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Complementary & Alternative Medicine
Index Of Alternative Therapies And Modalities
When deciding to begin a complementary therapy or to see a complementary practitioner, first speak with your primary health care provider.
Before engaging in any complementary medical technique, you should be aware that many of these techniques have not been evaluated in scientific studies. Often, only limited information is available about their safety and effectiveness. Each state and each discipline has its own rules about whether practitioners are required to be professionally licensed. If you plan to visit a practitioner, it is recommended that you choose one who is licensed by a recognized national organization and who abides by the organization's standards. It is always best to speak with your primary health care provider before starting any new therapeutic technique.
Massage techniques have been practiced for thousands of years in many cultures. There are references to massage in ancient records of Chinese, Japanese, Arabic, Egyptian, Indian, Greek and Roman nations.
Massage spread throughout Europe during the Renaissance period. In the 1800s, Per Henrik Ling (17761839) developed Swedish massage, a combination of massage and gymnastic exercises. George and Charles Taylor, two physicians who studied in Sweden, introduced massage therapy to the United States in the 1850s. By the early 1930s, massage became a less prominent part of American medicine because of increased focus on the biological sciences. Interest increased in the 1970s, when massage became popular among athletes as a therapy to help heal injuries and reduce pain. People were also using therapy as a way to improve well-being, help with relaxation, relieve stress relief, and enhance sleep and quality-of-life.
There are many types of therapy. Most involve the use of fixed or moving pressure on the muscles and soft tissues. Practitioners may use their hands, forearms, elbows, or feet with or without lubricants, such as oils, to improve the smoothness of massage strokes. Touch is central to massage. It allows therapists to locate painful or tense areas, to determine how much pressure to apply, and to establish a therapeutic relationship with clients.
Swedish massage involves several techniques:
- Effleurage Superficial stroking in a direction away from the heart or deep stroking toward the heart
- Friction Deep muscle stimulation using the palm, elbow and forearm
- Petrissage Kneading in a circular pattern using the fingers and thumbs, as a way to improve circulation and stimulate muscle tissues
- Tapotement Rhythmic movements, such as slapping or tapping, to stimulate the muscles. This technique is often used for athletes before competitions.
- Vibration This technique is delivered by the therapist's hands or by an electric vibrator.
There are many other massage approaches used throughout the world. Examples include:
- Aromatherapy massage uses essential oils with the goal of enhancing healing and relaxation.
- Bindegewebsmassage focuses on connective tissues between the skin and muscles. It is based on the theory that some health problems are caused by imbalances in these tissues.
- Classical massage is used to help people feel calm and relaxed. It is also used to encourage self-healing and revitalization.
- Craniosacral therapists strive to locate and realign imbalances or blockages that are thought to exist in the soft tissues or fluids of the back and head.
- Deep tissue massage uses slow strokes, friction, and direct pressure across the muscles with the fingers, thumbs, or elbows. Often, the goal of this therapy is to improve long-lasting muscular tension.
- Esalen massage focuses on generating a deep state of relaxation. It is often combined with other forms of massage.
- Ice massage has been studied for knee osteoarthritis, exercise-induced muscle damage and labor pain, with inconclusive results.
- Jin Shin Do involves applying finger pressure to acupoints of the body to release muscular tension or stress.
- Manual lymph drainage uses light, rhythmic strokes as a way to improve lymphatic flow and reduce swelling or nerve problems (called neuropathy).
- Myofascial release may be used by physical therapists, chiropractors or massage therapists. This approach involves gentle traction, pressure and body positioning to relax and stretch soft tissues.
- Neuromuscular massage, triggerpoint massage and myotherapy are forms of deep massage that are performed on specific muscles or nerve points. These therapies are used to release trigger points or entrapped nerves and to relieve pain.
- On-site or chair massage is administered to the upper body of fully clothed clients.
- Physiotherapy is performed to help stabilize the lower back in a flexed posture and to increase overall physical fitness.
- Polarity treatment is based on the concept that rebalancing the body's energy fields with gentle massage may improve health and well-being.
- Reflexology aims to return the body to its natural balance by targeting certain areas on the feet or ears that are thought to correspond to specific body parts.
- Rolfing® structural integration involves deep tissue massage. The goal is to relieve stress as well as improve mobility, posture, balance, muscle function and efficiency, energy, and overall well-being.
- Shiatsu emphasizes finger pressure at acupoints and along the body's meridians. This type of massage may incorporate palm pressure, stretching, and other manual techniques.
- Sports massage is similar to Swedish massage, except is adapted specifically for athletes.
- St. John's neuromuscular technique may be used for long-lasting pain conditions that involve the muscles and bones.
- The Trager approach involves relearning patterns of movement to improve efficiency and well-being.
- Tibetan massage may be performed on many different areas of the body, based on the practitioner's judgment of the patient's energy flow.
Many other styles of massage exist, and many therapies are specific to certain regions of the world.
Most massage approaches involve the client lying face down on a platform or table with a sheet covering the lower body. Depending on the technique, sessions may last 15 to 90 minutes. Many clients fall asleep during therapy. The environment is considered important. Massage therapy is usually performed in a comfortable, warm, quiet location. Soothing, repetitive, low-volume music or sounds may be played in the background. Massage therapy may be performed in a therapist's home, a private practice office, a hospital, spa, athletic club, hair salon, hotel, airport, or outdoors. Some practitioners will travel to a client's home or office. Sports massage may be administered in a gym or locker-room setting.
In the United States, licensure requirements for massage therapists vary from state to state. Some practitioners are licensed as nurses, physical therapists, massage therapists, or other types of healthcare professionals. Some have attended extensive programs that grant professional degrees. However, many massage practitioners are not licensed, and national or international organizations have not agreed on standards. The International Therapy Examinations Council offers testing in this area.
Patients who are seeking massage therapists for medical reasons are encouraged to discuss the choice of massage practitioner with their primary health care providers. References and training history should be checked before starting a therapeutic program.
There are many theories about how massage may work, although none has been scientifically proven. There is limited research in this area. It is suggested that massage may have local effects on muscles and soft tissues, reduce swelling, soften or stretch scar tissue, reduce the buildup of lactic acid in muscles, stimulate oxygenation of tissues, break up scar tissue, cause muscle relaxation, and improve the healing of soft tissues or damaged muscles. Other proposed effects include immune system enhancement, reduction of blood pressure, central nervous system relaxation and sedation, parasympathetic stimulation, blockage of sensations from nerves that sense pain (the "gate theory"), stimulation of blood and lymphatic circulation, decreases in heart rate, increases in skin temperature, endorphin release, changes in hormone levels (such as cortisol), stimulation of substance P release, stimulation of somatostatin release, sleep enhancement, or removal of blood toxins. Practitioners suggest that Swedish massage may help the body deliver nutrients and remove waste products from tissues.
There is little high-quality research of massage. Scientifically based conclusions about the effectiveness of massage cannot be drawn at this time for any health condition.
Scientists have studied massage for the following health problems:
Massage may help reduce aggressive behavior in adolescents, but there is currently not enough evidence to make recommendations. More studies are needed.
Massage shows promise as a treatment for alcohol dependence when it is combined with traditional medical detoxification programs. Further research is needed to confirm these results.
Several trials have tested massage in people with anxiety. Studies have focused on patients with agitation, cancer, long-lasting illnesses, headache, dementia, multiple sclerosis, fibromyalgia, anxiety, stress, depression, or premenstrual syndrome. It has also been used before or during medical procedures. However, better studies are needed to make a recommendation.
Arthritis (rheumatoid, osteoarthritis)
Massage may benefit children with rheumatoid arthritis, but there is currently not enough scientific data to make recommendations.
There is promising early evidence that massage may improve lung function in children with asthma. Better research is necessary to make a firm conclusion.
Massage administered by parents may help children with atopic dermatitis. More studies are needed before recommendations can be made.
Massage may help improve sleep patterns and behavior, as well as induce relaxation, in autistic patients. However, there is currently not enough data to make a firm conclusion.
Several studies in humans report that various types of massage may reduce low-back pain. However, better research is needed.
Bone marrow transplantation
Massage may modestly improve the psychological well-being among bone marrow transplant recipients. More studies are needed.
Burn and wound care
There is some evidence from one small study that massage may reduce stress in burn patients.
Cerebral palsy (spastic diplegia in adolescents)
Early evidence suggests that calf massage may help treat children with spastic diplegia, a form of cerebral palsy. However, more study is needed.
Chemotherapy-induced nausea and vomiting
Massage has been used to treat nausea, anxiety, and depression in patients with breast cancer who are undergoing chemotherapy. Massage may help nausea, but effects on anxiety and depression in these patients are unclear.
A small number of studies report that abdominal massage may be helpful in patients with constipation. Overall, these studies are not well designed or reported. Better-quality research is needed to make a recommendation.
Critical illness (intensive care unit patients)
Limited evidence suggests that simple massage techniques in the intensive care unit (ICU) may help reduce stress and improve mood. More studies are needed.
Early evidence suggests that parent-administered massage may improve mood and air flow in children with cystic fibrosis.
Musculoskeletal conditions (chronic pain)
Early research reports that massage may help relieve long-lasting pain. Soft tissue massage may also improve range of motion and function. Further well-designed research is needed to confirm these results.
Several studies have used massage (with or without essential oils) in patients with dementia. Early evidence suggests that aromatherapy with essential oils may reduce agitation in patients with dementia, although the effects of massage itself are not clear.
There is not enough scientific information to conclude if massage is helpful in patients with major depressive disorder, situational mood disorder, critical illness, pregnancy, or postpartum depression (including infant massage).
Massage may play help enhance the sensitivity and diagnostic ability of lymphatic mapping in breast cancer patients.
There is early evidence that parental massage of children with diabetes may improve blood sugar levels and symptoms. There is also some evidence that self-massage of injection sites may increase insulin absorption.
Sunflower therapy, which includes applied kinesiology, physical manipulation, massage, homeopathy, herbal remedies and neuro-linguistic programming, has been studied for childhood dyslexia. Although initial research appears promising, additional studies are needed to make a firm recommendation.
Several studies of weak design suggest that massage may improve muscle soreness after exercise. However, there is not enough data to form conclusions.
Several studies report that massage may improve pain, depression, and quality of life in patients with fibromyalgia. Additional research is necessary to form a recommendation.
Hand grip strength
There is not enough evidence to determine if massage can help improve hand grip strength. Early study results conflict.
High blood pressure
Based on early research, massage may decrease blood pressure in patients with high blood pressure. More studies are needed.
Evidence is limited and mixed as to whether massage may improve immune functioning or health services utilization in HIV patients.
Hypoxia (lack of oxygen)
Limited study suggests that massage may help children recover from central nervous system damaged caused by a lack of oxygen. More research is needed.
Iliotibial band friction syndrome
There is not enough scientific information to conclude if massage is helpful in patients with iliotibial band friction syndrome, a painful tendonitis of the lower leg that occurs in athletes, especially joggers or runners.
Early research reports that massage may improve anxiety, depression, self-esteem, body image, and social functioning in patients with multiple sclerosis. Benefits on the disease process itself have not been well studied. Additional research is necessary to make a firm conclusion.
Infant development/neonatal care
Therapists or mothers sometimes use massage in pre-term infants as a way to improve infant development and weight gain. Although several studies are reported, it remains unclear if this is a beneficial therapy.
There is currently not enough scientific evidence available to determine if massage is an effective therapy for migraine.
Early evidence suggests that massage may reduce the number and intensity of painful trigger points. More studies are needed.
Massage that is limited to specific areas of the body may help reduce neck or shoulder pain. It remains unclear if massage itself is effective.
Early scientific evidence suggests that people with Parkinson's disease might have reduced symptoms after massage. More studies are needed.
Several massage approaches have been used after surgery with the aim of improving recovery and decreasing pain. Better research is needed to make a firm conclusion.
Pregnancy and labor
Massage approaches are sometimes used during pregnancy and labor, more commonly in Europe than in the United States. Reduction of pain or anxiety is often the goal. There is not enough research to determine if this is effective or safe. Pregnant women should speak with their health care providers before starting massage therapy, particularly if massage to the abdominal area is involved.
Premenstrual syndrome (PMS)
There is not enough scientific information to conclude if massage is helpful in women with premenstrual syndrome (PMS) or with premenstrual dysphoric disorder (PMDD).
Preparation for surgery
A small number of studies have tested the effects of massage before invasive surgical procedures. However, results are mixed.
Quality of life (nursing home residents)
Hand massage did not appear to affect comfort levels or satisfaction with care in nursing home residents in one study. Larger, well-designed studies are needed before a recommendation can be made.
Early research suggests that massage as a means of general rehabilitation for the bedridden elderly or elderly living in long-term care facilities has not been demonstrated to have significant benefits. More studies are needed before a firm recommendation can be made.
Massage may be generally beneficial in rheumatic pain conditions. However, there is not enough evidence to make a recommendation.
Scar healing (hypertrophic, pediatric)
It is unclear if massage can reduce severity of hypertrophic scarring in children. More studies are needed before this use of massage can be evaluated.
Spinal cord injury
Early evidence suggests that massage may benefit patients with spinal cord injuries. In these patients, abdominal massage may also have positive effects on bowel dysfunction. However, there is not enough evidence to make recommendations.
A 15-minute weekly massage has been studied as a possible way to reduce physical and mental stress in nurses. Massage was not beneficial for physical stress, but was found beneficial in reducing mental stress levels. Further study is warranted.
Well-being in cancer patients
Massage techniques are frequently used in cancer patients as a possible way to improve well-being and reduce anxiety. Although some people have reported benefits, there is not enough scientific evidence to draw a firm conclusion.
Early evidence suggests massage therapy may preserve immune function. Some research suggests that massage helped maintained a healthy immune system in children with HIV who were not taking anti-HIV medications. Another study stated an increase in white blood cells in women with breast cancer. Further research is needed before a firm conclusion can be made.
Attention-deficit hyperactivity disorder (ADHD)
Early research suggests massage therapy improves mood and behavior in children with ADHD. Additional evidence is needed before a recommendation can be made.
Massage has been suggested for many other uses, based on tradition or on scientific theories. However, these uses have not been thoroughly studied in humans, and there is limited scientific evidence about safety or effectiveness. Some of these suggested uses are for conditions that are potentially life-threatening. Consult with a health care provider before using massage for any use.
Balance and posture
Body fat reducer (cellulite)
Chronic fatigue syndrome
Coronary heart disease
Endorphin release stimulation
Enhanced lymph flow
Heart rate reduction
Increased insulin activity at injection sites
Increased parasympathetic nervous system activity
Inflammatory bowel disease (Crohn's disease and ulcerative colitis)
Intensive care unit stress
Irritable bowel syndrome
Lumbar disc herniation
| Malnutrition (emaciation in children)|
Repetitive strain injury
Restless legs syndrome
Temporomandibular joint disorder
Side effects of massage are considered rare, although this area is not well studied. Broken bones, discomfort, skin bruising, swelling of massaged tissues, bruised liver hematoma, cerebrovascular accidents, displacement of a ureteral stent, embolization of a kidney, leg ulcers, nerve damage, posterior interosseous syndrome, blood vessel problems (pseudoaneurysm), blood clot in the lungs (called a pulmonary embolism), ruptured uterus, strangulation of the neck, overactive thyroid (called thyrotoxicosis), and various pain syndromes have been reported.
Areas of the body where there are broken bones, weakened bones from osteoporosis or cancer, open or healing skin wounds, skin infections, recent surgery, or blood clots should not be massaged. People with bleeding disorders or low platelet counts or those taking blood-thinning medications (such as heparin or warfarin) should avoid vigorous massage. Allergies or skin irritation may occur with some essential oils used in massage.
Pregnant women should speak with their health care providers before starting massage therapy, particularly if massage to the abdominal area is involved. In general, touch-based therapies should be used cautiously in people with histories of physical abuse. Massage should not cause pain to the client.
Massage should not be used as a substitute for more proven therapies. Massage has not been tested as a way to diagnose medical conditions.
Many types of massage are used throughout the world for many health conditions. It is commonly used to reduce pain, anxiety, muscle spasms, muscle tension, and depression. Many athletes use massage therapy before competitions. There is limited reliable scientific evidence in these areas, and it remains unclear if massage is effective for any specific health condition. Massage should not be used as a substitute for more proven therapies, and it is not a diagnostic technique. Massage should be used cautiously in pregnant women and in those at risk of broken bones or bleeding.
The information in this monograph was prepared by the professional staff at Natural Standard, based on thorough systematic review of scientific evidence. The material was reviewed by the Faculty of the Harvard Medical School with final editing approved by Natural Standard.
- Natural Standard: An organization that produces scientifically based reviews of complementary and alternative medicine (CAM) topics
- National Center for Complementary and Alternative Medicine (NCCAM): A division of the U.S. Department of Health & Human Services dedicated to research
Selected Scientific Studies: Massage
Natural Standard has reviewed all of the currently available medical literature to prepare the professional monograph from which this version was created.
Some of the more recent studies are listed below:
- Aly H, Moustafa MF, Hassanein SM, et al. Physical activity combined with massage improves bone mineralization in premature infants: a randomized trial. J Perinatol 2004;24(5):305-309.
- Billhult A, Bergbom I, Stener-Victorin E. Massage relieves nausea in women with breast cancer who are undergoing chemotherapy. J Altern Complement Med 2007;Jan-Feb, 13(1):53-57.
- Blanc-Louvry I, Costaglioli B, Boulon C, et al. Does mechanical massage of the abdominal wall after colectomy reduce postoperative pain and shorten the duration of ileus? Results of a randomized study. J Gastrointest Surg 2002;6(1):43-49.
- Bowles EJ, Griffiths DM, Quirk L, et al. Effects of essential oils and touch on resistance to nursing care procedures and other dementia-related behaviours in a resident care facility. Internat J Aromather 2002;12(1):22-29.
- Brosseau L, Casimiro L, Milne S, et al. Deep transverse friction massage for treating tendonitis. Cochrane Database Syst Rev 2002;(2):CD003528.
- Diego MA, Field T, Sanders C, et al. Massage therapy of moderate and light pressure and vibrator effects on EEG and heart rate. Int J Neurosci 2003;114(1):31-44.
- Ernst E. The safety of massage therapy. Rheumatology (Oxford) 2003;Sep, 42(9):1101-1106. Epub 2003;May 30. Review.
- Field T, Diego MA, Hernandez-Reif M, et al. Massage therapy effects on depressed pregnant women. J Psychosom Ostet Gynaecol 2004;25(2):115-122.
- Field T. Massage better than relaxation therapy for fibromyalgia. J Clin Rheumatol 2002;8(2):72-76.
- Fogel GR, Cunningham PY 3rd, Esses SI. Coccygodynia: evaluation and management. J Am Acad Orthop Surg 2004;Jan-Feb, 12(1):49-54.
- Forchuk C, Baruth P, Prendergast M, et al. Postoperative arm massage: a support for women with lymph node dissection. Cancer Nurs 2004;27(1):25-33.
- Furlan AD, Brosseau L, Imamura M, et al. Massage for low-back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine 2002;27(17):1896-1910.
- Goffaux-Dogniez C, Vanfraechem-Raway R, Verbanck P. Appraisal of treatment of the trigger points associated with relaxation to treat chronic headache in the adult: relationship with anxiety and stress adaptation strategies. Encephale 2003;Sep-Oct, 29(5):377-390. French.
- Hasson D, Arnetz B, Jelveus L, Edelstam B. A randomized clinical trial of the treatment effects of massage compared to relaxation tape recordings on diffuse long-term pain. Psychother Psychosom 2004;Jan-Feb, 73(1):17-24.
- Hernandez-Reif M, Ironson G, Field T, et al. Breast cancer patients have improved immune and neuroendocrine functions following massage therapy. J Psychosom Res 2004;57(1):45-52.
- Hernandez-Reif M, Martinez A, Field T, et al. Premenstrual symptoms are relieved by massage therapy. J Psychosom Obstet Gynaecol 2000;21(1):9-15.
- Howatson G, Van Someren KA. Ice massage: effects on exercise-induced muscle damage. J Sports Med Phys Fitness 2003;Dec, 43(4):500-505.
- Khilnani S, Field T, Hernandez-Reif M, et al. Massage therapy improves mood and behavior of students with attention-deficit/hyperactivity disorder. Adolescence 2003;38(152):623-638.
- Macgregor R, Campbell R, Gladden MH, et al. Effects of massage on the mechanical behaviour of muscles in adolescents with spastic diplegia: a pilot study. Dev Med Child Neurol 2007;Mar, 49(3):187-191.
- Muller-Oelinghausen B, Berg C, Scherer P, et al. [Effects of slow-stroke massage as complementary treatment of depressed hospitalized patients]. Dtsch Med Wochenschr 2004;129(24):1363-1368.
- Moyer CA, Rounds J, Hannum JW. A meta-analysis of massage therapy research. Psychol Bull 2004;130(1):3-18.
- Perlman AI, Sabina A, Williams AL, et al. Massage therapy for osteoarthritis of the knee: a randomized controlled trial. Arch Intern Med 2006;Dec 11-25, 166(22):2533-2538.
- Piotrowski MM, Paterson C, Mitchinson A, et al. Massage as adjuvant therapy in the management of acute postoperative pain: a preliminary study in men. J Am Coll Surg 2003;197(6):1037-1046.
- Remington R. Calming music and hand massage with agitated elderly. Nurs Res 2002;Sep-Oct, 51(5):317-323.
- Roh YS, Cho H, Oh JO, et al. Effects of skin rehabilitation massage therapy on pruritus, skin status, and depression in burn survivors. Taehan Kanho Hakhoe Chi 2007;Mar, 37(2):221-226.
- Shor-Posner G, Miguez MJ, Hernandez-Reif M, et al. Massage therapy in HIV-1 infected Dominican children: a preliminary report on the efficacy of massage therapy to preserve the immune system in children without antiretroviral medication. J Altern Complement Med 2004;10(6):1093-1095.
- Silva LM, Cignolini A, Warren R, et al. Improvement in sensory impairment and social interaction in young children with autism following treatment with an original Qigong massage methodology. Am J Chin Med 2007;35(3):393-406.
- Underdown A, Barlow J, Chung V, et al. Massage intervention for promoting mental and physical health in infants aged under six months. Cochrane Database Syst Rev 2006;Oct 18, (4):CD005038.
- van den Dolder PA, Roberts DL. A trial into the effectiveness of soft tissue massage in the treatment of shoulder pain. Aust J Physiother 2003;49(3):183-188.
- Vickers A, Ohlsson A, Lacy JB, et al. Massage for promoting growth and development of preterm and/or low birth-weight infants (Cochrane Review). The Cochrane Library 2002;(2).
- Walach H, Guthlin C, Konig M. Efficacy of massage therapy in chronic pain: a pragmatic randomized trial. J Altern Complement Med 2003;Dec, 9(6):837-846.
- Waters BL, Raisler J. Ice massage for the reduction of labor pain. J Midwifery Womens Health 2003;Sep-Oct, 48(5):317-321.
- Westcombe AM, Gambles MA, Wilkinson SM, et al. Learning the hard way! Setting up an RCT of aromatherapy massage for patients with advanced cancer. Palliat Med 2003;Jun, 17(4):300-307.
- Wilkinson SM, Love SB, Westcombe AM, et al. Effectiveness of aromatherapy massage in the management of anxiety and depression in patients with cancer: a multicenter randomized controlled trial. J Clin Oncol 2007;Feb 10, 25(5):532-539.
- Wunschmann BW, Sigl T, Ewert T, et al. Physical therapy to treat spinal stenosis. Orthopade 2003;Oct, 32(10):865-868. Review. German.
Last updated May 01, 2008
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