Massage

content provided by the Faculty of the Harvard Medical School

Massage

Before engaging in any complementary medical technique, you should be aware that many of these techniques have not been evaluated in scientific studies. Often, only limited information is available about their safety and effectiveness. Each state and each discipline has its own rules about whether practitioners are required to be professionally licensed. If you plan to visit a practitioner, it is recommended that you choose one who is licensed by a recognized national organization and who abides by the organization's standards. It is always best to speak with your primary health care provider before starting any new therapeutic technique.

Background

Massage techniques have been practiced for thousands of years in many cultures. There are references to massage in ancient records of Chinese, Japanese, Arabic, Egyptian, Indian, Greek and Roman nations.

Massage spread throughout Europe during the Renaissance. The basis of Swedish massage was developed in the 1800s by Per Henrik Ling (1776-1839) as a combination of massage and gymnastic exercises. George and Charles Taylor, two physicians who had studied in Sweden, introduced massage therapy to the United States in the 1850s. By the early 1930s, massage became a less prominent part of American medicine because of increased focus on the biological sciences. Interest increased in the 1970s, when massage became popular among athletes as a therapy to promote musculoskeletal injury healing and pain reduction, as well as well-being, relaxation, stress relief, sleep enhancement and quality-of-life.

Many approaches can be classified as massage therapy. Most involve the use of fixed or moving pressure or manipulation of the muscles and connective tissues. Practitioners may use their hands, forearms, elbows or feet with or without lubricants to aid the smoothness of massage strokes. Touch is central to massage and is used by therapists to locate painful or tense areas, to determine how much pressure to apply and to establish a therapeutic relationship with clients.

Swedish massage involves several techniques:

Effleurage - Superficial stroking in a direction away from the heart or deep stroking toward the heart

Friction - Deep muscle stimulation using the palm, elbow and forearm

Petrissage - Kneading in a circular pattern using fingers and thumbs, with the goals of enhancing circulation and stimulating muscle tissue

Tapotement - Rhythmic movements such as slapping or tapping to stimulate muscles, often used for athletes before competitions

Vibration - Delivered by the therapist's hands or by an electric vibrator

There are many other massage approaches used throughout the world. Examples include:

Aromatherapy massage uses essential oils with the goal of enhancing healing and relaxation.

Bindegewebsmassage focuses on connective tissues between the skin and muscles and is based on the theory that some ailments are caused by imbalances in these tissues.

Classical massage aims to provide calmness and relaxation and to encourage self-healing and revitalization.

Craniosacral therapists strive to locate and realign imbalances or blockages that are thought to exist in the soft tissues or fluids of the sacrum, head and spine.

Deep tissue massage uses slow strokes, friction and direct pressure across the muscles with fingers, thumbs or elbows, often with the goal of improving chronic muscular tension.

Esalen massage focuses on generating a deep state of relaxation and is often combined with other forms of massage.

Jin Shin Do involves finger pressure to acupoints of the body to release muscular tension or stress.

Manual lymph drainage uses light, rhythmic strokes with the goals of improving lymphatic flow and reducing edema, inflammation or neuropathy.

Myofascial release may be used by physical therapists, chiropractors or massage therapists. This approach involves gentle traction, pressure and body positioning to relax and stretch soft tissues.

Neuromuscular massage, triggerpoint massage and myotherapy are forms of deep massage administered to specific muscles or nerve points, used to release trigger points or entrapped nerves and to relieve pain.

On-site or chair massage is administered to the upper body of fully clothed clients.

Polarity treatment is based on the concept that rebalancing the body's energy fields with gentle massage can improve health and well-being.

Reflexology aims to return the body to its natural balance by targeting certain areas on the feet (or ears) believed to correspond with specific body parts or organs.

Rolfing® Structural Integration involves deep tissue massage aimed at relieving stress as well as improving mobility, posture, balance, muscle function and efficiency, energy and overall well-being.

Shiatsu emphasizes finger pressure not only at acupoints but also along the body's meridians. This type of massage can incorporate palm pressure, stretching and other manual techniques.

Sports massage is similar to Swedish massage but is adapted specifically for athletes.

St. John's neuromuscular technique may be used for chronic pain conditions that involve the musculoskeletal system.

The Trager approach involves relearning patterns of movement to improve efficiency and well-being.

Tibetan massage may be performed on any of several areas of the body, based on the practitioner's judgment of the patient's energy flow (for example, head, neck, vertebra, abdomen, legs).

Many other variations and styles of massage or touch exist, often developed in specific regions of the world.

Most massage approaches involve the client lying face down on a platform or table with a sheet covering the lower body. Depending on the technique, sessions may last from 15 to 90 minutes. Many clients fall asleep during therapy. Environment is considered integral to massage therapy and often consists of a comfortable, warm, quiet location. Soothing repetitive low-volume music or sounds may be played in the background.

Massage therapy practices may be based in a therapist's home, a private practice office, a hospital, spa, athletic club, hair salon, hotel or airport or outdoors. Some practitioners will travel to a client's home or office. Sports massage may be administered in a gym or locker-room setting.

In the United States, licensure requirements for administering massage therapies vary from state to state. Some practitioners are licensed as nurses, physical therapists, massage therapists or other types of health care professionals. Some have attended extensive programs that grant professional degrees. However, many massage practitioners are not licensed, and national or international organizations have not agreed on standards. The International Therapy Examinations Council offers testing in this area.

It is recommended that patients seeking a massage therapist for medical reasons discuss the choice of massage practitioner with their primary health care provider. References and training history should be checked before starting a therapeutic program.

Theory

There are many theories about how massage may work, although none has been scientifically proven. There is limited research in this area. It is suggested that massage may have local effects on muscles and soft tissues, reduce inflammation, soften or stretch scar tissue, reduce the buildup of lactic acid in muscles, stimulate oxygenation of tissues, break up adhesions, induce muscle fiber relaxation and stimulate healing of connective tissues or damaged muscles. Other proposed effects include immune system enhancement, reduction of blood pressure, central nervous system relaxation and sedation, parasympathetic stimulation, blockage of sensations from nerves that sense pain (the "gate theory"), stimulation of blood and lymphatic circulation, decreases in heart rate, increases in skin temperature, endorphin release, alteration of hormones such as cortisol, stimulation of substance P release, stimulation of somatostatin release, sleep enhancement or removal of blood toxins. Practitioners suggest that Swedish massage may assist the body in delivering nutrients and removing waste products from various tissues.

There is little high-quality research of massage. Scientifically based conclusions about the effectiveness of massage cannot be drawn at this time for any health condition.

Evidence

Scientists have studied massage for the following health problems:

Unproven Uses

Massage has been suggested for many other uses, based on tradition or on scientific theories. However, these uses have not been thoroughly studied in humans, and there is limited scientific evidence about safety or effectiveness. Some of these suggested uses are for conditions that are potentially life-threatening. Consult with a health care provider before using massage for any use.

Potential Dangers

Reports of adverse effects of massage are rare, although this area is not well studied. Bone fractures, discomfort, skin bruising, swelling of massaged tissues and a case of liver hematoma (internal bruising) have been reported.

Areas of the body where there are fractures, weakened bones from osteoporosis or cancer, open or healing skin wounds, skin infections, recent surgery or blood clots should not be massaged. Individuals with bleeding disorders or low platelet counts or those taking blood-thinning medications (such as heparin or warfarin) should avoid vigorous massage. Allergies or skin irritation can occur with some essential oils used in massage.

Pregnant women should speak with their health care provider before beginning massage therapy, particularly if massage to the abdominal area is involved. In general, touch-based therapies should be used cautiously in people with a history of physical abuse. Massage should not cause pain to the client.

Massage should not be used as a substitute for more proven therapies. Massage has not been evaluated as a method to diagnose medical conditions.

Summary

Various types of massage are used throughout the world for many health conditions. Relief of pain, anxiety, muscle spasm or tension or depression and athletic event preparation are common uses. There is limited reliable scientific evidence in these areas, and it remains unclear if massage is effective for any specific health condition. Massage should not be used as a substitute for more proven therapies, and it is not a diagnostic technique. Massage should be used cautiously in pregnant women and in those at risk of fracture or bleeding.

The information in this monograph was prepared by the professional staff at Natural Standard, based on thorough systematic review of scientific evidence. The material was reviewed by the Faculty of the Harvard Medical School with final editing approved by Natural Standard.

Resources

1. An organization that produces scientifically based reviews of complementary and alternative medicine (CAM) topics

2. A division of the U.S. Department of Health & Human Services dedicated to research

Selected Scientific Studies: Massage

Natural Standard reviewed more than 500 articles to prepare the professional monograph from which this version was created.

Some of the more recent studies are listed below:

1. Blanc-Louvry I, Costaglioli B, Boulon C, et al. Does mechanical massage of the abdominal wall after colectomy reduce postoperative pain and shorten the duration of ileus? Results of a randomized study. J Gastrointest Surg 2002;6(1):43-49.

2. Bowles EJ, Griffiths DM, Quirk L, et al. Effects of essential oils and touch on resistance to nursing care procedures and other dementia-related behaviours in a resident care facility. Internat J Aromather 2002;12(1):22-29.

3. Brosseau L, Casimiro L, Milne S, et al. Deep transverse friction massage for treating tendonitis. Cochrane Database Syst Rev 2002;(2):CD003528.

4. Callaghan MJ. The role of massage in the management of the athlete: a review. Br J Sports Med 1993;27(1):28-33.

5. Ernst E. Does post-exercise massage treatment reduce delayed onset muscle soreness? A systematic review. Br J Sports Med 1998;32(3):212-214.

6. Ernst E. Massage therapy for low back pain: a systematic review. J Pain Symptom Manage 1999;17(1):65-69.

7. Field T, Henteleff T, Hernandez-Reif M, et al. Children with asthma have improved pulmonary functions after massage therapy. J Pediatr 1998;132(5):854-858.

8. Field T. Massage better than relaxation therapy for fibromyalgia. J Clin Rheumatol 2002;8(2):72-76.

9. Furlan AD, Brosseau L, Imamura M, et al. Massage for low-back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine 2002;27(17):1896-1910.

10. Hernandez-Reif M, Martinez A, Field T, et al. Premenstrual symptoms are relieved by massage therapy. J Psychosom Obstet Gynaecol 2000;21(1):9-15.

11. Trotter JF. Hepatic hematoma after deep tissue massage. N Engl J Med 1999;341(26):2019-2020.

12. Vickers A, Ohlsson A, Lacy JB, et al. Massage for promoting growth and development of preterm and/or low birth-weight infants (Cochrane Review). The Cochrane Library 2002;(2).

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Last updated:	August 21, 2006