Massage is the manipulation of the bodily tissues for therapeutic purposes. It is one of the oldest forms of treatment still used to alleviate symptoms due to disease or injury. Primitive man probably used massage intuitively by rubbing or stroking an injured or painful area of the body. Ancient Hindu and Chinese writings refer to well-developed systems of massage as part of their early medical practices. In the West, Hippocrates, about 400 B.C., wrote in detail about the beneficial therapeutic effects of massage and gave indications for its use.
Massage has continued to be a useful form of therapy in many clinical conditions, although some claims for its effectiveness are probably exaggerated. Despite the ancient history of massage and its widespread use in the healing arts, knowledge concerning its effectiveness is limited by a scarcity of precise medical data.
The techniques of massage vary widely among its practitioners. In general they can be divided into two groups: manual and mechanical. Most medical massage is performed manually, requiring the skilled hands of a trained physical therapist or nurse. There are several techniques of manual massage. Effleurage consists of long, rhythmical stroking movements of the therapist's hands applied with varying pressure over the part to be treated. Petrissage is kneading or compression of the underlying muscle tissues. Friction is a deep, circular rolling motion of the therapist's fingers, especially around bony prominences or joints. Tapotement is a striking or percussion movement of varying intensity over muscle and other soft tissue. And vibration is a vibratory, or trembling, movement administered through the therapist's fingers or whole hand to the part to be treated.
Mechanical massage can be administered by a wide variety of devices consisting of motor-driven vibrators, rollers, and belts. These devices, which vary much in their design and effectiveness, are more a tribute to the mechanical ingeniousness of their inventors than to their therapeutic value. It is unlikely that any mechanical apparatus will ever approach the usefulness of manual massage administered by a skilled therapist.
The term automassage is sometimes applied' to rhythmic alternation of pressure produced by the contraction of skeletal muscles and respiratory motions during normal physical activity. This type of physiologic massage is an important adjunct in aiding circulation in the veins and lymphatic channels.
Effects of Massage
The physiologic effects of massage can be described by the changes it produces in the skin and fatty tissues, the muscles, the circulation of blood and lymph, and the nervous system. Effleurage acts directly on the skin surface, removing excessive secretions and superficial deposits. The skin temperature can be elevated from 2° to 3°C by the direct mechanical effects of massage, as well as by reflex dilatation of the underlying small blood vessels. Although it is frequently thought that massage can remove undesirable fat deposits in various regions of the body, there is no positive clinical or experimental evidence that adipose tissue can be altered by even vigorous local massage.
It is believed that massage affects muscles by both direct and reflex changes, increasing the circulation in these deeper tissues. It has been demonstrated, however, that the production of lactic acid is not increased by massage, as does occur following muscular exercise. It is generally agreed that massage does not increase muscular strength, as this can be accomplished only through exercise. Certain abnormal states of muscular activity, such as cramping, spasm, or twitching, can be significantly relieved by properly applied massage. This relief is effected by both direct action upon the muscles and reflex action mediated through the nervous and circulatory systems. Massage may also alter intramuscular connective-tissue adhesions formed by disease or injury. The adhesions are stretcheu and proper function is restored by the mechanical effect of massage.
Swelling of the extremities may occur when muscular activity is reduced by disease, injury, or immobilization, and is due to the inefficient circulation in the veins or lymphatics. This swelling may be prevented or minimized by the proper application of massage, which increases the circulation of blood and lymph. Aside from the direct effect of pressure on the blood and lymphatic vessels, massage can produce changes in the contraction or relaxation of the muscular walls of the blood vessels by means of nerve reflexes that are initiated by stimulation of the skin.
In addition to the reflex effects on muscle and blood vessels, massage may exert a beneficial effect on the central nervous system of the body. In the case of most individuals, massage acts as a sedative when it is applied, reducing anxiety and tension. This relief is accomplished through a variety of complicated nerve reflexes, whose nature is not well understood. Thus, in addition to the purely physical effects, massage may have a most desirable though temporary psychotherapeutic value.
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