chapter 5: massage routines and relevant anatomy and physiology image bank

Chapter 5: Massage routines and relevant anatomy and

physiology

Image bank

Figure 5.1 Anatomy of the leg

Figure 5.2 Areas to be massaged

Figure 5.3 Areas to avoid

1. Effleurage (front and sides)

Massage routine for front of legs

2. Deeper effleurage over thigh


3. Alternate palmar kneading over abductors and adductors (avoid massaging over the femoral triangle)


4. Reinforced or double-handed kneading over thigh


5. Wringing to thigh (medial to lateral and back)


6. Picking up – reinforced or double handed(double-handed picking up illustrated here; follow with tapotement if

appropriate)


7. Tapotement (optional) – hacking. The movements in steps 7–10 will depend on the type of massage the client needs.


8. Tapotement (optional) – cupping


9. Tapotement (optional) – beating


10. Tapotement (optional) – pounding


11. Deep effleurage to thigh


12. Thumb kneading around patella


13. Effleurage to lower leg


14. Thumb kneading to anterior tibials (lateral to shin bone)


15. Stroking to dorsal surface of foot


16. Digital kneading around malleoli


17. Thumb kneading between metatarsals


18. Thumb kneading to toes


19. Ulnar border kneading to sole of foot


20. Thumb kneading to sole of foot


21. Effleurage to whole leg.


1. Effleurage to back of leg and buttock (lighten the pressure over the popliteal space)

Massage routine for back of legs

2. Deep effleurage to hamstrings and buttock


3. Alternate palmar kneading to hamstrings and buttock


4. Reinforced or double-handed kneading to top of thigh and buttock


5. Wringing to hamstrings and buttocks


6. Double-handed picking up to hamstrings and buttocks


7. Hacking, cupping, beating and pounding


8. Deep effleurage to thigh and buttock


9. Effleurage to gastrocnemius


10. Reinforced kneading to gastrocnemius


11. Wringing to gastrocnemius


12. Reinforced picking up to gastrocnemius


13. Effleurage to gastrocnemius


14. Effleurage to back of leg and buttock (lighten the pressure over the popliteal space)


Figure 5.4 Anatomy of the arm

Figure 5.5 Flexors of the lower arm

Figure 5.6 Extensors of the lower arm

1. Effleurage to arm

Massage routine for the arms

2. Alternate palmar kneading over deltoid. Work down the deltoid to the point of insertion on the anterior and posterior fibres, as shown above,

then work up the middle fibres. Repeat the movement.


3. Single-handed kneading to triceps


4. Single-handed picking up to triceps


5. Single-handed kneading to biceps (support the elbows as shown in 6)


6. Single-handed picking up to biceps


7. Wringing to triceps (if suitable). If the movements shown in steps 7–9 are suitable for your client, support the client’s arm with a bolster pillow

or rolled towel


8. Hacking


9. Cupping to triceps


10. Stroking to upper arm


11. Effleurage to forearm. Change over handsand effleurage the flexors of the lower arm


12. Thumb kneading to flexors of wrist (anterior aspect). Your hands support the client’s arm. The client’s hand should not rest against you


13. Thumb kneading to extensors of wrist (posterior aspect)


14. Thumb kneading around styloid processes


15. Thumb kneading between metacarpals (dorsal aspect)


16. Thumb kneading to fingers (it is more comfortable for the client to support their arm below the styloid processes)


17. Thumb kneading to thenar and hypothenar eminences and palm


18. Effleurage to arm


Figure 5.7 Anatomy of the chest and abdomen

Figure 5.8 Chest and abdomen: points to consider

1. Effleurage to abdomen. Place a bolster pillow or a rolled towel under the upper legs to relax the abdominal area

Massage routine for the abdomen

2. Reinforced kneading to the waist


3. Wringing to the waist if suitable


4. Skin rolling to the waist


5. Digital kneading around colon. When working over the colon pressure is applied on the upward movement over the ascending

colon; across on the transverse colon; and down on the descending colon


6. Ulnar border kneading around colon


7. Reinforced stroking to colon


8. Effleurage (see step 1)


Figure 5.9 Anatomy of the back

Figure 5.10 Back: points to consider

1. Stroking over the back. Use this movement to palpate and sense the tissues as you move over the area

Massage routine for the back

2. Effleurage over back


3. Effleurage over trapezius (neck and shoulders)


4. Finger kneading each side of neck


5. Thumb kneading either side of neck


6. Alternate thumb stroking on neck area


7. Picking up on the neck


8. Digital or thumb kneading to upper fibres of trapezius. Be aware of your client’s body language; ensure the depth of pressure is

comfortable


9. Digital or thumb kneading from neck down between scapulae


10. Finger kneading around scapulae


11. Reinforced stroking around scapulae (figure of eight)


12. Alternate palmar kneading all over back: work down the back then on return stroke work up close to the spine.


13. Double-handed kneading over back (one side to other and back in four strips)


14. Thumb kneading to scarum and lumbar area


15. Transverse stroking over back


16. Alternate finger kneading down right and left erector spinae


17. Stroking down right and left erector spinae


18. Effleurage over the back(Repeat movement shown in step 2)


Figure 5.11 Bones of the skull

Figure 5.12 Bones of the face

Figure 5.13 Facial muscles

Figure 5.14 Muscles of the face and skull (side view)

2. Effleurage. Place fingertips at the side of the neck. Slide under the clavicle onto the sternum, fingers overlapping above the breasts. Pull

hands apart, apply suitable pressure towards the axilla, on and around the shoulders, over the trapezius, up the neck and stretch before

reaching the occipital bone

Massage routine for the décolleté/chest area

3. Repeat Step 2, using finger kneading over the trapezius, up the back of the neck, stretch before reaching the occipital bone


4. Knuckling. Place fingertips at the side of the neck. Slide under the clavicle onto the sternum, with fingers overlapping above the breasts. With knuckles facing, knuckle across the pectoral muscle in circular

movements towards the axilla, slide around the deltoid, over the trapezius up the neck and stretch before reaching the occipital bone


5. Alternate finger stroking. Place the fingertips at the side of the neck, slide around the clavicle onto the pectorals. Work on the right side,

fingers of the left hand point to the axilla, fingers of the right hand point towards the sternum. Work across towards the right axilla with short

overlapping strokes. Repeat movement three times. Work on left side three times


6. Lymph drainage. Left hand in fist at axilla, fingers of right hand point towards the fist. Move fist lightly over pectorals on left side, apply

pressure with fingers and first as they move over pectorals on right side, draining lymph into right axilla. Change over right hand in a fist at right axilla, fingers of left hand point towards the fist. Move lightly over

the right pectrorals, increasing the pressure over the left pectorals, draining lymph into the left axilla.


7. Repeat Step 2


1. Effleurage. Place the right hand at the base of the neck on the left-hand side. Place the left hand on the jawline on the left-hand side. Six

alternate strokes across the neck draining into submandibular submental lymph nodes. Left hand finishes at right-hand jawline. Slide along the jawline to the left-hand side and repeat movement. Position

the fingertips under the chin area ready for the next movement

Massage routine for the face

2. Knuckling across the neck in three rows, starting at the top of the neck either side of the windpipe, working out until in line with the ear lobes. Repeat with two more rows, working down to just above the

base of the neck


3. Double-handed picking up along the jawline – centre to left; left to right; right to centre


4. Finger kneading up the labial nasal folds – pressure on the upward movement. Repeat movement


5. Levator lifts. Place the index fingers together (tips only) above the top lip and tips of the middle fingers under the bottom lip. Pull Fingers

apart beyond the corner of the lips. Turn and lift the index fingers, holding the muscle with the middle and ring fingers. Move up the sides of the nose without pressure and lift the corrugator. Move fingers still pointing downwards, across the forehead to the temples (avoid lifting the eyebrows). Slide down the face along the jawline with ring finger

and repeat movement


6. Masseter lifts. Take the right hand down the side of the face along the jawline, on the left side, with the fingers pointing towards the ear

and wrist above the chin lift the masseter muscle. Hold in position for a count of two; still in contact, turn hand so fingers are pointing down

towards the neck. Hold in position for a count of two. Release muscle and slide hand up and over the forehead to the right temple. Repeat on

right side


7. Finger pressures (index, middle and ring fingers) to cheek area in three lines. Starting either side of the nostrils work out, slide in. Repeat

the movement under the zygomatic bone and ridge of eye sockets, following the lines as shown in step 8


8. Lymph drainage over cheek area. Place index, middle and ring fingers either side of nose under zygomatic bones. Slide out towards

the parotid lymph node to drain area. Repeat on other two lines


9. Lymph drainage over forehead. Place fingers at temples and thumbs side by side on the corrugator. Slide thumbs with pressure to the

hairline and place overlapping hands on the forehead. Draw fingers outwards towards and drain to parotid lymph node. Repeat the

movement


10. Eye circles. Place the fingers at the temples and slide the ring fingers under the eyes and in towards the nose; just above the corner

of the inner eye lift the corrugator towards the eyebrow, releasepressure and return to the temples. Repeat the movement


11. Thumb frictions. place thumbs together just above the eyebrows and, working in a clockwise direction, apply pressure in a small circular

motion, release and move up the forehead and repeat themovement


12. Forehead stroking. Position the hands horizontally, slide the right hand over the forehead closely followed by the left hand. Contour hand and fingers to the area. For the last movement, place one hand on top

of the other and slide out to the temples


13. Effleurage. Slide index fingers down the jawline, heel of hands to stay in contact with the chin. Cup the chin by overlapping hands or

linking fingers, pull apart, slide over the cheek area, up either side of the nose, pull up on the corrugator with the fingers and slide out to

temples and apply pressure. Repeat movement


1. Stroking. Place thumbs in front of the ears and fingers lightly on top. The pads of the thumbs trace the hairline in a stroking movement to the centre of the forehead. Draw the fingers of both hands through the hair from roots to tips; pull at the roots to stimulate hair growth. Repeat the

movement

Massage routine for the scalp

2. Stroking movements. The right hand works over the left side of the scalp and vice versa. Place the fingers of the right hand on the left side of the scalp at the hairline above the ear. From the hairline slide over the scalp and draw the fingers through the hair, from roots to tips; pull slightly at the roots to stimulate hair growth. As this movement finishes

follow with the left hand. Slide fingers through the hair covering the right side of the scalp. Work with alternate hands to cover the scalp


3. Reinforced thumb frictions. Circles in a clockwise direction down the centre of the scalp from hairline to crown. Ensure thumbs move the

scalp and do not move over the scalp


4. Alternate thumb stroking, working from hairline to crown


5. Finger and thumb friction movements to the entire area (digits move the scalp and do not move over the scalp). Use small circular

movements


6. Palmar kneading (static movement). Place hands at each side of the scalp above the ears with fingers covering the temples. Circle the scalp

in a clockwise direction twice. Move slightly towards the midline and repeat the movement twice. Place the palms over the crown, thumbs

touching, and repeat the movement twice


7. Rake through the hair using fingertips. Place fingers on the hairline above each ear and rake over the scalp from roots to tips. Repeat the

movement, each time moving up towards the midline


8. Knuckle and pull. Start above each ear and work towards the midline in lines. Grasp the hair near the roots, turn the knuckles in towards the

scalp and hold for a few seconds before releasing and moving on


9. Turn the head to the left. Place the hands over the ears with the fingertips pointing downwards towards the shoulders. Gently turn the

head to the left. Work the right hand


10. Stroking. Start at the base of the skull and work medially to laterally in three lines, following the contour of the skull to the crown (each line is similar in shape to a segment of an orange). With the fingers of the right hand, work up the first line contouring the skull and at the crown

pull the fingers through the hair from roots to tips. Repeat the movement on the other two lines


11. Finger and thumb frictions to the area (see Step 5 )


12. Palmar kneading (static) to the scalp (see Step 6). Contour the right hand over the skull with fingers pointing to the neck. Hand moves the

scalp in a clockwise direction. Release move up towards the crown and repeat movement


13. Rake through the hair using the fingertips (see Step 7). Start at the base of the skull and work medially to laterally in three lines following

the contour of the skull to the crown


14. Knuckle and pull (see Step 8). Start at the base of the skull and work medially to laterally in three lines, following the contour of the skull

to the crown


15. Finger kneading (index and middle fingers). Place fingers in the indentation behind the mastoid process and perform finger kneading

following the line beneath the occipital bone


19. Stroking (repeat Step 1)


chapter 5: massage routines and relevant anatomy and physiology image bank

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