The Art of Massage
J. H. Kellogg, M.D.

    A proper understanding of massage and its skillful application requires a good knowledge of anatomy.  Physiology is also of the highest value to the masseur, but a practical study of anatomy is absolutely indispensable.  This is not the place for a detailed anatomical consideration of the body, but the learner may perhaps be somewhat assisted by the following brief enumeration of some of the anatomical structures with which he must become familiar: --

    The Bones. - First of all, the student of massage should make a serious study of the bones (Fig. 4), as in all the manipulations of massage their conformation must be kept carefully in mind.  Every bony prominence, hollow, furrow, ridge, articulating surface, together with the points of origin and insertion of the principal muscles; in relation to the skull, the points of entrance and exit of nerve trunks, arteries, and veins; also the joints and ligaments (Figs. 5-llb), should be made thoroughly familiar by a minute and careful study of the skeleton.  The following points in relation to the skeleton should receive special attention : 
    1. Head: Vertex, occiput, parietal eminence, mastoid process, zygoma, temporal fossa, orbit, angle of lower jaw.
    2. Neck: Cervical Vertebrae, vertebra prominens, hyoid bone.
    3. Chest: Dorsal vertebrae; twenty-four ribs (on each side, seven true ribs, three false ribs, two floating ribs); sternum, cartilages of ribs, xiphoid cartilage.
    4. Arm: Shoulder bones, consisting of the scapula, or shoulder blade, with its spine, acromion process, coracoid process, and glenoid cavity ; clavicle, or collar-bone; humerus or upper arm bone; head, neck, tuberosity, internal and external condyles.
    5. Forearm: Ulna, olecranon process, sigmoid cavity, styloid process; radius, head.
    6. Hand: Eight carpal bones, five metacarpal bones, fourteen phalanges.
    7. Spine: Eight cervical, twelve dorsal, and five lumbar vertebrae; sacrum, coccyx.
    8. Pelvis: Sacrum, coccyx, ilium, crest of ilium. pubes, tuberosity of ischium, acetabulum.
    9. Thigh: Femur, or thigh bone-head, neck, great trochanter, lesser trochanter, outer and inner condyles, popliteal space.
    10. Lower Leg: Patella; tibia-head, outer and inner tuberosities, tubercle, internal malleolus, crest; fibula-styloid process, external malleolus.
    11. Foot: Tarsus, seven bones - os calcis, astragalus, cuboid, scaphoid, three cuneiform; metatarsal bones, five; phalanges, fourteen.
    The Muscles. - The following is a list of the principal muscles (Fig. 12) which are dealt with in the different regions to which massage is especially applied: 
    1. Cranium: Occipito-frontalis.
    2. Face: Muscles of mastication, forming the fleshy portion of the cheek, and situated at the back part of the face; muscles of expression, found chiefly about the eyes, nose, and mouth (Fig. 13).
    3. Neck: Posterior,. trapezius; anterior, muscles which act upon the hyoid bone; lateral-sterno-mastoid, platysma rnyoides, scaleni (Fig. 14).
    4. Upper Back: Trapezius, supra- and infra-spinatus, rhomboid (Fig 16).
    5. Lower Back: Extensors and latissimus dorsi (Fig. 16).
    6. Chest: Pectoralis, major and minor, serratus magnus (Fig. 15)
    7. Abdomen: Rectus, external oblique, quadratus lumborum (Fig 15).
    8. Shoulder: Deltoid and supra-spinatus, which raise the arm; infra-spinatus and teres minor, which rotate arm outward and bold shoulders back; teres major and latissimus dorsi, which rotate arm inward and draw arm to side (Fig 16).
    9. Arm: Anterior, flexors - biceps, coraco-brachialis, and brachialis; posterior, extensor - triceps (Fig. 15).
    10.  Forearm: Radial (thumb) side, supinators, extensors, .and thumb flexor; ulnar (little finger) side, flexors, pronator  teres (Fig. l5).
    11. Hand: Palmar surface - short flexors of fingers; dorsal surface - interossei.
    12.  Hip: Glutei, which rotate thigh outward and inward and abduct it; obturators and pyrifornis, which tilt pelvis forward, increasing obliquity of the pelvis (important in relation to correct standing).  With thighs flexed upon abdomen, nearly all the muscles of the hip except the obturator, externus (which rotates femur outward) act as abductors (Figs. 18, 19).
    13.  Thigh: Anterior, extensors, quadriceps (Fig. 17); posterior, flexors (Fig. 19); internal, adductors (Fig. 20).
    14.  Lower Leg: Inner portion-extensors of foot and flexors of toes, gastrocuemius (Fig. 20); anterior, flexors of foot and extensors of leg, tibialis anticus (Fig. 17) ; outer and upper extensors, peronei (Fig. 18).
    15.  Foot: Plantar surface, flexors of toes; dorsal, interossei.

    Veins. - The arteries are not so important in massage as are the veins, as they lie too deep to be influenced to any considerable degree by the manipulations ordinarily employed.
    1. Neck: Jugular (Fig. 21).
    2. Arm: Axillary and brachial (upper); cephalic (outer); basilic (inner) (Fig. 21).
    3. Forearm: Radial (outer); anterior ulnar (inner); median anterior, posterior ulnar  (posterior) (Fig. 21).
    4. Leg: Femoral (upper anterior); long saphenous (inner anterior, beginning at arch of foot); short saphenous (posterior outer, beginning behind the outer malleolus); popliteal (Figs. 22, 25).

    The Nerves. - So large a proportion of the physiological effects obtained by the employment of massage being the result of reflex action, it is highly important that the masseur or the student of massage should have a good knowledge of the physiology of the nervous system.  The more he knows of anatomy the better, but he must know the names and location of the principal nerve trunks.  The location of those which will be mentioned is so clearly shown upon the colored plates that it will not be necessary to do more than name them here.
    1. Face: Facial, trifacial (Fig. 27).
    2. Arm: Median, ulnar, musculo-spiral (Figs. 23 and 24).
    3. Leg: Crural, sciatic (Fig. 25).
    The sacral nerve passes across the sacro-iliac synchondrosis, or junction of the sacrum and ilium.
    The pneumogastric, or par vagum, is the large nerve from the brain, which passes down the side of the neck, entering the chest just behind the top of the sternum, near the median line.  It is distributed to the heart, lungs, and all the abdominal viscera (Fig. 27).
    The sympathetic nerve controls the function of the digestive organs, kidneys, liver, and other viscera of the abdomen, all the glands of the body, and the action of the heart and blood vessels.  Its principal divisions of interest to the masseur are the cervical ganglia, the renal plexus, the hepatic plexus, the lumbar or umbilical ganglia (situated at the back of the abdominal cavity and two inches on either side of the umbilicus), and the subumbilical ganglion, or lumbar aortic plexus, located two inches below the umbilicus (Fig. 27).

    The Viscera. - Nearly all the contents of the abdomen and pelvis may be brought under the direct influence of massage.  Their general form and normal location should be carefully studied (Figs. 28, 29, 30, 31); viz., the heart, stomach, pancreas, liver and gall bladder, spleen, kidneys (right lower than left), colon, appendix vermiformis, bladder, prostate gland, uterus, Fallopian tubes, and ovaries.

    Landmarks and Regions. - While the profound knowledge of surgical landmarks and regions important for the physician is not needed by the masseur, some knowledge of this kind is essential to skillful work.  The student is advised to familiarize himself with the following, by the aid of a good anatomy:
    Linea alba, the median line of the body, extending from the sternum to the pubes.
    Linea semilunaris, the outer border of the rectus muscle.
    Umbilicus, commonly called the navel, located, in symmetrical persons, midway between the end of the sternum and the pubes, normally higher in women than in men.
    Poupartís ligament, the fibrous band connecting the anterior superior spine of the ilium with the spine of the pubes.
    External inguinal ring, an opening in the abdominal wall just above the spine of the pubes, through which the spermatic cord passes in the male and the round ligament in the female; larger in men than in women.
    Femoral ring, an opening below Poupart's ligament, the seat of femoral hernia; larger in women than in men.
    Axilla, the armpit, space under the arm bounded by tendons, in front by the pectoral muscles, and behind by the sub-scapular, teres major, and latissimus dorsi muscle.  Enlarged glands are often found in the axilla.
    Groin, the fold at the junction of the leg with the body, a little below Poupart's ligament.  A number of enlarged glands are often felt in this region, even in healthy persons.
    Popliteal space, the space underneath the knee.  It contains large vessels and nerves, hence too strong pressure in this region should be avoided.
    Fold of the buttocks, the furrow just below the buttock, marking the lower border of the large gluteal muscle.
    The regions of the abdomen may be said to be nine in number, divided by lines drawn upon the surface (Fig. 30), - right hypochondriac, left hypochondriac, epigastric, right lumbar, left lumbar, umbilical, right inguinal, left inguinal, hydrogastric.