History of massage

MASSAGE, or systematic rubbing and manipulation of the tissues of the body, is probably
one of the oldest of all means used for the relief of bodily infirmities. There is evidence that
massage was employed by the Chinese as early as 3000 years ago. Their literature contains
treatises upon the subject written some thousands of years ago. An ancient Chinese book
entitled, “The Cong-Fu of the Tao-Tse, " of which a French translation appeared about a
century ago, was probably the foundation both of our modern massage and of the manual
Swedish movements so admirably elaborated and systematized by Ling. Massage is still very
extensively employed by the Chinese, and also by the Japanese, who doubtlessly learned the
art from the Chinese. Among the Japanese, massage is employed almost exclusively by blind
men, who go about the streets soliciting patronage by shouting in a loud voice the words
Amma ! amma ! (shampooing, or massage). In the Japanese massage, which was administered
to client by a first-class manipulator, for the relief of a severe cold accompanied with fever: -
“The shampooer used to sit in Japanese fashion at the side of the patient, as the latter lay on a
futon (thick comforter or quilt) on the floor, and began operations on the arm; then took the
back and the back of the neck, afterward the bead (top and forehead), and ended with the
legs. On the arms, back, back of the neck, and legs, he used sometimes the tips of his fingers,
sometimes the palms or the backs of his hands, sometimes his knuckles, sometimes his fists.
The movements consisted of pinching, slapping, stroking, rubbing, knuckling, kneading,
thumping, drawing in the hand, and snapping the knuckles. The rubbing in the vicinity of the
ribs was slightly ticklish, and the knuckling on the back of the neck, and at the side of the
collarbone, a little painful. On the head he used gentle tapping, a little pounding with his
knuckles, stroking with both hands, holding the head tight for a moment, grasping it with one
hand and stroking with the other. The operator seemed to have a good practical knowledge of
physiology and anatomy, and certainly succeeded in driving away the headache and languor,
in producing a pleasant tingling throughout the body, and in restoring the normal circulation
of the blood. He is to be criticized, however, for one serious fault in his operations, - that of
shampooing down, instead of up. A portion of the good done is thus neutralized, one object
of scientific massage was to massage in the direction of the veins. However, the criticism
may not be supported because of the mode of manipulation employed by the Japanese
masseur, who seems to have been more skilled than most of the manipulators, since he was
apparently aware of the fact that the limbs should be rubbed down, rather than up, for the
relief of the condition of feverishness and irritation from which his patient was suffering.

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Massage has been employed from the most ancient times by the Hindus and Persians, who
still practice it, some of their native masseurs being possessed of remarkable skill. The
ancient Greeks and Romans also employed massage constantly in connection with their
famous baths.
Hippocrates, the renowned Greek physician, made extensive use of this mode of treatment,
designating it ‘anatripis’. He evidently appreciated the principles of the art very well, as he
directed that friction should be applied centripetally, or in the direction of the veins. [Genuine
Works of Hippocrates, Vol. 11, page 16.] Hippocrates learned massage, as well as
gymnastics, from his teacher Herodicus, the founder of medical gymnastics.

Asclepiades, another eminent Greek physician, held the practice of this art in such esteem
that he abandoned the use of medicines of all sorts, relying exclusively upon massage, which
he claimed effects a cure by restoring to the nutritive fluids their natural, free movement. It
was this physician who made the discovery that sleep might be induced by gentle stroking.

Plutarch tells us that Julius Caesar, a century before the Christian era, had himself pinched all
over daily for neuralgia. It is well known that Julius Caesar was subject to a severe nervous
disorder (epilepsy), and it is more than probable that his prodigious labors were only rendered
possible by the aid derived from massage. Pliny, the great Roman naturalist, had himself
rubbed for the relief of chronic asthma. Arian recommended massage for horses and dogs,
asserting that it would strengthen the limbs, render the hair soft and glossy, and cleanse the
skin. After giving directions for massage of the legs, abdomen, and back, he directed that the
treatment should be terminated in the following peculiar manner, which indicates that he
understood the value of nerve-stretching, at least for dogs: “Lift her up by the tail, and give
her a good stretching; let her go, and she will shake herself and show that she liked the
treatment.
"Celsus, the most eminent of all Roman physicians, who lived at the beginning of the present
era, was very familiar with massage, and used great discretion in its application. He
recommended manipulations of the head for the relief of headache, and general
manipulations to restore the surface circulation in fever, making this wise remark: " A patient
is in a bad state when the exterior of the body is cold, the interior hot with thirst; but, indeed,
also, the only safeguard lies in rubbing." Galen, the greatest physician of his time, in the
second century recommended massage in many diseases. He seems to have had a good
understanding of the various forms of friction and kneading. A sort of percussion, called
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whipping, was employed by the ancient Roman physicians in various diseases, and is still
used by the Laplanders and the Finns, who beat the body with bundles of birch twigs.

The natives of the Sandwich Islands have, from the most ancient times, employed massage,
which they term lomi-lomi. They frequently administer lomi-lomi to an exhausted swimmer
while in the water, supporting him with their hands until his forces are rallied by the
manipulations.
The Maoris of New Zealand practice massage under the name of romi-romi.

The natives of Tonga Island employ massage under the name of toogi-toogi, the literal
meaning of which is "to beat," for the relief of sleeplessness, fatigue, etc. Melee denotes
rubbing with the palm, and foot kneading with the thumb and fingers. Paracelsus, the prince
of charlatans, who flourished at Basle, Switzerland, four hundred years ago, made great use
of massage, and taught it to his pupils in the medical school of that city. Massage has been
used in France for two hundred years. It was much employed in the early part of the present
century by eminent English surgeons, especially in the treatment of sprains and other injuries
of the joints. Its use in modern times, however, is chiefly due to its systematic development
and employment by Mezger, of Amsterdam.

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 MASSAGE THERAPY

DEFINITION:-
Massage is the manipulation of superficial and deep layers of muscles and connective
tissue to enhance function, aid in the healing process promote relaxation and well being.
It 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 movement of the body.

MASSEUR: The Man who administers Massage is called Masseur.

MASSEUSE: The Woman who administers Massage is called Masseuse.

CENTRIPETAL: Centripetal means towards the center. The term is applied to movements
made in the direction of the blood current in the veins.

CENTRIFUGAL: Centrifugal means from the center. The term is applied to movements
made in the direction of the arterial blood current.

LUBRICANTS OF MASSAGE:
Massage may be performed with or without a lubricant. Lubricants are made of either oil or
blends of oil. Water and thickening ingredients and serve different functions.

Oil:
Oils are made from plants or seeds. Oil locks in moisture, leaving the skin soft and smooth
and allows your hands to glide over the muscles and tissues.

Lotion:
It is made from oil, water and a thickening agent. Lotion absorbs more quickly into the skin
than straight oil and adds moisture. Lotion is good for deeper, more controlled work where
you want to grasp muscle and tissue. Some clients prefer lotion to oil because it doesn’t leave
them feeling greasy.

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Cream or Body Butter:
Cream and body butter have higher oil content than regular lotions, provide more glide and
go for further between reapplication by adjusting the amount used. They can be used for
either Swedish or deep-tissue massage.

Gel:
Massage gel is a thickened form of oil and is usually blended with vegetable wax which
allows the oil to spread. It can also be adjusted for the use with different kinds of massage
strokes.

Powder:
Used for oily skin, who doesn’t like oil massage and allergic to oil.

Essential Oils:
It can be added to any massage lubricant. Add the oil according to client preference or
sensitivities for fragrance.

Use of Lubricants in Massage:

 Reduces friction on the skin
 Protects fragile skin from being stretched
 Protects very hairy skin from being pulled
 Some oil (e.g. Wheat, olive) are said to give nutrition to skin.
 Perspiration can be absorbed by using a powder lubricant
 Essential oils can be selected for their therapeutic properties.
Contraindication:
 Allergic condition

Precautions:
 Precautions for each oil should understand
 Certain oils should not be used in pregnancy
 Damaged skin or skin problems
 During pregnancy

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  Cardiac and any respiratory problems
 Injury or rod fitted in the body
 Sensitivity oils should not be used on babies and young children
 Oils should not fall on eyes and wearing lens.

RULES & REGULATIONS APPLICABLE TO MASSAGE

THERAPIST:-

 Correct use of terms is necessary

 Good Health:
The person administering massage should have perfect health and fit to give massage.
 Personal Cleanliness:
A masseur who does his duty will perspire vigorously, hence the necessity of due
attention to personal cleanliness, special attention must also be given to the hands,
teeth, nasal cavity and hair.
 The hands:
o Good hands are necessary for success in massage. The hand must be soft,
warm, dry, strong and flexible.
o The hands should also be free from warts, abrasions, chaps etc.
o Nails should be trimmed close.
o Always wash the hands just before and after massage.
 Personal appearance: Simplicity, neatness and tidiness in dress.
 Do not be hurried, flurried nor out of breath from fast walking in approaching a
patient to administer massage.
 Avoid a busting, nervous manner.
 The room in which massage is given should be well ventilated, temp about 75-80o F
 The patient should be placed in an easy, comfortable position.
 As a rule, the patient should be undressed or clad in a single loose gown. Care should
be taken to keep the body well covered with the exception of the part undergoing
manipulation.
 The position of operator varies with the part operated upon, but should always be such
as it best suited for the part undergoing manipulation.

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  In bending over the patient the body should be flexed at lower back and the
movements of hands should always with wrist joint.

TYPES OF MASSAGE:
 Swedish Massage:
The term "Swedish Massage" refers to a variety of techniques specifically designed to
relax muscles by applying pressure to them against deeper muscles and bones, and
rubbing in the same direction as the flow of blood returning to the heart. Swedish
massage techniques include: long strokes, kneading, friction, tapping, percussion,
vibration, effleurage, and shaking motions.

 Ayurvedic Massage
Ayurvedic massage, also known as Abhyanga is usually performed by one or two
therapists using a heated blend of herbal oils based on the Ayurvedic system of
humors.

 Hot Stone Massage

A stone massage uses cold or water-heated stones to apply pressure and heat to the
body. Stones coated in oil can also be used by the therapist delivering various
massaging strokes. The hot stones used are commonly Basalt stones (or lava rocks)
which over time have become extremely polished and smooth. Heated, smooth stones
are placed on certain points on the body to warm and loosen tight muscles and
balance energy centers in the body. The massage therapist may also hold stones and
apply gentle pressure with them. The warmth is comforting. Hot stone massage is
good for people who have muscle tension but prefer lighter massage.

 Thai massage
Thai massage aligns the energies of the body using gentle pressure on specific points.
Thai massage also includes compressions and stretches. You don't just lie there. The
therapist moves and stretches you into a sequence of postures. Thai massage is more
energizing than other forms of massage.

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 Water massage:
Hydro massage is a type of massage based on the therapeutic use of warm water. The
essence of hydro massage is applying massage techniques to the human body
(thermally, mechanically, or chemically) through the water (which can be mineral,
acerous or any other). Hydro massage helps to relax muscles, increase blood
circulation, and relieve muscular pain and tension. Hydro massage therapy can help
alleviate muscle and soft tissue injuries caused by low back pain, arthritis, chronic and
acute pain, neck injuries, fibromyalgia, tendinitis and stress management and many
more diseases and ailments.

 Vibro massage
Vibro massage (also called vibratory massage, vibra-massage, and vibration therapy)
is a type of massage based on the use of mechanical devices for vibration therapy,
which pass vibration onto the body surface that is being massaged.

 Pregnancy Massage:
Also called prenatal massage, pregnancy massage is becoming increasingly popular
with expectant mothers. Massage therapists who are certified in pregnancy massage
know the proper way to position and support the woman's body during the massage,
and how to modify techniques.
Pregnancy massage is used to reduce stress, decrease swelling, relieve aches and
pains, and reduce anxiety and depression. The massage is customized to a woman's
individual needs.

 Reflexology:
Although reflexology is sometimes called foot massage, it is more than simple foot
massage. Reflexology involves applying pressure to certain points on the foot that
correspond to organs and systems in the body. Reflexology is very relaxing,
especially for people who stand on their feet all day or just have tired, achy feet.

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  Sports Massage:
Sports massage is specifically designed for people who are involved in physical
activity. But you don't have to be a professional athlete to have one-it's also used by
people who are active and work out often. The focus isn't on relaxation but on
preventing and treating injury and enhancing athletic performance.

 Acupressure massage:
Acupressure is a traditional Chinese medicine (TCM) technique derived from
acupuncture. With acupressure physical pressure is applied to acupuncture points by
the hand, elbow, or with various devices.

Basic Human Anatomy and Physiology of the Human Body

From the smallest to the largest part of the human Body or structural and functional unit,
sequential order is as follows:

 Cells – Body is made up of cells – many cells make tissue- group of tissue makes up
organs (like, lung / kidney/ liver). Any change in the cell at cellular level will cause
change in overall physical body. Deficiency in nutrient will cause change in our
system, so correcting the cellular level is important, that we shall see through
massage.
 Tissues –Each tissue is made of specialized cells that are grouped together according
to structure and function. Tissue makes up organs and other body parts. There are 4
main types of tissue:
Muscle, Epithelial, Connective and Nervous.
 Organs –An organ is made of several types of cells & tissues. Combination of organs
forms system. e.g.- Respiratory system that takes care of breathing , Digestive system
takes care of digestion .
 Systems - There are 12 Systems in human body and 206 Bones.

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Human Anatomy &Physiology:

Human anatomy includes both gross anatomy and microscopic anatomy. Gross anatomy
includes those human structures that can be seen with the naked eye.
Microscopic anatomy is the study of those parts of the human body structures that are viewed
only with a microscope.

Human anatomy is the study of the body parts /structures like bones, muscles etc.
It deals with the location of body parts, from molecules to bones.
Its relation & interact to other organs to form a functional unit.

Human Physiology: is scientific study of the functions and mechanisms within the body. The
focus of physiology is on how organisms, organ systems, organs, cells, tissues
and biomolecules carry the chemical and physical functions that exist in a living system.

Human Body Parts:

1 )Skull:

A human adult skull is made of 22 bones – 8

Cranial bones and 14 Facial bones. The skull
is divided by Sutures (looks like stiches joining
the edges of skull bones). The 2 two main parts
are:

The Cranium & the Mandible

I ) The Cranium is the largest part of the skull enclosing :

1. Frontal
2. Parietal
3. Temporal

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 4. Occipital
5. Eye Orbit (eye ball)
6. Nazal Bone
7. Zygomatic (cheekbone)
8. Maxilla

II )Mandible is the lower jaw, also known as the jaw bone.

2) Collar Bone or Clavicle

The Clavicle or collar bone is part of the shoulder girdle

that connects the arm to the trunk of the body. There is
one clavicle in each shoulder, connected between the
shoulder blade (scapula) and the breastbone (sternum)
just above the first rib. The clavicle is classified as a long
bone, even though it is a relatively short and curved
bone.

3) Scapula : a flat, triangular shaped bone at the back of

the shoulder girdle. The top of the scapula is attached to

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the clavicle. The outer side of the scapula connects with the Humerus bone of the upper arm.
This connection stabilizes the arm & the movement at the shoulder.

Acromion Process – (process is any bone extending out from that bone or bone area)

4) Sternum or Breastbone

The Sternum is a long flat bone in the centre /middle

of the Chest. It protects the heart, lungs and major
blood vessels from damage.

The sternum connects with 12 ribs.The first seven

bones are called the true ribs. These bones are
connected to the spine/ Vertebral (the backbone).
The next 3 pairs of bones (8, 9 and 10) are called
false ribs. These bones are slightly shorter than the
true ribs. The last 2pairs (11& 12) bones are called floating ribs. They are attached to the
spine at the back, but not in the front. The front floats free, hence their name floating ribs.

5) Arm

The Arm consists of 3 joints, shoulder, elbow, wrist. The arm bone refers to the part of the
upper limb between the shoulder and the elbow. These joints allow movements of the arm.

The Humerus bone is in the upper arm. One end connects with the scapula at the shoulder
joint. The other end connects with the Radius and Ulna at the elbow joint.

"Forearm" describes the upper limb between the elbow and the wrist.

The Radius (lateral bone) and Ulna (medial bones).the radius connects to the thumb side of
the wrist.}

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6) Wrist Joint and Bones (22bones)

The wrist bones connect the lower arm with the

fingers. The wrist consists of 8 bones called Carpal
bones. These bones interconnect the metacarpal
bones with the radius and ulna bones of the forearm.
The Metacarpal- 5 bones are in the palm they are 5
bones. Phlanges are 14 Finger bones.

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7) Spine, Spinal Column or Vertebral Column

The spine cod is cod like structure which is composed of various nerves in the spinal column.
It stretches from the head to lower back and hips. The spine is also known as the spinal
column, vertebral column or backbone. These vertebrae join each other by Internal
Vertebral disc for movement and Shock absorption.
The spine consists of 33 vertebrae.
The spinal column is normally divided into 3 major sections:
I) Cervical- The cervical section consists of 7 vertebrae (C1 known as Atlas - C7 knows as
Axis). They are the smallest and lightest vertebrae. These allow the head& neck rotational
movement.

II) Thoracic - The thoracic section consists of 12 vertebrae (T1 - T12), it is joined to the rib
cage .

III) Lumbar -The lumber section consists of 5

vertebrae (L1- L5) These are the largest of the
vertebrae and bear much of the upper body weight.

IV) Sacrum - The sacrum is a single bone structure

made from 5 fused vertebrae with no
intervertebral discs. The sacrum is connected to
the hip bones.

V) Coccyx are also called tailbone its at the pelvic

section.it is also a single bone structure, made of 3
fused vertebrae with no intervertebral discs.

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8) Pelvis or Pelvic Girdle

The pelvic girdle is a ring of bones connecting the

spine, or vertebral column, to the femur bones in
the legs. In the centre of the pelvis is the Pelvic
Cavity. The pelvic cavity contains and protects the
reproductive organs and the rectum

The pelvis consists of 2 hip bones connected to

either side of the sacrum. The hip bone consists of
3 bones fused together.

I )Ilium – Ilium bone on either side (upper portion). The

ilium is connected to the sacrum by the sacroiliac joints.

II) Pubis or pubic bone –either side (bottom).it joins at

one point that is called Pubic Symphysis.

III) Ischium: It’s at the back side on which we sit

IV) Hip Joint provides the main connection between the

leg and the pelvis. It connects the femur of the leg with
the hip bone. The hip bone provide movement in three
directions: forward and backward, left to right, and
rotation around the femur.

10) Humans have 2 lower limbs

Upper part or thigh: Femur is the longest bone in ,it

starts from the lower side of the hipbone- called the Head
of Femur, this bone stretches down to the knee joint /
knee cap called Patela The femur is also known as the
thigh bone.

Lower part of the leg: The Tibia(the medial ) and

Fibula(the lateral). The tibia is sometimes called the

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shinbone. The fibula is the smaller, rear calf bone in the lower leg.

Ankle joint connects the foot with the leg. Total

bones in foot are 26.

The ankle has 7 Tarsal bones, 5 Meta Tarsal bones, 14

Phalanges bones.

Muscles

Muscles are soft tissues made up of many individual muscle fibres. The muscular system is
responsible for the movement (contraction & relaxation) of the human body. Attached to the
bones of the skeletal system are about 700 named muscles that make up roughly half of a
person's body weight.

Anterior Body Muscles

1) Head and Face: There are over 30 muscles in the head and face. The facial muscles
are just under the skin, they control facial movements like smiling, laughing,
movement of the eyes, movement of the jaw to talk and chew food.

Muscles of the Head are

I)Frontalis : is on the frontal bone at forehead

near the eyebrows. II) Temporalis: is on both
the side towards the ear. III) Occipitalis: is on
the backside of the head.

Muscles of Face are:

I) Orbicularis-oculi: is the circular muscle of

the eye. These muscle group assist in moving

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the eye to look upward, lateral, and downward.

II) Orbicularis-oris: is the circular muscle of the mouth.

III) Masseter: is a bulky, rectangular shaped muscle located on the outer cheek region. It
begins on the lower zygomatic bone. The masseter participates in the action of closing an
opening jaw, in expressions of annoyance, nervousness, and emotional tension.

2) Neck Muscles (SCM)

The front of the neck muscle is called Sterno-

cleido- mastoid (SCM) these muscles support the
rotation, and upward/downward movement of the
neck. They connect the skull upper wards and
downward to clavicle and sternum. There are
certain other set of muscles in the neck like
splenius, scalenous muscle.

3) Chest Muscles

I) Pectoralis- major: is the major muscle in the

chest. This large fan-shaped muscle stretches from
the armpit up to the collarbone and down to the
lower chest region on both sides of the chest.
II) Pectoralis- minor: resides under the pectoralis
major. These muscles perform most upper-body
movements like pushing- shopping cart, free style
swimming, throwing a ball, etc.

III) Intercostal muscles are smaller muscles between the ribs they give protection & stability
to support in expansion and contraction while we breathe.

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4) Abdominal Muscles:

It consists of 6 muscle groups

that extend from the ribs, below
the sternum to the pelvis. They
are often called "The Core
Muscles ". These muscles
support upper body movement,
twisting and rotation. They
provide support &stability to the
trunk. They protect the spine
against back injury or strain
during movement also support good posture.

These muscles include: I) A pair of External Oblique & A pair of Internal Oblique. The
external oblique is outer muscle (direction is from top, ribs to bottom hip bone in oblique
manner) and beneath it, there is Internal oblique (direction starts from bottom to top in
oblique manner). The left internal oblique and right external oblique muscle contracts to
rotate the trunk to the left. The right internal oblique and left external oblique contract to
rotate the trunk to the right

I) Transverse Abdominis are the deepest abdominal muscles. (In a horizontal pattern)

II) Rectus Abdominis muscles are located on either side of the abdominal midline. They
are often called the “abs” and because of their external appearance on abdomen, they are
called as six or eight packs. They support the movement of bending down & getting up from
the bed.

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5) Arm & Hand Muscles

The muscles of the upper arm divide into

two basic groups:

The Flexor muscle group: located on the

anterior region of the upper arm.
The Extensor muscle group: located on
the posterior region.

The Muscles of the Upper Arm are

I) Deltoid Muscles: is a large muscle

covering the shoulder, it starts from collar
bone & narrow down to humerus.
The 3 major movements of the Deltoid
muscles are:

Anterior deltoid – helps to raise the

arms.

Lateral deltoid–helps to move the arms

sideways.

Posterior deltoid– helps to move the arm backward.

II) Biceps Brachii, The biceps is the front of the upper arm region. It moves the lower arm
toward the upper arm from the elbow joint (flexion).

III) Brachialis is located beneath the Biceps brachii muscle mainly hidden between the
triceps and the biceps, only a small area is seen on the surface with a slight bulge. It supports
bending the forearm toward the upper arm from the elbow joint (flexion).

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6) Hand Muscles:

Interossei Muscles: are between metacarpals

they support the movement of fingers like
griping / shaking hands.

4 main Hand Movements:

Pronator Muscle– Pronation .

Supinator Muscles– Supination.

Flexor Muscles – Flexion

Extensor Muscles – extension

7) Legs, Thigh and Foot Muscles

The Anterior muscles and upper front leg

muscles also called the Thigh muscles. It is
located at the hip region and extends to the knee.

I) The Adductor Muscle Group: this is located

on the medial of the upper leg, commonly known
as the inner thigh muscles.
They perform the action of moving an
outstretched leg towards the torso (trunk). They
also support in standing & bending the upper leg
at the hip joint.

1.1- Adductor-magnus. (Magnum means big) .

1.2 - Adductor-longus. (longus means long)
1.3- Adductor-brevis (small in size)
1.4- Gracilis .

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Sartorius: begins at the ASIS (anterior superior iliac spine) of the pelvis; goes down to the
knee. It’s the longest muscle in the thigh. It sweeps obliquely downward across the upper leg,
continued on the lower leg below patella, it joins the
tibia with the tissues.

II) Anterior Thigh Muscles:

i) VastusMedialis, Medialis pertains to the

median/Medius means “middle”.
ii)VastusIntermedius, Intermedius means “in between
iii)VastusLateralis,pertains to the outer (lateral) side.
iii)RectusFemoris: The muscle begins near the ASIS
of the pelvis directly above the acetabulum (hip
socket).
It occupies the central portion of the quads; it is
positioned beside& over the vastusmedius & lateral.
It inserts into the patella by way of tendon.
The rectus femoris helps straighten the lower leg at the
knee joint (extension) and to bend the femur in a
forward direction at the hip joint (flexion).

III) Lower Leg: below the knee till the ankle –

Tibialisanterior.

Posterior Muscles

Posterior Neck /Shoulder/ Back & Lower back

The muscles at the back of the shoulder include the levator scapulae, trapezius, rhomboid
major, and rhomboid minor. The levator scapulae helps move the shoulder up and down. The
trapezius muscles support up and down movement, as well as upward and forward rotation of
the shoulder. The rhomboid major and rhomboid minor works together to provide downward
rotation of the shoulder and forward movement of the scapula.

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The sternocleidomastoid, although primarily a neck muscle, also play a role in helping
respiration by raising the sternoclavicular joint.

5 major muscles in the back of the neck are trapezius, levator scapula, splenius, cervical
muscles.

The Trapezius muscles connect between the neck, shoulders and back body. It starts from
Mastoids Process on both side of shoulder and goes down to the spine. They are used to lift
the shoulder up and down towards the ears. And also does adduction of the scapula.

The Levator scapula connects between the neck and shoulder. It is used to lift the shoulders
and turn the head.

The Splenius & Capitis muscles connect the back of the head and neck; it starts below
Mastoid Process on the upper back vertebrae. The splenius muscles help to rotate the head
(sideways) and tilt it backward.

Latissmus dorsi which connect from the shoulder to the back in thoraco-lumbar fascia, help
pull the arm down towards the pelvis, or pull the body up when doing chin-up exercises. It
attaches into the humerus.

Erector Spine running on both the side of the spine support the body posture

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Rhomboid –below trapezius for pulling action

Teres major Teres minor –it is above latissmus (superior)

Sarratus Posterior – starts from spine goes to the ribs

Posterier of the arms:

The triceps brachii is a large three-headed

muscle occupying most of the posterior of
the upper arm. Fleshy horseshoe shape will
appear on the surface when the muscle
contracts. Triceps is responsible for
extending or straightening the arm at the
elbow, also responsible for extending the
arm at the shoulder.

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Posterior of Lower Limb:

There are four gluteal muscles:

i )Gluteus maximusis the largest of the four

gluteal muscles and dominates the posterior hip
region, it begins on the iliac crest of the pelvis
and the outer edges of the sacrum and coccyx
(tailbone) and inserts into the femur and the
upper portion of the iliotibial tract.

ii) Gluteus medius is a fan-shaped muscle that occupies the central portion of the pelvis bone.

iii) Gluteus minimus on the central portion of the pelvis, beneath the gluteus medius.

iv ) (Lateral) Tensor fasciae latae :teardrop-shaped muscle that begins on the ASIS of the
pelvis and then flares slightly as it inserts into the fascia and upper portion of the iliotibial
tract .

Posterior Thigh Muscles are called the Hamstrings.

These muscles consist of

1) Biceps femoris,
2) Semitendinosus
3) Semimembranosus.

These muscles are responsible for

flexing rotation of inward &outward
direction as well as bending the leg at
the knee.It also helps straighten the
upper leg at the hip joint.

Biceps Femoris: is positioned on the

posterior and lateral portions of the
upper leg. As its name (BI implies, it
has two heads (a long head and a short head). The long head begins on the Ischial tuberosity

24
of the pelvis and attaches to the lateral of the knee. The short head of the biceps femoris
muscle origins from the femur and attaches to fibular head and lateral tibial epicondyle.

The Semitendinosus is positioned on the posterior and medial portions of thigh. The muscle
begins on the Ischial tuberosity of the pelvis.

The Semimembranosus it is mostly covered by the semitendinosus muscle.

Leg Muscle Group- (calf muscles)

It consists of :1) Two Gastrocnemius muscle- on either side of the calf, oval muscular shape
occupying the upper half of the lower leg in the posterior region. It also helps raise the heel
tiptoe position.

2) Soleus muscle: beneath the gastrocnemius, only its outer and inner borders appear on the
surface.

3) Plantaris a smaller muscle. The muscle begins on the lower part of the femur near the
lateral epicondyle smaller muscle. This helps in (plantar flexion movement).

25
Lateral Region Leg Muscles

1) Iliotibial Tract–it’s a band like structure with is connected to muscles anteriorly and
posteriorl. It starts from Iiiac crest
of the hipbone and attaches to the
Tibia bone hence it is called as
Iliotibial tract.

2) Tensor-Fasciae-latae this
muscle is attached to the iliotibial
band on the lateral side; it supports
movement of the thigh and leg.

3) The gluteus medius is

positioned on the Lateral central
portion of the pelvis, attached to
ilio-tibial tract posterolaterally.

Organ Systems

2 cavities – Diaphragm Muscle is dome shape divide 2 cavity, chest cavity & abdominal
cavity.

1 ) Lungs: There are 2 lungs which are a

part of respiratory system.
The right lung is made up of 3 lobes.
The left lung has only 2 lobes and a
cardiac notch (curve)
Lungs are covered by a thin tissue layer
called Pleura, which protects the lungs.
The lungs begin at the bottom of the
trachea (windpipe).
The trachea is a tube that carries the air in and out of the lungs.
Each lung has a tube called a bronchus that connects to the trachea.

26
Each bronchiole tube ends with a cluster of small air sacs called alveoli (individually referred
to as alveolus). They look like tiny grape bunches or very tiny balloons. In the alveoli, oxygen
from the air is absorbed into the blood which then goes to the heart.

2) Heart: Blood Vessels – are vessels which carry the blood through the body.

Arteries: arteries are blood vessels which carry

blood from the heart to the body, Arteries are
deep structures.
Branches of Arteries are called Arterioles
(smaller than arteries)
Veins – are blood vessels carry blood from the
body to the heart.
Braches of veins are called Venules.
Arteioles &Venules further divide into
capillaries. capllaries are the smallest blood
vessels.

The heart is the central pump for the circulatory system.

There are 4 chambers in the Heart, the upper is called Atrium and the lower is called
Ventricles. The right half includes the right atrium and right ventricle and is separated by the
tricuspid valve. The left half includes the left atrium and left ventricle and is separated by the
mitral valve.

Impure-blood from the body enters the right atrium of the heart from the superior and
inferior vena cava. The blood flows downwards through the tricuspid valve to the right
ventricle. The tricuspid valve prevents the blood from flowing backward between heart beats.
The right ventricle pumps the blood out the pulmonary valve into the pulmonary artery that
goes to the lungs.

27
In the lungs, the blood picks up oxygen and releases carbon dioxide. This oxygenated blood
flows back through the pulmonary vein to the left atrium. The blood then travels through the
mitral valve to the left ventricle, and is then pumped through the aortic valve to the aorta.

The aorta branches into many arteries, and then capillaries, delivering oxygenated blood to
the body's organs, tissues and cells.

3) Stomach : The stomach is located in the upper-left side of the abdomen,. The stomach is
about 12 inches long and 6 inches wide in
an adult. It is J shape bag like structure.

The stomach has 3 main areas.

The Fundus is the upper rounded portion.

The largest part is the Body of the stomach.

The lower end of the stomach is the

(Pylorus)

There is a one way valve at the end of the stomach called as cardiac Sphincter, which does
not allow acid to flow out of the Esophagus.

The wall of the stomach consists of several layers. The Mucosa membrane is the inner-most
layer. The mucosa produces enzymes and stomach acids (acids like Hydrochloric acid)
gastric juices, and Gastrin (hormone) which helps in digestion, to kill microorganisms and
break down the food into smaller particles. Although, the stomach absorbs very little of the
food's nutrients, Most of it moves into the small intestine for absorption.

4) Small Intestine- it is about (5 -7mt) long. It is the longest part of the gastrointestinal tract.
The small intestine is made up of 3 parts:

28
Duodenum- The duodenum is the upper part of the small intestine. Most of the chemical
digestion and breakdown of the food happens in the duodenum. Food is mixed with bile from
the gallbladder and digestive juices from the
pancreas. Absorption of vitamins, minerals
and other nutrients begins in the lower part of
the duodenum. The pancreas also releases
bicarbonate.

Jejunum: Once the chyme leaves the

duodenum, it enters the middle section of the
small intestine. The jejunum is responsible
for absorption the majority of nutrients from
the chyme. The digested food passes into the
capillaries and lymphatic vessels in the wall of the intestine. Nutrients such as glucose and
amino acids are absorbed into capillaries, while fats are absorbed into the lymph vessels.

Ileum: The ileum is the last section of the small intestine. It mainly absorbs vitamin B12 and
bile salts. The ileum connects with the large intestine. Any food that remains undigested and
unabsorbed by the small intestine passes into the Large intestine.

1 Large Intestine: The primary responsibility of the large intestine is to extract water and
salt from digestive products before they are eliminated from the body as waste.

It has 4 parts
Ascending Colon
Transverse Colon
Descending Colon
Sigmoid Colon (shape S)

The undigested and unabsorbed food waste enter the ascending colon, from the Ileum .The
ascending colon extends upwards to the level of the liver, then bends to the left and crosses
the abdomen as the transverse colon. It then goes downward to the lower abdomen, i.e. the
descending colon where it becomes the sigmoid colon. This all happens in clockwise
direction. The sigmoid colon becomes the rectum and anus.

29
The main functions of the large intestine are absorption of water and minerals, and the
formation and elimination of feces.

2 Kidney /1 Urinary bladder / 2 ureters (in pelvic

cavity):

The kidneys are paired, bean-shaped organs located

in the abdomen, on either side. They are made of a
large number of structural and functional subunits
called nephrons. These nephrons perform the
primary task of filtering blood and removing waste
products.

Ureters

There is one ureter that comes out of each kidney as an extension of the renal pelvis.
The ureter is a thin muscular tube that carries urine from the kidneys to the bladder.

Urinary Bladder:

It is a sac-like structure that is lined with smooth muscle layer and is responsible for storage of
urine till it is expelled from the body by micturition. The bladder receives urine from the ureters,
one from each kidney. The level of the urinary bladder placement in the body differs in men and
women.

Urethra:

This is a tube that arises from the urinary bladder and functions to expel urine to the outside by
micturition. The urethra is shorter in females and longer in the males.
The adrenal glands are small glands located on top of each kidney. They produce
hormones called Adrenaline & Nor Adrenaline

30
Liver:

The liver is the largest internal

organ of abdominal cavity in the
human body. It is a solid
structure, its weigh is 1 to 1.5kg
in adults, it is located on the right
side of the abdomen stretching to
the centre and reaching to the left
side. Liver is part of the Hepatic
system. It’s cells are called
hepatic cells.

Function
1) It is responsible for processing and storing nutrients in the body. All the nutrients, drugs,
chemicals and food absorbed from the small intestine go to liver through portal circulation. It
purifies by detoxifying the blood and sends the blood to heart through vena cava.

1) Its main function is to filter /detoxify the blood coming from the digestive tract and
the Non-useful materials, such as toxins are extracted and delivered to other digestive
processes for disposal.

2) It has regenerative capacity; it can re-grow to its normal shape n size.

3) It produces Cholesterol, which is used for producing hormones through various glands

4) Bile - green to yellowish brown fluid, produced by the liver, Bile contains bile acids,
which are important for digestion and absorption of fats and fat-soluble. it is stored in
Gallbladder .

5) Liver produces antibodies which is major component for immunity. It helps fight
infection & bacteria’s from bloodstreams by making immune factors.

6) Stores and releases glucose as needed.

31
Gallbladder: The gallbladder is a hollow organ located below the liver. It is approximately
3 inches (7.5 cm) long and 1 inch (2.5 cm) wide. The function of the gallbladder is to store
bile from the liver.

The gallbladder receives bile from the liver through the hepatic duct. It is capable of storing
about 1.7 fluid ounces (50 ml) of bile.

When we eat fatty food, hormones released from the duodenum signal the gallbladder to
contract. This contraction squeezes bile through the common bile duct into the duodenum. In
the duodenum, the bile mixes with the food to help digest fats.

Sometimes bile in the gallbladder can crystallize forming gallstones. Gallstones can cause
inflammation and pain in the gallbladder or common bile duct.

1 Spleen: It is located in the upper-left posterior to stomach, beside the

kidney. It is protected inside the rib cage by 9th, 10th, 11th and 12th
ribs.

The spleen filters blood removing old Red Blood cells. The spleen also
stores blood. This stored blood can be used by the body in emergencies,
such as loss of blood due to a bad cut. The spleen also plays an
important role in the immune system. The spleen's role in digestion is
somewhat indirect. Once the blood is filtered in the spleen, the hemoglobin is transferred to
the liver for further metabolism making it more water-soluble.

1 Brain

The Cranium (skull) is the skeletal

structure of the head, it’s the hard
bone of the head that protects the
brain.

32
 The brain is divided into many regions, but the 3main parts are: 1) Fore brain
/cerebrum. 2) Mid Brain. 3) Hind Brain /cerebellum/brain stem. Brain consist of 80-
90% fat cells.

Functions of brain:
Frontal Region – controls voluntary muscles movements, responsible for reasoning.
Parietal Region – Higher functions like problem solving, critical thinking, processes
touch, taste and temperature.
Occipital Region – it controls sensory information like audio-visual & vision memory.
Temporal Region – Broca’s area Processes Hearing, responsible for speech. language
learning, Long term memory.
Cerebellum- Responsible for balance, coordination of body movements-walking ,
writing, Motor skills.

The Brain is covered with three layers of

Meninges.
1. Dura mater
2. Arachnoid mater
3. Pia mater: Each layer of the
meninges serves a vital role in the
proper maintenance and function of the
central nervous system. The meninges are the membranes that surround and
protect the brain and the spinal cord.

Medulla- spinal cord is the extension of pons and medulla which are part of Mid-Brain

There are 12 pairs of Nerves which arise from brain called as Cranial Nerves

O- olfactory
O- optic
O- occulomotor
T- trochchear
33
 T- trigeminal
A- abducens
F- facial
V- vestibulocochlear
G- glossopharangeal
V- Vagus
A-accessory spiral
H- hypoglossal

CNS (Central Nervous System) consists of the brain nerve and spinal nerve. Cranial Nerves
are from the brain, they are responsible for a wide variety of activities in your body.

Spinal Nerves are from Spinal cord, they are responsible for the transmission of neural
signals between the brain and the rest of the body. It also contains neural circuits that can
independently control many reflex actions in the body.

In the body there are various areas where we can access the nerves roots through manual
pressure. This act is called Nerve Compression. Example: on sides of Umbilicus & Spinal
cord.

Glands
Endocrine system is a network of glands
which produces hormones having
different functions in our body.
List of glands and Hormones and their
function

1) Hypothalamus gland –it is an

important gland located in the
brain and controls Pituitary gland.

34
 Function:
↓
i) ADH –antidiuretic Hormones
Function –it regulates the water balance, that needs to be absorbed into the blood through
urine.

ii) Corticotrophin Hormone

Function – It helps to regulate and mobilize to release certain steroids with the help of
Pituitary gland.

iii) Gonadotropin Hormone

Function – works with pituitary gland for sex hormones.
iv) Oxytocin Hormone
Function – responsible for production of milk and regulating sleep cycle
and body temperature.

v) Prolactin Hormone
Function – it helps in the process for breast milk production.

vi )Thyrotrophin Hormone
Funtion – it activates Thyroid gland to produce thyroid hormones.

2) Pituitary gland:
Functions –
ACTH stimulates adrenal gland to produce cortisol & other hormones.
TSH activates thyroid glands to release thyroid hormones.
GH regulates to develop the Physical body.
PRL helps in producing breast milk in women.
FSH it involves in estrogen secretion. It produces & helps in growth of egg cell in women
and sperms in men.
LH is responsible of secretion of estrogen in women and testosterone in men

Pineal Gland is a small, pea-shaped gland in the brain.

35
Function: Melatonin is best known for the role it plays in regulating hunger and sleep
patterns.

3) Tyroid Gland – T3 (tri –iodo- thyronine

T4 (Thy – ro xine)
Function –it regulates metabolism..

4) Thymus Gland:
It secretes chemicals that help T cells of the immune system to develop. These cells have a
major role in fighting the disease producing pathogens like viruses, bacteria and other
microorganisms.

5) Pancreas – this gland produces 2 hormones –Insulin & glucagon contrary both help in
regulating blood sugar.
6) Adrenal gland produce adrenaline and nor adrenaline hormones which help in critical
thinking in stressful situation, help to regulate hormones produce in these situation.
7) Ovaries: It produces 2 hormones; estogen & progesterone. These help in reproductive
functions.
8) Testis produces testosterone and this helps in reproductive function in males.

36
Joint Movements:

Movement of Adduction and Abduction

Adduction pertains to moving a body

part toward midline.

Moving the limb closer to the body is

Adduction & moving away is
Abduction.

Muscles responsible for adduction of

legs -Adductor-magnus
Adductor-longus

Adductor-brevis

Muscles responsible for abduction are:

Tensor fasciae lateral
Gluteus medius

37
Movement of Flexion & Extension

Movements always happen at joints, between 2

bones. When there is reduction in the angle degree, it
is flexion.

When joints (2 bones) extends and the angle between

the two increases, it is called extension

38
Dorseflexion – feet upward Plantarflexion –feet downwards

39
40
Movements of massage:
The movements in the massage techniques are broadly of 7 types:

1. Touch
2. Stroking
3. Friction
4. Kneading
5. Percussion
6. Joint movements
7. Vibration or shaking

Touch:
Any contact between the client’s body part and masseur’s hand or any part by which massage
is employed is called as touch.

Touch can be classified into 3 types, namely

 Simple touch: A simple contact between patient’s body and masseur’s hand
 Pressure touch: contact between patient’s body part and masseur’s hand with
involvement of pressure
 Nerve compression: when a masseur compresses an area of a patient’s body where
there is any nerve plexus or a nerve root in a very close proximity is called nerve
compression.

Figure 1 Simple Touch Figure 2 Pressure Touch

41
 Figure 3 Nerve Compression

Stroking:
Touching the patient’s body along with movement is a specific direction is called stroking.

Stroking can be classified as following:

 Centripetal stroking: stroking in the direction towards the heart.

 Centrifugal stroking: stroking in the direction away from the heart.
 Digital stroking: stroking given by the tips of the fingers.
 Reflex stroking: stroking given to an area which has a reflex connection to some other
area of the body

Figure 4 Centripetal Stroking

Friction:
When the masseur, with his hands applies pressure on to a part of the body of client or patient
and combines it with movement and direction, it is called as friction.

Friction can be classified as following:

 Centripetal friction: friction in the direction towards the heart.

42
  Centrifugal friction: friction in direction away from the heart.
 Spiral friction: friction in a spiral manner i.e. spring like fashion
 Circular friction: when friction is given in a circular manner on the patient’s body, it
is called as circular friction.

Figure 5 Centrifugal Friction Figure 6 Centripetal Friction

Figure 7 Spiral Friction Figure 8 Circular Friction

Physiological effects of Friction:

 Effects of superficial friction is stimulation, warming and increases blood and lymph
flow.
 Deep friction spreads up muscle fibers and breaks adhesions

Contraindications of friction:

 Do not apply friction over open skin lesions, skin diseases, bruises, acute injuries,
inflammation or moderate to severe varicose veins

43
Kneading:
Kneading involves multiple movements which are meant to manipulate the soft tissues of the
body in the fashion quite similar to kneading of dough.

Kneading can be broadly classified into

 Superficial kneading
 Deep kneading

Superficial kneading is manipulating the superficial skin:

Fulling: fulling is a type of superficial kneading which involves pulling and leaving the skin
acted upon with the help of both the hands in an alternate manner.

Deep kneading:

Deep kneading includes the following movements:

 Digital kneading: kneading using fingers or thumb is called digital kneading.

 Palmar kneading: kneading done by using palmar surface of the hand is called palmar
kneading
 Fist kneading: kneading using one of both the fists.
 Rolling: rolling of tissues using both the hands against the underlying bone.
(applicable only on limbs)
 Wringing: wringing of the tissues similar to wringing of clothes against the
underlying bone using both the hands in alternate manner.
 Petrissage: involves grabbing of the musculatures, pulling and movements in the
direction of their origin and insertion.

Figure 9 Fulling Figure 10 Digital Kneading (Face)

44
Figure 11 Palmar Kneading Figure 12 Fist Kneading (Abdomen)

Figure 13 Wringing Figure 14 Rolling

Figure 15 Petrissage Figure 16 Digital Kneading

45
 Figure 17 Petrissage (Neck) Figure 18 Thumb kneading

Physiological effects of Kneading:

 Stimulates sebaceous glands

 Improves circulation and lymph flow
 Relaxes muscles and decreases adhesions

Contraindications of kneading movements:

 Avoid use with atrophied muscles that lack moderate tone.

 Do not use over skin lesions, skin diseases, bruises, acute injuries, inflammation or
moderate to severe varicose veins.

Percussion:
Percussion involves those movements which involves movements of both the hands in
combination like that of used in instruments like drums and table.

Percussion has following types:

 Hacking: the blades of the hands coming in contact with the patient’s body
 Tapping: tips of both the hands coming in contact with the patient’s body in alternate
manner.
 Spatting: the whole palms coming in contact.
 Beating: the ventral surface of the hands of masseur coming in contact when the
fingers are bent at phalangeal joints.
 Clapping: when the hands of the masseur are flexed in such a manner to form cups
and ventral part coming in contact.
 Pounding: the masseur makes fists of his hand and manipulates so that the medial
border of hands are coming in contact.

46
 Figure 19 Hacking Figure 20 Tapping

Figure 21 Beating Figure 22 Spatting

Figure 23 Clapping Figure 24 Pounding

47
Physiological effects of Percussion or Tapotement:

 Short applications are stimulating

 Long applications are relaxing
 Light percussion causes vasoconstriction of capillaries in the local area.
 Moderate percussion causes increased circulation
 Useful for loosening mucous

Contraindications of percussion or tapotement movements:

 Do not apply percussion over kidneys, over bony areas, especially directly over spine
or bruises or varicose veins.

Joint Movements:
It involves passive movements of the joints of the part acted upon in their respective
movements and full range of motion in a gentle manner.

Following movements are commonly done in the following joints:

Neck: Flexion, Neck twisting, extension and sideward flexion

Shoulder joint: Flexion, extension, abduction, adduction, internal and external rotation.

Elbow joint: flexion and extension

Wrist joint: flexion, extension, ulnar and radial deviation

Phalangeal joints: flexion and extension, adduction and abduction of thumb

Hip joint: flexion, abduction, adduction, internal and external rotation

Knee joint: flexion and extension

Ankle joint: dorsi flexion, plantar flexion, eversion and inversion.

Phalangeal joints: flexion and extension.

And compound joint movement of hip and knee are also administered.

Physiological effects of joint movements:

 Stimulates the production of synovial fluid.

 Nourishes joint structure
 Increases Range of motion

Contraindications of joint movements:

 Acute injuries of bones, joints, muscles, or nerves.

48
  Traction of joint are contraindicated for sprains, rheumatoid arthritis and hyper mobile
joints.

Vibration or shaking:
These movements involve either giving vibratory movements to the part acted upon using
one or both the hands or giving shaking movements to the limbs by holding the appropriate
joint and giving slight degree of traction.

Physiological effects of Vibrations:

 Primarily stimulates and then relaxes

 Sustained vibrations in numbing and analgesic, decreases muscle guarding.
 Fast vibrations can cause muscle contractions and stimulate nerves.

Contraindications of Vibrations:

 Do not apply vibration on Open skin lesions, skin diseases, bruises, acute injuries,
inflammation or moderate to severe varicose veins.

Physiological effects of massage therapy:

The therapeutic effects of the massage have been recorded for many years, for this many
physiologists have studied the effects of the massage on the subject and have recorded it with
association with the Battle Greek Sanatorium established by John Harvey Kellog.

These physiological effects can be studied under the following main heads:

1. Mechanical: in mechanical effect the tissues are influenced mechanically by the hands
of the manipulator. It influences the blood and lymph and even the organs.
2. Reflex: reflex effects deal with the stimulation of the nerve endings which sends
impulses via cerebrospinal and spino-thalamic tracts and the brain sends impulses to
the related parts of the body via efferent connections and induces changes through
reflex action.
3. Metabolic: the massage also influences the metabolic functions of the parts directly
acted upon and the parts reflexly connected to the areas acted upon.

49
The physiological effects on principal system of the body:

Nervous system:

The effect of the massage therapy on the nervous system is through the simulation of the
nerve endings. These nerve endings have connection with the cerebrospinal and sympathetic
nervous system.

Direct stimulating effect: Using the massage movements like nerve compression and
vibration, the nerve trunks can be stimulated and also the nerve centers connected to the
nerve trunks.

Friction may influence the languid or tired nerves. Similarly other movements like light
percussion can cause slight nerve irritation and on the other hand strong percussion can cause
strong nervous irritability and cause nerve fatigue and gives benumbing effect. Movements
like tapping, slapping, and clapping can cause excitation of the nerve centers when applied to
the spine.

Reflex effects: very light stroking gives remarkable effects in the reflex areas. Also, the
movements like percussion and vibration can produce strong reflex areas by influencing the
glandular and vascular activity.

Sedative effect: The sedative effects are obtained by the certain movements of the massage
which are as follows:

 Gentle stroking gives a sedative effect by acting upon the nerve centers through reflex
action.
 Kneading and percussion movements give sedation by derivative effects.
 Centrifugal friction reduces the flow of blood to the brain and hence, the sedative
effect is achieved.

Restorative or reconstructive effect:

The massage movements set up the circulation and thus, improve the nutrition to the tissues
and aids in restoration and reconstruction.

50
Effects on Muscular system:

Encourages nutrition:

Through massage movements, the muscles receive good amount of circulation and hence
improves the nutrition.

It was also observed that after massage the muscles become firmer and more elastic.

 To excite muscular contraction:

To excite the muscular contraction: a strong blow on muscle is known to produce a degree of
muscular contraction.

A blow after another also produces a titanic contraction in the muscles.

 Increases electro-excitability:

Numerous experiments have proven that the massage produces the electro-excitability of the
muscles which is proven by the fact that a small amount of electric impulses are required to
cause a muscle to contract.

 Removes effects of muscular fatigue:

Experiments have shown that the massage reduces the fatigue of the muscles by reducing the
toxic load which has caused them fatigue after a certain amount of work.

Effects on bones, ligaments:

Bones have the same blood supply as its overlying musculatures. Thus, massage improves the
blood circulation to bones as well along with muscles.

The lymph channels and blood vessels are in ample quantity in the vicinity of the joints. The
joint movements employed in the massage improve the circulation in them and helps in
development of surrounding structures like ligaments, cartilages and health of the joint.

Effects on circulation:

51
The massage has a profound effect on the circulation and the effects may be local or general.
Massage also improves the circulation as in exercise but with the difference that is does not
increase arterial tension as in exercises. And also, influences heart beats.

Massage improves the drainage through its mechanical actions and reduces the load on heart
by dilating the peripheral vessels. This mechanism also helps in reducing the toxins from the
blood.

Locally, massage produces degrees of hyperemia due to the manipulations involved in

massage.

Light percussion causes vessels to constrict a bit and strong percussions produce dilatation in
the vessels.

When applied to reflex area, it influences the circulation related to respective nerve centers.

Massage to the abdomen slows the pulse by raising the general blood pressure of the body.

Centrifugal friction reduces the congestion in the portal and pulmonary circulation.

Massage to legs directly influences the portal circulation and massage to both extremities
reduces congestion in the pulmonary circulation.

Massage has powerful effect on circulation by promoting action of diaphragm which results
in increase in depth of respiration.

Massage influences the flow of the lymph in a greater rate as compared to in the resting
phase. By improving the lymph flow, it helps in reducing the toxic load in the blood and
lymph.

The absorptive capacity of the peritoneum is also increased by massage.

Effects on respiratory system:

 Increases respiratory activity: massage improves the depth of the respiratory activity
which results in more elimination of the CO2 from the circulation and increases
oxygenation.
 Increase of tissue respiration: massage improves the metabolism at the cellular level
as it increases the circulation to the musculatures. It improves the cellular uptake of
the glucose and O2 in an optimum amount and influences all the systems of the body.

52
 The action of diaphragm is also improved by massage which results in greater
pumping of blood and lymph into the thoracic duct.
It also influences brain activity by influencing the drainage and supply of O2 to it.
 Effect on heat: the massage can either increase heat dissipation or production. The
friction increases heat dissipation by influencing peripheral circulation and activating
sweat glands. On the other hand, kneading and other massage movement’s increases
heat production.

Effects of massage on digestion:

 Improves appetite: increased overall circulation and elimination leads to increased

demand of the nutrients in the body.
 Improves secretion of digestive fluids: massage to the abdomen by reflex actions
influence glands and circulation to the stomach and intestines thus improving the
quality and quantity of their secretions.
 Improves the absorption: massage influences the time the food remains in the stomach
and results in better absorption of the products of digestion.
 Improves peristalsis: massage influences the reflexes by which the food moves along
the GIT and thus removal of leftover is influenced.

Effects of massage on Nutrition, Hematogenesis and Phagocytosis:

It has been proved by the experiments that after massage the amount of red blood cells
increases in the blood stream. This may be due to the RBCs are released from the organs like
spleen and liver or may be due to increase in the hematogenesis in the bone marrow.

Along with the influence on red blood cells, massage also enhances the activities of white
blood cells which are responsible for draining the body of inflammatory processes.

Massage is meant to influence the entire bodily system, thus increasing the appetite and
restoring the nutrition in the undernourished people is highly evident.

Effects of massage on elimination:

 Improves elimination: massage tends to increase the lymphatic drainage and venous
drainage and also the exchanges at the tissue and cellular levels are enhanced.

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  Improves activity of the liver: the massage to abdomen highly influences the portal
circulation and aids the liver in its detoxification process.
 Encourages renal activity: the massage to abdomen has a great effect on the formation
of urine and its elimination. It influences the lumbar ganglia and the solar plexus.
 Encourages the elimination through skin: massage influences the skin activity by both
direct and indirect ways. Directly, it activates the glandular activity in the skin and
promotes perspiration and indirectly by acting upon vasomotor nerves which
improves the circulation at skin.

Local Effects of Massage:

1. Increase of blood and lymph circulation.
2. Increase in both constructive and destructive tissue change.
3. Absorption of waste or effused products.
4. Development of the muscles, ligaments, and other structures acted upon.
5. Increased heat production and tissue respiration.
6. Reflex or sympathetic effects upon the vasomotor centers and through them upon the
large internal organs, the liver, spleen, stomach, intestines, kidneys, and the general
glandular system of the whole body.

Procedure of massage:

Sequence of the message to be followed:

Supine position:

1. Hands
2. Shoulders
3. Legs
4. Thighs
5. Chest
6. Abdomen

Prone position:

1. Legs
2. Thighs

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 3. Back
4. Hips

Sitting position:

1. Head
2. Neck
3. Face

MASSAGE technique with sequence:

Arms:

Ask the patient to lie down on the massage table in supine position and help the patient
for the same if necessary.

Perform the following movements on both the sides

1. Centripetal friction: in this the whole hand will be moved on the surface of the
patient’s body.
The masseur should follow the main venous trunk like radial, ulnar by using the
thumb.
Massage to the hand: the patient’s extended hand is allowed to rest in the hand of
masseur and now the masseur uses his other hand and glides his fingers in such a way
that his hands pass through the groves between the fingers and metacarpals. This is
repeated several times.
After repeating the movements, now the patient’s hand is turned upwards and same
movements are provided with a change that it is done till the masseur’s hand is resting
in the grove of the patient’s hand. Then, a firm rotary friction is applied in the fleshy
part of the hand to empty the veins and bring in new circulation.
Massage to forearm: the patient’s forearm is half flexed and the masseur facing the
patient grasps his forearm firmly and apply friction on one side and with the other
hand on the other side of the patient’s forearm. So that whole area of the forearm is
covered.
Massage to the arms: same as massage to forearm.

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 Massage to the shoulder: the masseur should stand by the side of the patient and
operate the shoulder with both hands in alteration. It should be kept in mind that the
friction should be centripetal or towards the heart or the center of the body.
2. Fulling: in this movement the skin of the arm and forearm of the patient is grasped
between the thumb and the last two phalanges of the first finger and left after a
considerable amount of tension. These movements are done by both the hands in
alteration. In case of thick skin two fingers with opposition to thumb can also be used.
3. Spiral friction: the hand to be operated is grasped by one hand of the masseur and the
masseur gives the friction movements of his other hand in a spiral manner from distal
to proximal.
4. Centripetal friction
5. Petrisage: in this the masseur stands facing the patient in such a way that he stabilizes
the arm of the patient with one hand and by other hand he grasps the muscular area
between his finger and the thenar eminences with fingers closed to one another.
6. Rolling: the arms of the patient is well extended and the masseur grasps the upper
limb starting from shoulder with his both hands with fingers held close together and
making to and fro movements so as to roll the underlying tissues against the bone in a
rolling manner. The movements have to done from shoulder till the wrists of the
patient. And repeated on the other side as well. The movements should be quick
enough.
7. Centripetal friction
8. Wringing: the arms of the patient have to be grasped by both the hands of the masseur
firmly and moved in the opposite direction so as to give wringing motion. These
movements have to be started from proximal to distal i.e. form arms to forearms and
wrist.
9. Centripetal friction
10. Percussion: hacking, spatting and beating is employed.
Hacking: In this movement, the masseur uses his little fingers; ulnar area of the hand
with fingers separated but kept loose of both the hands and gives the movements in
alteration to the arms of the patient which gives vibrating effect.
Spatting: the masseur uses his both hands with extended fingers held tightly and
movements are employed on the patient’s arms through the palmar surface of the
hands.
11. Joint movements:
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 12. Vibration-shaking: the masseur grasps the hands of the patient with both the hands
and shakes rapidly to give vibratory movements.
13. Digital stroking: after all the above movements are being done, the masseur uses his
both the hands with slightly flexed fingers held loose and moved over the arms from
above downwards or proximal to distal. Only fingers should be touching the body of
the patient without any pressure.

Legs:

The position of the masseur should be on the side on which the massage is to be
performed.

Make the patient comfortable and perform the following movements in sequence

1. Friction (centripetal) followed by centrifugal stroking. The patient lying on his back
and the masseur standing by the side of the patient facing the patient. Both or one
hand may be employed and friction is given in the direction of the veins i.e. from
below upwards. The friction is to be followed by stroking.
Thighs are dealt first and then the legs. If the patient’s built is small whole of the
lower limb can be dealt at one time.
2. Fulling (superficial kneading): in the same position, the tissues of the legs and thighs
are grasped with thumb and the first two fingers of both hands in alteration.
3. Spiral friction: centripetal friction is given in the direction of the veins with a
difference that the hands should move in a spiral fashion.
4. Circular friction: both or one hand may be employed to give friction in circular
fashion.
5. Centripetal friction: same as above
6. Petrisage: both hands are employed to grasp the tissues of the thighs and legs in
between the heels of the hands and tips of the fingers and manipulated. The tissues
grasped may be moved to and fro.
7. Rolling: the legs are grasped with two hands and rolled against the underlying bone.
8. Centripetal friction: same as above
9. Wringing: the tissues of the legs are grasped with two hands and alternate to and fro
movements are given.
10. Centripetal friction: same as above

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 11. Percussion (hacking, spatting, beating, clapping)
12. Joint movements, stretching.
13. Shaking: the whole of the limb is grasped and given a strong shaking movement.
14. Stroking (digital stroking): after finishing the above movements whole of the leg is
given stroking movements so as to soothen the parts.

Perform the same movements on both the sides.

Chest:

While doing massage to the chest the masseur should stand on the head side of the
patient facing his feet.

1. Light centripetal friction: the patient lying in the supine position and the masseur
standing on one side of the patient facing the patient’s feet. The movements should
start form the insertion of the pectorals towards the mid-line to the sternum.
Both the hands may be employed working in succession. And also chest on both the
sides may be done simultaneously.
2. Fulling: this movement is done with special care. The fulling on the chest is done with
both the hands as mentioned in the fulling of the arms.
3. Centripetal friction: same as point number 1
4. Palmar kneading medial to lateral: the masseur stands by the side of the patient with
patient lying in supine position. The whole palm of both the hands is being used to
grasp the muscles and skin of the chest.
5. Percussion to fleshy person: tapping, hacking, spatting, beating and clapping to be
given to very fleshy persons only.
Tapping: done with both the hands with fingers slightly flexed and tip of the fingers
coming in contact with the patient’s chest.
Beating is done with the flexed fingers of both the hands and the knuckles and thenar
eminences coming in contact with the patient’s body.
6. Assistive and resistive breathing: to assist the expiration compresses the chest from
the sides by the hands.
To resist the inspiration, place one hand on the abdomen and apply a definite amount
of pressure and ask the patient to lift the hand through breathing.

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Abdomen:

Stand on the side of the patient in a comfortable position.

Ask the patient to fold his/her knees.

Perform the following movements in sequence:

1. Preliminary breathing-deep breathing, Inspiratory lifting, Lifting the abdominal

contents:
2. Reflex stroking: the masseur is on one side of the patient facing his face and with the
ends of his fingers makes very light stokes on and around umbilicus moving
outwards. These strokes may be repeated 2-3 times. Strokes should also be made
upward along the mammary line and parallel to the rectus abdominis muscle.
3. Nerve compression (solar plexus): the patient should be lying on his back with his
knees folded so that the abdomen is fully relaxed. The masseur then applies pressure
on each side of the umbilicus 2 inches away. This is the location of the lumbar
ganglia. The pressure should be firm so as to reach the ganglia.
4. Vibration (deep, lateral shaking, circular shaking): this is employed with either one or
two hands. The hand is placed directly on the abdominal surface and made to move
without gliding on the surface. This makes vibratory movements on the surface as
well as in the abdominal organs.
5. Percussion: the movements employed in this are spatting, tapping, hacking, beating
and clapping
For percussion movements, the masseur standing on side of the patient and facing the
patient uses his both or one hands in alteration.
Spatting movement is employed by both the hands extended and the palmar surface
coming in contact with the patient’s body.
Tapping is employed with the tips of the fingers coming in contact with the patient’s
body when fingers are partially flexed.
Hacking movement is employed by the ulnar surfaces of the fingers coming in contact
of the patient’s body surface when fingers are loosely held.
Beating is performed with the fingers half flexed held close and coming in contact
with the patient’s body.

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 Clapping is performed by making cup of the hands with fingers held close and tight.
This is marked by a typical clapping sound when coming in contact with the patient’s
body.
6. Deep kneading (digital, fist, finger, heel of the hand): the masseur stands facing the
patient on the ride side of the patient.
Digital kneading is performed with the fingers slightly flexed starting from the side
from below upwards. The other hand should be placed above the hand to reinforce it.
The movements should be started in the direction of ascending colon with
considerable amount of pressure till the lower border of ribs. Same movements have
to be performed on the left side in the direction of descending colon from above
downwards and finally ending the movements in the direction of sigmoid colon.
Fist kneading is performed by the closed fist and pressing the abdomen surface in the
direction of the colon. This kneading is done by the both hands. The movement
should start from the caecum till the lower border of the ribs following the border of
ribs to midline and after crossing the midline following the lower border of the ribs on
the left side till the pubis just left to the midline. Remember not to release the pressure
with one hand till the other is in motion.
Thumb kneading: thumb kneading is executed with the thumb on the front and fingers
at the back grasping the loins, the right hand grasping the caecum and the left hand
grasping the upper part of the descending colon. Then movements are executed
upwards on the right side and downwards on the left side.
7. Mass kneading: this movement is performed by standing on the side of the patient and
both hands being used. The hands are employed in such a way that the fingers of one
hand work in opposition to the heel of other hand and vice versa. This gives an
impression of baker making movements with dough.
8. Rolling: the masseur stands on side of the patient facing his face and uses his both the
hands on both side of the abdomen of the patient parallel to the body and rolls the
abdominal viscera and gives shaking movements. Repeat the movements for 4-5
times.
9. Fulling: give fulling movements up and down along the rectus abdominis muscle and
around the umbilicus.
10. Petrissage: in this movement the main muscle to operate upon are recti and external
oblique muscle. The masseur stands by the side of the patient facing him. Both the

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 hands have to be placed upon the rectus muscles and movements have to be made
from below upwards.
11. Stroking: hands of both the palms are being used and stroking is given on the
abdomen.
12. Hip raising and knee separating exercises.

Now ask the patient to lie down on his/her abdomen in prone position.

Back:

While performing the movements on back the masseur may stand on the head side or to
the side of the patient/client

Following movements are to be performed in sequence:

1. Centripetal friction: the massuer standing on one side of the patient facing patient’s
head and employs the movements with the whole of one or both hands in the direction
of veins.
2. Fulling of neck, shoulder, sides and loins: In the same position the fulling movements
are employed as for other parts of the body
3. Circular friction: same as before. The difference being it is employed first on one side
and then on the other side of the back.
4. Centripetal friction: same as above
5. Deep kneading (palmar, rolling, above scapula, digital kneading. Following ribs,
palmar kneading up and down the spine. Digital kneading of the spine: The
movements are given from spine to outward in the direction of the ribs.
Then, starting from the base of the skull the thumbs are employed in alteration to
whole of the spine to stretch the skin around the spine. The pressure should be
considerable and not too much.
6. Nerve compression: in this movement, a strong pressure is made on either side of the
spaces between the vertebras.
7. Percussion: tapping. Hacking slapping, beating and clapping.
8. Friction: centripetal friction same as above.
9. Stroking: the movements are finished by giving stroking movements to soothen the
area.

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Now ask the patient to sit and make him/her comfortable, and ask to take 2-3 deep breaths

Now the position of the masseur should be behind the patient. Thus, the patient may also be
asked to sit on a stool or chair.

Hips:

Perform the following movements in sequence

1. Light centripetal friction: both or one hand may be used and friction movements are
given in the direction of the veins. Repeat the movements 4-5 times.
2. Fulling: fulling movements are performed in the same way as mentioned above in the
massage to the arms.
3. Circular friction: both or one hand may be used and friction is given in a circular
direction
4. Petrisage: in this movement the muscular tissues of the hips are grasped and moved to
and fro by one or both the hands.
5. Palmar kneading: the palms of the hands are used and the tissues of the hips are
manipulated using the heels of the palms.
6. Centripetal friction: same as above
7. Nerve compression: a deep pressure by the thumb is given at the junction of sacrum
and ilium and over the sciatic nerve i.e. lower posterior portion of the gluteal region.
8. Percussion: hacking, spatting, beating and clapping movements are employed.
9. Stroking: palmar stroking is employed over the fleshy portion of the hips.

Perform the massage to back of the legs in the same sequence as done in supine position

HEAD AND FACE MASSAGE:

Now perform the following movements in sequence:

Massage of the face:

1. Oil application
2. Fulling: fulling is done on the facial skin in a careful manner

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 3. Digital kneading: thumb or tips of the fingers are used to manipulate the skin of the
face
4. Circular friction is then employed on forehead, cheeks and chin
5. Ear rolling: the ears are grasped with the both the hands and rolled in clockwise and
anticlockwise direction.
6. Stroking:

Massage of the Head:

1. Digital kneading, from forehead to occiput: the tip of the fingers and thumb are being
employed to compress the scalp against the underlying bony surfaces. Similarly the
movements have to be employed starting from the forehead to the occiput.
2. Hacking, from before backward.
3. Chucking: one hand placed upon the forehead or the side of the head, the other opposite.
4. Tapping: Tapping on all over the head is performed
5. Hacking.
6. Head rolling, flexion, and twisting both active and passive, repeated four to eight times.
7. Stroking from vertex to base of skull, down back of neck, and along the sub maxillary
groove.
8. Vibration - shaking: The head is grasped with both the hands and strong movements are
given. The masseur has to be very careful in doing so.
9. Pressure.
10. Hypnotic stroking: Hypnotic stroking is referred to the stroking on the forehead which is
very relaxing and produces hypnotic effects in some patients.

After the massage had been done, ask the patient to relax comfortably for 5 minute

Massage in Special Conditions:

Reflex Massage:

Reflex massage is a technique used in the conditions where the part to be operated has some
severe injury and cannot be massaged directly and thus, massaging the contra-lateral side
gives the desired effects.

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Such a massage is done in the cases of fractures, severe muscle sprain, metal implants in
which the part contra-lateral to the affected part is massaged and gained the desired effects.

Derivative massage:

Derivative massage is a special technique which is used in the conditions like osteoarthritis,
inter-vertebral disc prolapsed, lumbar pondylosis, cervical spondylosis, rheumatoid arthritis,
post joint surgeries etc.

In this technique the affected part is not massaged directly but, the massage can be
administered on the surrounding tissues in order to improve the circulation and promote
healing.

Infant massage or massage to babies:

The massage administered baby should be with caution and done with great care. The babies
are benefited in many ways by massage like:

 Builds bond between parent and child

 Improves digestion and elimination
 Improves circulation
 Promotes growth and development of the baby
 Sensory awareness is increased
 Enhances and promotes overall function of the body

In spite of these benefits there are some precautions to be taken while administering massage
to the babies or infants:

 Parents must learn to understand the behavioral cues of the baby

 If baby is not making eye contact and arching the back, kicking and jerking the legs,
then the baby is probably not receptive of taking massage
 Baby can be massaged after 30-45 minutes of feeding
 For special conditions like pre term babies, any medical condition or baby with
special needs, a trained therapist should only administer the massage.
 Oils used should be natural or cold pressed. Use edible oils because babies tend to put
the hands in their mouth. Coconut oil and olive oil are the better choices.
 Babies with diarrhea, vomiting, fever should not be given massage.

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Geriatric Massage:

The massage given to the people with age 65 and above is called as Geriatric massage. Such a
population has various needs as per their physical health conditions.

The massage to geriatric population promotes overall health and helps in healthy ageing.

Benefits of massage to geriatric population:

 Increases circulation
 Increased lymph flow
 Enhances immune system
 Improves flexibility
 Reduces the chances of injuries
 Alleviates pain
 Sleep is enhanced
 Reduces muscle tension
 Improves skin condition
 Reduces stress

Precautions or contraindications of geriatric massage:

 Use a thorough medical history to know the health status of the patients of this group
and to understand the medications they are undergoing if any
 Watch for bed sores, arthritic joints, varicose veins and recent surgeries

Indications of massage:

1. Disorders of nutrition like anemia, malnourishment etc.

2. Fatigue
3. Rheumatism
4. Diabetes mellitus
5. Chronic conditions of heart
6. Reynaud’s disease
7. Chorea, muscular dystrophy, pseudo-hypertrophy of muscles
8. Sciatica, trigeminal neuralgia, writer’s cramp, migraine, hemiplegia, locomotor ataxia
etc

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 9. Indigestion, constipation etc.
10. Acute inflammatory conditions of the liver.
11. Renal insufficiency, edema in renal conditions etc.
12. Amenorrhea, dysmenorrheal etc
13. Pleurisy, emphysema, bronchial asthma etc
14. Some forms of eye and ear disorders like corneal ulcers, mild degree of deafness,
acute and chronic nasal catarrh etc.

Contraindications of massage:

1. Recent fractures and dislocations

2. Uncontrolled high blood pressure
3. Recent surgeries
4. Metal implants
5. Pregnancy (selectively permitted)
6. Open wounds

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 REFERENCES:

1. Susa G.Salvo, History of massage, Massage Therapy, Principles and Practice, Fifth
edition, Elsevier, Pg 2-
2. John Harvey Kellog, Procedures of Massage, Art of massage
3. Massage Mastery, overview of Swedish massage, page number 402-403

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