When the movement is given as a respiratory exercise the strap is not used round the hips, but the gymnast controls the movement with one hand on the patient's abdomen so that it is not pushed too far forward, while with the other he gives the movement. After the expansion of the chest the patient draws himself back against slight resistance of the gymnast. In this way the movement causes slight exercise for the muscles of expiration. Repeated six to eight times.

Stretch-grasp-standing Forward-drawing (Fig. 119). - Best given at the wall-bar or peg-post. The gymnast stands in front of the patient, taking leverage with one foot against the apparatus. Grasp and movement as in Half-lying Chest-lift-stroking, but the expansion at the beginning of the movement is made more strongly, and the patient draws his own trunk back while breathing out, as in the preceding exercise. Repeated six to eight times.

Effects And Uses

The movement assists both inspiration and expiration strongly, and is used, therefore, in the same way as other respiratory exercises, and as a special movement in the treatment of emphysema, in which, however Heave-grasp-standing position is to be preferred, because it allows more complete expiration than Stretch-grasp-standing.

Fig. 118.

Fig. 119.

Special Massage Manipulations.

The massage manipulations found among the so-called passive movements of the old gymnasts were different forms of Hacking, Clapping, Beating, Shaking, Kneading, Stroking, Nerve Pressures; recently also Nerve Frictions and Abdominal Kneading or Abdominal Treatment, in which several of the above manipulations are included.

All these may without difficulty be classified under the four well-known groups of massage movements: Effleurage, Petrissage, Frictions, and Tapotement.

Hacking, clapping, beating, and shaking are thus only different forms of tapotement. Kneadings are done partly as petrissage, partly as a kind of large frictions. Strokings are generally done in a centrifugal direction, less often as effleurage, i.e., centripetal stroking. Nerve pressures and nerve frictions are really only modifications of tapotement or friction applied to nerves.

The technique for all these manipulations, however, is somewhat different, according to the various places where they are applied, so that the most important are here shortly named and described.

Hacking.

Hacking can be done in many ways, and each gymnast develops usually a special way for himself.

A very good way is that the gymnast, with the arms bent at the elbows, hands bent back at the wrists and fingers spread out wide, performs hacking chiefly by pronation and supination combined with small flexions and extensions of the elbow. After some practice hacking can in this way be given continuously and, according to the requirements, with greater or less force.

By spreading the fingers each stroke becomes elastic and also made up of three to four small strokes, as the fingers do not all at once meet the part worked upon, but follow one after the other. If hacking is to be given more strongly, one may bend the fingers slightly and let them all together strike the part with their dorsal surfaces, or in specially strong hacking it may be done with the ulnar border of the hand. In very strong hacking the wrist and elbows also take part in the movement.

The general effects of hacking are naturally included in the effects of tapotement, but may here be briefly recapitulated: -

(a) Light hacking causes a mechanical stimulation and consequently increased activity of the cells of the tissues worked upon.

(b) Hard hacking assists the dissolution of the products of inflammation, partly by mechanically breaking them up, partly by increased hyperemia (see below).

(c) Applied to nerves, hacking causes a stimulation which is carried both centrifugally and centripetally, by which the conducting paths and their central and peripheral endings are set in action; consequently also the muscles. This again causes, according to physiological laws, increased supply of blood and increased nutrition to the parts set in action. The change in the condition of a nerve, so often spoken of, causing neuralgic pain to cease, which is said to be brought about by tapote-ment of the nerve trunk, is no doubt often connected with the dissolution of products of inflammation in the nerve and its surroundings.

(d) On vaso-motor nerves light short hacking produces stimulation, causing contraction of the blood vessels. A stronger and more continuous hacking produces, on the contrary, expansion of the vessels (by paresis of the constrictors). This is made use of to produce hyperaemia and thus make torpid inflammatory processes more acute.

Hacking has a very wide use in mechano-therapeutics, and can be given on almost all accessible organs and tissues. A few special forms will be spoken of in more detail.

Sitting Head-Hacking, Or Head-Treatment

This comprises several different kinds of hacking, viz. : -

1. Ordinary light hacking, beginning in front and going backward over the whole head.

2. So-called point hacking, performed more slowly and strongly so that all the finger-tips of one hand meet the head at the same time.

3. "Combing," in which the tips of the fingers, pressing against the scalp, are quickly carried through the hair; the fingers should be crooked so that the dorsal surface comes in contact with the scalp.

4. "Brushing" is performed by the palmar surface of the fingers or hands quickly and lightly gliding over the head.

5. "Piano-playing" is hacking given with the tips of the fingers, which, as in piano-playing, run lightly over the head.

6. "Light stroking" begins at the crown of the head and continues over the side, neck, and arms down to the hands.

Effects And Uses

(a) Helps to break up inflammatory products in the scalp, and thus relieves headaches of rheumatic origin.

(b) Possibly produces a slight contraction of the blood vessels in the membranes of the brain and its outermost layers, through which the feeling of weight, due to congestion in the head, is relieved. When this effect is required the treatment must not continue too long.