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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5521_Библиотеки_им_академика_М_И_Перельмана.pdf
Chapter 9 / Massage Strokes andFlow 391
BOX 9-9
1. Standing at the client’s left side in an asymmetric stance, place your hands on top of the drape and apply a resting
stroke to the client’s low back.
2. Expose the client’s back and, working only on the client’s left side, massage the:
• Back
• Scapular area
• Shoulder area
• Neck area
3. Use connecting strokes to walk around the client’s head to the client’s right side and massage the right side of the
client’s back, scapular area, shoulder area, and neck area.
4. Redrape the back and use connecting strokes to move to the client’s right gluteal area.
5. Massage the right gluteal muscles on top of the sheet, with compression and possibly some petrissage.
6. Expose the client’s right leg and massage the:
• Upper leg
• Lower leg
7. Redrape the right leg, leaving the right foot exposed, and sit or stand at the end of the table to massage the client’s
right foot.
8. Redrape the right foot and use connecting strokes to walk around the table to the client’s left gluteal area.
9. Massage the left gluteal muscles on top of the sheet with compression and possibly some petrissage.
10. Expose the client’s left leg and massage the upper leg and lower leg.
11. Redrape the left leg, leaving the left foot exposed, and sit or stand at the end of the table to massage the client’s
left foot.
12. Redrape the left foot, and place one hand on each of the client’s feet as a resting stroke.
392
INTRODUCTION TO MASSAGE THERAPY
BOX 9-10
(Client Positioned as in Fig. 9-4)
1. Stand at the side of the table, facing the client’s back, and
rest your hands on the client’s right shoulder and hip.
2. Expose the client’s back and massage the right side of the:
• Back
• Scapular area
• Shoulder
• Neck
Chapter 9 / Massage Strokes andFlow 393
BOX 9-10
(Client Positioned as in Fig. 9-4) (continued)
3. Redrape the back and maintain contact with your client as
you walk around his or her head to the other side of the
table.
4. Facing your client, expose the right arm and massage the:
• Hand
• Forearm
• Upper arm
• Shoulder
• Neck
5. Redrape the right arm, and use connecting strokes to move
to the legs.
394
INTRODUCTION TO MASSAGE THERAPY
BOX 9-10
(Client Positioned as in Fig. 9-4) (continued)
6. Expose the right leg (top leg) and massage the:
• Upper leg
• Lower leg
• Foot
7. Redrape the right leg and use connecting strokes as you
move around the client’s feet to the other side of the table
and stand beside the left leg.
Chapter 9 / Massage Strokes andFlow 395
BOX 9-10
(Client Positioned as in Fig. 9-4) (continued)
8. Expose the left leg and massage the:
• Upper leg
• Lower leg
• Foot
9. Redrape the left leg and use a head-to-toe nerve stroke to
reconnect the body.
396 INTRODUCTION TO MASSAGE THERAPY
BOX 9-11
(Client Fully Clothed)
1. Stand behind the client’s chair, and gently rest your hands on the client’s shoulders.
2. Slowly move your hands to the top of the client’s head and massage the:
• Scalp
• Neck
• Shoulders
• Scapular areas
• Any areas of the back you can access easily, which depends on the chair
3. Maintain contact with the client as you move to the client’s left side.
4. Sit or kneel next to the client to massage the left hand.
5. Stand up to massage the:
• Forearm
• Upper arm
• Shoulder
6. Use connecting strokes as you move around to the client’s right side and sit or kneel next to the client to massage
the right hand.
7. Stand up to massage the forearm, upper arm, and shoulder.
8. Sit or kneel next to the client’s right foot and massage the:
• Right foot
• Right lower leg
• Right thigh
9. Move to the client’s left foot and massage the left foot, left lower leg, and left thigh.
10. Stand up, facing the client, and use a head-to-toe nerve stroke to reconnect the body.
Chapter 9 / Massage Strokes andFlow 397
Below are some suggested flows to familiarize you with the
process of combining basic massage strokes with resting
strokes and connecting strokes. These flows are only a guide
to get you started. Once you are comfortable holding and
touching clients and you can use different massage strokes
effectively, use the strokes you think are most appropriate
and treat the client’s body parts in the order that makes
sense to you. In all of the following flows, clients start fully
draped in the position indicated, and you have already performed your grounding and centering techniques. There
are no specific directions for lubricant application because it
is up to you to determine how much is necessary to make
your strokes comfortable with the right amount of slip.
BOX 9-12
Client’s Chest, Neck, and Head
1. Standing at the client’s head, uncover the client’s upper
chest, tuck the drape underneath the client’s armpits, and
perform a resting stroke with one hand on each shoulder.
Supine: Chest, Neck, and Head
A supine client’s chest, neck, and head can all be accessed from
one position, as you stand at the head of the massage table.
When massaging the chest and neck area, do not put pressure
over the endangerment sites of the anterior triangle of
the neck, the jugular vein, or the brachial plexus.
Box 9-12 illustrates a massage sequence for a supine cli-
ent’s chest, neck, and head.
2. Effleurage the client’s chest, from the sternum to the
shoulders, with both palms simultaneously, two to
threetimes.
398
INTRODUCTION TO MASSAGE THERAPY
BOX 9-12
Client’s Chest, Neck, and Head (continued)
3. Effleurage the back of the client’s shoulders, from the
deltoids to the neck, using both palms simultaneously,
two to three times.
4. Redrape the upper chest and slide both hands under
the shoulders to cradle the client’s upper thoracic spine
with both hands. Using your finger pads, effleurage and
petrissage the muscles just lateral to the spine, all the way
up to the occipital ridge, about 20 seconds.
5. Cradle the client’s head and perform passive joint
movements:
• Neck flexion
• Neck rotation to the left and to the right
• Lateral neck flexion to the left and to the right
6. Petrissage the entire scalp and external parts of the ear
with your fingertips and thumbs, 20 seconds.
Chapter 9 / Massage Strokes andFlow 399
BOX 9-12
Client’s Chest, Neck, and Head (continued)
7. Starting medial and moving laterally, use your thumbs and
fingertips to effleurage once or twice each:
• Along mandible
• Along maxilla
• Along inferior surface of zygomatic process to temples
• Along eyebrow ridge
• Along the top of the forehead
8. Use your fingertips to apply tapotement lightly to the face,
10 seconds.
9. Apply nerve strokes from the chin to the temples, twice.
10. Loosely cradle the client’s head.
400 INTRODUCTION TO MASSAGE THERAPY
Supine: Arm
It is possible to massage the client’s arm in both the prone
and supine positions. The shoulder, however, is capable of
more joint movements when clients are supine. The massage sequence in Box 9-13 describes how you can massage
the arm of a client who is in the supine position.
Supine: Abdomen
The abdomen is often left untreated during a massage session
for different reasons. Many people are uncomfortable with
abdominal massage, but it is beneficial for the digestive system and is worth learning. Scientific research has shown that
abdominal massage provides relief from constipation as well as
intestinal discomfort and pain. The parasympathetic nervous
BOX 9-13
Client’s Arm
response, induced by relaxation massage, stimulates digestive
activity. When pressure is exerted on the abdomen, underlying
structures are compressed and pushed out of the way. An effleurage stroke can mechanically push intestinal contents through
the intestines. Massage may also stimulate peristaltic contractions of the intestines, which is the body’s natural mechanism
for pushing contents through the digestive tract toward the rectum. The individual effleurage strokes must be applied in the
same direction as peristalsis to enhance digestive progress.
Because clients are often unfamiliar with abdominal
work, always ask them if they want the work done. With
their permission, you can proceed. The abdomen is best
accessed via the supine position. The client’s knees must be
bent to keep the abdominal area soft enough to let you apply
pressure, so a bolster is particularly helpful under the knees.
Draping requires at least one extra blanket or large towel, if
not two, in addition to the standard sheets. Properly draping
the abdomen is slightly more complicated than draping the
1. Stand at your client’s right side, facing your client.
2. Push the drape aside to take hold of the client’s right hand and expose the arm, tucking the edge of the sheet under
the client’s arm and under the armpit, and place the arm on top of the sheet.
3. Effleurage and petrissage the palm and the back of the client’s hand and each finger individually, using your
thumbs and finger pads, for about 20 seconds.
4. Perform joint movement by passively extending client’s wrist and fingers in pairs:
• Pinky and thumb
• Ring finger and index finger
• Middle finger and wrist
5. Jostle the client’s arm while grasping the client’s hand andsupporting the elbow.
6. Effleurage and petrissage the forearm, maintaining your grasp of the client’s wrist with one hand for stability while
you apply a stroke with your other hand, and then alternate hands to apply strokes, proximally from wrist to elbow,
forabout 20 seconds.
7. Rest your client’s arm on the table for support while you apply effleurage and petrissage with alternating hands,
proximally from elbow to shoulder and over the deltoids, forabout 20 seconds. You can abduct your client’s arm to
putthe deltoids into passive contraction, which allows you toget deeper into the tissues with less work.
8. Apply nerve strokes from shoulder to wrist.
9. Redrape the arm and apply nerve strokes from shoulder tohand.
10. Connect the client’s wrist and shoulder with a resting stroke.