Massage for diseases of the joints.
In a number of diseases, often involving a long loss of working capacity, one of the first places is occupied by joint diseases. An important role in the system of complex therapy of joint diseases belongs to massage, under the influence of which pain decreases, absorption of effusion in the joint and periarticular mucous bags is accelerated, lymph and blood circulation in the joint and periarticular tissues improve.
Under the influence of massage, reflex muscle hypertonus, often observed in joint diseases, also decreases, the development of muscle atrophy is prevented, the secretion of synovial fluid is increased and the joint mobility increases with its stiffness, local and general interstitial metabolism, and redox processes in the body are improved, which generally contributes to accelerate the restoration of function of the affected joints.
Applying massage for diseases of the joints, the massager should clearly know their normal configuration, their boundaries, accesses to the joint bag, the location of periarticular mucous bags that are often involved in the process, signs of effusion in the joint and its inversions and the ability to detect them, and, finally, volume movements in individual joints.
Only under this condition, the massage therapist can correctly perform the massage technique indicated by the doctor. A joint massage should be preceded each time by a survey about the patient’s well-being, the nature and localization of pain and other complaints, the knowledge of which can help the massage therapist both in choosing massage techniques and their dosage, and in assessing the effectiveness of the massage used.
For joint diseases of rheumatic or other infectious origin, massage is used in the subacute and chronic stages of the process.
In the presence of reactive phenomena in the affected joint (swelling, increased local temperature, significant soreness when feeling the joint, especially when penetrating the joint gap, etc.), massage is applied out of focus.
The attention of the massager should be primarily aimed at weakening muscle hypertonicity, which, as a rule, in the subacute stage reflexively arises in the muscles associated with the affected joint. For example, when the knee joint is involved in the process, an increase in tone is observed in the following muscles: straining the wide fascia of the thigh, quadriceps, semi-tendon, semi-membranous and biceps femoris, as well as in the calf muscle.
Increased tension is also observed in the patellar ligament and in the joint tendon of the tailor, tender and semi-tendon muscles, while in some muscles and tendon attachments, stress can be more pronounced, in others weaker. With careful palpation, a change in muscle tone in the direction of its increase can also be detected in the muscles of the lower thoracic and lumbosacral spine.
Elimination of muscle hypertonicity is best achieved by applying gentle mechanical vibration. With increasing tension of the subcutaneous connective tissue, its massage is performed according to Leiba and Dicke (technique of reflex-segmental massage). After easing the tension of tissues in the back, you can proceed to massage the muscles associated with joint damage.
Along with the phenomena of muscle hypertonicity in infectious nonspecific polyarthritis, selective muscular hypotrophy is observed, which is especially pronounced in the chronic course of the process.
In diseases of the hip joint, gluteal muscles are the first to be affected, the knee joint – the quadriceps muscle, the ankle joint – extensors of the lower leg and foot; in diseases of the shoulder joint — the deltoid, supraspinatus, infraspinatus, and small round muscles, the elbow joint — the triceps muscle, the wrist joint — extensors of the forearm, and of the finger joints — interosseous muscles.
From massage techniques for muscle hypotrophy, rubbing, stroking and gentle kneading are used alternately. In this process, myogelosis can be observed in the muscles adjacent to the joints, which are most often localized at the points of muscle attachment when they go into fascial stretching or tendon (the massage technique for myogelosis is described above).
Turning to massaging the affected joint, it is necessary to bypass the painful places in the first days of the massage. In order to free the pathways of lymphatic drainage from the joint cavity, first periarticular and then soft tissues covering the joint are massaged, as with infectious joint diseases (non-specific infectious polyarthritis), arthrosis, skin elasticity, its mobility, mobility are often impaired, as indicated primarily by thickening , as well as soreness when taking the skin into a crease.
The main massage technique is rubbing in the form of a hatch, which is performed slowly, tangentially and in layers (skin, subcutaneous connective tissue, fascia). Once selected, the layer depth should gradually change, while the subsequent layer should be affected as little as possible.