Massage with osteochondrosis of the lumbosacral spine

Techniques of massage are reduced to the usual stroking, grinding, kneading, vibration, etc. Movements are made from the periphery to the center along the course of the lymph flow and venous blood.

Classical (curative) massage

Massage plan: impact on the paravertebral zones of the sacral, lumbar and lower thoracic spinal segments (S3-S1 L5-L4, Th ₁₂ -Th ₁₁ ). The massage is performed in the area of the gluteus muscles, the sacrum area, the crests of the iliac bones.

Massage of painful points. Concussion of the pelvis.

The starting position of the patient lies on the abdomen, the cushion (cotton-gauze) is placed under the abdominal area and under the ankle joint.

Depending on the condition of the muscles, receptions are applied selectively: for example, the contracted muscles are relaxed by soft vibrational movements and stretched, and where the muscles are weakened and hypotrophic, almost all massage techniques are included in the procedure, from light exposure to stronger.

Massage begins with a general superficial and deep stroking of all the muscles of the back.

Surface planar stroking is performed in the form of a spiral stroking, starting from the gluteal region. The pressure of the hands of the massage therapist is gradually increasing. Alternating rubbing (it is more convenient to conduct in an oblique direction), deep planar stroking is performed by the palm surface of the hand and the phalanges of the fingers of both hands. Hands of the masseur are installed one beside the other in the area of the sacrum and move upwards parallel to the spine, one hand to the right, and the other to the left of the spine. When the palms' bases reach the lower ribs, the pressure is completely weakened and both arms return to their original starting position in an arcuate motion. The second line of motion passes laterally first from below upwards and to the sides between the lower ribs and the crest of the ilium to the intercostal and axillary lymph nodes. The third line of stroking passes lateral to the second to the inguinal lymph nodes.

Sawing is done transversely or in an oblique direction, planar deep stroking, planing (in an oblique direction), spiraling rubbing with four fingers one or both hands along the same lines as planar stroking, transverse kneading, stroking with weights along the same lines as deep planar stroking, semicircular kneading, smoothing of the large fingers of the hand along the paravertebral lines, over the crest of the ilium and along the sacroiliac joint; spiral-like rubbing with a thumb pad along the same lines as stroking; alternating pressing with two thumbs along the paravertebral lines; punctuation; embracing stroking. At the same time, the masseur sets both hands in the area of the sacrum so that the thumbs are parallel to the middle line of the back, and the other fingers of the hand are arranged obliquely, as if trying to grab the lower back. From this position, both hands simultaneously move from bottom to top and slightly laterally.

Patting: flat surface stroking.

In addition to stroking and rubbing, kneading, patting and vibration are used.

The long back muscles on the side of the curvature are massed mainly by triturating and patting. For grinding, the elevation at the base of the first finger of the hand (thenar) is predominantly used. These muscles are not massaged all over, but before "zapadeniya" in the lumbar region.

Due to the asymmetry of the pelvic girdle (raised on the side of the lumbar "zapadeniya"), the approach of the costal arch to the wing of the ilium occurs. This entails a rapprochement of the attachment points of the muscles of the lumbar region. At this site, the massage is similar to the massage of the upper thoracic region and pursues the task of relaxing the muscles, widening the gap between the iliac wing and the costal arch. This expansion promotes the stretching of the contracted lumbar muscles.

It is more expedient to spend massage in and. Lying on the side (on the side of the lumbar curvature). The therapist is standing in front of the patient. He puts his left hand on the lower border of the chest (without grasping the area of the "abrasion" of the muscles); The right hand is located on the crest of the ilium. In the approaching movements of the hands, soft tissues are sent to the zone of "Westernization" for relaxation, filling it (without getting fingers into the recess), and then by stretching the arms, the muscles stretch. Movement is repeated 6-8 times; after finishing their massage therapist hands (folded in the "lock") captures the crest of the ilium and pulls the pelvis downwards. At the same time, the "sunken" muscles are stretched and fumigated in the form of small strands.

If there is on the side of the lumbar curvature of the muscular cushion (muscular lobe), it is also recommended. Lying on his stomach. The masseur stands on the side of the lumbar curvature. To reduce the tension of the muscular roller, relaxing techniques are first used, and then the trituration, kneading and finger-pinching techniques are also recommended; aimed at strengthening the muscles.

The massage ends with a corrective action, i.e. Using pressure on the muscular roller on the back surface of the main and middle phalanges in the direction from the spinal column.

Due to the small surface of the massaged area for both hands, when pressing, one brush is superimposed on the other and a sliding rhythmic movement is made from the top down, bypassing the crest of the ilium.

ATTENTION! In all cases of massage in the area of "sunken" ribs and muscles, you should not allow pressure.

Great importance is attached to strengthening the abdominal muscles. Due to the change in the position of the pelvic girdle, the ratio of the tonus of the abdominal muscles sharply changes, especially the oblique muscles become weaker.

To strengthen the muscles, the usual methods of massage (comb-like rubbing of abdominal muscles, kneading muscles, tapping of abdominal muscles, etc.) are used.

Massage of the muscles of the lower limb

A. Massage of the hip joint region. The initial position of the patient lies on the abdomen, the muscles of the affected limb should be as relaxed as possible.

Massage techniques are carried out in the following sequence:

• deep circular stroking of the pads of the four fingers;
• circular grinding with a thumb pad.

The finger of the masseur is placed between the large spit and the bum of the ischium on the buttock. It is recommended to penetrate as close as possible to the acetabulum.

B. Massage of the thigh muscles: grasping stroking (hands are placed in the upper third of the shin so that both palms are located next to each other and the tips of the middle fingers are on the same level, the fingers are tightly compressed) is held up to the sub-sciatic fold; alternating grinding (both in the longitudinal and transverse direction); enveloping incessant stroking with wringing the fists (the hands and fingers of both hands are stacked with a "ladle" and on both sides grasp the thigh). Stroking begins from the upper third of the shin in the direction to the sub-sciatic fold, then the reception continues (with the tenars of both hands) towards the inguinal lymph nodes; spiral grinding with four fingers of one or both hands; ironing; longitudinal uninterrupted kneading. The reception is performed with both hands, while the thigh is wrapped on both sides so that the fingers are pointed along the thigh. One hand of the masseur is located in front of the other by 5-7 cm. The muscles are grasped, pulled off and squeezed by the tenar and the rest of the fingers; plane flat-sequential stroking; semicircular kneading (alternately performed by one, then the other hand); embracing intermittent stroking; transverse kneading; embracing an uninterrupted stroking; concussion and general stroking.

C. Massage of the knee joint region: a common bracing non-slip stroking (direction - from the upper third of the lower leg to the lower third of the thigh); alternating rubbing; stroking with the pushing of the tenars (the direction is from the bottom up to the lower edge of the patella, then to the popliteal lymph nodes.) The second move is from the initial position upward movement, but the teknars are placed on the patella, from where they slide to the popliteal fossa. Set above the upper edge of the patella and from here also stroke in the direction of the popliteal fossa .This technique is recommended for accelerating the resorption of effusions in the joint cavity); spiral grinding with four fingers of one or both hands; embracing an uninterrupted stroking; ironing with two thumbs along the edge of the patella and along the joint slits; spiral grinding with one or two thumbs along the same lines and in the same direction; flattening of the thumbs around the patella and on the articulate neck; patella patching with two thumbs; tearing the patella with two thumbs; patella patching with two thumbs; spiral twisting of the patella with one thumb; patella smoothing; a general embracing continuous stroking.

Massage of the painful points of the posterior surface of the thigh in the region of the gluteal fold, at the border of the upper and middle thirds of the thigh and at the border of the middle and lower thirds of the thigh: stroking and rubbing circularly, continuous vibration with fingertips, puncturing.

D. Massage of the calf muscles

1 Back massage of the muscles of the neck . The patient's initial position is lying on his stomach.

Receptions of massage:

• surface planar stroking with both hands (direction - from the heel to the lower third of the thigh);
• alternating rubbing;
• planar deep stroking;
• spiral grinding with four fingers;
• Embracing an uninterrupted stroking with both hands;
• longitudinal continuous kneading;
• embracing intermittent stroking;
• transverse kneading, embracing continuous stroking;
• wallow;
• Embracing a separate-sequential stroking;
• concussion and general stroking.

When massaging the posterior muscle group, special attention should be paid to the massage of the gastrocnemius muscle, while the external and internal abdomen are massaged separately.

When the external abdomen is massaged, the movements start from the Achilles (heel) tendon. The thumb slides along the furrow between the peroneal and gastrocnemius muscles, and the rest - along the midline of the gastrocnemius muscle. When massaging the inner abdomen, the thumb should pass along the inner side of the tibia, and the remaining fingers of the hand - from the inner edge of the Achilles tendon along the middle line, then along the groove between the outer and inner abdomen of the gastrocnemius muscle. The fingers then converge in the popliteal fossa. The popliteal fossa is quite sensitive to pressure, as in its fiber there are vessels, nerve trunks and lymph nodes, so all the techniques of massage should be performed cautiously.

2. Massage of anterolateral group of muscles of lower leg.

Receptions of massage:

• the general covering continuous intermittent stroking from the base of the fingers to the lower third of the thigh (performed with both hands);
• alternating rubbing;
• smoothing the anterolateral group of lower leg muscles with the thumbs of the hands;
• spiral grinding with the thumb of the hand;
• ironing with your thumbs;
• tweezed kneading with both hands;
• a common embracing intermittent stroking.

The massage of the anterior muscle group starts from the outer ankle and continues upward toward the outer condyle of the thigh. When performing massage techniques, the brush, as it were, wraps the shin from above, with the thumb on the front of the shin and moves upward along the inner edge of the tibia, and the rest - from the front edge of the external ankle to the anterior edge of the fibular head.

When the external surface of the lower leg is massaged, the wrist also grabs the shin, but now the thumb slides upward from the anterior edge of the external ankle to the anterior margin of the fibula, and the remaining fingers pass along the boundary line between the peroneal and calf muscles.

E. Massage of the ankle.

The procedure begins with its front surface, then passes to the side surfaces under the ankles and to the back, covered with the Achilles tendon. Round rubbing is performed by pads of the large and the remaining 4 fingers, fixing them alternately on the surface of the joint. Stroking and rubbing can be done with two hands at the same time - each on its own.

Receptions of massage:

• embracing pressing pressing, alternating grinding with both hands from the base of the toes to the middle of the shin;
• stroking with your thumbs in the ankle area from the bottom up (the hands of the masseur have this: thumbs are placed on the back of the ankle, and the other fingers pick up the foot under the heel). Spiral-like rubbing with the thumb (the thumb carefully spreads the extensor tendons, penetrating deep into the joint gap from the anterior wall of the capsule of the ankle);
• a common embracing intermittent stroking.

Great importance is attached to the massage of the Achilles (heel) tendon, which withstands a great physical load. One of the methods of strengthening the tendon is massage. Massage techniques begin with the heel, then pass to the tendon and then to the calf muscle.

It is recommended to apply the following sequence during the procedure:

• stroking one or both hands;
• spiral-like rubbing with a pad of one thumb (the thumb of the other hand serves as a support and is located on the other side of the tendon);
• gilt-stroking;
• tweezed kneading with both hands;
• pinched stroking.

E. Foot massage.

When massage the foot, each finger is massaged separately and in the direction to the base of the finger. On the foot, trituration is best performed on the depressions between the metatarsal bones, which promotes better blood circulation in the entire limb.

Massage the rear of the foot is as follows:

• Embracing an uninterrupted stroking with both hands from the base of the fingers to the middle of the shin;
• alternating rubbing;
• encompassing pressing stroking;
• spiral grinding with four fingers;
• smoothing of the interosseous muscles with the thumb;
• spiral-like rubbing of the interosseous muscles with the thumb;
• smoothing of the interosseous muscles with the thumb;
• pressing;
• general stroking.

Massage the soles with the thumb or the joint of the middle finger, bent at an acute angle, in the direction from the fingers to the heel and ankle joint. Massage movements should be strong, until the patient feels slight soreness. Massage techniques are as follows:

• flat-foot stroking with one hand (with the right hand the massage therapist takes the right foot of the patient behind the rear of the foot so that the thumb goes into the furrow between the outer ankle and the Achilles tendon, and the palm of the left hand strokes from the base of the fingers to the heel;
• sawing with one hand;
• comb-like stroking;
• comb-like grinding;
• smoothing of the interosseous muscles with the thumb;
• spiral-like rubbing of the interosseous muscles with the thumb;
• flattening of the joint with the thumb of the interosseous muscles;
• pressing with a thumb pad;
• general planar stroking.

Methodical instructions to the technique of massage of the lumbosacral spine

1. During the massage of the lumbosacral region, it is not necessary to apply all the techniques, especially on the first procedures, you should choose only those that are most appropriate in this case, taking into account the initial state of the tissues of the massaged area and its anatomical-topographical features.
2. In the presence of muscle soreness, especially the increase in their tone in the lumbar spine, first of all, the sacrospinal muscles must be massaged and only after the weakening of their tension and the reduction of soreness in the palpation pass to the massaging of the muscles innervated by the sciatic nerve, and also to the action on the nerve itself.
3. When massaging the affected leg in the acute stage, the following techniques are recommended:
   • stroking (surface planar and girth);
   • rubbing of the joints and muscles of the anterior hip and shin groups;
   • easy felling of muscles;
   • vibratory surface stroking and continuous vibration of the calf muscles and femur of small amplitude.
4. In the subacute stage, massage of the affected sciatic nerve is indicated, and the following techniques should be used:
   • flat deep stroking of the palmar surface of the thumb along the nerve from the middle of the popliteal cavity to the gluteal fold to the lower edge of the ischial hillock;
   • rubbing along the nerve with both thumbs, moving one after the other and describing the semicircles in mutually opposite directions;
   • vibration - puncture with the tip of the thumb.
5. Massaging the lumbosacral region, it is necessary to pay special attention to the angle between the spine and the crest of the ilium. On this site, it is recommended to use smoothing, circular rubbing with your thumb and stable vibration. Deep smoothing is better done from the bottom up and out.
6. When massage in the popliteal fossa, massage techniques should be performed cautiously due to the fact that there is a vascular-neural bundle. Particular attention should be paid to massage the external and internal edges of the popliteal fossa, where the tendons of the semimembranous, semitendinocephalic, biceps femoris and head of the gastrocnemius pass.

In the lesion of the lumbosacral region, special combinations of techniques are carried out:

• screwing,
• concussion of the pelvis,
• massage of the crest of the ilium,
• displacement of the skin with friction,
• massage of the buttocks,
• massage of the iliac region,
• massage of the sacrum,
• rolling of the platen,
• saws,
• shear,
• tension,
• interstystootrekovy reception,
• massage of the lower extremities.

Receiving screwing. The patient's initial position is lying on his stomach. The masseur stands to the left of the patient, has his right hand on the sacrum with his thumb to the left, the rest to the right of the spine. II-V fingers of the masseur brush perform screwing and circular movements, by which the skin tissues are displaced at the lumbar region. By moving the fingers in the proximal direction, all segmental roots are worked through, while the thumb acts as a support.

Concussion of the pelvis. It is carried out in the same initial position. The palms of the masseur are located on the crests of the iliac bones. There are short vibrational movements between the lower edge of the ribs and the crest of the ilium.

Massage of the crest of the ilium. The starting position is the same (perhaps sitting on a chair). The masseuse has II-V fingers on the iliac crest and massages the tissues with small displacements of the skin with friction and dosed pressure towards the spine. In this case, the muscles located in the corner between the spine and the iliac crest are massaged more intensively.

Displacement of skin with friction. The starting position is the same. The masseur has his brush in the lumbosacral region and the tips of the II, III and IV fingers (possibly pressure on the rear of the second hand) perform small circular movements. In this case, the fingers of the hand should fit snugly against the skin and move it.

Gluteus muscle massage. The starting position is the same. Muscles are treated by friction with a shift from the iliac and the iliac crest to the sacrum. Friction should be performed by small, deeply exciting circles in order to detect changes in muscles. Slipping fingers over the skin without shifting it has no effect. The tension at the bottom of the iliac crest from the rear is particularly well reduced by low-pressure vibration combined with friction (J. Cordes et al.).

Massage of the iliac region. Friction with the displacement of the skin and the reception of stroking the masseur conducts along the median, arched and lateral sacral ridges from the caudal to the cranial areas. Massage should be completed between the iliac crest and the last lumbar vertebra.

Accept roll rolling. To massage the left side of the lumbar region, the finger of the right hand should be placed on the back in the caudal region next to the long extensor of the back so that an acute angle forms between them. The finger is inserted into the groove of the long extensor and lies parallel to the muscular margin. The thumb of the left hand is likewise cranial from the left. The extensor of the back is in front of the thumbs like a roller, and by means of light rotational movements and dosed pressure the main phalanges of the thumbs are rolled to the spine. Alternately, the thumbs of the brush the masseur moves in the cranial direction.

Reception saw. The thumb and forefinger of both hands are bred and placed on the spine in such a way that a skin roller forms between them. By sawtooth counter-movements of both hands, tissue massage is carried out towards the cranial areas.

Receiving a shift. The masseur stands to the right of the patient (IP - lying). With his left hand he fixes the pelvis of the patient, clasping the wing of the ilium, and with the palm of his right he performs screw-like movements towards the spine from the caudal to the cranial divisions (the skin always shifts). The left hand at the same time produces a slight movement in the opposite direction.

Admission of tension. The masseur stands to the right at the head end of the couch. The index and middle fingers of the right hand are slightly divorced, the tips of the fingers should be directed in the caudal direction and located on the lower part of the lumbar region on both sides of the spinous processes. The skin under the fingers is displaced in the cranial direction.

ATTENTION! Massage of the lower extremities is performed only after the massage of the corresponding radicular segments on the back, mainly in the form of grinding with a shift of the skin and kneading by small circular motions with vibration.

Massage of connective tissue of the thigh. The starting position of the patient lies on the back.

The method of screwing the fingers works out the posterior edge of the wide fascia of the thigh from the distal to the proximal areas. In this case, the thumb of the hand serves as a support for the reception.

Massage of the adductor muscles of the thigh is recommended to carry out deep grinding with a shift of the skin from the inner side of the popliteal fossa to the passage of the channel of the adductor muscles. In the final part of the procedure, circular kneading should be carried out by small movements with a slight vibration along the medial edge of the sartorius muscle when advancing in the proximal direction, depending on the positioning of the fingers (J.Cordes et al.).

Massage of the anterior sulcus muscle. The right hand of the masseur grasps the right foot of the patient, the left one is placed on the shin in such a way that the thumb of the hand is located transversely to the lateral edge of the anterior tibial muscle. Rotating movements of the patient's foot, the muscle is kneaded about the left thumb.

Connective tissue massage

A. Massage of the lateral surface of the trunk. When massage of the lateral parts of the trunk using subcutaneous and fascial techniques, the effect on the body is through the brachial plexus:

A) short massage movements with fascial technique at the edge of the latissimus muscle of the back. The masseur has fingers at the beginning of the muscles in the upper third of the iliac crest. The tension is perpendicular to the lateral edge of the fascia. Massage movements are recommended to be performed up to the level of shoulder blades or shoulders.

B. Massage of the dorsal surface of the chest:

• short massage movements in the spine. The masseur is behind the patient and works with the third finger of the same hand. Massage is performed by short movements from the medial edge of the muscle, straightening the spine, starting from the caudal towards the cranial areas along the spine;
• short massaging movements at the lateral edge of the muscle, straightening the spine. The initial position of the patient and the hands of the masseur is the same as described above. Massage is performed using subcutaneous or fascial technique, as well as with short massage movements in the spine;
• the connection of massage in the spine and at the lateral edge of the muscle, which straightens the spine. The masseur places the fingers of the hands at the lateral edge of the muscle, which straightens the spine. Displacement of tissues and tension is carried out in the cranial direction. The tension is carried by slightly rotating the brush.

Irritation by movement continues over the muscle and ends again somewhat cranial in the spinous processes. Thus a small sinuous line appears;

• long massage movements across the back. The masseur sits behind the patient and works with one (the same name) hand. Long massage movements are performed from the edge of the latissimus muscle of the back to the lateral edge of the muscle, straightening the spine and between the ribs. Massage movements are carried out sequentially up to the bottom angle of the blades;
• longitudinal massage of the paravertebral areas. The masseur has fingers of the hands at the lateral edge of the muscle, straightening the spine. The tissues are displaced in the cranial direction, the tension is carried out to the lower angles of the blades.

B. Sacrum and pelvic massage:

1. massage at the edge of the sacrum. The patient's starting position is lying on his side. The masseur has fingers of the opposite hand near the interannual fold at the edge of the bone, the tissues are shifted towards the gluteal fascia. The tension is also carried out;
2. short massage movements from the lower to the upper edges of the lumbosacral joint. Massage movements are performed in the same way as described above;
3. short massaging movements on the sacrum with the same hand. Massage movements begin at the interannual fold and are performed successively one after the other on the right side of the sacrum. The tension is carried out in the cranial direction. Massage is performed without pressure on the tissue;
4. short massaging movements at the edge of the iliac crest. Massage movements begin at the upper edge of the lumbosacral joint, extend to the anterior superior iliac spine or to the back axillary line;
5. massage of the pelvic area. It is carried out by longitudinal movements with the same name of the hand of the masseur. Massage movements are performed until the spinous process of the V lumbar vertebrae to the anterior superior iliac spine or to the edge of the rectus abdominis muscle as follows:
   • The fingers of the hand should be placed near the spinous process of the V lumbar vertebra;
   • It is recommended to shift the tissues laterally;
   • for all longitudinal movements, massage techniques are possible only when the patient has "cutting" sensations when stretching the tissue.

When overstretching the tissues, massage the pelvic area is recommended by the following method:

• from the upper edge of the lumbosacral joint to the anterior superior iliac spine or to the edge of the projection of the rectum;
• from the upper edge of the lumbosacral joint to the spinous process of the V lumbar vertebra.

D. Massage of the area of the large trochanter. The patient's starting position is lying on his side.

The masseur has fingers on the back of the thigh approximately 10 cm distal to the trochanter. Displacement of tissues is carried out to the dorsal margin of the iliac-tibial tract, and the tension of the tissues to the edge of the fascia. Massage movements are recommended to be performed before the areas located behind the trochanter. When improving the elasticity of tissues, longitudinal movements can be carried out. Displacement is carried out in the proximal direction.

D. Massage of the muscles of the lower extremities. The starting position of the patient lies on the back. The masseur works the opposite hand:

• massage of the iliac-tibial tract. Short massage movements with the use of subcutaneous or fascial technique are performed from the middle of the thigh in the proximal direction, from the middle - in the distal direction to the knee joint. Longitudinal massage is recommended to be carried out using only subcutaneous techniques;
• massage in the area of the medial edge of the sartorius muscle. Masseur works with one hand. Short massage movements using subcutaneous or fascial technique are performed from the middle of the muscle in the proximal and distal directions. Longitudinal massage, with the use of only subcutaneous technique, depending on the indications is carried out in a similar way;
• short massaging movements in the soleus muscle area. The masseur has the tip of his middle finger of the same name at the beginning of the gastrocnemius muscle. The tension is pulled in the distal direction. With increased tension of tissues, massage movements are recommended to be performed with the use of subcutaneous techniques;
• short massage movements in the ankle. The masseur middle finger of the opposite hand places in the area of the ankle fork; The opposite hand supports the foot in the middle position. Tension is performed due to plantar flexion of the foot;
• short massage movements in the heel area. The masseur has his fingers from the lateral or medial side of the heel. The opposite arm supports the foot in the position of the middle plantar flexion. Admission of tension is carried out by rear bending of the foot (exposure - two short massage movements in a row);
• short massage movements on the back and plantar sides of the main joints of the toes. The masseur places his fingers on the brushes at the base of the toes of the toes (fingers are in a state of back or plantar flexion). Admission of tension is carried out by rear or sole bending of the toes;
• short massaging movements at the lateral and medial surface of the foot. The masseur has his fingers on the soles of the lateral or medial edge. The tension is applied in the direction of the sole. Massage movements are carried out in the direction from the heel to the mounds of the fingers.

Methodical instructions:

• in the acute course of the disease, it is recommended to apply small doses of exposure;
• in muscle hypertension and superficial hyperalgesia, non-intensive doses of exposure are used;
• when muscle hyperalgesia is recommended to use moderate doses, with muscle atrophy - intensive effects;
• Hyper-irritating zones and the maximum point should be massaged superficially, nonintensively;
• the intensity of pressure should increase from the surface to the depth of the tissues, and, conversely, decrease from the caudal-lateral to the cranial-medial zones; it is advisable to gradually increase it from procedure to procedure;
• the average duration of segmental massage is 20 minutes; in acute conditions, less prolonged exposure is shown.

ATTENTION! Segmental massage should be stopped when all reflex manifestations are eliminated, as further continuation of it can cause new disturbances in the tissues.

[1], [2], [3]

Acupressure

When massage of the lumbosacral region and lower limbs is mainly inhibitory. In the first 2-3 treatment procedures, it is recommended to sedative effect on distant points of a wide spectrum of action, especially characterized by analgesic action: C ₁₄ he-gu, C ₁₁ qu-chi - on the upper limbs and E ₃₆ tszu-san-li, VB ₃₄ yang- Lin-chuan, VB ₃₉ Xuan-zhong, PP ₆ San-yin-jiao, PP ₇ Yin-lin-Quan - on the lower. In the following, local and segmental points are massed:

• in the lumbosacral region - V ₂, wei-shu, V ₂₄ tsi-hai-shu, V ₂₅ da-chan-shu, V _{2 g} pan-guan-shu, V ₃₁ _ ₃₄ ba-liao, V ₅₂ zhi- soup, VC ₃ yao-yangguang, VC ₄ min-V ₅₄ zhi-bian, men;
• on the lower limb - V ₃₆ chen-fu, 40 wei-chung, V ₅₇ chen-shan, V ₆₀ kun-lun, V ₆₂ shen-mai, VB ₃₀ huang-tiao, VB ₃₄ yang-ling-chuan, VB ₃₉ syuan -zhzhun, E ₃₆ tszu-san-li, PP ₆ sang-yin-chiao, PP ₁₀ su-hai, II yin-lyan.

Point massage, as well as other types of reflex therapy, it is recommended to combine with other types of massage.

Thus, in the treatment of patients suffering from spinal diseases, massage has two main thrusts:

• to relax tense muscle groups;
• to stimulate the function of weakened muscles.

The first group of receptions include:

• stroking,
• shaking,
• riding,
• wallow,
• braking method of acupressure,
• methods of reflex action.

The second group of receptions include:

• deeper stroking,
• trituration,
• effleurage (as a kind of vibration) and other methods of reflex action.

[4]