Wellness Massage Subject for

1. CHAPTER II

2. Effleurage/
stroking
Petrissage
Friction
Percussion
(tapotement)

3. 1. STROKING (OR) EFFLEURAGE
 It is unidirectional manipulation of soft tissues from distal to
proximal in the direction of the lymph drainage.
 Effleurage is used more than any other massage technique.
 It usually initiates and ends each treatments
Definition
Any stroke that glide over
the skin is called as effleurage
Types of Stroking
1. Superficial Stroking or Superficial Effleurage
2. Deep Stroking or Deep Effleurage

4. Effect of effleurage
◦ Performed either from Proximal to
Distal or Distal to Proximal
◦ Accustoms the patient to your
touch.
◦ Assessment of the skin and tissues
state
◦ Improves sensory analgesia.
◦ Slow stroking will relax and
sedate, and decreases muscle tone.
◦ Faster strokes will stimulate
superficial blood flow accelerating
lymph drainage.
◦ Applied from distal to proximal
only.
◦ Assists lymphatic and venous
return.
◦ Assists interchange of tissue fluid.
◦ Assists removal of waste product
◦ Passively stretches muscle fibres.
◦ Restores mobility at tissue
interfaces.
◦ Light strokes decrease muscle
tone.
◦ Deep strokes increase muscle tone.
Superficial Stroking Deep Stroking

5. • Knuckling – Clench the fist in palmar flexion, gradually
bring the hand from flexion to extension.
• Bilateral - Both hands progressing simultaneously on the
either side.
• Single - Single hand used for the stroke

6. 2. Pressure manipulations (petrissage)
Petrissage
Kneading
Picking Up
Wringing
Rolling
Shaking
Compressing tissues against the underlying structures

7. A. Kneading
It is circular manipulation performed so that the skin and subcutaneous tissues
are moved in a circular manner on the underlying structures. It is performed
with palmar aspect of the whole hand, with palm only, with all fingers, or with
the pads of the thumb or fingers.
 Effects
◦ Stimulates venous and lymphatic flow.
◦ Increases mobility of fibrous tissues.
◦ Helps interchange of tissue fluids.
◦ Helps prepare soft tissue for exercise.
◦ Helps removal of waste products.
◦ Increases length and strength of connective tissues.
◦ Restores mobility between tissue interfaces.

8. Classification of Kneading
• Grade 1: is sufficient to influence superficial vessels and
compress superficial tissues of underlying structures.
• Grade 2: effects deeper tissue drainage and will compress
deep tissues of underlying structures.
• Grade 3: is applied to superimposed or reinforced strokes.
It may be applied as strongly as can be tolerated by the
patient without producing tissue damage.

9. B. Picking up
Compressing the tissues against the underlying structures, then
'picked up', lifted, squeezed and released.
The manipulation can be single-handed in a C-shape , double-handed
in alternate C-shapes and V-shapes or double-handed in a V-
shape.
 Effects - The same as for kneading

10. C. Wringing
 Compressing the tissues against underlying structures, then one hand pulls
towards the you while the other hand pushes away.
 Effects of wringing
◦ Same as for kneading.
 particularly good for separating superficial and deep adherent tissues.
 There are only two grades for wringing:
◦ Grade 1 is usually applied to finger strokes only.
◦ Grade 2 uses the whole hand.
◦ There is no grade 3 as it would be too painful to tolerate.

11. D. Rolling
 The fingers pull the tissue towards the thumbs and then the
thumbs squeeze and lift to push the tissue away.
◦ Types: skin rolling and muscle rolling
 Effects
◦ Same as for kneading.
 Mobilises scar tissue.
 When performed slowly, it has a stretch effect on the tissues
being manipulated

12. E. Shaking
 Muscle or more superficial tissue can be shaken from side to
side
◦ Tips or whole hand are used
 Effects
◦ Produces a feeling of stimulation.
◦ Increases tissue mobility.
◦ Assists in breaking down tissue adhesions.
◦ Stimulates lymphatic and venous flow.
◦ Helps prepare soft tissues for stretch and exercise.

13. 3. Friction
 It is a localized manipulation applied at the injury point aiming to give a
stretching across the fibers to separate them and restore mobility.
 Effects
◦ Restore tissue mobility.
◦ Stimulate local circulation.
◦ Aid the resolution of inflammation.
◦ Reduce pain as a counter-irritant effect.
◦ Stretch fibrous tissue.
Types:
1. Circular : Friction is applied in circular manner by the fingers. Rest of hand
should be out of the contact. This manipulation can be used over ligaments and
myofascial junctions.
2. Transverse: Friction is applied horizontally by the thumb or fingers. This
manipulation can be used over tendon, ligament, myofascial junctions and
muscles

14. Classification of Friction
• Grade 1 does not apply to this technique as it is aimed at
deeper structures.
• Grade 2 is sufficient to affect deep tissue and cause
compression.
• Grade 3 applies to reinforced and most transverse frictions
and may produce pain before causing numbing.

15. 4. PERCUSSION (TAPOTEMENT)
Percussion
Hacking
Clapping
Beating
Pounding
Tapping
Vibration
Percussion movements (Tapotement) involve a series of light,
brisk,
striking actions applied with alternate hands in rapid
succession.

16. A. Hacking
• Hold the hands so that the palms are parallel. Strike the part with a series
of soft, but brisk blows, using the lateral borders of the middle, ring
and little finger. Use both hand alternatively and strike rapidly with
pronation and supination at forearm.
 Effects
◦ Stimulates local circulation.
◦ Stimulates muscle tone.
◦ Gives a generalized feeling of stimulation.
◦ Provokes muscle and tendon reflexes.
◦ Light strokes affect superficial tissue.
◦ Deeper strokes aid the evacuation of secretion
from the lungs.

17. Classification of Hacking
• Grade 1 uses only the medial borders of the fingers.
• Grade 2 uses the medial borders of hands and fingers.
• Grade 3 uses the medial borders of hands and fingers
more deeply and slowly.

18. B. Clapping (cupping)
• It performed with your palms facing downwards, forming a
hollow curve. Strike the part with the palmar surface of the hand.
The striking sound should be hollow like a horse trotting. Use
both hand alternatively and strike rapidly.
 Effects
◦ Same as for hacking, with the
exception of provoking
a tendon or muscle reflex

19. Classification of Clapping
• Grade 1 clapping is very superficial and is often called
skin clapping. This is performed at a fairly fast pace with
minimal contact.
• Grade 2 clapping is deeper, slower and firmer.
• Grade 3 clapping is very firm and may involve elbow as
well wrist action.

20. C. Beating
 Involves the use of lightly clenched fists to hit the area
 Effects
◦ As for clapping.
 Classifications of beating
◦ Grade 1 beating is performed at a fast rate, with fairly light
contact.
◦ Grade 2 is slower, with firmer contact.
◦ Grade 3 is very deep and the rate can be varied as required.

21. D. Pounding
 The hands are held in lightly clasped with the thumbs
resting against the first fingers
 Effects
◦ As for clapping.
 Classifications of beating
◦ Grade 1 of this stroke applies to a fast rate with light contact.
◦ Grade 2 is used at a slower rate with firmer contact
◦ Grade 3 is deeper, with varying rates.

22. E. Tapping
• Tapping is done the tips or pads of the fingers.
It is used on very small areas such as the face.
 Effects
◦ As for clapping.
 Classifications of beating
◦ Grade 1 of this stroke applies to a fast rate with light
contact.
◦ Grade 2 is used at a slower rate with firmer contact
◦ Grade 3 is deeper, with varying rates.

23. F. Vibration
• A fine tremulous movement, made by the hand or fingers
placed firmly against a part, will cause the part to vibrate.
• Tips of the finger or whole hand is used for vibration.
• Vibration involves a movement in which the tissues are
pressed and released using an up and down motion.
 Effects
◦ Stimulates muscle tone.
◦ Stimulates the local circulation.
◦ Provides a feeling of well-being.