individual areas of the muscle. Usually, intermittent kneading is used when it is necessary to bypass the affected areas of the skin, as well as to stimulate the activity of the neuromuscular apparatus.

Cross kneading. It is used to massage the limbs, back and abdomen, pelvic and cervical areas.

Cross kneading is also used to absorb edema, increase lymph drainage and improve blood circulation. In this case, the movements should be directed to the lymph nodes located next to the massaged area.

To increase muscle tone, activate its contractile function, massage is useful in different directions along the entire length of the muscle.

When kneading across the hand, place it across the muscle to be kneaded. The angle between the hands placed on the massaged surface should be approximately 45 degrees. The thumbs of both hands are located next to one side of the massaged surface, and the rest of the fingers of both hands are on the other side. All kneading phases are performed simultaneously or alternately. If kneading is performed simultaneously, both hands shift the muscle to one side (Fig. 42), in the case of alternating transverse kneading, one hand should move the muscle towards itself, and the other - away from itself (Fig. 43).

If kneading is carried out with one hand, the other hand can be used for weights (fig. 44).

Cross kneading should be started from the abdomen (body) of the muscle. Further, the movements should be gradually directed towards the tendon.

Figure 43. Figure 44.

It is better to knead the head of the muscle and the tendon with one hand longitudinally, therefore, approaching the tendon, the other hand can be removed and kneading with one hand can be finished.

After the tendon and the place of muscle attachment have been massaged, you can start moving in the opposite direction, in this case, you need to put the second, free hand on the muscle and perform transverse kneading with both hands. One muscle should be massaged in this way several times, changing the transverse kneading to the longitudinal kneading.

The types of longitudinal and transverse kneading include:

· Ordinary;

· Double ordinary;

· Double neck;

· Double annular;

· Double ring combined kneading;

· Double annular longitudinal kneading;

· Ordinary longitudinal;

· Circular;

· Kneading with the base of the palm with a roll.

Ordinary kneading. This type of kneading is used to massage the muscles of the neck, large dorsal and gluteal muscles, the front and back of the thigh, the back of the lower leg, shoulder, abdomen.

When performing an ordinary kneading, the muscle must be very tightly grasped across the rivers with straight fingers. Then the muscle should be lifted by pushing the thumb and all other fingers towards each other. The fingers should move with the muscle, not slide over it. The next stage is the return of the muscle to its original position. At the same time, the fingers should not let go of the muscle, the palm should fit snugly against the muscle. Only when the muscle takes its original position, the fingers can be unclenched. So massage all areas of the muscle.

Double ordinary kneading. This technique effectively stimulates muscle activity.

When massaging the muscles of the back of the lower leg and shoulder, the person being massaged should lie on his back. If the thigh muscles are being massaged, the leg should be bent at the knee.

The difference between this technique and the usual ordinary kneading is that with both hands you need to alternately carry out two ordinary kneading. In this case, the movements should be directed from bottom to top.

Double neck. This method is used to massage the muscles of the anterior and posterior surfaces of the thigh, oblique muscles of the abdomen, muscles of the back and buttocks, and shoulder muscles.

The double bar is performed in the same way as the regular kneading, but the double bar must be carried out with weights. There are two options for the double neck.

Option 1. When performing this version of the double bar, the hand of one hand is weighed down by the other in such a way that the thumb of one hand presses on the thumb of the other hand. The rest of the fingers of one hand apply pressure to the fingers of the other hand.

Option 2. A double bar in this version is performed with weights with the base of the palm of one hand on the thumb of the other hand.

Double ring kneading. It is used to massage the trapezius muscles, abdominal muscles, chest, latissimus dorsi, muscles of the limbs, neck and buttocks. When massaging flat muscles, double ring kneading cannot be used due to the impossibility of pulling these muscles up.

It is more convenient to do this kneading by laying the person to be massaged on a flat surface. The massaged person should relax the muscles as much as possible. The brushes of both hands must be positioned on the massaged area so that the distance between them is equal to the width of the hand. The thumbs should be on the opposite side of the massaged surface from the rest of the fingers.

This is followed by straightened fingers to grab and raise the muscle. In this case, one hand displaces the muscle in the direction away from itself, and the other towards itself. Then the direction is reversed. You should not let go of the muscle from your hands; this kneading should be done smoothly, without sudden jumps, so as not to cause pain to the massaged person.

Double ring combined kneading. The technique is used for kneading the rectus abdominis muscles, latissimus dorsi, gluteal muscles, pectoralis major muscles, thigh muscles, the back of the lower leg, shoulder muscles. This technique of execution is similar to a double ring kneading. The difference is that when performing a double circular combined kneading, the right hand performs an ordinary kneading of the muscle, and the left hand kneads the same muscle. For the convenience of performing this technique, you should put the index finger of your left hand on the middle finger of your right hand. The movements performed by each hand should be performed in opposite directions.

Double circular longitudinal kneading. It is used to massage the front of the thigh and the back of the lower leg.

To perform this kneading technique, you need to put your hands on the massaged area, squeezing your fingers together (your thumbs need to be taken to the sides). Having grabbed the muscle with both hands, you should make circular movements with your fingers, the hands should move towards each other. Having met, they continue to move, moving away from each other at a distance of 5-6 cm. Thus, you need to massage all parts of the muscle.

When massaging the right thigh and left leg, place the right hand in front of the left, and when massaging the left thigh and right leg, in the opposite order.

Ordinary longitudinal kneading. The technique is used to knead the back of the thigh.

This technique combines ordinary and longitudinal kneading: longitudinal kneading is used to massage the outer surface of the thigh, and ordinary (transverse) kneading is used for the inner surface.

Circular kneading can be divided into the following subspecies:

· Circular beak-shaped;

· Circular kneading with the pads of four fingers;

· Circular kneading with the pad of the thumb;

· Circular kneading with phalanges of fingers clenched into a fist;

· Circular kneading with the base of the palm.

Circular beak kneading is used to massage the long and broadest muscles of the back, cervical muscles and muscles of the limbs.

When performing this technique, the fingers fold in the shape of a bird's beak: press the index and little fingers to the thumb, place the ring finger on top, and then the middle finger. When massaging, the hand moves in a circular or spiral manner towards the little finger. You can carry out such kneading with both hands alternately.

Circular kneading with the pads of four fingers. The technique is used to massage the muscles of the back, neck muscles and muscles of the extremities, as well as massage the head. Kneading should be carried out with the pads of four fingers, placing them diagonally to the muscles. The thumb should be positioned along the muscle fibers. He does not directly participate in kneading, he only glides over the surface, and the pads of four fingers press on the massaged surface, making circular movements towards the little finger.

Circular kneading with the pad of the thumb. The technique is used to massage the back muscles, muscles of the limbs and sternum.

The reception is performed with the pad of the thumb in the same way as the circular kneading with the pads of four fingers, only in this case, four fingers do not take any part in kneading.

The technique can be performed with one hand, making a circular motion with the thumb towards the index finger. The pressure of the finger on the massaged surface should be different, the strongest at the beginning, and weaker when returning the finger to its original position. Every 2-3 cm, you should move your finger to a new area of ​​the massaged surface in order to stretch the entire muscle in this way. When performing this technique, it is necessary to ensure that the thumb does not slide over the surface, but moves the muscle. Reception can be performed with two hands alternately or with one hand with weights.

Circular kneading with the phalanges of the fingers clenched into a fist. The technique is used to massage the muscles of the back, limbs, sternum. It is also used to massage the anterior tibial and calf muscles, but in this case the massage is performed with two hands. When performing this kneading technique, the phalanx of fingers bent into a fist put pressure on the muscle, and then shift it in a circular motion towards the little finger. When performing the technique with two hands, the hands, clenched into a fist, should be placed on the massaged surface at a distance of about 5-8 cm from each other. Circular movements towards the little finger are made with both hands alternately. You can perform this technique with one hand with weights.

Circular kneading with the base of the palm. Reception is used to massage the muscles of the back, buttocks, limbs, sternum. Circular movements are performed with the base of the palm towards the little finger. You can perform this technique with two hands, placing them on the massaged surface at a distance of 5-8 cm from each other. You can knead with one hand with weights.

Kneading with the base of the palm with a roll. The technique is used to massage the deltoid muscles, long back muscles, pectoralis major muscles, gluteal muscles. A hand with fingers pressed together is placed with the palm down along the muscle fibers. Lifting your fingers, you should apply pressure, rolling the hand from the base of the thumb to the base of the little finger over the base of the palm. So it is necessary to move throughout the muscle further.

In addition to the above techniques, there are auxiliary techniques:

Felting;

· Rolling;

· Shifting;

· Stretching;

· Pressure;

· Compression;

Twitching;

· Forceps kneading.

Wallow. It is usually used to massage the muscles of the shoulder and forearm, thigh and lower leg. In addition, due to the sparing effect of felting, it is used for damage to muscle fibers and blood vessels as a result of trauma, with sclerotic vascular lesions, etc. The technique is performed with two hands. The brushes of both hands should grasp the massaged area on both sides, while the brushes are parallel to each other, the fingers are straight. The movements of each hand are performed in opposite directions, the hands should be gradually moved over the entire area of ​​the massaged surface (Fig. 45).

Figure 45. Figure 46.

Rolling. The technique is used to massage the anterior abdominal wall, as well as the muscles of the lateral surfaces of the back, chest, in the presence of significant fatty deposits, in case of muscle flabbiness. When carrying out a massage of the abdominal muscles, you should first relax the muscles by performing a planar circular stroking of the massaged surface of the abdomen. After that, place the edge of the palm of the left hand on the surface of the abdomen and try to immerse it deeply into the thickness of the abdominal wall. With your right hand, grab the soft tissues of the abdomen and roll them onto the left hand. Perform in a circular motion kneading the captured part, and then proceed to rolling the areas located nearby (Fig. 46).

Shifting. The technique is usually used to massage long muscles for the treatment of cicatricial formations, skin diseases, in the treatment of paralysis and paresis. Shifting increases blood circulation and lymph flow, helps to improve metabolism in tissues, this technique warms the tissues and has an exciting effect on the body.

When performing a sliding technique, it is necessary to raise and grab the massaged area with the thumbs of both hands, and then move it to the side. You can, without grabbing the tissue, put pressure on the massaged surface and move the tissue towards each other using your palms or fingertips. It should be shifted both in the longitudinal and transverse directions.

With the help of gripping, a large pectoral muscle and gluteal muscles. While massaging the back muscles, you do not need to grip when shifting. The displacement of the sternocleidomastoid muscles occurs with the help of a gripping forceps.

When massaging the tissues of the cranial cover, the hands are applied to the forehead and the back of the head, with light pressure, the hands should alternately slowly move from the forehead to the back of the head. If the frontal plane of the skull is massaged, the hands must be applied to the area of ​​the temples. In this case, the shift occurs towards the ears.

When you massage the hand, the interosseous muscles of the hand shift as follows. With the fingers of both hands, you should grab the brush of the person being massaged by the radial and ulnar edges. In short movements, the tissues are shifted up and down. In a similar way, you can make a shift in the muscles of the foot (Fig. 47).

Figure 47. Figure 48.

Stretching. This technique has an effect on the nervous system, with the help of it paralysis and paresis, scars after injuries and burns, postoperative adhesions are treated.

As with shifting, you should grab the muscle, and if this is not possible, press on it. Then you need to push the tissues in opposite directions, while the muscles are stretched (Fig. 48). You should not make sudden movements, because it can hurt the person being massaged.

To grip a large muscle, use the entire hand; small muscles need to be gripped by forceps with your fingers. If the muscles cannot be grasped (flat muscles), they need to be smoothed out with your fingers or palm, thus stretching also occurs. When stretching adhesions and scars, use the thumbs of both hands against each other.

To stimulate muscles with paresis and paralysis, it is advisable to alternate rhythmic passive stretches with gentle passive stretches, directing the movement towards muscle contraction. This procedure has a positive effect on the muscle tendons.

Pressure. With this technique, tissue receptors are excited, as a result of which tissue nutrition and blood supply are improved. It also exerts pressure on the internal organs, activating the secretory and excretory functions of the body, as well as the peristalsis of the internal organs.

Use pressure in the treatment of diseases of the musculoskeletal system (damage to the spine, the consequences of bone fractures, etc.).

This technique is performed with intermittent pressure, the rate of movement is different - from 25 to 60 pressure per minute.

Pressing can be done with the palm or the back of the fingers, with the pads of the fingers, the supporting part of the palm, as well as with a hand clenched into a fist.

When massaging the anterior abdominal wall, it is best to press with the palmar or the back of the fingers or with a fist at a pace of 20-25 times per minute. At the same pace, you can massage the internal organs. When massaging the abdomen, you can use pressure with weights. When massaging the back to activate muscle activity pressure should be applied to the spine. In this case, the hands should be placed across the spinal column, the distance between the arms should be approximately 10-15 cm, while the fingers should be placed on one side of the spinal column, and the wrists on the other. With rhythmic movements (20-25 movements in 1 minute), the hands should be moved up the spinal column to the cervical region, and then down to the sacrum, thus making pressure in the area of ​​the muscles along the entire spinal column (Fig. 49).

Figure 49. Figure 50.

The mimic muscles of the face are massaged by the palmar and dorsal surfaces of the fingers folded together. For 1 minute, it is necessary to make about 45 presses.

Massage of the scalp can be performed with the fingertips, placing them in a rake-like manner, producing from 50 to 60 presses in 1 minute.

You can also press the scalp with the palmar surface of the hands, clasping your head with your palms on both sides. With this method, 40 to 50 movements should be performed in 1 minute.

Compression. The technique is used to massage the muscles of the trunk and limbs. Compression promotes activation of blood circulation and lymph flow, increases the supply of blood to muscles, increases muscle tone and improves their contractile function.

Compression is used to massage the face to improve skin nutrition. As a result, there is an increase in the tone of facial muscles, the skin becomes more elastic and elastic. Compression should be done with short squeezing movements of the fingers or a hand (Fig. 50).

The tempo when performing the technique should be about 30-40 movements in 1 minute. Compression during facial massage should be performed at a pace of 40 to 60 movements in 1 minute.

Jerking. This technique is used in facial massage in order to activate the work of facial muscles, as well as to increase the elasticity and firmness of the facial skin. Twitching is also used with the flabbiness of the muscles of the anterior wall of the abdomen, in the treatment of paresis and paralysis of the muscles of the upper and lower extremities.

Twitching is also used in the treatment of scars after burns and injuries, as well as postoperative adhesions, because this technique improves the mobility and elasticity of the skin.

Twitching should be done with two fingers: thumb and forefinger, which should grab a piece of tissue, pull it back and then release it. You can also twitch with three fingers: thumb, forefinger, and middle. The rate of twitching should be from 100 to 120 movements in 1 minute. You can perform movements with one or two hands.

Figure 51.

Pincer kneading. This technique is used to massage the muscles of the back, chest, neck, face. Pincer kneading is good for massaging small muscles and their outer edges, as well as tendons and muscle heads. The technique should be performed with the thumb and forefinger folded in the form of forceps (Fig. 51). You can also use your thumb, forefinger, and middle finger. The forceps kneading can be transverse or longitudinal. When performing a transverse forceps kneading, the muscle must be grasped and pulled back. Then, with alternating movements from yourself and towards yourself, knead the muscle with your fingers. If a longitudinal forceps-like kneading is performed, the muscle (or tendon) should be grasped with the thumb and middle fingers, pulled back, and then kneaded between the fingers in a spiral-visible.

Methodical instructions (according to V.I. Dubrovsky).

1. When kneading, the muscles to be massaged should be relaxed and in a comfortable physiological position.

2. Kneading is performed vigorously, but gently, without harsh