Position

The patient is lying or half-lying on a bed or couch. The operator sitting at his side performs the following manipulations :

1. Stroking of the foot, sole and dorsum; quick stroking with the palm of the hand to the sole of the foot finishing with firm and quick clappings with one hand, the other grasping the ankle underneath, so as to elevate the limb.

2. Stroking with both hands from the ankle to the hip, the hand on the outside reaching up to the crest of the ilium, the thumb of the hand on the inside, with moderate pressure, going down toward the groin. (Avoid pressure upon the tibia.)

3. Friction with the thumb upon the outside of the leg from ankle to knee-joint, covering principally the flexors of the foot.

4. Stroking with one hand of the same part.

5. Friction with the thumb upon the inside and posterior part of the leg, covering principally the gastrocnemius and the soleus.

6. Stroking with one hand of the same part.

7. Friction with the thumb or hand upon the outside, inside and the back part of the thigh, dividing it into four distinct parts so as to thoroughly work upon all the different muscles.

8. Repeated strokings over the whole extremity, from ankle to hip.

9. Kneading with the two thumbs or both hands upon the different muscles of the foot and leg.

10. Hacking or clapping upon the whole extremity, avoiding the bones.

In certain cases (dropsy, rheumatism, etc.), it is well to have the limb elevated, thereby promoting the return of the venous blood.

The limb should be frequently turned, so that the posterior part may receive proper attention.