1M Massage Nov09 (Secured)

Massage
Healing Touch

Property of Lay Institute for Global Health Training www.lightingtheworld.org 1
Table of Contents

PART 1 INTRODUCTION AND HISTORY OF MASSAGE............................................................................................... 2
PART 2 -POSTURE...................................................................................................................................................................... 2
PART 3 TERMS AND DEFINITIONS.................................................................................................................................... 3
PART 3 - BENEFITS, EFFECTS, CONTRAINDICATIONS.................................................................................................. 4
BENEFITS ..................................................................................................................................................................................... 4
EFFECTS ....................................................................................................................................................................................... 4
CONTRAINDICATIONS................................................................................................................................................................... 6
PART 4 -BASIC MASSAGE STROKES.................................................................................................................................... 9
1. TOUCH...................................................................................................................................................................................... 9
2. GLIDING MOVEMENTS OR EFFLEURAGE .................................................................................................................................. 9
3. KNEADING MOVEMENTS OR PETRISSAGE................................................................................................................................. 9
4. PERCUSSION MOVEMENTS OR TAPOTEMENT.......................................................................................................................... 10
5. JOINT MOVEMENTS ................................................................................................................................................................ 11
PART 5 BACK MASSAGE...................................................................................................................................................... 12
PART 6 FIVE MINUTE CHAIR MASSAGE....................................................................................................................... 13
HEALTH EXPO MASSAGE ........................................................................................................................................................... 13
PART 7 FLEXIBILITY EXERCISES ................................................................................................................................... 14
Upper Body Flexibility Exercises.......................................................................................................................................... 14
Lower Body Flexibility Exercises.......................................................................................................................................... 14
PART 8 - RANGE OF MOTION EXERCISES ....................................................................................................................... 15
UPPER EXTREMITY..................................................................................................................................................................... 15
LOWER EXTREMITY ................................................................................................................................................................... 16

The work of Christ in cleansing the leper from his terrible disease is an illustration of His work in cleansing the soul
from sin. The man who came to Jesus was "full of leprosy." Its deadly poison permeated his whole body. The
disciples sought to prevent their Master from touching him; for he who touched a leper became himself unclean. But
in laying His hand upon the leper, Jesus received no defilement. His touch imparted life-giving power.
Desire of Ages, p. 266.
Massage
Healing Touch

Part 1 Introduction and History of Massage

Definition- systematic manual or mechanical manipulations of the soft tissues of the body by:
* Rubbing * Kneading *Pressing *Rolling *Slapping *Tapping
Massage is used therapeuticly for such purposes as:
o promoting circulation of the blood and lymph
o relaxation of the muscles and relief from pain
o restoration of metabolic balance and more
Origin of the word, Massage

Fast Facts about Massage
o It is one of earliest remedial practices known to man
o Most natural and instinctive means of relieving pain and discomfort
o Practiced in nearly all ancient cultures and developed and taught primarily by physicians
o Written about extensively in medical books since 500 B.C.
o Used by Chinese starting around 3000 B.C. - It is found in Hindu books around 1800 B.C.
o Used by Greeks well before 300 B.C. - Discovered by Japanese around 6th century A.D.
o Declined severely during Dark Ages (along with the Bible), but revived in Renaissance era
o Has fluctuated in popularity through time until now
o Continues to be a powerful ministry tool to win peoples hearts and confidence
Note the following quote from: "The American Woman's Home," by C. E. Beecher and Harriet Beecher Stowe
Quoted by Ellen G. White in the Health Reformer, June 1, 1873.
Would it not be quite as cheerful, and a less expensive process [than paying for a massage], if young girls from early
life developed the muscles in sweeping, dusting, starching, ironing, and all the multiplied domestic processes which our
grandmothers knew of? A woman who did all these, and diversified the intervals with spinning on the great and little
wheel, did not need the Swedish movement cure, which really [is] a necessity now. does it not seem poor economy
to pay servants for letting our muscles grow feeble, and then to pay operators to exercise them for us? I will venture to
say that our grandmothers went over, in a week, every movement that any gymnast has invented, and went over them
with some productive purpose, too."

Part 2 -Posture

Education, p. 198. Among the first things to be aimed at should be correct position both in sitting and standing. God
made man upright and He desires them to possess not only the physical but the mental and moral benefit, the grace and
dignity and self-possession, the courage and self-reliance, which an erect bearing so greatly tends to promote
Definition #1: refers to the relationship and alignment of body parts to one another
Definition #2: is the correct alignment of body segments habitually maintained by muscles
Normal posture varies with the person and it does not necessarily mean good posture
Good posture = body balanced between left and right, front and back, and properly aligned parts
Benefits of Good Posture:
o All joints of the body are less susceptible to restriction and strain.
o The organs of the body are permitted to function more efficiently.
o Less effort and energy are required to maintain the body in balance.
o Muscular efficiency is improved.
o Personality is expressed through good posture.
o Personal appearance is improved.
o Poor posture habits cause fatigue and strain on the muscles, joints, and spinal column.
Greek - masso or massein Latin - massa Arabic - massh Sanskrit - makeh
means to touch, handle, knead or squeeze means to press softly
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PART 3 Terms and Definitions

Anatomical Position
The body is in an erect or standing posture with the arms at the sides and palms turned forward. The head and feet also
point forward. The anatomical position is a reference position that gives meaning to the directional terms used to
describe the body parts and regions.
Supine: The body is lying face upward
Prone: The body is lying face downward

Anatomical Directions
1. Superior: toward the head
2. Inferior: toward the feet
Example: The lungs are superior to the stomach.
3. Anterior: in front of
4. Posterior: in back of
Example: The nose is on the anterior surface of the body; the scapula is on the posterior surface
5. Medial: toward the midline of the body
6. Lateral: toward the side of the body or away from its midline
Example: The great toe is at the medial side of the foot.
7. Proximal: toward or nearest the trunk of the body, or nearest the point of origin of one of its parts
8. Distal: away from or farthest from the trunk or the point of origin of a body part.
Example: The elbow lies at the proximal end of the lower arm, and the hand lies at the distal end.

9. Superficial: nearer the body surface
10. Deep: farther away from the body surface
Example: The skin of the arm is superficial to the muscles below it; the bone is deep to the muscles that cover it.

Bursa - a fluid filled sac that cushions movement. (eg. Tendons slide over bones)(bursitis)

Hematoma - a crush injury in which many small blood vessels are broken. Blood seeps into the surrounding tissue and a
bruise or lump appears

Inflammation - irritation, swelling, reddening, and heat combined

Joints - where any two bones meet

Ligaments - tough, fibrous tissue that connects bone to bone

Rupture - complete tearing apart of a muscle, tendon or ligament

Sprain- an irritation, slight swelling, or microscopic tearing of a ligament

Strain - an irritation, slight swelling, or microscopic tearing of a muscle or tendon

Tendon - tough, fibrous tissue that connects bone to muscle

Tendinitis - an irritated, swollen and strained tendon

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Part 3 - Benefits, Effects, Contraindications
Benefits

Physical Benefits
o Increases metabolism
o Speeds healing
o Relaxes and refreshes the muscles
o Improves the detoxifying functions of the lymphatic system
o Helps to prevent and relieve muscle cramps and spasms
o Improves circulation of blood and lymph
o Effective in pain management
o Healthy skin tone

The immediate effects of massage are noticeable on the skin. Friction and stroking movements increase blood
circulation to the skin and increase activity of the sweat and oil glands. Accompanying the increased flow of blood,
there is a slight reddening and warming of the skin. Nutrition to the skin is also improved. Massage treatments over
a period of time impart a healthy radiance to the skin. The skin tends to become softer, more supple, and of finer
texture. The physiological effects of massage are not limited to the skin. The stimulation of muscular, glandular, and
vascular activities through massage give an overall benefit.

Physiological Benefits
o Relieves fatigue
o Reduces tension and anxiety
o Stimulates muscles and immune system*
o Calms the nervous system*
o Promotes a sense of relaxation and renewed energy*
*These various effects depend on the type of stroke you use with the person.

!!NOTE!! Under no circumstances should massage be applied so vigorously that it causes the patient to feel
exhausted or results in bruised or injured tissues.

Effects

Effects on the Musculoskeletal System
Massage encourages the nutrition and development of the muscular system by stimulating its circulation, nerve
supply, and cell activity. Regular and systematic massage causes the muscles to become firmer and more elastic.
Massage is also an effective means of relaxing tense muscles and releasing muscle spasms.
The supply of blood to the muscles is proportionate to their activity. It is estimated that blood passes three more
times as rapidly through muscles being massaged than muscles at rest. Petrissage or kneading and compression
movements create a pumping action that forces the venous blood and lymph onward and brings a fresh supply of
blood to the muscles. Massage aids in the removal of metabolic waste products and helps nourish tissues.
Massage prevents and relieves stiffness and soreness of muscles. Muscles fatigued by work or exercise will be
more quickly restored by massage than by passive rest of the same duration. Muscle tissue that has suffered injury
heals more quickly due to consistent treatments, and friction massage, when properly applied, prevents and reduces
the development of adhesions and excessive scarring following trauma.
Improves muscle tone and helps prevent or delay muscular atrophy resulting from forced inactivity.
Encourages the retention of nitrogen, phosphorus and sulfur necessary for tissue repair in persons convalescing
from bone fractures.
Lessens pain in conditions such as arthritis, neuritis, labor and delivery, whiplash, muscular lesions, sciatica,
headache, muscle spasms, and many other conditions

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Effects on the Nervous System
May have a sedative, stimulating or even exhausting effect on the nervous system depending on the type and
length of massage treatment given.
The effects of massage on the nervous system depend on the direct and reflex reaction of the nerves stimulated.

1. Stimulating massage techniques:
a. Friction (light rubbing, rolling, and wringing movements) stimulates nerves
b. Percussion (light tapping and slapping movements) increases nervous irritability. Strong percussion for a short
period of time excites nerve centers directly. Prolonged percussion tends to anesthetize the local nerves.
c. Vibration (shaking and trembling movements) stimulates peripheral nerves and all nerve centers with which
nerve trunk is connected

2. Sedative massage techniques:
a. Gentle stroking, especially over reflex areas, produces calming and sedative results
b. Light friction and petrissage (kneading movements) produce marked sedative effects

Effects on the Circulatory System
Massage procedures affect the quality and quantity of blood coursing through the circulatory system. With the
increased flow of blood to the massaged area, better cellular nutrition and elimination are favored. The work of
the heart is lessened due to the improvement in surface circulation. Under the influence of massage, the blood-
making process is improved, resulting in an increase in the number of red and white blood cells. Increases blood
supply and nutrition to muscles without adding to their load of toxic lactic acid, produced through voluntary
muscle contraction. Thus, it helps to prevent buildup of harmful fatigue products resulting from strenuous
exercise or injury.
Can compensate, in part, for lack of exercise and muscular contraction in persons who, because of injury, illness,
or age, are forced to remain inactive. In these cases, massage helps return venous blood to the heart and so eases
the strain on this vital organ.
By improving the general circulation, increases nutrition of the tissues. It is accompanied or followed by an
increased interchange of substances between the blood and tissue cells heightening tissue metabolism.
Increases the excretion (via the kidneys) of fluids and waste products of protein metabolism, inorganic phosphorus
and salt in normal individuals.
Stretches connective tissue, improves its circulation and nutrition and so breaks down or prevents the formation of
adhesions and reduces the danger of fibrosis.
Improves the circulation and nutrition of joints and hastens the elimination of harmful deposits. It helps lessen
inflammation and swelling in joints and so alleviates pain.
Helps to reduce edema (or dropsy) of the extremities.
Disperses the edema following injury to ligaments and tendons, lessens pain and facilitates movement.

**An important principle to remember in massage is to always massage toward the heart. Massage movements
should be directed upward along the limbs and lower parts of the body and downward from the head, thereby
facilitating the flow of venous blood and lymph back toward the heart and other eliminatory organs.

Massage movements affect blood and lymph channels in the following ways:
1. Light stroking produces an almost instantaneous, though temporary, dilation of the capillaries, while deep stroking
brings about a more lasting dilation and flushing of the massaged area
2. Light percussion causes a contraction of the blood vessels, which tend to relax as the movement is continued
3. Friction hastens the flow of blood through the superficial veins
4. Petrissage or kneading stimulates the flow of blood through the deeper arteries and veins
5. Friction, kneading, and stroking stimulate lymph circulation
6. Compression produces an increase in the amount of blood stored in the muscle tissue

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Psychological Effects
The psychological effects of massage should not be underestimated. If the patient feels healthier, invigorated, and
more energetic, the massage has been worth the effort. People have regular massages as much as for psychological as
for physical benefit.

**Many people suffer from stress and find that massage promotes relaxation as it soothes away minor aches and
pains. For some, regular massage keeps them feeling more youthful and encourages then to pay more attention to
proper nutrition, exercise, and good health practices.
Massage helps people to become more aware of where they are holding tension, and where they have tight
muscles or painful areas. You may discover areas that the patient may not have been aware of previously. By
understanding these conditions, the patient can begin to focus on relaxing them both during the massage and on a
daily basis. The patient should be told that when muscles are tight there is constriction in the circulation to the
restricted area. Becoming aware of these trouble spots and responding to them is considered a part of preventative
medicine.

Conditions relieved by massage:
Stress and tension.
Mental and physical fatigue.
Pain in the shoulders, neck, and back.
Muscles and joints become more supple.
Muscle soreness from overexertion can be reduced or prevented.
Circulation is improved, improving skin tone.
Digestion, assimilation, and elimination are often improved.
Facial massage tones the skin, helps prevent blemished skin.
Headache and eyestrain.
Deep relaxation is induced and insomnia relieved.
Muscular spasms are relieved.
Obesity and flabby muscles can be improved when combined with proper exercise and diet programs.
Pain in joints, sprains, and poor circulation.
Mental strain is reduced.
Mildly high blood pressure is temporarily reduced.
Joint mobility can be increased.

Contraindications
In some cases massage should NOT be done at all, such as:
o severe, uncontrolled hypertension
o shock
o acute pneumonia
o toxemia during pregnancy

Cancer - disease that can be spread through lymphatic system
o Massage tends to increase lymph flow so it would aid cancer growth

Intoxication
o Massage can spread toxins and overstress the liver

Endangerment sites
o Areas in which the nerves or blood vessels are close to the surface of the skin (eyes, facial nerve, lymph nodes,
azillary area, etc.)
o Areas that contain bony projections that could be broken off by pressure (zyphoid process)
o Loosely suspended organs (kidneys)
o When working on an endangerment site either avoid the area or use light pressure

Abnormal body temperature
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o 98.6 F or 37.0 C is considered normal body temperature although it may vary slightly from 96.4 to 99.1 F.
o Take patients temperature if they feel abnormally hot
o Fever generally indicates body is trying to isolate and eliminate an invading and massage could add extra an
extra burden and distraction to disease-fighting processes.

Acute infectious disease
o Typhoid
o Malaria
o Diphtheria
o Severe colds
o Influenza, etc.
o Massage will intensify the illness and expose the therapist to the virus

Inflammation
o Massage could further irritate the area or intensify the inflammation.
o Helpful pressure points for inflamed joints
o Therapeutic touch, simply placing your hands on or near the inflamed area, may be helpful.
o Listen for disease that end in itis. For example: arthritis

Inflammation due to tissue damage - bodys natural response to protect and speed tissue healing
o Characterized by swelling, redness, heat, and pain.
o Any reddening is a sign of inflammation.

Osteoporosis
o Leads to deterioration of bone
o Advanced stages bones become brittle; are sometimes easily broken
o Prevalent in elderly and in certain kinds of diseases.
o Best to obtain advice of clients physician before giving massage

Varicose veins - valves in veins break down because of back pressure in circulatory system
o Veins bulge and rupture, usually in legs
o Usually result from crossing legs or standing daily for long periods of time
o In women pressure on large veins in pelvic area during pregnancy can cause varicose veins
o Extensive back pressure in veins causes veins to enlarge and stretch to the point that the valves become
incompetent.
o The weight of the blood further distends the veins and more valves then become dysfunctional.
o When veins become abnormally dilated due to excessive back pressure, they rupture and are called varicose
veins.
o Blood then accumulates in the enlarged portion of the vein.
o If the flow of blood becomes obstructed, clotting may occur.
o Appear bluish, protruding, thick, bulbous, distended superficial veins usually in lower legs
o Use caution around small reddish groupings of broken blood vessels that often surround a small, protruding
vein.
o Deep massage on these areas may set blood clot loose in general circulation and cause a serious problem.

Phlebitis - inflammation of a vein accompanied by pain and swelling
o May be result of surgery, secondary to infection or injury, or have no apparent cause

Aneurosa - localized dilation of a blood vessel or an artery
o It can be caused by arteriosclerosis, hypertension, or trauma and is generally located in the aorta, thorax, and
abdomen and sometimes the cranium.

Hematoma - is a mass of blood trapped is some tissue or cavity of the body
o Is the result of internal bleeding. Examples: contusions or bruises
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! Contusions usually occur as a result of a blow that is severe enough to break a blood vessel.
! Escaping blood leaves familiar black and blue spot.
! Blood quickly clots; in time, body naturally reabsorbs cellular debris.
! Bruise changes color to greens and yellows and eventually disappears.
! In acute phase, massage is contraindicated because of risk of re-injuring the tissue.
! Once bruise has changed colors, light massage enhances circulation to area; aids healing

Edema - Excess accumulation of fluid in tissue spaces; Is a circulatory abnormality
o Appears as puffiness in extremities; sometimes more widespread.
o Massage and mild exercise may be helpful if edema is result of back pressure in veins due to immobility

High blood pressure (160/95)
o Do not massage an individual with uncontrolled hypertension
o Massage may help mild HBP and is good for those who have their hypertension under control

Fatigue
o In cases of chronic fatigue, the excretory system is already over-burdened and there is little to nourish those
overworked and exhausted tissues
o Massage should be extremely light and superficial to induce rest and relaxation.

Frail elderly people:
o May have fragile bones and very sensitive skin.
o Do a gentle massage if necessary

Scoliosis - a crooked spine
o Massage must be recommended by their physician.
o Use caution.

If condition is only to a local part of the body, other areas of the body may still be massaged. Examples include:
o open wounds
o acute neuritis or arthritis

Skin problems:
o Usually only the affected areas are of concern
o Examples include: Acne, broken vessels, Burns, Blisters, Boils, Bruises, Carbuncles, Eczema, Moles, Skin
Tags, Pimples, Sores, Impetigo, Rashes, Stings, Bites, Inflammation, Scaly sports, Tumors, Lacerations,
Scratches, Warts, Lumps, Skin Cancer & Open Wounds.

Hernia - a protrusion of an organ or part of an organ; ex. intestine poking through abdominal wall
o Also referred to as a rupture
o Massage is not recommended over or near the afflicted area.

Specific conditions or disease:
o Examples - severe asthma, diabetes, or any type of heart or lung disease
o Massage should not be given without the physicians knowledge and advice.

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Part 4 -Basic Massage Strokes

Overview of Swedish Massage Strokes
These strokes can be performed in any combination on the different parts of the body
The therapist must understand the movement to be applied to a particular part of the body. For example,
Light movements are applied over the thin tissues or over bony parts.
Heavy movements are indicated for thick tissues or fleshy parts.
Gentle movements are applied with a slow rhythm.
Vigorous movements are applied in a quick rhythm and stimulate.
When applying the movements, the therapist must pay close attention to the overall response of the client as well
as the response of the tissue or body part to which the manipulation is being applied and adjust the application
accordingly.
An important rule in Swedish massage is that most manipulations are directed toward the heart (centripetal).
Many massage techniques are intended to enhance venous blood and lymph flow and therefore are directed towards
the heart and other eliminative organs. Only strokes light enough that they do not affect fluid flow may be directed
away from the heart.
The duration of a treatment should be regulated. Usually a therapeutic full-body massage takes about one hour,
but some therapists like to take more or less time. A prolonged massage can be fatiguing to some clients. While
learning, a student might take up to a maximum of two hours. It takes practice for the movements to become smooth
and efficient. Knowledge and experience will help regulate the massage based on the patients need.
1. Touch
This is the first technique you will use in in developing a therapeutic relationship with your patient. This is the
primary communication used by the massage therapist.
Light or superficial touch is purposeful contact in which the natural and evenly distributed weight of the
therapists finger, fingers, or hand is applied on a given area of the patients body. Touch can be remarkably effective
in the reduction of pain lowering of blood pressure, control of nervous irritability, or reassurance for a nervous, tense
client. If a person has signs of contraindications for a basic massage, or is in fragile condition, a complete treatment
using light touch exclusively is acceptable.
Deep touch using pressure is performed with one finger, thumb, several fingers, or the entire hand, knuckles, or
elbow. This is used when calming, relaxing, or stimulating effects are desired. Deep pressure may be used with other
techniques such as cross-fiber friction, compression, or vibration. Deep pressure is useful in soothing muscle spasms
and relieving pain at reflex areas, stress points in therapy, and trigger points in muscles. When using deep pressure,
caution must be used to stay within the pain tolerance of the patient. *Body mechanics are used in such a way that the
pressure is delivered through body movement rather than simply hand and upper-body strength.
2. Gliding movements or Effleurage
These strokes may be done using a varying amount of pressure and length of strokes. These glide over the
patients entire body, body part, or a specific area.
Feather stroking: use very light pressure of the fingertips or hands with long flowing strokes. The application of
feather stroking, sometimes called nerve stroking, is usually done from the center outward and is used as a final
stroke to individual areas of the body. Two or three such strokes will have a slightly stimulating effect on the nerves,
while many repetitions will have a more sedating response.
Gliding or effleurage: is the succession of strokes applied by gliding the hand over a somewhat extended portion
of the body. There are two varieties of effleurage: superficial and deep. These techniques are accomplished either
with the fingers, thumbs, the palm of the hand, the knuckles, or the forearm.
3. Kneading movements or petrissage
is used on all fleshy areas of the body. Like gliding, kneading enhances the fluid movement in the deeper
tissues. Skillfully applied, kneading helps reduce adhesions and stretch muscle tissue fascia. In this movement, the
skin and muscular tissues are raised from their ordinary position and then squeezed, rolled, or pinched with a firm
pressure, usually in a circular direction.
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Fulling: is a kneading technique in which the therapist attempts to grasp the tissue and gently lift and spread it
out, as if to make more space between the tissue or muscle fibers. The fleshy body part is gathered up between two
hands, then raised and separated by the thumbs and gently separated.
Skin rolling: is a variation of kneading in which only the skin and subcutaneous tissue is picked up between the
thumbs and fingers and rolled. Skin rolling warms, stretches, and begins to separate adhesions between fascial
sheaths; in particular, this movement is excellent for eliminating skin ischemia. Use no lubricant for this technique.
Gather up a roll skin between the thumbs and fingers. Continue to gather up more skin with the fingers as you slowly
progress along the surface of the body. The thumb supports the roll of skin and slowly slides along as more skin is
picked up by the fingers.
4. Friction
involves moving more superficial layers of flesh against the deeper tissues. Friction presses one layer of tissue
against another layer in order to flatten, broaden, or stretch the tissue. Friction is done in such a way that it also
increases heat. As heat increases, the metabolic rate increases. Friction also increases the rate at which exchanges
take place between cells and the interstitial fluids (fluids situated between the cells and vessels in the tissues of an
organ or body part.) The added heat and energy also affect the connective tissue surrounding the muscles, making
them more pliable so they function more efficiently. Friction movements may be circular or directional.
Circular friction: the fingers or the palm of the hand contact the skin to move it in a circular pattern over the deeper
tissues. This is intended to produce heat and stretch and soften the fascia. This is used as a general stroke to warm
the area in preparation for more specific or deeper work. Also, circular friction is valuable for palpating an area when
assessing the condition of the underlying tissues.
Cross fiber friction: is applied in a transverse direction across the muscle, tendon, or ligament fibers. It is usually
applied with the tips of the fingers or the thumb directly to the specific site of lesion. The intention of cross fiber
friction is to broaden, separate, and align the fibrous tissue. When massaging a fibrous band, this friction stroke is not
so broad that it snaps across the fiber. The fingers do not move over the skin but move the skin and superficial tissues
across the target tissue.
Compression: is rhythmic pressing movements directed into muscle tissue by either the hand or fingers.
Palmar compression: is done with the whole hand (palm side) or the heel of the hand over the large area of the body.
Compression movements cause increased circulation and a lasting hyperemia in the tissue.
Rolling: is a rapid back and forth movement with the hands, in which the flesh is shaken and rolled. The intention of
rolling is to warm and relax the tissue, and to encourage deep muscle relaxation.
Chucking: is accomplished by grasping the flesh firmly in 1 or 2 hands, and moving it up and down along the bone.
Wringing: is a back and forth movement in which both of the therapists hands are placed a short distance apart on
either side of the limb. It resembles wringing out a washcloth. The hands work in opposing directions, stretching and
twisting the flesh against the bones in opposite directions. Pressure is not so excessive as to cause pinching or
burning (irritation) of the skin. Wringing gently stretches and warms the connective fascia.
Shaking: is a movement that allows the client to release tension and at the same time indicates to the therapist where
the client may be storing tension in a part of the body. The relaxed body part is gently yet forcefully shaken laterally
or horizontally so that the relaxed flesh flops around the bone. The therapist observes where the body moves freely
and where it seems to be stiff. Rigidness indicates body areas that are tense and require more attention.
Vibration: is a continuous shaking or trembling movement transmitted from the therapists hand and arm or from an
electrical appliance to a selected area from the body. Vibration is usually done with the pads at the ends of the fingers
or the palm of the hand. Light contact is made and the hand shaken back and forth as quickly as possible without
moving over the skin where contact is being made. The effect of this technique depends on the rate of vibration, the
intensity of pressure, and the duration of the treatment. This form of massage is soothing and brings about relaxation
and release of tension when applied lightly. It is stimulating when applied with pressure. A numbing effect is
experienced when vibrations are applied for a prolonged period of time.
4. Percussion movements or tapotement
include quick, striking manipulations such as tapping, beating, and slapping, which are highly stimulating to the
body. Percussion movements are executed with both hands simultaneously or alternately. They do not use much
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force, as each blow to the body is a glancing contact wherein the therapists wrists remain very relaxed. The general
effects of percussion movements are to tone the muscles and impart a healthy glow to the part being massaged. With
each striking movement, the muscles first contract then relax as the fingers are removed from the body. In this way,
muscles are toned.
Tapping or tapotement: is the lightest, most superficial of the percussion techniques. Tapping is used over delicate,
sensitive area such as the face. Only the fingertips are used for tapping.
Slapping: is very stimulating and must be used sparingly. It encourages peripheral circulation and creates a glow
to the area. It is applied with the palmar surface of the fingers and the hand. Heavy pressure is avoided.
Cupping: is most often employed over the rib cage. To perform cupping, form a cup by keeping the fingers together
and slightly flexed and the thumb held close to the side of the palm. Only the perimeter of the hand touches the body.
The resulting sound is a hollow popping.
Hacking: encourages relaxation and local circulation. Some theories claim that hacking stimulates the nerve
responses in muscles and helps to firm the muscles. Hacking is a rapid striking movement that can be done with one
or both hands. When both hands are used the hands may strike alternately or together. A quick glancing strike is
made with the little finger and the ulnar side of the hand. The wrist and fingers remain loose and relaxed and the
fingers are slightly spread apart.
Beating: is the heaviest and deepest form of percussion and is done over the thicker, denser, and fleshier areas of the
body. The hands are held in a loose fist. Contact is made with both hands either together or alternately. The wrists
are relaxed so the contact is the result of a rebounding, whiplike action of the hand and wrist. The force is never
heavy or hard. Instead it is firm and quick.
5. Joint movements
The basic classifications of joint movements are passive and active. Passive joint movements (PJM) are done
while the client remains quietly relaxed and allows the therapist to stretch and move the part of the body to be
exercised. Passive joint movements can be used as an assessment tool to determine normal movement (ROM without
restriction or pain). PJMs gently stretch the fibrous tissue and move the joint through its range of motion. They are
used therapeutically to improve joint mobility and range of motion. Active joint movements (AJM) are done with the
client actively participating in the exercise by contracting the muscles involved in the movement. This type of
treatment is usually used as a therapeutic technique to restore mobility, flexibility, or strength to a limb that has been
injured. (In particular, active resistance joint movements).
To be most effective, joint movements should be applied through the full ROM. ROM = Range of Motion, which
is the movement of a joint from one extreme of the articulation to the other. Joint movements have a great
therapeutic benefit as an assessment tool and as a treatment to enhance function and mobility.

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Part 5 Back Massage

Preliminary Steps:
o Obtain all necessary supplies and arrange as needed.
o Perform a consultation to determine the clients needs and contraindications.
o See that the client has all items needed to prepare for the massage.
Therapists Preparation for Massage:
o Wash and sanitize your hands.
o Assist the client onto the massage table.
o Drape the clients body with a sheet or towel.
o Pray.

Skin Roll: Pick up the skin between the thumbs and fingers and roll forward slowly, lightly applying pressure between
the thumbs and fingers.
Butterfly Stroke: Standing at the top of the table with hands resting on either side of the spine, effleurage up the neck
applying slight traction to occiput, then effleurage down neck and shoulders, pivot at deltoids, over scapula, and down
mid back, and include fan strokes to the lower back area, and smoothly return to neck area. May include light traction to
lower back region during sequence.
Erector Compression: Standing at top of table, place thumbs on both sides of the spine. Apply pressure, and slowly
glide the thumbs down the erector muscles, until you reach the sacrum, then slowly bring hands back up to neck, and
repeat.
Racking Intercostals: Rake with the pads of fingers along intercostal spaces in between the ribs in a pulling motion from
opposite side of table. May use hand over hand sequence.
Petrissage: Petrissage entire back and shoulder regions, and back of neck.
Scapula Release: Gently place clients forearm across their lower back, and place your upper hand under the same
shoulder where it can be lifted to further expose the scapula. Use gentle to deep effleurage to warm up tissue under the
scapula.
Forearm Stroke: Standing at clients side, effleurage up back using your forearm. Pivot elbow to follow around medial
side of the scapula. Apply pressure by gently leaning over the working arm.
Wringing: Consists of full horizontal wringing strokes across muscle fibers moving up and down entire back. Therapist
should be standing on side of table.
Sacral Heel Press: Apply gentle yet firm pressure with palm of hands on either side of the spine over sacral region.
Slowly with continued pressure slide out away from spine along sacrum. Come back up by pulling skin in upward
direction toward sacrum.
Fan Strokes: Standing at the side of the table facing toward the head of the client, place hands on either side of spine and
effleurage up and out in a fan-type movement. Continue moving up the back covering only a section of the back at a
time as you go. May also use wider and longer strokes to cover entire back more quickly, or stand at head of client, and
begin at upper back.
Tapotement: May use hacking or cupping in shoulders and upper back. Avoid spine and kidney areas. Percussion
(tapping) is beneficial to loosen secretions in the lungs of congested clients.
Nerve Strokes: Light even strokes made with the fingertips starting at the lower back, pulling toward the head.

Massage
Healing Touch


Part 6 Five Minute Chair Massage

Health Expo Massage

The Procedure
The massage subject should remove all extra clothing such as a jacket, sweater or tie. Seat them where they can be
comfortable, preferably in a chair where the head and upper back are in easy access. Both feet should be flat on the floor.
If possible, the head should be supported by some kind of face rest.

1. Posterior effleurage of the entire back, five times
Begin by standing behind your subject, placing your hands on their shoulders. Lean your body
forward and press firmly, yet gently, gliding your hands over their entire back (being careful not to
pull the shirt or blouse.). This warms the muscles and introduces the patient to your touch.

2. Shoulder and Neck Petrissage (Kneading)
With one hand on each shoulder, knead the nape of the neck, moving hands laterally to the
shoulders, and then back. This motion is similar to that of kneading dough.

3. Palm Friction
Then, using the heel of your hand, move in a circular motion alongside the spine from the bottom to
the top. Work one side first, then the other, and repeat.

4. Digital Friction
With your thumb on one side of the neck and your index and middle fingers on the other, rub the
neck muscles with a circular motion (friction). Rub from the base of the skull to the base of the
neck.

5. Posterior Percussion (Tapotement)
Now, using the sides of your hands and with fingers extended and together, hack to the back on either
side of the spine, and on the shoulders and neck.

6. Nerve Vibration
We end the routine with fingertip vibration all across the back, shoulders and neck.

There are a few other important points youll want to remember.
Once you touch the person, do not remove your hands until the massage is completed.
In all massage strokes, maintain equal rhythm and pressure.
Be friendly and sociable, but be careful not to over talk.
Be attentive to the body language of the person.
Ask the individual several times throughout the massage if the level of pressure is comfortable.

Massage
Healing Touch

Part 7 Flexibility Exercises

Stretching has been shown to improve an individuals overall health and wellbeing. For best results do these exercises
after the body has been warmed up by exercise.

General stretching guidelines:
Stretch the muscle fully but not until it hurts
Breathe out into the stretch
Do not hold your breath
Hold the stretch for 10-30 seconds
Shake out the limbs between stretches
Complete 2-3 stretches before doing th next stretch

Upper Body Flexibility Exercises
Stretch #1 Shoulder & Chest
This can be performed kneeling or standing. Clasp hands behind back and straighten arms. Raise
hands as high as possible and bend forward from the waist and hold.

Stretch #2 Arm Across Chest
Place one arm straight across chest. place hand on elbow and pull arm towards chest and hold. Repeat with
other arm.

Stretch #3 Triceps Stretch
Place one hand behind back with elbow in air. Place other hand on elbow and gently pull towards head.
Hold and repeat with other arm.

Lower Body Flexibility Exercises
Stretch #4 Glute Stretch
Sitting on floor with right leg bent, place right foot over left leg. Place left arm over right leg so
elbow can be used to push right knee. Hold and repeat for other side.

Stretch #5 Adductor Stretch
Stand with feet as wide apart as is comfortable. Shift weight to one side as knee bends. Reach towards
extended foot and hold. Repeat for other side.

Massage
Healing Touch


Stretch #6 Single Leg Hamstring
Place leg out straight and bend the other so your foot is flat into your thigh. Bend forward from the
waist keeping your back flat. Hold and repeat with the other leg.

Stretch #7 Standing Quadriceps
Standing on one leg grab the bottom of one leg (just above ankle). Pull heel into buttocks and push the hips out.
Your thigh should be perpendicular to the ground. Hold and repeat with the other leg.

Stretch #8 Standing Calf
Place feet in front of each other about 18 inches apart. Keep back leg straight and heel on the floor. Push
against a wall to increase the stretch. Hold and repeat with other leg.

Information adapted from www.sport-fitness-advisor.com/flexibility-exercises.html

Part 8 - Range Of Motion Exercises

Upper Extremity

Shoulder
Flexion Starting at side, arm is raised through 180
o
arc to a vertical position above head.
ExtensionArm is returned through the same arc to the side.
AbductionStarting at side, arm is raised laterally, to a side horizontal position through an arc of 90
o
.
AdductionArm is returned through the same arc to the side.
Internal and External rotationThe arm is abducted to a horizontal position, the elbow is flexed upward with the
forearm at right angles, which brings the shoulder joint in a position of external rotation, bringing the forearm
forward and downward produces internal rotation (a 90
o
arc).
CircumductionA combination of the above movements, a complete circular or swinging motion around the axis.

Massage
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Elbow
FlexionStarting with arm at side, elbow is bent through range of motion, to about 145-160
o
.
ExtensionElbow is straightened to original position.
PronationMovement of forearm in turning palm down.
SupinationMovement of forearm in turning palm up.
Wrist
FlexionBending wrist forward from normal to about 90 o.
ExtensionReturning to normal of previous motion.
AbductionMove hand toward the thumb side.
AdductionMove hand toward the little finger side.
CircumductionCombination of the above.
Fingers
FlexionBending through range of motion.
ExtensionStraightening through range of motion.
AbductionSpreading of fingers.
AdductionBringing fingers together.
Thumb
FlexionCurl in on palm.
ExtensionBring thumb out so as to make a flat hand.
AbductionBring out so as to make a right angle with hand (thumb up toward ceiling).
AdductionBring thumb to hand in line with fingers.
OppositionBring thumb to meet fingers.
Lower Extremity
Hip
FlexionMovement of thigh (with knee bent) 150
o
or more with knee extended 90 o or less.
ExtensionReverse of previous motion.
AbductionMoving limb away from the other, sidewise about 50
o
.
AdductionReverse of previous motion.
Internal rotationTurning leg inward (about 30
o
).
External rotationTurning leg outward (about 60
o
).
Knee
FlexionBending of knee joint (about 135 o).
ExtensionStraightening of knee joint.
Ankle
DorsiflexionElevation of the front of the foot toward front of leg.
Plantar flexionA depression of the foot in a direction just opposite to that of dorsiflexion.
AbductionForefoot turned out.
AdductionForefoot turned in.
EversionAbduction plus a lifting of the outer border of foot.
InversionAdduction plus a lifting of the inner border of the foot.
CircumductionCircular combination of the above.
Toes
FlexionBending through range of motion.
ExtensionStraightening through range of motion.
AbductionSpreading of toes.
AdductionBringing toes together.

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