The ends of the fingers, or the knuckles of the closed hand, or the palmar surface of the hand, are placed on some part of the patient's body; it may be on a nerve, or a joint, or the abdomen. A trembling sensation is conveyed to the part through the hand of the masseuse. The joints of the fingers and wrist are quite slack ; the muscles of the forearm and arm are contracted, and from these the vibrations proceed. The movements are even, elastic, and very rapid ; the amount of pressure varies, but the hand must not slip on the skin.

1.  The fingers, drawn together at the tips, are placed on a nerve ; the arm and hand of the operator are made to tremble, and thus convey vibrations to the nerve. The fingers remain stationary or may follow the course of the nerve.

2.   The fingers, separated from each other, are made to surround a joint, and vibration conveyed to it in the same way.

3.   The palmar surface of the hand or hands is laid on the abdomen (liver, stomach, or intestines). A vigorous vibration is given.

4.   At each side of the spinal column the knuckles are used or the thumbs.

5.   The larynx is vibrated by a thumb and finger being placed on either side of the thyroid cartilage.

6.   Another way of giving nerve vibration is to draw the fingers rapidly one after the other, beginning with the little finger, across a nerve. The median and ulnar nerves are easily got at by extending and supinating the arm.

There is a movement which partakes of the character of a vibration and of pétrissage. The fingers and thumb extended grasp a mass of muscle, and raise it from the bone ; it is held for a moment or two while a trembling movement is given through the hand ; the muscle is then dropped. It is a deep, vigorous, and stimulating movement. It is desirable that massage be applied directly to the skin, but it can be given over a garment. Some patients prefer that it should be Vibrations are given over the clothes, also tapotement.

Superficial kneading is so called because in it the skin and immediately underlying tissues only are taken up, not because it is done superficially. It is done as thoroughly and firmly as deep kneading. Each is of equal importance in its own sphere. The movements are the same, but the muscles are not included in the grasp which is the distinctive feature in deep kneading. Pincement is a form of superficial kneading.

Effleurage seems a very simple movement, yet there is often much difficulty (and not always success) in learning to do it properly. The strokes should be long and regular. On the limbs they should begin below one joint, and end above the next joint, or the whole limb may be included as from wrist to shoulder. Short, uneven strokes must be irritating to a patient. Care should be taken that this movement does not degenerate into mere up-and-down rubbing. The exceptions to pressure being made in the direction of the venous flow are when it is desirable to retard the circulation or to soothe a painful nerve. In the case of open, slowly healing wounds the strokes are made towards the wound.