DEFINITION
What is massage? No uniform answer seems to exist to this question. Massage is one of those terms, which are easily understood than expressed. People find it difficult to define massage, although they are confident of its meaning. Many definitions of massage have been offered from time-to-time. Given below are some of the definitions.
- Massage is the scientific mode of curing certain forms of disease by systematic manipulations.– Murrel
- Massage refers to all mechanical procedures that can cure illness.– Hoffa
- Massage signifies a group of procedures, which are usually done with hand on the external tissue of the body in a variety of ways either with a curative, palliative or hygienic point in view.– Graham
- Massage is the scientific manipulation of the soft tissues of body with the palmar aspect of hand(s) and or fingers.
- Massage can be defined as the hand motions practiced on the surface of body with a therapeutic goal.
- Massage is the application of force to the soft tissue without producing any movement or change in the position of joints.
- Massage is a term applied to certain manipulations of the soft tissues. These manipulations are most efficiently performed with the palmar aspect of hand and administered for the purpose of producing effects on the nervous system, muscular system as well as on the local and general circulation of the blood and lymph.– Beard
- Massage is the mechanical stimulation of soft tissues of the body by rhythmically applied pressure and stretching.
- Massage is a healing art.
Most of these definitions are inadequate because neither do they include the complete dimension of massage nor do they offer any criteria to decide whether a given technique can be included in massage or not.
Definitions of Murrel and Hoffa restrict the application of massage to sick people. Though, throughout the history massage has been used not only by sick but also by the healthy people for therapeutic, restorative as well as preventive purposes. Moreover, these definitions do not address the technical specifications of massage.
Few definitions emphasise that manipulation of soft tissue should be performed by hand. While this is true for most of the techniques, it cannot be considered as a criteria for defining massage, because in some methods of massage parts of body other than the hands are also being used during manipulation. For example, in tread massage there is predominance of leg work. Besides, according to this criteria several mechanical devices like vibrator, percussor, pneumatic massage, etc. which essentially have the similar mechanism of action and physiological effects cannot be included in massage despite the fact that these machines were primarily devised to save the time and energy of the therapist.
If the techniques of massage are analysed carefully, it becomes obvious that mere rubbing or handling of the skin by hand does not produce the desired effects. Rather it is the variable amount of mechanical energy imparted to the body tissue during various manoeuvres, which accounts for the effects of massage. These mechanical forces may be generated by hand or by any other mechanical device and can be a criteria for defining massage and classifying its various techniques.
This concept has been dealt with in the definitions of massage given by Graham and Beard. These definitions while acknowledging the predominance of hand works in massage also hint at the possibilities of other ways of manipulating the tissues.
However, transmission of mechanical energy is also involved in the various joint mobilisation and manipulative procedures which also use the therapist's hand as a major tool. Therefore, it is imperative that these two major categories of manual therapy should be distinguished from each other. While the joint mobilisation and manipulation procedures achieve their aim by producing movement (either physiological or accessory) of the joint, massage manipulates the soft tissue and essentially does not produce any change in the position of the joint during manipulations.
These facts can be assimilated to outline the essential features of massage technique which may then form the criteria to decide whether a given technique can be included in the category of massage or not.
FEATURES OF MASSAGE TECHNIQUE
Essential features of massage technique can be listed as follows:
- Technique should apply mechanical force to the soft tissue of the body.
- These forces must not produce any change in the position of the joint.
- The technique must evoke some physiological and/or psychological effect which serve to achieve the therapeutic, restorative or, the preventive goal.
Considering these features, any technique, be it manual or mechanical, which imparts mechanical energy to the soft tissue of body through the skin without producing any change in the position of joint, in order to elicit certain physiological or psychological effect which can be utilised for therapeutic, restorative or preventive purposes either on sick or a healthy individual can be defined as massage.
CLASSIFICATION OF TECHNIQUES
Basis of Classification
Application of touch and pressure in various manners constitute the manoeuvres of massage. The effects produced by a technique entirely depend upon the type of tissue approached during a particular technique and the character of the technique governs this. Any given technique can be analysed and compared with other techniques of massage in terms of:
- Magnitude of applied force
- Direction of force
- Duration of force
- Means of application of force.
So, the characters of technique could be one of the bases of classification. Massage can also be classified on the basis of depth of tissue approached during a technique. The region of body, to which massage is given, has also been used to classify massage. Massage manoeuvres can be done either by hands of the therapist or by various mechanical devices. This can be another basis of classifying massage (Fig. 1.1).
CLASSIFICATION OF MASSAGE
On the Basis of Character of Technique
According to the nature of character of technique classical/manual massage techniques are classified into following 4 basic groups. Each group has more than one subgroup (Fig. 1.2).
- Stroking manipulations: Superficial stroking, effleurage
- Pressure manipulations: Kneading, petrissage, friction
- Tapotement/percussion manipulations
- Vibratory manipulations.
Stroking Manipulations
The technique of this group consists of linear movements of relaxed hand along the whole length of segment known as “Strokes”, which usually cover one aspect of the entire segment of the body at a time. An even pressure is applied throughout the strokes, which are repeated in rhythmical way. According to the amount and direction of applied pressure, it is divided into two techniques.
Superficial stroking: It is the rhythmical linear movement of hand or a part thereof over the skin in either direction, i.e. proximal to distal or vice versa, without any pressure.
Effleurage: It is the linear movement of hand, over the external surface of body in the direction of venous and lymphatic drainage, with moderate pressure.
Pressure Manipulations
In this group of techniques, the hand of the therapist and skin of the patient move together as one and fairly deep localised pressure is applied to the body. The techniques are directed towards the deeper tissue. The aim is to achieve the maximal mechanical movement of different fibres with the application of that maximum pressure, which a patient/subject can tolerate comfortably.
Depending upon the type and direction of applied pressure it can be divided into following three major subgroups. Each subgroup consists of more than one technique.
- — Kneading
- — Petrissage
- — Friction.
Kneading: In this group of techniques, the tissues are pressed down on to the underlying-firm-structure and intermittent pressure is applied in circular direction, parallel to the long axis of bone. The applied pressure increases and decreases in a gradual manner but the contact of the therapist's hand(s) with the patients body is never interrupted. Different techniques of this group are:
- — Digital kneading: Pressure is applied with the fingers (finger kneading) or thumb (thumb kneading).
- — Palmar kneading: Pressure is applied with the palm.
- — Reinforced kneading/ironing: Both the hands, placed over one another, are used to apply pressure. The lower hand, which is in contact with the patient's skin, receives reinforcement from the other hand.
Petrissage: In this category of massage, the tissues are grasped and lifted away from the underlying structures and intermittent pressure is applied to the tissue in the direction that is perpendicular to the long axis of bone. Different techniques of this group are:
- Picking up: Tissues are lifted away from underlying structures, squeezed and then released using one or both the hands.
- Wringing: Using both the hands, tissues are lifted away from the underlying structures, squeezed, twisted and then released.
- Skin rolling: The skin and fascia are lifted up with both the hands and moved over the subcutaneous tissues by keeping a roll of lifted tissue continuously ahead of the moving thumb.
Friction: In this group of technique the tissue are subjected to small range of to and fro movement performed with constant deep pressure of the finger or thumb. Different techniques of this group are:
- — Circular friction: Direction of movement is circular.
- — Transverse friction to and fro movement is performed across the length of structure. It is also called cross-fibre massage.
Vibratory Manipulations
In this group of techniques, the mechanical energy is transmitted to the body by the vibrations of the distal part of upper limb, i.e. hand and/or fingers, which are in constant contact with the subjects skin, using the body weight and generalised cocontraction of the upper limb muscles. This technique is mainly directed towards the lung and other hollow cavities.
Depending upon the direction and frequency of vibration it is divided into two techniques:
Vibration: In this technique, the fine vibrations are produced, which tend to produce fine movement of hand in upwards and downward direction.
Shaking: In this technique, coarse vibrations are produced, which tend to produce fine movement of hand in sideway direction.
Percussion/tapotement manipulations
In this group of techniques, a succession of soft, gentle blows are applied over the body, which produce a characteristic sound. The striking hands are not in constant contact with the skin and strike the body part at regular interval. This results in the application of an intermittent touch and pressure to the body during these manipulations.
The different parts of hand are used to strike the subject's skin and accordingly the techniques are named:
Technique | Administered with |
Clapping | Cupped palm |
Hacking | Ulnar border of the 5th, 4th and 3rd digits |
Beating | Anterior aspect of the clenched fist |
Tapping | Pulp of the fingers |
Pounding | Medial aspect of the clenched fist |
The features of various techniques of classical massage is given in table 1.1.
On the Basis of Depth of Tissue Approached
Depending upon the depth of tissue approached during manipulations, massage techniques can be classified as:
Light Massage Techniques
The force applied during the manoeuvre are light, so that the effect of massage is confined to the superficial tissue only. e.g. stroking, tapping, etc.
Deep Massage Techniques
The forces applied during the massage are moderate to deep so that the effect of massage reaches to the deeper tissues like muscle. e.g. friction, kneading, etc.
On the Basis of Region Massaged
Massage can also be classified as below, according to the region to which it is given.
General Massage
Massage applied to the entire body is usually termed as general massage. However, massage administered to a large body segment like the back, lower limb, etc. can also be included in this category. It is usually administered in debilitated persons following prolonged recumbency and on athletes after exhaustive physical work to bring a sense of well-being and comfort.
Local Massage
When massage is administered in a particular area of the body segment it is termed as local massage. This is used in the treatment of the local pathological conditions. For example, massage of wrist in tenosynovitis, friction to lateral ligament of ankle following sprain, etc. can be considered as local massage.
On the Basis of Means of Administration of Technique
On this basis, the massage can be classified into the following two categories.
Manual Massage
The word “manual” refers to the ‘lying on’ of hand over the subject's body. The massage administered with the hand or other body part of the therapist is called manual massage. e.g. technique of classical massage, connective tissue massage, trigger point massage, accupressure massage, etc.
Mechanical Massage
When the mechanical devices based on the principles of massage, administer the mechanical energy to the patient's body, in order to manipulate soft tissue, it may be termed as mechanical massage. e.g. vibrator, compression devices, pneumatic massage, etc.