Tapotement   The most popular methods of tapotement, or percussion, are cupping, hacking, and pincerlike or pincing movements.

Cupping  The cupping action produces an invigorating and stimulating sensation. It is a series of percussion movements rapidly duplicated at a constant tempo. One's hands are cupped to such an extent that the beat emits a dull and hollow sound, unlike the sound of the slap of the open hand. The hands move alternately, from the wrist with the elbow flexed and the upper arm stabilized. The cupping action should be executed until the skin in the area develops a pinkish coloration. 

Hacking   Hacking can be used in conjunction with cupping to bring about a varied stimulation of the sensory nerves. It is similar to cupping, except the hands are rotated externally and the ulnar, or little finger, border of the hand is stroking the surface. Only the heavy muscle areas should be treated in this manner.

Pincing   Although pincing is not in the strictest sense percussive, it is listed under tapotement because ofthe vigor with which it is applied. Alternating hands lift small amounts of tissue between the first finger andthumb in quick, gentle pinching movements.

Vibration    Vibration is rapid movement that produces a quivering or trembling effect. It is mainly used in sports for its ability to relax and soothe. Although vibration can be done manually, the machine vibrator is preferred.

Deep Transverse Friction Massage
The transverse, or Cyriax, method of deep friction massage is increasingly being used in sports medicine. It is a specific technique for treating muscles, tendons, ligaments, and joint capsules. The major goal of transverse massage is to move transversely across a ligament or tendon to mobilize it as much as possible. This technique often precedes active exercise.

Deep transverse friction massage restores mobility to a muscle in the same way that mobilization frees a joint.

The position of the hands is important in gaining maximum strength and control. Four positions are recommended: A. index finger crossed over the middle finger, B. middle finger crossed over the index finger, C. two fingers side by side, and D. an opposed finger and thumb.

The massage must be directly over the site of lesion and pain. The fingers move with the skin and do not slide over it. Massage across the grain of the affected tissue. The thicker the structure, the more the friction is given. The technique is to sweep back and forth over the full width of the tissue. Massage should not be given to acute injuries or over highly swollen tissues. A few minutes of this method will produce a numbness in the area, and exercise or mobilization can be instituted.

Acupressure Massage

Acupressure is a type of massage based on the ancient Chinese art of acupuncture. Acupuncture, along with herbal medicine, composes traditional Chinese medicine. Only recently has the amount of research, publication, and interest in acupuncture in Western medical literature increased dramatically.

Acupuncture points lie along a series of meridians that run throughout the body. These points are named according to the meridian on which they lie. Whenever there is a pain or illness, certain points on the surface of the body become tender. When pain is eliminated or the disease is cured, these tender points seem to disappear. According to acupuncture theory, stimulation of specific points through needling can dramatically reduce pain in areas of the body known to be associated with a particular point. Thousands of acupuncture points have been identified by the Chinese.

There is evidence for the physical existence of these points. The electrical resistance of the skin at certain points corresponding to the acupuncture points is lower than that of the surrounding skin, especially when a disease state is present.

Examining acupuncture points by sectioning indicates increased nerve endings at these points. Despite this evidence, there is no definite physical attribute of all acupuncture points, nor is there a thoroughly demonstrated mode of action for the technique. Whatever the explanation, it appears that the locations and effects of stimulating specific acupuncture points for the relief of pain have been determined empirically (knowledge gained through experiment).

In Western medicine, the counterpart of the acupuncture point is the trigger point. Trigger points, like acupuncture points, are associated with visceral (internal organs of the body) structures; stimulating of these points has also been proved to relieve pain.

Physiological explanations of the effectiveness of acupressure massage may likely be attributed to some interaction of the various mechanisms of pain modulation.

With the use of acupuncture charts specific points are selected, which are described in the literature as having some relationship to the area of pain. The charts provide a general idea of the location of these points. Two techniques may be used to specifically locate acupressure points. Because it is known that electrical impedance is reduced at acupuncture points, an ohmmeter may be used to locate the points. Perhaps the easiest technique is simply to palpate the area until either a small fibrous nodule or a strip of tense muscle tissue that is tender to the touch is felt.

After the location of the pain, massage is begun using the index or middle fingers, the thumb, or the elbow. Small circular motions are used on the location (point). Patient tolerance will determine the amount of pressure applied to these acupressure points ; however, it must be intense and will likely be painful to the patient. Generally, the more pressure tolerated, the more effective the treatment.

Effective treatment times range from 1 to 5 minutes at a single point per treatment. To achieve the greatest effects it may be necessary to massage several points during the treatment . In this instance, it is best to work distal (furthest from heart) points first and to move proximally (closest to the heart).

During massage, the patient may mention a dulling or numbing effect and will often mention that the pain has lessened or subsided totally during the massage. These effects may last for only a short while however in some it may last for several hours.