Professional full body massage. Types and techniques of performing medical massage - indications for treatment, rehabilitation and prevention of diseases

Massage in the clinic Rehabilitation medicine, SAO.

Therapeutic medical massage is carried out more intensively than classic or relaxing; the actions of the massage therapist are aimed at removing blocks and clamps, Special attention is given to problem areas where there are deviations and pathologies. During a therapeutic massage, the patient experiences quite intense sensations.

In principle, any professional massage can be called medicinal- he mobilizes protective forces body, increases immunity, has a beneficial effect on the state of the cardiovascular, nervous, digestive, respiratory systems, blood circulation, relieves congestion, improves joint mobility, is effective for radiculitis, osteochondrosis.

Therapeutic massage in Moscow - VosstMed clinic

The Restorative Medicine Medical Center practices massage as one of the main procedures for treating diseases of the musculoskeletal system, joints, muscles and ligaments.

Segmental and acupressure massage

Segmental medical massage involves influencing the segments in which changes have occurred (muscles, skin, bone). Reflex changes are corrected with special massage techniques. The affected areas are found by palpation, when painful areas are identified, increased excitability of one or another segment begin work to eliminate the source of pathology.

Segmental massage includes acupressure, which is considered a species.

Each type medical massage has its advantages, the doctor in each individual case will be able to advise one or another type of mechanical action depending on the treatment objectives.

General therapeutic body massage

Professional massage bodies at the VostMed clinic, photo

General medical body massage is a special type of massage in which the entire body is massaged, rather than individual areas. This type of procedure helps to relax and get rid of many diseases; it helps to achieve an effect on all systems of the body - muscular, digestive, lymphatic, endocrine, nervous, and the circulatory system. General therapeutic massage affects all areas of the body, helps get rid of insomnia, fatigue, stress, improves skin condition, improves metabolic processes and digestion of food, reduces the patient’s weight, and calms the nervous system.

Features of classic massage

The most popular is classic therapeutic massage, on the basis of which all other massage techniques are built. Stroking, kneading, rubbing are present in different types of massage, but in the classic one they are used longer, repeated more often, and have a certain repetition order.

First, the collar area is massaged, then the hands move along the location of the lymphatic pathways. Stimulating movements give the body strength, relieve stress, and increase overall tone. After a session of classic therapeutic massage, a person experiences a surge of strength, they leave painful sensations, sleep and appetite improves. Massage is good not only for improving well-being, but also for lifting your mood.

Massotherapy – method manual therapy, which is based on mechanical effects on surface tissues human body.

Therapeutic massage can be called the most popular and effective method therapeutic effects that do not require administration medicines. Despite the fact that modern medicine, with all its innovative techniques, and the latest developments in the field of pharmacology have the potential to treat almost any disease, therapeutic massage does not lose its position and is actively used both in a complex of therapeutic measures and as an independent therapy. medical procedure.

Various types of therapeutic massage are used in many areas of medicine: orthopedics, surgery, neurology, therapy and many others.

Of course, only a doctor’s prescription can be considered a sufficient basis for conducting a course of therapeutic massage. Despite the apparent simplicity and harmlessness of the procedures, the ability of massage techniques to influence the body is so high that their implementation can only be entrusted to a specialist.

If a patient gets an appointment with a massage therapist who does not have the required level of classification, at best it will be a waste of money, at worst it can result in serious health problems.

Indications for therapeutic massage sessions

Massage treatment is prescribed for pain in various areas of the back: from the cervical-collar to the lumbar, for osteochondrosis, postural disorders, and diseases of the spine.

Massage is effective in the treatment of diseases accompanied by stagnation and impaired fluid circulation in the patient’s body, and allows you to increase the metabolic rate, get rid of edema and excess weight.

As a method of rehabilitation, therapeutic massage is often used for patients who have suffered various injuries. Beneficial influence massage on blood and lymph circulation makes it an indispensable procedure for improving the condition of bedridden patients.

In addition, massage improves general state body skin, has a general strengthening effect, helps fight fatigue and stress.

Types of therapeutic massage

Massage of the head and neck-collar area
Prescribed when neurological diseases, which are accompanied by dizziness, fainting, changes in blood pressure, numbness of the hands, and headaches. Well this massage helps weather dependent people responsive to changes in atmospheric pressure and weather changes.

Massage cervical thoracic
Performed for osteochondrosis cervical region spine, which manifests itself frequent pain in the back of the head, poor neck mobility, pain between the shoulder blades, attacks of dizziness. Shown this method massage and for osteochondrosis of the thoracic spine, its symptoms are fatigue, “stiffness” of the back muscles and constant pain in areas along the spine.

Massage chest
Effectively helps with diseases of the respiratory system: chronic bronchitis, pneumonia and its residual effects, pleurisy, asthma. Chest massage helps remove mucus, relieves tension in the respiratory muscles, and increases the mobility of the diaphragm. However, chest massage cannot be performed in the acute phase of diseases, which is accompanied by difficulty breathing and elevated temperature bodies.

Massage of the lumbosacral region
Prescribed for the treatment of radiculitis in older people who often suffer from lower back pain and limited mobility. This massage is also useful for patients suffering from lumbar osteochondrosis. Often, pain in the lumbosacral region “radiates” to the legs, prevents the patient from fully straightening his back, makes the gait cautious, “shuffling” - all these symptoms can also be treated with massage of the lumbar area.

Massage of the upper and lower limbs
It is used to treat vascular diseases, injuries of soft tissues, bones, joints, and relieves pain in arthrosis and arthritis. Massage upper limbs carried out from the hand to shoulder joint. Massage of the lower extremities - from the foot to gluteal muscles And hip joint. In some cases, massage of the lower extremities is prescribed to treat varicose veins.

Full body massage
Helps fight stress and fatigue, eliminates pain, restores muscles after intense physical activity and injuries. General body massage is often performed to prevent diseases of the musculoskeletal system. The procedure for a general body massage involves a certain sequence: the massage begins from the back, then moves to the shoulders and neck, then the lower back, buttocks, and legs are massaged. After this, the patient is turned over on his back and the legs, abdomen, and chest are massaged. The session ends with a hand massage.

General principles of therapeutic massage sessions

Contraindications for therapeutic massage

• cardiovascular failure,
• infectious diseases during exacerbation,
• the presence of malignant and benign tumors,
• severe impairment internal organs.

1.2.3. Basics of therapeutic massage

Characteristics of therapeutic massage. Therapeutic massage is an effective therapeutic and rehabilitation method used to normalize body functions during various diseases and damage. The popularity of therapeutic massage is constantly growing, it has become the object of close attention and scientific study. It is used in surgery, traumatology, therapy, gynecology, neuropathology, cardiology, endocrinology, sports medicine and rehabilitation.

Methods of therapeutic massage. The most common method is classical massage is the main method in therapeutic massage, as it has a variety of techniques, allows you to widely vary the dosage, visually and tactlessly control the accuracy of the techniques and evaluate their results, etc. Manual massage has an advantage over hardware, foot and combined massage, since it can be used not only in the ward, massage room, but also at home, in a bathhouse, bath, etc., as well as in the form of self-massage.

Hardware massage method used as an additional one. Depending on the variety, it can be performed either through direct contact with the skin or through air or water. Among the varieties of hardware massage methods, vibration, hydro and pneumatic massage are the most widespread. Electrical stimulation, ultrasound massage, etc. are also used in medical practice. Hardware types of massage, as well as manual massage, can be used in the process of segmental, acupressure, periosteal and other types of massage. Combined massage method. Combined massage is a massage that uses manual and hardware massage.

Foot massage method It is performed using the feet: the heel, toes, and also knees, most often in sanatorium-resort conditions, in water clinics and baths.

It is especially worth emphasizing the great effectiveness of manual massage, since only with their hands can a massage therapist identify changes in the tissues of the massaged area, highlight the necessary points and purposefully influence them. Without denying the positive effects of hardware massage, medical practice However, it is preferable to use a manual one, since none of the devices can replace the hands of a massage therapist.

Therapeutic massage can be classified according to the nosological units for which it is used: massage for injuries and diseases of the musculoskeletal system, massage for diseases and injuries of the nervous system, massage for diseases of internal organs, etc. Each group of diseases has its own characteristics of the technique and methodology of a massage session. For each disease, the massage technique depends on the etiology, pathogenesis, clinical form, course and is differentiated in connection with these factors.

Methodological features when conducting therapeutic massage. Massage is a more adequate therapeutic effect in the first days after injuries or illnesses than exercise therapy. Therefore, to achieve a greater therapeutic effect, massage should be performed before physical exercise, and, if necessary, again after it. The technique and methodology for performing techniques in therapeutic massage are similar to those in hygienic, sports and other types of massage, namely: stroking - combined, longitudinal, alternating, etc.; squeezing - with the edge of the palm, the base of the palm, etc.; kneading - double ring, double bar, pads of 1-4 fingers, base of the palm, etc.; rubbing - “pinks”, with fingertips, the comb of a fist, etc.; shaking; vibration; movements, etc. The choice of techniques for creating a specific massage session technique depends on the disease and clinical forms its flow. The therapeutic technique of massage involves techniques of focal and extrafocal, or segmental-reflex, effects, a sequence of techniques, their combination with movements, and a gradual increase in impact.

Dosing of massage is carried out by: localization of segments of influence, choice of techniques, depth and area of ​​influence on tissues, number of massage manipulations, speed and rhythm of movements and their amplitude, duration of procedures and alternating them with other influences, rest intervals (pauses) between procedures, number of procedures per course of treatment, etc.

Therapeutic massage for all diseases and injuries is carried out in accordance with the periods of treatment and stages of rehabilitation. A massage session consists of three sections: introductory, main and final. Massage should not cause pain. It can be done 1-2 times daily or every other day. The course of treatment is from 10 to 18-25 procedures, the break between courses is from 10 days to 2 months, depending on the disease and agreement with the doctor in each individual case.

General indications and contraindications for therapeutic massage. Massage is often combined with other treatment methods, especially physical factors, physical therapy, but it can also be used as an independent method of rehabilitation. When prescribing a massage, it is necessary to clearly know the indications and contraindications for its use. It should be remembered that the use of undifferentiated techniques, the use of techniques indiscriminately can cause unfavorable responses, even aggravating the process. The same negative reactions occur when massage is prescribed at a time when massage is not yet indicated. It is important to take into account that when combining massage with physical factors, the latter may be accompanied by a reaction. Therefore, the massage technique should be more gentle; sometimes massage should be applied to an area of ​​the body distant from the source of exacerbation, or the procedures should be canceled, resuming them after the acute phenomena have subsided, according to the doctor’s decision in accordance with individual indications.

Massage should be performed along the lymphatic pathways towards the nearest lymph nodes, which cannot be massaged. The patient's position should prevent tension on the parts being massaged and on the entire body. Massage techniques should not cause pain.

The duration of a massage session depends on the disease, body area, body weight of the person, his age and current condition, etc. The first massage sessions are always short and gentle, and then the time and strength of the impact increase. The time for performing individual massage techniques depends on the parts of the body being massaged, the nature of the injuries or diseases, as well as the patient’s well-being. The correct choice of techniques largely determines the therapeutic effect of massage.

When performing massage for the purpose of treatment and rehabilitation, there are the following contraindications.

Acute febrile condition and acute inflammatory processes.

Bleeding, bleeding.

Blood diseases.

Purulent processes of any localization.

A disease of skin infection, unknown or fungal etiology. Skin rashes, damage, skin irritation.

Acute inflammation of the veins, vascular thrombosis, significant varicose veins with trophic disorders.

Endarteritis, complicated by trophic disorders, gangrene.

Atherosclerosis peripheral vessels, thromboangiitis in combination with atherosclerosis of cerebral vessels, accompanied by cerebral crises.

Aneurysms of blood vessels and heart.

Inflammation of the lymph nodes and blood vessels. Enlarged, painful lymph nodes adherent to the skin and underlying tissues.

Allergies with hemorrhagic and other rashes. Hemorrhages into the skin.

Excessive mental or physical fatigue.

Active form of tuberculosis.

Syphilis stage 1-2, AIDS.

Chronic osteomyelitis.

Causalgic syndrome after peripheral nerve injuries.

Malignant tumors of various locations.

Mental illnesses, with overexcitement, significantly altered psyche.

In some cases, contraindications to massage are temporary and after an acute inflammatory process, feverish condition, purulent process, exacerbation of a disease of the autonomic nervous system, etc. massage can be used (according to indications). Massage should also be prescribed after radical tumor removal. It often happens that massage may be indicated for the underlying disease, but it cannot be prescribed due to concomitant diseases.

Concluding the general part, it should be emphasized that knowledge of massage techniques individual parts body is necessary as a basis for subsequent mastery of private massage techniques for diseases and injuries. Only this approach to the study and use of massage makes it highly effective in the treatment and rehabilitation of various diseases and injuries. When prescribing a massage, the doctor must indicate in what combination and sequence with other procedures the massage should be used and constantly monitor the patient during the application of this method of treatment and rehabilitation.

A combination of therapeutic massage with exercise therapy and physiotherapy. In many cases, it is advisable to combine massage with various physiotherapeutic procedures: water therapy, light therapy, electrotherapy, etc. Physical treatments prepare the body tissues for massage. For example, it is advisable to pre-warm the limbs whose skin temperature is low (paresis, paralysis), or to reduce pain so that it becomes possible to deepen the massage, etc.

Massage And heat therapy. Heat significantly enhances the physiological effect of massage, causing active tissue hyperemia, reduces muscle excitability, relaxes spasms of muscles and blood vessels and significantly reduces pain. Therefore, in case of traumatic and inflammatory lesions of the joint-ligamentous and muscular system in the subacute period, as well as in chronic processes, joint stiffness, muscle contractures, vascular disorders with a tendency to spasms, it is advisable to combine massage with thermal procedures (water bath, paraffin applications, ozokerite, steam room , bathhouse, etc.).

The sequence of thermal procedures and massage in each case is determined by special indications. Thus, with functional disorders of the musculoskeletal system (joint stiffness, articular adhesions, delayed formation callus, muscle atrophy, paresis, neuritis and neuralgia) it is recommended to first apply heat and then massage. For vascular disorders (tissue swelling after a fracture, lymphostasis phenomena) - first massage, and then heat to avoid rupture of superficial vessels.

Massage and electrotherapy. With the combined use of massage and electro-gymnastics (amplipulse, electrical stimulation, etc.), massage is recommended to be carried out immediately after the electro-procedure. When prescribing electrophoresis with various medicinal substances in combination with massage, massage is first used, and then electrophoresis.

Massage and hydrotherapy. Depending on the indications, massage can be used before and after water procedures. For injuries and diseases of the musculoskeletal system (scar tissue adhesions, myogenic, arthrogenic contractures, joint stiffness, myofibrosis, tissue myosclerosis, etc.), as well as for injuries and diseases of the peripheral nervous system (lumbosacral radiculitis, neuromyositis, etc.) First, thermal and water procedures are used, and then massage; In case of severe pain, the massage is preceded by a hydrotherapy procedure.

You should not prescribe a general massage and a general light bath on the same day. The nature of the reaction is incompatible, for example, ultraviolet irradiation and massage or Charcot's shower and massage.

Physiotherapeutic procedures do not place a very large burden on the cardiovascular and nervous system and can be prescribed on the same day, but at different times: for example, a water bath (low temperature) and massage, mud therapy (local application) and massage.

Segmental reflex massage. In the arsenal of modern medicine there are many ways of reflex effects on the human body. Massage is largely based on the principles of such influence. Methods of reflex influence on the human body through pressure (pressure) include segmental, acupressure, connective tissue, periosteal and other types of massage. Their essence lies in the impact of certain techniques on individual parts of the body, zone or points of the skin surface, periosteum and other tissues of the human body. It should be noted that the body’s reactions are completely different depending on the type of exposure. These reactions are called reflex, and the method of influence (treatment) based on their use is called reflexology.

Segmental massage. Based on the physiological principles and theoretical principles of the teachings of I.P. Pavlova, A.E. Shcherbak (1903) proposed and substantiated a new direction in the development of therapeutic massage - segmental reflex massage, which is progressively developing and is effectively used in clinical and sanatorium practice in our country.

Segmental reflex massage involves direct impact not on the diseased organ, but on areas innervated by the same segments spinal cord(Table 1), i.e. indirectly influencing the mechanisms of pathogenesis. For example, by massaging the corresponding paravertebral zones and the epigastric region, you can influence the motor, secretory and evacuation functions of the stomach; for vascular diseases and injuries of the lower extremities, massage of the lumbar region has a positive effect on blood circulation, trophic processes in tissues and their regeneration, and improves the restoration of motor functions. Chest massage can help eliminate and resolve residual effects after inflammation of the lungs and pleura and prevent the development of adhesions; massage of the collar area - reduce arterial pressure for hypertension, eliminate headaches with neuroses and fatigue.

All tissues, organs and systems of the human body represent a single whole and are in certain relationships with each other. Therefore, not a single disease is local, but always causes reflex changes in segment-related functional formations, predominantly innervated by the same segments of the spinal cord. Reflex changes can occur in the skin, muscles, connective and other tissues and, in turn, affect primary focus and support the pathological process. By eliminating these changes in tissues with the help of massage, it is possible to help eliminate the primary pathological process and restore the normal state of the body.

The interrelations of our body are carried out through viscerosensory, viscero-motor and viscero-visceral reflexes, which are of great importance in clinical practice.

Areas of the skin surface with increased sensitivity, in which pain occurs due to diseases of internal organs, are called Zakharyin-Ged zones. The Russian clinician G. A. Zakharyin first described them in 1889. The connections of various internal organs with certain areas of the skin were described in more detail by Ged in 1893-1896. Physiologically, the appearance of zones of increased sensitivity is explained by the fact that pain stimuli coming through sympathetic fibers from the internal organs to the spinal cord irradiate to all sensitive cells of a given segment, exciting them. Such excitation is projected onto the areas of the skin associated with this segment. It is known, for example, that with cardiosclerosis and angina pectoris, pain occurs in the left arm, on the inner surface of the shoulder, in the axillary region, near the scapula. A reverse reflex process is also possible, when a pathological focus on the surface of the skin causes pain in the internal organs.

In diseases of the internal organs, long-term painful tension in the skeletal muscles sometimes occurs. For example, with liver diseases and biliary tract Reflex changes are observed in the trapezius muscle, in the latissimus dorsi muscle, in diseases of the pleura - in the intercostal muscles, in the sternocleidomastoid muscle, etc. In diseases of the internal organs, reflex changes in the periphery can manifest themselves as thickening or limited mobility of the skin, compactions in the subcutaneous tissue.

Establishing functional connections between all parts human body laid the foundation for the development of segmental reflex methods in physiotherapy, including massage. Research has shown that by influencing the surface of the body in certain areas with physical factors, it is possible to influence the vital functions of the body for therapeutic purposes. Based on the study of anatomical and physiological data and the results of clinical studies, it was determined special meaning some skin areas. Thus, the cervico-occipital and upper thoracic regions (collar zone) include the skin of the back of the neck, back of the head, shoulder girdle, upper back and chest. This entire skin zone is closely connected with the cervical and upper thoracic segments of the spinal cord (C 4 -D 2) and the formations of the cervical autonomic nervous system. The cervical part of the autonomic nervous system is connected to the autonomic centers of the brain and has extensive peripheral connections, due to which it plays a large role in the innervation of the heart, lungs, liver and other organs and tissues of the head, neck, upper chest, back and upper extremities. By influencing the skin segments of the collar zone with massage, it is possible to cause functional changes in the central nervous system, where the control of the vegetative activity of the body is concentrated, and to obtain a reflex response in the form of various physiological reactions from organs and tissues (metabolic processes, thermoregulation, etc.).

The lumbosacral region includes the skin of the lower back, buttocks, lower abdomen and upper third of the front of the thighs. This entire skin zone is closely connected with the lower thoracic (D 10 -D 12). lumbar and sacral segments of the spinal cord, with the lumbar part of the sympathetic department of the autonomic nervous system and its parasympathetic centers. In case of irritation by physical factors of the skin segments associated with nervous apparatus lumbar region, functional changes occur in the organs and tissues of the pelvis, in the intestines and lower extremities. Based on experimental studies and clinical observations of A.E. Shcherbak was the first to recommend segmental reflex massage techniques - massage collar And waist massage. The first of them is prescribed for hypertension, sleep disorders, trophic disorders in the upper extremities, etc., the second - for vascular diseases and injuries of the lower extremities, to stimulate the hormonal function of the gonads, etc.

Segmental reflex massage differs from classical massage in that in addition to the effect on the affected organ, there is an additional extrafocal effect on the affected tissues, organs and systems of the body. In an internal medicine clinic, where direct massage of a diseased organ is not available, segmental reflex massage is especially important. During segmental massage, all the basic techniques of classical massage are used: stroking, squeezing, rubbing, kneading and vibration. Auxiliary techniques are also used, for example, hatching, sawing, squeezing, felting, stretching muscles, joint-ligamentous apparatus, shaking the chest, pelvis, internal organs, etc. In addition, special techniques are used: drilling, moving, sawing, etc. Techniques segmental massage should be carried out rhythmically, gently, without brute force, having previously given the massaged body segment an average physiological position. In addition to the accepted directions of massage manipulations, segmental reflex massage also carries out specific directions of movements, determined by the functional structure of the spinal innervation segment and its neuro-reflex connections. Under the term segmental massage imply not only an impact at the level of a certain segment of the spinal cord, but also a special massage technique. Features of the segmental massage technique are sequential differentiated effects on the skin - stroking and squeezing; to influence the muscles - kneading and squeezing, which cause muscle stretching. In addition to these techniques, rubbing techniques are also used: on joints, fascia, tendons, and ligaments. Pressure and muscle shifting are applied to the muscles. Shifting of the vertebrae is also used.

Method of using segmental massage:

start the massage session with superficial tissues;

start with the lower segments, gradually move to the higher-lying sections, for example from D 8 - D 1;

It is advisable to start performing techniques from the segmental roots at the exit point of the spinal column.

Acupressure. Unlike segmental massage, acupressure massages narrowly limited point areas of tissue. It has been established that acupressure has mechanical, humoral, reflex and bioelectric effects. It is performed at the same points that are exposed to a needle or a wormwood cigarette during the therapeutic method of acupuncture and moxibustion. These healing methods originated in the countries of the Ancient East. Over the centuries, a whole system of therapeutic effects has developed, which included acupressure as one of the main methods of treatment. It has been established that some points on the human skin are functionally interconnected with various organs and systems of the body; they were called biologically active. In total, about 700 such points are described, but most often 100-150 of them are used. In the mechanism of therapeutic action on biological active points(BAT) are complex reflex physiological processes. When a particular zone or point of the skin is irritated, a response can be evoked at the level of a specific organ in an area that has no visible anatomical connection with the irritated one.

Studies of biologically active points have shown that exposure to the point excites or calms (depending on the technique) the autonomic nervous system, enhances arterial blood supply, regulates the activity of the endocrine glands, soothes pain, and relieves nervous and muscle tension. Biologically active points have specific features that distinguish them from other areas of the skin: reduced electrocutaneous resistance, high electrical potential, increased temperature and pain sensitivity (hence the term massage in pain points), higher level metabolic processes(V.I. Ibragimova, 1983). Pressure and rubbing at these points causes a feeling of aching, numbness, acute pain(similar sensations do not occur with pressure and rubbing at some distance from these points). These sensations are so constant and characteristic of biologically active points that they are a criterion for the correctness of their location.

Dosed exposure to strictly defined points selectively affects the functions of various organs and systems. The use of massage in the armpits, mammary glands and other areas large vessels not shown. Acupressure can be used in combination with drug therapy. It must be remembered that this ancient Eastern method of treatment only complements modern medical methods of treatment and recovery, but does not replace them.

Method for determining points. During palpation, the location of the BAP is identified using sliding squeezing movements with the pad of the most sensitive finger; when the point is found, a feeling of roughness, warmth, and increased pain appears.

The location of points can be identified using topographic maps, diagrams and drawings that inform about the location of points, as well as using ELAP, ELAP-VEF, ELITE-04, and “Reflex - 3-01” devices.

Acupressure technique. Depending on the technique of influencing a local point, the method can be stimulating or calming. Thus, in case of violations of muscle tone, with its increase, contractures of a central or peripheral nature (spastic paralysis, paresis, infantile cerebral palsy, contractures of facial muscles with complicated neuritis facial nerve), as well as for pain, especially of a muscular or joint nature, the goal of the intervention is relaxation, relaxation, calming, i.e. sedative effect. In this case, an inhibitory, sedative method is used: within 1-2 s they find the required point, within 5-6 s they make clockwise rotational movements, go deeper, pressing on this point and gradually increasing the force, fix the achieved level for 1-2 s , then make the opposite movement, “unscrewing” the finger counterclockwise, gradually reduce the pressure force, performing rotations for 5-6 s. Then, without lifting the finger from the fixed point, this cycle of movements is repeated (when exposed to a sedative method for 1 minute, 4 entries and exits are made, each for 15 s; if it is necessary to act for 2 minutes, then 8 entries and exits are made). With each impact, the pressure on the point increases depending on the sensation of the person being massaged (bloating, numbness, pain, warmth, etc.).

During the phenomena decreased tone, atrophy of muscle groups, neuritis of individual nerve trunks, paresis, a stimulating (tonic, stimulating; acupressure technique is used: find the point for 1-2 s, then perform clockwise rotational movements for 3-4 s, “screwing in” the finger and pressing on point, and then sharply torn away from the point, similar to how a bird hits with its beak, this movement is repeated 8-10 times at one point (40-60 s).Such impact on the points is carried out in a certain sequence, purposefully, according to the recommendations for the corresponding disease , syndrome.Figure 1 shows the position of the fingers and hand when performing acupressure.

Connective tissue massage. Areas of tissue with increased tension are designated as connective tissue zones. There is limited skin mobility here, which can be determined by palpation. In case of diseases of some internal organs or functional disorders in them, mobility connective tissue may be completely absent (for example, in severe angiopathy). Massage of reflex zones located in connective tissue is called connective tissue massage. The technique of its implementation is to influence tense areas of connective tissue (most often with the tips of the 3rd and 4th fingers). At the same time, in places with pronounced tension, acute sensation, resembling a cutting motion with a fingernail or a sharp pinch of the skin.

According to the method of execution, connective tissue massage is divided into 3 types:

cutaneous, when only the skin is displaced and the subcutaneous layer is not affected;

subcutaneous, when the subcutaneous layer is displaced, but the fascia is not affected;

fascial, when the displacement is made in the fascia.

Connective tissue massage is based on the tension of certain receptors (mechanoreceptors of the skin, subcutaneous tissues and vascular connective tissue), which causes various reflexes that can affect organs innervated by the autonomic nervous system.

Periosteal massage. The effect of periosteal massage (classified as pressure massage) is aimed at the bone surfaces or periosteum (it is carried out with the fingertips or interphalangeal joints) and consists in the fact that at the point of pressure, blood circulation and cell regeneration increase, mainly in the periosteal tissue, and there is a reflex effect on organs connected by nerve pathways to the massaged surface of the periosteum. There are experimental data that suggest that after periosteal massage in the area of ​​the cervical vertebrae or occipital region, visual acuity increases, and after massage in the area of ​​the ribs and sternum, heart rate decreases, i.e., the efficiency of the activity of the heart muscle increases. Periosteal massage significantly affects breathing, so it is used as aid in the treatment of patients with respiratory dysfunction. It is especially useful in case of a sharp decrease in the tidal volume of the lungs and impaired gas exchange. Periosteal massage is also indicated for pain or morphological changes in the periosteum and is the best method for arthrosis of the costovertebral or intervertebral joints with pain.

The technique of periosteal massage is simple: the fingertip or interphalangeal joint is lowered onto the painful point, the soft tissues covering it (primarily muscles) are shifted to achieve the best contact with the periosteum, and, gradually increasing the pressure, they press on it, simultaneously performing rhythmic small circular movements. Then the pressure is also gradually reduced without interrupting contact with the skin. Cycles of increasing and decreasing pressure last 4-6 s and are repeated for 2-4 minutes. After impacting each point with the tip thumb(or the tubercle of the thumb) perform a squeeze. The average duration of a massage session should not exceed 18 minutes. The frequency of procedures is 3 times a week.

Massage for diseases and injuries of the musculoskeletal system (MSA). The objectives of massage for musculoskeletal injuries are as follows:

in enhancing blood and lymph circulation and metabolic (trophic) processes in the damaged area of ​​the musculoskeletal system;

in reducing pain;

in promoting the resorption of infiltrates, effusions, edema, hemorrhages in the damaged area;

in accelerating regeneration processes, in particular the formation of callus during bone fractures;

in relieving muscle tension;

in preventing the formation of contractures and stiffness in joints; muscle atrophy.

Massage, due to mechanical effects and reflex effects, helps to increase blood and lymph circulation in the damaged area, improving trophism and promoting rapid healing of the damaged part of the musculoskeletal system.

Under the influence of massage, elasticity improves and mobility of the ligamentous-capsular apparatus increases, the secretion of the synovial membrane of the joint is activated, helping to reduce swelling and normalize its function.

Massage for bruises Massage is carried out on the 2-3rd day after the injury (if there is no rupture of large vessels and muscles, thrombosis). The massage begins above the site of injury, stimulating the outflow of lymph and blood from the area of ​​the bruise (suction massage technique). The techniques of stroking, light kneading and squeezing in the direction of the nearest, higher-lying lymph nodes are used. If there is no pain, you can begin to massage the area of ​​the bruise; the intensity of the effect depends on the patient’s sensation. At the first massage session in the area of ​​the bruise, light stroking techniques are limited. As the pain decreases, stroking begins to alternate with light rubbing and soft kneading with the pads of the fingers, in larger areas - with the base of the palm.

The duration of the massage procedure in the first days is 8-10 minutes. in the subsequent ones - 18-20. Gradually, passive movements and active exercises are added to the massage.

Massage for sprains. Massage begins on the 2nd or 3rd day after the sprain. The affected limb fits into several exalted position, and the massage begins above the affected area, using mainly stroking and rubbing techniques. From the 3-4th procedure, rubbing and active movements in the joint are added, gradually increasing the range of movements. It is better to perform a massage after thermal procedures.

For dislocations, massage begins after reduction and temporary immobilization by working out the muscles surrounding the joint, using stroking and kneading. Later they begin to rub the joint elements and perform movements in the joint.

Massage for fractures. For open fractures, massage is contraindicated (risk of wound infection); for closed fractures, massage and therapeutic exercises are mandatory elements of complex treatment of fractures. On top of the plaster cast, vibration massage is used in the area of ​​the fracture from the 2-3rd day after the injury. Before removing immobilization, massage of the healthy limb is useful. After the immobilization is removed, a suction massage is first applied, and then the fracture site is massaged using intermittent stroking, and a little later - rubbing and kneading the muscles. With slow fusion of fragments in the area of ​​injury, more active techniques are used: chopping, patting, tapping with a wooden hammer, vibration; for scar contractures on the side of stretched and weakened muscles, deep stroking is used, then kneading and light tapping. To stretch scars and adhesions, techniques such as stretching, shifting, forceps-like rubbing and crossing are indicated; for stretching muscles with muscle contractures, flat and enveloping stroking is recommended. Massage should be combined with gradual relaxation - stretching muscle contractures with your hands using light rocking movements in the joint.

In case of traumatic injuries, it is also necessary to act on the corresponding reflex-segmental area. Thus, in case of injuries to the upper limb, paravertebral zones are massaged in the area where the nerve roots of the spinal cord exit to the right and left of the cervico-occipital and upper thoracic spine, and in case of injuries to the lower extremities - the lower thoracic and lumbar spine.

Massage for joint diseases carried out to promote the resorption of inflammatory exudate in arthritis; increase blood circulation in the affected joint with osteoarthritis; reduce pain and stiffness in the joint; help restore normal range of motion in joints; strengthen muscles, prevent muscle wasting and increase their performance; prevent the development of contractures and stiffness in joints.

Massage for arthritis. The first procedures are carried out using a gentle method without special impact on the joints, using stroking and light kneading, trying to relieve tension in the muscles. From the 2-3rd procedure, the muscles surrounding the affected joint and the joint itself are affected. When performing a massage, it is important to be able to determine how muscle tone has changed: whether it is increased or decreased, to find areas of muscle compaction and knots, differentially influencing these changes and trying to eliminate them. Thus, areas of reduced muscle tone must be affected with strong techniques - rubbing, kneading, acting slowly. In the area with muscle hypertonicity, on the contrary, soft techniques and continuous vibration are indicated. If the upper and lower extremities are affected, massage can be performed on the patient while he is lying and sitting, achieving maximum muscle relaxation.

The duration of the massage procedure for one limb in the first procedures is 5-7 minutes, subsequently 10-15 minutes, per course - 15-17 procedures, after 0.5-1 month the massage course can be repeated.

Massage for arthrosis carried out more intensively, using all techniques classic massage depending on the clinical features manifestations of the disease and its severity. Much time is spent rubbing the joint elements and strengthening the muscle groups around the joint in combination with passive and active movements in the affected joint.

The duration of one procedure at the beginning of the course is 8-10 minutes and 20-25 at the end, a total of 10-12 procedures.

Massage for diseases and injuries of the nervous system and spinal osteochondrosis It is also used for vegetative disorders and neuroses in order to improve blood circulation, as well as tissue trophism in flaccid and spastic paralysis, strengthen paretic muscles, muscles in a state of contracture, preventing the development of muscle atrophy, reducing pain and activating nerve regeneration. Massage for spastic cuts and paralysis should be carried out with great care. Before the massage, if possible, warm the sore limb with a heating pad or lamp, achieving maximum muscle relaxation. At the beginning of the disease, in order not to cause an increase in hypertonicity of the spastic muscles, you need to use only the techniques of superficial stroking and gentle rubbing.

The massage begins from the lower extremities, from the proximal parts. Muscles in which the tone is increased are massaged with gentle, soft stroking and rubbing techniques at a slow pace. Stretched, atrophic, weakened muscles are massaged with passive movements. To reduce the excitability of the motor cells of the spinal cord and influence trophic processes, the paravertebral spinal segments are massaged - for the upper extremities - cervicothoracic - (C 5 - D 1); for the lower extremities - lumbar - (L 1 -S 2). In view of fatigue For patients with spastic paralysis, the duration of the massage at the beginning of the course is 6-8 minutes, gradually increasing to 15-20 minutes.

The use of massage for various diseases accompanied by flaccid paralysis is aimed at strengthening weakened muscles and relaxing antagonist muscles. Private massage techniques depend on the characteristics of the clinical forms of the lesion. Almost all the basic techniques of classical massage are used. For bilateral lesions - flaccid tetraplegia or tetraparesis - a pair massage is used by two massage therapists.

Massage for neuritis and neuralgia is used to reduce pain, improve tissue trophism and nerve conductivity, and improve sensitivity. The corresponding paravertebral zones are massaged along the course of the nerve, the point of exit of the nerve and the place of pain irradiation. In the presence of severe pain, massage is carried out using a gentle technique using mainly stroking and gentle rubbing.

Massage for neuritis of the facial nerve has some specifics. In the acute stage, massage the healthy half of the face lightly (gently). On the affected side, the massage begins in the recovery stage, stroking is performed from the middle of the forehead, nose and chin to the submandibular glands, light stroking around the eye; stroking the neck from front and back; rubbing and vibration along the nerve. They also produce skin vibration of paralyzed muscles. Duration of massage is 3-5-8 minutes daily. A course of 15-18 procedures.

Massage for diseases of the cardiovascular system is aimed at eliminating congestion in the pulmonary and systemic circulation, improving blood flow to the heart, developing collateral circulation, normalizing blood pressure, improving adaptation of the cardiovascular system to changing external conditions, and increasing physical activity. Massaging the chest enhances its suction effect, facilitating the work of the heart, and reduces congestion. It is also indicated for hypertension, neurocircular dystonia, angina pectoris, post-infarction condition, myocardial dystrophy. heart neurosis, heart disease V stage of compensation, chronic myocarditis, circulatory failure, vascular diseases (varicose veins, obliterating endarteritis). For diseases of the heart muscle (IHD, myocardial dystrophy, myocarditis, cardiosclerosis), a general massage is indicated, which is recommended to start from the back, where the large skin surface and muscles with an abundant network of capillaries are located relatively superficially. Thanks to the massage, which causes expansion of the capillary network, blood flow in the periphery increases, which significantly facilitates the work of the left ventricle of the heart.

The massage begins with stroking and kneading the interscapular area. Then massage the shoulder girdle in the direction from spinal column to the shoulder joints and shoulder blades, the back and sides of the neck. After stroking, rub and knead the same areas. Then, gentle stroking of the heart area is carried out, rake-like stroking and rubbing of the intercostal spaces from the sternum to the spinal column, and finally shaking and gentle tapping of the chest. After this, apply circular stroking and rubbing of the area of ​​the mastoid processes of the temporal bone and occipital protuberance, alternating them with stroking the neck and shoulder girdle. Then lightly tap the spinous process of the VII cervical vertebra and massage the upper and lower limbs with wide strokes in the direction lymphatic vessels. The duration of the procedure is 15-20 minutes, the course of treatment is 12-15 procedures daily or every other day.

Massage techniques for specific diseases will be outlined in the relevant sections.

Massage is a mechanical effect on the tissue of the human body using various physical actions: stroking, rubbing, kneading, pinching, effleurage and vibration. After acceptance massage treatments The patient's tone increases, stress is relieved and performance increases.

Receptors in the patient's skin and muscles receive a mechanical effect that is transmitted to the central nervous system. This transmitted signal depends on what techniques and massage techniques were used. Massage techniques can be both stimulating body tone and relaxing. Also, by competently using special massage oils and cream in parallel with the right techniques on various areas body of the patient, a relaxing or stimulating effect can be achieved.

Mechanical impact on muscle tissue leads to expansion blood vessels, due to which the blood supply to the massaged areas of the body and the entire body as a whole increases. A person’s muscles begin to receive more nutrition, begin to relax, their mobility increases, and pain from tension recedes. Nutrition increases during massage skin tissue, the skin takes on a firmer and more elastic appearance. By stimulating certain areas of the body, it is possible to improve the functioning of internal organs.

One of the most popular and ancient types of massages is therapeutic classic look massage. It is prescribed for many diseases and injuries. If there are no contraindications, it can be performed for chronic or acute diseases. In a general classical therapeutic massage, the patient's upper and lower limbs, back, abdomen, chest and most of the entire body are massaged.

Daily life in modern world often presents to a person stressful situations, due to which the normal activity of the human body or its individual systems is disrupted. Frequent stress on the musculoskeletal system causes no less harm to human health. Using this as a prophylactic medicinal type massage, you can relieve fatigue, gain confidence in your strength, increase efficiency and thereby reduce the risk of disease.

Sequence of actions during a general classical therapeutic massage

In this procedure, the back is first massaged, then the shoulder girdle and neck are massaged, then gradually the masseur begins to massage the lower back and upper part of the buttocks. After this, the back of the legs and lower buttocks are massaged. At the next stage, the patient lies on his back and his stomach, legs and chest are massaged. The last step in this procedure is massaging the front and back surfaces of the arms.

During the procedure of general therapeutic massage of the back and other parts of the body, the massage therapist performs a sequence of movements. First, the back is stroked, then kneading, rubbing, vibration, patting and squeezing. The same happens to other parts of the body, starting from the back and ending with the arms. Some techniques are repeated 4-5 times.

The main rule of this massage is that all movements made by the massage therapist should be directed towards the nearest lymph nodes. In this process, you first need to pay attention to large areas of the body (massage the back, abdomen, chest, shoulder girdle and lower back), then small areas (massage the buttocks, legs and arms). However, do not also forget about the sequence described above.

General massage has a very good effect on cardiovascular system and human respiratory organs. It is used for problems with the patient’s musculoskeletal system, digestive disorders and disorders in the nervous system. Therapeutic classic full body massage can speed up recovery processes after traumas suffered and after mental or physical fatigue.

Indications and contraindications for massage procedures

Before starting treatment, the patient should know in what cases he can receive a general classical massage and in what cases he cannot. General massage is allowed to be used after bruises and sprains, during treatment of the back or lower back, for hypertension and minor heart problems, for gastritis. By receiving a general massage, the patient’s blood and lymphatic fluid circulation improves, joints, muscles and tendons become more elastic, and the body begins to remove toxins more intensively. In the vast majority of patients, the nervous and immune systems stabilize.

You cannot perform a general classical massage with colds, high temperature, blood diseases, tumors and thrombosis. Before using general classical massage as a treatment, the patient needs to be examined by a specialist who can determine the indications and contraindications individually for each patient.

In addition to general classical massage, there are also many other types. Among them, it is worth noting the therapeutic cosmetology massage using the Jacquet method.

The advantage of cosmetological therapeutic massage according to Jacquet

Jacquet massage is a medical cosmetic procedure for the facial skin, which has many indications and contraindications for its use. This massage should only be performed by a qualified specialist. The Jacquet pinch massage procedure normalizes the working process of the sebaceous glands, reduces the inflammatory process during the formation of acne, and removes comedones and milia from the facial skin.

This cosmetic procedure also improves blood circulation in the part where it is directed and has a stimulating effect on trophic processes. In addition, when performing this Jacquet procedure, facial tissues are regenerated and renewed.

Indications for Jacquet massage

The main indications for the use of therapeutic massage according to Jacquet are diseases of the facial skin, such as: acne, post-acne and seborrhea. These diseases can be combined by one factor - the neuroendocrine regulation of the sebaceous glands is disrupted. The biochemical and physical structure of the secreted glands changes, which is why oily or dry seborrhea appears. In addition, massage can be used during hyperkeratosis, hyperpigmentation and in the presence of cicatricial formations and scars on the face.

Contraindications to Jacquet massage

Not all patients can perform this Jacquet procedure. There are strict restrictions here. It should not be done to people with integrity disorders skin having suppuration and viral infections on the face. It is strictly contraindicated to perform this procedure people suffering from chronic dermatosis (psoriasis), allergic diseases And atopic dermatitis. It is forbidden to use the Jacquet massage procedure if the trigeminal nerve is inflamed or there are other neuralgic diseases. Remember that if you do not take into account contraindications for this type of massage, the price may be high in the future. This is especially true for women who care about the beauty of their faces. Medicinal type massage using the Jacquet method is a very responsible and serious procedure.

Massage- this is a set of methods of mechanical dosed impact on the surface of the human body with hands or special devices(vibration, vacuum vibrating massager, ultrasonic, etc.).

The effect of massage on the body

Mechanisms of action:

1. neuro-reflex. Mechanical irritations excite mechanoreceptors of the skin, muscles, joints, and tendons. Mechanical energy is converted into a nerve impulse. Nervous excitement along sensory pathways it is sent to the central nervous system, from where along efferent pathways it is sent to various organs and tissues, changing their functions;
2. humoral. Biologically formed in the skin active substances(histamine, acetylcholine), which are carried throughout the body through the bloodstream and are involved in vasodilation and transmission nerve impulses;
3. mechanical action at the point of direct impact: increased flow of blood, lymph and tissue fluid(which facilitates the work of the heart), eliminating congestion, enhancing metabolism and skin respiration.

Leather. Horny scales are removed, blood and lymph circulation improves, local skin temperature increases, metabolism improves, secretory function sebaceous and sweat glands, skin and muscle tone increases, the skin becomes smooth and elastic.

Muscles. Blood supply improves, oxygen flow and removal of metabolic products increase, muscle tone and elasticity increase and contractility improves.

Ligamentous apparatus strengthens, increases its elasticity, improves joint mobility.

Types of massage

Forms of massage

1. General – massage the whole body.
2. Local – massage individual parts of the body.

Massotherapy

Therapeutic massage is widely used in medical institutions in combination with drug treatment (for the treatment of diseases of internal organs, nervous system, surgical and gynecological diseases; for diseases of the ear, throat, nose, eyes, teeth and gums). After surgical intervention held functional treatment and restoration of physical performance through rehabilitation massage. This massage is usually performed in combination with physical therapy, mechanotherapy and other methods. In case of illnesses and injuries, massage is prescribed as early as possible to normalize blood flow and relieve pain syndrome, resorption of edema, hematoma, tissue restoration, normalization of metabolic processes. The first stage of this treatment is carried out in combination with cold, the second - with thermal procedures. Immediately after an injury, massage is performed with ice. After some time, the cold massage is alternated with a warm one. Cold acts on the injured part of the body as a pain reliever (reduces sensitivity nerve endings) and anti-inflammatory agent. Usually, after an ice massage, the mobility of the massaged joint improves and tissue swelling decreases. The massage is easy to perform. Ice is placed in a special ice pack or in a thick plastic bag. The area of ​​injury (or disease) is massaged with ice for 2-3 minutes, then the patient swims in the pool or performs simple physical exercise. This procedure is performed several times. Therapeutic massage for colds (bronchitis, pneumonia, etc.) in the first 2-5 days is carried out as cupping massage, then percussion massage combined with inhalations (medicines and oxygen). A warming massage is recommended at night.

1. Classical– does not take into account reflex effects and is carried out in the area of ​​the diseased organ or near it

2. Segmental-reflex– affect areas of reflected pain – dermatomes, the innervation of which is associated with certain segments of the spinal cord, in which sensitive cells are excited under the influence of nerve impulses arriving through the sympathetic nerve fibers from a diseased organ. For example, with diseases of the liver and biliary tract, the sensitivity and tone of the trapezius muscle reflexively changes. Collar area(back surface of the neck, back of the head, shoulder girdle, upper back and chest) is connected with segments of the spinal cord (D2-D4) and the cervical part of the autonomic nervous system, which is connected with the autonomic centers of the brain. Massage of the collar area changes the function of the central nervous system and reflexively normalizes body functions (metabolism, thermoregulation, etc.). The lumbosacral area (buttocks, Bottom part abdomen and the upper third of the anterior surface of the thighs) is innervated by the lower thoracic (D10-D12), lumbar and sacral segments. Massage of this area is used for pain in this area, injuries and vascular diseases lower extremities, disorders hormonal function gonads. They use classic massage techniques and those modified in accordance with reflex changes. The main task of segmental massage is to relieve tension in the tissues of the detected affected areas. The massage therapist must know exactly the relevant segments.

Segmental innervation of internal organs

Massage movements are made in the direction of the Benningof lines, which characterize the greatest resistance individual areas skin stretching (Figure 1).

Figure 1. Location of lines of greatest resistance to stretching of individual areas of the skin according to Benninghoff. Front and back views.

3. Spot– influence biologically active points – BAP (projections of large nerves and vessels that have more high temperature and low electrical resistance) for the purpose of a reflex effect on various functions body, eliminating pain, reducing or increasing muscle tone. As in acupuncture, they use:

• braking technique when relaxation and calm are required. Press on the point and rotate clockwise, gradually increasing the pressure. Then “unscrew” the finger (counterclockwise movement), gradually reducing the pressure. Repeat the technique 4-8 times for 2-4 minutes continuously, without lifting your finger from the point;
• stimulant. A short, strong screw-in is performed with a sharp separation of the finger from the point. Repeat the movement 8-10 times for 40-60 seconds.

4. Connective tissue– affects mainly connective tissue, subcutaneous tissue. The method is based on the fact that in various diseases in body segments that have common innervation with the affected organs, areas of increased connective tissue tension—connective tissue cords—appear. Their massage reflexively affects the entire autonomic nervous system without affecting individual organs.

5. Periosteal– massage areas of the periosteum (where the muscles are weakly expressed), which in some diseases reflexively change: they become denser and are accompanied by sharp pain, especially when pressed. Massage improves trophism bone tissue and internal organs “associated” with it.

Indications for therapeutic massage

1. Pain in the back, lower back, neck, headaches, various ailments.
2. Osteochondrosis, bruises, sprains of muscles, tendons and ligaments, fractures at all stages of healing, functional disorders after a fracture and dislocation (joint stiffness, muscle changes, scar tissue adhesions), arthritis in the subacute and chronic stages, spinal curvature, flat feet, poor posture.
3. Neuralgia and neuritis, radiculitis, paralysis, trauma to the nervous system, consequences of cerebrovascular accident.
4. Cardiac ischemia, hypertonic disease, arterial hypotension, heart defects, diseases of the arteries and veins.
5. Chronic nonspecific lung diseases (emphysema, bronchial asthma during the interictal period, pneumosclerosis, chronic pneumonia, bronchitis, pleurisy).
6. Chronic gastritis, colitis, peptic ulcer of the stomach and duodenum (not exacerbation), chronic diseases of the liver and gallbladder, impaired motor function of the large intestine.
7. Diseases of the female and male genital organs: inflammatory – in subacute and chronic stages, incorrect positions of the uterus, vagina, anatomical changes and functional disorders of the uterus and ovaries, pain in the sacrum, coccyx.
8. Metabolic disorders: diabetes, gout, obesity.

Contraindications for therapeutic massage

1. Acute febrile conditions.
2. Bleeding and tendency to it.
3. Blood diseases.
4. Purulent processes of any localization.
5. Various diseases of the skin, nails, hair.
6. Acute inflammation of blood and lymphatic vessels, thrombosis, severe varicose veins veins
7. Atherosclerosis of peripheral vessels and severe sclerosis of cerebral vessels.
8. Aneurysm of the aorta and heart.
9. Allergic diseases with skin rashes.
10. Chronic osteomyelitis.
11. Tumors.
12. Mental illnesses with excessive excitement.
13. Circulatory failure of the 3rd degree.
14. During the period of hyper- and hypotonic crises.
15. Acute myocardial ischemia.
16. Acute respiratory disease(ORZ).
17. In case of intestinal dysfunction (nausea, vomiting, loose stools).
18. Active form of tuberculosis, syphilis.