5his is detail ppt for practical aspects of massage to be applied.

1. Practical aspects of Massage
Principles of applications of massage
By : Dr. Alpa J. Dhanani
MPT(Musculoskeletal & Sports)

2. Success of massage therapy depends upon
1. Position of patient,
2. Stance of the therapist,
3. Proper support of body parts,
4. Environment of treatment room,
5. Attitude and appearance of therapist etc..

3. 1.Position of the patient
• The patient must be placed in secure,comfortable
and safe position depending upon the age, sex,
physical condition and the part which is to be
treated.
• Adequate number of pillows should be placed
according to body contour to ensure proper
support, complete relaxation and gravity assisted
drainage.

4. Aims of the Positioning
• The part to be treated should be fully supported to
ensure relaxation and to gain the confidence of
patient.
• The body part should be easily approachable to the
therapist so that he/she does not face any difficulty in
proper administration of the techniques.
• It should not hamper the continuity of massage.

5. Positions adopted for therapeutic
application of massage
• Prone lying- for back, posterior aspect of lower limb
• Supine lying- for anterior aspect of lower limb, upper
limb, face and abdomen
• Half lying- for upper limb, chest and lower limb
• Side lying- for upper limb, chest and lower limb
• Sitting- for upper limb, neck and face

6. Prone lying
• In this position the patient is placed on a couch
or a treatment table with the face down.

7. Pillow positioning & purpose
• Support one pillow under the
abdomen
• Pillows under lower legs
• To flatten the back and to
obliterate lumbar Lordosis by
tilting the pelvis posteriorly. This
helps to relax extensor muscles of
spine.
• To support the legs and to
maintain knee in flexed position
which relieves the tension of
Hamstring muscles.
• Also to reduce pressure over
anterior aspect of ankle and to
keep the toes free as well as to
relieve tension of dorsiflexor
muscles.
• Support • Purpose

8. • Two pillows crossing one another at 90 degree
under the forehead or dorsal aspect of crossed
hands under the forehead to support the neck
in neutral position, to minimize the tension of
posterior neck muscles, to ensure the easy
access to the posterior neck and facilitate easy
breathing by not allowing compression of the
nose.

9. • Precautions
• While placing pillows under the abdomen care should
be taken to avoid pressure over scrotum in male and
breast in female.
• This position should not be used for patient of cardiac
and respiratory disorders because in this position the
abdomen and chest are compressed by the body
weight and inspiration is difficult.

10. Supine position
In this position the patient is placed on a
couch or a treatment table with the face
up and back supported

11. Pillow positioning
• Pillow under knees as one long pillow under both knees or two small pillows
under the knees to keep hip and knee in slightly flexed position to relieve
tension of Hamstrings, rectus femoris and iliofemoral ligament.
• To tilt the pelvis posteriorly to avoid back hollowing and relax lumber
extensors and to position the thigh in elevation so that the gravity assist the
venous and lymphatic drainage.
• Small pillow or a rolled towel under the neck to support the cervical Lordosis,
to maintain neck in neutral position and to relax the muscles around the neck.
Precautions
• This position is not suitable for respiratory and cardiac disorders patients as
they may experience breathlessness.

12. Half lying
Patient is positioned in such a way that his back is about 45
degree in relation to lower limb with pillow under both the knees.
This position is suitable for elderly,
cardiac and respiratory patients as the
breathing becomes easier in this position.
It is most commonly used for arm and chest massage.
In this position back is completely supported and the knees and
hips are flexed which helps to relax abdominal muscles and
makes the respiration easier.

13. Side lying
•This position is used for upper limb, chest and posterior aspect of lower limb.
•Support one pillow under the head to maintain alignment of neck in neutral position and to
relax the neck muscles.
• 2to 3 pillows under the upper most lower limb, 1 under thigh and 2 under legs to
completely support hip in line with trunk.

14. Sitting
• Most commonly used for the massage of the upper extremities, face and the
posterior aspect of neck.
• When used for upper limb the limb has to be placed on the plinth over
prearranged pillows to maintain 90 degree angle of flexion and abduction at
shoulder joint with elbow extended and wrist and fingers supported.
• Due to elevation of arm gravity assists the drainage.
• Notes:-When elevation of part is required in treatment of
Edema, number of pillows in the distal part should be
increased or the foot end of the bed may be raised.

16. • When used for the posterior neck and upper back patient
should faced the plinth and support is given to the
forehead placing over the dorsum of hands which are
crossed and kept over the plinth.
• Or placing the forehead on pillows or rolled towel placed
over the plinth ( if shoulder mobility is restricted) which
reduces cervical Lordosis to relax neck muscles and to
give complete access of the posterior neck to the
therapist.
• For doing facial massage neck should be supported on the
head rest.

17. 2. Draping
• The part to be massaged must be fully exposed so that therapist
can look over the part and ruled out the contraindications.
• Any adverse effects produced during manipulation can also be
noticed immediately.
• The part to be treated should be exposed but the rest of the body
covered with bed sheets, towels.
• Care should be taken not to embarrass the patient by unduly
exposing them. Draping helps to honor the modesty and privacy
of the patient, to keep the patient warm in cold weather and helps
to achieve proper relaxation.

18.  For back: exposed part from occipital to PSIS.
Cover lower limb up to glutei region and upper
limb up to shoulder joint.
 For lower limb: exposure from toe to groin cover
contra lateral limb, trunk and genitalia.
 For upper limb: exposure from tip of fingers to
axilla and supraclavicular Fossa. Cover
contralateral upper limb, trunk bellow clavicle.

19. 3. Examination of part to be treated
1. Look - at the skin for dryness, wetness, hairiness
2. Observe - for bruises, abrasions, lacerations.
3. Palpation - find out about increase of temperature, tone – tension of
the muscle, joint posture and sensitivity of the skin.
• Palpation starts with lager area that requires flat hand. Gradually increase pressure,
modifying hand posture with every part in contact, mentally count anatomical
landmarks and apply check test to identify them-
a. Arteries can be felt to pulsate
b. Pressure on veins occludes them so that they appear full distally
c. Tendons have muscle tissue attached that can contract
d. ligaments can be appear- disappear in different position of joints.

20. 4. Therapist position
• Generally the therapist during the manipulation adopt modification of
standing….
• Stride standing - The lower limbs are abducted at the hip joints and both the
feets are wide apart.
• Walk standing- one leg is placed directly forward to the other leg in such a
way that the heels of both the legs are placed in the same line and are
almost two feet apart.
• Fall our standing- one lower limb is placed directly forward by the flexion
of hip, two feet apart, knee of forward leg is slightly flexed while the other
knee remains in extended position.
• The body is thus inclined forward

21. 5. Attitude of the therapist
• Therapist should be completely relaxed.
• His/her manner should be pleasant and courteous.
• He/she should be confident and give necessary instructions
to the patient in an effective manner.
• His/her voice should be clear and soothing.
• Avoid discussion during the treatment.
• Instructions should be given in language which patient can
understand and should be simple, short and self explanatory

22. 6. Appearance of the therapist
• Nails should be short and clean.
• Remove all the rings, bangles and watch before doing massage.
• Hair should be preferably short. Long hair must be restrained not irritate the patient.
• Necklace and other jewelries should be removed.
• Sleeves of therapist’s apron should be either half or folded up to arms in order to increase the
efficient use of hand.
• In order to avoid any chance of cross infection the hand should be washed and dried up before
and after massage.
• When the climate is cold therapist’s hand must be warm. This is essential to avoid the
unnecessary stimulation of cold receptors which may produce discomfort and increase the
muscle tension of the patient.
• Should avoid perfumes as they can have a nauseating effect on some patient due to allergy.
• Shoes with low heel provide a more stable position.

23. 7. Self preparation of the therapist
• As close contact will inevitably occur therapist should wear protective
clothing which is easily washable and allows freedom of movement
while maintaining decency.
• The ROM of all joints of forearm and hands should be full.
• If you have stiff hands do a series of stretching exercises to increase
your range.
• Movements: full abduction and extension of thumb for wide grasp, full
flexion – extension of wrist, full pronation – supination of radioulnar
joint.

24. • Hand exercises:
• Touch the fingertips of both hands and press so that thumb
and all fingers are separated widely, push the fist of one hand
between two adjacent fingers of the other hand so that fingers
are separated in to abduction.
• Do for all finger space, place your hands together as in prayer
and with your thumb resting at chest push wrist downwards to
extend them without separating the heels of hands.
• Also turn them down to touch abdomen and up to touch chest
alternatively.
• Touch the hands reverse and push the elbow downwards thus
flexing wrist.

25. 8. Contact and continuity
(anatomical consideration.)
• The hands of the therapist should be relaxed and
molded to the parts.
• Amount of pressure should be modified according to
the condition of the structures being treated.
• There should not be any break in the continuity of
massage as it is a continuous process.
• Care must be taken not to use deep pressure in the areas
where neurovascular bundles are vulnerable or over
bony prominences.

26. 9. Selection of a technique
• The technique should be directed towards the
condition in order to achieve only desired
physiological effect.
• Contraindications should be ruled out.
• After examine the part to be treated accordingly
select the proper technique

27. 10. Lubricants
 The purpose of using the lubricants during massage is
1.To make the skin soft and smooth.
2.To reduce friction between therapist’s hand and patient’s skin.
3.To gain placebo effect.
 Indications:
• Presence of excessive sweating either with the patient or with the therapist.
• Poor condition of the skin : dry, rough, scaly and fragile skin.
 Types of lubricants:
• Powder
• Oil
• Cream

28. Powder:
• Preferably non perfumed powder should be used as many people are allergic to
the fragrance.
• French chalk or talcum powder is commonly used.
• In the presence of profuse sweating corn starch (Boric powder) which is
sterilisable and heavy powder absorbs sweat very readily.
Oils:
• The oil is helpful when the skin is dry and scaly. (after removal of plaster
cast.)
• Most commonly used oils are olive, coconut, mustard, mineral oil (liquid
paraffin) and some medicinal oils.
• All this oils exert a drag effect on the skin and provide smooth gliding.
• For this effect oil can be used in the presence of a very hairy skin.
• The use of edible oil in the therapy is avoided because they have a peculiar
smell which may be allergic to some people and may be attract insects
which may produce injury in person with anesthetic skin as in paraplegia
and leprosy.
Creams: lanolin or lanolin based creams are suitable for the mobilization of
scars due to burns and surgical trauma.

29. 11. The environment of treatment room
• The room should be well ventilated and well
heated.
• Atmosphere should be pleasant with light
music.

30. 12. Accessories
1. Stool or chair
2. Treatment table(couch)
3. Bed sheet
4. Towel
5. Pillows
6. Small kidney tray or bowl
7. Soap
8. Water tap
9. Movable trolley

31.  Low stool or chair without arm support: for sitting position.
 Treatment table: A foam mattress should be used on the plinth
Covered with washable plastic or rexine to facilitate cleaning and
disinfection.
• Height of the coach should be adequate so that the therapist need not
stoop (if table is too low) or reach up(if table is too high) to perform
massage.
• It should be wide enough to allow the patient to turn sides.
• A couch of 6.5feet long: 2.5feet wide: 3feet height is adequate for
the average height therapists.
• Ideally table with shelves is used to store accessories.

32. Bed sheet :- Six or seven ,easily washable large
bed sheet required to drape the patient.
• One bed sheet over the plastic surface of couch to
facilitate patient’s comfort.(also absorb
perspiration)
Towel :- 3to 4 large size towel to drape and
support the patient.
3-4 small size towel can be used to remove extra
lubricant from pt skin.
Pillows-7-8 soft pillows with washable pillow
covers needed to positioning the patient.

33. Bowl or kidney tray: to keep lubricants
Soap : Non perfumed soap should be used before
and after massage to wash the therapist hand.
Water tap: Running water tap to wash the hand or
else kept in small plastic container.
A movable trolley: Besides the table to keep
accessories near the table.
• Easily washable bed sheets, towels, pillows with
washable cover, bowl to keep lubricant, non
perfumed shop and water should be kept ready.

34. 13. Sequence of the massage
• Upper limb
• Lower limb
• Thoraco lumbar region
• Gluteal region
• Neck
• face

35. Protocol for massage treatment
1) Prepare the treatment the area
2) Arrange all accessories
3) Welcome your patient
4) Introduce yourself to your patient
5) History of patient: present, past, medical, surgical and family history
6) Ask the complaint
7) Examine the patient
8) See medical reports if available
9) Rule out general contraindications
10) Expose the part to be treated
11) Look for local contraindications such as redness, swelling, skin condition, pimples, wounds,
abrasions, cuts.

36. 12) Palpate for temperature, muscle tone and sensitivity of skin.
13) If any contraindication is present no massage treatment, but refer your patient to specialist or give
other modalities.
14) If no contraindications than proceed further
15) Give position to the patient
16) Drape the other part.
17) Select the techniques
18) Give massage
19) Termination of treatment.
20) Inspect the area for unwanted effects
21) Keep the record
22) Rearrange all accessories for next patient

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