Just Lucas-Championniere was, during his lifetime, the most eminent champion of the use of massage in the treatment of recent injury, and his work and writings have left behind him an impression which will never be eradicated from massage technique throughout the civilised world. His chief literary effort, Traitement des Fractures par le Massage et la Mobilisation, was, unfortunately, ill named. His whole teaching was founded on the axiom of Aristotle - "Movement is life"; and far less misconception of his work would have arisen had he chosen in selecting the title for his book to reverse the order of the words "massage" and "mobilisation." This would have helped to emphasise the fact that it was written, not to extol the use of massage, but to advocate the reduction of immobilisation to the minimum. With this in view, and with this only, did he originally advocate the use of massage. Indeed, almost up to his death he valued massage little, save as a means to an end, that end being a dose of mobilisation. In all else, massage for him was an unknown power. It was only in recent years that the great master began fully to appreciate how much the effects of massage can assist recovery, even apart from the benefit conferred by the subsequent dose of mobilisation. The latter, soon after injury, is impossible without the aid of massage. None the less the treatment of recent injuries by massage is not what he taught: it was always treatment by massage and mobilisation that he advocated.

At the outset, then, let it be clearly understood that in treating by massage a limb which has sustained a recent injury, the massage is applied chiefly as a means of preparing the way for a dose of mobilisation.

The immediate care of all injury is in the hands of the surgeon, and it is rarely that the masseur has the opportunity of administering treatment before effusion has taken place in and around the damaged structure.

If fortune is kind and the aid of massage is invoked in the earliest stage, the correct method is to place the hand firmly over the injured part and apply a kneading movement slowly and patiently, the hand never relaxing its pressure sufficiently to allow any trace of haemorrhage from vessels that may have been torn. By this action we are attempting to secure a dual mechanical result, first, to prevent further effusion (be it of blood or lymph) until there is a reasonable hope that clotting in the injured vessels has taken place, or until some other means of securing the same end is enforced; and, second, to hasten the removal of any effusion that may have already made its appearance, before it has had time and opportunity to commence a process of organisation. As soon as all trace of effusion has vanished - it should only require five minutes or so to accomplish this - the part must be bandaged firmly. And herein lies a great source of danger. It is usual to apply a bandage which is almost non-resilient and which at least exerts an uneven pressure. It is almost impossible with any bandage (with most of those made it is entirely impossible) so to apply it that each turn exerts exactly the same amount of pressure as every other turn, and also so that the pressure exerted by the central part and by the two edges is identical. Any uneven-ness in pressure and any insufficiency of resilience alike court disaster. It should be an unalterable rule that no bandage should ever be applied with a view to the prevention or checking of subcutaneous effusion unless there is a sufficiency of padding between the skin and the bandage to ensure that neither of these risks is run. By "sufficiency" is meant anything from six to ten thicknesses of cotton-wool of the type usually sold as "surgeon's." Moreover, this pad should completely surround the injured part; and then, but then only, is it safe to apply a so-called "firm" bandage.

As soon as this has been safely accomplished we are in a position to continue treatment on the lines about to be described, only now we are using our massage as a preventative rather than a curative measure.

To understand what we hope to do by our massage it is necessary first to realise what has happened. It will be more simple to take an actual case as a concrete example, and then to consider the various details that are applicable to other injuries. Let us suppose that a patient has stumbled and sustained a fissure fracture through the lowest inch of the radius. A fissure fracture is chosen so as to eliminate the surgical aspect of the case as regards the necessity of "setting" the fracture and any serious liability of the fragments to alter their relative positions. There has been no lateral force, the lower fragment has not moved, and therefore the periosteum will be still sufficiently intact to serve as a strong internal splint, although it may have been torn to an extent which will allow exudation of blood from the fractured surfaces.

The severity of the injury is adequate to ensure that there will be an intense teno-synovitis and that the wrist-joint will have sustained a traumatic arthritis. The ligaments of this joint will also have suffered - a few fibres of the internal lateral ligament may even have been ruptured. The inferior radioulnar joint will almost certainly be involved, and it is possible that the articular surface of the glenoid cavity in the shoulder may have been severely injured. For the moment we will assume that this complication has not taken place.

What has happened, then, is this, there is a fissure of the bone and there will be some extravasation of blood from the fracture. Some ligamentous fibres will have torn with similar result. There is a traumatic arthritis of at least one joint, and a tenosynovitis of the tendons of the wrist.

Taking it for granted that sufficient time has elapsed for haemorrhage to have ceased, and that immediate treatment has been carried out and diagnosis made, we know the direct result of injury, but the indirect has yet to be considered. Failing immediate and adequate treatment, this will take the form of general swelling and oedema. Some of the swelling is doubtless due to the outpouring of blood, but this is only local, and cannot possibly account for a swelling which may be intense from the finger-tips to the elbow or above.