Massage
therapy is a practice that dates back thousands of years.
There are many types of massage --Pressing, rubbing,
and moving muscles and other soft tissues of the body, primarily
by using the hands and fingers. The aim is to increase the
flow of blood and oxygen to the massaged area. therapy;
all involve manipulating the muscles and other soft tissues
of the body. In the United States, massage therapy is sometimes
part of conventional medicine --Medicine as practiced
by holders of M.D. (medical doctor) or D.O. (doctor of osteopathy)
degrees and by their allied health professionals such as
physical therapists, psychologists, and registered nurses..
1In other instances,
it is part of complementary and alternative medicine This
Backgrounder provides a general overview of massage therapy
used as CAM and suggests some resources you can use to learn
more.
1
Conventional medicine is medicine as practiced by holders
of M.D. (medical doctor) and D.O. (doctor of osteopathy)
degrees and by their allied health professionals, such as
physical therapists, psychologists, and registered nurses.
An example of massage therapy as conventional medicine is
using it to reduce a type of swelling called lymphedema.
2
CAM is a group of diverse medical
and health care systems, practices, and products that are
not presently considered to be part of conventional medicine.
While some scientific evidence exists regarding some CAM
therapies, for most there are key questions that are yet
to be answered through well-designed scientific studies.
An example of massage therapy as CAM is using it with the
intent to enhance immune system functioning.
Key
Points
- People
use massage therapy as CAM for a variety of health-related
purposes, from treating specific diseases and conditions
to general wellness.
- Scientists
do not fully know what changes occur in the body during
massage, whether they influence health, and, if so, how.
The National Center for Complementary and Alternative
Medicine (NCCAM) is sponsoring studies to answer these
questions and identify the purposes for which massage
may be most helpful.
- There
appear to be few risks to massage therapy if it is used
appropriately and provided by a trained massage professional.
- Tell
your health care providers about any CAM therapy you are
considering or using, including massage therapy. This
helps to ensure safe and coordinated care.
What
Massage Therapy Is
The
term massage therapy (also called massage, for short; massage
also refers to an individual treatment session) covers a
group of practices and techniques. There are over 80 types
of massage therapy. In all of them, therapists press, rub,
and otherwise manipulate the muscles and other soft tissues
of the body, often varying pressure and movement. They most
often use their hands and fingers, but may use their forearms,
elbows, or feet. Typically, the intent is to relax the soft
tissues, increase delivery of blood and oxygen to the massaged
areas, warm them, and decrease pain.
A few
popular examples of this therapy are as follows:
- In
Swedish massage, the therapist uses long
strokes, kneading, and friction on the muscles and moves
the joints to aid flexibility.
- A
therapist giving a deep tissue massage
uses patterns of strokes and deep finger pressure on parts
of the body where muscles are tight or knotted, focusing
on layers of muscle deep under the skin.
- In
trigger point massage (also called pressure
point massage), the therapist uses a variety of strokes
but applies deeper, more focused pressure on myofascial
trigger points--"knots" that can form in the muscles,
are painful when pressed, and cause symptoms elsewhere
in the body as well.
- In
shiatsu massage, the therapist applies
varying, rhythmic pressure from the fingers on parts of
the body that are believed to be important for the flow
of a vital energy called qiIn -- traditional Chinese
medicine, the vital energy or life force proposed to regulate
a person's spiritual, emotinal, mental, and physical health
and to be influenced by the opposing forces of yin and
yang..
Massage
therapy (and, in general, the laying on of hands for health
purposes) dates back thousands of years. References to massage
have been found in ancient writings from many cultures,
including those of Ancient Greece, Ancient Rome, Japan,
China, Egypt, and the Indian subcontinent.
In the
United States, massage therapy first became popular and
was promoted for a variety of health purposes starting in
the mid-1800s. In the 1930s and 1940s, however, massage
fell out of favor, mostly because of scientific and technological
advances in medical treatments. Interest in massage revived
in the 1970s, especially among athletes.
More
recently, a 2002 national survey on Americans' use of CAM
(published in 2004) found that 5 percent of the 31,000 participants
had used massage therapy in the preceding 12 months, and
9.3 percent had ever used it. According to recent reviews,
people use massage for a wide variety of health-related
intents: for example, to relieve pain (often from musculoskeletal
conditions, but from other conditions as well); rehabilitate
sports injuries; reduce stress; increase relaxation; address
feelings of anxiety and depression; and aid general wellness.
Who
Provides Massage Therapy
A person
who professionally provides massage therapy is most often
called a massage therapist, although there are some other
health care providers (such as chiropractors) who also have
massage training. This Backgrounder mainly uses the term
massage therapist. Most massage therapists learn and practice
more than one type of massage.
To learn
massage, most therapists attend a school or training program,
with a much smaller number training instead with an experienced
practitioner. Many students are already licensed as another
type of health care provider, such as a nurse.
There
are about 1,300 massage therapy schools, college programs,
and training programs in the United States. The course of
study typically covers subjects such as anatomy and physiology
(structure and function of the body); kinesiology (motion
and body mechanics); therapeutic evaluation; massage techniques;
first aid; business, ethical, and legal issues; and hands-on
practice of techniques. These educational programs vary
in many respects, such as length, quality, and whether they
are accredited. Many require 500 hours of training, which
is the same number of hours that many states require for
certification. Some therapists also pursue specialty or
advanced training.
At the
end of 2004, 33 states and the District of Columbia had
passed laws regulating massage therapy--for example, requiring
that massage therapists graduate from an approved school
or training program and pass the national certification
exam in their field in order to practice. Cities and counties
may have laws that apply as well. Professional organizations
of massage therapists have not agreed upon the standards
for recognizing that a massage therapist is properly and
adequately trained.
|
Licenses
or certifications for massage therapists include:
- LMT Licensed
Massage Therapist
- LMP Licensed
Massage Practitioner
- CMT Certified
Massage Therapist
- NCTMB Has
met the credentialing requirements (including
passing
an exam) of the National Certification
Board
for Therapeutic Massage and Bodywork,
for
practicing therapeutic massage and bodywork
- NCTM Has
met the credentialing requirements (including
passing
an exam) of the National Certification
Board
for Therapeutic Massage and Bodywork,
for
practicing therapeutic massage
|
What
Massage Therapists Do in Treating Patients
Massage
therapists work in a variety of settings, including private
offices, hospitals, other clinical settings, nursing homes,
studios, and sport and fitness facilities. Some also travel
to patients' homes or workplaces to provide a massage.
Massage
therapy treatments usually last for 30 to 60 minutes; less
often, they are as short as 15 minutes or as long as 1.5
to 2 hours. For some conditions (especially chronic ones),
therapists often advise a series of appointments. Therapists
usually try to provide an environment that is as calm and
soothing as possible (for example, by using dim lighting,
soft music, and fragrances).
At the
first appointment, a massage therapist will discuss your
symptoms, medical history, the results you (and your health
care provider, if applicable) desire, and possibly other
factors such as your work and levels of stress. She will
likely perform some evaluations through touch. If she finds
nothing that would make a massage inadvisable, she will
proceed with the massage. At any time, you can bring up
questions or concerns.
During
treatment, you will lie on a special padded table or sit
on a stool or chair. You might be fully clothed (for example,
for a "chair massage") or partially or fully undressed (in
which case you will be covered by a sheet or towel; only
the parts of your body that the therapist is currently massaging
are exposed). Oil or powder helps reduce friction on the
skin. The therapist may use other aids, such as ice, heat,
fragrances, or machines. He may also provide recommendations
for self-care, such as drinking fluids, learning better
movement, and developing an awareness of your body.
|
Why
People Use Massage Therapy
In
the 2002 national survey on Americans' use of CAM,
respondents who used a CAM therapy could choose from
five reasons for using the therapy. The results for
massage were as follows:
- They
believed that massage combined with conventional
medicine would help: 60 percent
- They
thought massage would be interesting to try: 44
percent
- They
believed that conventional medical treatments would
not help: 34 percent
- Massage
was suggested by a conventional medical professional:
33 percent
- They
thought that conventional medicine was too expensive:
13 percent
|
Side
Effects and Risks
Massage
therapy appears to have few serious risks if appropriate
cautions are followed. A very small number of serious injuries
have been reported, and they appear to have occurred mostly
because cautions were not followed or a massage was given
by a person who was not properly trained.
Health
care providers recommend that patients not have massage
therapy if they have one or more of the following conditions:
- Deep
vein thrombosis (a blood clot in a deep vein, usually
in the legs)
- A
bleeding disorder or taking blood-thinning drugs such
as warfarin
- Damaged
blood vessels
- Weakened
bones from osteoporosis, a recent fracture, or cancer
- A
fever
- Any
of the following in an area that would be massaged:
- An
open or healing wound
- A
tumor
- Damaged
nerves
- An
infection or acute inflammation
- Inflammation
from radiation treatment
If you
have one or more of the following conditions, be sure to
consult your health care provider before having massage:
- Pregnancy
- Cancer
- Fragile
skin, as from diabetes or a healing scar
- Heart
problems
- Dermatomyositis,
a disease of the connective tissue
- A
history of physical abuse
Side
effects of massage therapy may include:
- Temporary
pain or discomfort
- Bruising
- Swelling
- A
sensitivity or allergy to massage oils
Some
Other Points To Consider About Massage Therapy as CAM
- Massage
therapy should not be used to replace your regular medical
care or to delay seeing a doctor about a medical problem.
- Before
you decide about having massage therapy, ask the therapist
about:
- Her
training, experience, and any licenses or credentials
- Any
medical conditions you have and whether she has had
any specialized training or experience with them
- The
number of treatments that might be needed
- Cost
- Insurance
coverage, if any
- If
a massage therapist suggests using other CAM practices
(herbs or other supplements, a special diet, etc.), discuss
it first with your regular health care provider.
- For
findings from research studies on massage therapy for
various health conditions, see "For More Information." However, the available literature
is limited, and more research is needed to make firm conclusions.
How
Massage Therapy Might Work
Scientists
are studying massage to understand what effects massage
therapy has on patients, how it has those effects, and why.
Some aspects of this are better understood than others.
For example, it is known that:
- When
certain forces are applied to the muscles, changes occur
in the muscles (although those changes are not clearly
understood or agreed upon).
- Massage
therapy typically enhances relaxation and reduces stress.
Stress makes some diseases and conditions worse.
There
are many more aspects that are not yet known or well understood
scientifically, however. Some of the proposed theories 3 are that massage:
- Might
provide stimulation that may help block pain signals sent
to the brain (the "gate control theory" of pain reduction).
- Might
shift the patient's nervous system away from the sympathetic
and toward the parasympathetic. The sympathetic
nervous system helps mobilize the body for action.
When a person is under stress, it produces the fight-or-flight
response (the heart rate and breathing rate go up, for
example; the blood vessels narrow; and muscles tighten).
The parasympatheticnervous system creates
what some call the "rest and digest" response (the heart
rate and breathing rate slow down, for example; the blood
vessels dilate; and activity increases in many parts of
the digestive tract).
- Might
stimulate the release of certain chemicals in the body,
such as serotonin or endorphins.
- Might
cause beneficial mechanical changes in the body--for example,
by preventing fibrosis (the formation of scar-like tissue)
or increasing the flow of lymph (a fluid that travels
through the body's lymphatic system and carries cells
that help fight disease).
- Might
improve sleep, which has a role in pain and healing.
- Might
provide some health benefit from the interaction between
therapist and patient.
More
well-designed studies are needed to understand and confirm
these theories and other scientific aspects of massage.
3
On this topic, see especially the reference by C.A. Moyer
et al.
NCCAM-Sponsored
Research on Massage
Some
recent examples of NCCAM-sponsored research on massage include:
- How
massage affects healthy people, and whether these effects
are different depending on how many massages are given
and how often.
- The
effects of massage on chronic neck pain, and comparing
the benefits of conventional therapeutic massage with
usual medical treatment.
- Massage
for cancer patients at the end of life, to see if massage
helps relieve depression, improves emotional well-being
and quality of life, and eases the process of dying.
- Whether
massage given at home by a trained family member helps
reduce pain from sickle cell anemia.
References
Sources
are primarily recent reviews on the general topic of massage
therapy in the peer-reviewed medical and scientific literature
in English in the PubMed database, selected evidence-based
databases, and Federal Government sources.
Alvarez
DJ, Rockwell PG. Trigger
points: diagnosis and management*. American
Family Physician. 2002;65(4):653-660.
Barnes
PM, Powell-Griner E, McFann K, Nahin RL. Complementary
and alternative medicine use among adults: United States,
2002.* CDC Advance
Report #343. 2004.
Cherkin
DC, Sherman KJ, Deyo RA, et al. A
review of the evidence for the effectiveness, safety, and
cost of acupuncture, massage therapy, and spinal manipulation
for back pain*. Annals of
Internal Medicine. 2003;138(11):898-907.
Corbin
L. Safety
and efficacy of massage therapy for patients with cancer.* Cancer Control:Journal
of the Moffitt Cancer Center. 2005;12(3):158-164.
Dillard
MH, Knapp S. Complementary
and alternative pain therapy in the emergency department*. Emergency
Medicine Clinics of North America. 2005;23(2):529-549.
Eisenberg
DM, Cohen MH, Hrbek A, et al. Credentialing
complementary and alternative medical providers*. Annals of
Internal Medicine. 2002;137(12):965-973.
Ernst
E. The
safety of massage therapy*. Rheumatology.
2003;42(9):1101-1106.
Field
T. Massage
therapy effects*. American
Psychologist. 1998;53(12):1270-1281.
Goldstone
LA. Massage
as an orthodox medical treatment past and future*. Complementary
Therapies in Nursing and Midwifery. 2000;6(4):169-175.
Massage:
Bottom Line Monograph. Natural Standard Web site. Accessed
on August 22, 2006.
Massage
Therapists: Occupational Outlook Handbook, 2006-2007 Edition.
U.S. Bureau of Labor Statistics Web site. Accessed at http://www.bls.gov/oco/ocos295.htm
on August 22, 2006.
Moyer
CA, Rounds J, Hannum JW. A
meta-analysis of massage therapy research*. Psychological
Bulletin. 2004;130(1):3-18.
National
Center for Complementary and Alternative Medicine. Manipulative
and Body-Based Practices: An Overview. Bethesda, MD:
National Center for Complementary and Alternative Medicine;
2004. NCCAM publication no. D238.
National
Institute of Arthritis and Musculoskeletal and Skin Diseases.
Osteoarthritis. Bethesda, MD: National Institute
of Arthritis and Musculoskeletal and Skin Diseases; 2006.
NIH publication no. 06-4617.
National
Institute of Arthritis and Musculoskeletal and Skin Diseases.
Osteoporosis: Coping With Chronic Pain. National
Institute of Arthritis and Musculoskeletal and Skin Diseases
Web site. Accessed at http://www.niams.nih.gov/bone/hi/osteoporosis_pain.htm
on August 31, 2006.
Sherman
KJ, Cherkin DC, Kahn J, et al. A
survey of training and practice patterns of massage therapists
in two U.S. states*. BioMed Central
Complementary and Alternative Medicine. 2005;5:13.
Weerapong
P, Hume PA, Kolt GS. The
mechanisms of massage and effects on performance, muscle
recovery and injury prevention*. Sports Medicine.
2005;35(3):235-256.
For
More Information
NCCAM
Clearinghouse
The
NCCAM Clearinghouse provides information on CAM and NCCAM,
including publications and searches of Federal databases
of scientific and medical literature. Examples of relevant
publications include Manipulative and Body-Based Practices:
An Overview, Selecting a CAM Practitioner,
and Conference on the Biology of Manual Therapies, June
9-10, 2005: Conference Recommendations. The Clearinghouse
does not provide medical advice, treatment recommendations,
or referrals to practitioners.
Toll-free
in the U.S.: 1-888-644-6226
TTY (for deaf and hard-of-hearing callers): 1-866-464-3615
Web site: nccam.nih.gov
E-mail: info@nccam.nih.gov
Address: NCCAM Clearinghouse, P.O. Box 7923, Gaithersburg,
MD 20898-7923
CAM
on PubMed®
A service
of the National Library of Medicine (NLM), PubMed contains
publication information and (in most cases) brief summaries
of articles from scientific and medical journals. CAM on
PubMed, developed jointly by NCCAM and NLM, is a subset
of the PubMed system and focuses on the topic of CAM.
Web
site: www.ncbi.nlm.nih.gov/entrez
Web site: http://nccam.nih.gov/camonpubmed/
Acknowledgments
NCCAM
thanks the following people for their technical expertise
and review of this publication: Karen Sherman, Ph.D., M.P.H.,
Center for Health Studies, Group Health Cooperative; Jeanette
Ezzo, Ms.T., M.P.H., Ph.D., National Advisory Council for
Complementary and Alternative Medicine; and Partap Khalsa,
D.C., Ph.D.; Richard Nahin, Ph.D., M.P.H.; and Linda Rich,
M.P.S., C.M.T., NCCAM.
|
NCCAM has provided this material for
your information. It is not intended to substitute
for the medical expertise and advice of your primary
health care provider. We encourage you to discuss
any decisions about treatment or care with your health
care provider. The mention of any product, service,
or therapy is not an endorsement by NCCAM.
|
