Approximate algorithm for the massage of the upper limb. Upper limb massage technique Where does upper limb massage begin?

Diseases of the arteries of the upper extremities Technique The patient sits with his head resting on his hands, a cushion or a pillow. They start with a massage of the paravertebral zones D7-1, C7-3 (stroking, rubbing). Then massage the trapezius muscles and the latissimus dorsi muscles (stroking,

Massage of the upper limbs The shoulder girdle (scapula and collarbone) and the free upper limb (humerus, bones of the forearm, hand) are interconnected during various movements. The blood supply to the upper limb is provided by the subclavian artery, and the venous outflow

Massage for fractures of the bones of the upper extremities Massage begins in the presence of plaster immobilization or skeletal tension. When immobilized with plaster, the patient sits or lies on

Diseases of the arteries of the upper extremities Technique The patient sits with his head resting on his hands, a cushion or a pillow. They start with a massage of the paravertebral zones D7-1, C7-3 (stroking, rubbing). Then massage the trapezius muscles and the latissimus dorsi muscles (stroking,

Guidelines

1. Before the massage, the patient's muscles should be relaxed as much as possible by comfortable laying of the limb.
2. When massaging individual areas, carry out a preparatory massage of the entire arm.
3. Do not massage the hand and forearm separately (when massaging the forearm, the hand must also be affected).
4. When massaging the shoulder - massage the entire shoulder girdle.
5. When massaging the muscles of the shoulder, do not act on the internal groove of the biceps muscle.
6. In case of injuries, start the massage from the overlying area or from a preparatory massage of the entire limb.
7. The duration of the procedure depends on the purpose of the massage and can be 3-10 minutes when massaging individual areas and 12-15 minutes when massaging the entire limb.
8. Massage of the hand is carried out in the position of the patient lying on his back or on his stomach

9. Indications for massage of the upper extremities: diseases and injuries of soft tissues, bones, joints; vascular disease, peripheral nerves; skin diseases.

Shoulder massage. Massage begins with the trapezius and deltoid muscles. Use the techniques of deep stroking, intense rubbing and light kneading. The direction of movement is from the VI-VII cervical vertebrae (if you bend your head, the VII vertebra will protrude more than the rest) to the end of the deltoid muscle. The deltoid muscle should be well rubbed and kneaded.

Next, massage the triceps muscle, which is the extensor of the forearm. Apply techniques of superficial and deep stroking, vigorous rubbing and light kneading. Movements go from the elbow joint along the outer back surface of the shoulder to the shoulder joint.

Then they move on to massage the biceps muscle, which is the flexor of the forearm and shoulder. Movements are performed from the cubital fossa along the inner front surface of the shoulder to the armpit. The brachial artery, veins and nerves pass along the inner surface of the shoulder (on the inner groove). Therefore, when performing a massage, one must be especially careful and in no case exert any pressure on this surface.

Stroking in the direction of the axillary fossa - planar, encircling, forceps; rubbing - rectilinear, circular, spiral, crossing, sawing, hatching; kneading - felting, transverse, longitudinal (flexors and extensors are kneaded separately), stretching, shifting, forceps, pressure; vibration - shaking, puncturing, tapping, patting, chopping, shaking,

Forearm massage.

Stroking from the wrist joint to the area of ​​the elbow, planar, encircling, forceps, ironing; rubbing - rectilinear, circular, spiral, sawing, crossing, hatching; kneading - longitudinal, transverse, felting, pressing, shifting, stretching, squeezing to the elbow; vibration - tapping, patting, chopping, shaking, shaking

Massage of the hand and fingers.

Massage starts from the back of the fingers, then moves to the back of the hand. Stroking is planar, then pincer-like on the back of the hand, starting from the fingertips to the middle third of the forearm, then massage each finger separately towards its base along the back, palmar and lateral surfaces. Rubbing - along the palmar and lateral surfaces of each finger and hand is circular, rectilinear - along the inter-metacarpal spaces; kneading - tongs, pressure, stretching; vibration - puncturing, shaking, passive and active movements

Anatomical features lower limb

The lower limb is divided into the pelvic girdle and the free lower limb. The areas of the lower limb include: 1) the gluteal region, which passes into the back of the thigh. Its upper border is the iliac crest, the lower one is the gluteal groove, or crease; 2) thigh area: a) the anterior thigh area corresponds to the location of the quadriceps femoris and sartorius muscles. The lower border runs 4 cm above the patella; b) the posterior region of the thigh corresponds to the space bounded at the top by the gluteal fold and at the bottom by a transverse line drawn 3-4 cm above the base of the patella; 3) areas of the knee: a) the anterior area of ​​the knee is located on the anterolateral surfaces of the knee. This area includes the area of ​​the patella, corresponding to the contours of the patella and condyles of the thigh; b) the back of the knee is located on the back of the knee. This area includes the popliteal fossa; 4) region of the lower leg: a) the anterior region of the lower leg extends from the tuberosity of the tibia to the level of the base of the ankles and occupies the anterior surface of the lower leg; b) the posterior region of the lower leg, which includes the so-called calf, the most protruding upper part of the posterior region of the lower leg; 5) areas of the foot: a) the rear of the foot is located on the dorsal and lateral surfaces of the foot, ranging from the fold of the ankle joint to the proximal phalanges of the fingers; b) the sole of the foot is located on the plantar surface of the foot, ranging from the distal sections of the calcaneal tuber to the proximal phalanges of the fingers; c) the calcaneal region corresponds to the calcaneal tuberosity.

Figure 106. Bones of the lower limb 1. Pelvic bone 2. Patella 3. Fibula 4. Tibia 5. Tarsus 6. Metatarsus 7. Fingers 8. Foot 9. Lower leg 10. Knee 11. Femur 12. Femur 13. Pelvis.

A - front view

B - rear view

Figure 107. Muscles of the lower limb. A is a front view. B - rear view.

Figure 108. Muscles of the foot.

The muscles of the lower limb (Fig. 107, 108) are divided into the muscles of the pelvis and the muscles of the free lower limb. Among the latter, the muscles of the thigh, lower leg and foot are distinguished.

The muscles of the pelvis (pelvic girdle), in connection with the upright posture of a person, form a powerful muscle mass into which the hip joint is immersed. They implement the most important functions of the body, providing both the possibility of a vertical position of the body and movement in space. With wide ends, they begin on the bones of the pelvis or spine, and with narrowed tendons, they are attached to the upper part. femur. The complex complementary work of these muscles allows you to fix the hip joint in different modes and positions.

Some of these muscles originate on the inner surface of the pelvic bone or from the lumbar vertebrae. Among them is the iliopsoas muscle, which extends into the upper part of the anterior surface of the thigh. Most of the muscles of the pelvic girdle are located in the gluteal region (large, middle and small gluteal muscles; piriformis, external and internal obturator; twin; quadratus femoris).

The thigh muscles are unequal in length. Some of them extend from the pelvis to the bones of the lower leg and act on both the hip and knee joints, others, shorter ones, only on one of them. They all make up three groups.

The anterior group includes the tailor and quadriceps muscles. The latter is one of the strongest human muscles and consists of four parts, which are connected at the bottom into a common tendon that contains the patella. This is the only muscle that extends the leg at the knee. Its parts (the rectus femoris, the external, internal and intermediate wide muscles of the thigh) have different masses and lengths.

The inner group of muscles of the thigh provides mainly the adduction of the limb, acting on the hip joint (comb, long, short and large adductor muscles, thin muscle). The posterior group consists of the semitendinosus, semimembranosus and biceps muscles of the hip extensors and flexors of the knee joints. The primary importance of the lower leg muscles is that they provide fixation of the ankle joint when standing, orientation and support functions of the foot during movement (walking, running, etc.) . Among them there are relatively shorter muscles, the tendons of which do not go to the fingers (tibial, peroneal, three-headed). The flexors and extensors of the fingers, on the contrary, act on all joints of the foot.

The anterior leg muscles include the tibialis anterior, extensor digitorum longus, and extensor thumb longus. Their tendons run along the anterior surface of the ankle joint. These are the extensors of the foot and fingers (movement when the toe of the foot rises).

The back group is represented by two layers. The more superficial layer includes the gastrocnemius and soleus muscles, which are combined as the triceps muscle of the lower leg. They form one tendon, known to everyone as the Achilles tendon, which attaches to the calcaneal tuberosity. Deeper are the posterior tibial muscle, the long flexor of the fingers and the long flexor of the first finger. All these muscles act as foot flexors at the ankle joint, and they are especially stressed when standing on tiptoe. They are also involved in holding the arches of the foot, and those that extend to the toes, especially the first, provide, in addition, their supporting role when standing and walking.

The outer group consists of the long and short peroneal muscles, their tendons pass behind the outer ankle, these are also ankle flexors.

Fixing on the foot closer to its outer or inner edge, the leg muscles ensure its adaptation to the angle of inclination of the supporting surface, raising or lowering these edges.

Muscles of the foot. On the dorsum of the foot there is only a short extensor of the fingers with a separate part for the first toe.

The muscles of the sole are divided into the muscles of the first toe, little finger and middle group. The first two groups have almost the same set of muscles: finger abductor, short flexor. In the group of the first toe there is also a well-developed adductor muscle, which is important for strengthening the transverse arch of the foot. Yes, and other muscles of the sole, including the middle group (worm-shaped, interosseous muscles, short flexor of the fingers), despite their names, are of primary importance in keeping the arch of the foot. In addition, by ensuring that the fingers are fixed in a certain position, they turn them into reference points when standing and moving. That is why the muscles of the big, supporting toe are so well developed.

Table 8. Muscles of the pelvis and lower limb

Continuation of table 8. Muscles of the pelvis and lower limb

Continuation of table 8. Muscles of the pelvis and lower limb

Continuation of table 8. Muscles of the pelvis and lower limb

Figure 109. Blood vessels of the leg.

Lymphatic vessels and nodes of the pelvis are concentrated along the iliac arteries and veins and collect lymph from the walls of the pelvis, from Bladder, uterus, vagina, rectum, and prostate. From the external genital organs, lymph enters the superficial inguinal lymph nodes

Figure 110. Iliac and inguinal lymph nodes.
Front view.

1 - superficial inguinal lymph nodes; 2 - wide fascia of the thigh; 3 - superficial lymphatic vessels; 4 - great saphenous vein of the leg; 5 - femoral vein; 6 - deep inguinal lymph nodes; 7 - external iliac vein; 8 - inguinal ligament; 9 - external iliac lymph nodes; 10 - common iliac lymph nodes; 11 - bottom vena cava; 12 - abdominal part of the aorta; 13 - lumbar lymph nodes; 14 - subaortic lymph nodes.

Figure 111. Lymphatic vessels and lymph nodes of the lower limb; right. Front view. 1 - inguinal lymph nodes; 2 - medial group of lymphatic vessels; 3 - lateral group of lymphatic vessels.

On the lower extremities are popliteal and inguinal lymph nodes, which are divided into superficial and deep. Lymphatic vessels carry lymph away from the skin (superficial vessels) and muscles, joints, bones, and nerves (deep vessels).

Superficial vessels are divided into two main groups, which are concentrated along the great and small saphenous veins.

The most noticeable accumulation of lymph nodes of the lower limb is localized in the upper part of the thigh under the inguinal fold. These inguinal nodes collect lymph from the thigh, lower leg and foot, as well as from the anterior abdominal wall (below the navel), the gluteal region, the external genital organs, the perineum and part of the pelvic organs.

Massage technique. The position of the patient - lying on his stomach, on his back; to relax the muscles, special rollers are placed under the knee and ankle joints. Massage movements are carried out along the lymphatic vessels towards the popliteal and inguinal lymph nodes.

Ankle massage. The ankle joint is a trochlear joint formed by the articular surfaces of the distal ends of the tibia and fibula and the articular surface of the trochlea. talus. Both tibias are interconnected by ligaments and form, as it were, a fork covering the upper and lateral surfaces of the body of the talus (Fig. 113). The articular bag is reinforced with ligaments.

The blood supply to the ankle joint is provided by the anterior and posterior tibial arteries. The pulsation of the first of them is determined on the front surface of the joint., And the second - behind the inner ankle.

Movements in the ankle joint are possible mainly in two directions - in the plantar (flexion) and in the back (extension). The amplitude of these movements in adults reaches 60-70°.

Figure 113. Ankle and foot.

Figure 114. Movements in the ankle joint.

The main landmarks of the ankle region are the medial malleolus (the bony prominence at the distal end of the tibia) and the lateral malleolus (the distal end of the fibula). The ankle ligaments attach to the ankles and bones of the foot. The powerful Achilles tendon attaches to the posterior surface of the calcaneus.

Movement in the ankle joint is limited to plantar and dorsiflexion. Supination and pronation of the foot are possible due to the subtalar and transverse tarsal joints.

It is possible to influence the ankle joint simultaneously from the front and side surfaces. Circular uninterrupted embracing stroking, rubbing is performed. The most commonly used rubbing options are: “toncers” are straight-lined, when four fingers rub the outer surface of the ankle joint, and the thumb rubs the inside; circular pads of four fingers on both sides; the base of the palm at the ankles; rectilinear with the base of the palm and tubercles of the thumbs; spiral base of the palm.

Massage of the ankle joint is done from the heel bone - the place of attachment of the tendon - to the place where the tendon passes into the calf muscle. The following rubbing options are used: rectilinear “forceps” - four fingers rub the outer surface of the ankle joint, and the thumb rubs the inner one; circular-shaped pads of four fingers at the same time; the base of the palm at the ankles; rectilinear pads and tubercles of the thumbs; circular pads of the thumbs. All of these techniques are carried out slowly and alternate with stroking and active-passive movements.

The ankle pouch is accessible in three places: on the anterior surface, where it is widest and lies fairly superficially under the foot and toe extensor muscles; on both sides under the ankles; on the back, covered by the Achilles tendon.

For rubbing, the leg is placed on the couch, the foot should be slightly unbent. Circular movements are made with the pads of all fingers (four fingers are alternately fixed, then one). First, the area under the outer ankle is rubbed, then the front of the bag, and finally the inner ankle. After that, the massage therapist moves the pads of the fingers down, beyond the ankles, and performs rubbing movements in the area of ​​the Achilles tendon. Rubbing ends with stroking.

Leg massage. The position of the patient - lying on his back or stomach, or sitting. Initially, a preliminary massage is performed: planar and embracing continuous stroking from the fingertips to the condyles of the thigh; semicircular or spiral rubbing in ascending and descending directions.

In the area of ​​the calf muscles, continuous vibration is applied in the form of shaking (shaking). Then the anterior muscle group is massaged - separately the tibial, the long common extensor of the fingers and the long extensor of the thumb. The following options are used: 1) stroking: rectilinear; "forceps"; the base of the palm; 2) kneading: with the pads of four fingers; phalanges of fingers.

Massaging the posterior muscle group, the masseur should focus on the calf muscle - separately massage its outer and inner abdomen. When massaging the inner abdomen, it simultaneously affects the posterior tibial muscle and the flexors of the fingers. Longitudinal stroking with two hands, transverse and spiral, as well as kneading - ordinary (longitudinal and transverse), double ring, longitudinal with the pads of the thumbs, the base of the palm are also used. In addition, continuous vibration is made in the form of shaking. When massaging the left leg left hand masseur fixes the foot, and vice versa.

If the massage is performed in the supine position, the thumb of the right hand (during the massage of the left leg) moves along the inner edge, and the remaining fingers along the tibia; the thumb of the left hand is along the tibia, and the rest along the inner edge of the gastrocnemius muscle. The Achilles tendon and the place of its attachment to the calcaneal tuber are especially carefully massaged.

Due to the fact that most of the muscles of the lower leg with their long tendons end on the metatarsal bones, as well as on the phalanges of the fingers, the massage of the lower leg should always cover the foot (starting from the fingertips). Massage only the foot or lower leg separately should not be.

Massage of the knee joint. The knee joint is a block and ball joint (Fig. 115), formed by the lateral and medial condyles of the femur, the upper articular surfaces of the tibia and the patella.

Figure 115. Knee-joint.

The patella (patella) is embedded in the tendon of the quadriceps muscle, the continuation of which is the ligament of the patella. The articular surfaces of the condyles of the femur, tibia and patella are covered with hyaline cartilage. The articular bag of the knee joint is extensive, its synovial membrane forms inversions, synovial bags and folds containing adipose tissue. Anterior section The articular capsule is formed by the tendon of the quadriceps femoris muscle.

The main ligamentous apparatus of the knee joint consists of the lateral peroneal and tibial ligaments located on the lateral surfaces of the joint, as well as the cruciate (anterior and posterior) and transverse ligaments located in the cavity of the knee joint. Between the articular surfaces of the femur and tibia are two crescent-shaped cartilages - the inner and outer menisci. The main movements in the knee joint are flexion and extension. In a small range, rotation of the lower leg outward and inward in a bent position of the joint is possible.

The medial and lateral menisci are semilunar cartilage formations located on the articular surface of the tibia. They act as cushion pads between the femur and tibia.

The blood supply to the knee joint is carried out by branches of the femoral and popliteal arteries, and the venous outflow occurs in the popliteal and femoral veins. The knee joint is innervated by branches of the lumbar and sacral plexuses. Movements in the knee joint: mainly flexion and extension. There may also be slight hyperextension beyond the neutral position, as well as rotation of the tibia relative to the femur.

.Figure 116. Movement in the knee joint.

The hip joint (Fig. 119) is formed by the acetabulum and the head of the femur. The acetabulum is located at the confluence of the ilium, ischium, and pubis. It is smaller than the head of the femur in size; it is increased by a fibrous cartilaginous rim that runs along the edge of the cavity - the acetabular lip. The head of the femur is covered almost over its entire surface with a thin layer of hyaline cartilage, and the acetabulum is covered only along the semilunar surface. Articular bag hip joint goes along the edge of the articular cavity, goes to the femur and is attached in front of the intertrochanteric line, so most of the femoral neck is in the joint cavity. The articular bag of the joint is very strong, ligaments are woven into it: in front - ilio-femoral, from below and from the inside - pubic-femoral, behind - ischio-femoral, in depth the bag is strengthened by a circular ligament. The ligament of the femoral head is located inside the joint, its mechanical significance is not great, but the vessels feeding the femoral head pass through its thickness.

The hip joint belongs to multiaxial joints, however, the range of motion in it is limited by the great depth of the acetabulum and a powerful ligamentous apparatus. In the joint, flexion and extension, abduction and adduction, as well as outward and inward rotation are possible. Flexion is produced by the iliopsoas muscle, the rectus head of the quadriceps femoris, the tailor and tender muscles. Extension is carried out by the semimembranosus and semitendinosus muscles, the long head of the biceps femoris; the gluteus maximus and the adductor maximus muscles of the thigh take part in extension. The thigh is abducted by the middle and small gluteal muscles, and the muscles of the adductor group are adducted. Blood supply - along the branches of the lower gluteal and obturator arteries. Venous drainage occurs through the deep vein of the thigh and the internal iliac vein. The outflow of lymph goes to the internal iliac lymph nodes. hip joint. Innervated by branches of the femoral, obturator and sciatic nerves.

Figure 119. hip joint.

Movements in the hip joint (fig. 120): flexion is possible in a larger volume with a bent knee. Rotation of the hip with a bent knee is difficult. In this case, when the femur is rotated inward, the lower leg moves outward. Outward rotation of the thigh is accompanied by a medial displacement of the lower leg. It is thanks to the movements of the thigh that the indicated movements of the lower limb are possible.

Since the hip joint is closed on all sides by large muscles, this makes massage difficult. Planar stroking, rubbing with the base of the palm, phalanges of bent fingers in various directions are used. The massage of the hip joint ends with active-passive movements.

Essential massage nerve trunks upper limbs. The lumbar plexus is formed by the anterior branches of the 1st-4th lumbar spinal nerves, it is located in the thickness of the muscles on the anterolateral surface of the lumbar vertebrae. Its branches penetrate the inner, anterior and outer surfaces of the thigh.

The sacral plexus is located in the small pelvis, it is formed by the connecting anterior branches from the 5th lumbar to the 4th sacral spinal nerves. The branches given to them go to the gluteal region. The largest of them - sciatic nerve.

The nerves of the lumbar and sacral plexuses innervate the skin and muscles of the pelvic girdle and the free lower limb, as well as the external genitalia. They provide sensory and motor innervation of the gluteal region, perineum, thigh, lower leg and foot.

Figure 120. Movements in the hip joint.

The sciatic nerve is massaged in the most accessible place: along the line from the lower edge of the ischial tuberosity to the middle of the popliteal fossa. Here, planar continuous deep kneading is used with the thumbs of both hands; rubbing with thumbs moving one after the other and describing semicircles in opposite directions; continuous and intermittent vibration at the tip of the thumb. The force of pressure during vibration increases gradually towards the sciatic tubercle, since as it moves away from the knee joint, the sciatic nerve is more and more covered with a layer of muscles.

The femoral nerve is massaged under the inguinal ligament in the femoral triangle along the anterior and medial surfaces of the thigh. Sparing techniques are used - stroking and rubbing.

The peroneal nerve is massaged at the head of the fibula. The same methods are applied.

The tibial nerve is massaged in the area of ​​the medial malleolus and popliteal fossa. Apply rubbing and vibration.

Indications: in the treatment of diseases of the cardiovascular system, injuries of soft tissues, bones, joints, peripheral nerves, central paralysis.

The tasks and methods of massage are determined in combination with other methods of treatment.

Massage of the upper limbs covers: 1) fingers, 2) brush,

1. wrist joint, 4) forearm, 5) elbow joint, 6) shoulder, 7) shoulder joint, 8) the most important nerve trunks. The direction of massage movements is shown in Fig. 65.

joints, their stretching is applied by pulling the articular surfaces away from each other.
After massaging the fingers, the patient is offered to make active movements in the joints of each finger. With stiff joints, passive movements are shown.
Hand massage (carpus, wrist)
The installation of the brush is the same as when massaging the fingers. First, the back is massaged, then the palmar surface of the hand, starting from the ends of the fingers. Stroking the back of the patient's hand is performed with the palmar surface of the hand, massage movements go up to the elbow joint. After a general stroking of the back of the hand, each of the tendons located on the back of the body is massaged. Of the massage techniques, planar deep stroking is used, as well as rubbing in the form of shading. Then, with the thumb and forefinger (on the back and palmar sides), each interosseous muscle is massaged.
In order to make it easier to penetrate deep into the interosseous muscles, the patient is offered to spread his fingers and then the palmar surface of the end of the thumb is stroked along each interosseous space of the metacarpal bones. With wrinkling, violation of the elasticity of the interosseous muscles, they alternately capture two adjacent metacarpal bones and displace them in opposite directions.
11a of the palmar surface of the hand, which, when massaged, is transferred to the supination position, stroking is applied in the form of ironing and then rubbing.
Separately, the muscles of the elevation of the thumb are massaged, where the palmar branch of the median nerve and the muscles of the elevation of the little finger, where the branch of the ulnar nerve also superficially passes, are superficially branched.
Of the massage techniques, stroking, rubbing with the palmar surface of the thumb and the thumb and other fingers are used alternately - transverse kneading, vigorously pulling (squeezing) the tissues from the bones lying under them.

In conclusion, exercises are given to strengthen the interosseous muscles: the patient is asked to perform abduction and adduction of the fingers, providing resistance to each of these movements.
Wrist joint massage
The articular bag of the wrist joint is most accessible on its dorsal surface and from the sides, where it is less covered soft tissues. In the area of ​​this joint, a circular wrapping deep stroking is performed, followed by rubbing in the form of shading, which is done with the thumbs of both hands, both in the back and palmar sides, and then stroking is again applied to the middle of the forearm.
The pressure force when stroking and rubbing on the back surface of the joint should be less than on the palmar, since the articular bag on its back surface lies directly under the skin, while on the palmar surface it is covered with tendons of the flexors of the hand and fingers. For deeper penetration into the gap of the wrist joint from the back of the hand, the position of palmar flexion is given. After the massage, movements are made in the joint: dorsal - palmar flexion, ulnar - radial abduction of the hand.
Forearm massage
Introductory massage (patient’s right hand): with the left hand, the masseur fixes the patient’s hand, setting it in the pronation position, with the right hand he first flattens the back surface of the hand, starting from the fingertips, and then, reaching the wrist joint, embraces continuous stroking, continuing it on the back surface of the forearm and ending with a stroke] hs pas the lower third of the shoulder. Next, the hand is transferred to the supination position, and massage movements are made on the palmar surface of the fingers and hand in the form of stroking, and on the forearm - in the form of embracing continuous stroking in the same direction. After 4-5 strokes,

1. 4 shaking of the whole arm, if this technique is not contraindicated (presence of pain, etc.). Having finished the external massage, they proceed to separate massaging of the extensor muscle group along with the long arch support on the back of the forearm and the flexor muscle group on its palmar side. In order to further relax the muscles of the forearm, they bend at an angle of 110 ° relative to the shoulder and place it on a massage roller.

Rice. 67. Forearm massage -
stroking.
When massaging the extensor muscles of the forearm, the masseur's left hand fixes the patient's right hand in the pronation position, the right hand produces an encircling continuous stroking (Fig. 67), while the masseur's thumb slides along the inner edge of the ulna, and the remaining four fingers follow along the groove, separating the flexor muscles from the extensor muscles, towards the external condyle of the shoulder and up to the lower third of the shoulder.

When massaging the flexor muscles of the forearm, the hand is given a supination position. Fixing the patient’s hand with the left hand, the massager’s right hand, tightly adhering to the palmar surface of the forearm, also produces embracing continuous stroking, during which the massage therapist’s thumb slides along the interosseous ligament along the radius and then along the groove between the long supinator and flexors, the remaining four fingers - along the ulna. Massaging movements are carried out towards the inner condyle of the humerus and also reach the lower third of the shoulder. From other massage

Rice. 69. Massage llyovn.shon
muscles.
cms are used with both hands for semicircular rubbing and transverse kneading of the muscles of the forearm on the radial and ulnar sides, while massage movements are best done in a position average between supination and pronation of the forearm. Intermittent vibration is performed in the form of chopping.
The massage is carried out with the elbow joint bent (at an angle of 110°), which is located on the massage roller. The ligamentous apparatus of the joint is massaged from the radial and ulnar sides, as well as from the front and back surfaces. The articular bag of the elbow joint is most accessible from behind, where it is located on both sides of the ulnar cane. In front, the articular bag is covered with a thick layer of muscles and tendons, as a result of which access to it is difficult.
Of the individual massage techniques, when massaging the elbow joint, planar circular stroking is used, which is performed by the palmar surface of the thumbs of both hands around the entire circumference of the elbow joint; further, a spiral rubbing of the back surface of the elbow joint between the elbows is performed! process and epicondyles of the shoulder (Fig. 68). Separately produce rubbing in the area of ​​the radioulnar joint.
After the massage, the patient is offered to make movements: flexion, extension, supination and pronation.
Shoulder and shoulder massage
Massage begins with the shoulder, the superficial muscle layer of which is formed from behind by the trapezius, latissimus dorsi and deltoid muscles and in front by the pectoral muscles. The massage of all these muscles, with the exception of the deltoid muscle, has been described above (see "Massage of the chest" and "Massage of the back").

Massage of the deltoid muscle is performed in parts in accordance with the division of the ss into two bundles: anterior (clavicular) and posterior (scapular). The outer (acromial) muscle bundle does not stand out during massaging. First, an enveloping continuous stroking of the entire muscle is performed (Fig. 69), then, using a two-blade forceps-like stroking technique, the anterior and posterior muscle bundles are massaged separately: when massaging the anterior bundle, the thumb moves from bottom to top through the middle of the deltoid muscle to the acromial process of the scapula, the remaining fingers slide along the anterior edge of the deltoid muscle, and when massaging the posterior bundle - along the posterior bundle of the deltoid muscle.
Rubbing in the form of burning, as well as intermittent vibration in the form of chopping, is performed over the entire surface of the muscle; kneading the deltoid muscle is performed in parts.
After the massage of the shoulder girdle, they proceed to massaging the shoulder, first applying embracing continuous stroking of all the muscles of the shoulder, and then semicircular rubbing and kneading in the form of felting alternately with stroking. At the end of the preparatory massage, the following are massaged separately: a) a group of flexor muscles - the biceps muscle and an internal shoulder muscle, and b) a group of extensor muscles - the triceps muscle of the shoulder.
Massage begins with a group of flexor muscles. With embracing continuous stroking fingers right hand grasp the biceps and internal brachialis muscles below the elbow joint so that the thumb slides along the internal groove of the biceps muscle, and the remaining four fingers along the external groove towards the anterior edge of the deltoid muscle (Fig. 70).

Rice. 71. Shoulder massage - stroking the extensor muscle group.

Massaging movements end at the axillary cavity, and the thumb, having reached the deltoid muscle, moves along its front edge and converges there with the other four fingers.
When massaging the extensor muscles, the massaging hand captures the triceps muscle with the thumb and four other fingers: the thumb begins its movement at the radial side of the olecranon, slides along the outer groove of the biceps muscle, then moves along the posterior edge of the deltoid muscle to the axillary cavity; the remaining four fingers, starting their movement along the inner groove of the biceps muscle, also move along the inner edge of the deltoid muscle (Fig. 71). At the acromial process, the thumb and the other four fingers converge. Of the other massage techniques, semicircular rubbing is used, as well as longitudinal and transverse kneading in an upward and downward direction. These last two massage techniques are combined with embracing continuous stroking.
Shoulder massage
Massage of the shoulder joint begins with massaging the muscles of the shoulder girdle, the technique of which was described above. The articular bag is massaged from the front, back and bottom surfaces. For better access to the anterior surface of the articular capsule, the patient is offered to lay the massaged upper limb behind the back. In this position, the head of the humerus moves forward and protrudes the anterior wall of the articular bag of the shoulder joint.

To access the posterior surface of the joint capsule, the patient is offered to put the massaged hand on his healthy shoulder. 1 The lower surface of the bag of the shoulder joint becomes accessible when the upper limb is abducted from the body to an angle of 90°. In this position, penetration into the axillary cavity during massaging movements is greatly facilitated.
First, semicircular rubbing is performed alternately with stroking on the anterior surface of the shoulder joint, then on the posterior surface, for which you should try to penetrate as deeply as possible with the ends of your fingers in the direction of the acromial process, and finally, on the lower surface of the articular bag of the shoulder.
With stiffness of the shoulder joint, the massage therapist fixes the outer edge of the scapula with one hand, and with the other hand, grabbing the distal end of the shoulder, makes circular movements in the shoulder joint, gradually increasing their amplitude.
When the clavicular-acromial (Fig. 72) and clavicular-sternal joints (Fig. 73) are involved in the process, stroking and rubbing in the form of hatching are used. To enhance the mobility of the clavicular-acromial and clavicular-sternal joints, the patient is offered to raise and lower the shoulders, reduce and abduct them, and also make circular movements.

Massage of the most important nerve trunks
Massage of the nerve trunks that make up the brachial plexus is performed in those areas where the nerve either comes closest to the surface, or comes to the surface.
The axillary nerve is exposed to massage in the depth of the axillary fossa with a strongly abducted hand (Fig. 74).
The radial nerve is available for massaging at the elbow joint between the internal shoulder muscle and the long supinator (Fig. 75).
The ulnar nerve is massaged with a slightly bent arm, in the elbow joint in the area between the internal epicondyle of the humerus and the olecranon of the ulna (Fig. 76).
The median nerve is massaged on the palmar surface of the hand (Fig. 77).
Of the massage techniques, predominantly continuous vibration is used with the palmar end of the index finger and longitudinal and transverse rubbing alternately with stroking.
Guidelines

1. The massage of individual segments of the upper limb should be preceded by a preparatory massage of the entire upper limb.
2. Given that most of the muscles of the forearm, surrounding the radius and ulna from all sides with their long tendons, end on the middle and nail phalanges of the fingers, the massage of the forearm should always cover the hand as well,

starting from the fingertips. Massage only the hand or forearm separately should not be.

1. Due to the fact that a number of muscles attached to the shoulder are also located in the chest and back, shoulder massage should in all cases also cover the humeroscapular girdle.
2. When massaging the biceps, as well as the triceps, the ns should not be vigorously massaged in the area of ​​\u200b\u200bthe internal groove of the biceps, since large blood vessels (arteries and veins) and the radial nerve pass through this place.
3. When massaging the nerves, do not press vigorously on them, so as not to cause discomfort. Vigorous pressure on the radial nerve causes the patient to experience goosebumps on the back of the hand in the thumb area. Intense pressure on the ulnar nerve is accompanied by a feeling of numbness and a crawling sensation in the little finger.

Pain in the legs... Unfortunately, these extremely unpleasant sensations can significantly reduce not only your vital activity, but also disturb your sleep. Anyone who has ever experienced pain in the legs, especially in the evening, knows perfectly well that falling asleep with such pain is very difficult, if not impossible. And the causes of such pain can be varied: from overwork and high physical activity before serious illnesses lower extremities. Many also know the discomfort from muscle spasms, commonly called convulsions. Such a cramp lasts only a few seconds, but the consequences of it, manifested by pain in the muscle, poison life in the next couple of days. Among those suffering from pain in the legs, those who have suffered significant injuries in the form of a fracture of the lower limb stand apart. Due to the fact that the leg long time was fixed with a plaster cast, the muscles begin to lose their elasticity and partially atrophy over time. And in order to return the leg to its former mobility, it is necessary physical exercises and massage.

Indications for massage of the lower extremities

The main indications for massage may be:

• Paresis or paralysis of the limbs after a stroke;
• Hypertonicity or hypotonicity of muscles in multiple sclerosis;
• Cervicobrachialgia;
• Sciatica;
• Changes in muscle tone in hereditary and other degenerative diseases (Strumpel's disease, amyotrophic lateral sclerosis, etc.).
• Consequences of injuries of the central nervous system and peripheral nerves;
• Polyneuropathy in the absence of trophic changes;
• Mononeuritis.

Contraindications for massage of the lower extremities

Foot massage should never be done in the presence of varicose veins veins, fractures, allergic reactions on skin and other rashes.

Also, foot massage is not recommended if there are contraindications to classical massage, such as: inflammatory processes, blood diseases, fever, violation of pressure, inflammation of the lymph nodes, tumors, kidney failure, tuberculosis, hernias.

Upper limb massage

Somehow it so happened that we pay close attention to back pain, sore throat and runny nose, migraines, but do not attach of great importance pain in the hands. Hands experience significant and even harmful loads that were not "foreseen" by nature. This results in trembling of the hand, numbness of the fingers, pain in the elbows, etc. Pain in the hands often manifests itself in athletes, especially in those who independently “pump muscles” in sports clubs and halls. An uncomfortable grip on the barbell, a significant excess of the weight of the dumbbell, an unsuccessful turn of the hand and pain is already manifesting itself in full force. It is very important for your hands to periodically have massage sessions, as they wonderfully restore working capacity, relieve pain (and they begin to appear with age), tension in the limbs, relax muscles, strengthen ligaments and joints (and over the years this becomes more and more important), have a rejuvenating effect. effect, making the arms more toned and beautiful.

How is a hand massage done?

Such a massage usually includes the following procedures:

• Finger massage;
• brush massage;
• Massage of the wrist joints;
• forearm, elbow joints(often painful)
• Shoulders and shoulder joints.

If the muscles of the forearm and upper arm are kneaded intensively enough, then the elbow area requires more delicacy, and special attention should be paid to the massage of the fingers and hand. It is here that a huge number of active acupuncture points are concentrated, massaging which gives you strength, relaxes and at the same time calms the nervous system.

Indications for massage of the upper limbs

Massage of the upper extremities is used to restore strength, relieve fatigue, as well as in the following cases:

• flabby hands,
• increased fatigue,
• Cellulite on hands
• Increased load on the upper limbs (prolonged work with hands),
• Pain in the joints
• Salt deposits,
• Arthritis, arthrosis,
• Paralysis and stroke
• Decreased muscle tone
• Numbness, loss of sensation,
• Recovery of functions after sprains and fractures.

Contraindications for massage of the upper limbs

Although there are few contraindications, they still exist, and you should not forget about them:

• Increased body temperature (including with acute respiratory infections);
• Abrasions, cracks, damage to the skin;
• The presence of a fungal infection;
• Malignant neoplasms;
• Purulent wounds;
• allergic dermatitis;
• Infectious diseases;
• The presence of fractures;
• Chronic osteomyelitis.

Even if you do not have any pain in your hands, they should be given due attention, at least sometimes arranging a massage holiday for them. And already after the first session, you will feel how your working capacity is restored, fat deposits disappear and the skin becomes more elastic, pain in the joints disappears and they become more mobile, swelling disappears.