Massage Therapy: An Introduction
Massage therapy has a long history in cultures around the world. Today, people use many
different types of massage therapy for a variety of health-related purposes. In the United States,
massage therapy is often considered part of complementary and alternative medicine (CAM), although it does have some conventional uses. This fact sheet
provides a general overview of massage therapy and suggests sources for additional
information.
© Bob Stockfield
Key Points
- Scientific evidence on massage therapy is limited. Scientists are not yet certain what changes occur in the
body during massage, whether they influence health, and, if so, how. The National Center for Complementary and
Alternative Medicine (NCCAM) is sponsoring studies to answer these questions and identify the purposes for
which massage may be most helpful.
- Massage therapy appears to have few serious risks if it is used appropriately and provided by a trained
massage professional.
- Tell your health care providers about any complementary and alternative practices you use. Give them a full
picture of what you do to manage your health. This will help ensure coordinated and safe care.
History of Massage
Massage therapy dates back thousands of years. References to massage appear in writings from ancient China,
Japan, India, Arabic nations, Egypt, Greece (Hippocrates defined medicine as "the art of rubbing"), and Rome.
Massage became widely used in Europe during the Renaissance. In the 1850s, two American physicians who had studied
in Sweden introduced massage therapy in the United States, where it became popular and was promoted for a variety
of health purposes. With scientific and technological advances in medical treatment during the 1930s and 1940s,
massage fell out of favor in the United States. Interest in massage revived in the 1970s, especially among
athletes.
Use of Massage Therapy in the United States
According to the 2007 National Health Interview Survey, which included a comprehensive survey of CAM use by
Americans, an estimated 18 million U.S. adults and 700,000 children had received massage therapy in the previous
year.
People use massage for a variety of health-related purposes, including to relieve pain, rehabilitate sports
injuries, reduce stress, increase relaxation, address anxiety and depression, and aid general wellness.
Defining Massage Therapy
The term "massage therapy" encompasses many different techniques (see box for examples). In general, therapists
press, rub, and otherwise manipulate the muscles and other soft tissues of the body. They most often use their
hands and fingers, but may use their forearms, elbows, or feet.
Types of Massage Therapy: A Few Examples
In Swedish massage, the therapist uses long strokes, kneading, deep circular movements, vibration, and tapping.
Sports massage is similar to Swedish massage, adapted specifically to the needs of athletes. Among the many other
examples are deep tissue massage; trigger point massage, which focuses on myofascial trigger points—muscle "knots"
that are painful when pressed and can cause symptoms elsewhere in the body; and reflexology, which applies pressure
to the feet (or sometimes the hands or ears), to promote relaxation or healing in other parts of the body.
The Practice of Massage Therapy
Massage therapists work in a variety of settings, including private offices, hospitals, nursing homes, studios, and
sport and fitness facilities. Some also travel to patients' homes or workplaces. They usually try to provide a
calm, soothing environment.
Therapists usually ask new patients about symptoms, medical history, and desired results. They may also perform an
evaluation through touch, to locate painful or tense areas and determine how much pressure to apply.
Typically, the patient lies on a table, either in loose-fitting clothing or undressed (covered with a sheet, except
for the area being massaged). The therapist may use oil or lotion to reduce friction on the skin. Sometimes, people
receive massage therapy while sitting in a chair. A massage session may be fairly brief, but may also last an hour
or even longer.
Research Status
Although scientific research on massage therapy—whether it works and, if so, how—is limited, there is evidence that
massage may benefit some patients. Conclusions generally cannot yet be drawn about its effectiveness for specific
health conditions.
According to one analysis, however, research supports the general conclusion that massage therapy is effective. The
studies included in the analysis suggest that a single session of massage therapy can reduce "state anxiety" (a
reaction to a particular situation), blood pressure, and heart rate, and multiple sessions can reduce "trait
anxiety" (general anxiety-proneness), depression, and pain. In addition, recent studies suggest that massage may
benefit certain conditions, for example:
- A 2008 review of 13 clinical trials found evidence that massage might be useful for chronic low-back pain.
Clinical practice guidelines issued in 2007 by the American Pain Society and the American College of Physicians
recommend that physicians consider using certain CAM therapies, including massage (as well as acupuncture,
chiropractic, progressive relaxation, and yoga), when patients with chronic low-back pain do not respond to
conventional treatment.
- A multisite study of more than 300 hospice patients with advanced cancer concluded that massage may help to
relieve pain and improve mood for these patients.
- A study of 64 patients with chronic neck pain found that therapeutic massage was more beneficial than a
self-care book, in terms of improving function and relieving symptoms.
There are numerous theories about how massage therapy may affect the body. For example, the "gate control
theory" suggests that massage may provide stimulation that helps to block pain signals sent to the brain. Other
examples include theories suggesting that massage might stimulate the release of certain chemicals in the body,
such as serotonin or endorphins, or cause beneficial mechanical changes in the body. However, additional studies
are needed to test the various theories.
© Bob Stockfield
Safety
Massage therapy appears to have few serious risks—if it is performed by a properly trained therapist and if
appropriate cautions are followed. The number of serious injuries reported is very small. Side effects of massage
therapy may include temporary pain or discomfort, bruising, swelling, and a sensitivity or allergy to massage
oils.
Cautions about massage therapy include the following:
- Vigorous massage should be avoided by people with bleeding disorders or low blood platelet counts, and by
people taking blood-thinning medications such as warfarin.
- Massage should not be done in any area of the body with blood clots, fractures, open or healing wounds,
skin infections, or weakened bones (such as from osteoporosis or cancer), or where there has been a recent
surgery.
- Although massage therapy appears to be generally safe for cancer patients, they should consult their
oncologist before having a massage that involves deep or intense pressure. Any direct pressure over a tumor
usually is discouraged. Cancer patients should discuss any concerns about massage therapy with their
oncologist.
- Pregnant women should consult their health care provider before using massage therapy.
Training, Licensing, and Certification
There are approximately 1,500 massage therapy schools and training programs in the United States. In addition to
hands-on practice of massage techniques, students generally learn about the body and how it works, business
practices, and ethics. Massage training programs generally are approved by a state board. Some may also be
accredited by an independent agency, such as the Commission on Massage Therapy Accreditation (COMTA).
As of 2007, 38 states and the District of Columbia had laws regulating massage therapy. In some states, regulation
is by town ordinance.
The National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) certifies practitioners who pass a
national examination. Increasingly, states that license massage therapists require them to have a minimum of 500
hours of training at an accredited institution, pass the NCBTMB exam, meet specific continuing education
requirements, and carry malpractice insurance.
In addition to massage therapists, health care providers such as chiropractors and physical therapists may have
training in massage.
Licenses and Certifications
Some common licenses or certifications for massage therapists include:
LMT
Licensed Massage Therapist
LMP
Licensed Massage Practitioner
CMT
Certified Massage Therapist
NCTMB
Has met the credentialing requirements (including passing an exam) of the National Certification Board for
Therapeutic Massage and Bodywork, for practicing therapeutic massage and bodywork
NCTM
Has met the credentialing requirements (including passing an exam) of the National Certification Board for
Therapeutic Massage and Bodywork, for practicing therapeutic massage
If You Are Thinking About Using Massage Therapy
- Do not use massage therapy to replace your regular medical care or as a reason to postpone seeing a health
care provider about a medical problem.
- If you have a medical condition and are unsure whether massage therapy would be appropriate for you,
discuss your concerns with your health care provider. Your health care provider may also be able to help you
select a massage therapist. You might also look for published research articles on massage therapy for your
condition.
- Before deciding to begin massage therapy, ask about the therapist's training, experience, and credentials.
Also ask about the number of treatments that might be needed, the cost, and insurance coverage.
- If a massage therapist suggests using other CAM practices (for example, herbs or other supplements, or a
special diet), discuss it first with your regular health care provider.
- Tell your health care providers about any complementary and alternative practices you use. Give them a full
picture of what you do to manage your health. This will ensure coordinated and safe care. For tips about
talking with your health care providers about CAM, see NCCAM's Time to Talk campaign.
NCCAM-Funded Research on Massage Therapy
Recent NCCAM-sponsored studies have been investigating:
- The effects of massage on chronic neck pain and low-back pain
- Massage to treat anxiety disorder, alleviate depression in patients with advanced AIDS, and promote
recovery in women who were victims of sexual abuse as children
- Massage to relieve fatigue in cancer patients undergoing chemotherapy, reduce
treatment-related swelling of the arms in breast cancer patients, and alleviate pain and distress in cancer
patients at the end of life
- Whether massage improves weight gain and immune system function in preterm infants
- Whether massage given at home by a trained family member helps reduce pain from sickle cell anemia.
References
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