Short but important notes about massage
Massage has had many ups and down throughout history; mainly due to competition from other healthcare professions. Many osteopaths, chiropractors and GPs underestimate the value of massage, despite strong evidence supporting its multi-faceted benefits. The status of massage therapy differs across the world. In Canada, therapists need to complete a 2,000-hour course to qualify, unlike the UK where you can practice with only 75 hours under your belt!
Different types of massage have different names in different countries which can lead to confusion. This is sometimes deliberate in order to make one technique appear superior to another. For example, “Myo-Fascial Release” is another name for deep forearm strokes or it can be explained in terms of Swedish massage techniques.
What is massage?
Massage is defined as the manipulation of the body’s soft tissues (muscles, tendons, ligaments, skin, joints and others) in order to make physical and/or emotional gains.
Massage can be applied to aid the process of treating scar tissue from injury or surgery, relieve stress, improve mood and induce sleep, manage pain, moderate or eliminate migraine or sinus headache and improve circulation. Therapeutic benefits include lengthening of muscles, treating muscle tension, spasticity and/or contractures, and freeing restrictions between layers of connective tissue. Massage Therapy can be performed by a professional massage therapist, or by other healthcare practitioners such as chiropractors, osteopaths, and physiotherapists.
Legislation governing massage
Massage therapy in the UK for the most part is governed by common law and there is little legislation. Volume 28 of Halsbury’s Statutes contains information on the profession’s Supplementary to Medicine Act 1960, which establishes a Council, Boards and Disciplinary Committees for such professions as chiropodists, dieticians, laboratory technicians, occupational therapists, physiotherapists and radiographers. The term “massage practitioner” or “aromatherapist” is not used in Halsbury’s Statutes. See also Section 3.8 on the umbrella organisations governing massage practice in the UK. Much of the work of these bodies is being undertaken with a view to anticipating any possible legislative provision governing massage therapy.
Interestingly, the Venereal Disease Act 1917 specifically prohibits the treatment of syphilis, gonorrhoea or soft chancre (genital sores) by any complementary therapies. There is also legislation prohibiting anyone other than a registered midwife from giving massage to a mother during the first ten days after she has given birth.
In some parts of the country, local authorities require massage practitioners to obtain licences to practice. In some areas eg Nottingham, MTI practitioners have been granted exemption from this requirement on the grounds of being bona-fide health practitioners. In London, the London Licensing Act specifies a similar requirement. Since there is a need to secure agreement from all London local authorities, the MTI will be pursuing a blanket exemption for practioners in London through the General Council for Massage Therapy.
General Council for Massage Therapy (GCMT)
In September 1999, this new body was established through a partnership of the Federation of Sports Massage Therapists and the London and Counties Society of Physiologists. Originally called the British Association for Massage Therapy, this body is now well advanced in seeking to become the single national lead body for massage therapy in the UK. This is consistent with the Government’s approach, following the House of Lords report on complementary medicine in November 2000, to encourage each discipline in the field to become self-regulating and to establish a single national lead body for each profession. The GCMT now includes MTI, the Massage Training Institute (GB), ITEC and the Guild of Complementary Practitioners as well as the original members.
The GCMT is liaising between practitioner organisations, training schools and the Government. It is being assisted in this work by Healthworks UK, established by the Government to facilitate the formation of lead bodies for each complementary discipline. The GCMT also has the support of the Foundation for Integrated Health. An independent Chairman has recently been appointed. MTI is active in GCMT both at Executive Committee level and also on a Working Party to establish national occupational standards for massage. We have also been very influential in drawing up the Core Curriculum for Massage and associated guidance form the GCMT. Our standards are proving to be amongst the most thorough of the member bodies and MTI is having a significant influence on the development of national policy for the massage profession.
History of massage
Massage has been used for healing throughout recorded history (and no doubt before that). There is a natural instinct to rub a sore spot or ache to make it better, and cultures all over the world have built upon this to develop varied styles of massage. Massage is so ancient that the derivation of the word is uncertain - it may have come from the ancient Greek word "massin" (to knead), or the Arabic "mass" or the Hebrew "mashesh" (to press).
The earliest written reference to massage is in the "Nei Ching", the Yellow Emperor's Book of Medicine (written about 2700 BC in china), which describes many massage techniques and their use. Indian texts on Ayurvedic Medicine from about 1800 BC also describe massage. There are many references in the Old Testament of the Bible to the practice of people being "anointed with oil", particularly after a long journey. From about 500 BC, there are references to massage in medical texts from Egypt, Persia and Japan.
In Eastern systems of massage, the emphasis is on the idea of balancing energy in the body. Acupressure massage developed in China, based on the acupuncture energy meridians and points. It is often used in combination with other traditional systems such as "Anmo" (pressing and rubbing) and "Tuina" (pushing and pulling). In Japan "Amma" massage of pressing, rubbing, wringing and stretches, was traditionally practised by blind practitioners. Shiatsu combines this with pressure techniques on acupuncture points. Thai massage also combines pressure, rubbing and stretches with techniques that work on the energy lines of the body.
In addition to its use by skilled professionals, massage has been used within families throughout Asia and Africa, particularly by mothers massaging babies, and head massage is an automatic part of a visit to the barber or hairdresser throughout much of North Africa and Asia. Massage also developed independently in other parts of the world. Many of the early European visitors to Pacific islands described the use of massage (such as the Hawaiian "Lomilomi"); Captain James Cook, on his third Pacific voyage in the late eighteenth century, had massage ("romee") in Tahiti to relieve sciatic pain.
In the West, massage has often been used in tandem with exercise, quite commonly as a branch of medicine, and has therefore been influenced by developments in the knowledge of anatomy and physiology. In the fifth century BC, Hippocrates, the "father of medicine" preached the benefits of massage saying "the physician must be experienced in many things, but assuredly in rubbing". By then Gymnasia were established in many Greek cities, and the anointing of athletes with oils and powders was a common practice in the popular Games. In earlier times, Homer described in "The Odyssey" (about 1000 BC) how the war weary heroes were rested and replenished by the use of massage.
Thus two uses of massage - as a method of relieving stiffness, soreness and tightness in muscles, and as a treatment for particular problems - were well established in classical Greece, and were further developed in Roman times. The Roman physician Celsus (25 BC - 50 AD) wrote that "chronic pains in the head are relieved by rubbing the head itself" and that "a paralysed limb is strengthened by rubbing". Julius Caesar was "pinched" daily to relieve neuralgia. Galen, a Roman physician (AD 131-20l) promoted its use in the preparation of gladiators for combat and in the treatment of injuries.
Following the end of the Roman Empire in the fifth century, the Arabs sustained and continued to develop the knowledge and teachings of the classical world. Avicenna, a tenth century philosopher and physician, wrote that the object of massage was "to disperse the effete matters found in the muscles and not expelled by exercise". The Arabs also carried on the tradition of massage being done at the Public Baths - which continues to the present day in the "Hammams", the traditional Baths which operate in North Africa, the Eastern Mediterranean (e.g. Turkish Baths) and across into Pakistan and neighbouring parts of Asia.
Classical medical knowledge re-entered Europe from the Arab world during the Renaissance (approximately 1450 - 1600), firstly in the new commercial centres in Italy where medical schools were established, and then spreading to other European cities of rising prosperity. One of the first books from the Gutenberg press was "De Medicina" by the Roman Celsus (25 BC - 50 AD), which emphasised the importance of rubbing, exercise and anointing. During the sixteenth century, the French doctor Ambroise Pare (1517-1590), one of the founders of modern surgery, used massage, particularly friction massage, in the treatment of stiff and injured joints. His ideas were passed on to other French and German physicians. However massage began to have a less happy relationship with mainstream medicine, as the latter developed further away from being a primarily hands-on skill.
"Swedish Massage", which forms the basis for European styles of massage, is so called because it was first codified (from existing techniques) as one component of a system of gymnastics by a Swede - Pehr Henrik Ling (1776-1839). From the early nineteenth century, when he began teaching in Stockholm, his massage system began to be practised on its own, and spread throughout Europe. Just prior to Ling's death, one of his pupils established a clinic in St Petersburg; these techniques form the basis of Russian Medical Massage, which is widespread in the former Communist countries of Eastern Europe. In the 1840's, Dr Mathias Roth, another student of Ling, introduced it to Britain, and wrote the first book in English on Swedish Movements and Massage in 1850. Two of his students, the American brothers Charles Taylor and George R Taylor MD, established it in the US in 1856 and, over the next thirty years, published extensively both about Ling's system and their own work with it. By the 1880's, there was a growing popularity for massage throughout Europe and North America, and considerable literature on the subject.
Queen Victoria had successful treatments for rheumatic pains, which gave considerable publicity and prestige to the Swedish Massage Cure. The first formal organisation of massage practitioners in this country (The Society of Trained Masseuses) was formed in 1894, by women with nursing backgrounds. They continued to practice massage in medical settings, becoming the Chartered Society of Physiotherapy in 1943, with state registration in 1966, from which time they have, in fact, used massage less and less in their work (although the growing popularity of massage outside the medical setting has led to a renewed interest by a section of the physiotherapy profession).
Sports massage has developed into a well established and highly specialised field, covering pre and post event massages, and training to deal with sports injuries. Massage continued meantime in areas in which it was taught and applied very much as a routine - the gym/sauna "rubdown" and in the growing field of beauty therapy (as well as in "massage parlours", an unfortunate aspect of the lack of recognised national standards and registration of massage practitioners).
In recent decades, many interwoven factors have contributed to a growing public interest in massage - the fashion for fitness (in part, through the need to balance sedentary working lives); growing awareness of stress as a health/illness factor; a desire to receive personal treatment where appropriate (rather than be plugged into a machine; an interest in health maintenance that has seen such a growth in "complementary therapies" (the re-emergence of traditional Western and Eastern approaches, the increasing availability of approaches developed in other parts of the shrinking "global village", and the consequent development of "cross fertilised" hybrids); and the influence of physically based personal development disciplines (ranging from the purely physical to the spiritual - such as Yoga, Tai Chi and Eastern Martial Arts).
These have served not only to bring massage (of all sorts) into mainstream awareness; but have expanded the scope for massage to be seen as a meeting point of these and many other disciplines. In recent years, people have turned to massage not just for general physical relaxation and to release the muscle tension after a "workout", but also for its relevance to stress management as an adjunct to or even an essential part of counselling, psychotherapy, and personal/professional development; as "touch communication" to enhance partner, family or social relationships; and as an aid to comfort people in ill health, and nurture and replenish them in recovery. One of the important avenues of acceptance of massage has been in hospices, where the quality of care is important.
Massage training has developed which is geared towards the development of a widely skilled and flexible practitioner, who can adapt to a clientele in varied states of health and physical fitness, with a range of builds and lifestyles, and needing different sorts of treatments depending on the reasons for their tension and the events occurring in their lives which need to be taken into account. Simultaneously there has been a growing belief amongst many professionals that the practitioner's personal development needs to be an essential (and continuing) component of their training and work. This has been fuelled by the fact that it is standard practice in many of the eastern massage systems now established in this country (such as Shiatsu and Thai massage), in other body based disciplines (such as the teaching of Yoga, Tai Chi, the Martial Arts, the Alexander Technique and the Feldenkrais Method) and also by this development in professions such as Counselling and Psychotherapy.
Although, in some parts of Europe and most of North America there is a very high standard of training for massage practitioners, it is legally possible in Britain to set oneself up as a massage practitioner without having done any training at all. However, to work in a health centre or medical setting one does need to have done training which allows you to join an organisation with a code of ethics and disciplinary procedures and to take out professional indemnity insurance - as forms of public protection - so standards are thus being informally established. Unfortunately short trainings that merely teach massage routines can give these credentials.
The Massage Training Institute was established to bring together training courses that incorporate the developments described above. It is affiliated to the General Council for Massage Therapy, a collection of massage schools and practitioner organisations who are working with the Government to establish a voluntary self- regulatory framework for the massage profession.
