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December 2018 (Vol. 3 Issue 10)

Rubbing the right way

About the author: 
Cate Montana

Rubbing the right way image

There's a wide variety of massage treatments out there—from deep tissue and Thai massage to myofascial release. Cate Montana sorts out the best techniques for particular conditions

Two thousand years ago, the great Roman physician Galen recommended massage, along with a healthy diet, exercise and rest, as vital to health and wellbeing. The Greeks incorporated massage into both sports and medicine. Hippocrates himself advised "friction" as a method to treat injuries.

Now, science is finally catching up with the ancients' intuitive understanding that massage's potential therapeutic benefits stretch beyond the feel-good factor. Studies show that massage is good not only for relaxation, increased flexibility and increased muscle tone, but also for better posture, increased range of motion, increased blood circulation,1 a stronger immune system through a rise in the white blood cell count,2 reduced stress due to a decreased production of cortisol,3 less pain, depression and anxiety,4 and an overall greater sense of wellbeing.

Swedish massage is the best-known technique in the West, but nowadays, there are dozens of different techniques—trigger point therapy, myofascial release, neuromuscular therapy, jin shin do, hilot massage, Indian head massage and lomi lomi (Hawaiian) massage—with names ranging from the scientific-sounding to the exotic. The techniques themselves vary from deep, sometimes painful, working of the fascia, muscles and joints to feathery, almost non-existent, touches designed to move energy, and stretching and folding of the body into different postures.

Clinical studies are now substantiating the healing promise of these various techniques, and comparative studies are being done to see if there are certain massage therapies that are more or less helpful for people with specific conditions, a formidable task given the exponentially growing number of conditions, the number of massage therapies available, the subjectivity of such testing and the general lack of funding for it. Overall, though, studies reveal that people receiving massage experience fewer physical and psychological complications while undergoing medical treatments than those who do not.5,6

In the US and worldwide, professional associations have created various voluntary controls and registries for massage therapists. There is a drive in the alternative and complementary health community to make massage not only more legitimate, but also to follow some official set standards and protocols.

"We're in a fight to safeguard standards and protect the public in terms of what good massage entails," says Earle Abrahamson, national chair of the Massage Training Institute (MTI) in Hertfordshire, UK. "We need to make claims that are viable—how massage can be used to enhance health and healing."

But as the evidence shows, some techniques may be more appropriate for certain conditions or tastes than others.

To help you choose the right technique for your condition, WDDTY has rounded up some of the most popular techniques and what they may best be used for.

Swedish massage therapy

The oldest popular massage technique in the West and the foundation of many other styles of massage, Swedish massage therapy (SMT) is one of the most frequently scientifically studied forms because of its long-standing reputation for inducing general relaxation and lowering blood pressure, heart rate and other inflammatory markers of hypertension.7

It uses strokes that are fluid and sweeping, encompassing the whole body. Kneading, deep circular movements, vibration and tapping are also performed. "It relaxes the tissues, improving blood circulation, which, in turn, relaxes the nervous system, which can help with the psychological problems of stress, anxiety and trauma," says practitioner Anna Archer in Uckfield, East Sussex.

What's different about it? Lighter pressure is applied compared with many other styles. The whole body is the focus, not just particular muscles or areas where pain and tension are located—although such areas can receive special attention. SMT practitioners don't need specialty licenses.

What's it good for? Relaxation and de-stressing are the keynotes of Swedish massage. Most people are subject to stress, which is known to contribute to heart disease, asthma, headaches, anxiety and depression. Massage helps to alleviate stress and thus also has health benefits for related issues, such as pain reduction.

What's the evidence? Swedish massage can decrease pain and improve mood in cancer patients.5 It also significantly decreases levels of the hormone arginine vasopressin, which helps to regulate blood pressure, and can lower the production of the stress hormone cortisol while increasing serotonin and dopamine (the 'happy' hormones).3

As mentioned, Swedish massage can reduce both systolic (pressure during a heartbeat) and diastolic (pressure between beats) blood pressure in women with hypertension, and also the production of inflammatory markers—particularly, certain agents that play a role in atherosclerosis (hardening of the arteries).7 Swedish massage has also proved effective in improving childhood eczema.8

It worked for me. Louise, a 46-year-old woman living in Uckfield, East Sussex, UK, had been experiencing shoulder, neck and facial pain, along with headaches and migraines, for over four years. Chiropractic and physiotherapy had helped only in the short term, and Louise felt she wasn't getting any better until then she started seeing a Swedish massage therapist. "At last, I feel like I'm getting somewhere with sorting these long-term problems," she says. "I'm in less pain with all my symptoms every day!"

Where to find out more: Massage Therapy: www.massagetherapy.com

Deep tissue massage

What is it? Instead of concentrating on creating relaxation through long, gentle, sweeping strokes, deep tissue massage gets down into the deeper layers of muscle. This approach concentrates on particular problem areas, stimulating blood circulation, and releasing chronic tension held in specific muscles related to symptoms of pain and tightness.

What's different about it? Often used in combination with other massage procedures, the deep tissue practitioner uses considerable finger pressure while following the line of muscle tissues or crossing the muscle fibers, tendons and fascia in a scraping motion to break up adhesions (subdermal scar tissue) resulting from strain and injury.

Deep tissue work can sometimes be painful, depending on how chronic or long term the symptoms are. The number of adhesions, and degree of tension and muscle constriction around an injury all determine how deeply the practitioner must go into the muscle tissue, using hands, forearms and elbows to get results.

What's it good for? Bodybuilders, football players, dancers and other athletes use it to get relief from specific physical issues such as muscle pain, and to increase mobility and range of motion. Relief is often immediate.

Where's the evidence? Deep tissue massage has been proven to be an effective method for reducing pain and increasing function in patients suffering from chronic low-back pain,9 and for significantly lowering both blood pressure and heart rate.10 By breaking up scar tissue and other fascial restrictions through soft-tissue manipulation, it can also relieve chronic Achilles tendinitis.11

It worked for me. London resident Francesco Stea, 41, had considerable pain in his back and neck, and suffered from a sleep disorder. He couldn't even turn his head without experiencing stabbing pain. Doctors had no solutions other than to prescribe painkillers. But after having several deep tissue sessions a week, Francesco began to experience real pain relief for the first time, so much so that eventually he was able to cut his sessions down to once a week. Now he also sleeps well at night. "Most important, I don't take so many medicines anymore."

Where to find out more: Massage Therapy: www.massagetherapy.com

Aromatherapy massage

What is it? Aromatherapy massage incorporates the use of essential oils paired with various massage techniques. The kind of massage work and specific blend of oils used are chosen by the therapist to best suit the given client's perceived needs. It's thought that aromatherapy affects olfactory bulb receptors in the brain (for our sense of smell), triggering responses in the brain's limbic system, which processes emotions and memory, so inducing either relaxation or stimulation responses.

The oils themselves act rather like hormones, assisting the body, mind and emotions to maintain a healthy balance. "They all have, to varying degrees, anti-inflammatory, antiviral and antibacterial qualities," says Twickenham, UK-based aromatherapist Louise Crockart.

What's different about it? Aromatherapy combines massage with therapeutic oils that themselves have proven health benefits. For example, in a study of aromatherapy given to women during labor, it reduced their pain perception, plus none of their infants had to be transferred to neonatal intensive care units, compared to 2 percent of those born under standard care.12 Indeed, the combination of essential oils with hands-on massage seems to create a complex healing response that augments standard massage treatment.

What's it good for? Aromatherapy massage has wide applications, including the reduction of anxiety, depression and pain in terminal cancer patients,13 and the relief of constipation in the elderly.14


Where's the evidence? A recent study by Ruhr University Bochum in Germany showed that there are olfactory receptors in the skin that directly respond to the scent of sandalwood by facilitating skin regeneration and wound-healing.15

It worked for me. Veena Dookoo of West London, who suffers from endometriosis, first went to Louise Crockart 17 years ago. "Over the years, she has helped eliminate achy body [pain] as well as reduce symptoms in my menstrual cycle," says 50-year-old Dookoo. "My periods have been regular and pain-free. I would recommend aromatherapy massage to anyone that has any sort of condition."

Where to find out more: National Association for Holistic Aromatherapy: naha.org

Manual lymphatic drainage

What is it? The lymphatic system is a network of vessels that carries the fluid called 'lymph' throughout the body; lymph contains, among other things, white blood cells (lymphocytes) that make antibodies to fight infection. Manual lymphatic drainage, or lymph drainage therapy, is designed to help drain the hundreds of lymph nodes scattered throughout the body, and to help the lymphatic vessels transport lymph and lipids (fats) from bodily tissues to the bloodstream, while removing foreign substances, dead cells and waste products.

What's different about it? There is almost no pressure applied during the first part of a deep lymphatic treatment. Colloquially called 'the skin-stretching technique,' it involves moving the skin gently in separate motions to stimulate the lymphatic system, activating lymphatic flow and pushing the fluid toward the nodes, where harmful agents are filtered out. "Perhaps about an ounce of pressure is used," says East London deep tissue worker Fabrizio Leone. The second part of lymphatic drainage consists of manually stimulating the lymph nodes to increase lymph filtration.

What's it good for? It can help any condition involving fluid retention as well as muscle stiffness. In fact, the UK's National Health Service (NHS) website recommends 'decongestive lymphatic therapy,' including massage techniques like ordinary lymphatic massage, for controlling symptoms of lymphedema (swollen lymph nodes). In Leone's experience, it also assists with bowel and colon problems.

Where's the evidence? In one study, manual lymphatic drainage was better than connective tissue massage—
which manipulates superficial connective and subcutaneous tissues, yet has effects on organs distant from the site of stimulation—for stiffness, depression and quality of life in patients with fibromyalgia
.16

In those suffering from edema (excess fluid accumulation) due to musculoskeletal injury, lymphatic massage has resulted in significantly less swelling, with restoration of physiological function and improvement in wound-healing.17

It is also effective for skeletal muscle damage from sports injuries, and for easing fluid retention after ankle sprains and wrist fractures.18 Combined with therapeutic ultrasound, it can even reduce the pain and swelling associated with liposuction and lipoabdominoplasty ('tummy-tuck' surgery plus liposuction).19

It worked for me. Nicky Pearson, 55, was bothered by excess water retention, especially around her knees. "I felt very much 'lighter' after the first treatment," she says. "The massage helped hugely in reducing the fluid around my knees."

Where to find out more: Lymphology Association of North America: www.clt-lana.org

Traditional Thai massage

What is it? Traditional Thai massage (also called 'Thai yoga massage') is based on the manipulation of a series of invisible channels called 'sen,' similar to but distinct from the 'energy channels' or meridians used in Chinese acupressure and Japanese shiatsu. It incorporates elements from other techniques in addition to highly rhythmic gentle rocking, deep stretching and compression movements.

What's different about it? Practitioners use their body weight as well as their fingers, thumbs, palms, elbows, knees and feet. Thai massage is done on a mat on the floor, which enables the practitioner to perform procedures that aren't suitable or even possible on a table. The patient also remains fully clothed. "Patients often comment on how much more safe and expansive they feel because of this," says London practitioner Howard Evans. Treatment generally falls into one of two categories: full body routines and localized therapy.

What's it good for? Thai massage is designed to assist in restructuring of the musculoskeletal system, and is also effective for easing stress and tension, back pain, stiff neck, shoulder pain and sports injuries.

Where's the evidence? It proved effective for reducing muscle tension and pain intensity in patients with scapulocostal syndrome (deep pain in the shoulder muscles).20 One review of studies showed that Thai massage effectively relieves chronic musculoskeletal pain (of any cause) for up to 15 weeks, while also improving disability, muscle tension, flexibility and anxiety.21 It can also improve signs of stress by immediately increasing heart rate variability, a marker of resilience and good health, while reducing the pain associated with myofascial trigger points (nodules, or 'knots,' due to repetitive strain or injury).22

It worked for me. Julie Berry was under a lot of stress, and woke up one morning with the whole of her spine and neck completely "stuck." "I couldn't move my head left or right and my back was like a plank," she says. Evans treated her with Thai massage, after which she walked out able to move her head from side to side again and with her back feeling "much more flexible. I still go to him regularly."

Where to find out more: Traditional Thai Massage: www.thaimassage.com

Myofascial release therapy

What is it? Myofascial release therapy works on the fascia, the protein-based fibrous tissue that envelops every muscle, bone, organ, ligament, tendon, nerve and vein in the body. Direct myofascial release is about making an intentional change to tissues in a particular part of the body by applying pressure in a specific direction, along with active movements and muscle contractions made by the client. Indirect myofascial release is more global, and the client remains passive as the soft tissues are taken to their natural limits; after the tissues yield and 'release,' continued pressure in the direction of the release is then applied.

What's different about it? Instead of manipulating muscles, myofascial release works only with fascia. Proponents claim that emotional release, or an 'unwind,' can sometimes be achieved when the physical memories stored in fascia provoke a whole-body experience of 'letting go.'

What's it good for? Myofascial release is designed to lengthen muscles, increase the quality and range of movement, and break down scar tissue, particularly after surgery. "I use myofascial release with a lot of people post-surgery to help regain function and flexibility in tissues and affected joints," says London practitioner Mike O'Connor. "I also use it with professional elite athletes to optimize their structural integrity and functional movement patterns."

Where's the evidence? There's evidence that myofascial release "is beneficial for fibromyalgia symptoms," reducing fatigue and stiffness while improving quality of life.16 In a review of 10 studies of myofascial release for orthopedic conditions—defined as anything involving the muscles, ligaments and joints—the outcomes were mixed, but mostly positive.23

It worked for me. Marathon runner Caroline B. from London had myofascial treatment with O'Connor during which, she says, he checked her posture and the range of motion of all her joints, making sure that all her muscles were aligned and working properly. "He somehow got rid of all my aches and pains," she says. "I left feeling like a new person."

Where to find out more: John F. Barnes' Myofascial Release Approach: www.myofascialrelease.com

Trigger point therapy

What is it? Trigger point therapy (TPT) refers to the manipulation of those inappropriately 'bunched,' tightly contracted muscle fibers commonly referred to as 'muscle knots.' These knots can be painful to the touch, and cause contractions and imbalances in associated muscles and connective tissues, leading to 'referred pain' in other areas of the body. A trigger point in the back, for example, may produce referral pain in the neck. Treatment consists of several cycles of isolated pressure-and-release movements.

What's different about it? Recipients are active participants through deep breathing as well as identifying the exact location and intensity of discomfort, and giving appropriate feedback so that the practitioner can modulate the pressure placed on the point accordingly. Although there are published 'maps' showing the locations of the most commonly used points for therapists, trigger points are also individual and rather specific. "The trick," says London-based osteomyologist (an alternative practitioner specializing in bone and muscle) Paul Manley, "is not to follow the maps, but to palpate the points pertinent to the individual beneath our hands."

What's it good for? Athletes and people with chronic myofascial problems as well as those suffering from posture-related pain and its associated conditions are frequently helped by TPT.

What's the evidence? One study of myofascial TPT for chronic shoulder pain, for example, found that the group that had one treatment a week for 12 weeks experienced "significant improvement" compared to the untreated controls.24 Ischemic (blood-blocking) compressions of shoulder trigger points can also ease symptoms in patients with chronic shoulder pain.25 Women suffering from chronic tension-related headaches have also benefitted from TPT and not only in terms of pain, but also by a significant decrease in the number of trigger points.26

It worked for me. Stanislav Hvartchilkov, a 32-year-old classical guitarist, was in his final years of undergraduate study when he began to experience burning pain in his forearm muscles (the ones that move the hand) just above the wrist. He had inflammation and "big pain" in both forearms, and his right arm was so weak, he couldn't lift even light objects. After nine months of trigger point therapy, though, Hvartchilkov was back to playing the guitar. "I completely recovered," he says. "I was in better shape than ever before."

Where to find out more: National Association of Myofascial Trigger Point Therapists: www.myofascialtherapy.org


Sports massage therapy

What is it? Better sports performance and avoidance of injury as well as sports-related injury treatment is what sports massage, not surprisingly, is all about. Sports therapists only focus on what the client's athletic goals are and what they're trying to achieve. Trained practitioners of sports massage use a wide variety of techniques and are heavily schooled
in anatomy.

What's different about it? There's nothing calming about sports-based massage therapy. "The person giving the massage will actively try to move the patient to either re-establish a range of motion or to understand how the effects of the massage are impacting their client," says Earle Abrahamson, sports therapist and national chair of the Massage Training Institute in Hitchin, Hertfordshire, UK.

In addition, sports therapists are trained in how to apply muscle energy techniques (METs) designed to switch off certain muscles, allowing them to become calm and relaxed so that the practitioner can then increase the client's range of motion at the joint itself. Sports therapists are also trained to decide on the best form of rehabilitation for at-home care, including stretches and exercises that clients can do on their own.

What's it good for? Massage can affect any number of different muscle issues pertinent to athletes—from post-exercise muscle pain, tenderness and swelling27 to increasing the range of motion, for example, in the hip and knees.28

Where's the evidence? Few comprehensive studies have been conducted, but an early study evaluating the effectiveness of pre-event sports massage showed that ankle dorsiflexion (the movement needed for running)
was improved.29

One 1999 study of female university dance students showed that massage lowered levels of stress (cortisol) and anxiety as well as improved their mood.30 Less muscle fatigue after high-intensity cycling has also been noted as a side-benefit of sports massage,31 and the loss of grip strength due to exercise-related muscle fatigue was helped by five minutes of manual massage.32

It worked for me. When Simon Harting, a recreational tennis player in North London, changed his serve, he ended up with a 'frozen shoulder.' His doctor prescribed nonsteroidal anti-inflammatory drugs (NSAIDs), but his condition improved only slightly. In comparison, his sports therapist applied peripheral joint mobilization techniques to encourage shoulder joint movement and the production of synovial fluid, with soft-tissue manipulation, to ease the tightness. He also gave Simon a comprehensive home-care program to follow.

Within three months, Simon was back on the courts. "I now realize the importance of seeking advice and treatment from professionals who fully understand the physical and psychological aspects of sports performance," says Simon.

Where to find out more: American MassageTherapy Association: www.amtamassage.org


Painkillers: the 14-day time bomb image

Painkillers: the 14-day time bomb

An eye opener image

An eye opener

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