The treatment of the arms is concluded
with upward stroking (_effleurage_), as with the leg.
In the order usually pursued, the back is the next region treated. The
patient lies prone, folding the arms under the head; a firm pillow is
put under the epigastric region, so as to the better relax the back
muscles, which are too tense when a person lies flat. Beginning from the
occiput, both hands stroke firmly and rapidly downward and outward to
the spines of the scapulae, at first lightly, then with increasing force.
Then the whole back is vigorously rubbed--scrubbed one might call
it--with up-and-down strokes, as a preliminary application. The erector
spinae masses are treated by careful finger-tip kneading. Working from
the spine outward to the axillary line, the muscles of the ribs are
acted upon with flat-hand rubbing. The groups of the upper back and
shoulder-blades are kneaded and squeezed, the arms being partly
abducted so as to separate the shoulder-blades and allow the operator to
reach the muscles underlying them. The lumbar regions receive their
manipulation last.
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