The patient lies prone, folding the arms under the head; a firm pillow is put under the epigastric region, so as to the better relax the back muscles, which are too tense when a person lies flat.

Beginning from the occiput, both hands stroke firmly and rapidly downward and outward to the spines of the scapulae, at first lightly, then with increasing force.
Then the whole back is vigorously rubbed--scrubbed one might call it--with up-and-down strokes, as a preliminary application.

The erector spinae masses are treated by careful finger-tip kneading.

Working from the spine outward to the axillary line, the muscles of the ribs are acted upon with flat-hand rubbing.

The groups of the upper back and shoulder-blades are kneaded and squeezed, the arms being partly abducted so as to separate the shoulder-blades and allow the operator to reach the muscles underlying them.