Brief history
The roots of massage as a healing art extend 3000 years in the past, as documented in ancient writings. Ayurvedic medicine was probably the first to identify massage as part of a comprehensive system of healing, and we know that knowledge of Ayurvedic medicine spread to Asia and Europe many centuries ago. Massage was brought to the United States in the early 1900s by physicians who had studied at the Royal Swedish Institute. At the time, it was called movement cure or medical gymnastics. The resurgence of interest in recent years has been accompanied by an influx of Asian massage practitioners and teachers, as well as the development of new techniques and theories from American practitioners.

Massage has begun to enter the reimbursement portion of the health care system in the past decade, thanks in great part to the emergence of convincing research data on its therapeutic effectiveness and its cost savings over more invasive and expensive treatments such as surgery and prolonged drug therapy. Consumers visit massage therapists 75 million times a year, and as baby boomers age and increase their demand for access to natural health care, the profession is expected to continue its growth. The number of states licensing massage therapists more than doubled in the 1990s, which enormously helps consumers select a qualified practitioner.

Philosophy
The efficacy of massage as a healing art has been well documented by modern research. Practitioners have long believed that massage relieves tension, improves blood and lymph circulation, loosens tight muscles, improves function, induces relaxation, and generally improves health and well being. The physical impact of manual therapy reaches far beneath the skin and muscles, to virtually every body system. There are many theories about what kind of touch works the best (heavy vs. light pressure, long vs. short strokes) and where to focus the effort (trigger points, meridians, fascia), so it's not possible to define a detailed one-size-fits-all philosophy. Research is beginning to emerge identifying certain massage approaches as more effective than others for specific conditions, but right now, we don't have much information of that kind. We can honor the general philosophy that manual therapies of many kinds are powerful healing tools.

Scope of practice
Massage is probably the oldest manual therapy in human history. Today's rapidly growing profession encompasses an extraordinary array of methods for inducing relaxation and providing therapeutic benefit through manipulation of the soft tissues of the body. Therapeutic massage may be prescribed by a doctor, or self-prescribed, for many health conditions and symptoms which have been shown to benefit from manual therapy. And, of course, millions of Americans seek massage for relaxation and general well being. Massage therapists do not diagnose or treat disease (the classic definition of "practicing medicine"), although they do an ongoing assessment or evaluation that may lead to referrals or additional self-care for the client. A massage therapist, unless appropriately trained and/or licensed in other health care fields, does not do bony manipulation, nutritional counseling, homeopathy, acupuncture, herbs or other such therapies.

Most of us think of massage for sprains, strains and tension/stress effects, but that's only the beginning. Because massage directly improves circulation of blood and lymph, and induces a state of relaxation through touch, many other conditions can be helped as well. The Touch Research Institute (www.miami.edu/touch-research/home.html) provides a database of massage research in conditions from Alzheimer's to smoking cessation. One very interesting and well-replicated finding is that premature infants given massage in the hospital gained weight faster and left the hospital five or more days sooner than other infants. Implementing this practice nationwide could generate cost savings in the billions of dollars annually. Other research documents enhanced pain management, decreased use of antidepressants, improvement in autistic behaviors and many other fascinating results. We have just begun to understand the powerful modern uses of this ancient therapy. 

The range of methods available today within the field of massage is so large that even a knowledgeable consumer can feel daunted. What they all have in common is manipulation of the soft tissues for healing and relaxation. The touch may be superficial or deep, gentle or intense, broad strokes or pinpoint focus, but the goals are always the same: to improve health and wellbeing by releasing tension, improving circulation, maximizing function and balancing energy. The practitioner evaluates each client's needs and medical history, and matches the modality to the client's special circumstances.

Among the most common massage techniques consumers are likely to experience are (in alphabetical order): acupressure, myofascial release, polarity therapy, reflexology, Shiatsu, sports massage, Swedish massage and trigger point therapy. Other less familiar approaches include Ayurveda massage, Bonnie Prudden myotherapy, craniosacral therapy, cross-fiber friction massage, Esalen-style massage, Jin Shin Do, Jin Shin Jyutsu, manual lymphatic drainage, strain-counterstrain therapy and Tuina. And that's just the tip of the iceberg - the American Massage Therapy Association estimates there are more than 150 variations of massage, bodywork and somatic therapy techniques. Many practitioners utilize multiple techniques and continue to acquire training in new methods throughout their professional lives.

Regulatory Scope
Massage therapists are regulated in 29 states and the District of Columbia. Some states require national certification as part of the law. The statutory language defining massage varies a great deal among the different states; however, they all generally authorize manual manipulation of soft tissues for promoting health and well being. Massage therapists may not diagnose or treat disease, order laboratory tests, or engage in any other activities which may be construed as the practice of medicine. In unregulated states the practice by a trained professional will closely resemble that in the licensed states; however, it is incumbent upon the consumer to check into a practitioner's credentials since the state isn't doing that on your behalf. The actual modalities chosen by a massage therapist may be any of dozens that are available; generally, the statutes do not limit which techniques or approaches a practitioner may select. In many states, massage has begun to participate in third party reimbursement, generally requiring a referral from a primary care provider, but in some cases available by self-referral. Massage practitioners who have been credentialed by a managed care organization have undergone in many cases a more thorough review than that required for licensure.

Education and Credentialing
Although the statutes vary from state to state, most of the regulated states require a minimum of 500 hours of classroom instruction. Many well-respected programs offer considerably more hours, up to 800 or even 1000. In addition to inquiring whether a practitioner graduated from a program accredited by the Commission on Massage Therapy Accreditation (COMTA), there are other credentials available which assist consumers in making a good decision.

The National Certification Board for Therapeutic Massage and Bodywork offers a nationally recognized credential, indicating that the practitioner has the required hours of education, has passed a written examination, and is qualified to enter the field.

A number of modalities offer advanced training and certification in the specialty. Membership in the American Massage Therapy Association is limited to practitioners who have met the educational and testing requirements of COMTA and who agree to abide by AMTA's Code of Ethics.

The American Oriental Bodywork Therapy Association provides information on schools and programs teaching Asian bodywork techniques. The Association has established criteria for recognition of those programs. Graduates of schools and programs recognized by their Council of Schools and Programs (COSP) are automatically granted membership in the Association. They recognize 12 forms of Asian Bodywork Therapy: Acupressure, AMMA Therapy; Chi Nei Tsang, Five Element Shiatsu, Integrative Eclectic Shiatsu, Japanese Shiatsu, Jin Shin Do, Macrobiotic Shiatsu, Shiatsu Anma Therapy, Traditional Thai Massage, Tuina and Zen Shiatsu. Some of these forms are individually described on other pages of AlternativeDr.com (see Alternative Therapies/Bodywork), and form definitions are available on the Association website (see Resources, below).

Sometimes the best information comes from a knowledgeable referral; talk to friends and other health care practitioners about massage therapists they use and trust.

Typical first office call or visit
A well-trained massage therapist will open a file on each new client, inquiring about any significant medical history, the reasons for the visit, and searching for any contraindications to providing massage. There is a difference between relaxation massage and therapeutic massage. If you have come to work on a specific problem (e.g., low back pain, frozen shoulder, tension headaches), your massage is likely to focus on specific areas of the body which affect those conditions, and the work may entail some discomfort as tight, stiff muscles are stretched and tender areas are worked on. In relaxation massage, time will generally be distributed evenly over the whole body (unless you request a particular emphasis), and the work will usually be less intense.

The massage itself should take place in a warm, private space, with privacy for disrobing. The massage table should have fresh sheets and slipcovers for each patient, and a light blanket for warmth and modesty during the massage. You may undress to your level of comfort; only the part of the body being worked on is exposed during the massage. Please let the practitioner know if the work makes you uncomfortable in any way, or if you feel too exposed. Be sure to indicate if you cannot assume certain positions (e.g., lying on your stomach), or if you have particularly painful or stiff areas you are concerned about. A massage may last 30 minutes to an hour and a half (the first visit usually requires extra time for medical history). During that time, you may talk or be silent, request music if it pleases you, and in general feel very comfortable communicating your preferences and your experience of the therapy. On return visits, you will be asked about any new health information and any progress or consequences since your last visit.

One of the great pleasures of massage is the ability to relax and place your well being in trained hands for a brief period of time, experiencing compassionate touch and therapeutic effects that cannot be achieved any other way. Be sure to drink plenty of water following a massage, as stored wastes may be mobilized through increased circulation. Allow yourself to dress and resume normal activities slowly, as your body emerges from what can be a near-meditative state.

Limitations to be aware of
There are some conditions that may make massage inadvisable. If you have any of the following, please check with your physician or other qualified health care provider before seeking a massage: circulatory ailments (such as phlebitis), infectious diseases, cancer, cardiac problems, skin conditions or inflamed or infected tissues. An experienced massage therapist will also be able to tell you when massage is contraindicated; if either you or your therapist have any doubts, s/he may be able to check with your primary care provider on your behalf to clarify what procedures may be acceptable.

Resources
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