Massage for diseases of the cardiovascular system is used for myocardial dystrophy, weakening of the contractile function of the heart muscle, heart defects. after myocardial infarction, with hypertension, hypotension, angina without an attack and with various peripheral vascular diseases. The purpose of massage for these diseases is to improve the nutrition of the heart muscle, increase its tone. facilitate the work of the heart, eliminate congestion in the systemic and pulmonary circulation, promote the development of collateral circulation. In case of chronic insufficiency of the heart muscle caused by various diseases, a back massage is used, and then a massage of the arms and legs - stroking, rubbing and carefully - chopping and patting.
E. A. Morozova. Medical, therapeutic and cosmetic massage
Massage for diseases of the cardiovascular system
Massage in the complex of therapeutic measures for diseases of the cardiovascular system improves the regulatory capabilities of the body, indicators of vascular circulation and cardiac activity itself.
Usually, a massage of the back, collar zone, and sometimes, according to indications, a massage of the upper and lower extremities is prescribed.
The peculiarity of massage in diseases of the cardiovascular system lies in the slow pace and rhythmic movements with the patient in a semi-sitting position.
With functional neuroses - planar circular stroking, rubbing the left half of the chest, light vibration, kneading from the top of the heart to the base, very light. The movements are slow and rhythmic, light vibration can be applied.
With angina pectoris, the patient's position is sitting - light stroking, rubbing, kneading longitudinally and transversely, gentle patting, stroking and slight shaking of the chest. It is necessary to start the massage from the back - the trapezius muscle, the back of the neck, the sternocleidomastoid muscle, the intercostal muscles and the interscapular muscles with the transition to the region of the heart, pectoral muscles, left shoulder, joints, inner surface of the forearm from the side of the little finger. Stroking, rubbing, kneading, tapping, light chopping in area VII are used. cervical vertebra and slight rhythmic vibration. Finish the massage with a wide, slow, rhythmic stroke. With weakness of cardiac activity - patting in the area of \u200b\u200bthe heart and shoulder blades, concussion of the chest with respiratory movements.
Massage for rheumatic heart disease
Massage is prescribed in the absence of concomitant inflammatory processes. The back, chest, intercostal muscles, heart area, sternum, left costal arch, upper and lower limbs are massaged. Stroking, rubbing, kneading (longitudinal and transverse), patting, concussion of the chest with respiratory movements are used.
When massaging the area of the heart and sternum - stroking is superficial and deep, rubbing, kneading the pectoral muscles, continuous vibration, patting in the area of \u200b\u200bthe heart, stroking from the sternum to the spine, squeezing and stretching the chest with inhalation and exhalation.
The lower and upper limbs are massaged with wide strokes, using all techniques.
For a course of treatment 12 procedures for 20 minutes.
Massage for chronic coronary heart disease
With chronic coronary disease heart massage combined with therapeutic gymnastics eliminates congestion, improves coronary circulation, accelerates metabolic processes, including redox processes in muscles, has a beneficial effect on the patient's psyche, activates the patient for physical and mental labor.
Massage is prescribed in the absence of pain in the region of the heart, shortness of breath, arrhythmias at rest, with normal blood pressure.
We start the massage from the feet. We stroke the feet, lower leg, joints towards the inguinal region, gently, circular rubbing of the back surface of the feet alternate with stroking; shallow kneading of the lower leg, felting, longitudinal kneading alternate with stroking and passive, then active movements, with the transition (according to indications) to the buttocks, back. On the back, massage the trapezius muscle. We stroke, rub with the capture of the latissimus dorsi muscle, interscapular region, intercostal muscles to the back of the head; rake-like rubbing from the sternum to the spine; kneading the pectoralis major muscle and the left shoulder, slight vibration in the region of the heart, hands - with common strokes, stroking, rubbing, kneading from the little finger to the shoulder joint. Stroke the chest again.
For a course of 12-15 procedures for 20 minutes every day.
Massage for hypertension stages I-IIA
We massage the head, neck, collar zone while sitting, attention to the IV cervical and II thoracic vertebrae. Movement from top to bottom, rhythmically, of medium strength.
Head - light massage using the usual technique, emphasis on the occiput - rake-like stroking, circular rubbing, shifting and stretching of the scalp.
Then we move on to the neck. Flat forceps-like stroking with the transition to the sternocleidomastoid muscles, forceps-like kneading with the transition to the collar zone. If the blood pressure is high, massage the abdomen while lying down, because the pressure may drop sharply.
The course of treatment is 12-15 procedures for 15 minutes every day.
Massage for hypotension
Unlike massage for hypertension, with hypotension, the basis of the technique is movements from the bottom up: massage of the gluteal muscles and iliac crests, concussion of the pelvis, massage of the lower extremities with an emphasis on the calf muscles. Hypotonic disease is often accompanied by intestinal atony - in this case, bowel massage is also done. The technique ends with a massage of the collar zone.
Massage starts from the underlying areas to the overlying. Sacrum, buttocks and iliac bones - planar, embracing stroking. Circular rubbing of the buttocks (you can use your fist or elbow). Hatching, sawing, crossing, longitudinal kneading of the lumbar region, transverse - the anterior wall of the abdomen, vibration stroking, patting and shaking the pelvis.
Massage the lower limbs in stages, first the back part, then turning the patient on his back, and the front part. Planar encircling stroking of the lower leg and thigh, circular rubbing, planing, sawing, longitudinal and transverse kneading. Vibration, felting, patting, chopping, shaking limbs passive and active movements.
We mentally divide the stomach from the navel in half with a horizontal line. During the massage, we pull the upper part of the abdomen to the armpits, the lower one to the groin. Planar shallow stroking to the armpits, rubbing, shading, kneading the longitudinal and transverse of the anterior abdominal wall, rolling. With intestinal atony, pushing, horizontal and vertical shaking of the abdomen.
The collar zone is massaged in the usual way, only movements (in the direction and increase in effort) should be directed from the bottom up.
The course of treatment is 15 procedures for 20 minutes, it is good to combine with exercise therapy and balneotherapy.
Massage for obliterating endarteritis
Massage is done at the initial stage of the disease and in the absence of signs of thrombophlebitis and the threat of a blood clot. According to the same technique, massage is performed for varicose veins of the lower extremities with trophic changes in the skin, angiospasms, and atherosclerosis of the vessels of the extremities.
Methodology. The sequence and techniques used are almost common for limb massage. When massaging the lower extremities, one should begin with the lumbosacral region, then the buttocks, iliac tubercles, then fingers, soles, joints, lower leg, thigh. Massage is carried out with an elevated position of the limb.
When massaging the upper limbs - sternocleidomastoid muscles, back muscles, interscapular region, shoulder joint and hand, fingers, joints, forearm and shoulder. All techniques are used in massage.
Attention!
Bypass venous nodes, do not massage!
For a course of treatment 10-12 procedures for 15-20 minutes daily.
The History of Massage - In both India and China, massage was performed by priests. In addition, schools were established in these countries that taught massage techniques.
Means for massage - for prevention and treatment various diseases special ointments are used that have a positive effect on muscles and tissues due to the components they contain.
Foot massage - massage, carried out systematically for 2-3 weeks, will help prevent cramps and spasms in the muscles of the lower extremities in the future.
Neck massage - before moving on to massaging movements, it is necessary to prepare the skin: it must be cleaned, warmed and lubricated with a nourishing cream. Apply the cream with gentle stroking movements from the bottom up.
Prostate massage causes inflammation prostate are infectious diseases, sexual abstinence or sexual excess. Massage is recommended.
Lower back pain - sets of exercises should be performed only during periods of attenuation of pain and interrupted with its appearance.
Massage and metabolism - If you massage immediately after exercise, the release of nitrogenous substances will increase by 15%. In addition, a massage after muscle work accelerates the release of lactic acid from the body.
Massage and blood circulation - under the influence of massage, the movement of all body fluids, especially blood and lymph, is accelerated, and this happens not only in the massaged area of the body, but also in distant veins and arteries. So, foot massage can cause redness of the scalp.
Prevention and treatment cardiovascular disease with their prevalence and severe consequences to which they lead (Yu. E. Danilov, 1968, 1971), continues to be one of the problems that need to be resolved in public health.
Physical therapy plays an important role in the prevention and treatment of these diseases.
Application massage for diseases of the cardiovascular system in the complex treatment of patients, it helps to increase the effectiveness of treatment (L. F. Verbov, 1966; V. H. Moshkov, 1968, etc.). Until now, there are almost no massage techniques for coronary heart disease.
Indications for use massage for diseases of the cardiovascular system
- Hypertonic disease.
- Primary arterial (neurocirculatory) hypotension.
- Angina pectoris in the interictal period in combination with spondylosis, hypertension, cerebrosclerosis, traumatic cerebropathy.
- Myocardial dystrophy.
- Functional (neurogenic) disorders of the cardiovascular system (heart neurosis).
- Heart defects without decompensation (with rheumatism in the interictal period).
- Atherosclerosis of peripheral arteries, thromboangiitis without atherosclerosis of cerebral vessels and cerebral crises in the absence of pronounced trophic disorders and gangrene.
- Varicose veins without pronounced trophic disorders, not complicated by phlebitis, thrombophlebitis.
- Myocardial infarction, but not earlier than 2 weeks from the onset of the disease (very carefully!).
. V. H. Motkov (1950) developed in detail and substantiated by clinical and physiological observations a massage technique for patients with hypertension. The author conducted studies of the state of peripheral circulation by arterial oscillography before and after a single massage: a) head, neck in the area of the shoulder girdle; b) belly.
shown to all patients with this disease. V. M. Andreeva (1972) developed a method of massage of the collar zone and self-massage of hands and feet for use in complex treatment with therapeutic exercises and carbonic baths. The author observed favorable changes in clinical indicators and according to arterial oscillography, electrothermometry, electromyography, carried out immediately after the massage and during the course of treatment.
. As H. A. Glagoleva (1971) emphasizes, physical therapy methods, including massage for angina pectoris, can only be used in the interictal period. Long-term observations of the author made it possible to recommend massage of the collar zone in alternation with aminophylline electrophoresis in combination of angina pectoris with hypertension, traumatic cerebropathy, cerebrosclerosis.
. With the syndrome of functional disorders of the cardiovascular system due to neurosis, E. I. Sorokina, together with. us (1965) developed a technique for massaging the heart area. The procedure is carried out with the patient lying down with light stroking, rubbing, circular movements, tapping in the direction from the top of the heart to its base from 4 to 12 minutes every other day or every day. The course of treatment is prescribed 10-12 procedures.
can be used in the interictal period of rheumatism (Hentschel, 1962). The massage technique is differentiated depending on clinical picture diseases. In case of circulatory insufficiency of I and II degrees, it is advisable to massage the legs according to the type of “suction” massage, without a special effect on the muscles, joints. The duration of exposure is from 10 to 20 minutes.
. In case of obliterating diseases, due to the paradoxical reaction of the vessels, the tendency to thrombosis, massage of the extremities should not be prescribed. In order to improve lymph and blood circulation, it is advisable to influence the corresponding segmental zones. The lumbosacral region, the buttocks and the anterior outer surface of the thighs should be massaged with gazing, rubbing in the form of shading.
For all diseases of the cardiovascular system, physiotherapy exercises are an obligatory element of complex treatment. Its various forms are successfully used in combination with medicines and physiotherapy.
AT last years there has been a trend towards the use of increased physical activity in the procedures of physiotherapy exercises. Observations carried out jointly by the Institute of Cardiology named after prof. A. L. Myasnikova and the Department of Physical Therapy of the Central Research Institute of Balneology and Physiotherapy showed the feasibility of this approach in patients 6 months or more after myocardial infarction.
Experience has shown that massage and therapeutic exercises for these diseases are well combined on the same day, but they should be carried out separately.
Massage can be prescribed both before and after therapeutic exercises, the sequence and interval between procedures are determined by the clinical features of various forms of damage to the cardiovascular system.
test
2. General indications and contraindications for the appointment of therapeutic massage for cardiovascular diseases
Indications: functional (neurogenic) disorders of the cardiovascular system (heart neurosis); myocardial dystrophy with symptoms of circulatory failure I - II degree; rheumatic valvular heart disease without decompensation; myocardial and atherosclerotic cardiosclerosis with symptoms of circulatory failure I - II degree; angina pectoris in the interictal period in combination with osteochondrosis of the cervicothoracic spine, hypertension; cerebrosclerosis; traumatic cerebropathy; chronic ischemic heart disease; postinfarction cardiosclerosis; cerebral atherosclerosis (dyscirculatory encephalopathy); with chronic cerebrovascular insufficiency in I compensated and in II subcompensated stages (according to N.I. Bogolepov); primary arterial (neurocirculatory) hypotension.
Contraindications: acute inflammatory diseases of the myocardium and membranes of the heart, rheumatism in the active phase, combined heart defects with a predominance of stenosis of the openings of the pulmonary veins with a tendency to hemoptysis and atrial fibrillation; heart valve defects in the stage of decompensation and aortic defects with a predominance of aortic stenosis; circulatory failure IIb and III stage; coronary insufficiency, accompanied by frequent attacks of angina pectoris or symptoms of left ventricular failure, cardiac asthma; arrhythmias - atrial, paroxysmal tachycardia, atrioventricular blockade and blockade of the legs of the atrioventricular bundle; thrombolytic diseases of peripheral arteries; thromboembolic disease; aneurysms of the aorta, heart and large vessels; hypertension stage III; late stages of cerebral atherosclerosis with symptoms of chronic cerebrovascular insufficiency stage III (according to N.K. Bogolepov); endarteritis complicated by trophic disorders of gangrene, angiitis, thrombosis, acute inflammation, significant varicose veins with trophic disorders; atherosclerosis of peripheral vessels; thromboangiitis in combination with atherosclerosis of the cerebral vessels, accompanied by cerebral crises; inflammation of the lymphatic vessels and nodes - enlarged, painful lymph nodes, soldered to the skin and underlying tissues; systemic allergic angiitis occurring with hemorrhagic and other rashes and hemorrhages and hemorrhages in the skin; blood diseases; acute circulatory failure.
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Massage for diseases of the cardiovascular system is used for myocardial dystrophy, weakening of the contractile function of the heart muscle, heart defects. after myocardial infarction, with hypertension, hypotension, angina without an attack and with various peripheral vascular diseases. The purpose of massage for these diseases is to improve the nutrition of the heart muscle, increase its tone. facilitate the work of the heart, eliminate congestion in the systemic and pulmonary circulation, promote the development of collateral circulation. In case of chronic insufficiency of the heart muscle caused by various diseases, a back massage is used, and then a massage of the arms and legs - stroking, rubbing and carefully - chopping and patting.
E. A. Morozova. Medical, therapeutic and cosmetic massage
Massage for diseases of the cardiovascular system
Massage in the complex of therapeutic measures for diseases of the cardiovascular system improves the regulatory capabilities of the body, indicators of vascular circulation and cardiac activity itself.
Usually, a massage of the back, collar zone, and sometimes, according to indications, a massage of the upper and lower extremities is prescribed.
The peculiarity of massage in diseases of the cardiovascular system lies in the slow pace and rhythmic movements with the patient in a semi-sitting position.
With functional neuroses - planar circular stroking, rubbing the left half of the chest, light vibration, kneading from the top of the heart to the base, very light. The movements are slow and rhythmic, light vibration can be applied.
With angina pectoris, the patient's sitting position is light stroking, rubbing, kneading longitudinally and transversely, gentle patting, stroking and slight shaking of the chest. It is necessary to start the massage from the back - the trapezius muscle, the back of the neck, the sternocleidomastoid muscle, the intercostal muscles and the interscapular muscles with the transition to the region of the heart, pectoral muscles, left shoulder, joints, inner surface of the forearm from the side of the little finger. Stroking, rubbing, kneading, tapping, light chopping in the region of the VII cervical vertebra and light rhythmic vibration are used. Finish the massage with a wide, slow, rhythmic stroke. With weakness of cardiac activity - patting in the area of \u200b\u200bthe heart and shoulder blades, concussion of the chest with respiratory movements.
Massage for rheumatic heart disease
Massage is prescribed in the absence of concomitant inflammatory processes. The back, chest, intercostal muscles, heart area, sternum, left costal arch, upper and lower limbs are massaged. Stroking, rubbing, kneading (longitudinal and transverse), patting, concussion of the chest with respiratory movements are used.
When massaging the area of the heart and sternum - stroking is superficial and deep, rubbing, kneading the pectoral muscles, continuous vibration, patting in the area of \u200b\u200bthe heart, stroking from the sternum to the spine, squeezing and stretching the chest with inhalation and exhalation.
The lower and upper limbs are massaged with wide strokes, using all techniques.
For a course of treatment 12 procedures for 20 minutes.
Massage for chronic coronary heart disease
In chronic ischemic heart disease, massage in combination with therapeutic exercises eliminates congestion, improves coronary circulation, accelerates metabolic processes, including redox processes in muscles, has a beneficial effect on the patient's psyche, activates the patient to physical and mental labor.
Massage is prescribed in the absence of pain in the region of the heart, shortness of breath, arrhythmias at rest, with normal blood pressure.
We start the massage from the feet. We stroke the feet, lower leg, joints towards the inguinal region, gently, circular rubbing of the back surface of the feet alternate with stroking; shallow kneading of the lower leg, felting, longitudinal kneading alternate with stroking and passive, then active movements, with the transition (according to indications) to the buttocks, back. On the back, massage the trapezius muscle. We stroke, rub with the capture of the latissimus dorsi muscle, interscapular region, intercostal muscles to the back of the head; rake-like rubbing from the sternum to the spine; kneading the pectoralis major muscle and the left shoulder, slight vibration in the region of the heart, hands - with common strokes, stroking, rubbing, kneading from the little finger to the shoulder joint. Stroke the chest again.
For a course of 12-15 procedures for 20 minutes every day.
Massage for hypertension stages I-IIA
We massage the head, neck, collar zone while sitting, attention to the IV cervical and II thoracic vertebrae. Movement from top to bottom, rhythmically, of medium strength.
Head - light massage using the usual technique, emphasis on the occiput - rake-like stroking, circular rubbing, shifting and stretching of the scalp.
Then we move on to the neck. Flat forceps-like stroking with the transition to the sternocleidomastoid muscles, forceps-like kneading with the transition to the collar zone. If the blood pressure is high, massage the abdomen while lying down, because the pressure may drop sharply.
The course of treatment is 12-15 procedures for 15 minutes every day.
Massage for hypotension
Unlike massage for hypertension, with hypotension, the basis of the technique is movements from the bottom up: massage of the gluteal muscles and iliac crests, concussion of the pelvis, massage of the lower extremities with an emphasis on the calf muscles. Hypotonic disease is often accompanied by intestinal atony - in this case, bowel massage is also done. The technique ends with a massage of the collar zone.
Massage starts from the underlying areas to the overlying. Sacrum, buttocks and iliac bones - planar, embracing stroking. Circular rubbing of the buttocks (you can use your fist or elbow). Hatching, sawing, crossing, longitudinal kneading of the lumbar region, transverse - the anterior wall of the abdomen, vibration stroking, patting and shaking the pelvis.
Massage the lower limbs in stages, first the back part, then turning the patient on his back, and the front part. Planar encircling stroking of the lower leg and thigh, circular rubbing, planing, sawing, longitudinal and transverse kneading. Vibration, felting, patting, chopping, shaking limbs passive and active movements.
We mentally divide the stomach from the navel in half with a horizontal line. During the massage, we pull the upper part of the abdomen to the armpits, the lower one to the groin. Planar shallow stroking to the armpits, rubbing, shading, kneading the longitudinal and transverse of the anterior abdominal wall, rolling. With intestinal atony, pushing, horizontal and vertical shaking of the abdomen.
The collar zone is massaged in the usual way, only movements (in the direction and increase in effort) should be directed from the bottom up.
The course of treatment is 15 procedures for 20 minutes, it is good to combine with exercise therapy and balneotherapy.
Massage for obliterating endarteritis
Massage is done at the initial stage of the disease and in the absence of signs of thrombophlebitis and the threat of a blood clot. According to the same technique, massage is performed for varicose veins of the lower extremities with trophic changes in the skin, angiospasms, and atherosclerosis of the vessels of the extremities.
Methodology. The sequence and techniques used are almost common for limb massage. When massaging the lower extremities, one should begin with the lumbosacral region, then the buttocks, iliac tubercles, then fingers, soles, joints, lower leg, thigh. Massage is carried out with an elevated position of the limb.
When massaging the upper limbs - sternocleidomastoid muscles, back muscles, interscapular region, shoulder joint and hand, fingers, joints, forearm and shoulder. All techniques are used in massage.
Attention!
Bypass venous nodes, do not massage!
For a course of treatment 10-12 procedures for 15-20 minutes daily.
The History of Massage - In both India and China, massage was performed by priests. In addition, schools were established in these countries that taught massage techniques.
Means for massage - for the prevention and treatment of various diseases, special ointments are used that have a positive effect on muscles and tissues due to the components they contain.
Foot massage - massage, carried out systematically for 2-3 weeks, will help prevent cramps and spasms in the muscles of the lower extremities in the future.
Neck massage - before moving on to massaging movements, it is necessary to prepare the skin: it must be cleaned, warmed and lubricated with a nourishing cream. Apply the cream with gentle stroking movements from the bottom up.
Prostate massage - the causes of inflammation of the prostate gland are infectious diseases, sexual abstinence or sexual excess. Massage is recommended.
Lower back pain - sets of exercises should be performed only during periods of attenuation of pain and interrupted with its appearance.
Massage and metabolism - If you massage immediately after exercise, the release of nitrogenous substances will increase by 15%. In addition, a massage after muscle work accelerates the release of lactic acid from the body.
Massage and blood circulation - under the influence of massage, the movement of all body fluids, especially blood and lymph, is accelerated, and this happens not only in the massaged area of the body, but also in distant veins and arteries. So, foot massage can cause redness of the scalp.
Massage for diseases of the cardiovascular system
Massage for angina pectoris
Stable exertional angina is one of the main manifestations of IHD. The most typical manifestation of angina pectoris is retrosternal pain that occurs during physical exertion, emotional stress, when going out into the cold, walking against the wind.
Classification of the Canadian Cardiovascular Society (1976).
Class I - "Ordinary physical activity does not cause an angina attack." Pain does not occur when walking or climbing stairs. Seizures appear with strong, rapid or prolonged stress during work.
Class II - "slight limitation of usual activity". Pain occurs when walking or quickly climbing stairs, with emotional stress. Walking more than 100–200 m on level ground or climbing more than 1 flight of stairs at a normal pace.
Class III - "significant limitation of usual physical activity." Walking on level ground or climbing up one flight of stairs at a normal pace triggers an angina attack.
Class IV - "the impossibility of any physical activity without discomfort." Seizures may occur at rest.
Indications: atherosclerosis with a predominant lesion of the coronary vessels, chronic coronary insufficiency with functional spasms of the coronary arteries due to physical overstrain, with negative emotions (angina pectoris).
With mild attacks, massage can be prescribed the day after the attack; with rest angina pectoris - on the 4th - 5th day.
Massage plan: impact on the paravertebral zones of the spinal segments C6-C4; Th6 - Th2 and Th12-L1, massage of the sternum, heart, interscapular region and left shoulder, massage of the lower and upper limbs in combination with breathing exercises
Patient position- lying, sitting with head supported on hands, cushion, pillow.
When carrying out massage procedures, it is necessary to follow a certain sequence in increasing the dosage.
Massotherapy
1. Massage of the anterior surface of the chest. The following methods are applied:
Alternate rubbing; massage techniques should be smooth;
Planar deep stroking in the direction: from the bottom up and towards the shoulder joint; it is necessary to carry out the reception along the muscle fibers of the pectoralis major muscle;
Spiral rubbing with four fingers in the same direction as deep stroking;
Circular planar superficial stroking of skin hyperalgesia zones in the sternum and under the left clavicle.
2. Massage of the collar zone. The following methods are applied:
Circular planar surface stroking with both hands;
Alternate rubbing;
Sawing (can be done with one or both hands);
Spiral rubbing with four fingers with a slight pressure force in the direction: from bottom to top fan-shaped with one or both hands simultaneously;
Light cutting in the interscapular region.
3. Massage in the area of the inner surface of the left hand. The following methods are applied:
Light planar continuous stroking with one hand in the direction from the wrist joint to the armpit;
Light spiral rubbing with four fingers in the same direction.
ATTENTION!
Massage techniques are recommended to be alternated with stroking; after moving from one zone of influence to another, the maximum possible relaxation of the muscles of the shoulder girdle and the left upper limb, performing several breathing exercises (static and dynamic) are advisable.
The massage is preceded by the determination of the skin zones of Zakharyin - Ged, as well as reflex reflected changes in the subcutaneous connective tissue and muscles (according to Mekenzie).
Massage of reflexogenic zones provides primarily for the impact in the back (C7-Th1, etc.). The massaging finger first moves along the border of the reflexogenic zones without crossing it. With good tolerance of the massage by the patient and the weakening of the tension of the reflected reflex changes in the tissues, the trigger points (trigger points) of the reflexogenic zones are massaged. In the first 2-3 massage procedures (with increased reactivity of the patient and more) are limited to the impact on the reflexogenic zones in the back. When tissue tension in the back area decreases, skin hyperesthesia weakens, and they switch to massage of the reflexogenic zones on the anterior surface of the chest. On the left, starting from the sternum and towards the spine, the lower edge of the chest, respectively, segments Th8-Th9, then the intercostal muscles in the region of 3-4 intercostal spaces towards the spine and then the clavicular portion of the trapezius muscle are massaged. In places where there is an increase in tone (Mekenzi zones), the use of light vibration is recommended.
The dosage of massage exposure for angina pectoris depends on the nature of the violation of skin sensitivity and muscle tone:
In the presence of phenomena of skin hyperesthesia, increased muscle tone, which is usually observed in the area of the pectoralis major muscle, as well as the clavicular portion of the trapezius muscle, massage movements (rubbing in the form of shading) should not be energetic in order to avoid the resumption of pain and increased frequency of angina attacks;
With hypesthesia or a decrease in muscle tone, more vigorous massage movements should be used.
Glaser O. u. Dalicho A. W. give the following scheme of localization of reflex reflected changes in different layers of tissues in diseases of the cardiovascular system (Fig. 1).
Zonal changes are defined on the left.
Skin changes(zones of hyperalgesia):
Above the upper portion of the trapezius muscle (C6-C7);
Under the collarbone (Th1-Th2);
Below the sternum (Th6-Th7);
At the edge of the ribs (Th8-Th9);
The outer surface of the chest (Th5-Th7);
The area between the scapula and the spine (Th3-Th6).
Rice. one. Localization of reflex reflected changes in tissues in diseases of the cardiovascular system: 1– horizontal lines - changes in the skin; 2 - drawn areas - changes in the muscles; 3 - shaded areas - changes in the subcutaneous connective tissue
Changes in the subcutaneous connective tissue -
Between the inner edge of the scapula and the spine (Th3-Th5)
Inferior edge of chest (Th8-Th9)
Outer surface of the chest (Th5-Th8)
Places of attachment of the ribs to the sternum towards the collarbone (Th1-Th5)
Above the collarbone (C4)
Muscle changes -
Clavicular portion of the trapezius muscle (C4 and C6)
Infraspinatus (C8 and Th1)
Muscles that straighten the trunk (Th2-Th3 and Th5)
Trapezius muscle (Th6-Th7)
Beginning of the teres major muscle (Th4-Th5)
Sternocleidomastoid muscle (C4)
Pectoralis major muscle (sternocostal portion) - Th1-Th5
Serratus posterior superior (Th2-Th5)
Pectoralis Major (Th2-Th3 and Th5-Th6)
Rectus abdominis (Th8-Th9)
Iliac muscle (Th12 and L1)
Changes in the periosteum - ribs, sternum and shoulder blade.
ATTENTION!
It is advisable to move on to massaging trigger points within C7-Th3 in cases where muscle tension in the back of the chest segments, as well as on the anterior surface of the chest wall, begins to weaken. If these recommendations are not followed, pain in the heart area may occur, as well as angina attacks become more frequent.
Massage for arterial hypertension (essential hypertension)
Arterial hypertension (AH) is a pathological condition in which an increase in blood pressure is not due to the natural needs of the body for certain physiological situations, but is a consequence of an imbalance in the blood pressure regulation system (E. I. Chazov). All hypertension is divided by origin into primary (essential) and secondary (symptomatic). Essential hypertension (EAH), or hypertension, is not specifically associated with any process in the body. Symptomatic hypertension is included in the symptomatic complex of some diseases and is only one of their manifestations. The classification of blood pressure values, currently accepted, is given in Table. one.
Table 1
Criteria for the severity of arterial hypertension according to the classification of experts by WHO and the International Society for Hypertension (1999)
The prognosis in patients with hypertension depends not only on the level of blood pressure, but also on the presence of risk factors, in connection with which the stratification of patients depending on the degree of risk has been introduced into the modern classification. The higher the degree of risk, based on the assessment of target organ damage and the severity of cardiovascular complications, the worse the individual patient's prognosis.
table 2
Risk stratification criteria
The therapeutic effect of massage also lies in the normalization of the inhibitory-excitatory relationship of cortical processes and the restoration of their dynamic balance. Skeletal muscles, being a powerful regulator of autonomic functions, actively affect hemodynamics.
Under the influence of massage, discomfort in the heart area, heaviness in the head, headaches and tinnitus decrease, sleep improves, efficiency increases and blood pressure decreases.
Indications: hypertension stage 1-PA in the absence of vascular crises and pronounced phenomena of sclerosis of the vessels of the brain, heart, kidneys.
Massage plan: impact on the paravertebral zones of the cervical and upper thoracic spinal segments C7-C2 and Th5-Th1.
Patient position when massaging the head, collar zone, interscapular region - sitting on a chair; abdominal massage is performed with the patient lying on his back, and the massage therapist stands on the side of the patient's right hand.
Massage technique
Massage of the paravertebral zones from the underlying segments to the overlying segments Th5-Th1 and C7-C2: deep stroking, rubbing, kneading.
1. Massage of the trapezius muscles. planar and encircling stroking, semicircular rubbing, light shading, longitudinal, transverse kneading, shifting, transverse kneading of the upper clavicular edges of the trapezius muscles.
2. Massage of the interscapular region. The following methods are applied:
Light planar stroking with both hands in the direction from the occipital bone down to the level of the line connecting the lower corners of the shoulder blades. Both palms of the massage therapist move "reversely" on either side of the spine. Then apply stroking "rhombus". Longitudinal stroking and stroking with a "diamond" is considered as one technique (Dunaev I.V.);
Alternate rubbing of the interscapular region;
Deep stroking longitudinal and "rhombus";
Spiral rubbing with four fingers of the interscapular region in the direction from top to bottom "front" or "rear" stroke. It is better to perform the reception with one hand, and with the free one - the massage therapist fixes the patient's shoulder girdle;
Deep transverse intermittent kneading with both hands on the right and left in the direction from the spinal column from top to bottom;
Chopping along the interscapular region.
Neck massage. The masseur places his hands in the neck in such a way that the index fingers are at the angles of the lower jaw, and the two thumbs lie parallel, tightly pressed against each other, and their ends are directed upwards to the external tubercle of the occipital bone. The following methods are applied:
Embracing stroking with both hands in the direction from top to bottom from the occipital bone and to the sides along the shoulder girdle to the shoulder joints;
Alternate rubbing of the muscles of the neck and shoulder girdle;
Deep planar stroking “in reverse” in the direction from the occipital bone along the lateral and back surfaces of the neck and along the shoulder girdle to the shoulder joints;
Sawing on these surfaces;
Deep planar stroking "forward";
Spiral rubbing with four fingers "forward" with sufficient pressure;
Deep transverse intermittent or forceps-like kneading of the upper portion of the trapezius muscle in the direction from the occipital bone down and to the sides to the shoulder joints (along the muscle fibers);
Planar stroking "in reverse";
Patting (with the palms of the hands, light movements);
Circular rubbing of the occipital, temporal and frontal muscles (with fingertips).
4. Massage of the back of the head. The following methods are applied:
Long back stroke (performed with both hands). The movement of the hands starts from the crown in the direction from top to bottom along the back of the neck and along the shoulder girdle to the shoulder joints;
Zigzag rubbing of the back of the head with the pads of four fingers in the direction: from bottom to top;
Spiral rubbing with four fingers in the same direction (it is possible to hold the reception with the thumb);
Shift and puncture;
Stroking the back of the head and the back of the neck.
5. Massage of the forehead area. The following methods are applied:
Long front stroke (one or both hands). Hand movement: from the midline of the forehead, then - to the temporal region down to the corners of the lower jaw; further - the hands slide along the sternocleidomastoid muscles to the handle of the sternum and over the collarbones to the shoulder joints;
Spiral rubbing with four fingers on the anterolateral surface of the neck (reception is performed with both hands);
Spiral rubbing in the direction from the midline of the forehead to the temporal region. Reception is performed with four fingers of one hand, while right hand the massage therapist moves from the midline of the forehead to the left temple, and the free hand fixes the patient's head;
Stroking in the direction from the midline of the forehead to the temporal region simultaneously with both hands;
Punctuation.
6. Massage of the scalp. The following methods are applied:
Long front stroke;
Zigzag rubbing of the scalp in the sagittal direction (the technique is performed with one hand, the other hand fixes the patient's head);
Separate-successive stroking of the scalp;
Spiral rubbing with four fingers (thumb);
Shift, punctuation;
The procedure ends with a long front and long back stroking.
Massage of the head and collar zone is continued for 10–15 minutes daily.
In addition to massage of the head and collar zone, abdominal massage is also used for this disease. Abdominal massage normalizes intra-abdominal pressure, eliminates the high standing of the diaphragm, improves intestinal activity, reflexively through the vegetative nervous system lowers blood pressure. The abdominal area is massaged vigorously, the effect should be deep, but at the same time soft, elastic and painless.
7. The following massage techniques are used in the abdomen:
Circular planar surface stroking;
Spiral rubbing with four fingers;
Circular planar deep stroking;
rolling;
Transverse intermittent kneading;
Spiral rubbing with four fingers along the large intestine;
Ironing without weight (with weight) in the same direction and along the same line;
Circular planar stroking of the entire abdomen.
The duration of the massage procedure is 10-15 minutes daily.
The massage course consists of 15 procedures and is repeated after 1.5–2 months.
Massage for arterial hypotension
Blood pressure level below 100/60 mm Hg. Art. for persons under the age of 25 and below 105/65 mm Hg. Art. for persons over 30 years of age, it is diagnosed as arterial hypotension.
Classification.
Physiological arterial hypotension: a) an individual version of the norm (the so-called normal low blood pressure); b) arterial hypotension of high fitness ("sports" arterial hypotension); c) adaptive arterial hypotension (compensatory, typical for residents of the highlands, the Arctic).
Pathological arterial hypotension: a) collapse - acute vascular insufficiency resulting from a rapid drop in vascular tone; manifested by a sharp decrease in blood pressure, signs of cerebral hypoxia and inhibition of vital body functions; b) shock - an acute prolonged decrease in systolic blood pressure below 90 mm Hg. Art., accompanied by oligoanuria, symptoms of disorders of peripheral circulation and consciousness; c) orthostatic transient arterial hypotension; d) hypotension (synonym - permanent primary arterial hypotension); e) neurocirculatory arterial hypotension - with an unstable reversible course, disturbing the patient's well-being; f) orthostatic idiopathic arterial hypotension (primary vegetative insufficiency); g) permanent secondary (symptomatic) arterial hypotension with orthostatic syndrome, without orthostatic syndrome.
The pressor orientation of the BP reaction as a result of the direct impact of physical exercises and massage in this disease is ensured by the formation of conditioned reflex connections between skeletal muscles and vasomotor center. As a result of rehabilitation treatment, these connections and the formation of a new dynamic stereotype give a positive therapeutic result. The latter is expressed in improving the state of cardiac and extracardiac (in particular, strengthening the skeletal muscles of the legs and trunk) factors of blood circulation, normalizing vascular tone, blood pressure, and eliminating cardialgia.
Scheme 1. Pressor influence muscle activity(Temkin I. B.)
Massage plan: impact on the paravertebral zones of the spinal segments S5-S1, L5-L1 b Th12-Th6, massage of the sacrum, gluteal muscles and crests of the iliac muscles, "shaking" of the pelvis, massage of the muscles of the lower extremities, abdomen.
Patient position- lying down.
Given the patients' rapid fatigue and reduced skeletal muscle endurance, light massage is recommended. The first procedures should be short.
Massage technique
1. Massage of the paravertebral zones - from the underlying segments (S5) to the overlying (Th6), the area of the sacrum, gluteal muscles and iliac bones:
Stroking is planar and embracing;
Rubbing (circular with fingertips, ulnar edge of the hand and the supporting surface of the hand);
Hatching and sawing;
Crossing and rubbing the iliac crests;
Longitudinal kneading of the lumbar region;
Transverse kneading of the lateral surfaces of the anterior wall of the abdomen;
Vibrating stroking, patting, shaking the pelvis.
2. Massage of the back muscle group of the lower extremities. The following massage techniques are used:
Rubbing the muscles of the legs and thighs with fingertips;
Planing and sawing;
Kneading longitudinal and transverse;
Vibration (shaking, patting the palm across);
Light chopping - longitudinal, vibration stroking;
Massage of the anterior surfaces of the lower extremities:
Planar and enveloping stroking of the muscles of the legs and thighs;
Circular rubbing with the palmar surface of the hand and fingertips;
Kneading (longitudinal and transverse), felting;
Vibration stroking, patting, chopping, shaking the muscles of the limbs;
4. Massage the abdomen:
Planar circular superficial and deep stroking;
Embracing stroking of the upper half of the abdomen - to the axillary, and the lower - to the inguinal lymph nodes;
Rubbing - with fingertips, ulnar edge of the palm;
Hatching, kneading the anterior wall of the abdomen (longitudinal and transverse);
Concussion of the abdomen in the horizontal and vertical directions.
The duration of the procedure is 15–20 minutes. Course - 15-20 procedures every other day.
Massage for diseases of the peripheral vessels of the extremities
In the treatment of diseases of the peripheral vessels of the extremities effective tool is a segmental reflex massage (Moshkov V. N., Belaya N. A., Kunichev L. A., Glaser O. u. Dalicho A. W.). Localization of reflex (reflected) changes in tissues in vascular diseases is presented in the section "Segmental-reflex massage".
Indications: atherosclerotic occlusion of the arteries of the upper and lower extremities, angiospasms (Raynaud's disease, etc.); varicose veins of the lower extremities, the presence of trophic skin changes and non-extensive ulcers, phlebitis or thrombophlebitis without a tendency to relapse and erysipelas-inflammatory complications.
Rice. 2. Localization of reflex (reflected) changes in tissues in vascular diseases ( scheme)
Massage technique for diseases of the arteries of the lower extremities
(The position of the patient is lying down.)
Massage plan: impact on the paravertebral zones of the spinal segments S5-S1, L1-L5, Th12-Th10 from the underlying segments to the overlying ones.
Apply the following massage techniques:
Planar stroking (superficial and deep);
Spiral rubbing with the pads of four fingers;
Comb-like rubbing;
sawing and crossing;
Longitudinal kneading, shifting;
Shaking, patting, vibrating stroking.
I. Massage technique for the lumbosacral region and pelvic region
(Patient position - lying down)
Apply the following massage techniques:
Planar stroking (superficial and deep).
Rubbing the gluteal muscles with the ulnar edge of the palm, the supporting surface of the hand.
Sawing, rubbing the iliac crests in the direction from the upper anterior spine to the spine and costal arches from the xiphoid process to the spine.
Kneading the gluteal muscles, concussion of the pelvis.
II. Lower extremity massage technique
(The position of the patient is lying down.)
Apply the following massage techniques:
Stroking the plantar surface of the feet;
Planar and encircling surface stroking of the anterior surfaces of the lower leg and thighs;
Stroking and rubbing the joints with the palmar surfaces of the fingers;
Comb-like rubbing of the plantar surfaces of the feet.
The duration of the procedure is 12-15 minutes. The course of treatment is 12–15 procedures every other day.
III. Massage technique for diseases of the vessels of the upper extremities
(Position of the patient - sitting with head resting on hands, on a roller or pillow)
Massage plan: impact on the paravertebral zones of the spinal segments Th7-Th1 and C7-C3 from the underlying to the overlying segments.
Apply the following massage techniques:
Planar stroking of the back surface of the muscles of the neck, sternocleidomastoid muscles and upper portions of the trapezius muscles;
Rubbing with the palmar surface of the brush;
Sawing, hatching, kneading the latissimus dorsi, trapezius, sternocleidomastoid muscles;
Shifting back muscles.
1. Massage of the interscapular region - rubbing with the fingertips, shading and sawing, continuous vibration with the fingertips, patting and chopping.
2. Massage of the upper extremities - encircling stroking of the posterior and outer surfaces of the forearm and shoulder, stroking the muscles of the back of the hand, rubbing the palmar surface of the hand with the fingertips and a comb-like technique, circular rubbing with the fingertips of the posterior and lateral surfaces of the wrist and elbow joints.
3. Massage of the deltoid muscles - stroking, rubbing and kneading.
The duration of the procedure is 10–15 minutes. The course of treatment - 12 procedures every other day.
Massage technique for diseases of the veins of the lower extremities
(Position of the patient - lying on his stomach)
Massage plan: impact on the paravertebral zones of the spinal segments S3-S1, L5-L1, Th12-Th10.
Apply the following massage techniques.
With broad strokes, planar stroking of the lumbar region and the lower third of the chest.
Stroking the elbow edges of the brushes of the lower parts of the chest in the direction from the sternum to the spine.
Stroking the supporting part of the brushes of the iliac crests in the direction from the spine to the inguinal folds.
Rubbing with the fingertips of the paravertebral zones from the underlying to the overlying segments.
Rubbing the lower chest, sacrum and iliac crests.
Sawing and crossing.
Kneading the paravertebral and gluteal muscles.
Vibration (tapping with fingers, patting, chopping the buttocks).
Vibration stroking of the lumbar and gluteal regions. Concussion of the pelvis.
Massage of the muscles of the legs and thighs.
Surface planar stroking.
Embracing stroking, intermittent or rake-like, should be performed, bypassing the protruding varicose nodes.
Comb-like stroking of the plantar surface of the feet.
Gentle felting and vibration stroking of the muscles of the legs and thighs.
Stroking and rubbing the ankle, knee and hip joints.
The duration of the procedure is 12–15 minutes. The course of treatment - 12 procedures, every other day.
Massage in coronary heart disease and in the post-infarction period of rehabilitation of patients
In the system of medical rehabilitation of IHD patients and in the post-infarction period of rehabilitation, the means of therapeutic physical culture are widely used (motor mode, physical exercise and massage). Massage has a pronounced effect on the patient's psyche, which is an important factor in restorative treatment. Massage, acting in synergy with dosed physical exercises within the framework of the patient's motor regimen, stimulates the body's defenses, promotes faster adaptation and normalization of the functions of the nervous, vascular and sympathetic-adrenal systems. Its neuro-reflex and humoral influence enhances the positive effect of physical activity, which improves coronary circulation, blood circulation in the small and large circles, activates metabolism and trophic processes in tissues, and increases the absorption of oxygen by tissues. Having a reflex effect, massage eliminates congestion, facilitates the work of the left atrium and left ventricle, increases the pumping capacity of the heart. In patients with cardiovascular diseases, adequate physical activity (metered walking, physical exercises) has a more positive effect if they are combined with massage procedures (Moshkov V.N.; Kunichev L.A.).
Massage technique at the stationary stage of rehabilitation
The position of the patient is lying on his back.
1. Massage of the muscles of the lower extremities.
Superficial stroking of the back surface of the feet and leg muscles.
Circular rubbing with the fingertips of the back surface of the feet, ankles and knees, alternating with circular strokes.
Kneading the muscles of the legs - felting, longitudinal kneading.
Upper limb massage
Superficial stroking and rubbing of the back surface of the hand, forearms, elbow joints.
Longitudinal kneading of the muscles of the forearm.
Flat stroking of the lateral surfaces of the chest.
If it is possible to turn the patient to the right side,
massage of the back muscles and gluteal muscles - light stroking alternates with superficial rubbing of the paravertebral zones of the lumbosacral region and gluteal muscles.
The duration of the procedure is 3–7 minutes daily.
Massage technique at the outpatient stage of rehabilitation
Patient position- sitting with the support of the head on the hands, about the roller; lying.
1. Massage of the back muscles.
Stroking and rubbing the paravertebral zones in the direction from the underlying to the overlying segments, the latissimus dorsi and neck muscles.
Rake-like rubbing of the II-VIII intercostal spaces in the direction: from the sternum to the spinal column.
Rubbing with four (thumb) fingers of the left scapular and interscapular regions.
Kneading the muscles of the back and upper portions of the trapezius muscles.
Massage of the muscles of the lower extremities.
Stroking with broad strokes and intermittent kneading of the muscles of the legs and thighs.
Stroking and rubbing the feet and joints of the lower extremities.
Shift of the interosseous muscles of the foot.
Passive and active-passive movements in the joints.
3. Massage of the gluteal muscles.
Continuous stroking with the palmar surface of the hands.
Alternate rubbing with both hands.
Spiral rubbing of medium intensity with four fingers.
Longitudinal continuous kneading.
Shake.
Rubbing the crests of the iliac bones and the region of the sacrum.
4. Chest massage.
Stroking the region of the heart, sternum and costal arches.
Rubbing the left pectoralis major muscle and sternum.
Kneading the large pectoral muscles and muscles of the left shoulder.
Vibration stroking of the heart area.
5. Massage of the abdomen.
Planar superficial circular stroking of the abdominal muscles.
Alternate rubbing.
6. Massage of the muscles of the upper limbs.
Embracing continuous stroking in the direction from the wrist joint to the clavicular-acromial joint.
Double ring grinding.
Stroking (general strokes).
In the early post-stationary period, massage in combination with dosed physical activity aims to help restore neurohumoral processes, improve the function of the gastrointestinal tract, coronary circulation, increase the level of metabolic processes in the myocardium and thus promote the development of endurance and restore the body's performance (Moshkov V.N. .).
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