From Big Medical Encyclopedia

MASSAGE (fr. massage) — the method of treatment and prevention representing a set of methods of the mechanical dosed impact on various sites of a body surface of the person made by hands of the massage therapist or (more rare) special devices. M — a component physiotherapy exercises (see). Being method, physiologic for an organism, M. in a complex with medicamentous and other methods of treatment finds broad application in the most various areas a wedge, medicine, the dignity is used in complex. - hens. treatment, in system of medical rehabilitation, and also in a gigabyte. purposes.

Proceeding from it, distinguish M. medical (including in cardiology, traumatology, gynecology, cosmetology, pediatrics, etc. where M. has specific features) and hygienic (including in sport).


the Method arose in an extreme antiquity in sources of traditional medicine. In Ancient China written certificates on M.'s use belong to the third millennium BC. Descriptions of receptions of M. V Egypt, Libya, Nubia and other countries of Africa are also provided in Ancient India in the treatise «Ayur-Veda» (3 — 2 millennium BC) M. was known for 12 century BC. In Ancient Greece Gerodikos (484 — 425 BC) applied M. at a number of diseases. Hippocrates's works were of great importance for M.'s development. Asklepiad entered one of vibration M.'s receptions — concussions. Teachers of gymnastics massed participants of sports meets in Ancient Greece, rubbing with ointments, and strewed with the fine sand delivered from coast of Nile. In Ancient to Rima M. it was very eurysynusic as means of doctoring and physical. education; A. Tsels wrote about his advantage. K. Galen described a number of the main receptions of M. of Ar-Razi and Ibn-Xing promoted M.'s distribution in the countries of the East. At ancient Slavs as Nestor's chronicle testifies, in time and after washing in a bath it was used nakhlestyvany bodies by a broom («hvoshchevaniye»). A row of the Russian scientific 19 century possesses researches on fiziol, to M.'s justification, they defined indications and contraindications to its use. Very were positive for this method M. Ya. Mudroye, V. A. Manassein, S. P. Botkin, A. A. Ostroumov, G. A. Zakharyin, etc. N. A. Velyaminov widely used M. in travmatol. to practice. I. V. Zabludowsky possesses a large number of the works devoted to M.'s technique and fiziol, to justification of its use in therapy and surgery. The big contribution to studying fiziol, vibration M.'s actions was brought by B. M. Bekhterev, M. Ya. Breytman, S. A. Brustein, A. E. Shcherbak, etc.

At the end of 19 century in Russia there were centers for training of specialists on to lay down. M. At the beginning of 20 century M. began to apply in clinics,-tsakh, beauty shops.

M.'s improvement in the USSR is connected with development of physiotherapy exercises as they are applied, as a rule, in a complex, supplementing each other. The m was widely used in the period of the Great Patriotic War of 1941 — 1945 in complex treatment of wounded that promoted more bystry return them in a system.

The mechanism of action

the complex interdependent reflex, neurohumoral, neuroendocrinal, exchange processes regulated by c are the cornerstone of the mechanism of action of M. N of page. An initial link in the mechanism of these reactions is the irritation of the mechanioreceptors of skin transforming energy of mechanical irritations to the impulses coming to c. N of page; the forming responses contribute to normalization of the regulating and coordinating function of c. N of page, to removal or reduction of manifestations of a parabiosis, stimulation of regenerative processes and processes of recovery of function of peripheral nerves. Excitability of a nervous system depending on an initial funkts, its state, staging patol, process, M.'s technique can go down or increase. The local reactions arising under the influence of direct mechanical action of M. on fabric of the massed area are to some extent expression of generalized reaction of an organism of reflex character. At the same time a certain value has emergence in the humoral environment of biologically active agents, decomposition products of the proteinaceous compounds of muscular tissue (a histamine, acetylcholine, etc.) playing an active role in stimulation of adaptation and trophic function of sympathetic part V.n.s. Involvement of all these links at impact of the dosed M.'s receptions is resulted by mobilization and a training of protective and adaptive mechanisms that promotes ensuring therapeutic effect at a number of diseases, and at healthy people physical promotes. to improvement. At a rational, adjusted dosage of M. has soothing effect.

The m improves trophic processes in skin, clearing it from slushchivshikhsya cells of epidermis; stimulates function of sweat and sebaceous glands; promotes a rassasyvaniye of infiltrates; causes an aktivizirovaniye of a metabolism, increase in gas exchange in bodies and fabrics. Increasing exchange processes in an organism, strengthening release of fat from fat depos, M. promotes «combustion» of excess fat.

The m activates microcirculation: in skin and muscles new capillaries reveal thanks to what improves krovo-and to a lymphokinesis, the tone circulatory and limf is normalized, vessels, the tone and elasticity of muscles raises, their sokratitelny function improves, muscular working capacity as a result increases, force of muscles increases. The m improves blood supply in joints and periartikulyarny fabrics, accelerates a rassasyvaniye of an exudate and patol, deposits in them, strengthens joints and ligaments.

Medical massage

Medical M. is divided on manual and hardware. Manual M. is subdivided in turn on so-called classical and segmentary-reflex.

Indications and Contraindications

Indications. Diseases and injuries of a musculoskeletal system: a pseudorheumatism, dystrophic processes in joints, an ankylosing spondylarthritis (Bekhterev's disease), bruises and sprains and muscles, changes, contractures, scoliosis, flat-footedness, etc.; diseases and effects of injuries of c. N of page: traumatic defeats of a nervous system, effect of disturbance of cerebral circulation, spastic and sluggish paralyzes; diseases of a peripheral nervous system: neuritis, neuralgia, radiculitis, plexitis, etc.; diseases of cardiovascular system: a hypertension, primary arterial (neurocirculatory) hypertension, stenocardia in the mezhpristupny period, a myocardial dystrophy, funkts, disturbances of cardiovascular system, heart diseases without the expressed phenomena of a decompensation; hron, nonspecific diseases of a respiratory organs: hron, pneumonia and bronchitis, emphysema of lungs, bronchial asthma out of a stage of an aggravation; hron, diseases of the digestive system: funkts, diseases of intestines, atonic colitis, a peptic ulcer of a stomach and duodenum (all diseases out of a stage of an aggravation); ginekol, diseases (indications to them — see below, the section «Massage in Gynecology»); inflammatory diseases of the men's sexual sphere in subacute and hron, stages: hron, urethritis, prostatitis, vesiculitis, etc. Indications to M. in cosmetology and in pediatric practice — see below, appropriate sections.

Contraindications: acute feverish states, acute inflammatory processes, bleedings and bent to them, diseases of blood, purulent processes of any localization, infectious and fungus diseases of skin, nails, damages and irritations of skin, fibrinferment, thrombophlebitis, a varicosity, atherosclerosis of peripheral vessels of extremities and an obliterating endarteritis with trophic disturbances, the Thromboangitis, gangrene, aneurism of vessels, an inflammation limf, vessels, an active form of tuberculosis, veins. diseases, hron, the osteomyelitis, benign and malignant tumors, mental diseases which are followed by superexcitation or considerable changes of mentality.

Manual massage

Historically there were four the main M.'s reception: stroking, grinding, puddling and vibration. Each of them has auxiliary receptions which, keeping essence of the main movement of a hand of the massage therapist, give the chance to reach the greatest effect in relation to anatomic features and funkts, to a condition of fabrics of the massed area.

The general or partial (local) M. which is carried out with use of the described lower than four main receptions and auxiliary movements or classical M., is the most ancient and shirokorasprostranenny. There is also manual M.'s way based on the principle of use of a segmented structure of a body and reflex reactions arising at impact on certain reflexogenic zones — so-called segmentary-reflex M.

Fig. 1. Position of a hand of the massage therapist at plane superficial stroking of muscles of area of a back: the brush is straightened, fingers are in one plane, big is taken away.

Stroking — the massing hand slides on skin and, without shifting it in folds, makes various degree pressing. Distinguish the plane and clasping stroking. At plane stroking the brush of the massage therapist freely, without tension is straightened, fingers are closed and are in one plane (fig. 1); at clasping — the brush and fingers taking the form of a trench are weakened, the thumb is taken most away and opposed to the rest. Plane stroking is applied on big sites of skin — a stomach, a back, a breast, etc., clasping — on extremities, side surfaces of a trunk. At the same time stroking can be superficial and deep depending on degree of pressure of a hand of the massage therapist upon a body. Superficial stroking exerts the calming impact on a nervous system, promotes muscular relaxation, improves a tone of skin vessels, stimulates exchange processes in skin and hypodermic cellulose, increases elastic properties of skin. Deep stroking stimulates lympho-and veno-outflow, actively influences blood circulation in the massed site, promotes more bystry evacuation from fabrics of products of exchange, elimination of developments of stagnation.

Auxiliary methods of stroking are shchiptseobrazny, grableobrazny, grebneobrazny, crosswise stroking and an ironing. Shchiptseobrazny stroking is carried out shchiptseobrazno the put fingers, the massed fabrics take I and II, III fingers between the ends; apply it at M. of side surfaces of fingers, a brush and foot, and also sinews, separate small muscles, etc. make Grableobrazky stroking grableobrazno the put fingers: widely divorced fingers (the thumb is opposed to the rest) have the ends on the massed site at an angle 30 — 45 °; apply at M. of a pilar part of the head, intercostal spaces, etc. Grebneobrazny stroking is carried out bone ledges of average phalanxes of the fingers of a brush bent in a fist; use it for deep stroking of large muscles, and also at M. of palmar and bottom surfaces. Crosswise stroking is applied generally on extremities: hands link fingers, cross-wise, «in the lock», and, clasping the massed site, make stroking by at the same time palmar surfaces of both brushes. The ironing is made dorsums of the fingers bent at right angle in metacarpophalangeal joints.

In cases of hypostasis stroking is begun with the site located above a painful segment of an extremity in the direction to the next limf, nodes (the «sucking-away» M.) up. Stroking of all types is carried out rhythmically, at slow speed. Stroking is most often applied in M., begin with it and finish almost each reception.

Fig. 2. Position of hands of the massage therapist at the main and auxiliary methods of grinding of muscles (shooters specify the direction of the movement of hands of the massage therapist): 1 — grinding along a backbone a basic part of a brush; 2 — grinding along a backbone elbow edge of a palm; 3 — grableobrazny grinding of area of a back; 4 — grinding-pileniye of area of a waist.

Grinding — a hand, making pressing, displaces diversely the subject fabrics. During the grinding the massing hand does not slide on skin as during the stroking, and forward rectilinear or roundabouts, forming ahead of itself a skin fold in the form of the roller, makes moving, separation, stretching of fabrics and «mastication». Main receptions: grinding by fingers, elbow edge of a palm (fig. 2, 2) and basic part of a brush (fig. 2, 1). Auxiliary receptions: shtrikhovaniye, planing, grableobrazny (fig. 2, 3) and grebneobrazny grinding, grinding-pileniye (fig. 2, 4) and peresekaniye, shchiptseobrazny grinding. Shtrikhovaniye is made small pillows by I, II and III fingers separately or jointly II and III fingers put by «shovel»; apply at recovery treatment of dermatogenny and desmogenny contractures, the deforming skin cicatricial unions after burns and damages. Planing is carried out one or two hands — the fingers put together and most unbent in joints, short progress immersed small pillows in fabrics and bystry pressing make their stretching and shift; apply at M. of extensive cicatricial injuries of skin, at diseases of skin when methods of grinding are shown and at the same time it is required to exclude impact on the big struck its sites. Grableobrazny grinding, at Krom all fingers of hands are placed, carry out the same as grableobrazny stroking; it is used at M. of a pilar part of the head, intercostal spaces, etc. Grebneobrazny grinding is made the brush compressed in a fist, the distal ends of average phalanxes of fingers. Apply it to grinding of fabrics on a bottom part of foot, a palm or large muscular groups. Pileniye-rastiraniye fabrics, a cut carry out by elbow edge of one or both brushes, apply on large joints, on a back, a stomach, hips, etc. make Peresekaniye beam edge of a brush at taken most away thumb. Shchiptseobrazny grinding is used at M. of sinews, heads of muscles, etc.

Fig. 3. Position of hands of the massage therapist at some main and auxiliary methods of puddling of muscles: 1 — not discontinuous puddling in lengthwise direction (it is specified by an arrow); the massing hand the forward, wringing-out movements makes puddling of a muscle; 2 — cross puddling; the muscle is taken both hands, delayed up, squeezed and one hand wrung out, and another is pulled to themselves; then the directions of the movement of hands change; 3 — puddling moving of muscles - having taken a muscle, the short rhythmical movements shift it from a bone bed in the longitudinal and cross directions alternately.

Puddling — the massed muscle is taken, raised and delayed, squeezed and as if wrung out. Distinguish discontinuous and not discontinuous puddling, and also puddling in the longitudinal and cross directions. Not discontinuous puddling in longitudinal: direction (fig. 3, 1): the straightened fingers at the taken-away thumb impose on the massed area so that the thumb lay on one side, and other fingers — on another, densely covering a muscle; then raise a muscle, delaying it from a bone, and, without letting go, the forward, wringing-out movements make its longitudinal puddling. Cross puddling: the muscle is taken across both hands, delayed up, squeezed and wrung out one hand in the direction from itself, and another — to itself; then the hand which was wringing out a muscle from itself makes the movement to itself, and another — from itself. Making thus in two steps puddling, hands of the massage therapist slowly move on all massed muscle (fig. 3, 2).

Auxiliary methods of puddling: fulling, reeling, moving, stretching, pressing, shchiptseobrazny puddling, twitching. A fulling (apply generally at M. of extremities): hands of the massage therapist clasp with palms on both sides an extremity of the patient, fingers are straightened in the plane of palms, brushes are parallel each other; the movements of brushes in opposite directions (from themselves and to themselves) muscles displace, squeeze and stretch. Reeling is applied at M. of a front wall of a stomach: the left brush in the provision of semi-supination the sawing movements is deeply immersed in tissues of a stomach, at the same time, having taken the right hand on the site about the left brush of fabric, roll them on the left palm and two-three semi-roundabouts make puddling of fabrics between palms. Moving: having taken a muscle, the short rhythmical movements shift it from a bone bed in the longitudinal and cross directions (fig. 3, 3). On sites where it is not possible to take a muscle, the massage therapist pressing on the subject fabrics fixes hands and thus carries out moving of muscular layer from its bone bed. Stretching is made, as well as moving, by capture of a muscle or pressing on fabric and their extension to the opposite sides. Shchiptseobrazny puddling is carried out fingers — longwise and cross at M. of small muscles, the outer edges of muscles, etc. Twitching: taking big and index fingers of fabric, they are delayed and released, the movements make rhythmically, at bystry speed; apply at M. faces to stimulation of mimic muscles at their paresis and paralyzes. Rate of puddling only slow. Influence shall be deep, but absolutely painless. Compression is carried out by the bystry movements of the finger-tips shipped in depth of fabrics like squeezing of stones from berries.

Vibration — the massed fabrics are given to oscillating motions with various speed and amplitude. Distinguish not discontinuous and discontinuous vibration.

Fig. 4. Position of hands of the massage therapist at methods of vibration of muscles: 1 — not discontinuous stable vibration in a forearm; a hand of the massage therapist, without coming off the massed area, makes continuous oscillating motions with very small amplitude; 2 — not discontinuous labile vibration along a backbone; the hand of the massage therapist spiral-shaped moves ahead along the massed area (it is shown by an arrow), without coming off it.

At not discontinuous vibration report to a body of the patient the oscillating (trembling) motions during which the hand of the massage therapist, pressing on fabric, does not come off the massed site — stable vibration (fig. 4, 1). If the hand of the massage therapist moves on the massed site, vibration is called labile (fig. 4, 2). A series of not discontinuous vibrations is replaced by a pause. Not discontinuous vibration which is carried out by one, two or all fingers is applied at neuralgia, paresis of mimic muscles; not discontinuous vibration which is carried out by a palm — for impact on muscles and internals. The potryakhivaniye, concussion, stirring, pushing belong to not discontinuous vibration.

Potryakhivaniye is applied at impact on separate muscles and muscular groups to stimulation of sokratitelny and their motive function. Concussion represents indirect (outside) M.'s reception throats, a stomach, intestines, a liver, etc. The right hand is imposed on area of a projection of the massed body, left placed parallel to right so that thumbs of both hands were turned to each other. Bystry, rhythmical oscillating motions in the steep direction, deleting from each other hands, pulling together them, the massage therapist causes concussion of the massed body and the fabrics surrounding it. Stirring is applied on extremities to activation of blood circulation, decrease in muscular tension, increase in mobility of joints. Pushing is carried out similar to stirring, but with a bigger amplitude of movements; apply it at indirect M. of internals.

Discontinuous vibration: on fabrics put the single, rhythmically following one after another blows. Puncturation, effleurage, pat, a rubleniye, a steganiye belong to methods of discontinuous vibration. Puncturation is carried out small pillows of index and average fingers, separately one finger or jointly two fingers — apply after changes in the field of formation of a bone callosity, on small muscles, sinews, on nervous trunks and in places of an exit of nerves. Effleurage is carried out one or several fingers and a brush (open or a fist). Effleurage by one finger is made a palmar surface or elbow edge of index fingers. Such effleurage is applied at impact on the place of a change, on small sites of fabrics. At effleurage by a brush fingers are freely bent, small pillows II and III fingers of a brush slightly touch fabrics, leaving the void inside. The hand falls on a body of the patient cross in relation to an axis of a body. Effleurage by the brush compressed in a fist is applied on the sites having a big muscular layer — on a back, hips, buttocks. Pat by a palmar surface of a brush is carried out at slightly bent fingers that provides at the time of blow formation of the airbag between a palm of the massage therapist and a body of the patient. This reception is carried out on a back, buttocks, hips, a shin, a shoulder, a thorax, a stomach. At a rubleniya blows put with alternately right and left hand elbow edges of a brush. The brush of the massage therapist shall be in situation, an average between supination and pronation. Rubleniye is applied on big surfaces (a back, buttocks, a breast). Steganiye — reception when strike tangent blows to fabrics.

Use of features of a segmented structure of a body is the cornerstone of segmentarnoreflektorny massage: the irritation of skin receptors of certain zones makes impact on the internals and systems of an organism innervated by the same segments of a spinal cord. The merit of creation of a method of segmentary-reflex M. belongs to A. E. Shcherbak; special value of some skin zones and the related educations of century of N of page, in particular cervical and lumbosacral reflexogenic zones is established to them. Influencing M. the corresponding skin segments, it is possible to excite each of these reflexogenic zones with its difficult bonds and to receive the answer in the form of various fiziol. reactions from certain bodies and fabrics. The so-called collar zone corresponding to the segmented zone C4 is especially rich with receptors (cervical sympathetic a ganglion and the vegetative centers of a chest part of a spinal cord). M of this zone do, e.g., at migraine of a vasculomotor origin, at an idiopathic hypertensia. To exert impact on c. N of page, bodies of a thorax and vessels of upper extremities, mass juxtaspinal areas of cervical and verkhnegrudny spinal segments, tissues of the head, a neck and a collar zone. For impact on vessels of the lower extremities, abdominal organs and a small pelvis mass juxtaspinal areas of nizhnegrudny, lumbar and sacral spinal segments, fabrics of area of a basin and a thorax. In a wedge, practice apply the segmentary-reflex M.

Raznovidnostyyu's techniques of segmentary-reflex M. which are specially developed, differentiated for individual diseases dot M. is, at Krom mass tightly limited sites of fabrics. The choice of points is defined them funkts, activity and topographical compliance of a projection of the nervous trunks and neurovascular bunches passing in fabrics to separate bodies and systems. Segmentarnoreflektorny M. exerts fuller regulating and normalizing impact on exchange processes, secretory activity and other functions of an organism. At segmentary-reflex influence four the main also use method of massage — stroking, grinding, puddling and vibration. More widely and more variously use auxiliary receptions — a shtrikhovaniye, a pileniye, a fulling, stretching, etc.

Hardware massage

Hardware massage is carried out by means of special devices, however they cannot replace hands of the massage therapist, do not allow to differentiate thinly M.'s technique therefore, as a rule, hardware M. is not as effective as manual. Hardware M.'s kinds — vibromassage, a hydromassage, vacuum M. (pneumomassage), etc.

Vibromassage is most widespread. For transfer from the device to a body of the patient of oscillating motions serves various form massage tips — so-called vibratoda. Vibration devices subdivide into the devices for the general vibration causing concussion of all body (vibration «chair», «bed», «platforms», velotrab Goffy, etc.), and devices of local vibration influence for separate body parts — the VP vibration VMP-1 and «Vibromassage» device, the Tone automassager, etc. At emergence of unpleasant feelings, pains, etc. vibromassage should be cancelled.

A hydromassage — the combined influence by water jets and massage manipulations: underwater shower massage (see), M. vortex underwater, M. under water brushes, etc.

Fig. 5. A pneumomassage (vacuum massage) of a back by means of an aspirator — «a massage bell».

Vacuum M. is made due to alternation of the increased and diminished pressure of air in special aspirators («massage bells») which put to a body of sick (fig. 5). Kinds of devices for vacuum massage — sinkardialny M.'s devices by means of which the rhythm of impulses of pressure upon fabrics is made according to a rhythm of reduction of heart, and Kulazhenko's devices (for vacuum massage of gums at treatment of periodontosis).

Indications to hardware M. the same, as to manual, but in some cases by means of special vibratos to in it is possible to carry out M. in those anatomo-topographical areas where manual M. it is full it is difficult to carry out, napr, nasal cavities, drinks etc. The same contraindications, as to manual M.

the Technique

the Main methodical requirement at all types of M. — the maximum relaxation of muscles of the patient and giving to a body of a sick so-called average fiziol, provisions (e.g., the correct laying of the massed extremity taking into account funkts, conditions of muscular groups). The dosage of massage receptions and intensity of their performance shall accrue gradually. All described classical and segmentary-reflex M.'s receptions apply, as a rule, in a combination with each other, including as the main, and auxiliary receptions. Such complexes make individually for each patient depending on the purposes M., the massed body part, taking into account a nosological form of a disease and its wedge, pictures, reactivity of an organism of the patient. The m of a breast, a stomach, a back, extremities lympho-and blood circulations and improvements of venous outflow make for strengthening on the course limf, and blood vessels in the direction of a blood flow and a lymph. Hands of the massage therapist shall move rhythmically, at the beginning of the procedure slowly, and then quicker.

Bystry and spasmodic M., especially at the beginning of the procedure of N of a course of treatment, current of a lymph complicates and increases a lymphostasis. M.'s technique at a number of diseases has specific features. So, e.g., at spastic paralyzes the massage movements shall have preferential character of easy strokings and grindings. The movements should be dosed so that not to increase force of antagonistic muscles and the spastic phenomena. Deep puddling and vibration at them are contraindicated. At sluggish paralyzes in case of lack of the expressed pain syndrome of M. shall be M, more vigorous and long using all main receptions.

At a number of diseases of M. combine both with drug treatment, and with to lay down. gymnastics, physical. exercises in water, mechanotherapy, various physiotherapeutic (a medicinal electrophoresis, UVCh, ultrasound, microwave therapy, etc.) and balneoterapevtichesky procedures. So, at inflammatory and traumatic defeats of the joint and copular and muscular device (a tutopodvizhnost of joints, muscular contractures, etc.) for bigger relaxation of fabrics and improvement of blood circulation before M. do thermal procedures (paraffin, ozokeritovy applications, water or light bathtubs).

At the majority of diseases appoint 12 — 20 procedures M. which are carried out daily or (more often) every other day to a course of treatment. Duration of the procedure of local M. of 8 — 20 min., the general 45 — 60 min. The break between repeated courses is defined individually.

The m shall lead to improvement of health, reduction of pains and constraint, to cause a feeling of pleasant heat, cheerfulness, increase in an animal force, some patients can have an easy drowsiness. Bad portability of M. is possible in cases when it is applied methodically incorrectly or in that phase of a disease, at a cut it is impossible to appoint it, at overdose, especially at elderly people, at the wrong position of the patient during the procedure, at the wrong combination to other procedures.

For M.'s carrying out in to lay down. establishment specially equipped room is allocated — an office for M. Odezhd of the massage therapist shall be easy, not constraining movements, footwear soft, on a low heel. Special attention shall be paid to manicuring of the massage therapist, it is not necessary to allow dryness, coarsening, cracks for what wet hands need to be greased with the nutritious vitaminized cream.

Massage in gynecology

the Founder of a method ginekol. The m was the Swedish scientist Brandt (M. Th. E. Brandt, 1868). A number of fundamental works on M.'s use in gynecology belongs to D. O. Ott (in 1888 he organized in directed by it Obstetric and gynecologic in-those in St. Petersburg a special course ginekol. M), V. F. Snegirev, A. I. Nikolsky, N. I. Rachinsky. The m promotes considerable improvement of blood supply of internal generative organs, a rassasyvaniye of infiltrates, hemorrhages, elimination of commissures. In some cases normal situation of a uterus, its mobility is redeemed, pain decreases.

Indications: the wrong position of a uterus (an excess of a kzada, a deviation to the right or to the left, omission), the unstable or fixed shifts of appendages (commissure), residual inflammatory infiltrates, hems and unions in perimetric cellulose, a peritoneum and appendages of a uterus, an underdevelopment of a uterus with hypo - or an amenorrhea.

Contraindications: pregnancy, periods, acute and subacute inflammatory process of generative organs, gonorrhea, trichomoniasis, erosion of a neck of uterus, thrombophlebitis of veins of a basin, hip. Besides, for ginekol. M contraindications serve all diseases which are contraindications for M. in general.

Technique and equipment. As well as at gynecologic research (see), before ginekol. M intestines and a bladder of the patient shall be emptied. The m should make not earlier than in 2 hours after food. The doctor enters into a vagina of the patient one or two fingers and carefully delays a uterus of a kpereda (in case of a retroflexion, i.e. at an excess of a body of the womb of a kzada), or to a midline of a body (at lateroposition of a uterus); the elbow of a hand of the doctor entered into a vagina shall lean on his hip of the same name, the leg of the doctor is on a footboard or a stool. Other hand the doctor presses on a front abdominal wall, making roundabouts, and gradually moves ahead towards to fingers of the hand entered into a vagina. The combined movements of both hands make a metrectopia in the direction of its normal situation. The m needs to be produced. as it is possible more carefully and more gently, it is necessary to drag out commissures also very carefully. The patient shall not strain an abdominal wall, its breath shall be equal and quiet. Neither during M., nor after it there should not be pain. The procedure M. in the first day shall continue no more than 4 — 5 min. then do a break for 3 — 4 days and monitor reaction of the patient (the general condition, a picture of blood, ROE). Emergence of sharp pains in time or after M. excludes further holding a procedure. In the absence of complications of a basic disease the course M. is continued, appointing procedures lasting 5 — 10 min. every other day or in two days, to a course 12 — 15 procedures. Strict observance of the rules stated above allows to warn an aggravation of inflammatory process. It is reasonable to m to carry out in a complex with physiotherapeutic procedures or mud cure and special remedial gymnastics.

Along with manual in gynecology apply also hardware M. Indications and contraindications to it the same, as to manual M. Vibration M. is carried out by means of the device VMP-1; a hemispherical plastic vibrato house influences paravertebralno at the left and on the right in nizhnegrudny (Th10 — 12), lumbar and sacral departments of a backbone. Duration of influence from each party on 5 — min. After 5 procedures which are carried out daily do a two-day break. A course of treatment — 20 procedures. Carry out also a hydromassage in a bathtub with water of indifferent temperature (34 — 36 °). The distance of a vibrato yes from a body surface of 2 cm Vibratod is established one day over hypogastric area, the second (at a sitting position of the patient) — at the level of sacrolumbar area. Duration of the procedure is 15 min., a course of treatment of 15 procedures.

Massage in cosmetology

Massage in cosmetology can be divided on actually cosmetic, or hygienic, and medical. Division it is conditional since cosmetic M. at the same time renders and to lay down. action. Cryo-massage also belongs to cosmetic M. (see. Cryosurgery ). Persons, necks and M. of a pilar part of the head distinguish M.

Indications to cosmetic M. of the person and necks: premature withering of skin, especially at people with thin and dry skin, wrinkles, flabbiness and pastosity of skin, dysfunction of sebaceous glands (fat seborrhea), acne rash, paresis of a facial nerve; indications to M. of a pilar part of the head: hair loss, seborrhea, psoriasis.

Contraindications: the acute inflammatory, pustulous diseases of skin, eczema, a hypertrichosis of face skin expressed to a teleangiectasia, a rozatsea. It must be kept in mind that at quickly progressing hair loss of M. of a pilar part of the head it is contraindicated. Besides, contraindications to cosmetic M. are all diseases at which M. is contraindicated in general.

Technique and equipment. Cosmetic M. of the person shall be carried out by specially trained medical staff, be carried out with strict observance of rules of hygiene and on so-called massage lines. Self-massage of the person (manual or by means of devices) is not recommended since can cause undesirable effects: stretching of skin, deepening of wrinkles, change of a face form; besides, introduction of an infection is possible. Massage lines are located generally from the center to the periphery: from the middle of a chin towards lobes of ears, from the center of an upper lip and from an outside corner of an eye to a trestle of auricles, from the center of a forehead to temporal hollows.

M carry out every other day or two times a week, duration of the procedure from 6 to 15 min., all on a course 10 — 20 procedures. With the preventive purpose 2 — 3 times a year are reasonable to repeat a course M., and at fat seborrhea, acne rash — 3 — 4 times a year.

Fig. 6. The main lines and zones (are designated by a dotted line and wavy lines) at facial massage: 1 — 3 — during the stroking; 4 — during the puddling; 5 — during the grinding; 6 — at circular effleurage; shooters specify the direction of movements.

At cosmetic M.'s carrying out the person and neck of the patient conveniently is located in a chair with the leaning-back back. The pulling together clothes shall be taken off, muscles are relaxed. Hair remove under a kerchief with an oil-cloth rim, exempt a neck and a breast from clothes and cover with a sheet. The massage therapist costs behind a chair. Before M. the face and a neck are wiped with lotion, put for 2 — 3 min. a hot compress — the wafer or terry towel moistened with hot water or broth of herbs (a camomile, a sage) and wrung out. Wet heat macerates epidermis, promotes rejection of horn scales, expansion of a time, rush of blood to the person and the best penetration of cream into skin, it is especially useful at M. of dry skin. At porous, fat skin, especially in the presence of comedones, it is reasonable to apply a steam bathtub or a paraffin mask before M. Just before M. apply the softening cream which is distributed on the person the easy sliding movements on massage lines. The skin of upper eyelids which does not have sebaceous glands is greased with the same cream. For the best sliding of hands the massage therapist greases palms with cream if skin fat porous — talc, it is desirable to add to Krom powdery boric to - that (95 parts of talc and 5 parts to - you). The massage movements shall be rhythmical, each movement is repeated by four times. Their force in each case shall be defined by a condition of skin and age of the patient, M.'s portability and its purposes. However in the course of M. it is necessary to accent the movements on those sites of skin where wrinkles are more expressed, the tone of muscles is lowered. Cosmetic M. is carried out by means of four main receptions: stroking (fig. 6, 1—3), puddling (fig. 6, 4), grinding (fig. 6, 5) and vibration; besides, use auxiliary method — effleurage (fig. 6, 6). The movements at cosmetic M. shall be only sliding, but not shifting skin, to be made smoothly, without sharp transitions from one site to another.

Before M. persons by stroking, and then puddling mass a back surface of a neck, a front surface of a breast, area of mastoids. In the presence of fatty deposits in addition make a rubleniye — strike with serially elbow edges of brushes side surfaces of a neck. M of the person begin with stroking of a chin, a circular muscle of a mouth, infraorbital area, frontal and temporal muscles and continue grinding of muscles of a nose, forehead, chin etc. Effleurage but to all person, a so-called staccato, is carried out by means of abrupt loop-shaped movements. There are still some options M. determined by specific features of face skin. So, apply vertical deep pressings which begin under a chin on three lines to strengthening of the weakened face muscles: to auricles, on a masseter iod a zygoma, from under a chin up to corners of a mouth. At fat porous skin, residual infiltrates after acne rash, indurative eels apply «plucked» (so-called plastic) M. directed to expression of congestive skin fat from the sebaceous glands corked with comedones on strengthening of blood circulation with the purpose to cause an active hyperemia for acceleration of a rassasyvaniye of infiltrates and elimination of developments of stagnation. The elderly patient apply the vibration, pinching, pressing movements on massage lines. Having finished M. of the person, appoint the pulling together masks (mix 1 — 2 chayn. l. white clay, zinc, talc, alum, starch from 2% solution boric to - you or hydrogen peroxide). Mask from such mix, edge shall have a consistence of dense sour cream, prepare just before imposing, in 10 — 15 min. easily take off the dried mask a cotton plug.

M of a pilar part of the head begin with stroking, grinding, vibration in the field of superciliary arches, frontal and temporal muscles, all pilar part of the head and finish with grinding of a trapezoid muscle and skin of area of mastoids.

Massage at children

At children's age massage — an effective method of prevention and treatment of many diseases. Indications, contraindications, a technique and technology of use of M. for children of preschool and school age generally the same, as at adults.

The m at children of chest age makes an integral part of physical training along with special gymnastics (see. Gymnastics, for children of early age ) and hardening (see) also has some specific features. It promotes the correct development of an organism, to improvement of turgor of fabrics, normalization of function went. - kish. path. At weakness of muscles of a prelum abdominale, M.'s meteorism promotes release of intestines from gases. The m positively influences the psychoemotional sphere of the child, at excitable, nervous children the behavior and a dream is normalized.

Indications: at early children's age of M. together with gymnastics it is possible to apply since half-month age as means of strengthening and correct physical development of an organism of the child. According to special testimonies of M. it can be appointed also in earlier terms. The m is shown to the premature children, children who are on artificial feeding in all cases of lag of the child in physical development, to convalescents after postponed inf. and other diseases, at rickets, a hypotrophy, bent to obesity, the expressed neuropathic reactions. M. at pneumonia is effective, especially with a prolonged current, at bronchial asthma. M widely apply in children's ortopedo-neurologic and surgical practice.

Contraindications: all diseases at which M. is contraindicated to adults, and also a pyoderma, extensive skin displays of exudative diathesis, the acute and subacute course of rickets.

Fig. 7. Massage of the child by means of stroking, grinding and puddling: 1 — massage of hands reception of the clasping stroking; the child lies on one side; the massage therapist the left hand raises a hand of the child up, the right hand makes the slow stroking movements from the periphery to the center; 2 — 4 — massage of muscles of a back stroking, grinding and puddling; the child lies on a stomach, the massage movements are made from lumbar area towards shoulders of the child; all movements are made slowly, softly; 2 — stroking by dorsums of the relaxed hands of the massage therapist; 3 — grebneobrazny grinding by the average phalanxes of hands of the massage therapist compressed in fists; 4 — puddling by the ends of fingers of hands of the massage therapist by moderate pressing skin and the subject fabrics; 5 — massage of a stomach is made palms of hands roundabouts of the stroking character for improvement of a vermicular movement of intestines; 6 — 7 — massage of a shin grinding and ring-shaped puddling; 8 — plane grinding by palms of hands by circular movements from the periphery to the center; 7 — ring-shaped puddling by the clasping movements of big and index fingers of hands of the massage therapist; puddling make at the same time both hands, but in different directions, at the same time the direction of razminaniye from the periphery to the center.

Equipment The m at children includes use of all four receptions of classical M. — stroking, grinding, puddling and vibration. Stroking, grinding and puddling (fig. 7) are most widely used. Easy stroking calms a nervous system, causes positive emotions, improves food of skin, increases its elasticity, krovo-and the lymphokinesis, and also strengthens muscular system. At the same time oxygen consumption by fabrics increases, the metabolism amplifies that is shown by increase in appetite, increase in body weight, improvement of the general state. Stroking is especially shown at a hypotrophy.

Grinding causes a dermahemia, hypodermic cellulose, muscles, sinews; it is made one or several fingers in the circular direction. Grinding is widely used at treatment of diseases of a musculoskeletal system, «manual» grinding of shins is especially shown.

Vibration — the vigorous reception which is followed by concussion of the subject fabrics in pediatric practice is used seldom, only according to special indications, generally at M. of a thorax and for increase in static function of a backbone, is shown also to children with an excess weight.

Puddling influences hl. obr. on deeply located fabrics, at the same time their blood supply and food amplifies, the tone of muscles, their sokratitelny ability improves. This method is widely used at treatment of the rickets which is usually followed by considerable weakness of muscular system and an arrest of development of movement skills, especially static functions.

All receptions of M. at children should be carried out by the same methodical rules, as at adults, but it is more careful, smoothly, gently; it is necessary to consider vulnerability of thin skin of the child, easily arising excitement of its nervous system. Tender approach to the child, positive emotional background promote achievement of therapeutic effect. The massage therapist should follow rules of personal hygiene especially strictly. At M.'s carrying out to children of chest age, as a rule, do not use vaseline and talc; the room shall be well aired, air temperature in it not lower than 20 °.

Hygienic massage

Gigabyte. The m serves for strengthening of health, preservation of high performance, the prevention of diseases. Such M. promotes bystry removal of exhaustion and increase in working capacity; it is recreational, recovery means at sports activities, a gigabyte. The m can be carried out also in the form of self-massage. Methods of self-massage and the rule of their use same, as in classical M. General gigabyte. self-massage is carried out in a certain sequence: head, neck, hands, breast, back, stomach, legs and area of a basin. Separate somites mass from the periphery to the center, to the next limf, nodes. Most often at self-massage stroking, grinding, puddling is used. Each reception is repeated, as a rule, by 3 — 8 times. Not discontinuous and discontinuous vibration is applied restrictedly because of difficulties of performance. The initial position at self-massage of a rump, a breast and stomach — lying, at self-massage of the lower and upper extremities, spins, a neck and a pilar part of the head — sitting. Duration of the procedure of the general self-massage of 15 — 20 min.

The gigabyte has specific features. M in sport.

Massage in sport it is applied for physical improvement, achievement and preservation of sportswear by preparation for a sports competition or a long campaign, to removal of exhaustion and maintenance during the sports training, competitions, and also after them.

According to it distinguish preparatory, training and recovery sports M. Preparatory M. raises the general tone of an organism, «warms» muscles, increasing their sokratitelny ability (especially in cold season), increases operability of an organism, helping the athlete to enter sportswear quicker. Training M. is applied to increase in efficiency of those muscular groups on which the greatest loading falls during the sports trainings.

Recovery M. is shown after hard muscular work for bystreyshy elimination of exhaustion and maintenance of an organism. Contraindications to sports M. — a wedge, signs of an overtraining of the athlete.

Technique. The general M. is recommended to be applied to the athletes doing sport, at Krom all bodies and systems (swimming, fight etc.) are involved in work; first of all mass the muscles which are exposed to the greatest loading; the most part of time of the procedure is allowed for their M. So, e.g., at long-distance runners, skaters, football players are massed in the beginning by the lower extremities, then upper; at oarsmen, throwers, fencers are massed earlier by upper, and then lower extremities. During the general M. it is impossible to allow coolings; those parts of a body which are not massed at once shall be wrapped up. The general M.'s duration is 50 — 60 min. Local M. has selective character and extends to those parts of a body or group of muscles on which the greatest loading falls during the training or sports competitions, such M.'s duration — 25 — 30 min. In sports M. use the same main and auxiliary methods which are used at to lay down. M. The choice of receptions of M., ways of their carrying out, and also intensity and a dosage of massage movements depend on sport, and also on the purpose M. (preparatory, training, recovery). Intensity (force and speed of movements) depends also on sport. To the persons who are going in for weightlifting, fight, boxing, and also runners and racers on long distances of M. carry out vigorously, to athletes, swimmers, skiers, tennis players — less intensively. Vigorous and long (45 — 50 min.) the general M. is not recommended to carry out before a training and a competition since it can cause slackness, drowsiness and on a nek-swarm time to reduce physical effeciency. The best effect gives the easy and short-term M. (within 10 — 15 min.) which is carried out in 2 hours prior to a training or a sports competition. The same M. is recommended in breaks between performances (e.g., between rounds in boxing). It is possible to start recovery M. not earlier than in 20 — 30 min. after the strengthened training or a competition, and at strong exhaustion — in 1 — 2 hour and later, depending on the general condition of the athlete; the massage movements shall not be vigorous and bystry.

At recovery M., especially at easily excitable persons after strong contagious excitation, from receptions easy stroking, grinding, puddling is applied; discontinuous vibration (pat, effleurage, a rubleniye) is not recommended.

In sport apply also self-massage which it is possible to make after morning a gigabyte. gymnastics, in the course of the sports training, after the competition or upon long transitions. A technique of its use, and also technology of separate receptions same as at classical M., but it is carried out more vigorously.

Bibliography: Topical issues of cosmetology, under the editorship of V. Ya. Arutyunov, M., 1970; Arkhangelsk N. V., etc. Reference book on medical cosmetics, M., 1975; White N. A. Guide to medical massage, M., 1974, bibliogr.; In e r-@ about in A. F. Bases of medical massage, M., 1966, bibliogr.; Glezer of the Lake and D is scarlet and x about A. V. Segmented massage, the lane with it., M., 1965; Ivanov S. M. of ides of river. Medical physical culture at diseases at children's age, M., 1975; Kaptelin A. F. and L and with with to and I am L. A. Labor therapy in traumatology and orthopedics, M., 1979, bibliogr.; To at N and - the p e in L. A. Medical massage, M., 1976; The Multivolume guide to obstetrics and gynecology, under the editorship of L. S. Persianinov, t. 4, book 1, page 162, M., 1963; Rozentul M. A. General therapy of skin diseases, M., 1970, bibliogr.; Sarkizov-Serazini I. M. Sports massage, M., 1963; Sloushch 3. And. Efficiency of a vibration hydrotherapy at chronic inflammations of appendages of a uterus, Kazansk. medical zhurn., No. 2, page 52, 1966; Sports massage, under the editorship of V. A. Makarov, M., 1975; The Reference book on cosmetics, under the editorship of M. A. Rozentul, M., 1964; Strugatsky V. M. and d river. Stimulation of an ovulation vibration massage, Akush, and ginek., No. 9, page 13, 1976, bibliogr.; Fedorov V. L. Vibration massage, L., 1971; Fonarev M. I. Medical physical culture at diseases of children of early age, L., 1973, bibliogr.; Helmrich H. E. Bindegewebsmassage, Bd 1 — 2, Heidelberg, 1978; Massage in Bild und Wort, Grundlagen und Durchfiih-rung der Heilmassage, hrsg. v. A. Hamann, B., 1976, Bibliogr.; Thure-B rand t A. Massage bei Frauenleiden, Stuttgart, 1937.

H. A. Belaya; A. F. Verbov (sport. medical), To. H. Zhmakin (gin.), S. M. Ivanov (ped.), M. A. Rozentul (cosmetology).