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Massage is the practice of soft tissue manipulation with physical (anatomical), functional (physiological), and in some cases psychological purposes and goals. 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". An older etymology may even have been the Hebrew me-sakj "to anoint with oil". In distinction the ancient Greek word for massage was anatripsis, and the Latin was frictio.
Massage involves acting on and manipulating 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, 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.
Ancient and medieval times
Writings on massage have been found in many ancient civilizations including Rome, Greece, India, Japan, China, Egypt and Mesopotamia. A biblical reference from c.493 BC documents daily massage with olive oil and myrrh as a part of the beauty regimen of the wives of Xerxes (Esther, 2:9-12). 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.
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 1800s 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, such services are sometimes advertised as "massage," hence the rise of the term "massage therapy" 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.
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.
Many different types of oils can be used including fractionated coconut oil, grape seed oil, macadamia oil, sesame oil, pecan oil, and mustard oil. Aromatherapy oils such as neroli oil and pine oil can also be mixed with carrier oils. Salts are also used in association with oils to remove dry skin.
Practitioners of massage include massage therapists, athletic trainers and physical therapists. 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, and fever.
Acupressure (a blend of "acupuncture" and "pressure") is a traditional Chinese medicine (TCM) technique derived from acupuncture. In acupressure physical pressure is applied to acupuncture points by the hand, elbow, or with various devices.
Anma is a traditional Japanese massage involving kneading and deep tissue work.
Ayurveda is a natural health care system originating in India that incorporates massage, yoga, meditation and herbal remedies. Ayurvedic massage, also known as Abhyanga is usually performed by one or two therapists using a heated blend of herbal oils based on the ayurvedic system of humors.
Balinese massage techniques are gentle which makes the patient feel relaxed and calm throughout. The techniques include skin rolling, kneading, stroking, etc. 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
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 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 Swedish techniques performed by the massage therapists feet.
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. It is based on practices developed by Australian Tom Bowen.
Breema bodywork is performed on the floor with the recipient fully clothed. It consists of rhythmical and gentle leans and stretches.
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 also not uncommon for receivers of Deep Tissue Massage to become sore or even bruised over the next few days, though there should be no pain to the client during a session if the therapist is doing the work correctly.
Esalen Massage was developed by Charlotte Selver and 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 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 is used to reset dislocated and sprained joints, diagnose and treat musculoligamentous and musculoskeletal ailments, and even to aid in giving birth and to induce abortion.
Hoffman massage is a system of intuitive massage and bodywork developed by Bronson Bertschinger. The main idea behind the Hoffman system of massage and bodywork is based on the facts that humans are very complex and consist of material, emotional, subtle and spiritual energy. We are too complex to fit into a routine style of treatment that many massage schools and styles teach. Hoffman massage uses techniques that are aimed to affect and balance many systems of the body in the treatment. Techniques very from deep touch to very subtle energetic healing.
Lomi Lomi 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 Maori 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.
Massage used in the medical field includes decongestive therapy used for lymphedema which can be used in conjunction with the treatment of breast cancer. 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.
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.
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.
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.
Raynor Massage has a goal of finding any tension in the muscles and any blockage in the flow of chi and getting rid of it. Usually it is a very deep tissue form of massage with an emphasis on deep abdominal massage and "emotional releases".
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.
Russian Massage has three phases. The first phase is gentle, slow and mild. The second phase is hard, deep and fast. The third phase is similar to the first phase which is slow and gentle. The massage therapist applies honey.
Shiatsu (指圧) ("shi" meaning finger and "atsu" meaning pressure.) is an eastern (oriental) born 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 persons back, legs and feet (special set up is required for the "foot" shiatsu).
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 river stones 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's aim is to unwind the strain patterns residing in your 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 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 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 not really known in the country of Sweden, where it is called "classic massage".
Known in Thailand as นวดแผนโบราณ (Nuat phaen boran, IPA: [nuɑt pʰɛn boraːn][missing tone]), 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.
The Trager approach combines movement, massage and education.
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.
One form is Mayan abdominal massage which is practiced in many countries in Latin America. This type of massage was developed by Elijio Panti of Belize and brought to the United States by Rosita Arvigo. Even though Panti was a respected and well known user of Mayan massage, he did not develop this modality. "Mayan Massage" techniques have been used since before the Spanish conquest and is still practiced today by many Sobadores or Hueseros.
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.
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 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. In one study, cancer patients self-reported symptomatic relief of pain. This study, however, did not include a placebo control group so these effects may be due to the placebo effect or regression towards the mean. 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.
- Attention: After massage, EEG patterns indicate enhanced performance and alertness on mathematical computations, with the effects perhaps being mediated by decreased stress hormones.
- Other: Massage also stimulates the immune system by increasing peripheral blood lymphocytes (PBLs). However, this immune system effect is only observed in aromatherapy massage, which includes sweet almond oil, lavender oil, cypress oil, and sweet marjoram oil. It is unclear whether this effect persists over the long term.
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, involving stretching, has been shown to help with spastic diplegia resulting from Cerebral palsy in a small pilot study. The researchers warn that these results should "be viewed with caution until a double-blind controlled trial can be conducted". 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.
In the United States there are about 90,000 massage therapists. 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 State Massage Therapy Boards launched a new certification exam titled the MBLEx. Approximately 13 states have accepted this certification exam.
In Canada only three provinces regulate massage therapy: British Columbia, Ontario, and Newfoundland and Labrador. The Canadian Massage Therapists Alliance (CMTA) has set a level of 2200 practice hours in Ontario, and Newfoundland and Labrador and 3000 hours in British Columbia, which has the highest education standard in North America.
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 Medizinische 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, Gyancology, Pediatry, Psychiatry, Psychology, Surgery, and probably most importantly Dermiatry and Orthopedics. They are tranined in Electrotherapy, and Hydrotherapy. Hydrotherapy includes: Kneipp, Wraps, underwater Massage, therapuetic 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 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.
Because the art and science of massage is a globally diverse phenomenon, different legal jurisdictions sometimes recognize and license individuals with titles. 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
Prevalence in the United States
In 1997 there was 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 (which runs USA Today), General Electric, 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.
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- Applied kinesiology
- Erotic massage
- Massage therapist organizations
- Physical medicine and rehabilitation
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