Massage is the manipulation of the body’s soft tissues. Massage techniques are commonly applied with hands, fingers, elbows, knees, forearms, feet, or a device. The purpose of massage is generally for the treatment of body stress or pain. A person professionally trained to give massages is traditionally known as a masseur (male) or a masseuse (female) in European countries. In the United States, these individuals are often referred to as massage therapists because they must be certified and licensed as a “Licensed Massage Therapist” (LMT).
In professional settings, clients are treated while lying on a massage table, sitting in a massage chair, or lying on a mat on the floor. There are many different modalities in the massage industry including but not limited to: Swedish, deep tissue, structural integration, trigger point, manual lymphatic drainage, sports massage, Thai massage, and medical-massage.
The word comes from the French massage “friction of kneading,” which, in turn, comes from the Arabic word مَسَّ massa meaning “to touch, feel”. Others claim an origin from the Portuguese amassar “knead,” from the Latin massa meaning “mass, dough,” from the Greek verb masso (masso) “to handle, touch, to work with the hands, to knead dough”. In distinction the ancient Greek word for massage was anatripsis, and the Latin was frictio.
Massage developed alongside athletics in both Ancient China and Ancient Greece. Taoist priests developed massage in concert with their Kung Fu gymnastic movements, while Ancient Greek Olympians used a specific type of trainer (“aleiptes”) who would rub their muscles with oil. Pehr Ling’s introduction to massage also came about directly as a result of his study of gymnastic movements.
The massage therapy industry is continuously increasing. In 2009, U.S. consumers spent between $4 and $6 billion on visits to massage therapists. In 2015, research estimates that massage therapy was a $12.1 billion industry. All but six States require massage therapists to be licensed, and licensure requires the applicant to receive training at an accredited school, and to pass a comprehensive exam. Those states that require licensure also typically require continuing education in massage techniques and in ethics.
Bio-mechanical stimulation (BMS) is a term generally used for localised biomechanical oscillation methods, whereby local muscle groups are stimulated directly or via the associated tendons by means of special hand held mechanical vibration devices. Biomechanical oscillation therapy and training is offered in a variety of areas such as competitive sports, fitness, rehabilitation, medicine, prevention, beauty, and used to improve performance of the muscles and to improve coordination and balance. It is often used in myofascial trigger point therapy to invoke reciprocal inhibition within the musculoskeletal system. Beneficial effects from this type of stimulation have been found to exist; the efficacy of the BMS Matrix therapy was proven in an independent study carried out by TUV-Sud which was commissioned by German health insurer BKK Gesundheit.
Craniosacral therapy (CST) aims to improve fluid movement and cranial bone motion by applying light touch to the skull, face, spine, and pelvis.
Manual lymphatic drainage is a technique used to gently work and stimulate the lymphatic system, to assist in reduction of localized swelling. The lymphatic system is a network of slow moving vessels in the body that carries cellular waste toward the liver, to be filtered and removed. Lymph also carries lymphocytes, and other immune system agents. Manual lymphatic drainage claims to improve waste removal and immune function.
Many use medical massage to describe a specific technique, others use it to describe a general category of massage and many methods such as deep tissue massage, myofascial release and trigger-point therapy, as well as osteopathic techniques, cranial-sacral techniques and many more can be used to work with various medical conditions.
Massage used in the medical field includes decongestive therapy used for lymphedema which can be used in conjunction with the treatment of breast cancer. Light massage is also used in pain management and palliative care. Carotid sinus massage is used to diagnose carotid sinus syncope and is sometimes useful for differentiating supraventricular tachycardia (SVT) from ventricular tachycardia. It, like the valsalva maneuver, is a therapy for SVT.
A 2004 systematic review found single applications of massage therapy “reduced state anxiety, blood pressure, and heart rate but not negative mood, immediate assessment of pain, and cortisol level,” while “multiple applications reduced delayed assessment of pain,” and found improvements in anxiety and depression similar to effects of psychotherapy.
Myofascial release refers to the manual massage technique that claims to release adhered fascia and muscles with the goal of eliminating pain, increasing range of motion and equilibrioception. Myofascial release usually involves applying shear compression or tension in various directions, cross fiber friction or by skin rolling.
Reflexology, also known as “zone therapy”, is an alternative medicine involving application of pressure to the feet and hands with specific thumb, finger, and hand techniques without the use of oil or lotion. It is based on a pseudoscientific system of zones and reflex areas that purportedly reflect an image of the body on the feet and hands, with the premise that such work effects a physical change to the body. Shiatsu (shi meaning finger and atsu meaning pressure) is a type of alternative medicine consisting of the fingers and palm pressure, stretches, and other massage techniques.
Sports massage is the use of specific massage therapy techniques in an athletic context to improve recovery time, enhance performance and reduce the risk of injury. This is accomplished using techniques that stimulate the flow of blood and lymph to and from muscles. Sports massage is often delivered before or after physical activity depending on the subject’s needs, preferences and goals.
Structural Integration’s aim is to unwind the strain patterns in the body’s myofascial system, restoring it to its natural balance, alignment, length, and ease. This is accomplished by hands-on manipulation, coupled with movement re-education. There are about 15 schools of Structural Integration as recognized by the International Association of Structural Integration, including the Dr. Ida Rolf Institute (with the brand Rolfing), Hellerwork, Guild for Structural Integration, Aston Patterning, Soma, and Kinesis Myofascial Integration.
The most widely recognized and commonly used category of massage is the Swedish massage. The Swedish massage techniques vary from light to vigorous. Swedish massage uses five styles of strokes. The five basic strokes are effleurage (sliding or gliding), petrissage (kneading), tapotement (rhythmic tapping), friction (cross fiber or with the fibers) and vibration/shaking.
The development of Swedish massage is often inaccurately credited to Per Henrik Ling, though the Dutch practitioner Johann Georg Mezger applied the French terms to name the basic strokes. The term “Swedish massage” is actually only recognized in English- and Dutch-speaking countries, and in Hungary. Elsewhere the style is referred to as “classic massage”. Clinical studies have found that Swedish massage can reduce chronic pain, fatigue, joint stiffness, and improve function in patients with osteoarthritis of the knee.
Tui na is a Chinese manual therapy technique that includes many different types of strokes, aimed to improve the flow of chi through the meridians.
Specialized massage tables and chairs are used to position recipients during massages. A typical commercial massage table has an easily cleaned, heavily padded surface, and horseshoe-shaped head support that allows the client to breathe easily while lying face down and can be stationary or portable, while home versions are often lighter weight or designed to fold away easily. An orthopedic pillow or bolster can be used to correct body positioning.
Ergonomic chairs serve a similar function as a massage table. Chairs may be either stationary or portable models. Massage chairs are easier to transport than massage tables, and recipients do not need to disrobe to receive a chair massage. Due to these two factors, chair massage is often performed in settings such as corporate offices, outdoor festivals, shopping malls, and other public locations.
Many different types of massage cremes, lotions, gels, and oils are used to lubricate and moisturize the skin and reduce the friction between skin (hands of technician and client).
These instruments or devices are sometimes used during massages. Some tools are for use by individuals, others by the therapist. Instrument-assisted soft-tissue massage can deploy stainless-steel devices to manipulate tissue in a way that augments hands-on work. A body rock is a serpentine-shaped tool, usually carved out of stone. It is used to amplify the therapist’s strength and focus pressure on certain areas. It can be used directly on the skin with a lubricant such as oil or corn starch or directly over clothing. Bamboo and rosewood tools are also sometimes used. They originate from practices in southeast Asia, Thailand, Cambodia, and Burma. Some of them may be heated, oiled, or wrapped in cloth.
Cupping massage is often carried out using plastic cups and a manual hand-pump to create the vacuum. The vacuum draws the soft tissue perpendicular to the skin, providing a tensile force, which can be left in one site or moved along the tissue during the massage.
Hand-held battery-operated massaging and vibrating instruments are available, including devices for massaging the scalp following a haircut. Vibrating massage pads come in a range of sizes, some with the option of heating. Vibrating massage chairs can provide an alternative for therapy at home.
The main professionals that provide therapeutic massage are massage therapists, athletic trainers, physical therapists and practitioners of many traditional Chinese and other eastern medicines. Massage practitioners work in a variety of medical settings and may travel to private residences or businesses. Contraindications to massage include deep vein thrombosis, bleeding disorders or taking blood thinners such as warfarin, damaged blood vessels, weakened bones from cancer, osteoporosis, or fractures, and fever.
Peer-reviewed medical research has shown that the benefits of massage include pain relief, reduced trait anxiety and depression, and temporarily reduced blood pressure, heart rate, and state of anxiety. Additional testing has shown an immediate increase and expedited recovery periods for muscle performance. Theories behind what massage might do include enhanced skeletal muscle regrowth and remodeling, blocking nociception (gate control theory), activating the parasympathetic nervous system, which may stimulate the release of endorphins and serotonin, preventing fibrosis or scar tissue, increasing the flow of lymph, and improving sleep.
Massage has been shown to reduce neuromuscular excitability by measuring changes in the Hoffman’s reflex (H-reflex) amplitude. A decrease in peak-to-peak H-reflex amplitude suggests a decrease in motoneuron excitability. Others explain, “H-reflex is considered to be the electrical analogue of the stretch reflex… and the reduction” is due to a decrease in spinal reflex excitability. Field (2007) confirms that the inhibitory effects are due to deep tissue receptors and not superficial cutaneous receptors, as there was no decrease in H-reflex when looking at light fingertip pressure massage. It has been noted that “the receptors activated during massage are specific to the muscle being massaged,” as other muscles did not produce a decrease in H-reflex amplitude.
According to research done by the American Massage Therapy Association, as of 2012 in the United States, there are between 280,000 and 320,000 massage therapists and massage school students. As of 2011, there were more than 300 accredited massage schools and programs in the United States. Most states have licensing requirements that must be met before a practitioner can use the title “massage therapist”, and some states and municipalities require a license to practice any form of massage. If a state does not have any massage laws then a practitioner need not apply for a license with the state. Training programs in the US are typically 500 hours to 1000 hours in total training time and can award a certificate, diploma, or degree depending on the particular school. There are around 1,300 programs training massage therapists in the US; study will often include anatomy and physiology, kinesiology, massage techniques, first aid and CPR, business, ethical and legal issues, and hands-on practice along with continuing education requirements if regulated. The Commission on Massage Therapy Accreditation (COMTA) is one of the organizations that works with massage schools in the U.S. and there are almost 300 schools that are accredited through this agency.
Forty-three states and the District of Columbia currently offer some type of credential to professionals in the massage and bodywork field—usually licensure, certification or registration. Thirty-eight states and the District of Columbia require some type of licensing for massage therapists. In the US, 39 states use the National Certification Board for Therapeutic Massage and Bodywork’s certification program as a basis for granting licenses either by rule or statute. The National Board grants the designation Nationally Certified in Therapeutic Massage and Bodywork (NCTMB). There are two tests available and one can become certified through a portfolio process with equivalent training and experience. Between 10% and 20% of towns or counties regulate the profession. The National Certification offered by the NCBTMB does not mean that someone can practice massage in any state. These local regulations can range from prohibition on opposite sex massage, fingerprinting and venereal checks from a doctor, to prohibition on house calls because of concern regarding sale of sexual services.
In the US, licensure is the highest level of regulation and this restricts anyone without a license from practicing massage therapy or calling themselves by that protected title. Certification allows only those who meet certain educational criteria to use the protected title and registration only requires a listing of therapists who apply and meet an educational requirement. It is important to note that a massage therapist may be certified, but not licensed. Licensing requirements vary per state, and often require additional criteria be met in addition to attending an accredited massage therapy school and passing a required state-specified exam (basically the certification requirements in many states). In the US, most certifications are locally based. Some states still do not require a license or a certification, but this is changing as more regulatory bodies governing the profession of massage are established in each state. Some states allow license reciprocity, where licensed massage therapists who relocate can relatively easily obtain a license in their new state.
In late 2007, the Federation of State Massage Therapy Boards launched a new certification exam titled the MBLEx. Currently, 40 states have accepted this certification exam, along with the District of Columbia, Puerto Rico, and the US Virgin Islands.
In 1997 there were an estimated 114 million visits to massage therapists in the US. Massage therapy is the most used type of alternative medicine in hospitals in the United States. Between July 2010 and July 2011 roughly 38 million adult Americans (18 percent) had a massage at least once.
People state that they use massage because they believe that it relieves pain from musculoskeletal injuries and other causes of pain, reduces stress and enhances relaxation, rehabilitates sports injuries, decreases feelings of anxiety and depression, and increases general well-being.
In a poll of 25-35-year-olds, 79% said they would like their health insurance plan to cover massage. In 2006 Duke University Health System opened up a center to integrate medical disciplines with CAM disciplines such as massage therapy and acupuncture. There were 15,500 spas in the United States in 2007, with about two-thirds of the visitors being women.
The number of visits rose from 91 million in 1999 to 136 million in 2003, generating a revenue that equals $11 billion. Job outlook for massage therapists is also projected to grow at 20% between 2010 and 2020 by the Bureau of Labor Statistics, faster than the average.