Massage as a Healing Process Practised from the Earliest Times - Three Methods of Applying Massage - Why Massage is Useful - Its Employment in Surgical Cases - Passive and Active Move ments - How to Massage
Every nurse must study the subject of massage, and practise the active and passive movements so much used for treating stiffness of the joints and deformities due to weakness of the muscles and ligaments.
Massage has been used for healing purposes from the earliest times. More than 3,000 years ago the art was practised in India and China, whilst some of the wonderful masseurs in modern times are to be found in Japan.
Massage of the forehead for relieving headaches and neuralgia
The Greeks and Romans were also skilled in massage movements, but the art fell into disrepute owing to its application by quacks and bonesetters in the exercise of their trade. Of late years, however, the subject has been studied scientifically, and it is generally recognised as a valuable therapeutic measure in the hands of skilled persons.
Massage consists in the application of pressure to the muscles and connective tissues lying underneath the skin by means of the human hand. Articles have already appeared dealing with the subject from the point of view of beauty culture (see pages 2392, 2572, Vol. 4).
The three chief methods which the nurse should learn are:
I. By effleurage the skin is lightly massaged, either by means of stroking movements upwards towards the heart, or by a to-and-fro friction movement so that the superficial blood-vessels are dilated, the blood flows to the surface, and the skin is in a glow. At the same time the nerve endings are soothed, and a sensation of rest or comfort is felt by the patient. Thus, the movement is used to deal with neuralgia, headache, and sleeplessness. The efficacy of this type of massage is easily demonstrated in the case of an ordinary headache or neuralgia of the brows. The light rubbing movement is practised outwards along the eyebrows, and upwards to the scalp. Gradually the pain ceases and the patient drops off to sleep.
2. Tapotement, or tapping, is massage of the deeper structures. It consists in striking the muscles transversely with the edge of the hand or half-closed fist, with varying force. This exerts pressure on the nerve trunks, thus tapping is sometimes used in dealing with sciatica. The muscles also are stimulated, and even the joints are affected by this movement.
3. Petrissage, or kneading, is essentially used for the muscles and deep structures. The muscles are taken between the fingers and thumb and rolled and pressed - not pinched. When the patient complains of pain the nurse is not massaging properly, she is probably pinching the muscles and nerves between her fingers.
An excellent pressure movement for the muscles of the back is the following :
Lay the hand flat on the back. Whilst keeping the fingers stiff, bend the hand at the junction of hand and fingers. Flatten out the fingers again and repeat. Thus, by a sort of caterpillar movement the hand passes up the muscles of the back, kneading as they go. Then reverse the movement, keeping the palm fixed, sliding the fingers upwards and flattening the hand again. Repeat the movements until all the muscle has been kneaded. The effect is to stimulate the muscles and to get rid of waste products from the tissues by increasing the venous flow of blood back to the heart.
Manipulation of the joints by the nurse while the patient's muscles remain passive
When a muscle contracts, a certain chemical process takes place. Acid products are deposited in the substance of the muscle, and if these are in excess after prolonged exercise, for example, they poison the nerve endings and we feel tired. Massage by stimulating the blood flow causes these products of fatigue to be carried away, and the tired feeling passes off. Athletes for this very reason are frequently massaged after exercise.
Active movements, in which the patient resists" the nurse, are useful in convalescence
Then when muscles are flabby for lack of exercise, massage brings a healthy blood supply to the part and they are nourished and toned. When people are in bed the muscles have no chance of exercise, but massage takes the place of it quite effectively if properly performed.
Apart from the local effect in the muscles, massage strengthens the heart by its action on the circulation, nourishes the brain, and improves digestion by increasing the flow of digestive juices. Thus, chiefly through its effect upon the circulation of blood, massage makes all the organs healthier and more vital.
A nurse will have to use massage in many surgical cases. In dealing with fractures, sprains, and strains, it is a most valuable therapeutic measure. It saves time and hastens complete recovery. It also soothes pain, and prevents after stiffness.
In many general illnesses, such as anaemia, dyspepsia, chronic disorder of the liver and other organs, nervous ailments, etc., massage is useful for its general effects upon the circulation and nervous system. Spinal deformities of the back and shoulders are best treated by massage and exercises of the part. Sleeplessness is often cured by properly applied massage, and constipation is another ailment which can be treated by this measure.
Before describing how to massage a patient systematically, something must be said about passive and active movements.
Passive movements consist of manipulation of joints by the nurse, the patient exerting no force nor; energy. Every muscle must be relaxed, absolutely off tension. The nurse then grasps a limb gently above and below a joint and steadily and gradually bends the joint, exerting a little more pressure every day if stiffness has to be overcome.
In active movements the patient slightly resists the action of the nurse. For example, whilst lying in. bed she holds the nurse's hands and resists an upward pull. Active movements again, may consists of muscular exercises such as may be practised with advantage in convalescence.
When proceeding to massage a patient, first inspect the limb. Notice if there is any swelling, if the skin is cold or warm, rough or smooth. Now apply the light effleurage movement until the skin glows. Then apply kneading or petrissage over the muscular parts such as the calf or the muscles of the arm.
Now take each joint and move it separately. For example, each finger is bent in turn, then the wrist and elbow, and lastly the shoulder is moved up and down and circularly, and then the strong muscles of the part are kneaded.
Tapping, or tapotement, may be used for the biceps and shoulder muscles. The legs are treated in the same way and then the trunk. Circular rubbing movements are used for the muscles of the chest and abdomen, and deeper pressure as already described for the back.
The spine and head should be massaged last as the patient is gradually soothed to sleep.
When massage is ordered by the doctor it is most important for the nurse to understand thoroughly its method of application. When applied in the right way it is an excellent measure in treatment, but, especially in the case of sprains and strains, it may do a great deal of harm when the amateur nurse simply rubs in haphazard fashion, irritating the patient and perhaps causing inflammation of joints. But once proper movements are learned the nurse who is interested in her work, and likes it, will soon become extremely efficient as a masseuse by practice. And she will soon discover how beneficial it is in convalescence.
Wrapping the limb in warm flannel after it has been massaged and rubbed with oil