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backgrounder
Massage Therapy as CAM

Keywords: Swedish massage, deep tissue massage, trigger point massage, pressure point massage, shiatsu massage, vital energy

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Massage therapy is a practice that dates back thousands of years. There are many types of massagePressing, rubbing, and moving muscles and other soft tissues of the body, primarily by using the hands and fingers. The aim is to increase the flow of blood and oxygen to the massaged area. therapy; all involve manipulating the muscles and other soft tissues of the body. In the United States, massage therapyPressing, rubbing, and moving muscles and other soft tissues of the body, primarily by using the hands and fingers. The aim is to increase the flow of blood and oxygen to the massaged area. is sometimes part of conventional medicineMedicine as practiced by holders of M.D. (medical doctor) or D.O. (doctor of osteopathy) degrees and by their allied health professionals such as physical therapists, psychologists, and registered nurses.. 1In other instances, it is part of complementary and alternative medicine (CAM)A group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. Complementary medicine is used together with conventional medicine, and alternative medicine is used in place of conventional medicine..2 This Backgrounder provides a general overview of massage therapy used as CAM and suggests some resources you can use to learn more.

1 Conventional medicine is medicine as practiced by holders of M.D. (medical doctor) and D.O. (doctor of osteopathy) degrees and by their allied health professionals, such as physical therapists, psychologists, and registered nurses. An example of massage therapy as conventional medicine is using it to reduce a type of swelling called lymphedema.

2 CAM is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. While some scientific evidence exists regarding some CAM therapies, for most there are key questions that are yet to be answered through well-designed scientific studies. An example of massage therapy as CAM is using it with the intent to enhance immune system functioning.

Key Points

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What Massage Therapy Is

The term massage therapy (also called massage, for short; massage also refers to an individual treatment session) covers a group of practices and techniques. There are over 80 types of massage therapy. In all of them, therapists press, rub, and otherwise manipulate the muscles and other soft tissues of the body, often varying pressure and movement. They most often use their hands and fingers, but may use their forearms, elbows, or feet. Typically, the intent is to relax the soft tissues, increase delivery of blood and oxygen to the massaged areas, warm them, and decrease pain.

A few popular examples of this therapy are as follows:

Massage therapy (and, in general, the laying on of hands for health purposes) dates back thousands of years. References to massage have been found in ancient writings from many cultures, including those of Ancient Greece, Ancient Rome, Japan, China, Egypt, and the Indian subcontinent.

In the United States, massage therapy first became popular and was promoted for a variety of health purposes starting in the mid-1800s. In the 1930s and 1940s, however, massage fell out of favor, mostly because of scientific and technological advances in medical treatments. Interest in massage revived in the 1970s, especially among athletes.

More recently, a 2002 national survey on Americans' use of CAM (published in 2004) found that 5 percent of the 31,000 participants had used massage therapy in the preceding 12 months, and 9.3 percent had ever used it. According to recent reviews, people use massage for a wide variety of health-related intents: for example, to relieve pain (often from musculoskeletal conditions, but from other conditions as well); rehabilitate sports injuries; reduce stress; increase relaxation; address feelings of anxiety and depression; and aid general wellness.

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Who Provides Massage Therapy

A person who professionally provides massage therapy is most often called a massage therapist, although there are some other health care providers (such as chiropractors) who also have massage training. This Backgrounder mainly uses the term massage therapist. Most massage therapists learn and practice more than one type of massage.

To learn massage, most therapists attend a school or training program, with a much smaller number training instead with an experienced practitioner. Many students are already licensed as another type of health care provider, such as a nurse.

There are about 1,300 massage therapy schools, college programs, and training programs in the United States. The course of study typically covers subjects such as anatomy and physiology (structure and function of the body); kinesiology (motion and body mechanics); therapeutic evaluation; massage techniques; first aid; business, ethical, and legal issues; and hands-on practice of techniques. These educational programs vary in many respects, such as length, quality, and whether they are accredited. Many require 500 hours of training, which is the same number of hours that many states require for certification. Some therapists also pursue specialty or advanced training.

At the end of 2004, 33 states and the District of Columbia had passed laws regulating massage therapy--for example, requiring that massage therapists graduate from an approved school or training program and pass the national certification exam in their field in order to practice. Cities and counties may have laws that apply as well. Professional organizations of massage therapists have not agreed upon the standards for recognizing that a massage therapist is properly and adequately trained.

Licenses and Certifications

Licenses or certifications for massage therapists include:

  • LMT          Licensed Massage Therapist
  • LMP          Licensed Massage Practitioner
  • CMT          Certified Massage Therapist
  • NCTMB     Has met the credentialing requirements (including
                       passing an exam) of the National Certification
                       Board for Therapeutic Massage and Bodywork,
                       for practicing therapeutic massage and bodywork
  • NCTM        Has met the credentialing requirements (including
                       passing an exam) of the National Certification
                       Board for Therapeutic Massage and Bodywork,
                       for practicing therapeutic massage

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What Massage Therapists Do in Treating Patients

Massage therapists work in a variety of settings, including private offices, hospitals, other clinical settings, nursing homes, studios, and sport and fitness facilities. Some also travel to patients' homes or workplaces to provide a massage.

Massage therapy treatments usually last for 30 to 60 minutes; less often, they are as short as 15 minutes or as long as 1.5 to 2 hours. For some conditions (especially chronic ones), therapists often advise a series of appointments. Therapists usually try to provide an environment that is as calm and soothing as possible (for example, by using dim lighting, soft music, and fragrances).

At the first appointment, a massage therapist will discuss your symptoms, medical history, the results you (and your health care provider, if applicable) desire, and possibly other factors such as your work and levels of stress. She will likely perform some evaluations through touch. If she finds nothing that would make a massage inadvisable, she will proceed with the massage. At any time, you can bring up questions or concerns.

During treatment, you will lie on a special padded table or sit on a stool or chair. You might be fully clothed (for example, for a "chair massage") or partially or fully undressed (in which case you will be covered by a sheet or towel; only the parts of your body that the therapist is currently massaging are exposed). Oil or powder helps reduce friction on the skin. The therapist may use other aids, such as ice, heat, fragrances, or machines. He may also provide recommendations for self-care, such as drinking fluids, learning better movement, and developing an awareness of your body.

Why People Use Massage Therapy

In the 2002 national survey on Americans' use of CAM, respondents who used a CAM therapy could choose from five reasons for using the therapy. The results for massage were as follows:

  • They believed that massage combined with conventional medicine would help: 60 percent
  • They thought massage would be interesting to try: 44 percent
  • They believed that conventional medical treatments would not help: 34 percent
  • Massage was suggested by a conventional medical professional: 33 percent
  • They thought that conventional medicine was too expensive: 13 percent

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Side Effects and Risks

Massage therapy appears to have few serious risks if appropriate cautions are followed. A very small number of serious injuries have been reported, and they appear to have occurred mostly because cautions were not followed or a massage was given by a person who was not properly trained.

Health care providers recommend that patients not have massage therapy if they have one or more of the following conditions:

If you have one or more of the following conditions, be sure to consult your health care provider before having massage:

Side effects of massage therapy may include:

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Some Other Points To Consider About Massage Therapy as CAM

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How Massage Therapy Might Work

Scientists are studying massage to understand what effects massage therapy has on patients, how it has those effects, and why. Some aspects of this are better understood than others. For example, it is known that:

There are many more aspects that are not yet known or well understood scientifically, however. Some of the proposed theories 3 are that massage:

More well-designed studies are needed to understand and confirm these theories and other scientific aspects of massage.

3 On this topic, see especially the reference by C.A. Moyer et al.

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NCCAM-Sponsored Research on Massage

Some recent examples of NCCAM-sponsored research on massage include:

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References

Sources are primarily recent reviews on the general topic of massage therapy in the peer-reviewed medical and scientific literature in English in the PubMed database, selected evidence-based databases, and Federal Government sources.

Alvarez DJ, Rockwell PG. Trigger points: diagnosis and management*. American Family Physician. 2002;65(4):653-660.

Barnes PM, Powell-Griner E, McFann K, Nahin RL. Complementary and alternative medicine use among adults: United States, 2002.* CDC Advance Report #343. 2004.

Cherkin DC, Sherman KJ, Deyo RA, et al. A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal manipulation for back pain*. Annals of Internal Medicine. 2003;138(11):898-907.

Corbin L. Safety and efficacy of massage therapy for patients with cancer.* Cancer Control:Journal of the Moffitt Cancer Center. 2005;12(3):158-164.

Dillard MH, Knapp S. Complementary and alternative pain therapy in the emergency department*. Emergency Medicine Clinics of North America. 2005;23(2):529-549.

Eisenberg DM, Cohen MH, Hrbek A, et al. Credentialing complementary and alternative medical providers*. Annals of Internal Medicine. 2002;137(12):965-973.

Ernst E. The safety of massage therapy*. Rheumatology. 2003;42(9):1101-1106.

Field T. Massage therapy effects*. American Psychologist. 1998;53(12):1270-1281.

Goldstone LA. Massage as an orthodox medical treatment past and future*. Complementary Therapies in Nursing and Midwifery. 2000;6(4):169-175.

Massage: Bottom Line Monograph. Natural Standard Web site. Accessed on August 22, 2006.

Massage Therapists: Occupational Outlook Handbook, 2006-2007 Edition. U.S. Bureau of Labor Statistics Web site. Accessed at http://www.bls.gov/oco/ocos295.htm on August 22, 2006.

Moyer CA, Rounds J, Hannum JW. A meta-analysis of massage therapy research*. Psychological Bulletin. 2004;130(1):3-18.

National Center for Complementary and Alternative Medicine. Manipulative and Body-Based Practices: An Overview. Bethesda, MD: National Center for Complementary and Alternative Medicine; 2004. NCCAM publication no. D238.

National Institute of Arthritis and Musculoskeletal and Skin Diseases. Osteoarthritis. Bethesda, MD: National Institute of Arthritis and Musculoskeletal and Skin Diseases; 2006. NIH publication no. 06-4617.

National Institute of Arthritis and Musculoskeletal and Skin Diseases. Osteoporosis: Coping With Chronic Pain. National Institute of Arthritis and Musculoskeletal and Skin Diseases Web site. Accessed at http://www.niams.nih.gov/bone/hi/osteoporosis_pain.htm on August 31, 2006.

Sherman KJ, Cherkin DC, Kahn J, et al. A survey of training and practice patterns of massage therapists in two U.S. states*. BioMed Central Complementary and Alternative Medicine. 2005;5:13.

Weerapong P, Hume PA, Kolt GS. The mechanisms of massage and effects on performance, muscle recovery and injury prevention*. Sports Medicine. 2005;35(3):235-256.

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For More Information

NCCAM Clearinghouse

The NCCAM Clearinghouse provides information on CAM and NCCAM, including publications and searches of Federal databases of scientific and medical literature. Examples of relevant publications include Manipulative and Body-Based Practices: An Overview, Selecting a CAM Practitioner, and Conference on the Biology of Manual Therapies, June 9-10, 2005: Conference Recommendations. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.

Toll-free in the U.S.: 1-888-644-6226
TTY (for deaf and hard-of-hearing callers): 1-866-464-3615
Web site: nccam.nih.gov
E-mail: info@nccam.nih.gov
Address: NCCAM Clearinghouse, P.O. Box 7923, Gaithersburg, MD 20898-7923

Fax: 1-866-464-3616

CAM on PubMed®

A service of the National Library of Medicine (NLM), PubMed contains publication information and (in most cases) brief summaries of articles from scientific and medical journals. CAM on PubMed, developed jointly by NCCAM and NLM, is a subset of the PubMed system and focuses on the topic of CAM.

Web site: www.ncbi.nlm.nih.gov/entrez
Web site: http://nccam.nih.gov/camonpubmed/

Acknowledgments

NCCAM thanks the following people for their technical expertise and review of this publication: Karen Sherman, Ph.D., M.P.H., Center for Health Studies, Group Health Cooperative; Jeanette Ezzo, Ms.T., M.P.H., Ph.D., National Advisory Council for Complementary and Alternative Medicine; and Partap Khalsa, D.C., Ph.D.; Richard Nahin, Ph.D., M.P.H.; and Linda Rich, M.P.S., C.M.T., NCCAM.

This publication is not copyrighted and is in the public domain. Duplication is encouraged.

NCCAM has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your primary health care provider. We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy is not an endorsement by NCCAM.

NCCAM Publication No. D327
Created: September 2006

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