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Chapter 9 / Massage Strokes andFlow 371
Close your eyes and focus on deep breathing in an
attempt to quiet your mind and eliminate any stray thoughts
or concerns. Listen to the air as it moves through your airway. Feel the expansion of your rib cage while you relax the
muscles in your shoulders and your pelvic floor. Focus on a
few deep breaths to clear your mind, and as you feel yourself
calm down, start turning your attention to your client.
Think about the client’s concerns and consider how his or
her life is being affected. By giving clients your full attention,
you can better respond to, and be guided by, their needs and
your intuition. The purpose of centering is to put your own
concerns aside and focus on the client’s needs and wants.
Diaphragmatic Breathing
The process of breathing involves the antagonistic actions of
inhalation and exhalation. Inhalation occurs in two phases.
In the first phase of proper, natural breathing, the diaphragm
contracts and pulls downward until it rests on the abdominal
organs. The abdomen expands as the diaphragm pulls air
down into the lungs. Once the organs stop the diaphragm,
the second phase of inhalation begins. The diaphragm continues to contract and pull air into the lungs, resulting in
an upward expansion of the rib cage. With palpation, you
can feel your belly expand during the first phase of inhalation and your sternum rise up in the second phase. Normal,
natural exhalation occurs in the opposite sequence, with the
chest deflating first, and the abdomen contracting second.
To take a full, deep breath, you need to use your diaphragm muscle instead of the scalenes and other accessory
muscles. First, make sure your waistband or belt is loose to
give your abdomen room to expand. Place one hand on your
abdomen, and the other hand on your sternum. Sit or stand up
straight, drop your shoulders, and slowly inhale through your
nose and feel the expansion of your belly followed by the rise
in your rib cage. You can look in the mirror or use a partner to
monitor your shoulders while you take a deep breath. Watch
to make sure that the shoulders do not elevate significantly and
that the scalene muscles do not tense up. Slowly exhale through
your mouth, feeling the deflation of your rib cage followed by
the contraction of your abdomen. Full, deep diaphragmatic breathing is more efficient than quick, shallow breathing
because it provides more oxygen with less energy expenditure.
Now try to make yourself yawn while you keep your hands in
position to monitor the expansion and contraction that occurs.
Notice how your body naturally breathes properly during a
yawn, straightening the back, lifting the head on top of the
spine, and using the diaphragm to breathe in and out.
Resting Stroke
The resting stroke involves no movement, no slip, and no application of pressure, but it requires that you touch your client with
a therapeutic intent. When you stop moving and lightly rest your
relaxed hands, fingers, or arms on clients for several seconds, it is
considered a resting stroke. It is a good stroke to use at the beginning of the massage, as a sort of greeting to the client’s body, but
it can be used just as effectively anytime during the massage.
When applied at the beginning of the massage, a resting stroke establishes your initial contact with the client and
lets his or her nervous system recognize your touch as safe
and nonthreatening. Figure 9-6 illustrates some different
hand positions for resting strokes. Besides using the resting stroke to signal the nervous system that you present no
danger, you can use the resting stroke as an initial palpation
assessment tool to evaluate body rhythms and temperature,
texture, and fullness of the tissues under your relaxed hands.
In addition to using it at the beginning of your massage,
you can use the resting stroke periodically throughout the
massage. You can use it to ground or center yourself or to
reevaluate the client’s tissues to help you choose the appropriate technique at any given moment. After you work on a
specific area for a long time or use a lot of therapeutic techniques on one area, your touch can be perceived as a source
of aggravation that stimulates the sympathetic nervous
response. Avoid that situation by using a resting stroke to
settle the nervous system and allow relaxation to continue.
Another way to use a resting stroke during the massage
is to use it as a connecting stroke. You want to minimize the
number of times you break contact with the body because
every time you break contact, you have to reinitiate contact,
and initial contact can be stimulating. To move from one area
of the body to another without breaking contact, you can
leave one hand on the area that you have just finished massaging, and place the other hand on the area that you will start
working on. Essentially, your resting stroke connects the area
that has been massaged with the area that will be massaged.
The six basic massage strokes involve the application of pressure
in some form, and they all have mechanical and reflexive effects.
Some strokes incorporate slip on the client’s skin, and others do
not. Compression is a variation of a resting stroke, but because
pressure is applied, it is considered a basic massage stroke. The
fundamental massage techniques that arise from Per Henrik
Ling’s Swedish Movements include effleurage (EF-lur-ahzh),
petrissage (PET-rih-sahzh), tapotement (tuh-POHT-ment),
372 INTRODUCTION TO MASSAGE THERAPY
friction, and vibration. A Swedish massage, also called a relaxation or wellness massage, is one that generally includes these
basic strokes and no specific therapeutic techniques.
Compression
The compression stroke applies pressure to soft tissues to
squeeze them together without any slip. The tissues can
either be pressed against the underlying bone, or they can
be manually squeezed together with your own hands or fingers. Compression can be used to increase circulation, warm
the tissues, decrease muscular tension, and reduce pain. You
can apply compression with your thumbs, finger pads, the
palm or heel of your hand, the knuckle portion of a fist, or
your forearm. In a special form of bodywork called Shiatsu,
therapists also use their feet and knees to apply compression. (Fig. 9-7 shows some examples of compression.)
Effects of Compression
With your knowledge of anatomy and physiology of circulatory vessels, you can understand how compression is useful for increasing circulation and warming tissues. Blood is
pushed through the arteries with the forceful contractions
of the heart. By compressing the arteries and arterioles
and stopping the flow of oxygenated blood, pressure builds
behind the blockage as the heart continues to pump blood.
When the compressed artery is released, a larger amount of
blood rushes forth with a higher force than usual, warming
the tissues supplied by that artery.
The veins and lymph vessels are equipped with valves
that force their contents to flow in only one direction.
Compression strokes force blood out of the veins and
through the one-way valves toward the heart. Likewise,
compression on the lymph vessels forces lymph toward
the lymph ducts that drain into the heart. There are better
strokes for enhancing venous and lymph flow, but manual
CDE
Figure 9-7. Compression strokes. (A) Back of knuckles(fist). (B) Forearm. (C) Fingers. (D) Thumbs. (E) Palm/heel of hand.
Chapter 9 / Massage Strokes andFlow 373
compression works as effectively as the active muscle contractions of the skeletal muscle pump.
Because of the thixotropic property of fascia, compression strokes can soften the fascia to restore movement and
circulation to the muscles. Thus, compression can reduce
muscular tension.
Muscles are composed of organized groups of muscles
cells bundled together with fascia. Nerves and nerve cells
travel through that fascia, carrying nerve impulses to and
from the skeletal muscles. Compression on the soft tissues
puts pressure on the nerves as well as the blood vessels and
can reduce the nerve impulses transmitted by pain receptors. Consider the many ways people instinctively use pressure for pain relief:
• People put pressure on their cheek when they have
a toothache.
• People press on their temples when they have a
headache.
• People press on muscles that are sore.
• People press on their shin when they bump it.
• People squeeze or press on the abdomen when they
experience abdominal pain.
Application of Compression
Thumbs, finger pads, the palm or heel of the hand, fists, and
forearms can be used to deliver compression. The stroke
requires no slip on the skin, making it easier to apply compression without lubricant or on a clothed client. You can
squeeze tissues together to compress them, but that form
of compression requires muscular work from your hands,
which should be avoided when possible. To apply compression with less work, simply touch the client and gradually
apply pressure using proper body mechanics such that your
compression slowly sinks into the client’s tissues. You can
use your fingers to press on the tissues of the face or phalanges, but for the larger leg or gluteal muscles, you need to use
good body mechanics with a proper lean to compress the
tissues against underlying bones. If you are leaning instead
of pushing into the large muscles, you will sink farther
into the tissues as they soften up, without any extra effort.
You can support your hand, finger pad, or thumb with the
other hand when you need to maintain the compression for
extended periods.
There is a variation of compression called rolling. Like
the method you use to roll a pencil back and forth on a
table, you can use rolling on the arms, legs, fingers, and toes
by applying compression and rolling the structure back and
forth under the pressure. There is no slip on the skin, so it
does not matter whether there is lubricant on or not. The
amount you can roll a body part varies with the size of the
body part, the joint structure, and the soft tissue restrictions.
Move slowly enough to sense a joint’s end feel and stop the
movement.
Compression should not be applied over open skin or
contagious skin conditions, bruised areas, moderate
to severe varicose veins, or areas of acute injury.
Effleurage
Effleurage is an elongated, slow stroke that slides across
the surface of the client’s skin with minimal drag. It benefits the skin by warming it with friction and increasing
its circulation of blood and lymph, stimulating the sebaceous glands that make the skin soft and pliable. It is used
to apply and spread lubricant, assess the client’s soft tissues, create heat, increase circulation of blood and lymph,
decrease muscle tension, relieve pain, and encourage relaxation and for connecting strokes. Your forearm, the palm or
heel of your hand, your knuckles, thumbs, or finger pads
can deliver effleurage strokes, but you need to use common sense. It is obviously inappropriate to use a forearm
to apply effleurage to someone’s face. The pressure varies
from superficial to deep, and you need to keep your hands
and wrists relaxed so they can gently encompass or mold to
the client’s body throughout the stroke. During the stroke,
make palpation assessments regarding the quality of the client’s tissues.
Effects of Effleurage
Most often, effleurage is used to apply and spread lubricant, and it is one of the best strokes for assessing the
quality of superficial and deeper layers of tissue. You can
feel the movement, fullness, texture, temperature, and
body rhythms as your stroke travels across the tissues.
When theeffleurage stroke is directed toward the heart,
it assists the return of blood and lymph through the valve
system in the veins and lymph vessels, making it the best
stroke for circulatory enhancement. As the effleurage
stroke compresses tissues, it increases arterial circulation
and cellular metabolism, including glycolysis, the heatproducing chemical reaction that occurs in muscle cells.
Additional heat is created with the deformation and softening of the thixotropic fascia, which decreases muscular tension. Ischemic tissues, or tissues that have a poor
blood supply, are often painful as they suffer the effects
of insufficient oxygen. Effleurage can restore circulation
to ischemic tissues to improve the health of those tissues
and reduce pain. With less pain, people are better able
to relax. Effleurage applied with lighter pressure tends
to have reflexive effects, whereas deeper pressure causes
more of the mechanical effects on the circulatory system.
374 INTRODUCTION TO MASSAGE THERAPY
Application of Effleurage
You must use lubricant for effleurage because the stroke
travels across the surface of the client’s skin. The lubricant
reduces drag and increases slip to make the stroke more
comfortable for clients. Be that as it may, too much slip is
disadvantageous. It reduces your ability to assess the movement and texture of tissues, and you may need to compromise your body mechanics to resist the slip. Clients who
have a lot of body hair present a special challenge. You can
use more lubricant or use lubricants with a lot of slip, such
as oil or gel, to keep from pulling their body hair. Some people find it uncomfortable to be rubbed “against the grain”
of their body hair, so you may want to move in the same
direction the hair lies, but some clients are not bothered if
you use enough lubricant. Generally, effleurage strokes are
performed at a rate of about 1 to 2 inches per second, and
the excursion, or length of the stroke along the client’s skin,
is about 10 to 15 inches.
The amount of pressure that accompanies the effleurage
stroke depends on where and why you apply it. Effleurage on
the face typically uses very little pressure; effleurage on the
back and shoulders usually requires more pressure. With that
in mind, massage is a client-centered art that requires you to
be aware of the needs of each client and treat accordingly.
Body mechanics must be incorporated with every
stroke, but because effleurage is used so much, it is especially
important to learn to use proper body mechanics with effleurage strokes. Keep your wrist and hand as relaxed as possible
to minimize your own muscular tension and maximize your
palpation sensitivity. Keep your joints stacked as much as
possible and use a proper lean. Avoid twisting and bending,
and maintain an asymmetric stance. There are a few precautions to take when using your forearm to apply any massage
stroke. First, it is especially important to keep your wrist and
hand relaxed. A forearm with a relaxed hand and wrist feels
better to the person receiving the massage, and it also benefits you. It prevents you from building up excess tension, it
helps you conserve your energy, and it increases your sensitivity for palpation assessment. Second, although some recommend using your elbow to deliver pressure, you must use the
proximal part of your forearm and not the point of the olecranon process. The ulnar nerve, which is often referred to as
the “funny bone,” is relatively unprotected as it runs through
the cubital tunnel of the elbow, making it susceptible to damage if you use your olecranon process to apply pressure.
Alert
Use the proximal part of your ulna to deliver pres-
sure instead of the olecranon process because it protects the ulnar nerve from damage. Figure 9-8 shows various
applications of effleurage, including proper use of the forearm.
Effleurage should not be applied near or on an area of
inflammation, infection, or acute or subacute injury.
Other local contraindications for effleurage include
open wounds, contagious skin conditions, and
bruises. Avoid repetitive applications of effleurage on
the extremities of clients with high blood pressure,
cardiovascular disease, varicose veins, or edema.
Superficial Effleurage
Superficial effleurage strokes, also called nerve strokes, can
be performed with short, long, or circular motions with the
thumbs, fingertips, or palms of the hands. Short and circular superficial effleurage can be applied to the face and other
small areas of the body.
Nerve strokes are very light, feathery effleurage strokes
applied in long, sweeping motions that are slow or fast
(Fig.9-9A). You can use them to “brush down” an area of the
body after massaging it, giving the client’s nervous system an
opportunity to recognize that the invasive work is finished and
that there is no need to stimulate sympathetic nervous activity.
Massage can cause a client to feel “disconnected” toward
the end of the massage because each part of the body
receives what can seem like a separate massage. For example,
you spend some time massaging the client’s back, spend a
few minutes on the right arm, spend a few more minutes on
the left arm, move to the left leg and devote several minutes
to it, and then spend several minutes on the right leg, and so
on. Nerve strokes can be used as connecting strokes during
the massage, sweeping from the area that you just finished
to the area you plan on massaging next. They signal a transition from one area to the next to help the client know what
to expect. Remember, more relaxation is possible when the
sympathetic nervous response is not stimulated. Clients who
are comfortable and who know what to expect are more likely to relax throughout the massage, and nerve strokes are a
nonverbal way to let clients know what you are doing.
Slow nerve strokes that run from head to toe can also
be used at the end of the massage to conceptually and proprioceptively reconnect all of the separate body parts. The
proprioceptors are the sensory receptors responsible for
the position and tension of the muscles and joints to tell us
where we are in physical space and to help us coordinate our
movements. Nerve strokes that run the length of the body
serve as gentle proprioceptive reminders of the position of
all the body parts in space. The head-to-toe nerve stroke
should last between 5 and 10 seconds, and as you move
toward the client’s feet, you take steps as necessary to maintain proper body mechanics:
1. Stand next to the massage table, at the client’s shoulder,
facing the client’s head.
2. Gently rest the fingertips of both hands on the top of
the client’s head.
Chapter 9 / Massage Strokes andFlow
375
Figure 9-8. Different applications of effleurage. (A) Forearm. (B) Interlaced fingers. (C) Palm.
376 INTRODUCTION TO MASSAGE THERAPY
3. Apply a nerve stroke with your fingers from head to
toe, moving lightly from:
a. Top of the head
b. Shoulders
c. Elbows
d. Hands
e. From the hands onto the client’s legs
f. Knees
g. Feet
If you always end massages with this full-body nerve stroke,
your returning clients will learn that this stroke signals the
completion of the massage.
Deep Effleurage
The deeper strokes are often applied with your thumb, your
knuckles, the heel of your hand, interlaced fingers, or forearm. (Fig. 9-9B shows deep effleurage strokes.) You want
the client’s body to relax during deep effleurage so you can
assess and treat the deeper tissues; therefore, you must apply
the stroke slowly to avoid triggering protective muscular
tension.
Again, you need to maintain proper body mechanics
during effleurage. The asymmetric stance is usually better
because the stroke tends to travel along the client’s skin.
Apply deep effleurage strokes by leaning into tissues so that
your stroke runs uphill rather than downhill. The compression is more effective when you lean into uphill tissues, and
you tend to move more slowly and carefully. Gravity can
accelerate a downhill stroke, and you may have to hold your
body back to avoid sliding too fast. Resisting gravity requires
unnecessary work and can create excess stress, so direct your
deep effleurage strokes uphill.
Petrissage
Petrissage is directly translated from French as “the act of
kneading.” It is delivered as a rhythmic series of intermittent compressions combined with a grasping and lifting
action that pulls the tissues away from the bones. The tissues can either be compressed against the underlying bones
or manually squeezed with your hands, but you must use
proper body mechanics in either application. The benefits of
effleurage also pertain to petrissage, but petrissage is more
effective at improving muscle tone, increasing the elasticity
of muscle tissue, and increasing muscle contractility.
Effects of Petrissage
The pressure of petrissage strokes increases the circulation of
blood and lymph, stimulates sebaceous gland activity to soften the skin and keep it supple, warms the soft tissues, makes
the muscles and fascia more pliable, decreases muscular tension, relieves pain, and encourages relaxation in the same
way effleurage does. Petrissage is very effective at improving
the health of muscle tissue. The deep kneading increases circulation and metabolism of all of the cells and tissues within
a muscle, including the blood vessels, lymph vessels, nerve
cells, and muscle cells. Studies have shown that muscles
respond to massage with better muscle tone, more elasticity and pliability, and greater sensitivity to nerve impulses for
contraction or contractility. Muscles also demonstrate faster
reaction times and more coordinated movements.
The focus of superficial petrissage is to soften the thixotropic fascia and increase circulation to the superficial fascia.
Deep petrissage focuses on the muscle tissues and deep fascia. It deforms the deep fascia and improves the circulation
of blood and lymph to the deepest layers of muscles, which
increases the elasticity and health of the muscle tissue.
Figure 9-9. Types of effleurage. (A) Superficial effleurage, also
called nerve strokes. (B) Deep effleurage.
Application of Petrissage
The amount of force you put into your petrissage varies,
but generally thicker tissues take more pressure. Superficial
Chapter 9 / Massage Strokes andFlow 377
applications of petrissage are very much like skin pinches
and require little or no lubricant because the strokes only
treat the superficial fascia and subcutaneous fat. The strokes
can be effective when applied to general areas of the body,
both localized and broad, because the focus is on the continuous sheet of superficial fascia.
Because of the effects of deep petrissage on the muscle
tissues, these strokes are often applied to an individual muscle or a group of synergistic muscles rather than a general
area of the body. For deeper applications of petrissage, you
may need a small amount of lubricant to prevent the stroke
from pinching, to ensure that the strokes are comfortable,
and to help put the muscle or group of muscles into passive
contraction. When muscles are stretched out, the aligned
muscle fibers get closer together and become taut, like the
way a rubber band acts when it is pulled tight. In a passive
contraction, the therapist brings the origin and insertion
of a client’s muscle closer together while the client relaxes.
Again, like a rubber band, the muscle fibers are more flexible and pliable in this position, allowing you to work deeper
with less effort. If you attempt to resolve deep muscle tension in muscles that are stretched tight, you waste energy
and can hurt the client.
The petrissage stroke has no true excursion; you apply a
series of individual strokes all over the area you are treating.
Each stroke should move to a slightly different spot so that
you do not grasp the same exact tissues twice in succession.
As you apply petrissage in an attempt to reach the deeper tissues, slowly increase your pressure to allow the tissues time
to adjust and soften enough to let you in. Petrissage is generally applied with soft hands that squeeze, lift, and release
the client’s tissues in an alternating rhythm of left and right
hands. A typical rhythm for petrissage is about 1 stroke per
second, but the rhythm is faster for smaller or thinner tissues such as the face and hand, and slower for the thicker or
larger tissues like the thigh and scapular area.
Try to keep your fingers together and use them as one
large surface to scoop the tissues into the fleshy part at the
base of the thumb called the thenar eminence (THEH-nahr
EHM-ih-nents), grasp and squeeze those tissues gradually,
and then release them. By pulling the tissues up and away
from the bone, you mechanically deform and separate the
layers of superficial and deep fascia more than you can with
rhythmic compression or effleurage strokes. Some variations
of petrissage use your thumb and finger pads, whereas others use a soft fist to push the tissues into the relaxed, cupped
palm of the other hand. (Fig. 9-10 illustrates different forms
of petrissage.)
Petrissage is one of the more challenging strokes when it
comes to maintaining good body mechanics. The hand muscles are required to work harder than normal to squeeze and
lift tissues. Also, excessive strain occurs in the muscles that
move the forearm and wrist because you use so much active
supination, pronation, and wrist extension. As you repeatedly
compress and lift the tissues, it is easy to forget about leaning properly. To avoid stress on your low back, make sure you
maintain the straight line between your head and back toe
when you lean and lift. Try to minimize the amount of petrissage you use because it requires so much muscular work, and
when you do use it, watch your body mechanics.
Avoid petrissage on open or contagious skin conditions;
bruises; moderate to severe varicose veins; and
areas of acute injury, inflammation, or infection.
Variations of Petrissage
Deep petrissage is occasionally applied without the grasping and lifting component, which makes it resemble circular deep effleurage. Because the focus is still on intermittent
and rhythmic compression of the tissues, the stroke is still
considered petrissage. There is minimal slip on the skin, just
as with standard petrissage, but instead of grasping the tissues, you push them aside and out of the way, which causes
them to lift up to some extent.
During a massage, you may cross an area of restricted
superficial fascia, which can feel as if your massage stroke
is skidding along the client’s skin or has come to a stop.
In other words, the slip turns into drag. There are several
forms of petrissage that you can use to loosen these restrictions. Wringing is a slow application of petrissage that does
not include the lifting component. The hand movement of
this stroke mimics the act of wringing out a wet towel and is
very similar to an “Indian burn” that children give each other,
except there is no friction or slip on the client’s skin. You grasp
a limb with both hands and simultaneously rotate your hands
in opposite directions without any slip on the skin. One stroke
lasts 2 seconds, making it more like a very slow moving compression stroke that primarily deforms the superficial fascia.
Skin rolling is a variation of petrissage that primarily
lifts the superficial fascia to deform and loosen it.
Alert
Skin rolling may be uncomfortable to clients, so
move slowly, pay attention to their response to this
stroke, and make adjustments to your technique.
Grasp a large section of skin and superficial fascia with
your thumbs and finger pads. Pinch it together and lift it up,
away from the body. With the roll of tissue in your grasp,
very slowly walk your fingertips and thumbs away from you
while keeping the roll of tissue elevated (Fig. 9-11). The rate
of movement tends to be about 1cm per second, but looser
fascia can be rolled faster, and more restricted fascia must
be rolled more slowly. The excursion of the skin roll should
378 INTRODUCTION TO MASSAGE THERAPY
DE
Figure 9-10. Different kinds of petrissage. (A) Whole hand. (B) Thumb and fingers. (C) Into cupped hand. (D) Heel of one hand and
pads of fingers on other hand. (E) Heel of one hand and pads of fingers on other hand.
travel across the area of the restriction, which can be anywhere between 3 and 12 inches or longer. Make sure that
there is no lubricant on the skin because you need to have
a firm hold on the tissues, which is impossible with lubricant. If you find an area of restricted superficial fascia in the
middle of a massage and have already applied lubricant, you
can use a towel to wipe off the excess. This technique can be
applied therapeutically if you perform specific assessments
prior to using a skin roll. (See Chapter 10, Therapeutic
Applications, for more detail.)
Tapotement
Tapotement is a fast rhythmic stroke in which you use
both hands, like rapid drumming. In fact, sometimes
tapotement is referred to as percussion, and it can be
applied with cupped hands, flat hands, the medial side of
open hands, the medial side of the relaxed fists, or the fingertips. See Figure9-12 for different examples of tapotement. Initial and very light tapotement strokes stimulate
Chapter 9 / Massage Strokes andFlow
379
Figure 9-11. Skin rolling.
the sympathetic nervous system and cause superficial
vasoconstriction. Conversely, sustained and heavy tapotement results in superficial vasodilation, pain relief, and
relaxation.
Effects of Tapotement
The different effects of tapotement are determined by
its application. Consistent with the general physiological
effects of touch, initially tapotement is more stimulating
than relaxing, whereas prolonged applications encourage
relaxation. In addition to stimulating the parasympathetic
nervous response, research shows that performing several
minutes of tapotement has an anesthetic effect on hypersensitive nerve endings. 1 When applied with more force,
the effects of tapotement are similar to those of compression, including vasodilation, increased circulation, and
increased tissue temperature. Firm, abrupt applications
of tapotement, especially when applied near the musculotendinous junction, stimulate muscle contractions with
Figure 9-12. Tapotement. (A) Cupping. (B) Hacking. (C) Tapping.
the tendon reflex. The response to very light fingertip
tapotement is quite different, however, as the body reacts
with a more protective mechanism. Vasoconstriction of
the superficial blood vessels pulls them away from the
surface of the skin to keep them from being damaged.
Therapeutically, tapotement with cupped hands can be
used to break up congestion in the lungs of people with
cystic fibrosis. This stroke can be very effective, but you
need a thorough understanding of the pathological condition, you need to know the specific technique, and the
client will benefit more if you can work with the client’s
physician.
380 INTRODUCTION TO MASSAGE THERAPY
Application of Tapotement
There is no slip with any form of tapotement, so you can
perform the stroke with or without lubricant. The rhythmic
percussive strokes are delivered very quickly, somewhere
around five beats per second, but they can be applied faster
with the fingertips and more slowly with the fists. There is
a critical elastic component of tapotement that allows the
stroke to affect the deeper layers of tissue without damaging
the more superficial layers, and it can only be accomplished
by keeping your wrists and hands relaxed. In addition to
being safer for the client’s tissues and being less stressful
for your body, tapotement delivered with a relaxed, springy
rebound feels better. As in petrissage, there is no excursion
with the stroke. You apply a series of individual strokes over
the area you are treating.
The different variations of tapotement can be applied as
follows (Fig. 9-12):
• To use cupped hands (cupping), your wrists must
stay relaxed, but you need to hold your fingers
loosely in the cupped position. When you strike
the client’s skin, the cupped hand should make a
resounding kind of hollow noise.
• To use the flat surface of your finger pads (slapping),
keep your fingers together but keep your wrists and
fingers relaxed and loose. When your hand strikes
the client’s skin, it should sound and feel like a light
smack.
• If you use the medial edge of your open hands for
tapotement (hacking), keep your hands relaxed
so that your fingers are comfortably spread apart.
Upon striking the client’s skin, your relaxed fingers
“squish” together to absorb some of the shock.
• To use your fists for tapotement (pummeling or
beating), keep your fists and wrists loose, and only
use this stroke on the fleshy areas of the body such
as the hips, thighs, and gluteal areas. There is almost
no sound when your fist strikes the client’s skin.
• If you use your fingertips for tapotement (tapping),
the superficial fascia should be thin to create the
appropriate effect. No sound occurs with fingertip
tapotement because you use hardly any pressure, and
you keep your fingers relaxed to absorb what little
rebound there is.
As you apply tapotement, constantly move around to
avoid striking the same spot repeatedly and be careful of
areas where nerves and organs are relatively unprotected.
Donot use tapotement directly over the spine, bruised
areas, or varicose veins, and use caution when
applying it to the back in the kidney region.
The kidneys are relatively unprotected and are suspended in a fatty mass called the adipose capsule, and although it
is not likely that you will shake them loose with tapotement,
you need to ensure that you do not traumatize or injure
them. The kidneys are located on either side of the spine,
at the level of the superior lumbar vertebrae, just beneath
the rib cage.
As with the other strokes, avoid tapotement over open or
contagious skin conditions, bruises, varicose veins,
injuries, inflammation, or infection.
Watch your body mechanics when you use tapotement.
Besides keeping your wrists and hands relaxed, use your legs
with your knees slightly bent as you move around to apply
tapotement instead of bending and twisting at the waist.
Friction
Friction is a multidirectional stroke that you can apply
superficially or deep with completely different methods and
effects. Superficial friction is a brisk variation of light effleu-
rage intended to increase circulation in the superficial tissues
and dissipate body heat. The application of deep-fiber
friction (also called cross-fiber friction and transverse
friction ) resembles the variation of compression called roll-
ing. It is a deep, localized application of pressure, without
any slip on the skin, primarily used to break up fascial adhesions and separate the muscle fibers.
Effects of Friction
Heat is created by friction, which is the physical resistance
between two surfaces as they rub against each other. The
massage stroke called superficial friction is applied by briskly
rubbing the client’s skin to create heat. It mechanically
enhances the flow of blood and lymph and reflexively causes
vasodilation in the skin, which increases circulation in the
skin, increases the temperature of the skin and superficial
fascia, and dissipates body heat from the skin. The general
purpose of superficial friction is to create heat and increase
the blood flow to the treated area, or local hyperemia
(HAHY-per-EE-mee-ah).
Deep-fiber friction is quite different from superficial
friction. The pressure of the stroke increases circulation in
the deep fascia and muscle tissues, breaks up fascial adhesions and scar tissue, and separates the different components
within a muscle. Chronically hypertonic muscle tissue is
often accompanied by restrictions in the deep fascia. When
people “stretch” their connective tissues, the elongation of
the tissues also causes the muscle fibers and surrounding
fascia to get closer together. Deep-fiber friction, especially