Foundations of Swedish Massage Techniques_

163 INTRODUCTION The massage manipulations of Per Henrik Ling, often referred to as the father of Swedish massage, have been taught and performed for over two centuries. These techniques have been and are still being used by mas- sage therapists, other manual therapists and health care workers throughout the world. According to Dorland’s Illustrated Medical Dictionary (2000) a manipulation is applied skilfully as a form of treatment via the hands or with the use of mechanical means. Thus a therapist who uses massage manipulations as a form of treatment could be described as having the ability to treat with their hands in a skilful manner. Such manipulations would include the various ‘strokes’ introduced throughout this chapter. There are fi ve major categories of Swedish massage strokes that are commonly applied and these are known as: effl eurage; pétrissage; tapôtement; friction; and vibration. Each category has a specifi c role to play in contributing to the overall massage sequence. This chap- ter will defi ne each of the fi ve Swedish massage strokes and discuss their application, usage and variations. The importance of intelligent touch cannot be over- stated. A conceptual basis for intelligent touch through the development of palpatory literacy is also presented to help facilitate the student and practitioner to deliver quality massage applications. Firstly though, the value of therapist intent and presence will be discussed. HAVING INTENTION AND PRESENCE For massage strokes to be fully effective, the prac- titioner can increase the effi cacy of the application with the knowledge of how to use intention and presence as an effective tool. What is meant by inten- tion? Simply put, it is the conscious desire with focus to apply each stroke in a particular fashion. A skilled practitioner can utilise their intention to deliver the best possible outcome for their applied technique. Intent later becomes an energetic vehicle in which the practitioner can participate in the outcome of the application. Presence involves committing your body, mind, heart and soul to the task at hand in the moment. When performing massage, one should listen with all facul- ties, and attend to the effects of the applied application through the use of cognitive, intuitive, visual and audi- tory senses. It is a way to directly monitor the language of the body both quantitatively and qualitatively by the use of the hands and mind. Presence allows us to be fully aware in the moment with extraordinary relaxed focus on the massage task at hand. Both of these qualities, intention and presence, are the difference in what can take massage practice to the next level of excellence. PALPATORY LITERACY Most students and practitioners of massage focus upon the application of technique as the crucial element in the delivery of massage. The component most often miss- ing is the touch behind the technique and the ability to discern the tissues and structures below the practitio- ner’s hands. The ‘literacy of palpation’ or palpatory literacy is the ability to distinguish various tissue layers, discern localised temperature variations, tissue texture and chapter 16the techniques of Swedish massage LEARNING OUTCOMES ● Describe the conceptual context for palpation and palpatory literacy ● Describe the major Swedish massage strokes ● Discuss the application of each of the Swedish massage strokes ● Discuss the precautions of application for each of the Swedish massage strokes ● Describe the effects of each of the Swedish massage stroke Steven Goldstein and Lisa Casanelia 164 Section 5 Providing the massage treatment tonality. Thus, becoming literate in palpation is a means through which we achieve our ‘end’. Palpation serves as a bridge into the body – mind con- tinuum and between structure and function. It involves perception, discrimination and analysis (aspects of conscious awareness) as well as precision, sensitiv- ity and dexterity (aspects of physical process). This brings to awareness the ways which the mind is ex- pressed in physicality and how physical states are re- fl ected through the mind. (Burman & Friedland 2006: 161) The dictionary defi nition for palpation is obtained from the Latin word palpare (circa 1852), meaning to examine by touch especially medically (Merriam-Web- ster Dictionary). To use touch skilfully is to become profi cient in using palpation as a language that allows our ability to assess. Assessment is the foundation of manual therapy and, along with the delivery of massage, palpation is at the heart of assessment. It would be unimaginable to begin treatment without a sense of assessment, and assessment cannot occur without discerning palpation. How is one to determine objective or subjective fi nd- ings of the soft tissue without assessment of the soft tissue? The problem-solving and the evaluative process in selection of technique will have palpatory literacy at its core. Leon Chaitow writes that, according to Viola Frymann (1963), ‘Palpation cannot be learned by reading or listening; it can only be learned by palpa- tion’ ( Chaitow 2003 : 3). Practitioners with the great- est degree of ‘rigidity,’ in terms of their training, often have the hardest time allowing themselves to feel new feelings and sense new sensations. Those with the most open, eclectic approaches (massage therapists are a prime example) usually fi nd it easiest to ‘trust’ their senses and feelings ( Chaitow 2003 : 15). According to Karel Lewit (1999) , a noted Czecho- slovakian physician, to begin to learn palpatory skill, one must possess a fi rm grasp of anatomy and the sup- porting soft tissue structures. According to Chaitow: Palpation of tissue structures seeks to determine the texture, resilience, warmth, humidity and the possibil- ity of moving, stretching or compressing these struc- tures. Concentrating on the tissue palpated, and push- ing aside one layer after another, we distinguish skin, subcutaneous tissue, muscle and bone; we recognise the transition to the tendon, and fi nally the insertion. ( Chaitow 2003 : 5) Palpation is touch awareness, and it often requires tactile exploration of a variety of tissue layers over time, spanning multiple hours palpating a variety of body types. As they say ‘practice makes perfect’ and this aphorism is most true in palpatory literacy. Sensing the subtle variations in the qualities of vari- ous tissues requires much practice. Distinguishing the subtleties of tissues will enable the therapist to ‘build a personal database of tactile somatic experiences: ‘The fascia feels like … the muscles feel like … ’. We can then recall these bits of sensory recognition during our next hands-on experience as guideposts to knowing what we are touching; comparing this with other sen- sory memories stored in our somatic databases, and with what feels ‘normal’. Once we have a fi rm grip on what normal feels like, abnormal becomes more obvious. Also, it becomes easier to detect changes in our clients from session to session, and even during a session. ( Foster 2006 : 109) THE FIVE SWEDISH MASSAGE TECHNIQUES The fi ve Swedish massage techniques are a classifi - cation system of the many variations of techniques used in Western or Swedish massage. Johann Mezger (1838 – 1909) has been credited for the introduction of French terms still used to describe four of the fi ve mas- sage techniques: effl eurage , pétrissage , tapôtement and frictions ( Salvo 1999 ). That said, these fi ve often form the basis of massage training that goes on to blend and cross-fertilise more complex strokes. The fi fth applied technique, vibration , became popular in the late 19th century ( Tappan & Benjamin 1998 ). Over the years many authors have varied the classifi cation system to include additional manipulations: shaking, compression and touch. Effl eurage Defi nition Effl eurage is a gliding manipulation of the superfi cial tissues. It is used as an introduction to touch at the beginning of the massage, and can be blended as a tran- sition stroke between the other fi ve massage techniques. Generally at the beginning of a massage, effl eurage is used to apply the lubricant, spread it over the surface, warm the surface layer of tissue and refl exively create a smooth relaxing fl ow and rhythm for the application of the stroke. Local circulation is increased with the application of effl eurage, and the underlying tissues are warmed in preparation for deeper manipulations. Effl eurage is derived from the French verb effl eu- rer , meaning ‘to brush against, to skim over or to touch lightly’. Some authors equally refer to this manipula- tion as stroking or gliding ( Cassar 1999; Loving 1999; Tappan & Benjamin 1998 ), whilst others describe strok- ing and effl eurage as two different manipulations ( Rat- tray & Ludwig 2000; Hollis 1998 ; De Domenico & Wood 1997; Holey & Cook 1997 ). The major difference between stroking and effl eu- rage relates to the depth of pressure applied. Stroking is usually performed slowly with gentle pressure that is fi rm enough for the client to feel yet light enough so that there is minimal deformation of the subcutane- ous tissue ( Andrade & Clifford 2001 ; De Domenico & Wood 1997). It is believed that stroking offers little direct mechanical effect, as the depth of technique is too superfi cial. However, signifi cant refl exive effects have been observed with the application of stroking. 16516 The techniques of Swedish massage Effl eurage is applied with greater pressure than strok- ing, and its effect on the subcutaneous tissue could be described as deforming. Effl eurage by contrast has a greater mechanical effect and may also produce the same refl exive effects as stroking. Effl eurage is said to have a major effect on venous and lymphatic return. The therapist generally applies effl eurage with the whole palmar surface of the hand placed on the cli- ent’s body. The therapist then uses their body weight to ‘lean into’ the superfi cial tissues, pushing the stroke forwards. Traditionally, this technique is performed in the direction of venous and lymphatic fl ow in the direction of the heart ( Kellogg 1895; Palmer 1912; Beard & Wood 1964; Andrade & Clifford 2001 ). There is a belief amongst some authors that structural dam- age may occur to the valves within the veins if effl eu- rage is applied in a centrifugal direction ( Tappan & Benjamin 1998 ). However, no evidence exists to sub- stantiate this claim, yet if the treatment goals are to increase venous and lymphatic fl ow, then the direction of the technique should be aligned to the direction of fl uid fl ow. An excellent example of refi ned effl eurage is the Hawaiian bodywork of Lomi Lomi massage. Full con- toured gliding fl owing strokes are done primarily with the forearms and elbows with the hands as a guide. Description The application of stroking and effl eurage can be lik- ened to the affectionate caress of a loved one or the petting of a favourite animal. The stroke is applied pur- posefully with gliding movements that gently follow the contours of the body. It is applied over large areas, and usually moves distal to proximal in the direction of venous (blood returning to the heart) and lymphatic fl ow to enhance their effects. In order to maintain fl ow and continuity, the return stroke travels in the opposite direction with lighter stroking pressure to return to the starting position. Throughout the stroke, the contoured and sculpted palms, hands, fi ngers or fi ngertips mould and form to the shape of the body region being treated ( De Domenico & Wood 1997 ). The hands are relaxed and the stroke is performed in a smooth and rhythmic fashion. The pressure employed is derived from the therapist leaning their body weight into the stroke. Techniques The therapist can vary the way in which effl eurage manipulations are applied by using differing hand tech- niques. Depending on the region being treated and the desired effect, the therapist may apply effl eurage with the forearms, palms, contoured hands, fi ngers or fi nger- tips, and even the side or the back of the hand. Rowing stroke The rowing stroke is generally applied as an introduc- tory stroke and is often repeated throughout the massage sequence, integrating other strokes together, transitioning from one stroke to another and when moving positions around the massage table. The rowing stroke is per- formed by placing the palmar surface of the hand on the tissues. The hands glide toward the top of the trunk or limb, where the hands then separate and perform a return gliding stroke down the sides of the trunk or limb (see Figure 16.1 ). The hands should be broad and fl at with the entire surface area of the hand making contact with the tissue, the fi ngers should be relaxed and not rigid or squeezed together and the fi ngertips should be slightly curled down to meet the tissue. Half rowing stroke (reinforced effl eurage) Reinforced techniques allow the therapist to penetrate the deeper tissues of the body by decreasing the surface area of application from two hands to one and focusing the body weight of the therapist through this one hand. The half rowing stroke is generally performed after the rowing stroke, working deeper into the tissues. The technique is applied by placing one hand over the other to create a reinforced position. The hand closest to the body is the one making direct contact with the tissue and the hand reinforcing the stroke will be the more lat- eral hand, allowing for the body to be in a good position of alignment. The reinforced hands glide towards the top of the trunk or limb and then return lightly in a more lateral position along the side of the body, returning to the starting position (see Figure 16.2 ). Forearm effl eurage Forearm effl eurage is a broad gliding stroke performed with the fl eshy part of the therapist’s forearm. The thera- pist aligns their shoulder over the forearm to allow proper use of their body weight in the application of this tech- nique. Forearm effl eurage can be applied fl owing and swiftly warming the superfi cial layers of tissue or it can be applied more slowly and directly to specifi c tissues to penetrate into the deeper layers. The forearm can be applied in a longitudinal fashion using the length of the forearm with the hand leading or in a perpendicular fash- ion with the therapist’s hand facing across the body (see Figure 16.3 ). The therapist should ensure their hand is Figure 16.1 Rowing stroke 166 Section 5 Providing the massage treatment not squeezed into a tight fi st when using forearm effl eu- rage as this contracts the forearm muscles and hardens the feel of the technique. In addition, the therapist should be cautious that the point of the elbow doesn’t come into contact with spine or any other bony prominences. Fist effl eurage Loose fi st effl eurage is a broad strong effl eurage tech- nique primarily used on large muscle groups with well- developed or very tight muscles. This technique engages both the deep and superfi cial tissues and is performed with the ‘fl at’ surface of the fi st. The dorsal surface of the phalanges (as opposed to the knuckles) makes contact with the tissue. The technique is reinforced by the thera- pist’s other hand, which wraps around the wrist of the massaging hand to reinforce the wrist and strengthen the stroke (see Figure 16.4 ). An alternate reinforced position is with the second hand cupped inside the loose fi st; this allows for even greater depth of pressure to be applied. Hand after hand This rhythmic technique is soothing and warming to the tissues with short alternating strokes that should feel like one continuous stroke. One hand glides up the trunk or limb for a short distance followed by the other hand, the leading hand is lifted off as the other hand follows through and the massage therapist continues to alternate hands as they move forward (see Figure 16.5 ). Side pulls Side pulls are performed by reaching both hands across to the far side of the client’s trunk or limb. One hand glides toward the midline of the trunk or limb while the other hand begins the same action when the fi rst hand is halfway through its stroke (see Figure 16.6 ).The thera- pist can use their body weight to assist with the depth of the technique by leaning back into the technique as the hands move across the sides of the body toward the midline. This technique is unusual in the sense that the direction of the technique requires the therapist to pull back toward them rather than pushing the technique for- ward with their body weight behind them. Nerve strokes (light stroking) Nerve strokes (also known as cat or feather strokes) are a light stroking technique that is performed slowly with light pressure, using the fi ngertips. The fi ngertips stroke down the area of the body being treated in a continuous alternating pattern (see Figure 16.7 ). This stroke is gen- erally added as the fi nal technique in a sequence as it is the lightest of the effl eurage techniques and is a gentle and soothing way to complete an area of the body. Figure 16.3 Forearm effl eurage Figure 16.4 Fist effl eurage Figure 16.5 Hand after hand Figure 16.2 Half rowing stroke 16716 The techniques of Swedish massage Pétrissage Defi nition Pétrissage is a group of techniques that repetitively lift, roll, grasp, stretch, compress or squeeze the underlying tissue. Pétrissage is derived from the French verb pétrir meaning ‘to knead’. The intention when performing pétrissage manipulations is to lift and squeeze (or ‘milk’) or compress the tissue. When performing pétrissage, the therapist lifts, rolls, stretches, compresses, kneads or squeezes the underlying tissue or structures between their hands (Salvo 2003). Some authors equally refer to this manipulation as kneading ( Fritz 2000 ; Rechtian et al 1998). Pétrissage consists of several techniques; namely, kneading, squeezing, lifting, compression and skin rolling (De Domenico & Wood 1997; Cassar 1999; Loving 1999 ). Some texts add shaking ( Holey & Cook 1997; Hollis 1998 ) whilst others exclude compression ( Rattray & Ludwig 2000 ; Salvo 2003). Description There are many pétrissage manipulations and, as previ- ously mentioned, they involve lifting, rolling, stretch- ing, compressing, squeezing or kneading underlying tissues. Each technique has its own unique action and its own effect. The most common pétrissage attribute is known as kneading. This attribute is much like the kneading of bread dough. One or both hands compress, lift and twist the muscles and subcutaneous tissues, often in an alternating fashion. Pétrissage techniques involve the use of the whole hand, as the entire palmar surface, the fi ngers and the thumb, as well as the tips of every digit are recruited. With practice, the therapist will fi nd it is easier to grasp the tissue when kneading is performed slowly (allowing approximately 2 – 3 seconds for every pétrissage stroke). As profi ciency increases, the thera- pist can begin to use a more rapid kneading action to produce a stimulating effect on the nervous system. Chaitow and DeLany (2000) recommend the kne