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Massage involves working and acting on the body with pressure – structured, unstructured, stationary, or moving – tension, motion, or vibration, done manually or with mechanical aids. Massage can be applied with the hands, fingers, elbows, knees, forearm, feet, or a massage device. Massage can promote relaxation and well-being, can be a recreational activity, and can be sexual in nature (see Erotic massage).
The word comes from the French massage "friction of kneading", or from Arabic massa meaning "to touch, feel or handle" or from Latin massa meaning "mass, dough", cf. Greek verb μάσσω (massō) "to handle, touch, to work with the hands, to knead dough". In distinction the ancient Greek word for massage was anatripsis, and the Latin was frictio.
In professional settings massage involves the client being treated while lying on a massage table, sitting in a massage chair, or lying on a mat on the floor, while in amateur settings a general purpose surface like a bed or floor is more common. The massage subject may be fully or partially clothed or unclothed.
- 1 History
- 2 Types and methods of massage
- 2.1 Acupressure
- 2.2 Aquatic bodywork
- 2.3 Anma massage
- 2.4 Ashiatsu
- 2.5 Balinese massage
- 2.6 Bowen technique
- 2.7 Breema
- 2.8 Biodynamic Massage
- 2.9 Champissage massage
- 2.10 Craniosacral therapy
- 2.11 Esalen massage
- 2.12 Foot massage
- 2.13 Hilot massage
- 2.14 Infant massage
- 2.15 Kum Nye
- 2.16 Lomilomi and indigenous massage of Oceania
- 2.17 Lymphatic drainage
- 2.18 Medical massage
- 2.19 Metamorphic Technique
- 2.20 Myofascial release
- 2.21 Pediatric massage
- 2.22 Postural Integration (PI)
- 2.23 Prostate massage
- 2.24 Reflexology
- 2.25 Shiatsu
- 2.26 Sports massage
- 2.27 Stone massage
- 2.28 Structural Integration
- 2.29 Swedish massage
- 2.30 Tantric massage
- 2.31 Thai massage
- 2.32 Traditional Chinese massage
- 2.33 Trager approach
- 2.34 Trigger point therapy
- 2.35 Tui na
- 2.36 Watsu
- 3 Equipment
- 4 Medical and Therapeutic Use
- 4.1 Practitioner Associations and Official Recognition of Professionals
- 4.2 Associated Methods
- 4.3 Beneficial Effects
- 4.4 Massage and Proprioception
- 4.5 Regulations
- 5 See also
- 6 References
Ancient and medieval times
BC 722-481: Huangdi Neijing is composed during the Chinese Spring and Autumn period (the beginning of recorded history). The Nei-jing is a compilation of medical knowledge known up to that date, and is the foundation of Traditional Chinese Medicine. Massage is referred to in 30 different chapters of the Nei Jing. It specifies the use of different massage techniques and how they should be used in the treatment of specific ailments, and injuries. Also known as "The Yellow Emperor's Inner Canon", the text refers to previous medical knowledge from the time of the Yellow Emperor (approx 2700 BC), misleading some into believing the text itself was written during the time of the Yellow Emperor (which would predate written history).
BC 500 Jīvaka Komarabhācca, also known as Shivago Komarpaj, the founder of Traditional Thai massage (Nuad Boran) and Thai medicine. According to the Pāli Buddhist Canon, Jivaka was Buddha's physician. He codified a healing system that combines acupressure, reflexology, and assisted yoga postures. Traditional Thai massage is generally based on a combination of Indian and Chinese traditions of medicine. Jivaka is known today as "Father Doctor" in Thailand.
BC 300 Charaka Samhita believed to be the oldest of the three ancient treatises of Ayurvedic medicine, including massage. Sanskrit records indicate that massage had been practiced in India long before the beginning of recorded history.
AD 581: China establishes a department of massage therapy within the Office of Imperial Physicians.
Middle-Ages: Medical knowledge, including that of massage, made its way from Rome to Persia in the Middle Ages. Many of Galen's manuscripts, for instance, were collected and translated by Hunayn ibn Ishaq in the 9th century. Later in the 11th century copies were translated back into Latin, and again in the 15th and 16th centuries, when they helped enlighten European scholars as to the achievements of the Ancient Greeks. This renewal of the Galenic tradition during the Renaissance played a very important part in the rise of modern science.
One of the greatest Persian medics was Avicenna, also known as Ibn Sina, who lived from 980AD to 1037AD. He was the foremost philosopher of medieval Islam and also a great philosopher, logician and medic. His works included a comprehensive collection and systematisation of the fragmentary and unorganised Greco-Roman medical literature that had been translated Arabic by that time, augmented by notes from his own experiences. One of his books, Al-Qānūn fī aṭ-Ṭibb (The Canon of Medicine) has been called the most famous single book in the history of medicine in both East and West. Avicenna excelled in the logical assessment of conditions and comparison of symptoms and took special note of analgesics and their proper use as well as other methods of relieving pain, including massage.
AD 1150: Evidence of massage abortion, involving the application of pressure to the pregnant abdomen, can be found in one of the bas reliefs decorating the temple of Angkor Wat in Cambodia. It depicts a demon performing such an abortion upon a woman who has been sent to the underworld. This is the oldest known visual representation of abortion.
AD 1776: Jean Joseph Marie Amiot, and Pierre-Martial Cibot, French missionaries in China translate summaries of Huangdi Neijing, including a list of medical plants, exercises and elaborate massage techniques, into the French language, thereby introducing Europe to the highly developed Chinese system of medicine, medical-gymnastics, and medical-massage.
AD 1776 Pehr Henrik Ling, a Swedish physical therapist, and teacher of medical-gymnastics is born. Ling has often been erroneously credited for having invented "Classic Massage" aka "Swedish Massage", and has been called the "Father of Massage".
AD 1779: Frenchman Pierre-Martial Cibot publishes ‘Notice du Cong-fou des Bonzes Tao-see' also known as "The Cong-Fou of the Tao-Tse", a French language summary of medical techniques used by Taoist priests. According to Joseph Needhan, Cibot's work "was intended to present the physicists and physicians of Europe with a sketch of a system of medical gymnastics which they might like to adopt—or if they found it at fault they might be stimulated to invent something better. This work has long been regarded as of cardinal importance in the history of physiotherapy because it almost certainly influenced the Swedish founder of the modern phase of the art, Per Hendrik Ling. Cibot had studied at least one Chinese book, but also got much from a Christian neophyte who had become expert in the subject before his conversion.”
AD 1813 The Royal Gymnastic Central Institute for the training of gymnastic instructors was opened in Stockholm, Sweden, with Pehr Henrik Ling appointed as principal. Ling developed what he called the "Swedish Movement Cure." Ling died in 1839, having previously named his pupils as the repositories of his teaching. Ling and his assistants left little proper written account of their methods. 
AD 1878: Dutch massage practitioner Johan Georg Mezger applies French terms to name five basic massage techniques, and coins the phrase "Swedish massage system". These techniques are still known by their French names (effleurage (long, gliding strokes), petrissage (lifting and kneading the muscles), friction (firm, deep, circular rubbing movements), tapotement (brisk tapping or percussive movements), and vibration (rapidly shaking or vibrating specific muscles)).
China: Massage has developed continuously in China for over 5000 years. Western ideas are considered within the traditional framework. It is widely practiced and taught in hospital and medical schools and is an essential part of health maintenance and primary healthcare.
United States: Massage started to become popular in the United States in the middle part of the 19th century and was introduced by two New York physicians based on Per Henrik Ling's techniques developed in Sweden.
During the 1930s and 1940s massage's influence decreased as a result of medical advancements of the time, while in the 1970s massage's influence grew once again with a notable rise among athletes. Until the 1970s, nurses used massage to reduce pain and aid sleep. The massage therapy industry is continuously increasing, with a projected 19% increase between 2008 and 2009. U.S. consumers spend between $4 and $6 billion on visits to massage therapists, as of 2009.
United Kingdom: Massage is popular in the United Kingdom today and gaining in popularity. There are many private practitioners working from their own premises as well as those who operate from commercial venues.
Massage in sports, business and organizations: Massage developed alongside athletics in both Ancient China and Ancient Greece. Taoist priests developed massage in concert with their Kung Fu gymnastic movements, while Ancient Greek Olympians used a specific type of trainer ("aleiptes") who would rub their muscles with oil. Pehr Ling's introduction to massage also came about directly as a result of his study of gymnastic movements.
The 1984 Summer Olympics in Los Angeles was the first time that massage therapy was televised as it was being performed on the athletes. And then, during the 1996 Summer Olympics in Atlanta massage therapy was finally offered as a core medical service to the US Olympic Team. Massage has been employed by businesses and organizations such as the U.S. Department of Justice, Boeing and Reebok. Notable athletes such as Michael Jordan and LeBron James have personal massage therapists that at times even travel with them.
Types and methods of massage
Acupressure (a portmanteau of "acupuncture" and "pressure") is a traditional Chinese medicine (TCM) technique derived from acupuncture. With acupressure physical pressure is applied to acupuncture points by the hand, elbow, or with various devices.
Aquatic bodywork includes Watsu and related bodywork forms involving movement, stretching, joint mobilization, and massage performed in warm water pools (e.g., WaterDance, Healing Dance, Jahara technique, etc.), as well as land-based bodywork and massage forms performed in water (e.g., Aquatic Craniosacral Therapy, Aquatic Myofascial Release Therapy, etc.)
Anma is a traditional Japanese massage involving vigorous kneading, rubbing, tapping and shaking. It is commonly performed through clothing. Anma contributed significantly to the formation of shiatsu and tui na.
In ashiatsu, the practitioner uses their feet to deliver treatment. The name comes from the Japanese, ashi for foot and atsu for pressure. This modality typically uses the heel, sesamoid, arch and/or whole plantar surface of foot, and offers large compression, tension and shear forces with less pressure than an elbow, and is ideal for large muscles, such as in thigh, or for long-duration upper trapezius compressions. Other modalities using the feet to provide treatment include Keralite, Barefoot Lomi Lomi, Chavutti Thirumal.
Balinese massage techniques are gentle and aim to make the patient feel relaxed and calm throughout. The techniques include skin folding, kneading, stroking,and other techniques. The massage therapist applies aromatheraphy oil throughout the massage. A patient's blood, oxygen and energy flow is said to increase due to the treatment. Balinese hot stones are an option.
Bowen technique involves a rolling movement over fascia, muscles, ligaments, tendons and joints. It is said not to involve deep or prolonged contact with muscle tissues as in most kinds of massage, but claims to relieve muscle tensions and strains and to restore normal lymphatic flow.
Breema bodywork is performed on the floor with the recipient fully clothed. It consists of rhythmical and gentle leans and stretches.
Biodynamic massage was created by Gerda Boyesen as part of Biodynamic Psychotherapy. Practised as a stand alone therapy, it is a combination of physical and energy work and also uses a stethoscope to hear the peristalsis.
Champissage is a massage technique focusing on the head, neck and face that is believed to balance the chakras.
Craniosacral therapy (CST) is a gentle approach that releases tensions deep in the body by applying light touch to the skull, face, spine, and pelvis.
Esalen Massage was developed at the Esalen Institute based on a combination of many massage and bodywork techniques. The two main influences were Swedish massage and the Sensory Awareness work of Charlotte Selver. Esalen Massage works with gentle rocking of the body, passive joint exercises and deep structural work on the muscles and joints, together with an energetic balancing of the body.
While various types of reflexology related massage styles focus on the feet, massage of (usually) the soles of the feet is often performed purely for relaxation or recreation.
Hilot is a traditional healing technique from the Philippines that uses massage, joint manipulations, and herbs such as banana leaves. Hilot is claimed to relax muscles, reset sprained joints, assess and treat musculoligamentous and musculoskeletal ailments, aid in giving birth and post-birth recovery for mother and baby, and to induce abortion.
Infant massage is a type of complementary and alternative treatment that uses massage therapy for human infants. This therapy has been practiced globally, and has been increasingly used in Western countries as a treatment for infants.
Kum Nye and sKu-mNyé are a wide variety of Tibetan religious and medical body practices. The two terms are different spellings in the Latin alphabet of the same Tibetan phrase (Wylie: sku mnye), which literally means "massage of the subtle body". Some systems of sku mnye are vaguely similar to Yoga, T'ai chi, Qigong, or therapeutic massage. "Kum Nye", Ku Nye, and Kunye are also used to transcribe the Tibetan phrases dku mnye ("belly massage") and bsku mnye ("oil massage"), which are pronounced identically to sku mnye. dKu mnye and bsku mnye manipulate the physical body, rather than the subtle (energetic) one.
Lomilomi and indigenous massage of Oceania
Lomilomi is the traditional massage of Hawaii. As an indigenous practice, it varies by island and by family. The word lomilomi also is used for massage in Samoa and East Futuna. In Samoa, it is also known as lolomi and milimili. In East Futuna, it is also called milimili, fakasolosolo, amoamo, lusilusi, kinikini, fai’ua. The Māori call it roromi and mirimiri. In Tonga massage is fotofota, tolotolo, and amoamo. In Tahiti it is rumirumi. On Nanumea in Tuvalu, massage is known as popo, pressure application is kukumi, and heat application is tutu. Massage has also been documented in Tikopia in the Solomon Islands, in Rarotonga and in Pukapuka in Western Samoa.
Manual lymphatic drainage is a technique used to gently work and stimulate the lymphatic system, to assist in reduction of localized swelling. The lymphatic system is a network of slow moving vessels in the body that carries cellular waste toward the heart, to be filtered and removed. Lymph also carries lymphocytes, and other immune system agents. Manual lymphatic drainage claims to improve waste removal and immune function.
Medical Massage is a controversial term in the massage profession. Many use it to describe a specific technique. Others use it to describe a general category of massage and many methods such as deep tissue massage, myofascial release and triggerpoint therapy as well as osteopathic techniques, cranial-sacral techniques and many more can be used to work with various medical conditions.
Massage used in the medical field includes decongestive therapy used for lymphedema which can be used in conjunction with the treatment of breast cancer. Light massage is also used in pain management and palliative care. Carotid sinus massage is used to diagnose carotid sinus syncope and is sometimes useful for differentiating supraventricular tachycardia (SVT) from ventricular tachycardia. It, like the valsalva maneuver, is a therapy for SVT. However, it is less effective than management of SVT with medications.
A 2004 systematic review found single applications of massage therapy "reduced state anxiety, blood pressure, and heart rate but not negative mood, immediate assessment of pain, and cortisol level", while "multiple applications reduced delayed assessment of pain", and found improvements in anxiety and depression similar to effects of psychotherapy. A subsequent systematic review published in 2008 found that there is little evidence supporting the use of massage therapy for depression in high quality studies from randomized controlled trials.
The Metamorphic Technique is a gentle form of foot, hand and head massage that can be carried out by anyone with a brief training in the technique. It draws on reflexology in its theory and approach.
Myofascial release refers to the manual massage technique for stretching the fascia and releasing bonds between fascia, integument, and muscles with the goal of eliminating pain, increasing range of motion and equilibrioception. Myofascial release usually involves applying shear compression or tension in various directions, or by skin rolling.
Pediatric massage is the complementary and alternative treatment that uses massage therapy, or "the manual manipulation of soft tissue intended to promote health and well-being" for children and adolescents.
Postural Integration (PI)
Postural Integration (PI) is a process-oriented bodywork combining deep tissue massage with breathwork, body movement and awareness as well as emotional expression.
Prostate massage was once the most popular therapeutic maneuver used to treat prostatitis. According to the Prostatitis Foundation "it used to be, in the age before antibiotics (before about 1960 for prostatitis), doctors performed massage when their patients had prostatitis. In some cases it was enough to cure them of the disease. ... it fell out of common practice with the advent of antibiotics."
Reflexology is based on the principle that there are reflexes in the hands and feet that relate to every organ, gland, and system of the body.
Shiatsu (指圧) (shi meaning finger and atsu meaning pressure) is a type of alternative medicine consisting of finger and palm pressure, stretches, and other massage techniques. There is no convincing data available to suggest that shiatsu is an effective treatment for any medical condition.
Also known as manual therapy, manipulative therapy, or manual & manipulative therapy, this is a physical treatment primarily used on the neuromusculoskeletal system to treat pain and disability. It most commonly includes kneading and manipulation of muscles, joint mobilization and joint manipulation.
A stone massage uses cold or water-heated stones to apply pressure and heat to the body. Stones coated in oil can also be used by the therapist delivering various massaging strokes. The hot stones used are commonly Basalt stones (or lava rocks) which over time have become extremely polished and smooth. As the stones are placed along the recipient's back, they help to retain heat which then deeply penetrates into the muscles.
Structural Integration's aim is to unwind the strain patterns residing in the body's myofascial system, restoring it to its natural balance, alignment, length, and ease. This is accomplished by deep, slow, fascial and myofascial manipulation, coupled with movement re-education. Various brands of Structural Integration are Rolfing, Hellerwork, Guild for Structural Integration, Aston Patterning, Soma, and Kinesis Myofascial Integration.
Swedish massage uses five styles of strokes. The five basic strokes are effleurage (sliding or gliding), petrissage (kneading), tapotement (rhythmic tapping), friction (cross fiber or with the fibers) and vibration/shaking. Swedish massage has shown to be helpful in reducing pain, joint stiffness, and improving function in patients with osteoarthritis of the knee over a period of eight weeks. The development of Swedish massage is often inaccurately credited to Per Henrik Ling, though the Dutch practitioner Johann Georg Mezger applied the French terms to name the basic strokes. The term "Swedish" massage is actually only recognized in English and Dutch speaking countries, and in Hungary. Elsewhere (including Sweden) the style is referred to as "classic massage".
Known in Thailand as นวดแผนโบราณ (Nuat phaen boran, IPA: [nûət pʰɛ́ːn boːraːn]), meaning "ancient/traditional massage", Traditional Thai massage (Nuad Boran) is generally based on a combination of Indian and Chinese traditions of medicine.
Thai massage – or Nuat Thai – combines both physical and energetic aspects. It is a deep, full-body massage progressing from the feet up, and focusing on sen or energy lines throughout the body, with the aim of clearing blockages in these lines, and thus stimulating the flow of blood and lymph throughout the body. It draws on yoga, acupressure and reflexology.
Traditional Chinese massage
Massage of Chinese Medicine is known as An Mo (按摩, pressing and rubbing) or Qigong Massage, and is the foundation of Japan's Anma. Categories include Pu Tong An Mo (general massage), Tui Na An Mo (pushing and grasping massage), Dian Xue An Mo (cavity pressing massage), and Qi An Mo (energy massage). Tui na (推拿) focuses on pushing, stretching, and kneading muscles, and Zhi Ya (指壓) focuses on pinching and pressing at acupressure points. Technique such as friction and vibration are used as well.
The Trager approach combines movement and touch, especially rocking and shaking, to educate the body/mind.
Trigger point therapy
Sometimes confused with pressure point massage, this involves deactivating trigger points that may cause local pain or refer pain and other sensations, such as headaches, in other parts of the body. Manual pressure, vibration, injection, or other treatment is applied to these points to relieve myofascial pain. Trigger points were first discovered and mapped by Janet G. Travell (President Kennedy's physician) and David Simons. Trigger points have been photomicrographed and measured electrically. and in 2007 a paper was presented showing images of Trigger Points using MRI. These points relate to dysfunction in the myoneural junction, also called neuromuscular junction (NMJ), in muscle, and therefore this modality is different from reflexology, acupressure and pressure point massage.
Watsu, developed by Harold Dull at Harbin Hot Springs, California, is a type of aquatic bodywork performed in near-body temperature water, and characterized by continuous support by the practitioner and gentle movement, including rocking, stretching of limbs, and massage. The technique combines hydrotherapy floating and immersion with shiatsu and other massage techniques. Watsu is used as a form of aquatic therapy for deep relaxation and other therapeutic intent.
Tables and chairs
Specialized massage tables and chairs are used to position recipients during massages. A typical commercial massage table has an easily cleaned, heavily padded surface, and a horseshoe-shaped head support that allows the client to breathe easily while lying face down and can be stationary or portable, while home versions are often lighter weight or designed to fold away easily. An orthopedic pillow or bolster can be used to correct body positioning.
Ergonomic chairs serve a similar function as a massage table. Chairs may be either stationary or portable models. Massage chairs are easier to transport than massage tables, and recipients do not need to disrobe to receive a chair massage. Due to these two factors, chair massage is often performed in settings such as corporate offices, outdoor festivals, shopping malls, and other public locations.
A Vichy shower is a form of hydrotherapy which uses a series of shower nozzles which spray large quantities of water over the client while they lie in a shallow wet bed, similar to a massage table, but with drainage for the water. The nozzles may usually be adjusted for height, direction, and temperature to suit the clients needs.
Dry-water massage bed
A dry-water massage bed uses jets of water to perform the massage of the client's muscles. These beds differ from a Vichy shower in that the client usually stays dry. Two common types are one in which the client lies on a waterbed-like mattress which contains warm water and jets of water and air bubbles and one in which the client lies on a foam pad and is covered by a plastic sheet and is then sprayed by jets of warm water, similar to a Vichy shower. The first type is sometimes seen available for use in malls and shopping centers for a small fee.
Cremes, Lotions, Gels, or Oils
Many different types of oils can be used including jojoba oil, fractionated coconut oil, grape seed oil, olive oil, almond oil, macadamia oil, sesame oil, pecan oil, mustard oil and (mineral) baby oil. Each oil has different properties and serves different purposes. Lotions, cremes and gels may also be used. Each lubricant has slightly different properties, and the choice tends to be a therapist’s preference. There are different views about the extent to which various oils and other substances are absorbed into the body through the skin. Salts are also used in association with oils to remove dry skin.
A body rock is a serpentine-shaped tool, usually carved out of stone. It is used to amplify the therapist's strength and focus pressure on certain areas. It can be used directly on the skin with a lubricant such as oil or corn starch or directly over clothing.
Medical and Therapeutic Use
The main professionals that provide therapeutic massage are massage therapists, athletic trainers, physical therapists and practitioners of many traditional Chinese and other eastern medicines. Massage practitioners work in a variety of medical settings and may travel to private residences or businesses. Contraindications to massage include deep vein thrombosis, bleeding disorders or taking blood thinners such as Warfarin, damaged blood vessels, weakened bones from cancer, osteoporosis, or fractures, bruising, and fever.
Practitioner Associations and Official Recognition of Professionals
The US based National Center for Complementary and Alternative Medicine recognizes over eighty different massage modalities. The most cited reasons for introducing massage as therapy have been client demand and perceived clinical effectiveness.
Many types of practices are associated with massage and include bodywork, manual therapy, energy medicine, and breathwork. Other names for massage and related practices include hands-on work, body/somatic therapy, and somatic movement education. Body-mind integration techniques stress self-awareness and movement over physical manipulations by a practitioner. Therapies related to movement awareness/education are closer to Dance and movement therapies. Massage can also have connections with the New Age movement and alternative medicine as well as being used by mainstream medical practitioners.
Peer-reviewed medical research has shown that the benefits of massage include pain relief, reduced trait anxiety and depression, and temporarily reduced blood pressure, heart rate, and state of anxiety. Theories behind what massage might do include blocking nociception (gate control theory), activating the parasympathetic nervous system, which may stimulate the release of endorphins and serotonin, preventing fibrosis or scar tissue, increasing the flow of lymph, and improving sleep, but such effects are yet to be supported by well-designed clinical studies.
Massage is hindered from reaching the gold standard of scientific research, which includes placebo-controlled and double blind clinical trials. Developing a "sham" manual therapy for massage would be difficult since even light touch massage could not be assumed to be completely devoid of effects on the subject. It would also be difficult to find a subject that would not notice that they were getting less of a massage, and it would be impossible to blind the therapist. Massage can employ randomized controlled trials, which are published in peer reviewed medical journals. This type of study could increase the credibility of the profession because it displays that purported therapeutic effects are reproducible.
Single Dose Effects
- Pain relief: Relief from pain due to musculoskeletal injuries and other causes is cited as a major benefit of massage. Acupressure or pressure point massage may be more beneficial than classic Swedish massage in relieving back pain. However, a meta-study conducted by scientists at the University of Illinois at Urbana-Champaign failed to find a statistically significant reduction in pain immediately following treatment.
- State anxiety: Massage has been shown to reduce state anxiety, a transient measure of anxiety in a given situation.
- Blood pressure and heart rate: Massage has been shown to temporarily reduce blood pressure and heart rate.
Multiple Dose Effects
- Pain relief: When combined with education and exercises, massage might help sub-acute, chronic, non-specific low back pain. Furthermore, massage has been shown to reduce pain experienced in the days or weeks after treatment.
- Trait anxiety: Massage has been shown to reduce trait anxiety; a person's general susceptibility to anxiety.
- Depression: Massage has been shown to reduce subclinical depression.
Massage has been shown to reduce neuromuscular excitability by measuring changes in the Hoffman's reflex (H-reflex) amplitude. A decrease in peak-to-peak H-reflex amplitude suggests a decrease in motoneuron excitability. Others explain, "H-reflex is considered to be the electrical analogue of the stretch reflex...and the reduction" is due to a decrease in spinal reflex excitability. Field (2007) confirms that the inhibitory effects are due to deep tissue receptors and not superficial cutaneous receptors, as there was no decrease in H-reflex when looking at light fingertip pressure massage. It has been noted that "the receptors activated during massage are specific to the muscle being massaged", as other muscles did not produce a decrease in H-reflex amplitude.
Massage and Proprioception
Proprioceptive studies are much more abundant than massage and proprioception combined, yet researchers are still trying to pinpoint the exact mechanisms and pathways involved to get a fuller understanding. Proprioception may be very helpful in rehabilitation, though this is a fairly unknown characteristic of proprioception, and "current exercises aimed at 'improving proprioception' have not been demonstrated to achieve that goal". Up until this point, very little has been studied looking into the effects of massage on proprioception. Some researchers believe "documenting what happens under the skin, bioelectrically and biochemically, will be enabled by newer, non-invasive technology such as functional magnetic resonance imaging and continuous plasma sampling" .
Because the art and science of massage is a globally diverse phenomenon, different legal jurisdictions sometimes recognize and license individuals with titles, while other areas do not. Examples are:
- Registered Massage Therapist (RMT) Canada
- Remedial Massage Therapist (RMT) New Zealand
- Certified Massage Therapist (CMT) New Zealand
- Licensed Massage Practitioner (LMP)
- Licensed Massage Therapist (LMT)
- Licensed Massage and Bodywork Therapist (LMBT) North Carolina
- Therapeutic Massage Therapist (TMT) South Africa
In some jurisdictions, practicing without a license is a crime.
In Canada only four provinces regulate massage therapy: British Columbia, Ontario, Newfoundland and Labrador, and New Brunswick. The College of Massage Therapists of Ontario (CMTO) has set a level of 2,200 practice hours in both Ontario and Newfoundland and Labrador, with New Brunswick following this standard as well as British Columbia (which required 3,000 hours until recently). Quebec has a voluntary registration under the Quebec Federation of massage therapists (FMQ), the "Alliance québécoise des thérapeutes naturels"., but neither are regulated by provincial law, and there are an additional 25 or so other associations also operating in Quebec.
Most types of massage, with the exception of some traditional Chinese medicine are not regulated in China. Although illegal in China, some of the smaller businesses are fronts for prostitution. These are called falangmei (发廊妹 "hairdressing salon sisters").
France requires three years of study and two final exams in order to get a license 
In Germany massage is regulated by the government on a federal and national level. Only someone who has completed 3,200 hours of training (theoretical and practical) can use the professional title "Masseur und Medizinischer Bademeister" or Medical Masseur and Spa Therapist. This person can prolong his training depending on the length of professional experience to a Physiotherapist (1 year to 18 months additional training). The Masseur is trained in Classical Massage, Myofascial Massage, Exercise and Movement Therapy. During the training they will study: Anatomy, Physiology, Pathology, Gynecology, Podiatry, Psychiatry, Psychology, Surgery, and probably most importantly Dermiatry and Orthopedics. They are trained in Electrotherapy, and Hydrotherapy. Hydrotherapy includes: Kneipp, Wraps, underwater Massage, therapeutic washing, Sauna and Steambath. A small part of their training will include special forms of massage which are decided by the local college, for example: Foot reflex zone massage, Thai Massage etc. Finally a graduate is allowed to treat patients under the direction of a doctor. He is regulated by the professional body which regulates Physiotherapists. This includes the restriction on advertising and oath of confidentiality to clients.
In India, massage therapy is licensed by The Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) under the Ministry of Health and Family Welfare (India) in March 1995. Massage therapy is based on Ayurveda, the ancient medicinal system that evolved around 600 BC. In ayurveda, massage is part of a set of holistic medicinal practices, contrary to the independent massage system popular in some other systems. In Siddha, Tamil traditional medicine from south India, massage is termed as "Thokkanam" and is classified in to nine types, each for specific variety of disease.
In Japan, shiatsu is regulated but oil massage and Thai massage are not. Although prostitution is illegal, prostitutes posing as massage therapists in fashion health shops and pink salons are fairly common in the larger cities.
In Mexico massage therapists, called "sobadores", combine massage using oil or lotion with a form of acupuncture and faith. Sobadores are used to relieve digestive system problems as well as knee and back pain. Many of these therapists work out of the back of a truck, with just a curtain for privacy. By learning additional holistic healer's skills in addition to massage, the practitioner may become a curandero.
In many parts of Mexico prostitution is legal and prostitutes are allowed to sell sexual massage. These businesses are often confined to a specific area of the city, such as the Zona Norte in Tijuana.
In New Zealand, massage is unregulated. There are two levels of registration with Massage New Zealand, the professional body for massage therapists within New Zealand, although neither of these levels are government recognised. Registration at the Certified Massage Therapist level denotes competency in the practice of relaxation massage. Registration at the Remedial massage therapist denotes competency in the practice of remedial or orthopedic massage. Both levels of registration are defined by agreed minimum competencies and minimum hours.
In South Africa, massage is regulated, but enforcement is poor. The minimum legal requirement to be able to practice as a professional massage therapist is a 2 year diploma in Therapeutic Massage and registration with The Allied Health Professions Council of SA (AHPCSA). The 2 year qualification includes 240 credits, about 80 case studies, and about 100 hours community service.
In Thailand, Thai massage is officially listed as one of the branches of traditional Thai medicine, recognized and regulated by the government. It is considered to be a medical discipline in its own right and is used for the treatment of a wide variety of ailments and conditions. Massage schools, centers, therapists, and practitioners are increasingly regulated by the Ministries of Education and Public Health in Thailand.
There are no national regulations relating to commercial massage or massage therapy in the UK, although various jurisdictions have licensing requirements for businesses performing massage.
According to research done by the American Massage Therapy Association, as of 2012 in the United States there are between 280,000 and 320,000 massage therapists and massage school students. As of 2011, there were more than 300 accredited massage schools and programs in the United States. Most states have licensing requirements that must be met before a practitioner can use the title "massage therapist", and some states and municipalities require a license to practice any form of massage. If a state does not have any massage laws then a practitioner need not apply for a license with the state. However, the practitioner will need to check whether any local or county laws cover massage therapy. Training programs in the US are typically 500–1000 hours in length, and can award a certificate, diploma, or degree depending on the particular school. There are around 1,300 programs training massage therapists in the country and study will often include anatomy and physiology, kinesiology, massage techniques, first aid and CPR, business, ethical and legal issues, and hands on practice along with continuing education requirements if regulated. The Commission on Massage Therapy Accreditation (COMTA) is one of the organizations that works with massage schools in the U.S. and currently (Aug 2012) there are approximately 300 schools that are accredited through this agency.
Forty-three states, the District of Columbia and five Canadian provinces currently offer some type of credential to professionals in the massage and bodywork field---usually licensure, certification or registration. Thirty-eight states and the District of Columbia require some type of licensing for massage therapists. In the US, 39 states use the National Certification Board for Therapeutic Massage and Bodywork's certification program as a basis for granting licenses either by rule or statute. The National Board grants the designation Nationally Certified in Therapeutic Massage and Bodywork (NCTMB). There are two tests available and one can become certified through a portfolio process with equivalent training and experience. Between 10% and 20% of towns or counties regulate the profession. The National Certification offered by the NCBTMB does not mean that you can practice massage in any state. These local regulations can range from prohibition on opposite sex massage, fingerprinting and venereal checks from a doctor, to prohibition on house calls because of concern regarding sale of sexual services.
In the US, licensure is the highest level of regulation and this restricts anyone without a license from practicing massage therapy or by calling themselves that protected title. Certification allows only those who meet certain educational criteria to use the protected title and registration only requires a listing of therapists who apply and meet an educational requirement. It is important to note that a massage therapist may be certified, but not licensed. Licensing requirements vary per state, and often require additional criteria be met in addition to attending an accredited massage therapy school and passing a required state specified exam (basically the certification requirements in many states). In the US, most certifications are locally based. However, as of March 2014, some states still do not require a license or a certification. However, this is thought to change eventually as more regulatory bodies governing the profession of massage are established in each state. Furthermore, some states allow license reciprocity where massage therapists who relocate can relatively easily obtain a license in their new state. Not all states provide this option.
In late 2007, the Federation of State Massage Therapy Boards launched a new certification exam titled the MBLEx. Currently, 40 states have accepted this certification exam, along with the District of Columbia, Puerto Rico and the US Virgin Islands.
In 1997 there were an estimated 114 million visits to massage therapists in the US. Massage therapy is the most used type of alternative medicine in hospitals in the United States. Between July 2010 and July 2011 roughly 38 million adult Americans (18 percent) had a massage at least once.
People state that they use massage because they believe that it relieves pain from musculoskeletal injuries and other causes of pain, reduces stress and enhances relaxation, rehabilitates sports injuries, decreases feelings of anxiety and depression, and increases general well being.
In a poll of 25- to 35-year-olds, 79% said they would like their health insurance plan to cover massage. Companies that offer massage to their employees include Allstate, Best Buy, Cisco Systems, FedEx, Gannett (publisher of USA Today), General Electric, Google, Hewlett-Packard, Home Depot, JC Penney, Kimberly-Clark, Texas Instruments, and Yahoo!. In 2006 Duke University Health System opened up a center to integrate medical disciplines with CAM disciplines such as massage therapy and acupuncture. There were 15,500 spas in the United States in 2007 with about a third of the visitors being men.
The number of visits rose from 91 million in 1999 to 136 million in 2003, generating a revenue that equals $11 billion. Job outlook for massage therapists is also projected to grow at 20% between 2010 and 2020 by the Bureau of Labor Statistics, or faster than average.
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