Performing massage for bronchial asthma. Massage technique for bronchial asthma Therapeutic massage for bronchial asthma

Respiratory tract diseases not only undermine a person’s health, but also prevent him from living a normal life. After all, without even, calm breathing, it’s difficult to even move actively. Therefore, it is important to closely monitor your health, stopping all attempts by pathogens to settle in the lungs.

Bronchial asthma and emphysema– two interrelated diseases of the respiratory tract and respiratory organs. Emphysema often develops against the background of asthma, and advanced asthma, in turn, can cause emphysema.

Bronchial asthma can be recognized by the following signs:

paroxysmal shortness of breath, which manifests itself especially often at night and in the morning;

wheezing that can be heard even without a stethoscope;

heaviness in the chest, feeling of congestion, inability to cough;

dry painful cough, which only aggravates the patient's situation.

People suffering from bronchial asthma report attacks when active physical activity, inhalation of cold air and simply with nervous disorders. Weakened bronchi cannot freely “drive” air due to the large amount of mucus. She, in turn, cannot drain normally due to swelling of the mucous membrane that occurs in the lungs during asthma.

Emphysema is a pathology of lung tissue that could arise due to various factors. More often there are several of them, and among the prerequisites for damage to the elasticity of lung (or lung) tissue is bronchial asthma. After all, any disease is a weakening of the immune system, which means it is fertile ground for the development of other diseases in this area.

Emphysema can affect both lungs or just one. The final diagnosis is made by a doctor after an x-ray, and a person can understand that something is wrong with his body by the following symptoms:

A painful cough, accompanied by redness of the face and swelling of the veins in the neck;

Difficulty breathing, which prompts a person to use auxiliary muscles (facial muscles, neck muscles);

Changing the shape of the chest, increasing its size;

Weakness, fatigue.

If both asthma and emphysema are detected, treatment is prescribed by a doctor. Usually this is a certain daily routine and taking medications. But sometimes, in parallel with this, additional treatments are prescribed, which may include therapeutic or hygienic (preventive) massage.

Massage for asthma and emphysema

Physiotherapy methods are not uncommon for treatment of diseases respiratory organs. Massage is one of the means that is absolutely harmless to the body. The main thing is to strictly follow technology, do not neglect the rules and contraindications, adhere to hygienic requirements, stop the session if you feel discomfort and do not resume massage if the patient’s well-being worsens.

Massage for bronchial asthma and emphysema is useful because the muscles of the chest are developed, metabolic processes in the tissues of the respiratory organs are stimulated, and local immunity improves. The massage therapist, performing various types of massage manipulations and mechanical effects, facilitates the breathing process for the person being massaged, extracting air from the lung tissue (where it should not be). In addition, the vibrations that are transmitted to the bronchi help to remove mucus from them, which also helps to “breathe deeply.”

Methods and techniques of massage

Since both asthma and emphysema have the same nature of occurrence and development, then massage technique and methodology approximately the same. The massage is performed in a position in which the patient can breathe comfortably. This is usually a semi-recumbent position, where a person lies on a couch with a pillow or bolster under the upper body. A similar technique is described in the article “Massage for bronchitis”.

The position of the person being massaged is lying on his stomach, a roller is placed under the ankle, arms parallel to the body. The intensity of all movements is selected based on the patient’s sensations. If he is sensitive to strong pressure or claps, then, of course, he should refuse them. With emphysema, the opposite is often the case: the patient feels more comfortable when the chest is compressed.

During the massage, all the techniques of classical massage are used, and they are combined in various variations (see video)

• 1) First, a lubricant is applied to the surface to be massaged using stroking and squeezing techniques;


• 2) Next, the tissues being massaged are warmed up using rubbing techniques (we use all known rubbing techniques);


• 3) After intensive rubbing, proceed to kneading the vertebral (paravertebral) muscles, latissimus muscles, trapezius and shoulder girdle area.


• 4) Now you can carry out a small vibration, namely: light effleurage, chopping, percussion (with fingertips), tingling all over the back;

Total back massage time: 15-20 minutes.

After the back massage, we move on to massage the front of the chest. The patient's position is lying on his back, a cushion is placed in the area of ​​the popliteal fossa, arms along the body.

• 1) Similar to back massage, front chest massage begins with techniques

Massage for asthma is a combination of methods of applying the hands of a massage therapist to the chest, as well as to nearby areas. Its goal in this case is to level out the symptoms of the disease in both adults and children.

Contraindications

There are the following contraindications for massage:

Childhood is also a relative limitation. For a child in the younger age category, massage sessions can be performed provided that the chest is lightly impacted.

Varieties

Current types of massage for asthma:

1. Classical.
2. Percussion.
3. Intensive.
4. Reflex-segmental.
5. Spot.
6. Periosteal.
7. Drainage.

Classical

The classical technique consists of successive stages:

1. General massage of the sternum while lying on your back.
2. Massage the collar area and neck while lying on your stomach.
3. Back massage in the same position.
4. Repeated massage of the sternum while lying on your back.

The procedure begins with stroking movements, progressing to squeezing, kneading and shaking. The massage can be completed with breathing exercises while sitting or standing. In this case, the massage therapist holds his hands symmetrically on the patient’s sternum and back. As the patient inhales, he moves his arms up. Pressure is applied several times. A general massage session can take up to 30 minutes, depending on the condition of the asthmatic. In connection with the same factor, the duration of the course is determined.

Percussion

Percussion massage is aimed at reducing muscle tension in the chest area, increasing air flow, increasing blood circulation, and removing phlegm. The massage is performed in a sitting or lying position according to the following algorithm:

1. Rubbing the chest in front and behind, as well as activating the respiratory function of the lungs, for which you can perform kneading techniques from a classic massage or perform rhythmic compression in the chest area.
2. During the massage, the specialist places his hands on the patient’s chest from the front and back, and strikes.
3. Upon completion, the specialist repeats the first point.

The duration of this type of massage is no more than 10 minutes. The duration of the entire course is also determined based on the degree of the disease and usually does not exceed two weeks.

Intensive

Intensive massage is performed within the framework of a rich but shortened scheme - no more than five sessions of 30 minutes (maximum 40 minutes) each. At the same time, for the body to recover, the break between sessions is several days.

This involves several asymmetrically located zones in the chest area: two in the front and two on the back. They are massaged in turn, starting from the bottom and moving to the upper zone. For example, the lower part of the left lung is worked, and then the upper part of the right, or vice versa. In this case, the following methods of influence are used: kneading, rubbing and vibration.

Segmental

Segmental massage is recommended for the purpose of improving respiratory function, reducing the number of asthma attacks or completely stopping them, as well as preventing the manifestations of pulmonary emphysema. It is better to massage in the first half of the day and before and after meals.

The massage therapist conducts the session in a certain sequence:

1. The patient's position is sitting.
2. Stroking movements, then rubbing the muscles of the back, neck at the back, as well as the sternum at the front and sides.
3. Massage the muscles of the back, back of the neck, intercostal area and the area above the shoulder blades.
4. In the final part, stroking, rubbing and effleurage are carried out.

Sometimes segmental massage is also performed in conjunction with breathing exercises, in which the massage therapist’s hands move from the spine to the chest. In this case, the movement of the arms is carried out with exhalation and pushes with increasing pressure on the chest.

Spot

Acupressure for bronchial asthma is aimed at facilitating the breathing process by influencing acupuncture points. These include points on the back, on the shoulder, in the intercostal area, under the collarbone, between the processes of various vertebrae. The main methods of acupressure are stroking and pressing. The duration of work with each point does not exceed 5 minutes. To carry out this manipulation, the massage therapist requires a good knowledge of the anatomical structure of the human body.

Periosteal

Periosteal massage involves a targeted effect on the connective tissue around the bones of the chest in order to improve metabolism in this area, which has a positive effect on the functionality of the lungs. Before the procedure, the massage area is palpated to identify painful areas or points. The main technique is rotational movements using the phalanx of the finger in the area of ​​the pain point. The actual points of influence for bronchial asthma are on the chest and back. In this case, the impact on them should be carried out while exhaling. If the patient experiences excessive pain while treating the point, the massage therapist changes the angle of the finger. Time after time, the number of points being worked on increases. Their maximum number for one massage session is 15-20.

This massage is carried out in a course with a break of one or two days until the maximum reduction in pain in problem areas. A combination of periosteal massage with the previously listed types is relevant.

Drainage

Drainage massage for asthma shows good results in the fight against difficult to separate sputum from the bronchi, which is why it can also be used for bronchial asthma. Massage actions are carried out both from the front and from the back.

Massage of the anterior zone is carried out using:

• stroking movements;
• rubbing the muscles in the intercostal space, from the lower edge of the costal arches towards the collarbones, shoulders and armpits;
• stretching the chest muscles;
• light tapping on the arches of the ribs;
• compression of the lateral walls of the sternum as you exhale.

Massage of the area from the back is carried out using:

• stroking and rubbing movements (including weights);
• kneading the back muscles along and across;
• grasping, pulling and pushing up the spinal muscles and trapezius muscles;
• intermittent vibrations.

Principles of correct execution

The principles of proper massage include the following:

1. Calculation of the duration of a single procedure and the entire course, carried out by the doctor who issued the referral for massage.
2. Availability of medical training as a massage therapist (carrying out home self-massage in this case is recommended if you have the necessary knowledge).
3. Preparation of premises and equipment for massage procedures: the presence of a couch, rollers, means for sliding the massage therapist’s hands (cream, oil, Vaseline, talc).
4. Hygienic support of the procedure: washing and disinfecting hands before exposure.

Since asthma is a constant companion in a person’s life from the moment of diagnosis, the course of massage should be repeated periodically. The frequency of courses is determined by the doctor, taking into account the individual characteristics of the patient and the stage of the disease.

Due to the variety of therapeutic massage techniques and variations in the duration of procedures, it can be prescribed for asthma at any stage of the disease. From session to session, the patient should experience noticeable relief of the current condition and a decrease in recurrent manifestations of the disease in the future. In addition, a properly performed massage gives the patient a feeling of emotional relaxation.

Massage plan

· Massage the collar, back and chest area.

· If necessary, massage the abdomen, head, nose, and sinuses near the nose.

Massage technique

The massage technique is selected depending on the period of the disease and its severity.

Massage during the period of subsiding exacerbation

The first procedures are prescribed during the period when the exacerbation subsides; the patient’s condition should be relatively satisfactory. The patient's position is lying on his stomach with his head elevated. Massage areas: collar area, back, chest, including lateral surfaces. The procedure is carried out very carefully and briefly (7-10 minutes).

Sharp, intermittent, rapid movements and strong pressure are contraindicated. Practical experience shows that if, in response to gently performed massage techniques, a patient experiences pronounced hyperemia of the skin (which indicates a paradoxical reaction of the patient’s body to massage effects), it is necessary to urgently stop the massage procedure so as not to provoke an asthmatic condition.

When the patient's condition improves, at each subsequent procedure the head position is gradually lowered, and the massage continues to be carried out in a horizontal position of the patient, and then - in the presence of a productive cough - the head is gradually lowered to a horizontal position, and then below the horizontal position. In this case, the procedure includes massage of the chest from the front, abdomen, and, according to indications, the head, face, nose and paranasal areas.

Gradually increase the duration of the massage procedure, which lasts 20-25 minutes. In the supine position, the front surface of the body is massaged, but the head is not lowered below the horizontal level.

Massage during remission

BACK MASSAGE FOR BRONCHIAL ASTHMA

The back is massaged in the position of lying on your stomach. Perform:

· planar superficial and deep stroking, stroking the back, starting from the spinal zones in the direction from the waist line to the axillary areas;

· gentle rubbing of the back in longitudinal and transverse directions with the palmar surface of the hands, spiral rubbing with fingers or a brush;

· spiral rubbing of the spinous processes of the vertebrae with fingers, rake-like stroking and rubbing of the interspinous spaces of the spine. Massage of paravertebral zones of the thoracic spine: planar stroking, ironing; rubbing with the palmar, supporting part of the hand, fingers; straight and spiral grinding, sawing, shading; kneading by pressing; gentle stable and labile vibration at the exit points of the spinal nerves; Having moved the muscles from the spine outward with your fingers, using your fingers to move left and right with your fingers (through previously relaxed muscles), rub the costovertebral joints, starting from the lower ones. Rubbing the shoulder blades, their edges and spine with fingers and the supporting part of the hand. Gently knead by pressing and moving the superficial ones first. and after relaxing them - the deep-lying muscle groups of the back. The edges of the trapezius and latissimus dorsi muscles are kneaded by longitudinal and transverse kneading, and their attachment points are kneaded by spiral rubbing.

· Rubbing the ribs with the fingers and the supporting part of the hand, vibrating pressure on the chest. Continuous vibration, stable vibration at biologically active points, labile vibration at the exit points of the spinal nerves, gentle shaking of the back muscles. Finish with vibration stroking. Intermittent vibration is not shown. In case of coronary heart disease, the intensity of massage techniques in the interscapular area on the left should be reduced.

Massage of the collar area.

The patient's position is lying on his stomach, hands under his head, or sitting at a massage table, his head resting on the patient's hands or headrest. Planar and grasping stroking of the posterior and lateral cervical areas. Spiral rubbing of the occipital region in the direction from the mastoid process to the external occipital crest and vice versa. Rubbing the back and lateral cervical areas with planar, spiral rubbing. Kneading the descending part of the trapezius muscle by pressing, displacement, longitudinal kneading, the sternocleidomastoid muscles by forceps kneading. Rubbing the spinous process of the VII cervical vertebra and the adjacent tissues with the fingers - “the sun”.

Massage of the chest area

The patient's position is lying on his back, with a bolster under his knees. Planar and enveloping stroking of the anterior and lateral areas of the chest in the direction of the axillary areas, bypassing the breasts in women. Rubbing the chest bone with the fingers and the supporting part of the hand with straight and spiral movements; straight and spiral rubbing with fingers, shading of the sternocostal and sternoclavicular joints. Stroking and rubbing with fingers the supra- and subclavian areas in the direction of the supra-humeral-clavicular joints.

Massage of the pectoralis major and serratus muscles: rubbing with fingers, the supporting part of the hand, kneading by pressing, shifting, the edges of the pectoralis major muscles - by longitudinal kneading, the attachment points - by spiral rubbing. Continuous labile vibration in the area where the ribs connect with the sternum (along the sternum), behind the movement of the pectoral muscles. Tapping, chopping, patting the chest area is not indicated. In case of coronary heart disease, massage of the pectoralis major muscle on the left is carried out carefully, monitoring the patient’s well-being. Rubbing the ribs, costal arches, projections of the attachment points of the diaphragm with the fingers and the supporting part of the hand.

MASSAGE OF THE COLLAR AREA FOR BRONCHIAL ASTHMA

Pressing on the lower costal edges during an extended exhalation. Rubbing the intercostal spaces like a rake towards the spine. Kneading is similar to a rake by pressing and stretching the intercostal muscles. For a more thorough massage of the intercostal and serratus muscles, the patient is sequentially returned to one side, then to the other. In the same position, continuous labile vibration is carried out in the areas of the ribs, vibration pressure on the chest, and gentle vibration of the chest during exhalation.

Coughing of the patient is currently effective. A mandatory component of the massage procedure is drainage massage (a combination of massage with pustural drainage). If the patient's condition allows, he is placed in a knee-elbow position and asked to cough periodically. At this time, the massage therapist performs gentle shaking of the chest. Then the patient is recommended to cough three times, during which the massage therapist, hugging the chest with his hands, squeezes it in the rhythm of coughing. At the same time, he presses with his hands on the anterior abdominal wall. Repeat 3-5 times. It is necessary to note that the absence of a productive cough is a contraindication for coughing, because difficult sputum discharge can provoke bronchospasm.

After this, the patient is placed on a couch with the leg end raised. Apply pressure in the area of ​​the spinal zones, normal and vibration pressure on symmetrical areas and opposite squares of the chest when exhaling. After a short rest, the patient is recommended to perform drainage exercises from a standing position: bending the torso forward, squats with the head lowered below the pelvic end and pressing on the anterior abdominal wall and coughing, speech - pronunciation of sounds (sound gymnastics). In this case, the inhalation should be short and necessarily through the nose, the exhalation should be longer. If nasal breathing is difficult, massage the nose and paranasal areas and special breathing exercises described for massage of children with bronchial asthma are performed. All massage techniques are performed gently, without sudden movements, under constant monitoring of the patient’s breathing quality.

Duration of massage - 15-25 minutes. The course of treatment is 10-12 procedures. For acute processes - daily, for chronic processes - every other day.

Massage for bronchial asthma is a technique that is approved by both doctors and adherents of traditional medicine. Patients like this method of treatment more than breathing exercises or special physical exercises.

It is not possible to cure asthma completely, but despite this, its course can be alleviated with the help of therapeutic procedures. Massage has a general strengthening effect and is prescribed for therapeutic and preventive purposes.

The best results can be achieved if it is used in combination with drug therapy, herbal remedies and exercise therapy.

The physiotherapeutic procedure has a good effect on the asthmatic’s body and helps reduce the frequency of asthma attacks.

Massage of the chest, as well as other parts of the body, for adults and children with bronchial asthma is prescribed to normalize the respiratory process. This is very important, since when the disease occurs, the patient’s airways narrow and the supply of oxygen to the body decreases.

In addition, treatment and prevention through massage strengthens the body's defenses, improves blood circulation and muscle condition.

Indications and contraindications

Massage procedures are indicated for patients with intermittent and persistent disease. This type of therapy is also indicated for patients with asthma complications.

Asthma and any massage are incompatible during an exacerbation of the disease. When attacks of suffocation occur frequently and are very difficult, emergency assistance is required, while massage actions can only aggravate the patient’s condition.

In the mild stage of asthma, the procedure is carried out if warning signs of an attack appear in order to improve the condition or eliminate the risk of suffocation.

Contraindications are also:

• tuberculosis;
• blood diseases;
• malignant neoplasms.

Relative contraindications are pustular skin diseases, heart and pulmonary failure, and circulatory disorders.

Types of massage

Massages for bronchial asthma are divided into several types. One or another option is selected depending on the nature of the disease.

The following massage techniques are applicable for asthma:

• segmental;
• classical;
• point;
• intense;
• periosteal;
• percussion

Most techniques are based on the use of such techniques:

• stroking;
• easy kneading;
• rubbing;
• vibration actions;
• blows.

Classic look

Massage for asthma involves massaging the patient lying on his back. First, the muscles are warmed up through stroking actions, and the direction should be from the abdomen and sides to the armpits.

After the warm-up activities, they move on to the kneading process. Such actions should be carried out carefully, bypassing the mammary glands. Next, the pectoral muscles and subclavian cavities are kneaded with the second phalanges of the fingers, and the movements should be circular. The intercostal spaces are developed with your fingers, moving in a straight line or zigzag.

Then they begin to knead the collar area and trapezius muscle. The person needs to roll over onto his stomach. The principle is the same: first the muscles are warmed up, then actively massaged.

The large back muscles are kneaded with pinching movements. Particular attention is paid to the intervertebral and intercostal spaces. They should be kneaded with your fingertips, moving in a straight line.

After this, the person returns to the starting position, after which the chest is developed. The final action is stroking it.

Segmental

This type of massage for people with bronchial asthma is significantly different from the previous one. The technique is based on the theory of the reflex relationship between the skin and organs, which states that when performing the segmental technique, a general strengthening effect is ensured.

The massage is performed with the patient sitting or standing. It is important that your back is straight. Before starting the procedure, the doctor must determine which segments will be warmed up.

The principle of movement is from the lower back and chest. When using the segmental technique, the following actions are applied:

• flat stroking;
• sliding the index and middle finger along the spine from the lower back to the cervical vertebrae;
• the specialist uses his thumbs and forefingers to roll a fold of skin along the spine, imitating the movements of a saw;
• rubbing the skin and muscles. One palm is placed on the shoulder blade, while the other is on the opposite side, on the lower back. Counter movements are performed with a small application of force.

When performing this procedure, you need to actively knead the shoulder area and intercostal spaces.

Intensive

This type of massage for manifestations of bronchial asthma is preferred if there are contraindications to other similar procedures. To do this, a person needs to lie on his back.

Kneading begins from the lower part of the chest. You need to massage each side separately. Next, move on to kneading the upper chest. Then the patient needs to roll over onto his stomach to knead the lumbar region and shoulder blades.

Percussion

This type of massage for asthma requires special skills from the massage therapist. The patient can sit or lie down. Before carrying out the procedure, you should warm up the muscles with rubbing movements, paying more attention to the chest.

The principle of percussion technique: a specialist acts on the surface of the back by tapping a fist through the second hand. The result of such actions is a contraction of the chest muscles.

The massage therapist strokes from the ribs to the spinal column as the person inhales; when exhaling, the manipulation is carried out in the opposite direction.

Thanks to such actions, the intercostal muscles contract better, fatigue is relieved, blood flow is normalized and sputum is easily discharged.

Periosteal

This massage, used for bronchial asthma, has an effect due to the activation of the points of the periosteum (periosteum) of the clavicles associated with the respiratory system.

The patient assumes a supine position. First, the specialist palpates the collarbones to locate the desired points.

When using this technique, your fingers make circular movements in place. Several active points are used in one session.

This procedure is carried out every two days with a gradual increase in the number of points. If unbearable pain occurs during exposure, the pressure should be reduced and the fingers should be moved slightly.

Spot

A similar manipulation is carried out if there is a feeling that an attack of bronchial asthma is beginning. When exposed to the points, the bronchi dilate and breathing improves.

Let's pay attention to points that help alleviate symptoms when diagnosed with asthma:

• between the sternum and collarbone;
• on the sternum below the collarbone;
• between the spine and shoulder blades;
• under the thumb on the bend of the hand;
• between thumb and palm.

The principle of acupressure is to perform kneading, pressing, stroking, rubbing, pushing and vibration movements. You can do this procedure yourself, as there are no contraindications or risk of harm.

Features of massage for asthmatic children

Massage of any type for bronchial asthma in children is carried out taking into account the well-being and age of the baby. The baby can be placed in any position; it is also allowed to sit on your lap. It is better for schoolchildren to bend down or get on all fours.

The massage technique for bronchial asthma is selected individually, but it is important to act in stages:

• Stroking should be done with palms on the back, starting from the hips.
• Rubbing is done with palms along the back sharply, in counter movements.
• To warm up the shoulder blades, circular movements are used. After this, the hands are stroked from below to the armpits.
• Wrapping your arms around the baby, you need to connect your fingers on the stomach. The palms should slide along the stomach up towards the spine. The reverse steps are also performed.
• They stroke the shoulders, shoulder blades and neck area, reaching the head, then in the opposite direction.
• To do cross rubbing, you should cover your right shoulder blade with your right hand, and place your second hand on the right side of your lower back. Circular movements should be done quickly, with light pressure.
• Movements reminiscent of kneading dough. Folding your palms like a boat, you should pat your chest.
• Make quick chopping movements with the edges of the brushes.
• With half-opened fists, the chest is patted, evenly passing over its entire surface.
• To carry out the vibration procedure, the massage therapist stands behind the child, places his fingers between the ribs, presses and makes vibrating movements with his hands.
• The thumbs are located near the spine, while the rest are on the lower back. With fingering movements, the fingers move towards the neck.
• Twisting actions are performed between the shoulder blades. The fold of skin is grabbed with two fingers and pulled to the sides, trying to connect.

How to do self-massage

Ideally, a massage to a patient should be performed by a qualified specialist, but there are situations when the need arises to help oneself.

Doctors say that an asthmatic should be aware of how to do self-massage for bronchial asthma in order to alleviate his condition.

You can reduce the frequency and intensity of attacks by massaging your neck and shoulders. This massage has a restorative effect for bronchial asthma. The work of the respiratory muscles is also normalized and the mobility of the ribs is improved.

By self-massaging you can relax and get rid of anxiety. To achieve better results, it is recommended to listen to calm music during the session.

The sequence of self-massage looks like this:

• rub the chest, intercostal spaces and sternum area;
• massage the collar area;
• knead the trapezius dorsal and cervical muscles;
• massage the front surface of the neck and chest muscles.

The last stage of self-massage is simple therapeutic exercises or breathing exercises.

Important nuances

1. During a massage session, a baby or young child must be placed on his knees; older children are placed on a chair.
2. The duration of the first massage treatments is a maximum of 15 minutes.
3. We must not forget that young patients have fragile bones. It is important to calculate the strength in advance.
4. If the child resists during the asthma massage, then it is worth suspending or rescheduling the procedure.
5. The doctor recommends performing some massage techniques yourself at home, subject to individual instructions.
6. Parents of sick children can learn how to perform medical procedures at home. For the purpose of prevention, it is enough to do a massage several times a month.

Finally

Massage is not a separate treatment method, but only an auxiliary one. Its effectiveness is monitored by the attending physician.

At an early stage of the disease, up to six sessions are sufficient. If a severe form of the disease is diagnosed, approximately 20 massages will be required.

In each specific case, the doctor prescribes a certain type of procedure, their number and frequency. Usually, proper massage requires the help of a highly qualified specialist.