Massage for osteochondrosis of the lumbosacral spine

Massage techniques are limited to simple stroking, rubbing, kneading, vibration, etc. The movements are carried out from the periphery to the center along the flow of lymph and venous blood.

Classic (therapeutic) 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 ). Massage is performed in the area of the gluteal muscles, the sacrum, and the iliac crests.

Massage of pain points. Pelvic concussion.

The patient's initial position is lying on his stomach, a roller (cotton-gauze) is placed under the abdominal area and under the ankle joint.

Depending on the condition of the muscles, the techniques are used selectively: for example, contracted muscles are relaxed with soft vibration movements and stretched, and where the muscles are weakened and hypotrophic, almost all massage techniques are included in the procedure, from light impact to stronger.

The massage begins with general superficial and deep stroking of all the muscles of the back.

Superficial planar stroking is performed in the form of spiral stroking, starting from the gluteal region. The force of pressure of the masseur's hands gradually increases. Alternating rubbing (it is more convenient to perform in an oblique direction), deep planar stroking is performed with the palmar surface of the hand and the phalanges of the fingers of both hands. The masseur's hands are placed next to each other in the sacrum area and move from the bottom up parallel to the spine, one hand to the right and the other to the left of the spine. When the bases of the palms reach the lower ribs, the pressure is completely weakened and both hands return to their original starting position with an arcuate movement. The second line of movements passes lateral to the first from the bottom up and to the sides between the lower ribs and the iliac crest to the intercostal and axillary lymph nodes. The third line of stroking passes lateral to the second to the inguinal lymph nodes.

Sawing is performed transversely or obliquely, flat deep stroking, planing (obliquely), spiral rubbing with four fingers of one or both hands along the same lines as flat stroking, transverse kneading, stroking with weighting along the same lines as deep flat stroking, semicircular kneading, smoothing with the thumbs along the paravertebral lines, above the iliac crest and along the sacroiliac joint; spiral rubbing with the pad of the thumb along the same lines as stroking; alternating pressure with two thumbs along the paravertebral lines; puncturing; encircling stroking. In this case, the massage therapist places both hands in the sacrum area so that the thumbs are parallel to the midline of the back, and the remaining fingers are positioned in an oblique direction, as if trying to embrace the lower back. From this position, both hands move simultaneously from bottom to top and slightly laterally.

Patting: flat, superficial stroking.

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

The long muscles of the back on the side of the curvature are massaged mainly by rubbing and patting. For rubbing, the eminence at the base of the first finger of the hand (thenar) is mainly used. These muscles are massaged not along their entire length, but until they "sag" in the lumbar region.

Due to the asymmetry of the pelvic girdle (raised on the side of the lumbar "sinking"), the costal arch comes closer to the wing of the ilium. This entails the convergence of the attachment points of the lumbar muscles. In this area, the massage is similar to the massage of the upper thoracic region and pursues the task of relaxing the muscles, expanding the gap between the wing of the ilium and the costal arch. This expansion helps stretch the contracted lumbar muscles.

It is advisable to perform the massage in the starting position lying on the side (on the side of the lumbar curvature). The masseur stands in front of the patient. He places his left hand on the lower border of the chest (without capturing the area of the "sunken" muscles); the right hand is placed on the iliac crest. With converging movements of the hands, the soft tissues are directed to the "sunken" area for the purpose of relaxation, filling it (without getting the fingers into the depression), and then the muscles are stretched by spreading the hands. The movement is repeated 6-8 times; after completing them, the masseur with his hands (folded in a "lock") grabs the iliac crest and pulls the pelvis downwards. In this case, the "sunken" muscles are stretched and conduited in the form of small strands.

If there is a muscle roller (muscle cord) on the side of the lumbar curvature, it is recommended to start the initial position lying on the stomach. The masseur stands on the side of the lumbar curvature. To reduce the tension of the muscle roller, relaxing techniques are used first, and then rubbing, kneading and finger tapping techniques are recommended, i.e. aimed at strengthening the muscles.

The massage ends with a corrective effect, i.e. using the technique of pressing on the muscle roller with the back surface of the main and middle phalanges in the direction from the spinal column.

Due to the small surface area of the massaged area for both hands, when pressing, one hand is placed on the other and a sliding rhythmic movement is made from top to bottom, bypassing the iliac crest.

ATTENTION! In all cases of massage in the area of "sunken" ribs and muscles, pressure techniques must not be used.

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

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

Massage of the muscles of the lower limb

A. Massage of the hip joint area. The patient's initial position is lying on his stomach, the muscles of the affected limb should be as relaxed as possible.

Massage techniques are performed in the following sequence:

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

The masseur places his finger between the greater trochanter and the ischial tuberosity on the buttock. It is recommended to penetrate as close as possible to the acetabulum.

B. Massage of the thigh muscles: enveloping 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 at the same level, fingers are tightly clenched) is carried out to the infragluteal fold; alternating rubbing (both longitudinally and transversely); enveloping continuous stroking with squeezing with fists (the hands and fingers of both hands are folded in a "scoop" and clasp the thigh on both sides). Stroking begins from the upper third of the shin in the direction to the infragluteal fold, then the technique continues (with thenars of both hands) towards the inguinal lymph nodes; spiral rubbing with four fingers of one or both hands; stroking; longitudinal continuous kneading. The technique is performed with two hands, while the thigh is clasped on both sides so that the fingers are directed along the thigh. One hand of the masseur is positioned 5-7 cm in front of the other. The muscles are grasped, pulled and pressed with the thenar and other fingers; planar separate-sequential stroking; semicircular kneading (alternately performed by one hand, then the other); enveloping intermittent stroking; transverse kneading; enveloping continuous stroking; shaking and general stroking.

B. Massage of the knee joint area: general enveloping continuous stroking (direction - from the upper third of the shin to the lower third of the thigh); alternating rubbing; stroking with squeezing with thenars (direction - from the bottom up to the lower edge of the patella, then - to the popliteal lymph nodes. The second move - from the starting position, move upwards, but thenars are placed on the patella, from where they slide to the popliteal fossa. The third move, when thenars are placed above the upper edge of the patella and from here they also stroke towards the popliteal fossa. This technique is recommended to accelerate the resorption of effusions in the joint cavity); spiral rubbing with four fingers of one or both hands; enveloping continuous stroking; stroking with two thumbs along the edge of the patella and along the joint spaces; spiral rubbing with one or two thumbs along the same lines and in the same direction; stroking with the thumbs around the patella and along the joint space; stroking the patella with two thumbs; alternating rubbing of the patella with two thumbs; stroking the patella with two thumbs; spiral rubbing of the patella with one thumb; stroking the patella; general enveloping continuous stroking.

Massage of pain points on the back of the thigh in the gluteal fold area, on the border of the upper and middle third of the thigh and on the border of the middle and lower third of the thigh: circular stroking and rubbing, continuous vibration with fingertips, puncturing.

G. Massage of the calf muscles

1 Massage of the muscles of the back of the lower leg. The patient's initial position is lying on his stomach.

Massage techniques:

• superficial flat stroking with both hands (direction - from the heel to the lower third of the thigh);
• alternating rubbing;
• flat deep stroking;
• spiral rubbing with four fingers;
• enveloping continuous stroking with both hands;
• longitudinal continuous kneading;
• enveloping intermittent stroking;
• transverse kneading, enveloping continuous stroking;
• wallow;
• enveloping separate-sequential stroking;
• shaking and general stroking.

When massaging the back muscle group, special attention should be paid to massaging the gastrocnemius muscle, with its outer and inner belly massaged separately.

When massaging the outer belly, movements begin from the Achilles (calcaneal) tendon. The thumb slides along the groove between the peroneal and gastrocnemius muscles, and the rest - along the midline of the gastrocnemius muscle. When massaging the inner belly, the thumb should pass along the inner side of the tibia, and the rest of the fingers - from the inner edge of the Achilles tendon along the midline, then along the groove between the outer and inner belly of the gastrocnemius muscle. The fingers then converge in the popliteal fossa. The popliteal fossa is quite sensitive to pressure, since its tissue contains vessels, nerve trunks and lymph nodes, so all massage techniques should be performed carefully.

2. Massage of the anterolateral group of calf muscles.

Massage techniques:

• general enveloping continuous stroking from the base of the fingers to the lower third of the thigh (performed with two hands);
• alternating rubbing;
• smoothing the anterolateral group of muscles of the lower leg with the thumbs of the hands;
• spiral rubbing with the thumb of the hand;
• smoothing with thumbs;
• pincer-like kneading with two hands;
• general enveloping continuous stroking.

Massage of the anterior muscle group begins from the outer ankle and continues upward to the outer condyle of the femur. When performing massage techniques, the hand seems to grasp the shin from above, with the thumb on the front surface of the shin and moving from the bottom up along the inner edge of the tibia, and the rest - from the front edge of the outer ankle to the front edge of the head of the fibula.

When massaging the outer surface of the shin, the hand also grasps the shin, but now the thumb slides upward from the front edge of the outer ankle to the front edge of the fibula, and the remaining fingers pass along the border line between the peroneal and gastrocnemius muscles.

D. Massage of the ankle joint area.

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

Massage techniques:

• enveloping pressing stroking, alternating rubbing with both hands from the base of the toes to the middle of the shin;
• stroking with the thumbs in the ankle area from the bottom up (the massage therapist positions his hands in this way: the thumbs are placed on the back of the ankle joint, and the other fingers grasp the foot under the heel). Spiral rubbing with the thumb (the thumb carefully spreads the extensor tendons, penetrating deep into the joint space from the side of the anterior wall of the ankle joint capsule);
• general enveloping continuous stroking.

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

It is recommended to use the following sequence when performing the procedure:

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

E. Foot massage.

When massaging the foot, each toe is massaged separately and in the direction of the base of the toe. On the foot, rubbing is best done along the depressions between the metatarsal bones, which promotes better blood circulation throughout the limb.

Massage the back of the foot as follows:

• enveloping continuous stroking with both hands from the base of the fingers to the middle of the shin;
• alternating rubbing;
• enveloping pressing stroking;
• spiral rubbing with four fingers;
• smoothing the interosseous muscles with the thumb;
• spiral rubbing of the interosseous muscles with the thumb;
• smoothing the interosseous muscles with the thumb;
• pressing;
• general stroking.

The sole is massaged with the thumb or the joint of the middle finger, bent at an acute angle, in the direction from the toes to the heel and ankle joint. The massage movements should be strong, until the patient feels slight pain. The massage techniques are as follows:

• flat stroking with one hand (with his right hand the massage therapist takes the patient's right foot by the back of the foot so that the big toe lies in the groove between the outer ankle and the Achilles tendon, and with the palm of his left hand he strokes from the base of the toes to the heel;
• one-handed sawing;
• comb-like stroking;
• comb rubbing;
• smoothing the interosseous muscles with the thumb;
• spiral rubbing of the interosseous muscles with the thumb;
• smoothing the interosseous muscles with the thumb;
• pressure with the pad of the thumb;
• general flat stroking.

Methodical instructions for massage technique of the lumbosacral spine

1. During a massage of the lumbosacral region, it is not necessary to use all the techniques, especially during 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 and topographic features.
2. In the presence of muscle pain, especially increased muscle tone in the lumbar spine, the sacral spinal muscles should be massaged first and only after their tension has been relieved and pain during palpation has decreased should they move on to massaging the muscles innervated by the sciatic nerve, as well as to influencing the nerve itself.
3. When massaging the affected leg in the acute stage, it is recommended to use the following techniques:
   • stroking (superficial, flat and enveloping);
   • rubbing the joints and muscles of the anterior thigh and lower leg;
   • slight muscle flexing;
   • vibratory superficial stroking and continuous vibration of the muscles of the lower leg and thigh 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 with the palmar surface of the thumb along the course of the nerve from the middle of the popliteal fossa to the gluteal fold to the lower edge of the ischial tuberosity;
   • rubbing along the nerve with both thumbs, moving one after the other and describing semicircles in mutually opposite directions;
   • vibration - puncturing with the tip of the thumb.
5. When massaging the lumbosacral region, special attention should be paid to the angle between the spine and the iliac crest. In this area, it is recommended to use smoothing, circular rubbing with the thumb and stable vibration. Deep smoothing is best done from the bottom up and outwards.
6. When massaging the popliteal fossa area, massage techniques should be performed carefully due to the fact that the vascular-nerve bundle passes there. Particular attention should be paid when massaging the outer and inner edges of the popliteal fossa, where the tendons of the semimembranosus, semitendinosus, biceps femoris and head of the gastrocnemius muscle pass.

In case of damage to the lumbosacral region, special combinations of techniques are used:

• screwing,
• pelvic concussion,
• iliac crest massage,
• displacement of skin with friction,
• buttock massage,
• iliac region massage,
• sacral massage,
• rolling the roller,
• saws,
• shift,
• tension,
• interspinous process technique,
• lower limb massage.

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

Pelvic concussion. Performed in the same initial position. The masseur's palms are placed on the iliac crests. Short oscillatory movements are performed between the lower edge of the ribs and the iliac crest.

Massage of the iliac crest. The starting position is the same (possibly sitting on a chair). The masseur places the II-V fingers of the hand on the iliac crest and massages the tissues with small displacements of the skin with friction and dosed pressure in the direction of the spine. In this case, the muscles located in the angle between the spine and the iliac crest are massaged more intensively.

Skin displacement with friction. The initial position is the same. The masseur places his hand in the lumbosacral region and with the tips of the II, III and IV fingers (possibly pressure on the back of the hand of the second hand) small circular movements are performed. In this case, the fingers of the hand should fit tightly to the skin and displace it.

Massage of the gluteal muscles. The starting position is the same. The muscles are worked by friction with displacement from the iliac spine and iliac crest to the sacrum. Friction should be performed in small, deeply gripping circles in order to detect changes in the muscles. Sliding the fingers over the skin without displacing it has no effect. Tension in the lower part of the iliac crest from behind is especially well reduced by vibration with weak pressure in combination with friction (J. Cordes et al.).

Massage of the iliac region. The massage therapist applies friction with skin displacement and stroking technique along the median, arcuate and lateral sacral crests in the direction from the caudal to the cranial sections. The massage should be finished between the iliac crest and the last lumbar vertebra.

Rolling technique. 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 is formed between them. The finger is inserted into the groove of the long extensor and lies parallel to the muscle edge. The thumb of the left hand is positioned in the same way, cranial to 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 of the main phalanges of the thumbs it is rolled toward the spine. The masseur alternately moves the thumbs of the hand in the cranial direction.

Saw technique. The thumb and index finger of both hands are spread apart and placed on the spine so that a skin ridge is created between them. By means of saw-like counter movements of both hands, a massage of the tissues is performed in the direction of the cranial sections.

Shift technique. The masseur stands to the right of the patient (s.p. - lying down). With his left hand he fixes the patient's pelvis, grasping the wing of the ilium, and with the palm of his right hand he makes screw-like movements towards the spine from the caudal to the cranial sections (in this case, the skin always shifts). The left hand makes a slight movement in the other direction.

Tension technique. The masseur stands on the right side at the head end of the couch. The index and middle fingers of the right hand are slightly spread apart, the fingertips 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 shifted in the cranial direction.

ATTENTION! Massage of the lower extremities is performed only after massage of the corresponding root segments on the back, mainly in the form of rubbing with displacement of the skin and kneading with small circular movements with vibration.

Massage of the connective tissue of the thigh. The patient's initial position is lying on his back.

The finger screwing technique works the posterior edge of the broad fascia of the thigh from the distal to the proximal areas. The thumb serves as a support when performing the technique.

Massage of the adductor muscles of the thigh is recommended to be performed by deep rubbing with displacement of the skin from the inner side of the popliteal fossa to the passage of the adductor canal. In the final part of the procedure, circular kneading should be performed with small movements with light vibration along the medial edge of the sartorius muscle while moving in the proximal direction depending on the position of the fingers (J. Cordes et al.).

Massage of the anterior tibialis muscle. The massage therapist's right hand grasps the patient's right foot, the left is placed on the shin so that the thumb is located transversely to the lateral edge of the anterior tibialis muscle. The muscle is kneaded by rotating the patient's foot against the left big toe.

Connective tissue massage

A. Massage of the lateral surface of the body. When massaging the lateral areas of the body using subcutaneous and fascial techniques, the body is affected through the brachial plexus:

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

B. Massage of the dorsal surface of the chest:

• short massage movements along the spine. The masseur stands behind the patient and works with the third finger of the hand of the same name. The massage is performed with short movements from the medial edge of the muscle that straightens the spine, starting from the caudal towards the cranial sections along the spine;
• short massage movements at the lateral edge of the muscle that straightens the spine. The initial position of the patient and the hands of the massage therapist is the same as described above. The massage is performed using subcutaneous or fascial techniques, as with short massage movements at the spine;
• Combination of massage at the spine and at the lateral edge of the muscle straightening the spine. The masseur places the fingers of the hands at the lateral edge of the muscle straightening the spine. The tissue displacement and tension are carried out in the cranial direction. The tension is carried out by slightly rotating the hand.

The stimulation movement continues above the muscle and ends again a little more cranially at the spinous processes. In this way a small sinuous line is created;

• long massage movements across the back. The masseur sits behind the patient and works with one (homonymous) hand. Long massage movements are performed from the edge of the latissimus dorsi to the lateral edge of the muscle that straightens the spine and between the ribs. Massage movements are performed sequentially to the lower angle of the shoulder blades;
• Longitudinal massage of the paravertebral areas. The masseur places the fingers of the hands at the lateral edge of the muscle that straightens the spine. The tissues are displaced in the cranial direction, tension is applied to the lower angles of the shoulder blades.

B. Massage of the sacral-pelvic region:

1. massage at the edge of the sacrum. The patient's initial position is lying on his side. The masseur places the fingers of the opposite hand near the intergluteal fold at the edge of the bone, the tissues are shifted towards the gluteal fascia. Tension is also applied;
2. short massage movements from the lower to the upper edges of the lumbosacral joint. Massage movements are performed similarly to the techniques described above;
3. short massage movements on the sacrum with the hand of the same name. Massage movements begin at the intergluteal fold and are performed sequentially one after another on the right half of the sacrum. Tension is applied in the cranial direction. Massage is performed without pressure on the tissue;
4. short massage movements at the edge of the iliac crest. Massage movements begin at the upper edge of the lumbosacral joint, and continue to the anterior superior iliac spine or to the posterior axillary line;
5. massage of the pelvic area. It is performed with longitudinal movements of the massage therapist's hand of the same name. Massage movements are performed to the spinous process of the 5th lumbar vertebra 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 at the spinous process of the 5th lumbar vertebra;
   • It is recommended to shift the tissues in the lateral direction;
   • With all longitudinal movements, massage techniques are possible only when the patient experiences a “cutting” sensation when the tissue is stretched.

In case of tissue tension, it is recommended to massage the pelvic area using the following technique:

• 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 5th lumbar vertebra.

G. Massage of the greater trochanter area. The patient's initial position is lying on his side.

The masseur places the fingers on the back of the thigh approximately 10 cm distal to the trochanter. The tissue is displaced toward the dorsal edge of the iliotibial tract, and the tissue is stretched toward the edge of the fascia. Massage movements are recommended to be performed to areas located behind the trochanter. When tissue elasticity improves, longitudinal movements can be performed. The displacement is performed in the proximal direction.

D. Massage of the muscles of the lower extremities. The patient's initial position is lying on his back. The masseur works with the opposite hand:

• massage of the iliotibial tract. Short massage movements using subcutaneous or fascial techniques 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 performed using only subcutaneous techniques;
• massage in the area of the medial edge of the sartorius muscle. The massage therapist works with one hand. Short massage movements using subcutaneous or fascial techniques are performed from the middle of the muscle in the proximal and distal directions. Longitudinal massage, using only subcutaneous techniques, depending on the indications, is performed in a similar way;
• short massage movements in the area of the soleus muscle. The masseur places the tip of his middle finger of the hand of the same name at the beginning of the gastrocnemius muscle. The tension is applied in the distal direction. In case of increased tissue tension, massage movements are recommended to be performed using the subcutaneous technique;
• short massage movements in the ankle area. The masseur places the middle finger of the opposite hand in the ankle fork area; the opposite hand supports the foot in the middle position. Tension is achieved by plantar flexion of the foot;
• short massage movements in the heel area. The masseur places his fingers on the lateral or medial side of the heel. The opposite hand supports the foot in a position of midplantar flexion. The tension technique is performed by dorsiflexing the foot (exposure - two short massage movements in a row);
• short massage movements on the dorsal and plantar sides of the main joints of the toes. The masseur places his fingers at the base of the joints of the toes (the toes are in a state of dorsal or plantar flexion). The tension is applied by dorsal or plantar flexion of the toes;
• short massage movements on the lateral and medial surfaces of the foot. The masseur places his fingers on the sole at the lateral or medial edge. The tension is applied in the direction of the sole. Massage movements are performed in the direction from the heel to the toe bumps.

Methodological instructions:

• in acute cases of the disease, it is recommended to use small doses of exposure;
• in case of muscle hypertonicity and superficial hyperalgesia, low-intensity doses of exposure are used;
• in case of muscle hyperalgesia, it is recommended to use medium doses, in case of muscle atrophy - intensive effects;
• hyperirritable areas and the maximum point should be massaged superficially, not intensively;
• the intensity of pressure should increase from the surface to the depth of the tissue, 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, a shorter duration is indicated.

ATTENTION! Segmental massage should be stopped when all reflex manifestations are eliminated, since its further continuation may cause new tissue disorders.

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Acupressure massage

When massaging the lumbosacral region and lower limbs, it is mainly of an inhibitory nature. In the first 2-3 treatment procedures, a sedative effect on distant points of a wide range of action is recommended, especially those characterized by an analgesic effect: C ₁₄ he-gu, C ₁₁ qu-chi - on the upper limbs and E ₃₆ zu-san-li, VB ₃₄ yang-ling-quan, VB ₃₉ xuan-zhong, PP ₆ san-yin-jiao, PP ₇ yin-ling-quan - on the lower ones. Subsequently, local and segmental points are massaged:

• in the lumbosacral region - V ₂, wei-shu, V ₂₄ qi-hai-shu, V ₂₅ da-chang-shu, V _2g pan-guang-shu, V ₃₁ _ ₃₄ ba-liao, V ₅₂ zhi-shi, VC ₃ yao-yangguan, VC ₄ min-V ₅₄ zhi-bian, men;
• on the lower limb - V ₃₆ cheng-fu, 40 wei-zhong, V ₅₇ cheng-shan, V ₆₀ kun- lun, V ₆₂ shen-mai, VB ₃₀ huan-tiao, VB ₃₄ yang-ling-quan, VB ₃₉ xuan-zhong, E ₃₆ tzu-san-li, PP ₆ san-yin-jiao, PP ₁₀ xue-hai, II yin-liang.

Acupressure, like other types of reflexology therapy, is recommended to be combined with other types of massage.

Thus, when treating patients suffering from spinal diseases, massage has two main directions of techniques:

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

The first group of techniques includes:

• stroking,
• shaking,
• skating,
• wallow,
• braking method of point massage,
• reflex action techniques.

The second group of techniques includes:

• deeper stroking,
• trituration,
• tapping (as a type of vibration) and other reflex action techniques.

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