What Is It?
Massage is the manipulation of the soft-tissues of the body. It helps to ease stress and muscular tension, relieve pain from injuries, and speed healing from certain acute and chronic conditions. Today millions of people worldwide visit massage therapists as a form of regular health-care maintenance.

The practice of massage has been used for thousands of years. As early as 2700 B.C., the Chinese text, The Yellow Emperor's Classic of Internal Medicine, recommended that "breathing exercises, massage of the skin and flesh, and exercises of the hands and feet" should be used to treat paralysis, chills, and fever. In 400 B.C., the Greek physician Hippocrates wrote about the necessity for all physicians to use rubbing as a remedy, particularly to treat sports and war injuries. Ancient records from Japan also refer to massage therapy, and the technique is known to have been used by other cultures as well, including the Egyptians, Romans, and Arabs.

The roots of modern, science-based massage therapy begin with Per Henrik Ling (1776-1839), a Swedish fencing master and gymnastics instructor who developed a therapeutic system that included both massage and exercise. In 1813, Ling established the Royal Central Gymnastic Institute to make his methods available to the public. At the time, Ling's program included what he called "medical gymnastics" and "Swedish movement cure." Later the combination of the two came to be known as Swedish massage.

After studying in Sweden in the 1850s, two physician brothers, George and Charles Taylor of New York City, introduced massage therapy to the U.S. The technique gradually gained credence and was widely used by doctors until the early 1900s. But as biomedicine and new "high tech" equipment came into play, physicians lost interest in this labor-intensive therapy. A small number of massage therapists carried on the tradition until the 1970s, when a revitalized interest in alternative medicine sparked a demand for this healing technique.

Today there are some 80 different types of massage and related forms of bodywork. These techniques are generally organized into five broad categories:

Traditional European massage. This includes methods based on conventional Western concepts of anatomy and physiology. Five soft-tissue manipulation techniques are typically used: effleurage (long, gliding strokes); petrissage (kneading and compression strokes); friction (deep circular rubbing); tapotement (percussion tapping); and vibration (very fine, rapid shaking movements). Swedish massage, the most widely employed massage technique in the world today, is the primary example of traditional European massage.

Contemporary Western massage. Also based on modern concepts of anatomy, this category includes a wide variety of manipulative techniques that go beyond the original framework of Swedish massage. These include neuromuscular massage, (a form of deep massage that is intended to reach the connective tissues, tendons, ligaments, and nerves, and release knots of tension called trigger points); sports massage (a combination of Swedish massage and deep tissue massage that deals specifically with the effects of athletic performance on the body); myotherapy (a specialized form of muscle massage and stretching that uses deep manual pressure to release trigger points).

Structural realignment and movement integration. These techniques place an emphasis on body structure and movement. The methods organize and integrate the body in relationship to gravity through manipulation of the soft tissues and/or through correcting inappropriate patterns of movement. Examples include: Hellerwork, Rolfing, Feldenkrais, and the Alexander technique.

Oriental massage. Based on the principles of traditional Chinese medicine, Oriental massage techniques assess and restore the vital energy that is believed to flow through invisible channels in the human body. These methods include acupressure and Shiatsu.

Energy-based methods: These techniques, which are not founded in traditional Chinese medicine, are intended to affect the energy field that is believed to surround and infuse the human body. This is accomplished either by applying pressure and/or manipulation to the physical body, or by the passage or placement of the hands in or through the energy field. Examples of energy methods include polarity therapy, therapeutic touch, and Reiki. Many massage practitioners use a combination of these methods, depending on what the client needs at the time. For more information on different massage techniques, see the individual entries in the WholeHealth Chicago Reference Library.

How Does It Work?
Most types of massage affect the body in a similar way. When muscles are overworked, body waste products such as lactic acid can accumulate, causing soreness, stiffness, and even muscle spasms. Massage in general--and Swedish massage in particular--improves blood and lymph circulation and brings fresh oxygen and other nutrients to the affected tissues. This helps to flush out the toxins and enhance recovery.

Tense muscles may also compress blood vessels and stretch nerves, restricting blood flow and causing pain. As the affected area is massaged, the muscles gradually release their strangle hold on the irritated nerves, and the pain eases. The same mechanisms also make massage helpful in the recovery process for an injured muscle.

In addition, massage has been shown to increase the body's production of pain-killing endorphins and the mood-altering hormone serotonin. It can also slow the release of the stress hormone cortisol. For this reason, massage is often prescribed as an adjunctive therapy for people whose immune systems are compromised by stress.

What You Can Expect
What happens during a massage treatment depends on the type of massage you choose. To find out what you can expect from various techniques, see the WholeHealth Chicago Reference Library entries for individual types of massage.

Here's what you can expect from a Swedish massage:

On your first visit, the massage therapist will probably begin by asking you about your medical history, although the therapist is not licensed to make a medical diagnosis. Then will come some questions about your current physical condition, your lifestyle and stress level, any pain you may be experiencing, and why you're seeking treatment. This information will help the therapist determine what techniques to use and how to structure the session.

The room in which you will receive the massage will typically be warm and softly lit. The therapist may play soothing music (if you enjoy it), and/or burn candles or incense to add a pleasant scent. Often aromatic essential oils or lotions will be used to enhance the massage experience and prevent friction when the skin is rubbed.

You will probably be asked to disrobe partially or completely (in private) and you will be given a sheet or towel to drape over the areas of your body that are not being massaged. You will then be asked to lie down on a comfortable sheet-covered table. The table may have a special face-rest, which allows you to lie face-down without turning your head or neck.

Even someone trained specifically as a Swedish massage therapist may use a wide variety of strokes and techniques. You can request a full body massage or a massage that concentrates on a particularly painful or tight area. If at any time you feel uncomfortable, or the massage itself becomes painful, you should let the therapist know at once. A typical session usually lasts from 30 to 90 minutes.

Seated massage falls outside this general procedure. Here you usually remain fully dressed and sit in a special massage chair that supports the front of your body. In this type of massage, which usually takes 5 to 30 minutes, the therapist works on one area of your body--your shoulders, for instance, or your feet. Because the chair is portable, seated massage is increasingly available in the workplace to help reduce tension on the job.

The number of visits you'll require with a massage therapist can vary widely. If you are using massage for stress relief, you may want to visit a therapist as often as once a week. For acute injuries, the number of treatments will depend on the nature of your condition. Often massage therapy is prescribed by M.D.s to complement conventional care.

Health Benefits
Massage is believed to positively affect everything from circulation to the body's metabolism. Swedish massage in particular has been shown to relieve muscle pain, reduce stress, and improve immune function. It can also enhance respiratory function, reduce edema (swelling) due to blocked lymphatic vessels, and aid in the healing of soft-tissue injuries.

Many of the stress-related benefits of massage have never been documented by scientific studies, but during the past 20 years an impressive body of research--mainly on Swedish massage--has nevertheless accumulated. Much of this work was conducted at the University of Miami School of Medicine's Touch Research Institute, and several studies have been funded by the National Center for Complementary and Alternative Medicine.

Although more controlled trials are needed, the findings have included the following:

Hospitalized patients who were massaged attributed greater mobility, increased energy, positive mood changes, and a faster rate of recovery to massage therapy. Chronic low back pain sufferers reported experiencing less pain, depression, and anxiety--as well as improved sleep--after receiving two 30-minute massage sessions a week for five weeks. Other studies have been contradictory, however; therefore, more research is needed in this area. Office workers who were massaged regularly were more alert, performed better, and were less stressed than those who weren't massaged. Patients with fibromyalgia who received 30-minute massages twice a week for five weeks reported less pain, less stiffness, and less fatigue, as well as fewer nights of difficult sleeping. More studies are needed in this area. In burn patients, massage therapy decreased emotional effects (anxiety, tension, depression) and physical symptoms (pain and itching).

Massage has also been shown to have a profound effect on children as well as adults. Premature infants who were massaged, for example, gained weight and were released from the hospital sooner than those who were not massaged. Autistic children showed less erratic behavior after massage. Other ailments that have responded to massage include chronic fatigue syndrome, osteoarthritis, carpal tunnel syndrome, migraine, and sciatica.

For information on the health benefits of other forms of massage, see the individual entries in the WholeHealth Chicago Reference Library.

How To Choose a Practitioner
Thirty states and the District of Columbia have passed legislation regarding the licensing of professional massage therapists and defining what level of education and/or national testing they need in order to practice. While the rules for certification and licensing vary widely from state to state, many states require massage therapists to complete at least 600 hours of classroom instruction in massage therapy or be certified by passing an exam given by the National Certification Board for Therapeutic Massage and Bodywork (NCTBMB) in McLean, Virginia.

Ask friends and trusted health-care practitioners for referrals and recommendations. Before you make an appointment with a therapist, find out whether he/she is nationally certified and also a member of the American Massage Therapy Association (AMTA), located in Evanston, Illinois. Ask about what kind of training the therapist has had and whether he/she specializes in a particular kind of massage.

Remember, when you do go for an appointment, you should feel comfortable. If you don't like the personality or mannerisms of the therapist, find someone else with whom you feel more relaxed.

You may also want to learn how to do massage yourself or teach a friend or family member how to do therapeutic massage on you. There are dozens of books and video tapes on massage that can guide you. In most communities, you can also find classes in massage techniques at a community or adult education center.

Cautions
Avoid massage if you have a high fever, inflammation, infection, phlebitis, thrombosis, jaundice, or an infectious skin condition.

Do not have massage on an open wound or burn or at the site of a recent injury. Wait 24 hours before having massage on a strain or sprain.

If you have a chronic condition, such as arthritis, cancer, or heart disease, talk with your doctor before having massage therapy.

If you are pregnant, be sure to tell your massage therapist, as massage at certain sites on the body may induce labor. For information on the cautions associated with other forms of massage therapy, see the individual entries in the WholeHealth Chicago Reference Library.