1. Cotherm Type Tse Manual Lymphatic Drainage Certification
2. Learn Manual Lymphatic Drainage
3. Lymphatic Drainage Massage

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2. Aug 16, 2016  Two lymphatic disorders that massage therapy—more specifically manual lymphatic drainage (MLD)—has shown some promise in helping are edema and lymphedema. These conditions can occur for myriad reasons, including post-operatively (especially for cancer treatments that require lymph node removal), acute injury, orthopedic trauma and some autoimmune conditions, to name a few.

Manual lymphatic drainage is a type of massage based on an unproven hypothesis that it will encourage the natural drainage of the lymph, which carries waste products away from the tissues back toward the heart. The lymph system depends on intrinsic contractions of the smooth muscle cells in the walls of lymph vessels and the movement of skeletal muscles to propel lymph through the vessels to lymph nodes and then to the lymph ducts which return lymph to the cardiovascular system. Manual lymph dra.

Abstract

Manual therapists question integrating manual lymphatic drainage techniques (MLDTs) into conventional treatments for athletic injuries due to the scarcity of literature concerning musculoskeletal applications and established orthopaedic clinical practice guidelines. The purpose of this systematic review is to provide manual therapy clinicians with pertinent information regarding progression of MLDTs as well as to critique the evidence for efficacy of this method in sports medicine. We surveyed English-language publications from 1998 to 2008 by searching PubMed, PEDro, CINAHL, the Cochrane Library, and SPORTDiscus databases using the terms lymphatic system, lymph drainage, lymphatic therapy, manual lymph drainage, and lymphatic pump techniques. We selected articles investigating the effects of MLDTs on orthopaedic and athletic injury outcomes. Nine articles met inclusion criteria, of which 3 were randomized controlled trials (RCTs). We evaluated the 3 RCTs using a validity score (PEDro scale). Due to differences in experimental design, data could not be collapsed for meta-analysis. Animal model experiments reinforce theoretical principles for application of MLDTs. When combined with concomitant musculoskeletal therapy, pilot and case studies demonstrate MLDT effectiveness. The best evidence suggests that efficacy of MLDT in sports medicine and rehabilitation is specific to resolution of enzyme serum levels associated with acute skeletal muscle cell damage as well as reduction of edema following acute ankle joint sprain and radial wrist fracture. Currently, there is limited high-ranking evidence available. Well-designed RCTs assessing outcome variables following implementation of MLDTs in treating athletic injuries may provide conclusive evidence for establishing applicable clinical practice guidelines in sports medicine and rehabilitation.

Manual lymphatic drainage techniques (MLDTs) are unique manual therapy interventions that may be incorporated by medical practitioners as well as allied health clinicians into rehabilitation paradigms for the treatment of somatic dysfunctions and pathologies^–5. The theoretical bases for using such modes of manual therapy are founded on the following concepts: 1) stimulating the lymphatic system via an increase in lymph circulation, 2) expediting the removal of biochemical wastes from body tissues, 3) enhancing body fluid dynamics, thereby facilitating edema reduction, and 4) decreasing sympathetic nervous system responses while increasing parasympathetic nervous tone yielding a non-stressed body-framework state⁵. The physiological and biomechanical effects of MLDTs on lymphatic system dynamics in treating ill or injured patients have long been of interest to osteopathic, allied health, complementary, and alternative medicine practitioners^5, although it was not until the 19^th century that researchers began to theorize concepts regarding direct influences of human movement and manual inerventions, predominantely massage, on the lymphatic system. Subsequent clinical scientists focused their efforts on advancing investigations on the biodynamic properties of the lymphatic system from which treatment interventions were developed for therapeutic purposes^,.

Andrew Taylor Still, DO, proposed the initial principles of MLDTs with the advent of osteopathic manipulative techniques in the late 1800s. Still's appreciation for the complexities of lymphatic system functionality influenced many of the ensuing pracitioners who evolved this body of work. Elmer D Barber, DO, a student at Still's American School of Osteopathy, was the first author to publish works on manual lymphatic pump techniques for the spleen, in 1898. Another pupil of Still's philosophies, Earl Miller, DO, instituted the manual thoracic pump technique in 1920. Emil Vodder, PhD, was an additional clinical scientist who contributed to the development and advancement of MLDTs^,. Vodder focused his clinical research on gaining further insight into the treatment of various pathologies by manipulating the lymphatic system^,. In his work with individuals afflicted by various health ailments, Vodder reported successful treatment results using his manual lymph drainage technique throughout the 1930s^,. Vodder's treatment approach was similar to popular modes of Scandinavian massage therapies for that time period but it differed in that heavy pressure was discouraged and a light touch was substituted^,5,. This has led to the advent of the current Vodder Method, which is used by various healthcare professionals in treating several edematous conditions^,. Numerous other medical and allied health professionals, such as Bruno Chikly, MD, DO, have contributed to progressing the art and science of MLDTs, most notably with managing post-lymphadenectomy lymphoedema.

In contrast, the currently proposed criteria for successful management of most acute or chronic edematous conditions in allopathic-based orthopaedic sports medicine and rehabilitation have traditionally implemented cryotherapy, elevation, compressive dressings, suitable range-of-motion exercises, and applicable therapeutic modalities^,8. This commonly prescribed standard of care for injury to musculoskeletal tissues is often supplemented with bouts of oral anti-inflammatory analgesic medications^,8. These medications typically constitute non-steroidal anti-inflammatory drugs^,5,8, which have been the subject of increasing scrutiny and caution with the recent discovery of occasionally fatal side-effects.

Evidence-based practice is a common agenda in medical and allied health sciences, which serves to optimize rendering of health care services through the investigation of treatment interventions that yield positive patient outcomes for establishing clinical practice guidelines^9,10. Use of MLDTs to improve functionality and maintain homeostasis of the lymphatic system is a topic that warrants critical appraisal for determining efficacy in sports medicine and rehabilitation. Hence, it is the purpose of this systematic review to present manual therapy clinicians with a synopsis of the history, theory, and application of MLDTs as well as to discuss current evidence that scrutinizes its efficacy in sports medicine.

Methods

The elements of our clinical question were refined in a stepwise process employing the Participant, Intervention, Comparison, Outcome (PICO) model (McMaster University, UK) (Figure ​(Figure1).1). Manual lymph drainage is defined by MedlinePlus (United States National Library of Medicine) as “a light massage therapy technique that involves moving the skin in particular directions based on the structure of the lymphatic system. This helps encourage drainage of the fluid and waste through the appropriate channels.” This broad definition was used when surveying the relevant literature for our systematic review. Manual lymph drainage techniques reviewed included the Vodder Method and various lymphatic pumps, which demonstrate anatomical and physiological rationale supported by empirical evidence. Specialized concepts such as reflexology, craniosacral technique, and manual lymphatic mapping were not included due to the scarcity of reliable and valid evidence supporting these interventions.

Description for components of the PICO model.

Search Strategy

A comprehensive survey of recent scientific articles in suitable peer-reviewed journals published between 1998 and 2008 was conducted. A series of literature searches used PubMed, PEDro, CINAHL, the Cochrane Library and SPORTDiscus electronic databases. The keywords consistently used were lymphatic system, lymph drainage, lymphatic therapy, manual lymph drainage, and lymphatic pump techniques. We screened the titles of all retrieved hits and identified potentially relevant articles by analyzing associated abstracts. Entire articles were obtained if we deemed the research study satisfied inclusion criteria. Additional publications were identified through manual searches of cited references for related articles retrieved.

Inclusion Criteria

Inclusion criteria consisted of scientific publications that were complete articles with sufficient detail to extract the focal attributes of the research studies. Articles were eligible for inclusion in the critical appraisal if they were categorized as systematic reviews, randomized controlled trials (RCTs), or cohort studies. Due to limited applicable original research studies, pragmatic pilot and case studies pertinent to musculoskeletal health as well as innovative animal-model experiments were also included. Patients enrolled in the research studies had to have suffered from medically diagnosed musculoskeletal ailments, which included bone fracture, acute ankle sprain, fibromyalgia, orthopaedic trauma, and Bell's palsy. Healthy humans participating in research studies that experimentally induced acute skeletal muscle damage following standardized exercise were also included. Furthermore, all research studies included in this systematic review used reliable measurement tools employed in the biomedical, health, and rehabilitation sciences.

Exclusion Criteria

Articles published in languages other than English or prior to 1998 were excluded. Research studies investigating therapies such as reflexology, craniosacral technique, and manual lymphatic mapping were also omitted. With the focus of this systematic review specific to treating orthopaedic and athletic injuries, investigations directed towards management of other somatic dysfunctions or pathologies, such as cancer and lymphoedema, were eliminated.

Data Extraction and Critical Appraisal

The following data were extracted from selected publications to assess the efficacy and effectiveness of MLDTs in sports medicine and rehabilitation as well as to analyze treatment protocols employed in retrieved research studies: experimental design; sampled population size; patients/participants treated; control group; mode of MLDT; MLDT regimen; clinician administering treatment; concomitant interventions; outcome measures. Methodological quality of all scientific articles was critically appraised in this review as delineated per the levels of evidence (May 2001) categorized by the Centre for Evidence-Based Medicine (CEBM) (Oxford, UK)^9,10. Where applicable, selected RCT articles were further scrutinized with a validity score (PEDro scale).

Results

More than 100 titles were identified with the primary search in defined databases. However, the majority of the publications analyzed did not investigate the effects of MLDTs on musculoskeletal conditions in laboratory settings or clinical trials. Only nine articles were screened as potentially relevant for retrieval to a more detailed evaluation following analysis of associated abstracts (Figure ​(Figure22).

QUORUM statement flow diagram illustrating the results of our literature search strategy.

Diverse modes of MLDTs and outcome measurement tools were noted in the research studies. Three relevant human-subject research studies were selected for critical appraisal. One research study was classified as a RCT; it experimentally induced acute skeletal muscle damage after a standardized exercise protocol. The control group in this experiment received no treatment. Another RCT evaluated MLDT intervention following radial wrist fracture. In this instance, the MLDT group's contralateral extremity served as an internal non-treatment control and differences in bilateral limb volume were compared against a group who received the standard of care for a similar injury. A prospective randomized controlled nonconsecutive clinical trial was also identified assessing acute ankle sprains. In this research study, comparisons were made to a control group of participants who had sustained a similar injury and received the standard of care.

The RCTs^,, obtained a score of 6 or higher as scrutinized by the PEDro scale. All of the research studies lost two points as the result of not blinding the participants receiving and the therapists administering the MLDT treatments. However, it is inherent in manual therapy investigations that blinding is compromised because the patient perceives the intervention during treatment. Likewise, it is difficult for a manual therapist to administer a sham or placebo intervention without being cognizant of such during treatment. The validity scoring of the RCTs per the PEDro scare are listed in Table ​Table11.

TABLE 1

A pilot study evaluating the effect of MLDTs on fibromyalgia was also included¹³. Furthermore, two multimodal case studies were chosen pertaining to traumatic musculoskeletal injury and neuromuscular pathology. Three patient animal-model experiments^– were also included as they represented innovative basic science investigations in the theoretical domain of proposed MLDT biomechanisms. The characteristics of the retrieved articles are listed in Table ​Table2.2. A summary of the selected literature reviewed is presented in Table ​Table33.

TABLE 2

TABLE 3

Discussion

Foundations for Theory and Application to Evidence-Based Practice

Modern anatomists, physiologists, and medical practitioners consider the lymphatic system the crux of regulating homeostasis in the human organism^,,5,. Appropriate lymph dynamics are fundamental to an adequate immune system as well as facilitating cellular processes and by-product elimination^,,. However, congestion of the lymphatic system may arise as the result of various intrinsic and extrinsic factors, which include restricted hemodynamics due to focal ischemia, systemic illnesses, tissue injuries, overexposure to adverse chemicals, food allergies or sensitivities, lack of physical movement or exercise, stress, and tight-fitting clothing⁵. In order to address stagnant lymph or impaired lymph dynamics, administration of MLDTs to the limbs has been proposed to aid transport of lymph from the extremities^,5–. Furthermore, complementary lymphatic pump techniques are thought to augment lymph passage through larger, more extensive lymphatic channels in the thorax for the filtration and removal of pathological fluids, inflammatory mediators, and waste products from the interstitial space^,5,. The majority of MLDTs are considered safe but contraindications typically include major cardiac pathology, thrombosis or venous obstruction, hemorrhage, acute enuresis, and malignant tumors^,5,. Several modes of MLDTs, such as the Vodder Method and lymphatic pump techniques, are commonly practiced in osteopathic, complementary, and alternative medicine as well as physical rehabilitation for treating the lymphatic system. With applications specific to orthopaedic injury, MLDTs are proposed to stimulate the superficial component of the lymphatic system for aiding resolution of post-traumatic edema⁵. To an extent, the clinical effectiveness of such interventions has been suggested via pragmatic studies using MLDTs in physical rehabilitation interventions for musculoskeletal traumatic injuries and chronic conditions¹³ as well as neuromuscular pathology or dysfunction. Unfortunately, few basic, applied, or clinical research studies have been conducted that conclusively validate the proposed biophysical processes of MLDTs in humans⁵.

Conversely, several unique research studies have demonstrated evidence in animal models supporting the proposed biomechanisms underpinning MLDTs. Déry et al displayed increased measures of lymph uptake in a rat model subsequent to the application of a lymphatic pump technique. Furthermore, innovative studies by Knott et al and Hodge et al measured greater thoracic duct flow as well as leukocyte count respectively in a canine model with abdominal and thoracic lymphatic pump techniques. The laboratory techniques of Knott et al and Hodge et al specifically represent landmark contributions to this body of work by obtaining real-time indices for lymph mobilization with the implementation of MLDTs commonly applied in clinical osteopathic medical practice. Though the findings of Déry et al, Knott et al, and Hodge et al have supported proposed keystone theoretical concepts and suggested the potential efficacy of MLDTs in animal models, extrapolation of these findings to applicability in the human species is currently inconclusive.

Efficacy in Sports Medicine and Rehabilitation

Unfortunately, the literature regarding the influence of MLDTs for specific conditions encountered in conventional athletic injury rehabilitation is limited. To date, the most pertinent current research studies on the efficacy of MLDTs in sports medicine and rehabilitation are the work of Schillinger et al, Eisenhart et al, and Härén et al. Several pilot¹³ and case studies^, have been published that suggest clinical effectiveness of MLDTs for several musculoskeletal conditions but they have failed to bolster the CEBM level of evidence and grade of recommendation supporting efficacy of such interventions in sports medicine and rehabilitation.

Schillinger et al conducted a randomized controlled trial that analyzed biochemical indices of structural skeletal muscle cell integrity upon the implementation of MLDTs following a bout of endurance treadmill running to anaerobic threshold. Compared to control participants who received no manual therapy interventions, the MLDT group displayed a statistically significant decrease in concentrations of blood lactate dehydrogenase and aspartate aminotransferase immediately following a treatment session and at a 48-hour follow-up. The observed decrease in serum levels of specific skeletal muscle enzymes following an MLDT intervention demonstrates the potential for expedited regenerative and repair mechanisms to skeletal muscle cell integrity following structural damage as the result of taxing loads associated with physical activity. Eisenhart et al investigated the effects of osteopathic manipulative treatment (OMT) on acute ankle sprains managed in an emergency department. Participants randomly assigned to the OMT group received lymphatic drainage techniques in conjunction with the current standard of care compared to a control group prescribed only the standard of care. Results of one OMT session produced statistically significant decreases in pain and edema. At the follow-up evaluation one week post-intervention, the OMT group displayed improvement in outcome measures for range of motion compared to the control group. Though the results of Eisenhart et al demonstrate potential MLDT efficacy for this orthopaedic injury commonly treated by physical rehabilitation specialists, the definitive contribution of lymphatic drainage techniques in a multimodal OMT paradigm is difficult to ascertain. However, this research study may serve as a springboard for subsequent investigations on the effect of MLDTs in treating commonly encountered orthopaedic conditions.

Härén et al conducted a prospective cohort research study that evaluated the efficacy of MLDTs following wrist bone fracture and subsequent treatment of the distal radius. In this experimental design, all enrolled patients received the standard of care for this condition with participants then randomized into MLDT and control groups. In addition to the standard of care, the MLDT group received 10 MLDT treatments. Härén et al reported that the MLDT group displayed statistically significantly decreased measures of hand volume suggesting less edema present in the injured extremity. This preliminary evidence supports efficacy of MLDTs in sports medicine and rehabilitation specific to managing wrist bone fractures. However, continued investigations with larger sample sizes are required to confirm and validate the results of the three aforementioned human research studies.

Applicable case and pilot studies have produced results that support the clinical effectiveness of incorporating MLDTs into multimodal treatment interventions for musculoskeletal^,13 and neuromuscular ailments. These positive outcomes include statistically significant decreases in pain¹³ as well as clinically significant reductions in edema, improvements in wound healing, and restorations of anatomical structure and physiological functions^,. These pragmatic reports suggest that MLDTs are effective in a treatment paradigm when used in conjunction with other interventions. Although these results support the potential effectiveness of MLDTs for musculoskeletal conditions in a context that mirrors real-world clinical practice, unfortunately the specific contribution of MLDTs to these positive outcomes remains unknown. This is generally due to the research methods employed, i.e., predominately quasi-experimental designs, which rank low according to CEBM standards for ranking the levels of evidence and validity scores scrutinized by the PEDro scale^9,10. Hence, these pragmatic studies fail to support efficacy, in the strictest terms, of MLDTs in sports medicine and rehabilitation.

The strongest evidence from RCTs suggests that MLDTs may be efficacious in the resolution of enzyme serum levels associated with acute structural skeletal muscle cell damage as well as in the reduction of edema following wrist bone fracture of the distal radius and acute ankle sprain. However, based on CEBM standards for ranking the levels of evidence, there is currently an insufficient and inconsistent ensemble of evidence to support a grade of recommendation on which to establish clinical practice guidelines for the use of MLDTs in rehabilitating athletic injuries.

Cotherm Type Tse Manual Lymphatic Drainage Certification

Manual lymphatic drainage techniques remain a clinical art founded upon hypotheses, theory, and preliminary evidence. Researchers must strive to clarify the biophysical effects that underpin its various proposed therapeutic applications in the human organism. Randomized controlled trials and longitudinal prospective cohort studies are required to establish the efficacy of MLDTs in producing positive outcomes for patients rehabilitating from sports-related injuries. Researchers employing such experimental designs should use diligence in selecting specific modes of MLDTs to be incorporated in respective intervention regimens so that diverse forms of the therapy are avoided with investigated treatment protocols. The applied and clinical sciences research studies of Schillinger et al, Eisenhart et al, and Härén et al along with advanced basic science experimental methods implemented by Knott et al and Hodge et al may serve as groundwork references for future hybrid investigations in this domain of manual therapy. Once this facet of a proposed research paradigm has been established, the focus might expand to include determination of optimal treatment durations as well as the most effective rate and frequency of administered MLDTs for the development of a defined intervention algorithm.

Acknowledgement

We would like to thank Daniel Monthley, MS, ATC, for his assistance in reviewing and editing drafts of this manuscript.

REFERENCES

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. Massage can be applied with the hands, fingers, elbows, knees, forearm, feet, or a massage device. Massage can promote relaxation and well-being,^[1][2] can be a recreational activity, and can be sexual in nature (see Erotic massage).

In professional settings massage clients are treated while lying on a massage table, sitting in a massage chair, or lying on a mat on the floor, while in amateur settings a general purpose surface like a bed or floor is more common. Aquatic massage and bodywork is performed with recipients submersed or floating in a warm-water therapy pool. The massage subject may be fully or partially clothed or unclothed.

• 2History
• 3Types and methods of massage
• 4Facilities, equipment, and supplies
• 5Medical and Therapeutic Use
  • 5.3Beneficial Effects
  • 5.5Regulations

Etymology

The word comes from the French massage 'friction of kneading', or from Arabicmassa meaning 'to touch, feel' or from Latinmassa meaning 'mass, dough',^[3][4] cf. Greek verb μάσσω (massō) 'to handle, touch, to work with the hands, to knead dough'.^[5] In distinction the ancient Greek word for massage was anatripsis,^[6] and the Latin was frictio.

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 ^[7] (also known as 'The Tomb of the Physician') in Saqqara, Egypt 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).^[8][9]

BC 700 Bian Que, the earliest known Chinese physician uses massage in medical practice.^[10]

BC 500 Jīvaka Komarabhācca, also known as Shivago Komarpaj, the founder of Traditional Thai massage (Nuad Boran) and Thai medicine.^{[citation needed]} According to the Pāli Buddhist Canon, Jivaka was Buddha's physician.^{[citation needed]} He codified a healing system that combines acupressure, reflexology, and assisted yoga postures.^{[citation needed]} Traditional Thai massage is generally based on a combination of Indian and Chinese traditions of medicine. Jivaka is known today as 'Father Doctor' in Thailand.^{[citation needed]}

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).^[11]

BC 460: Hippocrates wrote 'The physician must be experienced in many things, but assuredly in rubbing'.^{[citation needed]}

BC 300 Charaka Samhita believed to be the oldest of the three ancient treatises of Ayurvedic medicine, including massage. Sanskrit records indicate that massage had been practiced in India long before the beginning of recorded history.^[12]

AD 581: Dr Sun Si Miao introduces ten new massage techniques and systematized the treatment of childhood diseases using massage therapy.^{[citation needed]}

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

Middle-Ages: Medical knowledge, including that of massage, made its way from Rome to Persia in the Middle Ages.^{[citation needed]} Many of Galen's manuscripts, for instance, were collected and translated by Hunayn ibn Ishaq in the 9th century. Later in the 11th century copies were translated back into Latin, and 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.

One of the greatest Persian medics was Avicenna, also known as Ibn Sina, who lived from 980AD to 1037AD. He was the foremost philosopher of medieval Islam and also a great philosopher, logician and medic.^{[citation needed]} His works included a comprehensive collection and systematisation of the fragmentary and unorganised 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 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.^[13]

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.^[9]

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'.^[14]

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.”^[15]

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.' 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. ^[9][16][17]

AD 1878: Dutch massage practitioner Johan Georg Mezger applies French terms to name five basic massage techniques,^[14] 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

China: Massage has developed continuously in China for over 5000 years.^{[citation needed]} 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.^[18]

United States: Massage started to become popular in the United States in the middle part of the 19th century^[11] and was introduced by two New Yorkphysicians based on Per Henrik Ling's techniques developed in Sweden.^{[citation needed]}

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.^[11] Until the 1970s, nurses used massage to reduce pain and aid sleep.^[19] The massage therapy industry is continuously increasing, with a projected 19% increase between 2008 and 2009. U.S. consumers spend between $4 and $6 billion on visits to massage therapists, as of 2009.^[20]

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 Fugymnastic movements, while Ancient Greek Olympians used a specific type of trainer ('aleiptes')^[21] 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 1984 Summer Olympics in Los Angeles was the first time that massage therapy was televised as it was being performed on the athletes. And then, during the 1996 Summer Olympics in Atlanta massage therapy was finally offered as a core medical service to the US Olympic Team.^[22] Massage has been employed by businesses and organizations such as the U.S. Department of Justice, Boeing and Reebok.^[23] Notable athletes such as Michael Jordan and LeBron James have personal massage therapists that at times even travel with them.

Types and methods of massage

Acupressure

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.

Acupressure is one of the important therapies based on principles of Traditional Chinese Medicine (TCM) and is believed to restore the energy balance throughout the body. Acupressure is considered as an important scientific therapy and has gain tremendous popularity in the western countries for management of pain, fatigue and some specific injuries. The technique of acupressure involves applying pressure to specific points on the body known as “Acu Points” in order to provide internal flow of energy. The pressure can be applied using fingers, hands, palms, wrists and knees by a therapist.^[24]

Evidence from clinical studies reveals that acupressure is effective in reducing musculoskeletal pain including low back pain and neck pain. Studies also report that acupressure treatment can help in reducing fatigue caused due to medical procedures such as haemodialysis, and even due to cancer.^{[25][26][27][28]}

Anma massage

Anma is a traditional Japanese massage involving vigorous kneading, rubbing, tapping and shaking. It is commonly performed through clothing. Anma contributed significantly to the formation of shiatsu and tui na.

Aquatic bodywork

Aquatic bodywork comprises a diverse set of massage and bodywork forms performed in water. This includes land-based bodywork and massage forms performed in water (e.g., Aquatic Craniosacral Therapy, Aquatic Myofascial Release Therapy, etc.), as well as forms specific to warm water pools (e.g., Aquamassage, Aquatic Integration, Dolphin Dance, Healing Dance, Jahara technique, WaterDance, Watsu).^[29]

Ashiatsu

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In ashiatsu, the practitioner uses their feet to deliver treatment. The name comes from the Japanese, ashi for foot and atsu for pressure.^[30] 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 an elbow, and is ideal for large muscles, such as in thigh, or for long-duration upper trapezius compressions.^[31] Other modalities using the feet to provide treatment include Keralite, Barefoot Lomi Lomi, Chavutti Thirumal.

Ayurvedic Massage

Ayurvedic Massage known as Abhyangam in Sanskrit is one of the most common and important Ayurvedic therapies. According to the Ayurvedic Classics Abhayngam is an important dincharya (Daily Regimen) that is needed for maintaining a healthy lifestyle. The massage technique used during Ayurvedic Massage is known to stimulate the lymphatic system to expel the toxins out from the body. The Ayurvedic Massage also stimulates production of lymphocytes which play a vital role in maintaining the immunity in human body. Thus regular Ayurvedic Massage can lead to better immunity and also help in body de-toxification. The other benefits of regular Ayurvedic Massage include pain relief, reduction of fatigue, prevention of ageing and bestowing longevity.^[32][33]

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 due to the treatment. Balinese hot stones are an option.

Bowen technique

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.

Breema

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

Biodynamic Massage

Biodynamic massage was created by Gerda Boyesen as part of Biodynamic Psychotherapy. Practised as a stand-alone therapy, it is a combination of physical and energy work and also uses a stethoscope to hear the peristalsis.^[34]

Champissage massage

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

Craniosacral therapy

Craniosacral therapy (CST) is a gentle approach that releases tensions deep in the body by applying light touch to the skull, face, spine, and pelvis.^[35]

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.

Foot massage

While various types of reflexology related massage styles focus on the feet, massage of (usually) the soles of the feet is often performed purely for relaxation or recreation. It is believed there are some specific points on our feet that correspond to different organs in the body. Stimulation of these points during foot massage can cause significant reduction in pain. Studies also suggest that foot reflexology massage can reduce fatigue and promote better sleep.^[36]

Hilot massage

Lymphatic Drainage Massage

Hilot is a traditional healing technique from the Philippines that uses massage, joint manipulations, and herbs such as banana leaves. Hilot is claimed to relax muscles, reset sprained joints, assess and treat musculoligamentous and musculoskeletal ailments, aid in giving birth and post-birth recovery for mother and baby, and to induce abortion.

Infant massage

Infant massage is a type of complementary and alternative treatment that uses massage therapy for human infants. This therapy has been practiced globally, and has been increasingly used in Western countries as a treatment for infants.

Kum Nye

Kum Nye and sKu-mNyé are a wide variety of Tibetan religious and medical body practices. The two terms are different spellings in the Latin alphabet of the same Tibetan phrase (Wylie: sku mnye), which literally means 'massage of the subtle body'. Some systems of sku mnye are vaguely similar to Yoga, T'ai chi, Qigong, or therapeutic massage. 'Kum Nye', Ku Nye, and Kunye are also used to transcribe the Tibetan phrases dku mnye ('belly massage') and bsku mnye ('oil massage'), which are pronounced identically to sku mnye. dKu mnye and bsku mnye manipulate the physical body, rather than the subtle (energetic) one.

Lomilomi and indigenous massage of Oceania

Lomilomi is the traditional massage of Hawaii. As an indigenous practice, it varies by island and by family. The word lomilomi also is used for massage in Samoa and East Futuna. In Samoa, it is also known as lolomi and milimili. In East Futuna, it is also called milimili, fakasolosolo, amoamo, lusilusi, kinikini, fai’ua. The Māori call it roromi and mirimiri. In Tonga massage is fotofota, tolotolo, and amoamo. In Tahiti it is rumirumi. On Nanumea in Tuvalu, massage is known as popo, pressure application is kukumi, and heat application is tutu. Massage has also been documented in Tikopia in the Solomon Islands, in Rarotonga and in Pukapuka in Western Samoa.^[37]

Lymphatic drainage

Manual lymphatic drainage is a technique used to gently work and stimulate the lymphatic system, to assist in reduction of localized swelling. The lymphatic system is a network of slow moving vessels in the body that carries cellular waste toward the heart, to be filtered and removed. Lymph also carries lymphocytes, and other immune system agents. Manual lymphatic drainage claims to improve waste removal and immune function.^[38][39][40]

Medical massage

Medical Massage is a controversial term in the massage profession.^[41] Many use it to describe a specific technique. Others use it to describe a general category of massage and many methods such as deep tissue massage, myofascial release and triggerpoint therapy as well as osteopathic techniques, cranial-sacral 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^[11] 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.^[42] However, it is less effective than management of SVT with medications.^[43]

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.^[44] A subsequent systematic review published in 2008 found that there is little evidence supporting the use of massage therapy for depression in high quality studies from randomized controlled trials.^[45]

Metamorphic Technique

The Metamorphic Technique is a gentle form of foot, hand and head massage that can be carried out by anyone with a brief training in the technique. It draws on reflexology in its theory and approach.

Myofascial release

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.

Namaste Massage

The Namaste Massage is a deep, fluid, rhythmic massage that use not only of the hands and arms but includes the use of different part of the body at the same time. The muscular stretching and the work with body joints are an important part of this technique.^{[citation needed]}

Pediatric massage

Pediatric massage is the complementary and alternative treatment that uses massage therapy, or 'the manual manipulation of soft tissue intended to promote health and well-being' for children and adolescents.

Postural Integration

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

Prostate massage

Prostate massage was once the most popular therapeutic maneuver used to treat prostatitis. According to the Prostatitis Foundation 'it used to be, in the age before antibiotics (before about 1960 for prostatitis), doctors performed massage when their patients had prostatitis. In some cases it was enough to cure them of the disease. ... it fell out of common practice with the advent of antibiotics.'

Reflexology

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.

Shiatsu

Shiatsu (指圧) (shi meaning finger and atsu meaning pressure) is a type of alternative medicine consisting of finger and palm pressure, stretches, and other massage techniques. There is no convincing data available to suggest that shiatsu is an effective treatment for any medical condition.^[46]

Sports massage

Also known as manual therapy, manipulative therapy, or manual & manipulative therapy, this is a physical treatment primarily used on the neuromusculoskeletal system to treat pain and disability. It most commonly includes kneading and manipulation of muscles, joint mobilization and joint manipulation.

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.

Structural Integration

Structural Integration's aim is to unwind the strain patterns residing in the body's myofascial system, restoring it to its natural balance, alignment, length, and ease. This is accomplished by deep, slow, fascial and myofascial manipulation, coupled with movement re-education. Various brands of Structural Integration are Rolfing, Hellerwork, Guild for Structural Integration, Aston Patterning,^[9] Soma,^[47] and Kinesis Myofascial Integration.^[48]

Swedish massage

The most widely recognized and commonly used category of massage is the Swedish massage. The Swedish massage techniques vary from light to vigorous.^[49] Swedish massage uses five styles of strokes. The five basic strokes are effleurage (sliding or gliding), petrissage (kneading), tapotement (rhythmic tapping), friction (cross fiber or with the fibers) and vibration/shaking.^[50] 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.^[51] The development of Swedish massage is often inaccurately credited to Per Henrik Ling, though the Dutch practitioner Johann Georg Mezger applied the French terms to name the basic strokes.^[52] The term 'Swedish' massage is actually only recognized in English and Dutch speaking countries, and in Hungary. Elsewhere (including Sweden) the style is referred to as 'classic massage'.

Clinical studies report that Swedish Massage can effectively reduce low back pain and the effectiveness can last for as long as 15 weeks. One study reported that Swedish Massage caused reduction in salivary cortisol indicating its role in management of stress and improvement in mood.^[53][54]

Tantric massage

A massage technique popularized by the neotantra movement, and drawing on modern interpretations of tantra.

Thai massage

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

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

Thai Massage is a popular massage therapy that is used for management of conditions such as musculoskeletal pain and fatigue. Thai Massage involves a number of stretching movements that improve body flexibility, joint movement and also improve blood circulation throughout the body. In one study scientists found that Thai Massage showed comparable efficacy as the painkiller ibuprofen in reduction of joint pain caused by osteoarthritis (OA) of the knee.^[55]

Traditional Chinese massage

Massage of Chinese Medicine is known as An Mo (按摩, pressing and rubbing) or Qigong Massage, and is the foundation of Japan's Anma. Categories include Pu Tong An Mo (general massage), Tui Na An Mo (pushing and grasping massage), Dian Xue An Mo (cavity pressing massage), and Qi An Mo (energy massage). Tui na (推拿) focuses on pushing, stretching, and kneading muscles, and Zhi Ya (指壓) focuses on pinching and pressing at acupressure points. Technique such as friction and vibration are used as well.^[56]

Trager approach

The Trager approach combines movement and touch, especially rocking and shaking, to educate the body/mind.

Trigger point therapy

Sometimes confused with pressure point massage,^[11] 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.^[57] and in 2007 a paper was presented showing images of Trigger Points using MRI.^[58] 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.

Tui na

Chinese modality that includes many different types of strokes, aimed to improve the flow of chi through the meridians.

Watsu

Watsu, developed by Harold Dull at Harbin Hot Springs, California, is a type of aquatic bodywork performed in near-body temperature water, and characterized by continuous support by the practitioner and gentle movement, including rocking, stretching of limbs, and massage. The technique combines hydrotherapy floating and immersion with shiatsu and other massage techniques. Watsu is used as a form of aquatic therapy for deep relaxation and other therapeutic intent. Related forms include WaterDance, Healing Dance, and Jahara technique.^[59][60]

Facilities, equipment, and supplies

Massage tables and chairs

Specialized massage tables and chairs are used to position recipients during massages. A typical commercial massage table has an easily cleaned, heavily padded surface, and a 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. An orthopedic pillow or 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

Temperature-controlled warm-water therapy pools are used to perform aquatic bodywork.^[61] For example, Watsu requires a warm-water therapy pool that is approximately chest deep (depending on height of the therapist) and temperature-controlled to about 35 °C (95 °F).^[62]

Dry-water massage beds

A dry-water massage bed uses jets of water to perform the massage of the client's muscles. These beds 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.^[63] The first type is sometimes seen available for use in malls and shopping centers for a small fee.

Vichy showers

A Vichy shower is a form of hydrotherapy which uses a series of shower nozzles which 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 clients needs.

Cremes, Lotions, Gels, and 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). lightly different properties, and the choice depends upon the type of massage and the therapist’s preference. Commonly used oils include jojoba oil, fractionated coconut oil, grape seed oil, olive oil, almond oil, macadamia oil, sesame oil, pecan oil, mustard oil^[64] and (mineral) baby oil.^[65] Each oil has different properties and serves different purposes.^[66] There are different views about the extent to which various oils and other substances are absorbed into the body through the skin.^[67] Salts are also used in association with oils to remove dry skin.

Massage Tools

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

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

Medical and Therapeutic Use

The main professionals that provide therapeutic massage are massage therapists, athletic trainers, physical therapists and practitioners of many traditional Chinese and other eastern medicines. Massage practitioners work in a variety of medical settings and may travel to private residences or businesses.^[11]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.^[11]

Practitioner Associations and Official Recognition of Professionals

The US based National Center for Complementary and Alternative Medicine recognizes over eighty different massage modalities.^[11] The most cited reasons for introducing massage as therapy have been client demand and perceived clinical effectiveness.^[68]

Associated Methods

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

Beneficial Effects

Peer-reviewed medical research has shown that the benefits of massage include pain relief, reduced trait anxiety and depression, and temporarily reduced blood pressure, heart rate, and state of anxiety.^[69] Additional testing has shown an immediate increase and expedited recovery periods for muscle performance. Theories behind what massage might do include blocking nociception (gate control theory), activating the parasympathetic nervous system, which may stimulate the release of endorphins and serotonin, preventing fibrosis or scar tissue, increasing the flow of lymph, and improving sleep,^[11] but such effects are yet to be supported by well-designed clinical studies.

Massage is hindered from reaching the gold standard of scientific research, which includes placebo-controlled and double blindclinical trials.^[70][71] 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.^[70] 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.^[70] Massage can employ randomized controlled trials, which are published in peer reviewedmedical journals.^[70] This type of study could increase the credibility of the profession because it displays that purported therapeutic effects are reproducible.^[71]

Single Dose Effects

• Pain relief: Relief from pain due to musculoskeletal injuries and other causes is cited as a major benefit of massage.^[11]Acupressure or pressure point massage may be more beneficial than classic Swedish massage in relieving back pain.^[72] 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.^[69]
• State anxiety: Massage has been shown to reduce state anxiety, a transient measure of anxiety in a given situation.^[69]
• Blood pressure and heart rate: Massage has been shown to temporarily reduce blood pressure and heart rate.^[69]

Multiple Dose Effects

• Pain relief: When combined with education and exercises, massage might help sub-acute, chronic, non-specific low back pain.^[72] Furthermore, massage has been shown to reduce pain experienced in the days or weeks after treatment.^[69]
• Trait anxiety: Massage has been shown to reduce trait anxiety; a person's general susceptibility to anxiety.^[69]
• Depression: Massage has been shown to reduce subclinical depression.^[69]

Neuromuscular Effects

Massage has been shown to reduce neuromuscular excitability by measuring changes in the Hoffman's reflex (H-reflex) amplitude. A decrease in peak-to-peak H-reflex amplitude suggests a decrease in motoneuron excitability.^[73] 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.^[74] 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.^[75] 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.^[73]

Massage and Proprioception

Proprioceptive studies are much more abundant than massage and proprioception combined, yet researchers are still trying to pinpoint the exact mechanisms and pathways involved to get a fuller understanding.^[76] Proprioception may be very helpful in rehabilitation, though this is a fairly unknown characteristic of proprioception, and 'current exercises aimed at 'improving proprioception' have not been demonstrated to achieve that goal'.^[77] Up until this point, very little has been studied looking into the effects of massage on proprioception. Some researchers believe 'documenting what happens under the skin, bioelectrically and biochemically, will be enabled by newer, non-invasive technology such as functional magnetic resonance imaging and continuous plasma sampling' .^[75]

Regulations

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) Canada
• Remedial Massage Therapist (RMT) New Zealand
• Certified Massage Therapist (CMT) New Zealand
• Licensed Massage Practitioner (LMP)
• Licensed Massage Therapist (LMT)
• Licensed Massage and Bodywork Therapist (LMBT) North Carolina
• Therapeutic Massage Therapist (TMT) South Africa

In some jurisdictions, practicing without a license is a crime.

Canada

In regulated provinces massage therapists are known as Registered Massage Therapists, in Canada only four provinces regulate massage therapy:^[78]British Columbia, Ontario, Newfoundland and Labrador, and New Brunswick.^[79] Regulated provinces have, since 2012, established inter-jurisdiction competency standards. 'Inter-Jurisdiction Competency Standards'(PDF). 2012-06-10.<templatestyles src='Module:Citation/CS1/styles.css'></templatestyles>

^[78]Quebec is not provincially regulated. Massage therapists may obtain a certification with any one of the dozens of 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 orthotherapists, naturotherapists and others), the Quebec Federation of massage therapists (FMQ), the 'Alliance québécoise des thérapeutes naturels'.<templatestyles src='Module:Citation/CS1/styles.css'></templatestyles>, however none are regulated by provincial law.

China

Most types of massage, with the exception of some traditional Chinese medicine are not regulated in China. Although illegal in China, some of the smaller businesses are fronts for prostitution.^[80] These are called falangmei (发廊妹 'hairdressing salon sisters').

France

France requires three years of study and two final exams in order to get a license ^[81]

Germany

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' or Medical Masseur and 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, and probably most importantly Dermiatry and Orthopedics. They are trained in Electrotherapy, and 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. He is regulated by the professional body which regulates Physiotherapists. This includes the restriction on advertising and oath of confidentiality to clients.^{[citation needed]}

India

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

Japan

In Japan, shiatsu is regulated but oil massage and Thai massage are not. Although prostitution is illegal, prostitutes posing as massage therapists in fashion health shops and pink salons are fairly common in the larger cities.

Mexico

In Mexico massage therapists, called 'sobadores', combine massage using oil or lotion^[82] with a form of acupuncture and faith.^[83]Sobadores are used to relieve digestive system problems as well as knee and back pain.^[82][83] Many of these therapists work out of the back of a truck, with just a curtain for privacy.^[83] By learning additional holistic healer's skills in addition to massage, the practitioner may become a curandero.^[84]

In many parts of Mexico prostitution is legal and prostitutes are allowed to sell sexual massage. These businesses are often confined to a specific area of the city, such as the Zona Norte in Tijuana.

New Zealand

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 recognised. 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.^{[citation needed]}

South Africa

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 2-year diploma in Therapeutic Massage and registration with The Allied Health Professions Council of SA (AHPCSA). The 2 year qualification includes 240 credits, about 80 case studies, and about 100 hours community service.

South Korea

In South Korea, blind and visually impaired people can become licensed masseurs.^[85]

Thailand

In Thailand, Thai massage is officially listed as one of the branches of traditional 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.^[86][87]

United Kingdom

There are no national regulations relating to commercial massage or massage therapy in the UK, although various jurisdictions have licensing requirements for businesses performing massage.

United States

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.^[88] As of 2011, there were more than 300 accredited massage schools and programs in the United States.^[89] 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. However, the practitioner will need to check whether any local or county laws cover massage therapy. Training programs in the US are typically 500–1000 hours in length, and can award a certificate, diploma, or degree depending on the particular school.^[90] There are around 1,300 programs training massage therapists in the country and study will often include anatomy and physiology, kinesiology, massage techniques, first aid and CPR, business, ethical and legal issues, and hands on practice along with continuing education requirements if regulated.^[11] The Commission on Massage Therapy Accreditation (COMTA) is one of the organizations that works with massage schools in the U.S. and currently (Aug 2012) there are approximately 300 schools that are accredited through this agency.

Forty-three states, the District of Columbia and five Canadian provinces currently offer some type of credential to professionals in the massage and bodywork field---usually licensure, certification or registration.^[68][91] Thirty-eight states and the District of Columbia require some type of licensing for massage therapists.^[92] In the US, 39 states use the National Certification Board for Therapeutic Massage and Bodywork's certification program as a basis for granting licenses either by rule or statute.^[93] The National Board grants the designation Nationally Certified in Therapeutic Massage and Bodywork (NCTMB). There are two tests available and one can become certified through a portfolio process with equivalent training and experience.^[94] Between 10% and 20% of towns or counties regulate the profession.^[79] The National Certification offered by the NCBTMB does not mean that you can practice massage in any state.^[95] 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.^[79][96]

In the US, licensure is the highest level of regulation and this restricts anyone without a license from practicing massage therapy or by calling themselves that protected title. Certification allows 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.^[96] It is important to note that 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 (basically the certification requirements in many states). In the US, most certifications are locally based.^[97] However, as of March 2014, some states still do not require a license or a certification.^{[citation needed]} However, this is thought to change eventually as more regulatory bodies governing the profession of massage are established in each state. Furthermore, some states allow license reciprocity where massage therapists who relocate can relatively easily obtain a license in their new state. Not all states provide this option.^[98]

In late 2007, the Federation of State Massage Therapy Boards launched a new certification exam titled the MBLEx. Currently, 40 states have accepted this certification exam, along with the District of Columbia, Puerto Rico and the US Virgin Islands.

In 1997 there were an estimated 114 million visits to massage therapists in the US.^[90] Massage therapy is the most used type of alternative medicine in hospitals in the United States.^[68] Between July 2010 and July 2011 roughly 38 million adult Americans (18 percent) had a massage at least once.^[99]

People state that they use massage because they believe that it relieves pain from musculoskeletal injuries and other causes of pain, reduces stress and enhances relaxation, rehabilitates sports injuries, decreases feelings of anxiety and depression, and increases general well being.^[11]

In a poll of 25- to 35-year-olds, 79% said they would like their health insurance plan to cover massage.^[22] Companies that offer massage to their employees include Allstate, Best Buy, Cisco Systems, FedEx, Gannett (publisher of USA Today), General Electric, Google, Hewlett-Packard, Home Depot, JC Penney, Kimberly-Clark, Texas Instruments, and Yahoo!. In 2006 Duke University Health System opened up a center to integrate medical disciplines with CAM disciplines such as massage therapy and acupuncture.^[100] There were 15,500 spas in the United States in 2007 with about a third of the visitors being men.^[92]

The number of visits rose from 91 million in 1999 to 136 million in 2003, generating a revenue that equals $11 billion.^[101] Job outlook for massage therapists is also projected to grow at 20% between 2010 and 2020 by the Bureau of Labor Statistics, or faster than average.^[102]

See also

References

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External links

• Arthur Shadwell (1911). 'Massage'. Encyclopædia Britannica (11th ed.).<templatestyles src='Module:Citation/CS1/styles.css'></templatestyles>