Massage therapy

What is it?

The term massage therapy (also called massage, for short) covers a group of practices and techniques. There are over 80 types of massage therapy and in all of them, therapists press, rub and otherwise manipulate the muscles and other soft tissues of the body, often varying pressure and movement.

Massage therapy has the potential to influence the body in many ways. When a person begins to relax and release muscular tension, there is easier access to a meditative state, lowered levels of stress, decreased pain, and an increased feeling of well-being.

Core philosophy

At a basic level, massage causes physiological changes in the body through:

  • Relaxation, which is an involuntary response of the nervous system to massage techniques and touch.
  • Mechanical responses, which are physical effects in the body when pressure is applied to soft tissues.

The relaxation response allows the heart and breathing rate to slow down, blood pressure to go down, production of stress hormones to decrease and muscles to relax. It also helps the level of serotonin, which are associated with positive emotions and thoughts. All these responses decrease the physical effects of stress, such as hypertension, arrhythmias, anxiety, insomnia, fatigue, sexual dysfunction, digestive disorders, etc.

The mechanical responses to massage therapy involves improvement of blood and lymph circulation (probably due partly to the physical manipulation of soft tissue and partly to the chemicals released as part of the relaxation response). Improved circulation can enhance the delivery of oxygen and nutrients to muscle cells. As cellular health improves, tissues function more efficiently.

In addition, another mechanical response to massage therapy is the relaxation of muscle tissue, which reduces painful contractions, spasms and nerve compression. When muscles are relaxed, nerves are no longer compressed and in theory they can assume their normal work of transmitting messages to and from the brain. Organs can also benefit from massage, as they share neurological pain pathways with muscles, bones and nerves.

Massage therapy

There are many more aspects that are not yet known or well understood scientifically, however. Some of the proposed theories are that massage:

  • Might provide stimulation that may help block pain signals sent to the brain.
  • Might shift the patient’s nervous system away from the sympathetic state (helping the body mobilize for action) to the parasympatheticnervous state (rest and digest).
  • Might cause beneficial mechanical changes in the body. For example, by preventing fibrosis or increasing the flow of lymph.
  • Might improve sleep, which has a role in pain and healing.

More well-designed studies are needed to understand and confirm these theories and other scientific aspects of massage.


The practice of using touch as a healing method derives from customs and techniques rooted in ancient history. Civilizations in the East and West found that natural healing and massage could heal injuries, relieve pain, and address illnesses. What’s more, it helped reduce stress and produce deep relaxation.

The concept of healing by touch goes as far back as the origins of Ayurveda. Texts detailing Ayurvedic principles and practices were written sometime between 1500 and 500 BCE. Based on these texts, Ayurveda was widely adopted throughout India and Southeast Asia.

Massage therapy history

Based on the patient’s health imbalances, constitutions and the time of year, Ayurveda recommends how to use the five senses to interact with the environment in order to create balance. Treatments in Ayurveda include diet and herbalism, aromatherapy, color therapy, sound therapy and touch therapy.

Similarly, in some of the oldest Chinese medical books, int’s one of the topics that is covered most extensively. It has been discovered that Chinese Amma techniques were practiced as far back as 3000 B.C.  The Chinese medical community continue to improve upon these techniques, referred to as “Amma”, and consider the use of massage an integral part of the Chinese health system.

As the use of massage therapy spread throughout Europe, the Greek culture adapted massage as a compliment treatment to their physical fitness and gymnastic rituals. It was widely believed that nutritious food, exercise and massage were the key elements to a healthy life.

By 1500, the invention of the printing press made writings about the positive effects of massage on the human body and other health related articles more visible to the average population. At this point, interest in the benefits of massage therapy began to grow.

During the late 1800’s, Dr. Johann Mezger of Holland, began to apply terminology to certain movements and manipulations of soft tissue. Through his work, massage began to be known as a necessary element in rehabilitation through physical therapy. His French terms of “effleurage”, “petrissage”, and “tapotement” are still used in modern massage therapy teachings today.

Through the early part of the 20th century, an increasing number of new and rediscovered massage techniques were documented and practiced. In particular, massage was used to treat World War I patients who suffered from nerve injury or shell shock.

However, massage remained out of the mainstream as a form of treatment for many years. It was perceived as a luxury reserved for the wealthy. Furthermore, its reputation endured another unsavory period with the advent of massage parlors where the practice became associated with the sex trade.

In the latter half of the 20th century, rising interest in natural healing methods revitalized massage. More and more states started to regulate the practice, and industry standards in licensing and education emerged. As a result, massage earned a place as a legitimate and respectable form of alternative and complementary medicine and because recognized in society’s wellness boom—the focus on disease prevention through maintaining wellness.

Benefits and uses

Massage therapy can relieve a number of ailments – from physical pain, to stress and anxiety. People who choose to supplement their healthcare regiment with regular massages will not only enjoy a relaxing hour or two with the practitioner, but they will see the benefits carry through the days and weeks after the treatment.

These are the 10 most common benefits reported from massage therapy:

  • Reduce stress: massage therapy is a great way to unwind and de-stress. Users are sure to notice themselves feeling relaxed and at ease for days and even weeks after their appointments.
  • Improve circulation: loosening muscles and tendons allows increased blood flow throughout the body. Improving circulation can have a number of positive effects on the rest of the body, including reduced fatigue and pain management.
  • Reduce pain: massage therapy is great for working out problem areas like lower back pain and chronic stiffness.
  • Eliminate toxins: stimulating the soft tissues of the body will help release toxins through the blood and lymphatic systems.
  • Improve flexibility: massage therapy helps loosen and relax the muscles, helping the body achieve its full range of movement potential.
  • Improve sleep: a massage will encourage relaxation and boost overall mood. In addition, going to bed with relaxed and loosened muscles promotes more restful sleep.
  • Enhance immunity: stimulation of the lymph nodes re-charges the body’s natural defense system.
  • Reduce fatigue: massage therapy is known to boost mood and promote better quality sleep, thus making the user feel more rested and less worn-out at the end of the day.
  • Alleviate depression and anxiety: massage therapy can help release endorphins in the body, helping the user to feel happy, energized and at ease.
  • Reduce post-surgery and post-injury swelling: a professional massage is a great way to safely deal with a sports injury or post-surgery rehabilitation.

Who practices it

Massage therapist is a common title used to describe both women and men who perform massage therapy. These professionals help relax and soothe client ailments by manipulating their soft tissues. The environments in which massage therapists work vary and can include health or chiropractic clinics, spas, vacation resorts and fitness centers. Many massage therapists, however, are self-employed.

There are four main steps that aspiring massage therapists take to become a reputable professional:

Step 1: Earn a certificate or diploma in massage therapy

Students should choose a program that’s recognized by their state’s licensing board. These programs often involve at least 500 hours of academic and clinical work. Courselwork typically includes anatomy and physiology, kinesiology fundamentals, pathology and professional ethics. Prospective massage therapists who plan to be self-employed may want to choose a training program that includes coursework in business finances, marketing and management. Classroom coursework is complemented by hands-on training in clinical labs.

Step 2: Take an approved national examination in massage therapy

Exams commonly accepted for state licensure include the Massage and Bodywork Licensing Examination (MBLEx) or the Board Certification Exam in Therapeutic Massage and Bodywork (BCETMB) offered through the National Certification Board for Therapeutic Massage & Bodywork (NCBTMB). Once a student has completed and approved massage therapy program, he or she can apply to take either of these exams.

Step 3: Apply for State Licensure

After graduation from an accredited massage therapy program and earning a passing score on a national examination, graduates can apply for licensure. Some states require a candidate to have a specified amount of liability insurance before he or she can be granted a license. Professionals should also check with their state for any additional regulations, such as how the license must be displayed at the therapist’s place of work.

Step 4: Meet continuing education requirements

To keep certification and licensure valid, professionals need to meet continuing education requirements. Candidates who have taken the BCETMB certification exam will need to complete a recertification process that includes showing evidence of 24 continuing education credits and 100 hours of work experience. Many states also require professionals to submit evidence of continuing education to maintain licensure. Specific coursework requirements and the frequency with which they must be documented vary by state.

Many people think becoming a massage therapist is easy. But the daily job of a massage therapist is quite challenging. A massage therapist is like any other physical or occupational therapist and must perform many duties that not only require strength and stamina but also, knowledge and training.

What to expect

Before the massage

Before the massage it is really important to make sure it is a good time to have a massage. If the user has fever, skin irritations or if any other developing illness, it is better to reschedule. It is also highly recommended to drink plenty of water a few days before the massage and to not eat before the massage.

First appointments generally begin with an intake process, starting with a health history. This history will ask about medical conditions, areas of concern, the level of pain on good and bad days, what helps with the pain and contact information. After the health history is completed, the massage therapist will review it and ask questions. In this process it is highly recommended to let the therapist know about any pharmaceutical drugs or botanical medicines that are currently being taken, because massage can enhance or reduce the effect of pharmaceutical drugs, such as blood pressure medication.

It is also recommended to let the therapist know what areas of the body he or she should focus on and what areas of the body he or she should avoid or be careful with. The therapist typically will outline what will happen in the session and leave the room so that the patient can undress to his or her comfort level. After that, the patient will lie down on the massage table and cover with the sheet or other draping on the table. The therapist will knock before re-entering.

Massage therapy table

During the massage

Generally the patient will lie on a massage table, covered by a sheet or large towel. The patient should ensure he or she is comfortable and let the therapist know otherwise. A professional massage therapist will never expose genitals or breasts, or any other areas the patient identifies. Only the area the therapist is working on will be exposed.

As the massage progresses, it is important to relax and try to let thoughts go. One way to do this is to focus on how the touch or technique feels. It is important to breathe and it promotes relaxation. Sometimes people hold their breath when a sensitive area is massaged, but it is best to breathe through it. In the same way, tightening muscles during the massage is counterproductive.

Massage therapy

After the massage

At the end of the massage, the therapist will leave the room to allow the patient to dress in private. It is best to wait a few minutes on the table as the patient gets grounded, especially if the patient feels light-headed. When entering the reception area, the therapist will offer a glass of water as it helps the body flush waste products.

How the patient feels after the massage will vary based on the style of massage used, the length of the session and the demands placed on the body afterwards. Feeling range from being relaxed or renewed to invigorated or excited, to recognizing the true level of fatigue and wanting only to rest.

Interesting facts

  • As touch is the first sense to develop in humans and the last to fade, there are approximately 5 million touch receptors in the skin – 3,000 alone in a finger tip.
  • While the use of massage is growing, the reasons people are turning to massage therapy are also expanding. Of the people surveyed who had at least one massage in the last five years, 31 percent report they did so for health conditions such as pain management, injury rehabilitation, migraine control and overall wellness.
  • There are more than 80 massage techniques. Some even consider reflexology a type of massage. The more popular techniques include:
    •  Swedish massage: gentle type of full-body massage that helps when there are muscle knots and it’s a good choice for when the patients wants to fully relax.
    • Hot stone massage: best for people who have muscle pain and tension. The therapist uses heated stones in lieu of or in addition to their hands.
    • Aromatherapy massage: best for people who have an emotional healing component to their massage. Aromatherapy massages combine soft, gentle pressure with the use of essential oils.
    • Deep tissue massage: uses more pressure than a swedish massage. It’s a good option if the patient has chronic muscle problems, such as soreness, injury or imbalance.
    • Sport massage: a good option if the patient has a repetitive use injury to a muscle, such as what one may get from playing a sport. It can be done as a full-body massage or the therapist may focus on the parts of the body that need the most attention.
    • Trigger point massage: best suited for people who have injuries, chronic pain or a specific issue or condition. Some areas of tightness in the muscle tissues (trigger points) can cause pain in other parts of the body. Trigger point massage uses broad, flowing strokes that are gentle and relaxing combined with stronger, deeper pressure.
    • Shiatsu massage: best for people who want to relieve stress and tension. The therapist will use their hands, palms, and thumbs to massage certain points of the body. Pulsing or rhythmic pressure is used.
    • Thai massage: best for people who want a more active form of massage and want to reduce and relieve pain and stress. It works the entire body using a sequence of movements that are similar to yogic stretching. The patient will be stretched in various positions.

Closing statement

In its many forms massage is a multi-dimensional intervention that addresses the physical, emotional and social aspects of pain and suffering. It is also the most sought-after of all complementary therapy modalities. The evidence favoring its use in palliative care is strong with good evidence of benefit for pain and anxiety as well as fatigue, and depression; and modest evidence of benefit for dyspnea and other conditions

Overall, with proper accommodation of relevant safety precautions, massage in some form can be offered to patients with the full spectrum of conditions seen in palliative care.