Physicians and healers of all forms and from all cultures have used hands-on manipulation throughout history as an integral part of health care practice. In the former Soviet countries, Germany, Japan, and China, massage has continued uninterrupted as massage therapists today work alongside doctors as part of the health care team.

In modern Germany massage therapy is covered by national health insurance. In China it is fully integrated into the health care system, where the hospitals have massage wards. In one Shanghai hospital the massage department covers two floors.

In this country, the medical use of massage began to diminish in the early part of this century with the evolution of pharmaceutical, surgical, and technological medicine. It reached a nadir in the 1930s, 40s, and 50s because it was considered too time intensive for the modern physician. Massage therapy duties were gradually handed over to aides, who eventually became the physical therapists of the modern era.

The professionalization of massage therapy in the United States began in 1943 when the graduating class of the College of Swedish Massage in Chicago decided to band together and form an association with twenty-nine charter members. What they created was destined to become the American Massage Therapy Association (AMTA).

In the 1960s, while modern medicine continued its march toward higher technology and drugs and away from physician contact with patients, such concepts as holistic health, self-improvement, and optimal health experienced a rebirth. The 1970s brought even greater interest in health promotion and a new openness to massage.

This was followed by explosive growth in the varieties of massage and bodywork available, and today there are now over eighty different varieties. The term "bodywork" evolved as a generic term for referring to this broadening field. It is now loosely used to incorporate massage and other forms of manipulation.

In the survey of alternative medicine that was published in The New England Journal of Medicine in January 1993,¹ massage therapy ranked third among the most frequently used forms of alternative health care. According to Elliot Greene, president of the AMTA, there are now an estimated fifty thousand massage therapists of various kinds in the United States, and the AMTA may be the fastest-growing organization of health care providers m the country. At this writing it has over eighteen thousand members and its rolls have more than doubled in the last three years.

Education
There are myriad programs of education and training for the many different forms of massage and bodywork. For the massage therapy field, the AMTA has been successful in establishing standards that are incorporated in many state licensing laws. Fifty-eight training programs are currently accredited or approved by the AMTA-affiliated Commission on Massage Training Accreditation/Approval, which requires at least five hundred hours of classroom instruction. The curriculum includes three hundred hours of massage theory and technique, one hundred hours of anatomy and physiology, and one hundred hours of additional required courses including first aid and cardiopulmonary resuscitation (CPR). There are of course many other training programs that do not meet all of these standards.

Training in other forms of bodywork is much less uniform and there are no licensing laws for bodywork methods as such. Many bodyworkers are also massage therapists, but this is not required for most bodywork traditions. The various associations described later in this chapter all have their own unique standards for training.

While there are a wide variety of forms of massage therapy and bodywork, all with their own theoretical or philosophical perspectives, there are certain basic principles they all tend to; hold in common.

Circulation of Blood. Perhaps the most basic principle in this field is that improved blood circulation is beneficial for virtually all health conditions. Tension in the muscles and other soft tissues can impair circulation, resulting in a deficient supply of nutrients and inadequate removal of wastes or toxins from the tissues of the body. This in turn can lead to illness, structural and functional problems, or slower healing. Recognition of the importance of blood circulation is implicit in all forms of massage and bodywork.

Elliot Greene describes the process as one of breaking up the scarring that had occurred in her muscles and connective tissue or fascia between the muscles, vertebra, and ribs, all of which had become stuck together. Blood flow through the area was restored and the depression that had been palpable in her spine gradually began to diminish. The full range of motion of the spine returned.

Movement of Lymphatic Fluid. The lymph system is almost as extensive as that of the blood. The circulation of lymphatic fluid plays a key role in ridding the body of wastes, toxins, and pathogens. The lymph system also benefits from massage, particularly in conditions where lymphatic flow is impaired by injury or surgery (e.g., in postmastectomy women).

Release of Toxins. Chronic tension or trauma to the soft tissues of the body can result in the buildup of toxic by-products of normal metabolism. Hands-on techniques help move the toxins through the body's normal pathways of release and elimination.

Release of Tension. Chronic muscular tension as a result of high stress lifestyles, trauma, or injury can accumulate and impair the body's structure and function. Psychological well-being is also affected. Release of tension allows greater relaxation, which has important physiological and psychological benefits.

Structure and Function Are Interdependent. The musculoskeletal structure of the body affects function and function affects structure. Both can be adversely altered by stress or trauma. Massage therapy and bodywork can help restore healthy structure and function, thereby allowing better circulation, greater ease of movement, wider range of movement, more flexibility, and the release of chronic patterns of tension.

Enhancement of All Bodily Systems. All bodily systems are affected by better circulation and more harmonious functioning of the soft tissue and musculature. Internal organ systems as well as the nervous system, the immune system, and other systems can benefit. There can be an overall improvement in the quality of life and physical health.

Mind/Body Integration. Mind and body have a reciprocal relationship. Soma (body) affects psyche (mind) and vice versa. Hence there can be somatopsychic effects, in which the conditions of the body affect the mind and emotions, and there can be psychosomatic effects, in which psychological or emotional conditions affect the body. Change in one domain may cause change in the other. A habit or fixed pattern in one may also impede change in the other and require special attention. Often psychotherapy and massage or bodywork complement each other.

Reduction of Stress. Stress is increasingly believed to induce illness, and perhaps 80 to 90 percent of all disease is stress induced. Massage therapy is an effective non-drug method for reducing stress and promoting relaxation.

Energy. Many modalities in this tradition work with the flow of energy through the body as a means to promote healing. Energy can be directed or encouraged to move through and around the body in such ways as to have impact on the physical structure and function of the body as well as on emotional well-being. This work may involve hands-on contact or may be done with no contact with the physical body.

According to Joanna Chieppa, R.M.T., a faculty member at Heartwood Institute in Garberville, California, and an energy healing practitioner in Sonoma County, "It is important for people to develop an awareness that the flow of energy in and around the body is just as important to well-being as the flow of blood, the flow of breath, the flow of cerebral spinal fluid— that it is essential for the health of body, mind, and spirit."²

For this chapter, the sections on varieties and techniques are combined. As stated earlier, there are over eighty different types of massage therapy and bodywork. Many are variations on each other, often developed by a practitioner who is trained in one particular approach and then goes on to develop his or her own variety, with its own new "brand name."

Most varieties can be broken down into the following five broad categories:

Traditional European Massage
Contemporary Western Massage
Structural/Functional/Movement Integration
Oriental Methods
Energetic Methods (Non-oriental)

The majority of activity in this field is oriented toward the traditional European and contemporary Western forms of massage simply because there are such large numbers of practitioners of these methods.

Traditional European Massage
Traditional European massage includes methods based on conventional Western concepts of anatomy and physiology and soft tissue manipulation. There are five basic kinds of soft tissue manipulation techniques: effleurage (long flowing or gliding strokes, usually toward the heart, tracing the outer contours of the body), petrissage (strokes that lift, roll, or knead the tissue), friction (circular strokes), vibration, and tapotement (percussion or tapping).

Traditional European massage was brought to the United States by two doctors from New York who were brothers— Charles and George Taylor—who studied in Sweden and introduced Americans to Swedish techniques in the 1850s. After the Civil War, the first Swedish clinics opened in Boston and Washington, the latter frequented by U. S. Grant.