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CHAPTER 3. PERIOSTAL MASSAGE (PM).

A. THE STRUCTURE AND FUNCTIONS OF PERIOSTEUM.
Periosteum refers to the double layer of connective tissue membrane covering the outer surface of the bones and tightly joined to them. Fig. 73 contains a microphotograph of a cross section of the tibia.

FIGURE 73. Cross section of the diaphysis of tibia.

1 - periosteum
2 - compact bone
3 - bone marrow

 The outer lamina of periosteum is a fibrous layer which contains dense, irregular connective tissue with nerves, blood, and lymphatic vessels. The inner lamina is an osteogenic layer which supports bone remodeling. It contains elastic fibers, osteoblasts, and osteocysts.

In the diaphysises of long bones, the periosteum has a thickness of about 2-3 millimeters, with a gradual decrease of thickness in the metaphysises and connecting to the cartilage in the epiphyses.

The periosteum is richly innervated and through it pass the blood vessels that feed the bone. This explains the significance of the role the periosteum plays in the processes of bone metabolism. Another important function of the periosteum involves remodeling of the bone. The periosteum plays a key role in the healing of fractures. Finally, ligaments and tendons are interwoven into the periosteum. They stabilize the joints and support the dynamic activity of the human body.

B. DISCOVERY OF THE PM AND ITS PATHOPHYSIOLOGICAL BASE.
In 1926, the French physician J. Dejerine for the first time described the segmental innervation of the bones of the pelvic and lower extremities. In 1944 his work was further developed by V.T. Inman and I.B. Saunders. They finally mapped segmental innervation of the periosteum throughout the human body. Dr. Inman and Dr. Saunders also established conception of the sclerotome.

PM was proposed in 1929 by the German scientists Dr. P. Vogler, MD and Dr. H. Krauss, MD. It was in the 1950s that it was finally accepted as an independent procedure of medical massage treatment. The authors detected pathological changes in the periosteum which originated only secondarily to diseases of the joints and inner organs. These changes have a reflex character and are seen in the areas of the periosteum (i.e. sclerotomes) which are located within the same neurometamers of the body as the original pathological process.

Abnormalities in the periosteum are represented either by local pain or by the changing structure of the periosteum. Such a change involves local thickening, roughness, and condensation.