massage, treatment of superficial parts of the body by systematic rubbing, stroking, kneading, or slapping. Massages can be administered manually or with mechanical devices. They are sought most often to relieve muscle stiffness, spasms, or cramps and to relieve anxiety and tension. Gentle massage has a soothing action on the sensory nerves. More vigorous massage quickens the circulation and aids the muscles in disposing of accumulated waste products. Some methods of massage cause the muscles to contract and thus exercise them when movement of the entire body is not possible or desirable, as in illness or paralysis. However, there is no evidence that massage can reduce or alter fat or adipose tissue. Men and women who are trained in the art of massage are known as masseurs and masseuses, respectively.

Systematic, scientific manipulation of body tissues with the hands to relieve pain and reduce swelling, relax muscles, and speed healing after strains and sprains. It has been used for more than 3,000 years by the Chinese. Early in the 19th century, the Swedish physician Per Henrik Ling (1776–1839) devised a massage system for joint and muscle ailments, which was later extended to relieve deformities of arthritis and re-educate muscles following paralysis. Manipulations include light or hard stroking, compression (kneading, squeezing, and friction), and percussion (striking with the edges of the hands in rapid alternation). In acupressure, a style of massage derived from China, pressure is exerted on Chinese acupuncture points for healing effects. Seealso physical medicine and rehabilitation.

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Massage is the treatment and practice of soft tissue manipulation with physical, functional, and in some cases psychological purposes and goals. 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". (In distinction the ancient Greek word for massage was anatripsis , 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. The most cited reasons for introducing massage have been client demand and perceived clinical effectiveness.

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.

History

Ancient and medieval times

Writings on massage have been found in many ancient civilizations including Rome, Greece, Japan, China, Egypt, Mesopotamia and India. A biblical reference from c.493 BC documents daily massage with olive oil and myrrh as a part of the beauty regimen of the wives of Xerxes. (Esther, 2:9-12) Hippocrates wrote in 460 BC that "The physician must be experienced in many things, but assuredly in rubbing." The ancient Chinese book called Huangdi Neijing by the Yellow Emperor recommended "massage of skin and flesh." The technique of massage abortion, involving the application of pressure to the pregnant abdomen, has been practiced in Southeast Asia for centuries. One of the bas reliefs decorating the temple of Angkor Wat in Cambodia, dated circa 1150, depicts a demon performing such an abortion upon a woman who has been sent to the underworld. This is believed to be the oldest known visual representation of abortion. In Romania some illnesses were treated by a massage in which the client was trodden on by a tame bear..

Modern times

United States: Massage started to become popular in the United States in the middle part of the 1800s and was introduced by two New York physicians based on Per Henrik Ling's techniques developed in Sweden.

During the 1930s and 1940s massage's influence decreased as a result of medical advancements of the time, while in the 1970s massage's influence grew once again with a notable rise among athletes. Massage was used up until the 1960s and 1970s by nurses to help ease patients’ pain and help them sleep.

Because it is illegal to advertise or offer sexual services in most of the United States, such services are sometimes advertised as "massage".

United Kingdom: Massage is popular in the United Kingdom today and gaining. There are many private practitioners working from their own premises as well as those who operate from commercial venues.

Massage in sports, business and organizations: The 1996 Summer Olympics in Atlanta was the first time that massage was offered as a core medical service. Massage has been employed by businesses and organizations such as the U.S. Department of Justice, Boeing and Reebok.

Equipment

Tables and chairs

Specialized massage tables and chairs are used to position clients during massages. A typical commercial massage table has an easily cleaned, heavily padded surface, and a horseshoe-shaped head support that allows the client to breathe easily while lying face down and can be stationary or portable. An orthopedic pillow or bolster can be used to correct body positioning. Ergonomic chairs serve a similar function as a massage table. Chairs may be either stationary or portable models. Massage chairs are easier for the practitioner to transport than massage tables, and clients do not need to disrobe to receive a chair massage. Due to these two factors, chair massage is often performed in settings such as corporate offices, outdoor festivals, shopping malls, and other public locations.

Oil

Many different types of oils can be used including fractionated coconut oil, grape seed oil, macadamia oil, sesame oil, pecan oil, and mustard oil. Aromatherapy oils such as neroli oil and pine oil can also be mixed with carrier oils. Salts are also used in association with oils to remove dry skin.

Massage methods

Massage can be performed by a massage therapist, or by other health care professionals, such as chiropractors, osteopaths, athletic trainers, and/or physical therapists. Massage therapists work in a variety of medical and recreational settings and may travel to private residences or businesses. Contraindications to massage include deep vein thrombosis, bleeding disorders or taking blood thinners such as Warfarin, damaged blood vessels, weakened bones from cancer, osteoporosis, or fractures, and fever.

Acupressure

Acupressure (a blend of "acupuncture" and "pressure") is a traditional Chinese medicine (TCM) technique derived from acupuncture. In acupressure physical pressure is applied to acupuncture points by the hand, elbow, or with various devices.

Ashiatsu

Ashiatsu massage is an eastern (oriental) born therapy that is designed to rebalance your physical being by rebalancing your energy field ("shi" meaning finger and "astsu" meaning pressure.) Ashiatsu uses pressure applied with thumbs, fingers and palms to specific pressure points of the body. It also uses techniques such as rolling, brushing, vibrating, grasping and in one particular technique developed by Suzuki Yamamoto, pressure is applied with the feet on the persons back, legs and feet (special set up is required for the "foot" Ashiatsu.)

Ayurvedic massage

Ayurveda is a natural health care system originating in India that incorporates massage, yoga, meditation and herbal remedies. Ayurvedic massage, also known as Abhyanga is usually performed by one or two therapists using a heated blend of herbal oils based on the ayurvedic system of humors.

Bowen therapy

Bowen technique involves a rolling movement over fascia, muscles, ligaments, tendons and joints. It is said not to involve deep or prolonged contact with muscle tissues as in most kinds of massage, but claims to relieve muscle tensions and strains and to restore normal lymphatic flow. It is based on practices developed by Australian Tom Bowen.

Breema

Breema bodywork is performed on the floor with the recipient fully clothed. It consists of rhythmical and gentle leans and stretches.

Cachunga Massage

Traditional Persian Massage. Cachunga introduced to the Achaemenid Empire of ancient Persia by Darius the 8th. This is a massage that primarily focuses on the breasts of females. Cachunga is a deep tissue massage used with oil. It is based on a fondling motion, and is usually performed in the direction of the heart to promote circulation.

Champissage

Champissage is a massage technique focusing on the head, neck and face that is believed to balance the chakras.

Esalen Massage

Esalen Massage was developed by Charlotte Selver and works with gentle rocking of the body, passive joint exercises and deep structural work on the muscles and joints, together with an energetic balancing of the body.

Lomilomi

Lomilomi is the traditional massage of Hawaii. As an indigenous practice, it varies by island and by family.

Medical massage

Massage used in the medical field includes decongestive therapy used for lymphedema which can be used in conjunction with the treatment of breast cancer. Carotid sinus massage is used to diagnose carotid sinus syncope and is sometimes useful for differentiating supraventricular tachycardia (SVT) from ventricular tachycardia. It, like the valsalva maneuver, is a therapy for SVT. However, it is less effective than management of SVT with medications.

Myofascial release

Myofascial release refers to the manual massage technique for stretching the fascia and releasing bonds between fascia, integument, and muscles with the goal of eliminating pain, increasing range of motion and equilibrioception. Myofascial release usually involves applying shear compression or tension in various directions, or by skin rolling.

Anma

Anma is a traditional Japanese massage involving kneading and deep tissue work.

Reflexology massage

Reflexology involves massaging, squeezing or pushing parts of the feet, hands and ears with a goal of encouraging health throughout the body. This theory is based on a perceived energetic flow of "meridians" in the body, and is considered pseudoscientific.

Shiatsu

Shiatsu (指圧) is a form of Japanese massage that uses thumb pressure and works along the same energy meridians as acupressure and incorporates stretching.

Stone massage

A stone massage uses cold or water-heated stones to apply pressure and heat to the body. Stones coated in oil can also be used by the therapist delivering various massaging strokes.

Structural Integration

Structural Integration's aim is to unwind the strain patterns residing in your body's myofascial system, restoring it to its natural balance, alignment, length, and ease. This is accomplished by deep, slow, fascial and myofascial manipulation, coupled with movement re-education. Various brands of Structural Integration are Kinesis Myofascial Integration and rolfing

Swedish massage

Swedish massage uses five styles of long, flowing strokes to massage. The five basic strokes are effleurage (light touch), petrissage (kneading), tapotement (rhythmic tapping), friction (compression), and vibration. Swedish massage has shown to be helpful in reducing pain, joint stiffness, and improving function in patients with osteoarthritis of the knee over a period of eight weeks. The development of Swedish massage is credited to Per Henrik Ling though the Dutch practitioner Johan Georg Mezger adopted the French names to denote the basic strokes.

Thai massage

Known in Thailand as นวดแผนโบราณ (Nuat phaen boran, IPA ), meaning "ancient/traditional massage", Thai massage originated in India and is based on ayurveda and yoga. It was believed that the massage art was brought over to Thailand by Shivago Komarpaj over 2500 years ago. The technique combines massage with yoga-like positions during the course of the massage; the northern style emphasizes stretching while the southern style emphasizes acupressure.

Traditional Chinese massage

Two types of traditional Chinese massage exist - Tui na (推拿) which focusses on pushing, stretching and kneading the muscle and Zhi Ya (指壓) which focuses on pinching and pressing at acupressure points. Both are based on principles from Traditional Chinese Medicine.

Trager Approach

The Trager approach combines movement, massage and education.

Trigger point therapy

Also called a pressure point massage, this involves stimulating hypothetical trigger point that may refer pain sensations to other parts of the body. Manual pressure is applied to these points. Trigger point therapy was founded by Janet G. Travell and David Simons.

Visceral manipulation

One form is Mayan abdominal massage which is practiced in many countries in Latin America. This type of massage was developed by Elijio Panti of Belize and brought to the United States by Rosita Arvigo.

Watsu

Watsu is the combination of hydrotherapy and shiatsu developed by Harold Dull. The work is done in skin temperature water with both the therapist and practitioner in the water, usually a pool which is between 3.5 ft to 4 ft (100–120 cm) deep. The work entails much movement in the water and practitioners believe that it incorporates the activation of the energy lines derived from shiatsu.

Associated methods

Many types of practices are associated with massage and include Bodywork (alternative medicine), manual therapy, energy medicine, and breathwork. Other names for massage and related practices include hands-on work, body/somatic therapy, and somatic movement education. Body-mind integration techniques stress self-awareness and movement over physical manipulations by a practitioner. Therapies related to movement awareness/education are closer to Dance and movement therapies. Massage can also have connections with the New Age movement and alternative medicine as well as being used by mainstream medical practitioners.

Beneficial effects

Peer-reviewed medical research has shown that the benefits of massage include pain relief, reduced trait anxiety and depression, and temporarily reduced blood pressure, heart rate, and state anxiety. Theories behind what massage might do include blocking nociception (gate control theory), activating the parasympathetic nervous system which may stimulate the release of endorphins and serotonin, preventing fibrosis or scar tissue, increasing the flow of lymph, and improving sleep but such effects are yet to be supported by well designed clinical studies.

Massage is hindered from reaching the gold standard of scientific research which includes placebo-controlled and double blind clinical trials. Developing a "sham" manual therapy for massage would be difficult since even light touch massage could not be assumed to be completely devoid of effects on the subject. It would also be difficult to find a subject that would not notice that they were getting less of a massage and it would be impossible to blind the therapist. Massage can employ randomized controlled trials which are published in peer reviewed medical journals. This type of study could increase the credibility of the profession because it displays that purported therapeutic effects are reproducible.

Single dose effects

Pain relief: Relief from pain due to musculoskeletal injuries and other causes is cited as a major benefit of massage. In one study, cancer patients self-reported symptomatic relief of pain. This study, however, did not include a no treatment or placebo control group so these effect may be due to the placebo effect or regression towards the mean. Massage can also relieve tension headaches. Acupressure or pressure point massage may be more beneficial than classic Swedish massage in relieving back pain. However, a meta-study conducted by scientists at the University of Illinois at Urbana-Champaign failed to find a statistically significant reduction in pain immediately following treatment.

State anxiety: Massage has been shown to reduce state anxiety, a transient measure of anxiety in a given situation.

Blood pressure and heart rate: Massage has been shown to reduce blood pressure and heart rate as temporary effects.

Attention: After massage, EEG patterns indicate enhanced performance and alertness on mathematical computations, with the effects perhaps being mediated by decreased stress hormones.

Other: Massage also stimulates the immune system by increasing peripheral blood lymphocytes (PBLs). However, this immune system effect is only observed in aromatherapy massage, which includes sweet almond oil, lavender oil, cypress oil, and sweet marjoram oil. It is unclear whether this effect persists over the long term.

Multiple dose effects

Pain relief: When combined with education and exercises, massage might help sub-acute, chronic, non-specific low back pain. Furthermore, massage has been shown to reduce pain experienced in the days or weeks after treatment.

Trait anxiety: Massage has been shown to reduce trait anxiety; a person's general susceptibility to anxiety.

Depression: Massage has been shown to reduce subclinical depression.

Diseases: Massage, involving stretching, has been shown to help with spastic diplegia resulting from Cerebral palsy in a small pilot study. The researchers warn that these results should "be viewed with caution until a double-blind controlled trial can be conducted".

Massage has been used in an effort to improve symptoms, disease progression, and quality of life in HIV patients, however, this treatment is not scientifically supported.

Regulation

In the USA there are about 90,000 massage therapists. Training programs in the US are typically 500–1000 hours in length, and can award a certificate, diploma, or degree depending on the particular school. There are around 1,300 programs training massage therapists in the country and study will often include anatomy and physiology, kinesiology, massage techniques, first aid and CPR, business, ethical and legal issues, and hands on practice along with continuing education requirements if regulated. The Commission on Massage Therapy Accreditation (COMTA) is one of the organizations that works with massage schools in the U.S.. 38 states and the District of Columbia require some type of licencing for massage therapists. In the US, 32 states use the National Certification Board for Therapeutic Massage and Bodywork's certification program as a basis for granting licenses either by rule or statute. The National Board grants the designation Nationally Certified in Therapeutic Massage and Bodywork (NCTMB). There are two tests available and you can become certified through a porfolio process if you have equivalent training and experience. Between 10-20% of towns or counties regulate the profession. These local regulations can range from prohibition on opposite sex massage, fingerprinting and venereal checks from a doctor, to prohibition on house calls because of concern regarding sale of sexual services.

In the USA licensure is the highest level of regulation and this restricts anyone without a license from practicing massage therapy or by calling themselves that protected title. Certification allows only those who meet certain educational criteria to use the protected title and registration only requires a listing of therapists who apply and meet an educational requirement.

In Canada only three provinces regulate massage therapy : British Columbia, Ontario, and Newfoundland and Labrador. The Canadian Massage Therapists Alliance (CMTA) has set a level of 2200 practice hours in Ontario, and Newfoundland and Labrador and 3000 hours in British Columbia. In India, massage therapy is licenced by The Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) under the Ministry of Health and Family Welfare (India) in March 1995.

Because the art and science of massage is a globally diverse phenomenon, different legal jurisdictions sometimes recognize and license individuals with titles. Examples are:

• Registered Massage Therapist (RMT) Canada
• Certified Massage Therapist (CMT)
• Licensed Massage Practitioner (LMP)
• Licensed Massage Therapist (LMT)
• Licensed Massage and Bodywork Therapist (LMBT) North Carolina

Prevalence in the United States

In 1997 there was an estimated 114 million visits to massage therapists in the US. Massage therapy is the most used type of Complementary and alternative medicine in hospitals in the United States.

People state that they use massage because they believe that it relieves pain from musculoskeletal injuries and other causes of pain, reduces stress and enhances relaxation, rehabilitates sports injuries, decreases feelings of anxiety and depression, and increases general well being.

In a poll of 25-35 year olds 79% said they would like their health insurance plan to cover massage. Companies that offer massage to their employees include Allstate, Best Buy, Cisco Systems, FedEx, Gannett (which runs USA Today), General Electric, Hewlett-Packard, Home Depot, JC Penney, Kimberly-Clark, Texas Instruments and Yahoo. In 2006 Duke University Health System opened up a center to integrate medical disciplines with CAM disciplines such as massage therapy and acupuncture. There were 15,500 spas in the United States in 2007 with about a third of the visitors being men.

The number of visits rose from 91 million in 1999 to 136 million in 2003, generating a revenue that equals $11 billion.

See also

• Applied kinesiology
• Erotic massage
• Massage therapist organizations
• Physical medicine and rehabilitation

References

External links

• Glossary of bodywork
• How Massage Works