Classification, Definitions, and Descriptions of the Basic Massage Strokes and Relaxed Passive Movements

Chapter 4 Classification, Definitions, and Descriptions of the Basic Massage Strokes and Relaxed Passive Movements

As the brief history of massage presented in Chapter 1 revealed, there have been, and still are, many different ways of defining the various massage techniques. This chapter provides specific information about each of the traditional massage strokes that are based on the system known as Swedish remedial massage. The definitions and descriptions represent a current view of the various techniques. Of course, some of the descriptions of the strokes are at variance with earlier ones. This is not surprising, given the considerable disagreement over massage terminology used in the past. Indeed, it is hoped that the classification and descriptions detailed in this chapter are logical, accurate, and worthy of adoption. In most cases, photographic examples are given of each of the strokes to several body parts, and many of these strokes are also featured in Chapters 7 and 8, which address general and local massage techniques.

The DVD that accompanies this text demonstrates each of the basic strokes to all the main regions of the body in a way that cannot be replicated with still photographs. For each technique, the DVD section is identified, making it easy for the reader to view the technique in question. Of course, it is possible to pause and repeat the video section as needed. The video provides an opportunity for viewers to understand the finer points of each technique, such as the rate and rhythm. In addition, the surface anatomy sections of the DVD provide essential information to support the practical techniques demonstrated in the video.

A section on the techniques known as relaxed passive movements or simply passive movements follows the descriptions of the basic massage techniques. Although these techniques are not massage per se, they are important soft tissue manipulation techniques that need to be addressed. In general, these techniques should be used after massage and before active exercise. The basic techniques are demonstrated on the accompanying DVD, which features a section on relaxed passive movements for the neck, the upper limb, and the lower limb (see DVD Chapter 4).

Before defining the individual massage strokes, it is helpful to start with a definition of the general concept of soft tissue manipulation itself. Several terms are often used interchangeably, so it may be useful to mention these here as well. Soft tissue manipulation is described as follows:

What then are the soft tissues of the body? Essentially, the soft tissue of the body comprises all structures that are not a direct part of the skeleton. Thus, the bones, and therefore the joints, can be considered as the hard tissues, together with articular and fibrous cartilage. In addition, the teeth, fingernails, and toenails can be classified as hard tissue. Although there is an entire discipline of manual therapy dedicated to mobilizing and manipulating the joints, one can argue strongly that even these techniques are directed at the soft tissues rather than the bones and joints themselves. The bones and joints do not bend and stretch during or in response to these techniques. Instead, it is the soft tissues surrounding the joints (skin, capsules, ligaments, tendons, etc.) that are affected, together with those muscles whose tendons span the joints being treated. A simple classification of soft and hard tissues is shown in Table 4-1.

Table 4-1 A Classification of Soft and Hard Tissues

Skin Bones
Subcutaneous tissues Teeth
Muscles Finger and toenails
Tendons Articular and fibrous cartilage
Joint capsules  
Blood vessels  
Lymph vessels  
Heart and lungs*  
Abdominal organs*  
Pelvic organs*  

* These structures/tissues are soft tissue in nature but cannot be massaged because of their anatomical locations.

Some of the structures/tissues listed in Table 4-1 are soft tissue in nature but cannot be massaged because of their anatomical locations (e.g., brain, heart, lungs). Although soft tissue manipulation can affect the abdominal viscera in a general way, it cannot be applied directly to a specific abdominal or pelvic organ. Clearly then, soft tissue manipulation can have an effect on almost all tissues of the body. Many of these effects are discussed in Chapter 5. There are a variety of techniques that can be considered as types of soft tissue manipulation, and these are listed in Box 4-1.

With regard to the various systems of massage and bodywork (another common term for a type of soft tissue massage), this text differentiates two basic groupings: recreational massage and therapeutic massage. Some of the specific massage strokes described in this text (or modifications of them) can be used for both recreational and therapeutic massage. In this regard, it is important to clearly differentiate between the two categories.

Collins English Dictionary defines the word recreation as “refreshment of health or spirits by relaxation and enjoyment.” Other major English dictionaries use similar descriptions, and it is in this context that the term recreational massage is intended.

Dorland’s Medical Dictionary defines therapeutics as “the branch of medical science concerned with the treatment of disease.” Clearly intended in this definition is the assumption that a health problem exists that requires healing. For this reason, the term therapeutic massage is used to denote a massage treatment intended to facilitate healing when a specific health problem exists. This text deals only with various forms of therapeutic massage.

There are numerous variations of technique used in recreational massage. Although many of these techniques certainly feel good to the client, some may have little therapeutic value. Other techniques seem similar to the more therapeutic procedures. Of course, all of these techniques have considerable psychological value. For this reason, it is helpful to distinguish between recreational massage and therapeutic massage.

Recreational massage is defined as follows:

Therapeutic massage is defined as follows:

In addition to these major distinctions, it may be helpful to define three basic ways in which therapeutic massage may be given to a patient. A specific chapter in the text is devoted to each of these concepts. In each case, various techniques are combined to form a massage sequence, and these may be given to the entire patient (Chapter 7), to one or more regions of the body (Chapter 8), or to a specific anatomical structure (Chapter 9).

General massage is defined as follows:

Local massage is defined as follows:

Focal massage is defined as follows:

In addition to a detailed description of each massage stroke, the following sections discuss the specific effects of each technique and the common contraindications. This approach brings together all of the information pertinent to each stroke.



Deep Stroking

Deep stroking is given with much greater pressure and is usually performed slowly. Given in this manner, it tends to stimulate the circulation to the deeper muscle tissue. For this reason, it is generally given in the direction of the venous and lymphatic flow.

Figures 4-1, 4-2, and 4-3 show the different directions for the technique of stroking. In addition, the DVD demonstrates stroking on several body areas.


Depth and Pressure

To affect the contents of the superficial veins and lymphatics, effleurage must be performed with significant pressure. Pressure should gradually increase throughout the stroke so that the venous blood and lymph are pushed through the veins and lymph channels. There should be a definite pause at the end of each stroke, at or near the appropriate group of superficial lymph glands. This allows the valves in the vessels to close, thus minimizing back flow. These changes in pressure during the stroke make it important to maintain firm but comfortable pressure on the tissues. The greatest pressure is exerted at the end of the stroke when the hands or hands are stationary.

Effleurage to a variety of body areas is depicted in Figures 4-4 throuh 4-6. In addition, on the DVD effleurage is demonstrated to several body areas, as noted in the following table.

Contraindications to Effleurage

The general concept of contraindications is covered in Chapter 3. As a technique, effleurage may be contraindicated when any of the situations listed in Table 4-4 are present.

Table 4-4 Main Contraindications to the Use of Effleurage

Large open areas (e.g., burns or wounds) in the areas to be treated, especially if they are infected A
Cancer in the skin or any other tissue in the area to be treated A
Serious infections in the tissues to be treated (tuberculosis, septic arthritis, etc.) A
Gross edema in the areas to be treated if there seems to be a possibility of splitting the skin A
Lacerations, bruising, infections, or foreign bodies (e.g., glass, grit, metal) in the skin of the area to be treated A
Chronic swelling in the areas to be treated, in the lower limb associated with severe congestive cardiac failure or any other heart condition with which lower limb edema is associated U
Acute or chronic skin conditions affecting the areas to be treated (e.g., psoriasis, eczema, or dermatitis) U
Marked varicosities in the areas to be treated if damage to the vein wall might result (very light stroking may be possible) U
Within 3 to 6 months following radiation therapy in the area to be treated (skin is usually hypersensitive) U
Areas of hyperesthesia in the areas to be treated (i.e., those very sensitive/ticklish to touch) R
Extremely hairy areas in the areas to be treated (if stroking causes pain) R

A, Always contraindicated; U, usually contraindicated; R, rarely contraindicated.



Pressure manipulations (pétrissage, from the French word pétrir: to knead), include several different massage strokes that are characterized by the application of firm pressure to the tissues. In the majority of cases, these strokes aim to mobilize deep muscle and tendon tissue, including the skin and subcutaneous tissues covering them. Four distinct types of stroke are discussed in this section: kneading, picking up, wringing, and skin rolling.


Basic Technique and Direction of Movement

Kneading is a stroke in which the therapist’s hands and the patient’s skin move together on the deeper structures whenever pressure is applied to the tissues. It can be performed with several parts of one or both hands, including the entire palmar surface and the pads/tips of the fingers or thumbs. In each case, the basic direction of the movement is circular. Pressure is applied during half of the circular motion and released with relaxation during the other half. Although kneading can be performed in a stationary manner (stationary kneading), it is more usual for the hands to move across the body surface during the technique. Movement of the hands is achieved during the relaxation phase of each circular motion. The hands usually move in parallel lanes to cover the entire area to be treated. The larger the area, the more lanes are needed. This type of kneading compresses the tissues and is therefore known as palmar kneading. Several variations of the technique can be used, and these will be considered in a later section. Figure 4-7 illustrates the concept of circular motion and movement in parallel lanes. It is common to most, but not all, types of kneading.


Several variations of the basic kneading stroke are used, and these are explained in the following sections.

Palmar Kneading.

When the entire palmar surface is used, the technique may be called palmar kneading. The basic palmar kneading stroke is also called compression kneading, circular kneading, flat-handed, and whole-hand kneading. In this manipulation the tissues are compressed upward and inward in a circular motion against the underlying tissues and then released. Overlapping lanes of circular strokes are used to cover a large area of the body, such as the back. If the tissues are flat, such as the back region, both hands can be used on the same plane of motion (side by side). In the limbs, however, the hands usually work opposite to each other (on either side of the limb). This produces more movement of the whole muscle masses involved.

Figures 4-8 and 4-9, A, illustrate the basic two-handed technique. The techniques shown in Figure 4-9 are good examples of the therapist’s hands working opposite each other and out of phase. Palmar kneading, using one- and two-handed techniques, is also demonstrated on the DVD.

Finger Pad Kneading.

This technique is also called digital kneading, and it involves the basic palmar kneading stroke performed with one or more finger pads, using one or both hands. If the therapist’s hands are placed opposite each other, for example, around the knee region, then the finger pads usually work in phase with each other. It is quite possible, however, for the finger pads to work out of phase, and this is simply a matter of preference. The technique is useful for treating small- to medium-sized areas and areas of irregular shape (e.g., around the elbow, knee, or ankle). When both hands are used, they may work side by side in some situations, or opposite each other, as in Figures 4-10 and 4-11, which illustrate finger pad kneading around the elbow and knee regions, respectively. Finger pad kneading is also demonstrated on the DVD (see DVD Chapters 4-31, 4-48, 4-51, and 4-63).

Thumb Pad Kneading.

The basic palmar kneading stroke can also be performed with the pads of one or both thumbs, usually working side by side. This technique is especially useful along fusiform muscles (e.g., the flexors and extensors of the wrists and fingers or the anterior tibial muscles). It is also useful for the treatment of small areas in the hand, foot, and face. Figure 4-12 illustrates the stroke. Thumb pad kneading is also demonstrated to various body areas on the DVD (see DVD Chapters 4-35, 4-37, 4-50, 4-52, and 4-64, 4-65, 4-66).

Jun 4, 2016 | Posted by in MANUAL THERAPIST | Comments Off on Classification, Definitions, and Descriptions of the Basic Massage Strokes and Relaxed Passive Movements

Full access? Get Clinical Tree

Get Clinical Tree app for offline access