Thought Bytes...
March 2003

Massage: How does it work?

Therapeutic massage is a fast growing part of our health care industry. As North Americans move away from a paternalistic model of health care, we are taking a more active role in our own well being, and looking for different ways to meet our needs. Massage is an ancient modality, but has only recently become a valid and respected choice for treatment in our modern world. As it’s usage increases, more people in the public, health industry, and scientific community are taking notice. Today therapeutic massage is increasingly prescribed by doctors, covered by extended benefit plans, and researched by the scientific community.

How Massage Therapy Works

First, we must note that there are many different types of treatments that are often listed under the term bodywork, such as Reflexology, Reiki, Acupressure, Therapeutic Touch, and Craniosacral therapy. These are all wonderful therapies that have helped many people, but for simplicity, this article only deals with therapeutic massage. To clarify further, massage that is based in Swedish technique (though a massage therapist may incorporate many different modalities in a session).

Though there is still a lack of scientific studies in this field, there are some commonly accepted explanations for how it works (and the evidence to support these is increasing). Massage therapy affects both a local, mechanical level and also on a deeper, systemic level. Different techniques are used to target either or both of these responses. We will explore the local effects first. When a particular muscle is receiving massage, several things are happening:

The tissue “warms up”, meaning circulation to the area is increased, both by the warmth of the therapist’s hands, and the action of stimulating activity in the soft tissues (muscle, skin, etc.) When muscles are in spasm (tight), they shorten and the fibres twist up like a rope – so the tiny blood vessels are compressed. Increased circulation is important to remove built up waste products of muscle metabolism, and to bring fresh oxygen and nutrients to the area, thereby improving the health of the tissue.

The mechanical action of the therapist’s hands helps the tissue to “release”, allowing the fibres to open up and lengthen. This allows again for increased circulation, as well as better range of motion and decreased pain.

The therapist stimulates tiny reflex actions within the tissue, further causing it to release the contraction. This is a slightly more complicated mechanism, involving stretch receptors within the muscle and tendon (Golgi tendon organs and muscle spindle). Basically, when these receptors are stimulated, a nervous system response is initiated, causing the muscle to relax and lengthen.

On a systemic level, massage therapy stimulates the parasympathetic nervous system, which has several effects. A basic understanding of the physiology of the nervous system will be helpful here:

The nervous system is divided functionally into two main areas of control. These are the voluntary nervous system, which is consciously controlled, and the autonomic nervous system, which regulates the aspects of our bodies that are unconsciously controlled. This includes things like our breathing patterns, heart rate, hormone regulation, and digestive system – all the things that we don’t have to think about in order to make happen. Massage therapy primarily is concerned with this autonomic division, which also is split (functionally) into the sympathetic and parasympathetic systems. Here is a brief description of each:

Sympathetic	Parasympathetic
increase blood flow to extremities	decrease blood flow to extremities
decrease blood to core organs	increase blood to core organs
increase alertness and adrenaline	decrease alertness and adrenaline

To summarize, the sympathetic system is our “fight or flight” stress response, where most of us spend too much of our time, and the parasympathetic is our “rest, digest, and heal” response. Massage therapy helps our bodies to switch into the parasympathetic mode, which promotes both physical and emotional healing. This is done through both the massage itself, and the soothing environment the therapist provides. Many people notice that after a massage session, they feel relaxed and drowsy. This is a result of that switching mechanism. Systemically, massage therapy helps to temporarily lower blood pressure, slow heart rate and breathing, and encourages digestion. Clients often feel chilly after a massage as a result of this. The need to urinate after is also common – increased blood means increased activity in all the organs!

These massage techniques are not the limit of how a therapist works with a client. Education is also an important tool. A therapist will talk about healthy lifestyle habits and offer suggestions about how a client can take a more active role in their well being. This may include ideas about how to set up a more ergonomic workspace, tips on improving posture, ways to incorporate more activity into a busy life, and specific exercises to strengthen weak or injured muscles. Also in a session, a massage therapist may work with range of motion exercises, stretching, breathing patterns, and many other techniques to promote or restore health.

Who might a massage therapist treat?

Like any other health practitioner, people come to massage therapists for a variety of specific reasons, which generally fall into two main categories – to promote health and prevent problems, or to restore health. Naturally, a client may fall into either of these categories at different times. For example, a nurse may come to heal her/his back pain, but after it has been successfully treated, may continue sessions every month or two in order to discourage it from reoccurring. Here is a list of reasons a person may wish to include massage therapy into their health care team, although there are far too many to completely list:

General health & well being	Headaches
Back/neck pain	General aches & pains
Strains/sprains	Knee, shoulder, or any joint injury
Stress/anxiety	Tendonitis (such as tennis elbow)
Chronic pain	Fibromyalgia
Multiple Sclerosis	Pregnancy
Motor vehicle accident injuries	Spinal cord injuries
Repetitive motion/strain injuries	Carpal tunnel
Frozen shoulder	Thoracic outlet syndrome
Patellofemoral syndrome	Scoliosis

How to choose a Massage Therapist

In Alberta, there is no provincial regulation of the profession. (This is something the Massage Therapist’s Association of Alberta is working hard to change.) That means that the prospective massage client needs to be informed. Here are some important guidelines:

Ask about their education. They should have at least 1000 hrs of education to treat a fairly basic condition. The M.T.A.A. would like to establish a minimum standard of 2200 hours, which is closer to other provincial requirements. This is about 2 – 2 1/2 years of school. The Grant MacEwan College in Edmonton and Mount Royal in Calgary are two examples of schools that meet this standard.

Make sure your therapist is registered in an association. This helps to establish their credibility with your insurance company. They should have a number that appears on your receipt.

To simplify this process, it is a relatively safe bet that if your massage therapist works in a clinic with other health care professionals, they probably meet these requirements. There are many well-educated massage professionals that operate from home or in massage therapy – only clinics as well, just make sure you ask! As a side note, many insurance companies will only reimburse your massage therapy expenses if you have a doctor’s prescription. Most doctors will do this with no problem.

This article is meant to be a brief, simple introduction to the massage therapy profession. If you have any questions about massage, please do not hesitate to contact me – I will be happy to try to answer them.

Ami Brodribb,
Registered Massage Therapist

Contact me or book appointments at:
Lendrum Health Centre
5846 – 111th St.
Edmonton, Alberta
T6H 3G1
(780) 433 – 1499

or email me at: ami@ualberta.ca

Home | Services | About ErgoSum | Contact