Massage Therapy

List ISHAR Online Sources: Massage Therapy


Massage is to work and act on the body with pressure. Massage techniques are commonly applied with hands, fingers, elbows, knees, forearm, feet, or a device. The purpose of massage is generally for the treatment of body stress or pain. People who are professionally trained to give massages were traditionally known as masseurs or masseuses, but the term massage therapist has been promoted.


Types and methods

Active release technique

Active release technique (ART) is a form of deep tissue manipulation patented by P. Michael Leahy in which specified techniques are used to release what are presumed to be soft tissue adhesions.[22]:578


Acupressure [from Latin acus "needle" (see acuity) + pressure (n.)[23]] is an alternative medicine technique similar in principle to acupuncture. It is based on the concept of life energy which flows through "meridians" in the body. In treatment, physical pressure is applied to acupuncture points with the aim of clearing blockages in those meridians. Pressure may be applied by fingers,palm,elbow,toes or with various devices.

Some medical studies have suggested that acupressure may be effective at helping manage nausea and vomiting, for helping lower back pain, tension headaches, stomach ache, among other things, although such studies have been found to have a high likelihood of bias.[24]

Aquatic bodywork

Aquatic bodywork comprises a diverse set of massage and bodywork forms performed in water. This includes land-based forms performed in water (e.g., Aquatic Craniosacral Therapy, Aquatic Myofascial Release Therapy, etc.), as well as forms specific to warm water pools (e.g., Aquatic Integration, Dolphin Dance, Healing Dance, Jahara technique, WaterDance, Watsu).[25]


In ashiatsu, the practitioner uses their feet to deliver treatment. The name comes from the Japanese, ashi for foot and atsu for pressure.[26] This technique typically uses the heel, sesamoid, arch and/or whole plantar surface of foot, and offers large compression, tension and shear forces with less pressure than an elbow, and is ideal for large muscles, such as in thigh, or for long-duration upper trapezius compressions.[27] Other manual therapy techniques using the feet to provide treatment include Keralite, Barefoot Lomi Lomi, Chavutti Thirumal.

Ayurvedic massage

Ayurvedic Massage known as Abhyangam in Sanskrit is one of the most common and important Ayurvedic therapies. According to the Ayurvedic Classics Abhayngamis an important dincharya (Daily Regimen) that is needed for maintaining a healthy lifestyle. The massage technique used during Ayurvedic Massage is known to stimulate the lymphatic system to expel the toxins out from the body. The Ayurvedic Massage also stimulates production of lymphocytes which play a vital role in maintaining the immunity in human body. Thus regular Ayurvedic Massage can lead to better immunity and also help in body de-toxification. The other benefits of regular Ayurvedic Massage include pain relief, reduction of fatigue, prevention of ageing and bestowing longevity.[28][29]

Burmese Massage

Known in Myanmar as Yoe Yar Nhake Nal Chin, meaning "traditional massage", Burmese massage has its ancient origins from Thai, Chinese and Indian medicine. Currently, Burmese massage also includes the use local natural ingredients such as Thanaka, which helps to promote smooth skin and prevents sunburn. 

Burmese massage is a full body massage technique that starts from head to toes, drawing on acupuncture, reflexology, and kneading. Signature massage strokes include acupressure using the elbows, quick gentle knocking of acupressure points, and slow kneading of tight muscles. The massage is aimed to improve blood circulation and  quality of sleep, while at the same time help to promote better skin quality. 

Biodynamic massage

Biodynamic massage was created by Gerda Boyesen as part of Biodynamic Psychotherapy. Practised as a stand-alone therapy, it is a combination of physical and energy work and also uses a stethoscope to hear the peristalsis.[30][31]

Craniosacral therapy

Craniosacral therapy (CST) is a gentle approach that releases tensions deep in the body by applying light touch to the skull, face, spine, and pelvis.[32]

Foot massage

While various types of reflexology related massage styles focus on the feet, massage of (usually) the soles of the feet is often performed purely for relaxation or recreation. It is believed there are some specific points on our feet that correspond to different organs in the body. Stimulation of these points during foot massage can cause significant reduction in pain. Studies also suggest that foot reflexology massage can reduce fatigue and promote better sleep.[33]


Lomilomi and indigenous massage of Oceania

Lomilomi is the traditional massage of Hawaii. As an indigenous practice, it varies by island and by family. The word lomilomi also is used for massage in Samoa and East Futuna. In Samoa, it is also known as lolomi and milimili. In East Futuna, it is also called milimili, fakasolosolo, amoamo, lusilusi, kinikini, fai’ua. The Māori call it roromi and mirimiri. In Tonga massage is fotofota, tolotolo, and amoamo. In Tahiti it is rumirumi. On Nanumea in Tuvalu, massage is known as popo, pressure application is kukumi, and heat application is tutu. Massage has also been documented in Tikopia in the Solomon Islands, in Rarotonga and in Pukapuka in Western Samoa.[34]

Lymphatic drainage

Manual lymphatic drainage is a technique used to gently work and stimulate the lymphatic system, to assist in reduction of localized swelling. The lymphatic system is a network of slow moving vessels in the body that carries cellular waste toward the heart, to be filtered and removed. Lymph also carries lymphocytes, and other immune system agents. Manual lymphatic drainage claims to improve waste removal and immune function.[35][36][37]

Medical massage

Medical Massage is a controversial term in the massage profession.[38] Many use it to describe a specific technique. Others use it to describe a general category of massage and many methods such as deep tissue massage, myofascial release and triggerpoint therapy as well as osteopathic techniques, cranial-sacral techniquesand many more can be used to work with various medical conditions.[39]

Massage used in the medical field includes decongestive therapy used for lymphedema[9] which can be used in conjunction with the treatment of breast cancer. Light massage is also used in pain management and palliative care. Carotid sinus massage is used to diagnose carotid sinus syncope and is sometimes useful for differentiating supraventricular tachycardia (SVT) from ventricular tachycardia. It, like the valsalva maneuver, is a therapy for SVT.[40] However, it is less effective than management of SVT with medications.[41]

A 2004 systematic review found single applications of massage therapy "reduced state anxiety, blood pressure, and heart rate but not negative mood, immediate assessment of pain, and cortisol level", while "multiple applications reduced delayed assessment of pain", and found improvements in anxiety and depression similar to effects of psychotherapy.[42] A subsequent systematic review published in 2008 found that there is little evidence supporting the use of massage therapy for depression in high quality studies from randomized controlled trials.[43]

Myofascial release

Myofascial release refers to the manual massage technique that claims to release adhered fascia and muscles with the goal of eliminating pain, increasing range of motion and equilibrioception. Myofascial release usually involves applying shear compression or tension in various directions, cross fiber friction or by skin rolling.[44]


Reflexology also known as "zone therapy", is an alternative medicine involving application of pressure to the feet and hands with specific thumb, finger, and hand techniques without the use of oil or lotion. It is based on a pseudoscientific[45] system of zones and reflex areas that purportedly reflect an image of the body on the feet and hands, with the premise that such work effects a physical change to the body.[46]


Shiatsu (指圧) (shi meaning finger and atsu meaning pressure) is a type of alternative medicine consisting of the fingers and palm pressure, stretches, and other massage techniques. There is no convincing data available to suggest that shiatsu is an effective treatment for any medical condition.[47]

Structural Integration

Structural Integration's aim is to unwind the strain patterns residing in the body's myofascial system, restoring it to its natural balance, alignment, length, and ease. This is accomplished by deep, slow, fascial and myofascial manipulation, coupled with movement re-education. Various brands of Structural Integration are Rolfing, Hellerwork, Guild for Structural Integration, Aston Patterning,[7]Soma,[48] and Kinesis Myofascial Integration.[49]

Swedish massage

The most widely recognized and commonly used category of massage is the Swedish massage. The Swedish massage techniques vary from light to vigorous.[50] Swedish massage uses five styles of strokes. The five basic strokes are effleurage (sliding or gliding), petrissage (kneading), tapotement (rhythmic tapping), friction (cross fiber or with the fibers) and vibration/shaking.[51] Swedish massage has shown to be helpful in reducing pain, joint stiffness, and improving function in patients with osteoarthritis of the knee over a period of eight weeks.[52] The development of Swedish massage is often inaccurately credited to Per Henrik Ling, though the Dutch practitioner Johann Georg Mezger applied the French terms to name the basic strokes.[53] The term "Swedish" massage is actually only recognized in English and Dutch speaking countries, and in Hungary. Elsewhere the style is referred to as "classic massage".

Clinical studies report that Swedish Massage can effectively reduce low back pain and the effectiveness can last for as long as 15 weeks. One study reported that Swedish Massage caused reduction in salivary cortisol indicating its role in management of stress and improvement in mood.[54][55]

Thai massage

Known in Thailand as นวดแผนโบราณ (Nuat phaen boran, IPA: [nûət pʰɛ́ːn boːraːn]), meaning "ancient/traditional massage", traditional Thai massage (Nuad Boran) is generally based on a combination of Indian and Chinese traditions of medicine.

Thai massage – or Nuat Thai – combines both physical and energetic aspects. It is a deep, full-body massage progressing from the feet up, and focusing on sen or energy lines throughout the body, with the aim of clearing blockages in these lines, and thus stimulating the flow of blood and lymph throughout the body. It draws on yoga, acupressure and reflexology.

Thai Massage is a popular massage therapy that is used for management of conditions such as musculoskeletal pain and fatigue. Thai Massage involves a number of stretching movements that improve body flexibility, joint movement and also improve blood circulation throughout the body. In one study scientists found that Thai Massage showed comparable efficacy as the painkiller ibuprofen in reduction of joint pain caused by osteoarthritis (OA) of the knee.[56]

Traditional Chinese massage

Massage of Chinese Medicine is known as An Mo (按摩, pressing and rubbing) or Qigong Massage, and is the foundation of Japan's Anma. Categories include Pu Tong An Mo (general massage), Tui Na An Mo (pushing and grasping massage), Dian Xue An Mo (cavity pressing massage), and Qi An Mo (energy massage). Tui na (推拿) focuses on pushing, stretching, and kneading muscles, and Zhi Ya (指壓) focuses on pinching and pressing at acupressure points. Technique such as friction and vibration are used as well.[57]

Trigger point therapy

Sometimes confused with pressure point massage,[9] this involves deactivating trigger points that may cause local pain or refer pain and other sensations, such as headaches, in other parts of the body. Manual pressure, vibration, injection, or other treatment is applied to these points to relieve myofascial pain. Trigger points were first discovered and mapped by Janet G. Travell (President Kennedy's physician) and David Simons. Trigger points have been photomicrographed and measured electrically[58] and in 2007 a paper was presented showing images of Trigger Points using MRI.[59] These points relate to dysfunction in the myoneural junction, also called neuromuscular junction (NMJ), in muscle, and therefore this technique is different from reflexology, acupressure and pressure point massage.

Tui na

Tui na is a Chinese manual therapy technique that includes many different types of strokes, aimed to improve the flow of chi through the meridians.


Watsu, developed by Harold Dull at Harbin Hot Springs, California, is a type of aquatic bodywork performed in near-body-temperature water, and characterized by continuous support by the practitioner and gentle movement, including rocking, stretching of limbs, and massage. The technique combines hydrotherapy floating and immersion with shiatsu and other massage techniques. Watsu is used as a form of aquatic therapy for deep relaxation and other therapeutic intent. Related forms include WaterDance, Healing Dance, and Jahara technique.[60][61]


Medical and therapeutic use

The main professionals that provide therapeutic massage are massage therapists, athletic trainers, physical therapists and practitioners of many traditional Chinese and other eastern medicines. Massage practitioners work in a variety of medical settings and may travel to private residences or businesses.[9] Contraindications to massage include deep vein thrombosis, bleeding disorders or taking blood thinners such as Warfarin, damaged blood vessels, weakened bones from cancer, osteoporosis, or fractures, bruising, and fever.[9]

Practitioner associations and official recognition of professionals

The US based National Center for Complementary and Alternative Medicine recognizes over eighty different massage techniques.[9] The most cited reasons for introducing massage as therapy have been client demand and perceived clinical effectiveness.[66]

Associated methods

Many types of practices are associated with massage and include bodywork, manual therapy, energy medicine, and breathwork. Other names for massage and related practices include hands-on work, body/somatic therapy, and somatic movement education. Body-mind integration techniques stress self-awareness and movement over physical manipulations by a practitioner. Therapies related to movement awareness/education are closer to Dance and movement therapies. Massage can also have connections with the New Age movement and alternative medicine as well as holistice philosophies of preventative medical care, as well as being used by mainstream medical practitioners.

Beneficial effects

Peer-reviewed medical research has shown that the benefits of massage include pain relief, reduced trait anxiety and depression, and temporarily reduced blood pressure, heart rate, and state of anxiety.[67] Additional testing has shown an immediate increase and expedited recovery periods for muscle performance. Theories behind what massage might do include blocking nociception (gate control theory), activating the parasympathetic nervous system, which may stimulate the release of endorphins and serotonin, preventing fibrosis or scar tissue, increasing the flow of lymph, and improving sleep,[9] but such effects are yet to be supported by well-designed clinical studies.

Massage is hindered from reaching the gold standard of scientific research, which includes placebo-controlled and double blindclinical trials.[68][69] Developing a "sham" manual therapy for massage would be difficult since even light touch massage could not be assumed to be completely devoid of effects on the subject.[68] It would also be difficult to find a subject that would not notice that they were getting less of a massage, and it would be impossible to blind the therapist.[68] Massage can employ randomized controlled trials, which are published in peer reviewed medical journals.[68] This type of study could increase the credibility of the profession because it displays that purported therapeutic effects are reproducible.[69]

Single-dose effects

  • Pain relief: Relief from pain due to musculoskeletal injuries and other causes is cited as a major benefit of massage.[9] A 2015 Cochrane Review concluded that there is very little evidence that massage is an effective treatment for lower back pain.[70] A meta-analysis conducted by scientists at the University of Illinois at Urbana-Champaign failed to find a statistically significant reduction in pain immediately following treatment.[67] Weak evidence suggests that massage may improve pain in the short term for people with acute, sub-acute, and chronic lower back pain.[70]
  • State anxiety: Massage has been shown to reduce state anxiety, a transient measure of anxiety in a given situation.[67]
  • Blood pressure and heart rate: Massage has been shown to temporarily reduce blood pressure and heart rate.[67]

Multiple-dose effects

  • Pain relief: Massage may reduce pain experienced in the days or weeks after treatment.[67]
  • Trait anxiety: Massage has been shown to reduce trait anxiety; a person's general susceptibility to anxiety.[67]
  • Depression: Massage has been shown to reduce subclinical depression.[67]

Neuromuscular effects

Massage has been shown to reduce neuromuscular excitability by measuring changes in the Hoffman's reflex (H-reflex) amplitude. A decrease in peak-to-peak H-reflex amplitude suggests a decrease in motoneuron excitability.[71] Others explain, "H-reflex is considered to be the electrical analogue of the stretch reflex...and the reduction" is due to a decrease in spinal reflex excitability.[72] Field (2007) confirms that the inhibitory effects are due to deep tissue receptors and not superficial cutaneous receptors, as there was no decrease in H-reflex when looking at light fingertip pressure massage.[73] It has been noted that "the receptors activated during massage are specific to the muscle being massaged", as other muscles did not produce a decrease in H-reflex amplitude.[71]

Massage and proprioception

Proprioceptive studies are much more abundant than massage and proprioception combined, yet researchers are still trying to pinpoint the exact mechanisms and pathways involved to get a fuller understanding.[74] Proprioception may be very helpful in rehabilitation, though this is a fairly unknown characteristic of proprioception, and "current exercises aimed at 'improving proprioception' have not been demonstrated to achieve that goal".[75] Up until this point, very little has been studied looking into the effects of massage on proprioception. Some researchers believe "documenting what happens under the skin, bioelectrically and biochemically, will be enabled by newer, non-invasive technology such as functional magnetic resonance imaging and continuous plasma sampling".[73]





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