1. The Techniques of Massage
Chapter II
The Techniques of Massage

2. Massage Techniques Percussion (tapotement) Friction Petrissage
Effleurage/ stroking
Petrissage
Friction
Percussion (tapotement)

3. 1. STROKING (OR) EFFLEURAGE
It is unidirectional manipulation of soft tissues from distal to proximal in the direction of the lymph drainage.
Effleurage is used more than any other massage technique.
It usually initiates and ends each treatments
Definition
Any stroke that glide over
the skin is called as effleurage
Types of Stroking
Superficial Stroking or Superficial Effleurage
Deep Stroking or Deep Effleurage

4. Effect of effleurage Superficial Stroking Deep Stroking
Performed either from Proximal to Distal or Distal to Proximal
Accustoms the patient to your touch.
Assessment of the skin and tissues state
Improves sensory analgesia.
Slow stroking will relax and sedate, and decreases muscle tone.
Faster strokes will stimulate superficial blood flow accelerating lymph drainage.
Applied from distal to proximal only.
Assists lymphatic and venous return.
Assists interchange of tissue fluid.
Assists removal of waste product
Passively stretches muscle fibres.
Restores mobility at tissue interfaces.
Light strokes decrease muscle tone.
Deep strokes increase muscle tone.

5. Types of Effleurage
Knuckling – Clench the fist in palmar flexion, gradually bring the hand from flexion to extension.
Bilateral - Both hands progressing simultaneously on the either side.
Single Single hand used for the stroke

6. 2. Pressure manipulations (petrissage)
Compressing tissues against the underlying structures
Petrissage
Kneading
Picking Up
Wringing
Rolling
Shaking

7. Kneading
It is circular manipulation performed so that the skin and subcutaneous tissues are moved in a circular manner on the underlying structures. It is performed with palmar aspect of the whole hand, with palm only, with all fingers, or with the pads of the thumb or fingers.
Effects
Stimulates venous and lymphatic flow.
Increases mobility of fibrous tissues.
Helps interchange of tissue fluids.
Helps prepare soft tissue for exercise.
Helps removal of waste products.
Increases length and strength of connective tissues.
Restores mobility between tissue interfaces.

8. Classification of Kneading
Grade 1: is sufficient to influence superficial vessels and compress superficial tissues of underlying structures.
Grade 2: effects deeper tissue drainage and will compress deep tissues of underlying structures.
Grade 3: is applied to superimposed or reinforced strokes. It may be applied as strongly as can be tolerated by the patient without producing tissue damage.

9. Picking up
Compressing the tissues against the underlying structures, then 'picked up', lifted, squeezed and released.
The manipulation can be single-handed in a C-shape , double-handed in alternate C-shapes and V-shapes or double-handed in a V-shape.
Effects - The same as for kneading

10. Wringing
Compressing the tissues against underlying structures, then one hand pulls towards the you while the other hand pushes away.
Effects of wringing
Same as for kneading.
particularly good for separating superficial and deep adherent tissues.
There are only two grades for wringing:
Grade 1 is usually applied to finger strokes only.
Grade 2 uses the whole hand.
There is no grade 3 as it would be too painful to tolerate.

11. Rolling
The fingers pull the tissue towards the thumbs and then the thumbs squeeze and lift to push the tissue away.
Types: skin rolling and muscle rolling
Effects
Same as for kneading.
Mobilises scar tissue.
When performed slowly, it has a stretch effect on the tissues being manipulated

12. Shaking
Muscle or more superficial tissue can be shaken from side to side
Tips or whole hand are used
Effects
Produces a feeling of stimulation.
Increases tissue mobility.
Assists in breaking down tissue adhesions.
Stimulates lymphatic and venous flow.
Helps prepare soft tissues for stretch and exercise.

13. 3. Friction
It is a localized manipulation applied at the injury point aiming to give a stretching across the fibers to separate them and restore mobility.
Effects
Restore tissue mobility.
Stimulate local circulation.
Aid the resolution of inflammation.
Reduce pain as a counter-irritant effect.
Stretch fibrous tissue.
Types:
1. Circular : Friction is applied in circular manner by the fingers. Rest of hand should be out of the contact. This manipulation can be used over ligaments and myofascial junctions.
2. Transverse: Friction is applied horizontally by the thumb or fingers. This manipulation can be used over tendon, ligament, myofascial junctions and muscles

14. Classification of Friction
Grade 1 does not apply to this technique as it is aimed at deeper structures.
Grade 2 is sufficient to affect deep tissue and cause compression.
Grade 3 applies to reinforced and most transverse fric­tions and may produce pain before causing numbing.

15. 4. PERCUSSION (TAPOTEMENT)
Percussion movements (Tapotement) involve a series of light, brisk,
striking actions applied with alternate hands in rapid succession.
Percussion
Hacking
Clapping
Beating
Pounding
Tapping
Vibration

16. Hacking
Hold the hands so that the palms are parallel. Strike the part with a series of soft, but brisk blows, using the lateral borders of the middle, ring and little finger. Use both hand alternatively and strike rapidly with pronation and supination at forearm.
Effects
Stimulates local circulation.
Stimulates muscle tone.
Gives a generalized feeling of stimulation.
Provokes muscle and tendon reflexes.
Light strokes affect superficial tissue.
Deeper strokes aid the evacuation of secretion
from the lungs.

17. Classification of Hacking
Grade 1 uses only the medial borders of the fingers.
Grade 2 uses the medial borders of hands and fingers.
Grade 3 uses the medial borders of hands and fingers more deeply and slowly.

18. Clapping (cupping)
It performed with your palms facing downwards, forming a hollow curve. Strike the part with the palmar surface of the hand. The striking sound should be hollow like a horse trotting. Use both hand alternatively and strike rapidly.
Effects
Same as for hacking, with the
exception of provoking
a tendon or muscle reflex

19. Classification of Clapping
Grade 1 clapping is very superficial and is often called skin clapping. This is performed at a fairly fast pace with minimal contact.
Grade 2 clapping is deeper, slower and firmer.
Grade 3 clapping is very firm and may involve elbow as well wrist action.

20. Beating Involves the use of lightly clenched fists to hit the area
Effects
As for clapping.
Classifications of beating
Grade 1 beating is performed at a fast rate, with fairly light contact.
Grade 2 is slower, with firmer contact.
Grade 3 is very deep and the rate can be varied as required.

21. Pounding
The hands are held in lightly clasped with the thumbs resting against the first fingers
Effects
As for clapping.
Classifications of beating
Grade 1 of this stroke applies to a fast rate with light contact.
Grade 2 is used at a slower rate with firmer contact
Grade 3 is deeper, with varying rates.

22. Tapping
Tapping is done the tips or pads of the fingers. It is used on very small areas such as the face.
Effects
As for clapping.
Classifications of beating
Grade 1 of this stroke applies to a fast rate with light contact.
Grade 2 is used at a slower rate with firmer contact
Grade 3 is deeper, with varying rates.

23. Vibration
A fine tremulous movement, made by the hand or fingers placed firmly against a part, will cause the part to vibrate.
Tips of the finger or whole hand is used for vibration.
Vibration involves a movement in which the tissues are pressed and released using an up and down motion.
Effects
Stimulates muscle tone.
Stimulates the local circulation.
Provides a feeling of well-being.