What is massage?

During massage, a therapist manipulates muscles and other soft tissues of the body to improve health and well being. Varieties of massage range from gentle stroking and kneading of muscles and other soft tissues to deeper manual techniques. Massage has been practiced as a healing therapy for centuries in nearly every culture around the world. It helps relieve muscle tension, reduce stress, and evoke feelings of calmness. Although massage affects the whole body, it particularly influences the activity of the musculoskeletal, circulatory, lymphatic, and nervous systems.

What is the history of massage?

The use of massage for healing purposes dates back 4,000 years in Chinese medical literature and continues to be an important part of Traditional Chinese Medicine (TCM). A contemporary form of massage, known as Swedish massage, was introduced to the United States in the 1850s. By the end of the 19^th century, a significant number of American doctors were practicing this manual technique, and the nation's first massage therapy clinic had opened its doors to the public.

In the early 20^th century, the rise of technology and prescription drugs began to overshadow massage therapy. For the next several decades, massage remained dormant, with only a few therapists continuing to practice the "ancient" technique. However, during the 1970s, both the general public and the medical profession began to take notice of alternative medicine and mind-body therapies, including massage therapy.

Are there many types of massage?

There are nearly 100 different massage and body work techniques. Each technique is uniquely designed to achieve a specific goal. The most common types practiced in the United States include:

• Aromatherapy massage. Essential oils from plants are massaged into the skin to enhance the healing and relaxing effects of massage. Practitioners believe essential oils have a powerful effect on mood by stimulating two structures deep in the brain known to store emotions and memory.
• Craniosacral massage. Therapists apply gentle pressure to the head and spine to correct imbalances and restore the flow of cerebrospinal fluid in these areas.
• Lymphatic massage. Therapists use light, rhythmic strokes to improve the flow of lymph (colorless fluid that helps fight infection and disease) throughout the body. One of the most popular forms of lymphatic massage, manual lymphatic drainage (MLD), focuses on draining excess lymph.
• Myofascial release. Therapists use gentle pressure and body positioning to relax and stretch the muscles, fascia (connective tissue), and related structures. Trained physical therapists and massage therapists use this technique.
• On site/chair massage. On site massage therapists use a portable chair to deliver brief, upper body massages to fully clothed people in offices and other public places.
• Polarity therapy. A form of energy healing, polarity therapy stimulates and balances the flow of energy within the body to enhance health and well being.
• Reflexology. Therapists use specialized thumb and finger techniques on the hands and feet. Reflexologists believe that these areas contain "reflex points" or direct connections to specific organs and structure, throughout the body.
• Rolfing. Therapists apply pressure to the fascia (connective tissue) to stretch it, lengthen it, and make it more flexible. The goal of this technique is to realign the body so that it conserves energy, releases tension, and functions better.
• Shiatsu. Therapists apply gentle finger and hand pressure to specific points on the body to relieve pain and enhance the flow of energy (known as qi) through the body's energy pathways (called meridians). Shiatsu is widely used in TCM.
• Sports massage. Often used on professional athletes and other active individuals, sports massage can enhance performance and prevent and treat sports-related injuries.
• Swedish massage. Therapists use a variety of strokes and pressure techniques to enhance the flow of blood to the heart, remove waste products from the tissues, stretch ligaments and tendons, and ease physical and emotional tension.
• Trigger point massage. Pressure is applied to "trigger points" (tender areas where the muscles have been damaged) to alleviate muscle spasms and pain.
• Integrative touch. A gentle form of massage therapy that uses gentle, non-circulatory techniques, integrative touch was designed to meet the needs of patients who are hospitalized or in hospice care.
• Compassionate touch. Combines one-on-one focused attention, intentional touch, and sensitive massage with communication to enhance the quality of life for elderly, ill, or dying patients.

How does massage work?

For centuries, human touch has been shown to be emotionally and physically healing. Particular massage techniques may either stimulate or calm the body's muscles and tissues to create a desired effect. When a practitioner massages soft tissue, electrical signals are transmitted both to the local area and throughout the body. These signals, in combination with the healing properties of touch, help heal damaged muscle, stimulate circulation, clear waste products via the lymphatic system, boost the activity of the immune system, reduce pain and tension, and induce a calming effect. Massage may also enhance well being by stimulating the release of endorphins (natural painkillers and mood elevators) and reducing levels of certain stress hormones.

What happens during a massage therapy session?

At your first massage therapy session, the practitioner will ask you about any symptoms you may have (like low back pain) and will also ask questions about your medical history. The practitioner may also initiate a discussion about what you expect to achieve from the massage session.

The therapist leaves the room while you undress and lie down on the massage table. A sheet is draped over your body during the session and moved only to expose the part of the body being worked on at any given time. Massage oil or lotion is often used to reduce friction between the practitioner's hands and your skin. The therapist will ask whether they are applying too much or too little pressure. Soft music may play in the background, and the room is usually kept warm and free of other distractions.

The manner in which a practitioner massages your body depends on the problem being treated. A massage session can last from 15 to 90 minutes and may include a schedule of follow up visits, depending on the severity of your situation.

What is massage good for?

In general, researchers believe massage supports healing, boosts energy, reduces recovery time after an injury, eases pain, and enhances relaxation, mood, and well being. It is useful for many musculoskeletal problems, such as low back pain, osteoarthritis, fibromyalgia, and sprains and strains. Massage may also relieve depression in people with chronic fatigue syndrome, reduce pain and improve quality of life, ease chronic constipation (when the technique is performed in the abdominal area), decrease swelling, alleviate sleep disorders, and improve self image. In the workplace, massage has been shown to melt away stress and enhance mental alertness. One study found that deep tissue massage reduced blood pressure levels (an average reduction of 10.4 mm Hg in systolic pressure and a diastolic pressure reduction of 5.3 mm Hg). Other studies show that massage may have immediate beneficial effects on pain and mood among patients with advanced cancer.

Clinical studies show that massage relieves chronic back pain more effectively than other treatments, including acupuncture, and in many cases, costs less than other treatments. Mothers and newborns also appear to benefit from massage. Mothers trained to massage their infants often feel less depressed and have a better emotional bond with their babies. Newborns who receive massage from their mothers also tend to cry less, and are more active, alert, and sociable. Premature babies who receive massage therapy have been shown to gain weight faster than preemies who do not receive this type of therapy. Infants who receive massage regularly may also sleep better, be less gassy or colicky, and have better body awareness, as well as more regular digestion.

Clinical studies also show that massage may be an effective for a wide range of health problems, including:

• Autism. Autistic children, who usually don't like being touched, show less autistic behavior and are more social and attentive after receiving massage therapy from their parents.
• Atopic dermatitis/eczema. Children with this scaly, itchy skin problem seem to experience less redness, scaling, and other symptoms if receiving massage between flares. Massage should not be used when this skin condition is actively inflamed.
• Attention deficit hyperactivity disorder (ADHD). Massage may improve mood in children with ADHD and help them feel less fidgety and hyperactive.
• Bulimia. Studies show that adolescents with this eating disorder feel less depressed and anxious after receiving massage therapy.
• Cystic fibrosis. Massage may reduce anxiety and improve respiration in children with this lung condition.
• Diabetes. Massage may help regulate blood sugar levels and reduce anxiety and depression in children with diabetes.
• Rheumatoid arthritis. Children with juvenile rheumatoid arthritis (JRA) have been shown to experience less pain, morning stiffness, and anxiety as a result of massage therapy.
• Labor. Studies suggest that massage helps reduce anxiety during labor. A bonus: massage increases oxytocin, a hormone known to facilitate bonding.
• Multiple Sclerosis. Studies suggest massage is more effective than exercise in reducing the frequency and severity of MS symptoms, including fatigue, pain, spasticity and quality of life.

Are there any risks associated with massage?

In general, massage is considered safe. Pain or other rare negative side effects are generally caused by an extremely vigorous massage technique.

Women should be very cautious about receiving massages during pregnancy. If you are pregnant, be sure to find a therapist specifically trained to perform massages on pregnant women.

Even though massage is a useful technique to help regulate blood sugar over time, if you have diabetes, you should check your blood sugar after receiving a massage because it may be too low. Plus, if you have diabetes and you are receiving massage on a regular basis, you should check your blood sugar frequently to evaluate changes over time.

Should anyone avoid massage?

People with these conditions should avoid massage:

• Heart failure
• Kidney failure
• Infection of the superficial veins (called phlebitis) or soft tissue (called cellulitis) in the legs or elsewhere
• Blood clots in the legs
• Bleeding disorders
• Contagious skin conditions

If you have cancer, check with your doctor before considering massage because massage can damage tissue that is fragile from chemotherapy or radiation treatments. People with rheumatoid arthritis, goiter (a thyroid disorder characterized by an enlarged thyroid), eczema, and other skin lesions should not receive massage therapy during flare ups. Experts also advise people with osteoporosis, high fever, few platelets or white blood cells, and mental impairment, as well as those recovering from surgery, to avoid massage. Check with your doctor.

Tell your massage therapist about any medications you are taking, as massage may influence the absorption or activity of both oral and topical medications.

What is the future of massage?

More research is needed to determine how effective massage therapy is, which health problems improve the most from this technique, and whether it is more cost effective than other types of treatment. Although massage is usually offered in the community by private practitioners, it is slowly being integrated into a variety of health care settings, such as hospice care facilities and hospitals.

How can I find a practitioner?

Certified massage therapists complete a training program of 500 or more hours, take national board exams, and are licensed or registered in many states. To find a massage therapist in your area, visit the American Massage Therapy Association (AMTA) website at www.amtamassage.org.

Although the AMTA has a listing of massage therapists who specialize in a variety of techniques, you may also use different resources to locate practitioners who specialize in the following techniques:

• Lymphatic massage. Massage therapists and physical therapists with at least 500 hours of massage or physical therapy training can become certified in lymphatic massage by taking a 4-week training program. To find a therapist who practices lymphatic massage, visit the North American Vodder Association of Lymphedema Therapists (NAVALT) website -- www.navalt.org.
• Reflexology. The American Reflexology Certification Board (ARCB) certifies reflexologists who undergo 100 hours of training and pass an exam. To find a qualified reflexologist go to www.arcb.net.
• Rolfing. Rolf Institute of Structural Integration -- www.rolf.org.
• Shiatsu. American Organization for Bodywork Therapies of Asia -- www.aobta.org.

Anderson PG, Cutshall SM. Massage therapy: a comfort intervention for cardiac surgery patients. Clin Nurse Spec. 2007;21(3):161-5; quiz 166-7.

Barlow A, Clarke R, Johnson N, Seabourne B, Thomas D, Gal J. Effect of massage of the hamstring muscles on selected electromyographic characteristics of biceps femoris during sub-maximal isometric contraction. Int J Sports Med. 2007;28(3):253-6.

Beider S, Mahrer N, Gold J. Pediatric Massage Therapy: An Overview for Clinicians. Pediatric Clinics of North America. 2007;54(6).

Bernas M, Witte M, Kriederman B, Summers P, Witte C. Massage therapy in the treatment of lymphedema. Rationale, results, and applications. IEEE Eng Med Biol Mag. 2005;24(2):58-68.

Billhult A, Bergbom I, Stener-Victorin E. Massage relieves nausea in women with breast cancer who are undergoing chemotherapy. J Altern Complement Med. 2007;13(1):53-7.

Billhult A, Stener-Victorin E, Bergbom I. The experience of massage during chemotherapy treatment in breast cancer patients. Clin Nurs Res. 2007;16(2):85-99; discussion 100-2.

Braun LA, Stanguts C, Casanelia L, et al. Massage therapy for cardiac surgery patients--a randomized trial. J Thorac Cardiovasc Surg. 2012;144(6):1453-9.

Buckle S. Aromatherapy and massage: the evidence. Paediatr Nurs. 2003;15(6):24-7.

Button C, Anderson N, Bradford C, Cotter JD, Ainslie PN. The effect of multidirectional mechanical vibration on peripheral circulation of humans. Clin Physiol Funct Imaging. 2007;27(4):211-6.

Cambron JA, Dexheimer J, Coe P. Changes in blood pressure after various forms of therapeutic massage: a preliminary study. J Altern Complement Med. 2006;12(1):65-70.

Dryden T, Baskwill A, Preyde M. Massage therapy for the orthopaedic patient: a review. Orthop Nurs. 2004;23(5):327-32; quiz 333-4.

Duimel-Peeters IG, Hulsenboom MA, Berger MP, Snoeckx LH, Halfens RJ. Massage to prevent pressure ulcers: knowledge, beliefs and practice. A cross-sectional study among nurses in the Netherlands in 1991 and 2003. J Clin Nurs. 2006;15(4):428-35.

Ezzo J, Haraldsson BG, Gross AR, et al.; Cervical Overview Group. Massage for mechanical neck disorders: a systematic review. Spine. 2007;32(3):353-62.

Field T, Diego M, Gonzalez G, Funk CG. Neck arthritis pain is reduced and range of motion is increased by massage therapy. Complement Ther Clin Pract. 2014; 20(4):219-23.

Field T, Diego M, Hernandez-Reif M. Potential underlying mechanisms for greater weight gain in massaged preterm infants. Infant Behav Dev. 2011;34(3):383-9.

Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database Syst Rev. 2008;(4):CD001929.

Gordon C, Emiliozzi C, Zartarian M. Use of a mechanical massage technique in the treatment of fibromyalgia: a preliminary study. Arch Phys Med Rehabil. 2006;87(1):145-7.

Guzzetta A, D'Acunto MG, Carotenuto M, et al. The effects of preterm infant massage on brain electrical activity. Dev Med Child Neurol. 2011; 53 Suppl 4:46-51.

Hennenfent BR, Lazarte AR, Feliciano AE Jr. Repetitive prostatic massage and drug therapy as an alternative to transurethral resection of the prostate. MedGenMed. 2006;8(4):19.

Kaye AD, Kaye AJ, Swinford J, Baluch A, Bawcom BA, Lambert TJ, Hoover JM. The effect of deep-tissue massage therapy on blood pressure and heart rate. J Altern Complement Med. 2008;14(2):125-8.

Kliegman. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Elsevier Saunders; 2011.

Kutner JS, Smith MC, Corbin L, Hemphill L, Benton K, Mellis BK, Beaty B, Felton S, Yamashita TE, Bryant LL, Fairclough DL. Massage therapy versus simple touch to improve pain and mood in patients with advanced cancer: a randomized trial. Ann Intern Med. 2008;149(6):369-79.

Maa SH, Tsou TS, Wang KY, Wang CH, Lin HC, Huang YH. Self-administered acupressure reduces the symptoms that limit daily activities in bronchiectasis patients: pilot study findings. J Clin Nurs. 2007;16(4):794-804.

Macgregor R, Campbell R, Gladden MH, Tennant N, Young D. Effects of massage on the mechanical behaviour of muscles in adolescents with spastic diplegia: a pilot study. Dev Med Child Neurol. 2007;49(3):187-91.

McNeill JA, Alderdice FA, McMurray F. A retrospective cohort study exploring the relationship between antenatal reflexology and intranatal outcomes. Complement Ther Clin Pract. 2006;12(2):119-25.

Montazavi SH, Khaki S, Moradi R, Heidari K, Vasegh Rahimparvar SF. Effects of massage therapy and presence of attendant on pain, anxiety and satisfaction during labor. Arch Gynecol Obstet. 2012;286(1):19-23.

Moraska AF, Stenerson L, Butryn N, Krutsch JP, Schmiege SJ, Mann JD. Myofascial trigger point-focused head and neck massage for recurrent tension-type headache: a randomized, placebo-controlled clinical trial. Clin J Pain. 2015;31(2):159-68.

Morhenn V, Beavin LE, Zak PJ. Massage increases oxytocin and reduces adrenocorticotropin hormone in humans. Altern Ther Health Med. 2012;18(6):11-8.

Munk N, Kruger T, Zanjani F. Massage therapy usage and reported health in older adults experiencing persistent pain. J Altern Complement Med. 2011;17(7):609-16.

Myers C, Walton T, Small B. The Value of Massage Therapy in Cancer Care. Hematology/Oncology Clinics of North America. 2008;22(4).

Negahban H, Rezaie S, Goharpey S. Massage therapy and exercise therapy in patients with multiple sclerosis: a randomized controlled pilot study. Clin Rehabil. 2013; 27(12):1126-36.

Plews-Ogan M, Owens JE, Goodman M, Wolfe P, Schorling J. A pilot study evaluating mindfulness-based stress reduction and massage for the management of chronic pain. J Gen Intern Med. 2005;20(12):1136-8.

Rakel B, Barr JO. Physical modalities in chronic pain management. Nurs Clin North Am. 2003;38(3):477-94.

Roh YS, Cho H, Oh JO, Yoon CJ. Effects of skin rehabilitation massage therapy on pruritus, skin status, and depression in burn survivors. Taehan Kanho Hakhoe Chi. 2007;37(2):221-6.

Sherman KJ, Cherkin DC, Deyo RA, Erro JH, Hrbek A, Davis RB, Eisenberg DM. The diagnosis and treatment of chronic back pain by acupuncturists, chiropractors, and massage therapists. Clin J Pain. 2006;22(3):227-34.

Skillgate E, Vingard E, Alfredsson L. Naprapathic manual therapy or evidence-based care for back and neck pain: a randomized, controlled trial. Clin J Pain. 2007;23(5):431-9.

Tekgunduz KS, Gurol A, Apay SE, Caner I. Effect of abdomen massage for prevention of feeding intolerance in preterm infants. Ital J Pediatr. 2014; 40:89.

Ucuzal M, Kanan N. Foot massage: effectiveness on postoperative pain in breast surgery patients. ain Manag Nurs. 2014;15(2):458-65.

Venesy DA. Physical medicine and complementary approaches. Neurol Clin. 2007;25(2):523-37.

Vernon H, Humphreys K, Hagino C. Chronic mechanical neck pain in adults treated by manual therapy: a systematic review of change scores in randomized clinical trials. J Manipulative Physiol Ther. 2007;30(3):215-27.

Wilkinson SM, Love SB, Westcombe AM, et al., Effectiveness of aromatherapy massage in the management of anxiety and depression in patients with cancer: a multicenter randomized controlled trial. J Clin Oncol. 2007;25(5):532-9.

Wu HS, Lin LC, Wu SC, Lin JG. The psychologic consequences of chronic dyspnea in chronic pulmonary obstruction disease: the effects of acupressure on depression. J Altern Complement Med. 2007;13(2):253-61.

Yang MH, Wu SC, Lin JG, Lin LC. The efficacy of acupressure for decreasing agitated behaviour in dementia: a pilot study. J Clin Nurs. 2007;16(2):308-15.