INDICATION
1. Edema
2. Muscle pain
3. Muscle spasm
4. Diabetic neuropathy
5. Periarthritis Shoulder
6. Tendinitis
7. Muscle atrophy
PATIENT PREPARATION
Position of the patient
Supine lying position with adequate support.
or
Sitting position with arm abducted to 90 degrees and elbow flexed
to 90 degrees and forearm pronated.
Position of the therapist
Walk standing position with your outer leg forward.
Draping
Entire body should be covered except the massaging arm
(for female shoulder straps should be slipped off)
Assessment before starting
 Before starting work, uncover the whole limb in order to
examine it.
 Check by observation the state of the skin for abrasion and
dryness, and the posture of joints, which may need extra
support.
 Then palpate by running your hand down the length of
each aspect of the limb.
 Note the temperature, tenderness and muscle tone.
 Ensure only light pressure over bony prominence.
SEQUENCES FOR UPPER LIMB
MASSAGE
1.
2.
3.
4.
5.
6.
7.
8.
9.
Stroking (superficial)
Effleurage
Kneading
Effleurage
Picking up
Effleurage
Wringing
Effleurage
Hacking.
10. Effleurage.
11. Tapping.
12. Effleurage
13. Friction
Effleurage to whole limb
 Effleurage to the upper
limb is usually performed
with one at a time while the order hand controls
both the stability of the limb and the position of the
hand.
 The grasp on the hand should be with your own palm
cupped so you obtain a contact with only your own
palm cupped so you obtain a contact with only your
own palmar margins, so that a ‘ sticky’ grasp does
not arise.
Effleurage
Extensor aspect
Directions for effleurage:
From little finger to axilla
2. From back of fingers to axilla
3. From thumb in mid
pronation to axilla
1.
Effleurage
Flexor aspect
From the thumb over the flexor surface of the forearm and the
flexor surface of the arm to axilla
5. from the palmar aspect of the fingers over the front of the forearm
and the anterior surface of the arm to the axilla.
6. from under the little finger, up the ulnar border of the forearm and
the medial surface of the arm to the axilla.
4.
Part strokes
 The shoulder.
 Upper arm.
 Forearm.
 hands.
 Interossoeus spaces.
 Digits.
Kneading
 Always be aware that the size of the circle must be
related to the size of the area under treatment.
 Ensure you are working on muscle or soft tissue
and avoid deep, moving pressure over bony ridges
and prominences.
 The pressure on all the manipulations should be
inwards towards the centre of the arm and with
upward pressure so that you can envisage assisting
venous blood and lymph flow from distal to
proximal.
Double - handed alternate kneading
 It is usually performed straight down the length of
the limb, from the shoulder to the finger tips,
 the hands start cupped over the shoulder and
deltoid, encircle the upper arm to work on triceps
and biceps, and turn at the elbow to lie obliquely on
the flexor and extensor aspects of the forearm and
hand.
Kneading the deltoid.
Kneading the biceps and triceps.
Kneading on the forearm
note the lifted position to facilitate the manipulation and
the practitioner ’ s hands both in contact yet in different
dispositions.
Kneading on the hand
Simultaneous thumb kneading to the abductor
pollicis brevis and abductor digiti minimi.
Single- handed alternate kneading
 The deltoid
 The triceps
 The biceps
 Extensors of the forearm
 Flexors of the forearm
 The hand.
 Finger kneading
 Thumb kneading
 Interosseous s paces
Picking up
 It is usually performed with one hand at once, and
from proximal to distal.
 The practitioner ’ s outer hand works on the
deltoid, triceps and brachioradialis, and the inner
hand on the biceps brachii and the forearm flexors.
 The free hand stabilises the limb adjacent to the
working hand.
The deltoid
 Picking up to deltoid – note the ‘ C ’ shape of the hand.
The triceps
 Picking up to triceps – note the practitioner ’ s forearm is
behind the model ’ s arm and the hand is ‘ C ’ shaped.
The biceps
 Picking up to biceps – note the practitioner ’ s forearm
is parallel with that of the model.
The brachioradialis
 Picking up to brachioradialis – note the ‘ V ’ shape of
the hand.
Wringing
 Wringing is most easily performed on the long
muscles of the triceps and biceps brachii.
 It is possible to wring a flabby or very relaxed
deltoid, but the muscle is so short that it presents
difficulties in performance.
The The deltoid and triceps
Muscle shaking
 The deltoid.
 The triceps.
 The biceps.
 The bachioradialis
Muscle rolling
 Muscle rolling can be performed on each of the
upper limb muscles which can be picked up.
 Brachioradialis.
 the two fl exor and two abductor muscles of the
thenar and hypothenar eminences.
Hacking and clapping