The use of body weight and pressure
A component of the massage movement is the angle at which the pressure is applied, and this is determined by the therapist’s posture, as already discussed, and the direction of the body move-ments. The body weight is therefore used to apply pressure from different angles:
Body weight poised equally on both legs
Pressure is applied through the arms
The whole body leans forward to exert pressure The feet are set at a slight distance from the massage table
The more medial hand stabilizes
the pelvis Body weight is
used to apply pressure through the arm
Movement in a cephalad direction
One foot rests on the floor to counterbalance the body weight Pressure is applied
through the arm and at an angle to the recipient's body
Body weight is used behind the movement
The more cephalad hand rests on the ipsilateral side of the body
The back heel is raised to shift the body weight forward
Figure 2.6 To-and-fro posture—the back heel is raised to shift the body weight forward.
Figure 2.7 Leaning posture—the whole body leans forward to apply pressure through the arms.
Figure 2.8 Some massage movements are best applied while sitting on the outer edge of the treatment table.
1. Body weight may be applied behind the movement, and pressure is exerted by applying the body weight more or less in line with the direction of the stroke (see Fig. 2.1).
2. Pressure may be applied at an angle to the recipient’s body. In some movements, especially those on the back, the pressure is applied at an angle to the body surface. This is in addition to the force exerted by the body weight behind the movement (see Fig. 2.6).
3. Body weight is applied from in front of the movement. In one or two instances, the body weight is used to pull the hands towards the therapist’s own body. This implies that any pres-sure applied to the tissues is being exerted by a pull rather than a push, and therefore from in front of the movement (see Fig. 2.3).
The correct use of the hands
The manner in which the hands are used is as rel-evant to the massage technique as the body pos-ture. Any tension in the therapist’s hands may reflect anxiety, which can easily be transferred to the recipient and eradicate any attempt to induce relaxation. Pressure for the massage stroke is pre-dominantly exerted by the weight of the body and not with the hands, and muscle contractions of the hands are therefore minimized. Palpation and assessment of the tissues is likewise most effective when the hands are relaxed. In a similar manner, any changes in the tissues that may occur as a reaction to the massage technique are also easily detected when the hands are relaxed.
Particular attention is needed when using the thumbs. Extending the distal interphalangeal joint when applying pressure with the thumb exerts a great deal of stress on the joint itself and can lead to pain and degeneration. It is therefore advisable always to keep the thumb straight or in a slightly flexed position (see Fig. 2.10).
In some situations, especially during back mas-sage, effleurage with the forearm is very effective and a good alternative to other effleurage tech-niques that are carried out with the palm of the hands, fists or thumbs. The health and condition of the therapist’s own hands and, indeed, the whole body is of equal importance as the
treat-ment being administered. It is also worth remem-bering that a massage treatment with heavy pres-sure, no matter how forceful, should not replace the patient’s responsibility for exercises, change of lifestyle and so forth. The position or movements of the hand and wrist during a massage technique are described as flexion, extension, abduction and adduction. Although these are self-explanatory terms it is worth bearing in mind the directions of the deviation.
Pressure
At this stage it is appropriate to introduce the concept of the ‘invitation’ rule. In all soft tissue work the muscles, and indeed the recipient, can-not be forced to relax. Increasing the pressure therefore does not lead to deeper relaxation; it may in fact cause further spasms. Tranquillity is therefore best achieved by ‘encouraging’ the muscles, and the individual, to let go of tension.
In turn, this is accomplished when the hands are relaxed and sensitive to responses from the tis-sues. Put another way, the therapist must not
‘barge in’ through the muscular wall but must wait to be ‘invited’ in as the tissues relax and yield to the pressure. By feeling the way through the tissues the sensitivity in the therapist’s hands is allowed to develop, and invariably the thera-pist can reach a degree of skill where excessive pressure is always avoided. Furthermore, caus-ing pain is almost anticipated and the pressure or the technique is adjusted before the tissues, or the recipient, have time to protest. This approach constitutes an essential factor in the palpatory skills and the art of soft tissue work. As well as being relaxed, the hands are used without any excessive abduction or adduction at the wrist. In addition, the thumb is never held in extension but in a horizontal position or in slight flexion.
The pressure of the massage strokes is also dis-cussed later on with the effects of massage and the perception of pain (see Chapter 3).
The rhythm of the massage stroke
When all the scientific theory on massage move-ments has been studied and absorbed, what
remains is the art of the techniques. Part of this involves the rhythm of the movements, not because they necessarily have to be performed in an artistic fashion but because the rhythm increases their effectiveness. In addition to all the mechanical and reflex effects of massage, relax-ation remains one of its most potent outcomes.
As noted elsewhere, the fact that the recipient is able to relax and remove anxiety is sufficient to set the body in a self-healing mode. A correct rhythm, therefore, is important for each move-ment. The slow and continuous stroking of light effleurage is the best example of massage for relaxation, and the rocking technique (see Chapter 4, pp. 161–2) is another example in which the appropriate rhythm is an essential aspect of the treatment. The speed of the movement, how-ever, is not as important as its regularity. This is particularly so when certain massage move-ments such as petrissage and kneading are being carried out, both of which can be relaxing as well as imparting other benefits. Another point that is worth bearing in mind is that the rhythm of the movements sets up the pace of the overall mas-sage treatment, and there is a considerable differ-ence between a treatment that is unhurried and reflective and one that is speeded up and super-ficial. It is also important to mention that estab-lishing a good rhythm to the overall treatment helps the practitioner to focus and tune in to the recipient, which means that the treatment is more about healing the patient than the tissues.
Furthermore, when the therapist is relaxed and working to a rhythm, the treatment can be expanded to include other aspects, i.e. the energy and subconscious levels. By visualizing the body as healthy, the therapist can also use intuition to feel and manipulate the tissues.
TERMINOLOGY
The study of anatomy and the practice of mas-sage necessitate the use of terms which describe the location of organs, the direction of move-ments and the position of the hands in relation to the regional anatomy. The following is a list of terms that are used frequently in this book.
● Anterior. The front of the body, in front of, before. For example, the abdomen is on the anterior side; the stomach is anterior to the spine. An illustration or observation showing the front of the body or of a region is referred to as the anterior view. A massage movement towards the front of the body is said to be in an anterior direction, or anteriorly.
● Caudad or caudal. Caudad is from the Latin cauda, meaning ‘tail’, and ad, meaning
‘towards’; opposite to cephalad. A similar word is caudal, from the Latin caudalis, meaning ‘per-taining to the tail’. The term refers to the loca-tion of a body organ or region which is situated nearer to the ‘tail’ (coccyx) than a particular ref-erence point; for example, the abdomen is cau-dad to the chest. This is in some ways synonymous with the term ‘inferior’. Caudad or caudal is also used to indicate a direction that is towards the posterior aspect of the body, and can be used for a movement or to indicate that an organ lies deeper inside the abdomen or below another organ (therefore more posteri-orly). In this book, the term is employed to describe the direction of a massage movement when it is carried out towards the pelvis or the feet. Another application is to specify which hand is needed for a particular stroke; for exam-ple, ‘the caudad hand (the one nearest to the patient’s feet) applies the effleurage whilst the cephalad hand (the one nearest to the patient’s head) stabilizes the limb’ (see Fig. 2.5).
● Centrifugal. From the Greek kentron, meaning
‘centre’, and the Latin fugere, meaning ‘to flee’.
Describes a movement moving away from the centre and towards the periphery.
● Centripetal. From the Greek kentron, meaning
‘centre’, and the Latin petere, meaning ‘to seek’.
Describes a movement towards the centre of the body from the periphery.
● Cephalad or cephalic. Cephalad from the Greek word kephale, meaning ‘head’; opposite to cau-dad. A similar word is cephalic, from the Latin cephalicus, meaning ‘cranial’ or ‘pertaining to the head’. The term is also synonymous with
‘superior’, and indicates the position of an organ or region that is closer to the head than a particular reference point; for example, the
chest is cephalad to the abdomen. In this text, the term is used to describe the direction of a massage movement when it is carried out towards the head (see Fig. 2.8). It also used to demonstrate which hand is needed for a par-ticular manoeuvre, as described above in the paragraph on Caudad or caudal.
● Contralateral. From the Latin latus, meaning
‘side’. This indicates the location of a region that is on the opposite side of the midline from the point of reference; for instance, the right side of the spine may be affected by a nerve impulse originating in the contralateral (left) side. In massage, the term is used to indicate the opposite side of the body to where the mas-sage therapist stands (see Fig. 2.4).
● Coronal plane. See frontal plane.
● Distal. From the Latin distare, meaning ‘to be distant’. Indicates the farthest point away from the centre of the body or from the trunk. The term is mostly used to describe the position of the part of a limb that is farther away from the trunk than the point of reference; for exam-ple, the wrist is distal to the elbow.
● Frontal plane. A plane which divides the body into the anterior and posterior portions, at right angles to the midsagittal plane.
● Hypothenar eminence. The prominent fleshy part of the palm, just below the little finger.
● Inferior. The location of a body part or organ which is beneath or deeper to the more super-ficial point of reference; for instance, the ribs are inferior to the pectoralis muscle group. The term is also used to describe the position of an organ, tissue or bony landmark that is further towards the feet than its point of reference; for example, the inferior border of the iliac crest is further towards the feet than the superior bor-der. This bearing primarily applies when the subject is in the standing posture (anatomical position), but it is equally relevant when lying down. In this context it is synonymous with the term caudad.
● Ipsilateral. From the Latin ipse, meaning ‘the same’, and latus, meaning ‘side’. Indicates the same side of the body as the point of reference;
for instance, a reflex action such as that of the patellar reflex is created by tapping the patellar
tendon just below the knee, which causes con-traction of the thigh muscles on the ipsilateral side. In massage it is used to describe a move-ment carried out on the same side of the body as where the therapist stands (see Fig. 2.6).
● Lateral. Towards the outside of the body; for instance, the lateral aspect of the femur is in the region of the iliotibial band. In this text the term is also used when describing a massage movement (see Medial, below).
● Midsagittal plane. An imaginary line passing through the body, dividing it into symmetrical halves (right and left).
● Medial. Towards the central axis of the body; for example, the medial aspect of the femur is in the region of the adductor muscles. The term is also used when describing a massage move-ment, and in this case the medial hand is the one which is positioned nearest to the midline or to the spine of the patient. The ‘lateral’ hand is the one which is positioned closer to the lat-eral border of the body. For instance, when a deep effleurage is applied to the back the medial hand carries out the stroke and it is rein-forced with the more lateral hand (see Fig. 5.5).
● Paravertebral or postvertebral. Alongside or near the vertebral column. These terms are fre-quently used to indicate the muscles of the back that are close to the spine.
● Passive movements. These are actions or move-ments of joints which are carried out by the therapist without any assistance from the sub-ject; for example, the hamstring muscles are stretched passively when the subject is lying supine and the lower limb is raised and flexed at the hip joint by the practitioner.
● Periphery. The outer part or outer surface of the body. The peripheral tissues are therefore those of the skin and subcutaneous fascia and their integrated soft tissue structures.
● Posterior. The back area of the body; for instance, the spine is located on the posterior region of the body.
● Prone. When the subject is lying face down.
● Proximal. Describes the position of that part of a limb which is nearer to the trunk than the point of reference; for example, the elbow is proximal to the wrist.
● Somatic. As a general term it is often used to differentiate between the innermost (visceral) regions of the body such as the thoracic and abdominal cavities, and those areas that are more superficial and make up the structures of the body wall, e.g. the skin, muscles, tendons, ligaments and skeletal structures.
● Superior. The position of a body region or organ that is situated above or higher than the point of reference; for example, the scapula is superior to the ribs. The term is also used to describe the position of an organ, tissue or bony landmark which is farther towards the head than its point of reference, e.g. the supe-rior border of the iliac crest is farther up than the inferior border. This bearing primarily applies when the subject is standing (anatomi-cal position) but it is equally relevant when they are lying down. In this context it is syn-onymous with the term cephalad.
● Supine. Opposite to prone; the body is lying down, facing upwards.
● Systemic. Pertaining to the whole body rather than to one part.
● Thenar eminence. From the Greek thenar, mean-ing ‘palm’. This term refers to the fleshy part of the hand at the base of the thumb, where the abductor and flexor muscles of the thumb itself are located.
● Thoracic. Pertaining to the upper back or tho-racic spine.
● Transverse plane. A plane which transverses the body horizontally at any level.