Indications for the purpose of massage may be with various bruises that provoke hemorrhage, stretching of muscles, tendons or ligaments, in fractures, regardless of the stage of healing, especially if a slow fusion of the fracture occurs, also if the fracture provoked various functional disorders (joint stiffness, muscle contractures , scarring of the tissues), with diseases of the joints caused by infection, in the chronic stage, granulating wounds and trophic ulcers, when preparing the amputation limb to the prosthetic tion. After the massage, pain and swelling pass much faster, the hemorrhage in the tissue decreases, as well as the effusion in the joints, the muscles strengthen, the function of the joints and muscles develop better, the bone callus begins to grow faster, the occurrence of connective tissue fusion, which can lead to contracture of the muscles and stiffness of the joint.
Massage with bruises and sprains of ligaments and muscles
One of the most common types of damage are the bruises of the limbs and constitute about 45% of all types of injuries. If the trauma occurred recently, while only the extension of the baggage-ligament apparatus occurred, and the integrity was not violated, massage should be performed in the first few days after the injury. If the massage is performed early, it can help reduce pain, accelerate the process of resorption of the hemorrhage, effusion in the joints and mucous bags, resulting in a much faster recovery of motor function. Before the massage, it is important that the patient can relax muscles as much as possible, for which it is necessary to establish a damaged limb in a physiological position.
In the early days, a so-called suction massage is performed, which takes place at a place above the injury, do not forget that it is necessary to fix the damaged joint well. Let's say that when carrying out a massage of a bag-and-ligament apparatus in the ankle, it is necessary that one hand fix the foot and the other massage the muscles of the thigh and lower leg. If there is a posterior longet, then during the massage it must be removed. During the massage, stroking is first used (it can be intermittent or intermittent), then the trituration (for example, spiral), in combination with the grasping stroking acting continuously.
To conduct massage follows the direction of venous outflow, with a frequency of up to two times a day for 5 to 10 minutes, and there should be no pain in the area of injury.
Later, after 4 - 5 days, if there are no noticeable reactive phenomena (no tissue swelling, stable temperature, absence of hyperesthesia zone in the area of the injury), you can already go to the massage in the place of injury. At this stage, the use of kneading is possible, and the effect should be easy in all directions, accompanied by a continuous bracing stroking. It is also necessary to massage muscles and various muscle groups separately. If the functional state of the tissues allows, then it is possible to use other massage techniques, while it should not be forgotten that such techniques as intermittent vibration performed in the form of rubbing, as well as effleurage at the first time after injury should be excluded. You should gradually increase the intensity of the massage. If it is necessary to massage with a bruise near the joint or when stretching the ligamentous apparatus of the joints, attention should be paid to the tendon and mucous bags and the twist of the joint.
In the early days, one or more sessions a day, lasting from 5 to 10 minutes, will be enough, gradually increasing the time to 15-20 minutes.
Massage should be combined with various physical exertion, during or after it. It is necessary to start with active movements from the side of the injuries, and there should be no increase in pain. If, in the area of damage, pain or swelling of the tissues arises, the damaged joint should be fixed for the first few days, and active joints should be performed in the joints closest to the damaged area. Also, the effectiveness of the massage is enhanced by thermal procedures, for example, warm water or air baths. First, you need to apply heat, and then start the massage.
One of the most common diseases leading to a loss of ability to work for a long time is joint disease. Massage plays a leading role in the complex therapy of various joint diseases. It allows you to reduce pain, increases the speed of resorption of effusion in the joint, as well as in periarticular mucous bags, stimulates blood circulation and lymph flow in the joints and periarticular tissues. When the massage is applied, there is a decrease in reflex muscle hypertension, which often occurs with various joint diseases, the onset of muscular atrophy is prevented, the secretion of synovial fluid is improved, which increases the mobility of the joint with stiffness, accelerates the interstitial metabolism, and, as a whole, lost function of damaged joints.
For the massage of patients with joints, it is necessary to have a clear idea of their normal configuration, boundaries, access to the joint bag, and the location of the paracentesis mucous bags, and you must also clearly know and be able to recognize all the signs of the existing effusion in the joints or their twists. With all the performed conditions, the massage therapist can competently massage, observing the technique indicated by the doctor. Before you start a massage, the massage therapist should ask the patient about the state of health, the presence and location of pain or other complaints. All the information obtained will help determine which methods should be used to massage. Also, the data obtained make it possible to draw a general conclusion about the effectiveness of the conducted procedures.
For rheumatic or infectious diseases of the joints, massage should be done only in the subacute or chronic stage of the disease. If, however, there are reactive phenomena in the affected joint, for example, swelling, high local temperature, severe pain when feeling the affected joint, then in this case the massage should be used outside the site. In the subacute stage, there is often a muscle hypertonia, which arises reflexively in response to joint damage, so the masseur must first of all achieve a decrease in muscle tone. Thus, with the involvement of the knee joint in the process, it is possible to observe an increase in the tone in the following muscle groups: the broad fascia of the thigh, the quadriceps, the semitendinosus, the semimembranous and biceps muscles of the thigh, and also in the gastrocnemius muscle. The tension can also be observed in the patellar's own ligament and in the joint tendon of the tailor, tender and semitendinous muscles, and it should be noted that in some muscles and tendon attachments a stronger tension is possible than in others. With carefully conducted palpation, muscle growth can also be observed in the muscles of the lower thoracic and lumbosacral spine. To eliminate muscle hypertonia, it is best to use gentle mechanical vibration. With increased tension of the subcutaneous connective tissue, it is best to massage using a reflex-segmental technique.
With a weakening of the tension of the tissues in the back area, it is possible to begin a massage of the muscles associated with the damaged joints. Also, when muscle hypertonicity occurs during infectious nonspecific polyarthritis, selective muscle hypotrophy is possible, which is especially pronounced in chronic conditions. In diseases of the hip joint, hypotrophy usually begins in the gluteus muscles, the knee joint - the quadriceps muscles, the ankle joint - the extensors of the shin and foot; with diseases of the shoulder joint-deltoid, supraspinatus, subacute and small round muscles, elbow joint - triceps muscles, wrist joint - extensors of the forearm, finger joints - interosseous mice. In muscle hypotrophy, it is best to use such techniques as alternating rubbing, stroking, and gentle kneading. During this process, muscles such as myogelosis, which is characterized by localization at the sites of attachment of muscles during their transition to fascial stretching or into the tendon, may occur in the muscles adjacent to the joints.
In the first days of the massage, always carefully walk around the area of the affected joint. Begins massage with periarticular, and then soft tissues, covering the joint, in order to improve lymph circulation in the joint cavity. It should not be forgotten that infectious joints often have a breach in the elasticity and mobility of the skin, which may be indicated by the appearance of thickening and painful sensations when the skin is folded. In such a situation, you should use the trituration method, performed in the form of shading, while the movements should be slow, the massage should be done layer by layer: first the skin, then the subcutaneous connective tissue, and then the fascia. The selected depth of the layer should not be constant, and the subsequent layer is massaged with less impact.
After massage of the soft tissues that are outside the joint, you should proceed to massage the bag-ligament apparatus. Careful attention should be paid to places that have the greatest access to the affected joint. If it's an ankle, then this place will be the back surface of the joint bag, located on both sides of the Achilles tendon. For the knee joint - the medial side from the side of the fold, access from the front surface of the articular knee bag can be at the minimum segment from different sides of the tendon of the quadriceps muscle. All this clearly shows how well a masseur needs to know access to various joints. During the massage, it is also necessary to take into account the location of the mucous bags near the joint, besides, they should be massaged separately. The most suitable methods will be circular rubbing and longitudinal strokes.
Physical exercises should be carried out in the form of active movements, the patient must begin active movements from the nearest place of joint damage, then, as the reactive phenomena subsided, to the aching joint.