Conservative treatment of osteochondrosis of the cervicothoracic spine: massage

Neck Muscle Massage

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 increases the outflow of venous blood and lymph from the cranial cavity and its integuments and thus has a beneficial effect on hemodynamics. The massage is performed with the patient sitting or lying down. The masseur is positioned behind or to the side of the person being massaged.

Massage plan: impact on paravertebral zones C7 _- C3 _and Th2 _- C7 _, reflexogenic zones of the chest. Massage should be performed in the interscapular region, in the area of the intercostal spaces, sternocleidomastoid muscles, the back of the neck, shoulder girdle and muscles of the upper limbs.

Massage of the collar zone

The massage of the “collar” zone is performed in the patient’s initial position - sitting on a stool, hands freely placed on the table, head lowered onto hands.

Some authors recommend starting this procedure with a massage of the interscapular region, others - with the muscles of the upper limbs. Doctors adhere to the opinion of Kunichev L.A. and others that the back muscles should be affected first, and then, as they are prepared, gradually move on to other zones.

• Massage of the interscapular region: light flat stroking with both hands from the back of the head down to the level of the line connecting the lower angles of the shoulder blades (both palms of the massage therapist move "backwards" along the paravertebral tissues). All other techniques are performed in the same direction to the specified line. Then use "diamond" stroking; longitudinal stroking and "diamond" stroking are considered as one technique. Alternating rubbing of the muscles of the interscapular region, deep longitudinal and "diamond" stroking, spiral rubbing of the muscles of the interscapular region with four fingers from top to bottom "forward" and "backwards". It is advisable to perform this technique with one hand, and with the other the massage therapist fixes the patient by the shoulder blade. Deep longitudinal and diamond-shaped stroking, deep transverse intermittent kneading with both hands paravertebrally from top to bottom, deep longitudinal and diamond-shaped stroking, chopping along the interscapular region, superficial longitudinal and diamond-shaped stroking. Then move on to massage of the neck and shoulder area.
• Massage of the back of the neck: enveloping stroking (the massage therapist's hands are positioned so that the index fingers are projected under the angle of the lower jaw, and the thumbs are under the external occipital tubercle - sliding the hands along the shoulder girdles to the shoulder joints), alternating rubbing, stroking in a "backward" direction from the superior nuchal line to the shoulder joints, spiral rubbing with four fingers, pincer-like stroking is performed with the pads of the thumb and index finger of both hands simultaneously, spiral rubbing with one thumb (performed in the angle between the transverse and spinous processes of the cervical vertebrae), deep stroking in a "forward" direction (it is recommended to perform the technique with one hand, the other fixes the shoulder joint; the base of the massage therapist's palm is near the occipital bone, and the fingers are turned outward, located parallel to the muscle fibers of the upper portion of the trapezius muscle; sliding is performed from above to the shoulder joint); pincer-like kneading is performed with the thumbs and index fingers of both hands (the fingers grasp the muscle ridge, pull and squeeze it, then grasp a new section of the muscle ridge - moving from above to the shoulder joint); stroking with a "reverse" movement, patting and enveloping stroking.
• Massage of the sternocleidomastoid muscle is performed with the patient in the same initial position, the masseur is behind him. The following massage techniques are performed sequentially: flat stroking with the pads of the index, middle and ring fingers. The masseur places his fingers in the area of muscle attachment, the thumb should be bent and adducted. The hands slide to the manubrium of the sternum; spiral rubbing, stroking, pincer-like kneading (performed with the thumb and index fingers), stroking. The masseur stands to the side of the patient: one hand fixes the patient's head, the other performs the therapeutic manipulation. It is recommended to massage the left muscle with the right hand, and the right muscle with the left. During the massage, the techniques described above are performed, but the hand performing them moves "backwards". When performing the "stroking" technique, the thumb is abducted. The first massage option is convenient when performing the procedure for both muscles at once, and the second option is more appropriate to use for selective massage of these muscles.
• Massage of the shoulder blade area: stroking with 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 infraspinatus muscles, alternate rubbing with both hands, stroking, spiral rubbing with four fingers in the same direction, stroking, sawing, stroking.

The patient's initial position is lying on his stomach. The long muscles of the back on the side of the curvature are massaged mainly by rubbing and patting. The elevation at the base of the first finger of the hand (thenar) is mainly used for rubbing. These muscles are massaged not along their entire length, but until they "sag" in the lumbar region.

In the kyphosis area, the scapula is pulled outward due to the stretching and weakening of the trapezius (middle and lower portions) and rhomboid muscles. To strengthen them, the scapula is actively brought to the midline. The massage therapist holds the shoulder pulled back with his left hand or places a bolster under it to fix it and massages the muscles of the interscapular and scapular region. The upper portion of the trapezius muscle is contracted, creating an asymmetry of the shoulder girdle lines. To normalize this portion of the muscle, it is necessary to relax it with light vibration movements of the fingers and stretch it.

The next area of massage is the opposite side of the thoracic region, where the massage therapist is located. In this area, there is a tendency for deformation: the ribs in the center of the concavity can be brought together and the intercostal spaces are brought together. The muscles in this area are contracted. The task of the massage is to bring the muscles to a state of relaxation, to expand the intercostal spaces. For this, mainly relaxing massage is used with the direction of movements from the periphery to the center of the depression, where the ribs and muscle layer are shifted, and when moving the hands in the opposite direction, the muscles are stretched. As the muscles relax, you should penetrate into the depression of the intercostal spaces and stretch them.

To pull the lower angle of the scapula in the area of the ribs, the masseur inserts the right hand under the angle of the scapula and pulls it away. To make this maneuver easier, the masseur should grasp the patient's left shoulder, raising and lowering it. At this point, inserting the fingers of the hand under the angle of the scapula becomes much easier and it is freely pulled away.

The muscles in the shoulder girdle and in the shoulder blade area on 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" pressure should not be allowed.

Massage of the muscles of the upper limbs

When starting to massage this region, it is important to remember that the superficial lymphatic vessels, like a net, envelop the arms from all sides. The largest vessels are located mainly on the inner surface of the forearm and shoulder. Large deep vessels are also located there. The main lymph nodes are located in the armpit, they also lie in the elbow bend. The nerve trunks accessible to the pressure of the massage therapist's hand are located mainly on the shoulder, from the elbow groove to the armpit. They are located over a significant distance in the area of the internal shoulder groove, and in 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:

• finger area;
• brush;
• wrist joint;
• forearm muscles;
• elbow joint area;
• shoulder area.

Massage of the finger and hand area

The complex anatomical and topographic relationships of the hand complicate the use of a certain number of massage techniques. The following are usually used first:

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

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

The fingers are stroked in a circular motion with the pads of the thumb, rubbed in straight, spiral and circular motions. Then they move on to stroking and rubbing the back and palmar surfaces of the hand, trying to slide along the tendons. At first, it is recommended to stroke and rub the interdigital spaces on the back side, then the hand is turned with the palmar surface upward and stroking and rubbing are performed. In this case, the muscles of the eminence of the 1st and 5th fingers are kneaded with the help of the thumb and little finger. The massage ends with movements of the fingers of the hand (passive, active with and active).

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

When starting to rub, it should be remembered that the joint capsule is most accessible from the back and sides of the joint.

When rubbing, mainly rubbing movements are used with the pad of the thumb. It is best to start rubbing from the lateral surface of the joint. Using small circular movements with the pad of the thumb, trying to penetrate into the depth of the joint capsule, move to the back surface of the joint, making sure that the hand being massaged is in a bent position.

When moving on to rubbing the flexor muscles, it is necessary to bend the wrist as much as possible so that it is possible to act on the joint capsule.

The following rubbing techniques are used:

• "pincers" formed by all fingers (the thumb on the back of the joint, and the rest on the palm). Rubbing is done with one or both hands;
• circular motion with the pads of the thumbs along the wrist joint space. The movements should be small, the fingers should penetrate as deeply as possible into the joint capsule;
• rectilinear and circular with the pads of the thumbs across the joint space. The patient's hand is grasped in such a way that the thumbs are on top and the rest of the fingers are below and support it. Rubbing is done alternately with one finger and then the other;
• circular, with the pads of all the fingers. The masseur places the base of the palm on the fingers of the hand being massaged. This technique is also performed with weighting - then the hand being massaged should lie on the masseur's thigh of the same name;
• zigzag with the base of the palm. This technique is performed in the direction from the fingers of the hand to the middle of the forearm.

After massage techniques, the patient is asked to perform movements in the joint (flexion, extension, abduction, adduction and rotation). The procedure is completed by shaking.

Massage of the muscles of the forearm

The masseur takes the patient's hand with his left hand and the flexor muscles of the forearm with his right. If the right hand is being massaged, the masseur's right hand strokes, squeezes or kneads in the direction of the elbow joint. It is recommended to start the massage from the wrist joint. The masseur's thumb first slides along the radius, and then along the groove between the long supinator and the flexor muscles, and the other fingers follow the course of the ulna. At the inner condyle, the thumb and the other fingers converge. Having massaged the flexor muscle group, one should move on to the dorsal surface of the forearm, where the extensor muscles are located. The masseur's right hand is located on the dorsal surface of the forearm, in its lower third, and is directed toward the elbow joint. In this case, the thumb of the hand is along the ulna, the other fingers are directed toward the groove separating the flexor muscles from the extensor muscles in the lower third of the forearm. The movement is carried out along the radius, between the long supinator and the flexor muscles. The fingers converge at the lateral condyle.

The following techniques are used in the massage procedure:

• stroking;
• squeezing without weights;
• kneading;
• beating.

The massage ends with stroking and shaking.

Massage of the elbow joint area

First, the joint is massaged around the entire circumference using a stroking technique. The massage therapist's hand movement begins on the forearm and ends in the middle third of the shoulder. The massage is performed alternately by the right and left hand of the massage therapist, while the other hand supports the patient's hand or forearm.

The main massage of the joint by rubbing is concentrated on the palmar surface of the forearm. Penetrating deep enough into the joint (for this it is advisable to bend the arm at the elbow joint), the fingers of the masseur easily contact the ligaments that are located above the coronoid process and the medial edge of the joint. Circular rubbing is used with the pads of the thumbs and other fingers. The masseur sits to the side of the patient, having finished stroking the joint area, he supports the patient's forearm with one hand, places the pad of the thumb slightly inward from the olecranon process and moves slightly outward with circular movements and finishes rubbing in the area of the palpated head of the radius. Circular rotating movements of the thumb alternate with stroking the joint with the pad of the thumb.

When stroking and rubbing the inner area of the elbow joint, the lower parts of the triceps, biceps and inner brachialis muscles are involved. Rubbing starts from the lateral surfaces of the joint, from the radial side - at the articulation of the radius and humerus and from the ulnar side - at the articulation of the ulna and humerus. From these two points, both thumbs of the masseur can move simultaneously. The masseur supports the patient's hand. Having reached the elbow eminence, the fingers slide along its edge and along the lateral surface of the triceps tendon, then return back. In addition to circular rubbing, "pincer" rubbing, spiral rubbing, and rectilinear rubbing are performed. Rubbing ends with passive movements in the joint.

Massage of the shoulder and supraclavicular area

When massaging this area separately, you should pay attention first of all to: a) the biceps area; b) the triceps area; c) the deltoid area.

It is recommended to start the massage with the flexor muscles.

Massage of the biceps muscle is performed from the upper third of the forearm towards the armpit. When stroking, squeezing, kneading, the massaging palm fits tightly to the surface of the muscle. In this case (if the right hand is massaged), the four fingers of the masseur slide along the inner groove of the biceps muscle, without pressing or pressing hard on it, since the brachial artery and vein, as well as the nerves of the arm, pass through it; the thumb at this time moves along the outer groove of the biceps muscle. In the armpit, the thumb, having rounded the front edge of the deltoid muscle, joins with the other fingers of the hand. Preferred techniques are stroking, kneading with one hand and squeezing.

The triceps massage is performed in the same direction. The right hand of the masseur supports the patient's right hand under the elbow. The left hand works mainly. When stroking, squeezing, kneading, the masseur's thumb, moving upwards, first moves along the outer groove of the biceps, and then along the outer edge of the deltoid to the armpit. At the same time, four fingers slide along the inner groove of the biceps, and then the deltoid. All fingers meet in the armpit. Stroking, squeezing, kneading and rolling are performed on the triceps.

The deltoid muscle is massaged in two ways. If the muscle is poorly developed, stroking, squeezing, and kneading can be done with one hand at once over the entire muscle area. The thumb of the right hand slides along the outer edge of the muscle, and the other four fingers slide along the inner edge to the collarbone and to the acromial process of the scapula (provided that the right hand is massaged). If the deltoid muscle is well developed, it is massaged separately. There is a fairly dense aponeurosis in the middle of the muscle, which makes it possible to massage two separate parts. First, the entire muscle is stroked. When massaging the front part, the thumb moves downwards through the middle of the muscle to the acromial process, and four fingers slide along the front edge of the muscle. When massaging the back part, they move along the back edge of the muscle. Rubbing, “chopping,” “sawing,” and tapping of the muscle are performed. They finish the massage with shaking and stroking and move on to massaging the shoulder joint.

Massage of the shoulder joint area

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

1. The masseur places his hand on the area of the patient's shoulder joint and begins rubbing, massaging from the bottom up over the head of the humerus. In this position, circular rubbing is performed, with the thumb of the hand resting on the area of the humerus (the other four fingers deeply enter the ligamentous apparatus with circular movements along the anterior edge of the joint to the armpit), and the four fingers of the hand serving as a support. At this time, the thumb, performing rotational movements on the back surface of the joint, is also directed towards the armpit along the articulation of the joint.

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

2. the masseur takes the patient's arm behind his back and places the back of his hand on the lower back in order to massage the front part of the joint capsule well. In this position, the head of the humerus pushes the joint capsule forward. The masseur stands behind the person being massaged and, resting his thumb on the pads of the other four fingers, 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 places his hand on the opposite shoulder so that the back of the joint capsule can be massaged. For example, when massaging the right shoulder, the patient moves the palm of the hand to the left shoulder. The massage therapist, resting the thumb on the head of the humerus, rubs the protruding areas of the back of the joint capsule with the pads of all four fingers or the index and middle fingers;
4. To rub the lower part of the joint capsule, the patient's straight arm is placed palm down on the masseur's shoulder. The masseur presses the pads of his four fingers against the area of the humeral head, and the pad of his thumb penetrates the armpit until he palpates the humeral head, and then begins to perform circular rubbing along the lateral surfaces of the armpit, without pressing on the lymph nodes.

The patient's hand is lowered down and the middle and ring fingers are used to rub the intertubercular groove, in which one of the biceps tendons is located. At the end of the massage, the patient should be asked to perform several movements in the joint (active, active with assistance, passive).

Massage of the chest area

The lymphatic vessels of the anterior surface of the chest go towards the supraclavicular and subclavian and axillary nodes. All massage movements are directed from the white line to the fibers of the pectoralis major muscle in an arcuate upwards, and in the area of the lateral and lower parts of the chest - to the axillary and axillary fossa. On the chest, the pectoralis major muscles, intercostal muscles and anterior serratus muscles are massaged.

Massage of the pectoralis major muscle. The fibers of the pectoralis major muscle have a dual direction: from the collarbone to the humerus and from the sternum to the humerus. The hand of the masseur slides on one side to the armpit, and on the other - from the sternum to the shoulder joint; the nipple is bypassed. The procedure uses stroking, kneading, squeezing, tapping, chopping techniques. It is more convenient to perform flat stroking with both hands in the form of separate stroking. The masseur's hands slide along the muscle fibers from the bottom up and in an arc to the shoulder joint. Spiral rubbing is performed with 4 fingers in the same direction; pincer-like kneading should be included in order to knead individual bundles of the entire muscle.

Massage of the anterior serratus muscle. The patient's initial position is lying on his side. The masseur places his hand on the lateral surface of the chest so that the base of the palm is located on the anterior axillary line, and the fingers of the hand are directed towards the shoulder blade. The movements are performed in an oblique direction upward, towards the shoulder blade, and cover the area between the 2nd and 9th ribs.

The following techniques are used:

• alternate rubbing with four fingers;
• stroking;
• tong-like kneading;
• stroking;
• pat;
• stroking.

Massage of the intercostal muscles is performed in the same initial position of the patient. The following techniques are used in the procedure: stroking (performed with the pad of the thumb or middle finger, the movements are directed from front to back - from the sternum to the spine), spiral or longitudinal rubbing (with the pad of the middle finger), stroking, alternating pressure (with the pads of the middle and index fingers), stroking, vibration.

In addition, when intercostal nerves are affected, massage is performed at the exit points of the intercostal nerve branches. These points are located along the paravertebral lines, along the middle axillary and along the parasternal lines. At the exit points of these nerves, massage is performed using the same technique as when massaging the exit points of the trigeminal nerve branches: circular planar stable stroking (with the pad of the middle finger), circular stable rubbing, stroking, continuous pressing, stroking, vibration and stroking.

Methodological instructions.

1. During the massage of the neck area, the patient's condition should be constantly monitored (complaints, examination of the heart rate and respiration, blood pressure).
2. Manual intermittent vibration should not be performed in the area of the cervical vascular-nerve bundle, as this may cause the patient to experience increased headache, dizziness, nausea, and fainting.
3. When performing a massage of the sternocleidomastoid muscles, it should be remembered that the external jugular vein, covered only by the cutaneous muscle of the neck, and the internal jugular vein, descending along the inner edge of these muscles, are located on them.
4. It is known that in the back there are two opposite flows of lymphatic fluid - one flow goes from top to bottom, the other - from bottom to top. Based on this assumption, it is proposed to massage the back muscles in two different directions - from top to bottom and from bottom to top.
5. Vibration techniques should be performed at paravertebral points, in close proximity to the spine, at the exit point of the posterior branches of the nerves. It is recommended to perform vibration using the pad of the thumb, gradually moving it in the cranial direction.
6. Massage of the pectoralis major muscles is used only for men, and for women - according to special indications.
7. When performing massage techniques such as chopping or patting on the left side of the chest in the heart area, care must be taken.
8. In the interscapular region, intermittent manual vibration techniques should be performed with caution, especially in cases of cardiovascular diseases.
9. For individuals with increased fragility of blood vessels, kneading and manual intermittent vibration techniques must be performed without applying significant pressure to avoid causing subcutaneous hemorrhages.

Classical (therapeutic) massage techniques should be combined or supplemented with other types of massage.