Traditional Hydrotherapy

from Hydrothermic Remedies...

Centripetal Peripheral Rub may be used as a sedative massage with deep stroking (of effleurage) as the principal movement, or for general treatment following general applications of hydrotherapy for tonic purposes.

Swedish or relaxing massage

Effects:

• Increase circulation of blood and lymph
• Sedative

Definition

The mechanical or manual manipulation of the soft tissues of the body, for therapeutic reasons.

Physiologic Effects

1. Stimulates venous and lymph circulation
2. Stimulates peristalsis (abdominal massage)
3. Sedative (quiets nerves) or stimulating depending on massage type
4. Increases glandular secretion
5. Enhances metabolism

Indications

1. To reduce Oedema and swelling; push fluids toward the heart
2. To promote relaxation in Stress
3. To maintain muscle tone - post CVA
4. To loosen fibrous tissue and increase joint mobility in Stiff Joints
5. To enhance drainage from the lungs (in conjunction with positioning) in Ineffective Cough and Viscid Phlegm
6. Pregnancy - Backache, leg Cramps and Ankle Oedema

Contraindications and Cautions

Very few contraindications, below are mostly cautions

1. Capillary fragility in Inactive Skin
2. Skin conditions such as Eczema, Acne, Boils, Ulcers and Wounds.
3. Underlying malignancy
4. Advanced Chronic Nephritis
5. Arteriosclerosis
6. Acute communicable disease or Inflammation
7. Phlebitis, thrombosis, Lymphangitis
8. Late Pregnancy - to abdomen and lower back
9. Osteomyelitis

Equipment

1. A pair of sensitive hands
2. An alert, observant mind
3. Lubricant (powder, lanolin, cocoa butter, cold cream)
   Lubricant must not evaporate quickly or become sticky or tacky.
   Linaments, which have a counter-irritant effect and cause local redness should only be applied for the last few strokes as they can cause blistering if used a primary lubricant.

Procedure

This brief but effectual massage introduces the basic stroking technique upon which almost all other massage is based.

The two primary uses are for relaxation and to push fluids toward the heart.

Relaxation will be produced if the basic principles are followed.

To reduce oedema (post mastectomy), the direction of firm effleurage is always toward to heart, from distally to proximally on the extremity.

However, just as a full bottle can be emptied only through a narrow neck, it is equally important to begin effleurage with the proximal muscle groups, proceeding to the next distal group. When the entire limb has been thus prepared for the complete, long effleurage strokes, we call it "uncorking the bottle."

Basic Techniques

• Effleurage -- stroking
• Petrissage -- kneading
• Tapotement -- percussion
• Friction -- deep manipulation
• Vibration -- shaking

Important Considerations

With certain exceptions, there are less than ten basic principles which, if well-learned and practiced, distinguish an excellent massage from a mediocre one. These are:

• The hands should be clean, warm, and smooth as possible. Fingernails should not be visible when the palmar surface of the hand is viewed.
• During massage, the hand should conform to body contours
• To promote relaxation, hands should maintain contact with the body
• For effective procedure, an even rhythm must be maintained.
• The speed of manipulation is important, being neither too fast nor slow
• Heavy effleurage strokes are always directed toward the heart; light effleurage strokes may be directed distally (a reflex action ensues)
• The patient must be kept warm and positioned comfortably
• The masseur/masseuse must choose and use good body mechanics

Preparation for Treatment

• Ensure the patient is comfortable and in proper position

Treatment: Upper Extremity

Lubricate from wrist to shoulder 2x, coming down to the fingers with 4 rotary movements

Centipetal Stroking

Deltoid

Support upper arm at elbow medially. Stroke deltoid up and over shoulder to just below the clavicle -- use lateral hand over anterior deltoid 3x and over lateral and posterior deltoid 3x.

Biceps and Triceps

Support arm at elbow, hands alternating while stroking biceps to axilla and triceps over shoulder 3x each.

Elbow

Support the arm at wrist laterally -- stroke the medial aspect of the elbow (antecubital fossae) 3x.

Forearm

Support the forearm (with elbow resting on the table) at the wrist, to stroke the forearm medially and laterally (flexors and extensors) 3x each.

Hand

Support hand by grasping as if shaking hands. Stroke the back of the hand and down over the wrist 3x. Turning the hand over, palm up, stroke the inside of the hand 3x.

Hand to Shoulder

Deep, firm stroking from hand to shoulder and subclavian (below clavicle), alternating medial and lateral surface 3x each. Glide back to hand without breaking contact with skin.

Percussion

Optional if indicated -- Spatting from wrist to shoulder up and down 1x

Completion of Treatment

Centrifugal Stroking

Light sedative

With both hands on shoulder stroke down the arm to fingertips 3x.

Treatment: Lower Extremity

Lubricate from ankle to hip coming down to the foot with 6 to 8 rotary movements.

Centipetal Stroking

Thigh

With two hands give firm, even stroking from knee to the anterior superior iliac spine of pelvis, 3x each of the
Anterior
Medial and lateral
Posterior, to gluteal fold

Knee

Use both hands simultaneously, medially and laterally, (thumbs at the side of patella and fingers in popliteal area) to give firm, even stroking 3x. Extend movement from well below to well-above the joint.

Lower leg -- leg extended

With both hands, stroke anterior surface starting at ankle, posterior to malleoli -- glide back without breaking contact with skin. 3x

Foot -- leg extended

Dorsum and sides -- with both hands, stroke dorsum of foot 3x. Give firm, even pressure with fingers to sides of foot. Use thenar surface of hand on mid-dorsum area.
Sole -- support foot at ankle and stroke with medial hand 3x giving a reinforced stroke to heel each time.

Foot to Hip -- leg extended

Deep stroking from foot to hip 3x. With two hands stroke anterior surface medially , laterally, then stroke posterior surface to gluteal fold.

Percussion

Optional if indicated -- Roll leg into internal rotation to give spatting laterally from ankle to hip and return 1x.

Completion of Treatment

Centrifugal Stroking

Light, sedative

With both hands at hip, stroke lightly the medial and lateral surfaces to the toes. 3x

Treatment: Chest (supine position)

The patient should be in a position of relaxation. Place a pillow under the knees for slight flexion to relax abdominal muscles. A pillow may be used for the head but avoid too much flexion of the neck. Position the arms to relax the pectoral muscles i.e. relaxed, slightly away from sides.

Treatment: Upper Chest

Drape lower chest with a towel covering the breasts. Tuck securely under each side.

Lubricate by stroking from midline (sternum) to the shoulders; make rotary movements on shoulders and upper chest with both hands 3x.

Centipetal Stroking - deep and firm

Neck

Place one hand each side of neck with fingers at mastoid area; use heel and palm of hand to stroke down each side of neck toward sternum 3x.

Pectorals

Place one hand on each shoulder over pectorals to sternum. Avoid pressure on bony prominences (clavicle).

Completion of Treatment

Reflex Stroking

Light, sedative

With one hand on each shoulder, stroke area toward midline 3x.

Treatment: Lower Chest

Use towel to drape upper area and shoulders -- covering breast area. Tuck securely at each side. Fold drape sheet below ribs at waist line and tuck in at side.

Lubricate by stroking from midline toward axilla. Make rotary movements over ribs to midline 3x.

Centipetal Stroking

Deep firm

Place hands at midline (spread thumb for increased hand-span). Stroke outward and upward over serratus anterior muscles toward axilla (lymphatic drainage) 3x.

Percussion

applied to chest for assisting in expectoration of sputum.

Completion of Treatment

Reflex Stroking

Light, sedative

Use lighter stroking from midline toward axilla 3x.

Treatment: Abdomen (supine position)

The patient should be positioned in the same manner as for chest procedures. Drape the patient carefully, using Turkish towel to cover the chest area, tucking it securely at each side. The sheet covering the patient should be folded down at lower abdomen and tucked securely under each hip. Remember it is important to keep abdominal muscles relaxed by use of a pillow under the knees.

Lubricate by placing the hands with the thumbs at midline and make rotary movements to cover abdominal area.

Centipetal Stroking

Deep, firm

Using both hands, one hand each side of the midline, stroke outward over side toward bed line. Progress down over abdominal area in the same manner. Last stroke should be directed outward and downward toward anterior superior spine.

Percussion

Not applied unless specifically ordered by the physician.

Completion of Treatment

Reflex Stroking

Light, sedative

Place one hand each side of midline. Stroke downward simultaneously toward hips 3x.

Treatment: Back (prone position

Use a pillow under lower chest and abdomen and a small pillow or folded towel for head.

Lubricate by stroking up the spine and return, making rotary movements to shoulders, scapulae, ribs, waist and buttocks 2x.

Centipetal Stroking

Spine and Outer Back

With both hands give firm pressure up each side of the spine to the neck. Gliding laterally out over trapezius, return without pressure to base of spine 3x.
With both hands give firm pressure on the outer lateral areas stroking up over the ribs and shoulders, glide back down the spine to return 3x.

Trapezius

With both hands stroke upper trapezius from ear to shoulder (bilaterally) 3x.
With both hands stroke middle trapezius from base of neck to the acromium process. 3x
With both hands, stroke lower trapezius from the spine at lower angle to scapula to acromium process 3x.
Note: The trapezius may be done unilaterally with an alternating two-hand count of four repeated 2 or 3x.

Latissimus Dorsi

Begin with hands between angle of scapulae and the waist line, stroke out to axillae, turn hand to use lateral side out over posterior axilla and deltoid 3x.
With both hands (thumbs lateral to spine) begin at waist line, stroke from the spine out and up to axillae 3x.

Buttocks

With both hands (begin below hips on each side) stroke gluteal area up to lumbosacral area. Cross over and continue stroking laterally over iliac crest (with pressure applied by heel of hand) 3x.

Spine and Outer Back

Repeat firm pressure up each side of spine with both hands 3x.
Repeat firm pressure with both hands up the outer lateral area from the waist up over the ribs and shoulders gliding back down the middle to return 3x.

Percussion

(Optional - use as indicated)
Give spatting up the outer side of the back returning down the medial area lateral to the spine. Do the far side of the back first, then the near side in the same manner.

Completion of Treatment

Centrifugal Stroking

Light sedative

Stroke the outer back with both hands from shoulder to hip 3x.
Stroke down the spine from the neck with hands alternating 3x each.

Illustration of Effleurage Movements to Back -- According to muscle groups -- CPR

Lubricate

1. From base of spine to neck
2. Lateral trunk, base to neck
3. Trapezius -- Upper fibres
4. Medial fibres
5. Lower fibres
6. Latissimus Dorsi -- Upper fibres (turn hands)
7. Lower fibres (turn hands)
8. Gluteus Major -- From greater trochanter to sacrum; cross hands -- stretch aponeurosis
9. Long Stokes Repeat No. 2
10. Repeat No. 1
11. Light, reverse stroke over area 2
12. Light, reverse stroke over area 1. End with one finger down mid-line.

• Maintain hand contact
• Hand conforms to body
• Watch rhythm, speed, pressure.
• Decrease pressure toward the last.

Illustration of Effleurage to Arms

Arm:	Hand:
1. Anterior deltoid	Left
2. Post. and lat. deltoid	Left
3. Biceps	Right
4. Triceps	Left
5. Antecubital fossa	Right
6. Anterior-medial forearm	Right
7. Posterior-lateral forearm	Left
8. Palm of hand	Right
9. Back of hand	Left
Full length strokes:
10. (8,6,5,3,1)	Both
11. (9,7,4,2)	Left
Finish with light downstrokes	Both

Illustration of Effleurage to Legs

Leg:	Hands:
1. Top of thigh	Both
2. Medial and lat. thigh	Both
3. Posterior thigh	Both
4. Knee, post. and lat.	Both
5. Gastroc. soleus (flex knee)	Right
6. Lateral leg	Left
7. Ant. foot and ankle	Both
8. Sole of foot -- heel	Right
Full-length strokes:
9. (7,5,6,4,1)	Both
10. (7,5,6,4,2)	Both
11. (7,5,6,4,3)	Both
Finish with light reverse strokes	Both

from Dr JH Kellogg's Hydriatic Techniques...

• Centrifugal Friction
• Centripetal Friction
• Dry Friction
• Dry Shampoo
• Oil Rub
• Percussion
• Shampoo

General deep muscle massage or Petrissage

• After prolonged cold in Obesity and obese Diabetes
• After local cold in local Paralysis or Muscle Wasting in
  • Neuritis
  • Sclerosis
• Very vigorous after cold baths in
  • Rheumatoid Arthritis or Osteoarthritis where exercise impossible in same diseases after hot baths as Eliminative
  • Articular Effusions
  • Muscle Rigidity
  • Trigger Points
• After Scotch Douche in Sciatica and pain in old Fractures.
• First 15min of Turkish Bath or 3min of Russian Bath to bring on sweating
• During Hot Tub Bath to reduce in
  • Dislocations
  • Enteroptosis
  • Uterine Displacements
• Gentle after mild general cold in Acute Nephritis