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Massage for Supportive Cancer Care

Kathleen Dzubur, MS; Francine Manuel, RPT; Gary Abrams, MD; Lee Erman, NCTMB; Ernest H. Rosenbaum, MD

Giving a Massage

Massage and Compassionate Touch

Types of Massage
Basic Strokes of Swedish/Western Massage

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One of the most soothing treatments for a bedridden person is massage. In Europe and elsewhere, it is used frequently to promote relaxation, decrease pain and speed healing. It may also help reduce or eliminate the need for certain medications. If you have a willing family member or friend, massage can be a pleasant way for others to participate in your recovery and gain satisfaction from being able to help. Massage therapy can help prevent bedsores. By turning over, you release pressure on the areas on which you have been lying. Massaging the pressured areas encourages more blood to flow into the tissue. If massage is done frequently, it will prevent skin breakdown. The buttocks, tail bone (coccyx), wings of the shoulder blades (scapulae), hips, heels, elbows and bumps (malleoli) around the ankles are susceptible spots for pressure sores.

Giving a Massage
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The following instructions can be used by a friend or family member to give you a massage. It is very important that you find a comfortable position at the start; no matter how soothing the stroke, an uncomfortable patient will not be able to tolerate the massage for very long. There are four basic massage strokes:

1. Effleurage (light or deep stroking)
Effleurage is the very slow stroking with which you begin and end every massage. The two types of effleurage are light stroking, which is used to relax the patient, and deep stroking, which empties the blood and lymphatic vessels. Begin by placing your hands very lightly on the area to be massaged. With the lightest pressure that you can apply, run your hands slowly over the area. Make full contact with the skin with both hands. All strokes should be done in a continuous motion: once you begin, never take your hands off the patient's body until you are finished a stroke. After five minutes of light stroking, begin to deepen the strokes in the direction toward the heart, gradually increasing the pressure. Lighten the strokes going away from the heart. Be careful: if the patient complains, you are doing it too hard. Massage should never hurt--that defeats the purpose of relaxation. Some people can tolerate only the lightest effleurage. Deep effleurage can be used to decrease edema (swelling from fluid collecting in tissues), but only with a physician's approval.

2.Petrisage (kneading)
Petrisage (kneading the muscles) can be done in two ways: with the palms or heels of your hands, or with your fingertips. In this stroke you actually pick up the muscle tissue away from the bones and work on the affected areas to decrease muscle spasm. Again, it should not hurt, although the patient may tell you that it ``hurts good''--a common response to an effectively given petrisage.

3. Tapotement (hacking or slapping)
Tapotement is done by hacking with the sides of your hands or by cupping your hands and using them to percuss (tap sharply) an area of the body. This stroke, while pleasing to most muscle-bound athletic stars, is not usually very pleasing to a seriously ill patient. It should never be used without a physician's approval. People have been known to fracture ribs by pounding on the chest. Tapotement can also be dangerous for anyone with kidney disease.

4. Friction
The last massage stroke is friction, which is done with one or two fingertips. Apply pressure in a circular manner over bony prominences, such as the pelvic bones, shoulders, vertebrae (backbones), and kneecaps. Do not move around with this stroke. Instead, stay in one spot for a prolonged time and then move on to another spot.

II. Massage and Compassionate Touch
Kathleen Dzubur, MS; Francine Manuel, RPT; Gary Abrams, MD; Lee Erman, NCTMB; Ernest H. Rosenbaum, MD
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One of the most relaxing and enjoyable experiences for a person with cancer (or for any other human being, for that matter) is to receive gentle, compassionate, accepting touch from another person. This can range from a from a 1 or 2-hour massage from a trained massage therapist to something as simple as having your hand stroked by a friend. Touch is fundamental. It is the first sense to develop indeed, all infant mammals require touch to survive and thrive. It may also be one of the last senses to be lost in the dying process.

Here are some of the values you might derive from compassionate touch:

  • Being sick can be lonely - being touched provides an accompaniment
  • An antidote to the probing, uncomfortable, impersonal touches that all too frequently are part of modern medicine
  • you take out of sensitive, loving touch what you most need in the moment, without needing to ask and without the toucher, or perhaps even you, needing to know what that is: hope, human contact, affirmation, release of anger, relief from pain, relaxation, playfulness, love, reuniting with your body, loving acceptance of changes to your body from surgery or other treatments, a reminder of something important, ...
  • the following have all been shown to be physical benefits of touch/massage under some conditions: relaxation; increased blood and lymph flow; endorphin release; release of tight muscles; toning of flaccid muscles; edema reduction and relief; normalized blood pressure; stress reduction; increased immune function; improved balance; pain reduction; sleep improvement; better digestion; increased energy and cognitive performance
  • communication without the need for words, by caregiver or you
  • communication without the need for energy, or even consciousness, of the receiver with appropriate precautions, touch/massage can be helpful to all persons with cancer with little risk of injury. Some people are concerned that the increased circulation promoted by massage might help spread the cancer. However, there is little evidence for this and many of the most prominent medical centers for cancer treatment support massage for their patients. General guidelines include not doing any deep work in known or suspected cancer areas, avoiding deep pressure for leukemia or if platelet counts are low, and being very careful in cases of bone metastases or osteoporosis. An overriding guideline: If any massage or touch technique does not feel right to you, do not allow it to continue - the goal should be to foster well-being with delightful touch, and no pain/no gain should not apply.

Although for effective focused therapeutic massage, a skilled and experienced massage therapist is needed, all humans are capable of providing loving and beneficial compassionate touch. We all have innate touching skills; however, many of us have not practiced those in our often touch-deprived culture. To help, here are some hints for anyone to provide effective compassionate touch:

  • First, center yourself.
  • Pay attention to the person you're touching- their words and their bodily actions/reactions. Never impose your preferences over theirs.
  • Open yourself to the sensations you feel while touching. You can directly sense only yourself - everything else is interpretation.
  • Enjoy touching. No matter how extreme the person's condition, revel in the miracle and beauty of him/her as a living human being.
  • Relax. Any tensions or apprehensions you have will be conveyed to the other person.
  • Don't do anything that makes you emotionally uncomfortable.
  • Don't do anything that makes you physically uncomfortable. Do what you need to find a comfortable position. Shoulders down. Back straight. Work from the center of your body, not from your hands or arms. Keep breathing smoothly.
  • Use your full hands, including the palms. Let your hands mold to fit whatever you're touching. Use and feel your own wonderful living fleshiness.
  • You don't have to rub, especially on thin or tender skin or on weak or meager muscles or bones. Squeeze gently, or just hold.
  • Move slowly. Even slower. Even slower than that...Just hold.
  • Good candidates for compassionate touch: hands, feet, back/shoulders, scalp.
  • Be gentle, but firm and definite.
  • Breath is central to all life. Breathe smoothly. Be aware of the person's breath. Try synchronizing with the person's breath.
  • Listen for and trust your intuition.
  • Give up any agenda or expectation of results -just experience the touch in the moment.

In addition to the benefits for the recipient, studies have also shown that the person providing the touch also benefits. So, turn the tables on your friend, caregiver, or another person with cancer and provide them with some loving compassionate touch- you'll both love it!

Types of Massage:
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Swedish/Western Massage:
Based on the Western concepts of anatomy and physiology, Swedish massage employs the traditional strokes of effleurage, petrissage, vibration, friction, and tapotement (percussion). Swedish/Western is the most widely used system in the west. (See below for a description of these strokes.) However, most massage therapists are trained in and utilize a wide variety of other techniques, blending them with Swedish/Western into a treatment tailored to your needs. Here are descriptions of a number of the most commonly used other techniques, in alphabetical order.

Cross-fiber Friction Massage:
Friction massage applied in a transverse direction across the muscle, tendon, or ligament fibers. The stroke is only long enough to cover the intended tissues. The fingers do notmove over the skin but move the skin and superficial tissues across the target tissue.

Myofascial Release (also called Connective Tissue Massage):
Slow, focused stretching through one or more body planes. This can also include ischemic compression (the application of progressively stronger pressure) to release the tenderness of trigger points. A trigger point is a hyper-irritable spot, usually within a taut band of skeletal muscle or within the muscle's fascia, thatis painful on compression and that can give rise to characteristic referred pain, tenderness, and autonomic dysfunction.

CranioSacral Therapy (CST):
A gentle, hands-on method of evaluating and enhancing the function of the craniosacral system - the physiological body system comprised of the membranes and cerebrospinal fluid that surrounds and protects the brain and spinal cord.

Deep Tissue Massage:
The term refers to various massage styles that are directed toward the deeper tissue structures of the muscle and fascia.Most deep-tissue massage techniques aim to affect particular areas within the various layers of fascia that support muscle tissues and loosen bonds between the layers of connective tissues. Various styles of deep tissue massage include Rolfing and structural integration.

Feldenkrais Method:
A form of somatic education that teaches through movement ? how we can improve our capabilities to function in our daily lives. It is an educational system that develops a functional awareness of the self in the environment.

Lymphatic Massage:
This method, a descendant of Swedish massage, was pioneered by Dr. Emil Vodder, Ph.D., of Denmark in the 1930s. Dr.Vodder's method of manual lymph drainage massages uses light, rhythmical, spiral-like movements to accelerate the movement of lymphatic fluids in the body.

Myofascial Release (MFR):
Helps restore fascial mobility with slow, focused stretching through one or more body planes.

Neuromuscular Therapy (NMT):
Identifies soft tissue abnormalities and manipulates the soft tissue to normalize its function. Addresses the neuromuscular dysfunctions created by trauma, improper body mechanics, poor posture, and other stressors.

This method originated with the Chinese and is based on the idea that stimulation of particular points on the surface of the body has an effect on other areas or organs of the body. Today's techniques focus mainly on the hands and feet.

A systematic program developed out of the technique of structural integration by Dr. Ida Rolf. Rolfing reshapes the body's physical posture and realigns the muscular and connective tissue through manipulation of the fascia (connective tissue).

Sports Massage:
A method of massage especially designed to prepare an athlete for an upcoming event and to aid in the body's regenerative and restorative capacities following a rigorous workout or competition. It is also designed to reduce the athlete's risk of injury.

A Japanese system of acupressure based on the Oriental concept of chi (life force energy) and tsubos (energy points). When pressure is properly applied to the energy points(via finger pressure), energy circulation is improved and the body is thought to be better able to heal itself.

The Trager method:
Developed by Dr. Milton Trager, this method uses movement exercises called "mentastics" along with massage-like, gentle shaking of different parts of the body to eliminate and prevent pent-up tensions.

Zero Balancing (ZB):
A hands-on body/mind system designed by Dr.Fritz Smith to align body energy with the body's physical structure. It represents the integration of Eastern views of energy with Western views of science and teaches how to use energy as a working tool in relation to body structure.

Basic Strokes Of Swedish/Western Massage:
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Touch: The stationary contact of the practitioner's hand and the client's body.
The pressure exerted may vary from very light to very deep depending on the intention. May be in the form of a hand shake or gentle hand on the shoulder.
* specific indications: Constitutes the first and last contact of the practitioner with the client. Touch is he primary communication tool used by the massage therapist. The main objective of light touch is to soothe and to provide a comforting connection that is calming. Light touch can be used as a complete treatment when basic massage is contraindicated.

Effleurage (gliding): The practice of gliding the hand over some portion of the client's body with varying amounts of pressure or contact according to desired results.
* specific indications: Generally applied prior to (and after) any other movement. Allows for practitioner assessment, distribution of lotion, and preparation of the area for other techniques. Often used to produce soothing effects.

Friction: Refers to a number of massage strokes designed to manipulate soft tissue in such a way that one layer of tissue is moved over or against another in order to flatten, broaden, or stretch the tissue.
* specific indications: Helps to separate the tissues and to breakdown adhesions and fibrosis, especially in muscle tissue and fascia. Friction has a marked influence on the circulation and glandular activity of the skin. Friction can also be used for increased circulation deep into the tissues.

Petrissage (kneading): Lifting, squeezing, and pressing the tissues.
* specific indications: Helps to reduce adhesions and stretch muscle tissue and fascia.

Vibration: A continuous trembling or shaking movement delivered by either the practitioner's hand or an electrical apparatus. Vibration may be classified as a type of friction.
* specific indications: This form of massage is soothing and brings about relaxation and release of tension when applied lightly. It is stimulating when applied with pressure. A numbing effect is experienced when vibrations are applied for a prolonged period of time.

Tapotement (percussion): A rapid striking motion of the practitioner's hands against the surface of the client's body, using varying amounts of force and hand positions.
* specific indications: To stimulate the body and tone the muscles. NOTE: Percussion movements should not be applied to muscles that are abnormally contracted or over any sensitive area.

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