A reference hand-book for nurses

by Amanda K. Beck

Massage (meaning to knead or manipulate) is one of the oldest therapeutic measures employed for the relief of disease. It is probable that the Chinese used this method of treatment several thousand years ago. The Japanese and the Greeks and Romans also were ancient users of massage. To-day it is recognized as one of our most useful adjuvants in the treatment of a great many disorders. Unfortunately, like some other therapeutic measures, it has been misused for personal gain by unscrupulous parties to the great detriment of this form of treatment; because of this many physicians have hesitated to adopt its use extensively for fear of being classed with the army of quacks and charlatans who endeavor to guile the public with a pretended knowledge of massage. It not being possible for all nurses to become proficient in the art of massage while doing general nursing (as it requires time, patience, and a great deal of experience to succeed), massage has become somewhat specialized, and we find many nurses who devote their time and attention exclusively to this work. Yet all nurses should have a general knowledge of the physiologic effects of massage and how to give it. The best results are obtained only when massage is given under the direct supervision of a physician, as massage may influence the function of almost every organ and tissue of the body.

Some general rules may be given as to the hour and duration of each treatment. A great deal depends upon the nature of the disorder in each individual case. In the treatment of neurasthenic patients where insomnia is often a troublesome symptom, massage given one or two hours before the patient quiets down for the night frequently results in improved sleep. Again, other patients will do better to have the treatment one or two hours after the morning meal. Individual peculiarities must be considered always in giving massage. The room should be of such temperature that the patient when exposed will not feel chilly. Absolute quiet should be maintained during the treatment, and after the treatment the patient should remain quiet in a recumbent posture for an hour or two as the condition may require. The oft-used expression “that a masseur or masseuse possesses a great deal of electricity which is transferred during the treatment to the patient,” should find no place in the intelligent mind in considering the effects of massage. It is true that one operator by his method of administering massage may please a patient and accomplish more than another, but this is due only to the fact that one understands how it should be given, and the other does not.

All the different movements in massage may be classed under the following: First, stroking; second, friction; third, kneading; fourth, vibration; fifth, percussion; sixth, joint movements.

Stroking.—This procedure may be given with two or three fingers or the palmar surface of one or both hands. The movement should be gentle, and the contact made as lightly as possible. Stroking should be done always in one direction, and, as a rule, in the direction of the blood currents in the arteries. The physiologic effects when properly applied should be sedative, as the purpose should be to diminish the blood-supply to the part. It produces a certain effect upon the cutaneous nerves which is very quieting. It is often found useful when applied about the forehead for sleeplessness. Nervous headache may be relieved by the same procedure. Neuralgic pains and the vague, but nevertheless uncomfortable, sensations complained of by neurasthenic patients are often relieved by this measure.

Friction.—In this procedure the whole or part of the palmar surface of the hand is moved over the surface of the body with considerable pressure. The principal effect of friction is upon the superficial blood-vessels and the lymphatics. In the lower extremities the movement should be from below upward in the direction of the venous flow. The same may be said of the upper extremities. The thumb may be made to follow the course of the larger veins, in this manner stimulating the venous circulation. Some patients object to friction applied by the dry hand, in which case some lubricant may be used; pure vaselin, cocoa-butter, and talcum powder are among the best for this purpose. Friction should always be used in the beginning of massage, especially if the surface of the body is cold.

It is not the intention here to give minute instruction as to the methods of procedure with all the different parts of the body; only general instructions can be here given, and those requiring further information should consult text-books upon this subject.

Physiologic Effects of Friction.—First, reflex effects upon the vasomotor nerves producing dilatation of the peripheral blood-vessels with increased circulation, aiding the venous and lymphatic circulation. It is useful in all conditions accompanied by poor peripheral circulation. It not only stimulates the circulation, but aids materially in elimination and increased nutrition. It aids in the relief of general dropsy and hastens the absorption of inflammatory exudates resulting from sprains and various joint affections, etc.

Kneading.—Kneading is one of the most important procedures in massage. It consists in the alternate compression and relaxation of the tissues, the hand not being allowed to slip over the surface as in friction. It may be administered in various ways, such as rolling, wringing, and the use of the palm or fingers. Furthermore, it may be deep or superficial. Superficial kneading stimulates all the functions of the skin, increases superficial circulation in the blood-vessels and lymphatics. In deep kneading the object is to influence the deep-lying muscles, and care should be exercised in this procedure not to injure the large blood-vessels and nerves. Here a knowledge of anatomy is essential. In the beginning of deep kneading little pressure should be exercised until tolerance is established; then greater pressure may be exercised without discomfort to the patient. It is quite essential that each muscle group be gone over carefully and thoroughly, so that every muscle so far as possible shall be included in the treatment. The physiologic effect of deep kneading is a stimulation of the functions of the nerves, blood-vessels, lymphatics, and cellular metabolism of the muscles. It is of especial benefit to patients who are unable to take a sufficient amount of active exercise, such as those suffering from neurasthenia, rheumatism, chronic neuritis, locomotor ataxia, and from localized disturbances, such as fractures, sprains, etc.

Vibration.—This procedure consists of vibratory movements to the body of the patient through the hand of the operator. It may be given by using the palmar surfaces of the hand or the finger-tips. This procedure stimulates the superficial circulation and acts as a mild general stimulant. It may be used in conditions of poor circulation from any cause, but is contraindicated in conditions of hypersensitiveness.

Percussion.—This procedure consists of blows or taps with varying degrees of force. The tips of the fingers may be used, the two hands alternating, or the palmar or the ulnar surface of the hands may be used for the same purpose. In any case, the force should not be sufficient to bruise the tissues. The physiologic results of percussion are stimulation for functions of the skin and a marked effect upon the underlying structures, muscles, nerves, and blood-vessels. It is useful in such conditions as sciatica, inactivity of the liver, chronic constipation, poor circulation from various causes, and to produce reaction after a cold bath, etc.