Massage

Massage therapy
Massage in Frankfurt, Germany.
NCCAM Manipulative and body-based methods Modality Professionalized
This article is part of the branches of Complementary and alternative medicine series.

Massage is the working of superficial and deeper layers of muscle and connective tissue using various techniques, to enhance function, aid in the healing process, and promote relaxation and well-being. 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.

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. Target tissues may include muscles, tendons, ligaments, fascia, skin, joints, or other connective tissue, as well as lymphatic vessels, or organs of the gastrointestinal system. Massage can be applied with the hands, fingers, elbows, knees, forearm, and feet. There are over eighty different recognized massage modalities. The most cited reasons for introducing massage as therapy have been client demand and perceived clinical effectiveness.

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. The massage subject may be fully or partly unclothed. Parts of the body may be covered with towels or sheets. Those who practice massage as a career are referred to as massage therapists. Most states in the US have licensing requirements for massage therapists.

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History

Drawings of accupressure points on Sen lines at Wat Pho temple in Thailand.

Ancient and medieval times

Writings on massage have been found in many ancient civilizations including Rome, Greece, India, Japan, China, Egypt and Mesopotamia. A possible biblical reference from c.493 BC documents daily "treatments" with oil of myrrh as a part of the beauty regimen of the wives of Xerxes (Esther, 2:12). Hippocrates wrote in 460 BC that "The physician must be experienced in many things, but assuredly in rubbing".

The Ancient Chinese book called Huangdi Neijing by the Yellow Emperor recommended "massage of skin and flesh". The technique of massage abortion, involving the application of pressure to the pregnant abdomen, has been practiced in Southeast Asia for centuries. One of the bas reliefs decorating the temple of Angkor Wat in Cambodia, dated circa 1150, depicts a demon performing such an abortion upon a woman who has been sent to the underworld. This is believed to be the oldest known visual representation of abortion.

In Romania some illnesses were helped by a massage in which the client was trodden on by a tame bear.

Modern times

Marathon runners receiving massages at the 2004 ING Taipei International Marathon

China: In modern times, massage in China has developed by absorbing western ideas into the traditional framework. It is widely practiced and taught in hospital and medical schools and is an essential part of 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. Massage was used up until the 1960s and 1970s by nurses to help ease patients’ pain and help them sleep.

Because it is illegal to advertise or offer sexual services in much of the United States, the term "massage therapy" has been used in an attempt to provide a distinction between sexual and non-sexual services.

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: The 1996 Summer Olympics in Atlanta was the first time that massage was offered as a core medical service. 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.

Equipment

Massage tables

Massage chairs in use

Tables and chairs

Specialized massage tables and chairs are used to position clients 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. 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 for the practitioner to transport than massage tables, and clients 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.

Vichy shower

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.

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.

Lubricant

Many different types of oils can be used including fractionated coconut oil, grape seed oil, olive oil, almond oil, macadamia oil, sesame oil, pecan oil, and mustard oil. Each oil has different properties and serves different purposes. Lotions, cremes and gels are also. Each lubricant has slightly different properties, and the choice tends to be a therapists preference. Salts are also used in association with oils to remove dry skin. Heat rocks are also used for relaxing muscles.

Body rock

A body rock is a serpentine-shaped tool, usually carved out of stone. It's 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.

Massage methods

The main professionals that provide massage include massage therapists, athletic trainers, physical therapists and practitioners of many traditional Chinese and other eastern medicines. Massage practitioners work in a variety of medical and recreational 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.

Acupressure massage

Main article: Acupressure

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.

Indian Traction Massage in marma therapy given in Sreepathy cvn kalari for intervertebral disc prolapse

Anma massage

Main article: Anma

Anma is a traditional Japanese massage involving kneading and deep tissue work.

Ayurvedic massage

Ayurveda is a natural health care system originating in India that incorporates massage, yoga, meditation and herbal remedies. Ayurvedic massage, also known as Abhyangha is usually performed by one or two therapists using a heated blend of herbal oils based on the ayurvedic system of humors.

Balinese massage

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 as a result of the treatment. Balinese hot stones are an option.

Barefoot deep tissue massage

Barefoot deep tissue, also known as barefoot compressive deep tissue, or barefoot sports massage, is a blend of Eastern barefoot techniques, such as barefoot Shiatsu massage, coupled with a Western manual medicine, encompassing deep tissue, myofascial release, trigger point therapy, transverse friction, compression, tension, shear, PNF, stretching, as well as parasympathetic response, on clothed clients using no oil. Dara Torres, 41-year-old Olympian, received barefoot compression massage on a daily basis in her training program.

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 elbow or thumb, and is ideal for large muscles, such as in thigh, or for long-duration upper trapezius compressions. The unclothed cousins of this modality are Keralite, Yumeiho, Barefoot Lomi Lomi, Fijian Barefoot, Chavutti Thirummal.

Ashiatsu Oriental Bar Therapy, which is a form of barefoot effleurage, combines western science and contemporary American ingenuity, for therapists who specialize in deep tissue work using myofascial and Swedish techniques performed by the massage therapist's feet.

Bowen therapy

Main article: Bowen technique

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. Because this technique is so gentle, so Bowen Therapy can be suitable for newborn baby to elderly. It is based on practices developed by Australian Tom Bowen and the practitioners are all over the world.

Breema massage

Main article: Breema

Breema bodywork is performed on the floor with the recipient fully clothed. It consists of rhythmical and gentle leans and stretches.

Champissage massage

Main article: Champissage

Champissage is a massage technique focusing on the head, neck and face that is believed to balance the chakras.

Deep tissue massage

Deep tissue massage is designed to relieve severe tension in the muscle and the connective tissue or fascia. This type of massage focuses on the muscles located below the surface of the top muscles. Deep tissue massage is often recommended for individuals who experience consistent pain, are involved in heavy physical activity (such as athletes), and patients who have sustained physical injury. It is not uncommon for receivers of deep tissue massage to have their pain replaced with a new muscle ache for a day or two. Deep tissue work varies greatly.

The term “deep tissue” is often misused to identify a massage that is performed with sustained deep pressure. Deep tissue massage is a separate category of massage therapy, used to treat particular muscular-skeletal disorders and complaints and employs a dedicated set of techniques and strokes to achieve a measure of relief. It should not be confused with “deep pressure” massage, which is one that is performed with sustained strong, occasionally intense pressure throughout an entire full-body session, and that is not performed to address a specific complaint. Deep tissue massage is applied to both the superficial and deep layers of muscles, fascia, and other structures. The sessions are often quite intense as a result of the deliberate, focused work. When a client asks for a massage and uses the term “deep tissue”, more often than not he or she is seeking to receive a full-body session with sustained deep pressure throughout. If a practitioner employs deep tissue techniques on the entire body in one session, it would be next to impossible to perform; it might lead to injury or localized muscle and nerve trauma, thereby rendering the session counterproductive.

Esalen massage

Main article: Esalen Institute

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.

Hilot massage

Main article: Hilot

Hilot is a traditional healing technique from the Philippines that also includes massage techniques. The massage techniques relax stressed muscles. Hilot also includes joint manipulations to help relax stressed muscles.

Hilot encompasses a wide variety of techniques beyond the treatment of stressed muscles. Hilot can be used to reset sprained joints, diagnose and treat musculoligamentous and musculoskeletal ailments, and even to aid in giving birth and to induce abortion.

Dislocated joints can also be reset by hilot after an X-ray has been done on affected body parts and medical experts advised that the same body parts are safe to be massaged.

After giving birth, hilot can be done on the mother and the baby born of normal delivery for 10 consecutive days so that they may recover easily. Hilot should not be done on mothers who deliver via caesarian section.

Hilot also uses banana leaves and herbs for enhanced efficacy.

Massage in Tarifa, Spain.

Lomi Lomi and indigenous massage of Oceania

Main article: Lomi Lomi

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.

Lymphatic drainage massage

Massage technique used to gently work and stimulate the lymphatic system, to assist in reduction of localised swelling

Medical massage

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 reiki, 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.

Meso-American massage

In Meso-America as in other areas of the world an indigenous form of soft tissue and structural massage has developed. Today this art survives thanks to the many Sobadoras/es or Hueseros/as that have handed-down these techniques via oral tradition.

Mobile massage

Given some of the main benefits of massage, many people prefer to have a therapist come to them to perform the treatment as opposed to visiting the therapist. Amongst other things, this type of treatment has the benefits of allowing the recipient to remain in their own environment with which they are likely most comfortable, to avoid the pre and post stresses of travelling to the therapist to receive their massage and of course to retire directly to a place of rest immediately following their massage. Therapists can bring a dedicated table with them on which to perform the massage or perform the treatment on the floor or the client's own bed. Mobile (or outcall) massages are particularly popular in big cities around the world where life can be more hectic than elsewhere and there are many operators of such services in places like London and New York.

Myofascial release massage

Main article: Myofascial release

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.

Myomassology

An integration of techniques including basic Swedish massage, aromatherapy, reflexology, shiatsu, energy balancing, and craniosacral therapy along with other modalities in conjunction with instruction in nutrition, meditation and yoga. The term Myomassology was coined by Irene Gauthier to describe her combined work of Swedish massage, craniosacral therapy, reflexology and body mechanics.

Postural integration (PI)

Main article: 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.

Reflexology massage

Main article: Reflexology

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.

Remedial massage

Massage techniques such as sports massage, trigger point therapy and PNF stretching combined for an overall curative approach.

Self massage

A few various techniques that are practiced on oneself, such as stroking the temples with strong pressure from front to back, rubbing the bottoms of the feet with one's knuckles or a wooden massage tool, and circular movement with thumb on palm of hand.

Shiatsu

Main article: Shiatsu

Shiatsu (指圧) (shi meaning finger and atsu meaning pressure) is a Japanese therapy that uses pressure applied with thumbs, fingers and palms to the same energy meridians as acupressure and incorporates stretching. It also uses techniques such as rolling, brushing, vibrating, grasping and, in one particular technique developed by Suzuki Yamamoto, pressure is applied with the feet on the person's back, legs and feet.

A hot stone massage.

Stone massage

Main article: Stone massage

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, releasing tension.

Structural integration

Main article: Structural integration

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 Kinesis Myofascial Integration and Rolfing.

Swedish massage

Swedish massage uses five styles of long, flowing strokes to massage. The five basic strokes are effleurage (sliding or gliding), petrissage (kneading), tapotement (rhythmic tapping), friction (cross fiber) 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. It has also been shown to be helpful in individuals with poor circulation . The development of Swedish massage is often inaccurately credited to Per Henrik Ling, though the Dutch practitioner Johan Georg Mezger adopted the French names to denote the basic strokes. The term "Swedish" massage is actually only recognized in English, Québécois or Dutch speaking countries. Elsewhere the style is referred to as "classic massage".

Thai Massage

Thai massage

Main article: Thai massage

Known in Thailand as นวดแผนโบราณ (Nuat phaen boran, IPA: [nûət pʰɛ́ːn boːraːn]), meaning "ancient/traditional massage", Thai massage originated in India and is based on ayurveda and yoga. The technique combines massage with yoga-like positions during the course of the massage; the northern style emphasizes stretching while the southern style emphasizes acupressure.

Traditional Chinese massage

Two types of traditional Chinese massage exist - Tui na (推拿) which focuses on pushing, stretching and kneading the muscle and Zhi Ya (指壓) which focuses on pinching and pressing at acupressure points. Both are based on principles from Traditional Chinese Medicine. Though in the Western countries Tui Na is viewed as massage, it is not. Massage of Chinese Medicine is known as Anmo(按摩）, which is the foundation of Japan's Anma.

Tui Na is Chinese Medicine's Physio-Therapy. Utilized for medical purposes instead of relaxation, Tui Na works to correct the patient's problems, from musculoskeletal conditions, to diseases, cancers and even minor and major headaches.

Within the foundation of Tui Na, Traditional Chinese Medicine principles are followed, from Meridian Applications to Herbal Formulas, Qigong Therapy and heated herbal application (Moxa). Technique applications such as friction and vibration are used as well.

Trager approach

Main article: Trager Approach

The Trager approach combines movement and touch 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.

Visceral manipulation

One form is Mayan abdominal massage which is practiced in many countries in Latin America. This type of massage may have been developed by Elijio Panti of Belize and brought to the United States by Rosita Arvigo.

Watsu

Main article: Watsu

Watsu is the combination of hydrotherapy and shiatsu developed by Harold Dull. The work is done in skin temperature water with both the therapist and practitioner in the water, usually a pool which is between 3.5 ft to 4 ft (100–120 cm) deep. The work entails much movement in the water and practitioners believe that it incorporates the activation of the energy lines derived from shiatsu.

Associated methods

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.

Beneficial effects

Le massage: scène au Hammam by Edouard Debat-Ponsan (1883)

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

Mechanical massage chairs at VivoCity in Singapore.

• 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 reduce blood pressure and heart rate as temporary effects.

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.
• Diseases: Massage has been used in an effort to improve symptoms, disease progression, and quality of life in HIV patients, however, this treatment is not scientifically supported.

Regulation

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

Canada

In Canada only three provinces regulate massage therapy: British Columbia, Ontario, Newfoundland and Labrador. The Canadian Massage Therapists Alliance (CMTA) has set a level of 2200 practice hours in both Ontario and Newfoundland and Labrador, and 3000 hours in British Columbia, which has the highest education standard in North America. Quebec has a voluntary registration under the Quebec Federation of massage therapists (FMQ) but is not regulated by law.

China

Most types of massage, with the exception of some traditional Chinese medicine are not regulated in China. Although illegal in China, many of the smaller massage parlors are fronts for prostitution. These are called falangmei (发廊妹 "hairdressing salon sisters").

France

France requires three years of study and two final exams in order to get a license.

Germany

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 (1year 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, Pediatry, 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.

India

In India, massage therapy is licenced 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.

Japan

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.

Mexico

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.

New Zealand

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.

South Korea

In South Korea, blind and visually impaired people can become licensed masseurs.

United States

In the United States there are about 300,000 licensed massage therapists. Most states in the United States require a license to practice massage therapy. 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.

Thirty-nine states, the District of Columbia and four 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, 32 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. 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.

In late 2007, the Federation of Massage State Boards Federation of State Massage Therapy Boards launched a new certification exam titled the MBLEx. Approximately 13 states have accepted this certification exam.

Prevalence in the United States

In 1997 there were an estimated 114 million visits to massage therapists in the US. Massage therapy is the most used type of complementary and alternative medicine in hospitals in the United States.

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 25-35 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.

See also

• Applied kinesiology
• Erotic massage
• Infant massage
• Massage for Relaxation
• Mechanotherapy
• Naprapathy
• Pediatric massage
• Physical medicine and rehabilitation

References

Notes

External links

• How Massage Works