The role of Substance P and inflammatory mediators in underlying mechanism of traditional Malay massage (urut Melayu) in reducing muscle stiffness and inflammation for stroke rehabilitation.

The stroke patients in intervention group (Group A) will be treated by two certified practitioner of traditional Malay massage, with the treatment being applied within 60 minutes in one session only (immediate effect). The traditional Malay massage will applied on upper and lower limb (full body), and will be treated and focused more on affected side. The practitioner will follow the protocol of traditional Malay massage for stroke that has been provided for and approved by the Ministry of Health, Malaysia. The location will be held in Physiotherapy Department at KPJ Seremban Specialist Hospital, Malaysia. The traditional Malay massage procedure involves all part of the body except head. Every parts of the body have its own technique. Oil massage will spread evenly the area that need to massage (follow the sequence of body part) to give smooth effect between therapist’s hand and patient’s skin during apply techniques. All techniques in each body parts will apply 5 times with pressure level of 3 except effleurage (pressure level of 2) and static pressure as well as friction using knuckles (pressure level of 4). Pressure level of massage is based on Walton’s scale. First procedure will start in toes area which is apply on right side. The techniques used in toe are effleurage from toes to heel, followed by thumb stroking on lateral side of footprint, double thumb stroking on the middle footprint. Then, do friction using knuckles with slow motion from heel to toes. Each toe will apply thumb stroking techniques and lastly apply effleurage technique from toes to heel. After that, proceed on the left side using the same techniques. The second part is calf area (below knee) which is apply on right side first. The technique includes effleurage that apply from lateral malleolus to popliteal fossa, thumb stroking (on lateral malleolus area), palmar kneading as well as hacking (the whole calf muscles). Effleurage is the last technique in calf area which is applies from lateral malleolus to popliteal fossa. After that, proceed on the left side using the same techniques. Next part is thigh area (above knee). Do apply the techniques on right side area includes effleurage that applies from popliteal fossa to below buttock area, forearm stroking technique apply on the whole thigh muscles, basic kneading as well as hacking techniques on the whole thigh muscles. A last technique is effleurage will apply from popliteal fossa to below buttock area. After that, proceed on the left side using the same techniques. Proceed to lower and upper back area. The techniques include in this area are effleurage (from lower back to upper trapezius), thumb stroking along the erector spinae muscle (each side), double thumb stroking on both sided along the erector spinae muscle. Then focus on right side from lower back to upper back area, apply palmar stroking and basic kneading. Same techniques are applied on the left side of lower back to upper back area. On the scapular area (right side), apply thumb stroking, thumb friction and rapid palmar stroking along the scapula blades. Same techniques are applied on the left scapula side. Next technique is give static pressure about 5 seconds using therapist’s palm with pressure scale of 4. After that, apply tapotement techniques from lower back to upper back area. Lastly is effleurage from lower back to upper back. Last area is hand which is divided into shoulder, forearm and fingers. Do all the techniques on right side then followed with left side using the same techniques. The first technique is effleurage that will apply from fingertips to shoulder. Then apply palmar stroking from wrist to forearm and proceed to shoulder. After that, apply thumb stroking on fingers, wrist, forearm and shoulder area. Lastly do effleurage again from fingertips to shoulder.