Massage therapy aims to induce physical and mental relaxation and promote well-being by stroking, kneading or pressing the soft tissues of the body.

Cultures all over the world and throughout the centuries have used massage to relieve pain and anxiety and to stimulate circulation and tonify body systems.

There are many different types of massage, from gentle manual lymph drainage to Swedish techniques and deep-tissue rolfing and Chinese tuina.

Aromatherapists and reflexologists are among complementary therapy practitioners who make use of massage techniques - here are descriptions fo the various massage therapy techniques.

But the therapeutic benefits of physiotherapy, developed from gymnast Per Henrik Ling's ‘Swedish movement treatment’ in the early 19th century, gave it respectability.

Far from being considered self-indulgent, massage's soothing effects have encouraged its use in NHS hospices and hospitals, particularly among the elderly, cancer and AIDS patients and those recovering from stroke and heart attacks.

The skin is the body's largest sensory organ and touch is said to be the first of the senses that we experience. In the dermis, or second layer of skin, are thousands of specialised receptors that react to stimulations such as pressure, cold and heat by sending messages to the brain via the nervous system. Brain centers respond by releasing chemicals that affect mood and physiological processes.
Privately, massage therapy is widely available in health and beauty centers and sports clubs. Practitioners will come to your home or workplace for on-site neck and shoulder massage.

What it's supposed to do

Gentle massage induces relaxation and a sense of well-being by stimulating nerve endings in the skin that trigger the release of endorphins, the body's natural opiates or ‘feelgood’ chemicals and inhibiting stress hormones. Stronger massage acts on circulation to supply more oxygen and nutrients to tissues and improve skin tone, and stimulates the lymphatic system which carries away waste products that can cause pain and stiffness in muscles and joints.

Massage can remind stressed people what physical and mental relaxation feels like. It is recommended to relieve pain and anxiety, for stress-related conditions such as insomnia and headaches, muscle and joint disorders such as arthritis and back pain, high blood pressure, digestive disorders such as constipation and irritable bowel syndrome.

How does it work?

Massage is simply the manipulation of the soft tissues of the body - the muscles, tendons and ligaments. A massage therapist's hands are his most important tool through which he not only treats the patient but also detects physical and emotional problems. The massage therapist palpates the patient's body to determine the condition of the tissues and the likely source of any pain, and thus the correct form of remedial treatment.

Massage works through the various body systems in one of two ways, a mechanical action and a reflex action. A mechanical action is created by moving the muscles and soft tissues of the body using pressure and stretching movement, thereby cleansing them of acids and deposits. This mechanical action breaks up fibrous tissue and loosens stiff joints.

A reflex is created when treatment of one part of the body affects another part of the body, much like pressing a light switch on a wall to turn on a light in the center of the room. Just like this electric connection, so too are different parts of the body connected to each other not just by flesh and bone but by nerve pathways, or flows of energy known as ‘meridians’ . So, by using reflex action, some therapists will treat a patient's stomach complaint by massaging the arms, and will alleviate pain in the legs by massaging the lower back.

What does treatment involve?

Each massage session will last 60-90 minutes, and will take place in a quiet room on a massage table. The patient will lie down undressed and the therapist will cover the parts of the body not being worked on with towels. Therapy will often start with the feet or with light stroking on the back to introduce you to the touch and for relaxation. The therapist will use either oils or talc and will work methodically around the whole body. The number of appointments required will depend upon the seriousness of the health problem.

The massage therapist will treat the patient through four stages of healing - relief, correction, strengthening and maintenance. For relief, the therapist will aim to alleviate any pain by sedating the sensory nerves, stimulating blood flow and reducing muscle tension, possibly by using hot and cold compresses. Secondly, for correction, the therapist will need to alleviate the underlying cause by rebalancing the muscles, clearing away lymph congestion and unknotting any fibers through various techniques of massage.

For strengthening, the weak joints and tissues should undergo continuing treatment to avoid repeated or additional injury. Finally, the massage therapist will recommend a monthly or bi-monthly maintenance program to help keep the tissues and ligaments healthy as ligaments never regain their original strength once they have been damaged.

What's the evidence?

Researchers at the Touch Research Institute, University of Miami, Florida, have found that massage can reduce anxiety and depression, relieve back and muscle pain, lower high blood pressure, ease PMS symptoms, re-invigorate office workers, and increase levels of natural killer cells that boost the immune system. Trials at the Royal Marsden Hospital, London, showed massage could reduce anxiety and improve the quality of life in cancer patients.

Precautions

Massage of the abdomen should be avoided in the first three months of pregnancy.
Do not massage bruises, fractures or skin infections.
Consult a doctor before having a massage if you have phlebitis, thrombosis, varicose veins, acute back pain, cancer, a personality disorder, psychotic illness or any undiagnosed pain, lumps or bumps.
Remember that not everybody enjoys massage. Don't continue if you feel uncomfortable.
If you have a serious ailment, avoid massage in a ‘health and beauty’ context.
Be wary of advertisements with phrases like ‘exclusive services’ or ‘executive massage’ .

Research

Massage can improve circulation and aid digestion and has been known to help insomniacs and migraine sufferers.

Relaxation massage has been shown to help reduce blood pressure by as much as 20 points. One nurse who measured a patient's blood pressure before and after a half hour massage, confirmed that blood pressure nearly always falls. In some cases the reduction was quite dramatic, for example, from 180 over 130 to 140 over 110 nmHg.

Massage improves the blood circulation in several ways without putting additional strain on the heart. It helps the flow of blood through the veins and also stimulates the nerves which control the blood vessels. It has the added benefit of relaxing tense muscles and tight connective tissues which may have been constricting blood vessels and thus enable blood to flow more freely. It is for this reason that soothing massage helps reduce emotional tension, it induces relaxation and calms stress-related cardio-vascular conditions.

Techniques

When using any of the following massage therapy techniques, the therapist works within the client's pain tolerance, establish a pain scale and asks the client to count while using certain deeper techniques. This is a great way to find a client's comfort zone.

"C" Bowing: This fascial massage therapy technique is performed with very little movement. Great for releasing restrictions, your thumbs are placed on the tissue beside each other while the fingers grasp the skin. The thumb sinks into the underlying tissue pushing it forward while the fingers pull back and distort the skin in a " C" shape until release is felt.

Cross Hand Facial Stretch: This fascial technique includes very little movement over the skin occurs. Movement should occur in the underlying fascia. The palms of the hands are placed on the skin, arms are crossed and the fingers point away from each other. The appropriate pressure is used to engage the fascia and the slack is taken away from the skin so that a release is felt.

Effleurage: a light, gliding motion over the skin that always maintains contact and directs the stroke towards the heart. This stroke is frequently used at the beginning and end of a massage treatment to invoke soothing and relaxing.

Fascial Techniques: This technique focuses on the body's fascia; a type of connective tissue that surrounds every muscle, bone, nerve, blood vessel and organ of the body. Massage therapists use different techniques to ease pressure in the fibrous bands of connective tissue (fascia) that encase muscles throughout the body. A breakdown of the fascial system due to trauma, posture or inflammation can create an adhesion in the fascia resulting in abnormal pressure on nerves, muscles, bones, or organs.

Frictions: These strokes are used to help break down connective tissue or adhesions, found within muscles, tendons and ligaments due to a direct injury accompanied by inflammation, like tendonitis. The therapist would use small circular motions making certain not to evoke an inflammatory response. Stretching and ice are applied to the treated tissue. Frictions are performed when tissue is in a relaxed neutral position and the thumb or fingers are used to compress the tissue over the lesion site. The pressure is increased and small back and forth movements are applied perpendicularly in the direction of the tissue fiber. No oil or lotion is used.

Heavy tapotement includes clapping or cupping, by using the concave surface of the palm, fingers and thumb held together firmly to form a cup. Light to heavy hacking is done with the ulnar border of your hand (baby finger side) and by beating with a closed full to half fist. Heavy tapotement techniques are used primarily for respiratory conditions to help loosen mucus.

Ischemic Compression: a static compression applied to a trigger point with the therapist's thumb or fingertips. The pressure used is always within the client's pain tolerance and the length of time varies - usually until the client feels the pain dissipate. Communication with the client is essential during this treatment.

Joint Mobilization Techniques: help increase range of motion. This massage therapy technique only takes the joint to its limited range of motion and no further. Chiropractic joint mobilizations take the joint beyond its range of motion; which isn't in a massage therapist's scope of practice.

"J" Stroke: This is the deepest of the fascial techniques, so it's used selectively. This stroke warms up the tissue using a fist position with the knuckles slightly raised. Skin is taken as the therapist increases depth making a small "J’ with the first knuckles while simultaneously pulling the tissues through. This massage therapy technique should be applied in an organized pattern along the tissue lines. Remember to always watch your client's reactions to stay within their pain tolerance.

Light tapotement includes pincement or plucking of the superficial tissue and tapping lightly with the fingertips. This type of tapotement is used to stimulate tight muscles and decrease fatigue.

Muscle Squeezing: This type of petrissage literally squeezes or compresses the muscle between the palm of the hand and the fingers. Pressure is directed slightly upwards. This should be done slowly at the beginning of treatment. Pressure will increase with each compression - within your client's pain tolerance.

Muscle stripping: This petrissage technique can be performed on a number of surfaces using the fingertips, the ulnar border of the hand (little finger side), the thumb or the elbow. The pressure is applied along the muscle fibers usually from origin of the muscle to insertion.

Myofascial Release utilizes a gentle blend of stretching and massage, to produce a healing effect upon the body tissues. Myofascial release effectively frees up fascia that may be impeding on blood vessels or nerves. This massage therapy technique also increases the body's instinctive restorative powers by improving circulation and nervous system transmission. The therapist uses light to moderate traction and twisting. Results include a decrease in muscle tension, increased range of motion and reduction in pain in the soft tissue.

Myofascial Trigger Point Therapy: A trigger point is defined as a spot within a taut band of skeletal muscle, or its fascia, that's painful if compressed.

Percussive Strokes (or Tapotement): This collection of stokes tends to make brief, repetitive contact with the hand or parts of the hand. These alternating blows have a stimulating, compressive effect to the skin and tissue, thus they are great when performed pre-event or to warm up the tissues for physical activities. Tapotement or percussive strokes reflexively tone the muscles during training.

Petrissage: consists of circular manipulations with shorter strokes - such as kneading, squeezing, pushing or grasping the muscle tissue. Petrissage can be performed with one or both hands, using the hand, the fingertips, thumb, forearm or knuckles. This type of stroke usually entails an increase in pressure, deeper than effleurage, which can become even deeper by using one hand to reinforce the other. Petrissage is generally used in the middle of massage treatments, after effleurage has been performed and the tissues are relaxed and warm. The response to petrissage can be both soothing and stimulating.

Picking up: this petrissage technique is done using the fingers and thumbs, or with the palm of the hand. It squeezes the muscle and lift it from the underlying tissue. Picking up begins slowly and progresses to a deep, firmer pick up.

Pulling or Tractioning: consists of a slow gentle pulling (or tractioning) action with the body part along its axis which causes the joint surface to slightly pull apart. This massage therapy technique is performed so that muscle stability can be assessed. Pulling or tractioning is performed in successive actions which nourishes the joint and also helps to decrease muscle tone affecting the muscles, ligaments and loosens any tissue that cross the joint being manipulated.

Repetitive Muscle Stripping: Applying pressure along the entire muscle length, increasing pressure with each pass until the trigger point is no longer felt. The tenderness will than disappear. Slow repetitive muscle strippings are performed on relaxed muscles with a trigger point present.

Rocking: the massaged part is manipulated in gentle or vigorous, rhythmic movements. It ends with the body part's return to its original position. Similar to the response produced by shacking, rocking also reflexively relaxes tight muscles. Rocking is often used to treat clients with joint problems, osteoarthritis and tight muscles.

Shaking: increases range of motion in a joint. It can be performed at the beginning, middle or end of a treatment, on tight muscles. Shaking affects the sensory nerves in the muscles and joints that reflexively relaxes the client and reduces the muscle tightness within. The action is done by grasping either the muscle belly, for direct shackings, or the limb furthest away from the body, for indirect sackings. The tissue is then moved back and forth at an even rhythm - from gentle to vigorous.

Skin Rolling: This petrissage technique lifts the skin between the thumb and fingers and is gently rolls over the area, very slowly. Skin rolling allows a release in the superficial restrictions between the skin and underlying tissue. It may be necessary to repeat rolling a few times over the same area in order to release any long term adhesions.

Stroking: This is one of the lightest petrissage techniques. The skin alone is stroked, so that the underlying tissue is not directly affected. Any part of the hand or fingers can be used to perform this rhythmic stroke. Stroking produces a stimulating effect with its multidirectional strokes, random rhythm and rate. Stroking is commonly used to end a treatment. It can be a soothing stroke if the client whishes to relax and stimulating if the client wishes to be alert.

Wringing: is a rhythmic picking up the tissue. Wringing fills the hand and tosses the tissue back and forth between in opposition. Your hands will conform to the tissue and the depth of the pressure will increase when tissue is lifted and torqued. The pressure eases when the hands return to their original starting position. A type of petrissage.

Vibrations: are applied lightly to the surface of the skin and vibrated or moved at a rapid rate. Vibrations are performed statically (in one place) or running (along the skin's surface). The trembling action of the hands and fingers transfers to the client rendering various results. For instance, when stroking is done briskly it becomes stimulating, but when stroking is performed gently it helps to relax and reduce any tension. This is another type of petrissage.

Click here for a description of the various massage therapy techniques.