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62 m a s s a g e & b o d y w o r k j a n u a r y / f e b r u a r y 2 0 1 6 Rhythmic passive and active joint movement. Fritz, Sandy. Mosby's Fundamentals of Therapeutic Massage, 5th ed. Elsevier, 2013. Lymph nodes Lymph nodes End Begin Rhythmic pumping of chest. Fritz, Sandy. Mosby's Fundamentals of Therapeutic Massage, 5th ed. Elsevier, 2013. Rhythmic pumping of abdomen. Fritz, Sandy. Mosby's Fundamentals of Therapeutic Massage, 5th ed. Elsevier, 2013. Short, pumping strokes move distally. Fritz, Sandy. Mosby's Fundamentals of Therapeutic Massage, 5th ed. Elsevier, 2013. The following sequence combines various methods to support fluid movement in the body. Little, if any, lubricant is used, so the skin can be easily moved. The approach is slow and methodical. The pumping protocol is performed in primarily the supine position, but can be modified for side lying and can be done with clients clothed. The massage protocol must be done on skin and can be done in all positions. Each section of the process can be used separately and is easily combined into general therapeutic massage application. Generalized pumping protocol (Total time: 10 minutes) • Begin the massage session by slow skin-stroking on the anterior cervical area above the clavicles. (60 seconds) • Place both hands on the anterior surface of the thoracic cage just below the clavicles and apply a firm but gentle rhythmic pumping action on the thorax (Image 3). Repeat this procedure four or five times. • As the client exhales completely, allow your hands to passively follow the movements of the thorax. When the client starts to inhale, resist the movement of the thorax with counter pressure for 5–7 seconds. Repeat this procedure four or five times.