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By Alice Lou Plastridge, Director of Physiotherapy, Georgia Warm Springs Foundation.

MUCH has been said and written about massage -- "the scientific method of manipulation of the body by rubbing, pinching, kneading and tapping, it is employed in therapeutics" to remove congestion in and improve the tone of the blood vessels, to accelerate the lymph flow; to aid in the removal of waste products in the tissues and improve the general nutrition by bringing a fresh supply of blood to that part.

Massage is a very effective and beneficial means of treatment for some conditions but for others it is either useless or injurious and should be used only under direction.

There are a great many methods of giving massage, depending largely upon the type of illness for which it is needed. It can be given heavily or lightly, with long sweeping strokes or short rotary motions; heavy kneading or fine finger strokes. It can be used for improving the general tone of the body, as a sedative or for joint injury, fractures and similar conditions. It can be stimulated or soothing as the case may be.

In itself, massage is not a cure-all, but because it has this direct effect upon the tissues, the lymph, and the blood, it helps nature bring about certain desired results. Frequently it is only a part of the necessary treatment.

This is particularly true in the after-care of poliomyelitis (infantile paralysis). As has been stated in previous articles, the use of supervised muscle training is the most important part of the treatment in restoring, partially or wholly, the function of the muscles, but all this can be made more effective if the circulation is good and the limbs are kept warm.

In all paralyzed muscles the circulation is very poor and frequently the limbs become cold and almost purplish in color. This is because the muscles are not active enough to keep the blood in the smaller blood vessels, especially in those of the extremities, moving as rapidly as it does in our normal activities. It is, therefore, necessary to use some artificial means of getting rid of the sluggish blood by sending it on, more quickly, toward the lungs and heart where it can be purified and pumped back to the extremities with its fresh supply of oxygen and food. In other words, massage must act as an auxiliary pump to increase the flow of blood from the extremities back to the heart.

To facilitate this stimulation the massage may be preceded by the application of heat -- in the form of hot water, hot moist towels, a thermolight (electric light) baker, or an infra red lamp (similar to a bathroom heater). This should be followed immediately by a light but effective massage.

Because the main blood vessels run parallel with the fibres of the muscles, one can get a more direct pressure on them if the muscles are stroked or kneaded in the direction in which these fibres run. In most instances this is in an upward direction -- toward the heart.

The action may be more easily understood if we consider each muscle group as a rubber tube filled with fluid. We attempt to empty the tube by pushing the fluid ahead of the hand and at the same time are careful to prevent any back flow. The idea is that the more nearly the tube can be emptied the greater will be the suction and the consequent inflow of fresh blood.

Before proceeding with a further description of this particular method of massage there are a few general rules which must be observed:

1. Never give pain by massage.

2. Make the patient comfortable by using pillows or rolls to give sufficient support to relax the muscles. Contracted or tense muscles cannot be worked on satisfactorily.

3. Use plain, unscented talcum powder to make the stroke smooth and prevent sticking. Oil or cocoa butter or cold cream may be used to soften the skin, but it is not possible to get as good a grip on slippery skin. There is very little if any nutritive value from using oil and it is much more "messy" to work with than powder.

4. Use gentle but firm and steady pressure in all strokes. They should not be too rapidly given.

5. In the extremities (both arms and legs) all strokes are toward the heart.

6. Massage must always be given directly on the skin. You cannot get a firm grip on the muscles otherwise.

7. Be sure there are no constricting bands like tight garters or rolled-up sleeves above the part being worked on.

8. It is more effective if each muscle group (as described below) is worked on separately. It allows a more direct pressure to the blood and lymph vessels.

9. Do not fatigue the patient. Too heavy or too long massage is as tiring as too much exercise. From five to ten minutes is sufficient for each limb.

No one muscle runs the entire length of the arm or leg, so the long, sweeping strokes covering the whole surface are not as beneficial in this particular condition as the shorter strokes taking in one muscle group at a time. In a rough way, the body may be divided up in this manner:

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1. The foot has four main groups; the inner, the outer borders, the top of the foot and the sole.

2. From the ankles to the knee there are four groups; the big calf muscle is divided into two sections, another narrower group lies along the outer side directly in line with the outer ankle bone, and the other group on the front just beside the tibia or, "shin bone."

3. The thigh has five groups; one on top from the knee to the hip, one on the inner aspect, two on the under side and one narrow one on the outer side.

4. In the upper extremities the fingers are each done separately, both the upper and under surfaces.

5. The lower arm has two main sections, top and bottom.

6. The upper arm has two groups, one on the front of the arm and the other on the back.

7. The muscles covering the top of the shoulder are done separately.

8. The back is divided into the long muscles which run up either side of the spine, then the groups from the crests of the hips up the sides of the body to the axillae or arm pits, and then the upper back groups, including the shoulders and sides of the neck.

9. The abdominal massage is more difficult and needs special instruction.

Remember that massage may be stimulating or soothing. Massage for poliomyelitis is only part of the treatment. Good massage never wearies a patient.

Detailed outlines of massage as it is used in poliomyelitis may be secured by readers of THE POLIO CHRONICLE. Address requests to Editor of THE POLIO CHRONICLE and enclose ten cents in stamps or currency.