Strokes

Giving names to particular strokes or types of strokes is one way to define the movement building blocks of massage for teaching purposes. In doing so, it needs to be kept in mind that the description of a 'stroke' is the description of an abstract shape in relation to an imagined body - it is given precise shape and meaning by working on a real body (adapting to the client's build, needs and comfort level) via the practitioner's ability to 'listen' with their hands (i.e. to monitor and adapt to the client's responses - verbal and nonverbal, including the moment by moment reactions at the tissue level). And a good massage is, of course, more than just a set routine of strokes, no matter how fluidly performed.

There are variations on aspects of the terminology of Swedish Massage, and even with the agreed categories, many strokes that teachers teach would not fit neatly into these groupings. It is therefore most useful to define groups of strokes in terms of the stage of the massage they belong to and how they are applied to the tissues. Although it is customary to view each of these stages as preparation for the next (and this can be helpful for students), bear in mind that the distinctions between these 'stages' are not clear cut, and that skilled practitioners can usefully break the sequence 'rules'.

Holds

Massage training has developed which is geared towards the development of a widely skilled and flexible practitioner, who can adapt to a clientele in varied states of health and physical fitness, with a range of builds and lifestyles, and needing different sorts of treatments depending on the reasons for their tension and the events occurring in their lives which need to be taken into account.

Simultaneously there has been a growing belief amongst many professionals that the practitioner's personal development needs to be an essential (and continuing) component of their training and work. This has been fuelled by the fact that it is standard practice in many of the Eastern massage systems now established in this country (such as Shiatsu and Thai massage), in other body based disciplines (such as the teaching of Yoga, Tai Chi, the Martial Arts, the Alexander Technique and the Feldenkrais Method) and also by this development in professions such as Counselling and Psychotherapy.

Although, in some parts of Europe and most of North America there is a very high standard of training for massage practitioners, it is legally possible in Britain to set oneself up as a massage practitioner without having done any training at all. However, working in a health centre or medical setting requires membership of a professional organisation and indemnity insurance. The best reassurance for members of the public is to have a high quality, reputable qualification and training that enables practitioners to treat a wide range of people.

MTI has played an active part in setting and raising standards for professional massage training in the UK. MTI members are encouraged to join the Complementary and Natural Healthcare Council.

Stroking

The practitioner then begins stroking the tissues - the 'effleurage' stage - 'saying hello' to the tissues and getting a feel for them by putting the oil on and warming them. This stage engages firstly with the skin, and then with superficial blood flow and lymph drainage, and, with more pressure, can be used for 'draining' or 'milking' (towards the heart) and to begin applying pressure on the superficial muscles. These strokes are also used later as the joining strokes (between other strokes, and between parts of the body), and finishing strokes (both for specific areas of the body, and for the whole body).

These can all be varied: the pace, speed and rhythm of application, the pressure applied (eg between very light 'feathering'' with fingertips to deep pressure effleurage) and the part of your hand that's used. The massage therapist can simultaneously have different things happening with different parts of the hand or with each hand. They can stroke (with short or long strokes, either separate or overlapping) in one direction only or 'flow' forward and back (like waves lapping at the edge of the sea). They can follow the contours of the client's body or stroke more specifically along or across muscles.

Moving the Tissues Around

Heavy, penetrating effleurage strokes are often used to lead into the next stage, in which the practitioner begins moving the tissue around, working through the skin to get at the muscles underneath. The terminology for this stage is contentious, but 'petrissage' is the most common way of defining it. This covers various ways of taking hold of the tissue to move it around - by lifting and stretching it, squeezing or pinching it, kneading it (as one would knead bread), and wringing or shaking it; and skin rolling is also usually included. Most of these strokes involve grasping the tissue with each hand, primarily with thumb and fingers, perhaps also involving the palm (depending on the size of the area being tackled), or, for large areas, using both hands simultaneously to squeeze or push the tissue between them.

Compression Strokes

Many authorities distinguish a third stage of working - the compression strokes, often called 'friction techniques', which are the deepest in the 'classical' Swedish Massage repertoire - where the practitioner digs into the muscles or presses them against the underlying bones. (However, as there is no clear boundary between the previous stage and this one, many people group both of them together under the Petrissage heading). The pressure can be static or, if moving pressure is applied, circular or along or across fibres. The heel of the hand (sometimes with the other hand on top) or the forearm are often used initially to apply some general pressure and to gauge the client's responses. If required, the thumbs, fingertips, knuckles or elbow will give a sharper, deeper, or more specific focus.

Vibration

The next stage (if appropriate to apply) is 'percussion'. (commonly called 'tapotement') and 'vibration'. 'Percussion' usually denoting strokes with intermittent contact, and 'vibration' those with continuous contact.

Percussion

This includes all the classic 'striking' strokes - tapping (with fingertips), cupping (with cupped hands), patting or slapping (with the front of the fingers or the open hand), hacking (with the side of the little finger), and pummelling'/beating/pounding with the side the fist or the flat surface of the knuckles. Other parts of the hands can also be used (e.g. the back of the hands).

Very light percussion strokes can sometimes be quite relaxing, stronger percussion is more commonly stimulating to the skin, blood circulation and muscles, while the heaviest (which emphasise compression of muscles) can encourage specific muscle release. Because you can get your hands around the limbs, percussion techniques here can easily also incorporate shaking the muscles (scaled down elements of which can be applied on the back). They include grabbing (between thumb and fingertips, or with the whole hand), and flicking or brushing (with the fingers).

Depending on your intentions - e.g. to gently loosen the tissues or to stimulate them, and to move them in a general way or to apply focused pressure - you can vary aspects of percussion strokes such as the pressure and depth of application and the size of the area being covered.

Vibrations can also be done in a small or gentle way for release, or vigorously for energising the tissues. They can range from 'classic' vibration ('jelly wobbling' from side to side) on an area of the skin (using fingers for small areas or the flat hand for more spread effect) or with more pressure applied to get into muscles, to the simultaneous lifting and shaking out of large muscles (especially on the limbs - grabbed by fingers or the whole hand). Vibrations can also incorporate elements of the other categories (e.g. maintaining a 'jelly shake' while doing a sliding movement). Body rocking and the shaking out of limbs are often included in this category.

Passive Movements

These are a further category of techniques, which are coming into widespread use in the field of massage (although they're not part of the 'classical' Swedish Massage repertoire which only covers strokes that are applied directly to the muscles). They are done by moving bones (especially of the limbs) around joints (mobilisations) to encourage movement in the muscles, in order to emphasise and amplify the suppleness and flexibility gained in the muscles through the previous techniques. They can be 'pure' stretches, or include shaking or vibrating, or incorporate elements of some of the other types of strokes (e.g. simultaneous petrissage or compression strokes on the stretched muscles).