CHAPTER II
Friction
Petrissage
Effleurage/
stroking
Percussion
(tapotement)
1. STROKING (OR) EFFLEURAGE

It unidirectional manipulation of soft tissues from distal
to proximal in the direction of the lymph drainage.

Effleurage is used more than any other massage technique.
It usually initiates and ends each treatments

Definition
Any stroke that glide over the skin is called as effleurage
Types of Stroking
1. Superficial Stroking or Superficial Effleurage
2. Deep Stroking or Deep Effleurage
Effect of effleurage
Superficial
◦ performed
either
from
Proximal to Distal or Distal to
Proximal
◦ Accustoms the patient to your
touch.
◦ Assessment of the skin and
tissues state
◦ Improves sensory analgesia.
◦ Slow stroking will relax and
sedate, and decreases muscle
tone.
◦ Faster strokes will stimulate
superficial
blood
flow
accelerating lymph drainage.
Deep
◦ applied from distal to
proximal only.
◦ Assists lymphatic and venous
return.
◦ Assists interchange of tissue
fluid.
◦ Assists removal of waste
product
◦ Passively stretches muscle
fibres.
◦ Restores mobility at tissue
interfaces.
◦ Light strokes decrease muscle
tone.
◦ Deep strokes increase muscle
tone.
• Knuckling – Clench the fist in palmar flexion, gradually
bring the hand from flexion to extension.
• Bilateral - Both hands progressing simultaneously on the
either side.
• Single - Single hand used for the stroke
2. Pressure manipulations (petrissage)
Compressing tissues against the underlying structures
Kneading
Shaking
Picking Up
Petrissage
Rolling
Wringing
A. Kneading
It is circular manipulation performed so that the skin and subcutaneous
tissues are moved in a circular manner on the underlying structures. It is
performed with palmar aspect of the whole hand, with palm only, with all
fingers, or with the pads of the thumb or of the fingers.

Effects
◦
◦
◦
◦
◦
◦
◦
Stimulates venous and lymphatic flow.
Increases mobility of fibrous tissues.
Helps interchange of tissue fluids.
Helps prepare soft tissue for exercise.
Helps removal of waste products.
Increases length and strength of connective tissues.
Restores mobility between tissue interfaces.
Classification of Kneading
• Grade 1: is sufficient to influence superficial
vessels and compress superficial tissues .on
underlying structures.
• Grade 2: effects deeper tissue drainage and will
compress deep tissue on underlying structures.
• Grade 3: is applied to superimposed or reinforced
strokes. It may be applied as strongly as can be
tolerated by the patient without producing tissue
damage.
B. Picking up
Compressing the tissues against the underlying structures,
then 'picked up', lifted, squeezed and released.
The manipulation can be single-handed in a C-shape ,
double-handed in alternate C-shapes and V-shapes or
double-handed in a V-shape.
 Effects
The same as for kneading
C. Wringing

Compressing the tissues against underlying structures,
then one hand pulls towards the you while the other hand
pushes away.

Effects of wringing
◦ Same as for kneading.
 particularly good for separating superficial and deep adherent
tissues.

There are only two grades for wringing:
◦ Grade 1 is usually applied to finger strokes only.
◦ Grade 2 uses the whole hand.
◦ There is no grade 3 as it would be too painful to tolerate.
D. Rolling

The fingers pull the tissue towards the thumbs and then
the thumbs squeeze and lift to push the tissue away.
◦ Types: skin rolling and muscle rolling

Effects
◦ Same as for kneading.
 mobilises scar tissue.
 When performed slowly, it has a stretch effect on the tissues being
manipulated
E. Shaking

Muscle or more superficial tissue can be shaken from
side to side
◦ Tips or whole hand are used


Whole limb shaking
Effects
◦
◦
◦
◦
◦
Produces a feeling of stimulation.
Increases tissue mobility.
Assists in breaking down tissue adhesions.
Stimulates lymphatic and venous flow.
Helps prepare soft tissues for stretch and exercise.
3. Friction


localized manipulation applied at the injury point aiming to
give a stretching across the fibers to separate them and restore
mobility.
Effects
◦
◦
◦
◦
◦
Restore tissue mobility.
Stimulate local circulation.
Aid the resolution of inflammation.
Reduce pain as a counter-irritant effect.
Stretch fibrous tissue.
Types:
1. Circular : Friction is applied in circular manner by the fingers. Rest of hand should
be out of the contact. This manipulation can be used over ligaments and
myofascial junctions.
2. Transverse: Friction is applied horizontally by the thumb or fingers. This
manipulation can be used over tendon, ligament, myofascial junctions and
muscles
Classification of Friction
• Grade 1 does not apply to this technique as it is aimed at
deeper structures.
• Grade 2 is sufficient to affect deep tissue and cause
compression.
• Grade 3 applies to reinforced and most transverse frictions and may produce pain before causing numbing.
3. Percussion (tapotement)
Percussion movements (tapotement) involve a series of light, brisk,
striking actions applied with alternate hands in rapid
succession.
Hacking
Vibration
Clapping
Percussion
Tapping
Beating
Pounding
A. Hacking
• Hold the hands so that the palms are parallel. Strike
the part with a series of soft, but brisk blows, using
the later borders of the middle, ring and little finger.
Use both hand alternatively and strike rapidly with
pronation and supination at forearm.

Effects
◦
◦
◦
◦
◦
◦
Stimulates local circulation.
Stimulates muscle tone.
Gives a generalised feeling of stimulation.
Provokes muscle and tendon reflexes.
Light strokes affect superficial tissue.
Deeper strokes aid the evacuation of the lungs.
Classification of Hacking
• Grade 1 uses only the medial borders of the fingers.
• Grade 2 uses the medial borders of hands and fingers.
• Grade 3 uses the medial borders of hands and fingers
more deeply and slowly.
B. Clapping (cupping)
• It performed with your palms facing downwards,
forming a hollow curve. Strike the part with the
palmar surface of the hand. The striking sound
should be hollow like a horse trotting. Use both
hand alternatively and strike rapidly.

Effects
◦ Same as for hacking, with the exception of provoking a tendon
or muscle reflex
Classification of Clapping
• Grade 1 clapping is very superficial and is often called
skin clapping. This is performed at a fairly fast pace with
minimal contact.
• Grade 2 clapping is deeper, slower and firmer.
• Grade 3 clapping is very firm and may involve elbow as
well wrist action.
C. Beating


Involves the use of lightly clenched fists to hit the area
Effects
◦ As for clapping.

Classifications of beating
◦ Grade 1 beating is performed at a fast rate, with fairly light
contact.
◦ Grade 2 is slower, with firmer contact.
◦ Grade 3 is very deep and the rate can be varied as required.
D. Pounding

The hands are held in lightly clasped with the thumbs
resting against the first fingers

Effects
◦ As for clapping.

Classifications of beating
◦ Grade 1 of this stroke applies to a fast rate with light contact.
◦ Grade 2 is used at a slower rate with firmer contact
◦ Grade 3 is deeper, with varying rates.
E. Tapping
• Tapping is done the tips or pads of the fingers.
It is used on very small areas such as the face.

Effects
◦ As for clapping.

Classifications of beating
◦ Grade 1 of this stroke applies to a fast rate with light
contact.
◦ Grade 2 is used at a slower rate with firmer contact
◦ Grade 3 is deeper, with varying rates.
F. Vibration
• A fine tremulous movement, made by the hand or fingers
placed firmly against a part, will cause the part to vibrate.
• Tips of the finger or whole hand is used for vibration.
• Vibration involves a movement in which the tissues are
pressed and released using an up and down motion.
 Effects
◦ Stimulates muscle tone.
◦ Stimulates the local circulation.
◦ Provides a feeling of well-being.