Massage is the manipulating of superficial and deeper layers of muscle and connective tissue using various techniques, to enhance function, aid in the healing process, and promote relaxation and well-being. The word comes from the French massage "friction of kneading", or from Arabic massa meaning "to touch, feel or handle" or from Latin massa meaning "mass, dough", cf. Greek verb (masso) "to handle, touch, to work with the hands, to knead dough". In distinction the ancient Greek word for massage was anatripsis, and the Latin was frictio. Massage involves working and acting on the body with pressure � structured, unstructured, stationary, or moving � tension, motion, or vibration, done manually or with mechanical aids. Target tissues may include muscles, tendons, ligaments, fascia, skin, joints, or other connective tissue, as well as lymphatic vessels, or organs of the gastrointestinal system. Massage can be applied with the hands, fingers, elbows, knees, forearm, and feet. There are over eighty different recognized massage modalities. The most cited reasons for introducing massage as therapy have been client demand and perceived clinical effectiveness. In professional settings massage involves the client being treated while lying on a massage table, sitting in a massage chair, or lying on a mat on the floor. The massage subject may be fully clothed or unclothed. In the case of the latter, the parts of the body that are not being massaged are usually covered with towels or sheets, but this can depend on the preference of the therapists and the type of work being performed. Almost all states in the US have licensing requirements for massage therapists.

HISTORY

ANCIENT AND MEDIEVAL TIMES

Archaeological evidence of massage has been found in many ancient civilizations including China, India, Japan, Korea, Egypt, Rome, Greece, and Mesopotamia. BC 2330: The Tomb of Akmanthor (also known as "The Tomb of the Physician") depicts two men having work done on their feet and hands, presumably massage. BC 722-481: Huangdi Neijing is composed during the Chinese Spring and Autumn period (the beginning of recorded history). The Nei-jing is a compilation of medical knowledge known up to that date, and is the foundation of Traditional Chinese Medicine. Massage is referred to in 30 different chapters of the Nei Jing. It specifies the use of different massage techniques and how they should be used in the treatment of specific ailments, and injuries. Also known as "The Yellow Emperor's Inner Canon", the text refers to previous medical knowledge from the time of the Yellow Emperor (approx 2700 BC), misleading some into believing the text itself was written during the time of the Yellow Emperor (which would predate written history). BC 700 Bian Que, the earliest known Chinese physician uses massage in medical practice. BC 500 Jivaka Komarabhacca, also known as Shivago Komarpaj, the founder of Traditional Thai massage (Nuad Boran) and Thai medicine. According to the Pali Buddhist Canon, Jivaka was Buddha's physician. He codified a healing system that combines acupressure, reflexology, and assisted yoga postures. Traditional Thai massage (Nuad Boran) is generally based on a combination of Indian and Chinese traditions of medicine. Jivaka is known today as "Father Doctor" in Thailand. BC 493: A possible biblical reference documents daily "treatments" with oil of myrrh as a part of the beauty regimen of the wives of Xerxes (Esther, 2:12). BC 460: Hippocrates wrote "The physician must be experienced in many things, but assuredly in rubbing". BC 300 Charaka Samhita believed to be the oldest of the three ancient treatises of Ayurvedic medicine, including massage. Sanscrit records indicate that massage had been practiced in India long before the beginning of recoded history. AD 581: Dr Sun Si Miao introduces ten new massage techniques and systematized the treatment of childhood diseases using massage therapy. AD 581: China establishes a department of massage therapy within the Office of Imperial Physicians. AD 1150: Evidence of massage abortion, involving the application of pressure to the pregnant abdomen, can be found in one of the bas reliefs decorating the temple of Angkor Wat in Cambodia. It depicts a demon performing such an abortion upon a woman who has been sent to the underworld. This is the oldest known visual representation of abortion. AD 1776: Jean Joseph Marie Amiot, and Pierre-Martial Cibot, French missionaries in China translate summaries of Huangdi Neijing, including a list of medical plants, exercises and elaborate massage techniques, into the French language, thereby introducing Europe to the highly developed Chinese system of medicine, medical-gymnastics, and medical-massage. AD 1776 Pehr Henrik Ling, a Swedish physical therapist, and teacher of medical-gymnastics is born. Ling has often been erroneously credited for having invented "Classic Massage" aka "Swedish Massage", and has been called the "Father of Massage". AD 1779: Frenchman Pierre-Martial Cibot publishes �Notice du Cong-fou des Bonzes Tao-see' also known as "The Cong-Fou of the Tao-Tse", a French language summary of medical techniques used by Taoist priests. According to Joseph Needhan, Cibot's work "was intended to present the physicists and physicians of Europe with a sketch of a system of medical gymnastics which they might like to adopt�or if they found it at fault they might be stimulated to invent something better. This work has long been regarded as of cardinal importance in the history of physiotherapy because it almost certainly influenced the Swedish founder of the modern phase of the art, Per Hendrik Ling. Cibot had studied at least one Chinese book, but also got much from a Christian neophyte who had become expert in the subject before his conversion.� AD 1813 The Royal Gymnastic Central Institute for the training of gymnastic instructors was opened in Stockholm, Sweden, with Pehr Henrik Ling appointed as principal. Ling developed what he called the "Swedish Movement Cure" with the help of a friend named Ming (full name never recorded) who was an expert in the martial arts and Kung-Fu based Tui na massage. Ling died in 1839, having previously named his pupils as the repositories of his teaching. Ling and his assistants left little proper written account of their methods. AD 1878: Dutch massage practitioner Johan Georg Mezger takes a sub-set of techniques from Dr. Ling's system, and coins the phrase "Swedish massage system". Notably, Ling's techniques, having been borrowed by Mezger, are still known by their French names (effleurage (long, gliding strokes), petrissage (lifting and kneading the muscles), friction (firm, deep, circular rubbing movements), tapotement (brisk tapping or percussive movements), and vibration (rapidly shaking or vibrating specific muscles)). Each of these techniques are fundamental elements of Tui na, and had been practiced in China for several thousand years prior.

MODERN TIMES

China: Massage has developed continuously in China for over 5000 years. Western ideas are considered within the traditional framework. It is widely practiced and taught in hospital and medical schools and is an essential part of health maintenance and primary healthcare. United States: Massage started to become popular in the United States in the middle part of the 19th century and was introduced by two New York physicians based on Per Henrik Ling's techniques developed in Sweden. During the 1930s and 1940s massage's influence decreased as a result of medical advancements of the time, while in the 1970s massage's influence grew once again with a notable rise among athletes. Massage was used up until the 1960s and 1970s by nurses to help ease patients� pain and help them sleep. United Kingdom: Massage is popular in the United Kingdom today and gaining in popularity. There are many private practitioners working from their own premises as well as those who operate from commercial venues. Massage in sports, business and organizations: Massage developed alongside athletics in both Ancient China and Ancient Greece. Taoist priests developed massage in concert with their Kung Fu gymnastic movements, while Ancient Greek Olympians used a specific type of trainer ("aleiptes") who would rub their muscles with oil. Pehr Ling's introduction to massage also came about directly as a result of his study of gymnastic movements. The 1996 Summer Olympics in Atlanta was the first time that massage was offered as a core medical service to the US Olympic Team. Massage has been employed by businesses and organizations such as the U.S. Department of Justice, Boeing and Reebok. Notable athletes such as Michael Jordan and LeBron James have personal massage therapists that at times even travel with them.

MASSAGE THERAPY

The main professionals that provide massage include massage therapists, athletic trainers, physical therapists and practitioners of many traditional Chinese and other eastern medicines. Massage practitioners work in a variety of medical and recreational settings and may travel to private residences or businesses. 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.

ACUPRESSURE MASSAGE

Acupressure (a portmanteau of "acupuncture" and "pressure") is a traditional Chinese medicine (TCM) technique derived from acupuncture. With acupressure physical pressure is applied to acupuncture points by the hand, elbow, or with various devices.

ANMA MASSAGE

Anma is a traditional Japanese massage involving kneading and deep tissue work.

AYURVEDIC MASSAGE

Ayurveda is a natural health care system originating in India that incorporates massage, yoga, meditation and herbal remedies. Ayurvedic massage, also known as Abhyangha is usually performed by one or two therapists using a heated blend of herbal oils based on the ayurvedic system of humors.

BALINESE MASSAGE

Balinese massage techniques are gentle and aim to make the patient feel relaxed and calm throughout. The techniques include skin folding, kneading, stroking,and other techniques. The massage therapist applies aromatheraphy oil throughout the massage. A patient's blood, oxygen and energy flow is said to increase as a result of the treatment. Balinese hot stones are an option.

BAREFOOT DEEP TISSUE MASSAGE

Barefoot deep tissue, also known as barefoot compressive deep tissue, or barefoot sports massage, is a blend of Eastern barefoot techniques, such as barefoot Shiatsu massage, coupled with a Western manual medicine, encompassing deep tissue, myofascial release, trigger point therapy, transverse friction, compression, tension, shear, proprioceptive neuromuscular facilitation (PNF), stretching, as well as parasympathetic response, on clothed clients using no oil. Dara Torres, 41-year-old Olympian, received barefoot compression massage on a daily basis in her training program. This modality 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 elbow or thumb, and is ideal for large muscles, such as in thigh, or for long-duration upper trapezius compressions. The unclothed cousins of this modality are Keralite, Yumeiho, Barefoot Lomi Lomi, Fijian Barefoot, Chavutti Thirummal. Ashiatsu Oriental Bar Therapy, which is a form of barefoot effleurage, combines western science and contemporary American ingenuity, for therapists who specialize in deep tissue work using myofascial and Swedish techniques performed by the massage therapist's feet.

BOWEN THERAPY

Bowen technique involves a rolling movement over fascia, muscles, ligaments, tendons and joints. It is said not to involve deep or prolonged contact with muscle tissues as in most kinds of massage, but claims to relieve muscle tensions and strains and to restore normal lymphatic flow. Because this technique is so gentle, Bowen Therapy can be suitable for newborn baby to elderly. It is based on practices developed by Australian Tom Bowen and the practitioners are all over the world.

BREEMA MASSAGE

Breema bodywork is performed on the floor with the recipient fully clothed. It consists of rhythmical and gentle leans and stretches.

CHAMPISSAGE MASSAGE

Champissage is a massage technique focusing on the head, neck and face that is believed to balance the chakras.

DEEP TISSUE MASSAGE

Deep tissue massage is designed to relieve severe tension in the muscle and the connective tissue or fascia. This type of massage focuses on the muscles located below the surface of the top muscles. Deep tissue massage is often recommended for individuals who experience consistent pain, are involved in heavy physical activity (such as athletes), and patients who have sustained physical injury. It is not uncommon for receivers of deep tissue massage to have their pain replaced with a new muscle ache for a day or two. Deep tissue work varies greatly. The term �deep tissue� is often misused to identify a massage that is performed with sustained deep pressure. Deep tissue massage is a separate category of massage therapy, used to treat particular muscular-skeletal disorders and complaints and employs a dedicated set of techniques and strokes to achieve a measure of relief. It should not be confused with �deep pressure� massage, which is one that is performed with sustained strong, occasionally intense pressure throughout an entire full-body session, and that is not performed to address a specific complaint. Deep tissue massage is applied to both the superficial and deep layers of muscles, fascia, and other structures. The sessions are often quite intense as a result of the deliberate, focused work. When a client asks for a massage and uses the term �deep tissue�, more often than not he or she is seeking to receive a full-body session with sustained deep pressure throughout. If a practitioner employs deep tissue techniques on the entire body in one session, it would be next to impossible to perform; it might lead to injury or localized muscle and nerve trauma, thereby rendering the session counterproductive.

ESALEN MASSAGE

Esalen Massage was developed at the Esalen Institute based on a combination of many massage and bodywork techniques. The two main influences were Swedish massage and the Sensory Awareness work of Charlotte Selver. Esalen Massage works with gentle rocking of the body, passive joint exercises and deep structural work on the muscles and joints, together with an energetic balancing of the body.

HILTOT MASSAGE

Hilot is a traditional healing technique from the Philippines that also includes massage techniques. The massage techniques relax stressed muscles. Hilot also includes joint manipulations to help relax stressed muscles. Hilot encompasses a wide variety of techniques beyond the treatment of stressed muscles. Hilot can be used to reset sprained joints, diagnose and treat musculoligamentous and musculoskeletal ailments, and even to aid in giving birth and to induce abortion. Dislocated joints can also be reset by hilot after an X-ray has been done on affected body parts and medical experts advised that the same body parts are safe to be massaged. After giving birth, hilot can be done on the mother and the baby born of normal delivery for 10 consecutive days so that they may recover easily. Hilot should not be done on mothers who deliver via caesarian section. Hilot also uses banana leaves and herbs for enhanced efficacy.

LOMI LOMI 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 Maori 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

LYMPATHIC DRAINAGE MASSAGE

Massage technique used to gently work and stimulate the lymphatic system, to assist in reduction of localised swelling.

MEDICAL MASSAGE

Medical Massage is a controversial term in the massage profession. 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 reiki, osteopathic techniques, cranial-sacral techniques and many more can be used to work with various medical conditions. Massage used in the medical field includes decongestive therapy used for lymphedema 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. However, it is less effective than management of SVT with medications.

MESO-AMERICAN MASSAGE

In Meso-America as in other areas of the world an indigenous form of soft tissue and structural massage has developed. Today this art survives thanks to the many Sobadoras/es or Hueseros/as that have handed-down these techniques via oral tradition.

MOBILE MASSAGE

Given some of the main benefits of massage, many people prefer to have a therapist come to them to perform the treatment as opposed to visiting the therapist. Amongst other things, this type of treatment has the benefits of allowing the recipient to remain in their own environment with which they are likely most comfortable, to avoid the pre and post stresses of travelling to the therapist to receive their massage and of course to retire directly to a place of rest immediately following their massage. Therapists can bring a dedicated table with them on which to perform the massage or perform the treatment on the floor or the client's own bed. Mobile (or outcall) massages are particularly popular in big cities around the world where life can be more hectic than elsewhere and there are many operators of such services in places like London and New York.

MYOFASIAL RELEASE MASSAGE

Myofascial release refers to the manual massage technique for stretching the fascia and releasing bonds between fascia, integument, 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, or by skin rolling.

MYOMASSOLOGY

An integration of techniques including basic Swedish massage, aromatherapy, reflexology, shiatsu, energy balancing, and craniosacral therapy along with other modalities in conjunction with instruction in nutrition, meditation and yoga. The term Myomassology was coined by Irene Gauthier to describe her combined work of Swedish massage, craniosacral therapy, reflexology and body mechanics.

POSTURAL INTEGRATION

Postural Integration (PI) is a process-oriented bodywork combining deep tissue massage with breathwork, body movement and awareness as well as emotional expression.

REFLEXOLOGY MASSAGE

Reflexology is based on the principle that there are reflexes in the hands and feet that relate to every organ, gland, and system of the body.

REMEDIAL MASSAGE

Massage techniques such as sports massage, trigger point therapy and PNF stretching combined for an overall curative approach.

SELF MASSAGE

A few various techniques that are practiced on oneself, such as stroking the temples with strong pressure from front to back, rubbing the bottoms of the feet with one's knuckles or a wooden massage tool, and circular movement with thumb on palm of hand.

SHIATSU

Shiatsu (shi meaning finger and atsu meaning pressure) is a Japanese therapy that uses pressure applied with thumbs, fingers and palms to the same energy meridians as acupressure and incorporates stretching. It also uses techniques such as rolling, brushing, vibrating, grasping and, in one particular technique developed by Suzuki Yamamoto, pressure is applied with the feet on the person's back, legs and feet.

STONE MASSAGE

A stone massage uses cold or water-heated stones to apply pressure and heat to the body. Stones coated in oil can also be used by the therapist delivering various massaging strokes. The hot stones used are commonly Basalt stones (or lava rocks) which over time have become extremely polished and smooth. As the stones are placed along the recipient's back, they help to retain heat which then deeply penetrates into the muscles, releasing tension.

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 Kinesis Myofascial Integration and Rolfing.

SWEDISH MASSAGE

Swedish massage uses five styles of long, flowing strokes to massage. The five basic strokes are effleurage (sliding or gliding), petrissage (kneading), tapotement (rhythmic tapping), friction (cross fiber) and vibration/shaking. 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. The development of Swedish massage is often inaccurately credited to Per Henrik Ling, though the Dutch practitioner Johan Georg Mezger adopted the French names to denote the basic strokes. The term "Swedish" massage is actually only recognized in English, Quebecois or Dutch speaking countries. Elsewhere the style is referred to as "classic massage".

THAI MASSAGE

Known in Thailand as (Nuat phaen boran, IPA: meaning "ancient/traditional massage", Traditional Thai massage (Nuad Boran) is generally based on a combination of Indian and Chinese traditions of medicine. It is a unique form of Buddhist physiotherapy that blends yoga, acupressure and reflexology.

TRADITIONAL CHINESE MASSAGE

Two types of traditional Chinese massage exist - Tui na which focuses on pushing, stretching and kneading the muscle and Zhi Ya which focuses on pinching and pressing at acupressure points. Both are based on principles from Traditional Chinese Medicine. Though in the Western countries Tui Na is viewed as massage, it is not. Massage of Chinese Medicine is known as Anmo, which is the foundation of Japan's Anma. Tui Na is Chinese Medicine's Physio-Therapy. Utilized for medical purposes instead of relaxation, Tui Na works to correct the patient's problems, from musculoskeletal conditions, to diseases, cancers and even minor and major headaches. Within the foundation of Tui Na, Traditional Chinese Medicine principles are followed, from Meridian Applications to Herbal Formulas, Qigong Therapy and heated herbal application (Moxa). Technique applications such as friction and vibration are used as well.

TRAGER APPROACH

The Trager approach combines movement and touch to educate the body/mind.

TRIGGER POINT THERAPY

Sometimes confused with pressure point massage, 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. and in 2007 a paper was presented showing images of Trigger Points using MRI. These points relate to dysfunction in the myoneural junction, also called neuromuscular junction (NMJ), in muscle, and therefore this modality is different from reflexology, acupressure and pressure point massage.

VISCERAL MANIPULATION

One form is Mayan abdominal massage which is practiced in many countries in Latin America. This type of massage may have been developed by Elijio Panti of Belize and brought to the United States by Rosita Arvigo.

WATSU

Watsu is the combination of hydrotherapy and shiatsu developed by Harold Dull. The work is done in skin temperature water with both the therapist and practitioner in the water, usually a pool which is between 3.5 ft to 4 ft (100�120 cm) deep. The work entails much movement in the water and practitioners believe that it incorporates the activation of the energy lines derived from shiatsu.

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 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. 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, 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 blind clinical trials. 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. 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. Massage can employ randomized controlled trials, which are published in peer reviewed medical journals. This type of study could increase the credibility of the profession because it displays that purported therapeutic effects are reproducible

SINGLE DOSE EFFECTS

Pain relief: Relief from pain due to musculoskeletal injuries and other causes is cited as a major benefit of massage. Acupressure or pressure point massage may be more beneficial than classic Swedish massage in relieving back pain. However, a meta-study conducted by scientists at the University of Illinois at Urbana-Champaign failed to find a statistically significant reduction in pain immediately following treatment. State anxiety: Massage has been shown to reduce state anxiety, a transient measure of anxiety in a given situation. Blood pressure and heart rate: Massage has been shown to reduce blood pressure and heart rate as temporary effects.

MULTIPLE DOSE EFFECTS

Pain relief: When combined with education and exercises, massage might help sub-acute, chronic, non-specific low back pain. Furthermore, massage has been shown to reduce pain experienced in the days or weeks after treatment. Trait anxiety: Massage has been shown to reduce trait anxiety; a person's general susceptibility to anxiety. Depression: Massage has been shown to reduce subclinical depression.

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