Fundamentals - Task 6

Historical, Cultural and Physiological Approaches to Massage
By Suzanne Cunningham


The history of massage goes back thousands of years. According to Beck (1999), there are records in the British Museum that show the Chinese practiced massage as early as 3000 B.C. Massage has had an interesting past and survived the rise and fall of many civilisations across many cultures. This essay will attempt to encompass just some of the cultural and spiritual diversities, the historical personalities that were influential in its development, along with some more recent events which have shaped the modern day approach to massage.

As mentioned, the Chinese are one of the oldest cultures to have recognised the value of massage and continued to use it throughout the centuries. Over time two very different traditional approaches to massage developed which have been simplistically described as Eastern and Western methods. In his Elluminate session, McQuillan (2009) advises that traditionally the Eastern method has included the physical approach and the concept of the energetic pathways which run within the body. It is a very spiritual and holistic approach to massage, where the body is addressed as a whole to include the spiritual, emotional, psychological and physical aspect of an individual. He goes on to say that it includes the rubbing and pressing of points that relate to the energy flow in different areas of the body. It is a very hands-on technique, usually without the use of lubricants and more about compression and stretching. In comparison, the Western method has been around since at least 460 B.C., and although it has come from the traditional Eastern techniques, it has evolved on a more physiological and scientific pathway. This method typically focuses only on the tissues of the body rather than including holistic balance in the equation.

The development of the Western tradition as we know it today has had many interesting historical milestones, each one spearheaded by a medical leader of their time. The most notable is Hippocrates (460-377 BC) – often referred to as the “Father of Medicine” (Beck, 1999, p. 7). Hippocrates was a Greek physician and according to Wikipedia (2009) he is recognised as being the first doctor to openly disagree with the belief that illness was a punishment from the Gods and declare that it was due to the persons environment, diet and living habits. Unfortunately, due to a taboo on the dissection of humans, much of his anatomy and physiology was incorrect but “…he was the first physician in Greek medicine to specifically describe the medical benefits of anointing and massage…” (Fritz, 2009, p. 14). He identified that massage could have a variety of effects depending on the strokes used. The most widely recognised translated quote is in regards to the ability of stimulating strokes to “…bind a joint that is too loose…” (McQuillan, 2009), and for relaxation type strokes to have the opposite effect. Many of Hippocrates theories and techniques remained almost unchanged until the Middle Ages, and many similar methods are still used today (Fritz).

The next major change on the evolution of massage was brought about by another Greek physician, Galen (130-201 AD). As he was able to perform human dissection, Galen was a leader in the development of anatomy and physiology and was able to use the work of Hippocrates and expand on it. Beck (1999) advises that Galen wrote many books in regards to his findings which were used for over a thousand years and that “His books on hygienic health, exercise and massage stressed the importance of massage and passive and active exercises for various physical disorders” (Beck, p. 8). Unfortunately after this time, medical, and therefore massage, advancement was limited by the unrest of the Dark Ages until the Renaissance (1450-1600). Massage was brought out from what Fritz (2009) refers to as “folk culture” (p. 14) and began to be recognised again for its medical value.

Per Henrik Ling (1776-1839) of Sweden continued the anatomical and physiological evolution of Western style massage. He “used physiological principles to explain the use of exercise and massage” (McQuillan, 2009), and this was so successful that he opened a school and treatment programme which incorporated his specialised active movements, passive movements, duplicated movements and massage with the focus of treatment of disease and injury. Salvo (2007) explains that Ling had many medical physicians attend his school and they were convinced of the value massage and exercise added to the practice of medicine. This system went on to become well known as the Ling System, or Swedish Movements. Unfortunately, due to his lack of medical training, there were some unwilling to embrace Ling’s teachings.

In more “recent” times, there have been some notable advancements in the understanding and acceptance of massage due to the passion of a range of people. Johann Mezger (1817-1893) was a Dutch physician who by being a doctor was able to have more of an influence on the medical and scientific acceptance of massage than Ling. In addition, “He has also been credited with the introduction of the still-used French terminology to the massage profession (e.g., effleurage, petrissage, tapotement)” (Salvo, 2007, p. 8)). Salvo also mentions the American, John Kellogg (1852-1943), who through his books and articles that were made available to the general public, he was able to increase the popularity of massage in the United States.

As more anatomical and physiological knowledge became available, different massage tools evolved that are still used today. Lymphatic drainage was developed by Austrian, Dr Emil Vodder, while American, Dr Janet Travell, pioneered work in myofascial pain, leading on to trigger points. Beck (1999) tells us about Dr James Cyriax, “…an English orthopaedic surgeon who is credited with popularising Deep Transverse Friction Massage.” He also is credited with developing the Range Of Movement assessment to identify where there are areas that are not working properly. All of these were major breakthroughs of their time and have become invaluable tools for healing and maintaining physical health.

Each culture has their own methods when approaching massage, this includes the New Zealand Maori. The methods of Miri Miri and Romi Romi have deep connections to the Eastern and Polynesian methods. Miri Miri is more holistic than the Western physiological approach, connecting physical health with spiritual, family and mental health, aiming for a balance of all for optimum well being. McQuillan (2009) tells us that this is a similar concept to our Western version of relaxation and energy work, but it adds spiritual healing and family connections. He goes on to say that Romi Romi is the same as Western deep tissue bodywork, using a range of tools such as elbows, hands, knees, feet, special sticks, stones and seawater.

Like any industry, there are always the few who ruin it for the majority. One of the big scandals occurred in England during the late 1800’s. Fritz (2009) tells us that “in a very real sense, massage was the victim of its own success” (p. 16), and the scandal that erupted “…eroded the publics and the medical professions confidence in massage as a legitimate medical art” (p. 16). Simply put, as massage became increasingly popular, there were many who tried to make a profit by providing inadequate training at an exorbitant cost, therefore flooding the market with poorly skilled therapists who were carrying a huge personal debt. This resulted in many turning to prostitution, under the banner of massage. Some businesses also made outrageous claims regarding the benefits of massage which, when not substantiated, further reduced the good-will of the public and the medical professions. Faith began to be restored when societies and associations began to form which set boundaries which included prerequisites for study, and the passing of written and clinical exams after being taught by trained teachers in approved schools that were regularly inspected (McQuillan, 2009).

The evolution of societies and associations was mirrored in the evolution of massage in New Zealand at the turn of the 20th Century. According to class notes from McQuillan (2009), there were over 300 massage therapists in the 1900’s and massage was taught at the University of Otago and Dunedin Hospital from 1913-1946. In 1947 this changed to become the School of Physiotherapy and massage became regulated under the Physiotherapy Act in 1949. Over time, physiotherapists moved away from massage, presumably due to the increased conservatism of the 1950’s and the ongoing scandals regarding prostitution. Also, massage was a reasonably time consuming technique and physiotherapy was moving towards a more hands-off, quick turnover approach. During this time it was illegal to practice massage if you were not a physiotherapist, which was considered ridiculous considering the way physiotherapy had evolved. The Massage Parlours Act of 1978 enabled massage therapists to work legally provided they worked in Massage Parlours (in the true sense of the word). In 2003 the Healthcare Practitioners Competency Assurance Act went on to replace this.

In the 1980’s there proved to be a need for a uniting body for massage therapists and the in 1985 the Massage Institute of New Zealand (MINZI) was formed. This was the first professional association for massage since it was separated from physiotherapy, and it focused on the education of therapists, set standards for teachers and held annual conferences for skill development.

In 1989 the New Zealand Association of Therapeutic Massage Practitioners (NZATMP) was also established. It had a strong focus on educational standards and how to raise them, professionalism and increasing the public awareness of massage. It went on to have a name change in the late 1990’s – Therapeutic Massage Association (TMA). During this time it created a new membership structure and had a change of focus towards supporting and representing the needs of qualified therapists, while being a voice for the massage industry. In 2006 MINZI and TMA joined to form Massage New Zealand, sharing common goals and motivations.

Medical advancements have had an enormous impact on the massage industry. Contemporary massage has developed a range of techniques that although they may have been available in the past, they are now becoming more understood and utilised. These techniques are often referred to as bodywork. Many are taken from the breakthroughs made by Cyriax (cross fibre friction massage), Vodder (lymphatic drainage), plus other developments such as Rolfing (Ida Rolf 1896-1979) and trigger points/myofascial pain (Travell). The main model currently used in New Zealand is orthopaedic massage, which we refer to as remedial massage.

Having said that, there are still many who treat the body as more than just a machine to be kept well oiled. The body approach focuses on the body and the effects that massage will have on it – very much a “cause and effect approach” (McQuillan, 2009). This is very strongly linked to the scientific and physiological approach of western medicine. However, it is becoming more widely accepted and understood that at the very least the mind needs to be included as an important factor. It is widely understood that the mind is our most powerful tool. The way you think can affect the body and therapists who use the body-mind approach need to consider this on many levels. For example, the way a therapist portrays themselves and their business environment is an important tool for putting a client at ease and promoting faith and trust in their therapists abilities, which can impact on the effectiveness of the treatment. Some may call this the placebo effect, but that in itself helps to support the importance the mind plays in the well being of the body.

The Body-mind-spirit approach is the next dimension and very much along the lines of the traditional Eastern methods of chi and energy flow. There are many different methods of incorporating the spirit be it praying, meditating or intention. This is a very subtle tool, but those who believe in it consider it to be a key factor in a truly successful massage.

Massage has had a very long and bumpy journey in its evolution. There are still so many diverse aspects to massage that we can never truly know them all, but it is thanks to the courage and passion of the early physicians that we can have a greater understanding of the physiological effects of what we do in our Western style of massage. Diversity is the colour of life, so by having some understanding of other cultural and philosophical approaches, such as the Eastern traditions, we are able to make ourselves more open and rounded in our own philosophies. In addition, we can also hopefully learn lessons from the mistakes of others, so we can move forward in a moral and ethical way to be the best we can be for ourselves, our clients and the massage industry.


References

Beck, M. F. (1999). Milady’s theory and practice of therapeutic massage (3rd ed.). New York: Milady Publishing.

Fritz, S. (2009). Mosby’s fundamentals of therapeutic massage (4th ed.).St Louis: Mosby, Elsevier

McQuillan, D. (2009). Fundamentals of massage. Dunedin, New Zealand: Otago Polytechnic

McQuillan, D. (2009, May 21). Fundamentals of massage: Retrieved June 2, 2009 from http://elluminate.tekotago.ac.nz/play_recording_confirmation.html

McQuillan, D. (2009, June 4). Fundamentals of massage Retrieved June 5, 2009 from http://elluminate.tekotago.ac.nz/play_recording_confirmation.html

Salvo, S. G. (2007). Massage therapy: principles and practice (3rd ed.). St Louis: Saunders, Elsevier

Wikipedia. Retrieved June 2, 2009 from http://en.wikipedia.org/wiki/Hippocrates