"The
physician must be experienced in many things, but most assuredly in rubbing." CC
Hippocrates
Hands-on
manipulation for healing is probably older than any other healing tradition.
The oldest written records of massage go back 3,000 years to China, but
of course it is much older than that. Touch and the laying on of hands
are human tendencies that seem to be in our genetic makeup.
Physicians
and healers of all forms and from all cultures have used hands-on manipulation
throughout history as an integral part of health care practice. In the
former Soviet countries, Germany, Japan and China, massage has continued
uninterrupted as massage therapists today
work alongside doctors as part of the health care team.
In
modern Germany, massage therapy is covered by national health insurance.
In China it is fully integrated into the health care system, where the
hospitals have massage wards. In one Shanghai hospital the massage department
covers two floors.
In
this country, the medical use of massage began to diminish in the early
part of this century with the evolution of pharmaceutical, surgical, and
technological medicine. It reached a nadir in the 1930's, 40's and 50's
because it was considered too time-intensive for the modern physician.
Massage therapy duties were gradually handed over to aides, who eventually
became the physical therapists of the modern era.
The
professionalization of massage therapy in the U.S. began in 1943 when the
graduating class of the College of Swedish Massage in Chicago decided to
band together and form an association with
29 charter members. What they created was destined to become the American
Massage Therapy Association (A.M.T.A.).
In
the 1960's, while modern medicine continued its march toward higher technology
and drugs and away from physician contact with patients, such concepts
as holistic health, self-improvement, and optimal health experienced a
rebirth. The 1970's brought even greater interest in health promotion and
a new openness to massage.
This
was followed by explosive growth in the varieties of massage and bodywork
available, and today there are now over eighty different varieties. The
term "bodywork" evolved as a generic term for referring to this broadening
field. It is now loosely used to incorporate massage and other forms of
manipulation.
In
the survey of alternative medicine that was published in the New England
Journal of Medicine in January 1993,[i]
massage therapy ranked third among the most frequently used forms of alternative
health care. According to Elliot Greene, President of the A.M.T.A., there
are now an estimated 50 thousand massage therapists of various kinds in
the U.S., and the A.M.T.A. may be the fastest growing organization of health
care providers in the country. At this writing it has over 18,000 members,
and its rolls have more than doubled in the last three years.
Education
KEY
PRINCIPLES
While
there are a wide variety of forms of massage therapy and bodywork, all
with their own theoretical or philosophical perspectives, there are certain
basic principles they all tend to hold in common.
Circulation
of Blood.
Perhaps the most basic principle in this field is that improved blood circulation
is beneficial for virtually all health conditions. Tension in the muscles
and other soft tissues can impair circulation, resulting in deficient supply
of nutrients and inadequate removal of wastes or toxins from the tissues
of the body. This in turn can lead to illness, structural and functional
problems or slower healing. Recognition of the importance of blood circulation
is implicit in all forms of massage and bodywork.
Movement
of Lymphatic Fluid.
The lymph system is almost as extensive as that of the blood. The circulation
of lymphatic fluid plays a key role in ridding the body of wastes, toxins,
and pathogens. The lymph system also benefits from massage, particularly
in conditions where lymphatic flow is impaired by injury or surgery (e.g.,
in post-mastectomy women).
Release
of Toxins.
Chronic tension or trauma to the soft tissues of the body can result in
the build-up of toxic by-products of normal metabolism. Hands-on techniques
help move the toxins through the body's normal pathways of release and
elimination.
Release
of Tension.
Chronic muscular tension, as a result of high-stress lifestyles, trauma,
or injury can accumulate and impair the body's structure and function.
Psychological well-being is also affected. Release of tension allows greater
relaxation, which has important physiological and psychological benefits.
Structure
and Function are Interdependent.
The musculoskeletal structure of the body affects function, and function
affects structure. Both can be adversely altered by stress or trauma. Massage
therapy and bodywork can help restore healthy structure and function, thereby
allowing better circulation, greater ease of movement, wider range of movement,
more flexibility, and the release of chronic patterns of tension.
Enhancement
of All Bodily Systems.
All bodily systems are affected by better circulation and more harmonious
functioning of the soft tissue and musculature. Internal organ systems
as well as the nervous system, the immune system, and other systems can
benefit. There can be an overall improvement in quality of life and physical
health.
Mind/Body
Integration. Mind
and body have a reciprocal relationship. Soma (body) affects psyche (mind)
and vice versa. Hence, there can be somato-psychic effects, in which the
conditions of the body affect the mind and emotions; and there can be psycho-somatic
effects, in which psychological or emotional conditions affect the body.
Change in one domain may cause change in the other. A habit or fixed pattern
in one may also impede change in the other, and require special attention.
Often psychotherapy and massage or bodywork complement
each other.
Reduction
of Stress.
Stress is increasingly believed to induce illness, and perhaps 80-90% of
all disease is stress-induced. Massage therapy is an effective non-drug
method for reducing stress and promoting relaxation.
Energy.
Many modalities in this tradition work with the flow of energy through
the body as a means to promote healing. Energy can be directed or encouraged
to move through and around the body in such ways as to have impact on the
physical structure and function of the body, as well as on emotional well-being.
This work may involve hands-on contact, or may be done with no contact
with the physical body.
According
to Joanna Chieppa, R.M.T., a faculty member at Heartwood Institute in Garberville,
California and an energy healing practitioner in Sonoma County, "It is
important for people to develop an awareness that the flow of energy in
and around the body is just as important to well-being as the flow of blood,
the flow of breath, the flow of cerebral spinal fluid C
that it is essential for the health of body, mind, and spirit."
VARIETIES
AND TECHNIQUES
For
this chapter, the sections on varieties and techniques are combined. As
stated earlier, there are over eighty different types of massage therapy
and bodywork. Many are variations on each other, often developed by a practitioner
who is trained in one particular approach and then goes on to develop his
or her own variety, with its own new "brand name."
Most
varieties can be broken down into the following five broad categories:
Traditional
European Massage
Contemporary
Western Massage
Structural/Functional/Movement
Integration
Oriental
Methods
Energetic
Methods
The
majority of activity in this field is oriented toward the traditional European
and contemporary western forms of massage, simply because there are such
large numbers of practitioners of these methods.
Traditional
European Massage
Traditional
European includes methods based on conventional western concepts of anatomy
and physiology, and soft tissue manipulation. There are five basic kinds
of soft tissue manipulation techniques: effleurage (long flowing or gliding
strokes, usually toward the heart, tracing the outer contours of the body),
petrissage (strokes that lift, roll or knead the tissue), friction (circular
strokes), vibration, and tapotement (percussion or tapping).
Traditional
European massage was brought to the U.S. by two doctors from New York who were
brothers C
Charles and George Taylor C
who studied in Sweden and introduced Americans to Swedish techniques in
the 1850's. After the Civil War, the first Swedish clinics opened in Boston
and Washington, the latter frequented by U.S. Grant.
Swedish Massage.
Swedish massage is by far the most predominant example of traditional European
massage, and it is the most commonly used method in the U.S. It was developed
by Per Henrik Ling in Sweden in the 1830's and uses a system of long gliding
strokes, kneading, and friction techniques on the more superficial layers
of muscles. It usually goes in the direction of blood flow toward the heart
because there is an emphasis on stimulating the circulation of the blood
through the soft tissues of the body. Swedish can be a relatively vigorous
form of massage, sometimes with a great deal of joint movement included.
Oil
is usually used which facilitates the stroking and kneading of the body,
thereby stimulating metabolism and circulation. Its active and passive
movements of the joints promote general relaxation and improve circulation
and range of motion, and relieve muscle tension. Swedish massage is often
given as a complete, full body technique, though sometimes only a part
of the body is worked on.
Contemporary
Western Massage
This
includes methods based primarily on modern western concepts of human function,
anatomy, and physiology, using a wide variety of manipulative techniques.
These may include broad applications for personal growth, emotional release,
and balance of mind-body-spirit, in addition to traditional applications.
These approaches go beyond the original framework or intention of Swedish
massage. They include Esalen or Swedish/Esalen, neuromuscular massage,
deep tissue massage, sports massage, and manual lymph drainage. Most of
these are American techniques developed from the late 1960's onward, though
the latter was developed in the 1920's.
Esalen
and Swedish/Esalen.
Esalen massage is a modern variation that was developed at the famous growth
center, Esalen Institute in Big Sur, California. Its focus is not so much
on relieving muscle tension or increasing circulation as it is on creating
deeper states of relaxation, beneficial states of consciousness, and general
well-being. Whereas Swedish is more brisk and focuses on the body, Esalen
is more slow, rhythmic, and hypnotic, and focuses on the mind/body as a
whole.
Esalen
massage is not widely taught as a pure form. Rather, a marriage of sorts
has been formed by the integration of Swedish and Esalen as a way of incorporating
the strengths of each. Many massage therapists describe their method as
Swedish/Esalen, and this hybrid is commonly taught in massage schools.
Neuromuscular
Massage.
This is a form of deep massage that applies concentrated finger pressure
specifically to individual muscles. This is a very detailed approach, used
to increase blood flow and to release "trigger points," intense knots of
muscle tension that refer pain to other parts of the body (they become
"trigger points" when they seem to trigger a pain pattern). This form of
massage helps to break the cycle of spasm and pain, and is often used in
pain control. Trigger point massage and myotherapy are varieties
of neuromuscular massage.
Deep
Tissue Massage.
This approach is used to release chronic patterns of muscular tension using
slow strokes, direct pressure, or friction. Often the movements are directed
across the grain of the muscles ("cross-fiber") using the fingers, thumbs,
or elbows. This is applied with greater pressure and at deeper layers of
the muscle than is Swedish massage, and that is why it is called "deep
tissue."
It
is also more specific. For example, in the case of someone with a sore
shoulder, the practitioner may focus on the trapezius and the rhomboid
underneath, trying to work in all the layers of muscle that might be involved.
Deep tissue massage lends itself to being more focused on a problem area.
Sports
Massage.
This uses techniques that are similar to Swedish and deep tissue, but the
techniques are more specifically adapted to deal with the needs of athletes
and the effects of athletic performance on the body. Sports massage is
used before or after events, as part of an athlete's training regimen,
and to promote healing from injuries.
Manual
Lymph Drainage Massage.
This approach improves the flow of lymph using light rhythmic strokes.
It is used primarily in conditions characterized by poor lymph flow, such
as edema.
Structural/Functional/Movement
Integration
These
approaches organize and integrate the body in relationship to gravity,
through manipulating the soft tissues, and/or through correcting inappropriate
patterns of movement. These are methods that bring about more balanced
use of the body and nervous system, creating greater integration and more
ease of movement.
This
category of approaches is interesting in that some do not even involve
the practitioner touching the client. There is no clear line of demarcation
between where the bodywork therapies end and the movement therapies begin.
Furthermore, many practitioners use multiple techniques that integrate
massage, deeper tissue work and movement all in the same session with a
client.
These
approaches work on the body structure and how it moves. The most common
approaches include Rolfing, Hellerwork, Rosen Method, Trager, Feldenkrais,
the Alexander Technique, and Ortho-Bionomy.
Rolfing.
Rolfing is the most established method of this category. There are over
800 Rolfers practicing in 27 countries, with about 700 in the U.S.
Rolfing
is a trademarked approach within the generic field of structural integration.
It was developed by Ida Rolf, Ph.D., a biophysicist who earned her doctorate
in the 1920's. She began doing her form of bodywork in the 1940's and 50's.
Her clientele included Georgia O'Keefe and Buckminster Fuller, and she
worked with other pioneers in the bodywork field. In the 1960's she began
teaching at Esalen Institute, the famous growth center in Big Sur, California.
She formed the Rolf Institute of Structural Integration in Boulder, Colorado
1972.
Rolfing
involves a form of deep tissue work for re-ordering the body so as to bring
its major segmentsChead,
shoulder, thorax, pelvis and legsCinto
a finer vertical alignment. The technique loosens or releases adhesions
in the fascia, or the flexible tissue that envelops our muscles and muscle
groups. The fascia is supposed to move easily and allow easy articulation
or movement of muscles or muscle groups past each other. However, trauma
such as injury or chronic stress can cause "stuck" points or adhesions,
in which the fascia is in a sense frozen, not allowing full freedom of
movement.
The
Rolfer works to restore this freedom of movement, resulting in a more balanced,
vertical alignment of the body, and often a lengthening or expansion of
the body's trunk. Rolfing usually takes place over a series of ten organized
sessions dealing with different areas of the body.
Hellerwork.
This approach was founded by Joseph Heller in 1979. A former Rolfer, Heller
developed a method that, along with structural reintegration, incorporates
a movement re-education process with exercises that teach stress-free methods
for performing everyday movements such as standing, walking, bending sitting
and reaching. (Since he left the Rolf Institute, Rolfing has also incorporated
movement in its work.) Heller's approach often includes video-feedback
to show clients how they move.
Hellerwork
takes place in a series of eleven sessions. Each session includes about
an hour of bodywork and a half hour of movement education. There are over
160 Certified Hellerwork Practitioners in twenty-three states and seven
foreign countries.
Rosen
Method. Marion Rosen
began her career in the 1930's and is still actively teaching her technique
today. She founded her training program in 1972. The Rosen Method sees
the body's tensions as indications of unexpressed feelings or other repressed
or suppressed aspects of the self. The result of such holding patterns,
which may be very subtle, can be life-long patterns of tension or organic
malfunction.
The
Rosen Method uses gentle, nonintrusive touch and verbal exchange between
practitioner and client to help draw the client's attention to areas of
holding. This serves to help the client become fully aware of how the patterns
of tension are associated with emotional or unconscious material. This
awareness itself is the key which allows the tension or holding patterns
to be released. Often the tightness softens and the area that was being
held begins to move easily with the breath.
In
the words of Marion Rosen, "This work is about transformation, from the
person we think we are to the person we really are."
Trager.
The Trager Approach is a system of movement re-education or "psycho-physical
integration" developed by Milton Trager, M.D. It uses gentle, non-invasive
movements to help release deep-seated physical and mental patterns, and
in turn allow deeper relaxation, increased physical mobility, and better
mental clarity.
A
session is one to one-and-a-half hours. The practitioner moves the client's
trunk and limbs in a gentle, rhythmic way so that the person experiences
new sensations of freedom of movement. The practitioner's concern is fostering
sense of freedom and lightness.
After
the hands-on portion of the session, the client is given instruction in
the use of Mentastics, a system of movement sequences developed by Trager
for the purpose of re-creating and enhancing the sense of lightness and
ease of movement initiated on the table. The benefits of the Trager approach
are cumulative, though there is no set series of sessions.
Feldenkrais
Method. This approach
was developed by Moshe Feldenkrais, a Russian-born Israeli educator. It
uses physical movement to focus learning on the juncture of thought and
action. It is known for its ability to improve posture and flexibility,
and alleviate muscular tension and pain.
It
works with the nervous system's capacity for change and learning new patterns
for moving, feeling, and thinking. The method involves two applications:
Awareness Through Movement (ATM) and Functional
Integration (FI). ATM consists of verbally directed, pleasurable, and effortless
exercise lessons involving highly sophisticated movement sequences. FI
is a one-on-one process that involves the use of specific skilled touch
and passive movement. It is known for its ability to address serious muscular
and neurological problems and improve human functioning.
The
Alexander Technique.
This is an approach to "psycho-physical re-education." It was developed
by the Australian actor F.M. Alexander, and works with unconscious patterns
of thinking and the resultant movements or postures that become set in
the musculature. Such patterns can be made conscious so the student can
then become aware of how he/she moves and can make the choice to change
patterns, allowing more balance, grace, and ease of movement, thereby reducing
and eliminating chronic tension or distortion in the musculoskeletal system.
The relationships among the head, neck and back are of particular importance.
The
Alexander Technique is taught in private, half-hour to hour lessons. The
teacher works with the student to observe and change mind/body habits that
interfere with optimal functioning. The teacher uses both verbal and hands-on
guidance to help the student experience new ways of moving and embodying
him or her self. It is not a fixed series of treatments or exercises, but often
a series of several lessons is recommended. Training to become a teacher
is three years (1600 hours).
Ortho-Bionomy.
Ortho-Bionomy was developed in the 1970's by Arthur Lincoln Pauls. This
approach uses gentle, relaxing movements and postures to help the body
release tensions and muscular holding patterns. No force or pressure from
the practitioner is used. Its goal is a restoration of structural alignment
and balance.
Oriental
Methods
Oriental
Methods are based on the principles of Chinese Medicine and the flow of
energy or "chi" through the meridians. The geography of the acupuncture
meridians is relied upon to determine points of applying the techniques,
and the ultimate goal is restoration of harmony or balance in the flow
of chi. These forms may also be used in
concert with herbs and acupuncture.
Pressure
is applied by finger or thumb tips to predetermined points, rather than
by the sweeping broad strokes of western style massage. Strong pressure
or very light pressure may be applied. There are over a dozen varieties
of oriental massage and bodywork therapy, but the most common forms in
this country are Acupressure, Shiatsu, Jin Shin Jyutsu, and Jin Shin Do.
Acupressure
and Shiatsu.
These are similar varieties of finger pressure massage. They are both based
on applying pressure to a pattern of specific points that correspond with
the acupuncture points. Pressure is applied with thumb, finger, and palm
rather than needles.
The
goal is the efficient and balanced flow of chi through the meridians. It
is believed that where there is tension being held in the musculature,
the flow of chi is impaired through those areas, which can lead to chronic
problems not only in the musculature but in the associated organs. Stretching
and movement are also sometimes used.
Acupressure
is the more generic term used for this approach, and Shiatsu is the Japanese
version.
Jin
Shin Jyutsu.
This approach comes from an ancient Japanese healing tradition that uses
touch to restore the internal flow of energy through the body by releasing
energetic blockages. A session lasts about an hour and the client is fully
clothed, lying on a table. The practitioner uses pulse diagnosis to identify
energy blocks, and then gently holds or touches a specific combination
of two of twenty-six acupuncture points, to allow release of the blockage.
As
it is practiced in the U.S. the holding uses less pressure than other forms
of acupressure or shiatsu, and there is no application of massage-like
movements to specific points. Rather the touch is very light and works
to balance the flow of energy.
Jin
Shin Do7
Bodymind AcupressureJ.
This approach was developed by California psychotherapist Iona Marsaa Teeguarden.
It applies stronger acupressure on the points and for a longer period of
time than does Jin Shin Jyutsu. It focuses on the deep release of "armoring"
(muscular tension of physical or emotional origins) through gentle yet
deep finger pressure.
Jin
Shin Do7
incorporates Taoist breathing techniques, oriental acupuncture theory,
Japanese finger pressure technique (sometimes holding points for as much
as one to three minutes), and Reichian segmental theory (an understanding
of how tensions in different parts of the body affect each other, and affect
particular feelings or emotions).
Energetic
Methods (Non-Oriental)
In
a sense, all the oriental methods described above are also energetic methods
in that they are working with energy according to Chinese medicine principles
and view the human being as an energy system. However, there are other
energetic methods that are not based on Chinese principles. The most prominent
of these are Therapeutic Touch, Polarity Therapy, and Reiki.
Therapeutic
Touch.
This method is unique in that it was born and reached its maturation within
the context of conventional western medicine. It was developed in the 1970's
by Delores Krieger, Ph.D., R.N., a professor at New York University, and
Dora Kunz, a natural healer. It is a contemporary interpretation of several
ancient healing traditions.
It
is based on the principle that the human energy field extends beyond the
skin, and the practitioner can use the hands as sensors to locate problems
in it, which correspond with problems in the physical body. Disease is
seen as a condition of energy imbalance or disorder, or blocked energy
flow. Assessment is done by passing the hands over the body from head to
toe at about two to four inches above the surface.
The
practitioner then serves as a "conduit" for universal energy, consciously
and actively transferring energy into the recipient. The hands are used
to direct and focus the energy, sometimes in rhythmical, sweeping motions.
The method is initially taught "off body," meaning the practitioner's hands
do not touch the physical body, though later with experience, some physical
touch may take place.
Since
it is not necessary to touch the physical body (what is being touched is
the "energy field" or "energy body"), this method can be applied in situations
where the patient may not be able to tolerate contact (e.g., in post-surgical
patients or burn victims). Sessions last up to thirty minutes, and can
be done sitting or lying down, fully clothed.
Therapeutic
Touch is currently taught in over 80 universities and 30 countries, and
is practiced by 20-30,000 health care professionals in the U.S. and around
the world.
Polarity
Therapy.
This is a form of energy work that was developed by Randolph Stone, a chiropractor,
osteopath, and naturopath in the mid-1920's.
The practitioner uses subtle touch or holding on specific points to harmonize
the flow of energy through the body, and to also enhance the body's structural
balance.
It
is based on the principle that every cell has both negative and positive
poles, and the body is gently manipulated to enhance the energy flow. Emotional
tension or physical pain are released as
the flow of energy becomes more properly balanced. Polarity therapy is
often given in a series of four sessions, and may be accompanied by guidelines
for diet and exercise.
Reiki.
This is the Japanese word for "Universal Life Force Energy." It is an ancient
approach in which the practitioner is a kind of "healer" in the sense that
he or she serves as a conduit for healing energy coming from the universe.
The
Reiki energy enters the practitioner through the top of the head and exits
through the hands, being directed into the body or "energy field" of the
recipient. Reiki is another very subtle form of healing, and may be done
through clothing and without any physical contact between practitioner
and client.
While
all the above energetic methods appear to operate on different principles
than most other varieties of massage therapy and bodywork, they nonetheless
have an important and growing role.
Other
Approaches
Integrative
Methods.
There are other approaches and combinations of approaches that do not fit
neatly into any of the above categories. Many massage therapists and bodyworkers
use combinations of approaches which could be called "integrative massage"
or "integrative bodywork."
CranioSacral
TherapyJ.
This approach was named in 1977 by John Upledger, D.O. and Ernest Retzlaff,
Ph.D. to distinguish it from Sutherland's cranial osteopathy. According
to Upledger, "CranioSacral Therapy is not osteopathy. Sutherland's approach
was bone-oriented and you make bony corrections. This is soft tissue-oriented,
fluid-oriented, membrane-oriented, and energy-oriented. It's much more
subtle than any other kind of cranial work I know of."
Palpation
(touch by the practitioner) is used to both observe and treat dysfunctions
in the craniosacral system which includes the head, spinal column and sacrum
in one continuous membranous sheath. This system has its own pulse for
circulating the cerebrospinal fluid (six to twelve cycles per minute),
and the practitioner can feel the rate, amplitude, symmetry and quality
of the rhythm C
somewhat analogous to pulse diagnosis in ayurveda and Chinese medicine.
Corrective pressure of only about five grams (the weight of a nickel) is
applied to various areas to promote the re-establishing of a normal, symmetrical
pattern of pulsation throughout the system. This in turn allows more efficient
functioning of the entire nervous system throughout the body.
Upledger
reports success in treating chronic pain, chronic brain dysfunctions when
there is no structural problem involved, endogenous depression, migraines,
learning disabilities, dyslexia, hyperkinesis, spasticity in cerebral palsy,
strabismus (cross-eyes), Meniere's disease (vertigo), and many other conditions.
Reflexology.
This approach involves the manual stimulation of reflex points on the ears,
hands, and feet. Similar methods resembling shiatsu and acupressure have
also been practiced in China for thousands of years. Thumb pressure is
applied to specific points that correspond
somatotopically to specific areas or organs of the body.
It
was introduced to this country by William Fitzgerald, who termed it "zone
therapy," in the early 1900's. One of the contemporary explanations for
how it works is that compression by specific touch techniques affects a
system of points and areas that are thought to "reflex" through neurological
pathways to distant parts of the body. The pressure on these reflex points
(also called "cuteneo-organ reflex points") is used to relieve stress and
tension, to improve blood supply, promote the unblocking of nerve impulses,
and to help restore homeostasis or balance in the body.
Zero
Balancing.
This is a painless, hands-on method of aligning body energy with body structure.
It is done through clothes and involves the practitioner in using gentle
pressure at key areas of the skeleton in order to balance the "energy body"
with the "structural body."
The
theory holds that each of us has an unseen energy body that exists hand
in glove with the physical body. When injury or trauma occurs, healing
of these two bodies does not necessarily occur simultaneously. "Balancing"
refers to balancing the relationship between energy and structure. Zero
Balancing seeks to bridge the gap between those methods that work with
structure and those working with energy.
SCIENTIFIC
SUPPORT
Prior
to the advent of pharmaceutical medicine earlier in this century, references
to massage therapy and research were not uncommon in the mainstream medical
literature. There were over 600 articles in various journals such as the
Journal of the American Medical Association, British Medical
Journal, and others from 1813-1939. Also, a great deal of research
was conducted in eastern bloc countries and China. In this country, after
World War I there was a precipitous decline in focus on this field as drugs
and other allopathic interventions gained the foreground.
With
the renewed interest in natural forms of treatment, research activity in
massage and bodywork has again gained momentum. Studies have documented
benefits for amputations, arthritis, cerebral palsy, cerebral vascular
accident, fibrositis syndrome, menstrual cramps, paraplegia/quadriplegia,
scoliosis, acute and chronic pain, acute and chronic inflammation, chronic
lymphedema, nausea, muscle spasm, soft tissue dysfunctions, gran mal epileptic
seizures, anxiety, depression, insomnia, and psycho-emotional stress which
may aggravate significant mental illness. Following are a few examples
of recent studies.
Massage
in the Elderly.
A controlled study showed massage therapy produced relaxation in 18 elderly
subjects. This study demonstrated physiological signs of relaxation in
terms of decreased blood pressure and heart rate and increased skin temperature.
Spinal
Pain.
A study of the combination of various types of massage in 52 patients with
traumatically-induced spinal pain led to significant improvements in acute
and chronic pain and increased muscle flexibility and tone. This study
also found massage to be extremely cost-effective in comparison with other
therapies with cost savings ranging from 15 to 50 percent.
Pain
Control.
Massage has also been shown to stimulate the body's ability to naturally
control pain. One study showed that massage stimulates the brain to produce
endorphins, which are chemicals that control pain.
Lymphedema.
Lymph drainage massage has been found to be more effective than mechanized
methods or diuretic drugs to control lymphedema (a form of swelling) caused
by radical mastectomy. It can be expected that using massage to control
lymphedema will significantly lower treatment costs. This is based on a
study comparing the use of sleeve-like pressure cuffs often worn by women
with lymphedema.
Inflammatory
Bowel Disease.
A study found that massage therapy can have a powerful effect on psycho-emotional
distress in patients with chronic inflammatory bowel diseases such as ulcerative
colitis and Crohn's disease. Stress can worsen the symptoms of these conditions
which can lead to great pain, bleeding, and hospitalization or death. Massage
therapy was effective in reducing the frequency of episodes of pain and
disability in these patients.
Therapeutic
Touch and Wound Healing.
A controlled trial examined the effects of therapeutic touch on healing
identical surgically-inflicted minor wounds in the shoulders of 44 male
college students. Twenty-three received therapeutic touch treatments, and
21 did not. Neither group was aware of the purpose
of the experiment, and those treated were not aware they were being
treated. After 8 days, the treated group's wounds had shrunk an average
of 93.5% compared to 67.3% for those untreated. After 16 days the figures
were 99.3% and 90.9%.
Reflexology
and P.M.S.
A controlled clinical study of 38 women with premenstrual syndrome examined
the effects of a 30 minute reflexology treatment weekly for eight weeks.
Those receiving the treatment were treated by ear, hand and foot reflexology.
Those in the control group were given placebo or "sham" reflexology. Based
on a daily diary that monitored the severity of 38 premenstrual symptoms,
the treated group had a 46% reduction, which was significantly greater
reduction than the 19% reduction of the control group.
Unlike
some of the hormone-altering drugs and antidepressant medications that
are often used, the treatment produced no side effects. The researchers
concluded that reflexology might work by softening adrenocortical reactivity
to stress, which is known to exacerbate symptoms in P.M.S.
Touch
Research Institute, University of Miami
The
most comprehensive program of massage-related research is the University
of Miami's Touch Research Institute. Created in 1991 by the School of Medicine,
it is the world's first center for basic and applied research in the use
of touch in human health and development. Directed by Tiffany Field, Ph.D.,
a professor of psychology, pediatrics, and psychiatry, the T.R.I. has a
multidisciplinary staff of 40 scientists from the fields of medicine, biology,
and psychology; and another 30 visiting scientists from other universities
participating in collaborative studies.
A
plethora of studies have demonstrated impressive benefits for integrating
massage therapy into medical care. In one study, premature infants treated
with daily massage therapy gained 47% more weight per day and had shorter
hospital stay by six days than those that were not massaged, resulting
in cost savings of approximately $3000 per infant.
A
study of the effects of massage therapy on H.I.V. patients found that those
who received a massage five time per week
for one month had higher numbers of natural killer (NK) cells and their
NK cells were more potent. They also had less anxiety and lower serotonin
(stress hormone) levels.
A
third study involved giving massage therapy to 52 hospitalized depressed
and adjustment disorder children and adolescents. A separate comparison
group viewed relaxation videotapes. Those receiving the massage therapy
were less depressed and anxious, and had lower saliva cortisol levels,
which is an indicator of less depression.
Following
is a list of other applications of massage therapy currently being studied
at T.R.I.:
!
Infant sleep disorders
!
Infants with cancer
!
Preschool children
!
Neglected children
!
Abused children
!
Autistic children
!
Post-traumatic stress disorder after Hurricane Andrew
!
Pediatric skin disorders
!
Asthma
!
Diabetes
!
Juvenile rheumatoid arthritis
!
Depressed teenage mothers
!
Teenage mothers' childbirth labor
!
Eating disorders
!
Job performance/stress
!
Pregnancy
!
Hypertension
!
HIV and improve immune function
!
Spinal cord injuries
!
Fibromyalgia syndrome
!
Rape and spouse abuse
!
Couples' sex therapy
!
Volunteer foster grandparents
!
Arthritis
!
Chronic fatigue syndrome
STRENGTHS
AND LIMITATIONS
Massage
therapy and bodywork obviously have a very broad, diverse range of applications.
Essentially, they can support any health condition that would benefit from
greater blood circulation and the release of tension. Psychological conditions
also are affected beneficially, as the physiological changes that occur
with these kinds of intervention help harmonize and rebalance the nervous
system and hormonal systems.
There
is great potential in using massage to reduce cumulative traumatic disorders
in the workplace. For example, chicken cutters in chicken processing plants
often develop carpal tunnel problems. Several companies in the chicken
processing industry in Virginia have developed worksite massage programs
that have shown impressive reductions in these problems. The most frequently
used techniques include cross-fiber, deep tissue, and Swedish, concentrated
on those muscle groups that are chronically stressed in the work (hands,
arms, shoulders, and back). The programs also teach self-massage techniques,
and the results include better morale and reduced absenteeism.
Contraindications
to massage or bodywork are few, and may include transmittable skin diseases,
unhealed wounds, post-operative conditions, and blood clots. In many cases,
of course, such therapy can avoid problem areas in the body, assuming the
practitioner is aware of the condition.
Many
people wonder about whether massage or bodywork could cause a cancer to
metastasize. According to Elliot Greene, "This is an area where research
is needed to define the risk. Practitioners are generally taught to err
on the side of conservatism. For example, massage is not recommended for
someone immediately after chemotherapy or radiation treatment.
"Physiologically,
it is not easy to metastasize a tumor from
simple pressure, and studies have shown that the body has a number of layers
of defenses to prevent that from happening simply from touch. It is known,
however, that certain kinds of chemotherapies in particular make the tissue
fragile for a couple of days, and massage immediately after such therapies
might irritate the tissues, and if there was any danger of metastasizing,
it would be more likely to happen closer to the treatment. A conservative
response would be to use much lighter forms of massage."
In
fact, massage therapy is increasingly being incorporated into complementary
cancer therapy programs. At the Cancer Support and Education Center in
Menlo Park, California, it has been an integral part of a program that
resulted in significant improvement in quality of life, even for patients
with metastatic disease.
The
ability of massage to reduce anxiety, depression, and stress is a logical
counter to the strain a cancer patient must deal with in facing a life-threatening
condition and traumatic treatment.
THE
PRACTITIONER-PATIENT RELATIONSHIP
Hands-on
therapies naturally foster a kind of intimacy between the practitioner
and patient. In many of the approaches, the recipient partially or fully
disrobes and lies on a table (though they are draped with a sheet and are
never fully exposed), which further contributes to the intimacy and vulnerability
that may be felt when using this tradition. Normal boundaries of social
interaction are crossed. Hence there is a special need for sensitivity
and regard for the client on the part of the practitioner that matches,
and perhaps even exceeds, that of many doctor-patient relationships.
There
is a wide range of attitudes among practitioners about how they view their
role. Some think of themselves as healers or therapists, working with the
whole person through the body. Certain approaches (e.g., The Rosen Method)
are explicitly focused on engaging the person on the emotional level and
working with emotional issues in the context of the body with subtle verbal
suggestions. Others may take a more mechanistic approach toward working
with the body. They may not wish to engage the client on the emotional
level at all, but rather concentrate on physical techniques. Some see themselves
as facilitators, some as educators.
There
is wide variation among practitioners, even within the specific
approaches, as to how much verbal exchange takes place and the degree to
which the practitioner is available for emotional or psychological support.
Finally,
some approaches require a series of sessions over a period of time (e.g.,
Rolfing, Hellerwork) which naturally fosters a therapeutic relationship
and requires communication, instruction and feedback. On the other hand,
many European or western forms of massage are complete in themselves as
one session and do not really require any communication between practitioner
and client. It is not unusual to experience an entire massage without a
word being spoken.
EVALUATING
PERSONAL RESULTS
The
subjective experience of the client is generally the most important way
of evaluating personal results. However, sometimes the change process naturally
causes temporary discomfort which needs to be accepted, so that expectations
of "feeling good" may not always be appropriate.
Practitioners
of the various methods can often also give the client feedback based on
what they feel through their hands and what they see with their eyes.
Some
modalities, particularly those of Structural/Functional/Movement Integration,
use visual feedback in the form of having clients look at themselves in
mirrors, or even taking "before and after" photographs. The photographic
record is particularly common in Rolfing and Hellerwork as a way of following
progress over time.
Some
of the movement integration therapies also use videotape to help observe
changes in function, posture, and range of motion.
RELATIONSHIP
TO OTHER FORMS OF MEDICINE
These
modalities tend to be highly complementary to all other medical traditions.
They can enhance the effectiveness of other forms of treatment by inducing
relaxation, promoting circulation, and their other common benefits. They
can also help patients tolerate more invasive approaches and handle the
side effects of other treatments.
COSTS
Costs
tend to be higher in urban areas. Generally, the cost of massage therapy
will range from $30 to $60 for an hour, and somewhat lower in less-urban
environments. Cost of other more specialized modalities may be higher.
Rolfing, for example, averages around $75 to $80 for a ninety minute session,
and is ordinarily done in a series of ten sessions, spaced at least a week
apart.
Other
modalities tend to fall within these ranges. Most insurance companies do
not cover massage and bodywork, although such coverage is much more likely
if it is prescribed by a physician. Massage therapy is more likely to be
covered than the other methods, although a physician's prescription and
the licensure of the practitioner may help increase the chances.
CHOOSING
A PRACTITIONER
Massage
Therapy
Massage
therapists are designated by a variety of titles, some referring to state
regulation and others to other forms of certification. Various counties
and cities may also have ordinances regulating the practice of massage.
It
should be noted that practitioners of many health care disciplines often
learn some massage therapy techniques during the course of their training
without necessarily having any of the following credentials. Thus they
may practice massage therapy (and facilitate insurance coverage) under
another kind of license or credential such as nursing, chiropractic, etc.
The
A.M.T.A. has recently begun to discourage practitioners from using initials
after their names, feeling this may be confusing to the public because
there is no standardization, and such initials tend to mimic academic degrees.
Instead the A.M.T.A. encourages practitioners to spell out what their credential
is. In some states the use of initials is controlled (such as licensed
massage therapist, LMT), but in many states it is meaningless.
The
most common titles for massage therapists are as follows:
Nationally
Certified in Therapeutic Massage and Bodywork.
This title designates the person has completed the requirements for and
passed the National Certification Board for Therapeutic Massage and Bodywork
(N.C.B.T.M.B.). This is the leading national certification exam.
Massage
Practitioner (M.P.):
This title is often used by practitioners whose training is less extensive
than that required for certification by schools or by the A.M.T.A. as a
massage therapist.
Certified
Massage Therapist (C.M.T.):
This is a voluntary, professional, non-governmental certification from
organizations that can attest to the therapist's competency. This is granted
by many massage therapy schools, which may or may not meet A.M.T.A. standards
for training. Thus the quality of this credential depends on the quality
of the certifier and its standards. (For example, even a person who has
only taken an eight hour course can claim to be certified.)
Registered
Massage Therapist (R.M.T.):
This is a form of voluntary licensing for the use of a specific professional
title. Rarely used in the U.S., some Canadian provinces use this to designate
government licensing. At one time it also designated a special credential
for members of the A.M.T.A. who had advanced training in therapeutic massage
and passed a special exam, but this usage has been discontinued.
Licensed
Massage Therapist (L.M.T.):
This refers to occupational licensing by a state or local government. Nineteen
states have licensing laws requiring massage therapists to meet minimum
standards of training. The basic requirement is usually 500 hours of classroom
training with instructors present, followed by a written and practical
exam. The following states have licensing laws:
Arkansas,
Connecticut, Delaware, Florida, Hawaii, Iowa, Louisiana, Maine, Nebraska,
New Hampshire, New Mexico, New York, North Dakota, Ohio, Oregon, Rhode
Island, Texas, Utah, and Washington.
In
states that do not require licensing, a good credential to seek is graduation
from an A.M.T.A. accredited program, which meets the 500 hour standard.
There are many schools of massage therapy and bodywork that require fewer
hours of training (often 100-200 hours), so the extent of training is an
important question in choosing a practitioner.
The
American Massage Therapy Association
is the predominant organization for massage therapists with over 18,000
members, representing all fifty states, D.C., the Virgin Islands and several
foreign countries. Membership
is a good indication of professional preparation. It requires one of the
following:
1.
Graduation from a training program approved by the Commission on Massage
Training Accreditation/Approval. This is an accreditation agency commissioned
by the A.M.T.A.. This assures the practitioner
has completed a program of a minimum of six months duration with 500 in-class
hours of training. There are currently 58 massage therapy schools accredited
by C.O.M.T.A.A. Subjects include anatomy and physiology, massage techniques,
and practical training.
2.
Holding a state license which meets A.M.T.A. certification standards.
3.
Passing an A.M.T.A. Membership Entrance Examination.
4.
Passing the National Certification Examination for Therapeutic Massage
and Bodywork. Six states have adopted this exam, developed by the A.M.T.A.,
as their licensing exam. It is anticipated that eventually all the states
that license massage will adopt this exam,
and the number of such states is expected to increase.
In
early 1994 this exam was accredited by the National Commission for Certifying
Agencies, a major independent agency that evaluates professional certification
programs according to stringent standards.
Membership
in the A.M.T.A. also requires six hours of continuing education every two
years.
The
A.M.T.A. publishes a Membership Registry for use by its members
and provides referrals to local practitioners. Address: 820 Davis St.,
Suite 100, Evanston, IL 60201-4444,
phone 708/864-0123.
Other
Forms of Bodywork or Energy Work
Finding
a competent practitioner of the other forms of bodywork or energy work
is essentially a matter of asking whether they are certified by the particular
professional association for the method being used. Some practitioners
integrate multiple methods, but if they are not certified in any one, their
preparation is dubious. It is best to work with someone who has completed
training and thereby has achieved a standard of expertise in at least one
method.
Following
are the professional associations for the most common forms of bodywork
and energy work.
Rolf
Institute of Structural Integration.
The training is typically twelve months long for basic certification. A
"Certified Advanced Rolfer" is one who has practiced at least five years
and has taken an additional six weeks training. A list of certified practitioners
is available. Address: 205 Canyon Blvd., Boulder, CO 80302, phone (800)530-8875.
Hellerwork,
Inc. Training is
a 1,250 hour program leading to certification as a Hellerwork Practitioner.
Trainings are offered internationally. Address: 406 Berry St., Mt. Shasta,
CA 96067, phone (800)392-3900 or (916)926-2500.
Rosen
Method Professional Association.
Certification training is two years plus an 18 month internship. Certified
practitioners must also hold a state-approved massage certificate. A directory
of practitioners is available from the association. Address: 2550 Shattuck
Avenue, Box 49, Berkeley, California 94704, phone (510)644-4166.
The
Trager Institute.
Training for Trager practitioners takes a minimum of 269 hours usually
over at least six months. A list of certified practitioners is available.
Address: 33 Millwood St., Mill Valley, CA 94941, phone (415)388-2688.
The
Feldenkrais Guild.
Only people trained by Moshe Feldenkrais or graduates of Guild Accredited
Training Programs are eligible to be members of the Guild. Practitioner
Members are qualified teachers of Awareness Through
Movement and Functional Integration. Associate Members are qualified
teachers of Awareness Through Movement.
The professional training program spans 160 days over three-and-a-half
years. The Guild publishes a directory of certified practitioners. Address:
706 Ellsworth St., P.O. Box 489, Albany, Oregon 97321-0143, phone (503)926-0981.
North
American Society of Teachers of the Alexander Technique.
N.A.S.T.A.T. formed in 1987 to educate the public about the Alexander Technique,
to establish and maintain standards for certification of teachers and teacher
training courses in the U.S., and to ensure that the educational principles
of the Alexander Technique are upheld. It publishes a directory of certified
teachers. Training to become a teacher is three years (1600 hours). Address:
P.O. Box 112484, Tacoma, WA 98411-2484, phone (800)473-0620 or (206)627-3766.
Nurse
Healers Professional Associates, Inc.
This organization provides information about Therapeutic Touch and training
for health care providers. The length of trainings
vary, and there is no formal certification. Address: 175 Fifth Avenue,
Suite 2755, New York, New York 10010, phone (212)886-3776.
Jin
Shin Jyutsu, Inc.
This is an organization for practitioners who have completed a five-day
training course in this method. Practitioners are encouraged to repeat
the basic training several times, but there is no formal certification.
There is also an advanced course. Address: 8719 E. San Alberto, Scottsdale,
Arizona 85258, phone (602)998-9331.
Jin
Shin Do7
Foundation for Bodymind AcupressureJ.
This is a network of authorized teachers and registered practitioners who
have received standardized training in this approach. Registered Practitioners
have 250 hours of training plus practical experience. A directory of Registered
Practitioners and Authorized Teachers is available from the foundation.
Address: J.S.D.F., 366 California Avenue, Suite 16, Palo Alto, California
94306, or P.O. Box 1097, Felton, California 95018, phone (415)328-1811.
American
Oriental Bodywork Therapy Association.
This is an educational and certifying organization for practitioners of
a variety of forms of oriental bodywork. Associate Members have at least
150 hours of training with a Certified Instructor, and 100 hours of practice.
Certified Practitioners have competed 500 hours of such training and passed
a certification exam. The A.O.B.T.A. has about 800 members and publishes
a membership directory. Address: 6801 Jericho Turnpike, Syosset, New York
11791, phone (516)364-5533.
Associated
Bodywork and Massage Professionals (A.B.M.P.).
This organization provides professional support and legislative advocacy
for massage therapists and bodyworkers. Membership is of two levels: "Practitioner"
level requires 100 hours of training. "Professional" level requires 500
hours or state licensure or registration. A.B.M.P. also publishes Massage
and Bodywork Quarterly. Address: 1746 Cole Blvd., Golden, Colorado
80401, phone 303/674-8478.
The
Upledger Institute, Inc.
This is an educational and clinical resource and training center for manipulative
therapies such as cranio-sacral therapy, visceral manipulation, and other
holistically-oriented approaches used by bodyworkers. Founded by John Upledger,
D.O., it conducts training nationally and internationally. It also produces
several instructional publications and a directory of alumni of its trainings.
Address: 11211 Prosperity Farms Rd., Palm Beach Gardens, FL 33410, phone
(800)233-5880.
American
Academy of Reflexology.
This organization conducts training in ear, hand, and foot reflexology,
and can provide referrals to certified practitioners. Address: 606 E. Magnolia
Boulevard, Suite B, Burbank, California 91501, phone (818)841-7741.
International
Institute of Reflexology.
This organization conducts two-day trainings nationally and internationally,
and a certification exam in the Ingham Method of reflexology. They also
can provide referrals to trained practitioners. Address: 5650 First Avenue
North, P.O. Box 12642, St. Petersburg, FL 33733, phone (813)343-4811.
Zero
Balancing Association
offers training in this method, a 50-hour basic course, and an 18-month
certification program. Address: P.O. Box 1727, Capitola, California 95010,
phone (408)476-0665.
Douglas
DeGood, Ph.D. at the University of Virginia was funded to study the degree
to which massage therapy can reduce anxiety and the need for follow-up
care in women undergoing surgery for uterine cancer.
Frank
Scafidi, Ph.D. at the University of Miami's Touch Research Institute is
studying the effects of daily massage on growth, cognitive development,
and immune function in premature infants born to HIV-infected mothers.
A
fifth study involves Therapeutic Touch. Melodie Olson of the Medical University
of South Carolina in Charleston is using a controlled experiment to examine
the effects of Therapeutic Touch on the immune functioning of highly-stressed
students preparing for professional board exams. Positive findings would
have implications for other highly stressed populations including cancer
and AIDS patients.