What Is Massage Therapy?
Massage therapy is recognized as one of the oldest methods of healing, with references in medical texts nearly 4,000 years old. In fact, Hippocrates, known as the "father of medicine," referenced massage when he wrote, in the 4th century B.C.: "The physician must be acquainted with many things, and assuredly with rubbing."
Now days massage therapy, often referred to as bodywork or somatic therapy refers to the application of various techniques to the muscular structure and soft tissues of the body. All of the techniques are used for the benefit of the musculoskeletal, circulatory-lymphatic, nervous, and other systems of the body.
Massage Therapy Index
1. What is Massage Therapy?
The term massage therapy covers a group of practices and techniques. There are over 80 types of massage therapy. In all of them, therapists press, rub, and otherwise manipulate the muscles and other soft tissues of the body, often varying pressure and movement. They most often use their hands and fingers, but may use their forearms, elbows, or feet. Typically, the intent is to relax the soft tissues, increase delivery of blood and oxygen to the massaged areas, warm them, and decrease pain.
A few popular examples of this therapy are as follows:
- In Swedish massage, the therapist uses long strokes, kneading, and friction on the muscles and moves the joints to aid flexibility.
- A therapist giving a deep tissue massage uses patterns of strokes and deep finger pressure on parts of the body where muscles are tight or knotted, focusing on layers of muscle deep under the skin.
- In trigger point massage (also called pressure point massage), the therapist uses a variety of strokes but applies deeper, more focused pressure on myofascial trigger points--"knots" that can form in the muscles, are painful when pressed, and cause symptoms elsewhere in the body as well.
- In shiatsu massage, the therapist applies varying, rhythmic pressure from the fingers on parts of the body that are believed to be important for the flow of a vital energy called qi.
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2. Massage Therapy Education and Certification
A person who professionally provides massage therapy is most often called a massage therapist, although there are some other health care providers (such as Chiropractors and Physical Therapists) who also have massage training. Most massage therapists learn and practice more than one type of massage.
To learn massage, most therapists attend a school or training program, with a much smaller number training instead with an experienced practitioner. Many students are already licensed as another type of health care provider, such as a nurse.
There are about 1,300 massage therapy schools, college programs, and training programs in the United States. The course of study typically covers subjects such as anatomy and physiology (structure and function of the body); kinesiology (motion and body mechanics); therapeutic evaluation; massage techniques; first aid; business, ethical, and legal issues; and hands-on practice of techniques. These educational programs vary in many respects, such as length, quality, and whether they are accredited. Many require 500 hours of training, which is the same number of hours that many states require for certification. Some therapists also pursue specialty or advanced training.
At the end of 2004, 33 states and the District of Columbia had passed laws regulating massage therapy--for example, requiring that massage therapists graduate from an approved school or training program and pass the national certification exam in their field in order to practice. Cities and counties may have laws that apply as well. Professional organizations of massage therapists have not agreed upon the standards for recognizing that a massage therapist is properly and adequately trained.
Licenses and Certifications
Licenses or certifications for massage therapists include:
- LMT Licensed Massage Therapist
- LMP Licensed Massage Practitioner
- CMT Certified Massage Therapist
- NCTMB Has met the credentialing requirements (including passing an exam) of the National Certification Board for Therapeutic Massage and Bodywork, for practicing therapeutic massage and bodywork
- NCTM Has met the credentialing requirements (including passing an exam) of the National Certification Board for therapeutic Massage and Bodywork, for practicing therapeutic massage
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3. What Massage Therapists Do
Massage therapists work in a variety of settings, including private offices, hospitals, other clinical settings, nursing homes, studios, and sport and fitness facilities. Some also travel to patients' homes or workplaces to provide a massage.
Massage therapy treatments usually last for 30 to 60 minutes; less often, they are as short as 15 minutes or as long as 1.5 to 2 hours. For some conditions (especially chronic ones), therapists often advise a series of appointments. Therapists usually try to provide an environment that is as calm and soothing as possible (for example, by using dim lighting, soft music, and fragrances).
At the first appointment, a massage therapist will discuss your symptoms, medical history, the results you (and your health care provider, if applicable) desire, and possibly other factors such as your work and levels of stress. She will likely perform some evaluations through touch. If she finds nothing that would make a massage inadvisable, she will proceed with the massage. At any time, you can bring up questions or concerns.
During treatment, you will lie on a special padded table or sit on a stool or chair. You might be fully clothed (for example, for a "chair massage") or partially or fully undressed (in which case you will be covered by a sheet or towel; only the parts of your body that the therapist is currently massaging are exposed). Oil or powder helps reduce friction on the skin. The therapist may use other aids, such as ice, heat, fragrances, or machines. He may also provide recommendations for self-care, such as drinking fluids, learning better movement, and developing an awareness of your body.
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4. How Massage Therapy Works
According to the American Massage Therapy Association, research shows that massage therapy provides several important health benefits, including:
- Massage improves blood circulation, which aids in recovery of muscle soreness from physical activity.
- Massage relaxes muscles for an improved range of motion. The muscle relaxation also helps with insomnia.
- Massage leads to increased endorphin levels. The increase of endorphin levels is actually one of the greatest benefits of massage therapy. Endorphins are the chemicals the body produces that make you feel good, which is very effective in managing chronic pain.
- Massage therapy typically enhances relaxation and reduces stress. Stress makes some diseases and conditions worse.
- Massage provides stimulation that may help block pain signals sent to the brain (the "gate control theory" of pain reduction).
- Massage may shift the patient's nervous system away from the sympathetic and toward the parasympathetic. The sympathetic nervous system helps mobilize the body for action. When a person is under stress, it produces the fight-or-flight response (the heart rate and breathing rate go up, for example; the blood vessels narrow; and muscles tighten). The parasympathetic nervous systemcreates what some call the "rest and digest" response (the heart rate and breathing rate slow down, for example; the blood vessels dilate; and activity increases in many parts of the digestive tract).
- Massage may cause beneficial mechanical changes in the body--for example, by preventing fibrosis (the formation of scar-like tissue) or increasing the flow of lymph (a fluid that travels through the body's lymphatic system and carries cells that help fight disease).
- Massage may improve sleep, which has a role in pain and healing.
- Massage may provide some health benefit from the interaction between therapist and patient.
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5. Benefits of massage therapy
- Relaxes the whole body
- Loosens tight muscles
- Relieves tired and aching muscles
- Increases flexibility and range of motion
- Diminishes chronic pain
- Calms the nervous system
- Lowers blood pressure
- Lowers heart rate
- Enhances skin tone
- Assists in recovery from injuries and illness
- Strengthens the immune system
- Reduces tension headaches
- Reduces mental stress
- Improves concentration
- Promotes restful sleep
- Aids in mental relaxation
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6. Side Effects and Risks
Massage therapy appears to have few serious risks if appropriate cautions are followed. A very small number of serious injuries have been reported, and they appear to have occurred mostly because cautions were not followed or a massage was given by a person who was not properly trained.
Health care providers recommend that patients not have massage therapy if they have one or more of the following conditions:
- Deep vein thrombosis (a blood clot in a deep vein, usually in the legs)
- A bleeding disorder or taking blood-thinning drugs such as Warfarin
- Damaged blood vessels
- Weakened bones from osteoporosis, a recent fracture, or cancer
- A fever
- Any of the following in an area that would be massaged:
- An open or healing wound
- A tumor
- Damaged nerves
- An infection or acute inflammation
- Inflammation from radiation treatment
If you have one or more of the following conditions, be sure to consult your health care provider before having massage:
- Pregnancy
- Cancer
- Fragile skin, as from diabetes or a healing scar
- Heart problems
- Dermatomyositis, a disease of the connective tissue
- A history of physical abuse
Side effects of massage therapy may include:
- Temporary pain or discomfort
- Bruising
- Swelling
- A sensitivity or allergy to massage oils
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7. Neuromuscular Massage and Trigger Point Therapy
The most effective type of massage therapy for lower back pain is neuromuscular therapy. Neuromuscular therapy is also called Trigger Point Myotherapy. The American Academy of Pain Management recognizes this form of massage therapy as an effective treatment for back pain caused by soft tissue injury (such as a muscle strain).
Neuromuscular therapy consists of alternating levels of concentrated pressure on the areas of muscle spasm. The massage therapy pressure is usually applied with the fingers, knuckles, or elbow. Once applied to a muscle spasm, the pressure should not vary for ten to thirty seconds.
Muscles that are in spasm will be painful to the touch. The pain is caused by ischemic muscle tissue. Ischemia means the muscle is lacking proper blood flow, usually due to the muscle spasm. This in turn creates the following undesirable process:
- Because the muscle is not receiving enough blood, the muscle is also not receiving enough oxygen
- The lack of oxygen causes the muscle to produce lactic acid
- The lactic acid makes the muscle feel sore following physical activity.
After the muscle is relaxed through massage therapy, the lactic acid will be released from the muscle, and the muscle should start receiving enough blood and oxygen.
Neuromuscular therapy will feel painful at first, but the pressure of the massage should alleviate the muscle spasm. At this point, it is extremely important to communicate with the massage therapist regarding the pressure - whether the pressure is too much, too little, getting better, getting worse. The therapist should listen and respond accordingly. The massage therapy pressure should never be overly painful. In fact, most people describe the pressure as “good pain”.
Following a neuromuscular therapy massage, any soreness that presents itself should fade after twenty-four to thirty-six hours. The muscles that were tight should remain noticeably more relaxed for four to fourteen days, depending on stress, activity level, and severity of back pain prior to beginning massage therapy.
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8. Massage Therapy Considerations for Low Back Pain
The muscle spasm should relax in response to the pressure applied by the massage therapist. If the muscle does not relax in response to the pressure, there is usually inflammation present. Massage is not the best treatment option for inflamed muscles, and patients should consult their doctor for treatment for the inflammation.
Most muscle spasms require four massage treatments, usually over the course of six weeks, to achieve the best effect. If muscle spasms do not begin to respond to neuromuscular therapy within two massages, neuromuscular massage therapy may not be the best treatment option.
Massage therapy will produce the best results when combined with medical treatments such as physical therapy, chiropractic, or physician care. Many massage therapy professionals will work as part of an interdisciplinary healthcare team in overall patient evaluation and treatment.
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9. Massage Therapy Research Fact Sheet
Massage therapy has been shown to address serious health issues by relieving symptoms associated with a variety of conditions. Here’s a look at just some of the ways in which massage therapy can be effective.
9.1 Relieve Back Pain
More than 100 million Americans suffer from lower-back pain, and nearly $25 billion a year is spent in search of relief. A 2003 study showed that massage therapy produced better results and reduced the need for painkillers by 36 percent when compared to other therapies, including acupuncture and spinal modification. Today, massage therapy is one of the most common ways people ease back pain.
Source: Annals of Internal Medicine, June 3, 2003
A study on massage and back pain conducted at the Touch Research Institute at the University of Miami in 2001 found that: “Massage lessened lower back pain, depression and anxiety, and improved sleep. The massage therapy group also showed improved range of motion and their serotonin and dopamine levels were higher.”
Source: International Journal of Neuroscience, 106, 131-145.
9.2 Treat Migraines
Of the 45 million Americans who suffer from chronic headaches, more than 60 percent suffer from migraines. For many, it’s a distressing disorder that is triggered by stress and poor sleep. In a recent study, massage therapy recipients exhibited fewer migraines and better sleep quality during the weeks they received massage, and the three weeks following, than did participants that did not receive massage therapy. Another study found that in adults with migraine headaches massage therapy decreased the occurrence of headaches, sleep disturbances and distress symptoms. It also increased serotonin levels, believed to play an important role in the regulation of mood, sleep and appetite.
Sources: Annals of Behavioral Medicine, August 2006; International Journal of Neuroscience, 1998.
9.3 Ease Symptoms of Carpal Tunnel
Carpal tunnel syndrome is a progressively painful condition that causes numbness and tingling in the thumb and middle fingers. Traditional treatments for carpal tunnel range from a wrist brace to surgery. However, a 2004 study found that carpal tunnel patients receiving massage reported significantly less pain, reduced symptoms and improved grip strength than those patients who did not receive massage.
Source: Touch Research Institute, University of Miami School of Medicine, Journal of Bodywork and Movement Therapies, 8, 9-14.
9.4 Reduce Anxiety
An estimated 20 million Americans suffer from depression. A review of more than a dozen massage studies concluded that massage therapy helps relieve depression and anxiety by affecting the body’s biochemistry. In the studies reviewed, researchers measured the stress hormone cortisol in participants before and immediately after massage and found that the therapy lowered levels by up to 53 percent. Massage also increased serotonin and dopamine, and neurotransmitters that help reduce depression.
Source: Touch Research Institute, University of Miami School of Medicine.
9.5 Alleviate Side Effects of Cancer
Massage therapy is increasingly being applied to symptoms experienced by cancer patients, such as nausea, pain and fatigue. Researchers at Memorial Sloan-Kettering Cancer Center asked patients to report the severity of their symptoms before and after receiving massage therapy. Patients reported reduced levels of anxiety, pain, fatigue, depression and nausea, even up to two days later.
Source: Journal of Pain & Symptom Management, September 2004.
In a study of breast cancer patients, researchers found that those who were massaged three times a week reported lower levels of depression, anxiety and anger, while increasing “natural killer” cells and lymphocytes that help to battle cancerous tumors.
Source: Touch Research Institutes, University of Miami School of Medicine, Journal of Psychosomatic
Research, Volume 57, Issue 1, Pages 45-52, July 2004.
9.6 Lower Blood Pressure
Hypertension, if left unchecked, can lead to organ damage. Preliminary research shows that hypertensive patients who received three 10-minute back massages a week had a reduction in blood pressure, compared to patients who simply relaxed without a massage.
Source: Biological Research For Nursing, Vol. 7, No. 2, 98-105 (2005).
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