The patient lies face downward if possible. Some patients cannot, for one reason or another, assume this position ; others have a rooted objection to do so. In such cases the patient must lie first on one side, then on the other, that the whole back may be well masséed. Then, again, the only position possible is sitting and leaning forward, as in phthisis and heart trouble ; the disadvantage in this is that the muscles are stretched and cannot be so well kneaded. A flannel jacket pu on with the opening at the back covers the chest and arms. The operator may stand at either side.

Supposing the patient to be in the typical prone position with elbows out and hands under forehead, or with arms straight by sides, palms turned upwards, a cushion under the stomach to relax the muscles of the back and to make the surface flatter.

1.   Effleurage with one hand rapidly from nape of neck to sacrum on spinal column (twenty times).

2.  The same with two hands, one following the other.

3.  The thumbs are placed at each side of upper part of the column lengthwise, the fingers spread out over the back ; pressure with thumbs towards fingers, drawing muscles out from middle line, at the same time kneading with the palms. To be repeated several times before moving the hands, and continued to the pelvis.

4.   Kneading with heel of hand outward from the spine all over the back, following the muscle fibres.

5.   Hacking.

6.   Flail.

7.   Clapping.

8.   Rolling effleurage, pressure downwards from the neck to the armpits, and upwards from the waist to the armpits, following lymphatics to axillary glands.

For the lower part of back, the upper part to be covered :

1.   Effleurage over sacrum.

2.   Kneading glutei with thumbs and finger

3.   Ditto with heel of hand.

4.   Hacking.

5.   Beating.