Massage therapy refers to a wide variety of methods that involve passive movement of the joints, and stroking, pressing, rubbing, kneading, rolling, or tapping the soft tissues of the body in order to stimulate circulation, release tension, induce relaxation and promote healing. Among the many different therapies are Swedish massage, sports massage, neuromuscular (trigger point) massage, deep-tissue massage, and manual lymph drainage. Massage techniques or approaches are intended to aid in reaching, maintaining and/or increasing overall health and well being, as well as for treating or relieving certain conditions.
Human touch is probably the oldest healing practice of all. The laying-on-of-hands is present in various forms in most cultures, religions, and medical traditions. Written records of therapeutic massage go back 3,000 years in China, and Hippocrates taught the healing power of massage to physicians in ancient Greece.
In modern times, massage therapists are an integral part of the health care team, working alongside physicians in many countries, including those of the former Soviet Union, Japan, China, and Germany. In fact, massage is covered today by national health insurance in Germany. Chinese hospitals commonly have massage wards, and, in one Shanghai hospital, the massage department occupies two floors.
In the United States, massage had a strong presence in medical practice until the development of pharmaceutical and technological medicine in the middle of the 20th century. At that point, it entered a period of being regarded as too time- and labor-intensive to occupy a major role in the modern practice of medicine.
However, since the 1960s and the integration and acceptance of such concepts as holistic health, the importance of stress reduction, and the general promotion of healthful living, the use of massage has been steadily growing. A survey of alternative medicine utilization, published in the New England Journal of Medicine in 1993, ranked massage therapy among the most frequently used forms of alternative health care(1). There are an estimated 50 thousand massage therapists now practicing in the United States.
Although there are many varieties of massage therapy, they tend to share several basic principles. Chief among them is improving the circulation of blood and lymph, which is considered beneficial for almost all health conditions. Release of toxins from the tissues is seen as a healthful consequence of improved circulation. Release of tension in the muscles aids in circulation and counters the effects of stress.
Another common principle is the interdependence of structure and function; that is, changes in structural aspects of the body, such as injuries, or chronic tension, affect its functioning, and vice versa. Massage therapy helps restore healthy structure and function, allowing better circulation, greater ease of movement, more flexibility, and the release of tension.
Massage therapy is considered to be holistic in the sense that it aims to improve the interrelationships among all bodily systems – the musculoskeletal system, internal organ systems, the nervous system, the immune system, cardiovascular system, etc. Consistent with this holistic principle is the idea of mind/body integration. Just as our mental and emotional states can cause physiological changes in the body, the body’s condition influences our mental and emotional states. Massage therapy is an effective means of stress reduction, and can help relieve the effects of stress on the body.
The belief governing most massage therapy approaches and techniques is that our vital energy is stimulated or enhanced through hands-on contact.
Massage therapy research has historically been well represented in the medical literature, where benefits for almost all major illnesses have been reported. The effects of massage on pain control have been documented(2), and benefits have also been shown for such diverse conditions as childhood asthma(3), depression in young mothers(4), cystic fibrosis(5), pregnancy(6), chronic constipation(7), postoperative pain(8), Attention Deficit Hyperactivity Disorder (ADHD)(9), atopic dermatitis(10), and bulimia(11).
What Are the Potential Uses of Massage Therapy?
Massage therapy has a very wide range of applications. It can often relieve stress-related disorders, and many other conditions that would benefit from greater blood circulation or the release of tension being held in the body. Psychological conditions may also improve as the physiological changes brought about by massage help restore balance in the nervous system and the hormonal systems, which often affect mood.
Some conditions in which massage is commonly used include:
Low back pain
Spinal cord injuries or spinal pain
Tension or migraine headache
Post-traumatic stress disorder
Neglected or abused children
Pregnancy, labor and childbirth
Job-related stress and general stress-related conditions
Chronic fatigue syndrome
Who Practices Massage Therapy and What is Their Training?
There are many schools and training programs for the many different forms of massage therapy. Currently, 29 states and the District of Columbia regulate massage therapists, and some cities and counties have their own regulations, as well. The American Massage Therapy Association’s training standards have been incorporated in many state licensing laws. The basic standard is 500 hours of classroom instruction, including 300 hours of massage theory and technique, 100 hours of anatomy and physiology, and 100 hours of additional required courses, including first aid and cardiopulmonary resuscitation (CPR). The Commission on Massage Therapy Accreditation (COMTA) approves training programs that meet the 500-hour standard.
There are, of course, less extensive training programs that may still qualify an individual for a license or permit to practice in certain areas. In states where massage therapy is not licensed, you should find out about local regulations. In addition to determining a practitioner’s credentials, you should always ask about his or her training, experience, and any membership in, and/or certification by, professional organizations, such as the National Certification Board for Therapeutic Massage and Bodywork.
For more information about types of certification, state licensing laws, and a directory of members of the American Massage Therapy Association, see their web site at http://www.amtamassage.org.
Is Massage Therapy Safe?
There are no recognized adverse effects from massage therapy per se. However, negative effects can occur, as noted in the following section.
Massage therapy is not advised in the following situations or conditions:
when there is a skin infection that could be spread to another area of the body, or to the practitioner
in cases of fever, in which massage may increase body temperature
in the presence of scar tissue, open wounds, or burned areas in which healing is still under way
with varicose veins or phlebitis, in which there could be complications from releasing a blood clot
directly on tumors, in which cancer cells could theoretically be loosened and spread (although there is no research documenting this)
with low platelet counts, in which rigorous massage may cause bruising(12).
In many of these cases, "off-body" alternatives to massage, such as Therapeutic Touch (TT), may be beneficial. In TT, the practitioner’s hands do not contact the skin directly, but work with the energy field close to the body. This method has been found to reduce pain(13) and accelerate the healing of wounds(14). The "off-body" alternative may be a more comfortable treatment approach for people who have experienced sexual abuse or others with post-traumatic stress disorder (PTSD).
What to Expect in a Practitioner’s Office
Typically, massage therapists will begin a session by discussing with the client any specific health conditions, injuries, or illnesses that may be of concern and which may influence how the treatment is to proceed. Usually the therapist will then leave the room while the client partially or fully disrobes, depending on the area(s) of the body to be treated. The client lies on a padded massage table, draped with a sheet or large towel. During the therapy session, only the areas being massaged are exposed, and they are covered again as the therapist moves to another area. Most practitioners use massage oils, which aid in reducing friction, improving circulation, and warming the skin. At the end of the massage, the practitioner will leave the treatment room, sometimes allowing the client to rest a while longer on the table before getting dressed.
Depending on their training, there is wide variation in how practitioners engage with the client during the massage session. Some concentrate on the physical techniques only, and it is not unusual to experience an entire massage without a word being spoken. Other types of massage (e.g., the Rosen Method) work with the mind/body relationship, and the massage therapist will invite a dialog with the client about what he or she is experiencing emotionally as the treatment progresses. Some also have training in hypnotherapy or psychotherapy, and apply these skills during the massage. Again, before choosing a practitioner, you should determine their skills and experience, and the therapy approach, or approaches, they employ. Prior to the massage session itself, you should be absolutely clear with the therapist about what sort of treatment you want.
William Collinge, Ph.D., M.P.H.
1. Eisenberg DM, Kessler RC, Foster C et al. Unconventional medicine in the United States: prevalence, costs, and patterns of use. The New England Journal of Medicine, 328(4):246-52 28 1993 January 28
2. Kaard B; Tostinbo O. Increase of plasma beta-endorphins in a connective tissue massage. General Pharmacology, 1989, 20:4, 487-9.
3. Field T; Henteleff T; Hernandez-Reif M et al. Children with asthma have improved pulmonary functions after massage therapy. J Pediatr, 132(5):854-8 1998 May
4. Field T; Grizzle N; Scafidi F; Schanberg S. Massage and relaxation therapies' effects on depressed adolescent mothers. Adolescence, 31(124):903-11 1996 Winter
5. Hernandez-Reif M; Field T; Krasnegor J et al. Children with cystic fibrosis benefit from massage therapy. J Pediatr Psychol, 24(2):175-81 1999 Apr
6. Field T; Hernandez-Reif M; Hart S. Pregnant women benefit from massage therapy. J Psychosom Obstet Gynaecol, 20(1):31-8 1999 Mar
7. Ernst E. Abdominal massage therapy for chronic constipation: A systematic review of controlled clinical trials. Forsch Komplementarmed, 6(3):149-51 1999 Jun
8. Nixon M; Teschendorff J; Finney J; Karnilowicz W. Expanding the nursing repertoire: the effect of massage on post-operative pain. Aust J Adv Nurs, 14(3):21-6 1997 Mar-May
9. Field TM; Quintino O; Hernandez-Reif M; Koslovsky G. Adolescents with attention deficit hyperactivity disorder benefit from massage therapy. Adolescence, 33(129):103-8 1998 Spring
10. Schachner L; Field T; Hernandez-Reif M et al. Atopic dermatitis symptoms decreased in children following massage therapy. Pediatr Dermatol, 15(5):390-5 1998 Sep-Oct
11. Field T; Schanberg S; Kuhn C et al. Bulimic adolescents benefit from massage therapy. Adolescence, 33(131):555-63 1998 Fall
12. Field T. Massage therapy. In W Jonas and J Levin (eds.), Essentials of Complementary and Alternative Medicine. Baltimore: Lippincott, Williams & Wilkins, 1999, pp 383-91
13. Turner JG; Clark AJ; Gauthier DK; Williams M. The effect of therapeutic touch on pain and anxiety in burn patients. Journal of Advances in Nursing, 28(1):10-20 1998 Jul
14. Wirth D. The effect of non-contact therapeutic touch on the healing rate of full thickness dermal wounds. Subtle Energies, 1(1):1-20 1990