What is Massage Therapy?

Massage therapy is a practice that dates back thousands of years. References to massage have been found in ancient writings from many cultures, including those of Ancient Greece, Ancient Rome, Japan, China, Egypt, and the Indian subcontinent.

Massage is the treatment and practice of soft tissue manipulation with physical, functional, and in some cases psychological purposes and goals.[1] 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”.[2][3] (In distinction the ancient Greek word for massage was anatripsis,[4] and the Latin was frictio). An older etymology may even have been the Hebrew me-sakj “to anoint with oil”.

Massage involves acting on and manipulating the client’s body with pressure (structured, unstructured, stationary, and/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, and/or organs of the gastrointestinal system. Massage can be applied with the hands, fingers, elbows, forearm, and feet. There are over eighty different massage modalities. [5] The most cited reasons for introducing massage have been client demand and perceived clinical effectiveness.[6]

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.

In the United States, massage therapy first became popular and was promoted for a variety of health purposes starting in the mid-1800s. In the 1930s and 1940s, however, massage fell out of favor, mostly because of scientific and technological advances in medical treatments. Interest in massage revived in the 1970s, especially among athletes.

There are many types of therapy; all involve manipulating the muscles and other soft tissues of the body by pressing, rubbing and moving muscles and other soft tissues of the body, primarily by using the hands, fingers, elbows and forearms of the practitioner. The aim is to increase the flow of blood and oxygen to the massaged area while helping restore normal and optimal muscle and supporting structure integrity.

People use massage therapy for a variety of health-related purposes, from treating specific diseases and conditions to pain relief (often from musculoskeletal conditions, but from other conditions as well); rehabilitate sports injuries; reduce stress; increase relaxation; address feelings of anxiety and depression; and aid general wellness.

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.

Who Provides Massage Therapy

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 or Physical Therapists) who also have massage training. This Backgrounder mainly uses the term massage therapist. Most massage therapists learn and practice more than one type of massage.

To learn massage, therapists attend state accredited schools or training programs. Board examinations and state licensure is also necessary.

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 or more 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.

What Massage Therapists Do in Treating Patients

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. He or she will likely perform some evaluations through touch. If she finds nothing that would make a massage inadvisable, he/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.

Why People Use Massage Therapy

In the 2002 national survey on Americans’ use of CAM, respondents who used a CAM therapy could choose from five reasons for using the therapy. The results for massage were as follows:

• They believed that massage combined with conventional medicine would help: 60 percent
• They thought massage would be interesting to try: 44 percent
• They believed that conventional medical treatments would not help: 34 percent
• Massage was suggested by a conventional medical professional: 33 percent
• They thought that conventional medicine was too expensive: 13 percent

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

How Massage Therapy Might Work

Scientists are studying massage to understand what effects massage therapy has on patients, how it has those effects, and why. Some aspects of this are better understood than others. For example, it is known that:

When certain forces are applied to the muscles, changes occur in the muscles (although those changes are not clearly understood or agreed upon).

Massage therapy typically enhances relaxation and reduces stress. Stress makes some diseases and conditions worse.

There are many more aspects that are not yet known or well understood scientifically, however. Some of the proposed theories 3 are that massage:

Might provide stimulation that may help block pain signals sent to the brain (the “gate control theory” of pain reduction).

Might 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 parasympatheticnervous system creates 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).

Might stimulate the release of certain chemicals in the body, such as serotonin or endorphins.

Might 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).

Might improve sleep, which has a role in pain and healing.

Might provide some health benefit from the interaction between therapist and patient.

More well-designed studies are needed to understand and confirm these theories and other scientific aspects of massage.

3 On this topic, see especially the reference by C.A. Moyer et al.

References

Sources are primarily recent reviews on the general topic of massage therapy in the peer-reviewed medical and scientific literature in English in the PubMed database, selected evidence-based databases, and Federal Government sources.

Alvarez DJ, Rockwell PG. Trigger points: diagnosis and management*. American Family Physician. 2002;65(4):653-660.

Barnes PM, Powell-Griner E, McFann K, Nahin RL. Complementary and alternative medicine use among adults: United States, 2002.* CDC Advance Report #343. 2004.

Cherkin DC, Sherman KJ, Deyo RA, et al. A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal manipulation for back pain*. Annals of Internal Medicine. 2003;138(11):898-907.

Corbin L. Safety and efficacy of massage therapy for patients with cancer.* Cancer Control:Journal of the Moffitt Cancer Center. 2005;12(3):158-164.

Dillard MH, Knapp S. Complementary and alternative pain therapy in the emergency department*. Emergency Medicine Clinics of North America. 2005;23(2):529-549.

Eisenberg DM, Cohen MH, Hrbek A, et al. Credentialing complementary and alternative medical providers*. Annals of Internal Medicine. 2002;137(12):965-973.

Ernst E. The safety of massage therapy*. Rheumatology. 2003;42(9):1101-1106.

Field T. Massage therapy effects*. American Psychologist. 1998;53(12):1270-1281.

Goldstone LA. Massage as an orthodox medical treatment past and future*. Complementary Therapies in Nursing and Midwifery. 2000;6(4):169-175.

Massage: Bottom Line Monograph. Natural Standard Web site. Accessed on August 22, 2006.

Massage Therapists: Occupational Outlook Handbook, 2006-2007 Edition. U.S. Bureau of Labor Statistics Web site. Accessed at http://www.bls.gov/oco/ocos295.htm on August 22, 2006.

Moyer CA, Rounds J, Hannum JW. A meta-analysis of massage therapy research*. Psychological Bulletin. 2004;130(1):3-18.

National Center for Complementary and Alternative Medicine. Manipulative and Body-Based Practices: An Overview. Bethesda, MD: National Center for Complementary and Alternative Medicine; 2004. NCCAM publication no. D238.

National Institute of Arthritis and Musculoskeletal and Skin Diseases. Osteoarthritis. Bethesda, MD: National Institute of Arthritis and Musculoskeletal and Skin Diseases; 2006. NIH publication no. 06-4617.

National Institute of Arthritis and Musculoskeletal and Skin Diseases. Osteoporosis: Coping With Chronic Pain. National Institute of Arthritis and Musculoskeletal and Skin Diseases Web site. Accessed at http://www.niams.nih.gov/bone/hi/osteoporosis_pain.htm on August 31, 2006.

Sherman KJ, Cherkin DC, Kahn J, et al. A survey of training and practice patterns of massage therapists in two U.S. states*. BioMed Central Complementary and Alternative Medicine. 2005;5:13.

Weerapong P, Hume PA, Kolt GS. The mechanisms of massage and effects on performance, muscle recovery and injury prevention*. Sports Medicine. 2005;35(3):235-256.

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