Conservative treatment of osteochondrosis of the cervicothoracic spine: massage

Massage of the neck muscles

The cervical region is characterized by the superficial location of large blood vessels and a large number of lymphatic vessels of the cervical lymphatic plexus accompanying the jugular veins and carrying lymph to the cervical and supraclavicular nodes. Neck massage enhances the outflow of venous blood and lymph from the cavity of the skull and its integuments and thus has a beneficial effect on hemodynamics. Massage is performed in the patient's sitting or lying position. The masseur is located at the back or side of the massaged.

The plan of massage: the effect on the paraverte-bralnye zones C _7- C ₃ and Th ₂ -C ₇, reflexogenic zones of the chest. Massage should be performed in the interscapular area, in the intercostal spaces, sternocleidomastoid muscles, posterior surface of the neck, shoulder girdle and muscles of the upper limbs.

Massage of the "collar" zone

Massage of the "collar" zone is carried out in the patient's starting position - sitting on a stool, hands are freely located on the table, the head is lowered to the hands.

This procedure, some authors recommend starting with a massage of the inter-shoulder area, others - with the muscles of the upper limbs. Doctors adhere to the opinion of Kunichev LA. And others, that in the beginning it is necessary to work on the muscles of the back, and then, as they are trained, gradually to move to other areas.

• Interblade area massage: easy planar stroking with both hands from the occiput down to the level of the line connecting the lower corners of the scapula (both hands of the massage therapist move "rear" in the paravertebral tissues). All other methods are performed in the same direction to the specified line. Then use stroking "rhombus"; longitudinal stroking and stroking "rhombus" is considered as one technique. Alternating rubbing of the muscles of the interlopar area, deep stroking of the longitudinal and "rhombus", spiral-like rubbing of four muscles of the muscles of the interlopar area from top to bottom with the "front" and "back" course. This method is more expedient to carry out with one hand, and another masseur fixes the patient for a shoulder-patch. Deep stroking longitudinal and "rhombus", deep transverse discontinuous kneading with both hands paravertebrally from top to bottom, deep stroking longitudinal and "rhombus", rubbing along the interscapular area, superficial stroking longitudinal and "rhombus". Then you should proceed to massage the neck and shoulder area.
• Massage of the posterior surface of the neck: grasping stroking (the hands of the masseur are positioned so that the index fingers are projected at the angle of the lower jaw, and the large ones - under the outer occipital tubercle - sliding of the hands along the shoulder-to-shoulder joints), alternating rubbing, stroking "back" lines to the shoulder joints, spiral rubbing with four fingers, pincer stroking performed by the pads of the thumb and index finger of both hands simultaneously, spiral grinding by one with the thumb of the hand (performed in the corner between the transverse and spinous processes of the cervical vertebrae), deep stroking with the "front" course (it is recommended to perform the procedure with one hand, the other fix the shoulder joint, the base of the palm of the massage therapist is located near the occipital bone, and the fingers are turned to the outside, parallel to the muscle fibers of the upper portion of the trapezius muscle, sliding from above to the shoulder joint); clamp-like kneading is performed by the thumb and forefinger of both hands (fingers grasp the muscular roller, pull and squeeze it, then grab a new area of the muscular roller - move from above to the shoulder joint); stroking "back", patting and embracing stroking.
• Massage of the sternocleidomastoid muscle is carried out in the same initial position of the patient, the masseur is located behind him. Consistently the following methods of massage are performed: flat-stroking with the pads of the index, middle and ring fingers. The masseur has fingers in the area of muscle attachment, the thumb should be bent and brought. Hands slide to the sternum; spiral grinding, stroking, tongue-like kneading (performed by the thumb and forefinger), stroking. The masseur stands on the side of the patient: one hand fixes the patient's head, the other is undergoing medical manipulation. It is recommended to massage the left hand with the right hand, and the right one with the left hand. When performing massage, perform the techniques described above, but the hand that performs them moves in a "reverse" course. When performing the "stroking" reception, the thumb of the hand is removed. The first variant of massage is convenient for carrying out the procedure for both muscles at once, and the second option is more suitable for selective massage of these muscles.
• Massage of the area of the scapula: stroking the palmar surface of the hand and fingers of one hand from the shoulder joint to the spine along the muscle fibers of the supraspinatus and subacute muscles, alternating rubbing with two hands, stroking, spiraling rubbing in the same direction, stroking, sawing, stroking.

I.p. Patient - lying on his stomach. 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.

In the kyphosis region, the scapula is diverted to the outside by stretching and loosening the trapezoid (middle and lower portions) and the rhomboid muscle. To strengthen them, the scapula is actively moved to the midline. The masseur holds his left arm with his left arm or, for fixation, he is pushed by a roller and massages the muscles of the interlopar and scapula. The upper portion of the trapezius muscle is shortened, an asymmetry of the lines of the shoulder-lines is created. To normalize this portion of the muscle, it is necessary to relax it with light vibrating movements of the fingers and stretch.

The next massage site is the opposite side of the thoracic area, where the massage therapist is located. In this area there is a tendency to deformation: the ribs in the center of concavity can be brought together and the intercostal spaces are brought together. Muscles in this zone are reduced. The task of massage is to bring the muscles into a state of relaxation, to expand the intercostal spaces. For this purpose, a relaxing massage with a direction of movement from the periphery to the center of the recess is applied, where the ribs and the muscle layer move, and when the arms move in the opposite direction, the muscles are stretched. As the muscles relax, it is necessary to penetrate into the deepening of intercostal spaces and stretch them.

To pull back the lower angle of the blade in the area of the deepening of the ribs, the masseur enters the right hand under the angle of the scapula and withdraws it. To facilitate this method, the masseur should grab the patient's left shoulder, then raise or lower it. At this moment, the introduction of the fingers of the hand under the angle of the scapula is greatly facilitated and it is freely retracted.

Muscles in the region of the foreleg and in the area of the shoulder blade of this side are weakened and hypotrophic. In this case, a strengthening massage is used.

ATTENTION! In all cases of massage in the area of "sunken ribs and muscles," no pressure should be allowed.

Massage of the muscles of the upper limbs

When starting to massage this region, it should be remembered that the superficial lymphatic vessels, like a net, fling their arms from all sides. The largest vessels are located mainly on the inner surface of the forearm and shoulder. There are also large deep vessels. The main lymph nodes are in the armpit, they also lie in the elbow bend. Nerve trunks, available to the pressure of the hands of the masseur, are mainly on the shoulder, from the elbow groove to the axilla. They are located at a considerable extent in the region of the inner humerus groove, and in only two thirds of the groove, only the median and ulnar nerves are accessible, and in the upper third - the radial nerve.

Massage of the muscles of the upper limb is performed in stages, massaged separately:

• area of fingers;
• brush;
• wrist joint;
• muscles of forearm;
• elbow joint area;
• brachial region.

Massage the area of the fingers and the hand

Complex anatomical and topographic relationships of the hand make it difficult to apply a certain number of massage techniques. Usually used in the first place:

• trituration;
• stroking;
• passive, active-passive and active movements.

Stroking and rubbing of finger phalanges should correspond to the course of the lymphatic vessels and be made in the form of transverse movements on the upper and lower surfaces of the fingers, because the blood and large lymph vessels on them are symmetrically located on both sides of the tendon of the finger, on the back and palmar sides of it.

The fingers are stroked in a circular motion with the pads of the thumb of the hand, rubbed with straight, spiral and circular techniques. Then they move to stroking and rubbing the back and palmar surface of the hand, trying to glide along the tendons. First, it is recommended to stroke and rub the interdigital spaces on the back side, then the brush is turned with the palm surface upward and stroking and grinding is performed. In this case, the muscles of the elevation of I and V fingers are kneaded with the thumb and little finger. The massage ends with the movements of the fingers of the hand (passive, active with the help and active).

Massage of the wrist joint always begins with stroking the area of the joint. The masseur grasps the fingers of the massaged hand and gives the forearm a stable position, the palm of the other hand is placed on the back surface of the hand and strokes to the elbow. Then he rotates the forearm with flexor muscles and palm up and continues stroking to the ulnar cavity. Consequently, the muscles of the hand are stroked in the position of pronation and supination along the entire length of the forearm.

When starting grinding, it should be remembered that the articular bag of the joint is most accessible from the rear and from the sides of the articulation.

When rubbing, they use mainly the rubbing movements of the thumb pad of the brush. It is best to start grinding from the side of the joint. In small circular movements, the thumb pad of the brush, which tends to penetrate into the depth of the bag of the joint, moves to the rear surface of the joint, making sure that the massed brush is in a bent state.

When switching to rubbing the flexor muscles, the hand should be bent as much as possible so that it can be applied to the bag of the joint.

Apply the following trituration techniques:

• "Forceps" formed by all the fingers (the thumb of the hand on the back of the joint, and the rest on the palm). Rubbing is carried out with one or two hands;
• circular pads of the thumbs of the hand along the wrist joint. Movements should be shallow, fingers should penetrate as deeply as possible into the joint bag;
• rectilinear and circular by the pads of the thumbs of the hand across the joint slit. The patient's brush is grasped so that the thumbs of the hand are on top, while the rest are from below and support it. Rubbing is done alternately with one finger or the other;
• Circular, pads of all fingers. The base of the palm is placed by the massage therapist on the fingers of a massaged hand. This method is also performed with weighting - then the massaged brush should lie on the same hip of the masseur;
• zigzag-shaped base of the palm. This technique is performed by directing from the fingers of the hand to the middle of the forearm.

After carrying out of massage receptions to the patient suggest to execute movements in a joint (a flexion, extension, diversion, reduction and rotation). Finish the procedure by shaking.

Massage of the muscles of the forearm

The masseur takes the patient's wrist with his left hand, and the right flexor muscles of the forearm. If the right hand is massaged, the right hand of the masseur strokes, squeezes or kneads towards the elbow joint. It is recommended to start massage from the wrist joint. The thumb of the massageist's hand slides first along the radius bone, and then along the furrow between the long arch support and flexor muscles, and the remaining fingers follow along the ulnar bone. The inner condyle is large and the other fingers converge. Massaging the group of flexor muscles, it is necessary to pass to the rear surface of the forearm, where the extensor muscles are located. The right hand of the masseur is located on the back surface of the forearm, in the lower third of it and is directed to the elbow joint. In this case, the thumb of the hand - along the ulna, the rest - go to the furrow, which separates the flexor muscles from the extensor muscles in the lower third of the forearm. Movement is carried out along the radius, between the long arch and the flexor muscles. Fingers meet at the outer condyle.

In the procedure of massage the following methods are used:

• stroking;
• squeezing without burdening;
• kneading;
• effleurage.

Finish the massage by stroking and shaking.

Massage of the elbow joint area

Initially, the joint is massaged around the entire circumference by stroking. The movement of the hand of the masseur begins on the forearm and ends in the middle third of the shoulder. Massage holds alternately the right, then the left hand of the masseur, while the other hand supports the hand or forearm of the patient.

The main massaging of the joint with the help of rubbing concentrates on the palmar surface of the forearm. Penetrating deep enough into the articulation (it is advisable to bend the arm at the elbow joint), the fingers of the masseur are easily in contact with the ligaments that are located above the coronoid process and the medial edge of the articulation. It is used for circular grinding with the help of pads of large and other fingers. The masseur sits on the side of the patient, after completing the stroking of the joint area, he supports the patient's forearm with one hand, the thumb pad is positioned somewhat inward from the elbow and in circular motions advances somewhat outward and ends rubbing in the region of the palpable radial head. Circular rotating movements of the thumb alternate with the strokes of the joint with a thumb pad.

When stroking and rubbing the inner region of the elbow joint, the lower portions of the triceps, biceps and inner shoulder muscles are captured. Rubbing starts from the lateral surfaces of the joint, from the radial side - on the junction of the radial and humeral bones and from the ulnar side - on the joint of the ulnar and humerus bones. From these two points, both thumbs of a massage therapist can move simultaneously. The masseur supports the patient's arm. Reaching the elbow, the fingers slide along its edge and along the lateral surface of the tendon of the triceps muscle, then return back. In addition to circular, rubbing is carried out by "forceps", spiraling, rectilinear. Rubbing ends with passive movements in the joint.

Massage of shoulder and forelegs area

In the case of separate massaging of this area, attention should be paid primarily to: a) the area of the biceps muscle; b) the region of the triceps; c) the area of the deltoid muscle.

It is recommended to begin massage with muscles-flexors.

Massage of the biceps muscle is carried out from the upper third of the forearm towards the axillary fossa. When stroking, squeezing, kneading, the palm of the hand tightly adheres to the surface of the muscle. At the same time (if the right hand is massaged), the four fingers of the masseur slip along the internal fissure of the biceps muscle, without pressing or pressing on it strongly, since it is followed by the brachial artery and vein, as well as the nerves of the hand; The thumb moves at this time along the outer groove of the biceps muscle. In the axillary fossa, the thumb, circling the anterior edge of the deltoid muscle, connects with the rest of the fingers of the hand. Preferred techniques - stroking, kneading with one hand and squeezing.

Massage of the triceps muscle is done in the same direction. The right hand of the masseur maintains the patient's right arm under the ulnar fossa. Works mostly left hand. When stroking, squeezing, kneading, the thumb of the masseur, going up, first moves along the outer bosom of the biceps, and then along the outer edge of the deltoid to the axillary fossa. Simultaneously, four fingers slide along the inner bosom of the biceps muscle, and then deltoid. All fingers are found in the armpit. On the triceps muscle perform stroking, squeezing, kneading and felting.

The deltoid muscle is massaged in two ways. With a weakly developed muscle - stroking, squeezing, kneading can be performed immediately with one hand throughout the muscle area. The thumb of the right hand slides along the outer edge of the muscle, and the other four - along the inner to the clavicle and to the acromial process of the scapula (provided that the right arm is massaged). If the deltoid muscle is well developed, then it is massaged separately. In the middle of the muscle passes a fairly tight aponeurosis, which makes it possible to massage in two separate parts. Initially, the entire muscle is stroked. When the front part is massaged, the thumb of the hand moves downward through the middle of the muscle to the acromial process, the four fingers slide along the front edge of the muscle. When the back massage is performed, they move along the posterior edge of the muscle. They produce rubbing, "chopping", "sawing," pokolachivanie muscles. Finish the massage by shaking and stroking and transfer to the massage of the shoulder joint.

Massage of the shoulder joint area

The deltoid muscle is stroked energetically, and then the fan-shaped stroking of the entire area of the shoulder joint is performed, rubbing the muscle. There are two ways of rubbing the shoulder joint:

1. The masseur has a hand on the area of the shoulder joint of the patient and starts rubbing, massaging from below upwards over the head of the humerus. In this situation, circular grinding is carried out, the thumb of the hand resting on the humerus region (the other four fingers penetrate deeply into the ligament apparatus at the anterior edge of the joint to the axilla), then the four fingers of the wrist serve as an abutment. At this time, the thumb, performing rotational movements on the posterior surface of the joint, is also directed toward the armpit at the articulation of the joint.

This method involves three positions of the patient's arm:

2. The masseur pushes the patient's hand behind his back and puts the back of the hand on the lower back so that the front of the bag of the joint is well massaged. In this situation, the head of the humerus pushes forward the articular bag. The masseur becomes behind the massaged and, leaning with the thumb of the brush on the pads of the remaining four, rubs the joint in a circular motion towards the armpit (in some cases, this technique is performed with the index and middle fingers);
3. the patient puts his hand on the opposite shoulder so that you can massage the back of the joint bag. For example, when massaging the right shoulder, the patient takes the palm of the hand to the left shoulder. The masseur, leaning his thumb on the head of the humerus, rubs the pads of all four fingers or the index and middle fingers of the protruding areas of the back of the bag of the joint;
4. To rub the lower part of the joint bag, the patient's straightened arm is placed with the palm down on the forearm of the masseur. A massage therapist rests against the head of the humerus with the pads of the four fingers, and the thumb pad of the brush penetrates into the armpit until the head of the humerus is palpated, and then begins to carry out circular rubbing along the lateral surfaces of the axilla without pressing the lymph nodes.

The patient's hand is lowered down and rubbed with the middle and anonymous fingers of the intercammonial sulcus, in which one of the tendons of the biceps muscle is located. At the end of the massage, the patient should be asked to perform several movements in the joint (active, active with the help, passive).

Massage of the thoracic region

Lymphatic vessels of the anterior surface of the chest go in the direction of the supra- and subclavian and axillary nodes. All massaging movements are directed from the white line to the fibers of the large pectoral muscle in an arcuate manner upward, and in the region of the lateral and lower parts of the thorax to the axillary and axillary basins. On the chest are massaged large pectoral muscles, intercostal muscles and anterior cog muscles.

Massage of the pectoralis major muscle. The fibers of the pectoral muscle have a twofold direction: from the clavicle to the humerus and from the sternum to the humerus. The hand of the masseur slides from one side to the armpit, and on the other - from the sternum to the shoulder joint; the nipple manages. The procedure uses techniques of stroking, kneading, squeezing, effleurage, rubbing. Planar stroking is more convenient to carry out with both hands in the form of separate stroking. Brushes of the masseur slip along the fibers of the muscle from below upward and arcuate to the shoulder joint. Spiral grinding is performed with 4 fingers in the same direction; gum-like kneading should be included to knead individual beams of the entire muscle.

Massage of the anterior dentate muscle. The patient's starting position is lying on his side. The masseur puts his hand on the side of the chest so that the base of the palm is located on the front axillary line, and the fingers of the hand are directed towards the scapula. The movements are made in an oblique direction upward, towards the scapula, and capture the zone between the 2 and 9 ribs.

Use techniques:

• alternating rubbing with four fingers;
• stroking;
• clasp-like kneading;
• stroking;
• pat;
• stroking.

Massage of the intercostal muscles is carried out in the same initial position of the patient. In the procedure, the following methods are used: stroking (performed with a thumb or middle pincushion, movements are directed from front to back from the sternum to the spine), spiral or longitudinal grinding (the middle finger pads), stroking, alternating pressing (middle and index finger pads), stroking, vibration.

In addition, when the intercostal nerves are damaged, the exit points of the intercostal nerve branches are massaged. These points are located along the paravertebral lines, along the middle axillary and along the parasternal lines. In the exit points of these nerves, massage is performed in the same way as in the massage of the exit points of the branches of the trigeminal nerve: circular flat stable stroking (the middle finger pads), circular stable rubbing, stroking, continuous pressing, stroking, vibration and stroking.

Methodical instructions.

1. During massage of the neck area, the patient's condition (complaints, examination of the number of heartbeats and breathing, blood pressure) should be constantly monitored.
2. In the region of the cervical neurovascular bundle, do not perform manual intermittent vibration, as this can cause the patient to have headaches, dizziness, nausea and fainting.
3. During the massage of the sternocleidomastoid muscles, it should be remembered that they have an external jugular vein covered only by the skin muscle of the neck, and an internal jugular vein that descends along the inner edge of these muscles.
4. It is known that in the backs of the back there are two opposite currents of the lymphatic fluid - one current goes from top to bottom, the other - from bottom to top. Proceeding from this assumption, it is suggested to massage the back muscles - from the top to the bottom and from the bottom upwards - in two different directions.
5. Methods of vibration should be carried out at the paravertebral points, in the immediate vicinity of the spine, at the site of the exit of the posterior branches of the nerves. Vibration is recommended using a thumb pad, gradually moving it in the cranial direction.
6. Massage of large pectoral muscles is used only in men, and in women - for special indications.
7. When performing massage techniques such as rubbing or patting on the left side of the chest in the heart, care must be taken.
8. Interblade area receptions of intermittent manual vibration should be performed cautiously, especially with diseases of the cardiovascular system.
9. In persons with increased fragility of blood vessels, mashing and manual intermittent vibration should be performed without applying significant pressure to avoid subcutaneous hemorrhage.

Methods of classical (therapeutic) massage should be combined or supplemented with other types of massage.