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.
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)
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
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.
References and Sources
Bialosky, J. E., Beneciuk, J. M., Bishop, M. D., Coronado, R. A., Penza, C. W., Simon, C. B., & George, S. Z. (2018). Unraveling the Mechanisms of Manual Therapy: Modeling an Approach. The Journal of orthopaedic and sports physical therapy, 48(1), 8–18. doi:10.2519/jospt.2018.7476
Çetkin, M., Bahşi, İ., & Orhan, M. (2019). The Massage Approach of Avicenna in the Canon of Medicine. Acta medico-historica adriatica: AMHA, 17(1), 103–114. doi:10.31952/amha.17.1.6
Chaitow, L. (2016). Dosage and manual therapies – Can we translate science into practice?. Journal of bodywork and movement therapies, 20(2), 217–218. doi:10.1016/j.jbmt.2016.03.003
Colles, A. (1888). On Massage. British medical journal, 2(1439), 175–176. https://doi.org/10.1136/bmj.2.1439.175
Geri, T., Viceconti, A., Minacci, M., Testa, M., & Rossettini, G. (2019). Manual therapy: Exploiting the role of human touch. Musculoskeletal science & practice, 44, 102044. doi:10.1016/j.msksp.2019.07.008
Graham, D. (1884). A Practical Treatise on Massage, Its History, Mode of Application, and Effects. W. Wood & Company
Hunt, E. R., Baez, S. E., Olson, A. D., Butterfield, T. A., & Dupont-Versteegden, E. (2019). Using Massage to Combat Fear-Avoidance and the Pain Tension Cycle. International Journal of Athletic Therapy and Training, 24(5), 198-201. doi:10.1123/ijatt.2018-0097
Iorio, S., Gazzaniga, V., & Marinozzi, S. (2018). Healing bodies: the ancient origins of massages and Roman practices. Medicina Historica, 2(2), 58-62.
Kennedy, A. B., Cambron, J. A., Sharpe, P. A., Travillian, R. S., & Saunders, R. P. (2016). Clarifying Definitions for the Massage Therapy Profession: the Results of the Best Practices Symposium. International journal of therapeutic massage & bodywork, 9(3), 15–26. https://doi.org/10.3822/ijtmb.v9i3.312
Langevin, H. M. (2020). Reconnecting the Brain with the Rest of the Body in Musculoskeletal Pain Research. The journal of pain: official journal of the American Pain Society, S1526-5900(20)30021-3. Advance online publication. https://doi.org/10.1016/j.jpain.2020.02.006
MacDonald, C. W., Osmotherly, P. G., Parkes, R., & Rivett, D. A. (2019). The current manipulation debate: historical context to address a broken narrative. The Journal of manual & manipulative therapy, 27(1), 1–4. doi:10.1080/10669817.2019.1558382
Miake-Lye, I. M., Mak, S., Lee, J., Luger, T., Taylor, S. L., Shanman, R., … Shekelle, P. G. (2019). Massage for Pain: An Evidence Map. Journal of alternative and complementary medicine (New York, N.Y.), 25(5), 475–502. doi:10.1089/acm.2018.0282
Moyer, C. A., Rounds, J., & Hannum, J. W. (2004). A meta-analysis of massage therapy research. Psychological bulletin, 130(1), 3–18. https://doi.org/10.1037/0033-2909.130.1.3
Murrell, W. (1886). Massage as a Therapeutic Agent. British medical journal, 1(1324), 926–927. https://doi.org/10.1136/bmj.1.1324.926
Quin, G. (2017). The Rise of Massage and Medical Gymnastics in London and Paris before the First World War. Canadian bulletin of medical history, 34(1), 206–229. doi:10.3138/cbmh.153-02022015
Rabey, M., Hall, T., Hebron, C., Palsson, T. S., Christensen, S. W., & Moloney, N. (2017). Reconceptualising manual therapy skills in contemporary practice. Musculoskeletal science & practice, 29, 28–32. doi:10.1016/j.msksp.2017.02.010
Ruffin, P. T. (2011). A history of massage in nurse training school curricula (1860-1945). Journal of holistic nursing: official journal of the American Holistic Nurses’ Association, 29(1), 61–67. doi:10.1177/0898010110377355
Pettman, E. (2007). A history of manipulative therapy. The Journal of manual & manipulative therapy, 15(3), 165–174. doi:10.1179/106698107790819873
Sherman, K. J., Dixon, M. W., Thompson, D., & Cherkin, D. C. (2006). Development of a taxonomy to describe massage treatments for musculoskeletal pain. BMC complementary and alternative medicine, 6, 24. doi:10.1186/1472-6882-6-24
Standley, P. R. (2014). Towards a Rosetta Stone of manual therapeutic methodology. Journal of bodywork and movement therapies, 18(4), 586–587. doi:10.1016/j.jbmt.2014.06.004
Terlouw, T. J. (2007). Roots of Physical Medicine, Physical Therapy, and Mechanotherapy in the Netherlands in the 19 Century: A Disputed Area within the Healthcare Domain. The Journal of manual & manipulative therapy, 15(2), E23–E41. doi:10.1179/jmt.2007.15.2.23E