Patients kneading a massage? Here’s a primer
Find therapists trained in informed touch’
Massage therapy is a broad term that describes a discipline encompassing a number of techniques, says Adela Basayne, LMT, a private practice massage therapist in Portland, OR.
The type of massage therapy most commonly used to treat anxiety and pain is traditional European massage, which includes methods based on conventional Western concepts of anatomy and physiology and soft tissue manipulation. There are five basic kinds of soft tissue manipulation techniques:
effleurage (long flowing or gliding strokes, usually toward the heart, tracing the outer contours of the body);
- petrissage (strokes that lift, roll, or knead the tissue);
- friction (circular strokes);
- vibration;
- tapotement (percussion or tapping).
Swedish massage is the most predominant example of traditional European massage, and it is the most commonly used method in the United States. It was developed by Per Henrik Ling in Sweden in the 1830s and uses a system of long gliding strokes, kneading, and friction techniques on the more superficial layers of muscles. This massage usually goes in the direction of blood flow toward the heart, because there is an emphasis on stimulating the circulation of the blood through the soft tissues of the body. Swedish massage can be relatively vigorous, sometimes with a great deal of joint movement included.
Oil is usually used to facilitate the stroking and kneading of the body, thereby stimulating metabolism and circulation. Swedish massage’s active and passive movements of the joints promote general relaxation, improve circulation and range of motion, and relieve muscle tension. Swedish massage is often given as a complete, full-body technique, though sometimes only a part of the body is worked on.
Hospices, however, may encounter more recently developed disciplines. Among them is contemporary Western massage. This includes methods based primarily on modern Western concepts of human function, anatomy, and physiology, using a wide variety of manipulative techniques. These may include broad applications for personal growth, emotional release, and balance of mind, body, and spirit, in addition to traditional applications. These approaches go beyond the original framework or intention of Swedish massage. They include Esalen or Swedish/ Esalen, neuromuscular massage, deep tissue massage, sports massage, and manual lymph drainage. Most of these are American techniques developed from the late 1960s onward, though manual lymph drainage was developed in the 1920s.
Esalen and Swedish/Esalen massage are recent variations that focus not so much on relieving muscle tension or increasing circulation as on creating deeper states of relaxation, beneficial states of consciousness, and general well-being. Swedish is more brisk and focuses on the body; Esalen, on the other hand, is more slow, rhythmic, and hypnotic, and focuses on the mind/body as a whole. Esalen massage is not widely taught as a pure form. Rather, a marriage of sorts has been formed by the integration of Swedish and Esalen as a way of incorporating the strengths of each. Many massage therapists describe their method as Swedish/Esalen, and this hybrid is commonly taught in massage schools.
Neuromuscular massage is a form of deep massage that applies concentrated finger pressure specifically to individual muscles. This is a very detailed approach, used to increase blood flow and to release trigger points, which are intense knots of muscle tension that refer pain to other parts of the body (they become trigger points when they seem to trigger a pain pattern). This form of massage helps to break the cycle of spasm and pain and is often used in pain control. Trigger point massage and myotherapy are varieties of neuromuscular massage.
Deep tissue massage is used to release chronic patterns of muscular tension using slow strokes, direct pressure, or friction. Often the movements are directed across the grain of the muscles (cross-fiber) using the fingers, thumbs, or elbows. This is applied with greater pressure and at deeper layers of the muscle than Swedish massage, which is why it is called deep tissue. This form of massage is also more specific. For example, in the case of someone with a sore shoulder, the practitioner may focus on the trapezius and the rhomboid underneath, trying to work in all the layers of muscle that might be involved. Deep tissue massage lends itself to being more focused on a problem area.
Basayne warns that uneducated amateurs may try to pass themselves off as trained massage therapists. Hospices should require national certification in massage therapy or proof of licensure in states that require massage therapists to be licensed.
"You want a massage therapist with training in pathology," Basayne says. "They need to understand the disease process and have an understanding of end-of-life care."
This is important, because a poorly trained massage therapist can add to a patient’s pain rather than help relieve it. Basayne recalls an AIDS patient she treated a few years ago who benefited from massage in the early stages of therapy. But as the disease progressed, she was limited in the places she could manipulate.
"By the end, I was just caressing his head and neck," she says. "A therapist is trained in informed touch. A therapist has to determine tolerance to touch."
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