Effleurage Technique

1. Ensure that the client is warm and 10. The whole of the palmar surface of the hand,
comfortable. fingers and thumb should maintain contact with
the body in a relaxed manner. (Do not extend,
2. Take up a walk standing position with the abduct or link the thumbs, and do not spread the
outside foot forward: make sure you can reach all fingers out, as these habits will give uneven
parts. pressure.)

3. Remember to bend the front knee as the 11. The hands usually work together with even
movement progresses and use body weight to pressure and rhythm. However, the hands may be
apply pressure (pressure must not be applied used alternately when care must be taken to
through the arms and shoulders alone). Keep maintain an even pressure under each hand and
your back straight. to synchronise the flow and rhythm.

4. Ensure that your hands are warm, relaxed and 12. On small areas, one hand may work while the
supple they mustmould and adapt to the body other supports the tissues. On very small areas
contours. such as the face, fingers or toes, the thumbs only
may be used in a sweeping action.
5. The hands must move in the direction of
venous return back to the heart, beginning Stroke Technique
distally and working proximally. 1. The therapist's stance depends on the direction
of movement walk standing (one foot in front of
6. The strokes must be directed towards, and end the other) if working top to bottom, stride
at, a group of lymphatic nodes wherever possible. standing (feet apart) if working from side to side.

7. The pressure should increase slightly at the 2. The hands must be warm, relaxed and supple;
end of the stroke. they may mould and adapt to the contours of the
body but this is not always so.
8. The hands maintain contact on the return of 3. The wrists must be very flexible and loose.
stroke but apply little pressure.
4. The movement can be performed in any
9. The movement must be smooth and rhythmical, direction.
with continuousflow and even pressure.
5. The pressure is selected at the commencement sliding and thumb walking Hand-use press
of the stroke and maintained throughout the release, slide and rotate
stroke. This pressure may be light to moderate
for a relaxing massage, or firm and heavy for a B. Back Area Procedure in Massaging Back Area
vigorous massage. Step 1: Starting on the back use a smooth
stroking movement "gliding downwards with
6. The movements must be rhythmical with thumb on either side of the spine (do not press
continuous flow. The hands may or may not be the bones outside them) and then take the hands
lifted off the part at the end of the stroke. to the side and glide back up the shoulders Step

7. The whole of the palmar surface of the hand, 2: From kneeling position at your partner's side
fingers and thumb may remain in contact with the use the whole of your hand and a smooth stroking
part, or the fingers only may be used. movement to pull up steadily. One hand at a time
working all the way up and down one side of
8. The hands usually work alternately, one hand partners back few time then repeat to other side.
commencing a stroke. as the other reaches the
end. Step 3: Squeeze the muscles from one hand to
the others, to knead the muscles of the back of
9. The hands may work in opposite directions if the shoulder and release deep selected muscles
working across the back, one beginning on the tension, make sure you knead generously, rather
right side, the other on the left side, then than using pinching movement, repeat to the
crossing the back. Stroking is frequently other side.
performed from the nape of the neck to the base
of the spine, or transversely across the abdomen, Step 4: Stretch the back using forearm to glide in
back or thigh. different direction, try to keep a constant, steady
pressure. Lift off the arm when they reach the
neck and buttocks. Return to the centre of the
AREA FOR MANIPULATION back and repeat a few times.
A. Head-use pinching, sliding and pressed release
manipulation pinching is to squeeze between C. Leg Area Procedure in massage of the leg area
your thumb and finger often in a painful way -
sliding - pressed release Shoulder-use figure of
eight tech-kneading or gliding Forearm-use
Step 1: moving down to the lower extremities foot However, other manipulations have evolved
area, press the muscles of the scalp then protect where the tissues are lifted away from the bone,
the tendon area. squeezed and then released. Some of the
manipulations in this group are quite difficult to
Step 2: Do not put over pressure on the area perform and much practice is needed to perfect
behind the knee, but glide over knead the back of them.
the thigh, then stroke all the way up leg handover
hand, always moving in an upward direction 2.1 Kneading There are many forms of kneading.
repeat on leg. The terminology used for each one will tell you
what should be done, so study them carefully
D. Foot Area Procedure in massaging the foot
area. Step 1.. Use the stroke of press on, release, 2.1.a Palmar kneading: this is kneading with the
rotate and slide, repeat these movement to the palmar surface of the hand. There are different
other side of the foot forms of palmar kneading.

After Care-end of Manipulation 2.1.b Digital kneading: this is kneading with the
digits (i.e. the fingers) index, middle and ring
2. Petrissage This comes from the French verb fingers are usually used.
pétrir meaning 'to knead. There are five
manipulations in this group, but some can be 2.1.c Thumb kneading: this is kneading with the
further subdivided: thumbs.

1 2.1.dUlnar border kneading: this is kneading with

2 the ulnar border of the hand (ulnar bone or little
3 finger side).
4
5 2.2 Wringing Wringing is a manipulation where
the tissues are lifted away from the bone, and
All the manipulations in this group apply pressure pushed and wrung from side to side as the hands
to the tissues, but each manipulation differs in move up and down. It must not be used on over-
technique. The true kneading manipulations stretched muscles or those with poor tone.
apply pressure to the tissue and move them over
underlying bone in a circular movement. Technique
 1. The stance is walk standing.
1. The stance is usually stride standing.
2. Spread the thumb away from the fingers, i.e.
2. The hands must be warm, relaxed and supple. abduct the thumb.

3. The tissues are grasped in the palm of the 3. Place the thumb on one side of the muscle or
hand and held between the fingers and thumb group and the fingers together on the other side.
(taking care not to pinch).
4. Grasp and lift the muscle in the palm of the
4. The tissues are lifted away from the bone. The hand, squeezing with the thumb and fingers (do
tissues are moved diagonally from side to side by not pinch).
pushing the fingers of one hand towards the
thumb of the opposite hand. 5. Release the muscle and move the hand
5. Keeping the tissues in the palm and lifted away forward, pushing upward with the palm and web
from the bone, the hands move up and down of the abducted thumb. Slight flexion and
along the length of the part, pushing the flesh extension of the wrist accompanies this
from side to side. Do not pinch with the thumbs movement.
and fingers of thesame hand.
6. The hand moves upwards in this manner,
6. The hands work up and down until the area is picking up, squeezing. releasing and moving on.
well covered and return to starting point.
7. The hand may work up and down, or it may
work up and slide back down.
2.3 Picking Up Picking up is also a manipulation
where the tissues are lifted away from the bone, 8. Use the other hand to support the tissues.
squeezed and released. It may be performed with
one hand or with both hands. It must not be used 2.4 Skin Rolling This manipulation presses and
on stretched muscles or those with poor tone. rolls the skin and subcutaneous tissues against
underlying bone.
2.3.a Single-handed picking up: technique This
method is performed with one hand grasping the Technique
muscle.
1. The stance is stride standing.
2. Place the hands flat over the area with the The pressure may be selected at the
3. Thumbs abducted. commencement and kept constant throughout, as
4. Lift and push the flesh with the fingers towards is usual with transverse frictions, or the pressure
the thumbs. may get progressively deeper, as with circular
5. Roll this flesh, using the thumbs moving across frictions. The pressure must, however, be
towards the fingers. completely released before moving on to a new
6. Move smoothly onto a lower area and then area. Frictions are performed on dry skin, free of
work back. oil or talcum powder, so that the fingers move the
skin and do not slip over it. Remember these are
2.5 Muscle Rolling This manipulation lifts the specialised movements, used when localized
muscle away from the bone and moves it from depth and pressure is required. They should not
side to side in a rocking manner. be confused with digital or thumb kneading,
which applies constant upward pressure using a
Technique circular movement.
1. The stance is stride standing.
2. Place the thumbs nail to nail in a straight line Fast stroking is also sometimes referred to as
on one side of the muscle and place the fingers brisk friction because the hands do apply friction
over the other side. to the area, but this covers a large area and is not
3. Grasp and lift the muscle away from the bone. localised
4. Push the muscle with the thumbs towards the
fingers, which give slightly as the muscle moves. 2.6.a Circular Frictions These are small circular
5. Push the muscle back towards the thumbs, movements performed by the fingers or thumb.
using the fingers in the same way. Technique
6. Push the muscle backwards and forwards, 1. The stance is usually walk standing.
applying pressure into the muscle and using a 2. Select and examine the small localised area
rocking action. where frictions are required.
7. Move along the muscle by sliding the hands. 3. Stroke it gently with the sweeping thumb or
palm.
2.6. Frictions These are much localized 4. Use the thumb or the fingers: the middle
manipulations performed with the fingers or finger is usually used to reinforce the index and
thumb. They may be applied transversely across ring fingers.
muscle fibres or in a circular movement. They are
deep movements performed with much pressure.
5. Do not hyper-extend any joints when applying pronate and the fingers to strike the part. The
pressure, as this will strain and damage the hands strike alternately.
joints. Keep the fingers straight.
6. Circular frictions are performed in small Technique
circles, moving deeper and deeper into the 1. The stance should be stride standing, with the
tissues to a maximum depth, then released. feet a good distance apart and the knees relaxed
Repeat three to four times over the same spot or bent, keeping the back straight.
and then move to another area as required. 2. Place the hands together with the fingers
7. The fingers or thumb must not slide or rub straight as in prayer, thumbs against chest.
over the surface of the skin, but the superficial 3. Take the elbows away from the sides, i.e.
tissues must move with the fingers over the abduct the shoulder joint. The wrists will now be
deeper ones. extended at an 80-90° angle.
8. Areas requiring frictions may be tender and 4. Place the arms parallel and just above the part
care must be taken not to cause unnecessary pain to be worked on.
through excessive pressure. 5. Supinate and pronate the forearm so that the
9. Effleurage or stroke the area frequently little fingers strike the part lightly and then lift
between friction manipulations. and at the end of away.
the treatment. 6. Practice this action until the arms roll easily.
7. Now practice the whole procedure. Part the
3. Percussion or tapotement: where the hands hands and strike the part alternately(remember
strike the tissues There are four manipulations in to keep the elbows out and wrists extended).
this group, named according to the position of the 8. Relax or slightly flex the fingers and, keeping
hands and the way in which they strike the part: the same action, strike the part alternately with
1. Hacking the ulnar border of the little, ring and middle
2. Cupping fingers.
3. Beating 9. Strike lightly, briskly and rhythmically with
4. Pounding alternate hands.
10. Work up and down or across an area - cover
3.1. Hacking This manipulation uses the ulnar thoroughly.
border of the hand and the little finger, ring and 11. The hands may also diverge the heels of the
middle fingers to strike the tissues in a light, hand stay close but the fingers diverge forming a
brisk manner. The forearm must alternately 'V' shape. This is useful over the upper fibres of
the trapezius, below the nape of the neck.
 the hands strike the part as the hands alternately
3. 2. Cupping Cupping (also known as clapping) is drop heavily onto the area,
performed using the cupped hands to strike the
part alternately. The movements are light and Technique
brisk, producing a hollow sound. 1. The stance is stride standing.
2. Loosely clench the fingers; keep the thumb
Technique against the hand.
1. The stance is stride standing, as for hacking. 3. Straighten the elbows.
2. Make a hollow shape with the hand by flexing 4. Place the loosely clenched hands on the part so
themetacarpo- phalangeal joints (knuckle joints). that the back of the fingers and heel of the hand
Keepthe thumb in contact with the index finger. lie in contact with the part.
3. Straighten the elbows they may flex and extend 5. Extend and flex the wrist and lift the arms
slightlywith the movement. slightly so that the hands fall alternately and
4. Place the hands on the part. heavily on the part.
5. Flex and extend the wrist as the hands lift up 6. Work up and down or across the area and
and downalternately; keep the wrists loose and ensure that you cover it thoroughly four to six
flexible. times.
6. Strike the part lightly and briskly with the 7. The movement should be brisk and rhythmical.
fingers, part of the palm and heel of the hand. The pressure can vary from light to heavy,
7. The hands should clap the area, making a depending on the required outcome and the type
hollow sound. Avoid a slapping noise, whichwill of tissue being worked on. Well-toned bulky
occur if the hands are too flat. This will sting and muscles or a depth of adipose tissue (fat) will be
be uncomfortable for the client. suitable for heavier pressure.
8. Work up and down or across the area. Cover it 8. It is usual to work with both hands striking the
thoroughly four to six times until anerythema is part alternately, but it is possible over small or
produced. awkward areas to use one hand only, supporting
the tissues with the other.
3. 3 Beating This is a heavier percussion
movement that is useful on very large heavy 3.4. Pounding This, again, is a heavy percussion
areas of adipose tissue, particularly over the movement, performed by the ulnar border (little
buttocks and thighs. The manipulation is finger side) of the loosely clenched fist. The side
performed by striking the area with a loosely of the hands strikes the part alternately.
clenched fist. The back of the fingers and heel of
Technique 1. The stance is walk standing or stride standing.
1. The stance is stride standing. 2. Support the part with one hand.
2. Loosely clench the fingers. 3. Place the other hand on the part.
3. Place the ulnar border of the hands on the 4. Keep the fingers straight and the thumb
part, with one hand slightlynin front of the other. adducted.
4. Lift the front hand and strike behind the back 5. Vibrate the hand up and down or from side to
hand as the back hand lifts off the part. side to produce a tremor in the tissues. The hand
5. Continue to circle the hands over each other, maintains contact throughout.
striking the part alternately with each hand. 6. Avoid tension developing in the working hand,
6. The movement should be brisk and rhythmical. arm and shoulder.
The pressure can vary from light to heavy,
depending on the desired effect and density of Customized Amount of Pressure Applied
tissue. Manipulations should be selected to suit the
7. Cover the area thoroughly four to six times, or client and personal preference or expertise.
until the desired erythema reaction is achieved. There are, however, basic rules and guidelines.

4.Vibrations Comfort: massage must always be comfortable. It

There are two manipulations in this group: must not hurt or injure the client, even the
shaking and vibration, Both produce vibrations or vigorous and stimulating techniques.
tremors within the tissues. Shaking is a much
bigger, coarser movement and produces shaking Direction: pressure must be applied in the
of the muscle, while vibrations are fine direction of venous drainage towards the heart
movements that merely produce a tremor. and the direction of lymphatic drainage to the
nearest lymphatic nodes. (Do not pull back what
4.1Vibration This manipulation is usually you have pushed along as this is counter-
performed with one hand. However, on large productive.)
areas both hands can be used. The hand is placed
over the area and vibrated either up and down or Order: begin with effleurage, follow with
from side to side. applicable petrissage manipulations then
The action produces vibrations in the underlying percussion if suitable, and complete with
tissue. effleurage. Effleurage and stroking may be
interspersed among any of the other
Technique manipulations.
 yourself from strain and injury by adopting the
Continuity: massage should be continuous the correct posture. There are two standing positions
transition between strokes should be barely used in massage: a) walk standing (i.e. with one
perceptible. The hands should not be lifted off the foot in front of the other) is used when massaging
area once treatment has commenced until that up and down the length of the body b) stride
area is completed. Move smoothly from one standing (i.e. with the feet apart) is used when
stroke to another. working across the body. Always keep the back
straight and the shoulders relaxed. c) Allow the
Speed: this must be selected according to the knees to bend when necessary to apply body
type of massage required slow for relaxing, weight and to reach all areas. Increased depth
moderate for a general massage, and faster for a and pressure must come from body weight
vigorous, stimulating massage. transmitted through the arms, but not by pushing
with the arms. Use a slight swaying body
Depth: this must be selected according to the movement to achieve this. Keep the feet apart
type of massage, as described moderate depth for this improves balance and provides stability, as it
a relaxing and general massage, deeper for a gives a wider base. Concentration: maintain your
vigorous massage. Depth must also be adjusted to concentration throughout the massage. Although
suit the client and the desired outcome of the massage movements become semi-automatic as
treatment. For example, young, fit clients will expertise develops, it is still important to
take greater depth than older clients; well-toned concentrate fully on the task in hand. Continuity
clients will take greater depth than those with and rhythm will suffer if there is a lapse in
loose, flabby muscles or thin clients; obese clients concentration, and this is transmitted to the
or those with specific areas of hard adipose tissue client. Coverage: cover the whole area
will require greater depth. Those accustomed to thoroughly. Do not neglect small areas as this will
massage generally prefer a deeper massage than result in uneven coverage. Duration of
new nervous clients. (Always ask the client if Application of Pressure The timing of a body
manipulations are too deep or not deep enough.) massage is usually one hour but may be longer.
Rhythm: this must be consistent regardless of the The order of covering the body is usually:
type of client. The rhythm is selected at the
beginning of the massage and maintained
throughout, e.g. slow rhythm for a relaxing
massage, moderate for a general, and a faster
rhythm for a vigorous massage. Stance: protect