By Dr. Ross Turchaninov
Kneading techniques are the most complex to execute but when they are done correctly they have the most profound effect on the client/patient level of stress or on the effectiveness of somatic rehabilitation.
While it is 400 years old, kneading is the youngest massage technique. It was first recorded in the works of the Italian physician Fabricus of Aquapedente (1537-1619). Kneading techniques are so important that: “One can estimate the level of a massage therapist’s expertise by testing the kneading technique only.” (Dr. Kramarenko, 1953)
The main target of kneading is the skeletal muscles, but the skin and connective tissue structures are affected as well. During kneading, the practitioner grasps the muscles and soft tissues, lifts, rolls, stretches and compresses them between the hands and against bone structures.
Every kneading technique consists of several components, which must follow and flow into each other. To properly apply kneading, the practitioner has to practice performing these techniques smoothly with as little hands’ strain as possible. Every part of the applied technique has to “ﬂow” into another. If several kneading techniques are used they also have to follow each other smoothly.
There are 13 kneading techniques developed by the Western School of Massage Therapy: Longitudinal Permanent Kneading, Transverse Permanent Kneading, Longitudinal and Transverse Interruptive Kneading, Simple Kneading, Digital Kneading, Scrolling Kneading, Double Scrolling Kneading, Mobile Kneading, Pinching Kneading, Wave Kneading, Rolling Kneading and Tissue Displacement Kneading.
The most valuable effects of kneading are inhibiting the effect on the motor cortex and its ability to reset muscle spindle receptors in the skeletal muscles affected by hypertonicity. The last effect guarantees the stability of clinical results when hypertonic muscle abnormalities are addressed.
Finally, during kneading the therapist alternates activation of muscle spindle and Golgi tendon organ receptors and by doing so he or she slightly increases and slightly decreases the muscle tone without participation of the motor cortex while the patient/client is relaxed and motionless. This is absolutely the unique effect of kneading. This is why kneading techniques have the nickname of “passive exercise of the muscles.”
It is not easy to illustrate the power of kneading and how these techniques affect muscle innervation and function. We recently had a patient in our clinic and his condition can be used as an excellent illustration of one of the kneading effects.
The patient is in his middle sixties and a very aggressive tennis player who practices daily and competes in his age group nationally. He came into our office with complaints about pain in his right shoulder, which increased significantly when he served the ball. After several weeks of unsuccessful PT and steroid injections he visited our clinic.
His rotator cuff was examined by MRI and no serious trauma was detected and changes fit his age group. Examination revealed a very tense and sensitive deltoid muscle and a significant increase in the inner pressure inside the shoulder joint.
After formulation of the correct Medical Massage protocol the treatment was started. Part of the therapy was application of permanent, fixed electric vibration on the supraspinatus and deltoid muscle. As soon as the vibrator was placed in the treatment area his arm muscles (deltoid and triceps brachii) started to uncontrollably contract as shown in the video below.
The patient couldn’t control contractions and they stopped as soon as vibration was ceased. Such hyperirritability of the muscle spindle receptors must be eliminated for the treatment to continue. To do so we applied kneading in the inhibitory regime on the arm muscle as it is shown in the video below.
After the kneading we re-applied electric vibration to the same area and then it didn’t trigger any uncontrollable contractions, as shown in the video below.
Now let’s evaluate from a clinical perspective and decode chain of what looks like simple events:
1. As a result of chronic overload of the right shoulder the anatomical length of the deltoid as well as rotator cuff muscles slowly decreased. That was a slow process and the patient didn’t feel it since initially the ROM he lost was just a couple of degrees.
2. At the beginning, muscle spindle receptors informed the patient’s motor cortex that the right shoulder muscles were tense and shorter. As a result he may felt moderate pain and tension. He took hot showers, did some stretches, went to get massages and initial symptoms subsided. However with tension going back and forth his muscle spindle receptors eventually started to see this shorter state of the shoulder muscle as the new norm. At this point they stopped to inform the motor cortex about the real picture of how much tension the muscles now carried.
3. The same chain of events may continue several times until the tension gets to some critical point when the muscles can’t execute motor commands from the brain anymore. All that time the brain was sure that the muscles were healthy, strong and their anatomical length was normal. In other words, changes in the threshold of muscle spindle receptors misled the brain, which relied on incorrect data when it asked the muscles to perform. As soon as tension reached a critical level and the muscles couldn’t compensate for it anymore the patient started to feel pain and looked for the help.
4. Since normal relations between the muscle spindle receptors and the motor cortex were broken their activity was not under full control of the motor cortex anymore.
5. At this stage the application of electric vibration even in permanent, fixed mode which in normal scenarios should inhibit muscle activity, now produces involuntary contractions of the arm muscles.
6. Application of kneading in the inhibitory regime to locally stretch, compress, and twist tensed muscle reset the muscle spindle receptors. Now application of the same vibration didn’t trigger involuntary contractions.