Soft tissue techniques

All the techniques act on meridians and their qi-points, stimulating qi and blood flow to release blockages in the same way as acupuncture does. The aim of the soft tissue massage techniques is to apply pressure to the meridians and their qi-points to affect underlying tissues – muscles, ligaments, tendons and blood vessels. This pressure is applied in a variety of ways: at right angles to the body; in a circular motion; or with a shearing motion across the underlying muscles. The most important benefits of Tui Na are listed below.

BENEFITS OF TUI NA TECHNIQUES

• Moves and enhances qi and blood flow through the meridians.
• Releases qi and blood blockages to remove pain.
• Focused massage on qi-points changes the qi status of the meridian to provide specific health benefits.
• Promotes lymphatic drainage to prevent or reduce oedema.
• Releases fibrotic muscle fascia for muscle relaxation.
• Releases fibrotic subcutaneous connective tissue.
• Warms the underlying tissues to promote healing.

HOW TO APPLY PRESSURE

Begin every technique with fairly gentle pressure and increase it gradually, releasing it progressively as you finish. Interact with your partner throughout and be guided by any reaction. When you first start pressing a tense, knotted muscle, it may be uncomfortable. Only with repeated firm, concentrated pressing and kneading will the muscle release its tension and the pain subside as blood and qi-flow are re-established. Always be ready to reduce the pressure you use, or change to a different technique. In Tui Na, if the qi-points being massaged are tender, this can highlight a problem on that meridian and in the related organ.

Apply the pressure by leaning into your working arm with your body weight. The amount of pressure can be varied enormously, depending on the part of your body you use, and the amount of body weight you lean into the movement. To feel this, sit in an upright chair and press with your whole hand on your thigh. Then, without changing the amount of force, move your hand so you press just with the thumb. Using your thumb, you are pressing over a smaller area, so the pressure is greater. If you rock the thumb to and fro, keeping the end of it pressed on one point, or if you rotate the heel of the palm over a point, you apply a different kind of pressure again. Always alternate between right and left hands to develop equal strength, and do not rely on your dominant hand. For some of the steps in the sequence, the techniques are described for one side of the body only. To treat the other side, reverse right and left in the instructions.

The techniques are presented in groups. Within each group there are variations. For example, for kneading you can use the whole hand, the finger and thumb, or both hands interlocked. In the techniques that follow, ‘you’ refers to the giver, and ‘your partner’ means the receiver.

Kneading

This technique is fundamental to all Tui Na soft tissue techniques. Kneading must move the underlying tissues to create a range of different pressures, delivered with subtle nuances of direction and force. Kneading is achieved in a variety of ways by combining simple kneading with squeezing, rubbing and plucking techniques.

Using the thumb, heel of the hand, elbow or forearm, a skilled therapist can knead with the right amount of pressure on the area treated. Kneading may be to and fro or circular, or both. It can produce gentle, relaxing pressure or deep stimulation. When kneading, progress steadily from light to heavier pressure, guided by your partner’s response.

SINGLE THUMB KNEADING The thumb moves in a circle or to and fro to apply a penetrating pressure; the rest of the hand supports the thumb. Thumb kneading applies a very concentrated stimulus to a qi-point or a knotted area of soft tissue. For more focused pressure, use your nail tip (nailing) on the qi- points at the start and end of meridian lines on the fingers and toes (such as LU 11 for an inflamed, sore throat).

DOUBLE THUMB KNEADING Press the other thumb down on top of the working one when stronger pressure is required.

HEEL OF THE THUMB KNEADING On the face, the Chinese use the fleshy area at the base of the thumb with a very loose side-to-side wrist action. The qi-point LU 10 in the centre of this area is called ‘fish belly’. It’s softer than kneading using the thumb or heel of the hand.

DOUBLE HEEL OF HAND KNEADING For even stronger pressure, place your other hand on top of the first to apply extra pressure. Bring your body weight over the hand to generate pressure, gently at first.

HEEL OF HAND KNEADING Thisuses the heel of one hand with the fingers relaxed on your partner's body. Pressure is focused through the heel, not the palm or fingers. Move the heel of the hand to and fro or in a circle. This technique covers a larger area than thumb kneading but with less focused pressure.

CROSSED DOUBLE HEEL OF PALMK NEADING With the heels of both hands pressing on the body, cross the fingers of one hand over the other. Lean into the body to give greater pressure with more precise control. Most frequently used on the bladder meridian on the back and legs.

SIDE-BY-SIDE HEEL OF PALM KNEADING With both heels of the palms side by side, use both hands simultaneously to apply pressure to massage the bladder meridian on the back or the thighs.

ELBOW KNEADING This technique uses the back of the elbow, not its tip, with to and fro or circular motion. It’s used on well-muscled areas, such as the hips, buttocks, thighs, shoulders and lower back. Increase the pressure gently, since very deep pressure can be generated if too much body weight is used.

Elbow kneading is usually used on qi-point GB 30 on the buttocks, and BL 23–BL 26 on the lumbar area. It can also be used on GB 21, if your partner is big.

FOREARM KNEADING For less penetrating pressure, use the upper forearm. Here, both forearms knead simultaneously in opposite directions. Both elbow and forearm kneading are good for buttock and thigh massage.

Use this technique on the back, covering the whole spine, and working from the centre outwards and back again. Give a push on the outwards movement to effect a slight stretch.

Kneading with squeezing

The ‘Tui’ in ‘Tui Na’ means pushing or kneading. The ‘Na’ translates as a grasp that involves squeezing. In a squeeze, the tissues are held in a way that subjects them to pressures from opposite directions. Every squeeze lifts up and kneads the area being massaged. As for all techniques involving deep pressure, you should begin the squeeze gently and increase it gradually.

WHOLE HAND KNEAD WITH SQUEEZE Place the thumbs where you start the squeeze. The fingers press towards the thumb and heel of the palm, creating opposing pressures. Each squeeze involves a lifting action with kneading.

Use both hands simultaneously to give greater coverage.

FINGER AND THUMB KNEAD WITH SQUEEZE A squeeze uses the thumb and all the fingers to give added strength to oppose the thumb pressure – for example, BL 60 and K 3; H 3 and LI 11; SP 10 and ST 34.

This squeeze and knead produces deep and concentrated pressure on specific qi-points.

HEELS OF PALMS KNEADING AND SQUEEZING IN OPPOSITION Placing one hand on either side of the limb being treated, squeeze and knead with the heels of the hands, using strong opposing pressure with to and fro or circular movements. You can interlock your fingers if the location permits. This is good for the temples, shoulders, knees and ankles.

Kneading with pushing

Pushing is kneading firmly, but with the movement in one direction only, sufficient to move the underlying tissues. Pushing techniques are deep and vigorous.

PALMAR KNEAD WITH PUSH

This is a long, strong push in one direction with the emphasis on the heel of the hand. It’s usually used on the du and bladder meridians.

THUMB KNEADING WITH A PUSH Both thumbs push outwards from the midline. This is used on the face.

Kneading with thumb rocking

This technique applies penetrating thumb pressure on qi-points, to produce acupuncture-like effects.

First make sure your thumb nail is short. Put your thumb pad on the area or qi-point to be treated and, with a small to and fro movement of the forearm, rock your hand over the thumb so that it bends at the first joint. The overall effect is to bend and straighten the thumb rapidly while holding it on the same spot to knead the underlying tissue. This technique should be done for several minutes on each qi-point.

Kneading with plucking

This technique uses a shearing action, with very deep, controlled, sideways movement across specific qi-points and muscles to move the underlying tissues. It’s effective on the inner bladder meridian and GB 21.

Place the thumb pad flat on the area being treated. Now use the heel of the other hand to push the thumb backwards and forwards, creating a kneading effect. Plucking works very well on qi-points over muscles that are tightly knotted.

Vibration

For this technique, the hand quivers, gently moving the underlying tissue and sending vibrations into them.

Holding your palm flat on your partner’s body, tense the muscles in your forearm while keeping your fingers loose, so that your hand quivers. This technique is used mainly on the abdomen.

Rolling

Rolling is a modern technique, only introduced last century, but it’s effective and important in Tui Na. Since the technique is difficult to learn from a book, an alternative version to Chinese rolling is also described here, which you may find easier. This is the single or double forwards knuckle roll, developed by the author. In all versions of the technique, the rolling action moves the underlying tissues like kneading does.

CHINESE ROLLING In Chinese rolling, the back of the hand rolls over the body. Press the outside edge of the back of the hand firmly against your partner’s body, fingers held slightly apart and relaxed, as shown below. Keeping your wrist relaxed, rotate your forearm so that your hand flips smoothly backwards. As your hand rolls across your partner’s body, it opens, so that the metacarpal region behind the knuckles and each of the fifth, fourth and third knuckles in turn make contact with the body.

Lean into your hand with your body weight to create the pressure required. The roll must be smooth, with the hand always in contact with your partner’s body. Do not allow the hand to flick up at the end of the roll. The return movement is also smooth, with the fingers loose, as if cradling an egg. Aim to make one complete movement per second. An expert moves the hand like a rolling pin, making about 130 rolls per minute.

MARIA’S SINGLE KNUCKLE ROLLING Curl the fingers loosely, with the thumb relaxed, and put your hand on your partner’s body, holding the top joints of the fingers and the nails against the area to be treated (see below). Roll the hand forwards, as far as the knuckles. Then retract the forearm so the hand rolls back into the original position.

This roll is a simple to and fro motion created by a piston-like action of the forearm. Each roll kneads the underlying tissues. Maintain an even pressure on the forward stroke as the backs of the fingers open out against the body. The hand should not rub or lose contact with the skin. This single roll is used down the inner bladder meridian from BL11 to BL 26.

MARIA’S DOUBLE FORWARD KNUCKLE ROLLING With this roll, it’s easier to control pressure than with the Chinese version. Place your free hand on top of the working one, which is more clenched than in the single roll. Only roll over your second finger joints as far as the knuckles. It’s like a to and fro kneading action using the finger joints to strongly move the underlying tissues. The technique is used on the upper arm and across the bladder meridian towards the spine.

Rubbing

The Chinese describe rubbing techniques as pushing, scrubbing, chafing and dragging. Rubbing involves movement over the skin’s surface, creating friction, which generates heat. The movements knead the subdermal tissues and can vary from a very gentle to and fro to a vigorous scrubbing.

ONE-HAND CHAFING This is rubbing with the outer edge of the hand, making long strokes with a fast sawing motion. The technique is used along the inner bladder meridian.

TWO-HAND CHAFING Here, both hands act like saws, moving in opposite directions with short, rapid strokes.

Chafing across the lumbar region warms and stimulates the kidney energies.

Chafing across the sacral area of the lower back generates heat that your partner may feel along the lines of the bladder meridian of the legs even as far as the feet.

PALMAR RUBBING With a loose wrist action, use the whole palm to make light circular, or to and fro, fast rubbing movements to stimulate the subdermal tissues. Here, on the back, the hands move to cover the whole back. For stronger pressure, use the heel of the hand.

PALMAR RUBBING IN OPPOSITION This technique gives a vigorous rubbing with the palms on both sides of arms, legs, fingers, thumbs and shoulders.

Begin at the top of a limb and move downwards gradually.

Percussion

Percussive techniques apply pressure for a very short time; the amount of pressure depends on the force used and the area over which it’s applied. Percussion is mostly used to apply penetrating pressure to areas of the body with thick layers of muscle, such as the buttocks, the lumbar region, thighs and the muscles across the shoulders. Each technique produces a specific, therapeutic sound.

PUMMELLING Using the outer edges of loose fists, vigorously pummel your partner’s body with a rapid staccato action. Alternate your hands as you pummel.

HACKING Hold the hands with palms together and fingers spread. Strike the body with the sides of the hands, with the emphasis on the little fingers so that the other fingers clap together.

CUPPING Hold the hand firmly in a cupped position. Allow the forearm to drop loosely with each stroke, with the movement coming from the elbow. You can strike with some force because there is a cushion of air trapped between your hand and your partner’s body. When cupping on the back, hold your hand across the sacral and lumbar area but lengthways along the spine itself. Use on well-muscled areas, such as GB 30 and the thighs. The technique should produce a cushioned sound not a slap.