It is important that the mechanism of all principal joints should be studied, as they give a great deal of work to the masseuse, and her success in the treatment of sprains, etc., greatly depends on her knowledge of the structure and functions of the parts involved. She should also understand how to bandage.

Recent Sprain.—In a sprain ligaments are overstretched, and may be torn ; the sheaths of tendons may be torn ; blood-vessels are wounded, and blood is poured out into, the spaces, of the tissues and into the synovial sacs. The result is swelling and pain.

The Ankle.—The operator sits beside the bed or couch facing the patient, with the hands on a level with the limb. If possible, the foot is raised on a pillow to favour return circulation, but it is not well to move about a painful limb.

If the foot has been twisted inwards at the time of the accident, the outer side will be the most discoloured and painful, and abduction will be impossible, owing to the pain caused. If the foot has been twisted outwards, the inner side will be the worse and adduction the most painful movement. Only flexion and extension should be used for some days. If a bandage has been applied, it must be removed most carefully.

1.   First visit : Effleurage for five minutes with one flat hand from ankle to above knee ; leg supported by the other hand.

2.   Effleurage lightly, with tips of fingers encroaching on injured part, avoiding the most painful spots; the whole foot to be carefully gone over to find out the most tender parts.

3.   Repeat No. 1 for two minutes.

4.   Flexion ; extension (ten minutes in all).

Second visit : The bruises will be found of deeper colour and spread over a larger surface, perhaps even reaching to the popliteal space. This need cause no alarm ; the manipulations given the previous day have brought the extravasated blood to the surface and spread it onward, a result much to be desired. The swelling and heat will be less. Treatment as before.

As improvement takes place, the manipulations may be more vigorous and rapid. As the fluid is absorbed, the shape of the foot becomes natural, tenderness decreases, the tissues are freely handled, and the treatment proceeds as in Chapter VII. Passive movements are given from the first to prevent adhesions from forming, and the joint becoming stiff. Effleurage of the leg is given to relieve the tension at the ankle by accelerating the circulation and encouraging absorption by the lymphatics. In this way the injured and painful tissues are relieved, and prepared for more direct manipulation. The bandage to be readjusted after each séance. If, instead of a bandage, a cooling lotion is at first applied, the cloth is freshly wrung out and laid on.

All sprained joints are treated after the same fashion. In the case of the wrist, t he fingers require manipulation, also the elbow, and passive movements to all the joints.