Massage therapy is the systematised manipulation of soft tissues for the purpose of ‘normalising’ them. Practitioners use a variety of physical methods including applying fixed or movable pressure, holding, or causing movement to the body. Therapists primarily use their hands, but may also use their forearms, elbows, or feet. The basic goal of massage therapy is to help the body heal itself and to increase health and wellbeing.
The History of Massage Therapy
The practice of using touch as a healing method derives from customs and traditions dating back to ancient history. Both Eastern and Western civilisations found that natural touch and massage could heal injuries, relieve pain, and prevent and cure illnesses. Touch is the core ingredient of massage therapy which is considered both an art and science.
Massage may be the oldest and simplest form of medical care
Egyptian tomb paintings show people being massaged. In Eastern cultures, massage has been practiced continually since ancient times. A Chinese book from 2,700 B.C., The Yellow Emperor's Classic of Internal Medicine, recommends 'breathing exercises, massage of skin and flesh, and exercises of hands and feet" as the appropriate treatment for complete paralysis, chills, and fever." The Chinese tradition of massage therapy developed from the combined expertise and methods of doctors in traditional Chinese medicine, practitioners of martial arts, Buddhists and Taoists who viewed touch as essential to their spiritual yoga, and laymen who offered massages for relaxation.
Chinese massage methods
Chinese massage methods are based on the principle that illnesses arise due to deficiencies or imbalances in the energy of specific pathways or ‘meridians’ that represent the body’s various physiologic systems.
Using massage and other bodywork techniques, energy could be made to flow more harmoniously through these pathways, allowing the body to heal itself naturally.
Chinese massage techniques include Tui Na, amno, amno, acupuncture and acupressure, to name a few. Practitioners may complement massage treatments with herbal remedies, dietary therapy and exercise recommendations.
Japanese monks studying Buddhism in China observed the healing methods of traditional Chinese medicine, including massage therapy. Japan soon began to import and customise Chinese massage techniques, giving rise to traditional Japanese massage or anma, which evolved into Shiatsu.
Western cultures massage
Western cultures embraced massage as a medical therapy as well. Massage was one of the principal methods of relieving pain used by Greek and Roman physicians. Julius Caesar was said to have been given a daily massage to treat neuralgia. Hippocrates of Cos (460 to 380 B.C.), known as the ‘father of medicine,’ and author of the Hippocratic Oath, wrote in his memoirs, “The physician must be experienced in many things but assuredly also in rubbing (anatripsis); for things that have the same name have not always the same effects. For rubbing can bind a joint that is too loose and loosen a joint that is too rigid… Rubbing can bind and loosen; can make flesh (referring to the ability to tone muscle tissue) and cause parts to waste (soften and relax). Hard rubbing binds; soft rubbing loosens; much rubbing causes parts to waste; moderate rubbing makes them grow.”
The Romans continued the Greek tradition culminating in the learnings and teachings of Galen (130-201 AD). Before becoming a notable physician to a number of Emperors in the first century AD, Galen spent several years ‘interning’ as physician to the Gladiators of the Circus Maximus.
He developed a complete regimen for the application of massage techniques to treat various diseases and physical injuries. Practically speaking, he was the innovator of what is today called Sports Massage or Orthopedic Massage.
Europe turned away from the teachings of Hippocrates and Galen during the Dark Ages.
Conservative and repressive religious dogma frowned upon any act that involved touching which was perceived as pleasurable by the recipient. These acts were considered unacceptable and even sinful.
Swedish Movement System
In the early 1800’s, the Swedish doctor, gymnast and educator, Per Henril Ling, developed a method of movement known as the "Swedish Movement System." This is regarded as the foundation of Swedish massage most commonly used in the West today. Although the "Swedish Movement System" was developed by Ling, it was a Dutch physician, Johan Georg Mezger, who defined the actual hand strokes of Swedish massage:
- Effleurage: Long, gliding strokes (the focus of pressure is moved by the hands gliding over the skin)
- Petrissage: Lifting and kneading the muscles (soft tissue is compressed between the hands or fingers and thumb)
- Friction: Firm, deep, circular rubbing movements (shearing stresses are created at tissue interfaces below the skin)
- Tapotement: Brisk tapping or percussive movements (the skin or muscle is impacted with repetitive, compressive blows)
- Vibration: Rapidly shaking or vibrating specific muscles
Through the early part of the 20th century, an increasing number of new and rediscovered massage techniques were documented and practiced. In particular, massage was used to treat World War I patients who suffered from nerve injury or shell shock. However, massage remained out of the mainstream as a form of treatment for many years. It was perceived as a luxury reserved for the wealthy. Furthermore, its reputation endured another unsavory period with the advent of massage parlors where the practice became associated with the sex trade.
In the latter half of the 20th century, rising interest in natural healing methods revitalised the practice of massage. More and more states started to regulate the practice, and industry standards in licensing and education emerged. As a result, massage earned a place as a legitimate and respectable form of alternative and complementary medicine and because recognised in society's wellness boom—the focus on disease prevention through maintaining wellness.
Massage is now used in intensive care units, for children, elderly people, babies in incubators, and patients with cancer, AIDS, heart attacks, or strokes. Most American hospices have some kind of bodywork therapy available, and it is frequently offered in health centers, drug treatment clinics, and pain clinics.
Today the most common types of massage practiced in the western hemisphere are Swedish massage and the Japanese massage practice of Shiatsu.
The Eastern Approach to Healing
Eastern medicine practitioners are trained to view the body as one unified system incorporating the physical body, the mind and the spirit – otherwise known as a holistic approach. Western medicine, on the other hand, traditionally separates the body by its different functions and only focuses on healing the area where pain is felt or disease is experienced.
The goal of the Eastern approach is to engage the self-healing mechanisms of both mind and body. Eastern massage focuses on channeling the inherent energy of an individual to bring about integration of mind and body to achieve a higher level of consciousness and being.
As mentioned, Chinese healing is based upon the system of the 12 traditional Chinese meridians (ie, major channels) of the body in which the energy, life force, called “qi” (pronounced “chee”, sometimes spelled “chi”) circulates. Acupressure pressure points, situated along the course of channels, allow access to these channels. Acupressure applies massage forces, largely through digital pressure, to the same points treated with acupuncture needles.
Imbalances of energy along the meridians are believed to cause disease and can be rectified by localised finger pressure.
Eastern Massage addresses the energy flow and balance within the body. It utilises pressure points along the energy meridians of the body. Stimulating and soothing these particular areas will improve the energy flow outwards along those meridians, having a positive effect on the areas regulated by each pressure point. The physical techniques used to stimulate the pressure points include rolling, rocking and striking them. These techniques are much more vigorous than those used in Western Massage.
Unlike Western medicine which relies on vital signs such as height, weight, body temperature, blood pressure, pulse and respiration, Eastern medicine utilises five elements (fire, earth, wood, metal and water) to interpret the relationship between the physiology and pathology of the human body. In Eastern massage, diagnosis is performed by observing the tongue and pulse. The pulse is examined by palpating it along three positions on wrist. A therapist can detect imbalances and disharmonies in various parts of body by examining the pulse in this way. The tongue is another organ which is subjected to detailed examination by an eastern massage therapist. The therapist aims to finding the root cause of complaint rather than a symptomatic diagnosis.
Another difference between Oriental and Western medicine is the value that Oriental medicine applies to the philosophical concepts of Yin and Yang. Yin represents the feminine qualities in the universe while Yang represents the masculine qualities.
Eastern massage techniques
Eastern massage techniques include the two traditional types of Chinese massages (Zhi Ya and Tui Na), Shiatsu, Thai massage, Ayurvedic massage, and Balinese massage. Zhi Ya, one of the two Chinese methods, uses acupressure techniques to find important points on the body that could relieve large areas of the body from muscle stress and pain. Tui Na, the other Chinese method of massage, focuses on the stretching and kneading of the muscles. In Eastern traditions, Tui Na is not considered a massage therapy technique, but rather a medicinal practice that is a part of Chinese medicine. Shiatsu massage is an oriental massage therapy technique that incorporates both acupressure and the stretching of muscles by using the thumbs, fingers, and palms of the hand to put pressure on the muscles. In combination with body work, movement therapy and breathing techniques, the body and mind are integrated through various practices like Yoga, Tai Chi and Qi Gong.
The Western Approach to Healing
Western Medicine views the mind and body as two separate entities. Eastern traditions see the mind and body as a unified entity stemming from the same energy source. This is more than a philosophical issue.
Western massage promotes relaxation, circulation, motion and relieving muscle tension and is based on concepts of anatomy, pathology, and physiology. It leans more heavily towards the physical, with a mechanistic approach to diagnosing the problem and addressing it directly. The massage therapists focus on the individual parts of the body where symptoms (such as pain or discomfort) reside. Symptoms are evaluated and massage is focused in these areas using five stroke techniques. These include: kneading, gliding, tapping, friction and vibration, but may also include: deep tissue massage, myofascial release, soft tissue massage, sports massage, and trigger point therapy. Western massage combined with bodywork and movement therapy has resulted in the Alexander technique, the Feldenkrais method, Hellerwork, Pilates, structural integration, and the Trager approach, to name a few.
Not surprisingly, the goals of Eastern and Western medicine are as different as the cultures they come from. Based on a culture that focuses on the physical world, Western medicine’s approach to the mind/body is to “fix” the physical body. Here, the mind is seen as an organ, the brain, and therefore, physical. If the body is missing a substance, the Western approach is to supply it. Medical science has evolved to further refine the “fixing” with better drugs and surgical technology. The limitations come with the appearance of medication side effects and the proliferation of the number of prescribed medicines.
Specific Example Demonstrating the Difference
The unique concept of “qi,” specific to Chinese medicine, still puzzles the scientific world. Acupuncture seeks to treat the body on the level of qi. There are pathways in the human body wherein this qi flows called meridians, or channels.
Needles inserted along these meridians influence the qi that flows to internal organs thus affecting their functions.
The effects of acupuncture are not limited to any one given organ system. Acupuncture affects all the organ systems at the same time.
Western or conventional therapies for diabetes have been geared toward regulating blood glucose with a combination of diet modification, insulin and/or oral pharmacological agents, weight loss when appropriate, and exercise.
Unlike Western medicine, Traditional Chinese Medicine (TCM) is not concerned with measuring and monitoring blood glucose levels in diabetic patients. Treatment is individualised and geared toward assessing and treating the symptoms that compose patterns of deficiency and disharmony. According to TCM, diabetes is known as “Xiao Ke” or “wasting and thirsting disease”, caused by an imbalance of Qi and Yin. This produces heat which drains and consumes the body’s fluids. That is why symptoms related to heat appear-excessive thirst, irritability, itchy skin, dry mouth and red, swollen gums.
When evaluating patients with a chronic illness such as diabetes, traditional Chinese medicine practitioners take a detailed, multi-system case history and supplement this information with observations that give information about the state of the patient’s health. These observations include the shape, colour, and coating of the tongue; the colour and expression of the face; the odor of the breath and body; and the strength, rhythm, and quality of the pulse. Many practitioners will palpate along meridians to detect points of tenderness that may indicate a blockage in the flow of Qi at that point.
Acupuncture and herbs have traditionally been used in the treatment of diabetes to reduce blood glucose levels and normalise endocrine function. Clinical and experimental studies have demonstrated that acupuncture has a beneficial effect on lowering serum glucose levels. A collaboration between Chinese, Korean, and Australian scientists at Sydney's Garvan Institute has revealed that the natural plant product, berberine, could be a valuable new treatment for type 2 diabetes. These researchers have shown that, in animal models of diabetes, berberine acts in part by activating an enzyme in the muscle and liver that is involved in improving sensitivity of the tissue to insulin -- this in turn helps lower blood sugar levels.
What Is Acupressure?
TuiNa is a medical treatment and is different than massage because it works on the energy level of the body and not solely on the muscles and tissues. Though different than acupuncture, TuiNa can be just as effective, and for some conditions, such as sports injuries, can be more effective.
Some Traditional Chinese Medicine doctors use a combination of acupuncture and TuiNa which is believed to accelerate healing. Acupressure and acupuncture are somewhat similar. Acupressure is sometimes referred to as "needleless acupuncture," because both forms of healing use the same points to achieve the desired results. The main difference is that an acupuncturist stimulates points by inserting needles, whereas an acupressurist stimulates the same points using finger pressure.
Stimulating specific points on the body can trigger the release of endorphins (chemicals produced by the body that relieve pain). When endorphins are released, pain is blocked, and the flow of blood and oxygen to the affected area is increased. This causes the muscles to relax and promotes healing.
In acupressure, as with most traditional Chinese medicine concepts, local symptoms are considered an expression of the whole body's condition. When performed correctly, acupressure is believed to increase circulation, reduce tension and enable the body to relax. Reducing tension, in turn, strengthens the immune system and promotes wellness. However, applying acupressure too abruptly, or using too much force during treatment, can lead to bruising and discomfort. Great care should be used when applying pressure to points on or near the abdomen, groin, armpits or throat. Not all Western practitioners believe in the efficacy of acupressure or even that these meridians exist. Instead, they attribute any results to other factors, such as reduced muscle tension, improved circulation, or stimulation of endorphins, which are natural pain relievers.
Common Acupressure Points
There are literally hundreds of acupuncture/acupressure points on the body -- too many to name. Here are three that are commonly used by acupuncturists and acupressure practitioners:
- Large intestine 4 (L14): This is in the soft, fleshy web between your thumb and forefinger.
- Liver 3 (LR-3): This is in the soft flesh that sits between your big and 2nd toes. It's an area similar to L14.
- Spleen 6 (SP-6): This is about three finger widths above your inner anklebone. It is a tender area of the lower calf muscle.
Health Problems Which Benefit From Acupressure
Research into the health benefits of acupressure is in its infancy. Many patient reports support its use for a number of health concerns. However, more well-designed research is needed. Here are a few health problems that appear to improve with acupressure:
Nausea: Several studies support the use of wrist acupressure to prevent and treat nausea and vomiting:
- After surgery
- During spinal anesthesia
- After chemotherapy
- From motion sickness
- Related to pregnancy
The PC 6 acupressure point is located in the groove between the two large tendons on the inside of the wrist that start at the base of the palm. Special wristbands are available over the counter in many pharmacies. These press on similar pressure points and work for some people. Other conditions treated with acupressure include:
Cancer: In addition to relieving nausea secondary to chemotherapy, there are individual reports that acupressure also helps reduce stress, improves energy levels, relieve pain, and lessen other symptoms implicated with cancer or its treatments.
Pain: Some preliminary evidence suggests that acupressure may help with low back pain, postoperative pain, or headache. Pain from other conditions may benefit, as well. To relieve headache, the L14 pressure point is sometimes tried.
Low back pain: In a systematic analysis of 401 participants with chronic, nonspecific low back pain, one third were randomly assigned to receive relaxation massage (including effleurage, petrissage, circular friction, vibration, rocking and jostling, and an option to listen to music from a compact disc player). Another third was assigned to receive structural massage including myofascial, neuromuscular, other soft tissue techniques, and an optional psoas muscle stretch. The last third was assigned to ‘usual care.’
Results showed greater improvement in function and symptom reduction at 10 weeks, 26 weeks and at 52 weeks in those patients receiving either structural or relaxation massage as opposed to those patients receiving 'usual care'. The improvements in function and symptom reduction were similar in the structural massage group and the relaxation massage group.
Arthritis: Some studies suggest that acupressure releases endorphins and promotes anti-inflammatory effects, relieving the pain of arthritis.
Fibromyalgia: In a study that randomized 24 adult fibromyalgia patients to massage or relaxation therapy consisting of 30-minute treatments twice weekly for 5 weeks, both groups showed decreased anxiety and depressed mood immediately after the first and last therapy sessions but showed no benefit in terms of the sleep disturbance associated with the disorder. During the course of the study, only the massage therapy group reported increased number of sleep hours and decreased frequency of sleep movements. Substance P levels decreased, as did physician's ratings of pain, disease, and the number of tender points.
Depression and anxiety
More than one study suggests that fatigue and mood may improve from the use of acupressure. According to Traditional Chinese Medicine, there are over 800 vital energy points along the meridians that run from the head down to the heels, especially along either side of the spinal column. Every point has specific therapeutic effects on the related organ. By massaging these points, the corresponding body area receives specific therapeutic treatment. It can be used to treat internal organ diseases, relieve internal discomfort, and relax yourself; or to promote overall wellbeing of the body.
Western scientists have shown that many of these points are located at key crossways of the autonomic nervous system. This may explain in part why they can affect pain that the patient experiences in a part of the body far from where the pressure is applied. Unlike Western massage, which applies long flowing hand movements to the superficial muscle layer for stress relief and relaxation, acupressure applies systematic and sequential pressure to the acupoints in order to correct blockages or aberrations in the flow of qi through the meridians and restore health.
Acupressurists uniquely recognise that stimulating an acupoint on one part of the body can trigger a healing response in another part of the body, that each acupoint can benefit a variety of complaints and symptoms, and that all of the muscles, organs and tissues of the body connect with and affect each other via the meridians.
Although numerous positive descriptive and retrospective reports on acupuncture had been published over previous decades, it was not until 2002, and 2003 that the first 3 randomised controlled trials of acupuncture for pain relief in labor were published. These included a total of 598 women. All compared pain assessments using a visual analog scale during or after labor or by comparing acupressure with the use of epidural analgesia or intravenous narcotics between those women randomly allocated to acupuncture and a control group (receiving either no acupuncture or "false acupuncture"). They also evaluated patient satisfaction with acupuncture. Women's reports of pain were significantly lower in the acupuncture groups in all 3 trials.
Evidence-Based Massage Therapy
Quantitative research reviews show that a series of massage therapy treatments consistently produces sizable reductions of depression in adult recipients.
The effects of massage therapy on anxiety are even better understood. Single sessions of massage therapy significantly reduce state anxiety, the momentary emotional experiences of apprehension, tension, and worry in both adults and in children. Multiple sessions of massage therapy, performed over a period of days or weeks, significantly reduce trait anxiety, the normally stable individual tendency to experience anxiety states.
Together, these effects on anxiety and depression are the most well-established effects in the scientific literature. These effects are especially important because anxiety and depression exacerbate many other health problems. In other words, it is reasonable to theorise that quite a few specific health benefits associated with massage therapy may actually be “second-order” effects that are a consequence of massage therapy’s “first-order” effects on anxiety and depression.
The effects of massage therapy on anxiety and depression, when quantified, are similar in magnitude to the effects observed in hundreds of psychotherapy studies. Other reported yet not scientifically proven benefits of massage therapy include:
- Improved circulation
- Stimulation of lymph flow
- Reduction of post-surgical adhesions and swelling
- Reduction of heart rate and blood pressure
While there is no consensus on the complete physiology of massage, it is generally accepted that there is more to this treatment approach than just the interaction of mechanical forces and human anatomy. There is a long history of touch as a natural, essential component to healing and health maintenance.
Influence of the Therapist/Patient Relationship
Undoubtedly, massage therapy temporarily changes the recipient’s bodily state, but how the recipient interprets that change must depend on their attitudes, expectations, and knowledge of massage therapy, and on their perception of the affective state and presentation of the therapist.
In one analysis of paediatric massage therapy, researchers made an interesting discovery regarding the effect of the massage therapy on state anxiety. When a series of massage therapy sessions was administered, the first session in the series provided significant reductions in anxiety, but the last session in the same series provided reductions that were almost twice as large. This pattern was consistent across all studies that the authors examined, which strongly suggests that experience with massage therapy is an important predictor of its success, at least where anxiety is concerned.
To put it another way, it is possible that the greatest benefits come about only when a person has learned how to receive massage therapy.
It has been noted that prior massage therapy research has not accounted for the communication that inevitably takes place between massage therapists and their recipients, nor has it examined the likelihood that therapists and recipients develop a therapeutic relationship during the course of massage therapy.
Massage therapy has important parallels (in both process and outcomes) to psychotherapy, a treatment that relies on communication and therapeutic relationship to provide effects. It seems likely that massage therapy effects, especially those belonging to the affective category, are mediated or moderated by these factors posing important and intriguing questions for future research.
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