Massage and Bodywork, by William Collinge, Ph.D.

Training in other forms of bodywork is much less uniform and there are no licensing laws for bodywork methods as such. Many bodyworkers are also massage therapists, but this is not required for most bodywork traditions. The various associations described later in this chapter all have their own unique standards for training.

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 Acupressure^J. 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.:

Bodywork Research

Little research has been conducted on the various forms of bodywork. One exception is Rolfing, for which several studies have found interesting effects.

In one controlled study, 48 participants were randomly assigned to either the experimental group (Rolfing) or a control group (no Rolfing). A significant decrease in anxiety was found in those who received the treatment over a five week period. The researchers explained these findings in terms of the theory that the Rolfing caused a release of emotional tension that had been stored up in the muscles, and this in turn resulted in lower anxiety scores on a psychological test of state anxiety .

Other studies of Rolfing have found improvements in muscular efficiency , reductions in anxiety , decrease in pelvic tilt, and increase in vagal tone (amplitude of respiratory sinus arrhythmia, a heart rate function that corresponds with reduced stress in the body).

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 Acupressure^J. 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.