Quiromassage

 

From an etymological point of view, the term "quiromassage" comes from the union of the Greek voice "χείρ, χειρός" that is "quiros" hands, with the voice "masa" (knead or squeeze gently). So it literally means 'hand massage' or 'manual massage' and is used to differentiate it from massages that use electrical devices or mechanical instruments. Massage techniques are established and applied depending on the specific objective to be achieved. The term "quiromassage" defines private studies initially taught in Spain, which have subsequently spread mainly to other Spanish-speaking countries.

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History
One of the first records of the word massage and the description of its use has recently been found in texts from Ancient Mesopotamia. Written in Sumerian and Akkadian titled "Mushu´u" (massages, in Spanish). According to these studies published in March 2007 by Barbara Böck, 1 philologist of the Higher Council for Scientific Research (CSIC), the ancient Sumerians practiced massages 4000 years ago. And the beginning (documented) of massage treatment dates back to that time.

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In Spain
The word "quiromassage" (QM) was used for the first time in Spain by Dr. V.L. Ferrándiz García (1893-1981), who studied naturopathy in the United States and Switzerland. Where he trained in the traditional European massage, the Swedish massage systematized by P. Henrik Ling (1776-1839). Ling, who was born in Sweden, traveled to China and on his return imported various massage techniques with which he developed the "Swedish system of exercise and massage", of which Chiromassage is a modality.

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Initially, massage treatment became popular, favoring the recovery of many injured and wounded from wars. But it declined again, as electro-mechanical stimulation and rehabilitation instruments became popular, and also due to the lack of scientific-medical training of some masseurs. The QM has left behind the exclusive use of the classic Swedish massage maneuvers and has integrated other techniques, mainly Japanese massage maneuvers, acupressure, sensitive massage or myofascial techniques, among others. Thus fulfilling the current trend in manual treatment, go towards the use of "eclectic massage techniques" (eclectic or combined).

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Definition, effects and actions
The "quiromassage" is a method of exploration (through perceptual palpation) and manual treatment, applied on the body covering and transmitted by the mechanical pressure of the hands to the different organs and tissues of the human body, which has at the same time, Regulatory effects on pain, the general feeling of energy, moods, fatigue and in general on the psyche. Depending on the indication and the proposed treatment objectives, effects that generate direct and / or reflex actions on the body can be achieved.

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The benefits of massage have reached our days, evolving from the simplest techniques to provide relaxation and promote sleep, to the specific development of some more complex ones to alleviate or eliminate specific ailments of the body and / or organism. The main effects are specified below: 

- Mechanical: in reference to how the mechanical forces related to each maneuver affect the tissues.
- Physiological-hygienic: when the massage is carried out on a healthy person to provide greater vigor to the body or to relieve fatigue and, this is associated with the practice of physical exercise or light gymnastics, and / or sauna, steam bath or Turkish bath , etc.
- Preventive: they are fulfilled when a tense area or with possible injury is located and delimited by palpation, we inform the subject receiving the massage and if it is feasible, refer to the physiotherapist, who is the professional who is legally trained to treat the syndrome of the myofascial pain. In addition, by advising that the treatment be combined with the practice of moderate exercise, well-being is promoted and that the massage lasts. Thus fulfilling several of the functions of the manual therapist: care-prevent, treat and promote health.
- Therapeutic: when massage is used to improve circulatory function, regain restricted mobility between damaged tissues, relieve and / or reduce pain, or to optimize sensory awareness. At the moment in which the massage provides human support, relaxation and well-being, helping in the recovery and maintenance of health, it becomes, even without intending it, a therapeutic act.
- Aesthetic-hygienic: when the skin is mobilized, a mechanical dragging or cleaning effect is produced, thus eliminating the scaly cells. When the QM is to improve the external appearance of the person, eliminating fat deposits, returning the muscle to its tone and relaxing fatigue. It has hygienic results since by eliminating fatigue in a healthy person it produces an aesthetic result.
- Sports: when it is carried out to prepare an athlete for competitive purposes before, during and after practicing it.
- Psychological-emotional: the contact of the experienced hand provides calm, security and comfort to the treated person, provides relaxation, while regulating and relieving psychophysical tension.
- Regulates the function: massage helps to improve the self-healing capacity of our body.

And as Dr. Ulrich Storck points out: "We must never forget that the success of massage depends on the multiple effects inextricably linked to each other". Effects that generate direct and / or reflex actions on the body, detailed below:

1º Direct or local: related to the mechanical action of the hand on the tissues, are those that are manifested in the place of application. For example: Moderate heating due to friction; pumping of blood circulation; stretching of soft tissues; detachment of scar tissues; collaborate in the breaking of adhesions and fibrosis; increased permeability between tissues; enzyme discharge; improves the elasticity of the fabrics and favors the sliding between them
2nd Indirect or reflex: arise at a distance from the place of application, examples: Relaxation; promote sleep; relieve pain; promote microcirculation; provide balance of the Autonomous Nervous System. These actions are similar to those indicated in other reflex therapies such as reflexology, acupuncture, faciotherapy ...
The combination of actions and effects generate a response on the different tissues and organs, as well as positive and balancing changes on the different states of mind and energy. Dr. Storck further specifies: "Wherever an increase in the capacity to meet the demands made must be considered, that is, where a certain organic and tissue fatigue has been implanted, the stimulation of massage is the most effective healing means" ; and designates massage as "regulator of function."

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We can add that the sum of the effects and actions of the massage also activates the body's self-healing capacity.

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Technique and indications
Massage techniques are established and applied depending on the specific objective to be achieved. In the case of a massage for relaxation, initially, it is done "on demand". But in the event of pain - with the aim of: "knowing the area to be treated to avoid causing damage" - and after data collection and subsequent observation, palpation and assessment techniques are used such as the "skin fold test of Kibler ", or" forceps rolled during treatment ", which allows to appreciate areas of hyperalgesia (the Head areas: areas of hyperalgesia of the skin associated with referred pain, which manifests an alteration of an internal organ, they are very sensitive to friction, cold and hot); to muscle stiffness and / or vegetative disorders.

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Technique
In practice, chiromassage is based on the use of a combination of technical movements called maneuvers. Some are similar to the movements of kneading a dough for bread: Kneading; others provide a component of friction, pressure, percussion, or vibration. To which you can add passive kinesitherapy appropriate to each situation, more stretching, and appropriate joint mobilization, etc.

Generally, the contact is exercised in a progressive and extensive way at the beginning to focus on the most limited and tense areas as the treatment progresses, in the same way the maneuvers are applied from less to greater intensity being the medium and medium-high intensity the most usual and, it is usually finished with soft. Although certain maneuvers that have their own intensity, eg: "soft rubs", also called "neurosedative passes" are applied superficially "almost without touching" and slowly. Instead friction requires greater contact and speed.

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Indications
The massage improves the functioning of the joints, increases blood flow and favors the peristaltic movements of the colon. The drainage of fluids (lymph and blood) is increased, optimizing the functioning of the organs and the transport of oxygen in the blood, essential to restore function.

Likewise, the "pumping" maneuvers favor the "passive washing effect", eliminating waste substances produced by muscle metabolism. And in a reflex way, massage actively collaborates in the regulation and balance of moods.

The massage fulfills several of the precepts of Andrew Taylor Still, one is: "The rule of the artery is absolute" since it nourishes, cleanses and increases the defenses of the tissues, the other is the "Law of self-healing of the body" because it above mentioned activates Vis medicatrix naturae, the self-healing capacity of the human body.

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Contraindications
Massage is a safe procedure. However, if its application is not appropriate or inappropriate, it can cause damage. Therefore, although the advantages are numerous, it is important to know the main contraindications so as not to harm and act safely and effectively. So it is necessary to perform: A careful evaluation; Monitoring the general situation of the patient and the treatment effects.

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As its name indicates, the contraindications refer to those cases in which partially or totally, it is not advisable to perform massage. And they are reduced, for the most part, to the application of massage in the area to be treated. For example (eg): it is appropriate to apply QM in the cervical area and in the trapezius muscle, to a person with significant arterial disease of the lower extremities (LES). But it is not appropriate to massage the LES in the case of significant edema in them. The most important contraindications are listed below:

1. During the first three months of pregnancy (after, with a prescription).

2. Infectious skin diseases (eg: fungi, lupus or SLE) and other generalized non-infectious (eg: allergic dermatitis). Pressure ulcers (or PUs) and burns.

3. Inflammatory vascular diseases (eg, phlebitis) inflammation of the lymph nodes and ganglion chains. Vascular weakness and severe circulatory retentions.

4. Thrombosis and arterial embolism, due to the risk of pulmonary embolism or of other body tissues, advanced varicose veins and in general heart disease (eg: tachycardia, arterial hypertension).

5. Acute or pathological inflammations with the typical symptoms: heat, redness (color) and increase in volume (tumor) and pain.

6. Recent bruises, hemorrhages, unhealed wounds, acute sprains, major contusions, acute edema, joint effusions.

7. Acute illnesses or in evolutionary phase, such as feverish states, nausea, gastric or very advanced duodenal ulcers.

8. Metabolic diseases such as gout.

9. Fibrosis and degenerative muscle diseases.

10. Acute rheumatic diseases.

11. Infectious or tumor diseases.

12. Inflammatory processes of bacterial origin.

13. Kidney problems in the acute phase.

14. Kidney Stones, gallbladder in expulsion phase.

15. Rupture or tears of muscles, sheaths, tendons, ligaments.

16. Recent trauma and surgical treatments.

17. Diseases of the nervous system: Lesions of the pyramidal pathways. Patients with nerve compression pictures.

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As a general rule, in the face of any pain that is not relieved by massage, but increases or worsens, it should be considered that there will be some cause that indicates that it is contraindicated, and it should be suspected that: there is a new problem or, that the diagnosis and therefore the treatment is not adequate. In any case, we must refer the patient to his doctor for a new assessment.

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Massage and pain
The application of the massage maneuvers should not cause pain, it is advisable to be attentive to the reactions of the subject who receives it, applying the contact (as already mentioned) in a progressive and extensive way at the beginning to focus on the most limited areas and tense as treatment progresses. On the other hand, in the case of a subject who arrives with pain, massage is a good resource to alleviate it.

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Well, it increases circulation and favors venous return; helps drain excess lymph that forms in edematous areas. It enables the release of nerve fibers trapped by mechanical imbalances in the joints and surrounding soft tissues by relaxing areas of tension.

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By gently touching the skin, or by maintaining pressure on the soft tissues during the massage, the mechanoreceptors are stimulated (the corpuscles or sensory receptor of changes resulting from the application of mechanical energy: touch, pressure, vibration). This makes it possible to "block" the ascent through the spinal cord of pain impulses, transmitted by pain receptors, (the nociceptors), on their way to the brain.

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Regarding this, R. Melzack and P. Wall develop in 1965 and correct in 1980, the "theory of the gate or the entrance door" ... of pain, or "the gate control theory of pain" [2], in which they advocated the existence of an inhibitory mechanism of pain in the spinal cord that could be activated by local neuronal connections such as, for example, the afferent fibers that transmit touch. Years later, the gaps found in said theory led to the existence of more than one type of pain according to the pathophysiological mechanism involved.

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Collecting the data known in the last decade on the study of pain, it was deduced that this can no longer be considered only as a subjective sensation (John J. Bonica, 1984, International Association Study of Pain, IASP [3]), but rather as a sensory and emotional experience in which social aspects also participate, such as education, cultural factors or expectations. Since it is the people who suffer pain. And that is where manual therapy can help by providing balance, calm, stimulating the self-healing power of the massage recipient and, therefore, their health.

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Technique with sensitivity
The quality of sensitivity is the ability to perceive and interpret the mood, character and way of acting of people, as well as the nature of the circumstances and environments that surround us at all times, to act appropriately for the benefit of others. If we add to this the learning of technical skills (in our case, the one who applies the massage) to regulate the contact and the rhythm of the different maneuvers; pressure, speed and time, we can influence both the tissues and organs of the body, as well as the general sensation of different moods.

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This way of acting of the masseur by means of a: "technique with sensitivity", allows him to achieve a balancing effect on the nervous system, thus the sum of all the possibilities of the massage activates the self-healing capacity of the treated person. It should not be forgotten that through listening and therapeutic contact, massage is very useful as a means of human support, and (after medical supervision) to reduce the stress caused by cancer or other serious diseases.

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Training
Chiromassage studies formatively train the future masseuse so that knowing the terrain to be treated avoids causing harm, since the Hippocratic principle: "Primum non nocere" (The first thing is not to harm), also applies to the masseur. The studies are private and authorized by the Ministry of Education, Social Policy and Sport of Spain and legalized by the different bodies of the Autonomous Communities.

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During his training, the massage student is instructed in anatomy and the QM technique. Likewise, they are trained in issues related to ethical conduct (personal, social and professional, since an implicit aspect during the massage is the massage therapist - client relationship, an aspect that forces to take into account a fact: The different maneuvers are the physical instrument of massage, they are applied according to a purpose and are a faithful reflection, at the same time, of the person who uses them. Similarly, emphasis is placed on the study of the effects, indications and contraindications of massage (some of them mentioned above).

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Bibliography

• K. Andrade, Results-based massage, Paidotribo.

• A. Biriukov, Sports Massage, Paidotribo.

• B. J. Bolto, Le corps entre les mains, Hermann Éditeurs.

• F. P. Carro, Massage, Therapeutic, Sports and Beauty Treaty, Distribuidora del Norte, Lugo.

• M. P. Cassar, Therapeutic Massage Technique, McGraw-Hill.

• J. H. Clay, Basic Clinical Massage Therapy, Lippincott.

• J. F. Cyriax, Cyriax, Injection and massage manipulative treatment, Marban.

• L. Chaitow, Manual therapy: assessment and diagnosis, McGraw-Hill Interamericana.

• G. Downing, The Massage Book, Pomaire.

• G. De Domenico, Massage, Beard Technique, Harcourt-Brace.

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• V. L. Ferrándiz García, New Orientations for the Chiromassage, Graphic Andros.

• Hoffa-Gocht-Storck-Lüdke, Massage Technique, JIMS (out of print).

• G. Inkeles, The new massage, Urano Editions.

• Kendall's, Muscles, functional tests, posture and pain, Marban

• W. Kuprian, Sport et physiothérapie, Masson.

• R. Melzack, PD. Wall, Pain mechanisms: A new theory, Science.

• A. Pilat, Myofascial Induction, McGraw-Hill Interamericana.

• J. Solé i Forn and J. Vendrell, Therapeutic Massage, Barcelona.

• J. Ylienen and M. Cash, Sports Massage, Hispanic European

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