Massage therapy

Definition

Massage therapy is the scientific manipulation of the soft tissues of the body, consisting primarily of manual (hands-on) techniques such as applying fixed or movable pressure, holding, and moving muscles and body tissues.

Purpose

Generally, massage is delivered to improve the flow of blood and lymph (fluid in lymph glands, part of immune system), to reduce muscular tension or flaccidity, to affect the nervous system through stimulation or sedation, and to enhance tissue healing. Therapeutic massage may be recommended for children and adults to deliver benefits such as the following:

• reducing muscle tension and stiffness
• relieving muscle spasms
• increasing joint and limb flexibility and range of motion
• increasing ease and efficiency of movement
• relieving points of tension and overall stress; inducing relaxation
• promoting deeper and easier breathing
• improving blood circulation and movement of lymph
• relieving tension-related headaches and eyestrain
• promoting faster healing of soft tissue injuries, such as pulled muscles and sprained ligaments
• reducing pain and swelling related to injuries
• reducing the formation of scar tissue following soft tissue injuries
• enhancing health and nourishment of skin
• improving posture by changing tension patterns that affect posture
• reducing emotional or physical stress and reducing anxiety
• promoting feelings of well-being
• increasing awareness of the mind-body connection and improving mental awareness and alertness generally

Massage therapy may also be recommended for its documented clinical benefits such as improving pulmonary function in young asthma patients, reducing psychoemotional distress in individuals who suffer from chronic inflammatory bowel disease, helping with weight gain, improving motor development in premature infants, and enhancing immune system functioning.

Description

Massage therapy is one of the oldest healthcare practices known. References to massage are found in ancient Chinese medical texts written more than 4,000 years ago. Massage has been advocated in Western healthcare practices since the time of Hippocrates, the "father of medicine."

Massage therapy is the scientific manipulation of the soft tissues of the body for the purpose of normalizing those tissues and consists of a group of manual techniques that include applying fixed or movable pressure, holding, and/or causing movement to parts of the body. While massage therapy is applied primarily with the hands, sometimes the forearms or elbows are used. These techniques affect the muscular, skeletal, circulatory, lymphatic, nervous, and other systems of the body. The basic philosophy of massage therapy embraces the concept of vis Medicatrix naturae , which means "aiding the ability of the body to heal itself."

Touch is the fundamental medium of massage therapy. While massage can be described in terms of the type of techniques performed, touch is not used solely in a mechanistic way in massage therapy. Because massage usually involves applying touch with some degree of pressure and movement, the massage therapist must use touch with sensitivity in order to determine the optimal amount of pressure to use for each person. For example, using too much pressure may cause the body to tense up, while using too little may not have enough effect. Touch used with sensitivity also allows the massage therapist to receive useful information via his or her hands about the individual's body, such as locating areas of muscle tension and other soft tissue problems. Because touch is also a form of communication, sensitive touch can convey a sense of caring to the person receiving massage, enhancing the individual's sense of self and well being.

In practice, many massage therapists use more than one technique or method in their work and sometimes combine several. Effective massage therapists ascertain each person's needs and then use the techniques that will best meet those needs.

Swedish massage is the most commonly used form of massage. It uses a system of long gliding strokes, kneading, and friction techniques on the more superficial layers of muscles, generally in the direction of blood flow toward the heart, and sometimes combined with active and passive movements of the joints. It is used to promote general relaxation, improve circulation and range of motion, and relieve muscle tension.

Deep tissue massage is used to release chronic patterns of muscular tension using slow strokes, direct pressure, or friction directed across the grain of the muscles. It is applied with greater pressure and to deeper layers of muscle than Swedish, which is why it is called deep tissue and is effective for chronic muscular tension.

Sports massage uses techniques that are similar to Swedish and deep tissue but are specially adapted to deal with the effects of athletic performance on the body and the needs of athletes regarding training, performing, and recovery from injury.

Neuromuscular massage is a form of deep massage that is applied to individual muscles. It is used primarily to release trigger points (intense knots of muscle tension that refer pain to other parts of the body) and also to increase blood flow. It is often used to reduce pain. Trigger point massage and myotherapy are similar forms.

Acupressure applies finger or thumb pressure to specific points located on the energy pathways or "meridians" in order to release blocked energy along these meridians that may be causing physical discomfort. The rebalance of energy flow releases tension and restores function of organs and muscles in the body. Shiatsu is a Japanese form of acupressure that applies these principles.

Massage therapy sessions can be at home or in a professional office. Most sessions are one hour. Frequency of massage sessions can vary widely as needed based on

the condition being treated. The cost of massage therapy varies according to geographic location, experience of the massage therapist, and length of the massage. In the United States, as of 2004, the average range is from $35 to $60 for a one-hour session.

The first appointment generally begins with information gathering, such as the reason for getting massage therapy, physical condition and medical history, and other areas. The client is asked to remove clothing to one's level of comfort. Undressing takes place in private, and a sheet or towel is provided for draping. The massage therapist will undrape only the part of the body being massaged. The individual's modesty is respected at all times. The massage therapist may use an oil or cream, which is quickly absorbed into the skin.

Insurance coverage for massage therapy varies widely. There tends to be greater coverage in states that license massage therapy. In most cases, a physician's prescription for massage therapy is needed. Once massage therapy is prescribed, authorization from the insurer may be needed if coverage is not clearly spelled out in one's policy or plan.

Massage therapy may be recommended for children to help relieve conditions such as allergies , anxietyand stress, arthritis, asthma and bronchitis , joint or limb injuries, post-surgical muscle rehabilitation, chronic and temporary pain, circulatory problems, depression, digestive disorders, tension headaches, sleep problems or insomnia, myofascial pain, sports injuries , and eating problems associated with temporomandibular joint dysfunction.

Precautions

Massage is comparatively safe; however, it should not be used if the child has one of the following conditions.

• advanced heart disease
• hypertension (high blood pressure)
• phlebitis
• thrombosis
• embolism
• kidney failure

If the child has cancer , massage is not advisable if the cancer is the kind that can spread to other organs (metastatic cancer) or if it involves tissue damage due to chemotherapy or other treatment. Massage may also not be advisable if the child has any of the following conditions.

• a cold
• an infectious disease
• a contagious skin conditions
• an acute inflammation
• an infected injuries
• an unhealed fractures
• dislocations
• is postoperative with a condition in which pain and muscular splinting are increased
• has frostbite
• has large hernias
• has torn ligaments
• has any condition prone to hemorrhage
• has a psychosis
• has any other psychological state that may impair communication or perception

Massage should not be used locally on affected areas (i.e., avoid using massage on the specific areas of the body that are affected by the condition) for the following conditions: eczema, goiter (thyroid dysfunction), and open skin lesions. Massage may be used on the areas of the body that are not affected by these conditions. The decision to use massage must be based on whether it may cause harm. A physician's recommendation is appropriate before a child with any health condition receives massage therapy.

Preparation

Going for a massage requires little in the way of preparation. Generally, one should be clean and should not eat just before a massage. Massage therapists generally work by appointment and usually provide information about how to prepare for an appointment. To receive the most benefit from a massage, parents should give the therapist accurate health information about the child and report discomfort of any kind (whether it is from the massage itself or due to the room temperature or any other distractions). The child can be encouraged to be as receptive to the process as possible.

Aftercare

There are no special recommendations for after a massage. A period of quiet activity or rest following the massage helps maintain full benefits from the procedure.

Risks

Massage therapy does not have notable side effects. Rather than feeling too relaxed or too mentally unfocused after a massage, a child may be both more relaxed and more alert.

Parental concerns

Parents who may not have experienced therapeutic massage themselves or who have doubts about its effectiveness may be interested in the results of research studies, particularly those conducted on groups of children. Well designed studies have documented the benefits of massage therapy for the treatment of acute and chronic pain, acute and chronic inflammation, chronic lymphedema, nausea , muscle spasm, various soft tissue dysfunctions, anxiety, depression, insomnia, and psychoemotional stress, which may aggravate mental illness.

Premature infants treated with daily massage therapy gain more weight and have shorter hospital stays than infants who are not massaged. A study of 40 low-birth-weight babies found that the 20 massaged babies had a 47 percent greater weight gain per day and stayed in the hospital an average of six fewer days than 20 infants who did not receive massage, resulting in a cost savings of approximately $3,000 per infant. Cocaine-exposed, preterm infants given massage three times daily for a 10-day period showed significant improvement. Results indicated that massaged infants had fewer postnatal complications and exhibited fewer stress behaviors during the 10-day period, had a 28 percent greater daily weight gain, and demonstrated more mature motor behaviors.

A study comparing 52 hospitalized depressed and adjustment disorder children and adolescents with a control group that viewed relaxation videotapes, found massage therapy subjects were less depressed and anxious and had lower saliva cortisol levels (an indicator of less depression).

Resources

BOOKS

Braun, Mary Beth, et al. Introduction to Massage Therapy. Baltimore, MD: Lippincott Williams & Wilkins, 2004.

Greene, Elliot, et al. The Psychology of the Body. Baltimore, MD: Lippincott Williams & Wilkins, 2003.

Hendrickson, Thomas G. Treating Soft Tissue Conditions with Orthopedic Massage. Baltimore, MD: Lippincott Williams & Wilkins, 2002.

Sinclair, Marybetts. Pediatric Massage Therapy. Baltimore, MD: Lippincott Williams & Wilkins, 2004.

ORGANIZATIONS

American Massage Therapy Association. 820 Davis Street, Suite 100, Evanston, IL 60201. Web site: http://www.amtamassage.org.

WEB SITES

National Certification Board for Therapeutic Massage and Bodywork. Available online at http://www.ncbtmb.com (accessed October 20, 2004).

L. Lee Culvert Elliot Greene