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16 PASSIVE MOVEMENTS:
are treated with petrissage, I work with the whole of the thumb
down to its thenar pare. I start above the effusion.
Fig. 4.
In order to obtain a larger and freer range of motion, the
thumb is put down a little above the place to be subjected to
manipulation, and carried back to the particular area to be
treated. If this precaution is not taken, the skin becomes
stretched and irritated by the onward movement of the thumb.
The thumb describes a half circle, with gradually increasing
pressure as long as it moves in the centripetal direction, then
the pressure is relaxed, the thumb is lightly moved back to the
starting place, and the same action repeated. The movement
should be given slowly and deliberately.
In the gluteal region the manipulation is made with the
lightly closed hand, and has the direction towards the sacrum.
The patient can then bear the treatment much easier, and will
allow it to go deeper.
The patient must always be placed in such a position that the
muscles to be worked at are relaxed. Thus, in petrissage for the
gluteal region, he lies face downwards, with the leg of the affected
side crossed over the other, as in fig. 5. He is not to stand bent
forwards, as is sometimes shown in illustrations, because the
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