Kleen
(1921) in a major textbook on massage at a time when massage was an orthodox medical therapy notes that in cases of chronic
constipation due to atony in different parts of the alimentary canal, massage of the abdomen is a successful therapy. He explains that after being used for some months, preferably twice a day, abdominal
massage can restore the bowel to normal function. He argues that the massage
promotes a strengthening of the weakened muscles which brings about the restoration of function, which should be the aim of
treatment. If it were only a question of direct or reflex stimulation of nerves,
or of pressing the contents of the intestine onwards by manipulation, the constipation would return when the massage sessions
ceased. Kleens clinical experience is that
if massage is performed correctly and for a sufficiently long period every day eventual recovery is only a question
of time usually months. In severe cases it may take some weeks of twice daily
sessions to secure the first evacuation. In other cases this, may begin after
only a few days, sometimes even after just one treatment. Treatment, advises
Kleen, must be continued for up to 4 months to ensure that the result is permanent, and even then some continuation of alternate-day
massage may be desirable.
Eccles
(1898) devotes 19 pages (5%) of a 361 page volume on massage to constipation. He
refers to the fact that the treatment of habitual constipation by massage has been successfully practised since advocated
by Laisné in 1868. Eccles says that two or three weeks of thorough daily abdominal
manipulation will usually be followed by the restoration of activity to the enfeebled bowel.
Eccles
also cites a method of self help for the patient rolling a small cannon ball over the belly in the recumbent position, combined
with active exercise. Graham (1890) also quotes this same remedy to a roll a
5lb cannon ball over the abdomen for 5 to 10 minutes each morning before rising.
Graham
is firm on his advice for constipation, stating that atony of the muscular coat of the stomach or intestine with deficient
peristaltic action is usually benefited to a marked degree by appropriate massage after ordinary exercise and other measures
fail. That benefit, he points out, is more likely to follow from repeated treatments
than as an immediate effect. What is common to the various massages described
by Graham and many others is the movement from the caecum, up the ascending colon across the transverse colon and down the
descending colon, with special attention to the flexures.
Palmer
(1901) describes such a massage in some detail. She addresses an exploratory
use of the fingers over the abdomen, noting any inequality of surface, hardness or tenderness and accumulation of faeces at
particular points of the colon. Her massage commences with kneading of the abdominal
muscles using thumbs and fingers. The palm of the hand is then used to give vibrations
to the small intestine and then over the ascending, transverse and descending colon, the stomach, and the liver. The ball
of the thumb is then used to knead around the umbilicus. The kneading with the
ball of the thumb (nowadays usually referred to as friction) then starts at the caecum goes up the ascending colon, across
the transverse colon and down the descending colon. Pressure is upwards on the
ascending colon, outwards on the transverse colon and downwards on the descending colon to the sigmoid flexure. Special attention is given to the flexures. The heels of the
hands are then used to knead simultaneously, the left at the beginning of the ascending colon and the right at the beginning
of the descending colon. The left moves up the ascending colon and across the
transverse colon whilst the right moves down the descending colon to the sigmoid flexure and outwards to the middle line. The fingers are then used to knead (friction) from the caecum all around the colon,
deeply and with a wave like motion. This is repeated with the side of a closed
hand (i.e. a fist). The colon then receives beating and the finger kneading (friction)
from the caecum upwards is repeated. In the cases of chronic constipation these
manipulations can start at the patients left side over the sigmoid flexure in the direction of the rectum and then re-start
repeatedly further back along the colon, eventually re-starting at the caecum.
The
major authors Kleen, Graham and Palmer and many others who produced text books on massage up to the 1940s were adamant that
the frequent (twice daily) massage of the type described above by Palmer was an effective remedy for chronic constipation.
Modern
books in massage by contrast sometimes do not even mention constipation in the index (e.g. de Domenico and Wood 1997). The modern form of massage is certainly significantly different from that described
above and is often predominantly effleurage. There is a need to re-examinee the
old methods but to first take stock of the effects of massage as currently practiced.
The review of massage of the abdomen in the paper above is such a first step.
REFERENCES
De Domenico
G & Wood E. 1997. Beards Massage.
4th
edition. Philadelphia: W.B. Saunders & Co
Kleen
E A G. 1921 Massage and Medicine Gymnastics.
2nd
edition. London: J&AS Churchill
Eccles
A. S. 1998. The Practice of Massage
2nd
edition New York: Wilham & Co
Palmer
M D 1911 Lessons on Massage
3rd
edition London:Bailliere, Tindall
& Cox
Graham, D 1890 A Treatise
on Massage 2nd edition
St Louis: J.H. Chambers & Co
New
York: J.H. Vail & Co
