William Collinge MPH PhD
“The physician must be experienced in many things,
but most assuredly in rubbing.”
Hippocrates
Hands-on manipulation for healing is probably older than any other healing tradition. The oldest written records of massage go back three thousand 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 1930s, 40s, and 50s 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 United States began in 1943 when the graduating class of the College of Swedish Massage in Chicago decided to band together and form an association with twenty-nine charter members. What they created was destined to become the American Massage Therapy Association (AMTA).
In the 1960s, 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 1970s 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 1993,1 massage therapy ranked third among the most frequently used forms of alternative health care. According to Elliot Greene, president of the AMTA, there are now an estimated fifty thousand massage therapists of various kinds in the United States, and the AMTA may be the fastest-growing organization of health care providers m the country. At this writing it has over eighteen thousand members and its rolls have more than doubled in the last three years.
Education
There are myriad programs of education and training for the many different forms of massage and bodywork. For the massage therapy field, the AMTA has been successful in establishing standards that are incorporated in many state licensing laws. Fifty-eight training programs are currently accredited or approved by the AMTA-affiliated Commission on Massage Training Accreditation/Approval, which requires at least five hundred hours of classroom instruction. The curriculum includes three hundred hours of massage theory and technique, one hundred hours of anatomy and physiology, and one hundred hours of additional required courses including first aid and cardiopulmonary resuscitation (CPR). There are of course many other training programs that do not meet all of these standards.
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.
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 a 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.
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Elliot Greene describes the process as one of breaking up the scarring that had occurred in her muscles and connective tissue or fascia between the muscles, vertebra, and ribs, all of which had become stuck together. Blood flow through the area was restored and the depression that had been palpable in her spine gradually began to diminish. The full range of motion of the spine returned.
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 postmastectomy women).
Release of Toxins. Chronic tension or trauma to the soft tissues of the body can result in the buildup 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 the 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 somatopsychic effects, in which the conditions of the body affect the mind and emotions, and there can be psychosomatic 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 to 90 percent 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— that it is essential for the health of body, mind, and spirit.”2
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 (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.
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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.
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 a 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.
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The Alexander Technique. This is an approach to psychophysical reeducation. 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 herself. It is not a fixed series of treatments or exercises, but often a series of several lessons is recommended. Training to become a teacher takes three years (sixteen hundred hours).
Ortho-Bionomy. Ortho-Bionomy was developed in the 1970s by the bodyworker 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® Bodymind Acupressuretm;.
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 the 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 United States 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 Do® Bodymind Acupressuretm;. This approach was developed by California psychotherapist lone 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 Do© 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 as well as 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 principles of Chinese medicine 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 1970s by Dolores 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 that correspond with problems in the physical body. Disease is seen as a condition of energy imbalance 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 postsurgical 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 eighty universities and thirty countries and is practiced by twenty to thirty thousand health care professionals in the United States 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-1920s. The practitioner uses subtle touch or holding on specific points to harmonize the flow of energy through the body and also to 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.
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As Elliot Greene states, “It is very common that someone will come in for one reason, and then they will discover another whole dimension to the problem or to themselves that they want to explore.”
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 that could be called integrative massage or integrative bodywork.
CranioSacral Therapytm;. 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.”3
Palpation (touch by the practitioner) is used both to 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—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-establishment 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), Ménière’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.
Reflexology was introduced to this country by William Fitzgerald, who termed it “zone therapy,” in the early 1900s. 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, to promote the unblocking of nerve impulses, and to help restore homeostasis or balance in the body.4
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 like a glove surrounding 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.
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 six hundred articles in various journals such as the Journal of the American Medical Association, British Medical Journal, and others from 1813 to 1939. A great deal of research was also 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, grand mal epileptic seizures, anxiety, depression, insomnia, and psychoemotional 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 eighteen elderly subjects. This study demonstrated physiological signs of relaxation in terms of decreased blood pressure and heart rate and increased skin temperature.5
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Spinal Pain. A study of the combination of various types of massage in fifty-two patients with traumatically induced spinal pain led to significant reductions 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 pain therapies, with cost savings ranging from 15 to 50 percent.6
Pain Control. Massage has also been shown to stimulate the body’s ability to control pain naturally. One study showed that massage stimulates the brain to produce endorphins, chemicals that control pain.7
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 massage with the use of sleeve-like pressure cuffs often worn by women with lymphedema.8
Inflammatory Bowel Disease. A study found that massage therapy can have a powerful effect on psychoemotional 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.9
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 forty-four male college students. Twenty-three received Therapeutic Touch treatments and twenty-one did not. Neither group was aware of the purpose of the experiment and those treated were not aware they were being treated. After eight days, the treated group’s wounds had shrunk an average of 93.5 percent compared to 67.3 percent for those untreated. After sixteen days the figures were 99.3 percent and 90.9 percent.10
Reflexology and PMS. A controlled clinical study of thirty-eight women with premenstrual syndrome examined the effects of a thirty-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 thirty-eight premenstrual symptoms, the treated group had a 46-percent reduction, which was a significantly greater reduction than the 19-percent 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 PMS.11
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 TRI has a multidisciplinary staff of forty scientists from the fields of medicine, biology, and psychology and another thirty 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 percent more weight per day and had shorter hospital stays by six days than those that were not massaged, resulting in cost savings of approximately $3000 per infant.12
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A study of the effects of massage therapy on HIV patients found that those who received a massage five times a week for one month had higher numbers of natural killer (NK) cells, which were also more potent. They also had less anxiety and lower serotonin (stress hormone) levels.13
A third study involved giving massage therapy to fifty-two hospitalized depressed and adjustment disordered 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.14
Following is a list of other applications of massage therapy currently being studied at TRI:
- Newborns of cocaine-addicted mothers
- HlV-exposed newborns
- Infants of depressed mothers
- Infant colic
- Infant sleep disorders
- Infants with cancer
- Preschool children
- Neglected children
- Abused children
- Autistic children
- Posttraumatic 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 improved immune function
- Spinal cord injuries
- Fibromyalgia syndrome
- Rape and spouse abuse
- Couples’ sex therapy
- Volunteer foster grandparents
- Arthritis
- Chronic fatigue syndrome
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, forty-eight 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, which in turn resulted in lower anxiety scores on a psychological test of state anxiety.15
Other studies of Rolfing have found improvements in muscular efficiency,16 reductions in anxiety,17 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).18
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 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, postoperative 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. 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.”19
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.20
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.
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.
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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.
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 tend to be higher in urban areas. Generally, the cost of massage therapy will range from $30 to $60 for an hour and will be 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
Maryon Stewart
Jim Strohecker
Daniel Redwood DC
Tom Ferguson MD