MASSAGE

I. Definition

Massage- It is a sensory input that stimulates large fiber nerve impulses. It is a

relatively easy intervention and takes only few minutes to perform, it requires
no special equipment and can be very effective for muscle, back pain and neck
pain.

II. Principles/Theories

1. The active principle of massage is pressure. The pressure differs in degree (light or
heavy) in its nature (continuous or intermittent) in its effects (reflex or mechanical)
and in the manner or mode of its production (various forms of massage).

2. Massage is performed by one who has received adequate training and has become
proficient in this art. However, every nurse should be able to carry out simpler form
and know when it is beneficial or harmful.

3. Massage should be given only under the direction of the physician.

4. The type of massage, the time and frequency of treatment and the duration of each
treatment depend on the diagnosis of the disorder or impairment and on the physiologic
effects desired.

5. The operator should be versed in anatomy and physiology and in the theoretical and
practical aspects of massage, he/she should be aware of the indications for its use and the
contraindications.

6. Observe the following:

a. The hands should be warm and dry and the fingernails rounded. smooth and
short
b. Change the article of clothing that hinder your movements. Do not wear rings
bracelet.
7. Bear in mind that massage improperly employed or performed can cause harm.

8. Every movement in massage has a purpose. make each one slow and deliberate

9. Be thorough, overlapping your strokes to cover every square inch of the focal area.

10. Be aware of your own the client’s breathing patterns. Deepen pressure when you exhale
together.
11. Provide privacy and observe safety measures.

III. A. Purposes :

1. For reflex effects – very light and slow movements tends to sedate whereas
slightly stronger and quicker movements tend to stimulate.
Massage :
a. induces relaxation and sleep
b. counteracts fatigue and expedites recovery from exercise
c. diminishes or alleviates pain
d. provides relief in hysteria, neurasthenia, and other nervous disorders.
e. relaxes muscular spasm.
f. dilates blood vessels.
g. Promotes functional processes of various internal organs.

2. For mechanical effects. On the skin, massage:

a. removes greasy deposits, excessive secretions and detritus
b. clears the opening of sebaceous and sweat glands.
c. loosens superficial scars and adherent skin

On the circulation, massage:

a. empties veins and lymphatics, and thus promotes venous and
lymphatic return which increases the flow of fresh blood,
lymph, and increases the erythrocytes and hemoglobin content
of the blood.
b. promotes nutrition of tissues.

On the muscles, massage:

a. assists absorption of exudates and local effusions.
b. relieves edema and congestion
c. displaces toxic or other foreign pathologic material, and the
waste products of the muscles.
d. loosens adhesions
e. stretches retracted muscles and tendons
f. prevents or counteracts muscle atrophy
B. Indication
1. dislocation, sprains, strains
2. fractures, joint stiffness, tendon injuries
3. amputation, contusion, fibrosis
4. muscular spasm, muscular atrophy, contracture, deformity
5. nervous conditions, such as headache , hysteria, insomnia, neurasthenia
6. spastic paralysis, sciatica
7. anterior poliomyelitis
8. circulatory disturbances
9. gastrointestinal conditions

C. Contraindications

1. Abdominal tumors and ulcers, large hernias

2. Acute communicable diseases
3. Acute inflammatory processes, malignant swellings, collection of pus
4. Acute phlebitis and thrombosis, lymphangitis
5. Acute skin affections, such as abscesses, acne, burns, eczema, wounds
6. Acute systemic disease accompanied with fever
7. Advanced nephritis and arteriosclerosis

IV. Equipment
1. Powder- if the skin is dry or scaly
2. Lubricant (olive oil, cocoa butter or cold cream)- if the part is hairy
3. Alcohol – to remove lubricant after treatment

V. Procedure Rationale

1. Check the prescription for massage. The prescription of massage is

comparable to that of drugs.
2. Bring equipment (if needed) at the
bedside.
3. Explain the procedure to the client.
4. Have the client in a position that is
comfortable, relaxed, and sulted to
the procedure. have the part or parts to
be massaged well supported.
5. Instruct the client to relax his muscles Contracted muscles narrow the
and to keep them relaxed lumen of blood vessels and so
counteract or nullify to large
extent in the influence of
massage.
6. Expose the area to be massaged.
In general massage uncover only the Provides privacy and prevent
area to be massaged at the moment chills.
and uncover it afterward. Remove,
loosen, or rearrange whatever may
impede the circulation proximal to
the area.
7. Powder the area or apply lubricant as Facilitates movement of
needed. hands.

8. Take the position that will best enable Your body should be erect
you to carry out the procedure and your feet so placed as to
comfortably, effectively, and without permit all swaying and gliding
straining. motions of the body to be
executed without interrupting
the rhythm, alternating the
pressure, or disturbing the
client. Avoid frequent and
unnecessary changes in position
if possible.
9. Start all manipulations gently and
gradually make any increases.

10. Suggested schedule for general massage, giving the order in which the several parts
may be massaged and the approximate duration of the treatment
is as follows:

Arms 10 mins (including hands and fingers)

Chest 5 mins
Abdomen 15 mins
Legs 20 mins (including the feet)
Back 10 mins

The duration of a local massage is from 5 to 10 mins.

11. Forms of massage:

a. Stroking (effleurage): b. Compression (pertrissage):
Light Friction
Light or superficial Kneading
 c. Percussion (tapotement):
Beating
Cupping, or clapping
Hacking d. Vibration
Slapping Shaking
Tapping

Stroking
Stroking is the commonest form of massage and is generally applicable
to more conditions than other forms. It consists in making long movements that
exert and even, rather continuous pressure over the given area. The movement
are made with the palmar surface of the hand or of the fingers held close together
or with both hand and fingers. The strokes should be uniform and rhythmical
and always in the same direction. Each beginning and ending without the clients’
feeling any jerky sensations and without scratching the skin.

Usual rate: 10 – 15 strokes a minute

Light or superficial stroking – The surface of the skin is barely touched and only a
reflex effect through a mild stimulation of the sensory nerves of the skin is
intended. This effect may be sedative or stimulating.
Deep stroking embraces also the underlying structures, and is intended to
produce a mechanical effect in deeper blood vessels and lymphatics.

Position of Arm and Direction of Effleurage in Giving a Massage

 Effleurage to Back in Direction of the Flow of Lymph

Effleurage to Inner Thigh

Indications of Effleurage
1. Smoothes and extends muscles, increases nutrient absorption.
2. Improves lymphatic and venous circulation.
3. Apply to elongated muscles group on torso, arms and legs
Compression
Compression (petrissage) is the act of pressing tissues together.
It produces intermittent rather than a continuous pressure.
Friction massage consists in making deep rolling movements. The
fingers or the hand is placed on the skin and moves it over the underlying
tissues in small circles. The pressure should be moderate and the motions
rhythmical. A lubricant is not put on since the fingers or the hand must not slide
over the skin.

Friction of the Elbow Joint Showing Masseur’s Left hand in Position

to Change Angle of Patient’s Elbow
 Digital Circular Friction to Spine

Position of Hand in Applying friction to Angle Joint

Indications of Friction:
1. Very useful for freeing superficial scars and for absorbing exudates.
2. Used in bony prominences and joints.
3. Breaks up muscle spasms in any area, especially the occipital ridge and the
glottal fold.
 Kneading massage consists in making wringing, squeezing and rolling
movements over a succession of small areas. A portion of a muscle or a muscle group is picked
up and then gently and rhythmically manipulated, usually in a circular direction.
This process is repeated, and the hands move slowly and smoothly until the entire area
has been covered. One or both hands may be used. The muscle is generally picked
up with the palm and the ball of the fingers rather than with the tips of the fingers.
In regions where the muscles cannot be lifted from the bone, they should
be rolled between the fingers of one hand and the thumb of the other.

Petrissage to the Triceps

Petrissage to the Muscle of the Back

 Petrissage to the Gastrocnemius Muscle of the Leg

Indications for kneading massage:

1. (Direct mechanical effect) For the purpose of assisting the venous and
lymphatic return of the waste products of the muscles. Loosening
adhesions, and stretching retracted muscles and tendons.
2. The reflex stimulus of kneading tends to dilate the vessels of the deeper
tissues.

Percussion
Percussion (tapotement) consists in striking some part of the body with
somewhat brisk, rapid blows. Both hands are used, the blows being delivered
alternately and coming only from the wrist.

Beating is done with the hand shaped into a half-closed fist. The parts
may be struck with the ulnar border of the hand or with the heel or knuckles. Since
is rather violent form of percussion, it is applicable only to large muscles, such as
those of the back and buttocks.

Cupping or clapping is done with the fingers and thumb slightly flexed
and the palm cupped so that the whole hand is arch-shaped. As the hand strikes the
part, it gives out a clapping sound.
 Clapping – A form of Tapotement

Procedure Rationale

Hacking is done with the ulnar borders

of the hand and the little finger. A series of
light or heavy blows is given to the part in rapid
succession.

Hacking to the Spine

Slapping is done with flattened palms.

Tapping is done with the cushion tip of the fingers. The first tap is given with the
little finger and the others follow in rapid succession. Strictly speaking,
tapotement means “tapping”.

Percussion produces intermittent pressure over a small area or over a succession

of small areas. It has mechanical effect on circulation. The first effect is a
blanching of the skin due to the contraction of the arterioles. The second
effect, which soon follows, is a reddening of the skin or hyperemia, since
the stimulation caused vasodilation.

Percussion is a very strenuous form of massage and is therefore much less

employed than the preceding forms.

Vibration

Vibration consists in inducing a continuous trembling movement of the

part. The vibratory movements are transmitted to the client’s body from the
muscles of the operator’s shoulder and forearm through the tips of her
fingers or through her whole hand

Vibration produces chiefly a reflex effect, either sedative or stimulative

and is applied generally along the course of a nerve especially along the spine.
the procedure is very difficult to perform manually and is very tiring on the
operator. Hence, vibrations id sometimes carried out by means of a vibratory
apparatus.

Note: After the treatment, let the client rest and remain lying for an hour or
two. Remove the lubricant with alcohol