Wikipedia

Massage

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Massageis the rubbing or kneading of the body'ssoft tissues.[1]Massage techniques are commonly applied with hands, fingers, elbows, knees, forearms, feet, or a device.[2][3]The purpose of massage is generally for the treatment of body stress or pain.[4][5][6]In European countries, a personprofessionallytrained to give massages is traditionally known as a masseur (male) or masseuse (female). In the United States, these individuals are often referred to as "massage therapists".[7]In some provinces ofCanada,they are called "registered massage therapists."[8][9]

Massage
This article is part of the branches ofComplementary and alternative medicineseries.
Massage (video)

In professional settings, clients are treated while lying on amassage table,sitting in amassage chair,or lying on a mat on the floor.[10]There are many different modalities in the massage industry, including (but not limited to): deep tissue,manual lymphatic drainage,medical,sports,structural integration,Swedish,Thaiand trigger point.[11]

Etymology

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The word comes from the Frenchmassage'friction ofkneading',[12]which, in turn, comes either from theArabicwordمَسَّmassameaning 'to touch, feel',[13]thePortugueseamassar'knead', from theLatinmassameaning 'mass, dough',[14]or theGreekverbμάσσω(massō) 'to handle, touch, to work with the hands, to knead dough'.[15]

Theancient Greekword for massage wasanatripsis[16][17]and the Latin wasfrictio.[18][17]

History

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Drawings ofacupressurepoints onSen linesatWat Photemple inThailand

Ancient times

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Archaeological evidence of massage has been found in many ancient civilizations includingChina,India,Japan,Egypt,Rome,Greece,andMesopotamia.

2330 BC: The Tomb of Akmanthor[19](also known as "The Tomb of the Physician" ) inSaqqara,Egypt, depicts two men having work done on their feet and hands, possibly depicting a massage.[20]

Akmanthor

2000 BC: The wordmuššu'u( "massage" ) is written for the first time, and its use is described, in some Sumerian and Akkadian texts found at the beginning of the 21st century in ancient Mesopotamia.[21]

722–481 BC:Huangdi Neijingis composed during the ChineseSpring and Autumn period.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 theYellow Emperor(c. 2700BC), misleading some into believing the text itself was written during the time of the Yellow Emperor (which would predate written history).[22][23][24][25]

762 BC: In the Iliad and the Odyssey, massage with oils and aromatic substances is mentioned as a means to relax the tired limbs of warriors and as a way to help the treatment of wounds.[18]

700 BC:Bian Que,the earliest known Chinese physician, uses massage in medical practice.[26]

500 BC:Jīvaka Komarabhāccawas an Indian physician who according to the PāliBuddhistCanon wasShakyamuni Buddha's physician. Jivaka is sometimes credited with founding and developing a style of massage that led to the type of massage practiced in current-day Thailand. Though this claim is disputed.

493 BC: A possible biblical reference documents daily "treatments" with oil ofmyrrhas a part of the beauty regimen of the wives of Xerxes (Esther,2:12).[27]

460 BC:Hippocrateswrote "The physician must be experienced in many things, but assuredly in rubbing."[28]

300 BC:Charaka Samhita,sometimes dated to 800 BCE, is one of the oldest of the three ancient treatises ofAyurvedicmedicine, including massage.Sanskritrecords indicate that massage had been practiced in India long before the beginning of recorded history.[29]

AD 1st or 2nd:Galenmentioned Diogas (Διόγας) who was aniatralipta(ἰατραλείπτης) (rubber and anointer/physiotherapist).[30]

AD 581: China establishes a department of massage therapy within the Office of Imperial Physicians.

Middle Ages

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Many ofGalen's manuscripts, for instance, were collected and translated byHunayn ibn Ishaqin the 9th century. Later in the 11th-century copies were translated intoLatinand again in the 15th and 16th centuries, when they helped enlighten European scholars as to the achievements of the Ancient Greeks. This renewal of the Galenic tradition during the Renaissance played a very important part in the rise of modern science.[non sequitur]

One of the greatest Persian medics wasAvicenna,also known as Ibn Sina, who lived from 980 AD to 1037 AD. His works included a comprehensive collection and systematization of the fragmentary and unorganized Greco-Roman medical literature that had been translated Arabic by that time, augmented by notes from his own experiences. One of his books,Al-Qānūn fī aṭ-Ṭibb(The Canon of Medicine) has been called the most famous single book in the history of medicine in both East and West. Avicenna excelled in the logical assessment of conditions and comparison of symptoms and took special note of analgesics and their proper use as well as other methods of relieving pain, including massage.

AD 1150: Evidence of massage abortion, involving the application of pressure to the pregnantabdomen,can be found in one of thebas reliefsdecorating the temple ofAngkor WatinCambodia.It depicts ademonperforming such an abortion upon a woman who has been sent to theunderworld.This is the oldest known visual representation of abortion.[31]

In Southeast Asia, massage traditions and techniques have already been entrenched in the people's diverse cultures for centuries before trade contact with Europe in the 16th century. In thePhilippines,a distinct massage and healing tradition calledhilotdeveloped,[32][33][34]while inThailand,the tradition of massage that developed was callednuad thai.Nuad thai was declared in 2019 as aUNESCOintangible cultural heritage.[35]

18th and 19th centuries

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AD 1776:Jean Joseph Marie AmiotandPierre-Martial Cibot,French missionaries in China translate summaries ofHuangdi Neijing,including a list ofmedical 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.[25]

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", also known as "Swedish Massage", and has been called the "Father of Massage".[36][37][why?]

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 English historian of ChinaJoseph Needham,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, Pehr 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."[38]

AD 1813: The Royal Gymnastic Central Institute for the training of gymnastic instructors was opened in Stockholm, Sweden, withPehr Henrik Lingappointed as principal. Ling developed what he called the "Swedish Movement Cure". Ling died in 1839, having previously named his pupils as the repositories of his teaching. Ling and his assistants left a little proper written account of their methods.[25][39][40]

AD 1868: Dutch massage practitioner Johan Georg Mezger applies French terms to name five basic massage techniques,[36]and coins the phrase "Swedish massage system". These techniques 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)).

Modern times

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China

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Massage room in Shanghai, China

As of 2005, with the city ofShanghaialone there were an estimated 1,300–2,000 foot massage centers, with more than 3,000 inShenzhen.It was also estimated that there were nearly 30,000 massage workers in Shanghai and over 40,000 in Shenzhen.[41]The average rate of pay for a worker in the massage industry in China is over 10,000 yuan per month, making them a well-paying job in China's service sector.[42]

United States

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Massage started to become popular in the United States in the middle part of the 19th century[27]and was introduced by twoNew Yorkphysicians,George and Charles Taylor, based onPehr Henrik Ling's techniques developed inSweden.[43][44]

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.[27]Until the 1970s,nursesused massage to reduce pain and aid sleep.[45]Popular books and videos, such asMassage for Relaxation,helped introduce massage to popular culture outside of a health setting. The massage therapy industry is continuously increasing. In 2009, U.S. consumers spent between $4 and $6 billion on visits to massage therapists.[46]In 2015, research estimates that massage therapy was a $12.1 billion industry.[47]

All but five states require massage therapists to be licensed, and licensure requires the applicant to receive training at an accredited school, and to pass a comprehensive exam. Those states that require licensure also typically require continuing education in massage techniques and in ethics.[48]

United Kingdom

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The service of massage or "physiological shampooing" was advertised inThe Timesfrom as early as 1880. Adverts claimed it as a cure for obesity amongst other chronic ailments.[49]

Sports, business and organizations

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Marathon runners receiving massages at the 2004 ING Taipei International Marathon

Massage developed alongside athletics in bothAncient ChinaandAncient Greece.Taoistpriests developed massage in concert with theirKung Fugymnasticmovements, whileAncient Greek Olympiansused a specific type of trainer ( "aleiptes" )[50]who would rub their muscles with oil.Pehr Ling'sintroduction to massage also came about directly as a result of his study of gymnastic movements.

The1984 Summer OlympicsinLos Angeleswas the first time that massage therapy was televised as it was being performed on the athletes. And then, during the1996 Summer OlympicsinAtlantamassage therapy was finally offered as a core medical service to the US Olympic Team.[51]Massage has been employed by businesses and organizations such as theU.S. Department of Justice,BoeingandReebok.[52]Athletes such asMichael JordanandLeBron Jameshave personal massage therapists that at times even travel with them.

Types and methods

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Acupressure

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Main article:Acupressure

Acupressure[from Latin acus "needle" (see acuity) + pressure (n.)[53]] is a technique similar in principle toacupuncture.It is based on the concept of life energy which flows through "meridians" in the body. In treatment, physical pressure is applied toacupuncture pointswith 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 ofbias.[54]

Ashiatsu

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A licensed massage practitioner performs Ashiatsu massage.

In ashiatsu, the practitioner uses their feet to deliver treatment. The name comes from the Japanese,ashifor foot andatsufor pressure.[55]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.[56]Other manual therapy techniques using the feet to provide treatment include Keralite, BarefootLomilomi,andChavutti Thirumal.

Ayurvedic massage

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Ayurvedic massage is known asAbhyangamin Sanskrit. According to the Ayurvedic ClassicsAbhayngamis an important dincharya (Daily Regimen) that is needed for maintaining a healthy lifestyle. The massage technique used during Ayurvedic Massage aims to stimulate the lymphatic system. Practitioners claim that the benefits of regular Ayurvedic massage include pain relief, reduction of fatigue, improved immune system and improved longevity.[57]

Burmese massage

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Traditional Burmese Foot Massage at Sapel inYangon

"Known inMyanmaras 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 of local natural ingredients such asThanakawhich helps to promote smooth skin and prevents sunburn. "[58]

Burmese massage is a full body massage technique that starts from head to toes, drawing onacupuncture,reflexologyand kneading. Signature massage strokes includeacupressureusing the elbows, quick gentle knocking of acupressure points, and slow kneading of tight muscles. The massage aims to improve blood circulation and quality of sleep, while at the same time help to promote better skin quality.[59][60]

Biomechanical stimulation (BMS) massage

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Biomechanical stimulation (BMS) is a term generally used for localised biomechanical oscillation methods, whereby local muscle groups are stimulated directly or via the associated tendons by means of special hand held mechanical vibration devices. Biomechanical oscillation therapy and training is offered in a variety of areas such as competitive sports,[61]fitness, rehabilitation,[62]medicine,[63]prevention, beauty and used to improve performance of the muscles and to improve coordination and balance. It is often used inmyofascial trigger pointtherapy to invoke reciprocal inhibition within the musculoskeletal system. Beneficial effects from this type of stimulation have been found to exist.[64]

Biodynamic massage

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Main article:Biodynamic massage

Biodynamic massagewas created byGerda Boyesenas part of Biodynamic Psychotherapy. It uses a combination of hands-on work and "energy work" and also uses a stethoscope to hear the peristalsis.[65]

Craniosacral therapy

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Main article:Craniosacral therapy

Craniosacral therapy (CST) is apseudoscience[66]that aims to improve fluid movement and cranial bone motion by applying light touch to the skull, face, spine, and pelvis.[67]

Erotic massage

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Main article:Erotic massage

A type of massage that is done in an erotic way via the use of massage techniques by a person on another person's erogenous zones to achieve or enhance their sexual excitation or arousal and to achieve orgasm.

It was alsoonce used for medical purposesas well as for the treatment of "female hysteria"and" womb disease ".[68][69]

Nuru massageis a Japanese form of erotic massage.

Hammam ( "Turkish bath" ) massage

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Le massage: scène au HammambyEdouard Debat-Ponsan(1883). AnOrientalistpainting depicting a massage at ahammam.

In the traditionalHammam,massage involves not just vigorous muscle kneading, but alsojoint cracking,"not so much a tender working of the flesh as a pummeling, a cracking of joints, a twisting of limbs..."[70]An 18th-century traveler reported:

...one of the attendants begins to press and handle the tops of the shoulders, the muscles of the arm, and successively the whole body; first gently, then by degrees increasing the pressure, till he comes to handle pretty roughly, but without giving pain. This is repeated at short intervals till the skin is perfectly softened. The attendant then taking hold of the bather's fingers, with a dexterous jerk makes each joint crack successively; after which, laying him flat on his back, and bringing the arms across the breast, the shoulder joints are made to crack in like manner.

— Alexander Russell,The Natural History of Aleppo(1756)[71]

Lomilomi and indigenous massage of Oceania

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Main article:Lomilomi massage

Lomilomiis the traditional massage ofHawaii.As an indigenous practice, it varies by island and by family. The wordlomilomialso is used for massage inSamoaand East Futuna. In Samoa, it is also known aslolomiandmilimili.In East Futuna, it is also calledmilimili,fakasolosolo,amoamo,lusilusi,kinikini,fai’ua.TheMāoricall itromiromiandmirimiri.InTongamassage isfotofota,tolotolo,andamoamo.InTahitiit isrumirumi.OnNanumeainTuvalu,massage is known aspopo,pressure application iskukumi,and heat application istutu.Massage has also been documented inTikopiain theSolomon Islands,inRarotonga,inPukapukaand inWestern Samoa.[72]

Lymphatic drainage

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Main article:Manual lymphatic drainage

Manual lymphatic drainage is a technique used to gently work and stimulate the lymphatic system, to assist in reduction of localized swelling. Thelymphatic systemis a network of slow moving vessels in the body that carries cellular waste toward the liver, to be filtered and removed.Lymphalso carrieslymphocytesand otherimmune systemagents. Manual lymphatic drainage claims to improve waste removal and immune function.[73][74][75]

Medical massage

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Main article:Medical massage

Medical massage is a controversial term in the massage profession.[76]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 releaseand trigger-point therapy, as well asosteopathictechniques,cranial-sacral techniquesand many more can be used to work with various medical conditions.[77]

Massage used in the medical field includesdecongestive therapyused forlymphedema[27]which can be used in conjunction with the treatment ofbreast cancer.Light massage is also used in pain management and palliative care.[78]Carotid sinus massage is used to diagnose carotid sinus syncope and is sometimes useful for differentiatingsupraventricular tachycardia(SVT) fromventricular tachycardia.It, like thevalsalva maneuver,is a therapy for SVT.[79]However, it is less effective than management of SVT with medications.[80]

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.[81]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 fromrandomized controlled trials.[82]

Myofascial release

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Myofascial releaserefers to the manual massage technique that claims to release adheredfasciaandmuscleswith the goal of eliminatingpain,increasingrange of motionandequilibrioception.Myofascial release usually involves applying shear compression or tension in various directions, cross fiber friction or by skin rolling.[83]

Reflexology

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Reflexology,also known as "zone therapy", is analternative medicineinvolvingapplication of pressureto the feet and hands with specific thumb, finger, and hand techniques without the use of oil or lotion. It is based on apseudoscientific[84]belief in a 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.[85]

Shiatsu

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Shiatsu( chỉ áp ) (shimeaning finger andatsumeaning pressure) is a form of Japanese bodywork based on concepts in traditional Chinese medicine such as qi meridians. It consists of finger, 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.[86]

Sports massage

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Sports massage is the use of specific massage therapy techniques in an athletic context to improve recovery time, enhance performance and reduce the risk of injury.[87]This is accomplished using techniques that stimulate the flow of blood and lymph to and from muscles. Sports massage is often delivered before or after physical activity depending on the subject's needs, preferences and goals.

Structural Integration

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Main article:Structural integration

Structural Integration's aim is to unwind the strain patterns in the body's myofascial system, restoring it to its natural balance, alignment, length and ease. This is accomplished by hands-on manipulation, coupled with movement re-education. There are about 15 schools of Structural Integration as recognized by the International Association of Structural Integration,[88]including the Dr. Ida Rolf Institute (with the brandRolfing), Hellerwork, Guild for Structural Integration, Aston Patterning,[25]Soma,[89]and Kinesis Myofascial Integration.[90]

Swedish massage

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Estonian massage therapy school teaching the Swedish classical massage technique.

The most widely recognized and commonly used category of massage isSwedish massage.The Swedish massage techniques vary from light to vigorous.[91]Swedish massage uses five styles of strokes. The five basic strokes areeffleurage(sliding or gliding),petrissage(kneading),tapotement(rhythmic tapping), friction (cross fiber or with the fibers) and vibration/shaking.[92]

The development of Swedish massage is often inaccurately credited toPer Henrik Ling,though theDutchpractitioner Johann Georg Mezger applied the French terms to name the basic strokes.[93]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 have found that Swedish massage can reduce chronic pain, fatigue,[94][95]joint stiffnessand improve function in patients withosteoarthritisof the knee.[96]

Thai massage

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Thai massage
Main article:Thai massage

Known in Thailand asNuat phaen boran,meaning "ancient/traditional massage", traditional Thai massage is generally based on a combination of Indian and Chinese traditions of medicine.

Thai massage 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 onyoga,acupressureandreflexology.

Thai massage is a popular massage therapy that is used for the 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 the reduction of joint pain caused by osteoarthritis (OA) of the knee.[97]

Traditional Chinese massage

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Main article:Traditional Chinese medicine

Massage ofChinese Medicineis known as An Mo ( mát xa, pressing and rubbing) orQigongMassage and is the foundation of Japan'sAnma.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( xoa bóp ) focuses on pushing, stretching, and kneading muscles, and Zhi Ya ( chỉ áp ) focuses on pinching and pressing atacupressurepoints. Technique such as friction and vibration are used as well.[98]

Trigger point therapy

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Sometimes confused withpressure pointmassage,[27]this involves deactivatingtrigger pointsthat 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 byJanet G. Travell(President Kennedy's physician) andDavid Simons.Trigger points have been photomicrographed and measured electrically[99]and in 2007 a paper was presented showing images of Trigger Points using MRI.[100]These points relate to dysfunction in the myoneural junction, also calledneuromuscular junction(NMJ), in muscle, and therefore this technique is different from reflexology acupressure and pressure point massage.

Tui na

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Main article:Tui na

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

Watsu

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Main article:Watsu

Watsu, developed byHarold DullatHarbin 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 combineshydrotherapyfloating and immersion withshiatsuand other massage techniques. Watsu is used as a form ofaquatic therapyfor deep relaxation and other therapeutic intent. Related forms includeWaterdance,Healing Dance, and Jahara technique.[101][102]

Facilities, equipment, and supplies

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Massage table prepared for a massage session.

Massage tables and chairs

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Specialized massagetablesandchairsare used to position recipients during massages. A typical commercial massage table has an easily cleaned, heavily padded surface, and horseshoe-shaped head support that allows the client to breathe easily while lying face down and can be stationary or portable, while home versions are often lighter weight or designed to fold away easily. Anorthopedic pillowor bolster can be used to correct body positioning.

Ergonomic chairs serve a similar function as a massage table. Chairs may be either stationary or portable models. Massage chairs are easier to transport than massage tables, and recipients do not need to disrobe to receive a chair massage. Due to these two factors, chair massage is often performed in settings such as corporate offices, outdoor festivals, shopping malls, and other public locations.

Warm-water therapy pools

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Temperature-controlled warm-water therapy pools are used to perform aquatic bodywork.[103]For example,Watsurequires a warm-water therapy pool that is approximately chest-deep (depending on the height of the therapist) and temperature-controlled to about 35 °C (95 °F).[104]

Dry-water massage tables

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A dry-water massage machine at a shopping mall in Fargo, North Dakota.

A dry-water massage table uses jets of water to perform the massage of the patient's muscles. These tables differ from a Vichy shower in that the client usually stays dry. Two common types are one in which the client lies on a waterbed-like mattress which contains warm water and jets of water and air bubbles and one in which the client lies on a foam pad and is covered by a plastic sheet and is then sprayed by jets of warm water, similar to a Vichy shower.[105]The first type is sometimes seen available for use in shopping centers for a small fee.

Vichy showers

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AVichy showeris a form of hydrotherapy that uses a series of shower nozzles that spray large quantities of water over the client while they lie in a shallow wet bed, similar to a massage table, but with drainage for the water. The nozzles may usually be adjusted for height, direction, and temperature to suit the patient's needs.

Cremes, lotions, gels, and oils

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A specially created aroma massage combining technique and aromatherapy oils.

Many different types of massage cremes, lotions, gels, and oils are used to lubricate and moisturize the skin and reduce the friction between skin (hands of technician and client).[106]

Massage tools

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These instruments or devices are sometimes used during massages.[107]Some tools are for use by individuals, others by the therapist.

Tools used by massage therapists

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Calf massage with a bamboo massage tool.

Instrument-assisted soft-tissue massage can deploy stainless-steel devices to manipulate tissue in a way that augments hands-on work.

A body rock is a serpentine-shaped tool, usually carved out of stone. It is used to amplify the therapist' strength and focus pressure on certain areas. It can be used directly on the skin with a lubricant such as oil orcorn starchor directly over clothing.

Bambooandrosewoodtools are also commonly used. They originate from practices in southeast Asia, Thailand, Cambodia, and Burma. Some of them may be heated, oiled, or wrapped in cloth.

Cupping massage is often carried out using plastic cups and a manual hand-pump to create the vacuum. The vacuum draws the soft tissue perpendicular to the skin, providing a tensile force, which can be left in one site or moved along the tissue during the massage.

Tools used by both individuals and massagers

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Hand-held battery-operated massaging and vibrating instruments are available, including devices for massaging the scalp following ahaircut.

Vibrating massage pads come in a range of sizes, some with the option of heating.

Vibratingmassage chairscan provide an alternative for therapy at home.

There is a widespread market inerotic massageinstruments, including electricdildosandvibratorssuch as themassage wand.[108]

Medical and therapeutic use

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The main professionals that provide therapeutic massage are massage therapists,athletic trainers,physical therapistsand practitioners of manytraditional Chinese and other eastern medicines.Massage practitioners work in a variety of medical settings and may travel to private residences or businesses.[27]Contraindicationsto massage includedeep vein thrombosis,bleeding disordersor taking blood thinners such aswarfarin,damaged blood vessels, weakened bones fromcancer,osteoporosis,orfractures,andfever.[27]

Beneficial effects

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Oil dispersion bath and brush massage

Peer-reviewed medical research has shown that the benefits of massage includepain relief,reducedtrait anxietyanddepression,and temporarily reduced blood pressure, heart rate, and state of anxiety.[109]Additional testing has shown an immediate increase in, and expedited recovery periods for muscle performance.[110]Theories behind what massage might do include enhanced skeletal muscle regrowth and remodeling,[111]blockingnociception(gate control theory),[112]activating theparasympathetic nervous system,which may stimulate the release ofendorphinsandserotonin,preventingfibrosis[113]orscar tissue,increasing the flow oflymph,and improvingsleep.[27][114]

Massage is hindered from reaching thegold standardofscientific research,which includesplacebo-controlled anddouble blindclinical trials.[115][116]Developing a "sham"manual therapyfor massage would be difficult since even light touch massage could not be assumed to be completely devoid of effects on the subject.[115]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.[115]Massage can employrandomized controlled trials,which are published inpeer reviewedmedical journals.[115]This type of study could increase thecredibilityof the profession because it displays that purported therapeutic effects arereproducible.[116]

Single-dose effects

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Mechanicalmassage chairs
  • Pain relief:Relief from pain due tomusculoskeletalinjuries and other causes is cited as a major benefit of massage.[27]A 2015 Cochrane Review concluded that there is very little evidence that massage is an effective treatment forlower back pain.[117]A meta-analysis conducted by scientists at theUniversity of Illinois Urbana-Champaignfailed to find a statistically significant reduction in pain immediately following treatment.[109]Weak evidence suggests that massage may improve pain in the short term for people with acute, sub-acute, and chronic lower back pain.[117]
  • State anxiety:Massage has been shown to reduce state anxiety, a transient measure of anxiety in a given situation.[109]
  • Blood pressure and heart rate:Massage has been shown to temporarily reduce blood pressure and heart rate.[109]

Multiple-dose effects

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  • Pain relief:Massage may reduce pain experienced in the days or weeks after treatment.[109][118]
  • Trait anxiety:Massage has been shown to reduce trait anxiety; a person's general susceptibility to anxiety.[109]
  • Depression:Massage has been shown to reduce sub-clinicaldepression.[109]

Neuromuscular effects

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Massage has been shown to reduce neuromuscular excitability by measuring changes in theHoffman's reflex(H-reflex) amplitude.[119]A decrease in peak-to-peak H-reflex amplitude suggests a decrease in motoneuron excitability.[120]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.[121]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.[122]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.[120]

Global regulation and practice

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Because the art and science of massage is a globally diverse phenomenon, different legal jurisdictions sometimes recognize and license individuals with titles, while other areas do not. Examples are:

  • Registered Massage Therapist (RMT) in Canada[123]and New Zealand[124]
  • Certified Massage Therapist (CMT) in New Zealand[125]
  • Licensed Massage Practitioner (LMP)[126]
  • Licensed Massage Therapist (LMT)[127]
  • Licensed Massage and Bodywork Therapist (LMBT) in North Carolina[128]
  • Therapeutic Massage Therapist (TMT) in South Africa[129]

In some jurisdictions,practicing without a licenseis a crime. One such jurisdiction isWashington state,where any health professionals practicing without a license can be issued a fine and charged with a misdemeanor offense.[130]

Canada

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Canadian massage therapist at work.

In regulated provinces massage therapists are known as Registered Massage Therapists, in Canada sixprovincesregulate massage therapy:[131]British Columbia,Ontario,Newfoundland and Labrador,Prince Edward Island,Saskatchewan,andNew Brunswick.[132]Registered Massage Therapy in British Columbia is regulated by the College of Massage Therapists of British Columbia (CMTBC).[133]Regulated provinces have, since 2012, established inter-jurisdiction competency standards.[134][131]Quebecis not provincially regulated. Massage therapists may obtain a certification with one of the various associations operating. There is the Professional Association of Specialized Massage Therapists of Quebec, also named Mon Réseau Plus, which represents 6,300 massage therapists (including ortho therapist, natural therapists, and others), the Quebec Federation of massage therapists (FMQ), and the Association québécoise des thérapeutes naturals; however, none of these are regulated by provincial law.

Canadian educational institutions undergo a formal accreditation process through the Canadian Massage Therapy Council for Accreditation (CMTCA).

China

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Most types of massage, with the exception of sometraditional Chinese medicine,are not regulated in China. Although illegal in China, some of the smallermassage parlorsare sometimes linked to the sex industry and the government has taken a number of measures in recent times to curb this. In a nationwide crackdown known as the yellow sweep ( "Yellow" inMandarin Chineserefers to sexual activities or pornographic content), limitations on the design and operation of massage parlors have been placed, going so far as requiring identification from customers who visit massage establishments late at night and logging their visits with the local police.[135][136]

France

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France requires three years of study and two final exams in order to apply for a license.[137]

Germany

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In Germany, massage is regulated by the government on a federal and national level. Only someone who has completed 3,200 hours of training (theoretical and practical) can use the professional title "Masseur und Medizinischer Bademeister" 'Masseur and Medical Spa Therapist'. This person can prolong his training depending on the length of professional experience to a Physiotherapist (1 year to 18 months additional training). The Masseur is trained in Classical Massage, Myofascial Massage, Exercise, and Movement Therapy. During the training, they will study anatomy, physiology, pathology, gynecology, podiatry, psychiatry, psychology, surgery, dermiatry, and orthopedics.[138]They are trained inElectrotherapyand Hydrotherapy. Hydrotherapy includes Kneipp, Wraps, underwater massage, therapeutic washing, Sauna, and Steambath. A small part of their training will include special forms of massage which are decided by the local college, for example, foot reflex zone massage, Thai Massage, etc. Finally, a graduate is allowed to treat patients under the direction of a doctor. Graduates are regulated by the professional body which regulates Physiotherapists. This includes restrictions on advertising and the oath of confidentiality to clients.[139]

India

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In India, massage therapy is licensed by The Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homoeopathy (AYUSH) under theMinistry of Health and Family Welfare (India)in March 1995. Massage therapy is based on Ayurveda, the ancient medicinal system that evolved around 600 BC. Inayurveda,massage is part of a set of holistic medicinal practices, contrary to the independent massage system popular in some other systems.[140]InSiddha,Tamil traditional medicine from south India, massage is termed as "Thokkanam" and is classified into nine types, each for a specific variety of diseases.[141]

Japan

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Traditional Japanese blind massage
See also:ja:あん ma マッサージ chỉ áp sưandAnma

In Japan,shiatsuis regulated but oil massage andThai massageare not.Prostitution in Japanis not heavily policed, and prostitutes posing as massage therapists in "fashion health"shops and"pink salons"are fairly common in the larger cities.[citation needed]

Myanmar

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InMyanmar,massage is unregulated.[142]However, it is necessary to apply for a spa license with the government to operate a massage parlor in major cities such as Yangon. Blind and visually impaired people can become masseurs, but they are not issued licenses. There are a few professional spa training schools in Myanmar but these training centers are not accredited by the government.[citation needed]

Mexico

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In Mexico massage therapists, calledsobadores,combine massage using oil or lotion[143]with a form of acupuncture and faith.[144]Sobadoresare used to relieve digestive system problems as well as knee and back pain.[143][144]Many of these therapists work out of the back of a truck, with just a curtain for privacy.[144]By learning additional holistic healer's skills in addition to massage, the practitioner may become acurandero.[145]

In some jurisdictions,prostitution in Mexicois legal, and prostitutes are allowed to sell sexual massages. These businesses are often confined to a specific area of the city, such as theZona NorteinTijuana.

New Zealand

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In New Zealand, massage is unregulated. There are two levels of registration with Massage New Zealand, the professional body for massage therapists within New Zealand, although neither of these levels are government recognized. Registration at the certified massage therapist level denotes competency in the practice of relaxation massage. Registration at the remedial massage therapist denotes competency in the practice of remedial or orthopedic massage. Both levels of registration are defined by agreed minimum competencies and minimum hours.[146]

South Africa

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In South Africa, massage is regulated, but enforcement is poor. The minimum legal requirement to be able to practice as a professional massage therapist is a two-year diploma in therapeutic massage and registration with the Allied Health Professions Council of SA (AHPCSA). The qualification includes 240 credits, about 80 case studies, and about 100 hours of community service.[citation needed]

South Korea

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InSouth Korea,only blind and visually impaired people can become licensed masseurs.[147]

Thailand

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InThailand,Thai massageis officially listed as one of the branches oftraditional Thai medicine,recognized and regulated by the government. It is considered to be a medical discipline in its own right and is used for the treatment of a wide variety of ailments and conditions. Massage schools, centers, therapists, and practitioners are increasingly regulated by the Ministries of Education and Public Health in Thailand.[148][149]

United Kingdom

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To practice commercial massage or massage therapy in the UK, an ITEC[150]or VTCT[151]certificate must be obtained through training which includes Beauty and Spa Therapy, Hairdressing, Complementary Therapies, Sports & Fitness Training and Customer Service.

Therapists with appropriate paperwork and insurance may join the Complementary and Natural Healthcare Council (CNHC), a voluntary, government regulated, professional register. Its key aim is to protect the public.[152]

In addition, there are many professional bodies that have a required minimum standard of education and hold relevant insurance policies including the Federation of Holistic Therapists (FHT),[153]the Complementary Therapists Association (CThA),[154]and the Complementary Health Professionals (CHP).[155]In contrast to the CNHC these bodies exist to support therapists rather than clients.

United States

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A hot stone massage performed by a professional in Oxnard, California.

According to research done by the American Massage Therapy Association, as of 2012 in the United States, there are between 280,000 and 320,000 massage therapists and massage school students.[156]As of 2022, there are an estimated 872 state-approved massage training programs operating in the U.S.[157]Most states have licensing requirements that must be met before a practitioner can use the title "massage therapist", and some states and municipalities require a license to practice any form of massage. If a state does not have any massage laws then a practitioner need not apply for a license with the state. Training programs in the US are typically 500 hours to 1000 hours in total training time and can award a certificate, diploma, or degree depending on the particular school.[158]Study will often includeanatomy and physiology,kinesiology,massage techniques,first aidandCPR,business,ethicalandlegalissues, and hands-on practice along withcontinuing educationrequirements if regulated.[27]The Commission on Massage Therapy Accreditation (COMTA) is one of the organizations that works with massage schools in the U.S. and there are almost 300 schools that are accredited through this agency.[159]

Forty-seven states,Puerto Rico,and theDistrict of Columbiacurrently offer some type of credential to professionals in the massage and bodywork field—usually licensure, certification or registration.[48][160][161]Forty-five states require some type of licensing for massage therapists.[48][162]There are two nationally recognized tests gain a massage therapy license, as well as state specific exams.[163][164]In the US, thirty-eight states accept the now defunct National Certification Board for Therapeutic Massage and Bodywork's (NCBTMB) certification program as a basis for granting licenses either by rule orstatute.[164][165]The NCBTMB formerly offered the designation Nationally Certified in Therapeutic Massage and Bodywork (NCTMB) but now only offers its certificate program, Board Certification in Therapeutic Massage and Bodywork (BCTMB) which does not qualify for licensure.[166][167]Forty-three states, as well as Puerto Rico and the District of Colombia, accept the Massage & Bodywork Licensing Examination (MBLEx), administered by the Federation of State Massage Therapy Boards (FSMTB).[168][169]Between 10% and 20% of towns or counties independently regulate the profession.[132]These local regulations can range from prohibition on opposite sex massage, fingerprinting and venereal checks from a doctor, to prohibition on house calls because of concern regarding sale of sexual services.[132][170]

In the US,licensureis the highest level ofregulationand this restricts anyone without a license from practicing massage therapy or calling themselves by that protected title.Certificationallows only those who meet certain educational criteria to use the protected title and registration only requires a listing of therapists who apply and meet an educational requirement.[170]In the US, most certifications are locally based. A massage therapist may be certified, but not licensed. Licensing requirements vary per state, and often require additional criteria be met in addition to attending an accredited massage therapy school and passing a required state-specified exam. Only Kansas, Minnesota, and Wyoming, California and Vermont do not require a license or a certification at the state level.[48]Some states allow license reciprocity, where licensed massage therapists who relocate can relatively easily obtain a license in their new state.[171]

In 1997 there were an estimated 114 million visits to massage therapists in the US.[158]Massage therapy is the most used type ofalternative medicinein hospitals in the United States.[160]Between July 2010 and July 2011 roughly 38 million adult Americans (18 percent) had a massage at least once.[172]

People state that they use massage because they believe that it relieves pain frommusculoskeletalinjuries and other causes of pain, reducesstressand enhancesrelaxation,rehabilitates sports injuries, decreases feelings of anxiety and depression, and increases general well-being.[27]

In a poll of 25–35-year-olds, 79% said they would like theirhealth insuranceplan to cover massage.[51]In 2006Duke University Health Systemopened up a center to integrate medical disciplines with CAM disciplines such as massage therapy andacupuncture.[173]There were 15,500spasin the United States in 2007, with about two-thirds of the visitors being women.[162]

The number of visits rose from 91 million in 1999 to 136 million in 2003, generating a revenue that equals $11 billion.[174]Job outlook for massage therapists was also projected to grow at 20% between 2010 and 2020 by theBureau of Labor Statistics,faster than the average.[175]

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