The practice of massage therapy is the assessment of the soft tissue and joints of the body and the treatment and prevention of physical dysfunction and pain of the soft tissue and joints by manipulation to develop, maintain, rehabilitate or augment physical function, or relieve pain. (Massage Therapy Act, 1991)
In Ontario, Canada, massage therapy is legislated and controlled under the Regulated Health Professions Act (RHPA). It brings massage therapy under the same legislation that governs nurses, doctors, dentists, pharmacists, chiropractors, kinesiologists and physiotherapists. Ontario has a 2,200-hour (two to three year) program that covers techniques, contraindications, supervised clinical time, anatomy, physiology, pathophysiology, hydrotherapy, hygiene, ethics, massage treatments, neurology, assessment and remedial exercise. This treatment-oriented training is sometimes called medical massage therapy, to distinguish it from more relaxation-oriented massage.
Benefits of Massage Therapy
The effects of massage are physiological and/or psychological. Massage therapy increases muscle flexibility and relaxation, and decreases stress levels. The psychological effects are the increased well being that usually occurs with positive touch. The most profound changes from massage seem to occur in the body in areas that were experiencing pathology or trauma, such as tissue that was edematous, fibrosed, ischemic or painful.
Effective in reducing or managing pain.
Effective in increasing or decreasing blood flow to the affected tissue.
Improves tissue health.
Improves lymphatic flow.
Benefits the immune system.
Reduces edema.
Lowers the chance of scar tissue formation.
Removes metabolic wastes.
Increases range of motion, joint flexibility.
Reduces immobilization or denervation after injury.
Relaxes muscles.
Decreases spasms.
Reduces trigger points, fibrosis and adhesions.
Improves respiratory function and chest expansion.
Reduces emotional stress levels.
What massage cannot do
No evidence has been found to support claims that massage can increase muscle tone or directly increase muscle strength or bulk. Massage will also not directly decrease the amount of “cellulite” or adipose tissue. Further, with a permanent nerve lesion, massage will not prevent muscular atrophy in the denervated tissue (Wood, Becker, 1981).
Contraindications and Modifications
A contraindication (CI) is a symptom or circumstance that makes a particular treatment inadvisable. A treatment modification is a change to the initial treatment plan when massage is appropriate for you, to allow for safe, effective treatment. Advise your therapist if any new or changing circumstances or symptoms arise.
N.B. Medication that you are taking may necessitate modifications to the treatment plan. For example: aspirin, antidepressant, anti-inflammatory, anticoagulants, anti-asthmatic medication, analgesics, corticosteroids, muscle relaxants. The length of time that a medication has its effect on the body varies depending on the dosage and your tissue health and metabolism. Therefore, it is important for the therapist to know whether you are taking any medication, including over-the-counter and herbal remedies.
Types of Massage
Therapeutic Massage
This type of massage is often described as “medical massage”. Therapeutic massage involves the manipulation of the soft tissue structures of the body to prevent and reduce pain, discomfort, muscle spasm, and stress; and, to promote health and wellness. It improves functioning of the circulatory, lymphatic, muscular, skeletal, and nervous systems and may improve the rate at which the body recovers from injury and illness.
Sports Massage
Sports massage is specifically designed for people who are involved in physical activity. But you don't have to be a professional athlete to have one. It is also used by people who are active and work out often. The focus isn't on relaxation but on preventing and treating injury and enhancing athletic performance. A combination of techniques are used. The strokes are generally faster than Swedish massage. Facilitated stretching is a common technique. It helps to loosen muscles and increase flexibility.
Myofascial Release
Connective tissue or fascia surrounds all muscles, muscle groups, bones and organs, holding them in place. Fascia is a continuous sheet of supportive tissue that envelops the entire body. It is strong yet mobile. There are three categories of fascia: superficial, deeper and subserous.
Fascial shortening, adhesions or restrictions due to inflammation, trauma, surgery, pathology or postural imbalances create abnormal tension patterns. Symptoms that appear unrelated may actually be transmitted from one body part to another through fascial imbalances. (Upledger, Vredevoogd, 1983).
There are numerous types of fascial or connective tissue techniques. Little or no lubricant is used as these techniques rely on tissue drag for their effects. The pressure is moderate to deep and the speed is slow. When restrictions are present, a painful burning sensation can be felt.
Swedish Massage Therapy
This is a common type of massage therapy. It is also known as Swedish massage. Massage therapists use long smooth strokes, kneading, and circular movements on superficial layers of muscle using massage lotion or oil. Swedish massage therapy can be very gentle and relaxing. Five styles of long, flowing strokes to massage are used. The five basic strokes are effleurage (light touch), petrissage (kneading), tapotement (rhythmic tapping), friction (compression), and vibration.
Trigger Point Therapy (Deep Tissue Massage)
It is also called a pressure point massage. This involves stimulating trigger points that may refer pain sensations to other parts of the body. Manual pressure is applied to these points.
Deep tissue massage targets the deeper layers of muscle and connective tissue. The massage therapist uses slower strokes or friction techniques across the grain of the muscle. Deep tissue massage is used for chronically tight or painful muscles, repetitive strain, postural problems, or recovery from injury. People often feel sore for one to two days after deep tissue massage.
Manual Lymphatic Drainage (MLD)
Manual lymphatic drainage encourages lymph flow and reduces certain types of edema. The slow, light, repetitive, rhythmical nature of these techniques also decreases pain perception and the effects of the sympathetic nervous system. They are also useful in reducing excess fibrin, metabolic products in the inflammatory process and, formation of scar tissue.
Neuromuscular Therapy
Neuromuscular therapy is a system of evaluation and treatment for structural imbalances that cause pain. A complete postural assessment is made before treatment begins to determine the specific muscles and fascia to be addressed. The system incorporates fascial techniques. Rate, pressure and direction all vary. Minimal lubricant is used to facilitate tissue drag. Specific remedial exercises to stretch and strengthen the affected tissues are also included. Neuromuscular therapy reduces pain, hypertonicity and postural dysfunction, and lengthens and strengthens tissues.
Mobilization and Joint Play
These techniques range from non-specific joint mobilizations such as rocking to very specific techniques to increase range of motion such as joint play. Because these techniques take a joint up to the limit of available motion and no further, they are sometimes called mobilization without impulse.
In contrast, chiropractic adjustments take the joint briefly past the limit of available motion. They are described as being high velocity, low amplitude thrust techniques, or mobilization with impulse (Greenman, 1989). Mobilization with impulse is outside the scope of massage therapists.
The joint play is described as the small, accessory, intrinsic movements occurring at a joint. These small movements must be possible in a joint for full, pain-free range of motion to occur (Neumann, 1989).
Joint play techniques are passive joint mobilizations. The technique is used to both assess and treat a dysfunctional joint. The aim is to stretch the joint capsule, reduce pain, decrease muscle spasm and, increase or regain range of motion.
Pregnancy Massage
Also called prenatal massage, pregnancy massage is becoming increasingly popular with expectant mothers. Massage therapists who are certified in pregnancy massage know the proper way to position and support the woman's body during the massage, and how to modify techniques. Pregnancy massage is used to reduce stress, decrease swelling, relieve aches and pains, and reduce anxiety and depression. The massage is customized to a woman's individual needs.
Hydrotherapy
Hydrotherapy uses water in its solid, liquid or gaseous form for its therapeutic effects. The term hydrotherapy also includes thermal applications which are not pure water, such as wax baths, thermophores, hydrocollators, and freezable gel packs.
Hydrotherapy is a useful adjunct to any treatment. It can prepare the tissue before a treatment; for example, heat is used before applying fascial techniques to increase the flexibility of the fascia. It can be applied after certain techniques to modulate their effects; for example, cold is used after frictions to reduce the inflammatory response.
Remedial Exercise
Remedial exercise uses a combination of active and passive exercise to restore and improve the client’s musculoskeletal health. Remedial exercises fall into three main categories: range of motion, stretching and resistance exercise. Remedial exercise is used by the therapist during treatment and by the client after treatment as self-care. The goals can be to maintain or increase range of motion; increase proprioception, circulation and lymphatic flow; lengthen soft tissue; reduce the formation of adhesions and contractures; decrease spasm and pain; or increase the strength, function and endurance of a muscle.
Reference
RATTRAY, F., LUDWIG, L., Clinical Massage Therapy – Understanding, assessing and treating over 70 conditions (2000), Talus Incorporated, Canada, 1178 pages.
