Masseuse or Masseur have been used since the early 1800’s to refer to people who perform massage’s professionally.  They are said to work at Massage Parlors. This was true before 1980 when people who perform massage professionally were beginning to be referred to as massage therapists.

Today in the U.S., the words have become more associated with illegal ‘massage parlors’ who are actually a front for prostitution and possibly human trafficking. It isn’t really clear as to how this has become more of the norm in the U.S. as the words are still widely used across Europe.

Professionally, the words often make licensed massage therapists cringe.  Massage Therapists now go through basic training in massage skills, pathology and basic anatomy/physiology.  They are also required to pass licensing exams in almost all US States.  (There are still a few states that do not require state licensing.) Some states will still even use the words in their licensing laws.  (That really needs to be changed!)

As I was searching for information on the history and origins of the words masseuse or masseur, I came across this handy chart showing the number of uses of the word in various literature.

So the words Masseuse or Masseur hopefully are on their way to retirement.  People who perform massage professionally and are licensed to do are directed by the legislation in their state as to what they are able to call themselves.  Masseuse and masseur are actually still used in some states although we are moving away from those terms.

Whatever people who do massage are called, doesn’t really matter as long as it is Great!
There is also a big difference between those who are professional massage therapists and places that say they are doing massage when in fact they are doing ‘happy endings’ and many of the ‘asian massage places’ which is really just another word for prostitution.  It helps to know the difference.

• Massage used in India, China, Egypt, Greece and Rome in temples and halls.
• 4th Century – Christian houses of refuge treated the sick and dying
• Middle Ages – Touch used as ‘laying on of hands’ in the care of sick and dying people.
• 18th Century- Used in Hospitals
• 1883 – John Kellogg Battle Creek Sanitarium, taught nurses massage.  The Art of Massage (book)
• 1923 – Soldiers receive massage in medical Barracks (History of Massage)
• Mid 1980s -Social Worker – Tedi Dunn and Nurse Marian Williams,  starts the massage program at the California Pacific Medical Center, San Francisco
• 1980 – Irene Smith, Dawn Nelson, Helen Campbell started teaching on how to work with HIV/AIDS
• 1980s – Dawn Nelson Pioneered work with the elderly
• 1980’s – Helen Campbell pioneered hospice and hospital massage
• 1980’s – Colorado.  Barbara Carnahan, Mary Rose of the Boulder Hospice
• 1980’s – Karen Gibson, nurse massage therapist, moved massage forward in hospitals in Colorado and partnered with the Boulder School of Massage to create an  internship program
• 1992 – National Association of Nurse Massage Therapists was founded in 1992 by Andy Bernay-Roman a registered nurse, massage therapist and psychologist
• 1995 – Hospital Based Massage Network created by Laura Koch in Colorado
• 2007 – Society for Oncology Massage
• 2015 – Over 125 hospital based programs listed on the Society for Oncology Massage website.

Statistics:  1998, 7.7% of US hospitals offered one or more CAM therapies. That number was up to 37% in 2007 according to a 2008 report by the American Hospital Association.  Massage for the Hospital Patient and Medically Frail Client” MacDonald, Gayle (2005)

The Reasons for Massage in a Hospital Environment

66% – Pain Management, 57% – Massage for Cancer Patients, 55% – Pregnancy massage, 53% – Physical therapy, 45% – Mobility training, 41% – Palliative care

2011 – salary stats from AMTA – In 2011, the average annual income for a massage therapist (including tips) was estimated to be $21,028.

2011 – ABMP has 79,444 members (combined massage therapists, yoga instructors and others.)  See ABMP growth chart.

July 2011 – International Massage Association owner – Will Green convicted of fraud.  See www.imagroup.com (website has been taken over by another insurance company)   See Massage Today Article – What Became of IMA?     ABMP responds On closure of IMA Group.

Nov 2011 – Steiner Leisure buys Cortiva.  Steiner runs the many cruise ship lines.  12 campuses for $33 Million. see the press release.

2012 – Salary Stats from the BLS :  $35,970 per year , $17.29 per hour. Number of jobs : 132,800

May 12, 2012  Diane Polseno passes away.  A leader in the massage profession.

June 20, 2012  – AMTA finally commits to educating consumers and announces their Massage Consumer Experience Tour. (See Press release)

Sept 2012 – Touchy Subjects by Steve Capellini, leader in the spa world publishes controversial book about what it was really like to be a massage therapist in the 70s and 80’s.

Sept 2012 – Roark Capital that owns Cinnabon, Arbys, Wingstop, buys Massage Envy

October 26, 2012 Dr John Upledger passes away.  Truly a leader in the massage profession.

2013 – FSMTB task analysis

2014 -AMTA approximately 57000 members

2014  – Entry Level Analaysis Project Completed  (ELAP)

2014 May – Federation of Massage State Boards Model Practice Act (PDF)

2014 –  NCBTMB releases National Exam into Federation of Massage State Boards Hands.   FSTMB and NCBTMB reach an agreement. (PDF)

ELAP Recommendation:

The Meaning of Massage and Its Technique By Dr. Emil A.G. Kleen   Y “MASSAGE means a manipulation or handling of the soft tissues by movable pressure in the form of stroking, rubbing, pinching, kneading or beating performed with a therapeutic aim. This is generally applied by hand, but can, of course, also be given by means of instruments and apparatus of different kinds.” Shown at left, abdominal massage or abdominal kneading. – Dr. Emil Kleen, 1888 Editor’s introduction: This excerpt is from Dr. Kleen’s 1921 book, Massage and Medical Gymnastics. Dr. Kleen was a Swedish physician whose first book, Manual of Massage, was published in 1888. The 1921 book is essentially the same book as the 1888 title, with some revision and additions. Dr. Kleen’s work was translated into several languages, but he wrote only in Swedish. This final edition of his book was printed shortly before his death in 1921. The book was intended to support the continuation of manual therapy work that was so successful during World War I. Dr. Kleen, along with other noted physicians of Europe, believed that manual therapies were an important part of medical practice. His writing brought massage to the awareness of many other physicians. He was a staunch critic of lay practitioners. He and most other physicians believed that massage was only valuable and inscrutable when performed by the physician or under his direction. The material that follows is from the first chapter of the book. His argument distinguishing between massage and gymnastics was a recurrent theme in his writing, but an important one that drew much criticism. It becomes obvious that his distinction is important when it comes to applying massage or gymnastics to specific medical conditions. This excerpt is in its original language taken directly from his writing. The article tells us what is and is not massage, the attributes of a masseur, to develop your own style of doing massage, describes the four classes of massage manipulations (strokes), that the hands are the best tool for massage, but that vibrators and other tools are helpful aids, the strength needed in applying massage to various conditions, the length of a session (“séance”), what lubricants are useful and it demonstrates with photos various techniques used on specific medical conditions. To limit accurately the term “massage” it is necessary in the first place to distinguish it from medical gymnastics, which is treatment by means of exercise of the organs of the motor apparatus. At a first glance at these definitions confusion of ideas seems unlikely. They have for long been denoted by different terms, and their existence has been distinguished both by the general public and by doctors. But the two methods of treatment have several points in common; they must often be used together therapeutically and are often performed by the same craftsman. Strangely enough the idea had never to my knowledge been definitely and clearly defined in literature before I formulated the two definitions, and pointed out the difference in my “Manual of Massage” in 1888. In a concrete case the differences stand out so sharply that one can scarcely understand that any one, especially any one practising massage and gymnastics, should have been unable to grasp them. One can, for example, massage an infiltration or a hæmatoma, since they are in a sense soft tissues, but it is impossible to apply gymnastics to them, since they are not organs and certainly not organs of movement. A muscle, on the other hand, can be treated both by gymnastics and massage: in the latter case it is treated not as an organ, but simply as a tissue (e.g., in getting rid of an infiltration by friction); in the former case it is used as an organ, and as such must act by shortening and lengthening, or by performing static work to maintain a position. The fact that massage by getting rid of the infiltration raises the muscle’s functional power, and in this has the same aim and to some extent the same effects as gymnastics, as well as the fact that gymnastics used along with massage helps to get rid of the infiltration, in no way contradicts the legitimate distinction between these two methods of treatment, which coincide neither in their character nor in their effects. In contrast to gymnastics, massage is not treatment by exercise. Opinions may differ as to considering passive movements exercise-treatment for parts of the motor apparatus other than the joints. Passive movements, however, are the part of gymnastics most closely allied to massage. Positions, too, are exercise of the motor apparatus, especially for muscles and nerves, and obviously belong to gymnastics and not to massage. We must also distinguish from massage some manipulations which even gymnasts cannot say belong to gymnastics, but which are sometimes assigned to massage. Static pressure, whether it can be reckoned in orthopædics or not, can under no circumstances be included in that division of physical therapy which is called massage. Similarly one must exclude from massage those manipulations which are performed in order to replace an organ or part on an organ from an abnormal position, e.g., taxis in case of hernia, manipulations through the abdominal wall to release an invagination or volvulus, replacement of the uterus, etc. Some obstetric manipulations I also consider outside the province of massage, Kristell’s method of expression of the fœtus, Crédé’s method of detachment of the placenta. For my own part neither do I regard as massage the strokings by which in a skin wound one can get rid of the air in traumatic emphysema. Lastly, I also exclude from massage the method (in more than one sense heroic) employed in England by Teale, Sir William Fergusson and others, of causing detachment of parts of the contents of an aneurysmal sac by kneading, with consequent embolism of the peripheral arteries, leading to complete consolidation of the aneurysm. Lastly, we cannot consider as massage manipulations for the introduction of medication, e.g., rubbing which is performed for the inunction of mercury. The technique of massage is peculiarly important, since its effect depends on the method in which it is performed. But massage as an art is easy, requiring less practice and skill than many other of the mechanical tasks in which every one of us must have a certain skill, e.g., the use of the laryngoscope or the catheter, the common typical operations, etc. For those who from the standpoint of anatomy, physiology, and pathology know what is present in individual cases, the different manipulations come as it were of themselves. In these there is the greatest difference between the scientifically trained and the uneducated masseur. The former has during his years of medical study travelled over most of the ground which leads to becoming a good masseur; for the rest he only requires comparatively short study, normal upper extremities of average strength, hands neither too thin nor too small, and some aptitude for mechanical work. Further, it is a great advantage to watch or help a skilled masseur for some time. One thus acquires the technique more easily and surely than in any other way, and, besides, gains more quickly knowledge which belongs especially to the masseur and can only be slowly obtained from one’s own experience. I would emphasise, on the other hand, that it is never worth while to follow slavishly a definite example in technique, but every one must work out his own method, which soon becomes as individual as his handwriting. It is obvious that manipulations which have quite the same effect on the patient may be performed in many different ways by the masseur. A good masseur thinks less of the way in which he moves his hands at his work than of the tissues he is working upon, and the quality of his massage depends to a very great extent on his knowledge of their condition. For such knowledge, besides the above-mentioned studies, the power of palpation is necessary; skill in this respect is the masseur’s most difficult task, and can only be acquired and maintained by practice. (The examinations which specially concern the masseur are mentioned later.) The manipulations which are met with in massage have been classified in very different ways. Many of the scientific exponents of massage are, however, fairly well agreed in distinguishing four different classes of manipulation, which are generally denoted by French names, and are: – 1. Effleurage = Stroking. 2. Friction = rubbing with pressure. 3. Pétrissage = pinching, rolling, kneading. 4. Tapôtement = blows, slapping, hacking, beating, clapping, shaking, vibration. Effleurage (Figs. 1-5) consists of centipetal strokings performed with varying strength generally over a large surface of skin, and with a large surface of hand; with the flat hand, with the ulnar or radial portion of the hand, with the thenar eminence, with the base of the hand, with thumb and forefinger, generally with one hand at a time, but sometimes with both hands together (as when a limb is grasped). Effleurage is a form of massage very frequently used and has a therapeutic aim which constantly recurs in practice. The chief function of effleurage is to hasten the circulation the blood and lymph vessels; it is therefore often performed over the more important veins, where these are easily affected, as in the front of the neck and in the extremities. Thus in general massage (as in other forms of massage) stroking over the veins of the extremities is used in the form of long strokes from the wrist to the proximal end of the upper are, or from the fold up to the fold of the groin.

In local massage also one often uses effleurage over the superficial veins to hasten the circulation within a comparatively small area. In both cases the stroking is given with very moderate pressure. Again, when one makes use of stroking to press the blood and lymph out of a whole muscle group one uses rather more strength in the manipulations.

Figs. 1 and 2 show effleurage of the leg as it is performed in general massage. Fig. 1 shows the hand of the masseur gliding up over the calf and approaching the popliteal space. When the hand has reached the popliteal vein and effleurage is to be continued over the veins of the thigh, the hand is turned so that the fingers are directed to the other side of the thigh (Fig. 2), in order to continue the effleurage right up to the groin without risking coming in contact with the external sexual organs.

Fig. 3 shows a method of performing effleurage over the front of the forearm, the thumbs gliding over the outer side, the other fingers over the inner side of the patient’s are, at the same time going over the large veins in that situation.

Fig. 4 shows another method of performing effleurage of the forearm. In this the tips of the fingers are towards the outer side of the arm while the base of the hand moves along its inner side.

Fig. 5 shows effleurage over the shoulder-joint, e.g., after a dislocation. The masseur, with bothhands flat, performs a circular stroking movement, one hand passing over the front, the other over the back of the shoulder with moderate speed and strength on both sides.

Friction is rubbing with pressure, generally performed over small areas, with the palmar surface of the last phalanx of the thumb or of the three middle fingers, but also may be performed in other ways, e.g., with the base of the hand or with the whole palm. Friction is used chiefly to hasten retrogressive changes in inflammatory products, infiltration’s and exudations, to press into the outlying lymphatics the disintegration products, and so to promote their absorption. The direction of this manipulation is therefore unimportant, but it is generally necessary to use firm pressure. This is generally possible, but not always. When friction is performed over the eye or over inflammatory products in the abdomen and pelvis, it is obvious that it must be performed with very moderate pressure.

Fig. 6 shows friction as it should be performed for rheumatic infiltrations of the neck in the upper part of trapezius or occipitalis. The masseur presses in on the affected parts, performing a small movement with the apposed tips of his three middle fingers.

Fig. 7 shows friction performed by the thumb on the knee-joint over an infiltration in its capsule, an affection called by Swedish doctors “capsulitis.”

Fig. 8 shows friction performed over the left supraorbital nerve for rheumatic interstitial neuritis. It is a small matter whether one prefers to use the palmar surface of the last phalanx of the thumb or of the three middle fingers.

Fig. 9 shows friction with the palmar surface of the last phalanx of the middle finger above and through theeyelid for opacities in the cornea. The fingers perform a small movement from side to side with as much pressure as may be given without risk.

Fig. 10 shows friction in a case of sciatica due to muscular inflammation, performed with the palmar surface of the last phalanges of the three middle fingers, over the gluteal muscles, which in these cases are often the seat of rheumatic infiltrations.
Fig. 11 shows friction performed with the base of the hand in a case similar to that shown in Fig. 10. It is a form of technique seldom seen but not objectionable.

Fig. 12 shows friction with the base of the hand over infiltrations in the back muscles. The remark in reference to Fig. 11 applies also to this.
Fig. 13 shows friction over rheumatic infiltrations in the back muscles given with the whole palmar surface of the hand, a method less often used but very useful in cases of widespread infiltrations.
It is obvious that since all massage manipulations vary in form and may be performed in different ways with the same effect, and since effleurage and friction in particular have to some extent the same object, in that they promote absorption, there must be various transition forms between the two. But generally speaking, effleurage is performed over a large surface of skin and less pressure is used than in friction.

Pétrissage consists of rolling, kneading, and pinching. Its physiological effects resemble those of friction in that it promotes absorption of the products of inflammation, and those of tapôtement in that it is a form of muscle stimulus. These react to a pinch as to a blow by a local contraction and thickening.

Fig. 14 shows pétrissage over the upper border of trapezius, which is a favourite situation for rheumatic muscle infiltrations. The masseur grasps the muscle between his thumbs behind and his fingers in front and lets his hands perform a series of pinching or wringing movements.

Fig. 15 shows pétrissage of the forearm as it is usually given in general massage. The masseur holds one hand on the front, the other hand on the back of the forearm, and kneads the muscle masses by a movement of one hand against the other.

Fig. 16 shows the same procedure on the upper arm. By their movements against each other the masseur’s one hand works on the flexors, his other on the extensor muscles.

Fig. 17 and 18 show pétrissage of triceps on the upper arm. In Fig. 17 the masseur holds his thumb on one side, his fingers on the other side of the muscle mass; in Fig. 18 the manipulation is performed by means of pinchings between the four fingers and the base of the hand; the latter form is much more seldom used than the former. Altogether, pétrissage is a form of massage less often used than effleurage and friction. Used as in Figs. 14 and 17, the manipulation has a diagnostic as well as a therapeutic value, since one can in this way palpate and recognise muscle infiltrations.

Tapôtement (Figs. 19-22) consists of manipulations which aim essentially at mechanical stimulation of muscles or nerves; these manipulations are all characterised by their blow-like nature and are named as already mentioned, hacking, beating, shaking, vibration* [See footnote below]. We work upon the skeletal muscles by beating them all over with the closed fist, by hacking them at right angles to their long axis with the ulnar border of the hand (Fig. 20), or, especially in the case of small thin muscles, as the extensors of the forearm, flicking them with the dorsal surface of the fingers generally held slightly apart (Fig. 21). By shakings performed from side to side with one hand on each side of the patient’s abdomen we affect both the muscles of the alimentary canal and its nerve elements. By hackings or vibrations over the head or spine we can mechanically stimulate the cerebro-spinal centres within their bony covering. By chest clapping we stimulate the vagus and consequently produce slowing of the heart-beat and pulse. We affect nerve trunks by percussion or vibration along their course, and lastly, we can stimulate the nerve endings in the skin by different kings of tapôtement, e.g., by blows with the flat hand or with different instruments.

Fig. 19 shows back hackings in standing position as performed by Swedish gymnasts; tapôtement given with the ulnar border of the masseur’s hands, the fingers being parted.

Fig. 20 gives a picture of tapôtement of the back in general massage. The hands are slightly supinated and strike the back with part of their dorsal surface. The hands go up and down several times on each side of the spine. Tapôtement is often given also over the spine.

Fig. 21 shows a method of performing tapôtement on the dorsal surface of the forearm. The masseur, with fingers held apart, flicks the thin extensors of the forearm with their dorsal surface.

Fig. 22 shows a method occasionally used by giving vibrations without instrumental aid over the posterior nerves on each side of and quite close to the spine. The three middle fingers of the masseur’s left hand go down the left side of the patient’s spine, the three middle fingers of his right hand down the right side, giving a series of small quick blows. This manipulation requires much practice.

Generally speaking, massage as a whole is performed best by hand, and no instruments exist or can ever be produced with which one can, even approximately, perform the various manipulations that go to a massage séance as well as by the hands.

But it cannot be denied that in some cases one may with advantage make use of instruments. Certain forms of tapôtement and especially vibrations are performed much more smoothly, quickly, and strongly by means of instruments than by hand.

A great number of cheap, efficacious and durable vibrators are now in the market – the “Veni-vici vibrator,” the “Auto-vibrator,” the “Medical vibrator,” etc. Of Zander’s well-known and ingenious apparatus most are concerned with gymnastics, but several with massage, and among the latter those which aim at vibrations are, beyond a doubt, those which best fulfil their aim.

Some masseurs use india-rubber balls provided with handles and long or short levers. An instrument for tapôtement looks like a thimble with such a ball at its point. At one time a “palate” was used, a round flat wooden slab on a lever with a handle, to stimulate the skin by repeated blows. At some of the Swedish seabathing places different kinds of seaweed, chiefly Fucaceœ are used for the same purpose.

Some masseurs make use in other forms of massage of small wooden wheels, straps, brushes, gloves, sponges; the latter or metal wheels are used at times to give electric treatment along with massage. Most doctors who give massage themselves make use of their hands only, except in the case of instruments for vibration.

The strength of the manipulation is, of course, a very important factor, and varies widely with the different therapeutic aims and the different morbid anatomy underlying the special case. For instance, if one is dealing with a fresh sprain, and massage has chiefly an antiphlogistic aim, one sets to work, especially in the beginning of the treatment, with quite light effleurage; if one has before on an extensive hard œdema with a plastic tendency, effleurage as well as friction is firm; if the question is to get rid of already partially organised exudations round a joint after a joint inflammation, one must use hard friction; again, if it is perityphlitic (“appendicitis”) or parametric exudation, one must exercise unceasing care, remembering the proximity of the peritoneum and the danger of a new inflammatory process, etc.; all matters which we shall deal with later more in detail, but which in individual cases must be left to the good sense of the masseur. With beginners the commonest fault is to be too hard-handed, but prefessional masseurs* [See footnote below] often tend, on the contrary, to be too superficial. I would especially call attention to the erroneous statement of certain authors that massage should never be done hard enough to produce marks of discoloration of the skin, and that every such mark is the “fault” of the masseur. This may be true of general massage and some other cases, but very many of the cases for which massage is suitable (e.g., many chronic joint affections) need such strong massage that marks are necessarily caused. They are of little or no importance and soon disappear.

The length of the massage séance is also important, but there can be no general rule. Several points must be considered in deciding what is enough, and, in the first place, the nature of the lesion. Often in this, as in the strength of the manipulation, one must be guided by the patient’s general condition, since nervous, sensitive patients can stand neither a long séance nor hard massage. In these cases one must begin the treatment gently and with a short séance, gradually increasing the strength of the massage and its duration. For local massage generally a quarter of an hour is suitable. General massage (which is usually done by some one other than a doctor) takes at least half an hour, often more.

In certain acute cases, and especially when used as an antiphlogistic (by means of effleurage), as, for example, in a recent sprain of the ankle, massage should be performed several times a day; in other cases at least twice, never less than once a day.

The masseur should from the beginning accustom himself to use both hands and divide the work equally between them. While he is still new to the work, like other mechanical workers, he squanders his strength and becomes easily tired, but he quickly learns to obtain the greatest possible effect, and can do much more work than seemed at first possible.

The masseur should never make use of narcotics to prevent or remove pain which he must occasionally cause. The pain is seldom great, and there are other means of counteracting it. Latterly hypnotism and hypnotic suggestion have begun to play a part, in many cases with wonderful success; but I can offer no opinion on the subject, as I have never attempted it.

Massage is almost always given directly on the skin, since in giving it over clothing, as is done by some masseurs in certain cases, one loses technical accuracy. Regard for modesty in a doctor’s consulting room can be carried too far, to the detriment of more important considerations, and also to the extent of producing the painful self-consciousness it aims at avoiding. One takes care, especially with women patients, not to uncover more than need be uncovered, and not to uncover at one time more than the part about to be massaged.

Most masseurs make use of some lubricant to make the patient’s skin soft and smooth. This is often a necessity, especially for firm effleurage, as otherwise one cases pain by dragging the hairs of the skin, and may irritate the glands of the skin and so cause acne or boils. Different skin lubricants may be used: glycerine, vaseline, lanoline, lard, “cold cream,” olive oil, cocoa butter, etc. Glycerine I definitely condemn, since its strongly hygroscopic properties make it irritating to the skin; vaseline irritates somewhat. Liquid oils are troublesome to handle. Solid cocoa butter is better, but it has a fairly strong smell. On the whole it seems to me that lard should have the preference.

Some masseurs use only talc or other powders. In general massage this often seems to me most comfortable for the patient. If, however, the masseur has the good fortune to possess really dry hands he can give general massage without either powder or lubricant.

For deep effleurage, especially over the forearms or legs, it is sometimes necessary to shave the part once or twice a week, otherwise “pimples” may arise.

The masseur’s hands must be carefully washed immediately before and after each séance; the nails should not be too long, and no rings should be worn.

The whole material outfit* [See Footnote at bottom of column] needed by a masseur (besides the above mentioned lubricant) consists of a couch of suitable length and breadth, and about 60 cm. high, accessible from all sides, a so-called plinth, preferable with one end which can be raised or lowered according to need. When massage is given to any part of the back, buttocks, chest, abdomen, pelvis or legs, sometimes even to the shoulder joint, the patient lies on the plinth and the masseur stands or sits beside it. When massage is given to the lower part of the arm up to and including the elbow joint, the patient and the masseur sit directly opposite each other, one on either side of the plinth (upon which the patent rests his forearm). For massage of front or back of neck the patient sits on the plinth, and the masseur strands in front in the first case, behind or beside in the second. The suitable position for the patient is in most cases obvious. Where this is not the case we shall return to the subject in the special chapters.

There are many different forms of massage according to the anatomical conditions. Generally massage is local and is applied only to a small part of the surface of the body, but it may also be applied to the greater part of the body, and is then called general. The different forms of local massage are described later in their proper places; for practical reasons, and to make the study of the physiological and general therapeutic effects mentioned in the next chapter easier for the reader, we give here a short description of the technique of massage of the front of neck and of the abdomen as well as of general massage.

Massage, or rather effleurage, of front of neck * (5) aims at hastening the circulation in the area of the bloodvessels concerned, which are for this purpose favourably situated anatomically. With the palmar surface of each hand pressed against the corresponding side of the patient’s neck, and with both hands together, the masseur passes his hands several times from above down with rather firm pressure over the jugular veins in as much of their course a possible, at the same time avoiding pressure on the hyoid bone or larynx (see Fig. 23.)

Fig. 24 shows the method of giving effleurage of front of neck used by Höffinger and others, standing behind the patient, which seems to me more comfortable and better than standing in front. The illustration is not quite satisfactory, as it gives the impression that the strongest pressure is given near the mid-line.

In case of necessity Gerst allows the patient himself to massage the front of the neck, using first one hand and then the other, with the thumb on the corresponding side of the neck passing down over the common jugular vein; the other fingers work over the veins of the other side of the neck. Effleurage of front of neck is performed with constantly repeated stroking for about ten minutes at a sitting; the number of sittings advisable in acute cases may be as many as five or six a day. In such cases a lubricant is useful. Massage of front of neck is preferably given by a doctor, but may be entrusted to others as Gerst has shown.

Abdominal massage or “abdominal kneading” aims at manipulating the alimentary canal through the abdominal walls, and is generally given (see later) for chronic constipation. The masseur, holding his fingers hyperextended, place the palmar surface of the three apposed middle fingers over the part which is for the moment to be massaged, with moderate force presses in the abdominal wall, and, by means of small circular manipulations with steady pressure, kneads or rubs the corresponding part of the alimentary canal, between the anterior and posterior abdominal walls (see Figs. 25,26). The patient’s skin moves with the masseur’s fingers and a lubricant is unnecessary. During this manipulation the masseur keeps his hand fixed in slight dorsal flexion at the (upper and lower) wrist joint, and in the sitting position the movement is divided between the elbow, shoulder, and hip joints. One hand is used at a time, the right and left moving alternately.

In massage of the stomach this manipulation is applied over the gastric and left hypochondriac regions, but reaches only a small part of the organ if it is approximately normal in size. If the stomach is dilated it is to that extent more within reach of massage. By performing the above manipulation more staccato (more after the manner of tapôtement, although the fingers do not leave the abdominal wall), for example, over an atonic or dilated stomach, one can give a stronger mechanical stimulus than by means of the smoother pressure to the non-striated muscle and so produced contraction. Among Zander’s apparatus there is a vibrating pellet which vibrates from side to side; by leaning against this with the part of the abdomen required the patient receives a forcible shaking over the stomach and bowels.

In manipulating the large intestine one begins over the cæcum, then going over the ascending, transverse, and descending colon and sigmoid flexure down to the symphysis pubis, paying careful attention to every 1/4 cm. of bowel, except those parts (the hepatic and splenic flexures) which for anatomical reasons cannot be reached. The small intestine is got at by similar manipulations over the umbilical and lumbar regions. In very sever cases of chronic constipation one should insist on treatment twice a day. The effect of the treatment depends essentially on the manipulation being performed long enough on each part of the bowel before the fingers are moved on to the next; the whole séance should occupy at least fifteen minutes.

To empty the contents of the large intestine into the rectum one can afterward with one hand – or better and more strongly with one hand applied over the other to strengthen it, only one hand coming in contact with the patient’s skin – perform stoking over the large bowel, especially over the transverse and descending colon and sigmoid flexure. One can also attain this object by placing the hands one over the other (see Figs. 27 and 28), and constantly moving first the under, then the upper hand a little at a time and without for a moment relaxing the pressure on the bowel. In this one does not press directly downwards all the time, rather upwards, but the whole procedure, which ends over the symphysis pubis, is extremely effective in emptying the contents of the large intestine into the rectum.

In ordinary cases there is no great necessity for the doctor to perform the abdominal kneading, and no danger in leaving it after some instruction to non-medical workers, although it then seldom gives such good or rapid results even when performed in the simple and effective manner above described. It is noteworthy and interesting that, in spite of the extreme simplicity of abdominal kneading and the eagerness of my pupils to learn it, I have great difficulty in getting them to do it properly; and I understand more readily since I have begun to teach these subjects how it happens that so few masseurs can perform the “miracles” so easily obtained in severs cases of chronic constipation. I will refer again to this subject at the end of the next chapter and in the chapter on Diseases of the Alimentary Canal and Abdomen.

The above-described simple technique is that which for nearly a quarter of a century I have found most effective while experimenting with different manipulations on a large number of patients with chronic constipation, and I think from my experience I am giving the reader good advice when I beg him not to waste time on other less effective or quite ineffective manipulations by whatever masseur they are recommended. Many classes of manipulations, so warmly recommended in some quarters, with circular strokings round the umbilicus, with pressures over the cœliac plexus (half-way between the ensiform process and the umbilicus), and over the splanchnic plexus (half-way between the umbilicus and the symphysis pubis), with sacral beating, etc., are empy “ornaments,” or at least of very doubtful and certainly subordinate value, and one only wastes time over the. Stroking over the colon, strongly performed with one had, or with one hand over the other, are certainly capable for the moment of sending the contents of the bowel into the rectum, and thus promote, also for the moment, a more immediate action. But this is not the chief aim of the treatment (see next chapter), and the same result is obtained by the manipulations already recommended, which in all their simplicity, when conscientiously performed, gain their end with certainty, although, in sever cases of chronic constipation, often not till after several months’ treatment.   General Massage * (6), during which the patient lies undressed in bed (and should always be massaged by some one of the same sex), comprises the greater part of the body, begins with the extremities, and on the whole goes from the periphery towards the centre. The patient lies on the back except while the back is being massaged, when he lies on his face. General massage is given by my pupils as follows: – The masseur begins with the upper extremity, using his hands as follows: – With his opposite (e.g., left) hand he grasps the patient’s (right) hand, and with the whole palmar surface of his other hand performs effleurage over the superficial veins of the front and radial side of the whole are, from the wrist upwards, namely, over the cephalic, basilic, and median veins and their anastomoses (Figs. 3 and 4). After half a dozen such strokes he begins treatment of the forearm by compressing by deep effleurage with one (right) hand the muscles on the anterior surface, and then with the other (left) hand the muscles on the dorsal surface. Pétrissage of the forearm follows, and, like all the manipulations, is repeated a few time. It is performed over the whole muscle mass; the masseur, holding his thumbs moderately abducted and the four fingers somewhat flexed, grasps the forearm between his tow hands, one on each side (front and back), touching it with the palmar surface, with the radial surface of the forefinger, and with the palmar surface of the thumb (Figs. 15 and 16). He then kneads with small, smooth, circular movements, which by degrees, without the hands ever leaving the patient’s skin, travel over the whole surface from the wrist to the elbow. In the tapôtement which follows he gives light blows with the fist to the thicker muscles on the flexor aspect; to the thinner extensors he gives light blows on the dorsal aspect of the forearm with the dorsal surface of the four fingers of the open hand (see Fig. 21). The muscles of the forearm are then again compressed by effleurage as described above. This finishes the treatment of the forearm. Before going on to the treatment of the upper are, effleurage over the whole are may be repeated. He compresses the anterior muscle groups with one hand, and then with the other hand treats the posterior muscles in the same way. In the pétrissage which follows he treats the anterior muscle groups by themselves and the posterior by themselves; he gets at the posterior muscles best by adducting the patient’s upper arm in front of this chest (Fig. 17). He then gives tapôtement (best with the fist) over both muscle groups, and again compresses them by effleurage. He strokes, kneads, claps, and strokes again the deltoid muscle by itself, and completes the treatment of the arm by effleurage over the whole. When both arms have been thus treated the masseur goes on to the lower extremities, grasps with his opposite (e.g., left) hand the patient’s (right) foot, compresses with the thumb of his corresponding (right) hand the network of veins on the dorsal surface of the foot, and with a continuous movement strokes with the palm of the same hand over the veins of the calf and the popliteal vein, following the saphenous vein with the thumb (Fig. 1). When the masseur’s hand in this continuous effleurage has reached the lower part of the femoral vein on the front of the thigh he then rotates this hand (without breaking off the effleurage which should go with one stroke over the whole limb) so that the thumb, which would otherwise be directed outwards on the front of the thigh, is now directed downwards towards the knee, and the other four fingers, which would otherwise be directed inwards on the front of the thigh (towards the mid-line of the patient), are now directed outwards (Fig. 2). By thus changing the position of the hand, when the effleurage ends at the groin the hand comes near the external genital organs without discomfort. Treatment of the leg begins and ends, like that of the forearm, arm, and thigh, with compression of the muscles, in which he lets the thumb of the corresponding hand go on the inner side of the calf muscles, while the four fingers encircle them. With the four fingers of the other hand he then compresses the peronei, letting the thumb act in the same way over tibialis anticus. The calf muscles must be kneaded by themselves and tibialis anticus by itself. For tapôtement it is best to use the fists over the thick calf muscles. In massage of the thigh one divides the muscles into four groups, and treats separately, one after the other, quadriceps femoris, the adductors, the inner flexors (semimembranosus and semitendinosus), and biceps by compressing them in the ordinary way, giving pétrissage, hacking, and compressing again. The best way to place the patient and oneself for comfort and ease in reaching the part is too obvious to mention. After the special treatment of the thigh one again gives effleurage over the whole limb. After finishing the treatment of the leg one next performs abdominal massage, or the so-called abdominal kneading, as above described (Figs. 25-28). It is a very important and effective part of general massage, and should not be omitted without special reason. It should occupy about fifteen minutes. After abdominal kneading the patient should lie on the face for treatment of the back. Although the anatomical conditions are not particularly favourable for effleurage, to help the circulation we begin and end the treatment of the back with long, quick strokings, carrying both hands one on each side of the spine up and down over the whole surface between the neck and the hips. We knead the muscles over both sides of the whole back by performing small circular movements (Fig. 13) in which the patient’s skin accompanies the hand of the masseur. One uses either the palmar surface of the whole hand, or its uppermost part (“heal” or base of hand). We then give a series of vibration-like manipulations with both hands at once, one on each side of and close to the spine, using the tips of the three middle fingers from the neck down to the lumbar region inclusive (Fig. 22), a treatment which has a very stimulating effect, but which, to be given will, needs some practice. Tapôtement is then given in the form of back hacking from the upper part of the chest to the lower part of the lumbar region, the masseur’s elbows being slightly supinated and the metacarpo-phalangeal joints slightly flexed (Fig. 20). Not only the ulnar border of the little finger comes in contact with the skin, but also its dorsal surface and that of the ring finger. Both these fingers, and especially the little finger, are held somewhat abducted; many masseurs, zealous of technique, attach great importance to a certain “feathering” done with the abducted fingers, thinking that the power to do this and back hacking altogether offers a very good criterion for a clever masseur. Each side of the back is hacked separately, and then the spine itself in many cases. Before and after back hacking one treats the muscles of the shoulder blade by themselves by giving effleurage, tapôtement (with the finger tips), and again effleurage above and below the spine of the scapular. The gluteal regions are next treated in the same way; but many patients dispense with this altogether. The treatment of the back ends as it began, with effleurage. With women patients we leave the chest untouched; with men one can treat the pectoral muscles and subclavius by stroking, hacking, and repeated stroking. If special indications exist for massage of front of neck, one may suitably end general massage with this. In general massage all the manipulations are as a rule performed with moderate strength. It is important for patients, especially those who are having a long course of it, that it should be performed comfortably, or at least without discomfort. If the masseur has quite dry hands, he generally uses no lubricant for general massage; if not, he uses either a lubricant or talk power for effleurage. General massage should take at least half an hour (preferably about an hour), demands little more than mere mechanical skill, and can in most cases be quite well performed by non-medical workers. The doctor in busy practice has seldom time to give it himself, and can entrust it to any trustworthy person of the same sex as the patient, after he has once given instructions for the special case. FOOTNOTES (1)* The French word massage may be derived either from the Arabic mass (to press), or from the Greek anatripsis (to rub). (2)* Vibrations are, by some authors, considered as a special fifth group of manipulations. They are distinguished however from other forms of tapôtement merely by the greater frequency of the blows in a given time and by the smallness of the movement. They aim at a similar stimulation and produce similar effects. Then vibrations are given by instrumental means on mucous membranes which are difficult to get at by means of the fingers (see later) they are really a substitute for frictions. (3)* Busy masseurs are under constant temptation to make their séances shorter and less vigorous than is really consistent with the patient’s interest, the result of simple calculation which we leave to the perspicacity of the reader, the consequence being that their work yields quick returns only in an economic sense. (4)* Even this bench is not at all necessary, and of later years I have myself used an ordinary couch. Plinths of different kinds are used in my Institute. During all the many years which I have used massage in my practice I have used no instrument but my hands and a vibrator. This last should be in the possession of every one who makes much use of massage. (5)* Massage of front of neck has been used in Sweden at least since the time of Ling, who mentioned it and understood its chief effects. In our days Gerst, Weiss, and others have laid stress on its therapeutic value in various inflammatory processes and hyperæmic conditions of the head (see later). (6)* General massage has been used in the interests of health from time immemorial (especially with baths) by nearly all Oriental, as well as by several European races, and it is widely met with as a popular remedy, for example, in the islands of the Pacific. Medically it is perhaps most often used and with much benefit as a substitute for physical exercise when this is for some reason impossible. It plays an important part in the so-called Weir-Mitchell treatment. In dystrophies, “general weakness,” and chlorosis it is also of value. From Volume 1, Issues 1 and 2 of Massage Heritage Times. Compiled and Edited by Robert Calvert. Back to Article Archives Pages 1 2 3 4 5 6

Editor’s introduction: John Harvey Kellogg, M.D., (1852-1943) is best known as the charismatic director of the Battle Creek Sanitarium in Michigan. The “San” as it was called, featured more than 200 varieties of water treatments along with massage and other natural therapies. Dr. Kellogg’s book, The Art of Massage: It’s Physiological Effects and Therapeutic Applications, was first published in 1895. The text in this edition of the Massage Heritage Times is taken from that book. The Art of Massage was last published by Dr. Kellogg in 1921. Unlike many other books about massage written during this period, his has endured beyond all others. It is still used as a reference at many massage schools today. Dr. Kellogg spared no details in describing the many effects of massage. In this and upcoming issues of MHT we’ll explore his wide range of knowledge and experience on the subject of massage and hydrotherapy.

The interest in the therapeutic applications of massage which has increased so rapidly within the last twenty years has led to numerous investigations by able physiologists for the purpose of determining with exactness the physiological effects of the various procedures included under the general term massage, and thus obtaining a correct basis for their therapeutic use. Many of these experiments have been repeated and verified by the writer in the physiological laboratory under his charge in connection with the Battle Creek Sanitarium, and some of the results will be recorded in an Appendix, in addition to this brief summary of the conclusions which have thus far been obtained by those who have most carefully studied the subject. These investigations have established beyond all possibility of question, that massage affords one of the most effective means of influencing the functions of the human body.

Experiments clearly show that every function of both animal and organic life may be powerfully influenced by some or all of the numerous procedures of massage. The various effects produced my be included under the following heads: –

1. Mechanical, in which the tissues are wholly passive, being simply acted upon in a mechanical way by the hand of the manipulator, as in the movement of the blood and lymph in the venous and lymph channels, or the restoration of a displaced viscera to its normal position.

2. Reflex, in which the peripheral and central portions of the nervous system, both cerebro-spinal and sympathetic, are chiefly active, an impression made upon the nerve ends of the sensory or afferent fibers connected with the nerve centers of the cerebro-spinal and sympathetic systems being transmitted to the related centers, where new activities are set up, resulting in the sending out of nerve impulses by which vital changes are effected, not only in the parts directly acted upon, but in related parts.

3. Metabolic, in which important modifications occur in the tissue activities both of the parts directly operated upon and of the body as a whole, as the result in part of the direct mechanical effects of massage upon the tissues, and in part of the reflex activities set up by it.

In a brief manual like this there is not space to consider in detail the modus operandi of all the different effects of massage. We must be content with a simple enumeration of the specific effects upon the principal systems and functions of the body.

Effects of Massage upon the Nervous System

All the different procedures of massage produce a decided effect upon the nervous system through the influence of the manipulations upon the nerve endings of both the cerebro-spinal and the sympathetic nerves, which are found in so great abundance in the skin and muscles – the former in connection with the special senses of locality, temperature, pressure, and weight; the latter more especially in connection with the glands, blood vessels, and thermic mechanism located in the skin and muscles.

1. Direct Stimulating Effects. – Vibration and nerve compression may be made to act directly upon nerve trunks, thereby causing powerful stimulation not only of the peripheral nerves but of all the nerve centers with which a nerve trunk is connected.

Friction is an effective means of exciting languid nerves.

Light percussion simply increases nervous irritability, while strong percussion may cause so great a degree of nervous irritability as to exhaust the nerves, and thus produce a benumbing effect.

Tapping, slapping, clapping, and hacking are the most effective means of exciting nerve trunks.

Beating and vigorous hacking are especially useful for exciting the nerve centers, and hence are especially applicable to the spine. The nerve centers may also be directly excited by deep vibration and by strong percussion.

2. Reflex Effects. – The reflex effects of massage are very remarkable and exceedingly interesting. All the procedures of massage produce powerful reflex effects. Some of the most striking effects are produced by very light stroking, especially when applied to certain reflex areas.

Percussion and vibration are also powerful means of producing reflex effects, which include not simply muscular action, but increase or decrease vascular and glandular activity, and general tissue change.

3. Sedative Effects. – The sedative effects of massage are equally as marked as the stimulating effects. Strong percussion relieves pain in the same manner as does strong faradization [electrify], by tiring out and thus obtunding [to deaden] nerve sensibility. Pinching produces an anæsthetic effect in essentially the same way. The physician always pinches the skin before introducing the hypodermic needle.

Sedative effects are also produced by gentle stoking – the so-called hypnotic effect, doubtless, through reflex influence upon the nerve centers.

Very marked sedative effects are produced by derivative friction and kneading. Centrifugal friction (rubbing down) diminishes the blood supply of the brain, and hence lessens cerebral activity.

Light friction over a deep-lying organ diminishes its blood supply by increasing the activity of the overlying vessels, thus causing the blood to go around instead of through it.

Massage of the soft parts above a joint, and movement of the next joint above, relieve pain by emptying the lymph and blood vessels of the part.

4. Restorative or Reconstructive Effects. – Mental fatigue is relieved by massage, through its effect upon the circulation and the eliminative organs. The toxic substances produced by mental activity are more rapidly oxidized and removed from the body, while the hastened blood current more thoroughly repairs and cleanses the wearied nerve tissues.

General reconstructive effects are experienced by the entire nervous system through the improved nutrition induced by massage.

Effects of Massage upon the Muscular System
Massage, when skillfully administered, has to do chiefly with the muscles. That form of manipulation which consists simply of skin pinching excites the nervous system and the surface circulation, but has little influence upon the muscles. When we reflect that the muscles constitute one half of the bulk of the body, and receive one fourth of all the blood of the body, it is at once apparent that any procedure which acts directly upon them must have a decided influence upon the whole body.

Although the muscles constantly receive a certain blood supply, this supply is comparatively small except during activity; consequently, it may be said that “the muscles are well fed only when exercising.” When the muscle is inactive, the blood goes around it rather than through it; but the moment activity of the muscle begins, there is a great increase in its blood supply, even before any acceleration in heart activity has occurred.

Massage may serve to a considerable extent as a substitute for exercise by increasing the blood supply of a muscle, just as exercise may be considered a sort of massage, through the pressing and rubbing of the muscles against each other. When properly administered, the manipulations of massage act upon the muscles in such a way as to produce a suction, or pumping effect, pressing onward the contents of the veins and lymph channels, and thus creating a vacuum to be filled by a fresh supply of fluid derived from the capillaries and the tissues.

Specific Effects of Massage upon the Muscles. – Massage in its specific effects upon the muscles, may be said to accomplish the following results: –

1. To Encourage Nutrition and Development of the Muscles. – The increased blood supply of the muscle induced by massage naturally improves its nutrition. Experience shows that, when systematically and regularly employed, massage produces an actual increase in the size of the muscular structures. The muscle is also found to become firmer and more elastic under its influence.

Massage feeds a muscle without exhausting it, in which respect it differs from exercise; nevertheless, it is not a complete substitute for exercise, for the reason that exercise bring into active play the whole motor mechanism – nerve center, nerve, and muscle – while massage affects chiefly the muscle.

The improvement in the nutrition of the muscle, as regards increase in size or firmness, is seldom noticeable for the first three or four weeks, and the most marked effects should not be expected until after two or three months.

2. To Excite Muscular Contraction. – A smart blow upon a muscle is one of the ways by which contraction may be excited. By a succession of blows, one following another with sufficient rapidity, tetanic contraction of a muscle may be induced.

Strong vibration will also cause tetanic contraction of a muscle; but very rapid and strong vibrations are required to produce tetanus. In voluntary tetanus (ordinary muscular contraction) the number of impulses received by the muscle per second is ten to twenty. It is evident that the rate of vibration required for producing tetanus must be as great or greater, and consequently mechanical means of some sort must be applied, as the highest rate of movement which can be communicated by the hand directly is ten to twelve double movements per second. A vibratory apparatus which I have had in use for many years, and which produces decided muscular contractions, has a movement of thirty per second.

In certain cases, muscular contraction may be induced more readily by the application of percussion than by the faradic current.

3. To Increase Electro-excitability of the Muscle. – Numerous experiments have shown that massage increases the electro-excitability of a muscle, as indicated by the fact that a smaller number of milliamperes of current is required to cause contraction of the muscle after massage than before.

According to Kroneker, however, a muscle is less easily tetanized after massage than before, but its power of action is greatly increased. An abnormal degree of muscular irritability is certainly relieved by massage.

This effect of massage may be advantageously utilized as a preparation for applications of electricity in cases in which the electro-excitability of a muscle is diminished by trophic changes, as in infantile paralysis.

4. To Remove the Effects of Muscular Fatigue. – Ranke, Helmholtz, Du Bois-Raymond, Mosso, and more recently, Abelous, have conclusively shown that special toxic substances are produced as the result of muscle work, and that the phenomena of fatigue are due to the influence of these substances upon the nervous and muscular system.

Abelous has shown that the first effect is a sort of auto-curarization, or paralysis, of the terminal motor plates of the nerves which actuate the muscles, while in advanced fatigue the muscle itself is exhausted by the consumption of the material (glycogen) necessary for work.

The fact that a fatigued muscle can be restored to full vigor at once by simply rinsing its vessels with a normal saline solution, as shown by Ranke, demonstrates the toxic character of the phenomena of fatigue. Bowditch, Bernstein, and others have shown that the nerve itself is indefatigable.

Zabloudowski has shown that frogs completely exhausted by faradization of the muscles, although not restored by fifteen minutes’ rest, were revived at once by massage, and were even able to do twice as much work as before.

In another experiment, a man lifted with his little finger, one kilo (2 1/5 lbs.) 840 times, lifting the weight once a second. The muscles of his finger were then completely exhausted. After five minutes’ massage he was able to lift the same weight 1100 times, and his muscles were even then not greatly fatigued.

The Sandwich Islanders employ massage under the name of lomi-lomi as a means of resting fatigued persons, and sometimes even apply it to restore an exhausted companion when swimming long distances in company. An intelligent native Maori informed the writer that the same method is used by the natives of New Zealand to relieve cramp resulting from cold when swimming in the sea. The term used for massage among the Maoris is romi-romi, the literal meaning of which is the same as pétrissage in French.

The stiffness and soreness of muscles which occur from so-called consecutive or secondary fatigue resulting from over-exercise, is also relieved by massage. It should be remembered, however, that secondary fatigue may be produced by too vigorous an application of massage in a person not accustomed to it, especially in those who are very fleshy.

Muscular Electricity. – Physiological experiments have demonstrated that with each muscular contraction an electrical discharge takes place, and Mervy has shown that a muscle is a sort of electrical accumulator, electricity doubtless being generated by the muscular and thermic activities which are constantly present in the muscle. As an accumulator it is auto-excitant, and may also be excited by induction or by contact. In this way the muscles of the person masséed may be favorably influenced through induction from the more highly charged muscles of the masseur. This influence, however, must be very slight, and its therapeutic value can scarcely be said to be established.

Effects of Massage upon the Bones, Skeleton, and Ligaments

That massage is capable of influencing such hard structures as the bones, ligaments, and cartilages, is clearly demonstrated by numerous facts and observations. A bone has essentially the same blood supply as its overlying muscles. It is for this reason that the same exercise which causes increase in the size of a muscle, at the same time induces growth in the bone to which the muscle is attached. The bones and joints of persons who are much addicted to exercise are decidedly larger than those of persons who have made little use of their muscles. This is especially noticeable in comparing the large, strong hand and knotty knuckles of the laboring man with the puny hand and straight, slender fingers of the man of sedentary pursuits.

The blood vessels and lymphatics are largest in the vicinity of the joints, and the change of fluids effected by joint movements, resulting from the action of the muscles upon the bones, necessarily produces increase in the nutrition of the parts, and consequently an increased growth in the cartilages, ligaments, and other structures of the joint.

It is said that among the South Sea Islanders, the chiefs, who have themselves masséed daily, are very much larger than the average of the people. The well-known fact that “cracking” or “snapping” the fingers will cause enlargement of the joints is another evidence of the effects of joint movements in producing change in the growth of the hard structures of the body.

Effects of Massage upon the Circulation

Massage profoundly affects the circulation, both general and local, its effects differing, however, according to the mode of application and the part acted upon. General massage increases the rate and the force of the heart beat, as does exercise, with the difference that it does not raise the arterial tension as does exercise, and does not accelerate the heart to the same degree, though producing a full, strong pulse. This is due to the fact that the influence of massage is chiefly upon the peripheral circulation.

The vigor of the circulatory activity is increased not only in answer to the greater demand for the removal of the poisons resulting from oxidation as in exercise, but through the mechanical assistance afforded by massage, in moving the blood forward in the venous and lymph channels, and in setting up reflex activities whereby the small vessels are dilated and their activities quickened. The reflex influence of massage acts as a tonic for the heart, while the dilation of the vessels decreases the resistance so that the heart acts more freely and efficiently in performing its functions. Recent experiments by Brunton, verified by the author, show that general massage produces at first, but briefly, a rise in arterial pressure.

Locally, the effect of massage is to produce an active hyperæmia of the part. Under the influence of massage the blood vessels become more active, pumping forward the blood into the veins, through which its flow is assisted materially by the manipulations. The increase of blood is usually accompanied by reddening of the surface and an increase of warmth, sensibility, and general vital activity.

Light percussion of the surface causes contraction of the blood vessels of that portion of the skin acted upon. Strong percussion very quickly produces dilation of the blood vessels which may even amount to paralysis. Light percussion, if sufficiently prolonged, also produces dilation.

When applied to a reflex area, percussion doubtless also excites the circulation in the vessels of the related nerve centers. This is the explanation of the influence of percussion of the soles of the feet, the inner portion of the thighs, and the gluteal region, upon the genito-urinary organs.

Massage of the abdomen retards the pulse by causing portal congestion, and thus withdrawing a large quantity of blood from the general circulation. The pulse movements are also somewhat fuller, the result of the influence of abdominal massage upon the great sympathetic centers.

Massage has chiefly to do with the circulation of fluid in the veins and the lymph channels, since these are more readily accessible from the surface than the arteries.

Friction acts chiefly upon the superficial veins, while pétrissage and other forms of deep kneading act upon the deeper vessels as well.

Indirectly, the portal and pulmonary circulations are also influenced by massage. Massage of the extremities, for example, especially if concluded with centrifugal friction, may relieve congestion of both the portal and the pulmonary systems.

Massage of the legs acts more directly upon the portal system, while massage of both extremities favorably influences the pulmonary circulation in case of congestion of the lungs. Massage of the arms and legs also acts derivatively upon the brain and spine. For derivative effects upon the brain, however, care should be taken to avoid such exciting procedures as percussion and reflex stroking.

Massage also has a powerful effect upon the circulation by promoting the action of the diaphragm, which serves efficiently as a pump in assisting the circulation, as well as in carrying on the process of respiration. M. Camus has shown by experiments upon dogs that the increase either of the rate or the depth of respiratory movement increases the flow of lymph in the thoracic duct. The same has been shown in regard to the blood circulation by numerous investigators.

The influence of massage upon the lymph circulation is especially worthy of attention. The lymph vessels drain the tissues of waste and toxic substances, and prevent clogging from wandering cells. Lymph channels are most abundant in the subcutaneous tissue and in the fascia which cover and lie between the muscles, so that these vessels are mechanically acted upon in massage, especially by friction and kneading movements.

That massage and exercise of muscles greatly increase the flow of lymph has been repeatedly demonstrated by experiments upon animals, as, for example, it was found that the flow in the lymph vessels of a dog’s leg nearly ceased when the animal was quiet, but as soon as the limb was exercised or masséed, the flow of lymph began again (Reibmayr).

It has also been shown that the flow of lymph from a limb in a state of inflammation was very easily induced, and was seven or eight times greater than from a sound limb. A swollen limb was found to diminish during the flow of lymph (Lessar).

The same author has shown that massage of a lymph gland increases the outflow of the fluid. Deep massage applied to a limb diminishes its size. The central tendon of the diaphragm contains a large number of lymph channels. The diaphragm may be regarded as a great lymph pump, since by its rhythmic movement, the lymph channels are alternately dilated and contracted.

Höffinger has shown that the absorptive power of the peritoneum is greatly increased by massage. In experiments upon rabbits, the peritoneum was found to absorb under the influence of massage twice as much water in an hour as without massage.

An experiment made by Mosengeil, an eminent German physiologist, graphically demonstrates the influence of massage in promoting absorption. The joints of rabbits were injected with ink. Massage was applied to some of the rabbits and not to others. In the cases subjected to massage, the swelling which was produced by the injection rapidly passed away. When the rabbits were killed, some months afterward, it was found that the ink had entirely disappeared from the joints which had been masséed, and was found in streaks between the muscles, and accumulated in the lymphatic glands, indicating the course of the lymphatic channels. In cases in which the joints were not masséed, ink was found in the joints, but none in either the muscles or lymphatic glands. This result affords a striking illustration of the value of massage in affections of the joints accompanied by exudate.

It is through its power to promote absorption that massage is of great value in the treatment of local œdemas, general dropsy, and ascites.

Effects of Massage upon Respiration
These effects may be thus enumerated:
1. Increase of Respiratory Activity. – Massage, as does exercise, increases the depth of the respiratory movements. This is doubtless in some measure due to the reflex influence of massage, but must also be attributed in part to its effect in bringing into the circulation waste products requiring elimination through the lungs, and in increasing oxidation, or CO2 production, which necessarily accompanies the increased heat production resulting from the effect of massage upon the muscles.

2. Increase of Tissue Respiration. – It should be borne in mind that the function of respiration is not confined to the lungs. Respiration begins and ends in the lungs, but the most important part of the process is effected in the intimate recesses of the tissues themselves.

Massage is certainly a most efficient means of increasing tissue metabolism, by which oxygen is absorbed by the tissues and CO2, taken up by the blood. This process takes place chiefly in the muscles, through the oxidation of the glycogen, of which they contain one half the total bodily store. Hence it is that massage, by acting directly upon the muscles, increases the tissue respiration by promoting circulation and general tissue activity.

In thus promoting the depth of respiratory movement and the intensity of tissue respiration, massage profoundly affects all the bodily functions. Through the increased lung activity there is also increased circulation, as the lungs materially aid the heart in the circulation of the blood. Increased activity of the diaphragm serves to pump both blood and lymph toward the heart with greater vigor. Digestion, liver action, and other of the vital functions come in for their share of benefit in the increased vigor and efficiency of the respiratory process. The functions of the brain are more easily performed on account of the more perfect movement of venous blood and the better supply of oxygen received.

Influence of Massage upon the Heat Functions of the Body

The heat functions of the body being so intimately connected with the circulation and general tissue activity, it is clear that any agent which profoundly affects the latter must also affect the former proportionately. The heat functions consist of three distinct processes, – heat production, heat elimination, or dissipation, and heat regulation. Massage materially influences all three of these processes.

The muscles are the chief seat of heat production in the body, containing a great store of glycogen and a special mechanism which, under the influence of the nervous system, gives rise to increase or decrease of oxidation, or combustion of the glycogen. The muscles may be considered as the furnace of the body. During activity, heat production is very active; while during rest, it is considerably diminished. In fever there may be either a great increase of heat production or simply a loss of heat regulation, or both conditions may exist. It is thus evident that those procedures of massage which especially concern the muscles, such as different forms of deep kneading and strong percussion,, must exert a powerful influence upon heat production.

By actual observation it has been shown that massage of a muscle, as well as exercise, may cause a rise of temperature amounting to several tenths of a degree Fahrenheit. The importance of this fact will be recognized when it is recalled that four fifths of all the food eaten goes to the production of heat, only one fifth of the force represented in the food reappearing as work or energy. This explains the enormous increase of CO2 in connection with muscular exercise. The quantity of CO2 eliminated during vigorous muscular effort sometimes rises to nearly five times the usual amount. Muscular waste and weakness in fever is chiefly due to the consumption of the glycogen, which occurs under the influence of the toxic substances present in the tissues during febrile states.

The continued activity of the muscles in heat production, even when the body is at rest, is doubtless due to the slight muscular activity constantly present as so-called muscular tone.

Winternitz has shown that under some circumstances heat elimination by the skin may be nearly doubled (increased ninety-five per cent) by friction. He accordingly recommends friction, in connection with the cold bath, for reducing temperature in fevers.

Celsus, the famous old Roman physician, recommended rubbing in fevers when the surface was cold, although he carefully interdicted rubbing in fevers at other times. The increased heat dissipation resulting from massage is directly due to the increased circulation of blood in the skin. The higher the temperature of the skin the more rapidly will be the dissipation of heat from the body. The skin is the principal means by which the blood is cooled, the heat brought from the interior to the surface being dissipated by radiation, conduction, and especially by the evaporation of water poured out of the skin by the sweat glands.

Massage, by dilation of the blood vessels and acceleration of the peripheral circulation, brings an increased quantity of heat to the surface, and at the same time, through increasing the blood supply and by reflex influence upon the sympathetic nerves, it induces increased activity of the sweat glands, which leads them to pour out an increased amount of perspiration. Thus heat dissipation is increased both by radiation and by evaporation as the result of the application of superficial massage.

It thus appears that bodily temperature may be either increased or diminished by massage, since by kneading the muscles we may increase heat production, while by friction we may increase heat elimination. It is particularly important to remember that when massage is applied for the purpose of increasing heat dissipation, only such procedures should be adopted as will act upon the surface alone, since any manipulation of the muscles will increase heat production.

A small amount of heat is communicated to the surface by the hand of the manipulator, and a further small quantity is generated by the friction of the hand upon the surface; but these sources of heat are too small to deserve more than mere mention.

Another point worthy of notice is the fact that while general massage increase heat production, it does not necessarily increase the bodily temperature, for the reason that the increase in heat production may be more than balanced by the increases dissipation of heat. For example, in a case in which general massage increased the surface temperature 1.4° F., the rectal temperature fell .8° F.

Abdominal massage, however, exercises an effect the opposite of that of general massage. Massage of the abdomen may cause a fall of surface temperature of .2° F., while the rectal temperature rises 2.2° F.

Effect of Massage upon Digestion

There is no single function which may be more clearly demonstrated to be directly encouraged by massage than digestion. By is judicious application, the digestive process is promoted in several ways: –

1. By Improving the Appetite. – The general improvement in nutrition occasioned by the removal of waste and the acceleration of the blood and lymph circulations, creates a demand for an increased supply of nutriment which nature manifests by an improvement in appetite.

2. By Promoting Secretion of the Digestive Fluids. – Massage, especially abdominal massage, through its reflex influence upon the glands and circulation of the stomach and intestines, promotes the production of the digestive fluids in sufficient quantity and quality.

3. By Promoting Absorption of the Products of Digestion. – Hopadzë has shown that massage of the abdomen, for even so short a time as ten minutes, applied at once after eating, diminishes by fifteen to seventy-five minutes the length of time the food is retained in the stomach.

Hirschberg declares that massage of the abdomen hastens the passage of food from the stomach even more efficiently than does either exercise or electricity. This fact the writer has frequently demonstrated.

4.By Aiding Peristalsis. – Massage not only aids the absorption of food from the stomach, and its passage from the stomach into the intestine, but also excites the reflexes by which the alimentary mass is moved along in the small intestine to the colon, and finally discharged from the body. Indeed, massage has no rival in its efficiency as a means of promoting intestinal activity.

Influence of Massage upon Nutrition, Hæmatogenesis, and Phagocytosis

That massage encourages the blood-making process is demonstrated by the rapidity with which the number of red blood corpuscles and the amount of hæmoglobin increase in the blood under the influence of this therapeutic means in cases of anæmia. The value of this fact can scarcely be over-estimated. The blood is one of the most important of all the tissues of the body. The total amount of blood contained in the body is about ten pounds, each cubic millimeter of which contains from four and a half to five million corpuscles, making in all 32,500,000,000,000 – more than twenty thousand times the entire population of the globe. These little bodies have a combined area of nearly 2900 square meters, or more than 31000 square yards – equal to a square nearly 175 yards on each side. When we consider that this enormous area of blood must pass through the lungs every twenty-two seconds in order to secure the proper amount of oxygen for the tissues, it is readily apparent how great a loss must be suffered when the quantity of blood is diminished ten to twenty or even seventy-five per cent, as in cases of anæmia, and also the great gain effected by a like increase in the number of corpuscles, or oxygen carriers.

Another important influence of massage upon the blood which has recently been noted is the immediate increase in the number of corpuscles produced by a general application of massage. Winternitz pointed out, a year or two ago, the interesting fact that by the application of cold water to the surface in such a way as to secure vigorous reaction, the number of corpuscles could be immediately increased from twenty five to fifty per cent. In one case an increase of more than 1,800,000 corpuscles was noted within half an hour after the administration of the cold bath.

Winternitz also showed that exercise has a like effect, and Mitchell, of Philadelphia, has proven the same for massage.

It is not to be supposed, as is remarked by Winternitz, that this sudden increase of blood corpuscles is due to a new production of blood cells; the apparent increase in numbers is due to the sudden bringing into the circulation of a great number of corpuscles which had previously been retained in the large vascular viscera of the interior of the body, especially the spleen and liver.

Quincke has noticed that the corpuscles accumulate in the capillaries of the liver and spleen in great numbers just before they are disintegrated, which naturally leads to the suggestion that the corpuscles set free by massage, and restored to usefulness by being brought into circulation, are at the same time rescued from destruction by the organs devoted to this work in the body, so that we have in massage not only a means of bringing useless cells into activity, but also of combating the anæmia which in certain cases results from the excessive destruction of blood cells rather than from deficient production. The sudden bringing into the circulation of the blood of many extra square yards of blood corpuscles destined to pass through the lungs for the discharge of CO2 and the absorption of oxygen every twenty-two seconds, very clearly explains the wonderfully rejuvenating effects of massage and its powerful influence in aiding nutrition.

Phagocytosis. – This interesting phenomenon, the complete demonstration of which was worked out by Metchnikoff in Pasteur’s laboratory, is influence by massage to a remarkable degree.

In the case of exudates in parts which have suffered from inflammatory processes, the removal of the exudate depends first upon its solution. This is effected by the white blood corpuscles, which actually digest the inflammatory products, thus setting them free so they can be carried off by the venous and lymph currents. It is thus apparent that the first thing essential for the removal of chronic exudates is an increased blood supply. Through the influence of massage directly applied, not only is an increased supply of blood made to circulate through the vessels which have remained intact, but old blood and lymph channels which have been obliterated are reopened, and thus the vital streams are made to flow through and about the affected part with greatly increased activity.

Phagocytosis is also the principal means by which the body antagonizes an invasion of foreign microbes which always takes place in connection with infectious disease. Microbes of various sorts, and even animal parasites, such as the plasmodia of malaria, are captured and destroyed by the white blood corpuscles. It is, indeed, through the action of these blood cells that the vital current is kept free from foreign matters of various kinds. They seem to be, in fact, a sort of vital patrol which march up and down the highways of the body, resisting and destroying intruders of various sorts.

It is evident that massage, as already pointed out, by bringing into circulation an increased number of blood cells, must greatly increase the resisting power of the body. It is especially worthy of notice that while both the red and the white corpuscles are greatly increased by massage, the white corpuscles are increased in much greater proportion than the red ones.

Massage is also valuable as a regulator of the nutritive processes. Hopadzë has proven that massage increases the assimilation of nitrogenous food substances, while Zabloudowski has shown that massage both diminishes the weight of very flesh persons and increases the weight of badly nourished persons, giving increased appetite and sleep. He showed that these effects continue not only during the treatment but for some time afterward.

Influence of Massage upon Elimination

The chief effects of massage upon elimination are: –

1. To Improve Elimination. – In general it sets waste matters free, by encouraging oxidation, by encouraging cell exchanges by which the waste matters are poured into the blood and the lymph currents from the tissues, and by stimulating the flow of the venous blood and the lymph, as well as by promoting general activity of the circulation, thus bringing the waste matters in contact with the organs devoted to their elimination.

2. To Encourage Activity of the Liver. – The liver requiring oxygen in the various branches of its work as an eliminative organ, its action is greatly encouraged by the increased amount of oxygen brought into the blood by massage. The increased activity of the portal circulation produced by abdominal massage especially aids the liver.

Hepatic activity may also be directly stimulated by the application of massage to the liver – especially by vibratory movements and percussion applied over the organ. The fact is worthy of notice that not only hepatic activity but renal efficiency depend upon the integrity and activity of the hepatic cell, which, when stored with glycogen, is capable of transforming leucomaines and various other toxic substances normally produced in the body, into less toxic forms, preparing them for elimination by the kidneys, and also actually destroying ptomaines and other alkaloids which may be taken in with the food or generated in the alimentary canal. Massage, by promoting these important activities in the liver, not only aids elimination through both liver and kidneys, but contributes to purity of blood by the destruction of poisons.

3. To Encourage Renal Activity. – That massage aids renal activity has been actually demonstrated by experiments upon both dogs and human beings. Abdominal massage frequently gives rise to a copious discharge of newly formed urine, although massage of the back or loins does not produce the same effect. Abdominal massage doubtless promotes kidney activity through its influence upon the lumbar ganglia of the abdominal sympathetic and the solar plexus.

In experiments made upon a dog, it was observed that massage of the legs also promoted renal activity. The increased secretion of urine was, however, observed to be but temporary, probably because the quantity of fatigue-poisons in the body, the removal of which was especially aided by massage, was soon exhausted. It was found that the same effect was again noticeable after tetanizing the leg, whereby a new quantity of fatigue-poisons was produced.

4. To Promote Activity of the Skin. – The activity of the skin is promoted by massage, both in the direct stimulus of the sweat and sebaceous glands and the hair follicles, and also in the reflex influence upon the vasomotor nerves whereby an increased supply of blood is brought to the skin, thus promoting and continuing the glandular activity directly excited. An evidence of this stimulation of the skin as the result of massage is to be seen in the reddening of the surface; the increased perspiration, which may be so great as to interfere with the manipulations; the increased production of oil, which is particularly noticeable in cases in which the skin is abnormally dry at the beginning of a course of treatment; and the increased growth of hair, especially upon the legs and arms. Winternitz has shown that friction of the skin increases the elimination of water sixty per cent.

When it is remembered that the skin is an organ of respiration as well as perspiration, its increased activity must be regarded as one of the most valuable effects of massage.

It is also noticeable that massage of the skin increases its reactive power and so gives it increased ability to defend itself against changes in temperature, weather changes, etc.

Local Effects of Massage. –

The local effects of massage my be briefly stated to be: –

1. Increase of blood and lymph circulation.
2. Increase in both constructive and destructive tissue change.
3. Absorption of waste or effused products.
4. Development of the muscles, ligaments, and other structures acted upon
5. Increased heat production and tissue respiration.
6. Reflex or sympathetic effects upon the vasomotor centers, and through them upon the large internal organs, – the liver, spleen, stomach, intestines, kidneys, and the general glandular system of the whole body.

From Volume 1, Issues 1 and 2 of Massage Heritage Times. Compiled and Edited by Robert Calvert.

Editor’s introduction: This article comprises one of the smallest books on the subject of massage, only twenty-one pages in length. It was written by the author in 1887 while he was a practicing physician and proponent of massage in Boston, Massachusetts. It is evident from the material that he was widely read on the subject because his material reflects the thinking of most other proponents of massage during his time. In the article he deplores rubbing, describing how it is not massage and distinguishes massage from “magnetic treatments.” Dr. Balkam describes various basic techniques and mentions cross-fiber strokes with some detail. He includes contraindications such as inflammations and tells his reader, the practitioner, to begin gentle and work toward stronger treatments. He consistently gives advice to the practitioner about demeanor, technique, lubricants and the requisites of a good manipulator. Advising that massage treatments be given at the home of the patient, he emphasizes the need for complete rest after the session. Dr. Balkam believes most ailments are due to poor blood circulation and so massage is an excellent form of therapy. The practitioner must, though, look to the root causes of the disease or disorder.

In commencing these lessons on massage, it is perhaps best at the beginning to inquire a little into the history of the massage mode of treating the sick and afflicted in times long gone by. The reader may possibly think that massage is something new or but recently put in practice by physicians and others; but such however, is not the case, massage or some of the procedure belonging to it have been in practice and used by both civilized and uncivilized nations far back in remote times, and no doubt before the history of any people or nation had been written, massage was practised to remove the effects of violent exercise, pain, effects of overwork, and the fatigue incident to travel and other causes. The history of massage, according to writers and authors on the subject is very ancient, written allusions to it reaching back among the Chinese to a period three thousand years before our era. Among the nations of old who utilized and understood the good effects of massage, I might mention the Greeks and Romans; as combats between gladiators; severe athletic sports and games were among the entertainments to please the public. The actors engaged in these severe sports were often bruised, crippled, and otherwise used up, and it is stated that they resorted to the use of massage to bring their bodies and limbs back to their normal condition.

The different processes of massage, of which I shall speak farther on, when used according as the case requires, can not fail to show its good effects from the first treatment; you have not to wait one month or three to find out if you are cases of extreme tenderness of the skin and muscles, an unguent of some kind is necessary; it may be oil, lard, or vaseline, cocoa butter, or if a soothing effect is desired, a little laudanum added to simple ointment. It may be said as a general rule that no skilful masseur or operator will use lubricants or unguents unless the patient orders their use, or the circumstances of the case require it; as for making use of lubricants in every case would be considered by experts in the art of massage as a sure index of ignorance, and lack of experience and tact on the part of the operator, as bunglers generally resort to lubricants in order that their rough and unskilful work will not cause abrasion, and we might add dislocations, for if the patient is well greased they would be in the condition of the greased pig at the fair, and could stand a great deal of pulling and pounding, grabbing and scratching without apparent injury. It is well at the end of a treatment as a wind-up, to give the patient a light rubbing down with some simple medicated bath or lotion, as it might seem to end a treatment in a more medical and professional manner. It is best in all cases to treat patients at their own homes if possible, because the effects of massage produces and inclination to sleep; a disposition to rest and remain quiet, both mental and physically should be encouraged, as it is best for the patient to remain in a passive and easy condition in order that nature, or the system of the patient, may carry on its changes while at rest. The good effects of massage is partly lost by active exercise or sudden change of temperature immediately after treatment; for certain physiological and pathological reasons it is better for the patient to indulge in rest for a time, after a treatment by massage.

In giving directions in regard to the length of time to be taken for a treatment, we might say one hour including rests between processes for a general treatment, and a half-hour for a local treatment; but the operator must be guided by the disposition and endurance of the patient as well as by the amount of surface operated upon. In drawing these lessons or instructions to a close, I shall mention the necessary qualifications for a successful masseur or manipulator by massage; it is requisite first, to possess good health and physical strength; second, a cheerful disposition; third, a soft hand at the same time not too soft, a certain firmness without being hard is good. A pleasant address and confiding manner is a help.

It is necessary or a great aid to a masseur or manipulator to understand something about anatomy and physiology, so that they may know the location of the arteries, veins, and nerves, and the positions of the principal vital organs belonging to the body and their functions; the course of the circulation of the blood and nerve fluids, and the processes of digestion, so as to have a clear knowledge of the effects produced by the different forms of massage, and how to apply, and where to apply the different processes.

Like every other physical science or art, massage must be practised in order to perfect the operator; the theory may be taught, but the best teacher cannot impart tact, talent, or genius to any one; so the reader will understand that however well stored his mind may be with knowledge on the subject, or how well posted he may be on the theory and art of massage, he must have practice, and gradually acquire the art.

I think in the future, the massage mode of treating the sick, and those afflicted with chronic ailments will be more resorted to both by physicians and the people, and I consider its use a happy medium between the extremes of mental or mind cure on the one hand, and dosing and drugging the system with patent medicines and minerals through the stomach, on the other. While acknowledging that massage belongs to the people, and has been practiced in all ages by cultivated and uncultivated people and nations, I do not think it can be scientifically applied by every man or woman who may fancy themselves cut-out by nature for healers of the people. Still, I would throw no obstacle in the way of any, who with right motives are trying to benefit their fellow men by massage, or any other mode of healing the sick and allaying pain. In my judgment the worst cases to handle, and the cases that will bring all the powers, tact and skill of the masseur in play, are those met with occasionally, and are classified under the heading of nervous mental ailments. In examining these cases, sometime we fail to locate any serious functional, to say nothing of organic disease of any of the vital organs of the body or system; but we find sluggish action and slow circulation of the blood, especially to the feet.

As every effect must have a cause, we seek to find out if possible the causes that have led to the state we find these patients in. And right here it is pertinent to remark that no one can regain lost vitality and permanent health, if they continue to practice habits and vices that cater to causes that produce disease and disorder in their physical bodies. And what I wish to impress on the reader’s mind is, that as long as the cause of disease remains undisturbed, you may dose, drug, and employ massage or any other mode of treatment without any permanent good results. We should direct if possible, our investigations to discover and remove the cause of disease on the start, and then the conditions will be favorable to employ treatment. It sometimes happens, that the cause of the trouble in nervous patients are family or social inharmonies, uncongenial companionship or something approximating to it. In such cases it would be best on the start to have such patients removed entirely away from their place of residence, for change of scene and environment is one of the first proceedings towards a cure. After getting the patient removed to other and more harmonious quarters you may then proceed to employ massage as your best judgment would dictate. In treating such patients try and inspire them with hope and confidence in their ultimate recovery, and as soon as their strength will permit, urge them to take a drive in the open air, and when still stronger, to use their limbs in walking, and other exercise that will not be too tiresome.

It would fill a large volume to give directions suitable for every case, that might present itself to a practical masseur, so I shall not attempt it. I would advise the students in the art of massage however, to procure a work on anatomy and physiology, to assist them in mastering the art. It also being a very interesting study, would help to while away an hour at times, that might be otherwise spent in doing something that would neither improve the mind or body.

To go a little more into detail in regard to practical massage of the hands and feet, I would say in giving treatment to those parts, the same processes are applied in giving either a general or local treatment, unless there is local inflammation or soreness from some cause. In that case notice, and go by the advice laid down in the preceding instructions, where it treats of inflamed parts. If there is no inflammation or soreness, commence the manipulations if treating the hands, with rotary movements of the fingers, grasping the patient’s wrist with one hand, and working with the other. After rotary movements of all the fingers and thumbs, gently pinch, pull, squeeze and press them, then treat the body of the hand from fingers to wrist, using one or both hands so as to be thorough and expediate your treatment. After concluding massage of the hand, take the patient’s wrist in one hand, and with the other give the hand a rotary movement have the wrist as a centre, also press and give the hand a bending movement, forward and backward, taking care not to hurt the patient, working gently and with sufficient force to accomplish the desired results. In massage of the feet, proceed the same as with the hands, using one or both hands as seems best, or when they can be both utilized together, manipulate the toes in the same manner as fingers. Rotary movement of the foot with the ankle as a centre, forward and backward, stretching and bending, percussion or slapping, when the patient can stand it are in order, and excellent to promote the free circulation of the blood to these parts.

Before I quit the subject of manipulations, I wish to state for the benefit of the reader who may practice massage, that kneading and gentle pinching where they can be employed or applied to the patient, are considered the most effective by physicians and practical operators by massage, for either chronic ailments or hygienic effects.

In writing these instructions on massage, I have endeavored to avoid being prolix, and also to refrain from repeating as much as possible. It has been my desire to place at the student’s command, a short practical treatise on the art of massage, stripped as far as the circumstances would permit of the usual medical verbiage and technicalities that generally accompany a work of this kind, and which to my mind only serve to mystify and confuse the reader, and are really not necessary, or of paramount importance in acquiring the practical art of massage. And unless the student had previously obtained a medical education, the medical terms, technicalities, and phrases would be annoying, if not repulsive. I have been assisted in these instructions, or lessons on the art of massage by the experience of others, and have quoted and used some of the phraseology employed by such eminent doctors and physicians as Drs. Douglas, Graham, Taylor and Lee, well-known practitioners and others; also with the results of my own personal experience and practice, which has enabled me to put this practical work into the readers’ hands containing the necessary information (coupled with the reader’s desire to learn) suitable instructions to qualify any one of ordinary intelligence for immediate practice in the art of massage.

25 Years History in the Making by Ruth Williams   1943-1968

All links are PDF Files!

Forward and Dedication

1944-1952

1953-1956

1957-1961

1962-1964

1965-1967

1967-1968

1969-1970

Summary, Important Dates

Sports Massage has long been popular in European Countries and is a primary source of care.

Trainers and coaches in the US used massage for restorative purposes, especially in boxing and track and field.

Jack Meagher, author of “Sports Massage” encountered the techniques of sports massage while in France in WWII and developed the system further in the US.

The modern history of sports massage started at the 1924 Olympic Games in Paris. Paavo Nurmi from Finland brought a personal massage therapist to the running competition and won 5 gold medals. Nurmi claimed that his training program included this special massage treatment.

The following are key dates and milestones:

Circa 400 BCE Early Greek Gymnasiums focused on exercise that consisted of wrestling, jumping, boxing, running, throwing and ball games, massage and baths

1BC – Roman Gymnasiums built for bath and exercise

1900’s – Australian Aborigines used massage during their football games

Circa1900 Finnish School of Massage, originating from Swedish Massage system, develops first system of sports massage.

1924 Runner Paavo Nurmi, the “Flying Finn” from Finland, wins 5 gold medals at the Olympic Games in Paris. This includes the 1.5K and 5K titles, in one day, with only a 30 minute break between events. Nurmi credits special massage treatment as one of the important components of his training program.

1924 to 1930 Dr. I.M. Sarkisov-Sirasini formulates basic concepts for Russian Sports Massage and begins teaching it at the Central Institute of Physical Therapy in Moscow.

Circa 1945 A German POW provides massage to Jack Meagher, U.S. professional athlete and massage therapist. Jack reports “my ability to move while playing was astounding”. (Jack had already graduated from a school of Swedish Massage, but had never heard of this technique before.) Jack goes on to learn the technique from a German instructor familiar with the technique.

1950 Russian athletes, competing internationally, get strong support for sports massage from Soviet government. Extensive research programs and proven techniques continue to be developed in Russia today.

1972 Lasse Viren, the other “Flying Finn”, sets a world record time in the 10K and an Olympic record in the 5K at the Summer Olympics in Munich. Runners learn that Viren received massage daily.

1980 After 30 years of experience with “sports massage”, Jack Meagher writes his classic book, entitled Sportsmassage: A Complete Program for Increasing Performance and Endurance in Fifteen Popular Sports. (Book no longer in print.)

1985 The American Massage Therapy Association, as part of a public relations campaign, creates the National Sports Massage Team (NSMT), and offers massage at the Boston Marathon. (NSMT no longer exists.)

1996 Sport & Remedial Massage Therapy written by Mel Cash

2004 – Book: Understanding Sports Massage written by Patricia Benjamin

2006 – Book: Therapeutic Massage in Athletics by Patricia Archer, athletic trainer, massage school teacher/owner.

2010 Massage for Sport Performance written by Michael McGuillicuddy

Sports massage has been slow in catching on in the US as compared to Europe.  In Russia, sports massage is a daily routine with Olympic athletes

This unique History of Massage is the modern version of what it really took to get us where we are today.  The heck with Ling and all those guys.  These are the days of our lives.

This history starts in the 1960’s, more specifically in 1962 with the founding of Esalen Institute which  became the center for many transformational therapies and studies in human behavior and massage/bodywork.  In 1964,  Fritz Pearls with his Gestalt Therapy, lead the way for more experiments in present moment living and personal responsibility along with client centered relationships.

The Curious 6o’s

1960 -The American Massage & Therapy Association (AM&TA later to become AMTA) was incorporated as a non-profit organization in 1960.  A Code of Ethics was developed in 1960, and the Massage Journal replaced The Masseur as the official AM&TA publication in 1962.

1960’s – John Barnes Developed Myofascial Release Therapy

1962 – Esalen Founded by Michael Murphy and Dick Price

1966 – Raymond Nimmo:  The Receptor Tonus Method.  noxious generative points.

1968 – Ruth William’s writes “25 years: History in the Making”  which is the history of the AMTA.  Read the full book here in PDF format.

1968 – The Heartwood Institute founded.

The Formative 70’s

1970 – Massage schools started being curriculum approved schools as compared to schools from 1930-1970 that were self credentialed schools.  1987 outside accrediting agencies were created to accredit schools.

1971 – Core Energetics developed by Dr. John Pierraolcos.

1972 – Moshe Felednkrais writes Awareness Through Movement which follows up to his 1949  publication “The Body and Mature Behavior” and  “The Potent Self: A Study of Spontaneity and Compulsion.

1972 – George Downing  “The Massage Book” – An international classic book on the art of massage for lay people.

1973 – Zero Balancing developed by osteopath and acupuncturist, Dr. Fritz Smith

1996 – Myotherapy developed by Bonnie Prudden.

1977 – Aston – Patterning developed by Judith Aston

1988 –   The History of National Certification:

The idea of having a national certification board was initiated by AMTA (American Massage Therapy Association) in 1988.  AMTA gave $150,000 and later another $75,000 from their general funds to create an exam that was initially an entrance exam for AMTA potential members.  Sometime and somehow, in 1989, the intentions changed and it became a national exam. 

In April of 1989, 60 massage therapists signed and sent a joint initiative to AMTA to stop the process until more information could be gathered regarding whether or not national certification was necessary for the profession.  This was rejected by AMTA.

A steering committee was chosen by  4 AMTA officers.  It consisted of 2 members of AMTA who initially proposed this action, Susan Rosen of Washington and Susanne Carlson of Oregon. Within the committee,  7 out of 9 members were AMTA members.

In May 1990, the steering committee declared that it was now separate from AMTA. 

Massage Magazine in Jan/Feb 1991 reports that there were never any studies, surveys or reports done that established a need for certification.  There was a survey of AMTA members asking whether or not they supported the action, but not not if the thought national certification was needed.  1,420 AMTA members responded of which 1,042 said they supported national certification.  At the time there were approximately 60,000 therapists nationwide.

National Certification was developed in an attempt to bring credibility to the profession.  It’s intentions were to improve the status and image of the bodywork community.  The exam would certify that certain educational and professional standard were met.  The educational requirements were the bare minimum thought to be need to practice massage. The exam is based on a study done to find out what practitioners do and what they need to know.

The national certification board has created an entry level test.  It does not mean that therapist who take it will be a good therapist.  It has not eliminated prostitution or the idea the massage is often equated with prostitution. It does not mean that the therapist will know what to do when they work on your herniated disc or other injury. It does not eliminate having to be fingerprinted (in some cities) or get a massage parlor license to set up a massage business.

The test questions were supposedly made after doing a survey of what therapists do in their practices. It claims to have based the questions on what current therapists have been using in their practice. I would love to see how the survey was done and who it was sent to. How long have these people been in practice?  What information did they learn after massage school?
The test itself is questionable as it includes topics such as meridians, chakras, other types of therapies such a Ayuvedic medicine, what color your organs are on a energetic level.   I feel these do not have anything to do with doing basic massage.  

What it does do, is protect the massage profession from being regulated by other professionals such as doctors, chiropractors and physical therapists. It does often give credibility to a therapist in a state that doesn’t have any regulations and states where the legislative members are uneducated about massage. There are still some cities/towns that have zoning laws restricting the practice of massage in certain areas.  There are also some places where massage is still equated with the practice of prostitution.  

 1989 – AMTA also created the Commission on Massage Training/Accreditation (COMTAA) in 1989 when it was created by the American Massage Therapy Association (AMTA) to set educational standards for the massage therapy profession with a goal of eventual recognition by the U.S. Department of Education (USDE). – See more at: http://comta.org/about-comta/#sthash.yPQKwWuu.dpuf

1990’s  – Were you there?

1990 – AMTA had 8,500 members.

1990 – ABMP had 2100 members

1990 – 1999 another 16 states and Washington, D.C. took the step for licensing.

Jan. 1999 – 137,390 massage therapists (ABMP statistics)

1999 – The Educated Heart by Nina McIntosh – one of the first ethics books.

 1999 – Commission on Massage Training/Accreditation (COMTAA)  was officially changed to the Commission on Massage Therapy Accreditation (COMTA) –

2000 and beyond

2000 – Mississippi, Illinois, Kentucky, South Dakota, Oklahoma, Georgia, Nevada, Arizona, Massachusetts, Colorado, Indiana, Michigan, Pennsylvania and Montana have passed regulatory legislation.

2002 – Massage Envy Franchise started by John Leonesio (former owner of a chain of health clubs) and Shawn Haycock (Licensed Massage Therapist) in Scottsdale AZ.
Leonesio created a chain of health clubs that he sold to 24 hour fitness in 1999.  2008 – Massage Envy was sold to the Essel Group.  2010 – Massage Envy Sold to Sentinel Capital Partners (owners of groups of Taco Bell, Pizza Hut and Cottman Transmission franchises) — and now the franchise network is owned by Roark Capital Group (Roark after the character in the book the Fountain Head.)

2002 – COMTA was recognized by the USDE as an approved institutional and programmatic accrediting agency of massage therapy schools and programs – See more at: http://comta.org/about-comta/#sthash.yPQKwWuu.dpuf

2004 -COMTA officially separated from AMTA

2004 – Salary Statistics from BLS:  “Median hourly earnings of massage therapists, including gratuities earned, were $15.36 in May 2004. The middle 50 percent earned between $9.78 and $23.82. The lowest 10 percent earned less than $7.16, and the highest 10 percent earned more than $32.21. Generally, massage therapists earn 15 to 20 percent of their income as gratuities. For those who work in a hospital or other clinical setting, however, tipping is not common.”

2005  – Massage Magazine sold to Doyle Group

2005 – Federation of  State Massage Therapy Boards (FSMTB) Created

2004-2006 ish – Cortiva goes on a buying spree of massage schools, buying up smaller “mom and pop” type schools.

2005 – Average massage-related income for massage therapists in 2005 was $18,950, with a median income of $14,500 (2005 ABMP Member Survey from internet archives)

2005 –  ABMP salary stats: Total earnings by massage therapists, including their earnings from other employment, were $32,506 (2005 ABMP Member Survey).

First-year practice average income was $9,589, reflecting the challenges of establishing a professional-service practice (2005 ABMP Member Survey).

2006 – 241,058 massage therapists in the United States as of January 2006 (ABMP ) up from 137,390 in January 1999

2006 -A U.S. Department of Labor forecast for 2006–2007 projected an 18 percent to 26 percent increase in job opportunities through 2014 (Source: U.S. Department of Labor, Bureau of Labor Statistics, 2006–2007 Occupational Outlook Handbook)

2007  – First job task analysis by FSMTB.

2007 – ABMP Metrics Section (see Internet Archives):  ABMP 2007 Member Survey also indicates:

• The average age of ABMP members graduating in 2007 and entering the profession is 44. The median age is 45. (We believe profession-wide average and median ages are a few years lower.)
• Close to 83 percent are women and 54.5 percent are married.
• Massage therapists had an average of 14.4 client contact hours (12 hours median) in the week prior to the survey, according to the ABMP member study.
• 65.6 percent wish they had more clients ó 21.2 percent indicated that (more clients) was the one change they would most like to make to their practice.
• Nearly half of the respondents (51 percent) report supplementing their income with another job, a job at which they spend an average of 25 hours per week. The top five second occupations include: office/secretary/clerks; massage instructor; medical, including nurses; teacher/education; and sales/retail.

• 90 percent have at least some college.

2008 – Massage Envy sold to Veria – a Texas-based, health-focused multimedia company that is a unit of Indian conglomerate The Essel Group.

2008 – Rick Rosen writes a White Paper :  On Becoming a Profession. (PDF on massagemag.com)

2009 – Alliance for Massage Therapy Education founded.  (Founding Members)

January 2009 –  AMTA announced it is now backing the Massage & Bodywork Licensing Exam (MBLEx) , developed by the Federation of State Massage Therapy Boards (FSMTB) was the better exam, and withdrew their support of the NCBTMB. Uhoh…  The NCB says the AMTA was saying that “AMTA’s decision to endorse the MBLEx was driven by passion rather than reason”.  see Massage Today March 2009.

Feb 2009 – Massage Therapy Body of Knowledge Task Force Created.

March 2009  March issue of MT reported on the American Massage Therapy Association’s (AMTA) recent support of the Massage and Bodywork Licensing Examination(MBLEx).

June 2009 – The NCBTMB loses their way and starts offering discounts on Pizza and Oil Changes : see the breaking news.

Spring 2010– 43 states licensed plus WA.DC.

2010 – Veria sold Massage Envy to Sentinel Capital Partners, a New York-based private-equity firm that owns Taco Bell, Pizza Hut, Church’s Chicken and other franchises in a number of states.  See article.

[table] Year, Number of Massage Schools

1985, 50

May 1991 , 190

Jan 1995 , 316

Dec 1998 , 572

June 2002 , 875

Nov 2004 , 1346

2006, 1582

2009 , 1600

2011, 1400

[/table]

By Carl W. Nelson

Information collected From
Martin Ashley, Massage: A Career at Your Fingertips (Barrytown, NY:
Station Hill Press, 1992; Carmel, NY: Enterprise Publishing, 2nd Edition, 1995;
3rd Edition, 1999; 4th Edition, 2003), the number of massage schools in the USA
is listed as 190 in

May
1991, as 316 in January 1995, as 572 in December 1998, and as 875 in June 2002.

From the Associated Bodywork & Massage Professionals website —
www.massagetherapy.com/careers/training.php
(the most comprehensive, reliable, and up-to-date state-by-state Internet
listing) – In November 2004 I counted a total 1346 massage schools in the
entire 50 states – ranging from one in Wyoming to 232 in California. In
September 2006 I counted 262 in California. From the Associated Bodywork &
Massage Professionals press release of April 4, 2007 – The ABMP massage school
database peaked at 1582 schools in 2006, but early 2007 survey results showed
52 of those schools were no longer offering massage programs. In May 2007 I
counted a total 1550 massage schools in the entire 50 states – ranging from two
in Wyoming to 264 in California.

—–
Carl W. Nelson

Distribution of Massage
Schools by State in the USA

Martin Ashley, Massage:
A Career at Your Fingertips (Barrytown, NY: Station Hill Press, 1992;
Carmel, NY: Enterprise Publishing, 2nd Edition, 1995; 3rd Edition, 1999; 4th
Edition, 2003). With respect to the number of massage schools in the USA, the
1st edition listed 190, the 2nd edition 316, the 3rd edition 572, the 4th
edition 875. By state, they are distributed as follows:

May 1991

January 1995

December 1998

June 2002

Distribution of Massage Schools by
State in the USA in November 2004

According to the
Associated Bodywork & Massage Professionals website —
www.massagetherapy.com/careers/training.php
(the most comprehensive, reliable, and up-to-date Internet listing) – there are
currently 1346 massage schools in the USA and by state they are distributed as
follows:

Distribution in May 2007

There are now
1550 massage schools in the USA and by state they are distributed as follows: