Historical, cultural and philosohical approaches to massage

The following is about historical and cultural development of massage, comparing development of massage in eastern and western traditions, the role of key individuals in the history of western massage, The massage scandals of the 1800s and the impact on the massage industry. Compares Maori massage with western massage, covers the development of professional massage in New Zealand and contemporary massage today as well as how body, body-mind and body-mind-spirit relate to the contexts discussed.

Massage in the eastern and western traditions developed over thousands of years. What appears to be touch was found in cave paintings from prehistoric times that date back to 15000 BC (Salvo 2007). Traditional massage relates back to the village Sharman, the healer of the village, who used herbal remedies, magic rituals, prayer and massage. Further development depended on the culture which impacted on techniques used.

Records reveal massage practise in China dates back to 3000 BC. Traditional Chinese medicine
included massage and was known as TuiNa (East West Healing Arts Institute Inc, 2008). Their knowledge of massage and acupuncture developed into a style called Amma. Massage found its way into Japan around 6th century AD and was named Shiatsu. It moved into India around 1800 BC and became part of the Hindu tradition and named Ayurveda.
Eastern massage is energy based. Energy flows through the body along pathways called meridians. It has such names as Ki, Chi in Chinese and Ti or Ki in Hawaiian. Also called vital life force or the universal life force. Treatments are holistic incorporating mind, body and spirit.

Western massage developed around seventh and sixth centuries BC. This goes back to the roots of western medicine in Greece when health and medicine began to take shape. In the Middle ages when the Roman Empire collapsed there was a period of decline in western medicine until the Renaissance when foundations of human anatomy were established. From the sixteenth, seventh and eighteenth century massage re-established itself for health maintenance and treatment.
Western massage focuses on the structure of the musculoskeletal system with its two functions movement and support and being physiology based. Mainly used is Swedish massage with relaxation and deep tissue techniques.

Key individuals that have played a role in the development of massage in the western tradition are:
Hippocrates of Cos (460 - 377 BC) Accepted as the father of Western medicine (Integrative touch and body work, 2005). Well known advocate of massage, wrote about friction for the treatment of ailments. Focus was on the patient and believed that the healer should take care to avoid causing any additional harm.

Galen of Pergamon (130 -201 AD) A Roman physician who followed Hippocratic medicine. Considered one of the greatest medical historians and physicians of antiquity. Related anatomy and physiology, was the original innovator of Sports Massage or Orthopaedic Massage(Integrative touch and body work, 2005).

Pehr Hendrik Ling (1776 – 1839) A Swedish physiologist and gymnastics instructor. His approach was to apply gymnastics to treat disease and injury using active, passive and duplicated movements and massage. Regarded as the father of Swedish massage.

Johann Metzger (1839 - 1909) A physician, Success was getting the medical profession to recognise massage and it becoming an integral part of physical therapy. Introduced terminology of effleurage, petrissage, tapotement.

John Harvey Kellogg (1952 - 1943) A physician and health food pioneer. Used massage and hydrotherapy and wrote numerous books on massage. Devoted his life to Battle Creek Sanitarium which was the emergence of the health spa.

Emil Vodder (1896 - 1986) Pioneered lymphology using careful hand movements to stretch and twist the skin to promote lymph movement. Today this is called manual lymphatic drainage (Wikipedia, 2008).

James Cyriax (1904 - 1985) "Einstein" of Orthopaedic Medicine. He developed clinical reasoning and treatment strategy for soft tissue lesions in the musculoskeletal system (Physiodb.info 2007). In 1940 he popularised deep friction massage.

Janet Travell (1901 - 1997) An expert and leading pioneer in diagnosis and treatment of myofascial pain and understanding and working with trigger points.

The massage scandals of 1800 and the impact on the massage industry developed as massage become more popular and doctors did not have time to treat everyone for massage. Nurses were trained as well as non medical women. In England as massaged gain popularity there was an upsurge in supposed massage training schools that opened up. Poor women were encouraged into these and offered free training in exchange for future employment within the school clinics. These turned out to be houses for prostitution. This had a huge impact on massage as it was associated with prostitution and seen as a less respective form of healing. Massage parlours where established and continued to damage the reputation of massage. Advances in medical technology during the mid 1900 also led people to believe that healing with a knife or a pill was superior to the primitive methods of massage.

Comparison of Maori massage with western massage

Maori massage is traditional healing. Knowledge has been passed down through generations of healers. It treats the body, mind and spirit focusing on the emotional/spiritual root of the problem and incorporating physical massage along with energy work, herbal medicine and counselling. The physical side of the massage is traditional to western massage and the energy work is more traditional to eastern massage.

Miri Miri - Works on all 4 dimensions – physical, spiritual, family and mental health. Physical dimensions are similar to western relaxation massage.

Romi Romi - Very deep tissue body work massage using elbows, hands, knees, feet, sticks of wood and stones. Similar to western deep-tissue body work.

Development of professional massage in New Zealand started in 1894. The Society of Trained Masseuses was formed. By early 1900 there were over 300 massage therapists in New Zealand. The British Medical Association considered it important that adequate training was available and a massage department was established at Dunedin hospital in 1913. Massage was taught through Otago University and the Hospital. In 1946 this became the School of Physiotherapy. The Physiotherapy Act was established in 1949 and superseded the 1920 Masseurs Registration Act. To practise massage you had to adhere to the Physiotherapy Act and train for 600 hours. Physios did not want to do massage so the need for massage therapists increased.
In 1985 MINZI was formed and focused on education and standards of massage therapist with annual conferences for skill development. NZATMP was formed as a professional body in 1989 for the therapeutic massage profession focusing on educational standards, standards of professional image and increased public awareness of massage therapist. The name changed in the late 1990’s to TMA and focus to support and represent the needs of qualified therapists and be a voice for the massage industry. TMA and MINZI merged in 2007 to become MNZ.

Contemporary Massage is a growth industry. More employment options are available within the Spa industry and established massage clinics as well as working with health professionals and multi-disciplinary opportunities.
Education options are developing - Certificate in Relaxation, Diploma in Massage and Degrees are increasing the massage skill base.
Relaxation massage consisting of Swedish, Holistic, Reflexology, Energy work, Bowen technique, Hot stone therapy and Indian Head Massage.
Remedial bodywork consisting of Deep-tissue, Trigger-point therapy, Myofascial release and Lymphatic drainage.
Evolving techniques are Fascial work, Somatic work and interdisciplinary uptake.

The Philosophical approaches to massage of Body, Body -Mind and Body-Mind-Spirit and their relation to historical and cultural context previously discussed are:
Body - Western approach with focus on anatomy and physiology. If we do something to the body then we can predict what the result will be. Mind is not a factor as what you think about the therapy does not matter. Most forms of modern medicine work this way.

Body-Mind - How you think does affect your body. The set up of your clinic and your professional appearance affects the client's perception of you and the effectiveness of your treatment. Limited to within the clients own body and mind.

Body-Mind-Spirit - Thoughts, emotion and intention can affect other people. Relates to the holistic approach of eastern massage. Reiki uses energy flow in healing the body, uses the mind for distant healing and calls on spirit guides to assist. Intention is to heal without doing anything physical to the body.

My thoughts

Massage is a universal language - touch. No matter which culture, eastern or western, massage has had historical beginings and graduated from traditional techniques. It is easy to understand how rubbing relieves pain as we all do it when we hurt ourselves.
My own personal experiences in receiving eastern and western styles of massage such as Reiki, Hot stone therapy, Indian head massage, Swedish relaxation and remedial massage is that they have all assisted with managing pain and stress.
Both eastern and western massage techniques are being merged together today to obtain better results for the client.


Resources

Reiki Training
Class Notes McQuillan, D. (2009). Fundamentals of massage. Dunedin, New Zealand: Otago Polytechnic.
Internet
Pervious Learning
Text Books



References

East West Arts Institute Inc, 2008. History of Massage. Retrieved June 1, 2009 from http://www.acupressureschool.com/massage_history.html

Integrative touch and body works, 2005. A brief history of massage. Retrieved from http://itandb.com/history.htm

Physiobd.info (2007). Orthopaedic medicine. Retrieved June 6, 2009 from http://www.physiobd.info/pt-concepts/om/dr-james-cyriax.htm

Salvo, S. (2007). Massage therapy -principles and practice (3rd ed). Missouri, USA: Saunders

Wikipedia (2008), Emil Vodder . Retrieved June 6, 2009 from http://en.wikipedia.org/wiki/Emil_Vodder

Sustainable Massage practice

How principles of sustainability relate to massage practice

In massage practise today we need to consider the effect our business has on environment, social and economic sustainability and that we are not causing pollution to our environment, using health-damaging products, having industrial accidents, stressed employees with illness and exploiting labour (Inkson & Kolb, 1998).

Economic Sustainability

Economic sustainability in a massage business is not just about continually achieving economic growth each year. We need to understand that it is only sustainable if it also improves our quality of life and the environment. (NHS Purchasing and supply agency, 2009).

Initially setting up a massage business requires financial budgets to be completed. Income needs to exceed expenses so that the business is profitable. Cash flows need to be completed regularly to ensure this is maintain so income can be drawn to improve your quality of life.

When spending money, purchase New Zealand made equipment and materials. If New Zealand made products are unavailable, purchase imported products but do this through a New Zealand business. Use business partners that also have an environmental, social and economic focus.

Whenever possible spend locally to support local business. This has a flow on effect through the community to help other.

Social Sustainability

Social sustainability in a massage business will ensures that basic needs are being met to help human life to flourish (Ministry of Environment, 2009).

A business has a roll on effect from the owners who have a financial stake to clients and customer who use the products and services. Employees and contractors depend on the business for their livelihood, these people live in the community where the business is located as well as creditors, bankers and suppliers (Inkson & Kolb, 1998).

We need to maintain a work/life balance. To take time out from our paid work of massage to enjoy family and community activities for social, sports, religious or cultural occasions. With working from home it is sometimes harder finding that balance. You do not walk into your business at 9.00 and walk away at 5.00. Work eats into leisure time with such things as cleaning, washing and ironing as well as phone calls.

Providing a massage business maintains the physical, mental and social well being of your clients and the remainder of the community that decide to use your services.

Joining support networks and have relationships in the community - Women in Business, Lions Clubs and the local promotional group all have flow on effect to help the community.

Membership to Massage New Zealand gives opportunity for learning by attending conferences as well as making contacts within the massage network.

Provide safety for staff with a healthy work place. They will enjoy coming to work. Ensure massage tables are set up for staff safety and that staff have manageable workloads.

In New Zealand food is considered as an important element affecting health (Inkson & Kolb, 1998).

Have nutritional food available and provide cooking facilities in favour of processed snacks from vending machines or local cafe. Supply filtered water for drinking and encourage intake of fluids for staff and clients. A saving on heating water for coffee and tea.

Environmental Sustainability

Environmental sustainability in a massage business is the use of resources and the impact it has on the environment now and in the future so that we can ensure we are meeting the needs of people today but at the same time safeguarding the interest of future generations.

The main materials I use in massage are electricity and physical materials.

Electricity - heating my room and lighting. A thermostatically controlled heater and energy efficient lighting can be used to reduce power consumption. Turn everything off at the plug when not in use. Dry linen on clothes lines and use a dryer only in emergencies. Use a green electricity company to provide your power.

Physical materials - recycle paper by using both sides. Only print off what needs to be printed from a computer. Ink cartridges can be refilled. This is also a cheaper option than purchasing new ones.

Pay accounts by Internet banking which saves paper on envelopes and cheques, no postage cost, and also lower bank fees. Bank statements can be received electronically.

Use bio degradable washing detergent and hand wash.

When shopping for materials take environmental bags with you so you do need the plastic bags used today by many businesses.

How I can make my massage business more sustainable

To make my massage business more sustainable I plan to do the following:

Insulation put into ceiling to reduce heat loss. Wool may be the option. It is natural and is recyclable.

Use energy efficient light bulbs.

Use biodegradable rubbish bags.

Use time effectively - Have more clients in a day and make sure I don’t have gaps between clients thereby reducing the time worked which will save on electricity for lighting and heating.

Become a member of Massage New Zealand for social networking. Attend local promotional meetings for my community.

Additional thoughts

Make sure that what we are doing towards sustainability is not having a negative impact on other areas such as hygiene.

Rooms have to be warm for massage. Thermostats need to be set at a high enough temperature to maintain this. No point in using a lower temperature to save electricity and then have the room cold for the client.

The use of a green electricity supplier may be more expensive. You need to way up the economic viability compared to the environmental viability.

There is no way I am going to save the planet but if we can lead by example maybe the following generations will be more educated towards sustainability than the past generations have been.

Resources

Class notes
McQuillan, D. (2009). Ethics. Dunedin, New Zealand: Otago Polytechnic.

Experience in setting up my own business

Internet

Previous Learning

Text Books

References

Inkson, K & Kolb, D (1998). Management - perspectives for New Zealand. (2nd ed). New Zealand. Longman.

Ministry of Environment. (2009). Govt: towards sustainability practise. Retrieved May 22, 2009, from http://www.mfe.govt.nz/issues/sustainable-industry/govt3/topic-areas/social-sustainability/index.html

NHS Purchasing and Supply Agency. (2009). Economic sustainability. Retrieved May 21, 2009. from http://www.pasa.nhs.uk/PASAWeb/NHSprocurement/Sustainabledevelopment/Economicsustainability

The Ethics of Professional Practice

Ethical considerations are covered under a code of ethics. These are standards that cover conduct of a person or member of a profession. Integrity of professions relies upon these.

Ethics are about the relationship between the massage therapist who is the professional and the client. They come into effect each time the therapist and client come together for massage therapy.

In massage therapy ethics cover the following:

Client-centred care

As massage therapists we take responsibility for our clients comfort and safety and provide this by understanding their needs and rights. Legal requirements cover clients under the Privacy Act 1993, Consumer Guarantees Act 1993 and Health and Disability Consumers Act 1994.

The primary responsibility is for the health and safety of the client. Work must be carried out with due care and diligence (The health information network (n.d.).


We should serve the best interests of the client at all times, putting the client first and giving them the highest quality service. Focus on the best interests of the client and avoid any activity that takes the focus away. Therapeutic relationships with clear boundaries and good open communication will help to ensure that the client feels safe and attended too as we as build trust and respect. Involving the client in the decision making enables you to be aware of their goals and gain consent to the treatment discussed. This will ensure the massage is beneficial to the client.

Informed consent

Before any treatment takes place you need to obtain informed consent from the client. Your client needs to understand exactly what they are consenting too and what their rights are. Obtain feedback to reassure yourself that they understand. If working with a minor written consent from a parent may be appropriate.

You need to advise your client on the clinical procedure of your business such as the terms of payment - cash, cheque, eftpos, the cost of treatment, your scope of practise and your referral system to other professionals as well as the way in which you are going to proceed with the proposed treatment and the likely after effects of the treatment.

Scope of Practise

These are the parameters that you work within to provide massage treatment. It defines what services you can and cannot provide as a massage therapist (Salvo, 2007).

Training, experience, competency and qualifications will define your scope of practise. By understanding and working within your capabilities you are taking the safety of the client into account as well as feeling safe about what you are doing.

Confidentiality

Client information is confidential. It is only to be used for the purpose it is provided. All information should be locked in a cabinet or if held on a computer accessibility is only with a password. Only record information about client treatment not the personal thoughts or feelings that are discussed. Records can be requested by a court of law so they need to be accurate and legible. Information is only released to a third party after receiving written consent from the client. Leaving messages on answer phones can be another breach of confidentiality. Who clears the messages?

As client trust increases they will open up and talk more about their thoughts and feelings. This stays between the therapist and client. When a client talks about their personal problems at one session then it should be the client that brings this up in future sessions not the therapist. Situations and emotions change and a client may regret what was discussed.

If you meet with a client socially ensure that confidentiality is respected. Eye contact and a smile will acknowledge the person but anything more should be initiated by the client.

Boundaries

“Professional boundaries create a healthy, professional distance between the client and the therapist. In fact the distance makes the therapeutic relationship a safe place for the client’s experience” (Salvo 2007, p 28).

Boundaries clarify roles, responsibility, expectations, and limitations as well as creating and preserving safety in relationships. Boundaries may be changed by use of effective communication to reduce misunderstandings.

Power Differentials

The imbalance of power - i.e. the therapist is the professional and the client has a need, the client has come in for a treatment and the therapist has knowledge and skill to provide the treatment, the client lies down and the therapist stands over the client. These are not problems but would be if the power is misused by the therapist. In these situations the client cannot say no easily.

Situations should not be used to the advantage of the therapist such as when a client is in deep relaxation as the client may agree to something that they would not normally agree to.

Relationships

These have to be therapeutic or personal but not both. Therapeutic relationships are unequal as a power differential has formed. Having both of these relationships with a client can make maintaining boundaries difficult also the therapist is responsible for any negative consequences of these relationships. Professional relationships need to be closed off before starting personal relationships.

Transference and Counter-transference

Transference occurs when client’s feelings for a person that was of importance in their life are transferred to the therapist. Warning signs can be that people may be dependent on you, they may give personal gifts, invitations to social events or have unrealistic expectations. To deal with this you need to maintain clear boundaries, have regular supervision and consider referral of clients to other therapists.

Counter-transference is when the therapist tries to meet their personal need through a client and can also occur when the therapist finds it hard to maintain boundaries. Warning signs are attachment to a client and the desire for more than a therapeutic relationship. To deal with this you need to know how your personal needs are related to your client’s relationship and undertake regular supervision.

Further thoughts

To have a code of ethics is not enough. Therapists have to have their own ethics and morals to be able to uphold the professions code. These standards come from such things as our education, peer influences, life experiences as well as beliefs which have been embedded by our parents. They include such things as honesty, integrity, respect and loyalty. You need to have a caring attitude to be able to show understanding and empathy to the client as well as enjoying your job. This has to be genuine and cannot be taught, it needs to come from the heart of the therapist.

Resources

Previous Employment
Previous Learning
Text Books
Class Notes
Internet

References

Salvo, S. (2007). Massage therapy - principles and practice (3rd ed). Missouri, USA: Saunders Elsevier.

The health information network (n.d.), A massage introduction, 5. Retrieved May 23, 2009. From http://www.nzhealth.net.nz/massage/ethics.shtml

The Effect of Massage Strokes

The effects of massage on the Autonomic Nervous System

The Autonomic Nervous System is divided into two systems that have opposite effects on the body in stressful situations. The sympathetic nervous system which is the action division that speeds up body activity and the parasympathetic nervous system is the relaxation system that slows down body activity (Koslova-Fu, 2007).

The sympathetic nervous system serves all parts of the body and the parasympathetic nervous system serves the head and trunk.

Different situations can affect the effects of massage, such as the time of day it is being preformed, the therapist and how they are feeling and also if it is the first time the client has been massaged.

Depending on the strokes used, massage can have a stimulating or soothing effect on the nervous system. Applying vigorous manipulation, with light or heavy pressure such as compression, tapotement and vibrations will have a stimulating effect on the sympathetic nervous system. The slower, flowing, rhythmical strokes such as effleurage and petrissage are likely to have a stimulating effect of the parasympathetic nervous system.

The Effects of Massage

Different massage strokes have different effects on the body.

Touch/Holding - used at the start of a massage holding gives grounding for you and your client and at the completion of a massage confirms that contact is about to end . As this is the initial contact with the client it creates intention and trust. Touch is the only communication with the body and through this you recognise what is happening with the tissue. Touch can effect us physiologically, cognitively, psychologically, and emotionally. Jenni Fraser mentions touch as number 3 of 20 basic needs (Fraser, 2009). No wonder it effect us in so many ways.

Effleurage - induces relaxation and has a sedating effect on the skin. This is preformed with the whole palm and is applied with unbroken gliding movements that can be superficial or deep. Superficial movements used at the start of massage will prepare tissue for deeper massage and when preformed after deep massage it soothes the area. Also increases lymphatic and blood circulation while relieving tension. Effleurage can be preformed in any direction. Kris Proctor mentions transverse and longitudinal and explains the different effects they have on the tissue (Proctor, 2009).


Petrissage - is performed using kneading, knuckling, lifting, rolling pinching and wringing and will help to tone and relieve muscle fatigue by removing waste products from the tissues and increasing venous return of blood and oxygen.

Compression - is used for increasing circulation and warming tissue. By using compression on arteries and arterioles the flow of blood will stop. As the heart continues to pump pressure builds up behind the blockage. When compression is lifted larger amounts of blood rush forward warming the tissue. (Braun, Simonson, Howard & Sinclair, 2007).

Tapotement - comes in several different movements - hacking, cupping, pounding, which has a stimulating effect, helps to soften adipose tissue, increases sluggish circulation, stimulates sensory nerve endings and improves muscle tone and response. Used at the end of a massage it will awaken the body.

Vibration - are movements performed with fingers tips or hands that include shaking, quivering, trembling and rocking. Contact remains with the skin during these massage strokes. Vibrations stimulate nerve endings when they are coarse, and induce relaxation when they are fine. Circulation is increased, also accesses deeper structures and reduces trigger points.

Other Effects of Massage

Blood Flow - effleurage and petrissage manipulations increase the blood flow in the arteries causing the blood vessels to dilate. This causes blood pressure to decrease.

Lymph Flow - Lymphatic vessels form a one way system in which lymph flows towards the heart. Lymph flows depends on pressure from adjacent skeletal muscles and changes in pressure in the thorax when you breathe or apply pressure during massage. Massage promotes this circulation which increased elimination of waste products and toxins more effectively.

Muscle Tension - Increased blood circulation brings extra oxygen and nutrients as well as aiding removal of waste to muscles. Reduces fatigue, tones weakened muscles, muscles that are tense and shortened can be relaxed and stretched.

Connective Tissue - Promotes bone healing as massage increases circulation around a fracture. A network of blood vessels is formed at the site. Where the fracture occurs callus is formed between and around the broken ends. Cartilage is produced and spongy bone then starts forming which is then replaced by compact bone.

Sleep Patterns - Massage increases delta brain wave activity. These are linked to sleep and relaxation. Clients have mentioned that they have a deeper sleep especially if the massage is in the evening.

Digestion -Is controlled by the parasympathetic nervous system. When stimulated by massage digestion is activated and not interfered with by the sympathetic nervous system.

Blood Pressure - this is the pressure within the large systemic arteries of the body. Systolic pressure is the peak pressure as the pulse passes. Diastolic pressure is the pressure between pulses. These both decline with massage as the blood vessels dilate and blood pressure decreases.

Pain - Massage activates general relaxation which has a diminishing effect on pain. Pressure on a specific area being massage will relieve pain.

Mood - With the effects that massage has on all the systems of the body, mental health status and mood has got to improve.

Concentration - By relaxing body and mind massage increases mental alertness and academic performance.

Satiety - Satisfaction can be gained by massage as it increases levels of hormones such as dopamine which reduce levels of stress and depression and also decrease levels of hormones such as norepinephrine that increase stress. Therapeutic massage can also satisfy the emotional needs such as touch, caring and acceptance for the client.

Bonding - Satisfying emotional needs along with touch will form bonding between the therapist and client.

My experience of massage is mainly for relief of pain and this has always been achieved. The different strokes do have different effects on the body as mentioned above. At this stage I consider massage to be an on going treatment for me due to the type of work I do, my posture and the conditions I have. Specific exercises along with the treatments help give extended relief from pain.
It is quite amazing how it effects the entire body and that within one massage session you can feel so different after the massage than you did before it. I am convinced that reqular massage maintains a healthier body.

Resources

Previous Learning
Text books
Class notes
Internet

References

Braun, M.B., Simonson, S. J., Howard, D. C., & Sinclair, M. (2007). Introduction to massage therapy. Philadelphia: Lippincott Williams & Wilkins


Fraser, J. (2009). The effects of massage strokes. Retrieved April 14th, 2009, from http://jennifraser-healinghands.blogspot.com/


Koslova-Fu, V. (Ed.). (2007). Cressy's beauty therapy fact file. Australia: Elsevier.

Proctor, K. (2009). The effects of massage strokes. Retrieved April 14th, 2009 from http://krisprocter-massagetherapy.blogspot.com/

Hi all

Just though I better try adding a post so I know what I am doing for our assessment and also because I haven't made an appearance here yet like everyone else has. Talking about appearances I have added a photo to my blog of my husband and me which was taken recently.
Hope you are all getting to grips with your study.

Assessment task

My name is Sheryl Popham. I live at Goodwood in Otago. Have been working from home as a beauty therapist for the last 6 years. Am interested in studing massage so I can add this service to my business and have a recognised qualification. After I graduate I will continue running my business.