Massage therapy

Definition

Massage therapy is the scientific manipulation of the soft tissues of the body for the purpose of normalizing those tissues and consists of manual techniques that include applying fixed or movable pressure, holding, and/or causing movement of or to the body.

Origins

Massage therapy is one of the oldest health care practices known to history. References to massage are found in Chinese medical texts more than 4,000 years old. Massage has been advocated in Western health care practices at least since the time of Hippocrates, the "Father of Medicine." In the fourth century b.c. Hippocrates wrote, "The physician must be acquainted with many things and assuredly with rubbing" (the ancient Greek term for massage was rubbing).

The roots of modern, scientific massage therapy go back to Per Henrik Ling (1776–1839), a Swede, who developed an integrated system consisting of massage and active and passive exercises. Ling established the Royal Central Gymnastic Institute in Sweden in 1813 to teach his methods.

Modern, scientific massage therapy was introduced in the United States in the 1850s by two New York physicians, brothers George and Charles Taylor, who had studied in Sweden. The first clinics for massage therapy in the United States were opened by two Swedish physicians after the Civil War period. Doctor Baron Nils Posse operated the Posse Institute in Boston and Doctor Hartwig Nissen opened the Swedish Health Institute near the Capitol in Washington, D.C.

Although there were periods when massage fell out of favor, in the 1960s it made a comeback in a different way as a tool for relaxation , communication, and alternative healing. Today, massage is one of the most popular healing modalities. It is used by conventional, as well as alternative, medical communities and is now covered by some health insurance plans.

Benefits

Generally, massage is known to affect the circulation of blood and the flow of blood and lymph, reduce muscular tension or flaccidity, affect the nervous system through stimulation or sedation, and enhance tissue healing. These effects provide a number of benefits:

• reduction of muscle tension and stiffness
• relief of muscle spasms
• greater flexibility and range of motion
• increase of the ease and efficiency of movement
• relief of stress and aide of relaxation
• promotion of deeper and easier breathing
• improvement of the circulation of blood and movement of lymph
• relief of tension-related conditions, such as headaches and eyestrain

• promotion of faster healing of soft tissue injuries, such as pulled muscles and sprained ligaments, and reduction in pain and swelling related to such injuries
• reduction in the formation of excessive scar tissue following soft tissue injuries
• enhancement in the health and nourishment of skin
• improvement in posture through changing tension patterns that affect posture
• reduction in stress and an excellent stress management tool
• creation of a feeling of well-being
• reduction in levels of anxiety
• increase in awareness of the mind-body connection
• promotion of a relaxed state of mental awareness

Massage therapy also has a number of documented clinical benefits. For example, massage can reduce anxiety, improve pulmonary function in young asthma patients, reduce psycho-emotional distress in persons suffering from chronic inflammatory bowel disease , increase weight and improve motor development in premature infants, and may enhance immune system functioning. Some medical conditions that massage therapy can help are: allergies , anxiety and stress, arthritis, asthma and bronchitis, carpal tunnel syndrome and other repetitive motion injuries, chronic and temporary pain, circulatory problems, depression , digestive disorders, tension headache, insomnia , myofascial pain, sports injuries, and temporomandibular joint dysfunction.

Description

Massage therapy is the scientific manipulation of the soft tissues of the body for the purpose of normalizing those tissues and consists of a group of manual techniques that include applying fixed or movable pressure, holding, and/or causing movement of or to the body. While massage therapy is applied primarily with the hands, sometimes the forearms or elbows are used. These techniques affect the muscular, skeletal, circulatory, lymphatic, nervous, and other systems of the body. The basic philosophy of massage therapy embraces the concept of vis Medicatrix naturae, which is aiding the ability of the body to heal itself, and is aimed at achieving or increasing health and well-being.

Touch is the fundamental medium of massage therapy. While massage can be described in terms of the type of techniques performed, touch is not used solely in a mechanistic way in massage therapy. One could look at a diagram or photo of a massage technique that depicts where to place one's hands and what direction the stroke should go, but this would not convey everything that is important for giving a good massage. Massage also has an artistic component.

Because massage usually involves applying touch with some degree of pressure and movement, the massage therapist must use touch with sensitivity in order to determine the optimal amount of pressure to use for each person. For example, using too much pressure may cause the body to tense up, while using too little may not have enough effect. Touch used with sensitivity also allows the massage therapist to receive useful information via his or her hands about the client's body, such as locating areas of muscle tension and other soft tissue problems. Because touch is also a form of communication, sensitive touch can convey a sense of caring—an essential element in the therapeutic relationship—to the person receiving massage.

In practice, many massage therapists use more than one technique or method in their work and sometimes

combine several. Effective massage therapists ascertain each person's needs and then use the techniques that will meet those needs best.

Swedish massage uses a system of long gliding strokes, kneading, and friction techniques on the more superficial layers of muscles, generally in the direction of blood flow toward the heart, and sometimes combined with active and passive movements of the joints. It is used to promote general relaxation, improve circulation and range of motion, and relieve muscle tension. Swedish massage is the most commonly used form of massage.

Deep tissue massage is used to release chronic patterns of muscular tension using slow strokes, direct pressure, or friction directed across the grain of the muscles. It is applied with greater pressure and to deeper layers of muscle than Swedish, which is why it is called deep tissue and is effective for chronic muscular tension.

Sports massage uses techniques that are similar to Swedish and deep tissue, but are specially adapted to deal with the effects of athletic performance on the body and the needs of athletes regarding training, performing, and recovery from injury.

Neuromuscular massage is a form of deep massage that is applied to individual muscles. It is used primarily to release trigger points (intense knots of muscle tension that refer pain to other parts of the body), and also to increase blood flow. It is often used to reduce pain. Trigger point massage and myotherapy are similar forms.

Acupressure applies finger or thumb pressure to specific points located on the acupuncture meridians (channels of energy flow identified in Asian concepts of anatomy) in order to release blocked energy along these meridians that causes physical discomforts, and re-balance the energy flow. Shiatsu is a Japanese form of acupressure.

The cost of massage therapy varies according to geographic location, experience of the massage therapist, and length of the massage. In the United States, the average range is from $35-60 for a one hour session. Massage therapy sessions at a client's home or office may cost more due to travel time for the massage therapist. Most sessions are one hour. Frequency of massage sessions can vary widely. If a person is receiving massage for a specific problem, frequency can vary widely based on the condition, though it usually will be once a week. Some people incorporate massage into their regular personal health and fitness program. They will go for massage on a regular basis, varying from once a week to once a month.

The first appointment generally begins with information gathering, such as the reason for getting massage therapy, physical condition and medical history, and other areas. The client is asked to remove clothing to one's level of comfort. Undressing takes place in private, and a sheet or towel is provided for draping. The massage therapist will undrape only the part of the body being massaged. The client's modesty is respected at all times. The massage therapist may use an oil or cream, which will be absorbed into the skin in a short time.

To receive the most benefit from a massage, generally the person being massaged should give the therapist accurate health information, report discomfort of any kind (whether it's from the massage itself or due to the room temperature or any other distractions), and be as receptive and open to the process as possible.

Insurance coverage for massage therapy varies widely. There tends to be greater coverage in states that license massage therapy. In most cases, a physician's prescription for massage therapy is needed. Once massage therapy is prescribed, authorization from the insurer may be needed if coverage is not clearly spelled out in one's policy or plan.

Preparations

Going for a massage requires little in the way of preparation. Generally, one should be clean and should not eat just before a massage. One should not be under the influence of alcohol or non-medicinal drugs. Massage therapists generally work by appointment and usually will provide information about how to prepare for an appointment at the time of making the appointment.

Precautions

Massage is comparatively safe; however it is generally contraindicated, i.e., it should not be used, if a person has one of the following conditions: advanced heart diseases, hypertension (high blood pressure), phlebitis , thrombosis, embolism, kidney failure, cancer if massage would accelerate metastasis (i.e., spread a tumor) or damage tissue that is fragile due to chemotherapy or other treatment, infectious diseases, contagious skin conditions, acute inflammation, infected injuries, unhealed fractures , dislocations, frostbite, large hernias, torn ligaments, conditions prone to hemorrhage, and psychosis.

Massage should not be used locally on affected areas (i.e., avoid using massage on the specific areas of the body that are affected by the condition) for the following conditions: rheumatoid arthritis flare up, eczema , goiter, and open skin lesions. Massage may be used on the areas of the body that are not affected by these conditions.

In some cases, precautions should be taken before using massage for the following conditions: pregnancy , high fevers, osteoporosis , diabetes, recent postoperative cases in which pain and muscular splinting (i.e., tightening as a protective reaction) would be increased, apprehension, and mental conditions that may impair communication or perception. In such cases, massage may or may not be appropriate. The decision on whether to use massage must be based on whether it may cause harm. For example, if someone has osteoporosis, the concern is whether bones are strong enough to withstand the pressure applied. If one has a health condition and has any hesitation about whether massage therapy would be appropriate, a physician should be consulted.

Side effects

Massage therapy does not have side effects. Sometimes people are concerned that massage may leave them too relaxed or too mentally unfocused. To the contrary, massage tends to leave people feeling more relaxed and alert.

Research & general acceptance

Before 1939, more than 600 research studies on massage appeared in the main journals of medicine in English. However, the pace of research was slowed by medicine's disinterest in massage therapy.

Massage therapy research picked up again in the 1980s, as the growing popularity of massage paralleled the growing interest in complementary and alternative medicine. Well designed studies have documented the benefits of massage therapy for the treatment of acute and chronic pain, acute and chronic inflammation, chronic lymphedema, nausea , muscle spasm, various soft tissue dysfunctions, anxiety, depression, insomnia, and psycho-emotional stress, which may aggravate mental illness.

Premature infants treated with daily massage therapy gain more weight and have shorter hospital stays than infants who are not massaged. A study of 40 low-birth-weight babies found that the 20 massaged babies had a 47% greater weight gain per day and stayed in the hospital an average of six days less than 20 infants who did not receive massage, resulting a cost savings of approximately $3,000 per infant. Cocaine-exposed, preterm infants given massage three times daily for a 10 day period showed significant improvement. Results indicated that massaged infants had fewer postnatal complications and exhibited fewer stress behaviors during the 10 day period, had a 28% greater daily weight gain, and demonstrated more mature motor behaviors.

A study comparing 52 hospitalized depressed and adjustment disorder children and adolescents with a control group that viewed relaxation videotapes, found massage therapy subjects were less depressed and anxious, and had lower saliva cortisol levels (an indicator of less depression).

Another study showed massage therapy produced relaxation in 18 elderly subjects, demonstrated in measures such as decreased blood pressure and heart rate and increased skin temperature.

A combination of massage techniques for 52 subjects with traumatically induced spinal pain led to significant improvements in acute and chronic pain and increased muscle flexibility and tone. This study also found massage therapy to be extremely cost effective, with cost savings ranging from 15-50%. Massage has also been shown to stimulate the body's ability to naturally control pain by stimulating the brain to produce endorphins. Fibromyalgia is an example of a condition that may be favorably affected by this effect.

A pilot study of five subjects with symptoms of tension and anxiety found a significant response to massage therapy in one or more psycho-physiological parameters of heart rate, frontalis and forearm extensor electromyograms (EMGs) and skin resistance, which demonstrate relaxation of muscle tension and reduced anxiety.

Lymph drainage massage has been shown to be more effective than mechanized methods or diuretic drugs to control lymphedema secondary to radical mastectomy, consequently using massage to control lymphedema would significantly lower treatment costs. A study found that massage therapy can have a powerful effect upon psycho-emotional distress in persons suffering from chronic inflammatory bowel disease. Massage therapy was effective in reducing the frequency of episodes of pain and disability in these patients.

Massage may enhance the immune system. A study suggests an increase in cytotoxic capacity associated with massage. A study of chronic fatigue syndrome subjects found that a group receiving massage therapy had lower depression, emotional distress, and somatic symptom scores, more hours of sleep, and lower epinephrine and cortisol levels than a control group.

Training & certification

The generally accepted standard for training is a minimum of 500 classroom hours. Training should include anatomy, physiology, pathology, massage theory and technique, and supervised practice. Most massage therapists also take additional courses and workshops during their careers.

In the United States, massage therapists are currently licensed by 29 states, the District of Columbia, and a number of localities. Most states require 500 or more classroom hours of training from a recognized training program and passing an examination.

A national certification program was inaugurated in June 1992 by the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB). The NCBTMB program is accredited by the National Commission for Certifying Agencies, the chief outside agency for evaluating certification programs. Those certified can use the title Nationally Certified in Therapeutic Massage and Bodywork (NCTMB). Most states use the NCBTMB exam for their licensing exams.

A national accreditation agency, the Commission on Massage Therapy Accreditation, designed according to the guidelines of the U.S. Department of Education, currently recognizes about 70 training programs. The Accrediting Commission of Career Schools and Colleges of Technology and the Accrediting Council for Continuing Education and Training also accredit massage training programs.

Resources

BOOKS

Beck, Mark F. Milady's Theory and Practice of Therapeutic Massage. Milady Publishing, 1994.

Capellini, Steve. Massage Therapy Career Guide for Hands-On Success. Milady Publishing, 1998.

Downing, George. The Massage Book. New York: Random House, 1998.

Loving, Jean E. Massage Therapy: Theory and Practice. Appleton & Lange, 1998.

PERIODICALS

Field, T., W. Sunshine, M. Hernandez-Reif, and O. Quintino. "Chronic fatigue syndrome: massage therapy effects on depression and somatic symptoms in chronic fatigue syndrome." J Chronic Fatigue Syndrome (1997):43-51.

Ironson, G., T. Field, F. Scafidi, and M. Hashimoto. "Massage therapy is associated with enhancement of the immune system's cytotoxic capacity." Int J Neuroscience (February 1996):205-217.

Joachim, G. "The effects of two stress management techniques on feelings of well-being in patients with inflammatory bowel disease." Nursing Papers (1983):4, 5-18.

Kaarda, B., and O. Tosteinbo. "Increase of plasma beta-endorphins in connective tissue massage." Gen pharmacology (1989): 487-489. Scafidi, F., T. Field, A. Wheeden, S. Schanberg, C. Kuhn, R.

Symanski, E. Zimmerman, and E.S. Bandstra. "Cocaine exposed preterm neonates show behavioral and hormonal differences." Pediatrics (June 1996):851-855.

Weintraub, M. "Shiatsu, Swedish muscle massage, and trigger point suppression in spinal pain syndrome." Am Massage Therapy J Summer 1992; 31:3; 99-1 09.

ORGANIZATIONS

American Massage Therapy Association. www.amtamassage.org.

Elliot Greene

Massage Therapy

Definition

Massage therapy is the scientific manipulation of the soft tissues of the body for the purpose of normalizing those tissues and consists of manual techniques that include applying fixed or movable pressure, holding, and/or causing movement of or to the body.

Origins

Massage therapy is one of the oldest health care practices known to history. References to massage are found in Chinese medical texts more than 4,000 years old. Massage has been advocated in Western health care practices at least since the time of Hippocrates, the “Father of Medicine.” In the fourth century B.C. Hippocrates wrote, “The physician must be acquainted with many things and assuredly with rubbing” (the ancient Greek term for massage was rubbing).

The roots of modern, scientific massage therapy go back to Per Henrik Ling (1776–1839), a Swede, who developed an integrated system consisting of massage and active and passive exercises. Ling established the Royal Central Gymnastic Institute in Sweden in 1813 to teach his methods.

Modern, scientific massage therapy was introduced in the United States in the 1850s by two New York physicians, brothers George and Charles Taylor, who had studied in Sweden. The first clinics for massage therapy in the United States were opened by two Swedish physicians after the Civil War period. Doctor Baron Nils Posse operated the Posse Institute in Boston and Doctor Hartwig Nissen opened the Swedish Health Institute near the Capitol in Washington, D.C.

Although there were periods when massage fell out of favor, in the 1960s it made a comeback in a different way as a tool for relaxation , communication, and alternative healing. Today, massage is one of the most popular healing modalities. It is used by conventional, as well as alternative, medical communities and is now covered by some health insurance plans.

Benefits

Generally, massage is known to affect the circulation of blood and the flow of blood and lymph, reduce muscular tension or flaccidity, affect the nervous system through stimulation or sedation, and enhance tissue healing. These effects provide a number of benefits:

• reduction of muscle tension and stiffness l relief of muscle spasms
• greater flexibility and range of motion
• increase of the ease and efficiency of movement
• relief of stress and aide of relaxation
• promotion of deeper and easier breathing
• improvement of the circulation of blood and movement of lymph
• relief of tension-related conditions, such as headaches and eyestrain
• promotion of faster healing of soft tissue injuries, such as pulled muscles and sprained ligaments, and reduction in pain and swelling related to such injuries
• reduction in the formation of excessive scar tissue following soft tissue injuries
• enhancement in the health and nourishment of skin
• improvement in posture through changing tension patterns that affect posture
• reduction in stress and an excellent stress management tool
• creation of a feeling of well-being
• reduction in levels of anxiety
• increase in awareness of the mind-body connection
• promotion of a relaxed state of mental awareness

Massage therapy also has a number of documented clinical benefits. For example, massage can reduce anxiety , improve pulmonary function in young asthma patients, reduce psycho-emotional distress in persons suffering from chronic inflammatory bowel disease, increase weight and improve motor development in premature infants, and may enhance immune system functioning. Some medical conditions that massage therapy can help are: allergies , anxiety and stress , arthritis, asthma and bronchitis , carpal tunnel syndrome and other repetitive motion injuries, chronic and temporary pain, circulatory problems, depression , digestive disorders, tension headache, insomnia , myofascial pain, sports injuries, and temporomandibular joint dysfunction.

Description

Massage therapy is the scientific manipulation of the soft tissues of the body for the purpose of normalizing those tissues and consists of a group of manual techniques that include applying fixed or movable pressure, holding, and/or causing movement of or to the body. While massage therapy is applied primarily with the hands, sometimes the forearms or elbows are used. These techniques affect the muscular, skeletal, circulatory, lymphatic, nervous, and other systems of the body. The basic philosophy of massage therapy embraces the concept of vis Medicatrix naturae, which is aiding the ability of the body to heal itself, and is aimed at achieving or increasing health and well-being.

Touch is the fundamental medium of massage therapy. While massage can be described in terms of the type of techniques performed, touch is not used solely in a mechanistic way in massage therapy. One could look at a diagram or photo of a massage technique that depicts where to place one's hands and what direction the stroke should go, but this would not convey everything that is important for giving a good massage. Massage also has an artistic component.

Because massage usually involves applying touch with some degree of pressure and movement, the massage therapist must use touch with sensitivity in order to determine the optimal amount of pressure to use for each person. For example, using too much pressure may cause the body to tense up, while using too little may not have enough effect. Touch used with sensitivity also allows the massage therapist to receive useful information via his or her hands about the client's body, such as locating areas of muscle tension and other soft tissue problems. Because touch is also a form of communication, sensitive touch can convey a sense of caring—an essential element in the therapeutic relationship—to the person receiving massage.

In practice, many massage therapists use more than one technique or method in their work and sometimes combine several. Effective massage therapists ascertain each person's needs and then use the techniques that will meet those needs best.

Swedish massage uses a system of long gliding strokes, kneading, and friction techniques on the more superficial layers of muscles, generally in the direction of blood flow toward the heart, and sometimes combined with active and passive movements of the joints. It is used to promote general relaxation, improve circulation and range of motion, and relieve muscle tension. Swedish massage is the most commonly used form of massage.

Deep tissue massage is used to release chronic patterns of muscular tension using slow strokes, direct pressure, or friction directed across the grain of the muscles. It is applied with greater pressure and to deeper layers of muscle than Swedish, which is why it is called deep tissue and is effective for chronic muscular tension.

Sports massage uses techniques that are similar to Swedish and deep tissue, but are specially adapted to deal with the effects of athletic performance on the body and the needs of athletes regarding training, performing, and recovery from injury.

Neuromuscular massage is a form of deep massage that is applied to individual muscles. It is used primarily to release trigger points (intense knots of muscle tension that refer pain to other parts of the body), and also to increase blood flow. It is often used to reduce pain. Trigger point massage and myotherapy are similar forms.

Acupressure applies finger or thumb pressure to specific points located on the acupuncture meridians (channels of energy flow identified in Asian concepts of anatomy) in order to release blocked energy along these meridians that causes physical discomforts, and re-balance the energy flow. Shiatsu is a Japanese form of acupressure.

The cost of massage therapy varies according to geographic location, experience of the massage therapist, and length of the massage. In the United States, the average range is from $35–60 for a one hour session. Massage therapy sessions at a client's home or office may cost more due to travel time for the massage therapist. Most sessions are one hour. Frequency of massage sessions can vary widely. If a person is receiving massage for a specific problem, frequency can vary widely based on the condition, though it usually will be once a week. Some people incorporate massage into their regular personal health and fitness program. They will go for massage on a regular basis, varying from once a week to once a month.

The first appointment generally begins with information gathering, such as the reason for getting massage therapy, physical condition and medical history, and other areas. The client is asked to remove clothing to one's level of comfort. Undressing takes place in private, and a sheet or towel is provided for draping. The massage therapist will undrape only the part of the body being massaged. The client's modesty is respected at all times. The massage therapist may use an oil or cream, which will be absorbed into the skin in a short time.

To receive the most benefit from a massage, generally the person being massaged should give the therapist accurate health information, report discomfort of any kind (whether it's from the massage itself or due to the room temperature or any other distractions), and be as receptive and open to the process as possible.

Insurance coverage for massage therapy varies widely. There tends to be greater coverage in states that license massage therapy. In most cases, a physician's prescription for massage therapy is needed. Once massage therapy is prescribed, authorization from the insurer may be needed if coverage is not clearly spelled out in one's policy or plan.

Preparations

Going for a massage requires little in the way of preparation. Generally, one should be clean and should not eat just before a massage. One should not be under the influence of alcohol or non-medicinal drugs. Massage therapists generally work by appointment and usually will provide information about how to prepare for an appointment at the time of making the appointment.

Precautions

Massage is comparatively safe; however it is generally contraindicated, i.e., it should not be used, if a person has one of the following conditions: advanced heart diseases, hypertension (high blood pressure ), phlebitis, thrombosis, embolism, kidney failure, cancer if massage would accelerate metastasis (i.e., spread a tumor) or damage tissue that is fragile due to chemotherapy or other treatment, infectious diseases , contagious skin conditions, acute inflammation, infected injuries, unhealed fractures, dislocations , frostbite, large hernias, torn ligaments, conditions prone to hemorrhage, and psychosis.

Massage should not be used locally on affected areas (i.e., avoid using massage on the specific areas of the body that are affected by the condition) for the following conditions: rheumatoid arthritis flare up, eczema, goiter, and open skin lesions . Massage may be used on the areas of the body that are not affected by these conditions.

In some cases, precautions should be taken before using massage for the following conditions: pregnancy, high fevers, osteoporosis , diabetes, recent postoperative cases in which pain and muscular splinting (i.e., tightening as a protective reaction) would be increased, apprehension, and mental conditions that may impair communication or perception. In such cases, massage may or may not be appropriate. The decision on whether to use massage must be based on whether it may cause harm. For example, if someone has osteoporosis, the concern is whether bones are strong enough to withstand the pressure applied. If one has a health condition and has any hesitation about whether massage therapy would be appropriate, a physician should be consulted.

Side effects

Massage therapy does not have side effects. Sometimes people are concerned that massage may leave them too relaxed or too mentally unfocused. To the contrary, massage tends to leave people feeling more relaxed and alert.

Research & general acceptance

Before 1939, more than 600 research studies on massage appeared in the main journals of medicine in English. However, the pace of research was slowed by medicine's disinterest in massage therapy.

Massage therapy research picked up again in the 1980s, as the growing popularity of massage paralleled the growing interest in complementary and alternative medicine. Well designed studies have documented the benefits of massage therapy for the treatment of acute and chronic pain, acute and chronic inflammation, chronic lymphedema , nausea, muscle spasm, various soft tissue dysfunctions, anxiety, depression, insomnia, and psycho-emotional stress, which may aggravate mental illness.

Premature infants treated with daily massage therapy gain more weight and have shorter hospital stays than infants who are not massaged. A study of 40 low-birth-weight babies found that the 20 massaged babies had a 47% greater weight gain per day and stayed in the hospital an average of six days less than 20 infants who did not receive massage, resulting a cost savings of approximately $3,000 per infant. Cocaine-exposed, preterm infants given massage three times daily for a 10 day period showed significant improvement. Results indicated that massaged infants had fewer postnatal complications and exhibited fewer stress behaviors during the 10 day period, had a 28% greater daily weight gain, and demonstrated more mature motor behaviors.

A study comparing 52 hospitalized depressed and adjustment disorder children and adolescents with a control group that viewed relaxation videotapes, found massage therapy subjects were less depressed and anxious, and had lower saliva cortisol levels (an indicator of less depression).

Another study showed massage therapy produced relaxation in 18 elderly subjects, demonstrated in measures such as decreased blood pressure and heart rate and increased skin temperature.

A combination of massage techniques for 52 subjects with traumatically induced spinal pain led to significant improvements in acute and chronic pain and increased muscle flexibility and tone. This study also found massage therapy to be extremely cost effective, with cost savings ranging from 15–50%. Massage has also been shown to stimulate the body's ability to naturally control pain by stimulating the brain to produce endorphins. Fibromyalgia is an example of a condition that may be favorably affected by this effect.

A pilot study of five subjects with symptoms of tension and anxiety found a significant response to massage therapy in one or more psycho-physiological parameters of heart rate, frontalis and forearm extensor electromyograms (EMGs) and skin resistance, which demonstrate relaxation of muscle tension and reduced anxiety.

Lymph drainage massage has been shown to be more effective than mechanized methods or diuretic drugs to control lymphedema secondary to radical mastectomy , consequently using massage to control lymphedema would significantly lower treatment costs. A study found that massage therapy can have a powerful effect upon psycho-emotional distress in persons suffering from chronic inflammatory bowel disease. Massage therapywas effective in reducing the frequency of episodes of pain and disability in these patients.

Massage may enhance the immune system. A study suggests an increase in cytotoxic capacity associated with massage. A study of chronic fatigue syndrome subjects found that a group receiving massage therapy had lower depression, emotional distress, and somatic symptom scores, more hours of sleep, and lower epinephrine and cortisol levels than a control group.

Training & certification

The generally accepted standard for training is a minimum of 500 classroom hours. Training should include anatomy, physiology, pathology, massage theory and technique, and supervised practice. Most massage therapists also take additional courses and workshops during their careers.

In the United States, massage therapists are currently licensed by 29 states, the District of Columbia, and a number of localities. Most states require 500 or more classroom hours of training from a recognized training program and passing an examination.

A national certification program was inaugurated in June 1992 by the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB). The NCBTMB program is accredited by the National Commission for Certifying Agencies, the chief outside agency for evaluating certification programs. Those certified can use the title Nationally Certified in Therapeutic Massage and Bodywork (NCTMB). Most states use the NCBTMB exam for their licensing exams.

A national accreditation agency, the Commission on Massage Therapy Accreditation, designed according to the guidelines of the U.S. Department of Education, currently recognizes about 70 training programs. The Accrediting Commission of Career Schools and Colleges of Technology and the Accrediting Council for Continuing Education and Training also accredit massage training programs.

Resources

BOOKS

Beck, Mark F. Milady's Theory and Practice of Therapeutic Massage. Milady Publishing, 1994.

Capellini, Steve. Massage Therapy Career Guide for Hands On Success. Milady Publishing, 1998.

Downing, George. The Massage Book. New York: Random House, 1998.

Loving, Jean E. Massage Therapy: Theory and Practice. Appleton & Lange, 1998.

PERIODICALS

Field, T., W. Sunshine, M. Hernandez-Reif, and O. Quintino. “Chronic fatigue syndrome: massage therapy effects on depression and somatic symptoms in chronic fatigue syndrome.” J Chronic Fatigue Syndrome (1997): 43–51.

Ironson, G., T. Field, F. Scafidi, and M. Hashimoto. “Massage therapy is associated with enhancement of the immune system's cytotoxic capacity.” Int J Neuroscience (February 1996):205–217.

Joachim, G. “The effects of two stress management techniques on feelings of well-being in patients with inflammatory bowel disease.” Nursing Papers (1983):4, 5–18.

Kaarda, B., and O. Tosteinbo. “Increase of plasma beta-endorphins in connective tissue massage.” Gen pharmacology (1989): 487–489.

Scafidi, F., T. Field, A. Wheeden, S. Schanberg, C. Kuhn, R.Symanski, E. Zimmerman, and E.S. Bandstra. “Cocaine exposed preterm neonates show behavioral and hormonal differences.” Pediatrics (June 1996): 851–855.

Weintraub, M. “Shiatsu, Swedish muscle massage, and trigger point suppression in spinal pain syndrome.” Am Massage Therapy J Summer 1992; 31:3; 99–1 09.

ORGANIZATIONS

American Massage Therapy Association. www.amta-massage.org.

Elliot Greene

Massage therapy

Definition

Massage therapy is the scientific manipulation of the soft tissues of the body for the purpose of normalizing those tissues and consists of manual techniques that include applying fixed or movable pressure, holding, and/or causing movement of or to the body.

Origins

Massage therapy is one of the oldest health care practices known to history. References to massage are found in Chinese medical texts more than 4,000 years old. Massage has been advocated in Western health care practices at least since the time of Hippocrates, the "Father of Medicine." In the fourth century b.c. Hippocrates wrote, "The physician must be acquainted with many things and assuredly with rubbing" (the ancient Greek term for massage was rubbing).

The roots of modern, scientific massage therapy go back to Per Henrik Ling (1776– 1839), a Swede, who developed an integrated system consisting of massage and active and passive exercises. Ling established the Royal Central Gymnastic Institute in Sweden in 1813 to teach his methods.

Modern, scientific massage therapy was introduced in the United States in the 1850s by two New York physicians, brothers George and Charles Taylor, who had studied in Sweden. The first clinics for massage therapy in the United States were opened by two Swedish physicians after the Civil War period. Doctor Baron Nils Posse operated the Posse Institute in Boston and Doctor Hartwig Nissen opened the Swedish Health Institute near the Capitol in Washington, D.C.

Although there were periods when massage fell out of favor, in the 1960s it made a comeback in a different way as a tool for relaxation , communication, and alternative healing. Today, massage is one of the most popular healing modalities. It is used by conventional, as well as alternative, medical communities and is now covered by some health insurance plans.

Benefits

Generally, massage is known to affect the circulation of blood and the flow of blood and lymph, reduce muscular tension or flaccidity, affect the nervous system through stimulation or sedation, and enhance tissue healing. These effects provide a number of benefits:

• reduction of muscle tension and stiffness
• relief of muscle spasms
• greater flexibility and range of motion
• increase of the ease and efficiency of movement
• relief of stress and aide of relaxation
• promotion of deeper and easier breathing
• improvement of the circulation of blood and movement of lymph
• relief of tension-related conditions, such as headaches and eyestrain
• promotion of faster healing of soft tissue injuries, such as pulled muscles and sprained ligaments, and reduction in pain and swelling related to such injuries
• reduction in the formation of excessive scar tissue following soft tissue injuries
• enhancement in the health and nourishment of skin
• improvement in posture through changing tension patterns that affect posture
• reduction in stress and an excellent stress management tool
• creation of a feeling of well-being
• reduction in levels of anxiety
• increase in awareness of the mind-body connection
• promotion of a relaxed state of mental awareness

Massage therapy also has a number of documented clinical benefits. For example, massage can reduce anxiety, improve pulmonary function in young asthma patients, reduce psycho-emotional distress in persons suffering from chronic inflammatory bowel disease, increase weight and improve motor development in premature infants , and may enhance immune system functioning. Some medical conditions that massage therapy can help are: allergies , anxiety and stress, arthritis, asthma and bronchitis, carpal tunnel syndrome and other repetitive motion injuries, chronic and temporary pain, circulatory problems, depression, digestive disorders, tension headache , insomnia, myofascial pain, sports injuries , and temporomandibular joint dysfunction.

Description

Massage therapy is the scientific manipulation of the soft tissues of the body for the purpose of normalizing those tissues and consists of a group of manual techniques that include applying fixed or movable pressure, holding, and/or causing movement of or to the body. While massage therapy is applied primarily with the hands, sometimes the forearms or elbows are used. These techniques affect the muscular, skeletal, circulatory, lymphatic, nervous, and other systems of the body. The basic philosophy of massage therapy embraces the concept of vis Medicatrix naturae, which is aiding the ability of the body to heal itself, and is aimed at achieving or increasing health and well-being.

Touch is the fundamental medium of massage therapy. While massage can be described in terms of the type of techniques performed, touch is not used solely in a mechanistic way in massage therapy. One could look at a diagram or photo of a massage technique that depicts where to place one's hands and what direction the stroke should go, but this would not convey everything that is important for giving a good massage. Massage also has an artistic component.

Because massage usually involves applying touch with some degree of pressure and movement, the massage therapist must use touch with sensitivity in order to determine the optimal amount of pressure to use for each person. For example, using too much pressure may cause the body to tense up, while using too little may not have enough effect. Touch used with sensitivity also allows the massage therapist to receive useful information via his or her hands about the client's body, such as locating areas of muscle tension and other soft tissue problems. Because touch is also a form of communication, sensitive touch can convey a sense of caring—an essential element in the therapeutic relationship—to the person receiving massage.

In practice, many massage therapists use more than one technique or method in their work and sometimes combine several. Effective massage therapists ascertain each person's needs and then use the techniques that will meet those needs best.

Swedish massage uses a system of long gliding strokes, kneading, and friction techniques on the more superficial layers of muscles, generally in the direction of blood flow toward the heart , and sometimes combined with active and passive movements of the joints. It is used to promote general relaxation, improve circulation and range of motion, and relieve muscle tension. Swedish massage is the most commonly used form of massage.

Deep tissue massage is used to release chronic patterns of muscular tension using slow strokes, direct pressure, or friction directed across the grain of the muscles. It is applied with greater pressure and to deeper layers of muscle than Swedish, which is why it is called deep tissue and is effective for chronic muscular tension.

Sports massage uses techniques that are similar to Swedish and deep tissue, but are specially adapted to deal with the effects of athletic performance on the body and

the needs of athletes regarding training, performing, and recovery from injury.

Neuromuscular massage is a form of deep massage that is applied to individual muscles. It is used primarily to release trigger points (intense knots of muscle tension that refer pain to other parts of the body), and also to increase blood flow. It is often used to reduce pain. Trigger point massage and myotherapy are similar forms.

Acupressure applies finger or thumb pressure to specific points located on the acupuncture meridians (channels of energy flow identified in Asian concepts of anatomy) in order to release blocked energy along these meridians that causes physical discomforts, and re-balance the energy flow. Shiatsu is a Japanese form of acupressure.

The cost of massage therapy varies according to geographic location, experience of the massage therapist, and length of the massage. In the United States, the average range is from $35–60 for a one hour session. Massage therapy sessions at a client's home or office may cost more due to travel time for the massage therapist. Most sessions are one hour. Frequency of massage sessions can vary widely. If a person is receiving massage for a specific problem, frequency can vary widely based on the condition, though it usually will be once a week. Some people incorporate massage into their regular personal health and fitness program. They will go for massage on a regular basis, varying from once a week to once a month.

The first appointment generally begins with information gathering, such as the reason for getting massage therapy, physical condition and medical history, and other areas. The client is asked to remove clothing to one's level of comfort. Undressing takes place in private, and a sheet or towel is provided for draping. The massage therapist will undrape only the part of the body being massaged. The client's modesty is respected at all times. The massage therapist may use an oil or cream, which will be absorbed into the skin in a short time.

To receive the most benefit from a massage, generally the person being massaged should give the therapist accurate health information, report discomfort of any kind (whether it's from the massage itself or due to the room temperature or any other distractions), and be as receptive and open to the process as possible.

Insurance coverage for massage therapy varies widely. There tends to be greater coverage in states that license massage therapy. In most cases, a physician's prescription for massage therapy is needed. Once massage therapy is prescribed, authorization from the insurer may be needed if coverage is not clearly spelled out in one's policy or plan.

Preparations

Going for a massage requires little in the way of preparation. Generally, one should be clean and should not eat just before a massage. One should not be under the influence of alcohol or non-medicinal drugs. Massage therapists generally work by appointment and usually will provide information about how to prepare for an appointment at the time of making the appointment.

Precautions

Massage is comparatively safe. However, it is generally contraindicated, i.e., it should not be used if a person has one of the following conditions: advanced heart diseases, hypertension (high blood pressure ), phlebitis, thrombosis, embolism, kidney failure, cancer if massage would accelerate metastasis (i.e., spread a tumor) or damage tissue that is fragile due to chemotherapy or other treatment, infectious diseases, contagious skin conditions, acute inflammation, infected injuries, unhealed fractures , dislocations, frostbite, large hernias, torn ligaments, conditions prone to hemorrhage, and psychosis.

Massage should not be used locally on affected areas for the following conditions: rheumatoid arthritis flare up, eczema, goiter, and open skin lesions. Massage may be used on the areas of the body that are not affected by these conditions.

In some cases, precautions should be taken before using massage for the following conditions: pregnancy , high fevers, osteoporosis , diabetes, recent postoperative cases in which pain and muscular splinting (i.e., tightening as a protective reaction) would be increased, apprehension, and mental conditions that may impair communication or perception. In such cases, massage may or may not be appropriate. The decision on whether to use massage must be based on whether it may cause harm. For example, if someone has osteoporosis, the concern is whether bones are strong enough to withstand the pressure applied. If one has a health condition and has any hesitation about whether massage therapy would be appropriate, a physician should be consulted.

Side effects

Massage therapy does not have side effects. Sometimes people are concerned that massage may leave them too relaxed or too mentally unfocused. To the contrary, massage tends to leave people feeling more relaxed and alert.

Research and general acceptance

Before 1939, more than 600 research studies on massage appeared in the main journals of medicine in English. However, the pace of research was slowed by medicine's disinterest in massage therapy.

Massage therapy research picked up again in the 1980s, as the growing popularity of massage paralleled the growing interest in complementary and alternative medicine. Well designed studies have documented the benefits of massage therapy for the treatment of acute and chronic pain, acute and chronic inflammation, chronic lymphedema, nausea, muscle spasm, various soft tissue dysfunctions, anxiety, depression, insomnia, and psycho-emotional stress, which may aggravate mental illness.

Premature infants treated with daily massage therapy gain more weight and have shorter hospital stays than infants who are not massaged. A study of 40 low-birth-weight babies found that the 20 massaged babies had a 47% greater weight gain per day and stayed in the hospital an average of six days less than 20 infants who did not receive massage, resulting a cost savings of approximately $3,000 per infant. Cocaine-exposed, preterm infants given massage three times daily for a 10 day period showed significant improvement. Results indicated that massaged infants had fewer postnatal complications and exhibited fewer stress behaviors during the 10 day period, had a 28% greater daily weight gain, and demonstrated more mature motor behaviors.

A study comparing 52 hospitalized depressed and adjustment disorder children and adolescents with a control group that viewed relaxation videotapes, found massage therapy subjects were less depressed and anxious, and had lower saliva cortisol levels (an indicator of less depression).

Another study showed massage therapy produced relaxation in 18 elderly subjects, demonstrated in measures such as decreased blood pressure and heart rate and increased skin temperature.

A combination of massage techniques for 52 subjects with traumatically induced spinal pain led to significant improvements in acute and chronic pain and increased muscle flexibility and tone. This study also found massage therapy to be extremely cost effective, with cost savings ranging from 15–50%. Massage has also been shown to stimulate the body's ability to naturally control pain by stimulating the brain to produce endorphins. Fibromyalgia is an example of a condition that may be favorably affected by this effect.

A pilot study of five subjects with symptoms of tension and anxiety found a significant response to massage therapy in one or more psycho-physiological parameters of heart rate, frontalis and forearm extensor electromyograms (EMGs) and skin resistance, which demonstrate relaxation of muscle tension and reduced anxiety.

Lymph drainage massage has been shown to be more effective than mechanized methods or diuretic drugs to control lymphedema secondary to radical mastectomy, consequently using massage to control lymphedema would significantly lower treatment costs. A study found that massage therapy can have a powerful effect upon psycho-emotional distress in persons suffering from chronic inflammatory bowel disease. Massage therapy was effective in reducing the frequency of episodes of pain and disability in these patients.

Massage may enhance the immune system. A study suggests an increase in cytotoxic capacity associated with massage. A study of chronic fatigue syndrome subjects found that a group receiving massage therapy had lower depression, emotional distress, and somatic symptom scores, more hours of sleep, and lower epinephrine and cortisol levels than a control group.

Training and certification

The generally accepted standard for training is a minimum of 500 classroom hours. Training should include anatomy, physiology, pathology, massage theory and technique, and supervised practice. Most massage therapists also take additional courses and workshops during their careers.

In the United States, massage therapists are currently licensed by 29 states, the District of Columbia, and a number of localities. Most states require 500 or more classroom hours of training from a recognized training program and passing an examination.

A national certification program was inaugurated in June 1992 by the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB). The NCBTMB program is accredited by the National Commission for Certifying Agencies, the chief outside agency for evaluating certification programs. Those certified can use the title Nationally Certified in Therapeutic Massage and Bodywork (NCTMB). Most states use the NCBTMB exam for their licensing exams.

A national accreditation agency, the Commission on Massage Therapy Accreditation, designed according to the guidelines of the U.S. Department of Education, currently recognizes about 70 training programs. The Accrediting Commission of Career Schools and Colleges of Technology and the Accrediting Council for Continuing Education and Training also accredit massage training programs.

Resources

BOOKS

Beck, Mark F. Milady's Theory and Practice of Therapeutic Massage. Milady Publishing, 1994.

Capellini, Steve. Massage Therapy Career Guide for Hands-On Success. Milady Publishing, 1998.

Downing, George. The Massage Book. New York: Random House, 1998.

Loving, Jean E. Massage Therapy: Theory and Practice. Appleton & Lange, 1998.

PERIODICALS

Field, T., W. Sunshine, M. Hernandez-Reif, and O. Quintino. "Chronic fatigue syndrome: massage therapy effects on depression and somatic symptoms in chronic fatigue syndrome." Journal of Chronic Fatigue Syndrome (1997): 43-51.

Ironson, G., T. Field, F. Scafidi, and M. Hashimoto. "Massage therapy is associated with enhancement of the immune system's cytotoxic capacity." International Journal of Neuroscience (February 1996): 205-217.

Joachim, G. "The effects of two stress management techniques on feelings of well-being in patients with inflammatory bowel disease." Nursing Papers (1983): 4, 5-18.

Kaarda, B., and O. Tosteinbo. "Increase of plasma beta-endorphins in connective tissue massage." General Pharmacology (1989): 487-489.

Scafidi, F., T. Field, A. Wheeden, S. Schanberg, C. Kuhn, R. Symanski, E. Zimmerman, and E. S. Bandstra. "Cocaine exposed preterm neonates show behavioral and hormonal differences." Pediatrics (June 1996): 851-855.

Weintraub, M. "Shiatsu, Swedish muscle massage, and trigger point suppression in spinal pain syndrome." American Massage Therapy Journal 31, Summer 1992:3; 99-109.

ORGANIZATIONS

American Massage Therapy Association. <http://www.amtamassage.org>.

Elliot Greene

Massage Therapy

Definition

Massage therapy is the scientific manipulation of the soft tissues of the body for the purpose of normalizing those tissues and consists of manual techniques that include applying fixed or movable pressure, holding, and/or causing movement of or to the body.

Origins

Massage therapy is one of the oldest health care practices known to history. References to massage are found in Chinese medical texts more than 4,000 years old. Massage has been advocated in Western health care practices at least since the time of Hippocrates, the "Father of Medicine." In the fourth century b.c. Hippocrates wrote, "The physician must be acquainted with many things and assuredly with rubbing" (the ancient Greek term for massage was rubbing).

The roots of modern, scientific massage therapy go back to Per Henrik Ling (1776–1839), a Swede, who developed an integrated system consisting of massage and active and passive exercises. Ling established the Royal Central Gymnastic Institute in Sweden in 1813 to teach his methods.

Modern, scientific massage therapy was introduced in the United States in the 1850s by two New York physicians, brothers George and Charles Taylor, who had studied in Sweden. The first clinics for massage therapy in the United States were opened by two Swedish physicians after the Civil War period. Doctor Baron Nils Posse operated the Posse Institute in Boston and Doctor Hartwig Nissen opened the Swedish Health Institute near the Capitol in Washington, D.C.

Although there were periods when massage fell out of favor, in the 1960s it made a comeback in a different way as a tool for relaxation, communication, and alternative healing. Today, massage is one of the most popular healing modalities. It is used by conventional, as well as alternative, medical communities and is now covered by some health insurance plans.

Benefits

Generally, massage is known to affect the circulation of blood and the flow of blood and lymph, reduce muscular tension or flaccidity, affect the nervous system through stimulation or sedation, and enhance tissue healing. These effects provide a number of benefits:

• reduction of muscle tension and stiffness
• relief of muscle spasms
• greater flexibility and range of motion
• increase of the ease and efficiency of movement
• relief of stress and aide of relaxation
• promotion of deeper and easier breathing
• improvement of the circulation of blood and movement of lymph
• relief of tension-related conditions, such as headaches and eyestrain
• promotion of faster healing of soft tissue injuries, such as pulled muscles and sprained ligaments, and reduction in pain and swelling related to such injuries
• reduction in the formation of excessive scar tissue following soft tissue injuries
• enhancement in the health and nourishment of skin

• improvement in posture through changing tension patterns that affect posture
• reduction in stress and an excellent stress management tool
• creation of a feeling of well-being
• reduction in levels of anxiety
• increase in awareness of the mind-body connection
• promotion of a relaxed state of mental awareness

Massage therapy also has a number of documented clinical benefits. For example, massage can reduce anxiety, improve pulmonary function in young asthma patients, reduce psycho-emotional distress in persons suffering from chronic inflammatory bowel disease, increase weight and improve motor development in premature infants, and may enhance immune system functioning. Some medical conditions that massage therapy can help are: allergies, anxiety and stress, arthritis, asthma and bronchitis, carpal tunnel syndrome and other repetitive motion injuries, chronic and temporary pain, circulatory problems, depression, digestive disorders, tension headache, insomnia, myofascial pain, sports injuries, and temporomandibular joint dysfunction.

Description

Massage therapy is the scientific manipulation of the soft tissues of the body for the purpose of normalizing those tissues and consists of a group of manual techniques that include applying fixed or movable pressure, holding, and/or causing movement of or to the body. While massage therapy is applied primarily with the hands, sometimes the forearms or elbows are used. These techniques affect the muscular, skeletal, circulatory, lymphatic, nervous, and other systems of the body. The basic philosophy of massage therapy embraces the concept of vis Medicatrix naturae, which is aiding the ability of the body to heal itself, and is aimed at achieving or increasing health and well-being.

Touch is the fundamental medium of massage therapy. While massage can be described in terms of the type of techniques performed, touch is not used solely in a mechanistic way in massage therapy. One could look at a diagram or photo of a massage technique that depicts where to place one's hands and what direction the stroke should go, but this would not convey everything that is important for giving a good massage. Massage also has an artistic component.

Because massage usually involves applying touch with some degree of pressure and movement, the massage therapist must use touch with sensitivity in order to determine the optimal amount of pressure to use for each person. For example, using too much pressure may cause the body to tense up, while using too little may not have enough effect. Touch used with sensitivity also allows the massage therapist to receive useful information via his or her hands about the client's body, such as locating areas of muscle tension and other soft tissue problems. Because touch is also a form of communication, sensitive touch can convey a sense of caring—an essential element in the therapeutic relationship—to the person receiving massage.

In practice, many massage therapists use more than one technique or method in their work and sometimes combine several. Effective massage therapists ascertain each person's needs and then use the techniques that will meet those needs best.

Swedish massage uses a system of long gliding strokes, kneading, and friction techniques on the more superficial layers of muscles, generally in the direction of blood flow toward the heart, and sometimes combined with active and passive movements of the joints. It is used to promote general relaxation, improve circulation and range of motion, and relieve muscle tension. Swedish massage is the most commonly used form of massage.

Deep tissue massage is used to release chronic patterns of muscular tension using slow strokes, direct pressure, or friction directed across the grain of the muscles. It is applied with greater pressure and to deeper layers of muscle than Swedish, which is why it is called deep tissue and is effective for chronic muscular tension.

Sports massage uses techniques that are similar to Swedish and deep tissue, but are specially adapted to deal with the effects of athletic performance on the body and the needs of athletes regarding training, performing, and recovery from injury.

Neuromuscular massage is a form of deep massage that is applied to individual muscles. It is used primarily to release trigger points (intense knots of muscle tension that refer pain to other parts of the body), and also to increase blood flow. It is often used to reduce pain. Trigger point massage and myotherapy are similar forms.

Acupressure applies finger or thumb pressure to specific points located on the acupuncture meridians (channels of energy flow identified in Asian concepts of anatomy) in order to release blocked energy along these meridians that causes physical discomforts, and re-balance the energy flow. Shiatsu is a Japanese form of acupressure.

The cost of massage therapy varies according to geographic location, experience of the massage therapist, and length of the massage. In the United States, the average range is from $35-60 for a one hour session. Massage therapy sessions at a client's home or office may cost more due to travel time for the massage therapist. Most sessions are one hour. Frequency of massage sessions can vary widely. If a person is receiving massage for a specific problem, frequency can vary widely based on the condition, though it usually will be once a week. Some people incorporate massage into their regular personal health and fitness program. They will go for massage on a regular basis, varying from once a week to once a month.

The first appointment generally begins with information gathering, such as the reason for getting massage therapy, physical condition and medical history, and other areas. The client is asked to remove clothing to one's level of comfort. Undressing takes place in private, and a sheet or towel is provided for draping. The massage therapist will undrape only the part of the body being massaged. The client's modesty is respected at all times. The massage therapist may use an oil or cream, which will be absorbed into the skin in a short time.

To receive the most benefit from a massage, generally the person being massaged should give the therapist accurate health information, report discomfort of any kind (whether it's from the massage itself or due to the room temperature or any other distractions), and be as receptive and open to the process as possible.

Insurance coverage for massage therapy varies widely. There tends to be greater coverage in states that license massage therapy. In most cases, a physician's prescription for massage therapy is needed. Once massage therapy is prescribed, authorization from the insurer may be needed if coverage is not clearly spelled out in one's policy or plan.

Preparations

Going for a massage requires little in the way of preparation. Generally, one should be clean and should not eat just before a massage. One should not be under the influence of alcohol or non-medicinal drugs. Massage therapists generally work by appointment and usually will provide information about how to prepare for an appointment at the time of making the appointment.

Precautions

Massage is comparatively safe. However, it is generally contraindicated, (should not be used) if a person has one of the following conditions: advanced heart diseases, hypertension (high blood pressure ), phlebitis, thrombosis, embolism, kidney failure, cancer if massage would accelerate metastasis (i.e., spread a tumor) or damage tissue that is fragile due to chemotherapy or other treatment, infectious diseases, contagious skin conditions, acute inflammation, infected injuries, unhealed fractures, dislocations, frostbite, large hernias, torn ligaments, conditions prone to hemorrhage, and psychosis.

Massage should not be used locally on affected areas for the following conditions: rheumatoid arthritis flare up, eczema, goiter, and open skin lesions. Massage may be used on the areas of the body that are not affected by these conditions.

In some cases, precautions should be taken before using massage for the following conditions: pregnancy, high fevers, osteoporosis, diabetes, recent postoperative cases in which pain and muscular splinting (i.e., tightening as a protective reaction) would be increased, apprehension, and mental conditions that may impair communication or perception. In such cases, massage may or may not be appropriate. The decision on whether to use massage must be based on whether it may cause harm. For example, if someone has osteoporosis, the concern is whether bones are strong enough to withstand the pressure applied. If one has a health condition and has any hesitation about whether massage therapy would be appropriate, a physician should be consulted.

Side effects

Massage therapy does not have side effects. Sometimes people are concerned that massage may leave them too relaxed or too mentally unfocused. To the contrary, massage tends to leave people feeling more relaxed and alert.

Research and general acceptance

Before 1939, more than 600 research studies on massage appeared in the main journals of medicine in English. However, the pace of research was slowed by medicine's disinterest in massage therapy.

Massage therapy research picked up again in the 1980s, as the growing popularity of massage paralleled the growing interest in complementary and alternative medicine. Well designed studies have documented the benefits of massage therapy for the treatment of acute and chronic pain, acute and chronic inflammation, chronic lymphedema, nausea, muscle spasm, various soft tissue dysfunctions, anxiety, depression, insomnia, and psycho-emotional stress, which may aggravate mental illness.

Premature infants treated with daily massage therapy gain more weight and have shorter hospital stays than infants who are not massaged. A study of 40 low-birth-weight babies found that the 20 massaged babies had a 47% greater weight gain per day and stayed in the hospital an average of six days less than 20 infants who did not receive massage, resulting a cost savings of approximately $3,000 per infant. Cocaine-exposed, preterm infants given massage three times daily for a 10 day period showed significant improvement. Results indicated that massaged infants had fewer postnatal complications and exhibited fewer stress behaviors during the 10 day period, had a 28% greater daily weight gain, and demonstrated more mature motor behaviors.

A study comparing 52 hospitalized depressed and adjustment disorder children and adolescents with a control group that viewed relaxation videotapes, found massage therapy subjects were less depressed and anxious, and had lower saliva cortisol levels (an indicator of less depression).

Another study showed massage therapy produced relaxation in 18 elderly subjects, demonstrated in measures such as decreased blood pressure and heart rate and increased skin temperature.

A combination of massage techniques for 52 subjects with traumatically induced spinal pain led to significant improvements in acute and chronic pain and increased muscle flexibility and tone. This study also found massage therapy to be extremely cost effective, with cost savings ranging from 15-50%. Massage has also been shown to stimulate the body's ability to naturally control pain by stimulating the brain to produce endorphins. Fibromyalgia is an example of a condition that may be favorably affected by this effect.

A pilot study of five subjects with symptoms of tension and anxiety found a significant response to massage therapy in one or more psycho-physiological parameters of heart rate, frontalis and forearm extensor electromyograms (EMGs) and skin resistance, which demonstrate relaxation of muscle tension and reduced anxiety.

Lymph drainage massage has been shown to be more effective than mechanized methods or diuretic drugs to control lymphedema secondary to radical mastectomy, consequently using massage to control lymphedema would significantly lower treatment costs. A study found that massage therapy can have a powerful effect upon psycho-emotional distress in persons suffering from chronic inflammatory bowel disease. Massage therapy was effective in reducing the frequency of episodes of pain and disability in these patients.

Massage may enhance the immune system. A study suggests an increase in cytotoxic capacity associated with massage. A study of chronic fatigue syndrome subjects found that a group receiving massage therapy had lower depression, emotional distress, and somatic symptom scores, more hours of sleep, and lower epinephrine and cortisol levels than a control group.

Training and certification

The generally accepted standard for training is a minimum of 500 classroom hours. Training should include anatomy, physiology, pathology, massage theory and technique, and supervised practice. Most massage therapists also take additional courses and workshops during their careers.

In the United States, massage therapists are currently licensed by 29 states, the District of Columbia, and a number of localities. Most states require 500 or more classroom hours of training from a recognized training program and passing an examination.

A national certification program was inaugurated in June 1992 by the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB). The NCBTMB program is accredited by the National Commission for Certifying Agencies, the chief outside agency for evaluating certification programs. Those certified can use the title Nationally Certified in Therapeutic Massage and Bodywork (NCTMB). Most states use the NCBTMB exam for their licensing exams.

A national accreditation agency, the Commission on Massage Therapy Accreditation, designed according to the guidelines of the U.S. Department of Education, currently recognizes about 70 training programs. The Accrediting Commission of Career Schools and Colleges of Technology and the Accrediting Council for Continuing Education and Training also accredit massage training programs.

Resources

BOOKS

Beck, Mark F. Milady's Theory and Practice of Therapeutic Massage. Milady Publishing, 1994.

Capellini, Steve. Massage Therapy Career Guide for Hands-On Success. Milady Publishing, 1998.

Downing, George. The Massage Book. New York: Random House, 1998.

Loving, Jean E. Massage Therapy: Theory and Practice. Appleton & Lange, 1998.

PERIODICALS

Field, T., W. Sunshine, M. Hernandez-Reif, and O. Quintino. "Chronic fatigue syndrome: massage therapy effects on depression and somatic symptoms in chronic fatigue syndrome." Journal of Chronic Fatigue Syndrome (1997): 43-51.

Ironson, G., T. Field, F. Scafidi, and M. Hashimoto. "Massage therapy is associated with enhancement of the immune system's cytotoxic capacity." International Journal of Neuroscience (February 1996): 205-217.

Joachim, G. "The effects of two stress management techniques on feelings of well-being in patients with inflammatory bowel disease." Nursing Papers (1983): 4, 5-18.

Kaarda, B., and O. Tosteinbo. "Increase of plasma betaendorphins in connective tissue massage." General Pharmacology (1989): 487-489.

Scafidi, F., T. Field, A. Wheeden, S. Schanberg, C. Kuhn, R. Symanski, E. Zimmerman, and E.S. Bandstra. "Cocaine exposed preterm neonates show behavioral and hormonal differences." Pediatrics (June 1996): 851-855.

Weintraub, M. "Shiatsu, Swedish muscle massage, and trigger point suppression in spinal pain syndrome." American Massage Therapy Journal 31, no. 3(Summer 1992): 99-109.

ORGANIZATIONS

American Massage Therapy Association. 〈http://www.amtamassage.org〉.

Massage Therapy

Definition

Massage therapy is the scientific manipulation of the soft tissues of the body for the purpose of normalizing those tissues and consists of manual techniques that include applying fixed or movable pressure, holding, and/or causing movement of or to the body.

Purpose

Generally, massage is known to affect the circulation of blood and the flow of blood and lymph, reduce muscular tension or flaccidity, affect the nervous system through stimulation or sedation, and enhance tissue healing. These effects provide a number of benefits:

• reduction of muscle tension and stiffness
• relief of muscle spasms
• greater flexibility and range of motion
• increase of the ease and efficiency of movement
• relief of stress and aide of relaxation
• promotion of deeper and easier breathing
• improvement of the circulation of blood and movement of lymph

• relief of tension-related conditions, such as headaches and eyestrain
• promotion of faster healing of soft tissue injuries, such as pulled muscles and sprained ligaments, and reduction in pain and swelling related to such injuries
• reduction in the formation of excessive scar tissue following soft tissue injuries
• enhancement in the health and nourishment of skin
• improvement in posture through changing tension patterns that affect posture
• reduction in stress and an excellent stress management tool
• creation of a feeling of well-being
• reduction in levels of anxiety
• increase in awareness of the mind-body connection
• promotion of a relaxed state of mental awareness

Massage therapy also has a number of documented clinical benefits. For example, massage can reduce anxiety, improve pulmonary function in young asthma patients, reduce psycho-emotional distress in persons suffering from chronic inflammatory bowel disease, increase weight and improve motor development in premature infants, and may enhance immune system functioning. Some medical conditions that massage therapy can help are: allergies, anxiety and stress, arthritis, asthma and bronchitis, carpal tunnel syndrome and other repetitive motion injuries, chronic and temporary pain, circulatory problems, depression, digestive disorders, tension headache, insomnia, myofascial pain, sports injuries, and temporomandibular joint dysfunction.

Description

Origins

Massage therapy is one of the oldest health care practices known to history. References to massage are found in Chinese medical texts more than 4,000 years old. Massage has been advocated in Western health care practices at least since the time of Hippocrates, the "Father of Medicine." In the fourth century b.c. Hippocrates wrote, "The physician must be acquainted with many things and assuredly with rubbing" (the ancient Greek term for massage was rubbing).

The roots of modern, scientific massage therapy go back to Per Henrik Ling (1776–1839), a Swede, who developed an integrated system consisting of massage and active and passive exercises. Ling established the Royal Central Gymnastic Institute in Sweden in 1813 to teach his methods.

Modern, scientific massage therapy was introduced in the United States in the 1850s by two New York physicians, brothers George and Charles Taylor, who had studied in Sweden. The first clinics for massage therapy in the United States were opened by two Swedish physicians after the Civil War period. Doctor Baron Nils Posse operated the Posse Institute in Boston and Doctor Hartwig Nissen opened the Swedish Health Institute near the Capitol in Washington, D.C.

Although there were periods when massage fell out of favor, in the 1960s it made a comeback in a different way as a tool for relaxation, communication, and alternative healing. Today, massage is one of the most popular healing modalities. It is used by conventional, as well as alternative, medical communities and is now covered by some health insurance plans.

Massage therapy is the scientific manipulation of the soft tissues of the body for the purpose of normalizing those tissues and consists of a group of manual techniques that include applying fixed or movable pressure, holding, and/or causing movement of or to the body. While massage therapy is applied primarily with the hands, sometimes the forearms or elbows are used. These techniques affect the muscular, skeletal, circulatory, lymphatic, nervous, and other systems of the body. The basic philosophy of massage therapy embraces the concept of vis Medicatrix naturae, which is aiding the ability of the body to heal itself, and is aimed at achieving or increasing health and well-being.

Touch is the fundamental medium of massage therapy. While massage can be described in terms of the type of techniques performed, touch is not used solely in a mechanistic way in massage therapy. One could look at a diagram or photo of a massage technique that depicts where to place one's hands and what direction the stroke should go, but this would not convey everything that is important for giving a good massage. Massage also has an artistic component.

Because massage usually involves applying touch with some degree of pressure and movement, the massage therapist must use touch with sensitivity in order to determine the optimal amount of pressure to use for each person. For example, using too much pressure may cause the body to tense up, while using too little may not have enough effect. Touch used with sensitivity also allows the massage therapist to receive useful information via his or her hands about the client's body, such as locating areas of muscle tension and other soft tissue problems. Because touch is also a form of communication, sensitive touch can convey a sense of caring—an essential element in the therapeutic relationship—to the person receiving massage.

In practice, many massage therapists use more than one technique or method in their work and sometimes combine several. Effective massage therapists ascertain each person's needs and then use the techniques that will meet those needs best.

Swedish massage uses a system of long gliding strokes, kneading, and friction techniques on the more superficial layers of muscles, generally in the direction of blood flow toward the heart, and sometimes combined with active and passive movements of the joints. It is used to promote general relaxation, improve circulation and range of motion, and relieve muscle tension. Swedish massage is the most commonly used form of massage.

Deep tissue massage is used to release chronic patterns of muscular tension using slow strokes, direct pressure, or friction directed across the grain of the muscles. It is applied with greater pressure and to deeper layers of muscle than Swedish, which is why it is called deep tissue and is effective for chronic muscular tension.

Sports massage uses techniques that are similar to Swedish and deep tissue, but are specially adapted to deal with the effects of athletic performance on the body and the needs of athletes regarding training, performing, and recovery from injury.

Neuromuscular massage is a form of deep massage that is applied to individual muscles. It is used primarily to release trigger points (intense knots of muscle tension that refer pain to other parts of the body), and also to increase blood flow. It is often used to reduce pain. Trigger point massage and myotherapy are similar forms.

Acupressure applies finger or thumb pressure to specific points located on the acupuncture meridians (channels of energy flow identified in Asian concepts of anatomy) in order to release blocked energy along these meridians that causes physical discomforts, and re-balance the energy flow. Shiatsu is a Japanese form of acupressure.

The cost of massage therapy varies according to geographic location, experience of the massage therapist, and length of the massage. In the United States, the average range is from $35-60 for a one hour session. Massage therapy sessions at a client's home or office may cost more due to travel time for the massage therapist. Most sessions are one hour. Frequency of massage sessions can vary widely. If a person is receiving massage for a specific problem, frequency can vary widely based on the condition, though it usually will be once a week. Some people incorporate massage into their regular personal health and fitness program. They will go for massage on a regular basis, varying from once a week to once a month.

The first appointment generally begins with information gathering, such as the reason for getting massage therapy, physical condition and medical history, and other areas. The client is asked to remove clothing to one's level of comfort. Undressing takes place in private, and a sheet or towel is provided for draping. The massage therapist will undrape only the part of the body being massaged. The client's modesty is respected at all times. The massage therapist may use an oil or cream, which will be absorbed into the skin in a short time.

To receive the most benefit from a massage, generally the person being massaged should give the therapist accurate health information, report discomfort of any kind (whether it is from the massage itself or due to the room temperature or any other distractions), and be as receptive and open to the process as possible.

Insurance coverage for massage therapy varies widely. There tends to be greater coverage in states that license massage therapy. In most cases, a physician's prescription for massage therapy is needed. Once massage therapy is prescribed, authorization from the insurer may be needed if coverage is not clearly spelled out in one's policy or plan.

Preparations

Going for a massage requires little in the way of preparation. Generally, one should be clean and should not eat just before a massage. One should not be under the influence of alcohol or non-medicinal drugs. Massage therapists generally work by appointment and usually will provide information about how to prepare for an appointment at the time of making the appointment.

Precautions

Massage is comparatively safe; however it is generally contraindicated, i.e., it should not be used, if a person has one of the following conditions: advanced heart diseases, hypertension (high blood pressure), phlebitis, thrombosis, embolism, kidney failure, cancer if massage would accelerate metastasis (i.e., spread a tumor) or damage tissue that is fragile due to chemotherapy or other treatment, infectious diseases, contagious skin conditions, acute inflammation, infected injuries, unhealed fractures, dislocations, frostbite, large hernias, torn ligaments, conditions prone to hemorrhage, and psychosis.

Massage should not be used locally on affected areas (i.e., avoid using massage on the specific areas of the body that are affected by the condition) for the following conditions: rheumatoid arthritis flare up, eczema, goiter, and open skin lesions. Massage may be used on the areas of the body that are not affected by these conditions.

In some cases, precautions should be taken before using massage for the following conditions: pregnancy, high fevers, osteoporosis, diabetes, recent postoperative cases in which pain and muscular splinting (i.e., tightening as a protective reaction) would be increased, apprehension, and mental conditions that may impair communication or perception. In such cases, massage may or may not be appropriate. The decision on whether to use massage must be based on whether it may cause harm. For example, if someone has osteoporosis, the concern is whether bones are strong enough to withstand the pressure applied. If one has a health condition and has any hesitation about whether massage therapy would be appropriate, a physician should be consulted.

Side effects

Massage therapy does not have side effects. Sometimes people are concerned that massage may leave them too relaxed or too mentally unfocused. To the contrary, massage tends to leave people feeling more relaxed and alert.

Research and general acceptance

Before 1939, more than 600 research studies on massage appeared in the main journals of medicine in English. However, the pace of research was slowed by medicine's disinterest in massage therapy.

Massage therapy research picked up again in the 1980s, as the growing popularity of massage paralleled the growing interest in complementary and alternative medicine. Well designed studies have documented the benefits of massage therapy for the treatment of acute and chronic pain, acute and chronic inflammation, chronic lymphedema, nausea, muscle spasm, various soft tissue dysfunctions, anxiety, depression, insomnia, and psycho-emotional stress, which may aggravate mental illness.

Premature infants treated with daily massage therapy gain more weight and have shorter hospital stays than infants who are not massaged. A study of 40 low-birth-weight babies found that the 20 massaged babies had a 47% greater weight gain per day and stayed in the hospital an average of six days less than 20 infants who did not receive massage, resulting a cost savings of approximately $3,000 per infant. Cocaine-exposed, preterm infants given massage three times daily for a 10 day period showed significant improvement. Results indicated that massaged infants had fewer postnatal complications and exhibited fewer stress behaviors during the 10 day period, had a 28% greater daily weight gain, and demonstrated more mature motor behaviors.

A study comparing 52 hospitalized depressed and adjustment disorder children and adolescents with a control group that viewed relaxation videotapes, found massage therapy subjects were less depressed and anxious, and had lower saliva cortisol levels (an indicator of less depression).

Another study showed massage therapy produced relaxation in 18 elderly subjects, demonstrated in measures such as decreased blood pressure and heart rate and increased skin temperature.

A combination of massage techniques for 52 subjects with traumatically induced spinal pain led to significant improvements in acute and chronic pain and increased muscle flexibility and tone. This study also found massage therapy to be extremely cost effective, with cost savings ranging from 15-50%. Massage has also been shown to stimulate the body's ability to naturally control pain by stimulating the brain to produce endorphins. Fibromyalgia is an example of a condition that may be favorably affected by this effect.

A pilot study of five subjects with symptoms of tension and anxiety found a significant response to massage therapy in one or more psycho-physiological parameters of heart rate, frontalis and forearm extensor electromyograms (EMGs) and skin resistance, which demonstrate relaxation of muscle tension and reduced anxiety.

Lymph drainage massage has been shown to be more effective than mechanized methods or diuretic drugs to control lymphedema secondary to radical mastectomy, consequently using massage to control lymphedema would significantly lower treatment costs. A study found that massage therapy can have a powerful effect upon psycho-emotional distress in persons suffering from chronic inflammatory bowel disease. Massage therapy was effective in reducing the frequency of episodes of pain and disability in these patients.

Massage may enhance the immune system. A study suggests an increase in cytotoxic capacity associated with massage. A study of chronic fatigue syndrome subjects found that a group receiving massage therapy had lower depression, emotional distress, and somatic symptom scores, more hours of sleep, and lower epinephrine and cortisol levels than a control group.

Resources

ORGANIZATIONS

American Massage Therapy Association. 820 Davis Street, Suite 100, Evanston, IL. 〈http://www.amtamassage.org〉.