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
Energetic Methods (Non-oriental)
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 massage 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 United States by two doctors from New York who were brothers— Charles and George Taylor—who studied in Sweden and introduced Americans to Swedish techniques in the 1850s. 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 United States. It was developed by Per Henrik Ling in Sweden in the 1830s 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, 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 1960s onward, though the latter was developed in the 1920s.
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 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 similar to Swedish and deep tissue but 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.
Frederick, a forty-eight-year-old attorney, was chopping wood in his garden when he pulled a muscle on his right shoulder blade. He had always been very active but was now unable to play tennis because his arm and shoulder would cramp up. He was even unable to sit down and write a letter because of the cramping.
His physician gave him steroid injections and sent him to physical therapy for two months, which helped eliminate some but not all of the pain. The physical therapy included ultrasound and electrical stimulation.
The massage therapist found him to have extreme spasms and tension of the muscles on the back of the shoulder blade, some of which were like rock. The therapist initiated very precisely focused, deep transverse friction cross-fiber work, as much as possible right on the places where the muscles had been damaged. Frederick was seen weekly for about a year, after which he now has full use of his shoulder and arm and can do gardening work without pain.
As Elliot Greene explains, the problem with severe spasm is that it cuts off its own circulation and becomes a self-reinforcing syndrome. This is another case of opening up the flow of blood and lymph through the area, releasing adhesions, and using deep transverse friction to encourage the unhealed part of the muscle to heal.
Manual Lymph Drainage Massage. This approach improves the flow of lymph 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, the Rosen Method, the Trager approach, the Feldenkrais Method, the Alexander Technique, and Ortho-Bionomy.
Rolfing. Rolfing is the most established method in this category. There are over eight hundred Rolfers practicing in twenty-seven countries, with about seven hundred in the United States.
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 1920s. She began doing her form of bodywork in the 1940s and 50s. Her clientele included Georgia O'Keeffe and Buckminster Fuller and she worked with other pioneers in the bodywork field. In the 1960s she began teaching at Esalen Institute. She formed the Rolf Institute of Structural Integration in Boulder, Colorado, in 1972.
Rolfing involves a form of deep tissue work for reordering the body so as to bring its major segments—head, shoulder, thorax, pelvis, and legs—into a finer vertical alignment. The technique loosens or releases adhesions in the fascia, 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 reeducation 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 1930s 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 lifelong 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 that 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 reeducation or psychophysical integration developed by Milton Trager, M.D. It uses gentle, noninvasive movements to help release deep-seated physical and mental patterns and in turn allow deeper relaxation, increased physical mobility, and better mental clarity.