E. A. Morozova. Massage for injuries and diseases of the musculoskeletal system. Medical, therapeutic and cosmetic massage. Therapeutic massage of the knee joint after injury

Anatomical and physiological features of the musculoskeletal system

Speaking about the use of massage for diseases of the musculoskeletal system, you must first understand the anatomy and physiology musculoskeletal system. A high-quality and truly beneficial massage cannot be performed without a clear understanding of the structure and functioning of the massaged areas of the body.

Research by modern scientists suggests that the condition of the bones and the skeleton as a whole speaks better than any other system or organ about the state of the human body, the stages of its development, health and aging.

But bones, unfortunately, for a long time and unfairly were considered some kind of secondary, insignificant system, and, moreover, static. While bone, on the contrary, is a constantly changing tissue that is easily rebuilt, functionally changed and restored.

A number of studies (microradiography, biochemistry, histology) have shown: in addition to the fact that the skeletal system is a supporting structure, it takes part in the work of the entire body, participates in metabolism, maintains minerals in a certain proportion in the tissues of our body, and is sensitive to changes in internal and external environment.

In order to take a closer look at the human skeleton, let us turn to osteology (the science that studies the skeletal system). Here we can see that it turns out that bones occupy quite a large part of our body and our entire skeleton consists of approximately two hundred and eight bones and weighs about 5-10 kilograms. Any single bone is organ, which has its own individual form and function.

There are long, short, wide and mixed bones. The long tubular bone is divided into a middle part - the diaphysis (bone body) and two thickenings - the epiphyses. The epiphyses are usually covered with articular cartilage; that part of the diaphysis that approaches the epiphysis is called the metaphysis. The diaphysis of large bones is filled with bone marrow inside.

Red Bone marrow serves as a hematopoietic organ, which consists of a network of connective tissue fibers, where a colossal number of red and white blood cells mature, from where they are, as it were, “washed out” and distributed throughout the body with the bloodstream.

The next group of bones are the short bones. Nature placed them where usually greater mobility is combined with a load that compresses the skeleton. These bones are created like the epiphyses of long tubular bones. This group includes the bones of the wrist, forearms, etc.

The third group is wide or, as they are also called, flat bones. Typically, this group of bones provides broad surfaces for the origin and insertion of muscles. It is significant that they are formed from two plates of a compact substance, between which there is a spongy substance (diploe).

Mixed bones partly have the same structure as short bones, and the other part of the same bone has the same structure as flat bones. A good example This type of bone is a vertebra.

There is also a separate form of bones, such as air bones. They are called so because they have cavities covered with mucous membrane and filled with air. These bones include the upper jaw, where the maxillary sinus is located, the frontal bone with the frontal sinus, etc.

Let's reverse Special attention on bone strength. P.F. Lesgaft discovered a law that states that: “The greatest strength of the bones combines the greatest lightness and the least amount of material, and the influence of any shocks received during movement is reduced.”

The first place in bone formation is occupied by bone tissue, which is compared to metal in strength and elasticity. This is proven by the experience carried out by many scientists, testing the strength of bone in compression, rupture and tension. Experience has shown that fresh bone has the same tensile strength as copper, nine times the tensile strength of lead, and the same tensile strength as cast iron. Withstands compression with a force of ten kilograms per square millimeter of cross-sectional area. Such high levels of the strength of our bones are determined by a combination of the following properties:

2) physical properties;

3) chemical properties;

4) bone structure and architecture.

Also, the strength of both an individual bone and the skeleton as a whole is influenced by various factors, for example, physical labor, sports Insufficient load, low mobility lead to a weakening of not only the muscular system, but also the bone system. So, for example, if a person leads sedentary lifestyle life, bones become weaker. In cases of severe illness, when a person is forced to remain in bed for a long time, calcium and other minerals are generally washed out from the bone.

Also, for good development of the bone system, good nutrition is necessary, especially in childhood. “Good nutrition” does not mean that you have to eat anything, anywhere, and as much as possible. This means food rich in both vitamins and mineral salts. After all, a person’s height and weight do not affect the content of mineral salts in the bone; their amount depends on the thickness, shape and size of the bone. For example, narrow bones with little thickness are more mineralized. It is believed that many dysfunctions of the limb, leading to a decrease in dynamic and static load, are accompanied by a decrease in the content of phosphorus and calcium in the bones.

We now know that:

1) A change in the shape of the bone occurs as soon as the pressure on it from surrounding tissues decreases or increases.

2) The difference in the growth of the contacting parts of the body is determined by the mechanical conditions, under the influence of which the bone changes shape.

3) Bone tissue usually forms in areas of maximum compression or tension.

4) Bones develop better the more the muscular system works.

5) When building bones, the greatest strength is achieved with the least waste of material.

6) The bone is easily rebuilt, its external shape reflecting the result of the application of external forces.

All ours musculoskeletal system connected to each other by joints, thanks to which our bones can bend, straighten, rotate around their axis and perform various other movements. In the human body there are about two hundred and thirty joints, completely different in shape and size.

Joints are divided into two large groups. These are synarthrosis, i.e. continuous joints, and diarthrosis – discontinuous. The first group, i.e. continuous joints, includes: bone, cartilaginous and fibrous joints. For example, fibrous are ligaments, interosseous membranes, sutures in the skull, etc.

All ligaments are different in their origin and functional characteristics. For example, ligaments made of collagen fibers are not very elastic and, after stretching, do not return to their previous state. While, for example, the yellow ligaments between the vertebrae consist of fairly elastic fibers, which provides us with high mobility of the spinal column. There are also mixed ligaments, that is, some of them are short, others are long. Ligaments are a fairly strong connection for our bones, but, unfortunately, their strength decreases with age. Ligaments also differ in their functional characteristics. There are ligaments whose function is simply to hold the bones in their correct position, these are strengthening ligaments. Other ligaments inhibit movement in the joints, there are ligaments that direct movement in the joints, for example, this cruciate ligaments in the knee joint.

Different bones have different connections. Thus, long tubular bones are connected at their ends, flat bones are connected to their neighboring edges. There are connections with the help of cartilage - these are intervertebral cartilaginous discs, the pubic symphysis, etc.

Most long bones are connected discontinuously, that is, when they are connected, the ends are immersed in the cavity, and between them there is a narrow gap - the joint space. It turns out that the joint space has some characteristic features, these are:

A) the ends of articulating bones;

B) the capsule surrounding them;

B) cavity created by the capsule;

G) synovial fluid contained in the cavity.

In places of direct contact, the ends of the bones are covered with hyaline cartilage, they are very smooth, which facilitates movement. As for the joint capsule, thanks to its universal structure, we can easily manipulate our movements. Nature created it as if it had two layers. On the outside, it is a thick layer of fibrous tissue, equipped with elastic and collagen fibers, as well as vessels and nerves, it is attached directly to the bones, gradually turning into the periosteum. Then comes the second layer of the same capsule - synovial. It is very thin and consists mainly of synovial cells. The cells of this tissue produce synovial fluid. The capsule must be strong enough, in some cases it is strengthened by capsular ligaments or compacted if functionally necessary.

Directly in the joint cavity there are so-called inversions, which are located between the bones, muscles or tendons. Also, the joint cavities can communicate with additional periarticular bursae or bursae.

Some joints also have their own auxiliary elements - these are ligaments, intra-articular and extra-articular. The articular labrums are peculiar cartilaginous rims that surround the articular fossa, thereby making the joint cavity deeper. Also, auxiliary elements include discs and menisci, their difference is found only in their shape - the disc, as you already understood, is a round plate, and the meniscus resembles a crescent. Since they are auxiliary elements in the joint, being in the cavity of the joint, they serve as spacers between the connecting bones and absorb shocks. There are also elements such as bursas(periarticular synovial bursae), in shape they resemble small flattenings, closed in a capsule with synovial fluid - this facilitates friction and pressure in the joint.

There are also additional bones of the skeleton placed in the joint capsule - these are sesamoid bones. They help increase the range of motion in the joint.

Here we briefly examined, without going into detail, what tissues and elements the joint consists of. This is a rather complex organ, and all its surfaces must strictly correspond to each other. The tasks of the joint are stability, movement, and prevention of early wear of rubbing parts. There are more than two hundred joints in our body, and they are all different in type. Anatomists have identified several main types of joints, these are:

1) spherical (shoulder, hip);

2) flat (between the bones of the forearm).

Another group is joints with two axes of rotation:

1) ellipsoid (wrist);

2) saddle-shaped (articulation of the 1st metacarpal bone with the large polygonal bone);

3) condylar (between the processes of the occipital bone and the 1st cervical vertebra).

Joints with one axis of rotation include:

1) trochlear (ankle);

2) cylindrical or rotational (joints between the ulna and radius bones).

Thanks to this universal structure, each joint has the opportunity for full movement, while maintaining sufficient strength. But such strength is obtained due to the natural tightness of the joint, which provides a rarefied environment in the joint cavity. Thanks to this, the joints, like magnets, dock with each other.

The spinal column is the basis of the skeleton and serves as the support of our entire body. The design of the spinal column allows it, while maintaining flexibility and mobility, to withstand enormous loads.

The spinal column is responsible for maintaining posture, serves as a support for tissues and organs, and also takes part in the formation of the walls of the chest cavity, pelvis and abdominal cavity. Each of the vertebrae that make up the spinal column has a through vertebral foramen inside. In the spinal column, the vertebral foramina make up the spinal canal, which contains the spinal cord, which is thus reliably protected from external influences. The mass and size of the vertebrae increase from the upper to the lower: this is necessary to compensate for the increasing load that the lower vertebrae bear.

In addition to the thickening of the vertebrae, the necessary degree of strength and elasticity of the spine is provided by several of its bends lying in the lateral projection. Four multidirectional curves alternating in the spine are arranged in pairs: the curve facing forward (lordosis) corresponds to the curve facing backward (kyphosis). Thus, thoracic and sacral kyphosis correspond to cervical and lumbar lordosis. Thanks to this design, the spine works like a spring, distributing the load evenly along its entire length.

In total, the spinal column has 32–34 vertebrae, separated by intervertebral discs and slightly different in structure.

In each vertebra there are vertebral body And vertebral arch, which closes the vertebral foramen. On the vertebral arch there are processes of various shapes and purposes: paired upper and lower articular processes, paired transverse ones and one spinous process protruding backward from the vertebral arch. The base of the arch has the so-called vertebral notches - upper and lower. The intervertebral foramina, formed by the notches of two adjacent vertebrae, provide access to the spinal canal on the left and right.

In accordance with the location and structural features of the spinal column, five types of vertebrae are distinguished: 7 cervical, 12 thoracic, 5 lumbar, 5 sacral and 3–5 coccygeal

The cervical vertebra differs from others in that it has openings in the transverse processes. The vertebral foramen, formed by the arch of the cervical vertebra, is large, almost triangular in shape. The body of the cervical vertebra (with the exception of the first cervical vertebra, which does not have a body) is relatively small, oval in shape and elongated in the transverse direction.

At the first cervical vertebra, or Atlanta, as it is also called, the body is absent; its lateral masses are connected by two arches - anterior and posterior. The upper and lower planes of the lateral masses have articular surfaces (upper and lower), through which the first cervical vertebra is connected to the skull and the second cervical vertebra, respectively.

In turn, the second cervical vertebra is distinguished by the presence on the body of a massive process, the so-called tooth, which by origin is part of the body of the first cervical vertebra. The tooth of the II cervical vertebra is the axis around which the head rotates along with the atlas, therefore the II cervical vertebra is called the axial vertebra.

On the transverse processes of the cervical vertebrae, rudimentary costal processes can be found, which are especially developed in the VI cervical vertebra. The VII cervical vertebra is also called protruding because its spinous process is noticeably longer than that of the neighboring vertebrae.

The thoracic vertebra has a larger body than the cervical ones and an almost round vertebral foramen. The thoracic vertebrae have a costal fossa on their transverse process, which serves to connect with the tubercle of the rib. On the lateral surfaces of the body of the thoracic vertebra there are also upper and lower costal fossae, into which the head of the rib enters.

The lumbar vertebrae are distinguished by strictly horizontally directed spinous processes with small gaps between them, as well as a very massive bean-shaped body. Compared to the vertebrae of the cervical and thoracic regions, the lumbar vertebra has a relatively small oval-shaped vertebral foramen.

The sacral vertebrae exist separately until the age of 18–25 years, after which they fuse with each other, forming a single bone - the sacrum. The sacrum has the shape of a triangle, pointing downward; it is distinguished by the base, apex and lateral parts, as well as the anterior pelvic and posterior surfaces. The sacral canal runs inside the sacrum. The base of the sacrum articulates with V lumbar vertebra, and the apex - with the coccyx.

The lateral parts of the sacrum are formed by fused transverse processes and rudiments of the ribs of the sacral vertebrae. The upper sections of the lateral surface of the lateral parts have articular ear-shaped surfaces, through which the sacrum articulates with the pelvic bones.

The anterior pelvic surface of the sacrum is concave, with noticeable traces of fusion of the vertebrae (which look like transverse lines), forms the posterior wall of the pelvic cavity.

Four lines marking the fusion of the sacral vertebrae end on both sides with the anterior sacral foramina.

The posterior surface of the sacrum, which also has 4 pairs of posterior sacral foramina, is uneven and convex, with a vertical ridge running through the center. This median sacral ridge is a trace of the fusion of the spinous processes of the sacral vertebrae. To the left and right of it are the intermediate sacral ridges, formed by the fusion of the articular processes of the sacral vertebrae. The fused transverse processes of the sacral vertebrae form the paired lateral sacral crest. The paired intermediate sacral ridge ends at the top with the usual superior articular processes of the 1st sacral vertebra, and at the bottom with the modified inferior articular processes of the 5th sacral vertebra. These processes, the so-called sacral horns, serve to articulate the sacrum with the coccyx. The sacral horns limit the sacral fissure - the exit of the sacral canal.

The coccyx consists of 3–5 underdeveloped vertebrae, having (with the exception of I) the shape of oval bone bodies that finally ossify at a relatively late age. The body of the first coccygeal vertebra has outgrowths directed to the sides, which are rudiments of transverse processes; At the top of this vertebra there are modified upper articular processes - the coccygeal horns, which connect to the sacral horns. By origin, the coccyx is a rudiment of the caudal skeleton.

Spinal nerves

The cervical plexus is formed by the union of branches of the four upper cervical nerves and is located on the deep muscles of the neck. Coming from under the posterior edge of the sternocleidomastoid muscle, the branches of the cervical plexus are divided into sensory, motor and mixed.

Sensitive branches include:

– small occipital nerve, going to the skin of the back of the head;

– great auricular nerve, which innervates the skin of the earlobe and the convex side auricle;

– transverse cervical nerve, going to the skin of the neck;

– supraclavicular nerves passing under the collarbone and above the deltoid muscle.

The motor branches go to the deep muscles of the neck and the muscles located below the hyoid bone, and also innervate the sternocleidomastoid and trapezius muscles.

The mixed branch of the cervical plexus is the phrenic nerve. The motor fibers of the phrenic nerve are directed to the diaphragm, and the sensory fibers innervate the pleura and pericardium.

The brachial plexus is formed by branches of the four lower cervical nerves and the anterior branch of the 1st thoracic nerve. The branches of the plexus extend to the neck between the anterior and middle scalene muscles and are directed to the axillary region. The plexus consists of a supraclavicular section, formed by short branches going to the shoulder girdle, chest and back, and a subclavian section, which includes long branches innervating the skin and muscles of the free part of the upper limb (with the exception of the axillary nerve going to the shoulder girdle).

The supraclavicular region includes:

– the dorsal nerve of the scapula, which goes to the rhomboid muscle and the levator scapulae muscle;

– long thoracic nerve innervating the serratus anterior muscle;

– medial and lateral pectoral nerves going to the pectoralis major and minor muscles;

– subclavian nerve, which innervates the subclavian muscle;

– suprascapular nerve, next to the supraspinatus and infraspinatus muscles;

– the subscapular nerve, which goes to the subscapularis muscle and the teres major muscle;

– the thoracodorsal nerve, which is a branch of the subscapular nerve and innervates the latissimus dorsi muscle.

The subclavian region is located in the axillary region and consists of three bundles: medial, lateral and posterior. The trunks of these bundles innervate the axillary artery and are the beginning of long branches.

The medial trunk includes:

– medial cutaneous nerve of the shoulder, going to the skin of the medial surface of the shoulder;

– medial cutaneous nerve of the forearm, innervating the skin of the medial surface of the forearm;

– ulnar nerve, which is mixed. Its sensory fibers are directed to the skin of the medial parts of the hand. On the palmar surface they innervate the skin of the fifth finger and the ulnar side of the fourth finger, on the dorsal surface - the skin of the fourth and fifth fingers and the ulnar side of the third finger. Motor fibers in the forearm are directed to the flexor carpi ulnaris and the medial division of the flexor digitorum profundus. On the hand, they innervate the adductor pollicis muscle, the muscles of the eminence of the little finger, as well as the 3rd-4th lumbrical muscles.

The lateral trunk includes:

– median nerve, which also belongs to the mixed nerve. It emerges from the lateral and medial trunks. Sensitive fibers are directed to the skin of the lateral part of the palmar surface and the skin of the 1st, 2nd and 3rd fingers, as well as to the radial side of the 4th finger and partly to the dorsum of these fingers. Motor fibers in the forearm innervate the flexors of the forearm, with the exception of the flexor carpi ulnaris and flexor digitorum profundus, and are also directed to the pronator quadratus and teres muscles. On the hand, the motor part innervates the muscles of the eminence of the thumb;

– musculocutaneous nerve, which is mixed. Its branches are directed to the flexors of the anterior surface of the shoulder;

– lateral cutaneous nerve of the forearm, which is the terminal branch of the previous nerve and innervates the forearm area.

Rear trunk includes:

– radial nerve, which is mixed. Sensitive fibers are directed to the skin of the lateral parts of the dorsum of the hand and the 1st and 2nd fingers, as well as the radial side of the 3rd finger. Motor fibers innervate the extensors of the shoulder and forearm;

– the posterior cutaneous nerve of the shoulder, which is a sensitive branch of the radial nerve and is directed to the skin of the posterior surface of the shoulder;

– posterior cutaneous nerve of the forearm, which is also a sensitive branch of the radial nerve and innervates the skin of the posterior surface of the forearm.

The anterior branches of the thoracic nerves do not form plexuses. The intercostal nerves are mixed and arise from the posterior branches. Their sensory fibers are directed to the skin of the chest and abdomen, and motor fibers are directed to the intercostal muscles, levator ribs, serratus posterior muscles, transverse thoracic muscles, as well as to the transverse and rectus abdominis muscles, external and internal oblique abdominal muscles.

The lumbar plexus is formed by the branches of the 12th thoracic nerve and the 1st-4th lumbar nerves and lies behind and partially in the thickness of the psoas major muscle, from under the lateral edge of which the branches of the lumbar plexus emerge:

– iliohypogastric nerve, classified as mixed. Its sensory fibers go to the skin over the tensor fascia lata and the gluteus medius muscle, as well as to the skin of the suprapubic region. Motor fibers are directed to the external and internal oblique and rectus abdominis muscles;

– the ilioinguinal nerve, which is also mixed, the sensory fibers of which innervate the skin of the scrotum in men and the labia in women, and the motor fibers are directed to the iliacus muscle and the quadratus lumborum muscle;

– the genital-femoral nerve, which is mixed, consists of two branches. The branches of the genital branch innervate the dartos scrotum and the levator testis muscle. The femoral branch goes to the skin below the inguinal ligament;

– lateral cutaneous nerve of the thigh, which is sensitive and innervates the skin of the lateral surface of the thigh;

– obturator nerve, which is mixed. Its sensory fibers go to the skin of the lower part of the medial thigh, and motor fibers go to the muscles of the medial thigh;

– femoral nerve, which belongs to the mixed nerve and is the largest nerve of the lumbar plexus. The anterior cutaneous branches are sensitive and are directed to the skin of the anterior thigh. The saphenous nerve, the longest branch of the femoral nerve, runs along the great saphenous vein and gives off many branches to the skin of the anteromedial leg and medial dorsum of the foot. The muscular branches of the femoral nerve go to the psoas major, iliacus, quadriceps and sartorius muscles.

The sacral plexus is formed by the anterior branches of the 4th-5th lumbar nerves, the anterior branches of the sacral nerves and the coccygeal nerve. The branches are divided into short and long and are directed to the greater sciatic foramen, forming a triangular plate located on the anterior surface of the piriformis muscle.

Short branches include:

– muscle branches innervating the quadratus femoris, superior and inferior gemellus muscles, piriformis and obturator internus muscles;

– the superior gluteal nerve, which innervates the tensor fascia lata, the gluteus medius and minimus muscles;

– the inferior gluteal nerve, which goes to the gluteus maximus muscle;

– the pudendal nerve is classified as mixed. Sensory fibers innervate the skin of the perineum and external genitalia, and motor fibers innervate the muscles of the perineum.

Long branches include:

– posterior cutaneous nerve of the thigh, which is sensitive and goes to the skin of the back of the thigh;

– the sciatic nerve, which belongs to the mixed nerve and is the largest nerve in the human body. Many branches extend from it, heading to the muscles of the posterior thigh. The nerve itself descends to the upper part of the popliteal fossa, where it divides into the tibial and peroneal nerves.

The tibial nerve runs along the posterior tibial artery between the deep and superficial flexors of the tibia and behind the medial malleolus tibia extends onto the plantar surface of the foot. In the region of the popliteal fossa, the tibial nerve gives off the following branches:

– The medial cutaneous nerve of the calf is directed to the skin of the posteromedial surface of the leg. In the lower part of the leg it unites with the lateral cutaneous nerve of the calf. Together they form the sural nerve, which passes behind the lateral malleolus and innervates the lateral parts of the dorsum of the foot;

– muscle branches innervate the muscles of the posterior surface of the leg.

In the lower leg, the tibial nerve gives off the following branches:

– medial calcaneal branches are directed to the skin of the medial parts of the heel;

– muscle branches innervate the deep layer of the posterior group of muscles of the lower leg.

On the surface of the foot, the tibial nerve divides into medial and lateral plantar branches, which are mixed and follow the same direction as the plantar arteries. Sensitive fibers of the medial plantar nerve are directed to the skin of the medial part of the sole of the foot and to the skin of the I, II, III, IV fingers.

Motor fibers are directed to the flexor digitorum brevis muscle, the muscle that abducts the big toe to the 1st-2nd lumbrical muscles. The motor fibers of the lateral plantar nerve innervate the flexor of the little toe brevis, abductor of the little toe, adductor hallucis, quadratus plantae, interosseous muscles and the 3rd-4th lumbrical muscles.

The common peroneal nerve is a mixed nerve and in the lateral part of the popliteal fossa is divided into the superficial and deep peroneal nerves. The main branches of the common peroneal nerve are:

– lateral cutaneous nerve of the calf, heading to the skin of the posterolateral parts of the leg and uniting with the medial cutaneous nerve of the calf;

– superficial peroneal nerve, which is mixed. Its sensory fibers innervate most of the skin on the dorsum of the foot, and motor fibers innervate the long and short peroneal muscles;

– deep peroneal nerve, following along the tibial artery. Its sensitive branch gives off many branches into the skin of the dorsum of the foot in the area of ​​the first interdigital space. Motor fibers innervate the anterior group of muscles of the lower leg and the muscles of the dorsum of the foot.

Superficial neck muscles

Rice. 32. Superficial and median muscles of the neck:

1 – laughter muscle;

2 – mylohyoid muscle;

4 – stylohyoid muscle;

5 – subcutaneous muscle of the neck;

6 – sternocleidomastoid muscle;

7 – upper belly of the omohyoid muscle;

9 – trapezius muscle;

Rice. 33. Superficial, median and deep muscles of the neck (side view):

1 – stylohyoid muscle;

2 – digastric muscle: a) posterior belly, b) anterior abdomen;

3 – mylohyoid muscle;

4 – splenius muscle of the neck;

6 – omohyoid muscle: a) upper abdomen, b) lower abdomen;

7 – sternohyoid muscle;

8 – muscle that lifts the scapula;

9 – sternocleidomastoid muscle;

10 – anterior scalene muscle;

11 – middle scalene muscle;

12 – posterior scalene muscle;

13 – trapezius muscle;

Rice. 34. Middle and deep muscles of the neck (side view):

1 – mylohyoid muscle;

2 – stylohyoid muscle;

3 – digastric muscle: a) anterior abdomen, b) posterior abdomen;

4 – longissimus capitis muscle;

5 – thyroid-hyoid muscle;

6 – longus capitis muscle;

7 – omohyoid muscle: a) upper abdomen, b) lower abdomen;

8 – sternohyoid muscle;

9 – sternothyroid muscle;

10 – muscle that lifts the scapula;

11 – longus colli muscle;

12 – anterior scalene muscle;

13 – middle scalene muscle;

14 – posterior scalene muscle;

The sternocleidomastoid muscle, when contracted bilaterally, throws the head back, and when contracted unilaterally, it tilts the head in its direction (to the side on which the muscle contracts) and turns it in the opposite direction.

The muscle is a thick, long cord with two heads, running obliquely from the mastoid process through the neck to the sternoclavicular joint. The lateral head of the muscle has its origin point at the anterior surface of the manubrium of the sternum, and the medial head has the sternal end of the clavicle. The muscle is attached to the mastoid process and the lateral part of the superior nuchal line.

When contracted bilaterally, the splenius neck muscle pulls the neck back, and when contracted unilaterally, it rotates the cervical spine in its direction. The muscle is located under the splenius capitis muscle, its origin point is the spinous processes of the III–V thoracic vertebrae, and its attachment point is the transverse processes of the two or three upper cervical vertebrae.

The levator scapula muscle, when contracted, raises the medial angle of the scapula, and when the position of the scapula is fixed, tilts the cervical spine to its side and posteriorly. The muscle itself is located under the trapezius muscle, begins on the posterior tubercles of the transverse processes of the four upper cervical vertebrae and is attached to the medial edge and angle of the scapula.

Back muscles

Superficial back muscles

The trapezius muscle is so called because the muscles on both sides together form the trapezius. Individually, each of these large flat muscles has the shape of a triangle, the base of which runs along the spinal column and is located in the upper back and back of the head. The trapezius muscle is divided into three parts, each of which performs its own functions. Top part the muscle lifts the shoulder girdle and scapula, the middle part moves the scapula towards the spine, and the lower part moves the scapula down. The muscle begins at the superior occipital protuberance, superior nuchal line, nuchal ligament and supraspinous ligament of the thoracic vertebrae, and is attached to the humeral process, the acromial (lateral) part of the clavicle and the spine of the scapula.

The latissimus dorsi muscle, contracting, brings the shoulder closer to the body and moves the upper limb back, while simultaneously turning it inward. When the upper limb is in a fixed position, the muscle brings the torso closer to it, and also helps to move the lower ribs upward during breathing movements. The muscle is located in the lower back; the point of origin is on the thoracolumbar fascia, the posterior part of the iliac crest and the spinous processes of the five to six lower thoracic vertebrae.

Rice. 35. Superficial back muscles:

2 – splenius capitis muscle;

3 – trapezius muscle;

4 – deltoid muscle;

5 – infraspinatus muscle of the shoulder;

6 – infraspinatus fascia;

7 – teres minor muscle;

8 – teres major muscle;

9 – rhomboid major muscle;

10 – triceps brachii muscle;

11 – latissimus dorsi muscle;

12 – thoracolumbar fascia;

13 – external oblique abdominal muscle;

14 – internal oblique abdominal muscle;

Superficial back muscles of the second layer

With unilateral contraction, the splenius capitis muscle turns the head in its direction, and with bilateral contraction, it pulls the head back. The muscle has an oblong shape, begins at the spinous processes of the III–VII cervical vertebrae, I–III thoracic vertebrae and nuchal ligament, and attaches to the lateral sections of the superior nuchal line, reaching the mastoid process of the temporal bone.

The rhomboid minor muscle moves the scapula toward the spine, slightly shifting it upward. Located under the trapezius muscle, it begins on the two lower cervical vertebrae and attaches to the vertebral (medial) edge of the scapula.

The rhomboid major muscle, like the minor muscle, moves the scapula towards the spine, slightly shifting it upward. Located under the trapezius muscle, it has its origin on the spinous processes of the four upper thoracic vertebrae, and its attachment point, like the minor muscle, is on the vertebral edge of the scapula.

The serratus posterior superior muscle moves the upper ribs back and up and also takes part in the act of inhalation. It is covered by the rhomboid muscles, begins in the area of ​​the lower part of the nuchal ligament, the spinous processes of the two upper thoracic vertebrae and two lower cervical vertebrae, and is attached to the outer surface of the II–V ribs, on the side of their corners.

The serratus posterior inferior muscle moves the lower ribs back and down and takes part in the act of exhalation. The muscle is covered by the vastus dorsi muscle; its point of origin is located on the superficial layers of the thoracolumbar fascia at the level of the two upper lumbar vertebrae and two upper thoracic vertebrae, and its attachment point is on the outer surface of the four lower ribs.

Deep back muscles

The suboccipital muscles, when contracted bilaterally, tilt the head back, and when contracted unilaterally, they tilt back and to the side (the inferior oblique muscle and partially the posterior major rectus muscle take part in the rotation of the head). The muscles are located between the occipital bone and the I–II cervical vertebrae. There is a small posterior rectus capitis muscle, which runs from the posterior tubercle of the arch of the atlas to the lower nuchal line, a large posterior rectus capitis muscle, which is located between the lower nuchal line and the spinous process of the II cervical vertebra, and a superior oblique muscle of the capitis, which runs from the transverse process of the atlas to the lateral section. the inferior nuchal line, and the inferior oblique muscle of the head, located between the transverse process of the atlas and the spinous process of the II cervical vertebra.

With bilateral contraction, the transverse spinal column extends the spinal column, thereby taking part in maintaining the body in an upright position; with unilateral contraction, it turns the spinal column in the opposite direction. The muscle runs along the spinal column under the rectifier torso. The muscle bundles are directed from the transverse processes of the lower vertebrae to the transverse processes of the higher ones. Surface layer The muscle is represented by the semispinalis muscle, the bundles of which spread across four to six vertebrae. It consists of the head, cervical and thoracic sections. The muscle begins from the transverse processes of the six lower cervical and all thoracic vertebrae. The attachment point for the muscle is the spinous processes of the six lower cervical vertebrae and the nuchal area of ​​the occipital bone. The middle layer consists of multifidus muscles, bundles of which spread across two to four vertebrae. These muscles are almost completely covered by the semispinalis muscle. Their point of origin is the transverse processes of the thoracic and lumbar vertebrae, the articular processes of the four lower cervical vertebrae and the posterior surface of the sacrum, and the point of attachment is the spinous processes of all cervical, except the atlas, thoracic and lumbar vertebrae. The deep layer of the transverse spinal muscle consists of the rotator cuff muscles. Their bundles predominantly connect adjacent vertebrae. The muscles of this group are divided into cervical rotators, thoracic rotators, and lumbar rotators. The origins of all muscles are located on all vertebrae, except the atlas, and the attachment point is on the spinous processes of the superior vertebrae, as well as on the bases of the arches of adjacent and neighboring vertebrae.

Rice. 36. Back muscles (superficial and deep layers):

1 – semispinalis muscle: head section;

2 – splenius capitis muscle;

3 – splenius muscle of the neck;

4 – muscle that lifts the scapula;

5 – supraspinatus muscle of the shoulder;

6 – rhomboid minor muscle;

7 – rhomboid major muscle;

8 – infraspinatus muscle of the shoulder;

9 – teres minor muscle;

10 – teres major muscle;

11 – serratus anterior muscle;

12 – latissimus dorsi muscle;

13 – lower posterior serratus muscle;

14 – muscle that straightens the spine;

15 – external oblique abdominal muscle;

17 – thoracolumbar fascia: superficial layer;

Rice. 37. Back muscles (second deep layer):

1 – rectus capitis posterior minor muscle;

2 – superior oblique muscle of the head;

3 – rectus capitis posterior major muscle;

4 – longissimus capitis muscle;

5 – inferior oblique muscle of the head;

6 – semispinalis muscle: head section;

7 – interspinous muscles;

8 – semispinalis muscle: cervical region;

9 – longissimus colli muscle;

10 – semispinalis muscle: thoracic region;

11 – external intercostal muscles;

12 – muscles that lift the ribs;

13 – longissimus muscle of the chest;

14 – lateral intertransverse lumbar muscles;

15 – iliocostal muscle;

16 – thoracolumbar fascia: deep leaf;

17 – transverse abdominal muscle;

The erector spinae muscle is the longest and most powerful of all the back muscles. A person’s posture depends on it, it helps maintain body balance, takes part in turning the head and lowering the ribs. With a bilateral contraction, the entire muscle extends the spinal column; with a unilateral contraction, it tilts it in its direction. The muscle runs along the entire length of the back on the sides of the spinous processes and has a complex structure. The origin of the muscle is located on the dorsal surface of the sacrum, in the area posterior section iliac crest, spinous processes of the lower lumbar vertebrae and on the thoracolumbar fascia. The muscle is then divided into three large sections, each of which, in turn, is divided into three parts. The spinalis muscle is located in the center of the back. The spinalis capitis muscle begins on the spinous processes of the lower cervical vertebrae and upper thoracic vertebrae, and is attached to the nuchal area of ​​the occipital bone. The spinalis capitis muscle is part of the semispinalis capitis muscle. The spinous muscle of the neck has its origin from the spinous processes of the two lower cervical vertebrae and the upper thoracic vertebrae. The place of its attachment is located on the spinous processes of the II–IV cervical vertebrae. The point of origin of the spinous thoracic muscle is located on the spinous processes of two or three lower thoracic vertebrae and two or three upper lumbar vertebrae, and the attachment point is on the spinous processes of the II–VIII cervical vertebrae. The longissimus muscle is located lateral to the spinalis and runs from the sacrum to the base of the skull. The longissimus capitis muscle begins on three to four transverse processes of the cervical vertebrae and the transverse processes of the three upper thoracic vertebrae; the attachment site is located on the posterior edge of the mastoid process. The longissimus colli muscle has its origin on the transverse processes of the five upper thoracic vertebrae, and its attachment point on the posterior tubercles of the transverse processes from the VI cervical to the II thoracic vertebrae. The longissimus thoracis muscle begins on the dorsal surface of the sacrum, the transverse processes of the lumbar vertebrae and six to seven lower thoracic vertebrae, and is attached to the corners of the ten lower ribs and to the transverse processes of all thoracic vertebrae. The iliocostalis muscle is located lateral to the longissimus muscle. The iliocostalis muscle of the neck begins in the corners of the five to six lower ribs and is attached to the transverse processes of the IV–VI cervical vertebrae. The iliocostalis muscle of the chest has its origin in the corners of the five to six lower ribs, and its insertion point in the corners of the five to seven upper ribs. The iliocostalis lumborum muscle begins at the iliac crest and on the thoracolumbar fascia, and is attached to the corners of the eight to nine lower ribs.

The interspinous muscles support the body in an upright position, holding the spinal column, and take part in straightening the spine. This muscle group consists of small muscle bundles located between the spinous processes of adjacent vertebrae and is divided into the interspinous muscles of the neck, interspinous muscles of the chest and interspinous muscles of the lumbar region.

The intertransverse muscles, when contracted bilaterally, hold the spinal column in a vertical position, and when contracted unilaterally, they tilt the spine to the side. These muscles are located between the transverse processes of two adjacent vertebrae. According to their location, the anterior intertransverse muscles, the posterior intertransverse muscles of the neck, the medial intertransverse lumbar muscles, the lateral intertransverse lumbar muscles and the muscles of the chest are distinguished.

Superficial layer of the chest muscles

The pectoralis major muscle adducts and rotates the humerus inward, when the arm is in a horizontal position, it lowers it, moving it forward and inward, and when the arm is in a fixed position, it takes part in the act of breathing (inhalation), expanding the chest and raising the ribs. This wide muscle is located in the anterosuperior part of the chest and limits the axillary fossa in front. The muscle begins on the inner half of the clavicle, the anterior surface of the manubrium and body of the sternum, the cartilages of the five to six upper ribs and the anterior wall of the fibrous sheath of the rectus abdominis muscle. The pectoralis major muscle attaches to the crest of the greater tubercle of the humerus.

The pectoralis minor muscle moves the shoulder girdle forward and down, and with the scapula in a fixed position, it raises the ribs. This flat triangular muscle is also covered by the pectoralis major muscle. Its starting point is located at the junction of the bone and cartilaginous parts of the III–V ribs. As they rise, the muscle bundles come together and attach to the coracoid process of the scapula.

Rice. 38. Superficial muscles of the chest and abdomen (side view):

1 – sternocleidomastoid muscle;

2 – deltoid muscle;

3 – trapezius muscle;

4 – triceps brachii muscle;

5 – infraspinatus muscle;

6 – teres minor muscle;

7 – pectoralis major muscle;

8 – teres major muscle;

9 – serratus anterior muscle;

10 – latissimus dorsi muscle;

11 – external oblique abdominal muscle;

12 – aponeurosis of the external oblique abdominal muscle;

The serratus anterior muscle moves the scapula forward and outward, pulling it away from the spinal column, and also participates in the rotation of the scapula when raising the arm to vertical position. Together with the rhomboid muscle, it fixes the scapula, pressing it to the surface of the chest. This flat broad muscle is located in the anterolateral part of the chest wall. Its upper part is covered by the pectoralis major muscle. The muscle begins on the outer surface of the eight to nine upper ribs and on the tendinous arch between the 1st and 2nd ribs. The attachment point is the medial edge of the scapula and its lower angle.

Massage for various diseases of the musculoskeletal system

Unfortunately, even such a strong and perfect system as the musculoskeletal system is susceptible to destruction and various diseases. The range of diseases affecting joints, bones and muscles is quite wide, ranging from the well-known osteochondrosis, which causes a lot of trouble for many, to more rare, little-known diseases.

In this section we will take a closer look at the most common diseases of the musculoskeletal system, which affect almost the entire population.

This group of diseases, unfortunately, in addition to painful sensations and temporary disability, can lead to disability in people who are still quite young and capable. Therefore, when you feel the first signs of even simple muscle pain, you need to take action and not wait until it “goes away on its own,” as we are all used to talking about it. “On its own” nothing passes anywhere. If the pain goes away without any treatment, this does not mean that you have recovered. The disease simply went into remission, that is, the acute form was replaced by a chronic one. The process of degeneration in tissues continues to develop, and one day it will remind you of itself with a new exacerbation, most likely more severe.

General principles of massage for diseases of the musculoskeletal system

Purpose of massage in this case, improve blood circulation to accelerate the resolution of inflammatory processes, resorption of salt deposits, accelerate regenerative processes, eliminate contractures and muscle atrophies, improve the functioning of the ligamentous apparatus, and reduce pain.

It should be taken into account that massage for injuries musculoskeletal system is done not earlier than the third day after damage. If there has been an injury and there is no threat of bleeding, you can start massage on the fourth day, provided that normal temperature bodies.

General methodology

For the first three days, the massage is done with gentle, suction, i.e. above the site of injury. Massage techniques include plane, grasping, superficial stroking, shading, planing, longitudinal kneading, vibration stroking. It is imperative to massage symmetrically located healthy segments, affecting the paravertebral zones spinal segments and reflexogenic zones.

In case of a fracture of the lower extremities, the gluteal muscles, costal arches, and iliac crests are massaged.

In case of a fracture of the upper limbs, massage the sternocleidomastoid muscles, the outer edge of the vastus dorsi muscle, the active muscles, and on the side of the injured limb - the sternoclavicular and clavicular-acromial joints.

Paravertebral zones are massaged from underlying to overlying segments: stroking, rubbing, kneading, vibration; on the joints, stroking and rubbing. If the patient notices improvement, then you can move to the damaged segment. Movements should be light, soft, gentle, gentle. Superficial, planar, grasping stroking, superficial rubbing, vibration stroking with low amplitude are used. If the result is positive, you can gradually increase the intensity. Damaged muscles are massaged by stroking, kneading longitudinally and transversely, felting, sliding, continuous vibration, patting and shaking, and stroking again. We stroke and rub the joint and joint capsules. Then we stroke again and move on to physical exercises. The beginning should be thermal procedures (sollux, paraffin or mud therapy). The course of treatment is 10–15 procedures every day, lasting from 10 to 20 minutes.

Pain syndromes of muscular and musculotendinous origin

Myositis is an inflammation of muscle tissue. Usually myositis occurs as a result of overload of any muscle group or during hypothermia and manifests itself muscle pain when moving. To the touch, the muscles become dense, less elastic, painful, and there is limited movement. If you feel any of the symptoms described above, you need to take a number of simple measures that will relieve you of myositis. It is necessary to avoid stress on the affected muscle group; you can use ointments and rubbing (see below). Massage will quickly relieve you of this disease.

Objectives of massage: improve blood circulation, reduce swelling, have an analgesic and absorbable effect.

Massage technique. The first two or three procedures give a gentle massage, i.e. you should not use all the “heroic prowess”. All techniques are used: stroking, rubbing, light kneading, light continuous vibration. The overlying areas and vertebral segments are treated first. For myositis of the muscles of the upper limb, the cervical-collar area is first treated, then the shoulder, forearm, hand, from the fourth or fifth procedure the load can be increased, i.e. all techniques are carried out more energetically, a good result is achieved by affecting the painful points (but this does not mean , that you need to put pressure on them until your eyes go dark), on pain points act up to the pain threshold.

The course of treatment is approximately 8-10 procedures of fifteen minutes each.

Myalgia

Myalgia manifested by swelling of the muscles, shooting pains, sometimes the pain has a “twisting”, “drilling”, “aching” character or looks like a sensation of “ache”. Roller-like thickenings or individual pockets of muscle tension form among relaxed areas of the muscle in the muscle tissue. If measures are not taken to treat this condition, then the phenomena of fibromyositis and myogelosis join the chronic course of myalgia.

Myogelosis

Myogelosis– this condition is characterized by low muscle elasticity, limited movement and nodular compactions in the muscle tissue. Also, with myogelosis, it is almost impossible to completely relax the muscles. If this pathological process is continued further, then the next stage will be myofibrosis.

Myofibrosis

Myofibrosis– as you already understand, occurs due to repeated stress, hypothermia and others unfavorable factors against the background of myogelosis. This disease can be described as a chronic degenerative process of muscle tissue. By palpation (by touch) you can feel peculiar “laces”, i.e. dense oblong cords. Again, as in previous conditions, there will be a decrease in muscle elasticity and pain on palpation.

Therapeutic measures in these conditions will be the same as in acute myositis. Distinctive points: you can increase the course of treatment to ten to fifteen procedures, repeat massage courses, even if there are no exacerbations. If your general condition allows, you can visit the bathhouse.

Traumatic soft tissue injury

In case of sprained tendons, muscles, ligament ruptures, bruises, rest is recommended for the first two days, exalted position limbs, tight bandage; in the first 3–4 hours apply cold to the bruised area. If not affected large vessels, on the third day you can start massage. At the first sessions, a suction massage is performed, i.e., the overlying parts of the limb are massaged. Planar grasping, stroking, circular rubbing, shading, planing, longitudinal kneading, and vibration stroking are used. All techniques should be done extremely gently, softly, symmetrically and on a healthy limb.

If there is no exacerbation or pain after the massage, you can move on to the sore area. You need to start the massage very gently, the movements are the same, but with a small amplitude and shallow. Massage each bony protrusion, joint capsule, tendon sheath, muscle tendon and their attachment points, combining with active and passive movements of the joint. Start the massage with 5-10 minutes, increase the time and intensity of movements to 15-20 minutes. There are 12–15 procedures per course of treatment. The massage will be especially effective after thermal procedures (paraffin baths, Sollux, etc.).

If the lower extremities are affected, the buttocks, costal arches to the iliac crests are massaged.

If the upper extremities are affected, massage the cervical sympathetic nodes, sternocleidomastoid muscles, trapezius muscles, deltoid and latissimus dorsi muscles (outer edges). Massage the paravertebral zones from underlying to overlying segments - stroking, rubbing, kneading and vibration. On joints and bones – smoothing and rubbing. After the massage, tight bandaging again, an elevated position and peace. The upper limb should rest on the scarf in a physiological position.

Joint injuries

The consequences of joint injuries can be post-traumatic ankylosis, contracture, and muscle atrophy.

In these cases, before applying a plaster cast, segmental reflex massage and/or local massage are performed, combined with the staged application of plaster casts, and the same is done after removing the bandages. If surgical treatment is indicated, then on the 14th day after surgery you can combine massage with exercise therapy.

Methodology:

The sore limb is massaged above the damaged joint, the joint itself and below it. Stroking, rubbing, kneading are used as a suction massage.

The damaged joint is massaged by stroking, rubbing, kneading - longitudinally and transversely, using felting, stretching and compression of the muscles.

For muscle wasting, stimulation techniques are used - passive stretching and contraction of muscles and tendons at a fast pace, ending the massage with good shaking and quilting.

For stiffness - stroking and rubbing the periarticular tissues and ligaments: massage with fingertips using forceps-like stroking. Shortened and weak ligaments are stroked, rubbed - shading and continuous vibration. Massage the fracture site with circular stroking, rubbing, vibration very gently, shifting and stretching the tissues fused to the callus.

In case of injury to the joints of the upper limb, the deltoid muscle is massaged in all ways, the shoulder joint is massaged by stroking and rubbing, grasping the clavicular-scapular joint, and finally, shaking the chest.

In case of injury to the joints of the lower limb: gluteal muscle - deep stroking, rubbing, shading, sawing, kneading, vibration of the iliac crests. The hip joint and ischial tuberosity are stroked and rubbed with shaking of the pelvis. The massage ends with a general broad stroking of the sore limb, passive and active movements and shaking of the healthy limb.

Joint dislocations

For dislocation of the elbow, wrist or finger joint, massage is prescribed on the 4th day, for dislocation of the shoulder joint after 10 days, for dislocation of the joints of the lower extremities on the 12th day after fixation of the joint or its reduction.

The first three days they massage the muscles with a gradual transition to the sore joint. If there was traction after reduction, for example, of the thigh or lower leg, then massage the pelvic area and the sore leg on the 7th day. For habitual dislocations after surgery, massage with elements of therapeutic exercises is started on the 10th day. If the knee joint is damaged, then massage the thigh, lower leg, hip joint, buttock, etc.

Methodology similar to the massage technique for residual effects after a fracture of the limb bones.

Prescribe 10–12 procedures of 15 minutes each, after thermal procedures with elements of therapeutic exercises.

Pain syndromes of spinal osteochondrosis

The reason for the exacerbation of this disease can be factors such as hypothermia, inadequate physical activity, static overstrain of the back muscles, and hypothermia in combination with physical overload will give the most rapid and severe exacerbation. Such processes are explained quite simply.

When hypothermia occurs, blood circulation in the affected area is disrupted, which leads to stagnation, oxygen starvation of the muscles, muscle spasms - here is ready-made inflammation with pain. With inadequate physical fatigue, myopathoses (functional-trophic lesions of muscles with pain) are formed. Such lesions of the muscular apparatus of the spine in the long term lead to disturbances in the biomechanics of the spinal column itself and lead to the formation of blockades of the intervertebral joints due to possible infringement of the intra-articular meniscoid. What does “formation of blockade of the spinal joints” mean?

In general terms, it looks like this: for example, the lumbar region has become hypothermic. As a result, inflammation of the paravertebral muscles of the back occurred ( lumbar region), muscle spasm, a kind of stagnation, as a result of which the affected muscle lags behind in work or even “turns off” for some time due to pain. This will lead to what was already mentioned above - the formation of a functional blockade, i.e. some joints of the lumbar spine will cease to participate in the mechanics of the spinal column, which will lead to a compensatory reaction of other joints of the spine. This means that increased mobility will develop in the joints above or below, which will compensate for the immobility of the blocked joints.

On the other hand, any inadequate load or awkward movement can lead to blockade of the spinal segments, which in turn will lead to inflammation in the soft tissues, pinched nerve roots, etc. The same process occurs, but on the other side. Here, perhaps, is a quick, superficial look at the formation of osteochondrosis and functional blockades of the spine.

Since the spine is one of the important integral systems of the body that innervates our entire body, damage to the spinal column leads to various reflex pain syndromes at each level of the spine and is the direct initiator of other diseases that we will now consider.

Massage technique for pain syndromes of spinal osteochondrosis

With predominant damage to the cervical spine, severe autonomic neurodystrophy occurs, damage to the roots of the cervicothoracic spine is radiculitis, etc.

Damage to the thoracic region is characterized by pain in the spine, in the interscapular region, intensifying after physical activity, stiffness of movement, pain in the heart, head, abdomen and right hypochondrium, up to genitourinary disorders.

Damage to the lumbar region causes pain in the lumbosacral region - lumbago; or pain radiating only to the leg - ischalgia. In addition, sensitivity disorders, atrophy and muscle paresis appear, accompanied by trophic disorders and circulatory disorders: the skin becomes dry and peeling appears. Functional dysfunction is also possible Bladder and intestines, limited mobility in the lumbar spine.

Methodology: for osteochondrosis of the cervical spine, massage the neck, collar area and upper limbs. All techniques are used: stroking, rubbing, kneading, patting. The exception is for painful areas; in them the massage is light, gentle, without shock techniques.

For osteochondrosis of the thoracic and lumbosacral spine, the entire back, lumbar spine and sore lower limb are massaged. Do the massage selectively: intense massage on healthy areas and gentle massage on sick areas. The purpose of massage for diseases of the spine is to improve blood circulation, nourish the affected areas, improve sensitivity, relieve local muscle spasm, combat atrophy, contractures and pain.

A massage is prescribed every day for 15–20 minutes in the amount of 10–12 procedures.

Cervicalgia

Cervicalgia– reflex pain syndrome of the cervical spine. The cause of this condition is usually osteochondrosis of the fourth-fifth and fifth-sixth intervertebral discs cervical segments. It manifests itself as pain, stiffness directly in the affected area and nearby tissues, limitation of movement, and lumbago in the neck. The nature of the pain can be very different. Increased pain sensitivity in the upper cervical region indicates disorders in the area of ​​the cervicocranial junction, and in the mid-cervical region it indicates a pathological process in the third to sixth vertebral joints. Often this condition of the cervical spine impairs mobility in the shoulder joints.

Treatment. If an acute states with In cases of severe pain, treatment is carried out gently, using gentle techniques. It would be good to have manual therapy procedures performed by an experienced specialist. (Manual therapy must be taken quite seriously; you should not trust home-grown chiropractors or neighbors. This procedure must be carried out by a certified specialist doctor.) If this is not possible, then you can conduct a course of drug anti-inflammatory therapy, and be sure to conduct a course of massage.

Objectives of massage: it is necessary to improve blood circulation in the affected tissues, relax spasmed muscles, restore normal mobility in the cervical spine, and provide an analgesic effect.

Massage technique. The massage is carried out according to standard methods. All techniques are used: stroking, rubbing, kneading, vibration. The first two or three procedures are carried out easily, in a gentle manner, observing the patient’s reaction. When manipulating the neck-collar area, it is necessary to monitor the state of blood pressure, since inadequate influence in this area can provoke surges in blood pressure, especially in those individuals who are predisposed to this; in the future, it is necessary to pay attention to kneading areas of muscle tension.

Acupuncture. A good result is achieved by influencing pain points and acupuncture points in the cervical-collar region (Fig. 39). If the pain is localized in the anterior surface of the neck, it is better to use local points: IG16, IG17. With maximum pain, the best effect is exerted by distant points: GI4, P7. For pain in the back of the neck:

Rice. 39. Acupuncture points used for cervicalgia

Local: VB20, VB21, VB12, T15, V10, V11, TR15, TR16, IG15.

Distant: IG3, V60, VB38.

Local and distant AT on the sore side are affected by the inhibitory method, on the opposite side - by the tonic method. Massage procedures can be carried out with therapeutic anti-inflammatory and warming rubs. The course of treatment depends on the dynamics of the process, on average 10 procedures.

Shoulder syndrome

The main cause of glenohumeral syndrome is osteochondrosis of the lower cervical spine; a similar condition can also be observed without osteochondrosis. The disease leads to reflex disorders in the muscle tissue of the shoulder, shoulder girdle, and chest.

The pathological process can also involve the tendons and periarticular tissues of the shoulder and elbow joints. Also in certain areas, changes in muscle and fibrous tissue occur, i.e., painful foci of local hypertonicity (small hard nodules in the muscles, of varying density and size) are formed. Pressing on these points causes pain (they are also called “trigger”, trigger points (Fig. 40). This condition is called the trigger stage. There is also an algic stage. At this stage, in the painful area there will be a hidden focus that manifests itself when pressed, or an active focus with unexpected pain arising, but no such foci of compaction are detected.If the process is started, that is, inflammation and dystrophic changes in the muscles and joints have begun, this means that the disease has passed into the muscular-dystrophic stage and will now develop independently of the processes in the cervical spine.In this case, the autonomic nervous system(her sympathetic part). This manifests itself in the form of pain of a squeezing or tearing nature. Mostly pain is felt in the glenohumeral region, sometimes in the cervicofacial or costal-axillary region.

Rice. 40. Trigger points (x) and pain zones (according to D. Travell and Rinzler)

Treatment glenohumeral syndrome is as comprehensive as possible: this includes manual therapy (if necessary), massage, drug therapy, and physiotherapy. Medications you can take are analgesics (baralgin, analgin, etc.), vasodilators (nicotinic acid, etc.). Massage in combination with acupuncture will provide significant assistance.

Objectives of massage: improve blood and lymph circulation, have an analgesic effect, reduce nerve swelling (if any), restore normal range of motion of the upper limbs, and combat vestibular disorders.

Methodology. Massage the cervical-collar area and upper extremities. The position of the person being massaged is sitting or lying on his stomach. First, stroking the neck, trapezius, deltoid muscles is performed, then rubbing with fingertips, sawing, etc., thoroughly treat the edges of the shoulder blades and the interscapular space. After this, they move on to kneading the muscles of the neck, trapezius muscles, and paravertebral muscles of the cervicothoracic region. Then they move on to the muscles of the upper limbs. Usually massage is done in the subacute and chronic stages, but if you approach this skillfully, then massage can also initially relieve an exacerbation. The first procedures are done easily, with soft, insinuating movements. Good results are achieved by targeting trigger points and biologically active points.

Acupuncture. For pain in the cervico-brachial region: VB21, TR15, T13, V11, IG10, IG12, IG13, IG14, IG15, TR14, TR15, VB20, V10, T15, T16, TR16 (Fig. 41). If the pain spreads along the front surface of the shoulder, use points GI4, TRK8. On the rear surface – IG10,14, TR3.

Rice. 41. Acupuncture points used for glenohumeral syndrome

There is no need to use all the points listed; it is enough to select (for each session) a few of the most effective ones. Positive result gives the application of the Kuznetsov applicator to the cervical-collar region (Fig. 42).

Rice. 42. Application of the Kuznetsov applicator

Humeroscapular periarthrosis

Scapulohumeral periarthrosis syndrome is also called “frozen shoulder.” This is also one of the manifestations of cervical osteochondrosis. Here the pathological process develops in the soft tissues of the surrounding joints. The development of this disease can also be caused by hypothermia, inadequate physical activity, injury, etc. The main symptoms here will be pain and stiffness in the joints. Pain is felt in the shoulder joint, shoulder girdle, upper arm, shoulder blade and neck. Typically, the pain intensifies with various movements in the shoulder joint, especially when abducting the arm or placing it behind the back. Also, an increase in pain occurs when the weather changes and at night.

Another problem of this syndrome, as already mentioned, is contracture of the musculo-ligamentous apparatus of the shoulder, i.e. the patient cannot perform movements with his hands such as moving the arm to the side and up, forward and up, placing the arm behind the back and behind the head.

Treatment a comprehensive treatment is carried out: medication, physiotherapy, massage of the cervical-collar region and upper limb, as well as physical therapy, gives very good results.

Objectives of massage: have an analgesic effect, relieve muscle spasms, improve blood circulation in tissues, and restore impaired mobility in the shoulder joint.

Methodology. Massage the cervical-collar region and upper limb. The massage is carried out according to the general scheme. During the procedure, it is necessary to focus on treating painful areas, muscle tightness and developing contractures. You can use medicinal rubs. Introduce passive, then active movements into the procedure. Impact on AT.

The course of treatment is 10–15 procedures, massage courses must be repeated.

For pain that intensifies with movement and radiates to the head - TR1, aggravates with raising the arms - R22, pain when rotating the arms - VB21, TR10,11, with changes in the weather - TR15.

Rice. 43. Fibroplastic tissue compactions in glenohumeral periarthrosis

Rice. 44. Acupuncture points used for glenohumeral periarthrosis

Epicondylosis (tennis elbow)

The causes of this disease are almost the same as those of glenohumeral periarthrosis. But a certain kind of repetitive work also plays a detrimental role, that is, if, due to some professional duties, a person is forced to keep the brachioradialis muscles in tension: In the forearm positions with the hand down or up. The main symptom here is pain. The disease develops unnoticed; Due to the fact that the pain is not severe in the initial period, many do not pay attention to it. Gradually, the pain intensifies, and movements in the hand become painful. The places where the muscles attach to the epicondyle also hurt.

Treatment almost the same as glenohumeral periarthrosis.

Rice. 45. Acupuncture points used for epicondylosis

Shoulder-hand syndrome

The disease is relatively severe. The main symptoms here are pain in the muscles and joints of the hands, increased sensitivity hand skin Slight swelling of the hand and blue discoloration are possible. With further development of the pathological process, contractures (stiffness) of the joints, atrophy of the muscles and skin of the hand may form.

Treatment a comprehensive procedure is carried out, i.e. the pain must first be relieved (this can be done with the help of medications). Reflexology and massage are also effective. As recovery progresses, passive and then active movements are included.

Objectives of massage– have an analgesic effect, remove swelling, improve blood circulation in tissues, prevent joint contractures.

Methodology. Massage the cervical-collar area and the affected limb. The massage is done using a gentle technique with soft, insinuating movements. After the exacerbation process has passed, physical therapy can be introduced. Acupuncture has a good effect, both in eliminating pain and in the further recovery process. The course of treatment is 10–15 procedures. Conduct 2-3 courses with short intervals.

Rice. 46. ​​Acupuncture points used for shoulder-hand syndrome

For pain in the hand – C7, MS7, GI5, P9, TR4, IG5;

For pain in the fingers - P6;

For pain radiating to back side brushes – GI10, palm – P9, P1;

Pain with numbness of the finger – P11;

When extending the fingers – TR4;

When bending the fingers, but without pain - TR3.

Vertebrogenic thoracalgia

Reflex pain syndrome of the thoracic spine. It occurs especially often as a result of disorders of the cervicothoracic junction. This syndrome is often confused with coronary heart disease (CHD), because the symptoms of these diseases are similar and it is quite difficult to distinguish between them, although it is possible. Cardiac pain in IHD is compressive, retrosternal, accompanied by a “feeling of fear of death”, in contrast, vertebrogenic pain will be aching, stabbing in nature, sometimes squeezing, burning. It can be either short-term or long-term, from several hours to a day. With ischemic heart disease, the pain is usually short-lived. Depends on physical activity and goes away with rest. With thoracalgia, pain may disappear after physical activity, but at rest the nature of the pain may change. Taking nitrates (nitroglycerin, etc.) relieves attacks of ischemic heart disease, but does not bring relief from thoracalgia. These symptoms can be used to distinguish between these seemingly similar diseases, but for diagnostic accuracy, an ECG is usually performed. There are several types of thoracalgia, characterized by disorders of various parts of the thoracic spine:

A) thoracalgia resulting from disorders in the lower cervical spine. The main symptom here will be pain. The pain is often associated with turning and tilting the head, localized in the upper chest or radiating to the neck, left shoulder and arm. When pressing in the area of ​​the trapezius muscle, its soreness and muscle tension will be noted;

B) thoracalgia resulting from a violation of the upper thoracic spine. With this disorder, the pain will be substernal, diffuse, aching in nature. Pain occurs regardless of body movement. In the muscle tissue of the damaged area of ​​the back, there will be an increased tone of the long back muscles, which are quite painful when pressed;

C) thoracalgia caused by dysfunction of the costotransverse joints. Here the pain will be completely different in nature: aching, stabbing, long-term, short-term, associated with the act of breathing, etc. The pain can spread in the isola, between the shoulder blades, on the side, below armpit. At deep dive fingers into the affected tissue, an increase in muscle tone can be detected in the levator scapulae muscle and intercostal muscles. Also with this syndrome, painful changes are found in the area of ​​the sternocostal joints and in the periosteum of the ribs;

D) anterior chest wall syndrome. Occurs when the function of the mid-thoracic region is impaired. The result is a dull, aching pain that can intensify with movement and lasts quite a long time. When pressed, painful areas are detected in the places of attachment of the pectoralis minor muscle along the midclavicular line at the level of the III–V ribs, and the tone of the pectoralis major and minor muscles is increased.

Treatment. Depends on the localization of the process. You must first clarify which of the four variants of the syndrome occurs in your case, then choose a treatment tactic. Very good effect manual therapy provides. After the elimination of the functional blockade or in parallel with it, it is necessary to conduct a course of massage.

Objectives of massage: improve blood circulation, relieve spasms and pain in the muscles, restore elasticity and normal mobility in the muscles and joints of this part of the spine.

Rice. 47. Areas of pain distribution in vertebrogenic thoracalgia

Massage technique. Cervicothoracic massage is carried out according to the general scheme. They start with general stroking, then move on to rubbing, kneading, and vibration. The first procedures should be carried out less energetically, calmly, studying the condition of the tissues of the affected area and the mobility of the joints of the spinal column. In the initial stages, vigorous rubbing should not be used.

Acupuncture. It has a good effect on painful points. When influencing biologically active points, it is necessary to determine along which intercostal nerve the pain passes; If there is a disease of any internal organ, pay attention to the diseased organ. The use of distant points depends on the localization of the process. So, when the Th 3 -Th 6 roots are affected, it is better to act on the points of the upper extremities. When Th 7 -Th 12 are affected - to distant points of the lower extremities (Popova, Voytanik et al., 1992).

Rice. 48. Acupuncture points used for vertebrogenic thoracalgia

Approximate combination of acupuncture points: V60, from V12 to V20 it is necessary to find the affected nerve and act paravertebrally on both sides of the spine. In addition, they include 2-3 pain points along the nerve, plus distant points. This may include: V40, V60, V62, V67, VB34, VB40, VB41, E36, E41, E42, RP6.

The braking technique is used. Using the Kuznetsov applicator gives a good effect.

Reflex syndromes in osteochondrosis of the lumbar spine

These syndromes arise for the same reasons as lesions of the upper parts of the spine: these are dystrophic changes in the discs, joints of the spine, weakness of the paravertebral muscles of the back, increased mobility of the joints of the spine, injuries, overexertion, etc. D. Konstandinov (1983 .) noted the following statistics: disc herniation and spondyloarthrosis are detected in 90% of patients with lumbosacral syndrome. But the cause of this syndrome is also pain caused by blockade of spinal motion segments - 20-23% of patients. Weakness and dystonia of paravertebral muscles – in 16% of patients.

How can you figure out where the disc pathology is, where the blockade of spinal motion segments is, where muscle weakness is, etc.? All these questions must be resolved by a neurologist based on an X-ray of the spine and objective data on the patient’s neurological status. But the first hints of disc pathology will be severe acute pain with a specific localization, perhaps aggravated by coughing, sneezing, or at night. The pain may radiate along the nerve roots. Characterized by muscular fixation.

With blockade of spinal motion segments, the pain is not so acute and there is no clear localization. It occurs mainly when moving, and usually radiates (pain) no lower than the knee.

Lumbago

We have already discussed the main causes of these syndromes above, so let’s move on to the main symptoms of this disease. A characteristic symptom of lumbago will be acute sudden pain in the lumbar spine. The disease can arise and develop so rapidly that it can simply catch you in the most inappropriate situation. Pain will occur with any awkward movement. Hypothermia or lifting a heavy object can trigger an attack. As a rule, the pain is quite sharp and on both sides, it can radiate to the lower abdomen, buttocks, and intensifies with any movement. Therefore, such patients are characterized by careful, gentle movements and forced postures. The paravertebral muscles in the lumbar region will be very tense and inflamed. Outwardly, they resemble two parallel ridges, quite dense and painful.

Treatment this syndrome is carried out carefully, especially in the initial stages. Complex therapy is needed here. Usually, from the first days, strict bed rest is prescribed and intramuscular injections anti-inflammatory drugs. For example, diclofenac (if there are no gastrointestinal diseases), prozerin with B vitamins (B 1, B 6, B 12 alternately), you can trigan, etc. In any case, before using medications, it is better to consult a doctor, because because each person is individual in his development, and almost everyone also has other concomitant diseases for which some specific medications are undesirable.

As for physiotherapeutic procedures, here they once again prove their effectiveness. Typically, massage is prescribed after the acute condition has been relieved. But if you approach this process professionally, you can also relieve pain and achieve improvement with the help of massage and reflexology.

Rice. 49. Acupuncture points used for lumbago

Objectives of massage: it is necessary to reduce pain, improve muscle tone and trophism, and restore normal mobility in the lumbar region.

Massage technique. Usually they do a classic massage, which has a good effect on biologically active and painful points. As mentioned earlier, it is necessary to take into account when carrying out massage procedures: the stage of the disease; severity of pain syndrome; the general condition of the patient and the condition of the segmental zones in the affected area; the appearance of his forced posture (possible bending of the spine - with the apex towards the painful side); limited movement in the lumbar region; pain when walking (possible lameness). Palpation check the condition of the muscles of the lower extremities (buttocks, thighs, legs), as well as the condition of large nerve trunks (sciatic nerve, femoral, tibial).

Based on all objective data, three stages of the disease can be identified, i.e. acute, subacute and the stage of clinical recovery. Having determined the stage of the disease, choose the tactics of massage manipulations. Thus, in the acute period, when severe pain, forced posture, etc. are noted, areas remote from the lumbosacral region (foot, lower leg) are usually massaged, and also remote acupuncture points are affected: V60, V56, V57, V58 , V65, V36.

They act using the inhibitory method. You should not massage all the above points at once. 2-3 points per session are enough. Treatment is carried out in parallel with medication. The patient must remain in bed. Usually this period lasts up to a week. Then the pain becomes less intense and usually occurs with awkward movements, overload, hypothermia, etc.

In this (subacute) period, you can already massage the lumbosacral region. But the massage is done in a gentle manner, with soft “stretching” movements, especially the first three or four procedures. Then, if there is noticeable improvement, you can increase the load slightly. It is also necessary to influence pain and acupuncture points: V25, V26, V27, V29, V30, VB30, V36, V37. They act using the braking method, symmetrically. For one session, 3–4 local and 1–2 distant points are selected. The course of treatment is 10–15 procedures, approximately 20 minutes each.

During the recovery stage, massage is carried out according to the general scheme, here it is already possible to act more energetically, including all massage techniques. After recovery, they usually take a course of massage for preventive purposes and repeat such courses at intervals: one course every three to four months.

Lumbodynia

The disease is much more common than lumbago and is usually a chronic process. The cause is most often a blockade of the spinal motion joints. This syndrome is provoked by the same factors: static load, hypothermia, inadequate physical activity, etc.

In this case, as already noted, the disease does not occur so acutely, so the pain may intensify over several days. The disease usually occurs in a subacute form. The pain makes it difficult to bend the body, especially forward. If in the previous syndrome the pain manifested itself symmetrically on both sides, then here the pain is mainly one-sided and muscle tension in the paravertebral muscles is not so pronounced. So you can palpate them and detect dense, painful nodes (myogelosis).

Rice. 50. Acupuncture points used for lumbodynia

Treatment: B in general, the treatment is almost the same as for the subacute and chronic stages of lumbago. But before starting treatment, it is advisable to take an x-ray lumbar region, because hernia and other injuries to the intervertebral disc very often occur in the lumbar region, although many do not even suspect it. In general, the origin of lumbodynia is not characterized by disc disorders, but anything is possible...

Returning to therapeutic measures, it is worth mentioning that manual therapy, massage, and the use of the Kuznetsov applicator have a good effect; You can use various rubbings (for massage).

During the recovery stage and after, it is advisable to do physical exercise.

Acupuncture points. If the pain intensifies when bending forward - RP3. All movements are painful – VB34. Pain when bending forward and backward – V38, RP2.

Local points are also used (see treatment of lumbago).

Hygialgia

This is also one of the syndromes of osteochondrosis of the lumbosacral spine. Here the sciatic nerve, which innervates the lower limbs, is involved in the process. The disease is quite long-term and can lead to long-term disability for a still fully capable person.

The cause of the disease may be associated with disc herniation, functional blockade vertebral joints, also the cause may be inflammation due to microtrauma of the ligamentous-articular apparatus.

The next stage is inflammation and swelling of the muscle, then irritation of the dorsal roots of the spinal nerves occurs. This results in symptoms such as pain in the lumbosacral region. The pain can be completely different in nature: dull, sharp, aching, shooting, squeezing. The pain usually radiates along the nerve along the back or side of the leg. Pain is often accompanied by impaired skin sensitivity. This may be a crawling sensation or slight numbness of the skin, but more often there is increased soreness of the skin. It is difficult for the patient to sit; he “spares” himself. The muscles in the lower back and buttocks may be tense. There is pain in the following points: VB30, V36, V37, V55, V60.

Rice. 51. Acupuncture points used for sciatica

Treatment. To accurately diagnose the cause of the disease, it is necessary to take an x-ray of the lumbosacral region. Having identified the cause and stage of the disease, treatment tactics are chosen. Depending on the patient’s condition, treatment is usually quite long, consisting of several courses, but even after recovery it is necessary to carry out preventive massage courses and engage in physical exercise aimed at strengthening and developing the spine and back muscles.

Objectives of massage. Relieve muscle spasm of the lumbar region, remove inflammation and swelling in the muscles and sciatic nerve. Eliminate pain, restore normal mobility of the lumbosacral region and lower limb. Improve lymph flow and blood circulation.

Methodology. In the acute period, treatment is almost the same as for lumbago, i.e. bed rest, medications, and distant points can be used. Some experts recommend massaging the healthy leg.

In the subacute stage, a gentle massage is performed. It is not recommended to do prolonged and vigorous rubbing, as this will cause increased blood flow to the muscles and, roughly speaking, will “compress” the already swollen and pinched nerve even more. Shock vibration techniques are also not recommended, but in general, massage is done according to the classical scheme, massaging the lumbosacral region and the affected limb. It is necessary to relax the muscles well. Manual traction can be used (Fig. 52). It must be performed with gradually increasing effort. The criterion for the effectiveness of traction is pain relief; if there is no relief, traction should be abandoned.

Rice. 52. Manual traction technique

It has a great influence on acupuncture points, both local and distant. Cupping massage and Kuznetsov's applicator give a good effect.

Spondylosis deformans

Spondylosis deformans is an advanced stage of osteochondrosis with the phenomena of bone growths of the vertebral bodies (“osteophytes”).

Methodology: plane stroking, circular rubbing, planing, sawing, longitudinal kneading, shifting longitudinally and transversely, continuous vibration, patting - for paravertebral zones.

When massaging the trapezius muscle - stroking, rubbing, forceps-like kneading, including the supraclavicular edges, forceps-like stroking and kneading the sternocleidomastoid muscles.

Latissimus dorsi muscles - stroking, rubbing with palms, longitudinal kneading, stretching and squeezing the outer edges of the muscles, vibration stroking.

Massage of the interspinous spaces and spinous processes from the underlying to the overlying parts of the spine - stroking, rubbing and continuous vibration with the fingertips, longitudinal sawing, intermittent, with pressure on the spinous processes.

Massage of the shoulder joints - stroking, rubbing the ligamentous apparatus, lower cervical vertebrae - stroking, rubbing, continuous vibration, VII cervical vertebra - all techniques and puncturing.

Lumbar massage - circular stroking, rubbing, continuous vibration, puncturing.

Gluteal muscles – superficial stroking and deep rubbing with a brush, shading, sawing, crossing, kneading, stretching and longitudinal shifting. Vibration – continuous, patting, chopping, vibration stroking.

The iliac bones are massaged in the direction from the groin area to the spine. Costal arches - from the sternum to the spine, as well as intercostal spaces.

Massage of the hip joints - stroking, rubbing the ligaments. In the area of ​​pain points - stroking, rubbing, vibration. Finally, massage the chest and shake the limbs.

The course of treatment includes 10–12 procedures for 15–20 minutes every day.

* * *

Tendon diseases

Inflammation of the peritendinous tissue. The disease is mainly occupational; it affects people who are exposed to constant physical stress due to the nature of their work (athletes, etc.). Due to prolonged, regular loading, microtraumatization occurs with possible frequent tears of individual fibers and surrounding tissue of the tendon, which causes pain, especially in the places of tendon attachment. The main symptom is a dull pain that increases with movement in the joint, and a feeling of awkwardness. As a rule, the tendons in the dorsum of the foot, heel, and lower third of the anterior surface of the hand or forearm are affected.

Movement in the joint will be limited and quite painful. Externally there is swelling. The tendon tissue will be changed - “nodules” along the tendon can be felt. IN chronic stage diseases, muff-like thickenings are palpable, painful when pressed, and aching pain is noted at rest.

Treatment. The list of recommended treatments includes massage and physiotherapy. During treatment and recovery, it is necessary to eliminate the traumatic factors that led to this disease. If, after recovery, you are again forced to subject the affected joint to prolonged stress, it is necessary to introduce preventive measures to prevent a recurrence of the disease. Such activities include massage (self-massage), bath, relaxation exercises, etc. But, returning to medical procedures, the objectives of massage should be noted: it is necessary to relieve inflammation, swelling, provide an analgesic effect, improve blood circulation and mobility in the joint.

Methodology. It is advisable to use a suction technique (to remove swelling in the joint area), i.e. massage begins from the higher areas. Movements go from bottom to top towards large lymph nodes. Includes all massage techniques, but adequate to the patient's response. It is not recommended to use shock techniques and intermittent vibration when performing vibration (but shaking and continuous vibration can be used). After treating the overlying section, they proceed to massage the joint capsule. Here it is more convenient to use circular stroking, rubbing with fingers, kneading, movements also go in the direction of the nearest large lymph node. It is convenient to use forceps-like stroking and rubbing, pressing, shifting, and stretching directly on the sore spot. Continuous vibration is also used. All techniques are alternated with grasping stroking over the entire limb in the direction of lymph flow. The procedure is completed with passive movements in the joint. The course of treatment is 10–15 procedures, 10–15 minutes each.

Tenosynovitis

Inflammation of tendon sheaths. Occurs as a result of monotonous, prolonged movements in persons with physical labor. The extensors of the foot and flexors of the hand are most often affected. Due to systematic overstrain, microtrauma occurs in the synovial membrane lining the inner surface of the tendon sheaths. Appear pinpoint hemorrhages, swelling, pain when moving, aseptic inflammation. A characteristic crunching sound (crepitus) and slight swelling along the tendon are noted. The disease occurs both acutely and chronically.

Treatment. In acute forms of the disease, massage is not done. Treatment consists of complete rest, ointment compresses, anti-inflammatory medications. For chronic forms of tendovaginitis, massage is successfully used.

Objectives of massage: it is necessary to provide an analgesic and absorbable effect, relieve swelling, improve blood circulation, and normalize movements in the joint.

Methodology almost the same as in the previous disease, i.e. they use the suction method. For example, if the tendons of the foot are affected, then the massage begins from the higher area - the thigh, then the lower leg. Movements also go in the direction of the nearest large lymph node. All techniques are used. A good effect is achieved by grasping stroking and squeezing. It is necessary to focus on the tendon attachment points. The course of treatment is 10–12 procedures, approximately 10–15 minutes each. It is good to combine massage with physiotherapy.

Tendinitis

Inflammation of the tendon itself. Usually the disease develops in the same way; with prolonged systematic overload, degenerative processes form in the tendon tissue. The blood supply to the collagen tissue of the tendon deteriorates, as a result of which its structure becomes less elastic, strength decreases, and the possibility of rupture appears. The Achilles tendon is most often affected. The main symptom will be aching pain during movement and at rest, more often after exercise. On palpation, a thin, painful tendon is felt.

Objectives of massage the same as in previous diseases.

Massage technique similar to the technique for tendovaginitis. Subsequently, it is necessary to monitor the load, do preventive massage courses and follow health measures: do self-massage, periodically visit the steam room, etc.

Diseases of the periosteum and bones

Inflammatory disease of the tendon attachment to the bone near the joint. The disease occurs as a result of degenerative-dystrophic changes in the tissue, with the addition of inflammation; microtraumas, sudden inadequate tension, and hypothermia also play a detrimental role. Typically, short and wide tendons are affected, which bear the greatest load and are subject to significant tension.

The most common are glenohumeral periarthritis, periarthritis of the elbow, wrist and knee joints.

Periarthritis of the shoulder joint

The most common periarthritis is periarthritis of the shoulder joint. This frequency of cases of shoulder damage is explained by the structure and functions of its periarticular tissue and the characteristics of the tendons at the points of attachment to the bones. In addition, the shoulder joints are constantly in “work”, which leads to rapid “wear and tear”. The pain is usually localized in the upper part of the shoulder at the insertion of the muscle tendons on the greater tuberosity. The pain intensifies when abducting and raising the arm up, as well as at night, especially when lying down on the affected side. On palpation, painful points are noted precisely at the sites of tendon attachment on the anterior outer surface of the shoulder and along the bicipital groove. When pressing on the area of ​​the subacromial bursa, a peculiar crunching sound is possible.

Periarthritis of the elbow joint

The extensor tendons of the hand and fingers are most often affected. Here the disease may be accompanied by reactive inflammation of the tendon tissue (tenoperiostitis).

Periarthritis of the wrist joint

Also a common disease. Here the pain is localized in the area of ​​the styloid process radius. Experts say that this occurs due to degenerative changes in the tendons of the long supinator at the site of its attachment to the styloid process.

The pain will intensify when turning the forearm and hand upward. Pain is also detected when pressing on the outer surface of the base of the process. Externally, swelling in the area of ​​the wrist joint is noticeable.

Periarthritis knee joint

Here the process is localized on the inner surface of the knee joint, at the site of attachment of the tendons of the semitendinosus and semimembranosus muscles and the internal collateral ligament of the knee joint. The causes are the same as for shoulder periarthritis. There is pain on the inner surface of the knee joint. The pain mainly occurs when bending the joint, but it can also occur at night. By palpation, you can identify pain points in the outer part of the popliteal fossa and the lower part of the thigh. When pressing on the place of muscle attachment, acute pain occurs, and there will also be pain when flexing, extending and turning the leg outward.

Periarthritis of the foot

Periarthritis of the foot is characterized by pain heel area. On examination, a round, painful swelling is noticeable. The Achilles tendon responds with pain when pressed.

Treatment of periarthritis. Massage and other physical treatments are usually used. It is necessary to ensure rest for the affected joint during treatment and during the recovery stage.

Objectives of massage: provide anti-inflammatory, analgesic, absorbable effect, improve blood circulation and lymph flow, restore impaired mobility in the joint.

Methodology. Regardless of the location of the disease, massage begins from distant areas (using the suction method). The rest of the massage is done according to the classical scheme using all techniques, but in accordance with the patient’s reaction. For example, if periarthritis is localized in the wrist joint, massage begins from the shoulder area. First, as usual, stroking - flat, grasping, then rubbing, kneading, etc. Having treated the shoulder, move on to the forearm, then directly to the affected joint. Focus on the attachment points of the tendons and joint capsule. All techniques are alternated with general stroking of the limb along the lymph flow (in the direction of the nearest large lymph node). Finish the massage with passive movements in the joint. The course of treatment is 10–15 procedures, 10–15 minutes each.

Periostitis

Non-infectious inflammation of the periosteum. Usually localized in the lower leg area. Most often, the cause is a mechanical impact on the shin bone (bruise, etc.). In this case, you can notice microbleeds in the periosteum. The disease can develop some time after the injury; it usually occurs in a chronic form. The main symptom will be pain in the front surface of the lower leg, usually aching, pulsating, short-lived.

At treatment For periostitis, massage the muscles of the thigh, then the lower leg, the massage is done according to the general scheme. Directly on the area of ​​the periosteum, a targeted effect is applied to places with altered bone tissue (seals, tubercles, etc. changes in the periosteum). Kneading and absorbable ointments (venoruton, butadione, etc.) also have a good effect.

Bursitis

Inflammation of the synovial bursa (bursa). Bursitis can be acute or chronic. Acute bursitis can develop when an infection occurs (with blood or lymph flow, in the presence of inflammatory foci). Chronic bursitis, in addition to the above-mentioned cause, can occur under the influence of small, frequently repeated microtraumas. With this option, the disease occurs without suppuration (unlike acute) and is limited to thickening of the wall of the mucous bursa and the accumulation of serous exudate in its cavity.

With chronic bursitis, a round swelling with a smooth surface, uniformly soft to the touch, and painful when pressed is formed at the location of the mucous bursa.

Massage is done for chronic forms of bursitis. You can also use medicinal anti-inflammatory drugs, or you can get by with just a massage.

Objectives of massage: it is necessary to carry out analgesic, absorbable and anti-inflammatory therapy.

Methodology. Massage begins from the overlying areas. So, if you are struck elbow joint, begin to massage the area of ​​the neck and shoulder girdle, then you need to massage the shoulder muscles well and only after that move on to massage the elbow joint. They focus on the outer surface of the joint. The massage is done using all techniques, ending the procedure with passive movements in the joint. The course of treatment is up to 15 procedures for 10–15 minutes.

Arthritis

Inflammation of the joint. The inflammatory process can affect almost all joint tissues: the membrane, joint capsule, ligaments, bone. There is monoarthritis (affecting one joint) and polyarthritis (affecting several joints).

The disease is quite severe and in the future can lead to complete immobility of the joint. Arthritis can occur as a complication after certain viral and bacterial diseases (ARVI, tonsillitis, etc.), but it can also be the result of injury. The main symptoms will be pain and limited movement in the joint. The pain can be quite severe, the contours of the joint will be smoothed, swollen, redness and fever may occur. The patient spares the affected joint while in a forced position. All movements in the joint are painful.

Treatment. In acute stages, complete rest (bed rest) is required. Drug treatment is carried out.

After the acute inflammatory process subsides, the main treatment is massage, physical therapy and physiotherapy.

Methodology. Begin the massage from the overlying areas. For example, for arthritis of the knee joint, they begin by treating the thigh muscles, massaging both the front and back surfaces. From the second or third procedure, a fairly active and energetic massage is performed (on the thigh muscles). Directly in the joint area for pain and swelling, mainly stroking and light rubbing are used. Then the popliteal area and lower leg are massaged (the reverse side of the popliteal fold is not massaged). You can massage using ointments. If swelling and pain are present, it is better to use anti-inflammatory ointments to reduce swelling (butadione, heparin, etc.). If there is no swelling, but there is pain and limited joint mobility, it is better to use warming rubs. Finish the massage with passive and active movements. The course of treatment is up to 15 procedures of 10–15 minutes for the upper extremities and 20–30 for the lower extremities.

Arthrosis

With arthrosis, degenerative-dystrophic changes occur in the tissues of the joint, leading to joint deformation. Smoothness of the contours of the joint, atrophy of the nearest muscle groups, impaired range of motion, and pain appear. On palpation, compactions can be detected in the tissues; a crunching sound can be heard when moving. Large joints are usually affected, but arthrosis of small joints (spine, hands) is also not uncommon.

Methodology. All muscle groups that take part in the functioning of the joint are massaged. The massage is done quite energetically using all techniques (in the absence of swelling). If swelling of the joint is noted, it is necessary to reduce the intensity of exposure. With arthrosis of the elbow joint, the joint itself is not massaged. The massage also ends with passive movements in the joint. The course of treatment is up to twenty procedures.

In the literature, when listing therapeutic measures associated with joint diseases, such a nuance as positional treatment is often mentioned. This is enough important point in almost all stages of the disease, since the patient will reflexively spare not only the affected joint, but also the joints adjacent to it. With a prolonged course of the disease, such adaptive measures can lead to limited mobility in the joints, and then it is very difficult to redo the “wrong” joint. Therefore it is necessary to give the joint correct position. It is also necessary to do physical therapy, which includes passive and active movements. Passive gymnastics is done with outside help, without active muscular participation of the patient. For example, a massage therapist takes your hand and makes various movements in your shoulder joint, while you are completely relaxed. This will be passive gymnastics for the shoulder joint. Active gymnastics, as you probably understand, is performed without outside help, directly through your own efforts.

At the beginning of the course of treatment, they do mainly passive gymnastics; as the exacerbation subsides, active movements take the leading role.

Everyone knows about the benefits of active gymnastics, but a question may arise about the meaning of passive gymnastics. Passive movements are also useful and necessary in therapeutic activities. They are used to influence the joint capsule and periarticular apparatus in order to restore impaired functions. It is important that passive gymnastics does not cause muscle contractions; therefore, there is no muscular need for oxygen and increased blood circulation; this also has its advantages, especially for those for whom active movements are not desirable due to the state of the cardiovascular system. It is important that all passive movements must be performed with completely relaxed joints.

In case of a chronic course (beyond the acute stage), preference is still given to active gymnastics, because, in addition to better recovery mobility, it strengthens the muscles of the body and the heart muscle. If for some reason it is difficult to perform active movements on the affected joint, you need to do a full active exercise on the crossed (healthy) limb. An important factor in the treatment of joint diseases is that the patient needs constant determination and volitional efforts, aimed at recovery, because in some cases, with a weak reactivity of the disease, some people quickly and relatively easily come to recovery, in other cases the disease proceeds for a long time, tediously, with frequent exacerbations. In this case, it is easy to fall into depression and abandon treatment, so you need to gather your willpower and continue all treatment procedures.

Other diseases of the musculoskeletal system

Indications for massage: restrictions on joint movement as a result of trauma, burns and inflammatory processes, scar changes in articular and periarticular tissues.

Purpose of massage: impact on paravertebral zones to improve blood supply, trophism, and eliminate muscle atrophy. Due to improved blood circulation, joint mobility improves, and the resorption of joint effusions and pathological deposits, both in the joints themselves and in adjacent tissues, is accelerated.

Methodology: Vigorous massage in areas above and below the damaged joint (for example, with contracture of the knee joint, the thigh and lower leg are massaged) using all techniques recommended for this area of ​​the body. The joint itself is gently massaged, warming stroking and rubbing are performed.

Residual effects after fracture of limb bones

Purpose of massage: accelerate the formation of callus, relieve swelling, prevent joint stiffness and contracture.

Methodology: start the massage with a healthy limb using broad strokes while stroking and kneading. In parallel to the diseased area, on a healthy limb, we perform deep stroking, rubbing, kneading, vibration, and shaking the limb.

The sore limb is massaged above the fracture, the sore part below the fracture. Stroking, rubbing, kneading are used as a suction massage.

The damaged segment is massaged by stroking, rubbing, kneading - longitudinally and transversely, using felting, stretching and compression of the muscles.

For muscle wasting, stimulation techniques are used - passive stretching and contraction of muscles and tendons at a fast pace, ending the massage with shaking and quilting.

In case of muscle contracture, massage the shortened muscle by stroking - flat, pincer-shaped, rubbing - circular; hatching, sawing, crossing. Gentle kneading and vibration.

For stiffness - stroking and rubbing the periarticular tissues and ligaments: massage with your fingertips, using forceps-like stroking. Shortened and weak ligaments are stroked, rubbed - shading and continuous vibration. Massage the fracture site with circular stroking, rubbing, vibration very gently, shifting and stretching the tissues fused to the callus.

If bone healing is slow and the callus is soft, deep massage with the fingertips in the form of circular stroking, shading, continuous vibration, effleurage, tissue compression, and chopping are acceptable. Do everything rhythmically, intensively alternating all stroking techniques with pauses.

If the bone callus is excessive, reduce the intensity and cancel the vibration.

In case of a fracture of the upper limb, the deltoid muscle is massaged in all ways, the shoulder joint is massaged by stroking and rubbing, grasping the clavicular-scapular joint, and at the end - a concussion of the chest.

For a fracture of the lower limb: gluteal muscle - deep stroking, rubbing, shading, sawing, kneading, vibration of the iliac crests. The hip joint and ischial tuberosity are stroked and rubbed with shaking of the pelvis. The massage ends with a general broad stroking of the sore limb, passive and active movements and shaking of the healthy limb.

For a course of treatment there are 10–12 procedures of 15–20 minutes each.

Spinal injuries

Spinal injuries, especially those associated with spinal cord damage, are primarily fraught with disorder motor function and require special care for the patient. Spinal injuries can lead to paralysis and paresis: it all depends on the severity and location of the injury. The most important thing for long-term bed rest– preventing bedsores and keeping the feet in a physiological position.

Massage can be started in the subacute period, 5–6 weeks after injury, combined with exercise therapy and physiotherapy.

It is necessary to start the massage outside the site of injury, gently and lightly - stroking, rubbing, kneading, vibration. Alternate massage of the limbs with passive and then active movements.

In the case of spastic (central) paralysis, massage techniques should be dosed, helping to reduce muscle tone - flat, circular stroking as a preparatory procedure, superficial grasping stroking, gentle longitudinal kneading, felting - for spastically contracted muscles.

For stretched muscles - stroking, rubbing, transverse kneading and short tapping with fingertips. The main thing here is to prevent excitation of spastic muscles and, as a result, increased spasticity. Carrying out the procedure in warm water contributes very well to the purpose of the massage.

Massage for flaccid (peripheral, atrophic) paralysis - deep stroking and kneading, fairly rhythmic muscle shifts and gentle rubbing of tendons and joints. In this case, be sure to make passive movements. Active movements are indicated during massage in case of paresis.

According to indications, massage is done every day or every other day for 10–20 minutes. The massage course can be long. Condition after limb amputation and preparation for prosthetics

If the patient is in general good condition and the wound is healing quickly, they tend to prescribe massage as early as possible. This achieves a reduction in swelling, prevention of muscle atrophy and contractures. The massage includes the following techniques: planar grasping stroking, rubbing with fingertips, shading, sawing, crossing, longitudinal kneading. On joints – stroking and rubbing in combination with passive and active movements.

After the sutures are removed, the stump is prepared for prosthetics. For this purpose, deep kneading and vibration of the thigh and lower leg are used - for the lower limb and deltoid muscle - for the upper limb. Massage of the stump - planar circular and grasping stroking, rubbing and pincer-like kneading, vibration, effleurage, chopping, quilting. For persistent contractures - strong, short vibrations.

For a course of treatment there are 15–25 procedures for 15–20 minutes. Spa treatment using underwater shower-massage, physiotherapy or massage of both segments and stump, stroking, rubbing, kneading and vibration is indicated.

Using medicinal rubs

In the treatment of diseases of the musculoskeletal system wide application got various ointments, gels, rubbing, etc. Some ointments can be used when performing a massage, others can be applied as an ointment compress. In this section we will look at the most common ointments used for diseases of the musculoskeletal system. It should be remembered that in case of swelling, pronounced inflammation, one should, first of all, use anti-inflammatory agents rather than warming ones. For severe pain without swelling, warming rubs help better. For injuries (especially fresh ones), it is advisable to use a gel (since gel ointments have a cooling and absorbable effect). It is not recommended to apply ointments (especially warming ones) to damaged skin. In general, it is recommended to keep a couple of different rubs from the list below in your home medicine cabinet. Let one ointment have a warming effect, and the other anti-inflammatory and absorbable. There is also such an important point as individual intolerance to any drug. Intolerance may occur if a person is allergic to any component of the ointment. In this case, you need to replace the product with another; for these purposes, the components of each ointment are given below.

Anti-inflammatory drugs

Used to treat rheumatoid and other types of arthritis, thrombophlebitis, etc.

Indomethacin(synonym: methindol) is a synthetic drug. Release form: 10% ointment in tubes of 40 g. Indomethacin has an anti-inflammatory and analgesic effect. It is considered an active antirheumatic agent. It is used for all stages of rheumatism, arthritis, bursitis, thrombophlebitis. A small amount of ointment is applied to diseased areas of the body twice a day.

Methyl salicylate– has anti-inflammatory and analgesic effects. Used pure or mixed with chloroform and fatty oils. The indications are the same as for the previous drugs.

Naftalgin– an anesthetic emulsion, which includes methyl salicylate, analgin, naphthalan oil, emulsifier, a mixture of fatty acids of sperm whale oil and distilled water.

Complex menthol ointment– contains menthol, methyl salicylate, distilled water, yellow wax, anhydrous lanolin.

Heparin ointment– has an anti-inflammatory, vasodilating effect, resolves swelling well.

Reparil gel– includes horse chestnut, heparin, salicylic acid ester. The gel is well absorbed through the skin and has a cooling and analgesic effect. Relieves swelling, a feeling of heaviness, has anti-inflammatory and regenerative effects. Indicated for lymphostasis, edema, inflammatory processes of various etiologies.

A small amount of gel is applied to the affected area and covered with a bandage.

Nikoven– contains heparinoid, benzyl nicotine and other active substances.

Used for hematomas, bruises, sprains, etc.

Venoruton gel– contains active plant components and alcohol. Has an analgesic, cooling effect, relieves muscle tension. Used for fresh injuries, bruises, swelling, thrombophlebitis, etc. The gel is applied to the damaged surface several times a day and covered with a bandage.

Raymon gel– includes active ingredients: etafenamit, etc. Indicated for muscle pain of a rheumatic nature, arthritis, periarthritis, etc.

Troxevasin gel– has anti-inflammatory and cooling effects. Guarantees rapid resorption of swelling. Used for pain and swelling due to injuries and venous insufficiency.

Painkillers, distractions, warming agents

Bom Benguet– a complex preparation, includes menthol, methyl salicylate, petroleum jelly, medical paraffin. The ointment has an analgesic and anti-inflammatory effect. Used for arthritis, polyarthritis. A small amount of ointment is rubbed into diseased areas of the body two to three times a day. After applying the ointment, burning and redness may occur. Do not use if skin is damaged.

"Golden Star", balm (Vietnamese “star”) – the preparation contains clove, eucalyptus, mint and cinnamon oils. Used as a distracting, analgesic, anti-inflammatory agent. Effective for bruises, sprains of muscles, joints, tendons.

Balm "Sanitas" includes: methyl salicylate, eucalyptus, turpentine purified oils, camphor, petroleum jelly, lard. Provides a distracting, analgesic effect. The balm is rubbed into the skin, after which the treated area is covered with a warm bandage.

Virapin contains bee venom. Used for myositis, radiculitis as a distracting, warming agent.

Viprosal– contains viper poison, camphor, salicylic acid, fir oil, paraffin, glycerin, petroleum jelly. Used for radiculitis, sciatica, myositis, etc.

Vipratox– contains venom from various snakes, methyl salicylate, camphor, and a base for liniment.

Capsitrine– liquid (external). Ingredients: tincture of capsicum, tincture of St. John's wort, green soap, ammonia solution, ethyl alcohol. When rubbed into the skin, the liquid has an irritating effect on skin receptors. It is used as a distracting, pain reliever for arthritis, myositis, and radiculitis.

Tiger ointment– includes clove oil, eucalyptus oil, camphor, menthol, paraffin, petroleum jelly.

Nicoflex– the composition includes capsacin, ethyl nicotinate, ethylene glycol salicylate, lavender oil, ointment base. It has a distracting and absorbable effect, dilates blood vessels well, and warms up the muscles. Used for arthrosis, myositis, arthritis, etc. Before applying the cream to the skin, it is advisable to wash the skin area with warm water and soap and wipe dry. Then squeeze out 4–5 cm of cream and rub until slightly red. Apply the cream 1-2 times a day. The cream is applied only to intact skin, after which you must wash your hands thoroughly.

Gymnastogal contains benzene ester, nicotinic acid and other active substances. On an ointment basis. The ointment has a strong warming effect.

Finalgon contains nicotinic acid and other active substances. The ointment, similar to the previous one, has an increased thermal effect. Used for arthrosis, lumbago, myositis, etc. Apply a small amount of ointment to the body and rub until redness appears, then cover with a bandage.

Efkamon contains camphor, clove, essential, mustard, eucalyptus oils, menthol, methyl salicylate, tincture of capsicum, thymol and hydrochloride, cinnamon alcohol, paraffin, spermaceti and petroleum jelly.

The ointment causes dilation of superficial blood vessels, redness of the skin, and a feeling of warmth. Used for arthritis, myositis, rheumatism, osteochondrosis, bruises, sprains. The ointment is rubbed into the skin 2-3 times a day, after which it is covered with a warm bandage.

Elakur– contains capsocin, methyl salicylate, propylene nicotinate and others active ingredients. Has an antirheumatic effect and a warming effect. Used for myositis, lumbago, arthritis, etc.

Capsoderm– the composition includes camphor, capsocin and other substances. The ointment causes severe skin hyperemia (redness). Indications: sciatica, arthrosis, arthritis, myositis, etc.

Neo-capsoderm contains camphor and other oils. The ointment is applied to painful areas of the body and rubbed in, then covered with a warm bandage.

Rikhofit-sport– consists of medicinal plants and oils. Massage with this cream promotes better muscle relaxation and skin regeneration. Used for myositis, myalgia, muscle cramps, sprains, etc.

Mellivenon– contains chloroform, bee venom and other components. Used for pain, periarthritis, lumbago, osteochondrosis, arthritis, bursitis. The ointment has a strong warming effect.

Algipan contains methyl nicotinate, glycol salicylate, mephenesin, casicin and other active and aromatic substances. The ointment dilates blood vessels well, relieves muscle pain, reduces contractures, and has an anti-inflammatory effect. The ointment is applied to the body in small portions and rubbed until reddened (you can massage). Apply the ointment 1-2 times a day.

Artrosenex– has a resolving and relaxing effect, improves joint mobility. Used for arthrosis (joint mobility increases by 20–40%). 2–4 cm of ointment is applied under a bandage or a massage is performed.

With almost all of the above ointments, you can massage, after which you need to cover the treated surface with a warm bandage (scarf, T-shirt, etc.). The use of gels during massage is somewhat difficult, because all gels are quickly absorbed into the skin, leaving a dry film that interferes with the “smooth” use of massage techniques.

Diseases and injuries of the spine.

Indications: compression of the nerve roots due to narrowing of the intervertebral foramina, protrusion, prolapse of intervertebral discs, disruption of the bursal-ligamentous apparatus of the vertebrae, neuralgia, neuritis, periarthritis, epicondylitis, spondylitis, lumbosacral pain, sciatica, lumbago, etc. (Fig. 118).

Rice. 118. Scheme of reflex changes in diseases of the spine (according to O. Glezor, V. A. Dalikho, 1982).

Contraindications: malignant and benign tumors, osteomyelitis, spinal deformities in which massage causes pain, etc.

Methodology. Combined effects on the back, chest, pelvis, and back of the head; all segments are processed from bottom to top from L 1 - C 3. They begin with plane strokes along the spine, then perform waist strokes from the underlying segments to the cervical region. Next, perform special techniques segmental massage paravertebral (drilling, impact between the spinous processes of the vertebrae, sawing, processing of the peri-scapular areas, lower costal arches and iliac crests).

With the patient lying on his back, massage the chest wall. All massage movements are directed to the nearest large lymph nodes. Then massage the intercostal spaces. Finish with a concussion technique.

If there are unpleasant sensations in the heart area, then it is necessary to massage the left edge of the chest, at the same time, if during the massage there are unpleasant sensations in the stomach area, then massage the lower edge of the chest on the left, but in the direction from the xiphoid process to the left iliac crest.

In total, carry out 6-8 procedures every other day, alternating with classical or other types of massage.

Methodologically, special techniques of segmental massage (for example, movement) should be carried out from the 4th-5th procedure, taking into account the patient’s response to manipulation.

In a weekly treatment cycle, massage using the segmental technique is performed 2-3 times, alternating with classical, acupressure and other types of massage.

Before starting the procedure, you should always make sure that there are reflex changes; if they disappear, then do not carry out more than 5 procedures, since you can again cause the appearance of various overstrains of individual muscle groups and pain at different levels of the spine. The whole procedure lasts 20-25 minutes.

Diseases and damage to joints.

Indications: damage to the bursal-ligamentous apparatus of the joints, dislocations, bruises of the joints, damage to the menisci, Hoffa’s disease, arthrosis, arthritis, traumatic bursitis, flat feet, etc.

Contraindications: severe forms of damage to bones and joints, accompanied by pronounced local or extensive reactive phenomena (inflammatory swelling, extensive hemorrhage, elevated body temperature), chronic forms of osteomyelitis, infectious nonspecific diseases of the joints in the acute stage, tuberculosis of bones and joints in active form, purulent processes in soft tissues, neoplasms of bones, joints, infections.

Massage for arthrosis. Arthrosis is a chronic disease of the joints. With dystrophic changes in articular cartilage smoothness of the contours of the joints appears, a slight atrophy of nearby large muscle groups, and a decrease in the amplitude of movements. On palpation, compactions are detected in the periarticular tissues, and a characteristic crunching sound is heard when moving. Painful points can be fixed in the abdomen, the projection of the heart.

More often, pathological processes are observed in large joints - knee, hip, ankle, but small joints, such as the spine, are also affected (spondyloarthrosis). This disease is more often observed in dancers, athletes, typists, and long-distance car drivers.

Objectives of massage: have an analgesic, absorbable effect; prevent the progression of the degeneration process; restore lost joint functions and normal range of motion in it; promote the healing and strengthening of the patient’s entire body.

Methodology. For deforming arthrosis of the knee joint, massage begins with the thigh of the affected leg. Apply stroking, rubbing, kneading, vibration - labile, both intermittent and continuous, the direction of movement is up and down. Its purpose is to improve tissue metabolism, create hyperemia, and prevent atrophy of muscle groups. Next, massage the knee joint directly, having massaged the lower leg area first. They begin to massage the joint with circular stroking, flat, pincer-shaped, rubbing of various varieties, but in the place of swelling and pain, movements are carried out gently and carefully.

With arthrosis of the elbow joint, the joint itself do not massage!!! Start the massage with the cervical and thoracic spine, shoulder girdle area, shoulder, forearms, using stroking, rubbing, kneading, vibration. Complete the massage with passive and active movements. Duration of procedures: 10-15 minutes - upper limbs and 15-20 minutes - lower limbs. A course of 10-12 procedures, every other day.

Massage for arthritis. Arthritis is inflammation of a joint. A distinction is made between monoarthritis (affecting one joint) and polyarthritis (affecting several joints). Significant changes in the joint, shell, bones, capsule, ligaments lead to limitation of movements (contractures), and more complex changes lead to complete immobility (ankylosis) of the joint.

Methodology. The patient sits or lies (if the lower extremities are damaged). Techniques: stroking, rubbing, kneading, vibration. Massage begins with paravertebral zones: if the joints of the upper extremities are affected - at the level of the spinal segments D 2 -C 4, if the joints of the lower extremities are affected - S 4-1 -D 11, then they are applied to the proximal parts of the extremities. Next - below the sore joint. They also affect symmetrically located areas of a healthy limb. When massaging the affected joint, you should pay special attention to the tendons, periarticular tissues, tendon sheaths, and joint capsules. The massage is completed with passive and active movements depending on the range of motion. Massage time is 10-15 minutes for the upper extremities and up to 25 minutes for the lower extremities. Course - 10-12 procedures, preferably every other day; thermal procedures can be used in combination with massage.

Massage for bursitis. Bursitis is a disease of the synovial bursae located between the protrusions of bones and muscles, tendons, fascia, between the skin and other tissues that are exposed to movement and friction between them. Chronic forms of bursitis are characterized by limited swelling on the anterior surface, pain on palpation and pressure.

Objectives of massage: have an analgesic, anti-inflammatory, absorbable effect, accelerate the restoration of lost functions in the joint.

Methodology. When bursitis is localized in the elbow joint, massage begins in the back (cervical and thoracic spine) - stroking, rubbing, kneading, vibration. Particular attention is paid to the shoulder muscles, then a massage of the elbow joint is performed with an emphasis on the outer surface of the joint - circular stroking, straight, circular rubbing, pincer-like kneading, pressing. At the end of the procedure, passive movements are used.

For bursitis in the area of ​​the knee joint, massage begins with the muscles of the thigh, the area of ​​the patella - stroking, rubbing, kneading, pressing, shifting, stretching, and continuous vibration. Next, the shin area is massaged - all techniques are used, and the procedure is completed by massaging the knee joint area with passive and active movements in it.

The duration of the procedure is 10-15 minutes, per course - 10-12 procedures, it is more effective to massage every other day.

Hoff's disease- hyperplasia of adipose tissue under the patella - characterized by slight pain during movement, tenderness on palpation, swelling on the sides of the patellar ligament. This disease is most often observed in athletes. Subsequently, the adipose tissue is replaced by connective tissue.

Objectives of massage: prevent muscle atrophy, improve lymph and blood circulation, relieve pain, prevent disease progression, restore joint function.

Methodology. The massage always starts from the thigh using a suction type (all techniques), then the knee joint is massaged directly, mainly using rubbing techniques with stroking to the nearest lymph nodes. Finally, passive movements are performed.

Diseases and injuries of the shoulder joint.

Methodology. The rule of one-sided influence is observed, i.e. from the side of the lesion. The massage begins with planar stroking along the spine paravertebral from bottom to top from D 6 to C 3. Segmental waist stroking from the underlying segments to the cervical region, repeating 3-4 times. Pay attention to the area of ​​the latissimus dorsi muscle (stroking, rubbing, kneading, vibration). After this, they switch to paravertebral techniques: drilling, impact on the tissue between the spinous processes of the vertebrae, the “saw” technique (performed vertebrally on one side of the spine), as well as movement. Next, they move on to treating the peri-scapular areas with an emphasis on the sore side. On the upper limb, segmental massage begins with the overlying areas (shoulder girdle, deltoid muscle, shoulder, forearm), and all techniques are performed (stroking, rubbing, kneading, vibration).

Methodologically, attention is paid to the subclavian area, where pain can be observed and which should be spared; the armpit is also affected, without affecting the lymph nodes.

At the end of the procedure, passive and active movements are performed. It is necessary to be careful about the displacement of reflexes during massage, especially very intense, in the armpit area, so the massage should be completed by applying pressure to the lower left edge of the chest to prevent discomfort in the region of the heart (Fig. 119).

Rice. 119. Scheme of reflex changes in diseases of the right shoulder joint.
1 - reflex skin changes; 2 - reflex changes in connective tissue: 3 - reflex changes in muscle tissue.

Diseases and injuries of the elbow joint, forearm and hand.

Methodology. All segmental massage techniques are carried out first paravertebrally from D 7 to C 3, then vertebrally on the affected side. After this, the area of ​​one shoulder blade is treated, on the affected side. The upper limbs begin to be massaged from the shoulder girdle, then the shoulder, forearm and hand are massaged. Use all techniques (stroking, rubbing, kneading, vibration). The procedure is always completed with passive and active movements. Each finger of the hand should be vigorously massaged.

The displacement of reflexes is the same as during segmental massage of the shoulder joint and shoulder (Fig. 120).

Rice. 120. Scheme of reflex changes in diseases of the right elbow joint and forearm.
1 - reflex skin changes; 2 - reflex changes in connective tissue: 3 - reflex changes in muscle tissue.

Diseases of the hip and thigh.

Methodology. The patient's position is lying down. The massage begins from the paravertebral region from L 3 to D 10, all the techniques of segmental massage are carried out, plane stroking, waist stroking from bottom to top, then drilling, impact on the interspinous spaces of the spine, the “saw” technique, moving. Next, massage the costal arches and the area of ​​the iliac crests. Pay attention to the sacral area and pain points (ba-liao). When massaging the gluteal region, more attention is paid to the subgluteal folds. On the lower extremities, the massage begins with the thigh, then the lower leg is massaged, where painful points are identified. All techniques on the lower extremities are carried out as in classic massage(stroking, rubbing, kneading, vibration). The procedure can be completed with the patient sitting and acting on the iliac crests using a shaking technique. The duration of the procedure is 15-20 minutes; per course - up to 10 procedures.

Pay attention to the displacement of reflexes. Most often, complaints may be in the bladder area (feeling of pressure, pain). To eliminate these unpleasant sensations, massage the area located in the lower abdomen in front, the pubic area (stroking, rubbing). If nagging pain or numbness appears in the leg, accompanied by itching, a crawling sensation, goosebumps, tingling in the area of ​​the ankles, soles, then massage the tissue between the greater trochanter of the corresponding limb and the ischial tuberosity - the pain will disappear (Fig. 121).

Rice. 121. Scheme of reflex changes in diseases of the right hip joint and thigh.
1 - reflex skin changes; 2 - reflex changes in connective tissue: 3 - reflex changes in muscle tissue.

Disease of the knee joint and lower leg.

Methodology. The massage begins with the patient lying on his stomach with paravertebral influences from S 3 to L 3, using all types of paravertebral influences (drilling, between the spinous processes of the vertebrae, the “saw” technique, pushing, moving). Then a massage is carried out on the lumbar and gluteal regions, the lower limb, starting from the thigh, highlighting the maximum points and the most important nerve trunks. The procedure is completed with active and passive movements and shaking. The duration of the procedure is 15-25 minutes. There are 10-12 procedures per course (Fig. 122).

Rice. 122. Scheme of reflex changes in diseases of the right knee joint and lower leg.
1 - reflex skin changes; 2 - reflex changes in connective tissue: 3 - reflex changes in muscle tissue.

Massage for joint contractures. Contractures are divided into congenital and acquired. Congenital are caused by underdevelopment of muscles (torticollis, articular clubfoot) or pathological changes in the skin (swimming membranes). Acquired contractures are more common; they are divided into traumatic, inflammatory, paralytic, dystrophic and fixation.

Objectives of massage: increase lymph and blood circulation, improve tissue metabolism, increase lost mobility and promote its restoration.

Methodology. For contractures in the joints of the upper limb. The massage begins by influencing the paravertebral areas D 11-6 and C 6-3, using all the techniques of segmental massage. Then the muscle groups are isolated: trapezius, sternocleidomastoid - using forceps-like stroking, rubbing, kneading, labile vibration. Next, a suction type massage is carried out on the upper limb with mandatory impact on the joints. So, when massaging the shoulder joint, the patient places his hand with the back of the hand on the lumbar region, which makes it possible to more effectively influence the anterior surface of the shoulder joint, then when massaging the back of the joint, the patient fixes the hand of the massaged hand on the opposite shoulder, which allows influencing the joint capsule from behind. If it is necessary to penetrate the joint from below, the patient moves his arm to the side. When massaging the elbow joint, more attention is paid to the outer surface, and when massaging the wrist joint, the articular capsule is most accessible to influence on the back of the joint.

At the end of the procedure, passive movements are performed in possible volume, with preliminary identification of the patient’s motor capabilities.

For contractures of the joints of the lower extremities, massage begins with paravertebral impact on S 5-1, L 5-1, D 12-10. All segmental massage techniques are used. Next, massage the lumbar region, pelvis, then the lower edges of the costal arches and iliac crests, ending with a shaking of the pelvis. On the lower limb, massage should be done using a suction method with a massage of each joint, trying to achieve the greatest penetration into the joint. In conclusion, passive and active movements and shaking are always performed with shaking of individual muscle groups.

The duration of the procedure is 15-25 minutes, per course - 15-20 sessions, preferably every other day, taking into account the patient's response. Repeat the course every 1-11 months.

With ankylosis (complete immobility of the joint) or with very minor movements, massage is ineffective. It is better to use positional treatment and other types of influence.

In Fig. 123-127 show methods of acupressure for lesions of the musculoskeletal system.

Rice. 123. Points used for pain in the joints (wrist).

Rice. 124. Points used for pain in the elbow joint.

Rice. 125. Points used for pain in the shoulder joint.

Rice. 126. Points used for arthritis of the knee joint.

Rice. 127. Points used for cramps of the calf muscles.

Massage for joint disease can alleviate the patient’s condition, but all manipulations must be performed by a competent and professional specialist who is well acquainted with the structure and anatomy of the joints, and the pathological processes that the disease provokes.

Joints are components of the body's musculoskeletal system. A joint is formed from two or more articular surfaces of bones that are covered with cartilage. There is synovial fluid inside the joint to facilitate movement in it. The joint is enclosed in a synovial membrane or joint capsule.

Indications for joint massage

• Spinal diseases of various etiologies: osteochondrosis, including complicated by protrusions and disc herniations, scoliosis, ankylosing spondylitis
• Joint diseases: osteoarthritis, gout (without exacerbation), rheumatoid arthritis, arthritis of other etiologies
• Consequences of joint injuries - limited mobility, joint pain
• Postural disorders in children and adults
• Stress, neuroses

In some cases, this manipulation practice can be a good alternative to manual therapy.

Treatment of arthrosis

Massage is a very effective remedy for the treatment of arthrosis, because when massaging sore areas, peripheral blood circulation improves, all tissues of the limbs begin to be supplied with oxygen and nutrients. Massage has very simple tasks - to provide a resolving, analgesic effect, restore all normal functions of the joint and prevent the progress of the degenerative process.

Massage for deforming arthrosis of the hip joint

For people suffering from this disease, massage is one of the main means of treatment. Its task is to provide analgesic, anti-inflammatory and absorbable effects, to accelerate the restoration of joint functions.

The massage is performed while lying on your stomach, and if necessary, on your side or back; the muscles surrounding the joint are extremely relaxed. If you are worried about severe pain in the joint, start the massage from the areas above and below, using light, shallow techniques.

1. Stroking on the upper part of the buttock and lumbar region - 8-10 times. The same on the lower part of the buttock and the upper third of the thigh.

2. Squeezing with the edge of the palm or the base of the palm (4-5 times).

3. Kneading the muscles around the hip joint. First - with the base of the palm (5-6 times), then - with the pads of the four fingers (circular; 3-4 times), with the fingers spread apart and rotation done towards the little finger.

4. If the pain is not very severe, then after kneading, rub around the hip joint:

a) dotted - with the pads of four fingers in all directions (2-3 times each);

b) circular - with the ridges of the fingers (3-4 times); c) circular - with the ridge of the thumb, which bends and rests on the index finger (5-8 times).

Repeat the entire complex 2-3 times and finish with shaking and stroking. As the pain subsides, the number of repetitions of each technique increases. The duration of the session is 8-10 minutes, it can be done 2-3 times a day.

For deforming arthrosis, vibration massage using an electric hand massager or the “Tonus” device also helps well. You can also use a mechanical massager. However, a hardware massage should always be preceded by a manual one, and it should also complete the session. This is especially important in the initial stage of treatment, as well as in case of severe pain in the joint. A hardware massage session should not last more than 7-8 minutes.

Method of performing knee joint massage

Of course, in case of arthrosis, only a certified and qualified person should massage the knee joint. knowledgeable person, with extensive experience, so that there are no complications and painful sensations. But there are also techniques that everyone can do at home, methods that are accessible to everyone. Their goal is to carry out preventive measures for arthrosis, as well as relieve painful sensations and inflammatory processes.

1. For arthrosis of the knee joint, the painful area is first heated with a heating pad. Then honey is applied to it and a massage is carried out with the knuckles in a circular motion and only clockwise.

After this, you can apply burdock and cover the joint with a warm cloth. This procedure is done at night, so that the warmed and massaged joint can then rest for 7-8 hours.

Usually a course of 10 procedures done over a couple of weeks is sufficient. After this, the feeling of stiffness and pain should go away.

2. Massage with fat: with this method, pork fat is rubbed into the sore knee joint for a month or two. In order to relieve at least the initial painful sensation, you will need at least 5 procedures.

Also, during massage they are often used various tinctures and ointments, which also need to be rubbed into the affected area. If arthrosis requires urgent treatment joints, Adam's root ointments will quickly and effectively solve this problem. Tinctures from it are also shown: for this, about 200 grams of crushed Adam's root must be poured with half a liter of alcohol and left for two weeks (in a dark place), not forgetting to shake periodically. This tincture should be rubbed on the sore spots, and then covered with a woolen cloth.

3. Another great way is with sunflower oil. To do this, you need to heat a couple of tablespoons of oil and rub it very carefully into the affected area and knee joint at night. Usually, to remove severe pain, you need about 5 daily procedures.

4. Massage using honey - this recipe helps so many people. Before massaging, for arthrosis, warm up the joint for 20 minutes using a heating pad. Then half a tablespoon of honey is heated in a water bath until it becomes very liquid and flowing. Next, you should take honey and, using gentle circular movements, rub it into the sore spot for 15 minutes. After this, you need to cover the area of ​​the knee joint with gauze or a bandage, and put a warm heating pad on top. This entire structure should be kept in place for a couple of hours, and then the bandage should be removed and the stained knee should be washed with warm water. The procedure can be performed once a day, for half a month.

5. You can also use a vibration mechanical massage, which will complement the action of a manual one. Mechanical massage is especially effective if the patient's muscle tone is very high. Vibration should be carried out using a spike attachment and a sponge.

6. People with arthrosis of the knee joint need daily walking, with the permission of a doctor, of course. If there are deformation changes in the joint, you can only walk short distances and be sure to rest by sitting down.

7. Swimming is also very effective, and best in an indoor pool with warm water. When swimming, the load on the joint decreases, overall tone increases and well-being improves. Rowing and cycling are also useful.

8. Moreover, patients with arthrosis are contraindicated from lifting weights, and in case of acute pain, they can only walk using a cane or stick.

Arthrosis of the joints of the hands

The massage begins with actions on the back of the hand. When performing techniques, one usually moves from the fingertips to the wrist joints. It all starts at the distances between the carpal bones. The following techniques can be used here:

1) Simple stroking

2) Different types of rubbing:

• circular
• rectilinear
• edge of the palm
• sawing
• pads of the first, third or all fingers

1) Rubbing:

• zigzag
• rectilinear
• spiral
• pads of the thumb and index fingers
• heel of the palm

2) Stroking

At the end of the massage, the brush is shaken several times.

Massage of hand joints - “dry washing”

Dry washing is not a common procedure, but it is worth doing every day. This is a very simple and easy-to-use self-massage technique that allows you to stretch the joints of your arms and shoulders. Massage helps restore joint mobility, prevents inflammation, activates blood circulation and patency blood vessels, prevents aches and pains in the arms and shoulders. It is especially good for those people who suffer from pain in their hands during the cold season.

Proper, diligent rubbing of the hands helps with chronic stiffness and freezing of the hands, which is usually associated with circulatory disorders in the capillaries. Also, this movement helps restore motor activity of the hands after paralysis, helps get rid of chills in the hands, expressed in the sensation of creeping goosebumps or tingling.

1. With your palms together, vigorously rub them together until a feeling of warmth appears.

2. Then “wash” your hands, alternating clasping one hand with the other, followed by massaging with force with the back of the clasped hand. Start by clasping your left hand around your right hand. Then grab the left one with your right. These circular movements are very similar to the movements we make when we soap our hands and rinse the soap off them under running water, but they are more energetic - something like when we scrub very dirty hands. Taking in one cycle massaging the left and right hands With such circular movements, perform 10 or more “washing” cycles.

3. Forcefully clench your hands into fists. Unclench them, relaxing them. Repeat these movements 10-20 times. This enhances the effectiveness of “washing”.

4. Place a relaxed hand on your thigh and, with a gentle rubbing motion in a circle, warm up the back of it first, and then the palm. After this, knead your hands completely (biologically active points are concentrated on them) - this promotes good sleep.

5. If you like profuse sweating, you have calluses on your hands, or you are concerned about increased sleepiness, you should not rub your hands. Replace rubbing with effleurage, spanking, kneading, which are just as effective.

Contraindications

• Chronic osteomyelitis
• Severe forms of damage to joints and bone tissue, many of which are accompanied by general and local reactive phenomena (extensive hemorrhage, inflammatory edema, fever)
• Tuberculosis damage to joint and bone tissues in the activation stage
• Various purulent processes occurring in soft tissues
• Nonspecific infectious diseases of the joints occurring in the acute stage
• Extensive purulent skin diseases
• Neoplasms on joints and bones
• Accompanying other diseases for which massage is contraindicated, for example, general infections

In rehabilitation therapy, joint massage is one of the most important means of therapy that has found application in the treatment of the human musculoskeletal system. Joint massage is prescribed for bruises that are accompanied by hemorrhage, stretching of muscles, ligaments, tendons, and for fractures at any stage of healing; the effect of massage is especially beneficial when healing of a fracture is delayed. Various functional disorders after fractures and dislocations, they can also be corrected by massage, and preparing the amputation stump for prosthetics with massage is less painless. Joint massage eliminates pain much faster, stopping tissue swelling, resolves hemorrhages in tissues, strengthens muscles faster, improving the function of joints and muscles, preventing the development of connective tissue adhesions that lead to joint stiffness.

Massage for joint diseases is a mandatory element of complex treatment and must be combined with positional treatment, therapeutic exercises and mechanotherapy.

Objectives of massage:

1. Improve blood circulation in affected joints, skin, muscles.
2. Relieve tension in the muscles of the limbs, improve their trophism, tone and strength.
3. Help restore normal range of motion in joints.
4. Promote the resorption of exudate in the joints, reducing pain and stiffness.
5. Promote the healing and strengthening of the entire body.

The massage therapist must place the fingers and hands in the correct position during the massage. After the massage you should:

1. If the metacarpophalangeal joints are affected, place a cushion under these joints in the position of their extension with the interphalangeal joints bent and the terminal phalanges of the joints extended.
2. If the interphalangeal joints are affected, the roller is placed so that the metacarpophalangeal joints remain free, and the interphalangeal joints are adjacent to the roller in the extension position, the terminal phalanges are slightly bent.
3. If there is a tendency to develop “walrus fins,” place the brush in a shredder angled toward the radial side.

With a pronounced inflammatory process in the knee joint, the patient keeps the leg bent, while the flexor muscles of the hip and knee joints tense. This contributes to the occurrence of contractures in the knee, hip-femoral and ankle joints. During the massage, as well as after it, in these cases, you should place your foot on a pillow, helping to relax the muscles.

With an inflammatory process in the ankle joint, a vicious posture in the form of a “horse foot” can develop. To prevent this position, you should place your foot at an angle of 90°, placing a box or bag of sand under it.

To maintain mobility in the hip-femoral joint, several times a day the patient is placed on a knitting needle without a pillow, the leg is abducted and lowered from the bed, being sure to place a support under the foot (or lowering it to the floor).

Massage area: hands-legs. When the muscles of the back and collar area are tense, these sections are also massaged.

The massage is performed with the patient lying down for better muscle relaxation. Subsequently, if the patient has sufficient ability to relax the arm muscles, it can be massaged while the patient is sitting. The procedure begins with the less affected limbs. A special feature of the massage is its special effect on joints, muscles, and skin.

During the massage, you should achieve maximum muscle relaxation. When massaging the front surface of the leg, it is advisable to place a cushion under the knee joints. Massage of the back surface is carried out with a roller placed under the ankle-foot joint.

Calf massage carried out in the direction from the toes to the outer edge of the kneecap, using a variety of stroking and rubbing techniques in different directions (ascending - from the toes to the knee and descending - from the knee to the fingers).

After a general impact on the entire area of ​​the leg, the muscles should be differentially massaged and the following groups should be distinguished:

1. On the front surface - the front tibialis muscle, extensor digitorum longus.
2. On the lateral surface are the peroneal muscles (in the upper half - the peroneus longus muscle, in the lower half - the peroneus brevis muscle).
3. On the back surface are the calf muscles and the Achilles tendon.

The direction of movement and muscle coverage are described .

Thigh massage is carried out with the patient on his back or stomach. The outer surface can be massaged in a lateral position (direction of movements .) Massage techniques are the same as on the lower leg. Massage the quadriceps, biceps, semitendinosus, semimembranosus and gluteal muscles.

Hand massage carried out in a lying or sitting position. In a sitting position, the patient places his hand on the massage table, and the massage therapist sits opposite him (a description of the direction of massage movements is given ).

The fingers are massaged with both hands. When performing a massage with one hand, the massage therapist fixes the patient’s hand. Using the palmar surface of the first and second fingers, planar continuous stroking of each finger is carried out on the dorsal, palmar and lateral surfaces. Then shading is performed in the longitudinal and transverse directions, stroking and kneading. With a special effect on the interphalangeal and metacarpophalangeal joints, the skin above them on the dorsal and lateral surfaces is stretched, which achieves greater penetration into the joint gap.

For contractures and stiffness, stretching is necessary.

The palmar surface is massaged in the supination position, using ironing and rubbing (A.F. Berbov).

In women with joint diseases, special attention should be paid to the muscles that adduct and abduct the first finger, since during prolonged knitting these muscles are tense and the first finger is significantly closer to the middle of the palm. This gradually leads to stiffness and even ankylosis in the metacarpophalangeal joint of the first finger.

Massage technique for various diseases and injuries

Objectives of massage

Strengthen blood and lymph circulation and metabolic processes in the damaged area, reduce pain, a feeling of stiffness, promote the resorption of hemorrhages, hematomas, hemarthrosis, restore functions lost in a given joint or area of ​​the body.

Methodology

In the first 2–3 days, suction massage is used. All Techniques begin above the site of injury in order to enhance the outflow from the area of ​​bruise.

Use stroking in the direction of the nearest large lymph node, rubbing, very light kneading along the flow of lymph, labile continuous vibration. From the 4th–5th procedure, a massage of the immediate site of the bruise is prescribed, its intensity is dosed depending on the condition and response of the patient.

Planar circular stroking is used, covering the lymph nodes along the course, rubbing with fingertips, gentle kneading, and continuous labile vibration. Impact techniques are contraindicated.

The duration of the procedure is from 15 to 20 minutes, the course is 5–10 sessions, preferably daily. Starting from the 3rd–4th procedure, physical exercises are included. For minor bruises, it is more rational to use active movements in the area of ​​injury for the first time.

Acute myositis is manifested by muscle pain during movement. Soreness is localized predominantly in the muscles that have been subjected to the greatest overload, especially unusual for this muscle group. The muscles become dense, limited movements are expressed. Myalgia is characterized by edematous swelling of the muscles, pain of an aching, shooting nature, roller-like thickenings and tensions are observed. In chronic forms of myalgia, the phenomena of fibromyositis and myogelosis are added (knotty compactions in the muscles, inability to relax the muscles).

Objectives of massage

Improve blood circulation, reduce swelling, pain, have a resolving effect, enhance redox processes, promote a speedy recovery of the limb.

Methodology

The muscles of the limb should be as relaxed as possible. Begin the massage above the painful area. The following techniques are used: stroking, rubbing, kneading, vibration. Then a gentle massage of the injury site is performed, combining it with thermal procedures. In the following days, the massage plan is the same, but it is carried out more energetically, and special attention is paid to painful points. The procedure is completed with planar stroking and rubbing.

The duration of the massage is 10–15 minutes, the course is 5–8 procedures, daily or every other day, depending on the patient’s response.

Burns and frostbite

Massage can begin from the moment of complete epithelization of the granulating surface in the scarring stage.

Objectives of massage

Activation of blood and lymph circulation, elimination of scar deformities, reduction of contractures, relieving pain, resorption of swelling, stimulation of regenerative processes, as well as increasing the protective properties of the body.

Methodology

Stroking and rubbing the tissues surrounding the site of damage, stroking and rubbing the scar itself or the area of ​​damage, using the following techniques: sawing, forceps-like stroking, rubbing, kneading; shifting and stretching, pressing, vibration is labile and continuous. Subsequently, vibration techniques are performed - puncturing, finger tapping, shaking the entire limb or shaking the entire body area.

The duration of the procedure depends on the degree of damage, location and dysfunction.

Course – 10–15 sessions with breaks of 1 month. or several days. Repeated course – 7–10 procedures, daily or every other day.

Preparation of the amputation stump for prosthetics

The process of forming a stump for the purpose of prosthetics is quite long - up to 15 months. The use of massage in combination with gymnastic exercises significantly reduces this period. Massage can begin after the surgical sutures are removed. The presence of a granulating surface in the absence of an inflammatory reaction is not a contraindication to massage. It is carried out for 5–10 minutes, gradually increasing the duration of each procedure to 15–20 minutes, using various techniques - stroking, rubbing, light kneading, vibration. In the 1st week, you should avoid massaging near surgical suture until he gets stronger. In the presence of scar formations fused to the underlying tissues of the stump, shifting the scar, forceps-like kneading, pressing, stretching, and light vibration should be used. Subsequently, to increase the supportability of the stump in the area of ​​the distal end, intermittent vibration is used in the form of puncturing, tapping, chopping, and pressing. Finish the massage with active and passive movements in the joints, shaking. Perform 10–12 procedures daily.

Tendon diseases and injuries

The most common cause of tendon damage is repeated microtrauma, leading to constant irritation of the tendon attachment points to the bone and the tendon sliding zone. A symptom of tendon damage is a dull pain that gets worse with movement in the joint.

Paratenonitis- a disease of the peritendinous cell of an inflammatory nature. Acute paratenonitis due to microtrauma with frequent tears of individual fibers and surrounding tissue of the tendon occurs from prolonged strenuous physical or sports activity. A person experiences a feeling of awkwardness and pain with certain movements. It is most often localized in the area of ​​the calcaneal tendon, dorsum of the foot, and in the lower third of the anterior surface of the hand or forearm. Upon examination and palpation, swelling is revealed, along the tendon there are many painful nodular seals, and increased sweating of the skin. Active and passive movements are limited and painful. If left untreated, paratenonitis becomes chronic, with aching pain at rest and palpation revealing muff-like thickenings that are painful when pressed.

Objectives of massage

Have an anti-inflammatory, analgesic effect, improve blood and lymph flow, reduce swelling, restore lost functions and mobility.

Methodology

You should always start with a preliminary massage of the area above (suction type): techniques - stroking, rubbing, kneading, vibration, excluding shock, intermittent techniques. The patient's position during massage should be comfortable, with the limbs slightly elevated. Then the joint capsule is massaged, starting with circular stroking, rubbing with fingers, and kneading. All movements should be carried out to the nearest large lymph node. At the site of pain, forceps-like stroking, rubbing, pressing, shifting, stretching, labile continuous vibration are performed, alternating with grasping stroking techniques to a large lymph node. Carry out passive movements in the joint. Duration of massage – 10–15 minutes. The course of treatment is 12–15 sessions in combination with physiotherapeutic procedures.

Tenosynovitis– disease of tendon sheaths. When overloaded, trauma occurs to the synoval membranes lining the inner surface of the tendon sheaths. Point hemorrhages, swelling, and aseptic inflammation are observed. In acute forms of the disease, do not use massage; in chronic tendovaginitis (usually on the extensors of the foot and flexors of the hand), massage is used.

Objectives of massage

Provide an analgesic and absorbable effect, improve blood and lymph circulation in the damaged area, and promote a speedy restoration of the motor function of the joint.

Methodology

On the lower extremities, massage is performed on the area above, thighs, and lower legs. All Techniques are used - stroking, rubbing, kneading, vibration in the direction of the nearest large lymph nodes, mainly of the grasping type, fixing all muscle groups in the massage area. Then the focus is on the tendon insertions.

Apply forceps-like stroking, rubbing, kneading, pressing. The massage is completed with movements with enveloping stroking to the nearest lymph node.

The duration of the massage is from 5 to 10 minutes. 2–3 times a day, per course – 7–10 procedures in combination with physiotherapeutic procedures.

Tendinitis is a disease of the tendon itself, which occurs due to prolonged chronic overstrain. With insufficient blood supply collagen tissue The tendon undergoes a degenerative process and aching pain occurs.

By palpation, you can determine the thinning of the affected tendon.

Objectives of massage

Provide an analgesic effect, accelerate lymph and blood circulation, improve tissue nutrition, and help restore functions lost as a result of tendon damage.

Methodology

Limb massage is carried out with proximal parts, use planar, grasping stroking, rubbing, kneading, especially longitudinal, felting, vibration - shaking, continuous, labile. On the tendon itself, forceps-like techniques are used, alternating them with a suction type of massage to the nearest lymph nodes. Duration of massage is up to 10 minutes. The session should always end with passive and active movements. Per course – from 7 to 10 procedures daily.

Diseases and damage to the periosteum

Periarthritis– damage to the places where tendons attach to the bone near the joint. The pathological process develops in short and wide tendons, which bear the greatest load and are subject to significant tension. The disease is based on degenerative-dystrophic processes with inflammatory phenomena.

Among the etiological factors contributing to the development of periarthritis are great importance is given to microtraumatization, hypothermia, severe overexertion (of a sudden nature). More often there is a unilateral lesion. Pain occurs at night, especially when lying on the affected side. On palpation, pain is detected at the tendon attachment sites. There are glenohumeral periarthritis, periarthritis of the elbow, wrist, and knee joints.

Objectives of massage

Provide analgesic, anti-inflammatory, absorbable and trophic effect, improve lymph and blood circulation in the corresponding affected area, speed up the process of restoring the lost functions of a given joint.

Methodology

The massage begins from the upper sections using a suction type. Techniques used include stroking, rubbing, kneading, and gentle, continuous vibrations. Then the site of the disorder is massaged, carefully palpating the periarticular tissues, using rubbing, flat stroking, highlighting the tendon attachment sites, tendon sheaths and joint capsules. So, for damage localized in the knee joint, massage begins from the thigh, hip joint, gluteal muscles and then directly to the site of injury (knee joint).

The duration of the massage is 10–15 minutes, the course is 10–12 procedures, depending on the patient’s response, you can massage 1–3 times a day. At the end of the massage, passive movements are used in the corresponding joint.

Periostitis– this is an aseptic inflammation of the periosteum with partial involvement in the process of the cortical layer of the bone at the places of attachment of muscles, tendons, and ligaments to it. In this case, tears of individual collagen fibers and microhemorrhages into the periosteum are observed. This injury is most often observed in the area of ​​the lower leg bones. Periostitis occurs subacutely and chronically. Its main symptoms are short-term aching, throbbing pain, mainly along the front surface of the lower leg, and sharp pain on palpation.

Objectives of massage

Have an anti-inflammatory and analgesic effect, strive to reduce the inflammatory process.

Methodology

The muscles of the thigh and lower leg are massaged using stroking and its variations - rubbing, kneading in the form of pressure, shifting and stretching, as well as forceps-like effects. At the site of pain, periosteal techniques and targeted effects are used, taking into account the patient’s condition. The duration of the massage is 5–10 minutes, the massage course is 10–12 procedures, the procedures can be performed 1–3 times a day. Various absorbable ointments are used (venoruton, vascularin, opinogel, butadione).

Epicondylitis

Epicondylitis develops as a result of a circulatory disorder in the shoulder or elbow joint (“tennis elbow”). The pathogenesis is based, on the one hand, on tears with subsequent changes in the epicondyle itself and the adjacent ligaments, and on the other hand, muscle overstrain and ischemia. Characterized by pain in the epicondyle area, limited movement in the joint, fatigue, and weakness.

Objectives of massage

Provide an analgesic, anti-inflammatory and absorbable effect, promote the speedy restoration of the lost functions of a given joint.

Methodology

The massage begins from the collar area, at the level of the spinal segments D2 - C4, segmental techniques can be used - drilling, sawing, impact on the tissue between the spinous processes of the vertebrae, then the trapezius and latissimus muscles are massaged, using stroking, rubbing, kneading, vibration. Next, massage the lateral surface of the neck, shoulder girdle and joint - all techniques are carried out sparingly, taking into account the patient’s condition. Focus on massage of the deltoid and pectoral muscles; if these muscles are hypertonic, use stroking and gentle vibration – labile, continuous. It must be remembered that with epicondylitis of the shoulder, the elbow joint is not massaged. The procedure should be completed with active movements and shaking. The duration of the massage is 10–15 minutes, the course is 7–10 procedures, preferably every other day.

Fractures of limb bones

Objectives of massage

Improve lymph and blood circulation in injured tissues, help reduce pain, enhance the resolving effect of hemorrhages, improve the trophism of damaged tissues, restore the functions of the damaged limb, reduce the time of callus formation, prevent muscle atrophy and stiffness in adjacent joints.

Massage for fractures of the upper limbs

Methodology

Massage begins when there is plaster immobilization or skeletal tension. When immobilized with a cast, the patient sits or lies on his back.

The massage begins from the upper thoracic region in the area D4 - C2, at the exit points of the nerve roots on the right and left. You can perform vibration massage using devices on a plaster cast in the direction from distal to proximal (bottom to top). Massage is applied to a healthy area symmetrical to the lesion, using all techniques quite energetically.

Starting from the 2nd week, in the absence of contraindications, you can cut out a window in the plaster cast and perform puncturing, shading, or use a vibration device to stimulate the formation of callus 2–3 times a day.

When using adhesive or skeletal traction, from 2–3 days after the fracture, massage the healthy limb for 15–20 minutes. daily. All techniques are combined with active movements.

On the side of the fracture, massage is performed outside the focus - above or below it, depending on the location of the fracture. Pay attention to accessible parts of the body, use stroking, intermittent vibration, rubbing, shading, planing.

The duration of the massage is gradually increased to 12–20 minutes. During massage, it is necessary to systematically check the state of muscle tone and the presence of spasms of individual muscle bundles.

If muscle tone on the injured side increases, the intensity of massage manipulations should be reduced and the duration of the session should be shortened.

Massage for fractures of the bones of the lower extremities

Objectives of massage

Prevention of congestion in the lungs, prevention of intestinal atony, improvement of lymph and blood circulation in the abdominal cavity and pelvic organs, prevention of contractures and improvement of trophism of the muscles of the lower extremities.

Methodology

The massage begins from the chest area (all techniques are used), then the abdomen is massaged, using gentle stroking, rubbing, light kneading, puncturing (abdominal massage is carried out with a complete guarantee of the absence of internal bleeding). Next, they move on to massage the lower extremities, using suction massage (all techniques).

The joints are massaged separately, and passive movements are performed if possible. The duration of the session depends on the patient’s response, but should not exceed 15 minutes, the procedures are carried out daily.

Massage after removing immobilization or stopping traction

During the first procedures, you should not use energetic, intense techniques or prolonged massage, since there is still lymphostasis, restriction of movements and these manipulations can cause hemorrhages, increased pain, and increased tissue swelling.

Methodology

Depending on the patient’s posture (lying on the stomach, back or sitting), a variant of segmental reflex massage is used on the lumbosacral region. When massaging the affected limb, the massage is carried out using a suction method, starting from the overlying segments to the distal sections, the lower parts of the limb are massaged more energetically, all techniques are used. At the fracture site, stroking and rubbing in the form of spiral movements are used. Intermittent vibration is also allowed, which depends on the patient’s response. When massaging tendons, stroking, rubbing, and kneading are used; on joints, passive movements with targeted effects are used. It is necessary to finish the massage with general stroking of the grasping type, shaking, shaking of the entire limb.

Procedure time 7–10 minutes. gradually increases to 25–30 minutes. The course of treatment is 15–20 sessions. The effectiveness of massage manipulations increases when combined with exercise therapy. Subsequently, hydromassage can be used.

Spinal fractures

Spinal injuries are classified as the most severe, especially if they are accompanied by compression of the damaged spinal cord. If the spinal cord is damaged, the patient experiences paresis, paralysis, loss of sensation below the site of injury, and the acts of defecation and urination may be impaired. Due to the violation of tissue trophism, bedsores develop very quickly, which in the future are difficult to treat. Men tend to develop impotence. With mild injuries of the spinal cord (bruise, slight compression), these phenomena quickly disappear.

Methodology

The procedure begins with a chest massage, using stroking, rubbing, kneading the large pectoral muscles, shock vibration techniques are carried out lightly. Next, they move on to a back massage, perform stroking and rubbing, massage the abdomen (all techniques) and finish the massage on the limbs, using various manipulations, combining them with passive movements, and in case of paresis - with active ones for the paretic muscles.