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The therapeutic effect has two components: 1. PM has a direct therapeutic effect on the musculo-skeletal disorders. PM on the affected areas of periosteum evokes local inflammatory response. This response provokes a number of reactions: support regeneration of the periosteum; improve the microcirculation; balance of metabolic processes in the bones and joints; and reinforce of capsule and ligaments of the joints (Yankovsky, 1982). The results are elimination of pain and delayed development of the degenerative process in the joints. Dr. P. Vogler and Dr. H. Krauss (1953) later believed that the local vasomotor reflexes are responsible for the direct therapeutic effects of PM.

2. PM through common spinal nerves has an indirect therapeutic effect on some inner organ disorders. PM interrupts a vicious circle which takes place between the affected inner organs and the reflex zones in the periosteum by the restoring local metabolism and eliminating reflex zones (see Fig. 51). The authors (1975) studied the clinical effects of PM on the different systems of the body. PM has greatest therapeutic effects on the cardiac, pulmonary, and gastric pathologies. For example, stomach peristalsis significantly increased and cardiac rate decreased 10-16 beats per minute after PM treatment on the periosteum of the ribs.  

C. INDICATIONS FOR PM.
Indications for PM treatment of inner organ disorders are limited. To estimate the clinical results, it is recommended that PM be used for treatment of patients with the following pathologies: 

1. Diseases and traumas of the musculo-skeletal systems. Delays of fractures consolidation andrehabilitation during the postsurgical period. 

2. Diseases of the cardio-vascular system.

a. Cardiac arrhythmias.
b. Coronary arteries diseases.

(1). Angina pectoris.
(2). Rehabilitation after myocardial infarction.

a. Pneumonia.
b. Bronchitis.
c. Bronchial asthma.

a. Gastritis, peptic ulcer.
b. Hepatitis, cirrhosis, cholecystitis.
We want to emphasis that PM is a radical method of treatment of pain syndromes which are caused by various diseases of the skeletal system.

D. DIAGNOSTIC TECHNIQUES FOR PM.
The diagnostic study is best performed by using the fingertips of the 2nd and 3rd fingers. The examiner has to determine, the location all trigger points in the periosteum. The appearance of roughness, depressions, or swells proves the existence of periosteal reflex zones.

Remember that only a small part of the periosteum is accessible for massage since it is covered by skin only or skin and thin muscular layer. Generally these are prominent parts of the bones in the areas