Medical therapeutic massage. Therapeutic (classic) massage. Neck and trapezius muscle massage

Therapeutic massage includes almost all types and techniques of massage that affect the body for various therapeutic purposes. Currently, this procedure is an excellent tool for the treatment of many ailments and diseases. With its help, the body begins to restore normal activity. It is also used to speed up the recovery of the body after an illness, and to treat various diseases.

Depending on the nature of the disease, a certain classification can be distinguished. To date, there are such types of procedures as:

• For injuries and diseases of the musculoskeletal system
• For diseases of the digestive system
• For respiratory diseases

Depending on how the nature of a particular disease changes, the method of execution also changes. In diseases of the musculoskeletal system, a technique is performed for diseases of the spine and diseases of the joints. If you have problems with the organs of the digestive tract, a technique for massaging the stomach, intestines, etc. is performed. If the cardiovascular system is out of order, a technique is performed for heart diseases, hypertension, etc.

For a certain disease, its own massage technique is performed, which, in turn, depends on such factors as the specifics of the disease, the cause, the clinical form of manifestation and other reasons. That is why, for example, a back massage for osteochondrosis is distinguished by the specifics of performing a back massage for scoliosis.

In addition, it is necessary to take into account the fact that at different stages of the same disease, different methods are performed. Also, the treatment of the same disease will be different for everyone, as different organisms perceive the treatment in their own way.

Technique and methodology of execution includes:

1. Stroking
2. kneading
3. Squeezing
4. Vibration
5. Trituration

Depending on where the movements need to be carried out, on the nature of the disease and on the individual characteristics of the muscles, the selection of techniques is performed. The effectiveness of the procedure can be increased several times if you add to the basic techniques such types of massage as segmental.

With its help, the body recovers much faster after an illness.

The effect of therapeutic massage on the human body

With the correct execution of techniques, the choice of methods of execution and the correct dosage, like any other massage, this procedure has a beneficial effect on the body. During the procedure, the patient feels pleasant sensations of warmth, the general condition improves, and vitality increases.

With the help of this procedure, you can reduce nervous excitability, relieve tension. If the intensity of the techniques is increased, the action will work in the opposite direction. It is also possible to restore the reflexes lost by the patient, improve tissue trophism, etc. The functioning of the pathways is restored, the reflex connections of internal organs and blood vessels are improved.

The positive effect of massage is also noticed on the peripheral nervous system. Certain techniques can relieve pain, speed up the process of recovery and treatment after injuries.

Of course, external factors can also affect the positive result and effect of massage. The therapeutic effect is reduced if the patient is faced with noise, long queues, loud conversations, etc.

Undoubtedly, the procedure has a positive effect on the condition of the skin, subcutaneous tissue. Through the techniques performed, the skin is cleansed of keratinized particles, foreign microbes and particles. The work of the sebaceous and sweat glands is normalized. Under the influence of massage, the skin becomes firm, velvety, elastic, and the musculoskeletal tone increases.

The procedure also has a positive effect on the action of skin capillaries, a kind of opening of reserve capillaries occurs. The massaged area is better supplied with blood and enriched with oxygen. The overall circulation of the whole body is significantly improved.

Forms of therapeutic massage

The form of the impact of the procedure can be divided into general and particular. The general form is performed on all parts of the body, but with special attention to those parts and areas of the body that are associated with a specific disease. As a rule, a general massage lasts for less than 1 hour. Period of execution: every other day or in series, depending on what form the disease is.

A private form of the procedure is performed on specific parts of the body. It can be a leg, arm, hand, finger, joint, etc. The duration of the procedure depends on which organ is being massaged. The duration can vary from 3 to 30 minutes. The method of private massage is carried out according to the general method, only with special care and a large number of techniques.

Things to do before a session:

• The patient should take a position in which his joints and muscles are in a relaxed state.

• The patient's body should be covered with a sheet. Only the massaged parts of the body should remain open.

• Without special need, it is not necessary to change the position of the patient during the entire session.

• In the room where the session is to be held, it is necessary to create the necessary environment, i.e. exclude the presence of unauthorized persons, noise or bright light.

• Use pillows when necessary. For example, hand massage, back massage for curvature of the spine, etc.

Massage for bruises

With the help of this procedure, it is necessary to remove the general pain syndrome, improve the metabolism in the damaged area, accelerate the resorption of edema, activate muscle contractions, etc.

Main goals:

• Relieve pain
• Improve metabolism and blood circulation in the affected area

Basic tricks:

1. Alternate and spiral stroking
2. Ring and longitudinal kneading (performed in a gentle mode)
3. Light patting and spiral stroking
4. Longitudinal kneading, circular with two hands, circular with phalanges of bent fingers.
5. Stroking and patting.

High pressure massage

In this disease, this therapeutic therapy has a hypotensive effect. This effect is very useful and effective, especially in the early stages of the disease. The execution technique for arterial hypertension does not include intensive movements, having a deep effect on the tissues. In this case, the technique is aimed at relaxing the body and calming the central nervous system, which is directly related to pathological vasoconstriction in hypertension.

First, the neck and collar area is massaged, gradually moving to the back area. Each muscle is carefully and slowly worked out. The masseur uses techniques such as stroking, squeezing and kneading.

Contraindications

Before proceeding with the massage and physiotherapy exercises, it is necessary to take into account all contraindications. Namely:

• Acute inflammatory process
• Blood diseases
• Purulent processes
• Various skin diseases
• Phlebeurysm
• mental illness
• Acute allergic diseases

Possessing the skills of professional therapeutic massage, specialists bring modern medicine and everything connected with it to a higher level. With its help, you can not only solve a health problem, but also improve overall well-being and vitality.

Massage- this is a set of methods of mechanical dosed impact on the surface of the human body with hands or special devices (vibration, vacuum vibratory massager, ultrasonic, etc.).

The effect of massage on the body

Mechanisms of action:

1. neuro-reflex. Mechanical stimuli excite mechanoreceptors of the skin, muscles, joints, tendons. Mechanical energy is converted into a nerve impulse. Nervous excitation is sent along sensory pathways to the central nervous system, from where it is sent along efferent pathways to various organs and tissues, changing their functions;
2. humoral. Biologically active substances (histamine, acetylcholine) are formed in the skin, which are carried throughout the body with blood flow and participate in vasodilation and transmission of nerve impulses;
3. mechanical action at the point of direct impact: increased blood flow, lymph and tissue fluid (which facilitates the work of the heart), elimination of stagnation, increased metabolism and skin respiration.

Leather. Horny scales are removed, blood and lymph circulation improves, local skin temperature rises, metabolism improves, secretory function of the sebaceous and sweat glands, skin and muscle tone increases, the skin becomes smooth and elastic.

muscles. Blood circulation improves, oxygen supply and removal of metabolic products increase, muscle tone and elasticity increase, and contractility improves.

Ligament apparatus strengthens, increases its elasticity, improves joint mobility.

Types of massage

Forms of massage

1. General - massage the whole body.
2. Local - massage individual parts of the body.

Massotherapy

Therapeutic massage is widely used in medical institutions in combination with drug treatment (for the treatment of diseases of the internal organs, nervous system, surgical and gynecological diseases; for diseases of the ear, throat, nose, eyes, teeth and gums). After surgery, functional treatment and restoration of physical performance with the help of rehabilitation massage is carried out. This massage is usually carried out in combination with physical therapy, mechanotherapy and other methods. In case of diseases and injuries, massage is prescribed as early as possible to normalize blood flow, relieve pain, resolve edema, hematoma, tissue repair, and normalize metabolic processes. The first stage of such treatment is carried out in combination with cold, the second - with thermal procedures. Immediately after the injury, massage is done with ice. After a while, cold massage is alternated with warm. Cold acts on the injured part of the body as an anesthetic (reduces the sensitivity of nerve endings) and an anti-inflammatory agent. Usually, after ice massage, the mobility of the massaged joint improves, tissue swelling decreases. The massage is easy to perform. Ice is placed in a special ice pack or in a tight plastic bag. The zone of injury (or disease) is massaged with ice for 2-3 minutes, then the patient swims in the pool or performs simple physical exercises. This procedure is performed several times. Therapeutic massage for colds (bronchitis, pneumonia, etc.) in the first 2-5 days is carried out as a can massage, then percussion massage in combination with inhalations (medicines and oxygen). A warming massage is recommended at night.

1. Classical- does not take into account the reflex effect and is carried out in the area of ​​\u200b\u200bthe diseased organ or near it

2. Segmental reflex- affect the areas of reflected pain - dermatomes, the innervation of which is associated with certain segments of the spinal cord, in which sensitive cells are excited under the influence of nerve impulses coming through the sympathetic nerve fibers from the diseased organ. For example, in diseases of the liver and biliary tract, the sensitivity and tone of the trapezius muscle reflexively change. The collar zone (back surface of the neck, nape, shoulder girdle, upper back and chest) is connected with the segments of the spinal cord (D2-D4) and the cervical part of the autonomic nervous system, which has a connection with the autonomic centers of the brain. Massage of the collar zone changes the function of the central nervous system and normalizes body functions (metabolism, thermoregulation, etc.) in a reflex way. The lumbosacral zone (buttocks, lower abdomen and upper third of the anterior surface of the thighs) is innervated by the lower thoracic (D10-D12), lumbar and sacral segments. Massage of this area is used for pain in this area, injuries and vascular diseases of the lower extremities, violations of the hormonal function of the sex glands. They use classical massage techniques and modified in accordance with reflex changes. The main task of segmental massage is to relieve tension in the tissues of the affected areas. The massage therapist must know exactly the relevant segments.

Segmental innervation of internal organs

Massage movements are made in the direction of the Benningoff lines, which characterize the greatest resistance of individual skin areas to its stretching (Figure 1).

Figure 1. The location of the lines of greatest resistance to stretching of individual areas of the skin according to Benningoff. Front and back view.

3. dotted- affect biologically active points - BAP (projections of large nerves and blood vessels with a higher temperature and low electrical resistance) in order to reflex effects on various body functions, eliminate pain, reduce or increase muscle tone. As in acupuncture, apply:

• braking reception when relaxation and tranquility are needed. Press on the point and rotate clockwise, gradually increasing the pressure. Then the finger is “unscrewed” (counterclockwise movement), gradually reducing the pressure force. Repeat the reception 4-8 times for 2-4 minutes continuously, without lifting your finger from the point;
• exciting reception. A short strong screwing is performed with a sharp separation of the finger from the point. Repeat the movement 8-10 times for 40-60 seconds.

4. connective tissue- affect mainly the connective tissue, subcutaneous tissue. The method is based on the fact that in various diseases in the body segments that have a common innervation with the affected organs, there are areas of increased tension of the connective tissue - connective tissue cords. Their massage reflexively affects the entire autonomic nervous system, without affecting individual organs.

5. periosteal- massage areas of the periosteum (where the muscles are weakly expressed), which in some diseases change reflexively: they become denser and are accompanied by sharp pain, especially when pressed. Massage improves the trophism of bone tissue and internal organs “associated” with it.

Indications for therapeutic massage

1. Pain in the back, lower back, neck, headaches, various ailments.
2. Osteochondrosis, bruises, sprains of muscles, tendons and ligaments, fractures at all stages of healing, functional disorders after fracture and dislocation (joint stiffness, muscle changes, cicatricial tissue adhesions), arthritis in the subacute and chronic stages, curvature of the spine, flat feet, impaired posture.
3. Neuralgia and neuritis, radiculitis, paralysis, injuries of the nervous system, consequences of cerebrovascular accident.
4. Ischemic heart disease, hypertension, arterial hypotension, heart defects, diseases of the arteries and veins.
5. Chronic nonspecific lung diseases (emphysema, bronchial asthma in the interictal period, pneumosclerosis, chronic pneumonia, bronchitis, pleurisy).
6. Chronic gastritis, colitis, peptic ulcer of the stomach and duodenum (without exacerbation), chronic diseases of the liver and gallbladder, impaired motor function of the large intestine.
7. Diseases of the female and male genital organs: inflammatory - in the subacute and chronic stages, incorrect positions of the uterus, vagina, anatomical changes and functional disorders of the uterus and ovaries, pain in the sacrum, coccyx.
8. Metabolic disorders: diabetes, gout, obesity.

Contraindications for therapeutic massage

1. Acute febrile conditions.
2. Bleeding and tendency to it.
3. Diseases of the blood.
4. Purulent processes of any localization.
5. Various diseases of the skin, nails, hair.
6. Acute inflammation of the blood and lymphatic vessels, thrombosis, severe varicose veins.
7. Atherosclerosis of peripheral vessels and severe sclerosis of cerebral vessels.
8. Aneurysm of the aorta and heart.
9. Allergic diseases with skin rashes.
10. Chronic osteomyelitis.
11. Tumors.
12. Mental illness with excessive excitement.
13. Insufficiency of blood circulation of the 3rd degree.
14. During hyper- and hypotonic crises.
15. Acute myocardial ischemia.
16. Acute respiratory disease (ARI).
17. With a disorder of intestinal functions (nausea, vomiting, loose stools).
18. Active form of tuberculosis, syphilis.

Classical massage of the whole body or back can be performed for the purpose of treatment or as a preventive measure, and such a session provides the patient with emotional relaxation. However, only an experienced specialist can carry out such a procedure, otherwise significant harm can be done to human health through ignorance. With many spine-related diagnoses, this is an auxiliary therapeutic measure to speed up the recovery process. The technique of classical massage is designed so that after the first course passed, complaints disappear and relief comes.

What is classic massage

This is a set of measures by a professional massage therapist, aimed at working out the tissues and muscles of the body. With the correct implementation of the basic techniques, you can permanently get rid of pains of different localization, adhesions, increased swelling, while stimulating systemic blood circulation, and normalizing the process of regeneration of injured tissues.

With the help of the massage technique being implemented, many patients manage to increase vitality and performance, strengthen joints without the participation of conservative methods of treatment. If we talk about anti-cellulite procedures, with their help you can achieve the correction of excess weight, quietly and without much effort to get rid of extra pounds, sagging skin.

Indications

In diseases of the joints and severe pain in different areas of the spine, doctors strongly recommend mastering the basics of classical massage. With a mechanical effect on the alleged foci of pathology, a long period of remission can be achieved in other, no less dangerous diseases. The main indications for a classic session are presented below:

• violation of the systemic circulation of the body;
• congestion;
• migraine attacks;
• radiculitis;
• consequences of stretching tendons, ligaments, muscles;
• arthritis of different stages;
• paralysis;
• decreased motility of the large intestine;
• peptic ulcer;
• rehabilitation after fractures of limbs;
• metabolic disease;
• emotional upheaval, stress, increased fatigue.

What is included in a full body massage

Massage is carried out with the participation of individual techniques, according to medical indications. Improving tactics are aimed at eliminating increased muscle tension, relaxing and stretching the vertebrae, and achieving emotional balance. The movements should be unhurried, but intense, and the fingers should be rigid and focused on the focus of the pathology. The principle of the classic session is based on:

• pressure;
• rubbing;
• strokes;
• tingling;
• vibrations;
• kneading.

Kinds

Varieties of masseur movements completely depend on the final result. The technique is determined individually, based on the specific area of ​​the skin that was involved in the pathological process. Doctors distinguish the following official classification:

1. Performing hygienic massage provides health promotion, prevention of various diseases. More often the session is carried out in combination with hygienic gymnastics.
2. Being interested in sports massage, it is useful to know that a session can be training (with a deep effect on the muscles), restorative (in order to properly relax the muscle corset), and preventive (from the consequences of increased loads).
3. A treatment session effectively eliminates the symptoms of certain diseases, accelerates and prolongs the period of remission.
4. Cosmetic massage works on the patient's skin, maintaining its health and beauty, preventing premature aging, correcting a number of cosmetic imperfections. This includes an anti-cellulite procedure.

How to prepare the body for a massage

During the preparatory activities, patients should use massage oils, which must be applied to a previously cleaned and dried body. Such aromatic agents have a relaxing effect on the nervous system, have a therapeutic, preventive effect. Other self-preparation measures for the classic procedure are presented below:

1. When processing the face, the first step is to remove makeup, after which the skin is thoroughly cleaned and dried.
2. When working on the neck and collar zone, clean problem areas, avoid local reactions in the form of irritation.
3. To safely strengthen the pectoral muscles (especially in women), it is important to exclude the presence of tumors in the breast.
4. If this is a session after an injury or to strengthen blood vessels, you must first consult with highly specialized specialists for contraindications.
5. Relaxing massage is required to be carried out using aroma oils, which significantly improve the final result.

Massage technique

The benefits of such therapeutic and preventive procedures are obvious, the main thing is to strictly adhere to the chosen technique, not to overdo it with the intensity of exposure with brushes and fingers. Here are the basic rules during this procedure:

1. Before taking it, it is important to lie on your stomach and ensure complete relaxation of the muscles.
2. During the procedure, the lymphatic system (nodes) is prohibited to work out.
3. When working on individual zones of acute attacks of pain should not occur.
4. Massage should begin with large areas, which helps to quickly “put into operation” stagnant vessels.
5. The duration of the sessions is determined on a purely individual basis.

Basic techniques of classical massage

To strengthen the back, improve vascular permeability and increase elastic muscle tissue, it is important to know the basic secrets of classical massage, which, with special education, can be safely put into practice. Below is a set of simple movements that works every muscle in the body and justifies the cost of a massage.

Stroking

This is the first and last exercise of classical massage, which helps to relax the body as much as possible, to set it in the right way. Such a leisurely and even pleasant movement is equally recommended for adults and children, moreover, parents should perform it almost from the first days of a baby's life. First, it is recommended to work out the back, then go down to the lower limb, do not forget about the arms and neck.

Trituration

The massage therapist uses this exercise already in the middle of the session, it provides for the displacement of the skin without harm to health. These should be progressive manipulations with both hands in one direction and the other, while the patient feels an internal feeling of heat, the skin turns noticeably red. This kind of rubbing is necessary for young children aged 3-6 months, however, it is recommended to choose circular movements of moderate intensity.

kneading

This technique includes several manipulations at once. Among these are stretching, squeezing, squeezing and lifting tissues. Muscles begin to work productively, systemic blood circulation increases, congestion and visible edema disappear. Movements should be unhurried, classical kneading is allowed for children from the age of one, earlier - exclusively for medical reasons. With quick and sharp manipulations, tissues and blood vessels can be injured.

Vibration

This is the attraction of oscillatory movements to enhance the effectiveness of a classic massage. In this way, you can work out the muscles not only of the back, but of the whole body. The technique involves the massage therapist grabbing the upper layer of the epidermis or muscle with the fingertips. The classical procedure itself is not complicated, but very effective for patients of any age.

Subsequence

The performance of the classical procedure depends on the affected area. These are the valuable recommendations that a knowledgeable specialist gives, but at the same time he strongly does not recommend superficial self-treatment. So:

1. Foot massage should be carried out from the feet to the knees, from the knee joint to the intimate areas.
2. When working out the back, it is required to move from the sacrum to the neck, and along the lateral surfaces of the back - to the armpits.
3. The classic chest procedure is carried out from the sternum to the armpits (knots).
4. Massage of the pelvic, lumbar and sacral regions is carried out towards the inguinal lymph nodes.
5. The rectus abdominal muscles are supposed to be worked out from top to bottom, oblique ones - from bottom to top.

Atlas of professional massage Vitaly Alexandrovich Epifanov

Therapeutic (classic) massage

In therapeutic massage, 4 main massage techniques are used: stroking, rubbing, kneading, vibration. Each of them has auxiliary techniques, which, while maintaining the essence of the main movement, make it possible to achieve the greatest effect in relation to the features of the anatomical configuration of the massaged area (Table 1).

Table 1

Basic and auxiliary massage techniques (Verbov A.F.)

When conducting a massage, as you know, one technique is rarely used. According to the figurative expression of J. Dollinger, "massage techniques, like individual tones of music, never sound alone for a long time, but go one into another, merging into a chord." Therefore, in order to achieve a good result, it is necessary to alternately apply the main massage techniques or the main and some auxiliary techniques. All these techniques are performed alternately with one or two hands, or separately (successively). For example, the right hand performs a kneading technique, and the left hand strokes (Fig. 1). Such a combined use of massage techniques is called combined (Verbov A.F., Belaya N.A.).

Thus, when performing a massage, one should distinguish: basic, auxiliary and combined massage techniques.

Rice. one. Combined massage technique - kneading and stroking the back muscles

Massage techniques

Stroking

The massaging hand slides over the skin, pressing on it with varying force. Stroking directly acts on the skin, freeing it from the exfoliating cells of the upper layer, and thus improves the function of the sweat and sebaceous glands. As a result of the application of the technique, the temperature reaction of the skin is increased, the flow of blood and lymph in the vessels is accelerated, the effect on the receptor apparatus embedded in the skin is activated, and through it on the central nervous system. A particularly important result of stroking is a more enhanced outflow of lymph and venous blood (Scheme 1).

Scheme 1. physiological effect of stroking

The main stroking techniques - planar and embracing - are performed with one or two hands (with the whole brush).

Planar and embracing stroking can be:

a) superficial - the massaging hand makes a reception without effort;

b) deep - the massaging hand exerts more energetic pressure on the underlying tissues (the effect is enhanced if the pressure is produced by the supporting part of the hand - the wrist).

With planar stroking, the masseur's fingers are closed and are in the same plane with the massaged area.

With embracing stroking, the brush and fingers of the massage therapist, clasping the massaged area, tightly adjoin to it with the palmar surface. This technique is used on: a) large flat areas of the body (for example, on the abdomen, back, chest); b) areas of a rounded configuration (shoulder, forearm, thigh and lower leg), lateral surfaces of the body and buttocks.

Stroking in the neck area is performed from top to bottom; on the back surface - from the occipital region down and outward, along the upper edge of the trapezius muscle, through the zone of the acromioclavicular joints towards the supraclavicular and subclavian nodes. On the lateral - from the temporal regions and mastoid processes downward along the sternocleidomastoid muscle towards the supraclavicular and subclavian nodes. On the front surface - from the edge of the lower jaw and chin to the sternum, through the zone of the sternoclavicular joints in the direction of the supra- and subclavian and axillary lymph nodes.

Stroking in the area of ​​the body is carried out along the border of the lymphatic section of the superficial vessels of the body, which is the waist line. Lymphatic vessels lying on the anterior, lateral and posterior surfaces of the body, above the waist line, drain lymph to the subclavian and axillary lymph nodes. In this direction, massage lines follow to the axillary nodes. The parts of the body below the waist line are massaged towards the inguinal nodes, where the vessels draining the lymph are also directed.

On the upper limb, if you follow the direction of the lymphatic vessels, stroking the back and palmar surfaces of the phalanges of the fingers is performed perpendicular to their longitudinal axis. The lateral surfaces of the fingers are stroked longitudinally from the nail to the main phalanges. The back and palmar surfaces of the metacarpus and wrist are massaged towards the wrist joint. On the forearm massaged from the distal end in the direction of the ulnar lymph nodes. On the shoulder and shoulder girdle, stroking is performed towards the axillary and subclavian nodes.

On the lower limb, the fingers are massaged in a similar way. Stroking the back and plantar surfaces of the foot is carried out in the direction of the ankle joint. On the lower leg - to the popliteal nodes, on the thigh and in the pelvic region - to the inguinal lymph nodes.

Stroking is carried out in the form of continuous sliding along the massaged area or in the form of intermittent spasmodic rhythmic movements (L. A. Kunichev).

Continuous stroking is more conducive to the appearance of an inhibitory reaction of the central nervous system, since, firstly, it acts on a large surface of skin reception; secondly, the force of pressure sensation does not have sharp contrasts, but increases slowly, which causes a rapidly developing decrease in the excitability of tactile receptors - adaptation. Continuous stroking, according to A. F. Verbov, provides unloading of the lymphatic and circulatory network when it is full and boosts the lymph and blood flow during stasis, thus enhancing the drainage functions of the lymph and circulatory network.

Intermittent stroking in the form of energetic rhythmic movements has a stimulating effect on the central nervous system, which is expressed in increased local blood circulation in the tissues, improving the contractile function of the muscles.

Auxiliary stroking techniques are tong-shaped, rake-shaped, comb-shaped, cruciform stroking and ironing.

With forceps-like stroking, the massaged tissues are captured between fingers I and II–III (Fig. 2).

Rice. 2. Pincer-like stroking of the outer edge of the foot

Rice. four. Comb-like stroking of the plantar surface of the foot

Rice. 3. Rake-like stroking of the intercostal spaces (with weighting with another brush)

Rake-like stroking. Spread fingers (the thumb is opposed to the rest) are placed at an angle of 30–45 ° to the massaged area. Reception is carried out in the longitudinal, transverse, zigzag and circular directions. Rake-like stroking is performed with one or two hands. Massage with two hands is performed either simultaneously, when the hands move in parallel, or sequentially - in this case, one hand follows the other (Fig. 3).

Comb-like stroking is performed with the distal ends of the main phalanges of the fingers bent into a fist (Fig. 4).

Cruciform stroking is used mainly on the muscles of the limb. For its implementation, the hands are clasped with fingers crosswise into a lock and, clasping the massaged area, they simultaneously stroke the palmar surfaces of both hands (Fig. 5) Ironing is carried out with the back surfaces of the fingers bent at a right angle in the metacarpophalangeal joints (Fig. 6 ). Reception has a calming effect.

Rice. 5. Cross-shaped stroking: a) the outer surface of the shoulder; b) back of the thigh

Rice. 6. Ironing the plantar surface of the foot

Guidelines

1. The direction of the massage therapist's hand always corresponds to the anatomical and topographic course of the lymphatic vessels, since the main task of the reception is to promote the outflow of lymph.

2. Due to the fact that the lymph moves slowly through the vessels (on average, its speed is 4 mm per second), stroking is performed calmly, rhythmically, not quickly. Without interruption anywhere, stroking should reach the nearest lymph nodes (for example, for the upper limbs - to the axillary, for the lower - to the inguinal, etc.).

3. The pressure of the massaging hand in the initial part of the segment of the massaged part of the body should progressively increase, reach a maximum in the middle of it and gradually weaken towards the end of stroking.

4. Complete emptying of the lymphatic vessels occurs only with simultaneous stroking of large and small lymphatic tracts, so it is necessary that the massaging surfaces of the hands fit snugly against the skin.

5. The masseur's hands should not stick to the massaged area, but slide over it easily and freely.

6. Stroking begins and ends the massage. Stroking the muscle should start from the distal end or from the tendon (from the site more distant from the body) and go to the proximal end, i.e., closest to the body.

7. Stroking serves as a preparatory massage for edema and in cases where the massaged area of ​​the body is painful. Massage in the early days is reduced exclusively to one circular concentric strokes. An approximate massage plan: for example, with swelling of the foot, the muscles of the thigh, lower leg, and then the foot are massaged first. Outside the painful area, the stroking hand produces a stronger pressure, and the superficial stroking turns into a deep one. This method of administration promotes the outflow of blood from the painful area, improves venous and lymphatic circulation in its central part.

ATTENTION!

Stroking and kneading when applied in the area of ​​painful sensations (for example, in the area of ​​affected joints) constitute the so-called "suction" massage.

8. In the “suction” massage, in case of damage to the joints, moderately strong strokes performed with one or two hands are performed from the periphery to the center. With a preliminary massage, stroking palms clasp the limb above the affected area and exert pressure on it, mainly with the radial edge of the palm.

9. With exudates or inflammatory reactions in the area of ​​the affected joint, stroking begins at the border of the spread of exudate, after which they proceed to massaging the affected area.

Trituration

Trituration consists in the movement, displacement or stretching of tissues in various directions. The hand of the massage therapist with translational rectilinear or circular movements forms a skin fold in front of him in the form of a roller.

Rubbing techniques have a pronounced calming effect on the central nervous system. Rubbing promotes faster resorption of effusions that accumulate in the joints, enhance local blood circulation, etc. (Scheme 2).

Scheme 2. physiological effect of rubbing

The main rubbing techniques: rubbing with fingers, rubbing with the elbow edge of the palm, rubbing with the supporting part of the hand (Fig. 7 a, b).

Rubbing with one finger is used on small surfaces - in the area of ​​\u200b\u200bthe fingers, in places where nerves exit, when exposed to trigger points, in the area of ​​​​articular bags.

Rubbing with fingers, palm or its supporting surface is performed in cases where it is necessary to exert a more energetic effect on tissues

Rubbing is done with one hand or both hands; rubbing with both hands can be done: a) separately - both hands simultaneously move in parallel in opposite directions; b) together - by laying one brush on the other (“burdened brush”).

Rubbing can be performed: a) longitudinally or transversely (carried out on small surfaces); b) circularly (like a gimlet) - the technique is used on small surfaces, as well as in the area of ​​\u200b\u200bthe joints; zigzag or spiral - the technique is used on large surfaces (muscles of the thigh, abdomen, back), as well as with partial maceration of the skin. Thanks to the use of this technique, such places can be easily bypassed.

Rice. 7. Rubbing techniques: a) circular rubbing with the fingertips of the knee joint area; b) rubbing the area of ​​the knee joint with the ulnar edge of the hand

Auxiliary rubbing techniques: hatching, planing, rake-like and comb-like rubbing, sawing and crossing, tong-shaped rubbing.

Hatching is performed with fingertips (I–III) individually or together (II and III). The patient's hand lies on the palmar surface of one hand of the massage therapist (Fig. 8). Avoiding sliding on the surface of the skin and pressing deeply, the fingers with short rectilinear translational movements, as if undercutting and shading, displace the underlying tissues in different directions, while achieving an increase in their elasticity. This technique can have both a stimulating and a sedative effect.

Rice. eight. Shading of soft tissues of the dorsum of the hand

Planing is performed with one or two hands, in the latter case, massaging movements are performed separately-sequentially, that is, one hand follows the other (techniques resemble planing). The masseur with straight fingers plunges into the tissues with short translational movements and, with quick pressure, stretches and displaces them (Fig. 9).

Rice. 9. Planing of soft tissues of the anterior surface of the thigh

Planing has an exciting effect on the neuromuscular system, so this technique is recommended for stimulating and increasing muscle tone.

Rake-like rubbing is performed with circular, zigzag and dashed movements with the pads of widely spaced fingers or the back surfaces of the nail phalanges (Fig. 10).

Rice. ten. Rake-like rubbing of the soft tissues of the back

Comb-like rubbing is carried out with the distal sections of the main phalanges of the fingers of a hand clenched into a fist (Fig. 11).

Rice. eleven. Comb-like rubbing of the muscles of the back

Sawing is a technique in which the rubbing of tissues is carried out with the ulnar edge of one or both brushes (Fig. 12). When sawing between the hands, a roller of massaged tissues should be formed. When rubbing, the brushes should displace the roller and the underlying tissues, avoiding sliding over the skin surface.

Rice. 12. Sawing supraclavicular areas of the trapezius muscle

Rice. 13. Transection of the soft tissues of the shoulder joint

Crossing is carried out with the radial edge of the hand with the thumb retracted (Fig. 13). When performing the reception with one hand, the hand, pressing with the radial edge, produces a deep displacement of the underlying tissues, with short rhythmic movements away from itself - in the direction of the index finger and towards itself - in the direction of the thumb. When crossing with two hands, the massage therapist's hands, facing each other with their back surfaces, produce deep displacements of the underlying tissues transversely from themselves and towards themselves.

Guidelines

1. When rubbing, the direction of the massage therapist's hands is not determined by the direction of the lymphatic pathways. Rubbing itself in most cases is performed on a limited area of ​​the skin surface and can be performed not only along the vessels, but also against the flow of lymph and blood.

2. Rubbing is the main technique in all pathological cases when it is required to enhance the local outflow of decay products. Therefore, it is most often used for damage to the locomotor apparatus. In addition, rubbing together with passive and active movements is the only technique that positively affects the mobility and elasticity of the articular apparatus.

3. Despite the apparent diversity, all rubbing techniques are reduced to straight, spiral and circular rubbing, in which individual fingers or all fingers together participate as necessary.

4. The fundamental difference between rubbing and stroking is that when rubbing, movements are made both in the direction of the flow of the contents of the discharge vessels, and against it.

5. When performing rubbing techniques, a significant centripetal force of pressure is applied, which often causes damage (!), traumatizes the skin. Therefore, the masseur requires great care when rubbing.

6. The pressure force during rubbing increases continuously when the fingers deviate from the horizontal and move to a perpendicular position. This force of pressure increases even more when burdening one hand with the other.

ATTENTION!

When rubbing sedentary scars soldered to the underlying tissues, lubricants should be avoided.

7. The effectiveness of rubbing the joints in sports practice increases when the reception is carried out in a hot water bath. This technique is an excellent preventive measure that prevents the formation of various effusions in the joints after minor injuries (Sarkizov-Serazini I.M.; Biryukov A.A.; Vasilyeva V.E.).

8. Vigorous rubbing in painful areas reduces hyperexcitability, improves local blood circulation and tissue trophism.

9. In addition to thorough rubbing of the joints, rubbing is used in medical practice throughout the body or in its extensive areas (muscles of the thigh, back, etc.). The most common rubbing techniques in such cases are as follows:

a) along the massaged area is the masseur's hand with fingers forward; it rests on the base of the palm and on the thumb, the remaining four fingers with the pads of their phalanges perform large circular movements and move forward. With this movement, the skin in the form of a roller is displaced in front of the fingers, which rolls in a given direction;

b) the technique is used when massaging the muscles of the lower leg and upper limbs. The masseur with the inner edge of the palm from the side of the index and thumb grabs the massaged part, lifts it up, perpendicular to the massaged part; the palm, together with the other three fingers, moves straight or spiral forward, pressing against the skin.

kneading

The massaged muscle is captured, lifted and pulled, squeezed and, as it were, squeezed out. This technique, performed intensively, helps to increase the mobility of the tendons, stretch the shortened fascia and aponeuroses, improve blood and lymph circulation. The latter leads to enhanced nutrition of muscle groups and rapid resorption of metabolic products. This process also occurs because the muscle bundles are between the fingers of the massage therapist squeezing them, which help to remove decay products from the muscle bundles. During kneading, especially deep kneading, which affects not only the muscles, but also the tendons and joint bags, there are those numerous efferent impulses coming from the proprio- and exteroceptors, which have a stimulating effect on the nervous system to varying degrees (Scheme 3).

Kneading is usually considered as passive gymnastics for muscle fibers. Kneading not only strengthens muscles, but also promotes regenerative (restorative) processes.

Basic stretching techniques: continuous or intermittent grasping, lifting (pulling) and squeezing of tissues; capture and alternate compression of tissues; squeezing and chafing of tissues; shearing or stretching of tissues.

Scheme 3. The physiological effect of kneading

Continuous kneading, depending on the indications, can be performed in the longitudinal, transverse and spiral directions.

Technique for performing reception in the longitudinal direction. When kneading with both hands, the reception is carried out as follows: both hands are applied with a palmar surface, for example, to the thigh area in such a way that the thumbs are located on one side and the rest on the other side of the muscle group. Then, with fingers, capturing as deeply as possible all the tissues on both sides of the thigh, starting from its distal end, they squeeze and gradually squeeze them out, continuing translational movements in the centripetal direction. Longitudinal kneading with one hand uses the same technique. Reception is most often used in the massage of the limbs (Fig. 14).

Rice. fourteen. Circular kneading with the pads of the thumbs

Technique for performing reception in the transverse direction. The massage therapist's hands are located transversely with respect to the length of the segment, cover with all fingers (as deep as possible) the underlying tissues in a somewhat oblique direction so that the thumbs are on one side, and all the rest on the other. The captured tissues are pulled with the right hand, squeezed and squeezed in the direction away from themselves, and with the left hand - towards themselves; then, without moving his hands, the massage therapist performs the same movements, but in the opposite direction: with his right hand he pulls, squeezes and squeezes the tissues towards himself, and with his left hand - away from himself. Gradually moving along the length of the massaged segment, the masseur produces the same two-phase helical movement each time. The technique is used when massaging the muscles of the limbs, back and abdomen (Fig. 15).

Rice. fifteen. Continuous kneading in the transverse direction of the triceps muscle of the shoulder

Technique for performing reception in a spiral direction. The hands of the massage therapist are located longitudinally or transversely with respect to the length of the segment. Without looking up from the massaged area, they produce spiral movements, while both hands should not touch each other. In the same way, semicircular kneading is performed. The technique is used on large surfaces in cases where it is necessary to spare the skin, bypass its individual areas.

Intermittent stretching. The execution technique is the same as with continuous kneading, except that the movement of the hands is performed spasmodically and rhythmically.

Auxiliary techniques: tong-like technique, felting, rolling, shifting, twitching, stretching, compression, pressure.

Forceps reception (squeezing). The massaged tissues are captured as deeply as possible, pulled up and then, as it were, passed between the thumb and forefinger or between the thumb and the remaining four fingers. Reception can be performed with one or both hands (Fig. 16).

Rice. 16. Forcep reception

Felting is a relatively gentle type of soft tissue kneading. One hand of the massage therapist lies on the outer part of the thigh, the other - on the inside. With a continuous movement of the hands, we roll the quadriceps femoris muscle from the outside to the inside (and vice versa), moving forward. The massaged tissues are subjected to compression and rubbing between the palms of the massage therapist's hands, moving in opposite directions (Fig. 17).

Rice. 17. felting technique

rolling

The left hand with the elbow edge of the massage therapist's hand is immersed in the thickness of the abdominal wall (as deep as possible); at this time, the right hand, grabbing soft tissues (skin, subcutaneous tissue), rolls them onto the left palm and then kneads them in a circular motion. The reception can also be performed with fingers folded into a fist (left hand), in this case, the reception is carried out with the right hand (Fig. 18).

Rice. eighteen. Roll reception

shift

With the thumbs, they lift and grab the underlying tissues into the fold, then with rhythmic movements they shift the fold to the side (Fig. 19).

Rice. 19. Shift reception

ATTENTION!

If the tissues are not lifted, not captured, then they are shifted on the surface with the pads of all fingers (in some cases, it is possible with the palms), depending on the anatomical features of the massaged area, in the direction most favorable for tissue displacement.

Reception is indicated for massaging the muscles of the back, short muscles (for example, the back of the foot, hands), with cicatricial adhesions (in order to mobilize tissues, release them from their adhesions).

stretching

The thumbs of both hands are placed against each other at the site of the scar or adhesion and alternately stretch the scar tissue. Reception can also be performed with two fingers - thumb and forefinger or all fingers (Fig. 20).

ATTENTION!

The use of this technique also eliminates the use of lubricants to prevent slipping of the fingers.

Rice. twenty. Stretch technique

Compression

The base of the brush captures the skin or deeper tissues and squeezes or squeezes the tissues with transverse movements. Massage movements are reminiscent of squeezing a bone out of a berry. Reception is recommended during facial massage in order to improve elasticity and improve skin nutrition (Fig. 21).

Rice. 21. Compression reception

pressure

The thumb and forefinger or the palmar surface of the last four fingers perform intermittent pressure on the skin or deep-lying tissues. Reception is shown when massaging the face (Fig. 22).

Rice. 22. pressure reception

Guidelines

Kneadings are those basic massage techniques that are designed for superficial and deep-lying muscle masses. Kneading, like no other massage technique, has a significant effect on large lymphatic and blood vessels and thereby enhances tissue nutrition.

1. Kneading is a passive gymnastics for the muscles, which is especially important for muscle hypotension, their poor performance, cicatricial adhesions.

2. Kneading is carried out at a slow pace, while sharp jerky movements, jerking and twisting of the muscles are not allowed.

3. When kneading individual muscle bundles, massage begins from the areas of transition of muscles into tendons, since metabolic products accumulate in the tendon sheaths, and inflammatory conditions of various origins are delayed for a long time.

4. You should start with light and superficial kneading, and only after several procedures (after tissue adaptation) move on to more vigorous and deep kneading.

5. After kneading, stroking must necessarily follow.

Vibration

The essence of vibration massage consists in the transfer of oscillatory movements to the massaged part of the body, performed at different speeds, frequencies and amplitudes, with the help of special equipment or with the hands of a massage therapist.

Depending on the place of application and the nature of the irritation, vibration causes distant reactions such as skin-visceral, motor-visceral and, in some cases, viscerovisceral reflexes (Mogendovich M. R.). At a certain frequency, vibration can have a pronounced analgesic and even anesthetic effect (Kreimer A. Ya.), improves the contractile function of muscles, as well as tissue trophism (Shcherbak A. E.). Under the influence of vibration, the excitability of the neuromuscular apparatus of the heart, as well as vascular tone, can decrease, blood pressure decreases, the rhythm of cardiac activity increases, motor and secretory activity of the stomach increases, as well as intestinal motility, regenerative processes become more active, significantly reducing, for example, the time of bone formation. calluses at fractures (Verbov A.F.), see Scheme 4.

Scheme 4. physiological effect of vibration

There are two types of vibration: continuous (continuous oscillatory movements) and intermittent (single rhythmic beats).

Continuous vibration. The masseur's hand, without breaking away from the massaged part of the body, produces various oscillatory movements, which must be performed strictly rhythmically. Vibration can be carried out: a) stably - in one place or b) labile - along the entire massaged surface (Fig. 23).

Rice. 23. Continuous vibration

Reception can be performed in the form of planar and embracing stroking or rubbing:

a) palmar surface of the terminal phalanx of one finger (point vibration);

b) the palmar surface of two fingers (thumb and index) or three fingers (index, middle and ring) and, finally, the thumb and the remaining four fingers;

c) palm (supporting surface), fist.

Vibratory movements with one or both hands can be carried out: a) longitudinally or transversely; b) zigzag or spiral.

Intermittent vibration. The massage therapist's hand, in contact with the massaged part of the body, moves away from it each time, as a result of which the vibrational movements become intermittent and take on the character of separate, successive shocks.

Vibration can be used in the form of chopping, patting, tapping, i.e. techniques that are, in essence, variants of the main massage technique - vibration.

Intermittent vibration can be performed in the same way as continuous vibration.

shaking

shaking (a kind of concussion) are used on large surfaces of large muscle groups (on the calf muscles, muscles of the thigh, shoulder and forearm, etc.). Shaking is always combined with kneading. It is recommended in the so-called restorative massage.

Shaking of the calf muscles. The massaged leg is lifted by the massage therapist's hand up. Complete relaxation of the entire muscle is required. The other hand grabs the muscle with the thumb and little finger, and the massage therapist makes quick shaking, spiraling movements.

Rice. 24. Shaking technique

Shaking of the anterior region of the thigh. The patient sits in a comfortable position with arms extended back. The masseur slightly turns the knee with one hand, and shakes it with the other (Fig. 24).

shaking

Shaking: a) upper limbs. The masseur takes the patient's hand with his fingers, slightly attracts his entire hand to himself and, with slow oscillatory movements, then takes it to the side, then returns it to its original position. It is necessary to ensure that the arm remains straight;

b) lower limbs. One hand of the masseur wraps around the leg from the side of the calcaneal tendon, the other is located on the back of the foot. The masseur draws the leg towards him and carries out small shaking movements, then retracting, then bringing the leg. The leg should remain straight (Fig. 25).

Rice. 25. shake reception

Guidelines

1. If continuous vibration is incorrectly performed, especially with prolonged use of this technique, pain, spasm of muscle groups, sensory disturbances and other disorders may occur.

2. To master the reception of continuous vibration, the following exercise is recommended: placing your fingers on the surface of the table, in the center of which there is a glass filled with water, then produce continuous oscillatory movements. With the correct mastering of the reception, the surface of the water in the glass remains almost motionless (only in the center there is a slight oscillation).

3. When performing continuous vibration, the strength of oscillatory movements depends on the angle of inclination of the massage therapist's fingers in relation to the massaged surface. The greater the angle of inclination of the fingers to the massaged surface approaches 90 °, the deeper and more energetic the effect on the tissues, and, conversely, the smaller the angle, the more superficial and softer the vibration effect.

4. When performing intermittent vibration (methods of chopping, patting), the strength, softness and elasticity of the impact depend on the following points:

a) the number of bone levers (segments of the limbs) involved during the performance of this massage technique; the more bone levers, the more muscle groups surrounding these levers are involved in the movement. If necessary, make a light blow, one small bone lever should be used - a brush; with a more energetic blow, two bone levers are introduced - the hand and forearm; with an even stronger blow - all three levers of the hand: hand-forearm-shoulder, that is, the massage technique is carried out with the whole hand;

b) the degree of tension of the wrist joint. The more tense the wrist joint of the massage therapist's hand, the rougher and harder the blow occurs with intermittent vibration. The more relaxed the wrist joint, the softer, more gentle the blow;

c) the degree of closing of the fingers of the hand. With closed fingers, the blow is sharp, strong, hard; when the fingers are spread apart, the blow becomes light and elastic. Impact softening occurs due to the springiness of the spread fingers and the air cushion formed between the spread fingers during impact;

d) the degree of flexion of the fingers. The more bent and spread the fingers of the hand, the softer, more gentle the blow, and, conversely, the less flexed and more bent the fingers of the hand, the harder and stronger the blow. With bent and spread fingers, an air cushion is formed, which softens the blow;

e) the direction of impact can be vertical or vertical, oblique or inclined in relation to the massaged surface.

The vertical or vertical direction of impact is used to influence deep-lying tissues in an area where there are few soft tissues (for example, the face area).

Vertical blows are applied with fingertips; in the same place where there are more soft tissues, they are produced with the back of the fingers or the ulnar side of the palm.

An oblique or oblique direction of impact is applied to superficially lying tissues.

Oblique blows, irritating the skin, cause the rapid occurrence of capillary hyperemia of the skin.

Intermittent vibration in the form of chopping, patting should not be energetic in places where the tissues are adjacent to the bones, especially in the elderly, as well as in obese persons, since their tissues are highly sensitive (Verbov A.F.).

For the successful implementation of massage procedures, the massage therapist must clearly represent the state of the massaged tissues and the features of massage techniques. On fig. 26 shows a diagram of the impact of various massage techniques on the tissues and organs of the patient (Dubrovsky V.I.).

Rice. 26. Schematic representation of the depth of the impact of various massage techniques on human tissues and organs (Dubrovsky V.I.): 1 -bone; 2 - ligament innervation; 3 - joint; 4 - innervation of the organ; 5 - organ; 6 - muscle innervation; 7 - muscle; 8 - aponeurosis; 9 - vascular innervation; 10 - cerebrospinal nerve; subcutaneous adipose tissue; 11 - blood vessels; 12 - skin innervation; 13 - fat lobules; 14 - germ layer; 15 - epidermis

The direction of the main massage movements

Rice. 27. The main directions of massage movements: a) on the upper limbs; b) on the lower limbs; in) in the back, waist, pelvis and neck; G) in the chest and abdomen

The position of the patient and the massage therapist during the massage procedure is presented in Table. 2.

table 2

The position of the patient and the massage therapist during the massage procedure (according to E. A. Zakharova, supplemented by N. A. Belaya)

Physical exercises combined with massage techniques

Physical exercises have a tonic (stimulating), trophic, compensatory and normalizing effect on the body.

Physical exercises affect the function of the joint, the adhesions that form in the periarticular tissues and limit its mobility, increased or decreased muscle tone, spasm of muscle groups, reducing them, accelerate blood circulation in the muscles, thereby improving tissue trophism.

In medical practice, the following exercises (movements) are most often used:

Dynamic exercises - exercises in which the muscle works in isotonic mode; in this case, periods of contraction alternate with periods of relaxation, i.e., the joints of the limbs and trunk are set in motion. Muscle tension during exercise isotonic exercises can be dosed using a lever, changing the speed of movement of the moved body segment and using additional weights. An example of a dynamic exercise is flexion and extension of the arm in the elbow joint, abduction and adduction of the straight arm in the shoulder joint, torso tilts back and forth and to the sides, etc .;

Static exercises - muscle contraction, in which it develops tension, but does not change its length, is called isometric. For example, if a patient from the starting position (ip) lying on his back lifts his straight leg up and holds it for some time (3-5 seconds), then he first performs a dynamic movement (raising the leg), and then a static hold, when the hip flexors produce isometric tension;

Active exercises can be performed by the patient himself under facilitated conditions, i.e., with the elimination of friction, gravity, etc.;

Passive-active exercises - exercises in which the patient helps the massage therapist to perform passive movements;

Passive movements - they can be performed by a massage therapist or the patient himself (for example, with the help of healthy limbs or under the influence of gravity); passive movements are used to stimulate the recovery of movements and prevent stiffness in the joints (for example, after injuries of the musculoskeletal system, paresis and paralysis, etc.);

Stretching exercises are used in the form of various movements that cause a slight excess of their inherent passive mobility in the joints. The therapeutic effect of these exercises is used for contractures and stiffness of the joints, a decrease in the elasticity of periarticular tissues, an excessive increase in muscle tone, to restore lost mobility in the joint due to disease or damage. The intensity of the exercises depends on the active tension of the muscles that produce stretching, the inertia force during swing movements (maximum amplitude), specially selected IP;

Movements with dosed resistance. There are two positions: a) the patient makes a movement, and the massage therapist resists with his hand; b) the patient resists, and the massage therapist performs the movement;

Exercises in active relaxation of various muscle groups can be applied to individual segments of the body (hand, foot), limbs as a whole, limbs and torso at the same time. They contribute to the normalization of increased tone in various manifestations of pathology (pain contractures, spastic paresis, etc.) and improve overall coordination of movements. Relaxation exercises can be divided into:

Exercises in relaxation of individual muscle groups at rest in I.P. sitting and lying;

Exercises in relaxation of individual muscle groups or muscles of individual segments of the body after their isometric tension or after performing isotonic work;

Exercises in relaxation of individual muscle groups or muscles of individual segments of the body in combination with active movements carried out by other muscles;

Exercises in relaxing the muscles of individual segments of the body, combined with passive movements in the same segments;

Exercises in relaxing all the muscles at rest in the I.P. lying down (exercises in muscle relaxation);

Breathing exercises - exercises during which the components of the respiratory act are regulated arbitrarily (by verbal instructions or by command). Respiratory exercises have an inhibitory and less often activating effect on cortical processes, improve blood circulation, and reduce increased (after the use of other physical factors) vegetative functions. Breathing exercises are divided into dynamic and static:

Static breathing exercises - exercises that are not combined with the movements of the limbs and torso;

Dynamic breathing exercises - exercises in which breathing is combined with various movements of the limbs or torso.