Sitting, arm supported on a table.

Lying, arm supported on a pillow, resting on the treatment couch.

Lying, arm elevated on pillows.

Lymph glands: in the cubital fossa at the front of the elbow and in the axilla.

Major muscle groups: trapezius, deltoid, triceps, biceps, brachioradialis, flexors and extensors of the forearm.

Effleurage: apply three overlapping strokes to the flexor aspect of the forearm with your right hand, repeat on the extensor aspect with your left hand (Fig. 8.2).

Kneading: trapezius, two-handed reciprocal kneading to deltoid (Fig. 8.3), biceps, triceps, forearm and hand.

Finger kneading: fibres of deltoid, between the forearm muscles, tendons of the wrist.

Picking up: deltoid, biceps, triceps (Fig. 8.4), brachioradialis.

Wringing: triceps (Fig. 8.5), biceps, brachioradialis.

Muscle shaking: biceps, triceps, brachioradialis (Fig. 8.6).

Clapping: flexor and extensor aspects of the arm and forearm (see Fig. 7.11).

Hacking: flexor and extensor aspects of the arm (Fig. 8.7) and forearm.

Sitting, arm supported on a table.

Swelling is commonly trapped in the fibrous compartments of the hand.

The areas between adjacent metacarpal bones may need special attention.

Splintage or chronic swelling may lead to soft tissue contracture which will require petrissage manipulations.

The hand contains numerous muscles and tendons that can be implicated in burns and scarring. As resulting disability can be serious massage should be vigorous.

It is often desirable to include the wrist in a hand massage (see Fig. 8.11); manipulations may include thumb kneading to the carpal bones, petrissage to the flexor retinaculum.

Effleurage: to the nearest proximal lymph glands with the whole hand (Fig. 8.8), individual fingers (Fig. 8.9), between the metacarpals, thenar and hypothenar eminences.

Kneading: finger kneading to individual fingers, thumb kneading to the thenar eminence and hypothenar eminence (Fig. 8.10), between the metacarpals. (See also Fig. 8.11.)

Wringing: skin on the dorsum of the hand (Fig. 8.12), the muscles of the thenar eminence (Fig. 8.13) and hypothenar eminence.

Picking up: the dorsum of the hand, the thenar and hypothenar eminences.

Lying supine, with leg elevated.

Lying supine, with leg supported on pillows.

Sitting on the treatment couch, with leg supported on pillows.

Lymph glands: in the popliteal fossa behind the knee and in the groin.

Knee, patella and iliotibial band require special attention.

Anatomical spaces behind the malleoli and either side of the Achilles tendon can contain swelling.

The posterior aspect of the limb can be massaged with the patient lying prone.

Major muscle groups: quadriceps, hamstrings, adductors, anterior tibials, triceps surae, interossei and the layers of the foot.