Massage and gymnastics have an important influence in counteracting the atrophy of muscles caused by orthopaedic treatment, or any other treatment necessitating the use of bandages. They are therefore often used either along with or after orthopaedic treatment or fixation.

In atrophy or any kind of muscular degeneration massage therefore plays an important part, as in cases of atrophy from disuse, in paralysis of cerebral, spinal, or peripheral origin (e.g., poliomyelitis), in contractures, after fracture, after severe infectious diseases (e.g., typhoid), in chlorosis, diabetes, alcoholism, chronic lead poisoning, pseudo-hypertrophic muscular paralysis, etc.

In all these cases effleurage, petrissage, and tapotement are the most important manipulations, and these after a little practice can in many cases be given by any one. The treatment is of long duration, and requires only mechanical facility.

Myositis is a very common affection. The masseur divides most muscle inflammations into two pathological classes - traumatic and rheumatic. The cause of traumatic inflammation he discovers by the history and by palpation; muscle inflammations of which he cannot discover the cause he considers rheumatic Muscle inflammation certainly results in many cases from changes of temperature, and is found especially in those parts of the body which are exposed, in the muscles of the head and neck, especially in the upper part of trapezius, occipitalis, sterno-cleido-mastoid, the scaleni, the pectoral muscles, the glutei, and the muscles of the forearm. But when these so-called "rheumatic" processes have an entirely different cause they may arise in any muscle, even those which are most protected from rheumatic influences. It has been thought possible, with thin abdominal walls, to palpate and remove by massage such myositis in psoas magnus (I. Lundberg. Upsala. Lakarfor. Forh., 1887).

The examination of muscle inflammation, especially of the nontraumatic type, by means of palpation is one of the most frequent and most difficult tasks of the masseur. It necessitates first of all an accurate knowledge of the normal construction and consistency of each separate muscle, and when once this knowledge has been acquired it is easier by means of palpation to discover slight objective changes, the symptoms of which are often troublesome. In many cases examination by palpation is very difficult, for the region which gives pain on pressure may be quite small, and the situation and extent of the infiltration can only be guessed. Even the most experienced masseur in forming his diagnosis must not disregard the information given by tenderness on pressure. The best method of examination is, after kneading the skin well with a lubricant, to give moderate pressure with the three middle fingers over the relaxed muscles ; the pressure must be adapted to the thickness of the tissues covering the muscles, and is given not only in the same direction as the muscle fibres, but also at right angles to them. By such examination of muscle, when the anatomical position is favourable, a complete knowledge of the condition of the muscular tissues is obtained by lifting the affected part between the fingers and carefully kneading it in the manner described for petrissage.

The acute myositis of non-traumatic origin arises, like the chronic, generally in portions of a muscle, and may be found in scattered spots in one or more muscles. The corresponding parts are hyperaemic, swollen, and laden with serum, and exudation of the various elements of the blood occurs in varying proportions. Palpation gives the impression of swelling of a doughy consistency and of lessened elasticity ; tenderness on pressure is often marked. Functional changes are often definite, and the patient avoids either contracting or stretching the painful muscles; hence arise positions of contracture.

If the inflammatory process is allowed to continue unchecked, the acute rheumatic myositis, with its fresh infiltration, is followed by a chronic rheumatic myositis with an organised infiltration of fibrous tissue, in which small acute processes occasionally appear. In such foci, which are often extensive, and may, for example, spread over one or both sides of the upper portion of trapezius, we find a great increase of fibrous tissue at the cost of the muscle substance, an "interstitial fibromyositis," which in severe cases gives rise to creaking, as described by Frorieps as long ago as 1834. The soft, doughy substance of the acute condition is transformed to hardened tissue, firmer than the surrounding relaxed muscle substance. In chronic rheumatic myositis the symptoms are less severe than in the acute; spontaneous pain, tenderness on pressure, and loss of movement are less marked in this condition, and positions of contracture arise less often in chronic myositis than in the acute form.

The symptoms of myositis vary considerably, according to the intensity of the inflammation and its position; they are due either to pressure of the inflamed muscle substance on the nerves or to neuritis caused by the spread of the inflammatory process by contiguity to the connective tissue of the nerves, and are of the nature either of reflex irritation or overflow of motor or sensory impulses; the physician often finds it difficult to diagnose with certainty. It is very important in nerve pains of doubtful origin in any region whatever to examine for myositis. Thus myositis in complexus and trapezius often gives rise to occipital neuralgia; myositis in the various muscles of the neck often causes pain in the region of the cervico-brachial or cervico-occipital nerves; myositis in supinator longus causes pain in the region of the radial nerve (musculo-spiral). The same condition in the glutei and pyriformis and muscles of the thigh in the neighbourhood of the great sciatic nerves is not infrequently the cause of sciatica, etc.

The pains, both when the disease is localised to one muscle and when it is in the course of a nerve, are very variable in nature, sometimes violent and acute, as in the case of lumbago due to myositis in the lumbar region (often in sacro-lumbalis), sometimes an indefinite dull ache, closely resembling feelings of fatigue, or the pains in anaemia and chlorosis. Important changes which may have escaped the patient's attention are often found by palpation.