Theories and Treatment Strategies

A wall painting found in the tomb of the highest official after the Pharaoh - Ankhmahor
A wall painting found in the tomb of the highest official after the Pharaoh – Ankhmahor. This wall painting is dated back to 2330 B.C

Theories and Treatment Strategies

For thousands of years, people with illnesses and disabilities were treated with various methods of massage, the history of which varies from country to country. Ancient Babylonia, Assyria, China, India, Greece and Rome all practiced some form of massage. One of the oldest accounts is in Egypt in the tomb of Akmanthor, in this tomb there is a painting dating back to 2330 BC that depicts two men having work done on their feet and hands.

Another historical account is in Homer’s Iliad and the Odyssey where “massage with oils and aromatic substances is mentioned as a means to relax the tired limbs of warriors and a way to help the treatment of wounds”. The use of massage for therapeutic purposes originated in a pre-scientific era and some of the reasoning once used to explain the effects do not make sense in the light of what we know today. As such we should aim to update some of our explanations and align it with current medical practice.

Before diving into effects and outcome it is important to establish clearly defined terminology. In this book massage and massage therapy have two different definitions

  • Massage is a patterned and purposeful soft-tissue manipulation accomplished by use of digits, hands, forearms, elbows, knees and/or feet, with or without the use of emollients, liniments, heat and cold, hand-held tools or other external apparatus, for the intent of therapeutic change.
  • Massage therapy consists of the application of massage and non-hands-on components, including health promotion and education messages, for self-care and health maintenance; therapy, as well as outcomes, can be influenced by: therapeutic relationships and communication; the therapist’s education, skill level, and experience; and the therapeutic setting.

These definitions were established by a group of international therapists and researchers (Kennedy et al., 2016). Here we see the contemporary practice of massage therapy defined as a multi-modal approach that includes, but is not limited to classical massage, Swedish massage, myofascial mobilization, instrument-assisted soft tissue mobilization (IASTM), cupping, joint mobilization, strain-counterstrain, neuromuscular therapy, muscle energy techniques, neural mobilizations, manual lymphatic drainage, and education. Each treatment approach in massage therapy may vary and despite being called different names, most of these techniques have similar effects and outcomes outlined in the chart below.

Overview of Massage Therapy Techniques

Commonly Used Techniques

Swedish massage (effleurage, petrissage, percussion, vibration, friction), 

Joint mobilization (grades 1-4)

Neural mobilization (nerve gliding, nerve flossing, sliders and tensioners)

Neuromuscular therapy and muscle energy techniques

Strain counterstrain and positional release

Lymphatic drainage techniques

Golgi tendon organ techniques

Rocking and shaking

Triggerpoint techniques (static compression, pin & stretch, muscle stripping)

Myofascial mobilization (muscle stripping, skin rolling)

Safety Considerations​

Patient comfort: Always treat client within the agreed upon pain tolerance​

Treatment related adverse effects: discomfort, increase of pain aching muscles, headache, and tenderness; reports of increased pain ​

Underlying pathologies: Varicosities, uncovered opening or recent cut, contagious skin lesion, hemophilia or anticoagulant medication, deep vein thrombosis, congestive heart failure, etc.​

Red flags: Refer patients to the appropriate health-care professional if a serious underlying pathology is suspected (e.g., cauda equina syndrome, spinal fracture, malignancy, and spinal infection).

Effects​ & Outcomes

Decrease pain perception​

Increase range of motion​

Decrease muscle spasm​

Increase local circulation​

Sensory motor integration (Whole-person integration)​

Stimulate the parasympathetic nervous system to promote relaxation & wellness

Enhanced body and postural awareness

Key Takeaways

As the body of knowledge to support the use of massage therapy to help alleviate the musculoskeletal disorders associated with everyday stress, physical manifestation of mental distress, muscular overuse and many persistent pain syndromes continues to grow, understanding the basic science behind what we do enable us to apply this work to a number of conditions. Treatment approaches in Massage Therapy may vary, but each therapeutic encounter involves some overlapping principles. This book will conceptualize the main domains of an evidence-based framework for Massage Therapy using recent scientific research.

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Evidence-Based Massage Therapy by Richard Lebert is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.

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