massage therapy

    What Is It?
    How Does It Work?
    What You Can Expect
    Health Benefits
    How To Choose a Practitioner


    Evidence Based Rating Scale


    What Is It?

    Massage is the direct manipulation of the soft-tissues of the body (the muscles, skin, tendons, and connective tissue) and the indirect manipulation of the body fluids in the circulatory or lymphatic system. It helps to ease stress and muscular tension, relieve pain from injuries, and speed healing from certain acute and chronic conditions. Today, millions of people worldwide visit massage therapists as a form of regular healthcare maintenance.

    The practice of massage has been used for thousands of years. As early as 2700 B.C., the Chinese text, The Yellow Emperor's Classic of Internal Medicine, recommended that "breathing exercises, massage of the skin and flesh, and exercises of the hands and feet" should be used to treat paralysis, chills, and fever. In 400 B.C., the Greek physician Hippocrates wrote about the necessity for all physicians to use rubbing as a remedy, particularly to treat sports and war injuries. Ancient records from Japan also refer to massage therapy, and the practice has been used by other cultures as well, including the Egyptians, Romans, and Arabs.

    The roots of modern, science-based massage therapy begin with Per Henrik Ling (1776-1839), a Swedish fencing master and gymnastics instructor who developed a therapeutic system that included both massage and exercise. In 1813, Ling established the Royal Central Gymnastic Institute to make his methods available to the public. At the time, Ling's program included what he called "medical gymnastics" and "Swedish movement cure." Later the combination of the two came to be known as Swedish massage.

    After studying in Sweden in the 1850s, two physician brothers, George and Charles Taylor of New York City, introduced massage therapy to the U.S. The technique gradually gained credence and was widely used by doctors until the early 1900s. But as biomedicine and new "high-tech" equipment came into play, physicians lost interest in this labor-intensive therapy. A small number of massage therapists carried on the tradition until the 1970s, when a revitalized interest in alternative medicine sparked a demand for this healing technique.

    Today there are some 80 different types of massage and related forms of Bodywork. These techniques can be organized into seven general categories:

    Traditional European massage: This includes methods based on conventional Western concepts of anatomy and physiology. Five soft-tissue manipulation techniques are typically used: effleurage (long, gliding strokes); petrissage (kneading and compression strokes); friction (deep circular rubbing); tapotement (percussion tapping); and vibration (very fine, rapid shaking movements). Swedish massage, the most widely employed massage technique in the world today, is the primary example of traditional European massage.

    Contemporary Western massage: Also based on modern concepts of anatomy, this category includes a wide variety of manipulative techniques that go beyond the original framework of Swedish massage. These include neuromuscular massage--a form of deep massage that is intended to reach the connective tissues, tendons, ligaments, and nerves, and release knots of tension called trigger points; sports massage--a combination of Swedish massage and deep tissue massage that deals specifically with the effects of athletic performance on the body; myotherapy--a specialized form of muscle massage and stretching that uses deep manual pressure to release trigger points).

    Structural and soft tissue integration methods: These techniques place an emphasis on treating the fascia (the connective tissue  that molds body structure and posture). These methods, including Structural Integration, Rolfing, Aston-Patterning, Hellerwork, and Craniosacral Therapy, are often offered via independently trained practitioners who do not consider themselves massage therapists, as well as by massage therapists who have undergone advanced training in these “bodywork” specialties.

    Somatic Education methods: These approaches to body-centered therapy work to organize the movement and posture of the body through changing the patterns of the control of movement in the nervous system. These methods use a learning model rather than a treatment model. They are not considered to be “massage therapy” by their practitioners; however, massage therapists and physical therapists might seek separate training in these specialties. Examples include Feldenkrais Method, Craniosacral Therapy, Alexander Technique, Rolfing, and the Trager Method.

    East Asian massage: Based on the principles of Traditional Chinese Medicine, East Asian massage techniques work with the soft tissues of the body to assess blockages and release the flow of vital energy (qi) that is believed to flow through the unseen meridians or energy channels in the human body. These channels are related to the nerve, fascia, and muscular anatomy of the body. Treating the body in order to physically balance energy flows can support recovery from pain or organic illness. Removing obstructions to the flow of vital energy in these channels improves overall health and well-being. These methods include acupressure, tui-na, an-mo, shiatsu, and Thai massage.

    Energy-based methods: These techniques, some of which are founded in traditional Chinese medicine, are intended to affect the energy field that is believed to surround and infuse the human body. This is accomplished either by applying light touch pressure to the physical body, or by the passage or placement of the hands in or through the energy field near the physical body. Examples of energy methods include polarity therapy, Jin-shin-jytsu, therapeutic touch, healing touch, and Reiki.

    Other methods: A commonly recognized massage-like therapy is reflexology. In this method, the therapist uses the fingers to stimulate points on the foot that correspond to a map of the body. This reflex point stimulation is believed to improve the health of the head, liver, joints, neck, back or any other spot that is mapped on the bottom of the foot. Other methods, such as Zero-balancing and Naprapathy, combine certain principles of osteopathy, chiropractic, Chinese energy medicine, and soft tissue work in a specialized bodywork technique.

    Many massage practitioners seek advanced training so they can use a combination of these techniques, depending on what the client needs at the time. For more information on these specialized forms of bodywork techniques, see the individual entries in the WholeHealthMD Reference Library 

    How Does It Work?

    Most types of massage affect the body in a similar way. When muscles are overworked, body waste products such as lactic acid can accumulate, causing soreness, stiffness, and even muscle spasms. Massage in general, and Swedish massage in particular, has been demonstrated in studies to improve blood and lymph circulation, which brings fresh oxygen and other nutrients to the area. This helps to flush out the toxins and enhance recovery.

    Tense muscles may also compress blood vessels and stretch nerves, restricting blood flow and causing pain. As the affected area is massaged, the muscles gradually release their strangle hold on the irritated nerves, and the pain eases. The same mechanisms also make massage helpful in the recovery process for an injured muscle.

    In addition, massage has been shown to increase the body's production of pain-killing endorphins and the mood-altering Hormone, Serotonin. It can also decrease release of the stress hormone cortisol. For this reason, massage is often prescribed as an adjunctive therapy for people whose immune systems are compromised by stress.

    What You Can Expect

    What happens during a massage treatment depends on the type of massage practitioner chosen. To find out what to expect from various techniques, see the WholeHealthMD Reference Library entries for individual types of massage and body work therapies. Those who are concerned about a specific health problem should seek a referral to a massage therapist with advanced technical or clinical training. For general stress and relaxation, a therapist with basic training is appropriate.

    Here's what to expect from a Swedish massage: At the first visit, the massage therapist will probably begin by taking a brief medical history. Although the therapist is not licensed to make a medical diagnosis, this information is useful in tailoring the treatment to the client's particular needs. The practitioner will ask some questions about any current physical conditions, any pain experienced, lifestyle and stress levels, and the reason for seeking treatment. This information will help the therapist to be aware of any areas that need extra work or should be avoided and to determine what techniques to use and how to structure the session. The treatment room will typically be warm and softly lit: often soothing music is added to the environment. Oils or lotions are used to prevent friction when the skin is rubbed and to enhance the sensations of the massage. Fragrance may be added based on preference or chosen for its specific therapeutic value as in aromatherapy. Clients with known allergies to any substances commonly found in fragranced body products should alert the therapist before beginning the session. Fragrance-free alternatives may better suit the client's needs.

    The client will probably be asked to disrobe partially or completely (in private) and will be given a sheet or towel to drape over the areas of the body that are not being massaged. The client will then be asked to lie down on a comfortable sheet-covered table. The table may have a special face-rest for lying face-down without turning the head or neck. Those who are uncomfortable completely disrobing should share their concerns with the therapist. They may have suggestions for accommodating such wishes; after all massages are supposed to be relaxing, and unconsciously harboring stress may prevent the client from fully enjoying all of the benefits of treatment.

    The client can request a full body massage or a massage that concentrates on a particularly painful or tight area. A typical session usually lasts from 30 to 90 minutes. Even someone trained specifically as a Swedish massage therapist may use a wide variety of strokes and techniques. In addition, the depth and amount of pressure applied to the body can be varied. If at any time, the client feels uncomfortable or the massage itself becomes painful, tell the therapist immediately.

    The number of visits required with a massage therapist can vary widely. Those using massage for stress relief may visit a therapist as often as once a week. For acute injuries, the number of treatments will depend on the nature of the condition being treated. Often massage therapy is prescribed by physicians to complement conventional care.

    Other types of massage may be done with clothes on, and without oils or lotions. In seated massage, the client usually remains fully dressed and sits in a special massage chair that supports the front of the body. In this type of massage, that usually takes 5 to 30 minutes, the therapist works on one area of the body, for example, the shoulders or the feet. Because the chair is portable, seated massage is increasingly available in the workplace to help reduce tension on the job as well as in airports and other locations.

    Health Benefits

    Massage is believed to positively affect everything from circulation to the body's metabolism and immune function. Swedish massage, in particular, has been shown to relieve muscle pain, reduce stress, and improve immune function. It can also enhance respiratory function, reduce edema (swelling) due to blocked lymphatic vessels, and aid in the healing of soft-tissue injuries.

    Specifically, massage may help to:

  • Relieve the intensity of chronic pain. Small randomized controlled trials of massage have shown it to relieve chronic pain for as long as three months after completion of treatment. (1, 2) A 2009 Cochrane Database review of 13 randomized studies showed that massage therapy relieves chronic pain for up to one year after the completion of treatment. The review also showed massage to be more effective in improving pain and function than joint mobilization, relaxation therapy, physical therapy, acupuncture, or self-care. Acupuncture massage (using massage prior to acupuncture treatment) was shown to be more effective than classic (Swedish) massage. (3) Some trials also report improvement in mood and reduced levels of depression. More studies will be necessary to determine if these results can be replicated in larger groups and how long pain relief can be sustained after treatment. However, those who live with chronic pain may want to ask a doctor about the utility of adding massage therapy to a treatment regimen, as any relief at all may be seen as a welcome change.

  • Encourage weight gain in pre-term infants. Interesting studies on premature babies indicate that these fragile babies gain weight more quickly when massaged by their mothers or other medical professionals for five to ten days. (4-8) These findings suggest that the massaged infants gained more weight, not due to increased food intake, but rather due to increased activity of the autonomic nervous and digestive systems. The studies have also shown that massage therapy leads to an up to six day shorter hospital stay for these infants. (9) 

  • Reduce high blood pressure caused by stress. Small trials have shown that Swedish massage may lower systolic and diastolic pressure. (10-12) One study in 263 healthy men and women showed that deep tissue massage reduced blood pressure levels by an average of 10.4 mm Hg in systolic pressure and 5.3 mm Hg in diastolic pressure. (12) A 2010 study in African-American women, a high-risk population, showed that chair massage and breathing exercises significantly decreased systolic and diastolic blood pressure, stress, and anxiety levels in this population for up to one week after treatment. (13) Currently, massage cannot take the place of conventional therapies for high blood pressure, but it can be recommended as an enjoyable and safe method to enhance the efficacy of conventional therapies without side effects. More research is needed.

  • Alleviate the symptoms of depression. Both pregnant women suffering from depression and depressed, hospitalized patients and have been shown to benefit from massage therapy. (14-15) Even more than just helping alleviate mood disturbance, the pregnant women had a decreased incidence of pre-mature and low birth weight babies than did their non-massaged counterparts. These results are particularly important in the pre-natal and post-natal periods when conventional medications may present greater risk to the fetus and neonate. A 2010 meta-analysis of 17 studies involving 786 participants found massage therapy to be significantly associated with alleviating depressive symptoms. (16) However, some studies have shown that massage is no better than other relaxation therapies in reducing anxiety and depression. (17, 18)

  • Help control shoulder pain. A small trial of patients referred to a physiotherapist for shoulder pain found that massage therapy reduced reported levels of pain by 4.9 points on a standard pain analysis questionnaire. (19) Furthermore, patients reported average improvement of 8.6 points in shoulder function after massage therapy. In a small trial of 16 participants with chronic neck and shoulder pain, massage therapy led to improved range of motion compared to light touch or a control intervention. (20) More research is needed.

  • Help relieve back pain. A 2003 meta-analysis of three randomized controlled trials on massage for back pain found it to be effective in cases of sub-acute (pain that builds up gradually overtime) and chronic back pain. (21) This is especially promising because many conventional treatments for this condition do not deliver effective relief. A 2009 Cochrane Database review of 13 randomized studies found that massage therapy is even more effective when combined with back strengthening exercises and education, and the benefits of massage therapy to relieve chronic back pain can last six months to one year after the completion of treatment. (3, 22)

  • Treat pain and disability relating to fibromyalgia. There are no accepted conventional medical treatments for fibromyalgia. Therefore, people suffering from this condition often turn to integrative medicine to help ease pain. A study of 40 people who completed a multidisciplinary treatment program for fibromyalgia, including massage, found that those in the treatment group had lower pain intensity, lower disability, reduced rates of depression and an overall increased level of self-reported health status over the course of the 6-week intervention These results, however, were not maintained when measured again 15 months after the treatment program. (23) A 2010 review of eight studies found some modest support for the use of massage therapy to treat fibromyalgia, but several of the studies were of poor quality and showed only short-term benefits. (24) What this means for those suffering from fibromyalgia is that, after an initial corrective series of treatments, a plan for periodic maintenance treatment may be needed to help keep symptoms under control. More, larger studies are needed.

  • Relieve chronic constipation. Abdominal massage can help mobilize fluids and stimulate contractions in the bowels, promoting relief of constipation. Treating chronic constipation with massage used to be a first line treatment, but until recently, it had fallen out of favor with the public and much of the medical community. However, it has enjoyed a recent revival in popularity. A meta-analysis of four studies indicates that massage is promising for the treatment of chronic constipation. (25) A small study found that while abdominal massage was effective in relieving abdominal pain and constipation and increasing the number of bowel movements, it did not lead to a decrease in laxative intake in 60 constipated adults. (26) However, laxative use is often habitual: longer studies may be needed to assess this outcome.

  • Prevent exercise induced muscle soreness. When training for competitive sports or just getting back into shape after a long hiatus from the gym, it is often necessary to push the body to achieve greater strides toward fitness goals. Sometimes that extra push also results in muscle stiffness, soreness, and decreased mobility. Researchers have learned that massage therapy may help reduce the incidence of delayed onset muscle soreness. (27) In a small 2003 study of 18 adults, massage administered two hours after exercise-induced muscle injury did not improve muscle function, but it did reduce the intensity of soreness 48 hours after injury. (28) A 2005 study of 10 healthy men and women found that massage therapy after exercise was effective in reducing swelling and in alleviating delayed onset muscle soreness by about 30%, but it had no effect on muscle function. (29) A 2008 randomized, controlled trial found that deep massage can reduce muscle soreness by 25 to 50%. (30) More research is needed to determine the appropriate time and type of massage required for maximum benefit.

  • Be beneficial for expectant mothers. A special kind of massage, called perineal massage (which focuses on the muscular tissue between the vagina and the rectum) is widely accepted as a preventative measure for expectant mothers. Preliminary research showed that performing this massage in the prenatal period significantly reduced pain and the need for an episiotomy during delivery. (31) However, conflicting evidence exists. In a 2008 prospective controlled trial of 234 first-time mothers, prophylactic perineal massage daily from the 34th week of gestation until delivery did not have any effect on the occurrence of perineal trauma. (32) A recent study in 2011, found that massaging the perineum with Vaseline during the second stage of labor decreased tears and the need for an episiotomy. (33) More research is needed.

  • Help alleviate the symptoms of cancer or cancer treatment. A three-year study of 1,290 patients at a large U.S. cancer center demonstrated that patients receiving massage therapy experienced 50% less pain, fatigue, stress/anxiety, nausea, and depression. (34) Patients still reported benefit even 48 hours after their massage treatment ended; other studies also suggest possible immune stimulating effects of massage in cancer patients. (35) Clearly, massage therapy and massage with aromatherapy oils should be considered when facing the challenges of cancer, cancer treatment, and its resultant symptoms. Other massage modalities, such as manual lymph drainage, may benefit the arm swelling that often occurs after removal of lymph nodes under the arm during surgery for breast cancer. (36) A 2006 Cochrane Database review of 18 trials found some evidence of post-intervention or short-term benefit of massage in relieving pain; but the same review also found two trials that indicated massage was not beneficial in relieving cancer-related pain compared to controls. (37) More research is needed.

  • Provide relief from symptoms of Multiple Sclerosis (MS). Traditional massage has shown benefit in the treatment of depression, anxiety, and low self-esteem in patients with MS. (38)  More recently, in a study with 53 patients, reflexology was also been found to be a useful treatment for the tingling, loss of sensation, urinary problems, and muscle spasms associated with MS. Measures of numbness were still reduced three months after treatment. (39) A 2009 study of 73 patients with MS found that both precision and sham reflexology treatment weekly for ten weeks led to a significant decrease in pain that was maintained for up to three months after treatment. Both treatments also led to significant decreases in fatigue, depression, disability, and spasm, as well as improvement in overall quality of life. (40) More research is needed.

  • Decrease postoperative pain. Studies involving both men and women indicate that post-operative massage may improve a patient's perceptions of pain. (41-44) More research is necessary to determine if these effects are confined to short-term improvements, or if they may also benefit measures such as length of hospital stay and time before return to work.

  • Induce relaxation in critically ill patients. The M-technique massage (using a series of light, stroking movements in a set sequence), has been shown to be useful in reducing pain and inducing relaxation in critically ill, fragile or dying patients who cannot tolerate deep tissue massage. In a preliminary study, M-technique massage led to greater improvements in blood flow to the brain than conventional Swedish massage, and these improvements increased when the M-technique was repeated over time (unlike Swedish massage). (45)

  • Other ailments that have responded to massage but have had limited research include chronic fatigue syndrome, osteoarthritis, carpal tunnel syndrome, migraine headache, and sciatica. Many insurance companies are now beginning to pay for therapeutic massage. Those who suffer from a chronic condition that has been improved by massage should check with their insurer to see if claims can be submitted, or if they are eligible for reduced cost treatment by a licensed massage therapist in a health plan related network.

    For information on the health benefits of other forms of body-centered therapies, see the individual entries in the WholeHealthMD Reference Library.

    How To Choose a Practitioner

    Thirty states and the District of Columbia have passed legislation regarding the licensing of professional massage therapists and defining what level of education and/or national testing they need in order to practice. While the rules for cer

Date Published: 04/19/2005
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