13.2 Different types of massage techniques.pptx

Different types of massage
techniques
By : Dr. Alpa J. Dhanani
MPT(Musculoskeletal & Sports)

1. Basic introduction
2. Technique
3. Physiological effect
4. Therapeutic uses
5. Cautions
6. Variation

a. Superficial and
b. deep stroking.
• The uninterrupted linear movement of hand along
the whole length of a segment called as “stroke” .
Features:-Even pressure,
- Equal rhythm,
- Constant contact of therapist’s hand with the patient’s body.
Stroking manipulation

Technique :
• Stroking should be performed with the palmer aspect of hand or finger pulp area.
• Intention of this technique is to obtain a sensory reaction either sedative or stimulating.
• The stroke can be applied from proximal to distal part or vice versa.
• The stroke can follow any direction (centripetal-from distal to proximal or centrifugal- from
proximal to distal)
• The stroke should start with firm contact and finish with a smooth lift off your hands.
• Slower strokes(12-15 stroke per min)are more sedative &
Faster strokes(30-40 strokes per min) are more stimulating.
How to apply:
• Therapist position :Walk standing or fall out standing position
• Therapist hand should be fully relaxed with fingers slightly apart and flexible so that they
can be molded according to the contour of the body.
Superficial stroking

Physiological effects:
1. Stimulates the cutaneous touch receptors. It has a sedative, soothing and reposing
effect on the body when apply slowly and stimulating effect when apply faster.
2. Indirectly improves the circulation by activating the axon reflex.
3. Facilitation effect on motoneuron pool helps to facilitates muscle contraction.
Therapeutic uses: (Indications)
1. Helps in assessment and to obtain information about contour, texture, tone,
temperature.
2. Helps to identify problem area and to determine the effect of treatment used.
3. Helps to relax muscles and to accustom the patient to manual contact prior to any
massage technique.
4. Apply to forehead in sleeplessness.
5. Longer duration in anxiety, tension and psychological stress is very helpful.
6. Fast stroking is used in hypotonic muscle.

Cautions:
1.In hypersensitive person stroking may produce unwanted and excessive tickling.
2. In severe spasticity stroking may elicit flexor withdrawal.
Variations:
1. Entire palm
2. Knuckles
3. Ball of thumb
Techniques of thousand hands :
 In this technique the entire length or segment is not covered in one stroke.
 It involves several overlapping strokes.
 a stroke of one hand overlap the stroke of other the hand.
 Strokes moved down to cover the entire length of part.
 Mostly used for relaxation.

Technique :
• Applied with Palmar aspect of hand over the external surface of body with
constant moderate pressure in the venous and lymphatic direction.
• Every massage begins and ends with effleurage.
• Each stroke begins from distal end of segment and is completed at the proximal
end usually at the site of a group of lymph node.
• Pressure applied during each stroke should be as deep as can be applied
without causing discomfort to the patient.
• Stroking should be slow (10-12 stroke / min) in order to allow sufficient time
for refilling of venous and lymphatic channels.
How to apply:
• Depending upon the area to be treated it can be performed with one or both hands.
• Usually palmer aspect of hand, fingers and thumb are used
Deep stroking or Effleurage

Physiological effects:
1. It produces squeezing of the veins and lymphatic fluid towards the heart as a result
of which
a. Chances of accumulation of waste product is prevented or minimized.
b. Stagnation of blood and lymph reduced.
c. Venous and lymphatic drainage improves.
d. Oedema reduces.
2. Mild stimulating effect on vasomotor nerves which supplying the blood vessels and
skin leads to elicitation of Axon reflex. Circulation in the capillaries facilitated.
3. Liberation of histamine due to stimulation of mast cells causes erythema.
4. Improves arterial circulation helps to improve nutrition of that part.
5. Exerts stretching effect on the subcutaneous tissue improves elasticity and mobility
of the skin.
6. Stimulation of touch and pressure receptors brings about sedative effect to sooth,
reduce pain and lessen muscle tension.
7. Remove dead cells of the skin and improves the activity of sweat and sebaceous
gland and tone of the skin improves.

Therapeutic uses:(Indications)
1. To accustom patient to the touch and helps to distribute lubricant
evenly over the skin if used.
2. Helps to search the area of muscle spasm, soreness and trigger points
to determine further management.
3. To reduce edema in
a. Mild varicose ulcer,
b. Gravitational edema
c. paralytic edema and
d. Lymphoedema in radical mastectomy.
4. To assist the absorption and removal of metabolites and inflammatory products in
muscle fatigue following severe exercises, sub acute and chronic inflammation,
soft tissue injuries.
5. To linkup and join various manipulation technique during massage.
6. To lessen the negative effect of mobility and lethargy associated with
psychological distress

Cautions:
• Newly healed scar tissues (due to stretching effect)
• Recent skin grafts
• Open wounds
• Flaccid paralysis
• Cystic swelling in varicose veins
Variations:
The basic technique can be modified depending on the area to be treated.
1. Both hands on the opposite aspect of the thigh.
2. One hand may follow the other hand with both hands ending stroke within
a short interval time.
3. One hand massages while other hand is used to support or change the
position of massaged segment mainly used in upper limb.
4. C grasp for forearm .
5. Indian effleurage :-direction of stroke is reversed in arterial blood flow
direction.
-C grasp & pressure is applied in proximal to distal direction
6. Cross hand massage used for knee area.

• Application of deep compression to the
muscular tissue with constant touch& deep
localized pressure.
It is divided as
• Kneading ,
• Petrissage and
• Friction
Pressure manipulation

Technique :
• It is performed in a circular manner to press down skin and underlying
structures along the long axis of the underlying bone.
• The pressure is increased or decreased in a gradual manner.
• Several small concentric circles performed parallel to the body surface
and each circle overlaps the previous one.
• The pressure is gradually increases during one half of the circle and
reduced gradually during other half of the circle.
So each circle has two phases
1 phase of compression
2 phase of relaxation
kneading

• On the non pressure phase of the circle the hand maintain the contact but glides on
to the next area of the skin a little to allow the next circle to cover at least half the
previous area.
How to apply:
• Therapist position :Walk standing or fall out standing position .
• Integrated flexion of hip, shoulder and elbow helps to transfer and use of body
weight.
According to the part of the hand used classification of kneading is
• Palmer kneading
• Digital kneading
• Reinforced kneading

• Performed with soft palmer surface of one or both hands.
• The care must be taken to avoid hard heel of the hand during
procedure.
• Pressure on bony prominences avoided. E.g. the coracoids and
acromian process and subcutaneous areas of the bone.
• Rhythm and continuity must be strictly observed throughout.
•
• It is important that the pressure should be deep and the muscle should
be moved on the bone otherwise only skin polishing occurs.
• Slower rates allow better penetration to the deeper tissues
Palmer kneading

• Technique is done with either thumb or fingers.
• Most commonly used around the joints, localized
area, face and prevertebral areas of the spine.
Subcategories
1. Finger kneading
2. Thumb kneading
Digital kneading

1.Finger kneading:
a. Whole finger kneading
• Palmer aspect of whole finger or part of it is used to apply pressure.
• It is divided into 3 groups.
• Flat finger or whole finger kneading
• Usually performed with palmer surface of 2nd, 3rd and 4th digits held
together to make broad area. It is applied over less muscular and
poorly padded area e.g. mandible area.
b. Finger pad kneading
• Performed with the finger pads either individually or more fingers
together to provide a linear contact and to cover the larger area.
Generally used for scar tissue, around joints and along the line of
ligaments.
c. Fingertip kneading
• Only tip of the finger pad is in contact with the part so care must be
taken to keep your nails off contact.
• It is used over small structures. For localized painful area e.g. long-
narrow interosseous space and over localized thickening of fibrocitic
nodules

2.Thumb kneading: divided in 2 sub groups.
a. Thumb pad kneading
• The whole pad of thumb is used over smaller and muscular area
e.g. thenar and hypothenar eminence, forearm and back.
b. Thumb tip kneading
• Usually performed with the side of the thumb tip over a long
narrow interosseous space.

• Both hands are used to transmit pressure to the very deep structures and used when
greater depth is required.
• In walk standing position therapist placed both the hands over each other and lower
hand in contact with the part.
• The superimposed hand rests on top either obliquely across when working on the
opposite side of the body or palm over fingers when working on the same side of
the body reinforces the other.
• Therapist kept his elbow in complete extension for effective transmission of
pressure.
• Intermittent circular pressure in increasing and decreasing order is transmitted to
the body through shoulder and elbow by controlled shifting of the body weight
from one leg to the other.
• Sliding movement of hand achieved by controlled flexion or extension of shoulder
after completion of one circle.
• It is mainly performed on back and gluteal region.
Rein forced or superimposed kneading (Ironing)

Variations:
• Elbow kneading: Performed by the bent elbow
for greater depth on the area to be treated. Used
on the interscapular region, back and gluteal
region.
• Heel of hand kneading: The whole heel of hand
is used on muscle bellies but not on tendon. Care
should be taken not to dig in with pisiform bone.

Contraindications:
• Hypotonia
• Early infantile paralysis
• Extreme debility
• Very hairy skin
• Early stages of recent injuries.

• Name derived from the French word “petriz” meaning to knead.
• Only difference with kneading is the direction of pressure
application.
• In kneading compression of tissues over underlying bone is vertical
while in Petrissage lateral compression of soft tissues lifted away
from the underlying bone and intermittent pressure is applied at a
right angle to the long axis of bone.
Three techniques:
1. Picking up
2. Wringing
3. Skin rolling
Petrissage

• Smooth, rhythmic and continuous movement performed with one or both hands on individual
muscle or group from one attachment to the other.
• First palpate the muscle to feel relaxation.
How to apply:
• Keep the hand in such a way that the web space between thumb and index finger lies across
the central line of the muscle bulk with either a “c” shaped grasp wider on larger areas or a
“v” shaped grasps which is narrowed on areas of lesser bulk.
• The muscle is first pressed against the bone, lifted, squeezed and relaxed.
• After completion of technique at one place released hand slides over to the next adjacent area
without losing contact and same procedure repeated
• Pressure should be evenly distributed to all the lifted tissue.
• For large group of muscles like calf, quadriceps, Hamstrings relaxation period should be
observed.
• If pain is felt during pressure than either pressure should be reduced or the amount of grasped
tissue is lessened.
A. Picking up

• It is resemble with activity of twisting and squeezing a wet towel.
• Both hands are placed on the part to be treated and moved in opposite direction so the
tissues are lifted and twisted in forward and backward direction.
• It is used to stretch the structures.
• Therapist is in walk standing position uses the body weight to apply compression with arms in
adduction, elbow slightly flexed wrist lifted to be more alongside one another.
•
• Movement is initiated by pulling the fingers of right hand to pull and lift the muscle from
underlying bone.
• At the same time left thumb pushes in opposite direction which stretches the lifted tissues.
• The process is repeated several times before moving on next area.
• It is useful in mobilization of adherent skin and muscle.
• This technique is used in arms, legs but if the area is very small as in tendocalcaneous the
manipulation is performed with thumb and fingertips.
• Never used in children, elderly and very thin person as it may damage delicate muscle fiber.
Wringing

• It is mainly used to stretch the cutaneous and subcutaneous tissue and
induce relaxation.
• The skin is lifted and rolled between the thumb and finger of the both
hands.
• Mostly given on back, abdomen, sides of the thighs, around superficial
joints like knee and in modify form on scar tissue which is thickened and
short.
• Therapist in walk standing position at the side of the area to be treated.
Both hands placed on the surface of the area distally with, your palms fully
in contact, thumb tips touching and parallel to the long axis of the part.
Rolling: skin rolling and muscle rolling

Physiological effects of kneading and Petrissage
• Due to pumping action of muscle there is local increase in
blood flow, Liberation of H substance and elicitation of axon
reflex.
• Decreases the stagnation of fluid and edema as well as
increase nutrition of the area.
• Stretches the tight fascia to help in restoration of mobility of
the skin and subcutaneous fascia.
• Helps to break adhesions there by increasing mobility of
adherent structures.
• Intermittent pressure stimulates tension dependent
mechanoreceptors – golgi tendons and decrease
• excitability of motoneuronol pool in healthy persons.
• Above effects collectively reduce pain.

Therapeutic uses
• To mobilize adhesions and stretch soft tissue in Chronic
inflammation, traumatic adhesions, organized edema.
• Improve mobility of skin by loosening scar in case of burns,
postoperative scar, fibrosis due to soft tissue injury and
laceration.
• To improve circulation in the muscles in case of fatigue
following intense work, disuse atrophy.
• To reduce muscle tension in spasm with pain and tension
headache.
Caution
• In case of flaccid paralysis excessive stretch to flaccid muscle may
prove to be counter productive.

• Small range oscillatory movement applied to
the deeper structures with pressure by thumb
or fingers.
• According to direction of movement it is
divided into
1. Circular friction
2. Transverse friction
Friction

Circular friction
• Similar to digital kneading but only difference is it has no phase of
relaxation and a constant deep pressure is applied to the tissue
during the whole procedure.
• The fingertips are placed over a localized area (i.e. joints, muscle
attachments, over fibrositic nodules and its vicinity )and along with
application of little pressure downwards, skin and fingers are moved
as one in circular direction.
• The amount of pressure is gradually increased as the superficial
structure becomes relaxed.
• It is most useful when a nerve trunk is embedded in consolidated
edema fluid and for Para vertebral muscle which are in prolonged
state of tension.

Transverse friction
• The direction of movement is transverse, across the long axis of the structure to be
treated.
It is performed by
• Tip of the index finger or thumb
• Index or middle finger reinforced by placing one over the other.
• Two or three fingers on tendon
• The other parts of the hand should not come in contact with the skin, fingers are
placed across the length of the structure.
• With pressure either forward or backward movement is performed in small ranges.
• The non contractile structure such as ligaments and tendons are placed in fully
taught or stretch position to provide immobile base where as the contractile tissue –
muscles should be relaxed.
• Otherwise friction will not penetrate deeply and broadening out of individual fibers
nit achieved.

• Patient should be informed about this painful procedure.
• The skin must be dry to ensure your fingers do not slip.
• If required spirit can be used.
• With this precaution blistering can be prevented but transient redness or
slight bruising in adipose tissues may occur.
• Maintain friction for 5 to 10 minutes but the area should be examined at
intervals to check that bruising or blister is not occurring.
Caution:
• Vigorous friction causes blister formation. Risk is
increased while performing on moist skin.

Physiological effects
• It forcefully broadens out the structure.
• It moves the individual collagen fibers over the underlying structure
and keep the structure free from adhesion.
• Pain facilitate the release of endorphin.
• Deep friction results in increase local blood supply and induce
hyperemia.
• Mild erythema occurs.
Therapeutic uses
• It is used for injured joint in case of chronic fibrocystic, nodular
thickening of aponeurotic sheaths of muscles.
• Scar tissue – stretched and loosen by friction and prevented from
becoming adherent to the underlying structure.
• Sub acute and chronic lesions of muscles, tendons, ligaments,
capsules, nodules, adhesions etc.
• Localized pain – trigger points
• Traumatic muscular pain – Tendonitis, Tenosynovitis
• Ligament sprain

Sites to be treated
• Musculo tendinous junction of
• Supraspinatus,
• Biceps, psoas,
• Anterior and posterior tibial muscles,
• Peroneal muscle,
• Muscle belly of brachialis, supinator, interossei of hand and
foot,
• Intercostal muscles,
• Oblique abdominals,
• Subclavius ligament,
• Around carpal bones,
• Coronary ligaments of knee,
• Posterior tibio tallar ligament,
• Anterior fascia of ankle.

Contraindications:
Harmful in
• Traumatic arthritis at elbow
• Calcification or ossification in soft tissue at suprasinatus tendon,
collateral ligaments of elbow
• RA – joint capsule
Not effective in
• Inflammation due to bacterial infection
• Bursitis
• Pressure on nerve
• Recently healed scar – danger of reopening of the wound
• Very sensitive area
• Swollen joint in recent injury: sprain, dislocation, painful joints,
• Tender joint in poliomyelitis

• Different techniques has characteristic feature of
intermittent touch and pressure to the body
surface.
• Utilise controlled movement of wrist and forearm
to strike the surface rhythmically with mild blow
applied of various pressure and different manner.
• Performed to assist evacuation of hollow organs
or to stimulate either skin or muscle reflexes.
Percussion/Tapotment

• Hacking
• Clapping
• Beating
• Pounding
• Tapping
• Tenting
• Contact heel percussion
Types

Technique:
Position of therapist: stride standing
 Arms abducted at 30°, elbow at 90° flexion and wrist extended.
 Pronation and Supination of forearm producing succession of short and
sharp blows with the Ulnar border of fingers across the muscle.
 The little finger strikes first.
 Whole length of muscle is treated.
 Avoid bony prominences.
• Hacking used over larger areas – back, thigh
• Rate of strike 10/min with each hand.
Hacking

Where to perform?
 Usually performed on head, neck and back.
 Position of patient: prone lying
 Position of therapist: walk standing at side or behind the patient at head end.
Mode :Divergent
 Hands placed on either side of spine below the scapula and diverge and converge
over the same area from where started.
 Continue until the whole of the back from mid scapular to sacral region covered.
Longitudinal
 Hands are placed at the either side of the spine from root of the hairs go downward
to the sacrum and work again to the starting point.
 Strokes are lighter in cervical and upper dorsal spine than lumber spine where the
tissues are much thicker and offers high resistance

Purpose
• Single strike – reflex contraction of muscle
• Slow deep strike – mechanical effect on hollow organs.
• Fast strike – skin stimulation and circulation.
Contraindications
• Subcutaneous bony areas
• Hyperesthesia
• Excitability
• Spasticity
• Over tissues which are tending to contract
• Hypotonic muscle until the tone has been recovered.

• Light hacking across the muscle stimulate the peripheral
nerve endings – muscle contract reflexely. (restoration of
muscle tone)
• Increase active flow of blood to the muscles- new sense
of warmth and feeling of refreshment to the muscles.
• Long time heavy stike temporary paralysed the blood
vessels which is dilated and blood circulation increased
with rise in temperature and metabolism.
Therapeutic uses
• After immobilization to the muscles suffering from lack
of nutrition.
• To maintain and restore tone of the muscles.
• Spinal nerve stimulation helps in depression, debility.

• Commonly useful technique has important role in the management of chronic
respiratory disorders where sputum retention is the problem.
Technique:
 Arms abducted at 30°, elbow at 90° flexion and wrist extended.
 Hands and fingers are cupped and whole hand is lifted and dropped on the part to
be treated with alternate flexion and extension of the wrist.
 Performed on chest, back and limbs.
 Do not apply undue pressure on the soft tissues of chest wall.
 Rate – 100-480 strike/min with both hands.
 Produce characteristic sound –easily differentiated from that produced by slapping.
 Usually performed with the skin lightly covered by a sheet or a single layered cloth.
Clapping

Caution
• Given with care as sensitivity of skin is more on the anterior aspect
off chest may induce cardiac arrhythmia than avoid on anterior chest
wall.
Physiological effects & uses
• Effects on skin and content of thorax.
• Causes gentle shacking which increases activity of lung and bronchi.
• As through out the lungs there is active circulation, helps to increase
gaseous interchange in the lung capillaries.
• Mucus loosened and expectoration greatly facilitated.
• Used in chronic lung diseases – bronchitis, bronchiectasis.
Contraindications
• Acute tuberculosis of lugs
• Early empyema before the chest wall healed. (the collection of pus
in a cavity in the body, especially in the pleural cavity.)

• Less used manipulation.
• Loosely clenched fingers make a fist is used to strike the body part.
• Either one or both the hands are used and anterior aspect of fist strikes the
part.
Position of therapist: Stride standing
• Arms (shoulder )at 30° and elbow at 90° flexion.
• Fingers are flexed at PIP and MP joints but DIP joints kept extended so flat
surface of dorsal aspect of two distal phalanx make anterior of fist.
• Wrist flexion and extension alternately done with whole arm raised in
abduction and than allow the wrist to drop in relaxation.
• Drop the arm and strike the part.
• Speed – 60beat/min
• Commonly used over back, thigh and other fleshy areas of body to obtain
relaxation.
Beating

Physiological effects and uses
• The movement on thorax produces a definite
shaking of lung tissue. -Loosen mucus.
• Sacral beating stimulates sacral and pudendal
nerves -sacral pain is relieved with slow
strokes.
Contraindications
• Debilitating patient

• Heavy movement – over back, thigh, fleshy – broad areas of the body to
obtain relaxation.
• Form of hacking done with loosely clenched fist.
• Arms abducted at 30°, elbow at 90° flexion and wrist extended.
• Pronation and Supination of forearm producing succession of short and
sharp blows with the lateral (Ulnar) border of fist strike the body part.
• Fingers are flexed at all joints and the thumb lies flat on the lateral side of
the hand halfway between adduction and flexion.
• Striking rate slightly slower than hacking.
Pounding

• Useful over small area with intermittent touch and pressure
application. – over face, neck and small bony areas.
 Arms abducted at 30°, elbow at 90° flexion and wrist extended and
in a fix position.
 fingers are held loose and relaxed.
 Alternate flexion and extension of MCP joints produce tapping
effect.
 Only pulp of fingers strike the body part.
 Either one or both hands may be used.
Tapping

• Modification of clapping.
• Concavity made between index and ring finger with
middle finger is slightly elevated and placed over
them.
• Small area of chest in premature child or new born
baby it is applied for loosening of the viscid
secretion.
Tenting

• Modification of clapping.
• Concavity produce between thenar and
hypothenar eminences.
Contact heel percussion

• Technique create a negative pressure into the lungs through the
chest wall like suction which helps to loosen viscid secretion
(sputum).
• After removal of secretion the gaseous exchange becomes
efficient which improves ventilation and arterial oxygenation.
• So there is intrathoracic pressure alteration in the range of 5-
15mm of H2O.
• Rhythmic intermittent touch stimulates the low threshold
mechanoreceptors which help to diminish the perception of
chronic pain.
Physiological effects of percussion

• Cutaneous vasodilatation is produced by elicitation of
axon reflex and release of H substance.
• Facilitates contraction of muscle by decreasing the
threshold of anterior horn cells.
• Induce relaxation and calm the mental state of the
patient if applied properly with rhythm and graduated
pressure induce sleep and relaxation.

1. Respiratory percussion
2. Stimulating percussion
Depending upon the physiological effect
classification

1. Respiratory percussion
 Technique directed towards lung and utilise the sound energy
to dislodge the sputum from the bronchial tree.
 Used only on the chest wall.
 Has widespread effect on hemodynamic system.
 Clapping, tenting and contact heel percussion.
2. Stimulating percussion
 Essentially do not have any effect on the respiratory
system.
 Main effect is to produce sensory stimulation and
induce relaxation.
 Hacking, beating, tapping and pounding

Contraindications
• Haemoptysis –blood coughing out
• Pleuritic pain –effusion of lungs
• Acute pulmonary tuberculosis
• Osteoporosis
• Rib fracture
• Over surgical incisions
• Metastatic deposition in ribs and spine
Caution
• RP tech may provoke onset of cardiac arrhythmia with a subsequent fall
in cardiac output and partial pressure of O2 in arterial blood.
• Bronchospasm occurs following excessive and rapid clapping.
• Sp tech may induce flexor withdrawal and aggravate spasticity in spastic
paralytic patients Avoid it.

 Therapist uses vibration of distal part of upper limb to
transmit the mechanical energy to the body of patient.
 Co contraction of upper limb muscles produce vibration
in fingers and hands which are in a constant touch.
 Position of forearm differentiates two technique of
vibration.
 Mainly directed towards the lungs and other hollow
cavities.
Vibratory manipulations

1. vibration: fine oscillation
 Forearm is kept in full pronation.
 Movement of hand is in upward and downward direction. Palmer
surface in completely contact with the patient’s body surface.
 Wrist n 70-90 degree of extension.
 Vibration helps to dislodge the thick sputum from the
bronchial wall.
 Facilitate movement of fluid and gases in the body cavities.
 Fine movement used where shacking and percussion are
contraindicated.

2. shacking:
• Forearm in mid prone position.
• Wrist assume 10 degree of extension. Vibration produces
by upper limb the hand moves relatively in the medio
lateral flexion. ( Radial –Ulnar deviation)
Limb shaking
Tech for leg:
 Patient: supine or half lying position
 Therapist: walk standing at the end of the plinth on foot
side.
 Grasp round the foot and heel with both hands, give slight
traction to separate the joint surfaces, gently move the
limb in upward and downward direction producing
shacking of the limb.

• Shacking produce coarse vibratory movement thereby transfer
mechanical energy to the lungs which helps to dislodge the thick
secretion from the bronchial tree.
• Mechanically shift sputum from smaller to larger bronchioles which
can be cleared off by coughing.
• Shacking over sternum during expiration stimulates cough.
• Limb shaking stimulates circulation helps in increase output of red
cells from bone marrow, may be useful in anemia.
Therapeutic uses
• Mobilise viscid secretion from the lungs.
• Post operative sputum retention
• COPD
• Cystic fibrosis- genetic disorder sudden Attack of brhochtis
• Neonatal respiratory distress associated with sputum retension.
• Chest condition where sputum is problem.
• Not alone but with other modalities.

Caution
• Unstable thoracic spine injuries
• Rib and sternum fracture
• Patient on prolonged steroidtherapy
• Osteoporosis
Contraindications
• Severe hymoptysis
• Acute pleuritic pain
• Active pulmonary TB
• Fracture rib
• osteoporosis

• Book reference
1.Principles and practice of therapeutic massage ,
2nd edition :Akhoury gourange sinha.

13.2 Different types of massage techniques.pptx

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