Definition

Feature
Classification
Practical basics
of
Massage
 Different definitions of massage are:

• Massage therapy is the scientific manipulation

of the soft tissues of the body for the purpose
of normalizing those tissues and consists of
manual techniques that include applying fixed
or movable pressure, holding, and/or causing
movement of or to the body.
• Massage is the scientific mode of curing
certain forms of disease by systematic
manipulations.
• Massage is the scientific manipulation of the
soft tissues of the body with the palmer
aspect of hand or finger.
• Massage is the application of force to the
tissue without producing any movement or
change in position of joints.
• Manipulations are most efficiently performed
with the palmer aspect of hand and administered
for the purpose of producing effects on nervous
system, muscular system as well as the local and
general circulation of the blood and lymph.
• Throughout the history massage has been used
not only by sick but also by the healthy people
for therapeutic, restorative as well as preventive
purposes.
 Features of massage technique
• 1. Technique should apply mechanical force to
the soft tissue of the body.
• 2. These forces must not produce any change in
the position of the joint.
• 3. The technique must evoke some physiological,
psychological effect which serves to achieve the
therapeutic, restorative and the preventive goal.
 Considering features definition of massage
is:
• Any technique, be it manual or mechanical
which imparts mechanical energy to the soft
tissue of the body through the skin without
producing any change in the position of joint
in order to elicit certain physiological or
psychological effect which can be utilized for
the restorative, therapeutic or preventive
purposes either on sick or a healthy
individual.
 Classifications of Techniques:

• Classification of any given technique can be

analyzed and compared with other techniques
of massage is based on the terms of
• Magnitude of applied force
• Direction of force
• Duration of force
• Means of application of force
●
stroking
●
pressure ●
light massage
●
percussion ●
deep massage
●
vibration

Character of depth of tissue

techniques approached

means
part of body
ofapplication of
massaged
pressure

●
general ●
manual
●
local ●
mechanical
Classification of massage technique on the
basis of character of techniques
STROKING -
• Superficial, Deep Or Effleurage
PRESSURE
• Kneading
Palmar, Digital, Ironing
• Petrissage
• Picking Up, wringing, Skin Rolling
• Friction
• Circular, Transverse
 – VIBRATARY
• Vibration
• Shaking
– PERCUSSION
• Clapping
• Hacking
• Tapping
• Beating
• Pounding
• Tenting
• Contact heel percussion
 Practical aspects of Massage:

• Success of massage therapy depends upon the

position of patient, stance of the therapist,
proper support of body parts, environment of
treatment room, attitude and appearance of
therapist etc.. are not related to the various
techniques of massage but play an important
role in efficacy of massage treatment.
 1. Comfort, safety and position of the
patient:
• The patient must be placed in a secure and
safe position depending upon the age, sex,
physical condition and the part which is to be
treated.
• Adequate number of pillows should be placed
according to body contour to ensure proper
support, complete relaxation and gravity
assisted drainage.
 Aims of the Positioning Are

• The part to be treated should be fully

supported to ensure relaxation and to gain the
confidence of patient.
• The body part should be easily approachable to
the therapist so that he/she does not face any
difficulty in proper administration of the
techniques.
• It should not hamper the continuity of massage.
Positions adopted for giving massage are

• Prone lying- for back, posterior aspect of lower

limb
• Supine lying- for anterior aspect of lower limb,
upper limb, face and abdomen
• Half lying- for upper limb, chest and lower limb
• Side lying- for upper limb, chest and lower limb
• Sitting- for upper limb, neck and face
Prone lying
• In this position the patient is placed on a couch or a
treatment table with the face down.
• Support one pillow under the abdomen to flatten the
back and to obliterate lumbar Lordosis by tilting the pelvis
posteriorly. This helps to relax extensor muscles of spine.
• Pillows under lower legs to support the legs and to
maintain knee in flexed position which relieves the
tension of Hamstring muscles. Also to reduce pressure
over anterior aspect of ankle and to keep the toes free as
well as to relieve tension of dorsiflexor muscles.
• Two pillows crossing one another at ninety
degree under the forehead or dorsal aspect of
crossed hands under the forehead to support
the neck in neutral position, to minimize the
tension of posterior neck muscles, to ensure
the easy access to the posterior neck and
facilitate easy breathing by not allowing
compression of the nose.
• Precautions:
• While placing pillows under the abdomen care
should be taken to avoid pressure over scrotum
in male and breast in female.
• This position should not be used for patient of
cardiac and respiratory disorders because
in this position the abdomen and chest are
compressed by the body weight and inspiration
is difficult.
Supine position
• In this position the patient is placed on a couch or a
treatment table with the face up and back supported.
• Pillow under knees as one long pillow under both
knees or two small pillows under the knees to keep
hip and knee in slightly flexed position to relieve
tension of Hamstrings, rectus femoris and iliofemoral
ligament, to tilt the pelvis posteriorly to avoid back
hollowing and relax lumber extensors and to position
the thigh in elevation so that the gravity assist the
venous and lymphatic drainage.
• Small pillow or a rolled towel under the neck
to support the cervical Lordosis, to maintain
neck in neutral position and to relax the
muscles around the neck
• Precautions:
• This position is not suitable for respiratory and
cardiac disorders patients as they may
experience breathlessness.
Half lying
• This position is suitable for elderly, cardiac and
respiratory patients as the breathing becomes
easier in this position.
• It is most commonly used for arm and chest
massage.
• Patient is positioned in such a way that his back
is about 45 degree in relation to lower limb with
pillow under both the knees.
• In this position back is completely supported
and the knees and hips are flexed which helps to
relax abdominal muscles and makes the
respiration easier.
Side lying
• This position is used for upper limb, chest and
posterior aspect of lower limb.
• Support one pillow under the head to
maintain alignment of neck in neutral position
and to relax the neck muscles
• 2to 3 pillows under the upper most lower
limb, 1 under thigh and 2 under legs to
completely support hip in line with trunk.
 Sitting
• Most commonly used for the massage of the upper
extremities, face and the posterior aspect of neck.
• When used for upper limb the limb has to be placed
on the plinth over prearranged pillows to maintain
90 degree angle of flexion and abduction at
shoulder joint with elbow extended and wrist and
fingers supported.
• Due to elevation of arm gravity assists the drainage.
• Notes:
• When elevation of part is required in
treatment of Edema, number of pillows in
the distal part should be increased or the
foot end of the bed may be raised.
• When used for the posterior neck and upper back
patient should faced the plinth and support is given to
the forehead placing over the dorsum of hands which
are crossed and kept over the plinth. Or placing the
forehead on pillows or rolled towel placed over the
plinth ( if shoulder mobility is restricted) which reduces
cervical Lordosis to relax neck muscles and to give
complete access of the posterior neck to the therapist.
• For doing facial massage neck should be supported on
the head rest.
 2. Exposure : Draping:

• The part to be massaged must be fully exposed so that

therapist can look over the part and ruled out the
contraindications.
• Any adverse effects produced during manipulation can
also be noticed immediately.
• The part to be treated should be exposed but the rest of
the body covered with bed sheets, towels.
• Care should be taken not to embarrass the patient by
unduly exposing them. Draping helps to honor the
modesty and privacy of the patient, to keep the patient
warm in cold weather and helps to achieve proper
relaxation.
– For back- exposed part from occiput to
PSIS. Cover lower limb up to glutei
region and upper limb up to
shoulder joint.
– For lower limb: exposure from toe to
groin cover contra lateral limb, trunk
and genitalia.
– For upper limb: exposure from tip of
fingers to axilla and supraclavicular
Fossa. Cover contralateral upper limb,
trunk bellow clavicle.
 3. Examination of part to be treated:
• 1. look - at the skin for dryness, wetness, hairiness
• 2. observe - for bruises, abrasions, lacerations.
• 3. palpation - find out about increase of temperature,
tone – tension of the muscle, joint posture and
sensitivity of the skin.
• Palpation starts with lager area that requires flat
hand. Gradually increase pressure, modifying hand
posture with every part in contact, mentally count
anatomical landmarks and apply check test to identify
them-
• Arteries can be felt to pulsate
• Pressure on veins occludes them so that they
appear full distally
• Tendons have muscle tissue attached that can
contract
• ligaments can be appear- disappear in
different position of joints.
 4. Comfort and safety of the therapist

• While performing massage therapist should

adopt a position with wide base to ensure proper
stability and effective use of body weight to
minimize muscle work while applying pressure so
that fatigue and discomfort can be minimized
during prolonged session of therapy.
• Flexion attitude of spine during massage strains
the back muscles should be avoided.
• Generally the therapist during the manipulation
adopt modification of standing
 (Stride, walk and fallout standing.)

• Stride standing:
• the lower limb are abducted at hip joint so that
feet are placed almost two feet wide apart.
• In this stance the base is widened laterally so that
the stability in the frontal plane is increased.
• Effective stance to perform percussion, skin rolling
and vibration.
• Most commonly used for massage of the back
and face.
• Walk standing:
• one leg is directly forward to the other leg in such
a way that the heels of both the legs are placed in
the same line and are almost two feet apart.
• In this stance base is increased in anterior
posterior direction.
• Pelvis is stabilized so that the movement of spine
can be effectively localized.
• Rotation of spine and the movements in anterior
posterior direction can be carried out efficiently.
• Used in effleurage and stroking where whole
length of the segment is to be covered in one go.
• Fallout standing:
• one lower limb is placed directly forward by
the flexion of hip, two feet apart, knee of
forward leg is slightly flexed while the other
knee remains in extended position.
• The body is thus inclined forward.
 5. Attitude of the therapist:

• Therapist should be completely relaxed.

• His/her manner should be pleasant and courteous.
• He/she should be confident and give necessary
instructions to the patient in an effective manner.
• His/her voice should be clear and soothing. Avoid
discussion during the treatment.
• Instructions should be given in language which
patient can understand and should be simple,
short and self explanatory
 6. Appearance of the therapist
• Nails should be short and clean.
• Remove all the rings, bangles and watch before
doing massage.
• Hair should be preferably short. Long hair must be
restrained not irritate the patient.
• Necklace and other jewelries should be removed.
• Sleeves of therapist’s apron should be either half
or folded up to arms in order to increase the
efficient use of hand.
• In order to avoid any chance of cross infection the
hand should be washed and dried up before and after
massage.
• When the climate is cold therapist’s hand must be
warm. This is essential to avoid the unnecessary
stimulation of cold receptors which may produce
discomfort and increase the muscle tension of the
patient.
• Should avoid perfumes as they can have a nauseating
effect on some patient due to allergy.
• Shoes with low heel provide a more stable position.
 7. Self preparation of the therapist
• As close contact will inevitably occur therapist should
wear protective clothing which is easily washable and
allows freedom of movement while maintaining decency.
• The ROM of all joints of forearm and hands should be
full.
• If you have stiff hands do a series of stretching exercises
to increase your range.
• Movements: full abduction and extension of thumb for
wide grasp, full flexion – extension of wrist, full pronation
– supination of radioulnar joint.
• Hand exercises:
• Touch the fingertips of both hands and press so that thumb and
all fingers are separated widely, push the fist of one hand between
two adjacent fingers of the other hand so that fingers are
separated in to abduction.
• Do for all finger space, place your hands together as in prayer and
with your thumb resting at chest push wrist downwards to extend
them without separating the heels of hands.
• Also turn them down to touch abdomen and up to touch chest
alternatively.
• Touch the hands reverse and push the elbow downwards thus
flexing wrist.
 8. Contact and continuity (anatomical
consideration.)
• The hands of the therapist should be relaxed and
molded to the parts.
• Amount of pressure should be modified according
to the condition of the structures being treated.
• There should not be any break in the continuity
of massage as it is a continuous process.
• Care must be taken not to use deep pressure in
the areas where neurovascular bundles are
vulnerable or over bony prominences.
 9. Selection of a technique:
• The technique should be directed towards the
condition in order to achieve only desired
physiological effect.
• Contraindications should be ruled out.
• After examine the part to be treated
accordingly select the proper technique
 10. Lubricants
• The purpose of using the lubricants during
massage is
To make the skin soft and smooth.
To reduce friction between therapist’s hand
and patient’s skin.
To gain placebo effect.
• Indications:
• Presence of excessive sweating either with the
patient or with the therapist.
• Poor condition of the skin : dry, rough, scaly
and fragile skin.
• Types of lubricants:
• Powder
• Oil
• Cream
• Soap and water
• Powder:
• Preferably non perfumed powder should be used
as many people are allergic to the fragrance.
• French chalk or talcum powder is commonly
used.
• In the presence of profuse sweating corn starch
(Boric powder) which is sterilisable and heavy
powder absorbs sweat very readily.
• Oils:
• The oil is helpful when the skin is dry and scaly.
( after removal of plaster cast.)
• Most commonly used oils are olive, coconut, mustard,
mineral oil (liquid paraffin) and some medicinal oils.
• All this oils exert a drag effect on the skin and provide
smooth gliding.
• For this effect oil can be used in the presence of a very
hairy skin.
• The use of edible oil in the therapy is avoided because
they have a peculiar smell which may be allergic to some
people and may be attract insects which may produce
injury in person with anesthetic skin as in paraplegia and
leprosy.
• Creams: lanolin or lanolin based creams are
suitable for the mobilization of scars due to burns
and surgical trauma.
 
• Soap and water: with or without the additional oil
is used for scaly skin after prolonged immobilization
in a cast or by use of some medications which
promote increase skin healing and at the same time
cause the skin to become dry and scaly.
 11. The environment of treatment room

• The room should be well ventilated and well

heated.
• Atmosphere should be pleasant with light
music.
 12. Accessories:

• Low stool for sitting position.

• Treatment table: A foam mattress should be used on the
plinth Covered with washable plastic or rexine to facilitate
cleaning and disinfection.
• Height of the coach should be adequate so that the
therapist need not stoop (if table is too low) or reach up(if
table is too high) to perform massage.
• It should be wide enough to allow the patient to turn sides.
• A couch of 6.5feet long: 2.5feet wide: 3feet height is
adequate for the average height therapists.
• Ideally table with shelves is used to store accessories.
• A movable trolley besides the table to keep
accessories near the table.
• Easily washable bed sheets, towels, pillows
with washable cover, bowl to keep lubricant,
• A non perfumed shop and water should be
kept ready.
 Protocol for massage treatment:

• Prepare the treatment the area

• Arrange all accessories
• Welcome your patient
• Introduce yourself to your patient
• History of patient: present, past, medical,
surgical and family history
• Ask the complaint
• Examine the patient
• See medical reports if available
• Rule out general contraindications
• Expose the part to be treated.
• Look for local contraindications such as redness,
swelling, skin condition, pimples, wounds, abrasions,
cuts.
• Palpate for temperature, muscle tone and sensitivity
of skin.
• If any contraindication is present no massage
treatment, but refer your patient to specialist or give
other modalities.
• If no contraindications than proceed further
• Give position to the patient
• Drape the other part.
• Select the techniques
• Give massage
• Termination of treatment.
• Inspect the area for unwanted effects
• Keep the record
• Rearrange all accessories for next patient.