13.3 Massage for upperlimb , neck, face, chest, back,& lower limb..pptx

massage techniques for different body part in detail

1. 13.3 massage for upper limb, neck, face, chest, back & lower limb By : Dr. Alpa J. Dhanani MPT(Musculoskeletal & Sports)

2. MASSAGE TO THE FACE (FACIAL PALSY) It is a common condition in which facial nerve is affected. Due to nonspecific inflammation (viral) the facial nerve becomes swollen within the limited space of facial canal which prevents conduction of the impulses and results in the paralysis of facial muscles. The paralysed muscles of facial expression are treated by using unilateral massage. Bell’s palsy: Isolated paralysis of the facial muscle on one side or both sides of unknown cause. 7 th nerve injury possibly of viral origin occurring in both sexes at any age. It presents with a facial pain on the affected side followed by an inability to close the eye or smile. The mouth appears to be drawn over to opposite side and fluids may escape from the angle of the mouth, lines of expression are flattened and patient is unable to wrinkle the brows. Facial nerve is purely motor nerve supplies muscles of expression which enters the face immediately below the ear after splitting up into several branches.

3. Aims of the treatment: To maintain suppleness and elasticity of the skin and muscles. To improve the circulation. To reduce the swelling due to inflammatory deposit at the stylomastoid foremen. Position of the patient: Supine lying with pillow under the knees as well as pillow under the head. Position of the therapist: Standing at the head side but more comfortable is sitting at the head side of the bed with head pillow resting on the knees.

4. Preparation of the patient: Remove outer clothing from the neck and shoulders. Also remove shoulder straps. Cover the body up to the subclavian level. Necklace and ear – nose rings should be removed. Spectacle or lenses if there must be removed. Long hair likely to obstruct can be restrained by a hair band.

5. Techniques to be administered Stroking, Effleurage, Finger tip kneading, Wringing, Plucking, Tapping, Vibration to the Exit Foramina of the Trigeminal nerve and sinuses, Occipitofrantalis stretching to obtain scalp movement, Clapping to the area of Platysma, and along with it Incorporate all facial muscle actions. Stroking It should be gentle but firm and stimulating . From chin upward to the temple . From middle of the forehead downwards to the cheek.

6. Effleurage: It is given considering the lymphatic drainage of different parts of face. It is directed from line of the face to just below the ear (sub auricular glands). Much of the palmer surface of the hand if possible is used to start but finish with finger pads as palms lift to clear the ear. First stroke: - from mid point under the chin to below the ear. Second stroke: - fingers spread above and below the mouth to below the ear. Third stroke: - from the nose to below the ear. Fourth stroke: - from midline of the forehead, goes downwards to below the ear.

7. Finger tip kneading: Line of work is similar as effleurage proceeding from midline to the sub auricular area. All the manipulations are performed with a lifting pressure upwards and inwards but deep pressure should be avoided. Wringing: It is performed between the finger pads of the index fingers and thumb. Start at the corner of the mouth and work out to the same ear than across the chin to the other ear. Now work back to the mouth, out to the ear from the nose, on to the same side of chick and across the forehead in three lines to the opposite ear in to the nose and back to the starting point. Depth should be light and speed is fast.

8. Plucking: Stimulating manipulation performed by the tips of the thumb and index finger. Tissues are grasped and let go very quickly. Tapping: Performed with fingertips. One, two or three finger tips are used according to the size of the area of the face being treated. The tap should be firm enough to cause slight indentation (a visible effect made on surface with pressure) of the skin at each Tap. Line of work is as same as Effleurage. It should be very gentle at forehead and supraciliary ridge where thin layer of soft tissues covers the bone.

9. Circular friction: At the point where the nerve enters the face (stylomastoid foramen) in order to soften any inflammatory deposit present over there followed by effleurage to drain them.   Vibration to the Exit Foramina of the Trigeminal nerve: Use either the index or middle fingertip over the points of exit of the Ophthalmic, maxillary and mandibular division of the trigeminal nerve. Ophthalmic branch emerges from supraorbital notch. Maxillary branch from Infraorbital foramen and Mandibular branch from mentalis foramen. (Used in trigeminal neuralgia and tension headache)

10. For sinuses: The fingertips can be placed over the area of the frontal sinus and maxillary sinus. Static vibrations performed to encourage a mechanical effect on the sinuses when they are congested or blocked. Position of patient for frontal sinus is upright position and for maxillary sinus patient is in opposite side lying position. Clapping to the area of Platysma: With cupped fingers area below the chin can be clapped. Strike is in forward and backward direction.

11. Occipitofrantalis stretching to obtain scalp movement: Place the Palmer surface of one hand on the forehead and the palmer surface of other hand under the occiput . Move both the hands simultaneously so that the hand on the forehead takes the front of the scalp downwards towards the eyebrows and other hand takes the back of the scalp upwards. The movement should be smooth and slow. This stretching movement helps in severe headache when the two bellies of Occipitofrantalis often remain in a painful spasm.

12. Incorporate all facial muscle actions: Place your fingertips on each of the muscles of facial expression and mould the muscle actions. Pursuing the lips, Opening the mouth Smiling, Sniffing Wrinkling the nose, Raising the eyebrows Frawnoning , Closing the eyes Blowing or whistling, Expressing disgust Caution: Care should be taken while working in the vicinity of eyes as little neglect may produce serious damage to eyes.

13. UPPER LIMB MASSAGE

14. Preparation of patient: Remove all the cloths from the arm and shoulder to be treated. Shoulder straps should also be slipped off. Position in sitting: Make your patient sit on the stool or chair comfortably. Put the blanket over the other shoulder and wrap it obliquely across both aspects of the trunk to cross under the axilla of the arm to be massaged. Provide a 30” or higher table with a top about the size of a standard pillow. Place a pillow with washable cover on the table. Place the patient’s arm on the pillow so that it rests in a comfortable position of shoulder abduction, elbow flexion and pronated forearm so that fingertips reach the front of the table

15. Position in lying: First prepare a couch with mat and washable cover sheet and fix them with straps. Provide pillow for head, one pillow alongside of the trunk so that the arm can rest on it in a slight abduction and flexion of the shoulder. Ensure that the pronated hand is fully supported on the pillow. Position with elevated arm: Position the patient in lying as above but use additional pillows to ensure that each distal joint is higher than its proximal one. Exposure: Before starting work uncover the whole limb and examine it.

16. Check by observation: about the state of the skin for abrasion and dryness and the posture of joints which may need extra support. Check by palpation: Run your hand down the length of each aspect of the limb and note the temperature, tenderness and muscle tone. Position of therapist: Therapist should stand in walk standing position at the end of the table just beyond the patient’s fingertips. Your outer leg foreword so that you face along the forearm.

17. Techniques: Superficial stroking: - From shoulder to fingers. 4 to 5 strokes covering all aspect of the upper limb. Effleurage: - Performed with one hand and the other hand holds the patient’s hand to Change the position of patient’s forearm which controls stability and position of the hand. 4 to 5 strokes from fingertips to entire length of upper limb which ends at axilla.

18. Strokes are performed in a following order:- Forearm pronated – extensor aspect Starts from postereomedial border of hand, ulnar border of forearm, medial surface of arm to the axilla. Starts from Dorsum of hand, posterior surface of forearm, posterior aspect of arm to the axilla. Forearm mid pronated : Lateral border of hand including thumb, radial border of forearm, and lateral surface of arm to the axilla. Forearm supinated –flexor aspect Palm of the hand, anterior surface of forearm, anterior aspect of arm to the axilla. Anteriomedial aspect of hand, anteriomedial aspect of forearm, medial surface of arm to the axilla.

19. kneading:- Double handed finger kneading around shoulder joint. Single handed finger kneading over deltoid. Palmer kneading alternately over biceps and triceps. Palmer kneading to upper part of the forearm. Fingertip kneading in the interosseous space. Thumb kneading over thenar and hypothenar eminence. Spiral kneading for all fingers. Picking up: - In upper limb muscles it is usually performed with one hand from proximal to distal. Outer hand works on deltoid, triceps and brachioradialis . Inner hand works on the Biceps brachii and forearm flexors. Wringing:- Most easily performed on the long muscles of triceps and biceps brachii .

20. Hacking and clapping: It is performed first on one aspect of the upper limb than altered the position of forearm and other aspect is treated. All bony prominences should be avoided during Hacking. Forearm pronated - start from posterior wall of axilla, over posterior deltoid slides down to triceps and forearm extensors. Forearm supinated - start from anterior wall of axilla, anterior deltoid, over biceps brachii to forearm flexors. Friction: Circular and transverse friction. After completion of all technique again give effleurage to whole upper limb.

21. LOWER LIMB MASSAGE

22. The whole lower limb is usually treated as one unit or it can be treated in part. To treat whole limb position your patient according to area to be treated. Position of therapist: Therapist should stand in walk standing position with rear foot distal to the patient’s foot and outer leg foreword level with the patient’s leg. Preparation of patient: Remove all the cloths below the waist except underwear. Check that the feet are clean and if not ask the patient to wash.

23. Position in lying Supine position: (to treat anterior aspect) First prepare a couch with mat and washable cover sheet and fix them with straps. lying flat or half lying position is used. Provide pillow for head, either large pillow for both knees or two small pillows under each knee. Cover the other leg and upper body part. For elevation of limb use additional pillows or raise the feet end of the coach. Prone position: (to treat posterior aspect) provide pillows for head, under abdomen, under both ankles to ensure slight flexion at knee and ankle.

24. Techniques Superficial stroking: From thigh to toe 3 to 6 strokes covering all aspect of the lower limb.   Effleurage: - Performed with both the hands alternatively or simultaneously. Starting from toe and ending at the inguinal lymph nodes. Over thigh: Effleurage: consists of 3 to 6 strokes covering all aspect of thigh. Stroke ends at inguinal lymph nodes. Kneading: double handed Palmar kneading to i anterio - posterior aspect together and ii. Medio - lateral aspect together Picking up: on quadriceps, adductors and hamstrings. Hacking and beating Effleurage

25. Over knee: Effleurage: performed by crossing both the hand above patella and ends at the Popliteal Fossa. Thumb kneading: around margin of patella. Friction: over medial and lateral collateral ligaments of the knee joint. Effleurage Over leg: Effleurage: starts from toe, ends at popliteal Fossa.   Over calf muscles: Palmar kneading on upper calf, thumb or finger kneading on the lower calf. Picking up Hacking Over tibial and peroneal muscles: Palmar kneading on upper half, thumb or finger kneading on the lower half. Picking up Hacking Effleurage Over foot: Effleurage : stroke ends at ankle Fingertip kneading: on the interosseous space and over extensor digitorum brevis . Effleurage to whole lower limb .

26. MASSAGE TO THE BACK

27. The back can be divided into 3 areas- Thoracolumbar , Gluteal Region And The neck. Thoracolumbar region Superficial stroking: from proximal to distal. Effleurage: Performed with both the hands working together, starts from the most lateral lumber region goes up to axilla. central lumber region up to axilla. From posterior superior iliac spine-mid line of back-neck-supraclavicular nodes. Ironing: over the entire back. First on the same side and change your position for opposite side.

28. Finger kneading: over paravertebral area both the hands used starting from lower back to the upper back. Hacking: entire back leaving the spinus process and scapular prominences. Beating and pounding Skin rolling: from side to midline and from distal to proximal.

29. MASSAGE TO THE NECK Effleurage: performed with palmar aspect of adducted fingers. It consists of 3 strokes in the following order. The direction of stroke is from upper to lower neck. Side of neck to supraclvicular area. Back of neck to supraclavicular area. Midline to side of neck to scapular muscle to axilla. Fingerpulp kneading to occiput, upper trapezius and midscapular muscles. Picking up: upper fiber of trapezius . Hacking effleurage

30. Gluteal region Self study

31. Book reference 1.Principles and practice of therapeutic massage , 2 nd edition :Akhoury gourange sinha .