Crook-Half-Lying Under-Kidney-Tremble-Shaking

Given to one kidney at a time. The gymnast places both hands close together and side by side against the front of the patient's abdomen about 6 cm. below the costal margin. Patient is told to make a quiet expiration, and at the same time the abdominal wall is pressed in as deeply as possible, while a shaking is made, directed obliquely upward and backward. If the kidney has sunk it is first replaced, by the hands being pressed in below the kidney, perpendicular to the posterior abdominal wall, and then slowly and carefully carried upward and backward.

Effects And Uses

(a) Stimulating to the tissues in the neighbourhood of the kidney, so that its maintenance in position is more likely (Brandt).

(b) After reduction the ureter is straightened out, so that urine obtains a free passage and distension of the pelvis of the kidney ceases and the patient is greatly relieved. One ought, therefore, to teach the patient himself to replace the kidney.

(c) With the idea that mechanical stimulation of the activity of the kidney is possible, this manipulation has been used in treatment of chronic inflammation of the kidney.

Kneading may be given in two ways; either the tissues worked upon, usually the muscles or skin, are lifted from the underlying surface and squeezed between the thumb and fingers (petrissage), or the tissues are pressed against the underlying surface by circular kneadings, or between both the gymnast's hands moving in as large circles as possible without gliding over the skin (frictions). If the kneading is given more superficially and gently it is called "rolling."

In medical gymnastics the kneadings used are : - Arm- and Leg-kneading, kneading of isolated muscles or groups of muscles, Skin-kneading, and Abdominal-kneading (or, more correctly, Abdominal-treatment, because it usually consists of several manipulations).

As for all manipulations, the tissues worked upon should be entirely passive and as relaxed as possible.

The general effects of kneading combine those of petrissage and friction. They are : -

(a) Mechanical stimulation of the tissues worked upon, so that the activity of the cells is increased.

(b) Breaking-up of products of inflammation.

(c) By the alternation of pressure, Arm- and Leg-kneading specially assist the venous circulation.

Kneadings have always been a favourite manipulation of Swedish gymnasts, and are much appreciated by patients. They are specially used: -

(a) In treatment of muscle atrophy and other conditions of loss of tone in the muscles.

(b) In muscular inflammation.

(c) In general weakness, because they increase general metabolism and the formation of heat in the body. They are then given over a large area (arms, legs, back, and abdomen).

(d) In treatment of heart patients, on account of their good influence on the circulation.

(e) In diabetes, because they increase the vitality of the muscles, and consequently the body's power of oxidising carbohydrates.

(f) Finally, in the treatment of obesity, vigorous kneading of fat masses in the skin promotes their absorption.

Sitting Or Half-Lying Arm-Kneading

The gymnast stands at the side of the patient in step-standing position, with the patient's arm over his knee. First the shoulder muscles arc kneaded thoroughly with one hand, the other steadying the front of the trunk; afterwards the arm from the shoulder down to the hand, for which both hands are used. Repeated two to three times. (N.B. - The gymnast performs the kneading most easily if he stands behind the arm when treating the right arm, and in front of the arm when treating the left.)

Half-Lying Leg-Kneading

The gymnast sits in front and at the side of the patient in stride position, and places one of the patient's legs over his inner leg. Kneading is given first over the hip muscles with one hand and then continued with both hands down over the whole leg, at the sides, back and front. The calf is kneaded most easily if the knee is bent and the foot supported against the gymnast's leg.

Crook-Half-Lying Abdominal-Kneading, Or Abdominal-Treatment

Abdominal massage consists chiefly of two manipulations, first, large kneadings of the whole abdomen, second, colon frictions.

Kneading may naturally be done in many ways. For example, the gymnast, sitting at the patient's side, places one hand, or one on the top of the other, on the patient's abdomen, and kneads first with large movements from side to side, then with more circular movements going from right to left, so that the heel of the hand, the ulnar and radial sides, and the fingers come into contact with the abdominal wall in turn - never the whole hand at once, as this would impede respiration too much. Another method, described by Dr. Wide, is that "the gymnast places himself in front of the patient and lays his hands one on each side of the patient's abdomen and then performs kneading with both hands, making circular movements so that one hand goes forward and the other backward."

Colon frictions are most suitably performed in the manner already described by Dr. Kleen, i.e., the gymnast, holding his fingers extended, brings the palmar surfaces of the middle three fingers closely adducted over the part which is to be massaged, with moderate force presses through the abdominal wall, and with small circular manipulations and even pressure, as it were kneads or presses the corresponding part of the alimentary canal between the anterior and posterior walls of the abdomen, while the patient's skin follows the masseur's fingers in their excursions, and no lubricant is necessary. In this way the colon is treated, beginning at the caecum and going over the ascending, transverse and descending colon, and the sigmoid flexure as far as the symphysis pubis, carefully working each square centimetre of the intestine, except those parts (hepatic and splenic flexures) which for anatomical reasons are out of reach. Abdominal-kneading is often combined with Stomach-pit-, Stomach-, Transverse-abdominal-, and Lumbar-side-shaking, also with Transverse-abdominal-, Colon-, or Lumbar-side-stroking. These are described together with the other shakings and strokings.

The effects of Abdominal-kneading have been previously spoken of by Dr. Kleen, and I will therefore only recall the most important : -

(a) Increased secretion of the digestive juices, and consequently improved digestion.

(b) Acceleration of the passage of the intestinal contents.

(c) Increased development and strength of the non-striated muscle fibres of the alimentary canal, and consequently permanent improvement in peristalsis and defaecation.

(d) Dissolution and absorption of products of inflammation in and around the walls of the alimentary canal.

(e) Stretching of adhesions.

(f) Improvement of portal circulation (by alternations of pressure in the abdomen).