Massage

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Massage is the practice of applying structured pressure, tension, motion, or vibration — manually or with mechanical aids — to body tissues, principally with the hands, "for the purpose of affecting the nervous and muscular system and the general circulation". Its known modes of action include stimulation of peripheral reflexes, and mechanical effects such as assisting fluid movement and muscle movement, the latter potentially releasing adhesions of tissues.[1] Unquestionably, massage is widely accepted as pleasurable. Massage is widely accepted as a physical therapy technique, both medically and in sports training. When the massage is based on biofield therapy, however, and manipulates purported energies, the efficacy becomes far less well-defined.

Where massage is used for its physical and psychological benefits, it may be termed massage therapy. Massage can also be a part of lovemaking, and often takes place in the context of sex work. As massage is a lightly regulated industry, clients are advised to get references, ask questions and judge for themselves.

Massage Basics

There are a variety of massage techniques, which may be combined in various forms of massage. There are six basic strokes:effleurage,petrissage, friction, tapotement, compression and vibration. Oil, cream, or lotion is applied on the skin to reduce friction and allow smooth strokes. This style of massage is generally attributed to the Swedish fencing master and gymnastics teacher Pehr Henrik Ling (1776-1839). However, it was in fact the Dutch practitioner Johan Georg Mezger (1838-1909) who adopted the French names to denote the basic strokes under which he systematized massage as we know it today, as Swedish or classic massage:[2]

  • Effleurage (stroking): Soothing, long, gliding strokes made with the entire flat surface of the hands that may be deep or superficial
  • Petrissage (kneading): Firmly but gently grasping the skin and surface muscles with thumb and fingers, and rolling, squeezing, or wringing them, and dropping them back into place.
  • Percussion: Stimulating, rapid alternate movements using both hands in:
    • Rapping - using fingertips
    • Hacking –using chop movements with stretched fingers. Hacking movements also are used in by respiratory therapists when performing postural drainage
    • Cupping - using cupped hand movements
    • Slapping - using flat, open palms
    • Pounding - using both fists
    • Tapotement- the lightest percussion-using drumming movements with fingertips .It is stimulating to the muscles and may be stimulating or calming to the nerves.
  • Friction: May be long, slow, firm stroking movements or rolling circular movement in which the hand is kept in contact with the skin and the superficial tissues are moved over the deeper underlying ones. Used in treatment of joints and around bony prominences to break down adhesions, clear out congestion and toxic waste build-up. It raises local temperature and should be followed by effleurage.
  • Vibration: Very rapid back and forth shaking or trembling movements performed by the whole hand or the fingers; used on the upper back, buttocks and thighs. Has a stimulating effect upon the nervous system by acting on the nerve centers or terminal nerve branches.

Good communication is essential to effective massage. In a commercial setting, the client is encouraged to communicate the type of treatment expected, for example relaxation or pain relief, full body massage, avoidance of, or focus on a specific area, the amount of pressure that is comfortable, preferred techniques, and past medical history and current physical condition.

In commercial settings, massage techniques involve the client being treated lying down on a massage table or in a massage chair, or on a mattress on the floor. Except for modalities such as Thai Massage or Barefoot Deep Tissue, the massage subject is generally unclothed, and the body may be "draped" with towels or sheets. This also helps keep the client warm. In some jurisdictions it is required that certain areas such as the genitals on both genders and the breast/nipple area on women be draped at all times. Due to the necessary physical contact between the practitioner and the client, sexual arousal (or signs of it) is possible, but rarely intentional. In many forms of massage, the treatment may start with the client face up or down for the first part of the session: the client then rolls over for the second half of the session. Relaxation is necessary for maximum therapeutic benefits to be achieved.

Efficacy of massage therapy

A meta-analysis of its role in palliative care for cancer suggested it may have promise but more rigorous trials are needed. [3] One study, with randomization (N=202) to light effleurage, extra nursing time, or standard nursing, showed subjective benefit ((p = 0.05).) in reducing the subjective unpleasantness of postoperative pain. [4]

Some studies indicate that combining massage and aromatic oils may be more effective than inhaled aromatherapy alone or massage alone, as in short-term knee pain (N=59), double-blinded. [5] In another study, it showed benefit in sleep quality for postoperative coronary artery bypass graft patients, with 40 total patients in two arms. [6]

Types of massage

There are well over 150 types of massage therapy. Various styles of massage have developed from a number of sources.

Not intended as medical therapy

Massage in this category may indeed have beneficial effects, but is offered because it is subjectively pleasant, relaxing or invigorating. The techniques defined for Swedish massage are, however, standard terminology in the West

Chair massage

Chair massage, also known as Corporate Massage, is by far the most convenient method of massage therapy. A chair massage session typically lasts 12-24 minutes, and is performed while fully clothed. Chair massage promotes better circulation, muscle stimulation and stress relief. This form of massage reduces tension in the back, neck, shoulders, head, arms, hands, legs or feet, providing a deep relaxation effect.

Chair massages are also advantageous because chair massage practitioners will frequently make work- or housecalls. Chair massage can also be done in hotels, airports and convention centers.

Swedish massage

This style utilizes long, flowing strokes, often but not necessarily in the direction of the heart.Swedish massage is designed to increase circulation and blood flow. Somehow, the term Swedish Movement System was transposed to Swedish Massage System sometime during the second half of the 19th century. Ling’s system was the Swedish Movement System or Swedish Gymnastic Movement System. This may be how he has become incorrectly associated for so long with Swedish massage (see [1]). In Sweden, the term "Swedish massage" is not used.

Scalp massage

In some barber shops in Hong Kong, scalp massage often lasts 30 minutes to 45 minutes during shampooing of the hair. It is also very common in India, after applying oil on the hair. It is still available in traditional North American barber shops and increasingly in day spas and similar institutions.

Sports massage

Massage is widely used for athletic conditioning, preparation for exercise, recovery after intense exercise, and for treatment of athletic injuries. There has been relatively little formal study of its efficacy.

A 2008 literature review concluded "Case series provide little support for the use of massage to aid muscle recovery or performance after intense exercise. In contrast, RCTs provide moderate data supporting its use to facilitate recovery from repetitive muscular contractions." [7]One very small (N=9), but well-publicized, study suggested it has no appreciable benefit for recovery after cycling. [8]

Therapeutic orientation

Massage used in a healing context can use the basic Swedish techniques, or some specialized methods described in subsections. There is a substantial body of research that shows benefit in improvements in comfort.

Deep tissue massage

Deep tissue techniques are generally designed for more focused massage work. Working a specific joint, muscle or muscle group, the practitioner can access deeper layers of the soft tissue. Starting superficially and easing into the depth of the muscle slowly often allows more movement. This is the recommended approach in this modality since each person experiences pressure differently. If the pressure is applied too deeply or too quickly, the muscle may tighten to protect that area, and unnecessary damage or inflammation can be induced. Very little lubricant is used as the pressure doesn't travel much over the skin.

The most commonly used 'tools' during deep tissue massage may include, 3 and 6 fingers, reinforced fingers, a flat elbow, opposing thumbs, the heel of the hand or foot, and the forearm.

Myofascial Release

For more information, see: Myofascial pain syndromes.

Myofascial release refers to the manual massage technique for stretching the fascia and releasing bonds between fascia and integument, muscles, and bones, with the goal of eliminating pain, increasing range of motion and balancing the body. Injuries, stress, trauma, overuse and poor posture can cause restriction to fascia. Myofascial release frees fascial restrictions, and allow the muscles to move efficiently. This is usually done by applying shear, compression or tension in various directions, or by skin rolling. This is one of the techniques used by sports massage therapists and physical therapists.

Myofascial release originators come from physical therapy and from Rolfing).

Myoskeletal alignment technique

Myoskeletal Alignment Technique (MAT) identifies postural distortions to improve and prevent pain conditions. MAT was developed by Erik Dalton, a clinical psychologist, with a background in Rolfing, who offers workshops and training materials; his book, Advanced Myoskeletal Techniques, was reviewed favorably in the American Massage Therapy Association Buyer's Guide. [9]

There do not seem to be formal clinical trials of the methods, although the developer's website speaks of their relevance to chronic pain. A reviewer in Massage Magazine said his method is "the link between osseous manipulation – chiropractic and osteopathy – and the soft-tissue work of massage therapists and bodyworkers. Dalton’s work focuses on the usual myofascial balance that structural integrators aim for, plus this near-bone musculo-ligamentous layer – a "bony intent" that sees bone as a soft tissue – the deepest layer, and a slow-changing layer, to be sure, but still a layer of connective tissue. This is, of course, the actual fact, but the artificial division between hard and soft tissues is one that has informed most of our education, and led to some separation between those who work with one (chiropractors and osteopaths) and those who work with the other (massage therapists and bodyworkers)."[10]

Neuromuscular therapy

Neuromuscular Therapy (NMT) is used for pain relief and specific problems. It was first developed in the 1930s by Stanley Lief, and has been developed by Raymond Nimmo, Janet Travell, Bonnie Prudden, Mary Shope and others. Consultation with primary physicians is recommended.

"NMT is based on neurological laws that explain how the central nervous system maintains homoeostatic balance, and in many cases, eliminates the cause of a person’s acute to chronic myofascial pain and dysfunction. [Procedures] include myofascial release, positional release and trigger point therapy, [to restore] homoeostasis ... between the nervous and musculoskeletal systems." [11]

It has been evaluated in a randomized controlled trial, using music relaxation as a control. "The findings suggest that NMT can improve motor and selected nonmotor symptoms in Parkinson's disease and that this effect is more durable for the motor symptoms. The results of this pilot study warrant larger controlled studies to examine dose range, durability, and mechanisms of NMT in PD function." [12]

Bowen therapy

Bowen Technique involves a rolling type movement over fascia, muscles, ligaments, tendons and joints. It is not strictly a massage technique, but a general healing method, "...a dynamic system of muscle and connective tissue therapy that was developed by the late Tom Bowen in Geelong, Australia. Sometimes called the “homeopathy of bodywork,” it utilizes subtle inputs to the body (known as “moves”), stimulating the body to heal itself. [13]

Traditional and tradition-derived

Tui Na (推拿) and Zhi Ya massage (指壓)

There are two traditional forms of Chinese massage. Zhi Ya is a form of Chinese massage based on acupressure. It is similar to Tui Na massage except it focuses more on pinching and pressing at acupressure points Tui Na is a form of Chinese massage (按摩) that is similar to Zhi Ya, but focusing more on pushing, stretching and kneading the muscle.

Chinese foot massage

Foot massage, as practiced by the Chinese is performed in the context of Qi, in that each spot on the sole of the foot corresponds to an internal organ, and the applied therapy is healing to one's overall well being. The theory supposes that an ailment of an internal organ will be associated with the nerve ending on the sole of the foot.

Before the massage, the patient's feet are soaked for about ten minutes in a foot bath, typically a dark colored solution of hot water and Chinese herbs. The massage therapist uses liberal amounts of medicated cream, to moisturize the foot and to provide lubrication. The knuckles on the therapist's hand are usually used to provide a hard and smooth implement for the massage. As pressure is applied to the sole, theory holds that a healthy patient should not feel any strong pain. Painful spots, reflexologists believe, reflect illnesses of other parts of the body. The practitioner rubs and massages the painful spots to break down rough spots and accumulated crystals and increase circulation.

The ailments are healed when the sore spots of the sole are treated and removed by massage. Based on this theory, some shoe liners are made with pressure points to stimulate the soles of the feet to promote better health of the overall body. The nature of these "crystals" has yet to be elucidated or demonstrated scientifically. Regardless of the actual correlation of reflexology to internal organs, many enjoy it for the mix of stimulation and relaxation.

Lomilomi — traditional Hawaiian massage

Lomilomi massage is a traditional Hawaiian method. They were taught their art over 20 years and received their last instructions from their master on his death bed. There are hundreds of styles of Lomilomi, the main ones being the style of Big Island which was passed on by Aunty Margaret Machado, and Maui style from Uncle Kalua Kaiahua. On the island of Kaua'i, Kahu Abraham passed on what is today called Kahuna Bodywork. It is not clear if other current practices - temple style, lomi lomi nui and others - are from Native Hawaiian practitioners or are modern adaptations.

Shiatsu (指圧)

Shiatsu is a form of Japanese massage that uses thumb pressure and works along the energy meridians in the body also with a lot of stretches the same meridians as acupressure. It is uncertain whether it originated from Chinese Zhi Ya.

Thai massage

Known in Thailand as นวดแผนโบราณ (Nuat phaen boran, IPA [nuɑt pʰɛn boraːn]), which correctly translates only as ancient massage or traditional massage, this form of massage is also known as Thai ancient massage, traditional Thai massage, Thai yoga massage, yoga massage, Thai classical massage, Thai bodywork, passive yoga or assisted yoga. It is usually soothing because of its emphasis on stretching and loosening the body. Its roots go back far into history, originating in India based on the Ayurveda, and then becoming popular in Thailand.

Originating in India and drawing from Ayurveda, it has inevitably incorporated modalities like yoga. The receiver is put into many yoga like positions during the course of the massage. In the northern style there are a lot of stretching movements unlike the southern style where pressure is emphasised. It was believed that the massage art was brought over to Thailand by Shivago Komarpaj (Jivaka Kumarabhacca), a contemporary of Buddha almost about 2500 years ago.

The massage recipient changes into pyjamas and lies on a mat or firm mattress on the floor. (It can be done solo or in a group of a dozen or so patients in the same large room). The massage giver leans on the recipient's body using hands and forearms to apply firm rhythmic pressure to almost every part of the taker's body. The massage generally follows the Sen lines on the body-somewhat analogous to Chinese Meridians and Indian nadis. In some gestures, legs and feet of the giver are used to fixate the body or limbs of the recipient. In other gestures, hands fixate the body, while the feet do the massaging action. Usually no oil is applied. A full course of Thai massage typically lasts two hours or more, and includes pulling fingers, toes, ears etc., cracking the knuckles, walking on the recipient's back, arching the recipient's back in a rolling action etc. There is a standard procedure and rhythm to the massage. Sometimes in a large group massage, the practitioners do the procedures in unison.

Note: The traditional therapeutic practice of Thai massage should not be confused with the sexual service of the same name that is available in some hotels and brothels.

Biofield oriented

This is an approximate term, since many of the traditional methods speak in terms of field or energy manipulation.

Breema

Breema bodywork is performed on the floor with the recipient fully clothed. It consists of rhythmical and gentle leans and stretches which leads to deep relaxation, increased vitality, and stimulation of the self-healing processes of the body. Sessions can be any length of time, although 50 minutes is common. There are also self-Breema exercises. The essence of Breema is expressed in the Nine Principles of Harmony. The Breema Center is located in Oakland, California, and there are Breema practitioners and instructors in many locations around the world.

Esalen Massage

The basis of Esalen Massage is traditional massage, which works in a very precise manner on the muscle and circulation systems. This is combined with the bodywork approach developed by Charlotte Selver, which emphasizes the deeply relaxing and emotional responses of the body when a conscious, structured and pleasant touch is applied. In addition, gentle rocking of the body, passive joint exercises and deep structural work on the muscles and joints, together with an energetic balancing of the body, are all part of this Esalen Massage “experience”.

MA-URI massage

MA-URI is a new form of massage introduced by Hemi Hoani Fox in 1990, who cites as its roots Hawaiian Lomi-Lomi Nui dance, claiming increased so-called energy flow within the body and mind. Focus is internal, upon breathing, intent, and concentration. Claimed benefits include mental and physical health. Study and advocation is primarily carried out at the MA-URI Institute, headed by Hemi and Katja Fox.

Muscle Energy Technique (MET)

Reciprocal Inhibition (RI) is when the therapist uses a client’s muscle to stretch the opposing muscle. The therapist takes the muscle that they are wishing to stretch to its point of bind. The therapist then gets the client to use the opposing muscle by moving away from the therapist. When the client relaxes the therapist then moves the muscle to realign the muscle fibres therefore stretching the muscle.

As an example, Muscle Energy Technique (MET) Reciprocal Inhibition (RI) can be applied to the calf when the client is lying supine on the treatment couch. The masseur can place one hand on the tibia just below the knee to isolate the knee preventing it from moving. The other hand is placed around the heel so that the masseurs forearm can be used to dorsiflex the foot. This is one of the techniques used by sports massage therapists.

Stone massage

Massage in which hot or cold stones, usually basalt or marble, are used to massage the body. Often the stones are placed on key energy points, such as chakras or meridians, in order to improve energy flow and healing.

Erotic massage

Erotic massage is a form of massage that includes the genitals and leads to sexual arousal and (sometimes) orgasm. It is widely practiced by couples as part of lovemaking, and is practiced commercially, which may be illegal in some jurisdictions. Music, lighting, and erotic attire may supplement the physical actions.

It involves touching the genitals, secondary erogenous zones such as the lips and breasts, and sensitive skin areas such as the thighs.

Veterinary massage

Massage techniques can be a part of exchanging care and emotion with animals. It also has a therapeutic role, as a subset of veterinary physical therapy. although veterinary supervision is urged. [14]

The position of the American Veterinary Medicine Association is
Veterinary massage therapy is a technique in which the person uses only their hands and body to massage soft tissues. Massage therapy on non-human animals should be performed by a licensed veterinarian with education in massage therapy or, where in accordance with the state veterinary practice acts, by a graduate of an accredited massage school who has been educated in non-human animal massage therapy. When performed by a nonveterinarian, massage therapy should be performed under the supervision of, or by referral from, a licensed veterinarian who is providing concurrent care.
Veterinary physical therapy is the use of noninvasive techniques, excluding veterinary chiropractic, for the rehabilitation of injuries in nonhuman animals. Veterinary physical therapy performed by non-veterinarians should be limited to the use of stretching; massage therapy; stimulation by use of a) low-level laser, b) electrical sources, c) magnetic fields, and d) ultrasound; rehabilitative exercises; hydro therapy and applications of heat and cold. Veterinary physical therapy should be performed by a licensed veterinarian or, where in accordance with the state practice acts, by 1) a licensed, certified or registered veterinary or animal health technician educated in veterinary physical therapy or 2) a licensed physical therapist educated in non-human animal anatomy and physiology. Veterinary physical therapy performed by a non-veterinarian should be performed under supervision of, or referral by, a licensed veterinarian who is providing concurrent care.

References

  1. Frederic J. Kottke and Justus F. Liberman (1990), Krusen's Handbook of Physical Medicine and Rehabilitation (Fourth ed.), W.B. Saunders, pp. 433-434
  2. Massage Technique : Strokes and Pressure, Massage Health Therapy
  3. Ernst E (13 Jan 2009 (epub)), "(Abstract) Massage therapy for cancer palliation and supportive care: a systematic review of randomised clinical trials.", Support Care Cancer 17 (4): 333-7.
  4. Marcia M Piotrowski, Cynthia Paterson, Allison Mitchinson, Hyungjin Myra Kim, Marvin Kirsh, Daniel B Hinshaw (2003), "Massage as Adjuvant Therapy in the Management of Acute Postoperative Pain: A Preliminary Study in Men", J Am Coll Surg 197: 1037–1046, DOI:10.1016/S1072-7515(03)00992-X
  5. Yip YB, Tam AC (4 March 2008 (epub)), "(Abstract) An experimental study on the effectiveness of massage with aromatic ginger and orange essential oil for moderate-to-severe knee pain among the elderly in Hong Kong.", Complement Ther Med 16 (3): 131-8
  6. Nerbass FB, Feltrim MI, Souza SA, Ykeda DS, Lorenzi-Filho G. (2010), "(Abstract) Effects of massage therapy on sleep quality after coronary artery bypass graft surgery.", Clinics (Sao Paulo) 65 (11): 1105-10.
  7. Best TM, Hunter R, Wilcox A, Haq F (September 200), "(Abstract) Effectiveness of sports massage for recovery of skeletal muscle from strenuous exercise.", Clin J Sport Med 18 (5): 446-60.
  8. A Robertson, J M Watt, S D R Galloway (2004), "(Abstract) Effects of leg massage on recovery from high intensity cycling exercise", Br J Sports Med 38: 173-176, DOI:10.1136/bjsm.2002.003186
  9. Product Reviews, Erik Dalton.com
  10. Thomas Myers (Jan/Feb 2001), "Body Language… An excursion through the alphabet in somatic terms.", Massage Magazine
  11. About Neuromuscular Therapy, NMT Centers
  12. LH Craig et al. (December 2006), "(Abstract) Controlled pilot study of the effects of neuromuscular therapy in patients with Parkinson's disease", Movement Disorders (no. 12): 2127–2133
  13. Bowtech - The Original Bowen Technique, Bowtech
  14. Michelle J. Rivera, Pedro Luis Rivera, DVM (April 2006), Western/Chinese Herbal Therapy & Massage Therapy, District of Columbia Academy of Veterinary Medicine