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History and assessment of massage therapy

Massage therapy is the manipulation of the soft tissue on the body by a practitioner through the movement of their hands and arms as well as advanced techniques. Massage has been used to help people relax as well as a way to help treat minor ailments as a complement to other medication or treatment. As A Whirlwind Tour through the entire History of Massage webpage states ‘Massage is a universal instinct. From the day they descended from the trees, humans have known that it helps to rub a sore limb and that to touch is beneficial.’ So since then we have used and developed the skills and techniques through the years into the massage routines we see and use today.

History of Massage;

Throughout ancient history many different countries have been using massage and developing their skills as well as passing these down through the years. They have been borrowed, stolen and shared through different times as well as different places geographically around the world, many of the different types of massages resemble each other as techniques have been copied, borrowed and shared.

Pre-historic people used to practise some forms of therapeutic touch or massage as there has been evidence to suggest that they used to massage their muscles and rub herbs and oils onto their bodies to help with healing or to protect as this has been found in caveman paintings and drawings showing the giving and receiving of massage.

After then the next stage that has been recorded in history to show the major use of massage where the Chinese in around 3000BC in a book called ‘Con Fou of the Tao-Tse.’ As mentioned in the eBook History of Massage, Therapies & Rules in China ‘for years, blind people where the main masseurs.’ According to A Whirlwind Tour Through the entire history of Massage ‘Chinese writing dates from around 1400BC, near the start of the Shang dynasty, and it from around this time that we can reliably date massage.’ It was in China that the first exam in massage was sat about fifteen hundred years later as an addition to the occult studies schools. Around the same times as China the Egyptians also used massage and this has been depicted in tomb paintings of individuals being ‘Kneaded’ by others. The Japanese’s received their knowledge from China through the study of Buddhism and soon customised the techniques which became known as anma, which later became Japanese Shiatsu. According to The history of Massage: Learn How Massage Dates Back over 5,000 Years Ago ‘The primary goal of Shiatsu is to raise the energy level in the patient. In turn, this increased energy level regulates and fortifies the functioning of the organs and stimulates natural resistance to illnesses.’ The practitioners use a variety of techniques to pressure points on the body to balance the energies and work without needles or other equipment to do so.

However, some sources believe India was practicing massage before the Egyptians and the Chinese while others believe they might have acquired it from China a little later so the dates of when India first started to use any forms of massage range from around 3000BC to between 1.800-500BC.

‘Massage in India is referred to in ancient Hindu books such as ‘Ayurveda’ (Art of Life) which was written around 1800BC. It describes how movements such as shampooing and rubbing were used to relieve tiredness, increase energy levels and improve general health.’ Francesca Gould in Body Massage for Holistic Therapists (2004).

After this stage in history the next step in the time line is around 2000BC when the Greeks and Romans first started to use massage in the early foundations of their civilisations. The ancient Greeks used the knowledge from the Egyptians massage techniques, and it was given to the athletes’, women and soldiers as described in History of Massage, Therapies & Rules. The Greeks wrote many books on massage including some written by Homer, Aesculapius, Herodotus and Hippocrates who was the ‘Father ‘of Medicine. It was the Greeks who used to rub up the body towards the heart to help the venous and lymph in that direction, they also used this technique to move sickness towards the centre of the body to where is can be expelled with the waste materials.

The Romans however used massage as more of an indulgence than as a medical therapy; it was saved for those who could pay for it. The Romans received massage from the Greeks and enjoyed bathing before a full body massage and it was said that even Julius Caesar was pinched every day. The Roman gladiators were vigorously massaged before fights to make sure their muscles where warmed up and supple. Galen was the main figure in Rome for massage but he was actually Greek, according to A Whirlwind Tour through the History of Massage he lived from 130AD to 201AD and he acquired his knowledge of anatomy and physiology through working with the gladiators. Massage then was used as an alternative for exercise to help relive their excessive eating and drinking.

Massage was used throughout the different tribes in North America before the Europeans arrived, some tribes would massage/rub down their warriors before and after battle or rub ointments into ailing joints or muscles. Massage has also been seen through a variety of different countries through history including those such as Persia, Kurdistan, Thailand, Tibet, Indonesia and Hawaii.

The most recent history of massage can be seen is western civilisation. The earliest record was written by Ambroise Pare (1510-1590) but he was ridiculed for his publication. However by the time Henrik Ling (1776-1839) became the father of modern western massage it had become less of a ridicule. As the History of Massage, Therapies & rules tell us Henrik Ling once put. "We ought not to consider the organs of the body as the lifeless forms of a mechanical mass," he wrote, "but as the living, active instruments of the soul." And through this he finally developed the system known as Swedish massage.

Massage has now moved back towards the old holistic attributes instead of the physiological attributes so we are back to seeing massage in the same way as the ancient Chinese, Egyptians and Greeks once saw the therapy. As reported by The Massage Bible, ‘during the first World War injured soldiers were treated with massage, while the Californian bodywork movement in the 1960s combined massage with personal growth.’ There are many different kinds of massage practiced today all over the world and many of them can be received by almost anyone unless they have a specific reason that it cannot be preformed. There are a few different people who have been in the forefront of massage in modern history and those are Cornelius E. Who is the ‘Father’ of massage in the USA, David Palmer, the ‘Father’ of chair massage, Dr Tiffany Fields, the ‘Mother’ of massage research and Jack Meagher the ‘Father’ of sports massage. In figure I. In the appendices is a time line of the history of massage along with the creation and history of other therapies this has been take from the eBook History of Massage, Therapies & Rules.

Massage Principles and Holistic Experience:

To decide if massage is a holistic therapy first of all we need to know what holistic means and according to thefreedictionary.com Holistic means ‘Concerned with wholes rather than analysis or separation into parts.’ And with this definition we shall determine whether or not massage is a holistic experience.

A massage whether it is a Swedish, Shiatsu or any other form of massage moves across the whole surface of the skin missing only a few vital places which are left for either health and safety reasons or due to the intimacy of the area. Most massages that even just incorporate one certain area such as an Indian head massage or even reflexology they all use different points of that area to correspond with different areas or energies upon the body. With different energies running throughout in specific channels which move around the entire body, when a massage is preformed to the whole body or even just a small portion of the body such as the hands, feet or head all the energies are involved which in turn incorporates the body as a whole. With this in mind a massage can be believed to be Holistic as this matches with the definition of holistic in taking the body as a whole instead of a separation of its individual parts.

There is only one reason as to not treat a certain part of the body and that is due to a contra-indication such as pregnancy where you would not touch or massage the abdominal area or is say someone had a fungal infection upon their feet you would not massage their feet and would move onto the next step of the massage itself. These contra-indications could be on a temporary basis or they could be permanent and therefore this client would not be able to receive a treatment. There are some contra-indications such as cancer, epilepsy and a few others which would need a doctor’s approval before a treatment could be carried out upon the client for insurance reasons. For example for epilepsy if you do not know the trigger for a seizure and you had not received a doctors approval for the treatment and the client unfortunately had a seizure upon your table then the client might decide to sue the practitioner for causing this, this is why doctors approval is sought.

Due to the Health and Safety at work act 1974 all employers and employees must maintain a high standard of health and safety in the work place as described in F. Gould’s Body Massage for Holistic Therapists.

‘Employers are responsible for the health and safety of anyone who enters their premises. If an employer has more than five employees, the work place must have a health and safety policy, of which all staff must be aware.’

There are many different procedures in the work place that all employees must adhere to such as the first aid and fire procedures, all employees should know where the first aid kits and fire extinguishers/ exits are located within the building for the safely of themselves and the clients, It is advisable however, that all practitioners are first aid qualified themselves in the event of an emergency. From the clients point of view the practitioner should know these things as well as have a basic understanding of personal hygiene in the sense of washing their hands properly, being of a clean and presentable appearance and be dressed appropriately for the treatment. This is due to the intimate nature of the massage with the close skin to skin contact as strong smelling perfumes or strong body odour can be very unpleasant for the client. A general knowledge of health and safety is beneficial for the example to clean up spillages as and when they happen as to avoid trips, slips and falls of either the client or yourself. A good general idea of protecting your equipment is ideal as oils and creams can become a hazard if left un-cleaned from the treatment table as this could cause a slip or the degrading of your equipment such as the vinyl of the table tops.

For insurance purposes the practitioner must ensure that they do not perform a massage while they are unwell or when the client is contagious due to the spread of infection and should always wear gloves if they have any open areas upon their hands. This is for their own protection and that of the client as to not pass anything between them or onto any other client from the previous client. However it is also important to know if the client is well enough to receive the treatment, for this the practitioner must refer to the contraindication lists to see whether or not the client is acceptable to treat. The client should also be aware that at any point the practitioner is legally allowed to refuse treatment for withholding information or for unacceptable behaviour. The practitioner must also get the permission off the client at all times before a treatment if they can touch the client themselves, and they must ensure the client understands this and what is going to happen during the treatment for insurance purposes for the protection of both the client and practitioner.

Personal safety for the practitioner is also important; these include the correct posture and the compression of the wrists. If either of these are incorrect then the practitioner later in their career could cause themselves more pain due to repetitive strain on the joints and could cause more damage if continued. To help prevent this the right table height should be selected for the practitioner as well as the correct foot wear to help with posture, also the right hand movements should be followed to help prevent the compression of the wrists. The most important piece of safety a practitioner should adhere to is their own safety when working with a client on their own such as a residential call or even in their own rooms at their treatment centre. If doing a residential call then the practitioner should only really perform these on clients that already know, they have a personal phone number for and they should always make sure someone knows where they are at which times and check in after the appointment with either a family member or work colleague to show they are safe. If they get a new client after a residential call they should always follow the rules of asking for the residential phone number and insist upon phoning the day before the treatment to see if they still wish to receive the treatment.

Making the treatment of a client a positive experience is one of the most important parts of making a massage holistic, the practitioner should look after their clients making sure they are comfortable with what is going on whether they are new or long term clients. To be a massage practitioner you should have excellent customer service skills, client care should be the most important thing to remember and should always be used every day with every client, the client should believe that the practitioner cares. The practitioner should always consult with the client and devise a treatment plan to suite the clients and stick to this plan unless anything changes in the circumstances with the client as well as receiving permission from the client for the practitioner to touch them during the treatment. During the treatment the discussion should be at a comfortable level for the client but also low enough for the client to relax and enjoy the treatment. After care should always be adhered to and offered to the client with a small encouragement of lifestyle changes if needed for the client’s needs.

Effects of Massage including the Physiological and psychological effects upon the client:

Massage even though it is a holistic experience has been seen to have an effect of other areas of the human body and not just as a way to relax; a massage has been seen to show that it has both physiological and psychological effect upon the clients. Physiological effects are those which are shown upon the body itself and its function whereas psychological effects are those which manifest themselves in the mind and the emotions of the client. There are many different outcomes which could manifest for both on the anatomy and the body systems. In two different clinical trials that have been preformed independently of each other there is a show of the two different effects received after a massage treatment, one for the Physiological effects and one for the psychological effects.

In the first trial the objective was to see if the early intervention with massage in children with Down syndrome would help with the motor skills and muscle tone. So parents with children suffering from Down syndrome where asked to attend one of two early intervention classes, one class was a body massage session and the other a reading session after a base line had been assessed upon their severity of the syndrome, some children were not used if sever mobility where involved or they had emotional problems as this might interfere with the trial.

Twelve of the children were assigned to the massage sessions and eleven to the control reading session, so in overall there where twenty one children involved in this trial. Each session was scheduled for the same times each week and specific times of the day for both classes, and each session was on an individual basis, the sessions lasted for half an hour each, twice a week for two months, while the reading session was conducted the same way with the therapist holding the child while reading for the half an hour.

This was the treatment that the children received in the following sequence:

‘The 30-minute massage therapy session started with the child lying on a small mat

on the floor. The therapist conducted the following sequence three times with the

child in a supine position: Legs and feet—(a) while forming hands like a letter ‘C’ and

wrapping the fingers around the child’s leg, long, milking and twisting strokes from

the thigh to the ankles; (b) massaging foot by gliding thumbs across bottom of foot

followed by squeezing and tugging each toe; (c) massaging across top of foot by gliding thumbs from ankle to toes; (d) flexing and extending the foot; (e) massaging from ankle to foot and back to ankle; (f) stroking from the ankle up towards the thigh; and (g) back and forth rolling movements (as if making a rope from dough) from the

ankle to the thigh. Stomach—(a) slow, circular, rubbing movements to stomach area

with one hand; (b) using the palms, hand over hand down the stomach in a paddlewheel fashion; (c) starting with thumbs together at the umbilicus, stroking horizontally to sides of body and then twice above and twice below the umbilicus; (d) using fingertips and starting below the umbilicus on the child’s right side, small circular upward movements until even with the umbilicus, then continuing across to the left side, and then down on the left side to below the umbilicus; (e) with one hand

following the other, short upward stroking from right side below the umbilicus, then

Massage and Down syndrome 401 across the umbilicus to the left side of the body, and then down on the left side to below the umbilicus; and (f) cupping or holding sides of knees, bending both knees simultaneously towards the stomach and holding for three to five seconds. Chest—(a) with palms of hands on child’s sternum, stroking outward across chest; (b) starting at sternum, stroking upwards and over tops of shoulders and down the sides of the ribs; and (c) starting at the right thigh, stroking diagonally through the chest to the opposite shoulder and back down to the same thigh; repeat starting at the left thigh; Arms and hands—same as legs and feet (i.e. replace ‘legs’ with ‘arms’ and ‘feet’ with ‘hands’). Face—(a) making small circles to entire scalp (as if shampooing hair); (b) with flats of thumbs together on midline of forehead, stroking outward towards the temples; (c) stroking gently over the eyes and brows; (d) starting at the bridge of the nose, stroking across the cheekbones to the ears; and (e) making circular movements under the chin, around the jaw line, around the ears, to the back of the neck and the rest of the scalp. The following sequences were done after placing the children on their stomach (in a prone position). Back—applying oil to the hands: (a) starting at the top of the spine, alternating hand strokes across the back working down towards the tail bone (never

pressing the spine) and reaching over to include the sides; (b) hand over hand movements from upper back to hips with flats of hands and then continuing to feet; (c) using circular motion with fingertips, from neck to hips stroking over the long muscles next to the spine and retracing on the other side of the spine; (d) making circular strokes with the palm of the hand to rub the tops of the shoulders; and (e) ending with long gliding strokes from the neck to the feet.’ As was described in the journal Children with Down syndrome improved in motor functioning and muscle tone following massage therapy (2006).

The trial was held at the children’s early intervention pre-school centres, while the test was run by the university of Miami school of medicine. The results of this trial show that there was a greater gain for the results of the children who where massaged in their sessions than to those who where read too. The improvements were shown in the gross motor skills and fine motor skills development of the children as well as a marginal effect in their language development. This then showed that through the early intervention with massage it could help children with Down syndrome enhance their motor development at a faster rate than if they were left to mature in their own way.

These results help to show that massage can have a physiological effect upon the body in helping to produce and enhance muscle tone. However, there is the argument that another control group could have been added into the trial to help show whether this is successful or not is a control group that uses light stokes instead of a pressure massage to help with the ethical problems of withholding the intervention from those in the reading session. This was all shown in the clinical trial journal of Children with Down syndrome improved in motor functioning and muscle tone following massage therapy (2006) which is located in the appendices.

The second trial is to determine whether or not massage can have a psychological effect on the client and for this the trial was preformed for the Association of Paediatric Haematology/Oncology Nurses (2009). The aim of this trial was to reduce symptoms of children with cancer and to reduce the anxiety of their parents.

‘Children with cancer, ages 1 to 18 years, received at least 2 identical cycles of

Chemotherapy, and one parent, participated in the 2- period crossover design in which 4 weekly massage sessions alternated with 4 weekly quiet-time control

Sessions.’ As described in the article Massage Therapy for Children with Cancer (2009).

To determine if the massage was helping to relieve the psychological symptoms of anxiety in the parents and the symptoms of the children while the trial was progressing they measured everyone’s heart and respiratory rates, blood pressure, and salivary cortisol level as well as their pain, nausea, anxiety, and fatigue levels.

According to the results of this trial the massage was more effective in reducing heart rate than quiet time in the children, the anxiety in the children aged fourteen and older and the anxiety in the adults. The clients all commented upon how the massage rather than the quiet time helped with their anxiety and helped them feel better. So due to their result it is feasible to massage children with cancer and their parents to help relieve their anxiety. Therefore this result helps to show that massage to the body can have a psychological effect upon the client in this sense it has reduced the anxiety of the both the children and the parents although in the younger babies the results did vary a little more than the other ages, but the results of the older children and the adults help to prove that just a massage on its own can have a psychological effect upon the human body. The trial that this assessment was based upon is located in the appendices as clinical trial 2.

So both of these trials show that massage can had a successful outcome on the physiological and psychological effects portrayed on the body, they both proved that through a short massage the body can manifest its effects through muscle tone or motor function progression as well as to reduce anxiety in both children and adults. Neither of these two trials have a negative out come and therefore both are a success but there shall be a few trials where massage has not appeared to be successful at all or shows that it is a little less successful than anticipated, these however are normal and show both sides to an ongoing argument about whether massage is actually good for the body, mind and spirit on a whole or if it just theoretically works on the body.

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