Massage after a stroke

Relatives and friends of a patient who has suffered a vascular accident are concerned about the question of whether it is possible to do therapeutic massage after a stroke and when can it be started? Massage is a necessary procedure for rehabilitation. After an ischemic stroke, already on the 2-3rd day, they begin to do a restorative massage with a satisfactory condition of the patient. In the case of a hemorrhagic stroke, the procedure is started a week after the event.

Tasks of massage in rehabilitation practice

Manual therapy, along with drug therapy and exercise therapy, is an important tool for restorative treatment. The technique of carrying out depends on the severity of neurological disorders. The first positive changes are observed 3-4 weeks after the start of classes. The main tasks of therapeutic massage after a stroke:

• Decrease and normalization of muscle tone;
• Optimization of blood circulation, normalization of the outflow of venous blood, reduction of intoxication of the body;
• improvement of sensitivity, restoration of sensorimotor functions of the affected limbs;
• improvement of lymph outflow, reduction of puffiness, prevention of bedsores;
• normalization of the work of internal organs, stagnation in the lungs is excluded, urination and defecation are established;
• relaxation, improvement of psycho-emotional mood, stress relief.
• reduction of pain syndrome.

Basic principles of conducting

Proper conduct of the treatment procedure is possible subject to the following conditions:

1. Massage is carried out in the first half of the day, not less than two hours after eating.
2. The beginning of the procedures should be short, no more than 5 minutes, gradually the duration of the sessions is brought up to 20-30 minutes.
3. The patient should lie on his back, head raised with a high pillow, knees slightly bent with a padded roller.
4. A comfortable temperature of +20˚С and silence should contribute to the patient's relaxation.
5.  The intensity of the first sessions is small, so as not to provoke an increase in blood pressure and interruptions in the work of the heart.
6. Parts of the body that are being massaged should be warmed up (heaters, salt baths or paraffin baths are used on the massaged areas).
7. The hands of the massage therapist should be warm, applying massage oil or baby cream to them is welcome.
8. About thirty massage sessions should be carried out, then a break of 1-1.5 months, after which the next course.

Features of the massage

The primary task of restorative massage is to exclude dystrophic changes in the limbs during physical inactivity. It must be borne in mind that the tone of different parts of the diseased body is different. The massage technique of each part of the body is carried out taking into account the muscular state of the organ.

Important! The basic rule of massage for a stroke: if the muscles are tense, then all passes should be neat and slow. If the muscles are relaxed, the strength and speed of movements can be increased.

Therapeutic actions in case of pathology begin from the collar zone, in the direction from top to bottom: upper back, shoulders, forearms, hands. From the back they go to the legs, starting from the hips down. The organs are worked out from the central part to the periphery in order to exclude an increase in blood pressure.

Medical manipulations begin with an undamaged part of the body. The massage therapist's hands should continuously touch the patient's body. The more tense the muscles, the softer the movements.

During the manipulations, it is necessary to monitor the patient's condition: if discomfort, tachycardia, increased blood pressure occur, the session should be stopped.

Movement technique

Restorative massage after a stroke is carried out using the following techniques:

• Trituration. Light movements affect the outer layers of the epidermis and subcutaneous layer. Movement of the hands in different directions, in a zigzag or straight line, forming folds on the skin. Performed with fingertips, palms or fist. With a rush of blood, the skin turns slightly red.
• Stroking. The relaxed palm gently glides over the surface of the skin, without affecting the muscles and without forming skin folds. There are superficial stroking, which relieves muscle hypertonicity, improves the metabolism of the epithelium and adipose tissue. Deep - activates blood circulation and reduces swelling.
• Kneading. The muscles are worked out with the fingers or the edge of the palm with little effort. Moderate massaging effect on the muscles. Compression, displacement, increase in tone, metabolic processes occur. The goal is to relieve muscle spasms.
• Vibration. Oscillatory movements with relaxed hands on the surface of the massaged organ. At a frequency of more than 120 vibrations per minute, muscle tone decreases. If the vibration frequency is less frequent, muscle tone increases.

Relatives of the victim need to understand that the rehabilitation period of the disease takes from one and a half to two years. They must make a choice: whether they will constantly invite a medical worker or master this profession themselves. Everyone can learn how to do therapeutic massage at home: the main thing is to know the basic principles, technique and sequence of massage.

Massage of individual parts of the body

Hands

The purpose of therapeutic manipulations is to relieve muscle hypertonicity, restore sensitivity, and increase motor functions.

Hands are massaged from the shoulder girdle down, ending with the hands, but the vector of movement is from the bottom up. The patient sits or lies on his back. The arm is straight, the palm is open. It is possible to fix this position with a bandage. The affected arm is usually hypertonic. Sequence of movements:

1. The muscles of the shoulder are massaged carefully, because. there is a risk of damage to the main vessels. The triceps muscle is massaged from shoulder to forearm. The movements are light stroking, kneading. The biceps muscle is often prone to hypertonicity, the massage technique is the same as that of the triceps muscle.
2. The trapezius and deltoid muscles are intensively rubbed.
3. Forearm. Manipulations are carried out starting from the back side by rubbing and kneading. The inside of the forearm is lightly stroked. See photo 1.
4. 4. Brush. Fingers. From the outside, the movements are intense, rubbing. From the inside - stroking, light rubbing, pinching with your fingertips. If the fingers are paralyzed, the intensity of the massage can be increased.

Hand massage after a stroke restores the functioning of nerve endings and restores normal limb mobility.

Legs

Foot massage improves blood circulation, relieves muscle spasm, and increases motor activity. The patient's body should be covered with a blanket, legs open, warm. If the heart does not bother, the prone position is preferable, to facilitate manipulation of the calf muscles. Therapeutic measures begin with the hip and, moving down, end with the foot:

1. Hip. Massaging medium intensity. Stroking movements from the thigh to the groin.
2. Shin. Begin the impact with the calf muscles, sparing movements, so as not to provoke a spasm. The movements are directed from the heel to the knee. Technique of movements - stroking, rubbing, kneading.
3. Foot. The heel is fixed in the hand, the foot is in the position of the fingers up. Passes are carried out from the fingers to the lower leg. The back side is massaged with force, on the folds - with light movements. A slight warmth should be felt in the massaged area. If the foot is paralyzed, you can increase the impact. The sole is massaged gently. See photo 2.

When conducting a therapeutic massage of the lower extremities, a prerequisite is the warmth of the patient's legs and hands of the massage therapist in order to exclude hyperkinetic reflexes.

Face

With paralysis, facial muscles often suffer. The sequence of actions:

• Vibratory movements on the scalp, especially in the back of the head;
• a palm is applied to the forehead and makes sharp movements from the bottom up;
• the whole head is massaged with soft rubbing movements;
• the damaged part of the forehead is pressed with the phalanges of the middle and ring fingers;
• with sawing movements, the edge of the palm moves in the direction from the forehead to the temples;
• massage of the oral area with a small soft ball, then light pressure with your fingers;
• at the final stage, the cheeks are massaged with light movements in the direction of the lymph flow.

Contraindications

Despite the undoubted benefits of manual therapy in rehabilitation, there are certain conditions in which the procedures are contraindicated. Massage should not be carried out at elevated temperature and blood pressure in a patient, the presence of tachycardia, spasms of cerebral vessels, renal and pulmonary insufficiency. Therapeutic measures are not carried out with thrombophlebitis and purulent skin lesions.  

Acupressure

In addition to standard methods of manual therapy, non-traditional methods are used. Acupressure after a stroke is aimed at preventing friendly movements that occur during the restoration of motor abilities. Its purpose is to irritate certain active points on the human body.

The first sessions of acupressure should be carried out by a qualified specialist with a medical education; it can be carried out at home at the later stages of rehabilitation with a stable condition of the patient.

The essence of the therapeutic effect is to press certain points:

• The first active point is to the left of the trachea. Slightly pressing, count up to 10, then release for 7-10 seconds, then repeat the procedure two more times.
• On the right side of the neck is a bundle of nerves, where you need to press in the same way.
• The middle fingers of both hands press on the points above and below the occiput. Repeat the action three times with an interval of ten seconds.
• The cervical notches on the sides of the spine are affected by three fingers of both hands, three times with interruptions.

Important! During the session, you need to monitor the state of the pulse by checking the point under the lower jaw.

It has been proven that point techniques effectively improve the patient's well-being.

Massage at home

After staying in the hospital for three to four weeks, the victim is discharged from the hospital for further rehabilitation at home. To fully restore lost functions, it is necessary to continue massage sessions.

When a specialist is called to a patient, the cost of a thirty-minute session ranges from 700 to 2000 rubles, depending on the region of residence. Not everyone can withstand such a financial burden. Therefore, the patient's relatives have to master the techniques of conducting massage at home, having agreed on a set of techniques with a neurologist or attending physician.

It is advisable to invite a massage therapist to your home, observe his work, remember the movements, the sequence and continue on your own. The first sessions of recovery manipulations should be carried out as carefully as possible. It is necessary to ensure that the patient's body is warm, the massage therapist's hands are warm.

Often, neurologists recommend the use of various massagers as an additional tool for massage. When choosing a massager for practicing after a stroke, devices with moderate hardness and a rough working surface are preferable. See photo 3.

When working with a massager, you need to monitor the condition of the victim, periodically measure the pulse and pressure. Work out from the central parts of the body to the periphery.

Recently, vibratory massagers have been popular. The use of the device is possible at the final stage of rehabilitation, when the patient can massage himself.

Conclusion

Massage after a stroke is an extremely important procedure to reduce the recovery period. With the help of manual therapy, they achieve a decrease in muscle tone, improve the sensitivity and mobility of injured limbs, and reduce pain. The regularity of treatment sessions is of great importance.