Varieties and Techniques of Massage and Bodywork

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.


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.

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.


John was a veteran of the Vietnam War who was still suffering from a war injury many years later. He had been dropped from a helicopter into a battle from six or seven feet up and landed on his shoulder with all of his weight. The medics gave him some injections and sent him back out into the field, so he never received any real therapy. Since his return home the injury had become chronic over many years. He had limited range of motion in his arm and was unable to perform in sports, which had been his hobby.

His massage therapist determined that there was deep damage to the deltoid muscle, which had been crushed, and the scarring of the muscle had adhered to the bone and become hardened. In fact he had an area about the size of a quarter deep in the muscle that felt like bone. After deep tissue work the area began to come alive again and over time he was able to enjoy sports again.

Elliot Greene explains, “Sometimes when you get a deep bruise to a muscle it actually calcifies. Also, when scar tissue does not heal well the fibers of the scar can grow in a matted way that impairs movement of muscle tissue—the scar tissue may cross the muscle fibers and restrict them.

“Then, through the adhesions that are formed around the scar, these tissues become stuck to adjacent tissues. In John’s case they became stuck to the periosteum, the skin that covers the bone. This is why when he would try to move this muscle, there would be a stabbing pain.

“This particular case took a lot of strength to break up the adhesions. With deep tissue therapy, after the scar begins to soften, the fibers begin to move more parallel to the muscle fibers, thus being less resistant to movement of the muscle tissue. This is ‘the stretch hypertrophy law.’ Also, the opening up of circulation of lymph and blood helped unfreeze the area.”

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.


Joan was a thirty-two-year-old graduate student about to receive her Ph.D. in geology. She was also engaged but had a lot of anxieties about getting married. She sought massage therapy because of chronic headaches. Upon palpating her neck and upper shoulders, the practitioner found the muscles to be very knotty and hard. They had obviously been chronically tense for a long time.

During the course of several sessions Joan began to realize there was a relationship between the headaches, the tension she was holding in her musculature, and memories of having been physically abused as a child. The practitioner encouraged her to explore this with a psychotherapist.

She came back a year later for another series of four sessions. When the tense areas were encountered, she responded differently from before by telling the practitioner, “This really hurts,” whereas in the past she had said nothing. The practitioner suggested she rephrase this by saying “I hurt,” at which she began to sob as she never had before.

This was a very cleansing kind of release and through it Joan realized that in childhood she had adopted a pattern of numbing out to escape painful feelings. Through four sessions of massage she was able to release that long-held pattern and her fear and mistrust of her fiancee also ceased.

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.

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.

Published by arrangement with Warner Books, Inc., New York, New York, U.S.A. All rights reserved.

Nothing in this book should be considered as medical advice for dealing with a given problem. You should consult your health care professional for individual guidance with specific medical problems.

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Written by William Collinge MPH PhD

Explore Wellness in 2021