Arthritis is an inflammatory disease of the human body that affects various groups of joints. Massage for arthritis is an important step in the treatment of the disease, which may be accompanied by the following unpleasant symptoms:
The main symptom of arthritis is impaired motor function, which often results in disability for the patient. Symptoms and the course of the disease may vary depending on the type of arthritis and the individual characteristics of the patient’s body.
If arthritis is not properly treated, a number of serious complications can occur. Contracture, that is, partial immobility of the affected joints, is provoked by changes associated with damage to the synovial membranes and cartilage of the joints, as well as damage to the muscles, ligaments and fixing diarthrosis. As a result of joint subluxation caused by cartilage deformation, joint hypermobility may develop.
Ankylosis is complete immobility of damaged joints. There are bone and fibrous ankylosis. Bone ankylosis is associated with the proliferation of bone connective tissue and is characterized by a complete absence of pain. In this case, the fusion of diarthrosis surfaces leads to complete immobilization of the joint. The fibrous type of complication develops as a result of the proliferation of fibrous tissue. In this case, the mobility of the joint may be partially preserved in the form of limited rocking movements, accompanied by severe pain.
Many years of practice show that various physical methods of combating arthritis are quite effective. One of these techniques is massage, which is an integral part of the therapy complex, combined with mechanotherapy, positional treatment and special gymnastics. Moreover, the methods of positional treatment and physical therapy can be used at any stage of the disease.
The effect of massage procedures is designed to improve blood circulation in joints, muscles and skin affected by arthritis. As a result of massage and therapeutic exercises, stiffness, pain and muscle tension are relieved, and the normal motor amplitude of the joints is restored. An important factor for patients with arthritis is the improvement of the removal of toxins from the body as a result of therapeutic massage, since the symptoms of the disease are associated precisely with the accumulation and crystallization of toxins in the joints, nervous system, blood and various tissues of the body.
In the process of fighting arthritis, it is very important to identify the following factors:
Therapeutic massage can be prescribed only at the stage of remission of the disease, which is characterized by the following symptoms:
The effectiveness of arthritis treatment and the results of therapy largely depend on the timeliness of starting massage procedures. The number of sessions is prescribed depending on the type of disease, the severity of the joint damage and the duration of the disease. When treating arthritis at the initial stage, you can usually get by with 5 sessions. In the case of a severe chronic form of the disease, in which the joint is deformed, at least 15 sessions are required. A therapeutic massage session lasts longer than a relaxing procedure, since treatment of the affected joint takes at least 20 minutes.
As a result of massage for arthritis, the following positive effects are provided:
To ensure maximum effectiveness of warming joint massage for arthritis, it is recommended to keep the room cool. In addition, massage therapy can and should be combined with physical therapy, physiotherapy and exercise therapy. Various massage techniques are used to treat arthritis, including acupressure and segmental massage. Depending on the area of the body being treated, general and private massages are distinguished:
Therapeutic massage for arthritis has various contraindications. Non-permanent contraindications, that is, alarming symptoms of various diseases, after which massage can be done without hindrance, include:
Massage for arthritis is contraindicated for patients suffering from the following diseases:
Private therapeutic massage is contraindicated for persons suffering from hernia and urolithiasis, as well as for women during menstrual bleeding and for 60 days after childbirth or termination of pregnancy. During pregnancy, private massage of the thighs, lumbar region and abdomen is not allowed.
Massage acts as an indispensable therapeutic and preventive measure, especially effective for arthrosis . This is due to the fact that manual intervention improves blood circulation in the diseased area of the body. Massage for joint diseases has the following goals:
Before prescribing a course of therapeutic massage, the specialist must find out the form of the disease (acute, subacute or chronic), the level of arthritis activity and the presence of joint dysfunction. It is very important to conduct a detailed study of the mobility of each joint, determining the possible presence of ankylosis and contractures. In addition, the doctor must clarify the condition of the muscle. You can do massage for rheumatoid arthritis in the intervals between attacks; for the rheumatoid form - at the chronic and subacute stages, regardless of the level of disease activity.
The period of exacerbation of arthritis is accompanied by limited mobility and swelling of the affected joint. In addition, there is a restriction in the movement of joints located above and below the affected one. In this case, there is a sharp tension in the muscles that fix the joints, so it is very important to try to ensure their maximum relaxation. For this purpose, special breathing exercises can be used. Various stresses during arthritis can aggravate the patient’s physical condition, while proper breathing ensures calm and restoration of the body’s natural balance.
Massage therapy is designed to minimize mobility limitations and pain. The first 2-3 sessions are aimed at relaxing the muscles as much as possible using methods of rubbing and stroking the surface of the skin, without resorting to direct impact on the joints. Starting from the 3-5th session, it is allowed to increase the intensity of muscle massage, ensuring their strengthening and reduction of wasting.
At the initial stage of massage therapy, a light effect on sore joints is provided, and special methods are used starting from 2-4 sessions. The joints with the least damage, which are characterized by less pain, are treated first. As the course of therapy progresses, the massage includes techniques of local rubbing and kneading, affecting all the patient’s joints.
Each massage session should begin with treatment of the joints least affected by arthritis. In the absence of sharp pain, you can directly influence the joints from the first sessions. In this case, it is important to pay due attention to improving the outflow of lymph from the joint cavity.
The muscles affected by contracture are rubbed and stroked, and the antagonist muscles are treated by rubbing, stroking, vibration and softening. Considering that the genesis of contractures is not paretic, vigorous stimulation should be applied to the antagonist muscles, accompanied by vibration techniques such as tapping and patting.
With the help of massage procedures performed for stiffness of the affected joint in combination with physical therapy and temperature exposure, in many cases it is possible to completely restore the mobility of the damaged organ. To improve the mobility of the shoulder joints, stroking, kneading and squeezing techniques are used, performed with the pads of the fingers and the edge of the palm. After kneading the treated area, shake it, then continue stroking and squeezing. Massage movements are performed starting from elbow diarthrosis and ending with shoulder. To treat the muscles responsible for shoulder extension, use the above techniques.
In order to improve the mobility of the elbow joint, you can add several more kneading methods to the movements described above, carried out using the edge of the palm or fingertips. Treatment of the elbow joint begins with a massage of the shoulder joint, smoothly moving to the forearm. Next, the muscles located above the elbow are worked on. The duration of the procedure depends on the condition of the joint itself and the muscles and tissues located around it. The size of the affected joint also plays an important role: for example, a hand massage can be done in 7 minutes, while it takes 10-15 minutes to work on a shoulder or knee joint.
The principle of acupressure is associated with physiological processes in the body. When acupressure is used with fingers or a hand, certain areas of the body are affected, providing a number of positive effects:
A specialist in performing acupressure must accurately find the necessary points on the patient’s body, the impact of which is carried out with the pad of the most sensitive finger. As a result of this effect on the points of biological activity, the patient experiences sensations of warmth, numbness and distension, and slight pain may occur in the treated area. In addition, when acupuncture points are exposed, “goose bumps” appear on the points being worked on.
To facilitate acupressure, you can use special diagrams that depict channels, lines and meridians, with the help of which you can determine the approximate location of the desired acupuncture point. Certain anatomical signs can be used during acupressure to find points located on the following areas of the skin:
Depending on the acupressure technique used, manual manipulation can have a calming or stimulating effect. In the case of patients with increased muscle tone caused by contracture and pain in the muscles and joints caused by arthritis, the effect is aimed at relaxation. This uses a soothing acupressure technique. If, with arthritis, there is a decrease in muscle tone and atrophy or paresis of certain muscle groups, it is necessary to do a massage using a tonic technique.
In the absence of the opportunity to resort to the services of a qualified massage therapist, therapeutic massage for arthritis can be done independently. This massage method has a number of positive features:
The main disadvantages of self-massage:
If self-massage is performed correctly, there should be no pain, damage or bruising to the skin. The massage is performed with active rhythmic movements that should not be too sharp. If the procedure is performed correctly, a feeling of warmth should appear in the treated area of the body.
In case of problems with large diarthrosis, primarily joints on the legs, the procedure should begin in areas located above the affected area. For example, treatment of the knee joint begins with the thigh. After treating the adjacent tissues, you can begin self-massage of the affected area. The duration of a self-massage for arthritis can vary depending on the size of the joint: when treating a hand, 3 minutes is enough, while a session of working on a large joint on the leg can take 25 minutes.
In order for self-massage to be effective and harmless, it is necessary to take the correct position in which the joints must be bent at the desired angles. When performing a massage, the direction of lymph flow should be taken into account: movements should be directed towards the nearest lymph nodes, while the lymph nodes cannot be massaged directly.
You should not perform self-massage during bleeding and exacerbations of diseases, or treat areas of skin with damage and ulcers. When performing self-massage as part of the treatment of arthritis, it is allowed to use various gels and creams with therapeutic effects that increase the effectiveness of the procedure.
For rheumatoid arthritis, massage procedures are prescribed at the stage of weakening of the disease, when there is no pain. The massage can be general or private, that is, aimed at working out individual joints in the arms or legs, or back muscles. For rheumatoid arthritis, a massage therapist usually uses the following techniques:
The duration of a course of massage therapy is usually 12-15 sessions, each of which can last 20-30 minutes. When treating the hands, it is recommended to use a soft roller, with which you can give the fingers a semi-bent position. In this case, each of the tendons is smoothed out through 8-10 manipulations, during which the pad and protrusion of the thumb move up and down the back of the hand. Then deep rubbing is done by hatching. When massaging the interosseous muscles, the patient's fingers should be spread apart, and smoothing and rubbing techniques are used to treat the palm. During one session, both hands are worked on.
In case of rheumatoid lesions of the feet, deep stroking is used in the direction from the toes towards the ankle. The massage is performed with the palms and thumbs and covers approximately a third of the lower leg. If the calf muscle massage is performed correctly, the condition of the feet improves significantly.
Treatment of the affected knee joint is carried out using the thumbs and hands of both hands. First, the thumbs are placed below the kneecap, after which they are gradually moved towards the thigh using stroking and rubbing techniques in a spiral. The knee should be massaged gently, since a large number of nerve endings are located in the popliteal cavity.
When massaging a back affected by rheumatoid arthritis, the left half is treated first, after which it moves to the right. You can use the following methods:
Physical therapy in the treatment of knee diarthrosis is aimed at stretching the leg muscles and improving the mobility of the knees. Exercises are performed slowly and with a gradual increase in load. If you choose the right set of exercises, gymnastics should be performed without pain in the joints. A complex of physical therapy for knee arthritis includes the following exercises:
Squats with knee arthritis are strictly prohibited. Therapeutic exercises can be performed in water, resulting in less stress on the affected leg joints.
Physical therapy aimed at developing shoulder diarthrosis includes moving the arms behind the back, to the sides and up. Soft rubber expanders and balls can be used to develop the hands. Instead of exercises, the joints of the hands can be developed by modeling from plasticine.
When at rest, it is recommended to place your hands on their edges or place them on a special rubber ball. As a result, the prevention of dislocations and subluxations of the wrist joints is ensured. To fix the hands and feet in the desired position during night rest, orthoses, which are special fixators for patients with arthritis, can be used.
The positional treatment technique is used when the affected joints require rest and the adjacent joints require frequent changes in position. In case of damage to the elbow joint, the arm should be bent at the elbow, and the bend angle should be close to straight. In this case, you should allow the arm to remain extended as little as possible. The forearm is placed in a position intermediate between pronation and supination, while the hand can be slightly straightened. The surfaces of the palms are directed towards the front of the body. Next, the shoulder is abducted at least 25-30° to the side and moved 30-40° forward of the body, after which the arm is placed on the pillow. In some cases, you can additionally rotate the shoulder outward.
It is very important to monitor the condition of the joints of the fingers and hands. In the case of arthritis of the metacarpophalangeal joints, a violation of extension is often observed; in case of damage to the interphalangeal joints, hyperextension is often observed, accompanied by subluxations and fraught with complete loss of mobility. Arthritis of the terminal phalanges may be accompanied by flexion.
In the presence of pronounced inflammation of the knee joint, patients try to keep the leg bent. This causes tension in the knee and hip flexor muscles, contributing to the formation of contractures in the hip, knee and ankle joints. In such a situation, during the massage and at the end of the procedure, the patient’s leg should be placed on a pillow, as a result of which the muscles can be fully relaxed.
Inflammation in the ankle joint can lead to the development of a complication, popularly called “horse foot.” To avoid this, the foot must be placed at right angles to the shin, and a bag or box of sand can be placed underneath. In order to maintain mobility of the hip joint, the patient should be placed on his back without a pillow several times a day, after which his leg is abducted and lowered from the bed, always placing the foot on the floor or placing a support under it.
Massage procedures are prescribed for arthritis in combination with medications, hormonal and vitamin preparations. The effectiveness of massage can be increased through mineral baths, mud therapy and ultraviolet irradiation. In addition, various herbal-based massage creams and oils can be used during massage: in particular, menthol, chamomile and camphor oils have been successfully used to reduce pain. In some cases, you can observe a positive effect when combining massage for arthritis with aromatherapy, which uses oils of lavender, rosemary, eucalyptus, marjoram, etc. Additional drugs and procedures should be used only after consultation with a specialist, since they have contraindications and individual intolerance.
Arthritis is an inflammatory disease localized to large and small joints. Treatment of this disease is carried out with the help of medications, physiotherapeutic procedures, and therapeutic massage. The goal of the therapeutic massage technique for arthritis is to improve local blood circulation, relieve swelling and reduce the intensity of the inflammatory process.
Therapeutic massage for arthritis can be performed both in a medical facility and independently. Before starting to master self-massage techniques, each person is recommended to familiarize themselves with the indications, contraindications and other features of this procedure.
With the development of arthritis, a person feels a decrease in mobility in the diseased joints. The progression of the disease often leads to loss of ability to work and disability. If not treated in a timely manner, the result of progressive arthritis is contracture. This complication is characterized by partial loss of motor activity in the affected joint.
The most serious complication of this disease is ankylosis - complete immobility of the diseased joint. This condition occurs when the articular surfaces are completely fused. If a person retains a slight potential for movement, it is usually accompanied by severe pain and discomfort.
In the fight against the complications of arthritis, drug therapy alone is not enough. Therapeutic massage techniques come to the aid of a person. The positive effect of this procedure is noticeable at any stage of the disease. Treatment of arthritis with physiotherapy can be combined only outside the acute phase.
Physical impact on the body through massage improves metabolic processes in the area of the diseased joint and the surrounding soft tissues. During a massage session, the removal of toxic and harmful substances from the body is accelerated, which is important for people suffering from arthritis.
Before starting a massage course, it is important to determine the following factors:
Impact on joints through massage is permissible only outside the phase of exacerbation of the disease. The subsidence of the pathological process can be recognized by the following signs:
The effect of massage procedures depends on the severity of the disease. The order and frequency of massage techniques is determined individually, based on the type and location of arthritis. For mild cases of the disease, 5-6 massage sessions are sufficient. For chronic and severe disease, at least 20 sessions are recommended.
The duration of one session is at least 20 minutes, since with arthritis there is a need for careful treatment of the joint area and surrounding soft tissues.
The invaluable benefits of this procedure are expressed in the following effects:
To enhance the therapeutic effect, massage procedures are recommended to be combined with drug therapy, physiotherapy and therapeutic exercises. Segmental and acupressure massage is used to treat various forms of arthritis. Depending on the area of the area involved, the following types of massage are distinguished:
Massage against the background of arthritis can bring not only benefits, but also harm. In order to prevent the development of serious complications, it is recommended to familiarize yourself with the main contraindications to its implementation. Such contraindications include:
Absolute contraindications for performing massage are:
Local massage is not recommended for people suffering from urolithiasis or inguinal hernia. This procedure is contraindicated for women during menstruation. When carrying a child, it is strictly forbidden to massage the abdomen, lower back and hips.
Before starting massage therapy, the attending physician determines the form of the disease, its location and severity. When starting a session, it is recommended to focus on the sore joint. Therapeutic massage includes the following techniques:
The duration of each appointment is 5-7 minutes. If a person feels a deterioration in their general condition due to the massage, it is recommended to postpone the procedure and seek advice from a medical specialist.
The impact of massage on biologically active points improves blood circulation, relieves swelling and inhibits the progression of inflammation in joint arthritis. Against the background of acupressure, pain is eliminated, metabolic processes in the body are improved, and joint mobility is restored.
It is recommended to perform acupressure for polyarthritis by a specialist who knows the location of biologically active points. If desired, each person can master self-massage techniques. To do this, it is necessary to study the layout of the desired zones that are subject to point action.
The search for biologically active points is carried out in the following areas:
A targeted effect on certain areas may be accompanied by an increase in nervous excitability or its depression. People suffering from arthritis with impaired motor function are recommended to take relaxing acupressure sessions. If arthritis is accompanied by atony and paresis of certain muscle groups, then the massage should have a tonic effect.
The acupressure technique can be performed at home or in combination with bath or sauna sessions. Before performing self-massage, you need to take a comfortable position, relax and begin to gently apply pressure to active points. The duration of exposure to each point is 10-15 seconds. At the same time, it is important to monitor your feelings.
If the massage is accompanied by intense pain and deterioration of the condition, it is recommended to reduce the intensity of pressure on the points and take a short break. If the technique is followed, the person will feel a pleasant warmth in the area being worked on. In order to improve the therapeutic effect, acupressure can be performed using anti-inflammatory ointments and creams.
Areas of damaged skin will not benefit from massage. After the massage, it is recommended to take a 15-minute rest, avoiding sudden movements in the sore joint.
This is inflammation of the joints, accompanied by limitation of movements, and with more complex changes - complete immobility (ankylosis) of the joints, pain during exercise, and later at rest. A distinction is made between monoarthritis (affecting one joint) and polyarthritis (affecting several joints).
Activation of the cardiovascular, respiratory systems, neuromuscular system, normalization of metabolism, improvement of joint mobility, increase in muscle strength, elimination of pain.
Active movements should be performed in easier conditions: lying down, on all fours, sitting, in water, hanging, etc. Avoid pain. The lesson includes walking, cycling, skiing, general developmental and breathing exercises, exercises with equipment (balls, sticks, dumbbells, etc.) in a standing and sitting position if the upper extremities are affected, lying and sitting – if the lower extremities are affected. , outdoor games. Exercises to relax the muscles of the sore limb are alternated with exercises for sore joints. Avoid jumping, hopping, and exercises with dumbbells and weights in a standing position. For ankylosis of the joints, mainly isometric muscle exercises are used, movements in less affected or healthy joints, and compensatory motor skills are also trained.
The massage is carried out in a lying or sitting position (if the lower extremities are damaged). The paravertabral zones are massaged: for damage to the joints of the upper extremities - segments D2-C4, for damage to the joints of the lower extremities - S4-1 - D11. Then the proximal parts of the limbs, areas below the diseased joint and symmetrically located parts of the healthy limb, the affected joint are affected. The duration of the massage for the upper extremities is 10-15 minutes, for the lower extremities – up to 25 minutes. Course – 10-12 procedures.
A chronic joint disease in which primary changes, mainly of a degenerative nature, occur in the articular cartilage. Later, other joint tissues change; bones - with their compaction ( osteosclerosis ) and growths ( osteophytes ), synovial membrane - with the development of reactive hyperemia, focal inflammation ( synovitis ) and subsequent fibrosis, as well as changes in periarticular soft tissues ( periarthritis ). There are primary (idiopathic) and secondary osteoarthritis, which is caused by dysplasia of the joints and bones, joint trauma, metabolic, endocrine disorders (for example, hypothyroidism), etc. The most commonly affected are the metatarsophalangeal joints of the toes, knee (gonarthrosis), hip joints (coxarthrosis), as well as the distal and proximal interphalangeal joints of the hands. In the initial stage of the disease, rapid fatigue in the joint, dull or aching pain are noted, which is caused by reflex changes in the muscles, hypoxia and poor circulation, and limitation of movements. As the disease progresses, pain occurs both during exercise and at rest, and ankylosis and even dislocation may develop. During the course of the disease, there are 3 periods: acute, subacute and remission.
Conservative and surgical treatment is used.
Objectives of exercise therapy and massage
In the acute period - improvement of local blood and lymph circulation, acceleration of regeneration, relaxation of tense muscles, elimination or reduction of pain; in the subacute period – they add an increase in mobility in the affected joint, a slowdown in the development of contractures; during the period of remission - strengthening the muscles adjacent to the joint, developing compensatory skills by including unaffected parts of the musculoskeletal system.
In the acute period, PH is carried out to reduce pain against the background of unloading the affected joint, in IP lying (for arthrosis of the lower extremities) and sitting (for arthrosis of the upper extremities): treatment with position (either an extensor or a flexion position), an exercise to relax muscles with increased tone , general developmental exercises for intact joints, breathing, isometric exercises.
In the subacute period , when there is no pain or they are insignificant, it is advisable to perform LH in the pool, add light swinging movements in the affected joint, muscle stretching exercises and with resistance (to increase muscle strength). Each movement is repeated many times. You cannot apply traction along the axis of the limb. For arthrosis of the upper extremities, LG is performed in a standing position: movements with objects, with apparatus, against a gymnastic wall. For osteoarthritis of the lower extremities, which manifests itself only as pain after long walking, the main importance is to reduce the load on the affected joint, reducing the duration of walking and standing. Exercise therapy for coxarthrosis and gonarthrosis is carried out only in a lying or sitting position. Excessive physical activity, including sports, running, long walking, is contraindicated; Cycling, swimming, water games, and exercise equipment are advisable.
For coxarthrosis, massage the back, gluteal muscles and lower limbs without using shock techniques; for gonarthrosis - segmental massage of the spine, then the thigh of the sore leg, the lower leg and the knee joint itself: circular stroking, rubbing (in places of swelling and pain - carefully); for arthrosis of the elbow joint - the cervicothoracic spine, shoulder girdle, shoulder, forearm, ending the massage by stroking the entire limb from the hand to the armpit (do not massage the elbow joint!). The duration of the massage is 10-15 minutes. Course – 15-20 procedures.
Massage, along with physiotherapy and exercise therapy, is one of the most popular methods of non-drug treatment of diseases of the musculoskeletal system, including arthrosis. It helps relieve the symptoms of arthrosis and stop degenerative processes. Massage for arthrosis goes well with other methods of influence: therapeutic exercises, manual therapy, physiotherapy, mud therapy and mineral baths, and the application of ointments. Performed by a qualified massage therapist, it can achieve significant improvement, while inept and untimely actions can only cause harm.
The impetus for the development of degenerative-dystrophic changes in the articular joint is often a violation of its blood supply and nutrition. People who lead a sedentary lifestyle weaken the muscles that support and partially relieve the load on the joint. Arthrosis is accompanied by pain in the area of the affected joint and in nearby muscles, and limited mobility. Forced restriction of motor activity leads to muscle wasting progressing, as a result of which the load on the joint increases and its blood supply deteriorates. Therapeutic massage helps combat the causes and consequences of arthrosis. Its therapeutic effect is mainly due to the fact that when treating soft tissues, peripheral blood circulation and lymph flow are activated. As a result:
It is useful for patients with arthrosis of peripheral joints to master self-massage techniques and combine them with exercise therapy complexes. Some massage techniques help to warm up and prepare muscles for exercise, while others help to relax and calm them after exercise.
If arthrosis is complicated by secondary synovitis, you must first treat it with medication. Massage is contraindicated in pathological processes in bone tissue, chronic osteomyelitis, bone tuberculosis, tumors. At stage 3 of osteoarthritis, when pronounced bone deformations develop, accompanied by the formation of cyst-like cavities, it is also not prescribed. Humeral periarthrosis (inflammation of the tendons and soft periarticular tissues) in combination with sympathoglionitis (damage to the sympathetic nerve trunk) is also a contraindication. In addition, you need to take into account general contraindications for any type of massage.
Many patients intuitively stroke and rub the joint area, that is, resort to simple self-massage techniques that relieve pain. Some master the technique of self-massage by studying literature, articles and videos on the Internet. It is better to consult with a doctor whether self-massage is indicated at this stage of the disease, what techniques to use, what area to influence, so as not to harm. You need to understand the difference between amateur and therapeutic massage. The capabilities of the first should not be overestimated, and the second can only be performed by a specialist with a medical education. Unprofessional impact on the paravertebral areas is especially dangerous. Massage for osteoarthritis is performed taking into account a number of rules:
In the subacute period of arthrosis of large joints, the effectiveness of massage increases if it is combined with traction of the joint along the axis. Underwater traction is more gentle. Underwater massage at a water temperature of 36–38° is also highly effective. Along with manual massage, you can resort to hardware massage under the supervision of a specialist.
For arthrosis of the joints of the hands, they resort to stroking and rubbing techniques. Rubbing can be done in a straight line, in a circle, in a spiral, or in a zigzag. It is performed with the pads of one or four fingers, the base or ulnar surface of the palm. For arthrosis of large joints, kneading and squeezing techniques are added. The position of the patient during the massage depends on which joint is affected by arthrosis and which area is being massaged.
With arthrosis of the hands, the patient sits with his forearm on the massage table and his hand half-bent. The massage begins with straight-line stroking of the back of the hand and fingers, first superficially, then deeper. Then the back surface of the hand is rubbed using different techniques. Movements are performed from the base of the fingers to the wrist joint. After the heel section of the hand, each finger is worked through rubbing techniques in the direction from the tips to the knuckles. The session ends with shaking the brush. Periodically, percussion massage can be performed, in which the patient’s hand is struck through the massage therapist’s hand. Self-massage techniques include pressing your palms against each other and simulating hand washing.
Massage for arthrosis of the foot is carried out in a supine position, with a cushion placed under the knee and ankle. First they work on the fingers, then the foot:
For coxarthrosis, massage is performed in a standing position with support on the healthy leg, the patient is moved to the side and back. If it is difficult for the patient to stand, he is placed on his healthy side. Massage sequence.
The lower back, gluteal and thigh muscles are worked through stroking, squeezing and rubbing techniques. The lower back is rubbed, the muscles of the sacrum are kneaded, the muscles around the sore joint begin to be worked in a gentle manner, increasing the force of influence in subsequent sessions. The main technique is kneading.
Massage for arthritis
This book is not just a useful guide for those who strive to always stay healthy, it focuses on massage for arthritis. The first part describes in detail the most common forms of the disease and their classification. Next, we consider in detail the techniques of classical massage, which form the basis of general, therapeutic, segmental and other types. Then the most important types of massage in the treatment of arthritis are described: therapeutic, segmental, acupressure, hardware, self-massage.
The chapter “Segmental massage” talks about how you can influence the body by influencing its reflex zones, because not everyone knows that by massaging individual areas of the body, you can have a beneficial effect on an internal organ or on an entire system of the body.
In the chapter “Acupressure”, in the form of drawings, the main points that need to be affected when treating each individual joint (elbow, knee, wrist, shin joints, etc.) are given. Massage can be performed for symptomatic treatment in order to reduce or completely eliminate pain symptoms, relieve swelling, and achieve better joint mobility. Massage is also one of the most effective ways to eliminate or mitigate the effects of arthritis - such as contractures and ankylosis of the joints.
Some types of manual massage, such as vibration, are now being successfully replaced by hardware massage. In the chapter “Hardware massage” you can learn about the most common vibration massage devices, their structure and methods of operation.
The greatest effect in treating the disease is achieved by using massage in combination with other physiotherapeutic procedures, and this book will tell the reader which ones and how.
Massage is also very convenient because it can be performed on your own body. Self-massage, when performed correctly, is in no way inferior to massage performed by a specialist, and has the same beneficial effect on the body. The main thing is to correctly and carefully follow all the requirements and rules described in the book.
The book is equipped with numerous illustrations that clearly show each specific massage technique and help to perform it correctly.
DISEASES OF THE JOINTS, THE CAUSES OF THEIR APPEARANCE AND PREVENTION
People can be divided into two categories. The first group includes those who never complain about joint-related ailments and therefore do not think about their condition. The second category includes people suffering from joint diseases. The first category of people should not forget that good health may not last long if there is no regular physical activity and proper nutrition that provides the body with the necessary elements. You can strengthen your joints and maintain their flexibility and mobility with the help of special gymnastic exercises and massage. Regular implementation of these procedures will improve the functions of all organs and systems of the body as a whole: increase muscle tone, restore blood circulation, breathing, and stabilize the nervous system.
Today, an increasing number of people suffer from a lack of physical activity, sitting all day at work and at home watching TV. Many people don’t even think about how much movement the body needs. The latest automated technologies perform all the physical work for a person. Basically, he does not have to do physical labor to earn his own food, as our ancient ancestors did, spending a lot of time searching for food, actively hunting and trying to survive in harsh environmental conditions. In modern society, everything is arranged for the benefit of man. Humanity, striving for new inventions and knowledge, pays more and more attention to mental work, as a result of which it suffers from physical passivity. Most diseases are “younger,” that is, they affect people at a younger age than before. These diseases include vascular diseases. Even if they are not fatal, they cause such pain to a person that makes life unbearable. There is one person in the world who suffers from some form of arthritis for every seven people. The word “arthritis” is translated into Russian as “inflammation of the joints.” People often mistake joint ailments that are not caused by inflammation for arthritis. Therefore, it is necessary to know the structure of the joints, the principles of their operation and the anatomical and clinical picture of arthritis.
Damage to a joint by disease can lead to partial or complete impairment of its mobility. In this case, the process can affect any part of the joint: cartilage, synovial tissue, joint fluid, as well as muscles and ligaments that fix the joint.
You should know that not every pain is a consequence of a joint disease. For example, back pain is often caused by muscle spasms. Therefore, it is important to establish the true cause of pain and, based on it, prescribe appropriate treatment.
The most common joint diseases include osteoarthritis, or degenerative changes in the joint. It affects mainly elderly people. At least 30% of the general population and 60% of people over 60 years of age have some form of osteoarthritis. This disease most often affects the hips, knees, fingers and back, but can also affect other joints. Osteoarthritis occurs primarily in one or a few joints, unlike rheumatoid arthritis, which affects all joints, is long-lasting, and is detected by a blood test.
People often call arthritis weakness and wear and tear of the joint, because, according to most, the disease occurs as a result of excessive stress. But this is not entirely correct. The joint is affected by using one part of the joint too often, while all the others remain immobile. During training, many athletes repeatedly push on the same area of the joint. All this suggests that you need to do physical labor, but you should choose optimal loads and not overload your joints and muscles. Excessive and long-term stress leads to inflammation of the muscles, ligaments and connective tissue. In this case, symptoms similar to arthritis may appear, but the destruction of articular cartilage does not occur.
Actively moving joints are much stronger than joints that lack exercise. But they must be used correctly. Movements should not be sudden. For example, in pianists suffering from arthritis, the disease never affects the joints of the hands, because when playing they actively move, and the movements of the fingers are flexible and smooth.
In medicine, there is an opinion that damaged cartilage cannot be restored. However, some experts are sure of the opposite. They believe that joint inflammation develops only when something interferes with the self-healing of cartilage. Studies have shown that the cause of the disease is the improper use of our body. Many doctors believe that certain exercises, as well as massage, have a very beneficial effect on affected joints. This can be explained as follows. Synovial fluid, located in the joint capsule, replaces blood in the joint. It provides it with nutrients and oxygen and absorbs metabolic products. In order for a liquid to actively perform its functions, it must be in constant motion. This occurs due to the pressure of the bones on each other. This creates pressure in the synovial bursa, which contains the synovial fluid, which means that for the normal functioning of the synovial fluid, the joints need movement. It should be as balanced as possible, i.e. it is necessary to use all areas of the body and not allow excessive tension in one area and inactivity in another. If, however, overload does occur, in this case massage is very effective. Often the disease affects only one limb - knee, hip, hand. Incorrect posture often contributes to joint damage. A person with poor posture strains one part of his body more than another when walking. People who tend to sit cross-legged or stand on one leg are susceptible to arthritis.
Joint diseases are associated not so much with age as with improper handling of them. If you constantly monitor your health, then, as a rule, over the years your movements will not be constrained.
To prevent the development of the disease, you must first pay attention to how much you move and how. You may have to change some habits. You should do gymnastics. And massage is especially effective in the prevention and treatment of disease.
Chapter 1. Structure of joints
A joint is a movable connection of bones. When healthy, they are able to move freely. Joints can be compared to hinges, the task of which is to ensure smooth sliding of bones relative to each other. In their absence, the bones will simply rub against each other, gradually collapsing, which is a very painful and dangerous process.
Most joints are synovial in type. They are characterized by the alignment of the contacting bones in front of each other (Fig. 1).
Rice. 1. Structure of the joint: 1.8 - bone, 2 - articular capsule, 3 - articular cavity, 4 - patella, 5 - articular fluid, 6 - medial disc, 7 - ligament
Joints are also divided into simple and complex. Simple bones are formed by two bones; complex bones are formed by more than two bones.
All types of bone connections are divided into two groups: continuous and discontinuous.
Discontinuous joint (synovial) - a movable joint of bones, between which there is a slit-like articular cavity.
A continuous connection is a fibrinous connection, in which the bones seem to be fused together by connective tissue.
Bones are connected by dense fibrous connective tissue, cartilage and bone tissue.
In movable joints there are basic formations:
Articular cartilage is tissue filled with fluid. The surface of the cartilage is smooth, strong and elastic, capable of absorbing and releasing liquid well.
The joint capsule has the appearance of a closed case and is formed by connective tissue. It surrounds the articulating ends of the bones and on the articular surfaces passes into the periosteum. The joint capsule has a thick outer fibrous fibrinous membrane and an inner thin synovial membrane. The latter secretes a special sticky synovial fluid into the joint cavity, which lubricates the articular surfaces.
The joint is surrounded by a fibrous capsule that helps keep the bones close and move easily. The inner layer of the joint capsule consists of synovial fluid, which lubricates and nourishes the cartilage and edges of the joint. It creates pressure that helps the joints resist the compressive forces that occur during movement. During the period of physical activity, the circulation of synovial fluid in the joint capsule improves, and as a result, movements become easier and freer.
In addition to the listed main formations, there are auxiliary ones:
- cartilaginous plates that wedge between the articular surfaces of bones.
Ligaments are dense bundles of connective tissue. They are located in the thickness of the fibrinous membrane or on top of it (extra-articular ligaments), sometimes in the cavity of the joint itself (articular ligaments). Ligaments hold the bones in the joint. Muscles are attached to the bones above and below the joint by ligaments, which are the long tapering ends of the muscles themselves.
The joints move along three mutually perpendicular axes: frontal (horizontal axis) – flexion and extension; sagittal axis – adduction and abduction; vertical axis – rotational movement. Ball and socket joints are also characterized by circular motion.
Joints moving along one axis are called uniaxial, while joints moving along two axes are called biaxial (ellipsoidal joints). There are also triaxial (joints with flat articular surfaces) and multiaxial (ball-and-socket) joints.
Intervertebral discs (cartilage) are located between the vertebrae in the cervical, thoracic and lumbar spine (Fig. 2). The intervertebral disc belongs to the group of fibrocartilages. It consists of the following parts:
– peripheral part (fibrinous ring);
– central part (nucleus pulposus).
Rice. 2. Intervertebral discs
The central part of the intervertebral disc is characterized by great elasticity and is a kind of springy layer, which, when the spine tilts, shifts towards extension.
The intervertebral disc fuses with hyaline cartilage, which covers the surfaces of the vertebra and matches them in shape.
There is no intervertebral disc between the atlas and the axial vertebra.
The thickness of the discs is uneven and decreases towards the lower part of the spinal column. The discs of the cervical and lumbar spine are slightly thicker in front than in the back. In the middle part of the thoracic region, the discs are thinner than in the sections located above and below. The cartilaginous section makes up a quarter of the length of the entire spinal column.
An arcuate joint is formed between the superior articular process of the underlying vertebra and the inferior articular process of the overlying vertebra.
The articular capsule is attached along the edge of the articular cartilage, the articular cavity - in the direction of the articular surfaces. Symmetrical facet joints are combined joints. When one joint goes into motion, the adjacent joint follows.
The long ligaments of the spinal column (Fig. 3) include the following:
1. Anterior longitudinal ligament, which runs along the anterior surface of the vertebrae from the atlas to the sacrum. The anterior longitudinal ligament in the lower spine is much stronger and wider. The deep layers of this ligament are somewhat shortened compared to the superficial ones. They connect only vertebrae adjacent to each other. The superficial ones extend over 4–5 vertebrae. The anterior longitudinal ligament protects the spine from excessive extension.
2. The posterior longitudinal ligament is located on the posterior surface of the vertebrae, in the spinal canal. The posterior longitudinal ligament, unlike the anterior one, is wider in the upper part of the spinal column. It is firmly fused with the intervertebral discs. The superficial bundles of this ligament are more elongated than the deep ones.
Rice. 3. Structure of the spinal column: 1 - cervical region, 2 - thoracic region, 3 - lumbar region, 4 - sacral region, 5 - coccygeal region
The short ligaments of the spinal column include the following:
1. Ligamentum flavum, occupying the space between the vertebral arches from the axial vertebra to the sacrum. They consist of vertically directed elastic bundles of a yellowish tint. Hence their name. These ligaments are very elastic and elastic. When extending the torso, they act like muscles, holding the body in a state of extension and reducing muscle tension. When you bend your torso, they are stretched, which also reduces muscle tension. The ligamentum flavum is absent between the arches of the atlas and axial vertebra.
2. Interspinous ligaments are plates that are located between the spinous processes of two adjacent vertebrae. The most powerful are the interspinous ligaments of the lumbar spine; they are least developed in the neck area. Posteriorly, the interspinous ligaments merge with the supraspinous ligament.
3. The supraspinous ligament is a continuous cord that runs along the tops of the spinous processes of the vertebrae in the lumbar and thoracic region.
4. The nuchal ligament is a thin plate consisting of elastic and connective tissue bundles. It runs upward from the spinous process and, expanding, attaches to the external occipital crest and external occipital protuberance.
5. Intertransverse ligaments are thin bundles, weakly expressed in the cervical and slightly in the thoracic spine. They are most developed in the lumbar region.
The sacrococcygeal joint is located between the bodies of the fifth sacral and first coccygeal vertebrae. It contains a small cavity in the intervertebral disc and is carried out by the following ligaments.
1. Lateral sacrococcygeal ligament. It stretches between the transverse processes of the last sacral and first coccygeal vertebrae.
2. Ventral sacrococcygeal ligament. It consists of two bundles located on the anterior surface of the sacrococcygeal joint. The fibers of these bundles intersect.
3. The superficial dorsal sacrococcygeal ligament stretches between the posterior surface of the coccyx and the lateral walls of the entrance to the sacral canal, covering its fissure.
4. Deep dorsal sacrococcygeal ligament.
Joints and ligaments between the occipital bone and the atlas and axial vertebra
The atlanto-occipital joint is a pair. The articular surfaces of the occipital bone are somewhat shorter in size than the articular surfaces of the atlas. The atlanto-occipital joint belongs to the group of ellipsoid joints. Both right and left joints have articular capsules. The articular capsule is attached along the edge of the articular cartilage. The joints perform movements simultaneously, forming one combined joint.
The anterior atlanto-occipital membrane stretches throughout the entire gap and fuses. The posterior atlanto-occipital membrane is located between the posterior edge of the foramen magnum and the superior edge of the posterior arch of the atlas. In the anterior section it has an opening through which blood vessels and nerves pass.
When the atlas and axial vertebra articulate, three joints are formed, two of which are paired and one is unpaired.
1. Lateral atlanto-axial joint - a paired combined joint formed by the upper articular surfaces of the axial vertebra and the lower articular surfaces of the atlas. It belongs to the type of low-moving joints. Its articular surfaces are flat and even. In this joint, sliding occurs in all directions of the articular surfaces of the atlas in relation to the axial vertebra.
2. The median atlanto-axial joint is formed between the posterior surface of the anterior arch of the atlas and the tooth of the axial vertebra. The posterior articular surface of the tooth of the axial vertebra forms a joint with the transverse ligament of the atlas. The tooth joints belong to the cylindrical group.
The ligamentous apparatus of the two joints described above includes:
1. Cover membrane. This is a wide, rather dense, fibrous plate stretched from the anterior edge of the foramen magnum to the body of the axial vertebra. This membrane covers the tooth of the axial vertebra from the side of the spinal canal, as well as the transverse ligament of the atlas and other formations of this joint. The integumentary membrane is part of the posterior longitudinal ligament of the spinal column.
2. The cruciate ligament of the atlas consists of two bundles: longitudinal and transverse.
The transverse fascicle is a dense connective tissue cord adjacent to the posterior articular surface of the tooth of the axial vertebra and strengthening it. The bundle is also called the transverse atlas ligament.
The longitudinal fascicle consists of two, upper and lower, legs. The superior pedicle runs from the middle part of the transverse ligament of the atlas to the anterior surface of the foramen magnum. The lower leg starts from the middle part of the transverse ligament, goes down and is attached to the posterior surface of the axial vertebra.
3. The apical ligament stretches between the apex of the axial vertebral tooth and the middle part of the anterior edge of the foramen magnum. This ligament is considered as a rudiment of the dorsal string.
4. Pterygoid ligaments are formed by bundles of connective tissue fibers stretched between the lateral surfaces of the tooth of the axial vertebra and the inner surfaces of the occipital condyles.
The rib head joint is formed by the articular surface of the rib head and the costal fossae of the vertebrae. The heads from the second to the tenth ribs are cone-shaped. The fossae on the vertebrae consist of two parts: the smaller upper costal fossa, located in the lower part of the body of the overlying vertebra, and the larger lower costal fossa, which lies at the upper edge of the underlying vertebra.
The articular surfaces of the costal fossae of the vertebrae and the heads of the ribs are covered with fibrous cartilage. In the cavity of the joints of the second to tenth rib there is an intra-articular ligament of the rib head. It goes to the intervertebral disc and divides the joint cavity into two chambers.
The articular capsule here is thin and is attached by the radiate ligament of the rib head, which, in turn, comes from the anterior surface of the rib head and is attached to the above and underlying vertebrae and intervertebral disc.
The costohumeral joint is formed by the articulation of the articular surface of the articular capsule of the tubercle of the rib with the transverse costal fossa of the transverse processes of the thoracic vertebrae. These joints are present only on the top ten ribs. Their articular surfaces are covered with hyaline cartilage. The articular capsule is thin and is attached along the edge of the articular surfaces. The joint is strengthened by many ligaments:
1. The superior costohumeral ligament begins from the lower surface of the transverse process and is attached to the crest of the neck of the underlying rib.
2. The lateral costotransverse ligament is stretched between the bases of the transverse and spinous processes and the posterior surface of the neck of the underlying rib.
3. The costotransverse ligament is located between the posterior surface of the rib neck and the anterior surface of the transverse process of the corresponding vertebra. The joints of the head and tubercle of the rib form a combined joint. During breathing, movements occur simultaneously in both joints.
The anterior ends of the ribs end in costal cartilages. The first costal cartilage of the rib fuses with the sternum. The costal cartilages of the second to twelfth rib articulate with the costal notches of the sternum, forming the sternocostal joints. The cavity of these joints is a narrow, vertically located gap. The articular capsules are formed by the perichondrium of the costal cartilages and are strengthened by the radiate sternocostal ligaments, the anterior ones of which are stronger than the posterior ones. These ligaments radiate from the end of the costal cartilage to the anterior and posterior surfaces of the sternum. They cross and intertwine with the ligaments of the same name on the opposite side, as well as with the above and underlying ligaments. As a result, a strong fibrinous layer is formed covering the sternum, called the sternal membrane.
The costal cartilages of the fifth to ninth rib are connected to each other using dense fibrous tissue and intercartilaginous joints. The tenth rib is connected by fibrous tissue to the cartilage of the ninth rib, and the cartilages of the eleventh and twelfth ribs end in the abdominal muscles.
Chapter 2. Arthritis
Arthritis is a large group of joint diseases of an inflammatory, dystrophic and mixed nature.
According to etiological, pathogenetic and clinical-anatomical principles, the main forms of arthritis are divided into four groups:
1. Infectious arthritis, which, in turn, are divided into:
– with an unknown pathogen (rheumatic);
– infectious nonspecific (rheumatoid);
– infectious diseases of a certain etymology (tuberculosis, gonorrheal, brucellosis, dysentery, syphilitic, influenza, post-typhoid, septic and arthritis after acute childhood infections).
2. Dystrophic (non-infectious) arthritis, among which there are:
– deforming osteoarthritis (arthrosis, spondylosis);
– metabolic-dystrophic (gouty, urinary disease);
– neurodystrophic (tabetic, with paralysis, spinal cord lesions, with damage to peripheral nerves, etc.);
– dystrophic, endocrinopathic (thyrotoxic, ovariotoxic, arthritis with acromegaly, etc.).
3. Traumatic arthritis, in which open and closed joint lesions occur.
4. Rare forms of arthritis include anaphylactic, psoriatic, intermittent hydrops of the joint, arthritis due to hemorrhagic diathesis, joint tumors, chondromatosis of the joints.
The inflammatory process in the joint can occur in the form of chronic or acute inflammation.
Rheumatic arthritis can occur in acute and chronic forms. Both forms have an as yet unknown etiology. There is an assumption that this disease is caused by a virus. Many experts believe that acute rheumatism develops due to the body’s increased sensitivity to a particular infection, the focus of which is present or previously existed in the body (frequent sore throats, sinusitis, etc.). In acute rheumatic arthritis, the disease begins with a sharp increase in temperature and severe pain in the joints. One or several joints are affected. Then remission lasts for some time, after which a new attack of rheumatism begins with an increase in temperature and involvement of new joints in the disease.
Severe pain is felt in the affected joints, which is a sign of the beginning of changes in them. The joints become swollen, the skin over them becomes tense, and swelling appears. Inflammation begins in the intra-articular bursa and periarticular tissues. Every movement causes severe pain, movements are limited. The patient is usually bedridden. The illness may last 1–2 months or longer. With proper treatment, significant changes in the joints do not occur, but the heart and other organs can be affected for a long time, and sometimes throughout life.
Chronic rheumatic arthritis occurs as a consequence of acute polyarthritis. With this form of the disease, not only joints that previously had painful changes are affected, but also healthy joints. The main symptom of the disease is aching pain in the joints, worsening in cold, damp weather. The disease occurs without an increase in body temperature. Swelling of the joints occurs, which is not so much a consequence of the destruction of the joints themselves, but rather due to a sluggish ongoing inflammatory process in the periarticular tissues. Over time, due to the destruction of the heads of the metacarpal and metatarsal bones, curvature of the fingers of the limbs occurs.
Chronic rheumatic arthritis includes nodular rheumatism, in which painful nodes appear in the subcutaneous tissue. In most cases, they occur symmetrically, most often on the shins, in the area of the knee, ankle and elbow joints, as well as on the fingers, sometimes on the toes. Occasionally, the nodes affect the heart muscle and the synovium of the joints. They differ from Heberden's nodes in that they are mobile, persist for a long time and disappear on their own, leaving a barely noticeable scar if the node was large.
Rheumatoid arthritis is a systemic disease of connective tissue with predominant damage to the joints of the type of erosive-destructive progressive polyarthritis. The causes of this disease have not yet been precisely identified. There is evidence that a virus plays an etiological role here. Some experts believe that the disease is caused by certain types of mycoplasmas and microorganisms that cause psittacosis. The development of the disease is facilitated by the state of initial reactivity, chronic infections, hypothermia, and excessive insolation.
A big role here is played by the human immune system, which, instead of protecting the affected areas, begins to “attack” its own joints. In rheumatoid arthritis, the body's immune system fights its own cells, mistaking them for foreign and hostile.
The cause of this disease has not yet been identified. But numerous studies have shown that the development of immune diseases, which include rheumatoid arthritis, is closely related to the stress suffered by the patient. There is an opinion that overexcitation of the sympathetic and parasympathetic nervous system plays a dominant role in the occurrence of rheumatoid arthritis.
Rheumatoid arthritis affects about 4% of the total population, and it is mainly common among women.
In some cases, at the beginning of the development of this disease, the patient may feel acute malaise. His temperature rises and there are sharp pains in the joints, especially in the morning. But more often, at the very beginning, the disease proceeds unnoticed. There are no significant changes in the joints. Unpleasant sensations appear in the joints, tingling in the fingers, muscle flaccidity, and decreased performance. In some patients, monoarthritis first appears (a large joint is affected), and only after a long time the disease spreads to other joints. Today, there are a number of methods that make it possible to identify the disease in the early stages of monoarthritis, when neighboring joints are affected to a small extent.
In most cases, small bone joints are affected, less often the spine. In this case, pain occurs, which intensifies with physical activity and subsides at night at rest. The disease is characterized by a sharply progressive decrease in motor activity, the gradual development of deformities, contractures, and subluxations. All this leads to muscle atrophy. Rheumatoid nodules form in the skin.
Also symptoms of arthritis are morning tension and pain in the joints, temporary loss of their elasticity, and these manifestations occur even after short-term inactivity of the joint, and after a night's sleep they increase significantly. This occurs due to the fact that during periods of inactivity, fluid accumulates around the joint, which is gradually eliminated when movements are performed. The disease may be accompanied by muscle pain, weight loss, anemia and fever.
Specific to arthritis is damage to the aorta and internal organs. In this regard, a distinction is made between articular and articular-visceral forms. Visceral and systemic manifestations may vary. The lungs, heart, eyes, kidneys, circulatory system, and intestinal tract are affected. The central nervous system is often affected. The patient becomes irritable and gets tired quickly. During an exacerbation of the disease, the joint swells and turns red.
There are three stages of the disease: minimal, moderate and maximum.
At the initial stage, there are no visible changes in the joint, only signs of osteoporosis are detected, i.e., a slight limitation of the mobility of the diseased joint without a decrease in performance. At the second stage, a narrowing of the joint spaces appears due to erosive damage to the cartilage and single bone erosions are formed. The patient is no longer able to work and is often incapable of self-care. At the third stage, joint deformation occurs and subluxations form. It is characterized by a complete loss of joint mobility or its sharp limitation. At the fourth (terminal) stage, fibrous and bone ankylosis is observed (Fig. 4).
Rice. 4. Joint damage in rheumatoid arthritis
The disease can occur in three different forms:
– monocyclic (one-time use), in which a person, having been ill for several weeks or months, recovers and never encounters manifestations of the disease in the future;
– polycyclic, in which the patient experiences repeated attacks of the disease, and in the periods between attacks the disease does not manifest itself at all or manifests itself, but only slightly;
– chronic, in which a person constantly suffers from an illness.
Infectious arthritis of a certain etiology
It is customary to distinguish primary acute arthritis, in which the infection enters the joint due to damage to its cavity (penetrating wounds) or when the inflammatory process in the joint develops as a result of blunt trauma to the joint with the occurrence of hemarthrosis, and secondary, in which the infection enters the joint cavity by hematogenous, lymphogenous route or penetrates into the joint from an inflammatory focus located in neighboring tissues. The most common are primary acute arthritis of traumatic origin.
Pathological changes in acute arthritis depend on the method of penetration of microorganisms into the joint cavity and their virulence. Depending on the nature of the effusion formed in the joint cavity, serous, serous-fibrinous and purulent arthritis are distinguished. In the absence of effusion in the joint cavity, arthritis is called dry.
With serous inflammation, constant pain is felt in the joint area, intensifying with movement. Hyperemia occurs in the affected area and the skin swells. Movement in the joint is limited. Exudate accumulates in the joint cavity. Symptoms of the inflammatory process in acute serous arthritis are mild. Sometimes the patient experiences a fever, general malaise, and chills.
Timely initiation and proper treatment allows you to completely get rid of the disease. However, in some cases, when conservative treatment of acute serous arthritis is unsuccessful and signs of general intoxication appear, the inflammatory process can progress to the stage of purulent inflammation. In this case, the patient must be urgently hospitalized in the purulent surgical department of the hospital.
Purulent arthritis occurs when pathogens of a pyogenic infection penetrate the joint. This causes acute inflammation of the joint. Purulent arthritis is divided into primary and secondary. Primary infection occurs through wounds (stab wounds, punctures, operating wounds, etc.). Secondary infection spreads to the joint from neighboring tissues (osteomyelitis, abscess, boil, etc.) or by hematogenous-metastatic route. The most common causative agents of the disease are staphylococci, sometimes gram-negative bacteria, anaerobic flora.
With purulent arthritis, the synovial membrane and joint capsule are often affected. As the inflammatory process progresses, periarticular phlegmon and leaks into the interfascial and intermuscular spaces develop. The disease is accompanied by severe pain in the joint, aggravated by movement, chills, and increased body temperature. The affected joint swells. Sepsis often develops. Complications may occur in the form of ankylosis, dislocations, arthrosis, shortening and deformation of the limbs, and fistulas.
The nature of the inflammatory process and its significance depend on the anatomical structure and function of the joints. Therefore, each joint should be considered separately.
Shoulder joint . The clinical picture is as follows: there is severe pain in the joint during movements, the body temperature is elevated, and high leukocytosis is characteristic. In general, the patient's condition is satisfactory. If the purulent process spreads to the joint capsule and periarticular tissues, phlegmon of the joint capsule is formed, and when the capsule breaks through, streaks occur. Deep periarticular ulcers form. In this case, a pronounced swelling of the joint appears, the temperature of the skin over the joint rises, the skin swells, and hyperemia forms. There is no mobility of the joint due to severe pain. The patient's general condition deteriorates sharply and may become septic.
Elbow joint . Serous and serous-fibrinous arthritis occur as a complication after a general infection. After an inflammatory process in the elbow joint, mobility is limited to varying degrees. Purulent arthritis here is expressed in the form of phlegmon of the joint capsule, less often - in the form of purulent synovitis of the joint. With phlegmon of the joint capsule, pus penetrates deep into the soft tissues and often into the intermuscular spaces of the forearm flexors. The disease causes severe pain in the joint, limited mobility, and smoothness of the contours.
With phlegmon of the joint capsule with extensive spread of the purulent process, the forearm swells, the skin acquires a bluish-red tint.
In case of purulent form of arthritis, it is necessary to ensure the immobility of this joint by fixing it with a splint or splint in a bent position at a right angle. For serous-fibrinous arthritis, passive movements and massage are recommended to avoid joint stiffness.
Wrist joint. The wrist joint is separated from the radioulnar joint by a cartilaginous plate, so infection usually does not transfer from one joint to another. The inflammation most easily spreads to the wrist joints. With the development of purulent synovitis, phlegmon is formed. In this case, the pus spreads to the periarticular tissues, forming fistulas. Extension of the hand causes sharp pain radiating to the fingers.
Hip joint. Acute inflammation of this joint can be serous, serous-fibrinous and purulent. Often, a fibrinous effusion forms in the hip joint, which leads to the formation of adhesions between the articular surfaces, resulting in stiffness.
The cause of acute inflammation of the hip joint is, as a rule, a complication after some general infection (typhoid, scarlet fever). Under the influence of infection, a serous or serous-fibrinous effusion occurs, which, when a staphylococcal or streptococcal infection penetrates, takes on a purulent character. The outcome of arthritis is ankylosis in a vicious position. If appropriate measures are not taken, the disease can take a severe form, which can lead to death.
Knee-joint. Acute purulent arthritis of the knee joint can develop according to the same principle as in the above joints.
Serous and serous-fibrinous synovitis is a complication of osteomyelitis of the proximal end of the tibia without direct penetration of pus into the joint. The cause of synovitis can be a boil or erysipelas in the area of the knee joint, as well as a previous general infection. The clinical picture is as follows. The knee joint increases in volume due to superior inversion. Skin color does not change. With palpation and movement, minor pain occurs in the joint. Synovitis has practically no effect on the general condition of the patient. The effusion usually resolves within a few days. Occasionally, when a large amount of effusion forms, a crunching sound is heard in the joint when moving. In this case, fusion may develop, which, in turn, leads to limited mobility in the joint.
Purulent arthritis of the knee joint can occur in the form of empyema, phlegmon of the joint capsule and panarthritis.
Secondary arthritis – complications of acute infectious diseases
Infectious diseases - such as scarlet fever, diphtheria, measles, typhus, etc. - are often complicated by lesions in the joints. The etiology of these lesions is usually similar to the underlying disease. But sometimes with infectious arthritis, a secondary infection can occur - septic, pyogenic, unrelated to the main disease.
The etiology of some arthritis, for example typhoid, diphtheria, etc., is due to the corresponding bacterial flora. Basically, joint damage begins at an early stage of the disease, in rare cases - at a later stage. Most joint diseases occur in an acute form and with significant destructive changes. There are forms with a milder course, as well as toxic or allergic ones.
Depending on the nature of the exudate, serous, serous-fibrinous and purulent forms of lesions are distinguished. Among purulent lesions, a distinction is made between suppuration of the joint - a severe disease that spreads to all parts of the joint (fibrous capsule, cartilage and bones) and empyema of the joint - purulent synovitis (purulent catarrh), in which there is no damage to the synovial membrane, it causes only minor destruction.
Sometimes, in especially serious cases, with a large accumulation of effusion, the so-called. distensional dislocations. Most often, the hip and shoulder joints suffer from this in typhoid, diphtheria, scarlet fever, and secondary osteomyelitic arthritis. With a large effusion, the ligaments are sprained, which in turn leads to dislocations. With the accumulation of exudate in the joint, the normally negative pressure increases, which leads to disruption of articular relationships. During distension dislocations, the bones of the joint are not affected and retain their structure. The round ligament usually lengthens, thins, and eventually ruptures.
Pathological dislocations in the hip joint in most cases take the form of iliac displacement. Dislocations can occur from the slightest movement of the leg, even spontaneously, and can be set back with the same ease, after which they can easily occur again.
When joints are affected, it is first necessary to identify the cause of the disease. Brucellosis arthritis usually occurs in the form of synovitis and is often serous or serosanguineous. In this case, an effusion appears, which gradually resolves. The joint capsule often degenerates and shrinks. Because of this, stiffness occurs in the joint.
This disease primarily affects large joints: hip, knee, ankle, shoulder, less often - elbow, wrist and small joints of the hands and feet. Very often, brucellosis arthritis affects the sacroiliac joint. With a milder course of the disease, “rheumatoid” aches are noted, sometimes a slight effusion and swelling of the joints with redness of the skin over them is formed. The pain increases and decreases depending on fluctuations in body temperature.
When treating this disease, physical therapy is recommended only after the acute period of the disease has ended.
Typhoid arthritis occurs in all types of typhus, mainly during recovery. With typhoid fever and paratyphoid fever, arthritis can occur at a much later date.
Typhoid arthritis is divided into arthralgia, arthritis with non-purulent effusion and purulent arthritis. The most common are synovial and synovial-cartilaginous lesions. With the latter, there is a dysfunction of the joint cartilage.
In most cases, typhoid arthritis affects the hip joint. The sternoclavicular, clavicular-acromial joints, and iliosacral joints are often affected.
Typhoid lesions do not provoke severe destruction in the bones of the joints, but cause minor destructive changes. Secondary joint lesions resulting from typhoid osteomyelitis are manifested by more significant destructive changes.
Typhoid arthritis is characterized by a significant accumulation of exudate, in which the joint capsule is greatly stretched, which can result in dislocations. They are observed mainly in the hip joint.
Pathological changes in typhoid arthritis may vary depending on the form of the lesion. In synovial forms, inflammatory changes occur in the synovial membrane, and serous and purulent effusion is formed. In synovial-cartilaginous forms, the cartilage covers are affected and superficial destruction develops.
With relapsing fever, mild, transient arthritis that does not affect the function of the joint is observed.
Typhoid arthritis is characterized by localization of the process in the spine, namely in its lumbar region. There is a sharp narrowing of the intervertebral space. Over time, the affected vertebrae are gradually connected by dense thick adhesions that run from the lateral vertebral bodies towards each other (Fig. 5).
Rice. 5. Bone adhesions connecting two vertebrae
Typhus produces purulent metastatic forms of joint disease, as well as non-purulent chronic forms, which are mostly mild.
In most cases, serous and purulent arthritis, which arise as a complication after typhus, are benign and often result in complete restoration of joint function.
At the early stage of joint damage, symptoms of synovitis are characteristic, in which rapid destruction of cartilage occurs. The joint space becomes unclear and narrows. The process also extends to the bone. But there are no special destructive violations observed here.
Influenza arthritis develops as a complication during the flu or immediately after it, rarely - one to two months after the illness. The disease usually affects large joints (shoulder, knee). There is a slight serous-fibrinous effusion in the joints. Intra-articular adhesions often form. The periarticular tissues are inflamed.
Patients complain of severe pain and aching in the area of the affected joint; the pain becomes stronger when moving. The joints become moderately swollen due to effusion. The fourth metatarsophalangeal joint of the lower extremities is often affected. After suffering from the disease during the period of complications, the patient experiences pain in the plantar surface of the foot when walking. When palpated, painful sensations appear in the area of the fourth metatarsophalangeal joint.
In acute forms of influenza arthritis, it is very useful to carry out thermal procedures. In chronic forms, heat and mud therapy gives good results. As a rule, the functions of the joints with proper treatment are not impaired, and movements in the limb are completely restored.
Scarlet fever is observed in children aged 5 to 10 years and occurs in 3% of people with scarlet fever. At a later age, after 25 years – in 25%. Arthritis develops during the first two weeks of the disease. With complications in the joints caused by scarlet fever, the disease occurs in a mild form, when only a few joints are affected. But sometimes more severe lesions develop with joint swelling and effusion. Bone components are only partially affected, and cartilaginous components are completely affected. The joint space narrows and becomes unclear. The function of the joint is severely impaired. The lesion usually develops into bony ankylosis. The hip joints are most often affected.
In other cases, severe changes occur in the bony components of the joint with septic suppuration of the joint. Such lesions are most often observed in the hip joint in the form of osteomyelitis.
Scarlet fever synovitis occurs in a milder form at normal and subfebrile temperatures. Many experts believe that they are toxic.
In severe pyemic forms, streptococci are found in the purulent joint effusion.
In smallpox, joint diseases are observed in most cases in the primary bone form, in the form of osteoarthritis. The joint is involved in the process for the second time when the destructive process spreads from the epiphyses and metaphyses. Changes in the joints are characterized by swelling, pastiness, extending beyond the joint, and pain when moving. In the case of severe destructive changes, the elbow joints experience looseness, due to which they are able to move in all directions. It is noteworthy that all these significant changes are not accompanied by a severe clinical picture: the temperature remains between 37°–38° C, and pain is insignificant when moving.
After one and a half to two months, reparative changes occur. Foci of destruction and periosteal layers disappear, the destroyed articular edges of the bone are smoothed out. Significant deformations of the articular ends of the bones remain forever as a consequence of destructive changes.
In most cases, the elbow joints are affected, less often the knee joints. In some cases, the wrist and lower jaw joint are affected. Fistulas are extremely rare. The process ends mainly without the formation of ankylosis.
Gonorrheal arthritis develops as a complication during the acute period of gonorrhea and occurs in only 2–3% of those suffering from this disease. The disease develops during the first month after the discovery of specific urethritis. Usually one joint is affected, mainly the knee (in men), wrist and ankle (in women).
The disease process can be of a different nature: 1) serous, 2) serous-fibrinous, 3) purulent, 4) phlegmonous.
In the serous form, hydrocele of the joint develops. Minor dysfunction of the joint occurs, the pain is minor. The disease lasts about a month and goes away without a trace.
The serous-fibrinous form is often accompanied by severe pain in the joint at low-grade fever. The joint capsule thickens.
In the purulent form, fibrinous-purulent exudate occurs. In this case, the joint swells, sharp pain occurs, and body temperature rises. An effusion forms in the joint, and the joint capsule thickens. An acute inflammatory process occurs in the synovium, which then spreads to the articular cartilage. There is pronounced osteoporosis, narrowing of the joint space, and destruction of the articular edges of the bones. The process usually ends with fibrinous ankylosis, turning into bone.
The phlegmonous form of synovitis occurs in the form of a strong inflammatory process. The temperature rises sharply. The slightest movement or touch to the joint causes sharp pain. When the ankle joint is affected, pain in the Achilles tendon area associated with inflammation of the joint capsules is characteristic. Rapid destruction of intra-articular cartilage occurs. The process involves periarticular tissues and ligaments, as well as the periarticular part of the tendon sheaths. The skin swells. The ligamentous apparatus of the joint relaxes, causing the joint to become loose and lose its normal contours. At the same time, atrophy of the limb muscles develops. The process takes months. A distinctive feature of gonorrheal arthritis is the involvement of periarticular tissues and, mainly, tendon sheaths in the process. Due to the formation of strong adhesions, the process often ends first with fibrous and then bone ankylosis.
Arthritis of the tertiary (gummy) period - acquired, congenital and late - have a similar clinical picture. Hereditary - late - syphilitic arthritis is detected between the ages of 20 and 30 years.
During the gummous period, all tissues of the joint can be affected: the synovial bursa, cartilage and bones.
With syphilitic synovitis, gummous nodes of various shapes and sizes are formed in the joint capsule. Villi grow on the synovial membrane, filling the entire joint. The effusion can be serous or serous-fibrinous. The process is slow. The bag thickens and wrinkles. This leads to deformation of the joint with displacement of the bones. In different parts of the bag, its uneven thickening and stretching occurs. With syphilitic synovitis, the joint looks lumpy.
The affected cartilages become loose. In some areas, defects with very smooth contours form, penetrating to the bone. Often, cartilage defects spread over large areas and expose bone.
In the bone substance around the epiphyses, bone growths are formed - osteophytes.
The knee joint is characterized by an enlarged patella.
The clinical picture looks like this: at night, pain occurs in the area of the affected joint, and its functions are partially impaired. The pain begins when the patient goes to bed, subsides by the middle of the night and disappears in the morning. If there is effusion, the joint thickens. The synovial bursa protrudes especially strongly.
It should be remembered that massage of the affected joints in syphilitic arthritis is strictly contraindicated.
Deforming arthritis, or more correctly arthrosis, is a primary chronic disease of the joint, which is based on a combination of atrophic, degenerative and proliferative, hypertrophic processes in cartilage and bones. These processes lead to joint disfigurement. This disease has several names. Some experts call it deforming arthrosis, osteoarthritis, degenerative joint disease, while patients simply call it arthrosis or salt deposition.
A characteristic sign of osteoarthritis is pain in the joints, which increases with movement and in cold and damp weather and is relieved by warmth and rest. The number of patients with osteoarthritis increases with age. The reason for this is that the cartilage that covers the inner surface of the joints ages over time and is more difficult to recover from injury and physical strain. The cartilage becomes flabby. Under the influence of movement and stress on the joint, the cartilage becomes thinner and in some places is completely worn out. All this ultimately leads to its destruction. The joint is exposed, causing the bones to come into direct contact with each other, creating irregularities on their surface. In this case, during movement, a specific crunch occurs in the joint. Over time, it disappears, because with friction, the bone surfaces are smoothed. Inflammation develops in the joint. Aseptic necrosis progresses in the bone tissue, then fibrinous tissue or small bone cysts form in it.
Arthrosis is characterized by a strong proliferation of bone tissue along the edges of the articular surfaces of the bones. Thickening and disfigurement of the epiphyses occurs. Intra-articular capsules can degenerate and dissolve, the joint capsule shrinks.
The disease develops in most cases in women after 40–50 years.
The development of the disease is facilitated by constant overload associated with sports, as well as some professions. For example, salespeople and teachers who have to stand for long periods of time have damage to their leg joints; for loaders and drivers - intervertebral discs; for builders - shoulders and elbows. Heredity plays a significant role in the occurrence of this disease.
At the initial stage, the disease may cause little concern; at first, pain occurs only with heavy exertion. As joint damage progresses, pain becomes more frequent and severe, limiting the patient's mobility. He develops lameness, the patient has difficulty moving.
The disease can affect any joint - knee (gonarthrosis), shoulder (oarthrosis). Quite often the hip joint and interphalangeal joints of the foot and hand are affected. Often, patients have several joints affected at once. In this case we are talking about polyarthritis.
Osteoarthritis occurs in three stages. At the first stage, there is a moderate decrease in joint mobility. At rest and with light exertion there is no pain. It often appears during longer periods of exercise or at the beginning of movement after a long period of rest. There is a slight narrowing of the joint space, minor bone growths of the articular cavity.
At the second stage of the disease, the limitation of mobility in the joint increases. When moving there is a strong crunching sound. The pain becomes more severe and subsides only after a long rest. A contracture of the joint is formed, which leads to shortening of the limb. The patient begins to limp, a functional distortion of the pelvis occurs, and scoliosis of the lumbar spine forms. The gap between the joints decreases two to three times, and rough bone growths appear around the articular cavity. The articular part of the femur is deformed.
At the third stage, the joint completely loses mobility. The joint space is completely absent. The articulating surfaces of the bones are greatly deformed and expanded due to marginal growths.
Ankylosing spondylitis (spondylosis)
This disease has another name - “Bechterew's disease”. When it occurs, inflammation occurs in areas of the body in those places where the ligaments are attached to the bones. Ankylosing spondylitis almost always affects the spine. It mainly affects men aged 20 to 40 years. During the course of the disease, the inflamed areas grow into the edges of the bone. The pain subsides, but movements are limited. Therefore, patients with ankylosing spondylitis suffer more from limited mobility than from pain. As a result of the disease, destruction of the vertebral bodies occurs, followed by deformation of the spine, and the ligaments ossify. The intervertebral cartilages become thinner, the vertebral bodies move closer together, but do not touch each other. Under the influence of load, the vertebrae seem to be compressed, mainly in the central section. Along the edges of the articular surfaces, bone spines with sharp ends are formed, running from one vertebra to another. Sometimes these spines are soldered to each other, forming intervertebral bridges that spread from one vertebra to another (Fig. 6). In places of adhesions, the mobility of the vertebrae is completely lost. In rare cases, the disease leads to immobility of the spine. A similar manifestation of spondylarthritis occurs in one out of a hundred patients.
Rice. 6. Spondylosis deformans (bone adhesions between vertebral bodies)
The disease develops slowly. Joint mobility is impaired. Pain occurs with movement and exertion, which subsides with rest and warmth. Gradually, deformation of the joints occurs. When moving, a clicking sound is heard in the joints.
It is impossible to completely stop the development of the deforming process. Therefore, the goal of treatment is to prevent the formation of contractures. The affected joint should be kept at rest. For this purpose, splints specially made for each joint are widely used (Fig. 7).
Rice. 7. Splint for fixing a finger in case of deformation and fracture
People with ankylosing spondylitis are susceptible to lung diseases such as pneumonia. The reason for this is that the chest becomes too rigid and does not allow the lungs to expand freely during breathing.
With this disease, one or more fingers are affected. It occurs mainly in women after 40 years of age. A sign of the disease is the appearance of nodules on both backs of the terminal phalanges of the fingers. At first, the nodules are soft and painful. The skin around them sometimes turns red. In the joint adjacent to the large phalanx of the finger, changes occur similar to changes in disfiguring arthrosis: the large phalanx of the finger at the base becomes dense, it is closely adjacent to the adjacent phalanx, becomes shorter and deformed. There are no painful sensations during the course of the disease.
Gouty arthritis usually develops in the first metatarsophalangeal joint in elderly people (Fig. 8). The disease occurs as a result of a violation of general metabolism due to improper function of the endocrine glands. In this case, in all tissues of the joint there is a deposition of uric acid salts (urates), which are there in the form of small grains or individual conglomerates merging with each other in the ligaments, cartilage, bones, joint capsule, and in the tissues surrounding the joint.
Rice. 8. Salt deposition in the first toe
The disease can occur in both acute and chronic form, with a sluggish, gradually progressive gouty process.
In an acute attack of gouty arthritis, sudden pain appears in the area of the metatarsophalangeal joint of the first toe, usually at night. By morning the pain subsides. In the joint area there is a sharp swelling of the tissues, the skin above them acquires a purplish-blue color and becomes tense. In some cases, the back of the foot swells. When touching the joint and moving, severe pain occurs. Gout attacks can recur up to 15 times per day. Then the process subsides, and the patient feels healthy again. Similar attacks of pain can be repeated two to three times a year.
The chronic form of the disease is more common. The disease develops slowly and imperceptibly, with the absence of pain and pronounced external signs of joint damage. But the joints gradually begin to thicken and become deformed, and the finger becomes somewhat bent. Movement in the area of the metatarsophalangeal joint is limited. Nodules (accumulation of urates) form in the tissues around the joint. The chronic form of gouty arthritis can be confused with rheumatoid arthritis and arthrosis deformans. It can be recognized only by the presence of specific nodules and x-rays.
This disease affects only men. Women pass hemophilia to their male children, but do not get it themselves. The disease occurs more often at a young age. In patients with hemophilia, due to a minor injury or awkward rotation of a limb, hemorrhage occurs under the skin, including into the cavity of the injured joint. Large joints are mainly affected (knee, elbow, ankle, hip). Small joints are affected much less frequently.
Joint damage in hemophilic arthritis is similar to traumatic intra-articular hemorrhage. The joint loses its normal contours, and slight pain occurs. The temperature rises slightly, but the patient's condition is satisfactory. Bleeding into the joint can occur several times at regular intervals. With the first hemorrhage, the hematoma resolves, the swelling disappears, and the temperature drops to normal. With repeated hemorrhages, blood clots are organized and the joint capsule thickens. The cartilage becomes thinner, which leads to a narrowing of the joint space. Sometimes, as a result of numerous hemorrhages, foci of necrosis develop in the spongy substance of the epiphyses.
Often, destruction of bone tissue occurs in the intercondylar fossa of the femur: a bone defect forms in the form of a deep fossa with smooth walls and overhanging edges (Fig. 9).
Rice. 9. Bone defect in the intercondylar fossa of the femur in hemophilic arthritis
With a mild course of the disease, the outcome is favorable. In more severe cases, when ligaments rupture and the joint capsule shrinks, joint contractures may develop. Sometimes, with severe destruction of the cartilage of the epiphyses, ankylosis of the joints occurs. In adulthood, hemorrhages into the joint cavity do not occur.
The disease occurs in older people. It mainly affects the lower extremities, namely the knee joint. Usually one joint is affected, but there are cases when several joints are involved in the process.
At the beginning of the disease, synovitis develops. Over time, villi appear on the synovial membrane, the rejected particles of which turn into free articular bodies. The joint capsule thickens. Often salt deposition occurs in it. The bag is fused with soft periarticular tissues, turning into a dense cover. Gradually, a violation of the trophism of the joint occurs. Cartilage and cruciate ligaments begin to deteriorate. Uzures appear on the cartilage. On the one hand, bone tissue is destroyed, on the other hand, the epiphyses are restored. Large osteophytes grow along the edges of the epiphyses, from which parts of the bone tissue are detached. At the same time, parts of the epiphyses on the side of the joint space are completely resorbed. The joint is severely disfigured (Fig. 10).
Rice. 10. Tabetic arthritis of the knee joint
The pathological process in the joint develops rapidly. The joint becomes greatly enlarged as a result of the formation of effusion. Fluid accumulation occurs quickly. The ligamentous articular apparatus relaxes, as a result of which the joint becomes loose and subluxations occur. When moving, a crunching sound is heard in the joints. Upon palpation, loose bodies can be easily felt. The function of the joint is impaired. At the very beginning, the disease is painless.
The disease develops in people in middle age, more often in men than in women, and the upper extremities are affected several times more often than the lower extremities. This is due to the fact that the cervical spinal cord is affected by syringomyelia more often than other parts of the spinal cord.
With syringomyelic arthritis, the bones do not just grow, but they seem to melt. The disease begins suddenly with the development of effusion in the joint. The joints become loose and disfigured. Because of this, dislocations occur and pathological fractures are possible. Despite significant pathological changes, the process is relatively painless. In some cases, specific dystrophy of the fingers develops. The ends of the nail phalanges are partially resorbed and necrosis occurs. The phalanx of the finger is shortened and disfigured. The distal ends of the heads of the main and middle fingers are resorbed. The articular platforms of the heads of the phalanges are deformed, their plane becomes oblique, as a result the contacting phalanges become at an angle to each other (Fig. 11).
Rice. 11. Deformed articular platforms of the phalanges of the fingers during the syringomyelic process
In patients with syringomyelic arthritis, bone fractures occur at the slightest trauma.
When a joint is repeatedly injured, traumatic arthritis can develop. Sometimes, even with microtraumas, intra-articular or periarticular hemorrhage occurs, which gives rise to aseptic synovitis. In this case, the synovial membrane and cartilage are saturated with blood. With the slow resorption of effusion, foci of destruction form in the cartilage. The cartilage becomes thinner. The joint space narrows. The edges of the bone begin to grow. These pathological disorders can cause dysfunction of the joint.
After the first acute injury, swelling develops within 24 hours. With any, even minor movement, acute pain occurs in the joint. The joint loses its normal contours, first from hemorrhage, then from synovitis. Mobility in the joint is limited. With microtraumas, significant bleeding into the joint does not occur; pain and dysfunction develop gradually.
With proper treatment, the outcome of the disease is generally favorable. Only rarely does the injured joint experience limited mobility as a result of bone overgrowth and cartilage destruction.
The main goal of treatment for traumatic arthritis is to accelerate the resorption of hemorrhage and prevent the development of joint stiffness. Therefore, a week after injury, physiotherapeutic procedures, including light massage, are recommended. If there is an intra-articular fracture, the joint must be kept at rest. In case of joint disease due to microtraumas, rest is recommended only in moments of severe pain. In the future, it is necessary to avoid such microtraumas.
Everyone knows what pleasure and relaxation a simple stroking of the skin gives and how rubbing the back relieves fatigue. These beneficial effects can be enhanced several times with the help of a properly performed massage, which is not only capable of relieving muscle tension, general fatigue, and stress, but is also widely used as one of the methods of treating certain diseases. Massage relieves pain and has a beneficial effect on the entire body, strengthening it and improving metabolism. If you use it in conjunction with proper nutrition and exercise, you can achieve good results in improving the functioning of the entire body and in the treatment of arthritis in particular.
Massage is gaining more and more recognition every day among doctors all over the world. Recently, athletes have also begun to actively use it. You don't have to be a medical specialist to use this massage to strengthen and heal the body. Anyone who wants to help their family and friends get rid of many health problems can learn massage.
The term “massage” refers to a system of various manipulations with the soft tissues of the body aimed at restoring and stimulating the muscular, nervous and circulatory systems. Massage is usually performed with the hands, but sometimes in some of its varieties, the forearms, knees and feet are used for massaging.
How does massage affect the body?
During various massage techniques, the nerve endings of the skin are stimulated. Nerve impulses arise and are transmitted to the central nervous system, namely the brain and spinal cord. Here they are turned into relaxation commands and sent back to the muscles, calming them. Similar massage techniques include stroking along the nerve fibers, which calms the peripheral nerve endings of the skin.
Massage has a beneficial effect on the circulatory system, expanding the subcutaneous capillaries and thus improving blood circulation. When performing a massage in a centripetal direction, i.e. towards the heart, the outflow of “waste” blood from muscle cells to the heart and lungs is accelerated, where the blood is again saturated with oxygen.
It has long been known how well massage relieves stress. This occurs due to the fact that due to improved blood circulation during massage, a temporary weakening of the pulse occurs, breathing slows down and evens out, the body goes into a state of rest and rests.
Massage not only promotes better blood circulation, but also increases the flow of lymph (the colorless fluid that carries proteins and other substances from muscles and bones into the blood).
With the help of massage you can have a beneficial effect on the muscular system of the body. During its implementation, the muscles tense and contract, which leads to an increase in their flexibility. Massage helps remove lactic acid, a by-product of metabolism, from overworked and tired muscles, thereby restoring them.
For fractures and tissue damage, massage is also useful. Massaging these areas increases the absorption of nitrogen, phosphorus and sulfur, which are important elements for repairing damaged areas.
When massaging the skin, skin respiration increases, stagnation is eliminated and metabolism improves (Fig. 12).
Rice. 12. The effect of massage on the body
In therapy, massage is widely used to treat joint diseases, in particular arthritis. It is used outside the stage of exacerbation of the disease, during the period of remission. In the presence of pain, it has an analgesic effect. Massage promotes rapid resorption of effusion that has accumulated in the joint during the course of the disease. In severe forms of the disease, the patient experiences contractures (limited joint mobility), and sometimes ankylosis of the joint develops (complete immobility). Using massage in combination with other physiotherapeutic means - such as heat, water procedures, physical therapy - you can mitigate the effects of the disease, improve or restore joint mobility, or prevent the formation of contractures. When massaging the affected joint, blood flows to the massaged area, blood circulation and metabolism improves. The affected areas are better supplied with oxygen and necessary elements, which means they recover faster.
It is also useful to carry out massage for the purpose of preventing joint diseases, since it is well known that the disease is often caused by low joint mobility caused by a person’s passive lifestyle. Massage is a kind of gymnastics for the body and has a similar effect.
Massage is also good because you can perform it yourself, having studied the basic techniques and rules of self-massage, as well as the physiological characteristics of the body and the effect of massage on it. Let's talk about all this in more detail.
Chapter 1. Anatomical and physiological foundations of massage
Effect on skin
The skin is a complex organ that performs a large number of functions. Massaging affects various skin layers, muscles, blood vessels, glands and the central nervous system.
The skin is usually divided into outer (epidermis), skin (dermis) and subcutaneous fat (Fig. 13). The epidermis contains a large number of sensory nerve endings. Epidermal cells gradually age and die, forming a superficial stratum corneum. This layer is quite durable and protects deeper layers from external physical and chemical influences. It is impermeable to water, but perfectly passes gases such as hydrogen sulfide, oxygen and others, as well as volatile liquids (alcohol, ether).
Rice. 13. Skin structure: A – epidermis, B – dermis (corium), C – subcutaneous adipose tissue.
1a - superficial keratinized layers of the skin epithelium, 1b - deep layers of the skin epithelium, 2 - loose connective tissue base of the skin, 3 - lobules of adipose tissue, 4 - root sheath of the hair (continuation of the skin epithelium), 5 - hair, 6 - bulbous thickening of the root hair, 7 – sebaceous glands, 8 – sweat gland, 9 – excretory duct of the gland
The next layer, the skin itself, consists of bundles of connective tissue fibers, thanks to which it has elasticity and strength. Lymphatic and blood vessels, sebaceous and sweat glands and hair follicles are located here. This layer contains nerves that provide information about pain, cold, heat, etc. to the central nervous system.
One of the components of subcutaneous fat is large cells filled with fat. Their layer protects the internal organs of the body from cold, various injuries and bruises.
The skin protects the body from external factors (wetness, drying, pressure), regulates body temperature, etc. Healthy skin prevents germs from entering the body. In addition to protective, the skin performs a number of other functions: excretory, intrasecretory, regulating.
There are many receptors on the surface of the skin, thanks to which, by acting on the skin, it is possible to influence the central nervous and circulatory systems. Long-term massage helps reduce fat deposits and prevents their accumulation. Moreover, it is not the direct effect of massage on adipose tissue, but its effect on metabolism, i.e. massage improves metabolic processes in the body and enhances the excretory function of the glands. All this helps to remove excess fat from cells.
During massage, the obsolete epidermis is mechanically removed from the skin, which improves skin respiration and regulates the functioning of the sebaceous and sweat glands.
During a massage, the skin temperature rises, histamine and acetylcholine are released from it, and they, in turn, actively expand the skin blood vessels, blood circulation improves, which means the tissues are better supplied with oxygen.
The effect of massage on the nervous system
Depending on the functional state of the nervous system and the method of massage, it is possible to achieve an increase or decrease in its excitability.
The human nervous system consists of a number of structures. Their task is to ensure mutual feedback between all organs and systems of the body, as well as to connect the body with the outside world.
The nervous system is divided into central and peripheral. The central one includes the brain and spinal cord, and the peripheral one includes ganglia and nerves. The nervous system is usually divided into the somatic system, which includes the motor system, skin, sensory organs, and the autonomic system, which includes internal organs and blood vessels. The autonomic nervous system is divided into sympathetic and parasympathetic divisions (Fig. 14).
Rice. 14. Structure of the autonomic nervous system: solid line – sympathetic fibers, broken line – parasympathetic. 1 - eye, 2 - salivary glands, 3 - heart, 4 - bronchi, 5 - stomach, 6 - liver, 7 - pancreas, 8 - intestines, 9 - kidneys, 10 - rectum, 11 - bladder, 12 - genitals
During massage, nerve endings that are connected to the cerebrospinal and autonomic nervous systems are exposed. Under the influence of massage, many different reactions occur, in which all tissues, organs and systems are involved. By changing the timing, methods and techniques of massage, you can influence the functional state of the cerebral cortex, reduce or increase general excitability, improve tissue trophism and the activity of various internal organs, and revive lost reflexes. Among all existing techniques, the technique of vibration has the most pronounced reflex effect.
Massage is of great importance for the peripheral nervous system. It relieves or eases pain, improves nerve conduction, and speeds up the recovery process after damage.
The beneficial effects of massage on the nervous system also depend on external factors. It is not recommended to perform a massage if the person being massaged is in a state of extreme excitement.
The effect of massage on the muscular system
Muscles are the active part of the locomotor system. They are very important for normal human life, because they provide mobility of body parts and keep it in a static state. Muscle work also plays an important role in the activity of the respiratory, circulatory, nervous systems, ensures lymph formation, heat regulation, metabolism, etc.
Massage has a strengthening effect on muscles. It helps to increase muscle tone, elasticity, improves contractile function and muscle performance. Massage ensures active blood flow to the muscles, which leads to their relaxation, relieving fatigue and recovery. During massage, lactic acid, which is a metabolic product, is expelled from overworked muscles. Efficiency after a five-minute massage increases 4–6 times. At the same time, during massaging, not only tired muscles are restored, but also muscles that did not take part in the work. Therefore, it makes sense to massage them too.
Massage prevents muscle atrophy, has a beneficial effect on redox processes, and increases the flow of oxygen to them.
The effect of massage on the circulatory and lymphatic systems
The circulatory system ensures blood flow to all organs and tissues. Through the circulatory and lymphatic systems, metabolic end products and carbon dioxide are removed from the body.
The capillary system is considered reflexogenic in the vascular system. The central nervous system regulates the process of blood circulation in the capillaries. Under the influence of massage, reserve capillaries open, which leads to improved blood distribution in the body, and this, in turn, facilitates the work of the heart in case of circulatory failure.
The blood carries hormones of various glands, and the humoral activity of various organs is carried out.
The lymphatic system (Fig. 15, 16) includes lymphatic capillaries, nodes and vessels through which lymph passes to the heart. Lymph is, on the one hand, a nutrient medium, and on the other hand, it is a medium into which cells secrete metabolic products.
Rice. 15. Placement of the lymphatic network on the upper and lower limbs
Rice. 16. Lymphatic network of the body: a – anterior surface; b – rear surface
Massage has a beneficial effect on lymph circulation. There is a constant exchange of substances between it, blood and tissues. Too slow movement of lymph slows down this process. Massage helps accelerate lymph circulation, which, in turn, leads to more active saturation of organs with oxygen and nutrients, as well as the removal of waste products from the body. Improving the flow of blood and lymph prevents the occurrence of congestion and effusions in the joints, abdominal cavity, etc. Under the influence of massage, the number of red blood cells and platelets in the blood increases.
The effect of massage on ligaments and joints
During massage, the massaged area warms up, its blood supply increases, and the volume of synovial fluid increases. This improves the mobility and elasticity of the ligamentous apparatus. Joint massage reduces periarticular swelling, effusions, eliminates congestion and pathological deposits in the joints. Joint massage is useful at low room temperatures, when it also has a warming effect.
It is recommended to give massage to older people as well. During this period of life, joints are usually inactive and movements are constrained. Under the influence of massage, the performance of joints increases. Therefore, it is widely used in sports and medical practice.
The positive effect of massage on metabolism
Studies have shown that massage has a beneficial effect on redox processes. This improves urination, the release of urea, uric acid, creatine and creatinine, and increases the release of mineral salts - such as sodium chloride, inorganic phosphorus. Massage techniques, in particular stroking and kneading, improve gas exchange. As a result of the active enrichment of tissues with oxygen, the acid-base balance is maintained, which protects the body from the development of acidosis and excessive amounts of lactic acid, so massage is good to perform after physical activity. In the latter case, it promotes the rapid removal of metabolic end products from the body.
Chapter 2. Massage hygiene
There are several conditions that should be taken into account when performing a massage procedure. Firstly, you must have good theoretical knowledge and be able to apply it in practice. Secondly, before performing a massage, you need to provide the necessary atmosphere and environment. Thirdly, depending on the presence and severity of the disease, the duration of the massage procedure should be adjusted.
Cabinet furnishings and means used for massage
The area of the room for massage must be at least 10 m2. The office should have good lighting and optimal air temperature (Fig. 17). Fluorescent lamps are best suited for lighting. The light must be installed so that it falls on the patient at an angle and does not irritate the eyes. If there is insufficient lighting, the patient will get tired quickly.
Rice. 17. Massage room
The most suitable air temperature for massage is 20–22 °C.
The massage room inventory includes:
1. Special couches or tables with a length of at least 175 cm, a width of 55 cm, and a height of approximately 70 cm. The peculiarity of the couches is the ability to adjust the height of the head and back parts. The table or couch should be soft enough, but keep in mind that equipment that is too soft will reduce the effectiveness of the massage. The table is usually made of wood or aluminum. It is necessary to create convenience not only for the patient, but also for the massage therapist; Therefore, it is advisable that the height of the table or couch be adjusted. Before starting the procedure, the table or couch is covered with a sheet to avoid contamination with creams or oils (Fig. 18).
Rice. 18. Massage tables
Sometimes the massage is performed on the floor. In this case, you need to lay a piece of foam 2.5–3 cm thick, measuring 220 x 120 cm, on the floor and cover it with a sheet.
2. Rollers are round in shape, up to 60 cm long and about 25 cm in diameter. They are necessary if it is impossible to raise the head of the couch, and are placed under the head when the patient lies on his back. If the patient is lying on his stomach, the cushion is placed under the shins.
3. A first aid kit, which must contain cotton wool, sterile bandages, adhesive tape, iodine, an alcohol solution of brilliant green, a 3% aqueous solution of ammonia, hydrogen peroxide, tincture of valerian, talc, baby cream. Additionally, you must have scissors, tweezers, a beaker, an hourglass, and a thermometer. It is advisable that a toilet, shower and changing room be located next to the massage room. There should be no strangers or unnecessary noise in the room. The massage therapist must focus all his attention on the massage procedure, and the patient must not be distracted by extraneous things.
4. Clean bathrobes, sheets, towel, cream or massage oil, detergents and a place to store them.
5. Sink with cold and hot water, a desk and two chairs or armchairs.
Requirements for a massage therapist
The massage therapist must not only have the necessary knowledge and skills, but also be attentive, patient, friendly, calm and objective towards the patient. The massage therapist must be able to correctly choose the most suitable massage technique for the patient. In addition, the massage therapist is required to have significant physical strength, since massage is not an easy procedure and requires great physical effort from the massager. Therefore, the massage therapist must be in good athletic shape and additionally train the muscles of the arms and back.
During the massage, the massage therapist should not be distracted by talking, since in this case the massage therapist’s breathing is disrupted, which leads to rapid fatigue.
The massage therapist's hands should be well-groomed. Abrasions, calluses, scratches, and cracks are not allowed on them. It is forbidden to have long nails. Before the massage, you must remove jewelry and watches from your hands. If you have any fungal or inflammatory diseases on your hands, you cannot perform a massage, as the disease can be transmitted to the patient.
Before the session, the massage therapist should wash their hands with soap and lubricate them with cream or oil. The cream should contain glycerin, an aqueous solution of ammonia, and 96% ethyl alcohol. If your hands sweat a lot, they should be lubricated with a 1% formaldehyde solution, rinsed with cold water, dried and covered with talcum powder.
A massage therapist must know the structure of the human body, the location of internal organs, muscles and tendons, their attachments, the course of nerve fibers and large vessels, and be able to identify indications and contraindications for massage.
The massage therapist should be dressed in a clean robe and have light, comfortable shoes on his feet. During the massage procedure, he is obliged to be attentive to his patient and monitor his condition. If there is the slightest complaint or discomfort, the procedure must be stopped.
When performing a massage, the massage therapist’s working position should be comfortable, it is advisable to change it periodically (Fig. 19).
Rice. 19. Massaging position relative to the patient
The session should be abandoned if the patient has a skin disease or any inflammation. Before starting the massage, the patient should take a warm shower.
As you know, a massage procedure requires a lot of energy from the massage therapist. Therefore, during the session he should save it as much as possible. The massage therapist's movements should be soft, smooth and at the same time rhythmic. When working, you need to change your hands from time to time; if possible, only those muscles that are directly involved in receiving the massage should be included in the activity. For example, in a technique that requires the use of the hand, you should not use the forearm, the muscles of which should remain relaxed. If the technique is carried out with weights, it is recommended to use the weight of the arm, and often the torso. In this case, you should not perform the technique using only muscle tension.
A massage therapist must constantly improve his knowledge, skills and physical capabilities. In order to achieve the latter, it is recommended to do special gymnastics aimed at strengthening the arms, legs, and back.
If a massage therapist works with athletes, then he will definitely need knowledge about the specifics of the sport in which the athlete is involved.
The massage therapist's working hours depend on the place in which he works. Often the working hours are irregular.
Long and particularly difficult massage sessions should be carried out at the beginning of the day and alternate with lighter ones. During the working day, you need to take two or three rest breaks lasting 5–10 minutes. After a general massage session, you should set aside 10 minutes for rest.
Being a massage therapist has its drawbacks. Staying in one position for a long time, standing on your feet, can lead to the occurrence of certain diseases, such as flat feet, dilated veins, impaired venous circulation in the abdominal cavity, and prolapse of internal organs. Therefore, for the purpose of prevention, the massage therapist is recommended to perform physical exercises during breaks to relieve fatigue from the back and improve blood circulation. Don't forget to change your position during the session. The height of the table must be adjusted so that the patient is in a position comfortable for the massage therapist, which would cause less tension in the muscles and ligaments and would not interfere with breathing; on the other hand, free access to what is being massaged must be ensured.
Lubricants are used to improve hand glide and prevent skin stretching. For this purpose, you can use baby cream, talc, aromatic oils, ointments, special creams and massage gels. Talc serves to absorb sweat, fat, gives the skin smoothness and elasticity, almost never irritating it. When choosing a massage cream, you need to take into account the patient's skin type and its condition. If the skin is dry and flabby, then it is better to use products containing vegetable oils and glycerin. It is not recommended to use petroleum jelly as a lubricant, as it greatly stains the skin, clogs pores, thereby making it difficult for the skin to breathe and disrupting metabolic processes.
Some experts believe that massage is best done on dry skin. On the one hand, such a massage is more effective, because the pores open and are cleansed of sweat and fat, and blood flows faster to the massaged part of the body. But, on the other hand, with a dry massage, abrasions and scratches can form on sensitive skin, and the skin can stretch.
For injuries and some diseases, massage uses ointments, gels and creams that have a healing effect. They contain various substances that have a specific effect on the massaged areas. For example, ointments such as finalgon, efkamon, gymnastogol increase blood flow to the painful area. In this case, a feeling of warmth appears in the area of massaging, as well as a slight burning or tingling sensation. A diseased area enriched with blood heals faster, because metabolic processes in this area are accelerated. Some ointments - such as venoruton, heparin ointment, lazonil - have anti-edematous and anti-inflammatory effects.
The massage therapist must have a good understanding of ointments and know in which cases which one to use. For example, for injuries, you cannot use ointments that cause tissue hyperemia; an analgesic and anti-inflammatory ointment is best suited here. This ointment usually contains heparin, plant extracts, and antirheumatic agents.
Before using the ointment, it is recommended to check whether it causes an allergic reaction in the patient. For this purpose, a small amount is applied to a small area of skin. If irritation does not occur, the ointment is applied to the entire massage area in a layer of 2–3 cm. After burning and tingling appears, the ointment is rubbed into the skin. If pain occurs at the massage site, the massage should be moved to an adjacent area. For the first time, a warming massage is best done in the evening, before bed. If the patient tolerates it well, the massage is repeated the next day three times - morning, afternoon and evening, gradually increasing the amount of ointment. After a warming massage, the affected area should be insulated with woolen cloth; under no circumstances should cooling be allowed.
Finalgon and dolpik ointments, when rubbed, form a film on the skin that must be washed off before each subsequent rubbing. These ointments should not be allowed to come into contact with the mucous membrane, and after the session you should wash your hands with warm water and soap.
Before applying the warming ointment, you need to perform a deep warming massage, then apply the ointment and massage, starting with easy techniques and ending with complex ones.
Folk remedies are often used for rubbing. For example, for inflammation of the joints, myositis, gout, rheumatism, use an infusion of birch buds in alcohol in a ratio of 1: 5. First, massage for 3–5 minutes, then rub the infusion into the diseased area.
Preliminary examination of the patient before massage
Before the massage, it is necessary to carefully examine the massage area and palpate (feel). When examining, pay attention to the color of the skin. If the skin is too pale, this indicates a low level of hemoglobin in the blood or the patient has an acute infectious disease. Various redness and irritations on the skin are a sign of dermatitis. A yellowish tint to the skin is a consequence of the patient's illness with cholecystitis or hepatitis.
You should also pay attention to skin moisture. Under normal conditions, in the absence of physical activity and at average air temperatures, skin moisture should be normal. Excessive sweating indicates neurosis in a person or increased body temperature when taking antipyretic drugs. Excessive dry skin indicates an acute lack of water in the body, and in old people it is a sign of insufficient activity of the sweat glands. After the plaster is removed, the skin in this area is also dry.
The degree of elasticity of the skin should also be taken into account. In its normal state it is elastic and dense. When you squeeze it into a fold with two fingers, healthy skin does not separate from the subcutaneous tissue and immediately straightens out after removing the fingers.
Sometimes there is swelling in the massaged area. Edema is the accumulation of fluid in tissues. It is divided into local and general. General swelling is a consequence of heart and kidney disease. Local swelling occurs due to injury, due to a disorder of blood and lymphatic flow, or is a consequence of injury.
If there are rashes on the skin, massage is not performed. They usually appear when taking certain medications or foods and indicate the presence of an allergic reaction to some substance, or the body’s rejection of this product or medication.
When examining a patient, it is necessary to pay special attention to the condition of the person’s joints. When a joint is damaged, swelling, pain, and low or complete absence of mobility occur. If the joint is severely inflamed, massage is not performed in this case.
Massage should be performed only after a thorough examination of the patient.
Requirements for the massaged
Before starting the session, the patient should take a warm shower or wipe off with a damp towel. Before self-massage, you can refresh the areas of skin being massaged with a damp towel or swab soaked in alcohol. Then you should wipe yourself dry with a towel, expose the part of the body being massaged so that clothing does not hinder the massage. If there are abrasions, scratches, cuts or other damage to the skin, they must first be treated with boric water or hydrogen peroxide, then cover the affected areas with a thin layer of xeroform ointment and seal the top with an adhesive plaster. In cases where the skin is affected by eczema or lichen, massage should be abandoned until recovery. After a restorative massage, you need to dress warmly or lie under a blanket. This restores performance better.
During the massage, the body should be as relaxed as possible. This significantly increases the efficiency of the procedure. Good relaxation may not be achieved right away. When the patient lies on his back, muscle relaxation can be achieved by moving the shoulder away from the table on which he lies by 45°; flexion of the forearm at the elbow joint at an angle of 100°; bending the hand at the wrist joint at an angle of 95–100° (fingers are bent).
If the person being massaged lies on his stomach, to achieve complete relaxation of the arm muscles, one should take the starting position depending on the massage technique. To relax the leg muscles, it is recommended to place a bolster under the knees.
You can check whether the muscles are completely relaxed by lifting the limb being massaged. If the weight of the hand is felt, the patient is relaxed. If the person being massaged involuntarily tries to help the massage therapist raise his hand, in this case the muscles are not relaxed. It is believed that the ability to voluntarily relax the muscular system is very useful for a person in everyday life. It helps relieve muscle tension after hard physical and mental work, strengthens them, and increases endurance. After approximately 5–10 massage sessions, the patient masters the ability to relax his muscles.
Indications and contraindications for the use of massage
When using massage, it is necessary to take into account the health, age and characteristics of the human nervous system. Thus, massage for elderly people and children should not be carried out too long and vigorously. The first sessions should include less intense techniques than subsequent ones.
Massage is contraindicated at elevated temperatures, acute inflammatory processes, skin diseases, skin damage and excessive irritability. It is not recommended to perform a massage if the patient is in a state of severe general fatigue and agitation, with a tendency to bleeding (nasal, hemorrhoidal), during menstruation and pregnancy, with inflammation of the lymphatic vessels, malignant and benign tumors.
With a special therapeutic massage, there are significantly more contraindications. Therefore, it should only be carried out as prescribed by a doctor.
Massage is indicated for all people, regardless of whether the person is healthy or sick, but for some diseases it cannot be performed.
Massage is recommended for use in the following diseases and injuries of the musculoskeletal system: rheumatoid arthritis and other lesions of the ligamentous system of the joint, dislocations, periostitis, dystrophic processes in the joints, ankylosing spondylitis, osteochondrosis of various parts of the spine, bruises, sprains, flat feet, poor posture and etc.
Chapter 3. Basic massage techniques
Conventionally, basic and auxiliary massage techniques are divided. Basic techniques include stroking, squeezing, kneading, and rubbing.
Each technique has its own specific physiological effect on the body and is used to achieve specific goals (Fig. 20).
Rice. 20. Directions of hand movement when performing techniques: a – straight; b – zigzag; c – spiral-shaped; g – circular; d – hatched
Stroking is considered one of the oldest massage techniques. This is a superficial and most gentle technique. First of all, it affects the skin. The upper obsolete layers of the epidermis are removed from it, skin respiration improves, the excretory function of the sweat and sebaceous glands and the contractile function of the skin muscles are enhanced. All this, in turn, contributes to the release of metabolic products from the body. The tone of the skin and muscles increases. The skin becomes smoother, firmer and more elastic.
On the other hand, stroking has a beneficial effect on blood vessels. When stroking, the vessels dilate, reserve capillaries are activated, as evidenced by redness of the skin (hyperemia). The rate of blood circulation in them increases, which means that tissues are more quickly enriched with oxygen. Tissue metabolism and the vital activity of cellular elements in the deep layers of the skin improve, and the number of red blood cells increases.
Stroking has a beneficial effect on the central and peripheral nervous system and relieves tension. Stroking for a long time helps relieve pain and reduce pain in injuries and diseases of the neuromuscular system. Stroking in reflexogenic areas (cervico-occipital, upper thoracic, epigastric, abdominal) has a reflex therapeutic effect on diseased tissues and internal organs.
When stroking, breathing usually slows down, which has a calming effect on the higher parts of the central nervous system. Therefore, stroking is recommended for people with increased excitability, as well as for relieving fatigue after hard physical and mental work, poor sleep, injuries and damage to relieve pain, spasms, twitching, etc.
Stroking is performed with a relaxed hand, palmar surface. To do this, you need to put four fingers together and move your thumb to the side as far as possible. You need to cover the maximum area of the body with your hand (Fig. 21).
Rice. 21. Palmar and dorsum of the hand: 1 – eminence of the fifth finger; 2 – terminal phalanges of the fingers (pads); 3 – elevation of the first finger; 4 – base of the palm; 5 – radial edge of the hand; 6 – ulnar edge of the hand (edge of the palm)
There are several types of stroking depending on what part of the body it is performed on and what tasks need to be performed.
Straight-line stroking (Fig. 22) is performed in a forward motion, that is, the hand slides forward with the thumb and forefinger.
Rice. 22. Straight-line stroking
Zigzag stroking. The brush is positioned diagonally across the area being massaged and glides in a zigzag pattern. Stroking should be done lightly, without tension. This technique is more relaxing than the previous one.
Combined stroking (Fig. 23) combines straight and zigzag stroking techniques. One hand moves forward, the other in the opposite direction. This technique is most effective for relieving tension and restoring performance during physical and mental fatigue.
Rice. 23. Combined stroking
Concentric stroking (Fig. 24) is used to massage joints. In this case, the movements become stronger when the brush slides to the proximal (located closer to the center) part of the massaged area, and weaken when returning to the distal (located further from the center) part.
Rice. 24. Concentric stroking
Forceps-like stroking (Fig. 25). The thumb and index fingers grasp the muscles, tendons, and skin and perform a stroking movement in a straight direction.
Rice. 25. Pincer stroking
The massage begins and ends with stroking.
Squeezing is considered the main technique in all types of massage. It has a beneficial effect on the skin, subcutaneous tissue, the surface layer of muscles, enhances blood and lymph circulation, deeply warms muscle tissue, improves tissue metabolism, and has a good effect on the central nervous system. This technique is actively used in sports and medical practice as a tonic. There are several varieties of it.
Transverse squeezing (Fig. 26). The thumb connects to the index finger. The brush is placed across the massaged area and moves forward.
Rice. 26. Transverse squeeze
Squeezing with the edge of the palm (Fig. 27). The brush is placed with the edge of the palm across the massaged area (fingers relaxed and slightly bent) and moved forward.
Rice. 27. Squeeze with the edge of the palm
Squeezing with the base of the palm (Fig. 28). The brush is placed along the area being massaged, with the thumb pressed against the index finger and the rest slightly moved to the side. The massage is performed mainly on the tubercle of the thumb and the base of the palm, the rest of the hand should remain relaxed.
Rice. 28. Squeeze with the heel of the palm
Squeezing with two hands (with weights) (Fig. 29). This technique is easy to perform if you have already mastered one-handed squeezing. When massaging, one hand is placed across the back of the massaging hand, thereby creating a burden.
Rice. 29. Two-handed push-up
Kneading is the main technique for massaging muscles. During kneading, the blood supply to the massaged area and nearby areas, especially those located in its lower part, improves. Under the influence of kneading, redox processes are activated and bone nutrition is improved. This is a kind of gymnastics for muscles and blood vessels, promoting stimulation of muscle tissue receptors, tendons, ligaments, fascia, periosteum, which improves the condition of the central nervous system.
In practice, the following types of kneading are most common.
Ordinary kneading (Fig. 30) is the easiest technique. The technique for performing it consists of two cycles. First: with the straight fingers of the hand, the muscle is tightly grasped across so that there is no gap between the palm and the massaged area; then the fingers are brought together (the thumb tends to the other four, and they, in turn, to the thumb), the muscle is raised and rotational movements are made towards the four fingers until failure. Second cycle: without unclenching your fingers (it is important not to release the muscle when it is displaced to failure), the hand returns together with the muscle to its initial position; at the end of this movement, the fingers release the muscle, but the palm remains tightly pressed to it. Next, the brush moves forward and captures the next area in the same way. The first cycle is performed again, then the second, and so on along the entire length of the muscle.
Rice. 30. Ordinary kneading
All elements of this technique should be performed without jerking, rhythmically, without causing pain to the person being massaged. Otherwise, the muscles will reflexively contract, which will lead to a decrease in the effectiveness of the massage. This technique is carried out in cases where a shallow and not too strong massage is required, for example after physical exertion or, conversely, after prolonged bed rest, as well as during self-massage.
Double neck. This technique uses both hands. In this case, the hand of one hand is placed on the hand of the other so that the four fingers of the massaging hand are under the four fingers of the pressing hand, while the thumb is located under the thumb. The double bar is performed in two cycles and is used to massage large muscles.
Double ring kneading. When massaging with a double ring kneading, the massager becomes perpendicular to the massaged part of the body, so that the hands are located across the massaged area of the body and at a distance from each other equal to the length of the hand, and the four fingers of both hands should be on the inside of the body, and the thumbs on the outside . The muscle is grasped with the straight fingers of two hands, compressed and raised, then with one hand it is shifted away from itself towards the four fingers, and with the other hand towards itself, towards the thumb. Then the reverse movement is made.
The technique is used on most muscles and is performed without sudden movements; twisting of the muscles is not allowed.
Double normal kneading. The most effective massage technique, which is used in sports practice, as well as for self-massage of the thigh muscles.
The thigh massage is performed while lying on your back, the shoulder massage is performed while lying on your stomach. The massager rests his knee on the couch and places the leg of the person being massaged on his thigh. One hand is placed on the back of the thigh being massaged above the knee joint (the right one, if the thigh is right), and the other hand is placed on the front of the thigh. All thigh muscles are massaged, resulting in rapid recovery of muscle function.
Longitudinal kneading. Both hands of the massager are placed with the palmar surface along the muscle being massaged so that only the thumbs touch. Using the pad of the thumb of the right hand, pressing on the muscle, shift it to the right of the left thumb. Then, returning the right finger to its original position, do the same with the left finger. At the same time, the right hand moves forward 2–4 cm smoothly, without jerking. So, alternately, the thumbs of both hands move forward, and the rest simply slide and press down on the muscle. The technique is not difficult; if possible, the arms should be extended at the elbows; then, by using body weight, the pressure force increases (Fig. 31).
Rice. 31. Longitudinal kneading
Kneading with your thumb. The hand is placed on the area of the body to be massaged in such a way that the thumb is positioned longitudinally to the area, and the rest are moved to the side diagonally. The muscle is pressed with the pad of the thumb, while at the same time shifting it towards the four fingers in a circular motion, then the thumb and muscle are returned to their original position. The thumb performs such rotations about 6–10 times on the calf muscle and 9–12 times on the back. At the same time, the brush moves forward along the massaged area of the body by 2–4 cm. During the massage, you can use your free hand for weights, pressing the edge of your palm on the nail phalanx of the thumb.
Compression. The technique is used on flat muscles - such as the longus dorsi, anterior tibialis, etc., as well as on large muscles - gastrocnemius, latissimus, quadriceps, etc. The fingers squeeze the muscle for 0.5 seconds, then release it. Compression is performed at a rate of 34–40 times per minute (Fig. 32).
Forceps kneading. This technique is performed only on flat muscles: longus dorsi, forearm (finger extensors), and anterior tibial muscles. The fingers of both hands are folded into the shape of forceps and grasp the muscle being massaged. At the same time, with both hands, the massager pulls the muscle and turns the hands alternately, with the right hand moving to the right, the left hand to the left (Fig. 33).
Rice. 33. Tong-shaped kneading
Kneading the phalanges of bent fingers. The muscle is pressed by the joints of the slightly clenched four fingers and the back of the middle phalanges to the bone bed. Then it moves towards the little finger, and the thumb rests on the massaged area and helps fix the hand and move it forward. If it is necessary to penetrate deep into the muscle, a rigid kneading is performed with the phalanges of the bent fingers. A greater effect can be achieved by performing the technique with weights and squeezing.
Kneading with fist ridges. The technique is used on large muscles and is performed with both one and two hands. With the phalanges of the fingers clenched into a fist, the massaged area is kneaded using various movements. The impact of this harsh technique on the skin is softened with the help of various ointments and oils. The technique is widely used when massaging in a bath (Fig. 34).
Rice. 34. Kneading with fist ridges
Rubbing involves displacing and stretching tissues in different directions. This technique irritates the receptors, which increases blood circulation. As a result, tissues receive more oxygen, nutrients and chemically active substances and get rid of metabolic products faster.
Rubbing is widely used in any type of massage. In the restorative mode, it helps remove under-oxidized products in the tissues; in the therapeutic mode, it accelerates the resorption of hardening, pathological salt deposits, fluid accumulation in the tissues and stretching of adhesions and scars. The technique is indispensable for massaging joints, tendons, and ligaments, especially during overloads and injuries that lead to swelling, decreased joint mobility and pain. Deep rubbing along the nerve trunks and at the sites of nerve endings reduces the excitability of the central nervous system and reduces pain. There are several types of rubbing.
Straight and zigzag rubbing with forceps. The technique is performed with one or two hands, possibly with weights. Four fingers, slightly bent at the interphalangeal joints, are placed on one side of the massaged area, and the thumb on the other. At the moment of flexion, the pressure of the fingertips on the skin increases, during extension it decreases, and the hand moves forward. This is straight-line rubbing (Fig. 35).
Rice. 35. Straight-line rubbing
If at the initial moment of bending the fingers and shifting the skin, a circular movement is performed with a return to the starting position, then the fingers seem to draw a zigzag, i.e., zigzag rubbing is performed. On large joints, rubbing is done with the palmar surface of all fingers. When rubbing with weights, one hand helps the other to penetrate deeper into the tissue.
Straight-line and zigzag rubbing can be performed with weights. Depending on the parts being massaged and the purpose of rubbing, weights are applied along or across the fingers.
Spiral rubbing with fingertips. The first method: four fingers move towards the thumb, rotating towards the little finger. The second method: the thumb moves towards the four fingers and rubs the massaged area, while rotating towards the index finger. These techniques are also performed with weights along or across the fingers (Fig. 36).
Rice. 36. Spiral rubbing
Concussive moves . These include shaking, tapping and vibration.
Shaking is most often used during restorative massage sessions when muscles are tired and swollen, after kneading and between kneading, as well as for joint diseases and arthritis. Shaking promotes better outflow of blood and lymph and uniform distribution of interstitial fluid. When performing this technique, the muscle is grasped with the thumb and little finger, the remaining fingers are in an elevated state. The massage therapist's hand should be relaxed, and the shaking muscle must also be extremely relaxed.
Shaking and shaking produce good results if done immediately after exercising the muscles.
Vibration . This shaking technique helps to enhance metabolic and regenerative processes, a rush of arterial blood to the massaged area, and improve tissue nutrition. Vibromassage reduces the excitability of the heart and neuromuscular system, increases the motility of the stomach and intestines, has an analgesic effect, and restores extinct reflexes. Vibromassage is actively used for deforming arthritis of the hip joint.
The essence of the technique is to transmit oscillatory movements of maximum frequency to the massaged part of the body. Movements are performed with the tips of one, two or all fingers, and on large muscles or muscle groups - with the palm or fist. The fingers are placed perpendicular (or horizontal) to the massaged area, along the nerve trunks. Vibration is produced continuously or intermittently, with movement. With continuous vibration, oscillatory movements are performed in spiral, longitudinal and transverse directions. If the vibration is performed at one place, it is called stable. Stable vibration carried out using one or two fingers is called point vibration (Fig. 37). In the case when, during vibration, the hand, massaging the surface of the body, moves along it, we are dealing with labile vibration (Fig. 38).
Rice. 37. Point vibration
Rice. 38. Labile vibration
The strength of the physiological impact of vibration massage depends on the frequency, amplitude and duration of the vibration used. Currently, this difficult technique for a massage therapist is being replaced by hardware vibration massage.
Pat. When patting, the fingers of the hand are slightly bent and the hand is turned with the fingers downwards. You can use one or two hands, alternately patting an area of the body with them. The forearms of the person being massaged should be bent at a right or obtuse angle (Fig. 39).
Rice. 39. Patting
Chopping is also a type of intermittent vibration technique. The brush is pulled out. Fingers should be open and relaxed. The blow is made with the little finger, the remaining fingers close when struck and enhance the effect of the technique. The brushes are located at a distance of 2–3 cm from each other. They move quickly, rhythmically and necessarily along the muscle fibers.
When massaging, your hands should remain relaxed. Otherwise, they will quickly get tired, movements will slow down, and the blows, accordingly, will be hard and painful for the patient (Fig. 40).
The movements are widely used in therapeutic, hygienic and sports massage. They improve blood and lymph circulation and have a positive effect on the musculoskeletal system. Movements can be active, passive or with resistance.
Active movements are performed by the person being massaged without the participation of external force, through willpower. For example, while lying on his back, he bends his leg at the knee joint. Active movements are preceded by muscle massage. The massager should help the patient if the latter has muscle atrophy. Active movements are used to stimulate the activity of the central or peripheral nervous system and strengthen the weakened nervous system. They have a beneficial effect on muscles, ligamentous-articular apparatus and the general condition of the body. The duration and intensity of active movements are determined by the objectives of the massage in each specific case.
Resistance movements are movements in which the muscles and ligaments overcome the resistance provided by the massage therapist. With the help of such movements, you can dose the load and exercise the muscles, which is important in the practice of sports and therapeutic massage for the prevention of injuries. In case of injuries, long journeys, when the athlete is not able to train, movements with resistance perfectly maintain training. When performing a movement by a massage therapist, the patient must smoothly overcome the resistance provided by the massage therapist. The resistance itself must correspond to the strength of the muscle during its contraction: at the beginning of the movement, the resistance should be weak, then strengthen and weaken again at the end of the movement.
Passive movements . At the moment of their execution, the person being massaged should occupy a comfortable position, be as relaxed as possible and not provide any resistance (Fig. 41).
Rice. 41. Passive movements
Passive movements are performed after a deep massage of the muscles and joints, as well as after the amplitude in the joint is determined using active movements. Under the influence of passive movements, hemorrhages resolve faster, muscle elasticity improves, and the contractility of muscle fibers increases, which is especially beneficial in the treatment of damaged joints after surgery.
Chapter 4. Therapeutic massage
In the prevention of exacerbation of arthritis, along with physical therapy and other physiotherapeutic procedures, therapeutic massage plays an important role. It includes all the basic techniques of classical massage. Treatment is considered more effective if, in addition to therapeutic massage, segmental, acupressure and other types of massage are performed, which will be discussed below.
The form of massage can be general or private. During a general massage, all areas of the body are massaged, with special attention paid to areas affected by the disease. This massage is performed for approximately one hour. Depending on the patient’s condition and the nature of the disease, massage sessions are prescribed every day, every two days or in series (several sessions every day, the rest every other day).
In the private form of massage, individual parts of the body are massaged - arm, leg, back, pelvis, hand, joint, etc. The duration of this massage ranges from 3 to 30 minutes, depending on the area of the body being massaged. In this case, a private massage is carried out on the same principle as a general one, only in a specific area and more thoroughly, with a larger number of techniques.
It is necessary to take into account contraindications to therapeutic massage. It should not be prescribed when the following processes occur in the patient’s body:
1. Acute inflammatory process.
2. High temperature, fever.
3. Blood disease.
4. Bleeding and predisposition to it.
5. Purulent process.
7. Diseases of the skin, nails, warts, skin rashes, lesions, skin irritation, ulcers, etc.
8. Trophic ulcers, gangrene in diseases of peripheral vessels.
9. Thrombosis, severe varicose veins with trophic disorders.
11. Atherosclerosis of peripheral vessels, thromboangiitis in combination with atherosclerosis of cerebral vessels, accompanied by cerebral crises.
12. Inflammation of lymph nodes and blood vessels. Enlarged, painful lymph nodes adherent to the skin and tissues.
13. Diseases of the autonomic nervous system during exacerbation (ganglionitis, diencephalic crisis).
14. Aneurysms of blood vessels, aorta, heart.
15. Allergies with hemorrhagic and other inflammations.
16. Active form of tuberculosis.
17. Chronic osteomyelitis.
18. Benign and malignant tumors of various locations before surgery. For fibroids that are not accompanied by surgical treatment, massage of the collar area, arms, legs and feet can be performed.
19. Mental illnesses accompanied by severe agitation and mental changes.
20. Third degree circulatory disorder.
21. Decompensation of blood circulation of the extremities in patients with atherosclerotic occlusions and thromboangiitis.
22. Acute period of hypertensive or hypotensive crisis.
23. Acute myocardial ischemia, occurring suddenly.
24. Severe sclerosis of cerebral vessels with a predisposition to thrombosis and hemorrhage.
26. Nervous and physical fatigue.
27. General severe condition in various diseases.
28. Acute respiratory diseases and the first five days after them.
29. Pulmonary heart failure of the third degree.
30. Diseases of the abdominal organs with a tendency to bleeding.
31. Nausea, vomiting, pain on palpation caused by the presence of any disease.
32. Syphilis of the first and second degree and other sexually transmitted diseases.
In the postoperative period, massage is contraindicated in the following cases:
1. Pulmonary edema, acute cardiovascular failure.
2. Pulmonary embolism.
3. Acute skin allergic reactions (urticaria, etc.).
4. Kidney and liver failure.
It should be borne in mind that for some diseases, contraindications to massage are temporary. So, after the completion of an acute inflammatory process, a feverish state, a purulent process, an acute form of arthritis, or an exacerbation of diseases of the autonomic nervous system, massage is allowed. Moreover, massage sessions are prescribed in some cases after complete removal of tumors, during remission after a hypertensive or hypotensive crisis, after drug treatment, acute myocardial ischemia after a week.
For skin diseases - psoriasis, eczema - manual massage is contraindicated.
In case of vascular aneurysm, blood diseases and angiitis, massage is strictly contraindicated.
There are also a number of contraindications for private massage. For example, it cannot be performed on the abdomen, lumbar region and hips during pregnancy, in the postpartum period and after an abortion in the first two months, during menstruation, with a hernia, gallstones and kidney stones. Massage of other parts of the body in these cases is permitted if there are no other contraindications.
Massage for nodular arthrosis of the hands
With this disease, nodular thickenings of the interphalangeal joints of the hands are formed. During periods of exacerbation, severe pain occurs, finger mobility is impaired, and flexion contractures form. The disease progresses slowly, with periods of exacerbation.
Massage is considered a particularly effective remedy in the fight against arthrosis, since it has a beneficial effect on the neuromuscular system and improves blood circulation in the diseased area of the body. The goals of massage are:
– analgesic effect and overcoming joint stiffness;
– improvement of blood and lymph circulation in affected areas;
– slowing down the onset of stiffness;
– preventing the development of muscle atrophy and ensuring better tissue trophism.
The patient is in a sitting or lying position. Massage is performed with one or two hands. If one hand is used for massaging, then with the other hand they fix the limb being massaged and help to grasp the muscles that are being affected. Massage techniques should be carried out along the lymphatic vessels, towards the lymph nodes (elbow area, armpit).
The massage begins from the back of the hand. Here you should massage the intermetacarpal areas in the direction from the knuckles to the wrist joint. When performing a massage, straight-line, flat-footed, and forceps-like stroking techniques are used. Then the palmar and lateral surfaces of each finger and hand are rubbed: straight with the pads of four fingers, zigzag with the pads of four fingers, circular with the pads of four fingers, straight with the pad of the thumb, circular with the pad of the thumb, circular with the pad of the third finger, spiral with the base of the palm. After this, they move on to kneading, using such types as longitudinal, transverse, felting, pressing, shifting, stretching. Then they begin to vibrate, alternately using tapping, patting, chopping, shaking, as well as acupressure techniques.
After this, they move on to massaging the fingers. Techniques should be performed from fingertips to knuckles. First, rubbing is carried out, and each finger must be rubbed separately. In this case, the following rubbing techniques are used: rectilinear forceps, zigzag forceps, straight with the pad of the thumb, circular with the pad of the thumb, circular with the pads of four fingers, circular with the pad of the index finger, and spiral with the base of the palm. Then shake the brush.
Massage for deforming arthrosis of the hip joint
For deforming arthrosis of the hip joint, massage is one of the main means of treatment. Its tasks include relieving pain, inflammation, accelerating the resorption of inflammatory effusion, and restoring joint function. The massage is performed while lying on your stomach or, if necessary, on your side or back. Before massaging, the muscles around the joint must be relaxed. If the affected area hurts, then the massage should be started from above or below the areas, using light, shallow techniques.
1. Massage the muscles along the spinal column . When massaging the spinal column, stroking the entire back is used, then squeezing and rubbing techniques are carried out along the entire length of the spinal column, from the sacral region to the intersection of the lower corners of the shoulder blades. You can use straight-line rubbing with the pads of your fingers, as well as circular rubbing of the spaces between the spinous processes with the pads of your thumbs. The last technique is performed as follows: the fingertips are located at a distance of 1–2 cm from the spinal column, after which they make rotational movements.
2. Lower back massage . When performing a massage of the lower back, stroking, squeezing, and various types of kneading are used - such as circular kneading with the pad of the thumb, circular kneading with the pads of the thumbs of both hands, and pincer kneading.
3. Massage of the lumbar region . In this massage, the following types of rubbing are used: straight with the pad and tubercle of the thumb, circular with the pads of four fingers, circular with the phalanges of bent fingers, circular with the radial side of the hand.
4. Massage of the gluteal-sacral area . The session begins in the gluteal region, where the gluteus maximus and gluteus medius muscles are located. The following techniques are effective here: stroking (8–10 times), squeezing with the edge of the palm or the base of the palm (5–6 times).
5. Thigh massage . During the massage, stroking, squeezing, and kneading techniques are performed. Of the varieties of kneading, you can use ordinary, double bar, double ring, ordinary-longitudinal, circular kneading with phalanges of bent fingers, beak-shaped kneading.
6. Hip massage . Only after performing the above techniques should you move on to massaging the hip joint if the pain is not too pronounced. In this case, carry out circular rubbing with the base of the palm, dotted rubbing with the pads of four fingers (2-3 times in each direction), circular rubbing with the phalanges of bent fingers (3-4 times), circular rubbing with the ridge of the thumb, which is bent and rests on the index finger (5 –8 times).
This area is particularly painful. Therefore, it should be massaged with great care, using a minimum of force, smoothly. With each subsequent session, depending on the patient’s condition and his response to the massage, the massage efforts can be gradually increased.
The entire complex should be repeated 2-3 times and finished with shaking and stroking. The session lasts 8–10 minutes. It should be carried out 2-3 times a day, depending on the patient’s condition.
For deforming arthrosis, vibration massage using an electric or mechanical hand massager is useful. But a hardware massage must certainly be preceded by a manual one. This is especially important at the beginning of treatment, as well as if the patient has painful sensations. A hardware massage session should last no more than 7–8 minutes.
Massage for deforming arthrosis of the knee joint
The massage begins with the thigh muscles. Massage techniques are used in the following sequence: combined stroking (3–4 times), squeezing with the edge of the palm (2–3 times), squeezing the fists with combs (3–4 times), shaking and stroking (2–3 times each technique), ordinary kneading (2–3 times), double circular (3–4 times) and double ordinary (4–6 times) kneading, shaking (3–4 times), double bar kneading (3–5 times), longitudinal kneading (3– 5 times), stroking (3-4 times).
In the area of the joint itself, concentric and circular stroking techniques are used along the lateral areas: straight-line rubbing with the base of the palms of both hands (6-8 times), forceps (3-5 times), straight-line and circular rubbing (3-4 times each time).
Then they move on to massaging the thigh again, but the number of repetitions for each technique is halved. After this, the joint is massaged again: its lateral areas are massaged by circular rubbing with the phalanges of the fingers clenched into a fist (4-6 times), circular rubbing with the base of the palms (3-6 times), concentric stroking (3-6 times). Next, the thigh muscles are massaged again by squeezing (3-5 times), shaking (2-3 times), stroking (2-3 times).
After this, carefully move on to active movements - such as flexion and extension (5-7 times), rotation of the lower leg in and out (5-7 times in each direction). Then they begin to massage the knee joint again. After concentric stroking in painful areas, rubbing is carried out with the base of the palm, the pads of the fingers and the phalanges of the fingers clenched into a fist (3-5 times). Finish the procedure by shaking and stroking (3-5 times).
The massage therapist must balance the efforts made with the sensitivity of the tissue being massaged. A good effect can be achieved by massage in warm water (37–39 °C) or after a bath.
Massage for arthrosis of the ankle joint
The massage procedure for this disease is quite complex, not so much in the technique of execution, but in the variety and multi-step nature of the techniques. During the session, the patient's position should change several times.
The massage should start from the lower leg. To do this, the calf muscle is first massaged with several types of stroking (2-3 times), then deep squeezing is performed (3-4 times with one and the other hand), after which techniques such as shaking (2-3 times), ordinary kneading are sequentially used (3-4 times, you can alternate, first with one hand, then with the other), kneading with fingertips (3-4 times), shaking (1-2 times), double bar (3-4 times). The procedure is completed by shaking and stroking. When massaging the calf muscle, special attention should be paid to the place where the Achilles tendon attaches to it. When massaging the Achilles tendon, the lower leg should be elevated at an angle of 45–90°. The massage is carried out along the entire length of the tendon, starting from the heel to the place of its articulation with the calf muscle.
After stroking with the fingertips (3-4 times), rubbing is performed. In this case, the following techniques are used: straight and zigzag tongs (the inner side is rubbed with the pads of four fingers, and the outer side is rubbed with the thumb); straight and circular rubbing (you can use weights, in this case you need to place a cushion under your leg); straight-line rubbing with the pads and tubercles of the thumbs. Each of the listed techniques is carried out 3-4 times, and between them, squeezing and shaking is performed on the calf muscle (1-2 times).
In the same position (lying on your stomach), rub the front and side surfaces of the ankle joint. The massage therapist stands to the side of the person being massaged. He places his hands on the joint so that the thumbs are located on the Achilles tendon, and the rest are located below. Straight-line and circular rubbing is carried out 4-6 times.
The following techniques are used on the tibial muscles (outer side of the shin): stroking, squeezing with the edge of the palm, kneading with the pads of four fingers (3-5 times), then stroking again 2-3 times, squeezing and kneading with the edge of the palm. The session ends with stroking.
Then they begin to massage the ankle joint and foot. The patient should take a supine or sitting position with his leg extended along the table. It is necessary to place a cushion under the Achilles tendon so that the heel does not touch the table, and the joint is relaxed and easily accessible to the massage therapist from all sides. A massage is performed on the front surface of the ankle joint as follows. Start with concentric stroking (4-6 times). Then, such types of rubbing are performed as straight-line forceps (3-4 times towards the Achilles tendon, i.e. along the ankle joint), straight-line and circular rubbing with the fingertips of both hands (4-6 times each time), straight-line and circular rubbing rubbing with one hand and with weights (3-4 times), straight with the base of the palm and the tubercles of the thumbs (4-6 times). Finish the massage with concentric strokes.
In the same position, they massage the back surface of the ankle joint - from the lower edge of the outer ankle along the Achilles tendon to the calf muscle. The massage therapist stands next to the person being massaged. He rubs the outside of the joint with one hand, and the inside with the other. In this case, such types of rubbing are used as straight-line rubbing with the pads of all fingers (towards the calf muscle, 4-5 times), circular rubbing with the pads of all fingers (4-5 times). Then the ankle joint is moved in different directions and the calf muscle, Achilles tendon, outer area of the leg and the joint itself are massaged again.
After massaging the joint, a foot massage is performed using rubbing.
Massage for arthrosis of the elbow joint
When massaging the elbow joint, the joint itself should be massaged for no more than 1–2 minutes. The massage should be light.
The position of the person being massaged is lying on his stomach. The procedure starts from the forearm. Techniques such as stroking, transverse squeezing, ordinary kneading, and double circular kneading are used. Each technique is performed 4–6 times. Then a shoulder massage is performed. The following techniques are used here: combined stroking (3–4 times), squeezing (4–6 times); All muscles of the shoulder are massaged: biceps, triceps, deltoid; ordinary kneading (4–7 times). Then stroking (2-3 times), squeezing (4-6 times), shaking (3-4 times), single and double circular kneading (3-4 times each time), stroking again (2-3 times) and shaking (2-3 times).
To massage the joint itself, the following techniques are used: stroking (5–8 times), rubbing with forceps (4–6 times), straight rubbing either with the pads of four fingers or with the thumb along the joint (5–8 times). Then you can repeat the massage on the shoulder, and then perform circular kneading with the pads of four fingers above and below the elbow joint for 20-30 seconds and stroking.
Forearm massage begins with the flexors of the hand and is performed in the following order: zigzag stroking (4–6 times), squeezing with the edge of the palm (4–6 times), shaking (2–3 times), ordinary kneading (3–4 times), kneading with phalanges fingers clenched into a fist, with the edge of the palm (3-4 times), squeezing (3-4 times). Finish with shaking and stroking techniques (3-4 times).
After this, repeat the shoulder massage (3-4 times each time) and begin massaging the outer side of the forearm. To do this, perform zigzag rubbing (2–3 times), squeezing (4–6 times), kneading with the edge of the palm and the phalanges of the fingers clenched into a fist (3–4 times), squeezing (3–4 times), kneading with the pads of four fingers (3-4 times) and stroking again (3-4 times). At the end of the procedure, you can additionally massage the shoulder and elbow joint.
Massage for arthrosis of the elbow joint is carried out both sitting and lying on the back. All techniques are performed with one hand. The sequence of massaging the parts of the arm remains the same: first the shoulder girdle, then the shoulder, elbow joint and forearm.
Massage for gout
Gout occurs due to a metabolic disorder, in which the level of uric acid in the blood increases and salt deposition begins in the joints, tissues and organs. Gout is a chronic disease that manifests itself in the form of acute attacks when the inner synovium of the joint becomes inflamed. As a consequence of this, synovitis develops, in which inflammatory effusion - exudate - often accumulates in the joint cavity. Inflammation gradually spreads to other parts of the joint, namely to the cartilage, epiphyses of the bones that form the joint, tendons, and joint capsule. In this case, sharp pain appears, swelling of the affected area, the temperature of the supra-articular tissues rises, and movements become limited.
In order to prevent periods of exacerbation of the disease, therapeutic exercises and massage are used.
You need to know that during the acute course of the disease, massage of the affected joints cannot be performed. In the subacute period, you can use a light relaxing and soothing massage. When the pain completely subsides, begin massaging the areas around and above the affected area. Then they gradually move on to massage the most painful joint. Therefore, before prescribing a course, it is necessary to determine the nature of the disease and the presence of functional insufficiency of the joint.
During the acute period, severe swelling forms in the affected area, and movements in the joint area become limited. Movement of the joints located above and below the diseased area is also difficult. The period of exacerbation is characterized by tension in the muscles that hold the joint.
The goals of massage are:
– providing an analgesic effect, reducing stiffness in the joint, accelerating the resorption of inflammatory effusion;
– muscle relaxation, increasing their tone and strength;
– improvement of blood circulation in the affected area;
– strengthening the body as a whole.
The massage technique is as follows: first you need to perform a preliminary massage, which will reduce pain and relieve muscle tension. Then the areas around the affected joint are massaged, and only then the joint itself. At the beginning, of course, techniques are used to reduce pain, stiffness, and relax muscles. Massage should be carried out carefully, gradually moving from a healthy place to a sick one. The course includes approximately 12–16 sessions, which are carried out daily or every other day, depending on the patient’s response.
For gout, all kinds of rubbing are used. If the metatarsophalangeal joint of the big toe is affected, first massage the back of the foot (instep), then around the joint of the big toe. The duration of the massage procedure in the first days should not exceed 7 minutes. The duration of subsequent sessions gradually increases. Massage should be performed 2-3 times a day. It is especially useful if the affected joint is well warmed up, for example after a bath. In this case, it is performed using soap. The technique for performing a massage in a bathhouse is the same as for a dry massage.
Massage for contractures and joint stiffness
Due to inflammatory processes in arthritis or after injuries, limited joint movement often occurs. In order to ensure better blood and lymph flow from the injured area, and therefore restore joint function, massage is widely used.
To gradually eliminate contractures, special devices are used. After contractures are eliminated or after their significant reduction, massage is necessary. With its help, as well as using thermal procedures and therapeutic exercises, normal joint mobility can be achieved.
Massage for stiffness of the joints of the upper extremities is performed in a lying or sitting position. Stroking and squeezing techniques are used on the upper back. Then kneading is done on the latissimus dorsi muscles and rubbing the trapezius muscle. If the mobility of the shoulder joint is limited, the massage begins with the shoulder girdle and performs stroking (up to 3 times), squeezing (up to 5 times), kneading with the edge of the palm (4 times) and with the pads of the fingers (5 times). After each kneading technique, shake (3-4 times), then squeeze and stroke again. It is recommended to perform techniques in the direction from the elbow joint to the shoulder joint and across all muscles. On the shoulder extensor muscles - deltoid and triceps - stroking, squeezing, and kneading techniques are also used.
When performing techniques on the shoulder, one should strive to perform them in the direction from the elbow joint to the shoulder joint and across all muscles; one should also stroke, squeeze, and knead on the upper back in the area of the scapula from the side of the shoulder joint. When massaging the chest, the person being massaged is on his back, with a slight elevation under his head. Using stroking, squeezing and kneading techniques, several circular movements are performed in the area of the attachment of the clavicle.
Stroking is applied up to 7 times, squeezing - up to 5 times, kneading - 4 times, shaking - up to 4 times. This massage complex is repeated three times, after which they begin to massage the latissimus dorsi muscles. The massage complex on the latissimus muscles is repeated twice: stroking (up to 6 times), squeezing (up to 5 times), shaking (up to 4 times), kneading (up to 5 times) and squeezing again (up to 4 times); finish by shaking and stroking (up to 5 times). Then massage the shoulder joint. It is massaged in various positions; it is important to position the hand so that the joint is relaxed and accessible for massage. Concentric straight stroking is initially done on the shoulder joint. Next, circular rubbing is performed with the pads of four fingers, the phalanges of bent fingers, and more vigorously with the edge of the thumb or the ridge of the fist. Then the rubbing is repeated again, straight and circular. With each rubbing, you should try to retract the shoulder so that no pain is caused. To increase joint mobility, after deep work on the muscles and ligaments, passive movements are performed in different directions. The massage is done in a gentle manner that does not cause increased pain. During the process, careful active and passive movements are recommended, which are excluded if the swelling is quite large.
Massage for stiffness in the elbow joint begins with the muscles of the shoulder and is carried out in the following sequence: stroking (2-3 times), squeezing (4-5 times), stroking and shaking (2-3 times), ordinary kneading (3-4 times), kneading with the pads of four fingers (3-4 times), shaking (2-3 times), squeezing (3-4 times), regular kneading again (4-5 times), squeezing (3-4 times), then kneading phalanges of fingers (3–4 times), ordinary kneading (3–4 times), shaking and stroking (2–3 times each).
The wrist flexors are massaged on the inside of the forearm. The following techniques are used: stroking (2–3 times), squeezing (4–5 times), ordinary kneading (3–4 times), squeezing (3–4 times), shaking (2–3 times), kneading with the edge of the palm (3-4 times), squeezing (2-3 times) and shaking. After this, kneading techniques are repeated: ordinary (3-4 times); phalanges of fingers bent into a fist (4–5 times); then squeezing the phalanges of the fingers clenched into a fist with the ridges (3-4 times); shaking; squeezing with stroking (all techniques 2-3 times).
On the outer side of the forearm, straight or zigzag stroking (4–5 times), squeezing with the edge of the palm (2–3 times), and transverse squeezing (2–3 times) are performed. This is followed by kneading: ordinary kneading (4-5 times), kneading with the edge of the palm (3-4 times). Then shake (3-4 times) and zigzag stroking (3-4 times); kneading the phalanges of the fingers bent into a fist (4–5 times); kneading with the edge of the palm and the pads of four fingers (3-4 times); squeezing (3-4 times); stroking (3-4 times).
On the muscles above the elbow joint, a massage is performed using squeezing to the middle of the shoulder (3-4 times), then regular kneading (3-4 times) and with the pads of four fingers (3-4 times). After this, you should perform 3-4 active movements and begin rubbing the joint itself. In this case, with each new movement, the fingertips should pass below and above the place of the previous rubbing. First, forceps are used: rub the joint from the outside with four fingers, and from the inside with the thumb (4-6 times). Then carry out circular rubbing with the pads of the fingers (4–6 times) and the phalanges of the fingers clenched into a fist (3–4 times) on the outside of the joint. This is followed by straight-line rubbing with the edge of the palm (10–12 times). It must be carried across the joint. This complex is repeated at least three times. After each rubbing complex, perform stroking and squeezing (2-3 times), kneading (5-6 times) and shaking on the shoulder and forearm.
Particular attention is paid to the area where the tendons are attached. This area is massaged thoroughly, and in the presence of scar ties and connections of the skin with subcutaneous tissue - more harshly. With this massage, the underlying tissues, right down to the muscles, restore lost functions and gain mobility. The duration of the procedure depends on the condition of the joint and the muscles and tissues located around it, and the size of the joint is also taken into account. For example, a massage of the wrist joint takes only 7 minutes, and a massage of the knee joint takes 10–15 minutes.
It is very useful to carry out this massage after undergoing thermal procedures, as well as in water. The best results in restoring joint function can be achieved by combining massage with physical therapy.
Chapter 5. Segmental massage
This type of massage is widely used for the treatment and prevention of joint injuries and diseases. The therapeutic effect when using this type of massage is achieved by influencing areas of the skin located directly above or near the diseased organ. This effect is called segmental.
The interaction of the integument of the body and internal organs is carried out by reflex. An important role in this process is played by the nervous system, through which irritations from internal organs are transmitted.
In the early stages of development, the body consists of a number of identical segments. During development, these segments are supplied by the corresponding spinal nerve, and the spinal cord externally acquires a segmental structure. Each spinal nerve innervates a portion of the skin of the corresponding segment (dermatome). This area is designated by the spinal segment that innervates it. The spinal cord is divided into 8 cervical (C1–C8), 12 thoracic (D1–D12), 5 lumbar (L1–L5) and 5 sacral (S1–S5) segments.
Segmental massage is based on the following principle: by influencing certain areas of the body surface (skin, subcutaneous tissue, muscles), it is possible to influence internal organs.
Indications for the use of this massage are damage to the ligamentous apparatus of the joints, dislocations, bruises, arthrosis, arthritis, traumatic bursitis, flat feet, etc.
Massage is contraindicated for damage to bones and joints, when inflammatory swelling, extensive hemorrhage, and elevated body temperature are observed; in the acute stage of infectious nonspecific arthritis; with tuberculosis of bones and joints in the active stage; with purulent processes in soft tissues, neoplasms of bones and joints.
During segmental massage, it is not advisable to use lubricants, as they interfere with the perception of sensations.
When performing segmental massage, the force of influence must be selected depending on the characteristics of the massaged area (tone, soreness, nature of pain). If there is severe pain in this area, the impact should be light.
The following conditions are optimal for segmental massage:
1. The procedure should take on average 20 minutes; for diseases of the heart, liver, gall bladder, the massage time increases.
2. It is recommended to increase the pressure force as you move from the surface into depth, and then decrease it.
3. As a rule, 2-3 procedures per week are sufficient, but if the patient’s condition allows, massage can be performed daily.
4. The total number of procedures depends on the effectiveness of the massage, the purpose of which is to eliminate all reflex changes. On average, a course includes 6–12 procedures.
After the massage, the patient's skin temperature rises at the massage site. Stroking during segmental massage rarely causes redness of the skin. And kneading, rubbing, and tapping are always accompanied by hyperemia. Breathing after a massage becomes calmer, more uniform and freer. Mobility in the affected joints of the limbs increases, pain decreases, and muscle strength increases. Segmental massage has a general healing effect on the entire body. Compared to other types of massage, segmental massage requires less energy and effort from the massage therapist.
Segmental massage technique
In segmental massage, along with classical techniques (see basic massage techniques), there are also specific ones that have a local effect (pressure, shifting, etc.). Classical techniques are modified in accordance with existing reflex changes (Fig. 42).
Rice. 42. Planar stroking during segmental massage
Drilling. There are two drilling methods. In the first case, the massage therapist is on the left side of the patient. The right hand is placed on the sacrum area so that the spine is between the first, second and fourth fingers. On the right side of the spine, using the second and fifth fingers, or rather, their pads, perform circular, helical movements. These movements should be directed towards the spine. Massaging occurs from bottom to top from one segment to another. The first finger is the supporting one. The left hand is always above the right, which allows you to regulate the pressure. Then the tissues to the left of the spine are massaged from the bottom up with the phalanges of the first finger, the remaining fingers serve as support.
In the case when the massager is to the right of the patient, the massage therapist’s right hand should be positioned so that the fingers point down. Massage should be done upward from segment to segment, first to the right of the spine, then to the left.
In the second method, the pads of the thumbs are located to the right and left of the spine. They make helical movements towards the spine, moving from segment to segment from bottom to top. The remaining fingers are supporting or are located on the sides of the patient’s body. The reception can be carried out either on one side of the patient or on both sides (Fig. 43, 44).
Rice. 43. Drilling technique: a – first method; b – second method
Rice. 44. Drilling the first way with weights
Impact on the spaces between the spinous processes of the vertebrae . The massage therapist is located to the left or right of the patient. The pads of the second and third fingers of both hands are placed on the spine so that the spinous process is located between the two fingers. For the first five seconds, small circular movements are performed, directed in opposite directions, going deeper below and above the spinous process. Then the massage is continued on the other, located above the spinous process.
This technique can also be performed with the first and second fingers of both hands, but the effect is less (Fig. 45).
Rice. 45. Massage on the spaces between the spinous processes of the vertebrae
Sawing technique . The first and second fingers are spread apart and placed on the sides of the spine so that a skin ridge is formed between them. Use both hands to perform sawing movements in opposite directions (without sliding over the skin). If the massage therapist stands to the right of the person being massaged, then his left hand serves as a weight, and if on the left, then vice versa (Fig. 46).
Rice. 46. Options for sawing
Reception of movement . The left hand is placed on the pelvis of the person being massaged (they grasp the iliac crest on the left buttock), and with the palm of the right hand they perform helical movements towards the spine, moving from bottom to top. With your left hand, fix the pelvis and make a slight movement in the opposite direction. When massaging the other side of the spine, the position changes accordingly (Fig. 47).
Rice. 47. Moving technique: a – lying down; b, c – sitting
Reception of influence on the peri-scapular region. The massage therapist is located to the right of the patient. With his left hand he clasps the patient’s right shoulder girdle, and with the second and fourth fingers of his right hand he performs small rubbings, starting from the place of attachment of the latissimus dorsi muscle and heading towards the outer edge of the scapula, to its lower corner. After this, the thumb is rubbed along the inner edge of the shoulder blade, up to shoulder level.
Then the left shoulder blade is affected. The massage begins with the thumb of the right hand from the attachment of the latissimus dorsi muscle, passes along the outer edge to the lower corner of the left shoulder blade and continues rubbing with the fingers along the inner edge of the shoulder blade and to the back of the head. The massage therapist uses his left hand to influence the tissues located under the scapula, as well as above and below its spine (Fig. 48).
Rice. 48. Segmental massage of the periscapular area
Pelvic concussion technique . The hands are placed on the body of the person being massaged so that the hands are in a pronated position on the iliac crests. Using short lateral oscillatory movements, the pelvis is shaken with simultaneous movement of the hands to the spine (Fig. 49).
Rice. 49. Impact on the pelvic area
Chest stretch technique. The massage therapist squeezes the patient's chest. After this, the patient must take a deep breath, and at this time the massage therapist sharply unclenches his hands. As the patient exhales, the massager again compresses his chest.
Segmental massage for the treatment of arthritis
The massage is performed in a sitting or lying position. In this case, the techniques of stroking, rubbing, kneading, and vibration are used. Paravertebral zones begin to be massaged: in case of damage to the joints of the upper extremities - at the level of brain segments D2–C4; in case of damage to the joints of the lower extremities - at the level of S4–1–D11. Then the proximal parts of the limbs are affected. Next, the areas located below the sore joint are massaged. They affect areas of healthy skin located symmetrically in relation to each other. When massaging the affected joint, special attention should be paid to the tendons, periarticular tissues, tendon sheaths, and joint capsules. The massage ends with passive and active movements. The duration of the massage is 10–15 minutes for the upper extremities and 25 minutes for the lower extremities. The course includes 10–12 sessions. Massage is carried out once every two days. It is recommended to carry out thermal procedures in combination with massage.
If the shoulder joint , a unilateral massage of the affected joint is performed. Massage begins with planar stroking along the spine from bottom to top from D6 to C3. Segmental waist stroking from the underlying segments to the cervical spine is repeated 3–4 times. In this case, you should pay special attention to the area of the latissimus dorsi muscle. Here they perform stroking, rubbing, kneading, and vibration. After this, they move on to drilling techniques, influencing the tissue between the spinous processes of the vertebrae, sawing and moving techniques. Next, a technique is performed on the peri-scapular areas with an emphasis on the diseased area.
Segmental massage of the upper limb begins with the overlying areas (shoulder girdle, deltoid muscle, shoulder, forearm). They use the techniques of stroking, rubbing, kneading, and vibration.
At the end of the massage, passive and active movements are performed.
During the massage, it is necessary to monitor the displacement of reflexes, especially intense ones, in the armpit area. Therefore, it is recommended to end the massage by applying pressure to the lower left edge of the chest to prevent discomfort in the heart area.
Damage to the elbow joint, forearm and hand. Segmental massage techniques are performed first paravertebrally from D7 to C3, then vertebrally in the affected area. Next, massage the scapula at the site of the lesion. Massage of the upper extremities is massaged starting from the shoulder girdle, then the shoulder, forearm and hand are treated. In this case, all the basic techniques are used (stroking, rubbing, kneading, vibration). The massage ends with passive and active movements. When massaging the hand, you should carefully massage all the fingers of the hand.
With this massage, reflexes are shifted in the same way as when massaging the shoulder joint and shoulder.
Damage to the hip joint and thigh. The patient is in a supine position. First, the paravertebral area from L3 to D10 is massaged using all segmental massage techniques. Use flat foot strokes, waist strokes from bottom to top; after this - drilling, massaging the interspinous spaces of the spine; carry out sawing and moving techniques. Then massage the costal arches and the area of the iliac crests. When massaging the gluteal region, special attention should be paid to the subgluteal folds. The lower extremities begin to be massaged from the thigh, then the lower leg and foot are massaged, where painful areas are identified. On the lower extremities, the basic techniques of classical massage are performed (stroking, rubbing, kneading, vibration). The massage is completed with shaking techniques in a sitting position, affecting the iliac crests. The session lasts 15–20 minutes, the course includes 10 procedures.
Particular attention should be paid here to the displacement of reflexes. The most common complaints are pain and pressure in the bladder area. To eliminate these unpleasant sensations, a pubic massage is performed in the area located in the lower abdomen using stroking and rubbing techniques. If you feel nagging pain or numbness in your leg, as well as itching, tingling in the area of the ankles and soles, or goose bumps appear, then massage the area between the greater trochanter of the corresponding limb and the ischial tuberosity. Pain and discomfort should stop after this.
Damage to the knee joint and lower leg. The person being massaged is in a prone position on his stomach. The massage begins with paravertebral influence from S3 to L3, using all techniques of paravertebral influence (drilling between the spinous processes of the vertebrae, sawing, pushing, moving). Next, massage the lumbar and gluteal region, the lower limb, starting from the thigh and highlighting the maximum points and the most important nerve trunks. The massage ends with active and passive movements and shaking.
The duration of the session is 12–20 minutes. The massage course includes 10–12 sessions.
The use of segmental massage in the treatment of arthrosis
The purpose of massage for arthrosis is to provide an analgesic, absorbable effect; preventing the progression of the degeneration process; restoration of lost joint function and normal range of motion in it; strengthening and healing the body as a whole.
For deforming arthrosis of the knee joint, first massage the thigh of the sore leg. In this case, stroking, rubbing, kneading, labile intermittent and continuous vibration are used, and the movements need to be directed up and down. This technique allows you to improve tissue metabolism, create hyperemia, and prevent muscle atrophy. Then the lower leg is massaged, followed by a massage of the knee joint itself. Circular, planar, forceps-shaped stroking, and types of rubbing are used here. In painful and swollen areas, perform a light and superficial massage.
If you have arthrosis of the elbow joint, you should not massage the affected joint . The massage begins with the cervical and thoracic spine, the area of the shoulder girdle, shoulder, and forearms. Stroking, rubbing, kneading, and vibration are used. Finish the massage with passive and active movements. Massage of the upper extremities lasts 10–15 minutes, lower – 15–20 minutes. The session is performed once every two days, the course is 10–12 procedures.
Segmental massage for joint contractures
Contractures are divided into congenital and acquired. The cause of congenital contractures is underdevelopment of muscles (torticollis, articular clubfoot) or pathological changes in the skin (swimming membranes). But more common are acquired contractures, which are divided into traumatic, inflammatory, paralytic, dystrophic and fixation.
The objectives of this massage are to improve blood and lymph circulation, metabolism in tissues, and restore lost joint mobility.
For contractures in the joints of the upper limb, massage begins with exposure to the paravertebral areas D11–6 and C6–3, using all the techniques of segmental massage. Next, muscle groups (trapezius, sternocleidomastoid) are treated using forceps-like stroking, rubbing, kneading, and labile vibration. When massaging the shoulder joint, the patient places his hand with the back of the hand on the lower back, which causes a greater effect when affecting the front surface of the shoulder joint. When massaging the back of the joint, the patient places the hand of the massaged hand on the opposite shoulder, so that the joint bursa can be freely processed from behind. When massaging the joint from the lower side, the patient moves his arm to the side. When massaging the elbow joint, you should pay special attention to its outer surface, and when massaging the wrist joint, you can best influence the joint capsule if you massage the back area of the joint.
Finally, it is useful to carry out passive movements as much as possible.
For contractures of the joints of the lower limb, massage begins with paravertebral impact on S5–1, L5–1, D12–10. In this case, segmental massage techniques are used. Then the lumbar region, pelvis, lower edges of the costal arches and iliac crests are massaged, ending the massage with a shaking of the pelvis. When massaging the lower limb, massage should be done according to the suction principle, affecting each joint and striving for maximum penetration into the joint. Finally, passive and active movements and shaking are performed with shaking of individual muscle groups.
The duration of the session is 15–20 minutes, the course includes 15–20 sessions, which are carried out every two days, depending on the patient’s condition and his response to the massage. This massage should be repeated after one to one and a half months.
With ankylosis of the joints (their complete immobility) or with severe contractures, the use of massage has little effect.
Chapter 6. Acupressure
Acupressure originated in ancient times. It is based on the same principles as acupuncture and moxibustion, with the only difference being that acupressure is applied with a finger or hand.
Acupressure is based on complex physiological processes. As a result of the studies, it was established that when exposed to a certain point on the human body, an energy balance is created, this effect stimulates or, conversely, calms the autonomic nervous system, improves blood circulation, regulates tissue trophism, the activity of the endocrine glands, relieves pain, reduces nervous and muscle voltage. Many studies conducted in our country have proven that the described points have specific features that distinguish them from other areas of the skin. For example, they have a fairly low electrical resistance, high electrical potential; absorb ultraviolet radiation more strongly, are characterized by a higher skin temperature in this area, increased sweating, a high level of metabolic processes and increased pain on palpation compared to other areas of the skin.
When exposed to these points, the patient usually feels aching, bloating, numbness, and pain in the area of massaging; Some people experience a feeling of warmth, goose bumps. All these features of the body's reaction are absent when palpating adjacent areas of the skin. This mechanism is used by the massage therapist to determine the desired point (Fig. 50).
Rice. 50. Position of fingers when performing acupressure
Acupressure can be used in combination with herbal medicine.
Ways to find points
During palpation, the necessary points are determined using sliding movements with the pad of the most sensitive finger. In the area where the point is located, roughness, greater stickiness, warmth, and increased pain are felt. Using special maps and drawings, you can determine the approximate location of a point on lines, meridians, and channels. On the back, for example, there are three such lines, on the chest in front - four, and the intersection of vertical lines with transverse ones at the level of the vertebra, rib or corners of the scapula, their spines, etc. makes it possible to find the desired point with relative ease. For example, at level D2–3 there is a feng men point along the first line, and fu fen is located along the second line on the back at this level (D2–3).
The points are also determined by external anatomical landmarks: various folds (wrist, elbow, shoulder, subgluteal), the tip of the nose, the tips of all fingers, protrusions, tubercles, depressions, places of muscle attachment.
In China, to more accurately determine points, they use the so-called. individual cun - the distance between the folds of the middle phalanx when bending the third finger (in men - on the left hand, in women - on the right). The width of one finger of the hand is taken as an individual cun. If you put the second and third fingers together, in this case their width will be equal to one and a half individual tsuns, and if you connect four fingers, you get three tsuns (Fig. 51).
Rice. 51. Definition of tsun: a, b – 1 tsun; c – 1.5 cun; g – 2 cun; d – 3 cun
Along with the listed techniques, the method of hardware search for points is also actively used. The devices mark points on the body that have low electrical resistance.
Acupressure technique
Depending on the technique, acupressure can have a stimulating or calming effect. For example, when muscle tone is disturbed, namely when it increases, with contractures, muscle and joint pain, the task of massage is relaxation. In this case, the “inhibitory”, sedative method is used, in which the desired point is found within 1–2 seconds. Then, for 5–6 seconds, using clockwise rotational movements, going deeper and pressing on this point and gradually increasing efforts, fix the achieved level for 1–2 seconds, and then direct the movement in the opposite direction, “unscrewing” the finger counterclockwise , gradually reducing the pressure, rotating for 5-6 seconds. Next, without lifting your finger from the fixed point, the steps described above are repeated several times, depending on the treatment recommendations. When massaging with sedation, four entries and exits are performed for 15 seconds each within one minute. If a two-minute exposure is required, then in this case eight inputs and outputs are made. With each impact, the pressure on the point becomes greater, depending on the desired effect (bloating, numbness, pain, warmth, etc.) (Fig. 52).
Rice. 52. Sedative method of influence during acupressure
For decreased muscle tone, atrophy of muscle groups, cuts, etc., use a stimulating tonic acupressure massage. In this case, find the point within 1–2 seconds, then perform clockwise rotational movements for 3–4 seconds, “screwing in” the finger with pressure on the point, then the massaging finger is sharply torn away from the point. This movement is performed 8–10 times at one point, the duration of the procedure is 40–60 seconds.
The points are impacted in a certain sequence depending on the disease syndrome.
Acupressure technique
According to the direction of action, the following points are distinguished:
1. General action (impact on these points in a reflex way affects the activity of the central nervous system).
2. Segmental, which are mostly located in the corresponding zone of innervation of these segments - hou-xi, xia-xi.
3. Spinal points located along the vertebral and paravertebral lines along the spine at the exit points of nerve roots and autonomic fibers. When exposed to them, a corresponding effect occurs in the internal organ or system.
4. Regional points located in the area of projection of internal organs onto the skin.
5. Local points on muscles, blood vessels, ligaments, joints.
The most commonly used points for joint diseases:
– along the dorsal radial line of the hand – shan-yang, he-gu, shou-san-li, tsui-chi – for motor disorders of the upper extremities, for arthritis of the shoulder joint;
– along the dorsal midline of the arm – Wai Guan, Zhi Gou, Siya Le, Tian Jing – for diseases of the joints of the upper extremities (Fig. 53);
Rice. 53. Lines and topography of points on the upper limb
– along the anterior outer line of the leg – Zu-Lin-Qi, Xuan-Zhong, Yang-Ling-Quan, Feng Shi, Xin-Jian – for motor and sensory disorders of the lower extremities;
– along the anteromedial line of the leg – nei-ting, jie-si, du-bi, tzu-san-li – in case of impaired motor function of the lower extremities, with arthritis of the knee joint;
– along the back line of the inner surface of the leg – yin-bai, gun-sun, zhao-hai, fu-liu – in case of impaired motor function of the lower extremities (Fig. 54);
Rice. 54. Lines and topography of points on the anterior surface of the lower limb
– along the outer line of the back surface of the leg – zhi-yin, jin-men, shen-mai, kun-lun – for rheumatoid arthritis (Fig. 55).
Rice. 55. Lines and topography of points on the inner (a) and outer (b) surface of the lower limb
In Fig. 56–59 show points that are recommended for joint pain.
Rice. 56. Points used for pain in the wrist joint
Regardless of the number of points located on a given channel (meridian), six most important and effective points are identified: tonic, sympathetic, sedative, stabilizing, assistant point, herald point. All of them, with the exception of the herald point, are therapeutic for this disease, and the herald point is informative, it is used for diagnosis.
The toning point is located on the main channel (meridian) and has a stimulating effect on the organ associated with it.
The sedative point is located on the main channel (meridian) and has an inhibitory effect on the organ associated with it.
The stabilizing point is often located at the end of the main channel (meridian). At the points of connection of a given channel with an adjacent one, it has coordination significance.
Rice. 57. Points used for pain in the elbow joint
Rice. 58. Points used for pain in the shoulder joint
The sympathetic point is located outside the main channel (meridian). Most often it is located on the bladder channel in the corresponding reflexogenic zone. When exposed to it, you can enhance toning or relaxation.
Rice. 59. Points used for knee arthritis
The assisting point is located on the main channel and helps to improve the effect and stabilize it during toning or relaxation.
The herald point is located outside its channel (meridian), next to the painful area, most often in the segmental zone, and has increased sensitivity.
Chapter 7. The use of massage in combination with physiotherapeutic procedures
It is advisable to combine massage for arthritis with various physiotherapeutic procedures.
Massage and heat therapy
The basis of thermotherapy includes elements such as heat, water, ozokerite, paraffin, therapeutic mud and other means that affect the body through temperature irritation. Temperature irritants mainly affect the skin. And irritation of skin receptors affects, in turn, tissues and organs, reducing the symptoms of the disease. Moreover, an increase in temperature increases pain, and a decrease reduces pain and contributes to its disappearance.
Thermal procedures are actively used in combination with therapeutic massage, as they significantly increase the physiological effects of massage, promoting vasodilation, which improves the absorption of therapeutic ointments, creams, gels; relieve spasm of muscles and blood vessels.
The sequence of application of massage and heat therapy is determined by the specific disease. Thus, in case of dysfunction of the musculoskeletal system, a thermal procedure should first be carried out, and then a massage. In case of tissue swelling, first of all, massage the areas of the body located above the lesion using the suction method, and then undergo thermal procedures.
Combination of massage with phototherapy
In phototherapy, irradiation with infrared rays is usually used using an incandescent lamp (sollux), a Minin lamp, etc. During irradiation, hyperemia is noted on the patient’s skin, which persists for 30–60 minutes and is caused by vasodilation. At the same time, metabolic processes in the affected area improve. Moderate doses of radiation have an analgesic effect. You can simultaneously use warming with a Sollux lamp and massage in case of dysfunction of the musculoskeletal system.
Water procedures include dousing, rubbing, wet wrapping, various types of showers - such as circular, rain, needle, fan, vortex, underwater, shower-massage, etc., as well as baths: fresh, contrast (two adjacent pools, in whose temperature differs by an average of 5–10 °C), vortex. Therapeutic baths can be sodium chloride, iodine-bromine, sulfide, nitrogen, carbon dioxide, oxygen, as well as baths that use radioactive and other substances - radon, aromatic, turpentine, pine.
All of the above types of water procedures are successfully used in combination with therapeutic massage, before, during or after it. Massage after a thermal water procedure is prescribed for injuries, arthritis beyond the acute stage, accompanied by scar tissue changes, joint stiffness (contractures), etc.
If there is severe pain, massage is prescribed before hydrotherapy. It is recommended to alternate baths with massage (day – massage, day – bath).
It should be remembered that massage is contraindicated during certain physiotherapy and balneotherapy procedures. For example, you should not perform massage and general diathermy or a general light bath, as well as ultraviolet irradiation and general massage on the same day. Between the mud therapy procedure and the massage it is necessary to take a break of several hours. For example, take a carbon dioxide bath on the first day, and have a massage on the second.
Massage combined with moderate movements
Massage is often combined with gymnastic exercises, with active and passive movements, movements with resistance, relaxation, and stretching. At the end of the massage it is useful to carry out breathing exercises. Sometimes movements make up 20% of the massage time.
Passive movements are not performed by the patient himself, but by the massager in the absence of volitional efforts and muscle contractions in the patient. They are an additional means of influence, along with massage, and are used for dysfunction of the musculoskeletal system, diseases of the joints, including arthritis. Under the influence of passive movements, effusions in the joints resolve much faster, movements prevent wrinkling and shortening of ligaments and muscles, and prevent contractures and ankylosis of the joints.
When performing movements, you should be guided by the following rules:
– the direction and amplitude of movements must correspond to the anatomical features of the structure of this joint;
– when performing passive movements on the upper limbs, the person being massaged should be in a sitting position; when massaging the lower limbs, the patient should lie down. Maximum relaxation of the patient’s muscles should be achieved;
– passive movements are carried out only on one joint, fixing the proximal and distal parts of the limbs;
– movements become more complex gradually during treatment. Initially, they are performed in straight directions, in the same plane, with low amplitude and slowly. Then the tempo, amplitude of movements and their complexity gradually increase (along with straight ones, circular and semicircular movements are performed);
– movements must be performed smoothly, rhythmically, without jerking, at a calm pace and in the absence of pain in the patient.
Active movements are movements performed directly by the patient himself under the control and command of a doctor. In complex treatment, active movements should be given special attention. They can be carried out before the massage, simultaneously with it or after it. If joints are stiff, active movements are used exclusively after massage and passive movements.
The simultaneous use of massage and active movements improves muscle performance, healing in fractures, and prevents atrophy, especially when a joint, tendon, or nerve is damaged, or with prolonged immobility.
The purpose of resistance movements is to strengthen the muscles. Such movements are characterized by the use of force. The massage therapist strictly doses the force and carries out this movement from various starting positions. The patient performs exercises for the muscles of the upper extremities while sitting or standing, and for the lower extremities – lying down.
We must not forget that when combining treatment procedures, the sequence of their implementation is important. For joint contractures, heat is applied first, then massage and, lastly, therapeutic exercises.
Movements in the shoulder joint include abduction and adduction, pronation and supination, and circular movements of the arms.
When performing this movement, the patient is in a sitting position, and the massage therapist stands behind him, placing his right hand on the left shoulder of the person being massaged, and the other hand on the forearm next to the elbow joint (Fig. 60).
Rice. 60. Passive movements in the shoulder joint
During abduction and adduction, the massager fixes the shoulder girdle in order to avoid movement due to the scapula, raises the patient’s arm, then lowers it.
Movements in the elbow joint are carried out through flexion and extension, pronation and supination (Fig. 61).
Rice. 61. Passive movements in the elbow joint
During this technique, the patient is in a sitting position with his forearm resting on the table. The massager holds the patient’s shoulder as close to the elbow joint with one hand, and the forearm in the wrist area with the other hand, then performs full flexion and extension at the elbow joint.
If the patient is in a lying position, the massage therapist places one hand under the elbow and the other under the wrist and performs flexion and extension movements. Additionally, the massage therapist turns the palm down (pronation) and up (supination).
Movements of the hand consist of abduction and adduction, flexion and extension, and circular movements. With one hand, the massager fixes the forearm above the wrist joint, and with the other hand holds the fingers of the person being massaged, performing the basic movements of this technique.
Finger movements include flexion and extension, extension and adduction. With one hand, the massage therapist holds the metacarpal joint, with the other he flexes and extends each finger, then brings and spreads each finger (Fig. 62).
Rice. 62. Passive finger movements
Movements in the hip joint are flexion and extension, abduction and adduction, pronation and supination, and circular rotation. The person being massaged is in a prone position on his stomach. The massage therapist places one hand under the knee joint, and with the other hand holds the buttock area so that the pelvis does not come off the table. Next, the massager lifts the limb, then returns it to its original position (Fig. 63).
Rice. 63. Passive movements in the hip joint
During abduction and adduction, the person being massaged lies on his side. The masseur places his hand under the shin, then raises the straightened leg.
Pronation and supination (turning in and out) are performed in a massaged position while lying on your back. The massage therapist, placing his hand under the shin below the knee joint, turns the leg alternately outward and inward.
Circular movements are performed while the massaged person is lying on his back. One hand of the massage therapist is located on the knee joint, and with the other he holds the foot from below. Then he bends the leg of the person being massaged at the knee and hip joints, first in one direction, then in the other direction.
Movements of the knee joint include flexion and extension. The person being massaged lies on his back while performing the exercises. The massager stands perpendicular to the patient. One hand is placed on the lower thigh, with the other hand he holds the shin under the ankle joint. Next, the massager bends the leg at the knee joint so that his hand is sandwiched between the thigh and shin. Then the massage therapist takes out the clamped hand and presses it on the shin, trying to get the heel to touch the gluteal muscle; after this, he smoothly returns the limb to its original position (Fig. 64).
Rice. 64. Passive movements in the knee joint while lying on the stomach
This technique is also carried out in the massaged position while lying on your back. This affects both the knee and hip joints (Fig. 65).
Rice. 65. Passive movements in the knee joint while lying on your back
Movements in the ankle joint consist of flexion and extension, pronation and supination, and circular rotation. These movements are performed while lying on your back. With one hand the massager fixes the ankle joint from below, with the other hand he holds the foot and performs flexion and extension, pronation and supination, as well as rotational movements in both directions (Fig. 66).
Rice. 66. Flexion and extension at the ankle joint
Toe movements involve flexion and extension of each toe individually. The person being massaged is in a lying position. The massage therapist holds the foot with one hand and performs the movements with the other.
Chapter 8. Self-massage for arthritis
Self-massage, along with other types of massage, is an effective tool in the fight against arthritis and its consequences, especially in cases where a massage specialist is not available. Self-massage can be performed in any position - sitting at a table, at home in a chair or lying down. A massage in a bathhouse is very useful. The main thing is to dose the massage correctly and not overdo it. Self-massage can be performed at a convenient time in combination with other physiotherapeutic procedures. The disadvantage of self-massage is that some areas of the body are often inaccessible, for example when massaging the shoulder. In addition, it is not always possible to completely relax the muscles in this case. Self-massage consumes a large amount of energy, so it is contraindicated for people suffering from the third stage of hypertension, cardiovascular failure, liver and kidney failure, organic diseases, etc. Inept performance of techniques, incorrect direction of movements and other violations of the rules have a negative effect. Therefore, when performing self-massage, you must adhere to the following requirements:
1. Movements during self-massage should not cause painful or unpleasant sensations: leave bruises or damage the skin. The massage should be carried out quite energetically, smoothly, but rhythmically. After it is performed correctly, warmth is felt in the area of the massaged area, the body as a whole relaxes, and the mood improves.
2. In case of disorders of the musculoskeletal system, self-massage begins from the overlying areas, for example, when massaging the knee joint, from the thigh. After massaging the surrounding areas, you can proceed directly to massage the affected area.
3. Self-massage lasts from 3 to 25 minutes, depending on the tasks.
4. It is necessary to choose the most comfortable position so that all the muscles of the massaged area are relaxed, i.e., take the so-called physiological position, in which the joints of the limbs are bent at a certain angle (Fig. 67). You should try to maintain the chosen position throughout the entire session. The abdominal area is massaged while lying on your back with your legs bent at the knee joint. If there are abrasions, scratches or other damage to the skin, they should be thoroughly treated and covered with adhesive tape before massage. If there is dense hair on the area being massaged, then the massage should be carried out through thin cotton or woolen fabric.
Rice. 67. Average physiological position of the limbs during self-massage
5. Lymph nodes cannot be massaged. All movements are made towards the nearest lymph nodes, taking into account the direction of lymph flow.
6. Self-massage, like massage in general, cannot be performed during an exacerbation of the disease; in acute inflammatory processes; bleeding; in places where there are pustules, as well as in other cases when massage is contraindicated.
7. When self-massaging, you can use various lubricants. But performing a massage with clean, warm hands is encouraged. For gouty arthritis, radiculitis and other diseases, special medicinal creams and gels are used for treatment; they can also be used during self-massage.
Self-massage for damage to the joints of the lower extremities
Self-massage of the lower extremities begins from the thigh. To do this, you need to sit on a chair, bend your legs or half-bend them at the knee joint so that they rest on the floor with your feet (Fig. 68).
Rice. 68. Position of the leg during self-massage of the thigh
In this position, you can massage the front and back of the thigh at the same time.
The back should have support, which can be the back of a chair, a wall, or a tree.
Self-massage includes several techniques, namely stroking, squeezing, rubbing, kneading, shaking, chopping, patting and percussive techniques. Each appointment ends with stroking.
Stroking is carried out in the direction from the knee joint to the groin. To do this, you need to connect the four fingers of your hand together and move your thumb to the side. In this way, you can cover a fairly large area of the body when massaging. Then the palm is pressed tightly onto the massaged area, lightly clasping it with your fingers, and slow sliding movements are made across the skin. Both hands are involved in the process alternately. After such straightforward stroking, they move on to combined stroking. At the same time, with one hand they continue to perform straight-line movements from the knee joint to the groin, and with the other they make zigzag strokes in the same direction (Fig. 69). When stroking, the upper dead layer of the epidermis is exfoliated, which helps improve the activity of the sebaceous and sweat glands, causes skin hyperemia, and increases blood flow and metabolism.
Rice. 69. Stroking technique during self-massage
Following stroking, a squeezing . It can be carried out with weights depending on the condition of the muscles and joints. The technique is performed with the base of the palm and the tubercle of the thumb, while the fingers must be closed.
There are two ways to perform this technique. In the first case, when massaging the inner surface of the thigh of the right leg, the right hand is used, and when massaging the outer surface of the leg, the left hand is used. The hand is located across the thigh (Fig. 70).
Rice. 70. Squeezing technique for self-massage
In the second case, massage the outer side of the right thigh with the right hand, and the inner side with the left. The hand is located along the thigh; when squeezing, the pressure is applied by the base of the palm.
rubbing technique is performed on the outer side of the thigh with the ridges of the fingers clenched into a fist. Straight, spiral, circular rubbing, as well as straight and circular rubbing with weights (using both hands) are used sequentially. Rubbing promotes the dilation of blood vessels and better blood circulation, warms the tissues, and accelerates resorption.
Kneading is an important technique for self-massage, since it can be used to influence not only superficial, but also deeply located tissues. It significantly contributes to the improvement of blood and lymph circulation in superficial and deep vessels. First, perform ordinary kneading on the inner, outer and upper sides of the thigh. To do this, the muscle is tightly grasped with straight fingers, squeezed and performed rotational movements while simultaneously moving forward and capturing new areas of the muscle (Fig. 71). The technique is performed with a sliding movement, smoothly, without jerking or strong tension.
Rice. 71. Reception of ordinary kneading during self-massage
Next, perform a double bar. This technique is carried out in the same way as ordinary kneading, but with weights. To do this, the four fingers of one hand connected together are placed on the four fingers of the other, and the thumbs are placed on each other (Fig. 72).
Rice. 72. Double bar for self-massage
Double ring kneading is performed as follows. The muscle is grasped crosswise with both hands. The distance between the hands is 5 cm. Then the muscle is slightly lifted and pulled with the hands in opposite directions. After this, without releasing the muscle, smoothly turn it in the other direction, etc. (Fig. 73).
Rice. 73. Double bar for self-massage
Longitudinal kneading is performed along the inner, midline and outer lines of the thigh. To do this, the hands are placed on the massaged area symmetrically relative to each other. The distance between them is 1–2 cm. First, the muscle is grabbed with the right hand, then with the left, shifting the muscle to the appropriate side.
Double ordinary kneading is carried out simultaneously on the front and back surfaces of the thigh. To do this, grab the muscles of the front and back of the thigh with your fingers and make spiral movements (Fig. 74).
Rice. 74. Double ordinary kneading during self-massage
Shaking is the fifth technique for self-massage of the thigh. When performing it, the muscle is grasped with the thumb and little finger, the remaining fingers are raised, and the hand quickly oscillates between these fingers. The massage therapist's hand should be relaxed, and the shaking muscle should also be extremely relaxed.
Percussive techniques include tapping, patting, and chopping. All these techniques cause hyperemia in the massaged area and provide better metabolism. They also irritate muscle fibers, increasing their ability to contract. When performing these techniques, the muscles should be as relaxed as possible.
When tapping, the fingers are folded into a fist, the little finger is slightly bent. Perform rhythmic strikes with the edge of the palm. The more tense the muscles of the massaged hand are, the more force the blow is made (Fig. 75).
Rice. 75. Effleurage during self-massage
Patting is performed with a relaxed hand, with two hands alternately, fingers pressed to the palm turned down (Fig. 76).
Chopping is done with the edge of the palm and the little finger. The remaining fingers are closed.
Rice. 76. Patting during self-massage
Self-massage of the back of the thigh is performed while sitting on a chair. The massaged leg should be moved to the side and the heel raised. In this position, the muscles are relaxed, which greatly facilitates the procedure.
Self-massage of the knee joint
The knee joint is one of the largest joints in the human skeleton. Regular self-massage of this area of the body helps prevent salt deposits, as well as other joint diseases, including arthritis.
Self-massage of the knee joint is performed in a sitting or standing position. When performing a standing massage, the center of gravity during the procedure is transferred to the non-massaged limb.
First, straight and circular stroking is performed, using both hands (Fig. 77). When massaging the right knee, stroke its outer surface with the right hand, and the inner surface with the left. Then they move on to rubbing, which begins with forceps-shaped straight rubbing.
Rice. 77. Straight-line stroking during self-massage
After this, perform straight-line circular rubbing with the pads of four fingers, resting on the thumb, and with the pad of the thumb, resting on the other four (Fig. 78).
Rice. 78. Rubbing during self-massage
These techniques can be performed with weights.
Active movements follow. To do this, you need to bend your leg at the knee and hip joints, trying to bring your thigh as close to your chest as possible. This exercise should be performed 6-7 times. Next, they do the same movement, but at the same time they clasp the shin with their hands and pull the thigh as close as possible to the chest. This exercise is repeated four times. Finally, perform the technique of stroking the knee joint with both hands.
Self-massage of this part of the body begins with the calf muscle. It is carried out in a sitting position. To do this, one leg is placed on top of the other so that the lower outer side of the massaged shin lies on the thigh of the second leg near the knee (Fig. 79).
Rice. 79. Position of the person being massaged on a chair during self-massage of the lower leg
Self-massage of the lower leg can be carried out in another position - sitting on the floor or on the bed, while bending the leg at the knee joint and resting the heel on the floor surface (Fig. 80).
Rice. 80. Position of the person being massaged on the floor during self-massage of the lower leg
Massage in the direction from the Achilles tendon to the popliteal fossa. First, straight, zigzag and combined stroking is performed alternately. During combined stroking, sliding zigzag movements are made with the right hand, and straight ones with the left. The left hand moves forward following the right. When stroking, you need to grasp the calf muscle in such a way that four fingers are located on top and the thumb is on the bottom. At the second stage, a squeeze is performed, in which the movements should be rhythmic and energetic. Then kneading is carried out, first ordinary, and then double circular, which is performed with both hands. The hands are placed across the calf muscle and alternately, either with the right or with the left hand, the muscle is shifted towards the little finger. This stage is completed with a double bar. Finally, shaking is done.
Self-massage of the Achilles tendon, foot and sole
This massage uses stroking and rubbing techniques (pincer-shaped, straight, circular).
When massaging the sole, it is advisable to use a special rubber massage mat. The sole is placed on it and rolled first from heel to toe, then in the opposite direction. You can move from foot to foot. Massage on such a simulator is performed for 2–3 minutes.
Begin the massage in a sitting position. This position is convenient because the soles become more easily accustomed to the pressure. After 30 seconds they get up from the chair. The duration of the massage depends on the sensitivity of the sole, as well as on body weight. The greater the weight, the greater the pressure on the legs and the shorter the procedure should be. If pain occurs, massage should be stopped.
Massage of these parts of the body can be carried out not only with the hand, but also with the foot. To do this, the massaged leg is placed on the floor. The heel of the second foot is used to rub the toes, instep, ankle joint and Achilles tendon. Perform linear, transverse, circular movements.
Self-massage of the upper limbs for arthritis
When self-massaging your hands, take a sitting or standing position. They begin with a massage of the shoulder, in particular with its biceps muscle, called the biceps (Fig. 81). The fingers glide gently along the inner groove. The direction of movement is from the elbow joint to the armpit. First, stroking is performed. To perform this technique, the massaging palm is placed across the muscle of the massaged arm so that four fingers are on the outside and the thumb is on the inside of the shoulder. Then a squeeze is applied, in which the thumb is pressed against the index finger and vigorous movements are made, as when stroking.
Rice. 81. Shoulder self-massage
Next, perform ordinary kneading. To do this, the muscle is slightly pulled back and kneaded, first with the pads of the fingers, then with the phalanges of the fingers clenched into a fist, and with the edge of the palm. Finally, shaking and light stroking are carried out.
When massaging the triceps muscle, the massaged arm should be lowered along the body. They use the techniques of stroking, squeezing, kneading, and shaking. Finally, stroking is performed. The direction of movement during self-massage is from the elbow joint up to the neck.
Massage of the deltoid muscle is performed in a sitting position. The elbow part of the forearm can rest on the knee of the bent leg. It is better to place the hand being massaged on a table or on the back of a chair. First, straight and spiral stroking is performed in the direction from the elbow joint up to the neck. After this, squeeze with the edge of the palm and thumb, then proceed to kneading.
Self-massage of the shoulder joint consists of sequential rubbing techniques, which are carried out around the deltoid muscle, kneading, shaking, active and passive movements. The massage is performed in any of the above positions.
Self-massage of the elbow joint begins with a massage of the outer part of the joint, while the massaged arm is turned palm up. At the first stage, forceps-like rubbing and its other varieties are done. Pincer-like rubbing is done with the fingertips. The elbow joint is clasped so that four fingers are located on the outside of the elbow, and the thumb is on the inside.
Straight-line rubbing is performed first with four fingers, resting on the thumb, then with the thumb, resting on the rest.
Zigzag rubbing is done with the phalanges of the fingers clenched into a fist and the edge of the palm. After this, they move on to passive and active movements - flexion and extension, turning the hand so that the palm faces first up and then down.
Self-massage of the forearm begins with a massage of the flexors (inner side of the forearm), then massage the extensors (outer side of the forearm). When massaging the internal area, the massaging brush is positioned with the palm facing up. The techniques of stroking, squeezing, kneading and shaking are used.
Self-massage of hands for nodular arthritis
The massage is carried out in a sitting position, the person being massaged rests his back on a wall or on the back of a chair. First, you can tap the fingers of one hand on a hard surface of the floor or on the edge of a chair. In this case, the wrist must be relaxed as much as possible, so that the hand easily bounces off the surface. The fingers should also be in a relaxed state. This movement is performed many times. At first, the fingers feel a pleasant stimulation, then they begin to hurt a little, followed by numbness, which again turns into a slight pain, and then into a pleasant sensation of stimulation. If severe pain occurs, the blows should be eased. This technique is considered the simplest and does not require special knowledge of massage techniques. Eventually, the fingers begin to burn as a large amount of blood enters them and the nerves' response to blows improves. All this leads to fingers becoming more sensitive. Then carry out the same procedure with the other hand.
Before starting the main massage, you need to rub your hands. This technique will improve blood circulation in them, warm them up and increase sensitivity. This can be achieved in different ways: rub one hand against the other, hold one hand motionless and rub it with the palm of the other hand, spread your fingers as wide as possible and rub them with one hand against the fingers of the other, rub the fingertips with the thumb, moving from the base of the palm along each finger When performing a massage, you should try to involve only the hands in the work, without using the muscles of the shoulders and other parts of the body.
Then they move on to movements. To do this, the hand is placed on the table so that all the joints of the hand rest on its surface. Then, with your left hand, you should take hold of the fingertips of your right hand and make passive rotational movements with your right hand, remembering that the muscles of the hand should remain relaxed. Rotation of the hand is performed in both directions until the hand ceases to resist the movement and tries to help it, i.e. until the muscles are completely relaxed.
Then you should grab your right hand with your left hand and perform slow rotational movements with your right hand, trying to describe a circle with as large a radius as possible. It is necessary to constantly ensure that the massaged arm does not strain. The hands and fingers should be in a relaxed state. Only the wrist takes an active part in the movement. This technique is repeated 10–20 times, after which they move on to passive movements.
This is followed by rotational movements with each finger of the right hand. First, passive movements are carried out, in which the left hand holds the finger and directs its movements, then active and again passive. These movements are performed for each joint on all fingers.
All the techniques done are repeated for the left hand. You need to constantly ensure that only brushes are used in the work. Otherwise, your hands and the whole body will quickly get tired, which will negatively affect the quality of the massage. You should concentrate on the movement of the muscles and joints in your hands. Breathing should remain slow and even while massaging.
All elements of self-massage are quite simple. They can be easily absorbed within 5-7 procedures. During the massage, you must not forget about proper breathing and do not hold it. Before starting to massage the sore joint, you can conduct a general self-massage session (Table 1).
If the massage is performed correctly, then after it the patient should feel a surge of strength, lightness throughout the body and significant relief from painful manifestations.
It should be noted that with further selective self-massage of individual joints, the sequence of techniques is maintained.
Chapter 9. Hardware massage
The most important element of hardware massage is vibration. Vibration is understood as mechanical oscillatory movements in which the physical body deviates in one direction or the other from a stable position. Oscillatory movements have an amplitude of movement (the amount of deviation of the body from a stable position) and a frequency of oscillations (the number of deviations of the body from a stable position per unit time).
Vibration, acting on a person, affects all his organs. Depending on the degree of penetration, it can be local or general.
The physiological effect of vibration on humans is associated with irritation of exteroreceptors (receptors located on the skin), interoreceptors (receptors located on internal organs) and proprioceptors (receptors located on muscles and tendons).
Studies have shown that vibration massage significantly reduces pain, activates redox reactions in the muscles, which leads to the release of tension from the muscles and restoration of their performance. Vibration massage has a positive effect on the functional state of the endocrine glands, autonomic and nervous systems.
Indications for the use of hardware vibration massage for joint diseases are subacute and chronic forms of infectious nonspecific polyarthritis, contraindications are the acute form of the underlying or concomitant disease.
Methods and techniques of hardware massage
To conduct a hardware massage, you must follow the following rules:
1. Before the massage, the desired vibrator should be secured in a special socket of the device.
2. Vibrators vary in shape, so you need to choose them based on the nature and size of the area being massaged. For large areas, flat vibrators with a large adjacent surface are used; on convex surfaces - concave; in the recesses of the body - spherical and button-shaped; in the hairy area - with rubber spikes and processes. In order to influence the deep layers of tissue, hard plastic vibrators are used; For a soft surface effect, rubber or sponge vibrators are used. Underwater massage is carried out in baths, half-baths, local baths for individual limbs. Massage in the bath takes place in a sitting or lying position. Massage of the knee joints is carried out in a lying position. Nozzles are selected depending on the nature of the procedure.
3. The choice of the area of influence is determined by the nature of the pathological process and its localization. You can act directly on the affected area (along the nerve trunks and blood vessels, on pain points, around joints) or on reflex zones (vertebral and paravertebral areas, ganglia, endocrine glands).
4. There are labile and stable methods of vibration massage. With the labile method, the vibrator is moved over the massaged area with slow longitudinal and circular movements, stroking, rubbing, evenly pressing its surface to the skin. In the second case, with a stable technique, the vibrator is installed in one place. The guide nozzle or vibrator is applied to the site of influence without moving it. With both methods, you can massage both intermittently and continuously.
5. In medical and sports practice, vibrations are used with an average frequency of 10 to 200 Hz and an amplitude of 0.1 to 3 mm.
6. The duration of the procedures is determined by the nature of the disease, the place of exposure, the general condition of the patient and his reaction to the massage. The duration of the procedures at the beginning of the course is 8–10 minutes. Over time, the duration of the massage can be increased to 20 minutes. Using vibration of the same frequency and amplitude for too long causes the body to become addicted, and a session lasting more than 20 minutes leads to fatigue for the patient.
7. At the very beginning, massage is prescribed once every two days. Over time, depending on the general condition of the patient and his response, massage can be prescribed two or three times in a row. The total number of procedures is selected for each patient individually depending on the nature of the disease, its stage, and the patient’s age. On average, a massage course includes 10–15 procedures.
8. Vibration massage in a bath or swimming pool is carried out after a light breakfast. Before and after the session you should rest for some time, about 15–20 minutes. After returning to the ward, the patient needs longer rest.
Devices (Fig. 82). For vibration hardware massage, the following devices created in our country are used:
1. Vibration apparatus for massage (model VMP-1) and electrical device “Vibrating massage” (model AM?2). These devices are an electromagnetic device that operates on AC power. The device is equipped with a vibration intensity regulator and various attachments, including:
– suction bell – for massage of the chest, abdomen, neck, face;
– spike attachment – for massaging the scalp;
– sponge – for weak vibration massage of the face, neck, painful areas located along the lymphatic vessels;
Rice. 82. Vibrating devices for massage: a – VMP-1: 1 – body, 2 – switch, 3 – regulator, 4 – plastic semicircle, 5 – suction bell, 6 – spike vibrator, 7 – sponge, 8 – ball; b – AM-2
– plastic nozzle – for deep massage of arms, legs, back, abdomen;
– various balls – for point vibration in places of nerve endings, in the area of tendons and periosteum.
2. Vibration apparatus by P. L. Beresneva. The device is equipped with an electric motor that rotates a flexible shaft with an eccentric. At this time, vibrations are formed that are transmitted to the vibrator.
3. Massage device designed by M. G. Babiya. It is convenient because, in addition to vibration, you can use it to perform various massage techniques. The device includes a stand, a hanging frame, an electric motor, a gearbox and a set of attachments, including:
– a cube-shaped vibrating grinder – its side faces can be used to perform rhythmic, continuous vibration; with the flat surface of the base of the cube – circular rubbing; with a light touch – flat stroking;
– a cylindrical sponge grinder – with its base, circular rubbing is performed; on the side surfaces - longitudinal and transverse rubbing, as well as shading;
– pyramidal electric kneader – pressing produces kneading of muscles and gentle continuous vibration;
– bladed vibration kneader – when rotating, the blades capture muscles, move them, perform circular kneading and continuous vibration;
– tong-shaped kneader – pinches tissues in a tong-like manner and produces circular kneading;
– vibrating effleurator – when two blades rotate, effleurage occurs;
– a cone-shaped circular kneader – equipped with three radically located deep furrows, between which there are ridges. When the nozzle rotates, the furrows capture soft tissues, displace them, and with the help of ridges a circular kneading is performed; The convex parts of the nozzle are used to perform circular rubbing.
Particularly effective is the use of hardware massage in combination with manual massage.
When performing massage with the above devices, stable and labile vibration is used. When stable, one area of the body is affected for 3–5 seconds, then after a pause they move to another area. Labile vibration is performed in circular and linear movements, moving through different parts of the body, taking into account the lymph flow on the limbs and torso (Fig. 83).
Rice. 83. Apparatus for mechanical massage designed by M. G. Babiya
Vibration-vacuum massage (pneumovibromassage)
The operating principle of this type of massage is the combined effect of vibration and vacuum. The vibration effect is achieved by creating alternating pressure.
The EMA-1 model device is used mainly in combination with manual massage. The EMA-2M model, unlike EMA-1, is equipped with two cylinders, which allows you to operate two vibrators at once. When massaging joints, the cup attachments of the device are used. Plastic vibrators are used to massage large muscle groups. When massaging the back surface of the body, the patient is in a supine position, when working on the anterior group of muscles - in the same position, when massaging the arms and neck, the person being massaged sits. For a sedative, calming effect, vibration with a frequency of 15 Hz is used.
Vibrator movements are usually made along the lymph flow, directing them depending on the massage task.
The main directions of movement of vibrators when using the EMA-2M device:
1. Vertical - a vibrator performs oscillatory movements perpendicular to the surface of the muscle.
2. Horizontal - vibrators are located on one or both sides of the muscle.
3. Horizontal-vertical – the vibrator is located at an angle of 90°.
4. Longitudinal vibrations - vibrators move towards each other.
5. Transverse vibrations - vibrators are located horizontally on the sides of the muscle and move towards each other.
6. Circular movements - one vibrator moves clockwise, the other counterclockwise.
7. Vibrations when vibrators are positioned at an angle to each other.
Vacuum apparatus for massage, proposed by V. I. Kulazhenko and A. A. Safonov. It has a simple design and consists of an air compressor and a double-action pump. A rubber hose with metal or rubber nozzles is attached to the device.
When massaging with a vacuum apparatus, labile or stable vibration is produced as follows: a suction cup (aspirator) is alternately applied to the sore spots for 30–40 seconds or slowly moved over the massaged area for 5–10 minutes. The initial pressure during massage is 600–500 mmHg. Art., then it is lowered to 200 mm Hg. Art. The procedure is performed every two or three days.
Pneumovibromassage also includes syncardial massage. With this massage, a mechanical effect on the tissues of alternating air pressure occurs (Fig. 84).
Rice. 84. Vacuum massage
This type of massage is carried out using the Tangentor-8 apparatus and various modifications of hydromassage units, which are produced in many countries around the world. The massage is carried out in special baths or pools. A stream of water under a pressure of 2-3 atm is ejected from a flexible hose, onto which various attachments are attached depending on the method and purpose of the massage. The techniques are performed in a certain sequence.
One of the types of underwater massage is a whirlpool shower. It is carried out in special cylindrical baths, in which a circular flow of water is created using a centrifugal pump.
The entire body or a specific part of it is placed in the bath. A vibrating vortex jet of water mixed with air is directed at the patient, with the help of which a deep painless massage is performed (Fig. 85).
Rice. 85. Bath for whirlpool underwater massage
It should be noted that by adjusting the temperature of the water, colder or warmer, a certain therapeutic effect can also be achieved.