Preparatory to Massage and Passive Movement
Massage and passive movement both presuppose relaxation of the area under treatment. Relaxation is obtained of a specific area by the application to that area of the general principles already described for the whole body. A general attitude of rest, however, will assist the process, e.g. the abducted and flexed arm supported by a table or slings is more inclined to relax when the patient lies or reclines in a chair, than when he sits bolt upright.
Spasm due to pain is protective and is most effectively reduced by the relief of the pain which caused it. However, if it persists because of fear of pain, techniques which ensure pain-free movement are often successful. Pendular movements which start in the free range and gradually increase in amplitude may restore confidence and achieve relaxation.
The relief of pathological spasm resulting from lesions affecting the central nervous system is only temporary unless some voluntary control remains and can be re-established. Temporary relief is useful to permit the re-development of voluntary control which is the affected area. The initiation of reflex movements by the use of the stretch reflex applied at the same time as a command for the patient’s voluntary effort of contraction can be used for this purpose but care must be taken to ensure that spasm which is useful is not reduced by hyperactivity of the antagonistic reflex unless sufficient voluntary power is present, e.g. extensor spasm of leg which makes it possible for the patient to stand!