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Chapter 1 / Welcome to the World of Massage Therapy! 11
The 18th Century
The rediscovery of ancient cultures lasted until the next
era, called the Age of Enlightenment or the Age of Reason,
which occurred during the 1700s. The dogma and tradition of the Church were challenged, the sense of reason
was explored and applied to different philosophies, humanitarianism blossomed, and education for everyone became a
cultural norm. In America, reason, rationale, and education
remained strong themes, but politics were the bigger part
of history. The Declaration of Independence was signed,
America became a free country, and the political system was
established. The political and philosophical changes of the
century bred inventions such as the bicycle, cotton gin, lightning rod, microscope, steam engine, telegraph, telescope,
and thermometer.
Medical history was marked by the discovery of vaccination and inoculation. The ancient Chinese medical reference the Cong Fou was translated into French by Jesuit P.
M. Cibot in 1779. The text, which recommended controlled
breathing and a system of exercises and positions for healthcare, was accompanied by illustrations in the French version.
It is very likely that this text served as the inspiration for Per
Henrik Ling’s Swedish Gymnastics.
with the same definitions to describe movement today.
Duplicated movements required physical work from both
the patient and the attendant, in which the attendant physically resisted the patient’s efforts to move his or her own
body. Dr.Mathias Roth, an English physician, wrote one
of the first books published in English about Swedish
Gymnastics, The Prevention and Cure of Many Chronic
Diseases by Movements , in 1851. His book included drawings
of treatments and showed the use of the low table, which
was originally introduced by Ling. As the popularity and
effectiveness of Ling’s techniques spread across Europe and
Russia, they were called the Swedish Movements , or the
Swedish Movement Cure.
The use of the term “Swedish massage” likely stemmed
from the Swedish Movements, even though the inclusion of
actual massage techniques as we know them today is questionable. Because of the popularity of the Swedish massage
technique, Ling has been credited with leading the revival
of the massage profession and is considered by some the
“Father of Swedish Massage.” The contribution of Ling’s
work is certainly better known than that of other historical
figures, but there are some people who are equally, if not
more, important in massage history.
Per Henrik Ling
Per Henrik Ling of Sweden (1776–1839) started a bodywork revolution during the transition from the 18th to 19th
century. Throughout his travels across Europe teaching,
translating, and writing poetry and plays, Ling learned to
fence. He noticed the repetitive motions and one-sided physical activity of fencing and their effects on his body. To balance the physical activity, he incorporated gymnastics into
his health regimen and consequently relieved his chronic
elbow pain. He never became a doctor, but he studied anatomy and physiology extensively and developed Swedish
Gymnastics , a movement system with four categories:
• Aesthetic—giving expression to feelings, emotions,
and thoughts
• Educational—developing the innate potential of the
body with good posture and control
• Medical—correcting bodily defects with active, passive, and duplicated movements
• Military—strengthening and toughening the body
The system included classifications of active, passive, or duplicated movements. Active movements were
defined as activities in which patients exercised or moved
their own bodies. Passive movements required the patients
to be relaxed and have their bodies moved by the attendant or to be relaxed and receive manipulation by the
attendant. The terms “active” and “passive” are still used
The 19th Century
Bodywork made a significant step forward into the 19th century with the help of Ling. His ability to demonstrate the
validity of Swedish Gymnastics as an independent therapy
quickly spurred other forms of manual therapy. Specific
massage and bodywork techniques were created, promoted,
and published in Europe and America.
Massage in 19th Century
Europe
Following the development of the Swedish Movements,
there were people who specifically promoted the field of
massage therapy. Dr. Johan Georg Mezger (1838–1909) of
the Netherlands coined some terms for massage techniques
that are still used today: effleurage (EF-luhr-ahzh), petrissage
(PEH-trih-sahzh), and tapotement (tuh-POHT-ment). It may
seem odd that a Dutchman would choose French words for
terminology, but the French words “massage,” “masseuse,”
and “masseur” were already gaining popularity. Table 1-2
lists massage terms with French roots.
Until Dr. Mezger’s influence, gymnastics were primarily Ling’s exercises and movements that sometimes included
massage techniques. Dr. Mezger was the first to identify classic massage strokes and differentiate them from gymnastics
and Swedish Movements. He reinforced and popularized his
terminology, which is still used as the standard worldwide.
12 INTRODUCTION TO MASSAGE THERAPY
French
Word
Masser MAH-say to rub or knead with hands
Masseur mah-SUHR male person who kneads with hands muh-SOOR
Masseuse mah-SUHZ female person who kneads with hands muh-SOOS
Massage MAH-sahzh a method of kneading with the hands Muh-SAHZH
Effleurer EF-luhr-ray to touch lightly
Effleurage EF-luhr-rahzh a method of light touching or stroking EF-luhr-ahzh
Pétrir pay-TREER to knead
Pétrissage PAY-trih-sahzh a method of kneading PEH- trih-sahzh
Tapoter TAH-poh-tay to tap
Tapotement TAH-poht-mahn a method of tapping or patting tuh-POHT-ment
The word “massage” was first found formally in a French-German dictionary in 1812, but French colonists in India may have
started using the term in the mid-1700s. When they found natives rubbing each other for therapy, they described the activity in their
journals, using their own French language. The terms “massage,” “masseuse,” and “masseur” are still used in many cultures, but in
the United States, as the profession has evolved, the term “massage therapist” or “massage practitioner” has become the norm.
French
Pronunciation English Translation
English Pronunciation
(If Applicable)
In 1888, Swedish physician Dr. Emil Kleen studied the
effects of effleurage, friction, pétrissage, and vibration on
circulation and lymph flow. He documented his results in
Handbook of Massage , in which he also emphasized the inclu-
sion of massage and manual therapy in medical treatment.
At the same time, he discouraged laypersons from practicing massage because of its medical applications. He identified medical gymnastics as a form of exercise or movement
of the muscles and differentiated it from massage, which
he defined as a manual therapy that is not exercise and is
applied by another individual. He stressed the importance
of anatomical and physiological education, palpation skills,
hands-on techniques, and the use of mechanical instruments for assistance in some situations. He also included
some guidelines for therapist self-care and acceptable lubricants and provided a general outline for a massagesession.
In the late 1800s, some British doctors made some
unfortunate discoveries in the field of massage. They
were noticing false claims of education and abnormally
high fees for massage treatment. As a result, the British
Medical Association ordered an inquiry and revealed patterns of inconsistency in the massage profession. Schools
with unqualified teachers and nonstandardized courses
were recruiting girls from poor neighborhoods and preparing students inadequately. They were giving students false
impressions regarding employment opportunities, and many
graduates were finding themselves unemployed. Some
schools opened massage school clinics and would forgive
school debts to students who would work in their clinics.
At best, these girls gave poor-quality massages. At worst,
these clinics were considered houses of prostitution that
deteriorated the reputation of massage practitioners. The
rapid growth of the practice resulted in an excess of therapists who were unqualified and damaged the profession as
a whole.
Legitimization of Massage
The negative repercussions of unregulated practice were
accompanied by some clear advantages. Massage in hospitals
and doctor’s offices became more prevalent because the only
massage therapists who were considered safe were directly
associated with a doctor or hospital. Additionally, qualified
massage therapists started organizing professional associations to protect the practice. The historical importance of
this period relates to the steps that were taken to provide
more legitimacy to the practice and to develop massage as a
profession instead of an amateur trade.
Eight women founded the Society of Trained Masseuses
in Britain in 1894 in an attempt to set a standard of highquality massage therapists. They modeled their organization
after the medical profession, where members had to meet
Chapter 1 / Welcome to the World of Massage Therapy!
13
specific academic requirements, pass an examination by a
board of professionals including at least one physician, and
receive training from a recognized school that received regular inspection and only hired qualified instructors. In 1900,
it became the Incorporated Society of Trained Masseuses.
When it expanded its membership to 12,000, it became the
Chartered Society of Massage and Remedial Gymnastics.
Massage practice was back on its way to being recognized as
a legitimate profession.
Massage in 19th Century
America
Healthcare made a transition in America during the 19th
century from heroic, folk medicine and treatment to professional medical care. Massage first gained notice in the
United States in the 1850s with Dr. George H. Taylor and
his natural approach to medicine. He brought the Swedish
Movements to the American medical community, integrated
them into his practice, and eventually founded the Remedial
Hygienic Institute in New York. Patients were taught a
holistic approach to their health and disease, including an
education regarding the nature of their illness, good nutritional habits, and an explanation of the treatment regimen, including water and massage therapies. Dr. Taylor’s
Movement Cure was later combined with Dr. Mezger’s
massage terms and techniques, one of which had the client
lie on a table for the entire session, creating a scene similar
to the present-day massage session.
Dr. John Harvey Kellogg (1842–1953) was an American
physician who pioneered the health food movement,
encouraging people to eat dry cereals for breakfast as part of
a healthy vegetarian diet. He became the superintendent of
the Battle Creek Sanitarium, a medical and surgical center
where patients were taught that a proper diet, exercise and
massage, fresh air, good posture, and sufficient rest result in
good health. The sanitarium specialized in water therapies
and massage and became famous for being “the place where
people learn to stay well.” 4
Dr. Kellogg made some very important contributions
to the history of massage. He conducted extensive massage research at the sanitarium, defining and examining
the mechanical , reflex , and metabolic effects of massage
on the different systems of the body. Table 1-3 explains the
physiological effects of massage determined by Dr. Kellogg.
Physiological Effects of Massage
Effect Description Example
Mechanical Client’s tissues remain
Reflex The therapist stimulates the
Metabolic A combination of mechanical
passive while the therapist
applies pressure or
manipulation to physically
change the shape or
condition of the client’s
tissues
client’s sensory neurons,
which triggers the client’s
nervous system to change
the shape or condition of the
tissues in both areas that
were addressed and other,
related areas
effects and reflex responses
in which the whole body is
affected
Strokes directed toward
the heart encourage
venous blood flow
Light touch on the sole
of the foot causes a
reflex contraction of the
rectus femoris, flexing
the hip and pulling the
foot away
Sustained touch of
massage activates
the parasympathetic
nervous response that
lowers heart rate and
encourages digestion
Photo courtesy of Robert Calvert, World of Massage Museum.
14 INTRODUCTION TO MASSAGE THERAPY
He found significant effects on the nervous, muscular, skeletal, circulatory, respiratory, integumentary, and digestive
systems as well as thermal regulation, cellular metabolism,
and kidney and liver activity. In 1895, Kellogg wrote about
these effects in his book The Art of Massage . The book is an
excellent reference with detailed and accurate information
regarding anatomical structures, physiological effects, massage techniques, therapeutic applications, joint movement,
massage for specific body regions and diseases, rules for
practice, and correct terminology. This text was published
again in 1909, 1919, and 1923 because of its superior presentation of information.
The 20th Century
Early in the 20th century, massage continued to establish
a strong foundation for growth. Associations of massage
professionals evolved to provide more legitimacy to the
profession. The medical community respected the practice enough to allow it to continue in British hospitals and
to be used as a form of rehabilitation for soldiers in World
WarsI and II. In London, hospitals combined massage,
physical exercise, physiotherapy, and orthopedic medicine
departments. Massage services were particularly desired by
private patients, so there was an increase in the number of
nurses who took massage courses, studied for a Massage
Certificate, and became nurse masseurs. Other students
studied for the examination of the Chartered Society of
Massage and Remedial Gymnastics, which later became the
Chartered Society of Physiotherapy.
Social conservatism, the advancement of physiotherapy,
physical therapy, and the use of electronic devices restrained
the use of massage to some degree. Despite the negative
connotations and technological progress, massage remained
a part of healthcare. The later part of the 20th century
brought much change to the massage profession, especially
as bodywork techniques were developed all over the world.
There are so many forms of bodywork generated in the
later part of the 20th century that we consider it a separate
period in massage history (Fig. 1-8).
Contemporary Massage Therapy
Bodywork has a long and rich history as a mode of physical,
mental, and spiritual healing in various cultures and arenas
that provides a solid foundation for the current massage therapy profession. For as much as bodywork has evolved over
the previous thousands of years, massage has grown exponentially in the last 50 years. The rapid growth shows the
popularity and validity of the practice, but it could also lead
to the downfall of the massage profession. Although there is
disagreement among current practitioners about standardization and governmental regulation, it encourages the safest
and most dependable environment for massage clients.
Contemporary massage therapy in America began
in the 1960s, when the younger generation rejected conservative habits and conformity in search of self-discovery.
The Esalen Institute in Big Sur, California, became one of
the major places to explore the “human potential,” or the
world of unrealized human capacities. Founded in 1962,
Esalen became famous for its beautiful landscape; its blend
of Eastern and Western philosophies; its experiential workshops; and the steady influx of philosophers, psychologists,
artists, and religious thinkers. Esalen is one of the first modern places where massage was taught; there, bodywork
is considered a pathway to well-being and transpersonal
growth. The Esalen massage is a fluid and flowing combination of the structured Swedish Movements with massage
strokes delivered in a sensitive, personal way.
The very popular human potential movement resulted in
numerous books written to accompany the explosion of new
bodywork techniques. Since then, many people have contributed to the advancement of the massage profession by conducting research studies to prove its therapeutic legitimacy
and writing books that include scientific proof. As a result,
massage is regaining acceptance with the public and the medical community as a valid therapy. Contemporary massage is
recapturing the historic roots of massage as a preventive and
rehabilitative medical approach and is reviving the rich tradition of bathing and anointing in the progressive spa industry.
Historically, massage techniques were based on the practices
of anointing and bathing as well as variations of gymnastics
and the Swedish Movements. Since then, numerous massage
and bodywork modalities have emerged (Fig.1-8). Keeping
with the distinction that was made by Dr. Mezger and
Dr.Kleen in the 1800s, massage is an activity that requires
the therapist to apply manual pressure to the client’s tissues.
Bodywork can be characterized as treatment that involves
manipulation of the client’s body as a way to maintain or
improve health. In other words, all forms of massage may
be considered bodywork, but not all forms of bodywork
may be called massage.
Chapter 1 / Welcome to the World of Massage Therapy!
15
3000 BCE Ancient Chinese medical texts, the Cong Fou and the Nei Ching are written
2500
2350
1825
1700
1000
400 BCE Hippocrates writes Hippocratic Corpus
400–1400 The Middle Ages in Europe, influenced by the Church, is marked by cultural emptiness that results in a decline of massage in Europe
1450–1600 The Renaissance brings anatomical art from Leonardo da Vinci and Andreas Vesalius
1700s Humanitarianism, reason, and education flood society, and many scientific inventions are created
1800s Sweden’s Per Henrik Ling creates Swedish Gymnastics
1914-1918 Swedish massage rehabilitates injured soldiers in WWI
1940s Therese Pfrimmer creates cross-fiber muscle therapy, later called Pfrimmer Deep Muscle Therapy
1950s Francis Tappan and Gertrude Beard write significant books and articles on massage techniques
1960s Esalen Institute establishes itself as a center to explore human potential
1970s John F. Barnes, physical therapist, introduces his therapy called Myofascial Release to the public
Ancient forms of bodywork: anmo, anointing, mordan, samvahana, Tui-na
BCE Ancient Indian scriptures, the Vedas, are written
BCE Ankhmahor’s tomb is inscribed with Egyptian drawings of bodywork
BCE Egypt’s Kahun Medical Papyrus is written
BCE Babylonian laws called the Code of Hammurabi include “eye for an eye” medical ethics
BCE Ancient Greek health regimen included massage and baths
CE Aulus Cornelius Celsus writes De Medicina
30
175 Greek physician Claudius Galenus (Galen) of Rome develops early scientific research method
The Middle Ages in the Arab world, less affected by the Church, generates the belief that health is affected by state of mind
René Descartes develops theory of mind–body connection, “I think, therefore I am”
1779 Jesuit P.M. Cibot translates the Cong Fou into French
The Netherlands’ Dr. Johan Mezger standardizes massage terminology and differentiates massage strokes from movement therapies
Dr. George Taylor popularizes the Movement Cure in America
Dr. John Kellogg pioneers the health food movement in America, researches the physiological effects of massage, and writes The Art of Massage,
which is still an excellent reference
British inquiry reveals unethical activity in the field of massage, which provides the stimulus for legitimization
1894 The first professional massage organization, the Society of Trained Masseuses, is founded in Britain
1913 Dr. William Fitzgerald develops Zone Therapy, a precursor to reflexology, based on reflex zones
1920 The Society of Trained Masseuses grows, incorporates, and becomes the Chartered Society of Massage and Remedial Gymnastics
Dr. Mikao Usui of Japan originates Reiki
1927 The first American massage association, New York State Society of Medical Massage Therapists, is founded
1939 The Florida State Massage Therapy Association, Inc. (FSMTA) organizes 85 charter members
1940 British osteopath James Cyriax creates deep transverse friction
1943 American Association of Masseurs and Masseuses (AAMM) formed in Chicago with dues of 50 cents
The first Massage Act is passed by the Florida Legislature
1949 Massage Registration Act formulated by AAMM
Dr. Randolph Stone develops Polarity Therapy
1952 Janet Travell researches trigger points
1958 AAMM becomes the American Massage and Therapy Association (AM&TA)
1960 Jin Shin Jyutsu, the Japanese art of circulation awakening, was brought to America by Mary Iino Burmeister
1964 Applied Kinesiology was founded by chiropractor George Goodheart
1972
Moshe Feldenkrais develops his own method of movement therapy
1977
Paul St. John, LMT, develops the St. John Method of Neuromuscular Therapy
1978
Joseph Heller develops Hellerwork, a structural bodywork
1980
Dr. Milton Trager opens the Trager Institute and teaches the Trager Approach to movement therapy
1981
Dr. Lawrence H. Jones develops Strain Counterstrain neuromuscular techniques for relieving trigger points
1983 AM&TA becomes the current American Massage Therapy Association (AMTA)
1987 Associated Bodywork and Massage Professionals (ABMP)
1992 Dr. Tiffany Field opens the Touch Research Institute
AMTA creates the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB)
National Institutes of Health establish the Office of Alternative Medicine
Figure 1-8. Timeline of bodywork and massage.
16 INTRODUCTION TO MASSAGE THERAPY
Modality Examples Modality Examples
Swedish Swedish massage
Relaxation massage
Health maintenance massage
Esalen massage
Deep tissue Connective tissue work
Myofascial work
Pfrimmer Deep Muscle Therapy
Cross-fiber friction techniques
Craniosacral work
SOMA Neuromuscular Integration
Neuromuscular St. John Method of
Neuromuscular Therapy (NMT)
Trigger point therapy
Muscle energy techniques
Proprioceptive neuromuscular
facilitation
Reflexology
Ortho-Bionomy
Circulation
enhancement
Manual lymph drainage (MLD)
Vodder techniques
Arterial enhancement
Venous enhancement
Energy Polarity therapy
Reiki
Therapeutic Touch
Touch for Health
Magnet therapy
Zero Balancing
Oriental/
Eastern
approaches
Structural
integration
Movement Feldenkrais
Special
populations
Acupressure
Shiatsu
Jin Shin techniques
Tui-na
Thai massage
Watsu
Qigong
Lomi Lomi
Rolfing
Hellerwork
Aston-Patterning
Alexander Technique
Trager work
Athletes
Corporate massage
Prenatal massage
Infant massage
Elderly massage
Physically disabled
Stone therapy
A modality is a collection of manual therapies that tends
to use similar applications of movement or massage strokes to
reach a similar goal. There has been inconsistency in the categorization of the various bodywork modalities, partly because
so many of the modalities fit more than one category. This
text separates and identifies the following nine categories of
bodywork: Swedish, deep tissue, neuromuscular, circulation
enhancement, energy, Oriental/Eastern approaches, structural/postural integration, movement bodywork, and special
populations (see Table 1-4). These categories are briefly introduced in this chapter, and many are covered in detail later in
the text. The techniques not covered in detail likely require
extensive study, training, and special certification.
Swedish Modalities
Swedish massage is the most widely recognized and commonly used category of massage. While the public commonly
identifies it as a gentle and superficial massage, the techniques
vary from light to vigorous. Generally, Swedish includes a
combination of long gliding (effleurage), kneading (petrissage), tapotement (percussion), and friction strokes applied to
the superficial tissues of the body. They can be applied separately or mixed and matched to adapt to the needs of the
client during the massage session. Oftentimes, these strokes
are combined with active and passive movements to create a
fluid, relaxing, circulatory-enhancing massage session.
Relaxation massage and health maintenance massage
are considered Swedish modalities. Their mechanical and
reflexive benefits are primarily intended to increase circulation of the blood and lymphatic fluid throughout the body
as well as increase joint range of motion. These techniques
and their effects are covered extensively in Chapter 9.
Deep Tissue Modalities
The deep tissue modalities are intended to affect the tissues that are deep within the body and are often difficult to
Chapter 1 / Welcome to the World of Massage Therapy! 17
palpate. They are usually applied slowly and specifically and
typically use long, sustained gliding strokes, prolonged direct
pressure, and strokes that travel across the muscles, perpendicular to the muscle fibers. This category of massage modalities
includes, but is not limited to, connective tissue, myofascial,
Pfrimmer, cross-fiber friction, and craniosacral techniques.
Connective tissue, myofascial, and Pfrimmer work are
frequently used when there is some kind of restriction in the
fascia or muscle. These restrictions, sometimes called adhesions, can form as a result of injury or chronic muscular tension patterns, may limit movement, create pain, and result
in postural compensation patterns. These techniques may
be uncomfortable for some clients, but by breaking up the
restrictions and restoring space to the tissues, circulation and
lymphatic flow are increased and health can be restored.
Dr. James Cyriax was an English physician who is considered the “Father of Orthopaedic Medicine.” He developed the connective tissue technique of cross-fiber (deep
transverse) friction that can be used to help heal muscular,
tendinous, and ligamentous dysfunctions resulting from
injury and overuse.
Deep tissue modalities often consist of applications
of intense, localized pressure to access the deep tissue layers, but there are also some very subtle techniques that
can accomplish the same thing. It may seem counterintuitive that a subtle technique could be a deep tissue modality, but there is a common misconception that “deep” means
“hard.” Consider the effect of vibrations. When you feel the
rumbling of loud thunder or the booming bass of a car stereo or you strike a tuning fork and hold it against your skin,
you may feel the vibrations resonate deep in your chest or
throughout your whole body. Likewise, the deeper tissue
layers can be affected with minimal energy and very little
pressure by applying vibration or other subtle techniques
such as craniosacral therapies or many of the energy modalities described later in this section.
Craniosacral therapy is a subtle technique that can affect
deep tissues and have very profound effects. Practitioners
palpate and manipulate the rhythmic flow of cerebrospinal fluid that bathes the brain and spinal cord. Altering the
rhythm of the flow can rearrange the fascia, restore space to
the tissues, and increase lymph and blood flow to the area.
The technique is applied very lightly, which is why it is sometimes considered an energy modality, but this text classifies it
as a deep tissue modality due to the cerebrospinal fluid being
deep within the body, as well as its effects on the deep fascia.
Neuromuscular Modalities
Neuromuscular modalities engage the relationship between
the nervous and muscular systems to create reflex responses.
The organ systems of the body are separate but very
interdependent processes. All of the activity of the muscular
system depends on the nervous system, which is the main
control system of the body. By using the physiological relationship between nerves and muscles, we can change muscle
length and kinesthetic perception. Some of the neuromuscular modalities use massage, but this may be considered more
of a bodywork modality. St. John Method of Neuromuscular
Therapy (NMT), trigger point therapy, muscle energy techniques, proprioceptive neuromuscular facilitation, and reflexology can be categorized as neuromuscular modalities.
Circulatory Enhancement Modalities
Circulatory enhancement modalities are massage techniques
that use purely mechanical effects to manipulate the movement of blood, lymphatic fluid, and waste within the body.
The flow of blood through the cardiovascular system can
be enhanced through the arteries as well as the veins. Basic
massage strokes are used in specific patterns to accomplish
both arterial and venous enhancement.
Lymphatic fluid from the body tissues is collected
and transported through the lymph vessels and is eventually emptied into the heart. The flow of lymph can also be
encouraged with specific manual techniques such as manual
lymph drainage (MLD) or the Vodder method.
Energy Modalities
Energy modalities are often associated with a sense of mystery and doubt, mostly because their validity may be unproven by scientific methods. There are several types of energy
bodywork, most of which use very light touch or off-thebody application to manipulate the human body’s energy
fields. Polarity therapy and Reiki are two of the more common energy techniques.
The famous physicists Albert Einstein, Prince Louis de
Broglie, and Max Planck suggested that matter is composed
of an essence of energy, having electromagnetic fields and
positive and negative poles. Polarity therapy, based on the
concept that the human body creates an energy field, suggests that the human energy field is affected by internal
and external inputs, including emotions, touch, sounds, and
movement. While the central nervous system is the main
component of our electrical or energetic existence, a whole
host of biochemical reactions play a part as well. Basically,
if biochemical reactions are hindered, the efficiency of
nerve transmission and other body systems is diminished.
Theoretically, if the blockages are removed, function can
18 INTRODUCTION TO MASSAGE THERAPY
be restored. Polarity therapy addresses the electrical field of
the body, attempting to balance it out in an attempt to allow
normal electrical activity to occur.
Reiki is an energy modality that restores flow to the life
force energy with spiritual guidance. The life force energy,
or Qi (CHEE), is a dynamic, changing energy force that runs
through the whole body, supplying and being supplied by
body processes and activities. It can be vaguely compared to
the flow of energy that you feel when you are enlightened,
optimistic, or motivated. Unlike most bodywork modalities,
Reiki is a technique that is transferred as a gift from one
practitioner to another, requiring no intellectual or spiritual
education. A very simplified explanation of Reiki portrays it
as a spiritually guided manipulation of the life force energy.
Oriental/Eastern Modalities
In traditional Eastern philosophies, the Qi travels through a
series of pathways called meridians. The philosophies teach
that a balanced, unrestricted flow of Qi is required for the
body to maintain good health, and disruptions or blockages
to Qi cause disharmony in the body. Theoretically, removal
of the disruptions and restoration of a balanced energy
flow can restore health. The Oriental bodywork modalities
manipulate the Qi mechanically to restore normal function
and health to the body. These techniques use external, visible
applications of pressure and manipulation, which classifies
them as massage techniques. In addition to mechanical pressure, these techniques also use internal, energetic manipulations that are not visible. The internal work is the more
profound of the two, which leads to the consideration of
the Oriental techniques as forms of art as opposed to science. Acupressure, Shiatsu, Jin Shin techniques, and Tui-na
are just some of the many Oriental modalities that use
mechanical pressure from fingers, hands, thumbs, elbows,
knees, and feet.
Movement Modalities
These bodywork modalities use movement to reorient the
body for more optimal function. Feldenkrais (FEHL-denkrahys), Alexander Technique, and Trager (TRAY-ger) are
examples of movement modalities.
Dr. Moshe Feldenkrais was a physicist, engineer, martial
arts master, and teacher who developed his own bodywork
method in the mid-1900s. Feldenkrais is a movement therapy that teaches body awareness, coordination, and flexibility
through movement techniques. Habitual activities that may
create dysfunctional movement patterns are studied and
then neuromuscularly reprogrammed by practicing precise
movement patterns that are balanced. The neuromuscular
component of this modality leads some to categorize it as a
neuromuscular therapy, but its focus is on movement.
The Alexander Technique was developed by Frederick
Matthias Alexander, a Shakespearean actor from the early
1900s. His technique studies the client’s balance, coordination,
flexibility, and support structure and encourages the client to
be aware of reactive, habitual movements. The practitioner
uses palpation skills and gentle movements to relieve muscular tension while the client demonstrates simple activities.
By reprogramming the body to make conscious movement
choices instead of reactive, reflexive motions, the technique
creates ease of movement and improves overall health.
Milton Trager, MD, developed a bodywork approach in
the mid-1900s that uses active and passive components similar
to ancient gymnastics. The client lies on a table for the passive component while the practitioner moves him in gentle,
natural rocking and shaking patterns that are intended to feel
unrestricted and effortless. The intent is to relieve chronic patterns of muscular tension. The active portion of the approach
requires clients to shake and loosen their bodies to reinforce
the practitioner’s table work. Giving the clients exercises to
use on their own allows them to take an active part in their
healthcare and can have longer lasting or permanent results.
Structural and Postural Integration Modalities
Structural and postural integration modalities, such as
Rolfing and Hellerwork, may be considered massage techniques. They generally focus on realigning the skeletal system to relieve pain from postural compensations. Posture
can significantly affect health, and although it often takes
a lot of bodywork that may be accompanied by discomfort, structural realignment can be very beneficial. The
Assessment chapter of this text, Chapter 7, discusses the
relationship between posture and health in further detail.
Special Populations
There are groups of clients who have special conditions or
require special considerations to receive massage and bodywork comfortably or safely. This text refers to these groups
as special populations, and the therapist must understand
their specific needs to determine which techniques are
appropriate and which should be avoided. Some special
populations a therapist may encounter include athletes,
corporate, geriatric, prenatal, infant, and physically disabled
clients. Essentially, the same massage strokes are used, but
special considerations are given to session duration, pressure, areas to avoid, positions to avoid, precautions to take,
and equipment to use. These special populations are covered
in more detail later in the text.
Chapter 1 / Welcome to the World of Massage Therapy!
19
Touch is one of the most basic of human needs and occurs in
every culture. Touch can be used as a method of communication and learning, for comfort, and to provide self-esteem.
Scientific research has indicated that it is required for healthy
growth, development, and immune function. It has also been
scientifically proven that deprivation of touch can cause significant developmental barriers in humans and animals. In
essence, the sense of touch is required for our very survival.
From the time you are in the womb, you depend on
touch to learn about the world. Infants commonly explore
objects by putting them in their mouths, discovering the
shapes, textures, and temperatures of objects in their world.
When babies cry, they are comforted when they are picked up
and held, stroked, or kissed. This comforting aspect of touch
continues into adulthood. When you are upset, you often
seek touch for comfort and validation. Handshakes, pats on
the back, hand holding, hugs, and kisses are different forms of
touch that provide comfort and validation, and they are also
used as modes of communication. Adults use touch to communicate, evaluate, and navigate through the world. Again,
touch is very powerful and, when used appropriately, can have
incredibly positive outcomes on the human experience.
One very early example of touch research is the classic study conducted in 1958 by University of Wisconsin
psychologist Harry Harlow. Infant rhesus macaque monkeys were taken from their real mothers, isolated in metal
cages, and offered different objects for sources of comfort
and security. Harlow showed that the infants preferred cuddling with a soft cloth, artificial mother to a wire model
with a head and face that held food (Fig. 1-9). In fact, when
the cloth model had the food as well, the infant monkeys
did not go to the wire model at all, suggesting that infants
may instinctively prefer cuddling and tactile stimulation to
food nourishment. There are so many people who believe in
the power of touch that the government and private interest
groups have funded research to prove its efficacy.
Government-Sponsored
Research
The National Institutes of Health established the Office
of Alternative Medicine in 1992 to study and recommend
Touch Physiology
The average person is covered with 18 square feet of skin,
making the skin the largest sensory organ of the body.
Unlike the other sensory organs, the skin remains in a constant state of readiness, sending pressure, temperature, and
pain sensations to the central nervous system for the appropriate response. This function is especially critical when a
person is blind or deaf or when other physiological changes
affect sensory input. The skin is the major structure of the
integumentary system and is covered in more detail in the
chapter on body systems.
Massage Research
Various forms of touch have long been a part of many cultures throughout history, but the formal, scientific study
of touch is relatively new. As the massage profession continues to evolve, research is vital for validating the effects
of massage. The hard scientific proof is helping the medical profession understand and accept the value of touch.
Several medical schools, including Duke, Harvard, and Johns
Hopkins, offer integrated medicine electives and research
opportunities to study the effects of touch and other bodywork modalities.
Figure 1-9. Harlow’s rhesus monkey clinging to the soft cloth
figure instead of the wire figure that holds nourishment.
20 INTRODUCTION TO MASSAGE THERAPY
further research on unconventional medical treatments.
In 1998, it expanded to become the National Center for
Complementary and Alternative Medicine (NCCAM).
“It is dedicated to exploring complementary and alternative healing practices in the context of rigorous science,
training complementary and alternative medicine (CAM)
researchers, and disseminating authoritative information
to the public. To fulfill its mission, NCCAM supports a
broad-based portfolio of research, research training, and
educational grants and contracts, as well as various outreach mechanisms to disseminate information to the
public.” 5
A growing number of Americans are using complementary approaches to healthcare and medical treatment
and are seeking healthcare providers who treat the whole
person instead of just an illness. As a result, then President
Bill Clinton established the White House Commission
on Complementary and Alternative Medicine Policy
(WHCCAMP) by issuing Executive Order 13147 on March7,
2000. The commission is composed of no more than 15 individuals who are knowledgeable in conventional, complementary, and alternative medicine. These representatives
were appointed by the president and were asked to address
the following issues:
• Research on CAM practices and products
• Delivery of and public access to CAM services
• Dissemination of reliable information on CAM to
healthcare providers and the general public
• Appropriate licensing, education, and training of
CAM healthcare practitioners
In March 2002, the WHCCAMP issued a final report
covering all their charged issues. The following is the overview of the report, as written:
“Although heterogeneous, the major CAM systems have
many common characteristics, including a focus on individualizing treatments, treating the whole person, promoting self-care and self-healing, and recognizing the spiritual
nature of each individual. In addition, many CAM systems
have characteristics commonly found in mainstream health
care, such as a focus on good nutrition and preventive practices. Unlike mainstream medicine, CAM often lacks or
has only limited experimental and clinical study; however,
scientific investigation of CAM is beginning to address this
knowledge gap. Thus, boundaries between CAM and mainstream medicine, as well as among different CAM systems,
are often blurred and are constantly changing.” 6
Dr. Tiffany Field and the Touch
Research Institute
Tiffany Field, PhD, is the pioneer of modern massage
research and remains one of the foremost authorities on
Figure 1-10. Dr. Tiffany Field.
scientific proof of the benefits of massage (Fig. 1-10). Her
interest in touch therapy began when her daughter was born
prematurely. She conducted her first study as a psychology
graduate student in 1982, determining that “infants given
pacifiers during their tube feedings gained more weight,
went off tube feedings earlier, did better on newborn behavior and neurological examinations, and were discharged
earlier, at a much lower hospital cost, than infants not given
pacifiers.” 7
Her remarkable work won her a start-up grant from
Johnson & Johnson in 1992 to create the Touch Research
Institute (TRI) at the University of Miami’s School of
Medicine. It was the first center in the world devoted to
studying the scientific aspects and medical applications
of touch, designing research studies that can prove how
touch promotes health and can be used to treat disease.
The outcomes of these critical research studies will help
validate the beneficial effects of massage. In fact, the TRI
has already shown that massage is medically beneficial for
premature infants and fibromyalgia, asthma, and diabetes
patients. TRI research has shown that massage enhances
the immune system by increasing production of natural
killer cells and increases alertness and computational accuracy. See Research Box 1-1 for specific research studies performed by the TRI.