Sprains. Synovitis. Varicose Veins.
SPRAINS.
A sprain is a sudden dislocation with a quick replacement of a joint.
By the bursting of some smaller veins and lymphatics there is quite an effusion in and
around the joint; the sooner that fluid is worked away mechanically the better for the
patient. It seems impossible to comprehend that many surgeons still use plaster of Paris
casts in the treatment of ordinary sprains, when massage properly applied will effect a
cure in a few days. In sprains it is necessary to begin with slight, careful introductory
massage, in the form of centripetal stroking, the pain being very severe. The strength of
the manipulation must not be increased until most of the swelling is gone, and the
operator must be very careful to work upon every part in the neighborhood of the joint,
applying, as a rule, stroking only. Then begin kneading the muscles and tendons, always
ending with stroking. The treatment is greatly assisted by water applications at night. A
flannel or rubber bandage must be used to keep the swelling down. Some authors recommend
movements from the beginning, but I have found the best results from the massage alone. In
contraction of the tendo Achillis, turning and rotation of the foot, also flexion and
extension, ought to be used after the fifth treatment. The weakness of the joint after a
sprain is frequently relieved by massage, the operator being careful to apply properly the
bandage after each seance.
FIG. 113. Friction
with the Thumb in Cases of Synovitis of the Knee-joint.
SYNOVITIS.
Massage is always indicated in cases of synovitis, so long as there
is no purulent inflammation. The introductory massage, in the form of centripetal
stroking, is to be used with great care. When the pain is diminished some passive
movements may be applied, as flexion and extension. If the joint be very sore, as is
usually the case, work in its neighborhood with kneading and stroking. In chronic
inflammation of the joints it is always necessary to pay special attention to atrophied
muscles above and below the joint. Friction (with strokings followed) is the most
effective manipulation around joints (see Fig. 113). In ankylosis always apply very hot
water before every seance. Evald Johnsen, a Scandinavian masseur, out of 137 cases of
synovitis, cured 94 perfectly, improved 39 and treated only 4 without any result. The
patient must not be kept in bed, but must use his limbs as much as possible. Massage not
only relieves stiffness of the joint, but also prevents total ankylosis. The treatment
must continue not for weeks, but for months.
VARICOSE VEINS.
It is best to slightly elevate the affected limb. Start the
treatment with massage of the thigh and if the saphenous vein is not seriously inflamed,
work with centripetal strokings gently up to the groin. In regard to the local treatment,
the operator should avoid too strong pressure directly over the veins affected, but should
try to improve the circulation in the collateral veins, thereby relieving the tension in
the varicose veins.
Stroking is the only safe manipulation directly over the vein, and I always use an oil
made of oil of sweet almonds three (3) parts and oil of eucalyptus one (1) part. This oil
prevents too strong friction and, besides being antiseptic, seems to have a soothing
effect on many patients. We must remember to use the various circulatory movements of the
foot and leg. We are used to hear persons suffering with this trouble complain during the
warmer season of the year about their elastic stockings as being so hot and uncomfortable.
I have used lately with great satisfaction the " Bender Elastic Bandage " instead of
elastic stockings. In cases of phlebitis we use similar treatment as here described for
varicose veins, except that we are safer in using more direct pressure over the veins.
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