Massage

Overview

What is massage?

Massage is a "hands-on" therapy in which muscles and other soft tissues of the body are manipulated to improve health and well-being. Varieties of massage range from gentle stroking and kneading of muscles and other soft tissues to deeper manual techniques. Massage has been practiced as a healing therapy for centuries in nearly every culture around the world. It helps relieve muscle tension, reduce stress, and evoke feelings of calmness. Although massage affects the body as a whole, it particularly influences the activity of the musculoskeletal, circulatory, lymphatic, and nervous systems.

What is the history of Massage?

The use of massage for healing purposes dates back 4,000 years in Chinese medical literature and continues to be an important aspect of Traditional Chinese Medicine (TCM) today. A contemporary form of massage known as Swedish massage was introduced to the United States in the 1850s. By the end of the 19 ^th century, a significant number of American doctors were practicing this manual technique and the nation's first massage therapy clinics opened its doors to the public.

In the early 20 ^th century, the rise of technology and prescription drugs began to overshadow massage therapy. For the next several decades, massage remained dormant and only a few therapists continued to practice the "ancient" technique. During the 1970s, however, both the general public as well as the medical profession began to take notice of alternative medicine and mind-body therapies, which thrust massage therapy back into the limelight. Today, there are more than 125,000 massage therapists practicing in the United States and their numbers are growing rapidly to keep up with the more than 80 million massage therapy appointments made every year.

Are there many types of massage?

There are nearly 100 different massage and body work techniques. Each technique is uniquely designed to achieve a specific goal. The most common types practiced in the United States include:

• Aromatherapy massage: Essential oils from plants are massaged into the skin in order to enhance the healing and relaxing effects of massage. Essential oils are believed to have a powerful effect on mood by stimulating two structures deep in the brain known to store emotions and memory. (See the Aromatherapy monograph for more details)  
• Craniosacral massage: Gentle pressure is applied to the head and spine to correct imbalances and restore the flow of cerebrospinal fluid in these areas.
• Lymphatic massage: Light, rhythmic strokes are used to improve the flow of lymph (colorless fluid that helps fight infection and disease) throughout the body. One of the most popular forms of lymphatic massage, Manual Lymphatic Drainage (MLD), focuses on draining excess lymph. MLD is commonly used after surgery (such as a mastectomy for breast cancer) to reduce swelling.
• Myofascial release: Gentle pressure and body positioning are used to relax and stretch the muscles, fascia (connective tissue), and related structures. Both physical therapists and massage therapists who are appropriately trained use this technique.
• On-site/chair massage : Popular in offices and other public places, on-site massage therapists use a portable chair to deliver brief, upper body massages to fully-clothed people.
• Polarity therapy : A form of energy healing, polarity therapists stimulate and balance the flow of energy within the body to enhance health and well-being.
• Reflexology: Specialized thumb and finger techniques are applied to the hands and/or feet. Reflexologists believe that these areas contain "reflex points" or direct connections to specific organs and structures throughout the body.
• Rolfing: Pressure is applied to the fascia (connective tissue) to stretch it, lengthen it, and make it more flexible. This goal of this technique is to realign the body so that it conserves energy, releases tension, and functions better. 
• Shiatsu: Gentle finger and hand pressure are applied to specific points on the body to relieve pain and enhance the flow of energy (known as qi ) through the body's energy pathways (called meridians). Shiatsu is widely used in Traditional Chinese Medicine (TCM). 
• Sports massage : Often used on professional athletes and other active individuals, sports massage can enhance performance and prevent and treat sports-related injuries.  
• Swedish massage: A variety of strokes and pressure techniques are used to enhance the flow of blood to the heart, remove waste products from the tissues, stretch ligaments and tendons, and ease physical and emotional tension.
• Trigger point massage: Pressure is applied to "trigger points" (tender areas where the muscles have been damaged) to alleviate muscle spasms and pain.  

How does massage work?

When a practitioner massages soft tissue, electrical signals are transmitted both to the local area and throughout the body. These signals help heal damaged muscle, stimulate circulation, clear waste products via the lymphatic system, boost the activity of the immune system, reduce pain and tension, and induce a calming effect. They may also enhance a general sense of well-being by stimulating the release of endorphins (natural pain-killers and mood elevators) and reducing levels of certain stress hormones.

What happens during a massage therapy session?

At your first massage therapy session, the practitioner will ask you about any symptoms you may have (like low back pain) and will also ask questions about your medical history. The practitioner may also initiate a discussion about what you expect to achieve from the massage session.

The therapist leaves the room while you undress and lay down on the massage table. A sheet is used as a drape during the session and is moved only to expose the part of the body being worked on at any given time. Massage oil or lotion is often used to reduce friction between the practitioner's hands and your skin. The room is kept warm and free of distractions. The therapist may have soft music playing in the background and frequently asks whether he or she is applying too much or too little pressure.

The manner in which a practitioner massages your body depends on the problem being treated. A massage session can last from 15 to 90 minutes and may include a schedule of follow-up visits, depending on the severity of your situation.

What is massage good for?

In general, massage is believed to support healing, boost energy, reduce recovery time after an injury, ease pain, and enhance relaxation, mood, and well-being. In addition to being of value for many musculoskeletal problems such as low back pain, osteoarthritis, fibromyalgia, and sprains and strains, massage may relieve depression in people with chronic fatigue syndrome, ease chronic constipation (when the technique is performed in the abdominal area), decrease swelling after a mastectomy (removal of the breast), alleviate sleep disorders, and improve self-image. In the workplace, massage has been shown to melt away stress and enhance mental alertness.

Studies have found that massage relieves chronic back pain more effectively than other treatments (including acupuncture and conventional medical care for this condition with education via books and videos) and, in many cases, costs less than other treatments for this common health problem. In addition, mothers and newborns also appear to benefit from massage. Mothers trained to massage their infants often feel less depressed and have a better emotional bond with their babies. Newborns who receive massage from their mothers also tend to cry less, and are more active, alert, and sociable. Premature babies who receive massage therapy have been shown to gain weight faster than preemies who do not receive this type of therapy. Infants who receive massage regularly may also sleep better, be less gassy or colicky, and have better body awareness as well as more regular digestion.

Studies have also shown that massage may be an effective treatment for young children and adolescents with a wide range of health problems including the following:

• Autism : Autistic children, who usually don't like being touched, show less autistic behavior and are more social and attentive after receiving massage therapy from their parents.
• Atopic dermatitis/Eczema : Children with this scaly, itchy skin problem seem to experience less redness, scaling, and other symptoms if receiving massage between flares. Massage should not be used when this skin condition is actively inflamed.
• Attention deficit hyperactivity disorder (ADHD): Massage   may improve mood in children with ADHD and help them feel less fidgety and hyperactive.  
• Bulimia: Studies have shown that adolescents with this eating disorder feel less depressed and anxious after receiving massage therapy.
• Cystic fibrosis: Massage may reduce anxiety and improve respiration in children with this lung condition.
• Diabetes : Massage may help regulate blood sugar levels and reduce anxiety and depression in children with diabetes.
• HIV : In a small study, teenagers with the human immunodeficiency virus (HIV) showed improved immune function and diminished feelings of depression and anxiety after receiving two massages per week for 12 weeks.
• Rheumatoid arthritis: Children with juvenile rheumatoid arthritis (JRA) have been shown to experience less pain, morning stiffness, and anxiety as a result of massage therapy.

Are there any risks associated with massage?

In general, massage is considered relatively safe. Pain or other rare negative side effects are generally caused by an extremely vigorous massage technique.

Women should be very cautious about receiving massages during pregnancy. If you are pregnant, be sure to find a therapist specifically trained to perform massages on pregnant women.

Even though massage is a useful technique to help regulate blood sugar over time, if you have diabetes you should check your blood sugar after a massage session because it may be too low just following a treatment. Plus, if you have diabetes and you are receiving massage on a regular basis, you should check your blood sugar frequently to evaluate for any changes over time.

Should anyone avoid massage?

Massage should be avoided by people with congestive heart failure, kidney failure, infection of the superficial veins (called phlebitis) or soft tissue (called cellulitis) in the legs or elsewhere, blood clots in the legs, bleeding disorders, and contagious skin conditions. If you have cancer, you must check with your doctor before considering massage because you should not receive such treatments under certain circumstances. For example, sometimes massage can damage tissue that is fragile from chemotherapy or radiation treatments. People with rheumatoid arthritis, goiter (a thyroid disorder characterized by an enlarged thyroid), eczema and other skin lesions should not receive massage therapy during flare-ups. Experts also advise that people with osteoporosis, high fever, few platelets or white blood cells, and mental impairment, as well as those recovering from surgery, may be better off avoiding massage. Also, be sure to let your massage therapist know any medications you are taking as the treatment may influence absorption or activity of both oral and topical medications.

What is the future of massage?

More research is needed to determine how effective massage therapy is, which health problems improve the most from this technique, and whether it is more cost-effective than other types of treatment. Although massage is usually offered in the community by private practitioners, it is slowly being integrated into a variety of healthcare settings, such as hospice care facilities and hospitals.

How can I find a practitioner?

Certified massage therapists complete a training program of 500 or more hours, take national board exams, and are licensed or registered in 29 states. To find a massage therapist in your area, contact the American Massage Therapy Association (AMTA), 820 Davis Street, Suite 100, Evanston, IL 60201; 847-864-0123; www.amtamassage.org .

Although the AMTA has a listing of massage therapists who specialize in a variety of techniques, you may also use different resources to locate practitioners who specialize in the following techniques:

• Lymphatic massage : Massage therapists and physical therapists with at least 500 hours of massage- or physical-therapy training can become certified in lymphatic massage by taking a 4-week training program. To find a therapist who practices lymphatic massage, contact North American Vodder Association of Lymphedema Therapists (NAVALT), P.O. Box 861, Chesterfield, OH 44026; 419-729-3258.  
• Reflexology: The American Reflexology Certification Board (ARCB) certifies reflexologists who undergo 100 hours of training and pass an exam. To find a qualified reflexologist, contact the ARCB, P.O. Box 620607, Littleton, CO 80162; 303-933-6921.  
• Rolfing : Contact the Rolf Institute of Structural Integration, P.O. Box 1868, Boulder, CO 80302-1868; 800-530-8875 or 303-449-5903; or www.rolf.org .
• Shiatsu : Contact the American Oriental Bodywork Therapy Association at 609-782-1616. 

Supporting Research

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Field T, Hernandez-Reif M, LaGreca A, Shaw K, Schanberg S, Kuhn C. Massage therapy lowers blood glucose levels in children with Diabetes Mellitus. Diabetes Spectrum. 1997;10:237-239.

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