Foundations

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foundations of
massage
third edition
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‘health’ — from the Old English health, meaning a state of wholeness,

and haelan, to heal or make whole
Dedicated to healers, past, present and future whose skills, knowledge and intent
assist to restore wholeness through the medium of touch.
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foundations of
massage
third edition
Lisa Casanelia
BHSc (MST), BA, RMT
Senior Lecturer — Remedial Therapies Dept, Endeavour College of
Natural Health, Melbourne, Australia
David Stelfox
Grad Dip Western Herb Med, BNat, Dip Rem Mass, Dip Nat,
Dip Herb Med
Academic Coordinator — Endeavour College of Natural Health,
Adelaide Campus
National Program Leader — Remedial Therapies Dept, Endeavour
College of Natural Health, Adelaide, Australia
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Sydney Edinburgh London New York Philadelphia St Louis Toronto
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Churchill Livingstone
is an imprint of Elsevier
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Tower 1, 475 Victoria Avenue, Chatswood, NSW 2067
Text © 2010 Endeavour College of Natural Health

Illustrative Material © 2010 Elsevier Australia
Colour Appendices 1 and 2 originally published in Acupuncture Channels and Points;
Elsevier Sydney; 2008 by Joan Campbell.
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This publication has been carefully reviewed and checked to ensure that the content is as
accurate and current as possible at time of publication. We would recommend, however, that
the reader verify any procedures, treatments, drug dosages or legal content described in this
book. Neither the author, the contributors, nor the publisher assume any liability for injury
and/or damage to persons or property arising from any error in or omission from this publication.
National Library of Australia Cataloguing-in-Publication Data
Casanelia, Lisa.
Foundations of massage / Lisa Casanelia; David Stelfox.
3rd ed.
9780729538695 (pbk.)
Includes index.
Bibliography.
Massage--Technique.
Massage--Philosophy.
Stelfox, David P.
615.822
Publisher: Sophie Kaliniecki

Developmental Editor: Sabrina Chew
Publishing Services Manager: Helena Klijn
Editorial Coordinator: Sarah Botros
Edited and indexed by Jon Forsyth
Proofread by Maria McGivern
Illustrations and internal design by Trina McDonald
Appendix illustrations by Nives Porcellato & Andrew Craig
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Cover design by Stan Lamond

Photography by Glenn McCulloch Photography
Typeset by TNQ Books and Journals
Printed by Ligare
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contents
Foreword vi Section 5 Providing the massage treatment
Preface vii 14 Body mechanics for the practice
Acknowledgments viii of massage 143
Reviewers viii Lauriann Greene and
Richard W Goggins
Contributors ix
15 Positioning and draping the client 151
Lisa Casanelia
Section 1 A framework for massage practice
16 The techniques of Swedish massage 163
1 Philosophies and principles of Steven Goldstein and Lisa Casanelia
massage and natural medicine 1
David Stelfox 17 Applying massage in practice 185
Lisa Casanelia
2 A history of massage 11
Katharine Callaway and Susan Burgess Section 6 Massage for specific
3 Massage in an integrative health care model 23 client groups
David Stelfox
18 Massage for clients with
4 The importance of touch 31 special needs 251
Sheena Worrall Margaret Hutchison
19 Massage during pregnancy 261
Section 2 The professional therapist
Suzanne Yates
5 Scope of practice, ethics and law in massage 20 Massage for infants 271
therapy practice 43 Clare Thorp
Janine Tobin
6 Defining boundaries in the Glossary 275
client–practitioner relationship 53
David Stelfox and Sonya Bailey Appendices
7 The evidence for massage therapy 61 Appendix 1 Body planes 279
Sandra Grace
Appendix 2 A natomy 282
Section 3 Preparing for massage practice Appendix 3 A natomical terms and common
medical abbreviations 287
8 The massage setting 73
Appendix 4 Client case history form 291
Lisa Casanelia
Appendix 5 Three ASTER chart samples 295
9 Self-care for the massage therapist 83
Lisa Casanelia Appendix 6 Case study 297
Index 298
10 Infection control in massage therapy
practice 93
Ellie Feeney and Heather Morrison
Section 4 Making initial contact with

the client
11 The health assessment process 105
Lisa Casanelia
12 Precautions and safe practice for massage 115
Jan Douglass
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13 Pharmacological considerations for massage

therapy practice 127
Michael Nott
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foreword
‘Massage is the study of anatomy in braille’ edition you are now holding in your hands. Its rewriting,
Jack Meagher revision, updating and enhancement has assured it of a
The sense of touch is one of our most underestimated continuing valued place amongst Australasian schools
of senses. Massage of course, is a celebration of the that train massage practitioners.
sense of touch and since ancient times this art has This textbook is comprehensive and geared
found practitioners in almost all cultures, who used it towards an Australasian audience in terms of cultural,
for relaxation, for therapy, for rehabilitation, and for ethical and legal considerations. Experienced massage
remediation of health problems. Presently throughout the practitioners, passionate educators and researchers
world, we are experiencing a resurgence of traditional, have contributed to the textbook and the scientific
complementary and alternative modes of treatment. basis of massage therapy is considered, while the latest
Massage, like the sense of touch, has always been a research is incorporated into the practical aspects of
constant in the background, its practice uninterrupted massage that the book deals with. Clear, comprehensive
during the passage of the centuries. However, we are text is complemented by relevant illustrative material
now seeing massage coming to the forefront of health that re-enforces the learning experience. Case-based
care in many areas. approaches are enhanced by practical, clinical advice and
Massage is being embraced in more and more supported by reference to industry-specific legislation.
situations of the modern world, an affirmation The appendixes and other additional reference material
of its effectiveness throughout the centuries. of the book further add to the usefulness of the text.
Massage therapists can deliver effective treatments Learning-oriented devices are incorporated into the
at gymnasiums, health clubs, private health care book at many levels, making it student-friendly and a
clinics and health spas. Corporate health care often pleasure to use both from a teacher’s as well as from a
incorporates massage and many sporting clubs have a student’s perspective.
massage practitioner on their payroll. Many massage I trust that you will find in this latest edition of
therapists run their own practice, and increasingly Foundations of Massage an old friend rejuvenated
remedial massage is standard care at many hospitals and much improved. While many teachers and students
and aged-care facilities. Massage is nowadays very of massage have benefitted from using its predecessors,
much ‘mainstream’, rather than ‘alternative’. the current edition will make new friends and help in the
The demand for competent, well-trained, professional training of competent, informed, well-rounded massage
massage practitioners requires a way of training and practitioners.
educating them to a national standard with well-defined
benchmarks to relaxation and remedial skill sets.
Although many massage courses exist around Australasia Dr Nicholas J. Vardaxis
in a variety of training settings, many of these until Director of Education,
recently use educational materials and texts that have Endeavour College of Natural Health,
been developed abroad. The success of the present text Melbourne 2009
as a locally written resource is highlighted by this third
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preface
The resurgence and growth of interest in personal health Australian perspective. The first edition of Foundations
and wellbeing that emerged in the last decades of the of Massage succeeded in satisfying this need. It became
twentieth century is very apparent in the increased the text of choice for providers of massage therapy
demand these days for services in the areas of fitness, education throughout Australia. For the second edition
beauty and natural health care. Of all the modalities or we brought together an experienced team of practitioners
areas of natural health, massage therapy is perhaps the and educators to expand the scope of the text. The
most commonly accepted and utilised. Once regarded inclusion of additional chapters covering areas such
as a luxury, massage therapy is now regarded by many as infection control, pharmacological considerations
as an essential means for promoting and maintaining and self-care ensured that all aspects of massage
optimum health, fitness and wellbeing. In a stressed-out therapy practice were covered comprehensively and
world, where individuals feel increasingly isolated and appropriately. Not only was the second edition taken up
deprived of touch, relaxation massage provides welcome by more schools and colleges in Australia, but it also
relief, and is an important and effective therapy, of gained popularity as a massage text in New Zealand.
benefit to a wide range of people and conditions. In this, the third edition of Foundations of Massage,
The increased demand for massage therapy by we have once again drawn together the knowledge and
consumers has resulted in the need for competently experience of massage therapists, health practitioners
trained massage therapists and in the establishment of and health educators, not only from within Australia but
national standards of education and training for massage also internationally, to provide an up-to-date, clinically
therapy practice. In Australia and New Zealand, based and well-rounded perspective on the practice of
government-accredited health training packages have massage. These contributors possess not just a wealth
instituted benchmarks of education standards for a of knowledge and experience, but also a passion for
number of natural health care modalities, including massage therapy and the benefits it can offer. It is our
relaxation massage and remedial massage therapy. hope that this passion may rub off on the reader and
Additionally, national peak bodies and professional student of this text and, along with the knowledge and
associations for natural medicine and massage therapy skills outlined throughout, provide a strong foundation
ensure that the standard of practice provided by for effective and successful massage therapy practice.
practitioners is consistent and high. We trust that you will find this book informative,
With the introduction of these education standards, practical and enjoyable.
it became apparent that the only massage therapy texts
available were overseas publications, and that there was
an urgent need for a comprehensive text that presented Lisa Casanelia
the fundamentals of massage therapy from a uniquely David Stelfox
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acknowledgements
We wish to express our heart-felt thanks to the book’s Thanks also to the reviewers who provided feedback
contributors, without whom this third edition would not which assisted with the update of this text.
have been possible. Thank you for sharing our vision for Finally we wish to acknowledge those who initiated
this text, and also for sharing your knowledge, expertise and contributed to the original idea for this foundation
and passion for the art and science of massage. Our massage text. You know who you are. It was your vision,
gratitude to Sophie Kaliniecki, Sabrina Chew, Helena your motivation, your dedication and support that has
Klijn and Sarah Botros from Elsevier Australia for their resulted in the evolution of Foundations of Massage to
commitment to getting this edition to print on time. this third edition.
reviewers
Paula Nutting, BHSc MST, Dip Rem Mass, Past Jason Patten, M.ExcSci, Dip RM
Registered Nurse Senior Educator, RMIT University, School of Life and
National President, Australian Association of Massage Physical Sciences, College of Science, Engineering and
Therapists Health, Melbourne, Australia
Allan Hudson, DRM, Dip Acup. Adv.Dip Nat Choong Ng, MBBS BMedSci DipRM CertIVFitness
Faculty Head of Tactile Therapies and the School of General Medical Practitioner, Evidence-Based Practice
Continuing Education, Nature Care College, Sydney, Researcher, Remedial Massage Therapist and Fitness
Australia Trainer (Private), Melbourne, Australia
Diana L Thompson, LMP (licensed massage therapist) Antony Porcino, BSc, CHP, PhD Candidate
President, Massage Therapy Foundation, Evanston, Project Director, Complementary Medicine Education
Illinois, USA & Outcomes, BC Cancer Agency, Vancouver, Canada
Carolyn Price, Dip Teaching, Cert IV TAA (Training Steve Lawson, MEd, BSc(CompMed),AdvDIpNat,Grad
and Assessment) DipMFR,GradDipCST,DTS,DRM
Cert IV Mass Ther, Dip Aroma, Reg.Teacher IAAMA Director of Education, Nature Care College, Sydney,
(International Aromatherapy and Aromatic Medicine Australia
Association); Coordinator, Complementary Health
Program, TAFE SA North, Adelaide, Australia
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contributors
David Stelfox, Grad Dip Western Herb Med, BNat, Dip Jan Douglass, BHSc, Dip Rem Mass
Rem Mass, Dip Nat, Dip Herb Med Lymphoedema Therapist, Flinders Surgical Oncology
Academic Coordinator, Endeavour College of Natural Clinic, Flinders Medical Centre, Adelaide Australia;
Health, Adelaide Campus; National Program Leader Instructor, Vodder Schools International
— Remedial Therapies Dept, Endeavour College of Michael Nott, BScHons (Melbourne), PhD (Strathclyde)
Natural Health, Adelaide, Australia Senior Lecturer, Discipline of Pharmaceutical Sciences,
RMIT University, Melbourne, Australia
Katharine Callaway, BHSc (Natural Medicine), Dip
App Sc (RemTh) Lauriann Greene, CEAS
Co-author, Save Your Hands! The Complete Guide
Susan Burgess, Dip HSc (Remedial Therapies), Dip to Injury Prevention and Ergonomics for Manual
(Reflexology) Dip (Indian Head Mass) LST Therapists, 2nd edn
Remedial Massage and Reflexology practitioner,
Denmark Richard W Goggins, M.S., CPE, LMP
Co-author, Save Your Hands! The Complete Guide
Sheena Worrall, Grad Cert Higher Education, Dip to Injury Prevention and Ergonomics for Manual
Ther Mass Therapists, 2nd edn
Lecturer, Faculties of Social Science and Bioscience,
Endeavour College of Natural Health, Gold Coast, Steven Goldstein, BA (Education), BHSc.(MST)
Australia Education Chair, Australian Association Massage
Therapists; Senior Lecturer, Faculty of Remedial
Janine Tobin, BHMS, BN, Dip Remedial Massage, Therapies, Endeavour College of Natural Health,
Grad Cert Higher Education Melbourne, Australia
Lecturer, Faculty of Biosciences, Endeavour College of
Natural Health, Brisbane, Australia Margaret (Margo) Hutchison, RN, Dip IYTA, Dip
Ther Mass, Grad Cert Higher Education
Sonya Bailey, Grad Cert Higher Education, BHSc On-line Course Tutor, Sessional Lecturer — Bio-
(MST) Science Dept, Endeavour College of Natural Health,
Lecturer, Faculty of Remedial Therapies, Endeavour Brisbane, Australia
College of Natural Health, Melbourne, Australia
Suzanne Yates, BA (Hons), DipHSEC, MRSS(T),
Sandra Grace, PhD, MSc Chiro (Res), Grad Cert APNT, PGCE
Sports Chiro, Dip Acup, DBM, DC, DO, Dip Ed Body-worker and birth educator, Director of Well
BA Research Fellow, The Education for Practice Mother, Bristol, England
Institute, Charles Sturt University, Australia
Clare Thorp, RN, GradDip (Public Health), GradDip
Lisa Casanelia, BHSc (MST), BA, RMT (Health Education), Dip (Aromatherapy, Cert Mass
Senior Lecturer — Remedial Therapies Dept, Endeavour Ther, Cert IV Reflex
College of Natural Health, Melbourne, Australia Practitioner Trainer and Certified Infant Massage
Instructor, Infant Massage Australia
Ellie Feeney, BHSc (MST), DipAppSc (RemTh), RN,
RM
Senior Lecturer — Bioscience Dept, Endeavour College
of Natural Health, Melbourne, Australia
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Heather Morrison, PhD, BSc (Hons)

Head of School — Health Science, Endeavour College
of Natural Health, Melbourne, Australia
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SECTION 1
1
philosophies and principles of
massage and natural medicine
David Stelfox chapter
LEARNING OUTCOMES
l Define massage
l Describe the philosophies, principles and practice of massage therapy within the context of
natural medicine
l Define and provide examples of complementary and alternative health care therapies
l Compare and contrast the principles and practices of chiropractic, osteopathy, physiotherapy
and massage therapy

INTRODUCTION
‘massage’. There are now so many different techniques
To be a competent and successful massage therapist — and approaches to soft tissue manipulation that it is dif-
or, for that matter, a health professional of any modal- ficult to classify them clearly under meaningful catego-
ity — a clear understanding of the nature (definition) ries. Many have tried, but confusion has often resulted,
of the discipline, as well as its guiding philosophy and as there will always be techniques that don’t fit neatly
principles, is essential. Without such understanding a under the proposed categories. For the purpose of this
health care practitioner cannot deliver consistent thera- text, the more commonly known methods are classi-
peutic services that lie within a clearly defined scope of fied under three broad headings — the subtle energy
practice. It is a bit like having a car without a road map practices, the relaxation methods, and the remedial
to help you find your way. approaches (see Table 1.1).
Massage therapy is generally classified as a ‘com- For the purpose of defining massage, the historical
plementary’ or ‘alternative’ form of health care and is roots of the word ‘massage’, and their individual mean-
generally perceived to be one of many modalities which ings, will be examined. ‘Massage’ means to touch, softly
come under the classification of ‘Natural Medicine’ press, squeeze, rub, handle or knead with the hands. The
(House of Lords Report 2000). These are terms that also English word ‘massage’ first appeared in American and
require definition and understanding. This chapter aims European literature around 1875. It was popularised in
at providing the massage student with an understanding the USA by Douglas Graham from Massachusetts (who
of the various philosophies, principles and definitions wrote a history of the art) and in Europe by an influen-
associated with natural medicine practice. Through this tial Dutchman, Dr Johann Mezger.
understanding the student should feel that they have The Greek word masso or massein means to touch,
an orientation to the profession in which they will be handle, knead or squeeze. Massa is the Latin root com-
practicing. ing directly from the Greek, and is reflected in the Portu-
guese verb amassar, to knead. The Arabic root mass’h,
MASSAGE THERAPY — A DEFINITION or mass, is very similar and means to press softly, as
One of the difficulties of defining massage is that the does the Sanskrit makeh. Ancient Jewish culture held
term means many things to many people. The terms the power of touch for ritual benefit in such high esteem
massage, tactile therapy, bodywork, manual therapy that the root word for anointing and rubbing with oils
and manipulative therapy have different connotations and for the Messiah is the same (Mãshiãh).
Massage is usually applied to the skin, fascia, mus-
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and different interpretations.

Massage as a profession has evolved significantly cles, tendons and ligaments (the soft tissues) of the
over the last century and today many different styles, body. Since most massage has the effect of bringing
techniques and approaches are embraced by the term about some sort of positive change in the individual,
1
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2 Section 1 A framework for massage practice
Table 1.1 Categories of massage therapy
Subtle energy practices Relaxation methods Remedial approaches

Reiki Swedish massage Manual lymphatic drainage
Therapeutic touch Esalen massage Neuromuscular technique
Polarity therapy Myofascial release
Pranic healing Aromatherapy
Aura balancing Reflexology
Chakra balancing An mo tui na (Chinese massage)
Jin shin do Shiatsu
Zero balancing Muscle energy technique
Rolfing
Postural integration
Bowen technique
Orthobionomy
Craniosacral therapy
Trager therapy
Sports massage
then its action may be said to be therapeutic in that it to soothe and loosen the body. The speed of delivery
provides physical, emotional, psychological or spiri- is slow and the pressure is light to moderate. An envi-
tual benefits. Therefore, the term ‘therapeutic massage’ ronment is created which may include soft lighting to
applies to all methods and forms of massage, since they soothe the eyes, pictures and props to create further
all provide therapeutic benefit to the receiver. Reduction visual pleasure, and aromatic oils dispersed in the air
of muscular tension, improvement of vascular and lym- to satisfy the mood and emotions. Music may be played
phatic circulation, regulation of the nervous system and to relax the mind and enhance the spirit, and the mas-
normalisation of pulmonary function are some of the sage table is draped for comfort and warmth. The mas-
claimed therapeutic physiological benefits of massage sage environment may contribute significantly to the
therapy (Turchaninov 2001). outcome of enhanced wellbeing and relaxation experi-
Massage therapy, then, may be defined as the use of enced by the client. (See Chapter 8 for further discus-
(predominantly) the hands to physically manipulate the sion on the massage setting.)
body’s soft tissues for the purpose of effecting a desir- Remedial massage is the application of more
able change in the individual. While anatomical and advanced techniques of treatment and assessment for
physiological changes are generally the focus, and may neuro-musculoskeletal dysfunctions. The primary aim
involve body systems other than the musculoskeletal of remedial massage is to restore or promote motion and
system, the emotional, mental and spiritual aspects of to reduce or prevent pain. To achieve this a variety of
the individual may also be affected, either objectively techniques may be employed. These may include ther-
or subjectively due to their interrelatedness. Typical motherapy, myofascial release techniques, neuromus-
fundamental massage techniques involve, but are not cular techniques (trigger-point therapy), muscle energy
necessarily restricted to, basic contact (touch), stroking techniques, joint mobilisation, positional release tech-
(effleurage), rubbing (friction), kneading (pétrissage), niques, post-isometric stretching and corrective exer-
percussion (tapôtement), vibration and compression. cise prescription.
Usually a lubricant, such as an oil or powder is used.
However, massage can also be provided without the NATURAL MEDICINE PHILOSOPHY
use of a lubricant (i.e. dry massage), and may be given AND PRINCIPLES
through clothing. Hot or cold applications (thermother- The philosophical basis of massage therapy draws from
apy), essential (aromatic) oils or water (hydrotherapy) the philosophy and principles of natural medicine in
may be utilised as adjuncts to massage treatment where general. The field of natural medicine embraces many
they are considered appropriate to providing the desired different individual modalities of natural therapies,
therapeutic effect. including massage, homoeopathy, aromatherapy, oste-
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Relaxation massage seeks to relax the client, opathy, colour therapy as well as complete systems of
improve general wellbeing and reduce mental stress natural healing, such as traditional Chinese medicine,
and general body tension. Techniques employed aim ayurveda, and naturopathy (House of Lords Report
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1 Philosophies and principles of massage and natural medicine 3
2000). What draws these many different approaches treat them, or if referral to another health care practitio-
together under the one umbrella is the philosophy that ner is more appropriate.
provides guidelines to their practice.
Natural medicine is most simply defined as any Prevention is better than cure
form of health care that acknowledges and relies upon Wherever possible, the practitioner of natural medicine
the body’s natural ability to heal itself. This principle will promote a strategy that helps to prevent illness
has been a feature of traditional medicine practices from eventuating, or at least from becoming worse,
for thousands of years. Traditional medicine is a term in the case of existing ailments. This is achieved via
used to describe any system of health care that has a combination of treatments and by involving clients
ancient roots, trained healers, cultural bonds and a in the process (e.g. regular exercise, adequate rest, bal-
theoretical construct; for example, traditional Chinese anced diet). Regular massage can serve the purpose of
medicine, ayurveda, herbal medicine (Segen 1998). relaxing the nervous system, toning or relaxing muscles
Natural medicine philosophy acknowledges nature’s and regulating circulation of body fluids, thereby pro-
ability to heal (vis medicatrix naturae — the heal- moting optimum health and reducing the risk of illness
ing power of nature). Given the right circumstances or injury.
(e.g. rest, nurturing, living according to nature’s laws)
a sick or injured individual can return naturally to a
state of optimum health. This can be easily illustrated The doctor (practitioner)
by the example of a fractured bone. Over a period of is a teacher
time the bone will heal (i.e. become whole again) of The original meaning of the word ‘doctor’ was ‘teacher’.
its own accord. It requires no intervention, although To achieve the best treatment outcome, to prevent the
immobilisation may assist the bone to return to its onset of illness or injury and to maintain optimum
original shape. The body heals itself, and nature pro- health and wellbeing, the natural medicine practitioner
vides the body with this ability. Any form of therapy, must educate her/his clients to take responsibility for
whether massage, nutrition, acupuncture, herbs or sur- their wellness and to get involved with creating their
gery, works simply by assisting nature’s own ability own health. Only by encouraging clients to live a more
to heal. balanced lifestyle according to nature’s laws, including
Apart from this core principle of the body’s abil- healthy dietary choices, regular exercise or activity, and
ity to heal itself, there are a number of other principles adequate rest, can the practitioner hope to assist. By
which feature commonly in natural medicine modalities teaching, motivating and supporting clients the practi-
and these are discussed below. tioner–client relationship is empowered. This relation-
ship in itself contributes significantly to the process of
Treat the whole person healing (Pizzorno & Murray 1999).
Optimum health and wellbeing is a complex interrela- The World Health Organization (WHO) estimates
tionship between the physical, mental, emotional and that 80% of the world’s population utilises natural
spiritual aspects of an individual (see Chapter 3). When medicine as its primary source of health care (WHO
imbalance occurs on any of these levels it eventually 1998). In Australia, around 69% of the population
results in disease. For example, long-term emotional uses natural medicine of some kind (Pfizer Austra-
stress will eventually affect the physical body via the lia Health Report 2006). These Australians are more
nervous and endocrine systems. It can then manifest likely to be female, aged 30–50 years, have tertiary
physically as muscle tension, neck and back pain, head- qualifications, earn more than $50 000 per year and
ache and physical fatigue. On the physical level, natural be employed in a professional or managerial posi-
medicine acknowledges and addresses the interrelation- tion. They choose natural medicine because they
ship between every cell, tissue, organ and system of are dissatisfied with other approaches to health care,
the body. Injury or illness is never seen to be affecting and because they see it as a natural, safe alternative
just an isolated part of the body. A change to one part (Therapeutic Goods Administration 2001). In view of
results in change to every part. Since illness can be the these facts then, natural medicine can hardly be seen
result of an imbalance in any, or a combination, of these as a radical, alternative healing approach on the fringe
aspects then healing must address each of them. Tactile of the mainstream biomedical model of health care.
therapy, including massage, has the potential to impact With well over half of the population relying upon it
upon every aspect of the individual and so it treats the to achieve a desired level of health, it is not unreason-
whole person. able to view natural medicine as part of ‘mainstream
medicine’.
First do no harm
Natural medicine uses therapies which are as close as COMPLEMENTARY AND ALTERNATIVE
possible to their natural state (e.g. human touch, herbs, MEDICINE
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food and nutrition) and that are unlikely to produce Natural medicine is sometimes referred to as ‘comple-
harmful side effects. Practitioners of natural medicine, mentary and alternative medicine’ (CAM). Alterna-
including massage therapists, learn to assess the health tive medicine is a term that was used more commonly
of clients and determine whether they can effectively during the 1980s and early 1990s. The New England
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Journal of Medicine (1992: 61) defined alternative practised as part of the traditional Chinese medicine
medicine as: (TCM) system, which is based on the Chinese philosophi-
… a heterogeneous set of practices that are offered cal concept of health and disease. This philosophy states
as an alternative to conventional medicine, for the that health is promoted and maintained via the unob-
preservation of health and the diagnosis and treatment structed flow of vital energy referred to as Qi through sub-
of health-related problems; its practitioners are often tle channels that run throughout the body. Illness occurs
called healers. when the flow of Qi becomes obstructed. Diagnosis is
achieved via thorough case taking, and pulse and tongue
At the time, this explanation reflected the fact that
analysis. Acupuncture and moxibustion (i.e. the burning
a minority of the population of the Western world used
of moxa) when administered to points located on these
natural therapies as an alternative to mainstream West-
channels (meridians) restore and regulate the flow of Qi.
ern biomedicine. ‘Alternative’ suggests an either/or
The TCM system also incorporates Chinese massage (an
choice, and provides no suggestion that Western bio-
mo tui na), Chinese herbal medicine, diet and food ther-
medicine and natural medicine could possibly work
apy and exercise therapy (e.g. tai qi, qi gong). While some
together for the ultimate benefit of clients. Alternative
practitioners of Chinese medicine may include all of these
medicine, then, is something which is used as an alter-
therapies in their practice, others may specialise in only
native to (i.e. to the exclusion of) conventional main-
some or even one (e.g. acupuncture or Chinese herbs).
stream medicine approaches. These days, the natural
medicine profession generally rejects the term ‘alterna-
tive’, as it prefers to view itself as part of an integrated Aromatherapy
approach to health care (see Chapter 3). Aromatherapy involves the administration of essential
By definition, the term ‘complementary’ means to oils distilled from plants to treat and prevent illness and
form a satisfactory or balanced whole (Collins Concise to promote wellbeing. The oils may be administered
Dictionary 1989). When used to describe natural medi- topically through the dermal interface, via massage,
cine, ‘complementary’ suggests that in conjunction with compress, poultice, creams and ointments, through the
the Western biomedical approach to health care, the two respiratory interface by means of a variety of inhalation
form a satisfactory and balanced holistic health care model techniques or less commonly via the digestive interface
(i.e. an integrated approach). However, it is taken by some through internal ingestion. An extensive range of health
to suggest that natural medicine plays only a secondary conditions may be treated with aromatherapy. Most aro-
role to the biomedical model, providing merely a supple- matherapists are trained in basic relaxation massage and,
mentary approach where appropriate, and cannot provide more often than not, also in the technique of specialised
a stand-alone option to the management of health. In this aromatherapy massage such as that developed by Mar-
respect, the term ‘complementary’ is an unsatisfactory guerite Maury (2004), an Austrian born biochemist who
description of natural medicine. Another perspective is significantly influenced modern aromatherapy practice.
that complementary medicine is something which may be
used to enhance, but not to replace, a conventional main- Ayurveda
stream approach to the treatment of a health condition.
Ayurveda is a traditional system of healing originat-
ing from the Indian subcontinent. It is thought to be
SCOPE OF PRACTICE OF NATURAL the oldest existing system of medicine practiced in the
MEDICINE MODALITIES world. Ayurveda has its own unique principles based
The philosophy and principles of natural medicine primarily on the three doshas (physiology/personality
define and guide the practice of the many therapies types). Pulse, tongue and urine analysis form part of the
that comprise this approach to health care. Most have method for diagnosis. Therapies used include herbal
unique knowledge bases (i.e. the theory and skills that medicine, diet and nutrition, massage, colour therapy,
define how the therapy is administered), although there exercise (yoga), meditation, sound therapy, lifestyle
is some overlap (e.g. Chinese massage and acupuncture counselling and aromatherapy. In the West, ayurveda
with their philosophy of Qi and energy flow through has become increasingly popular due largely to the writ-
meridians or channels). As a result, the scope of prac- ings of Indian-born endocrinologist Dr Deepak Chopra
tice (see Chapter 5) of these natural medicine modalities (author of Creating Health, Perfect Health, Quantum
often overlaps, and is not always clear or definite. It is Healing and other texts).
important for massage therapists to have a basic under-
standing of other natural medicine modalities and their Herbal medicine
scopes of practice. The following is a brief outline of
Herbal medicine practitioners usually specialise in the
some of the more common natural medicine modalities.
use of plant medicines (herbs) to treat any of a wide
variety of health conditions. While naturopaths usu-
Acupuncture and traditional ally incorporate herbs as part of their treatment strat-
Chinese medicine
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egy, along with nutrition, massage, flower essences

Acupuncture involves the insertion of fine needles, and and perhaps homoeopathy, the herbalist will gener-
the application of a burning herb material known as moxa, ally prescribe only herbal remedies. Phytotherapy and
to very specific points or areas on the body. It is a therapy botanical medicine are terms also used as alternatives
Account: s8715057
to ‘herbal medicine’. Herbal remedies were one of the Nutrition therapy

earliest forms of medication used by humankind, and Nutrition therapy, nutritional medicine, or clinical nutri-
most traditional healing systems include them as part of tion as it is also known, incorporates dietary counsel-
their treatment of ill health. ling (i.e. recommending appropriate changes to clients’
diets), food therapy (i.e. foods with therapeutic proper-
Homoeopathy ties) and nutrient supplementation to treat any of a wide
By comparison with ayurveda, traditional Chinese med- variety of health conditions. Supplementation with vita-
icine and even naturopathy, homoeopathy is a relative mins, minerals or other micronutrients is prescribed, not
newcomer to the field of natural medicine. It originated just where there may be deficiencies, but where an ill-
in Germany in the 1830s as the result of investigation by ness or injury has caused an increased demand for certain
Dr Samuel Hahnemann. Based on the principle of ‘like nutrients by the body. Clinical nutritionists are generally
cures like’ (similia similibus curantur), the concept of also trained in sports nutrition, an area that focuses on
homoeopathy is that a substance that can cause illness improving sporting performance and recovery via an
could also cure that same illness when administered in optimum diet and nutrient supplementation where neces-
greatly diluted doses (e.g. arsenic). Despite numerous sary. Treatment and management of allergies is another
controlled trials indicating benefits for the treatment of area in which nutrition therapists are usually trained.
a wide number of health problems, homoeopathy defies Where naturopaths usually incorporate diet and nutri-
explanation in terms of its mechanism of cure. Scientists tion therapy as one of their therapeutic tools, along with
have failed to provide an explanation of how something herbs, massage, lifestyle counselling and sometimes
that contains virtually no physical substance apart from homoeopathy, clinical nutritionists generally treat health
water can demonstrate an efficacy comparable with, and problems exclusively with diet and nutrition therapy.
even better than, that of pharmaceutical drugs.
Classical homoeopaths seek to establish the single Tactile therapies
best homoeopathic remedy to suit clients’ presenting
signs and symptoms, and prescribe no other form of The field of tactile therapy includes an ever-increasing
therapy or remedy. However, many naturopaths incorpo- range of therapies that involve tactile manipulation (i.e.
rate homoeopathic remedies in their treatment strategy the use of touch). It is sometimes referred to as body-
for clients when they consider them to be appropriate. work or physical therapy. While some forms of tactile
therapy mainly promote beneficial changes to the anat-
Naturopathy omy and physiology of the physical body (e.g. relax-
ation, tonification, or stimulation of muscles, tendons,
The term ‘naturopathy’ was first used in 1899, in the ligaments, nerves and circulation), others exert their
USA. It was an approach to health care based on the effects mainly on the subtle anatomy/subtle energy of
principles of ‘nature cure’ from Europe. Nature cure individuals. Reiki, therapeutic touch, aura massage and
was a general term used throughout Europe during the pranic healing are examples of tactile therapies that
nineteenth century to describe the use of natural prin- focus on changing the subtle energy/subtle body of cli-
ciples and therapies to prevent and treat disease. How- ents. Although therapies such as Swedish massage, Chi-
ever, naturopathy’s roots go back to ancient Greece and nese massage (an mo tui na), chiropractic, osteopathy,
the ‘father of medicine’, Hippocrates, who believed that sports massage and rolfing exert their effects mainly on
‘nature is the healer of all disease’. Disease was viewed the physical body, it is insisted by some that they also
as a result of violation of nature’s laws, and fresh air, have an effect on the subtle energy of clients (Tappan
pure water, whole foods, sunlight, exercise and ade- 1988; Chaitow 1996).
quate rest and relaxation are seen as the cornerstones of Because there are so many approaches to tactile
healthy living. therapy, it is inevitable that there are many similarities
In addition to promoting these healthy lifestyle between them. This includes both similarity of tech-
measures, naturopathic practice integrates a number of nique and similarity in what they can achieve therapeu-
modalities, principally nutrition, herbal medicine and tically. What they share in common exceeds how they
tactile therapy. Other modalities, such as homoeopathy, differ. For this reason there is a lot of crossover when it
aromatherapy, flower essence therapy, applied kinesiol- comes to mapping the scope of practice of these differ-
ogy, and hydrotherapy may also be incorporated. These ent tactile therapy approaches. While most practitioners
modalities are applied on the basis of specific principles, of tactile therapy are specialists in this particular area
and within the context of a healing environment, which of natural medicine, others may incorporate tactile ther-
endeavours to empower the individual, and motivate and apy as part of their overall approach to health care (e.g.
educate them in order to restore, maintain and optimise with nutrition, acupuncture, herbal medicine, flower
wellbeing. By way of in-depth consultations, naturo- essences). Naturopaths are an example of this.
paths decide upon strategies of treatment that will incor-
porate the most appropriate remedy/remedies to suit
Eastern/Asian massage therapies
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clients and their individual health condition. The health

assessment may also be aided by naturopathic diagnos- Oriental bodywork techniques are based on a differ-
tic methods such as iris, tongue and fingernail analysis, ent set of principles and philosophy than the Western
and also by physical examination and pathology tests. approaches to massage. The various Eastern approaches
Account: s8715057
manipulative therapy has always been of importance in

Box 1.1 Eastern/Asian bodywork approaches society, even though at times its popularity has declined,
usually as a result of criticism or discouragement by
l Acupressure religious bodies or biomedical practitioners. One such
l An mo tui na (Chinese massage) decline corresponded to (Greenman 1996: 3):
l Shiatsu (Japanese bodywork) … the approximate time of the split of physicians and
l Thai massage
barber-surgeons. As physicians became less involved
l Balinese massage in patient contact and as direct hands-on patient care
became the province of the barber-surgeons, the role
of manual medicine in the healing art seems to have
(see Box 1.1) to bodywork use different techniques and declined.
approaches, but their purpose is similar. Basically all However, manipulative therapy has always risen
these approaches to bodywork aim to restore, balance or again out of such declines. The most recent renaissance
maintain the flow of Qi (vital force) throughout the body took place in the late nineteenth century, a period of
(see the sections on acupuncture and traditional Chinese turmoil and conflicting views in the field of medicine.
medicine earlier in this chapter). It is the uninterrupted At about the same time two gifted Americans, Andrew
and harmonious flow of Qi that is responsible for main- Taylor Still (1828–1917) and Daniel David Palmer
taining physical, mental, emotional and spiritual health. (1845–1913) developed the systems of osteopathy and
When Qi is blocked, discomfort may be experienced chiropractic respectively.
spiritually, emotionally, mentally or physically. If this
blockage persists over time, the imbalance develops in
its complexity and eventually chronic and degenerative Osteopathy
health conditions will result. Andrew Taylor Still developed osteopathy as an alterna-
tive to the existing practice of medicine of the time. Dis-
MANIPULATIVE THERAPIES enchanted with the heroic approach to medicine which
These days the term ‘manipulative therapy’ is used included blood-letting, purging and heavy-handed
mainly to describe the practices of chiropractic, oste- prescribing of laxatives, calomel (mercury), narcotics
opathy and physiotherapy. The goal of manipulative and other drugs, Still developed his new ‘osteopathic
therapy has been defined as ‘to restore maximal, pain- medicine’ on a philosophy of traditional (i.e. longstand-
free movement of the musculoskeletal system in pos- ing) healing principles combined with a contemporary
tural balance’ (Dvorak, Dvorak & Schneider 1985). understanding of the functioning of the body. He began
This somewhat comprehensive definition was deter- offering his new approach to the public in 1874. Manip-
mined by 35 experts in the field of manipulative therapy ulation therapy was added to his approach by 1879.
at a workshop in Switzerland in 1983. By this widely Today manipulative therapy is the core of osteopathic
accepted definition, massage therapy also qualifies as a practice. For some osteopaths, manipulation is the only
form of manipulative therapy, but there are similarities therapy practised.
and differences between them. The philosophy of osteopathy is based on five key
Manipulation therapy, like massage and other forms principles as follows:
of tactile therapy, has been a part of the art and science 1 The body is a unit — the body does not function
of healing for thousands of years. Nearly every cul- as separate parts. All parts, including cells, tissues,
ture has had practitioners who specialised in boneset- organs, and body systems, relate to each other and
ting, vertebral adjustment and manipulation of tendons, function as an integrated unit. There is no hierar-
fascia, ligaments and muscles (for example, ancient chy of parts (i.e. no one structure of the body is
Egypt, Greece, Africa, North and South America, India of greater importance than another). For optimum
and Asia). Bonesetters practised the art of precise hand health to exist, all aspects of the body must function
thrusts to align the spinal vertebrae and also set and pro- optimally and harmoniously.
mote the healing of fractured bones. They have always 2 The healing power of nature — the body has an
been popular in rural areas, where farmers and manual innate capacity to heal and maintain health. The
labourers have sought their services. therapist’s role is to support this capacity.
History records camel drivers in Arabia who prac- 3 Structure and function are interrelated — when the
tised manipulation on each other, English peasant structure of any body part is negatively affected, the
women who relieved others of back pain, young girls function of that part, and other parts as well, will
who were taught to walk on backs, and families of bone- eventually be affected too. Conversely, if function is
setters who travelled from village to village practising disturbed (e.g. through a nutrient deficiency), sooner
their special art. These skills were often considered to or later the structure of the cells, tissues, organs or
be a special gift handed down from generation to gener- body systems will also be altered in some way.
ation (Kaptchuk & Croucher 1986). During the Middle 4 When normal adaptability is disrupted, or when
copyright law.
Ages the clicking of a spinal joint that resulted from environmental changes overcome the body’s capac-
a physical manipulation was thought to be the expul- ity for self-maintenance, ill-health may follow —
sion of demons or spirits from the body. The presence of apart from the obvious, this also implies that the
Account: s8715057
therapist must always look for the cause/s of illness An osteopathic treatment commences with the
and address them appropriately. It is never enough taking of a client’s history, a physical examination of
simply to treat the illness or its signs and symptoms. either the whole body or the region where the prob-
5 Rational treatment is based on all of the previous lem is located, possibly evaluation of X-rays, and the
principles — in any dysfunction, in any illness, the treatment itself. During the physical examination the
function and/or structure, and eventually both, will osteopath seeks to identify the area/s of dysfunction
be affected. The body attempts to self-correct via in the musculoskeletal system. Having identified the
its inherent self-healing mechanism. If or when the problem and evaluated the cause/s, the therapist then
body’s capacity for self-maintenance and adapta- determines the most appropriate manipulative tech-
tion is overcome, signs and symptoms will manifest. nique and the degree of force required to achieve
The role of a good therapist is not just to relieve the the desired result. Osteopaths generally use the least
symptoms, but to recognise the cause/s and how the amount of force necessary. Follow-up treatments are
body is attempting to cope with the situation. Hav- determined on the basis of the client’s response to the
ing established this, the appropriate treatment is one initial manipulation.
which supports, promotes and enhances the body’s
potential for self-healing. Chiropractic
It is worth noting that these osteopathic principles Daniel David Palmer, the originator of chiropractic, was
outlined above are in keeping with those that form the a magnetic healer and self-taught manipulative therapist
basis of natural medicine philosophy as described ear- from the US mid-west. Palmer developed the system of
lier in this chapter. chiropractic (‘done by hand’) manipulative therapy in
In the USA, its country of origin, osteopathy has the 1890s, around the same time that Still developed
always been a total medical approach. Students of osteopathy. While Palmer was chiropractic’s originator,
osteopathy in that country learn surgery and how to it was his son, Bartlett Joshua Palmer, who promoted
prescribe pharmaceutical drugs, along with structural the practice of this therapy to a professional status with
assessment and diagnosis, and manipulative therapy a devoted following.
skills. Taught within a framework of the philosophic Chiropractic is based on four main principles:
principles established by Still, osteopathy may be said 1 The nervous system plays an important role
to offer total patient care and is a licensed health care in health and disease — the nervous system in
profession throughout the US. However, in Australia, human beings is highly developed and influ-
New Zealand and the UK, osteopathic training and ences all other systems of the body, and their
practice is restricted to the skills and practice of physi- organs, tissues and cells.
cal manipulation, although Still’s philosophy and prin- 2 The human body has the innate capacity to heal
ciples are usually espoused as guidelines to osteopathic itself (vis medicatrix naturae) — chiropractic
practice. is based on the vitalistic theory which states
that all living things are pervaded by a vital
Techniques of osteopathic manipulation force, which maintains, promotes and restores
Osteopathic manipulations are applied to both the soft health.
tissues of the body, such as the muscles, ligaments, ten- 3 Any disease is caused by alteration of normal
dons, and fascia, and also to the bones and joints of the neural function — normal neural function can
body. The aim of osteopathic manipulation is to achieve be altered as a result of misalignments of the
improved physiological movement, relief of pain or dis- spinal vertebrae (subluxations). These sublux-
comfort, relaxation of tissues, and to support the body’s ations disturb the spinal nerves in their media-
self-healing capacity. It is possible to classify osteo- tion of mind and body and inhibit the vital force
pathic manipulative techniques into two broad catego- in its attempt to maintain health.
ries — direct and indirect. Direct technique is that which 4 ‘One cause, one cure’ — since sickness and dis-
confronts any restriction of movement by applying force ease are a result of disturbed neural function,
to the body part in the direction of the restriction. With and subluxated vertebrae are the major cause
indirect technique the body part is manipulated in the of such disturbance, then elimination of spinal
direction of ease of motion. The physiological effects subluxations via chiropractic manipulation will
of a manipulation include changes to muscular tone, restore health by restoring neural function and
central, peripheral or autonomic nervous system tone, promoting the body’s capacity for self-healing.
and circulatory system (lymphatic, vascular) response These principles are not too dissimilar to osteopathic
changes (Gallagher & Humphrey 2001). principles. Both chiropractic and osteopathy share the
Osteopaths may incorporate a variety of differ- view that the body’s various ‘parts’ (i.e. organs, tissues,
ent specific techniques. Some of these include: high cells) are interrelated and that health is dependent on
velocity, low amplitude (HVLA) thrusting; articula- this relationship. They both recognise the interdepen-
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tory technique; soft tissue therapy (similar to massage); dence of structure and function, and both approaches
craniosacral technique; muscle energy technique; myo- acknowledge the importance of the body’s self-healing
fascial release; visceral stretching and balancing tech- capacity (i.e. vital force) in maintaining and restoring
nique; and counter-strain technique. health.
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Chiropractic manipulative techniques lifestyle management advice to their clients (Kleyn-

Most chiropractors today restrict their manipulations to hans, Sweaney & Hunt 2003).
the spinal column and pelvis. Some chiropractors per- While in the past practitioners of chiropractic fully
form adjustments to the bones of the skull. Some also believed that all illness was the result of subluxation and
manipulate or adjust the joints of the body’s extremities. could therefore be effectively treated with chiropractic
Chiropractic manipulative technique consists mainly of adjustment, this view has changed. Most chiropractors
high velocity, low amplitude (HVLA) thrusting adjust- today view their profession as a form of complementary
ments. The aim of these adjustments is to increase therapy, which assists in the prevention and treatment
mobility of the spinal joints and eliminate spasms in the of ill-health.
associated muscles, thereby enabling the spinal nerves
to function effectively. Box 1.2 outlines the most com- Physiotherapy
monly used chiropractic techniques. However, it should Physiotherapy began to develop as a profession in Aus-
be noted that members of the profession use numerous tralia after 1939 with the establishment of the Austra-
other adjustment techniques. lian Physiotherapy Association (formerly the Australian
A chiropractic consultation and treatment involves Massage Association). From that time physiotherapy
the taking of a thorough case history, followed by a developed a strong reputation and a growing popular-
physical examination of the spine. X-rays of the spine ity in Australia and massage went into something of
are often requested to assist in the formulation of a diag- a decline during that period (see Chapter 2). Probably
nosis and treatment plan; then follows the chiropractic the main difference between the two professions was
treatment. Sometimes hot packs or massage are used that physiotherapy focused more on rehabilitation from
to help relax muscles prior to the adjustment. Chiro- injury. This was largely due to the increased demand
practors may also recommend exercise therapy or offer for rehabilitation services and skills as a result of World
War II casualties.
Although massage techniques formed the founda-
tion of physiotherapy practice, exercise therapy, ther-
Box 1.2 Chiropractic treatment techniques
motherapy, hydrotherapy and electrotherapy began to
play an increasing part. Spinal manipulations also began
l Receptor-tonus method (Nimmo technique) — to feature more frequently, especially where neck and
improves muscle function and postural balance back pain was concerned. Since that time physiotherapy
via techniques that eliminate trigger points. has continued to develop as a profession, with govern-
l Diversified — delivered to individual or groups of
ment registration in all Australian states, university
vertebral segments. degree education programs and WorkCover recognition
l Gonstead — direct thrust in the direction
of its services. Geoff Maitland, a prominent South Aus-
opposite to that of the motion restriction tralian physiotherapist, has been an influential figure
(i.e. similar to osteopathic indirect technique). in the development of manipulative physiotherapy in
l Activator — use of a spring-loaded gun-like
Australia. His techniques and approach to manipulative
device to deliver very high velocity force to therapy have had a significant influence on orthopaedic
vertebrae and sometimes soft tissues such as
manipulative therapy worldwide.
muscles or ligaments.
Physiotherapy’s main focus is the restoration of
l Thompson Terminal Point — HVLA adjustment
physical function, and an understanding of the muscu-
to the spine, especially the pelvis, using a
loskeletal system is the therapist’s key area of expertise.
specialised treatment table.
Manipulative therapy, prescription of therapeutic exer-
l Logan basic — fascial release technique to
cise and electrophysical therapy (e.g. ultrasound) are
the sacrotuberous ligament for the purpose of
used as the primary tools for minimising physical dys-
correcting subluxation of the sacrum.
function, restoring normal function and relieving pain.
l Flexion distraction — traction-mobilisation for
While a recent trend in manipulative therapies has seen
treatment of intervertebral disc problems.
a reduction in the use of HVLA thrusting adjustments,
l Hole-in-one technique — focuses on
these still form a significant part of physiotherapy.
manipulation of the first two cervical vertebrae
However, a greater emphasis on rehabilitative exercise
since these were seen to be crucial to the
alignment of all other spinal vertebrae.
therapy is evident in most physiotherapy practices.
These days, physiotherapy training incorporates such
l Sacro-occipital technique — aims to achieve
balance and alignment between the pelvis and
specialty areas as neurological, cardiothoracic, paediat-
the spine, thus enhancing the flow of ric, gerontological and of course, musculoskeletal phys-
cerebro-spinal fluid to optimise nerve function. iotherapy. With health assessment there is now greater
l Applied kinesiology — based on the concept
emphasis on identifying the dysfunction, its source and
that vertebral subluxations create specific also the causes of the source of dysfunction, and factors
contributing to it, rather than simply determining the
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muscle weaknesses; used to diagnose vertebral

misalignment and to correct associated muscle pathophysiology. Health evaluation has become more
weakness. client-centred, and the bio-psychological perspective of
the dysfunction has overshadowed a patho-biological
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understanding. Patho-biological diagnosis serves mainly in the appropriate techniques has been undertaken, and
to identify precautions and contraindications to the treat- where state/territory law permits (see Chapter 5).
ment and management of the problem (Maitland 2001). Remedial massage generally does not incorporate
Clients are encouraged to participate in the process of HVLA manipulations of the spine, however vertebral
rehabilitation as much as possible (by complying with subluxations may be addressed by applying massage and
the prescribed exercise regime). other soft tissue techniques (for example, trigger-point
therapy, post-isometric relaxation technique) to the soft
Physiotherapy manipulative techniques tissues that support and surround the spine. Once these
Manipulative physiotherapy techniques may be broadly muscles or ligaments have been satisfactorily relaxed
categorised into two types, gentle pain-modulating or returned to a balanced state, stretching and/or gentle
methods and stronger mobilising techniques. The stron- mobilisation of the affected joints may correct the align-
ger mobilising techniques are similar to the HVLA ment of the vertebrae.
methods used by chiropractors and osteopaths. They
force a movement beyond its limited range of motion MASSAGE TRAINING
via a sudden thrust. The gentler methods coax a move- In the past, massage therapy training was largely unreg-
ment by passive rhythmical oscillations performed ulated. Prior to the mid-1990s standards and qualifica-
within or at the limit of the range of motion. Most areas tions varied enormously and control of the quality of
of the body’s skeleton may be treated (i.e. not just the training was loose. However, national standards for the
spine). Wherever possible the gentler methods are pre- training of massage therapists were first endorsed and
ferred because the client has greater control, being able introduced in Australia in 2000, and reviewed in 2006.
to resist the mobilisation if they experience too much In the Vocational Education and Training (VET) sec-
pain, whereas the sudden HVLA manipulation prohibits tor, such standards are defined in the Health Training
any control by the client. Manipulation of the body’s Package for Complementary and Alternative Therapies;
soft tissues also takes place where appropriate. Massage which is a document that details the required skills and
technique is rarely used these days by physiotherapists, knowledge for the following bodywork qualifications:
although techniques such as trigger-point therapy, myo- l Certificate IV in Massage Therapy Practice
fascial release and muscle energy technique are being l Diploma of Shiatsu
used increasingly by some therapists. Physiotherapists l Diploma of Traditional Chinese Remedial Massage
stress that the manipulative techniques they employ are (an mo tui na)
based on scientific knowledge and research. They have l Diploma of Remedial Massage.
not been determined empirically. This training package aims to ensure that all Aus-
A typical physiotherapy session begins with a tralian massage professionals in the industry at least
detailed assessment that will incorporate the taking of have a minimum and consistent standard of training.
a case history and extensive physical examination. As This should contribute to a more consistent standard
previously mentioned, a client-centred approach to of service for Australian consumers of bodywork ther-
assessment has evolved. The physiotherapist is particu- apy, an increased acceptance of massage and the other
larly interested in the client’s expression of their signs bodywork methods as effective health care modalities,
and symptoms, and how their specific dysfunction limits and an even greater confidence in natural medicine
and affects their activities. Diagnosis of the pathology generally.
is not the ‘be all and end all’. In many cases of muscu-
loskeletal dysfunction the pathology will not be known
CONCLUSION
for certain and therefore the treatment strategy will be
determined largely from the information provided by the As massage therapy continues to evolve as a profes-
client and the signs and symptoms he/she is presenting. sion and also as a therapy, it seems likely that training
Evaluation of the client’s full range of motion, gait, pos- programs in massage, especially remedial massage,
ture and strength is usually undertaken. X-rays and CT will incorporate more advanced assessment methods
scans may assist the therapist in determining the most and techniques of manipulation (both of soft tissues
appropriate treatment strategy. The treatment plan will and bony structures). When this occurs, massage as a
inevitably involve stretching and exercise prescription, healing method will have come full circle, in that the
perhaps ultrasound or other electrophysical application, bodywork therapists from past civilisations and from
thermotherapy, and possibly manipulative therapy. Some other systems of medicine always integrated the art of
physiotherapists include musculoskeletal acupuncture bonesetting with the gentle skills of soft tissue massage,
(needling or laser) to the trigger points of affected areas. corrective exercise and posture technique.
Remedial massage therapy Questions and activities

Manipulation of the musculoskeletal system of the 1 You are designing a promotional flyer for use in
your clinic.
copyright law.
body is an integral part of remedial massage. While this

manipulation applies mainly to the body’s soft tissues, (a) Write a definition of massage for inclusion
mobilisation of joints can be part of the scope of prac- that makes reference to some of the original
tice of the massage therapist where adequate training meanings of the word.
Account: s8715057
(b) Write a paragraph that outlines the major —— 1989 Quantum Healing. Bantam Books, New York
principles underpinning the practice of natural —— 1990 Perfect Health. Harmony Books, New York
medicine. Collins Concise Dictionary 1989 Australian edition.
2 A client has asked you for a referral for their Collins, London
gastric reflux. They are not sure whether to visit a Dvorak J, Dvorak V, Schneider W (eds) 1985 Manual
traditional Chinese medicine (TCM) practitioner, Medicine 1984. Springer-Verlag, Heidelberg, Germany
ayurvedic practitioner or a naturopath. Describe Gallagher RM, Humphrey FJ 2001 Osteopathic Medicine:
A Reformation in Progress. Churchill Livingstone,
what you would tell them in relation to these
Philadelphia
different modalities, including any aspects of their
Greenman PE 1996 Principles of Manual Medicine.
practice that are common. Lippincott Williams & Wilkins, Philadelphia
3 A client asks you what the difference is between House of Lords — Science and Technology — Sixth
herbal medicine, homoeopathy and nutrition Report 2000 Complementary and Alternative Medicine.
therapy. What would you say? UK Parliament
4 Prepare a statement that could be provided to clients Kaptchuk T, Croucher M 1986 The Healing Arts: A Journey
that describes and outlines the benefits of each of Through the Faces of Medicine. British Broadcasting
the following modalities: Corporation, London
(a) osteopathy Kleynhans AM, Sweaney JD, Hunt RG 2003 Chiropractic.
(b) chiropractic In: Freckelton I, Selby H (eds) Expert Evidence.
Thomson Lawbook Co. Section 4-901–1083
(c) physiotherapy
Maitland GD 2001 Maitland’s Vertebral Manipulation
(d) remedial massage therapy. (6th edn). Butterworth–Heinemann, Oxford
—— 2005 Maitland’s Vertebral Manipulation (7th edn).
Recommended reading Butterworth–Heinemann, Oxford
Grossinger R 1995 Planet Medicine: Modalities (6th edn). Maury M 2004 Marguerite Maury’s Guide to
North Atlantic Books, New York Aromatherapy: the Secret of Life and Youth. Random
Maury M 2004 Marguerite Maury’s Guide to Aroma House, UK
therapy: the Secret of Life and Youth. Random House, New England Journal of Medicine 1992; 326:61
UK Pfizer Australia Health Report 2006 Australians and Their
Micozzi MS (ed.) 2001 Fundamentals of Complementary Medicines. Pfizer Australia, issue 24
and Alternative Medicine. Churchill Livingstone, New Pizzorno JE, Murray MT 1999 Textbook of Natural
York Medicine (2nd edn). Churchill Livingstone, London
Novey DW 2000 Clinician’s Complete Reference to Segen JC 1998 Dictionary of Alternative Medicine.
Complementary and Alternative Medicine. Mosby, Appleton & Lange, Stamford, Connecticut
St Louis Siahpush M 1998 Postmodern values, dissatisfaction with
Robson T (ed.) 2004 An Introduction to Complementary conventional medicine and popularity of alternative
Medicine. Allen & Unwin, Sydney therapies. Journal of Sociology, 34(1)
Ward RC (ed.) 2003 Foundations for Osteopathic Tappan F 1988 Healing Massage Techniques: Holistic,
Medicine (2nd edn). Lippincott Williams & Wilkins, Classic and Emerging Methods (2nd edn). Appleton &
Philadelphia Lange, Norwalk
Turchaninov R 2001 Therapeutic Massage: A Scientific
References Approach. Aesculapius Books, Phoenix, Arizona
Chaitow L 1996 Muscle Energy Techniques. Churchill World Health Organization (WHO) 1998 Traditional
Livingstone, Edinburgh Medicine. WHO Publications, Geneva, Switzerland
Chopra D 1987 Creating Health. Houghton Mifflin,
Boston
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a history of massage
Katharine Callaway and
Susan Burgess
chapter 2
LEARNING OUTCOMES
l Summarise the origins and history of massage
l Identify how historical events have led to current philosophies
l Develop an understanding of the importance of historical factors in the theory and practice of
massage today

INTRODUCTION
a form of pressure point massage applied to the hands,
The oldest written reference to what is now called mas- feet and ears.
sage is thousands of years old. As such, today’s prac- The Jews gained knowledge of using aromatic oils
titioners are quite possibly using skills that have been from the Egyptian embalming process, and developed
developed and refined over some 5000 years. anointing and rubbing rituals to cleanse and purify the
Knowledge of the history of massage will assist stu- body and mind.
dents to recognise their place in the profession and in Archaeological discoveries in China have contributed
forming their own beliefs and philosophies about how to our knowledge of the origins of massage. A text written
massage fits into society. by Unschuld (2000) makes reference to an archaeologi-
This chapter will discuss the development and cal site that discovered a funerary complex from 168 BC
growth of massage from its most primitive days to mod- known as Mawangdui, near the city of Changsha in the
ern times. From its starting point in ancient history, this central Chinese province of Hunan. This site uncovered
chapter moves through the ‘Dark Ages’ to modern times 14 medical manuscripts that document medical devel-
and includes contributions that early massage therapists opments during the end of the Zhou Dynasty (1122–
made to the profession in Australia. 221 BC), during the Qin dynasty (221–207 BC) and at
the beginning of the Han dynasty (206–220 AD). These
ANCIENT TIMES (3000 BC–AD 400) manuscripts, believed to constitute the oldest medical
There is evidence that massage was widely used in ancient text written in China, mention many methods of healing
times. The first recorded evidence dates back to around including what is now called massage.
2350 BC in Babylon (today’s Iraq) where cuneiform text Another ancient text is The Yellow Emperor’s Classic
inscribed on clay tablets implied that massage was used. of Internal Medicine (Nei Ching). Claimed by some to
Historians generally believe that Egyptian and Chi- be written around 2500 BC, it was more probably written
nese cultures developed at around the same time; however, around 200 BC or even later. The translation (Veith 1972)
dating of early Chinese texts is complicated because of shows that massage was considered one of the five treat-
the tendency at the time for Chinese writers to credit their ments of that era. It describes the treatment of paralysis,
work to a previous emperor as an expression of honour. chills and fever and states that ‘these diseases are most
In Egypt, foot and hand massage was documented as fittingly treated with breathing exercises, massage of the
a form of treatment. This is evidenced by a wall paint- skin and flesh, and exercises of the hands and feet’ (p 168).
ing (c. 2330 BC) in the tomb of Ankhmahor depicting a In ancient times, the Chinese referred to their system
physician massaging the hands and feet of a patient. The of massage as amma, which involved techniques such as
rubbing and finger pressure along the meridians of the
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wall painting suggests that techniques used in this form

of massage were thumb and finger pressures, as well as body. These ancient hand techniques are still employed,
squeezing and pressing with the fingertips. Today such along with additional techniques such as pulling of
techniques might be referred to as reflexology, which is limbs and pushing of the soft tissues. Today’s Chinese
11
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system of massage is referred to as an mo tui na, or Many Greek physicians began arriving in Rome.
traditional Chinese medicine (TCM) remedial massage. They were originally treated as slaves, but their medi-
The trade routes are believed to have resulted in a cal expertise was gradually recognised and they were
spread of massage techniques to India where it is sur- granted the rights of free citizens. Their treatment meth-
mised that massage was integrated with yoga to form a ods, including massage, were spread throughout the
system of exercise and massage to promote and main- entire empire across Europe reaching as far north as
tain health, spirituality and vitality. During 1800 BC, Britain. Julius Caesar and Pliny the Elder are both said to
four ‘books of wisdom’ were written in India, based have endorsed and received regular massage treatments.
on sacred Hindu teachings known as the Vedas. Many Originally from Greece, Claudius Galen (AD
authors believe that massage was written about in the 130–199) followed Hippocrates’ work and became a
Ayur-Veda volume. Kleen (1918: 1) states that ‘… prominent physician of this time. As physician to the
Professor Pagel of Berlin [could not find] anything on gladiators he used massage techniques to treat inju-
these subjects in the Ayur-Veda’. Later on however, in ries. Galen’s experience with the gladiators confirmed
300 BC, the Laws of Man mentioned massage as a duty his belief in the validity of massage as a treatment. In
of everyday life. Techniques such as kneading, tapôte- Rome he lectured and gave physical demonstrations on
ment, frictions and cracking are listed (Beck 1999: 6). the theory and practice of medicine. He also wrote over
In Japan, the Chinese amma philosophy of working 400 books on medical practices, including massage and
with the body’s meridians led to the development of shiatsu gymnastics (Chandler 1980).
therapy in the seventeenth century. This therapy, which is At much the same time in Rome, the physician Aulus
popular today in both Eastern and Western countries, uses Celsus (AD 129–199) published his De Medicina, in
thumb and finger pressure on tsubo points (energy points which rubbing and exercises are strongly favoured as a
along the meridians) as the fundamental technique. form of therapeutic relief.
Meanwhile in Ancient Greece Asclepius (Asclepia-
des), a practitioner of medicine, became regarded as a Bathing culture in Greece
god due to his healing arts. Kellogg (1895) writes: and Rome
Asclepiades … held the practice of this art in such es- The bathing culture, as used by the Greeks and Romans,
teem that he abandoned the use of medicines of all sorts, highlights one way in which massage was employed
relying exclusively upon massage, which he claimed ef- during ancient times. Around 400 BC large gymnasiums
fects a cure by restoring to the nutritive fluids their natu- (known as esclapeion) were built close to town or by
ral, free movements. It was this physician who made the the seashore and they were dedicated to healing, educa-
discovery that sleep may be induced by gentle stroking. tion and public discourse. In the centre of these palatial
Another legacy from Asclepius is the symbol of gymnasiums was the young men’s hall where athletes
the medical staff with two serpents twisting around it, and citizens discussed the tactics of sport and politics
cadeucus, which is widely recognised as a symbol of and would rest and massage each other (Calvert, 2002).
medical and pharmaceutical practices. The Roman baths were as important as the Greek
Hippocrates of Cos (c. 460–377 BC) was a follower gymnasiums and followed similar themes. By the last
of Asclepius’ work and was taught by Herodicus, the century BC, they ‘took on an importance unparalleled
founder of medical gymnastics, exercise therapy for the in human history’ (Calvert 2002). The following is a
development of the body, and for prevention and treat- testimony to the value the Romans placed on massage
ment of disease. Hippocrates became so famous he was (cited in Calvert 2002: 60):
given the title ‘father of medicine’. He believed that The wise and able Emperor Hadrian, 76–138 AD, who
medicine should be practised as an art inspired by the will be so well remembered as having built the wall
love of man. He chose surgery only as a last resort and from the Solway Firth to the Tyne, and whose reign
preferred to use natural medicines and hands-on tech- was distinguished by peace and beneficent energy, one
niques as a primary cure or preventative. Hippocrates day saw a veteran soldier rubbing himself against the
referred to his hands-on methods as anatripsis (rub). marble at the public baths, and asked him why he did
One of his most famous quotes relating to massage is so. The veteran answered, ‘I have no slave to rub me,’
(Beard & Wood 1964: 3): where upon the emperor gave him two slaves and gold
… the physician must be acquainted with many things sufficient to maintain them. Another day several old
and assuredly with anatripsis [rubbing], for things that men rubbed themselves against the wall in the emper-
have the same name have not the same effects. For or’s presence, hoping for similar good fortune, when
rubbing can bind a joint that is too loose or loosen a the shrewd Hadrian, perceiving their object, directed
joint that is too hard. them to rub one another!
The conquests of Alexander the Great took the
Greeks east across Asia Minor and as far as India where THE DARK AGES/MIDDLE AGES
they learnt ayurveda, the ancient Indian system of medi- (AD 400–1450)
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cine. After their return to the Mediterranean in 327 BC, The early Middle Ages are often referred to as the Dark
soldiers are reported to have used the Indian art of head Ages because of the low level of learning or ‘enlight-
massage known as champissage. enment’. During this time information was lost, new
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aterial was not written and, in most of Europe, Christi-

m used massage in the way that Hippocrates, Galen and
anity had a huge hold over the beliefs of men and women. Celsus advocated. Hoffman’s work contributed to the
By the end of the fifth century the Roman Empire medical practices in Germany, France and England and
was overrun by warring tribes. As a result of such inva- paved the way for the public to become aware of the
sions, works like De Medicina that Celsus wrote were benefits of massage and exercise.
‘lost’. Christianity gradually became a permeating Per Henrik Ling (1776–1839) was born in Sweden
influence and knowledge was closely guarded and mod- and, with two French associates, set the wheels in motion
erated by the monks, who were the Christian scholars to produce Svenska Gymnastikens (Swedish Exercise),
of the time. Anything that was considered to be hereti- which today is known as Swedish massage. In 1804 Ling
cal or non-Christian was not released to the Christian began lecturing at the Lunds Universitet on the art of
people. Christians did use touching as a part of their fencing and gymnastics. He studied anatomy and physi-
beliefs and it was referred to as the ‘laying on of hands’, ology and further developed his knowledge of how the
however the use of the body for pleasure was discour- human body moves. While teaching fencing to his stu-
aged and seen as sinful. Folk healers may have been the dents, Ling noted that some students could not physically
only people who practised massage during this time, but perform the moves he wanted them to. He learnt through
due to the beliefs about sinful behaviour being against teaching gymnastics to his students that posture could be
Christian doctrine, they were dubbed as going against re-educated to produce greater efficiency of movement.
God’s will and were often punished for their actions. Ling opened the Swedish Royal Central Institute of
While Christianity was being established in the Gymnastics in 1813, where he continued the develop-
West, a new religion and way of life, which is now ment of his ideas. Salvo (1999: 10) quotes Ling as say-
known as Islam, was founded in Arabia by the prophet ing: ‘[we] try by means of influencing movements to
Mohammad (c. 570–632). Around AD 750 the art of alleviate or overcome sufferings that have arisen through
making paper reached the Islamic world from China, abnormal conditions’. Ling began to classify his gym-
thus allowing new and rediscovered works to be tran- nastic movements into active (performed by the client
scribed. In time this learning reached Western Europe alone), passive (movements of the client’s limbs per-
via Spain, where Islam had become established. formed by the therapist) and duplicated (performed by
As a result of this, the lost work of Hippocrates, Galen the client with assistance from the therapist). Ling’s ‘pas-
and Celsus was revived and spread throughout Europe. sive movement’ incorporated massage techniques such
During the ninth and tenth centuries new medical texts as friction, hacking, pinching, squeezing and kneading.
were written. Some of the work of the Islamic–Persian By 1851, Ling’s teachings had spread to 38
philosopher/physician Rhazes, or Razi, (860–932) was schools throughout Europe. However, Ling’s name
based on the work of Hippocrates and Galen. Razi wrote was exploited to market Swedish gymnastics and this
an encyclopaedia in which he praised and promoted mas- brought his developments to the attention of the medi-
sage, as well as exercise and diet, to maintain health and cal fraternity, who ridiculed his work on the basis that
wellbeing. Another great Persian philosopher/physician, his education in anatomy and physiology was not exten-
Avicenna (980–1037) wrote the Canon of Medicine, bas- sive. Despite this, Ling’s work did receive a favourable
ing his beliefs about medicine on Galen’s work and pro- reception in parts of Europe.
moting the use of massage and exercise. In Holland, Dr Johann Mezger (1839–1909) and an
In about 1450 Johannes Gutenberg and his colleagues English physician, Mathias Roth, have been credited
brought together the elements of modern printing for for bringing Ling’s work to the scientific community.
the first time. It was this creation of the Gutenberg press Mezger introduced the terminology still used today,
that allowed works such as De Medicina by Celsus to be such as effleurage, pétrissage, tapôtement (including
circulated through the greater world once again. beating and clapping) and massage (Beard & Wood
1964). Mezger spread massage into Germany and Aus-
THE MODERN ERA (1450–2000) tria, through his extensive practice of this art and his
About 100 years later, well into the Renaissance, French ability to competently display its benefits to others in
physician Ambrois Paré (c. 1510–1590) wrote about the the medical profession.
use of massage as a treatment. Paré was mainly interested The French physician Just Marie Marcellin Lucas-
in the effects of massage on broken joints or after ortho- Championnière claimed, in about 1880, that ‘in fractures,
paedic surgery. He referred to the speeds and depths with the soft tissue union as well as the bony union should
which frictions were applied to the body, plus mobilisa- be considered from the start’ (Tappan 1988: 7). Lucas-
tion of the joints (Palmer 1912). Today these techniques Championnière’s ideas impressed Sir William Bennett
are constantly employed by massage therapists. who began using massage to treat patients at St Georges
In 1569, Girolamo Mercuriale (1530–1606) wrote Hospital in England during the late nineteenth century.
De Arte Gymnastica, following the theme that massage The validation of massage by Bennett and Roth influ-
and exercise were a partnership to be used during the enced British opinion as to its worth. Mennell later writes
same session. ‘those who have once seen the treatment first devised by
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Records show that a physician named Hoffman Lucas-Championnière applied to a recent fracture can-
(1660–1742) used massage and exercise as part of his not but admit that they have witnessed the result of a
medical practice in Germany. Along with exercise, he profound reflex’ (1920: 6).
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Interest in massage was not limited to Europe. In his colleagues, Guenther and Hildegard Wittlinger from
the US in 1856, two brothers, Charles and George Austria. The Wittlingers established the Dr Vodder
Taylor, introduced Ling’s work. They learned the tech- School in 1971 where the family continue Dr Vodder’s
niques from Roth and were the driving force behind work and teach his method in its original form, which
Americans’ belief in the benefits of massage. By 1880, is considered to represent the gold standard in manual
medical research had begun in New York on the benefits lymphatic drainage today. The work has spread world-
of massage in the management of anaemia. wide and a number of practitioners in Australia are spe-
Back in London, specifically during 1894, the Brit- cially trained in this technique today.
ish Medical Association (BMA) made a special inquiry Vodder always saw the human as a whole. His thesis
into the education and practice of massage practitioners. was ‘if one part is sick the whole human being is sick’.
This inquiry, which fuelled the ‘Massage Scandals of He only gave whole body treatments with special ded-
1894’, found that many schools of massage were using ication to the affected area.
questionable tactics to enrol students. Graduates of these (Wittlinger 2004)
schools were usually unskilled and in debt and were
Soft tissue manipulations were also popularised at
offered employment by their schools. However, it was
this time. In Germany Elizabeth Dick developed bind-
not unknown for this employment to include prostitution.
gewebs (connective tissue) massage in 1929. In Eng-
Thus the longstanding association between massage and
land an orthopaedic surgeon, James Cyriax, developed
prostitution was reinforced. The term ‘massage parlour’
transverse friction massage. Cyriax set up a department
as a euphemism for brothels was popularised by this
at St Thomas’s hospital in London, in 1938. It was
scandal. In addition, the BMA’s inquiry found that quali-
dedicated to developing massage and manipulation,
fications had been forged, leading to public mistrust.
and later became the department of orthopaedic medi-
A group of women started the first massage asso-
cine. He is credited today as the father of orthopaedic
ciation in London, named the Society of Trained Mas-
medicine. Cyriax published the Textbook of Orthopedic
seuses. They hoped to gain acceptance of massage as a
Medicine: Volume 2 (11th edn, 1984), and this laid the
legitimate field of study and an emerging career option
foundation for soft tissue manipulations.
and profession. The women used the medical model to
shape their society, making high academic standards a
part of the compulsory entrance requirements. Training Massage in Europe — World War I
was only done at selected schools, and these schools were to the present
monitored regularly to maintain the society’s standards. Throughout the two world wars, massage was fre-
Over the next hundred years, many types of mas- quently used to help the rehabilitation of service men
sage and bodywork developed. In 1920 Dr James in the Allied forces hospitals. Inside Nazi territory
Mennell divided massage effects into two categories — Felix Kersten (1898–1960), a manual therapist trained
mechanical actions and reflex actions. Mennell showed in Sweden, was obligated to use massage and pressure
that massaging a patient produced mechanical actions point techniques to relieve Reichfuhrer SS Himmler of
such as moving venous blood and lymph, and also his severe stomach pains. Before the war, Kersten had
stretched connective tissue affecting tendons and scar worked in Finland, Sweden and Holland. He was appar-
tissue. Mennell noted that when stimulating the tactile ently so effective in treating Himmler that he was able
skin receptors, reflex action occurring to soft tissue such to use his position to help many people escape the death
as muscle caused it to relax or contract, depending on camps (Calvert 2002). From 1945 massage was being
the type of stroke used. performed in athletic clubs and YMCAs for the benefit
About 15 years later a Danish physiologist, Emil of athletes and sportsmen.
Vodder, along with his wife Estris, developed manual The popularity of massage grew in Europe in the
lymphatic drainage, which uses very light circular 1960s and became a more commonly utilised form of
motion on the skin to work directly with the lymphatic therapy in the 1970s. Increased interest in alternative
system. In 1936 the Vodders’ presented their work to a therapies opened up opportunities to explore different
congress in Paris. Whilst in France, Emil Vodder was techniques of bodywork which came to Europe from
working as a medical massage therapist on English cli- America and Asia. Narendra Mehta introduced Indian
ents with chronic sinusitis, acne and migraine. He noted head massage to London in 1981 at the Mind, Body,
these patients had swollen lymph glands in the cervical Spirit exhibition in Olympia. Mehta integrated classic
region. It was taboo in medical profession of this time massage with Indian head massage and traditional
to stimulate the lymphatic systems for fear of spreading Indian Ayurvedic techniques to successfully create a
disease but Vodder and his wife discovered the swell- treatment that combined both eastern and western mas-
ing could be relieved by using light, pumping, circular sage methods. In the 1990s he went on to develop a
movements in the direction of the lymph flow. qualification in Indian head massage that is now recog-
However it was not until the 1960s, after Dr Asdonk nised internationally (Mehta 2000).
from Germany had conducted research on 20 000 More recently Mary D Nelson from Tucson, Amer-
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patients using the Vodder method, that manual lym- ica has bought to Europe her version of hot stone mas-
phatic drainage became accepted in conventional medi- sage. In 1993, Nelson discovered how the benefits of
cal institutions. Dr Vodder passed on his life work to using hot and cold balsam stones helped enhance the
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effects of a wide variety of massage techniques. She with a great respect for personal boundaries, and the
built upon and experimented with the different ways energy of the group, and would then ask if everything
the stones could be used on the body using modern was OK. This in itself is how a healing may take place.
and ancient traditions from Asia and native American The intention of the touch is to project healing rather
Indians. Today, her workshops have become popular than to specifically manipulate the body’s soft tissue.
amongst therapy schools within Europe and worldwide. The touch and concern of the first woman transfers
The growth of massage and complementary thera- into the second woman and the whole circle would be
pies in the UK has increased as has the requirement affected by this movement, the children would also be
for professional regulation. The Federation of Holistic affected and then they learn how to intuit that some-
Therapists (FHT) was established in 1962 to represent thing is up for someone, usually for their mothers and
and support multi-disciplinary therapists, promoting use this touch to transmit healing energy.
high standards in education, regulation and professional
practices for sports, beauty and complementary therapy. The period 1870–1920
Complementary therapies growth in the UK also led the By the 1870s massage therapists were known to be prac-
National Health Service (NHS) to set up a directory of tising in Melbourne and Sydney. There were different
complementary and alternative practitioners. In 1993, ways of obtaining a massage, including referral to private
HRH Prince Charles founded The Princes Foundation rooms by medical practitioners where massage was per-
of Integrated Health to promote a holistic approach to formed by therapists who had gained credible reputations.
medical care in the UK. Initially only modalities such According to Dunstan and Bentley (2000), in 1880
as osteopathy and chiropractic were registered. But, on an Australian doctor, Louis Henry, placed massage as ‘a
31 March 2008 a reception was held in the presence third branch of medical practice on equal footing with
of the British Minister of State for Health Services to surgery and medicine’. This statement helped to pave the
celebrate the formation of the Complementary and way for massage to be accepted as a mainstream therapy.
Natural Healthcare Council. This council has been set Practitioners such as Teepoo Hall (1860–1909) became
up to regulate massage and other complementary thera- well regarded as massage therapists. Hall worked with
pists within the UK. the surgeon Thomas Fitzgerald (1838–1908) and his cli-
We are infinitely complex beings — mind, body and ents included several dignitaries. He practised at what is
spirit — that cannot just be reduced to mechanical now the Austin and Repatriation Medical Centre (Aus-
functioning. Healthcare should, and must, attend ap- tin Hospital) and became one of the first clinical teach-
propriately to all three aspects ers of massage, rising to the position of senior masseur
(HRH The Prince of Wales 2008) and demonstrator at the Melbourne Hospital.
Likewise, Alfred Peters (1871–1944), who emigrated
MASSAGE IN AUSTRALIA to Australia from England, started working as a masseur
in Melbourne hospitals. He treated many sportsmen and
The Aboriginal connection
also the Russian ballerina, Anna Pavlova. When Peters
The healing methods used by the early Aboriginal emigrated to Australia he advocated the benefits of mas-
people were, and still are, based on mind, body, spirit, sage and the medical profession could not ignore his
socio-community, and environment. Approaches to claims. In his book, Massage: Its History, Its Curative
healing among the Aborigines appear to vary accord- Uses and Its Practical Results (1890), Peters refers to
ing to region. When interviewed on 4 March 2003 Ann massage as ‘one of the simplest, most rational, most effi-
Warren, an Aboriginal elder from the Dtjilmamidtung cacious and most valuable of curative agencies’ (p 3).
region, states that ‘the healings that take place cannot Figure 2.1 depicts massage in Australia before 1905.
be compartmentalised into any one modality’. What Around 1912 a masseur by the name of Joseph Fay
this means is that the Aborigines do not recognise the wrote a text titled Scientific Massage for Athletes. The
word massage, however they do recognise the practice title page heralded him as ‘The Australian Authority On
of touch. Warren also describes the healings as ‘wholis- Massage For Athletes’ and this text may well have been
tic’, whereby every part of the being is considered and the first sports massage text written in Australia. Fay
the person is treated as a whole. Warren describes a described what distinguishes an average massage thera-
method of using touch as a healing instrument in the pist from a practical massage therapist, namely ‘the for-
Dtjilmamidtung region as follows (2003): mer one merely pats or plays with the hide [skin], while
You may have a group of women in a circle exchang- the latter works with the meat, or muscle, between the
ing words and sharing experiences. In this group there hide and the bone so that it is in its highest state for exer-
would be children sitting across laps or lying in be- cise’. Fay classified three main massage movements as
tween two people. Everyone who makes the circle friction, kneading and vibration. In his text he described
would be touching in some way. Their knees may a method to massage the whole body such that it is done
be touching the person on either side of them or they in a systemic and organised fashion (Fay c. 1912).
may be holding hands. As the exchange and sharing By 1905, massage societies were in existence in
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progresses, one woman may get a feeling about an- New South Wales, Victoria and South Australia. In 1906
other woman that something is up for her. This woman a meeting chaired by Dr John Springthorpe resulted in
would then rub, touch and soothe the other woman the formation of the national Australasian Massage
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By 1905, massage societies were in existence in New South Wales, Victoria and South Australia. In 1906 a
meeting chaired by Dr John Springthorpe resulted in the formation of the national Australasian Massage
Association (AMA) and Peters was an integral influence in this association. By 25 April 1907 membership totals
for the AMA stood at 302: New South Wales 112; Victoria 141; South Australia 15; Queensland 12; Western
Australia 3; Tasmania 12 and New Zealand 7. Also there was a total of 196 honorary medical members on the
books. Although today each state has its own massage association, a comparison has been made to indicate
the membership growth of the professional massage associations: New South Wales 1200; Victoria and
Tasmania 1616; South Australia and Northern Territory 650; Queensland 1100; Western Australia 200; and
New Zealand 460.
Figure 2.1 Massage in Australia before 1905
ssociation (AMA) and Peters was an integral influence

A the ankle, contracture of the calf muscle with resultant
in this association. By 25 April 1907 membership totals foot drop deformities of the foot, etc.
for the AMA stood at 302: New South Wales 112; Victo- The AMA fought a huge battle of its own during
ria 141; South Australia 15; Queensland 12; Western Aus- WWI, striving for recognition. Eventually its efforts
tralia 3; Tasmania 12 and New Zealand 7. Also there were were noticed but ironically they underwent the same
a total of 196 honorary medical members on the books. challenges in WWII. Butler (1943: 625) wrote:
Although today each state has its own massage associa- This much at least is certain: whatever be the future of
tion, a comparison has been made to indicate the mem- the Australian Service of Massage, its members can be
bership growth of the professional massage associations: assured that their art and technique will rest now on a
New South Wales 1200; Victoria and Tasmania 1616; scientific basis of clinical and experimental research.
South Australia and Northern Territory 650; Queensland And for this they, and medical science in general, owe
1100; Western Australia 200; and New Zealand 460. a tribute to the pioneers of the war of 1914–1918.
Australia at war
Modern times in Australia
When World War I began, members of the AMA made
applications to serve as massage therapists, but were In 1939 the AMA changed its name to the Australian
turned down by the Australian Imperial Forces. Their Physiotherapy Association. Massage courses became
spirit remained steady and strong and as Butler (1943: less available during the next two decades. Physiotherapy
595) states ‘… the practitioners of massage were enthu- was growing in popularity and the two fields began to
siastic and, there can be no doubt, convinced believers separate. There are different theories about why this
in the value of their art and of the importance of its separation occurred. One theory is that of time man-
proper application’. agement. To conduct a massage can take 15 to 90 min-
After several further unsuccessful attempts, approval utes, resulting in fewer patients being seen in one day,
was finally given in 1915, due largely to the constant pres- whereas a physical therapy session is quicker and more
sure from the AMA. As recorded by Butler (1943: 597): patients can be treated per day. Another theory is that
the use of machines may be far less invasive for some
The dispatch of a party or section of masseurs in the
people than to have another human touch their body.
proportion of 1 male to 2 females, males to have pay
In Melbourne in the 1960s many people were treated
and privileges of staff-sergeants, females pay and
by Bill Mitchell, who was a trainer at the South Mel-
privileges of staff nurses. Under these conditions they
bourne Football Club. No appointments were available,
must be prepared to serve for the term of war, and
so patients would arrive at the clubrooms and wait in turn,
wear a uniform as directed for which allowance will
then be called in and treated. Mitchell would watch a cli-
be made.
ent walk towards him and by the time that client reached
One staff member alone would treat 15 cases a day. him he would have a fair idea of what the problem was.
A report made by Colonel McWhae to General Howse Payment was made by placing a donation in a tin that sat
states the following (Butler 1943: 613): on a shelf near the exit door. Mitchell was known only
All soldiers with stiffness of joints, contractures of through word of mouth, but his reputation was huge. One
muscles or tendons and similar lesions will receive reason that Mitchell was so popular was that he treated
remedial gymnastic treatment, providing no acute in- just about every size, shape, age and type of person. He
flammation, oedema or unhealed wounds (except in treated football players, grandmothers, adolescents and
special selected cases of the latter) are present. e.g. business folk, but he had a hidden talent that made him
Stiffness of the shoulder, elbow or wrist, limitation of a legend in Victoria, and that was charm. Mitchell, after
extension of the elbow, limitation of supination and watching patients walk across the floor, would greet
pronation of the forearm, stiffness of the wrist, hand patients with a handshake, look them right in the eye and
copyright law.
or fingers with contractures and loss of handgrip, through a smiling face say ‘I can fix that for yah!’. This
stiffness of the knee whether accompanied or not by was not always the case, but people did not seem to mind
a flexion, contracture, stiffness or limited mobility of as he had more successful treatments than unsuccessful.
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At the St Kilda Football Club the head trainer Jim infant structurally. For example, it was common prac-
Clancy used some of the methods that the Romans tice to bend the thumb of female infants backwards so
used when treating their athletes in Ancient Rome. One that when older, they may be better able to weave flax. It
method Jim employed was using a strigil on the players. was a belief that the best person to perform takahi mas-
This device was shaped liked a spoon and could remove sage was someone who entered the world via a breach
the dust and sweat from the players before the massage birth. Such people, born ‘feet first’, were thought des-
was administered. tined to practise takahi massage, which involved walk-
During the early 1960s two brothers, Harry and ing on parts that were sore or injured to relieve muscular
Arthur King, from Collingwood Football Club, estab- stiffness (Riley 1994). Such forms of massage have been
lished a trainer’s college that taught students the art of passed down the generations, and are used today by
massage, training methods and assessment of player many Maori health networks. Parallelling the use of this
injuries. This training school is still operating from traditional form of massage was the development in the
Hawthorn Football Club today. early twentieth century of modern massage practices.
Keith Cleaver was also in the football trade and The development of modern massage in New Zea-
worked for Richmond Football Club from 1955 until the land followed similar lines to that of Australia. Accord-
1990s. Keith learned some of his skills from Mitchell. In ing to Anderson (1977) there were over 300 massage
1977 Cleaver became head trainer for the club. He made therapists established in New Zealand by the early
several suggestions to the club that a freezer be installed 1900s. Some of these therapists held formal massage
in the clubrooms so they could have ice on hand to treat qualifications obtained through studies overseas, whilst
their player’s injuries. Finally, in the 1980s, the club others had trained in New Zealand under the guidance
agreed to this and that put an end to the trainers rush- of self-appointed massage teachers. In addition, some
ing out on footy morning to purchase a dozen bags of therapists received training in massage whilst nursing
ice to have on hand for the match (confirmed by Keith at the Auckland Hospital. Many of these massage thera-
Cleaver, personal communication, 17 April 2003). pists had their own practices and it was not uncommon
Events during the 1970s were absolutely vital for for husbands and wives to work together.
the survival of massage therapy. The Esalen Institute By 1913 a massage department had been established
in California was established and influenced thousands in the Dunedin Hospital. A Mr Booth acted as Honor-
of people in America, Australia, Europe and elsewhere ary Masseur within this department and later became
about awareness of body, mind and spirit. The concept a massage instructor to students when the department
of ‘holism’, that we are much more than just our physi- formed a school of massage. At this time an increasing
cal body, and that each aspect is interrelated, re-emerged number of the medical profession were becoming aware
as an important consideration in health care. ‘Alterna- of the use and need for massage, and the importance of
tive’ health care, based on age-old, traditional healing adequate massage training was apparent. The New Zea-
methods from across the globe, enjoyed a revival in the land branch of the British Medical Association (BMA)
West. Touch was integral to this philosophy and there- addressed this concern by establishing the School of
fore massage fitted in with it perfectly. It could affect Massage in Dunedin in conjunction with the Dunedin
not only the physical aspect, but also the mind and Hospital, under the auspices of the University of Otago.
spirit of a recipient. The Esalen Institute became a pub- After administration difficulties, full responsibility of
lic platform for many people to introduce their work, the school was transferred to the Otago Hospital Board.
including that of bodywork greats such as Ida Rolf and This board conducted examinations and issued certifi-
Moshe Feldenkrais. These contemporary philosophies cates in massage, as well as medical gymnastics and the
and concepts significantly influenced the growth, devel- use of medical electricity (Anderson 1977).
opment and popularity of massage therapy in Australia. The government of the time was aware of these
activities, and considered legal registration for all prac-
MASSAGE IN NEW ZEALAND tising massage therapists. This consideration was post-
The approach to health and wellness adopted by Maori poned due to the great war and was acted upon shortly
people is very much intertwined with their way of life. after when the Masseurs Registration Act of 1920 came
Traditionally, massage (mirimiri), herbal medicine into force (Sanford 2003). In 1949 this Act was modi-
(rongoa) and spiritual healing (wairua) formed the cor- fied to the Physiotherapy Act (which is still in existence
nerstones of holistic Maori health care. Today, mirimiri today) and massage therapy fell under the umbrella of
or massage is still widely practised in Maori circles by physiotherapy. Those who wanted to practise massage
Maori healers. and become registered had to adhere to the Physiother-
According to Riley (1994), the use of mirimiri by apy Act and were required to undertake 600 hours of
Maori people dates back centuries. Herbal or animal oils training.
were often used as lubricants in the application of the Decades passed until, in 1985, a man by the name
three main types of massage — roromi, toto and takahi. of Bill Wareham called all massage therapists in the
Roromi (or romiromi), usually administered by older Auckland area to a meeting. The intention Wareham
copyright law.
women, was practised daily on the adults and involved had was to form an institute of massage therapists. This
squeezing and pinching strokes, whilst toto was a form first meeting was fruitful and the Massage Institute of
of infant massage, often used to ‘correct’ or alter the New Zealand Incorporated (MINZI) became an entity.
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Wareham was a massage educator during this time and he l whether the National Health Service will provide
would offer his students the opportunity to become mem- for these treatments.
bers of the institute. In 1987 Wareham travelled to Wel- At this time in order for Australian massage thera-
lington where he conducted some massage education and pists to be considered for registration, massage would
it was during his stay that the Wellington branch of MINZI need to pose a significant health risk, and the industry
was established and Auckland became head office. The would need to present a unified lobbying position. Gov-
MINZI (now Massage New Zealand, MNZ) has focused its ernment regulation might also follow if massage gained
efforts on the education of massage therapists and the stan- suitable scientific credibility, which could be achieved
dards of massage teachers throughout New Zealand. They through conducting research programs. However, the
have more massage teachers on the books than massage most common way that research is achieved is when
therapists but consider all types of members to be equal. courses are at a certain academic standard. In Australia
MINZI supports and assists members to obtain higher edu- massage is, at highest, a diploma qualification. How-
cation and qualifications. MINZI run annual conferences ever, degrees in musculoskeletal therapy and myother-
over a three-day period where massage therapists can apy can now be studied and the need for research has
attend a wide range of workshops to develop and maintain been addressed.
their skills (Tall 2003, personnel communication). The Australian Association of Massage Therapists
In the late 1980s a massage therapist named Jim (AAMT) has launched the Australian Massage Research
Sandford invited fellow practitioners from around the Foundation (AMRF) which primarily exists to provide
country to a meeting to convey his perceived need for grants for massage related research which will contrib-
a professional body for therapeutic massage therapists. ute to the health benefits of massage.
This initial meeting led some time later to the formation In America massage research commenced around
of the New Zealand Association of Therapeutic Mas- 1880. Since then the Institute of Touch has been devel-
sage Practitioners (NZATMP), a national professional oped at the Miami Medical School, where research is
body established to service the therapeutic massage conducted to validate the benefits of massage. This
profession in New Zealand. research, sponsored by Johnson and Johnson, aims to
Thus the newly formed association was up and run- look at the value of massage when used with infants, for
ning and set about addressing such concerns as edu- postnatal depression, with premature babies and during
cation and training of therapeutic massage therapists, pregnancy. In addition, text has arisen from this region
standards of professionalism amongst practitioners and of the world describing how to conduct research as a
recognition of the profession of therapeutic massage in massage therapist.
New Zealand. NZATMP duly became an incorporated
society in September 1989 and has since grown from
strength to strength. Perhaps the most notable achieve- CONCLUSION
ments of NZATMP have been in the area of develop- An appreciation of the history of massage provides the
ing, establishing and implementing a comprehensive therapist with the ability to place current knowledge
program of education for individuals interested in pur- into an historical and developmental context, enabling
suing training in therapeutic massage. Today the asso- the therapist to tell people briefly about its 5000 year
ciation has grown to include members nationwide and lineage — how it survived even through the Dark Ages,
has recently changed its name to the Therapeutic Mas- the main figures in its history and the scandals that
sage Association (TMA). The TMA’s main function occurred along the way. The therapist can explain the
today is to keep a register of massage therapists who fight that massage had to undertake to serve injured men
have the National Diploma of Therapeutic Massage and during World War I, and how beneficial the massage
to foster the ongoing training, development and men- service was in that time.
toring of massage therapists (Vautier 2003, personal Despite the growth of competing forms of treat-
communication). ment through the ages, massage has survived. Though
the art of massage has sometimes faced extinction,
FUTURE OF MASSAGE somewhere, sometime throughout these threats, some-
one believed in it enough to speak highly of it and
In the UK, the House of Lords Science and Technology thereby influence the views of the public and medi-
Committee is starting to develop ways of monitoring the cal fraternity. Current massage students represent the
use of complementary and alternative medicine (CAM). future of massage. In time, their work will become the
Due to the large use of CAM, issues have arisen about: history for new practitioners. As inheritors of the tradi-
l what structures and regulations are in place with
tions of Hippocrates, Galen, Celsus, Avicenna, Ling,
practitioners of CAM to protect the public Mezger and Peters, students can think about the future
l whether the practitioners’ level of training is ade- of massage, what it means to them, what impact they
quate will have on this 5000 year-old art and what direction
l whether evidence has been accumulated and what the profession will take. Figure 2.2 is a time line of
copyright law.
research is being carried out the history of massage as a healing method. It illus-
l whether there are adequate information sources on trates the progression and decline of massage therapy
the subject throughout history.
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Copyright © 2010. Churchill Livingstone Australia. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses
The arrows indicate the highs and lows of massage as a progressive healing method
Indigenous tribes use touch as

a form of healing throughout
the entire world
Asclepius uses ‘Father of

massage above all medicine’ Indian text The The Chinese text Galen used Aulus Celsus
Developments in other healing Hippocrates used Laws of Man was the Nei Ching massage on the writes De
healing and health methods massage as a written mentioning was written and it gladiators and Medicina and
made in China form of healing in massage documents wrote over 400 massage is
Egyptian tomb of conjunction with massage as a texts in medicine documented as a
Ankhamor shows herbs practised healing where he method of healing
wall painting of method documented the
foot massage benefits of
Developments in massage
healing and health
made in India.
Babylon clay Four books of
tablets discovered wisdom (Veda’s)
that depicted were written
massage as a form
of healing
Possibility massage
was used to relieve
10,000BC tired limbs after
Prehistoric hunting 2350BC 2330BC 1800BC Ancient Greece 400BC 300BC 200BC ←0→ 160AD 170AD 500AD
permitted under U.S. or applicable copyright law.
2 A history of massage
Rome falls to
waring tribes, a
low level of
learning occurred
and many
previous texts were
lost, stolen or
ruined
Figure 2.2 Time line of historical events
19
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20
The arrows indicate the highs and lows of massage as a progressive healing method
Section 1 A framework for massage practice

Per Henrick
Ling uses
Swedish Massage Many
terms to Hollands Ling’s work travels into schools and
describe his Dr. Johann makes it to England training
medical Mezger USA via the from France institutions
gymnastics credits Taylor and from Teepo Hall offer
Lings work brothers diciples of and Alfred Diplomas
Persian
Islamic– French and who learnt Ling’s work Peters Football and some
philosopher
Persian physician Swedish Ling’s massage become clubs Bachelors
Avicenna Esalen
massage is method travels to degrees
Baghdad philosopher wrote the Gutenberg Ambrose Hoffmann established employ Institute in
born. in massage
became the Razi wrote Cannon of Press Paré wrote from Australia Society of massage trainers to California
centre of an allowed about the Mercuriale Germany Holland, from Clinical practitioners massage
Medicine Many texts becomes a
learning; encyclopedia multiple effects of wrote advocates Germany England Masseurs in Australia sports
based on on massage major
scholars of medicine copies of massage De Arte massage and Austria formed to injuries
Galen’s begin to influence in
from all based on the such text as after Gymnastica and learn the reinstate the
Mohammad work emerge hands-on
parts of the work of Celsus’s De surgery of mentioning introduces it benefits of benefits of
the Prophet modalities
world came Hippocrates Medicina to broken massage to a wider massage massage
forms a new
to learn the and Galen be printed joints audience into the
religion
re- British
which is

discovered community Massage
now Islam.
Text and texts and goes to war
information information and many
was benefits of
rediscovered massage
are
documented
at this time
Early 1915– Early 1979–
600AD 750AD 900AD 1000AD 1445AD 1550AD 1569AD 1700AD 1600AD 1850AD 1856AD 1880AD 1894 1894 1900AD 1900s 1918 1939 1960 1970s 2003
British Australian
massage Massage
scandals are Association
revealed by changed its
British Medical name to
Society Australian
Physiotherapy
Association
and massage
Account: s8715057
in Australia
declined
during this
period
Figure 2.2—cont’d
copyright law.
Questions and activities Calvert RN 2002 The History of Massage — An Illustrated

1 You have been asked to present a talk to the local Survey From Around the World. Healing Arts Press,
Rotary group on the benefits of massage. One Rochester, Vermont
Chandler CA 1980 Galen. In: The World Book Encyclopedia
Rotarian inquires about the development of modern
(vol 8). World Book-Childcraft International Inc,
massage. Detail your response to this question,
Chicago
making reference to the contributions of Ling. Cyriax JH 1984 Textbook of Orthopaedic Medicine:
2 Prepare a one-page visual handout that could be Volume 2 (11th edn). Baillière Tindall, London
used for a short presentation on massage, which Dunstan D, Bentley P (unpublished) 2000 The Australian
illustrates a timeline of significant historical events Physiotherapy Association Draft History
in the development of massage therapy. Fay HJC 1912 Scientific Massage for Athletes. Ewart,
3 Describe what prompted you to be drawn to the Seymour & Co Ltd, Windsor House. Kingsway,
practice of massage, and define your own personal London
philosophies of massage. HRH The Prince of Wales 2008 Reception to celebrate
4 It is a fact that as recently as the eighteenth and the formation of the Complementary and Natural
nineteenth centuries, medical physicians used Healthcare Council. 31 March
massage therapy as a form of treatment. Despite Kellogg JH 1895 The Art of Massage: Its Physiological
the acceptance of massage then, today massage Effects and Therapeutic Applications. Modern
therapists are being required to scientifically Medicine Publishing, Battle Creek, Michigan
Kleen EAG 1918 Massage and Medical Gymnastics. J & A
validate the use of massage as a form of therapy.
Churchill, London
Why do you think this is the case?
Massage New Zealand (MNZ). Online. Available: www.
massagenewzealand.org (accessed 21 Oct 2009)
Recommended reading Martyr P 2002 Paradise of Quacks, An Alternative History
Butler AG 1943 The Official History of the Australian of Medicine in Australia. Macleay Press, Sydney
Army Medical Services in the War of 1914–1918, McKay E 2002 Touchline Magazine. Queensland
vol. 3. Special Problems and Services. Australian War Association of Massage Therapists (QAMT), Brisbane
Memorial, Canberra Mehta N 2000 Indian Head Massage: Discover the Power
Calvert RN 2002 The History of Massage: An Illustrated of Touch. Thorsons, UK
Survey From Around the World. Healing Arts Press, Mennell JB 1920 Massage, Its Principles and Practice. J & A
Rochester Churchill, London
Kakkib li’ Dthia Warrawee’a 2002 There Was Once a Tree Palmer MD 1912 Lessons on Massage (4th edn). Baillière,
Called Deru. HarperCollins Publishers, Sydney Tindall and Cox, London
Peters A 1890 Massage: Its History, Its Curative Uses, and Peters A 1890 Massage: Its History, Its Curative Uses, and
Its Practical Results. Public Library, Melbourne Its Practical Results. Public Library, Melbourne
Veith I 1972 Huang Ti Nei Ching Su Wen: The Yellow Riley M 1994 Maori Healing and Herbal. Viking
Emperor’s Classic of Internal Medicine (new edn). Sevenseas NZ Ltd, Paraparaumu
University of California, California Salvo SG 1999 Massage Therapy Principles and Practice.
W B Saunders, Philadelphia
References Sanford J 2003 Personal correspondence by email
Anderson EM 1977 The Golden Jubilee History 1923– Smith C 1996 ARM Massage Newsletter. Association of
1973: The New Zealand Association of Physiotherapists Remedial Masseurs Incorporated (ARM)
Inc. The New Zealand Association of Physiotherapists Tall N 2003 Personal communication, 1 May
Inc, Wellington Tappan F 1988 Healing Massage Techniques — Holistic,
Australian Association of Massage Therapists (AAMT). Classic and Emerging Methods (2nd edn). Appleton &
Online. Available: http://www.aamt.com.au/ (accessed Lange, Connecticut
1 Sept 2008) Unschuld PU 2000 Medicine in China — Historical
Australian Massage Research Foundation (AMRF). Artifacts and Images. Prestel Verlag, Munich
Online. Available: http://www.amrf.org.au/ (accessed Vautier B 2003 Personnel correspondence by email
1 Sept 2008) Veith I 1972 Huang Ti Nei Ching Su Wen: The Yellow
Beard G, Wood EC 1964 Massage Principles and Emperor’s Classic of Internal Medicine (new edn).
Techniques. W B Saunders, Philadelphia University of California, California
Beck MF 1999 Milady’s Theory and Practice of Warren A 2003 Author’s interview with Aboriginal elder
Therapeutic Massage (3rd edn). Milady, Albany from the Dtjilmamidtung region
Bennett C 2003 Personal correspondence by email Wittlinger H 2004 Emil Vodder — His Life and His Life’s
Butler Colonel AG 1943 The Official History of the Work. Online. Available: www.vodderschool.com/
Australian Army Medical Services in the War of 1914– emil_vodder_life_work_article (accessed 16 Aug 2009)
1918, vol. 3. Special Problems and Services. Australian
War Memorial, Canberra
copyright law.
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copyright law.
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3
massage in an integrative
health care model
David Stelfox chapter
LEARNING OUTCOMES
l Define holistic health care
l Define integrative medicine
l Describe the benefits of massage therapy within an integrative approach to health care
INTRODUCTION shamanic practice were also common features. Such

Massage is as old as the art and science of healing practices have been passed down through generations
itself. The majority of the cultures on this planet have of indigenous people, and continue to be used by many
incorporated bodywork, massage or manipulative ther- indigenous groups today.
apy (i.e. physical manipulation of the body’s muscles,
ligaments, tendons and bones) within their traditional WHAT IS HOLISTIC/INTEGRATIVE
system of healing in some way. As outlined in Chapter MEDICINE?
2, the earliest records of the use of massage date back The word ‘health’ originally stems from the Germanic
over 3000 years and come from the East (Thailand and and Old English word hœlan meaning ‘whole’ (Austra-
China). Other evidence suggests that over the centuries lian Concise Oxford Dictionary 1995). The act of heal-
India, Tibet, Egypt, Polynesia, Indonesia, North and ing literally means the act of making whole, or restoring
South America, Europe and Australia all have a history to a state of wholeness. Traditional medicine systems
of the use of various forms of tactile therapy/bodywork address each and every aspect of one’s being, and as
within their healing traditions. such are seen as ‘holistic’ or ‘integrative’ approaches.
Each of these traditions recognised the benefits, (W)Holistic medicine (the spelling differs for this
indeed the necessity, of tactile therapy within its overall word but the meaning is the same in either form) is an
approach to health care. Furthermore, the indigenous approach to health care that recognises the intercon-
healers from these cultures understood the importance nectedness between the body, mind, emotions and spirit
of the health of mind, emotions, spirit and body, and (i.e. it addresses the ‘whole person’).
their interrelatedness in regard to overall wellbeing. The The World Health Organization (WHO), a division
therapies comprising these traditional healing systems of the United Nations, has defined holistic health care
were ones that aimed at specifically addressing each as (WHO 1998):
of these aspects of the health of a person — the mind, that of viewing man in his totality within a wide ecologi-
body, emotions and spirit. cal spectrum, and of emphasising the view that ill health
While the techniques used or philosophies adopted or disease is brought about by an imbalance or disequi-
may vary slightly from one culture to another, the librium of man in his total ecological system and not
modalities of therapy are indeed similar. Typically only by the causative agent and pathogenic evolution.
they include diet and nutrition therapy, the use of plant
Furthermore, the WHO views traditional systems of
medicines (herbs), counselling (both psychological and
health care as (WHO 1998):
spiritual), exercise therapy (e.g. yoga, tai qi, qi gong)
and, of course, some form of tactile therapy/bodywork. one of the surest means to achieve total health care
coverage of the world’s population, using safe and
copyright law.
Among indigenous people, massage or manipulative

therapy was employed to exorcise evil spirits, to cor- economically feasible methods.
rect a person’s physical structure or simply to make ‘Integrative’ medicine may be considered from two
a person feel good. Ritual, prayer, devotion and often perspectives. The first perspective, similar to ‘holistic’
23
Account: s8715057
medicine, emphasises the unity, or integration, of mind, simply prescribes medications (natural or pharmaceuti-
body, spirit and emotions in a healthy, balanced individ- cal) does the art of healing a great disservice.
ual, and the use of appropriate therapies for attending to
them. However, integrative medicine goes further than INTEGRATIVE MEDICINE — THE
this, suggesting that the practitioners of these different HEALTH CARE MODEL FOR THE
therapies need to work cooperatively and in consulta- TWENTY-FIRST CENTURY
tion with each other, as well as the client, so that health/
This chapter now examines the first perspective of inte-
wholeness and wellbeing can be optimally achieved and
grative medicine (the one that considers the importance
maintained. In this sense the various individual thera-
of body, mind, emotions and spirit for maintaining and
pies within a medical system, and the practitioners of
restoring optimum health) and the role that massage
them, determine which therapies will be of greatest ben-
therapy can play in delivering this unified approach to
efit to the patient/client at the time. Since they all work
health care in the 21st century.
within the philosophical framework of that particular
With the conscious recognition of the complex-
health system, and the principles that define it, then they
ity of modern society there has emerged an awareness
have an understanding and appreciation of each of the
of the contributions of environment, lifestyle, stress,
therapies which comprise that system and recognise the
emotional disturbance, psychosocial and cultural fac-
value and importance of referral to specialist practitio-
tors and chronic ‘unwellness’ to the process of disease.
ners where necessary. The system of healing is there-
As a result of this recognition, health care has begun to
fore ‘integrative’ from this perspective.
take a turn toward self-care, mind–body therapy, per-
Integrative therapies are sometimes administered by
sonal and spiritual development and wellness enhance-
a single therapist who is skilled in the practice and the-
ment to counterbalance the excesses and limitations of
ory of all of them. Sometimes it may be that a number of
the biomedical model (Dacher 2001). This turnaround
practitioners, each trained and skilled in a specialty area
is leading to a desire for a person-centred, wellness
of treatment (e.g. bodywork/herbal medicine/counsel-
approach to health care rather than the disease-centred
ling/exercise therapy/diet or nutrition) may work within
orientation that has characterised the Western bio-
an overall guiding philosophy of a particular healing
medical model. The 21st century health care consumer
system (e.g. traditional Chinese medicine/naturopathy/
demands to be seen as an individual whose experiences
ayurveda).
constitute a dynamic unity. Today’s consumer holds a
The second perspective of integrative health care is
certain distrust or suspicion of most things perceived as
a more contemporary one. Integrative health care is a
‘scientific’ (Siahpush 1998). The consumer demands an
term coined within the last 10 years by a new breed of
understanding of their existing health condition, and a
general medical practitioner, one who recognises the
desire to be actively involved in the process of improv-
value of integrating ‘mainstream’ biomedical health
ing that condition (Siahpush 1998). The appropriate
care with complementary/alternative/natural healing
health care model for this century must therefore cater
approaches. While this is an admirable view, it is often
to these consumer demands and provide choices based
the case that such doctors (i.e. biomedical practitioners)
on patients’ preferences, respect for other therapeutic
have little understanding of the guiding philosophy/
approaches and acknowledgment of the specialised
ies of the complementary healing approaches and the
skills and expertise of practitioners of other therapies.
system of medicine they represent. It is perhaps a sad
In other sections of this book, the value, indeed the
reflection of the current mainstream system of medi-
importance, of touch in maintaining and promoting
cine that most of its practitioners are only prescribers
health is discussed at length. Massage, or any form of
of medicines. The integrative medicine approach, then,
manual therapy that involves touch, inevitably impacts
while appearing to integrate the best of both worlds,
more than just the physical level of one’s health. The
simply applies either ‘mainstream’ or ‘alternative’
idea of the body being touched in a deliberate way to
medical approaches within the context of the Western
achieve specific results is well documented and readily
biomedical model of health care. In such a model, natu-
accepted, yet the ability of touch to evoke the power-
ral medicine therapies are usually administered without
ful emotional responses and shifts in mental attitudes or
regard to the philosophy or principles that define them
spiritual perspective that often accompany most physi-
(see Chapter 1), largely as alternatives to pharmaceuti-
cal manipulations or tactile experiences is usually over-
cal drug therapy or, less commonly, surgery.
looked or ignored. Clearly, any integrative approach to
This approach is ultimately doomed to failure since
healing must include massage or some other form of
it overlooks or simply dismisses the most beneficial fea-
manipulative or tactile therapy. Let’s now examine this
tures of the natural medicine health care model; that is,
claim in more detail.
it’s guiding principles — one of which is the concept
of the doctor as teacher (docere). This principle stipu-
lates that therapists should educate their clients and MASSAGE AS COMPLEMENTARY
encourage self-responsibility for their health. It also THERAPY
copyright law.
recognises and promotes the therapeutic potential of the The benefits of massage as an effective therapy in its
practitioner–client relationship. Any health care practi- own right must never be underestimated. However,
tioner, whether of natural or orthodox medicine, who this chapter will focus on the valuable contribution
Account: s8715057
3 Massage in an integrative health care model 25
that massage has to make as a complement or adjunct environment — that is, a healing environment. A heal-
to other approaches to healing — in other words, how ing environment is one that cocoons the client, and the
it can augment the therapeutic value of other healing therapist, from the outside world. It provides security,
modalities. comfort, serenity and a feeling of being nurtured. In
such an environment the client feels safe to contemplate
Massage and naturopathy the nature of their disease; to ponder the causes or con-
Naturopathy incorporates an eclectic blend of thera- tributing factors. It is a healing space; something hard to
pies in its attempt to promote the body’s ability to heal find in the often chaotic world of today. In such a space,
itself. Historically, manipulative therapy or massage it is possible that the individual can discover what may
has always been one of the healing modalities incor- be required of them to obtain a satisfactory improve-
porated as part of this system of holistic health care ment of, if not a resolution to, their health problems.
(others include diet and nutrition therapy, herbal medi- The naturopath must be aware of this potential and seek
cines, flower essences, homoeopathy, exercise, lifestyle to provide her/his clients with this opportunity when-
counselling) (Lindlahr 1975). The main reason for the ever appropriate.
inclusion of massage or manipulative therapy is its abil- On the physiological level, one of the many benefits
ity to restore structural balance to the body while also of massage therapy is to improve circulation throughout
helping to relieve stress and promote emotional, mental the tissues of the body. This circulation is not restricted
and spiritual wellbeing. to the blood, but also includes lymph, interstitial and
In Australia, 50% of practicing naturopaths incor- intracellular fluids. It may also extend to the circula-
porate massage in their practice (Hale 2002).This per- tion of energy or vital force. In many healing traditions
centage is probably similar in New Zealand. In North massage and soft tissue manipulation were employed
America, naturopathy education programs include primarily to remove obstacles and promote the unim-
bodywork therapy, usually remedial massage and peded flow of life energy (e.g. Qi or Prana) via the sub-
manipulative techniques. Similarly, in the UK naturo- tle energy channels or meridians.
paths are trained in remedial massage techniques and Nutrients, oxygen, hormones, antibodies and other
employ them as an integral part of the naturopathic immunisers, and of course water, must be delivered
health care model. The inclusion of massage therapy as to every single cell continually if it is to survive and
part of the naturopathic therapeutic strategy for a cli- respond the way it should, and all kinds of toxic wastes
ent can play a major role in helping to develop rapport must be borne away. There is no tissue that cannot be
between the practitioner and the client, and thereby weakened and ultimately destroyed by chronic interrup-
enhance the healing potential of the client–practitioner tions of these various circulations (Juhan 1998).
relationship. The omission of massage from training Kaptchuk and Croucher in their book The Healing
courses in naturopathy has the potential to contribute Arts — A Journey Through the Faces of Medicine (1986)
to a trend towards ‘prescription-pad medicine’ (i.e. the make the following comment (p 38) concerning the omis-
prescribing of alternative drugs — herbs, nutritional sion of tactile therapy from the practice of medicine:
supplements and homoeopathic remedies — without Perhaps the greatest loss that medicine has suffered
the inclusion of other important holistic considerations over the course of the centuries is that of personal
such as lifestyle counselling, dietary modification or contact. Sophisticated doctors throughout the world
any form of tactile therapy). The danger this presents tend to avoid the healing power of the human hand.
is that the client is no longer the focus of attention. The The only form of contact that seems to have survived
client’s symptoms and signs, and the disease, become worldwide is the elevated art of surgery — perhaps
the focus for treatment rather than the individual. This is because it can be practised in the most detached and
something for which mainstream medical practitioners impersonal setting. Other types of physical contact
have been frequently criticised over the last 50 years. are dispersed into secondary, often disparaged catego-
In a world deprived of the benefits of touch, mas- ries, which are left to vie among themselves for some
sage can provide nurturing and comfort to many people badge of accomplishment: osteopathy, chiropractic,
(Johnson 1985; see also Chapter 4). When so many of the acupuncture, bonesetting and manipulation and mas-
health problems experienced today stem from the stress sage in its many forms.
and emotional confusion associated with 21st century
living, tactile therapy provides a means by which unex- Far from being able to exude a feeling of fellowship
pressed or suppressed emotions such as grief, sadness, and warmth, in many societies, doctors, especially
anger and frustration might be safely released. It is well men, have assumed the mantle of an unapproachable
known that emotions such as these are a common part priesthood. Worse, the profession condemns some,
of the experience of most physical illness (even hav- and discourages many, of the therapies of touch that
ing the effect of further compounding and complicat- have helped millions of people physically as well as
ing the disease picture). Therefore massage is clearly an psychologically. From the perspective of other cul-
important part of the naturopath’s treatment strategy as tures and other times such attitudes could politely be
copyright law.
a holistic practitioner. described as provincial.

Part of the process for delivering a massage or tac- Naturopaths must be careful that they do not make
tile therapy treatment requires provision of a suitable this same mistake and view massage as a form of
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s econd-rate manual labour, discarding it from their ther- 25% is attributed to the actual therapy employed (Miller
apeutic repertoire in favour of the glamour and appeal 1998). The positive experience of a massage treatment
of ‘prescription-pad medicine’. Without the inclusion when combined with a homoeopathic prescription can
of massage as a therapy, naturopathy would struggle only produce a therapeutic outcome with more impact
to address emotional, mental and spiritual aspects of for the client.
health and perhaps fail in its effort to provide true holis-
tic, integrative health care. Massage and osteopathy,
chiropractic and physiotherapy
Massage and acupuncture It is becoming increasingly commonplace for massage
The same can be said of acupuncture, or traditional Chi- therapists to work together with other manipulative
nese medicine (TCM), as has been stated for naturopa- therapists (i.e. osteopaths, chiropractors and physio-
thy. Without the inclusion of tactile therapy, acupuncture therapists) for the purpose of achieving optimum results
is a therapeutic modality, not a holistic system of health with musculoskeletal health problems. While there has
care. Thankfully, the practice of acupuncture involves been a significant movement away from high velocity–
making physical contact, but this contact may be brief, low amplitude (HVLA) thrusting adjustments (Chaitow
and may be administered with clinical efficiency rather 2001) resulting in a number of chiropractors, osteopaths
than in a way that is comforting and nurturing. Simi- and physiotherapists adopting much gentler manipula-
larly, the inclusion of an mo tui na (traditional Chinese tions of the soft tissues of the body, a large number of
massage) in the TCM system (of which acupuncture is these practitioners still focus predominantly on spinal
a part) focuses largely on achieving a therapeutic result, adjustments. Massage complements this type of work,
and the techniques employed are often strong, forceful especially when it is administered prior to a high-speed
and dynamic. While the Western approach to massage manipulative treatment, by relaxing the muscles and
therapy (e.g. Swedish style) was derived originally from nervous system, and improving circulation to the prob-
the Chinese an mo tui na, it is generally less forceful, lem areas. In achieving this, the client is effectively pre-
as pain is considered undesirable in the Western world. pared for the treatment that will follow.
The inclusion of a more gentle approach to mas- Often, as a result of tight or hypertonic muscles, it
sage in a TCM or acupuncture practice may offer many may be difficult for a manipulative therapist to achieve a
benefits to the Western client. This is certainly not sug- satisfactory result for a client without some preliminary
gesting that Chinese massage therapy is in any way less soft tissue work being performed. Furthermore, regu-
effective — simply that the Western mind/psyche may lar appropriate massage may be beneficial as ongoing
respond more readily to an approach that is perceived therapy, both to maintain the results of the manipulative
as gentler, more soothing, more comforting and more therapy and also to possibly reduce the need for exces-
relaxing. The impact of such an approach on the emo- sive follow-up treatment.
tional, mental and spiritual wellbeing of a client may be It is important for massage therapists to recognise
more successful than a more forceful one, and from this the scope of their knowledge and skills, to develop pro-
perspective is certainly worth considering as an adjunct fessional relationships with other health care providers,
to acupuncture and TCM. including chiropractors, osteopaths and physiothera-
pists, and to feel comfortable to refer their clients to
Massage and homoeopathy other therapists who may be able to better address the
A typical homoeopathic consultation involves extensive health needs of the client. As massage therapists and
case-taking on the part of the practitioner. The client practitioners of the other various manipulative therapies
undergoes a thorough interview process during which see the positive results of working together coopera-
many details concerning the individual’s health, symp- tively, either in their separate or in integrated practices,
toms and signs, personality and likes and dislikes are they feel more confident and comfortable with such an
determined so that the most appropriate homoeopathic arrangement and their clientele spreads word of their
remedy can be determined and prescribed according to satisfaction. Trust and effective communication are no
the indications. While the process is most extensive, and doubt key factors to a successful integrative practice,
calls upon the client to consider issues that are physical, and to working towards achieving what is best for the
emotional, mental and spiritual, the interview process client.
may be seen as very much a cerebral exercise.
The incorporation of massage as part of the treat- Massage and fitness therapy,
ment package for homoeopathy can certainly add personal training and sports
another dimension to the treatment experience. As pre- coaching
viously discussed, the benefits of tactile therapy in con- While the benefit of massage therapy to sporting perfor-
tributing to the client–practitioner relationship, and the mance is well established, its application to fitness ther-
contribution of that relationship to the healing process, apy and personal training is perhaps a little less obvious.
copyright law.
are quite significant. The contribution of the client– For decades coaches of all sports have called upon
practitioner relationship to the process of healing has the massage therapist to prepare their sportsmen and
been estimated to be at least 40%. Thirty-five per cent of women for optimum performance, to help them recover
the process of healing is attributed to ‘self-healing’ and from the trauma of the event and from physical injury.
Account: s8715057
Massage therapists now accompany most professional masseuses and also warned against the unsavoury nature
sporting teams and the number of massage therapists of massage as practised in some so-called massage
who provide their services at the Olympic games has establishments in London. Surgery’s significant rise in
increased significantly every 4 years. With the ever- status had a lot to do with the decline in use of massage
increasing commercialisation of sport and the associ- and manipulative therapy by physicians. Relegated to
ated pressure on sportsmen and women to succeed, the the lowly status of barbers during the Middle Ages, sur-
inclusion of the massage therapist as a crucial member geons were previously regarded as relatively unskilled
of the team is obviously essential. It seems certain that and their ‘art’ was seen as a last-resort approach.
the demand for well-trained, competent massage thera- ‘Surgery’ derives from the Greek word meaning
pists who specialise in sports massage will continue to ‘hand work’. Physicians were once seen as superior to
increase. surgeons in terms of their training, knowledge and skills,
Personal trainers and fitness therapists primarily and were therefore given the title of ‘Doctor’ (teacher)
focus on improving the level of fitness, strength and to reflect their elevated status. Surgeons, on the other
flexibility of their clients. Demand for the services of hand, were manual, hands-on practitioners who were
these professionals has increased markedly as a result also trained as barbers (barber–surgeons). They held
of the trend towards improved physical health and well- the title of ‘Mister’ which reflected their lower status.
being, and the desire to look and feel vital and youth- These titles are maintained today, although the status
ful. These professionals work as consultants, providing attached to each is a reversal of the previous.
advice and direction, and prescribing exercise regimens While the use of massage in hospitals continued at a
to achieve the desired result for the client. Some assist low level throughout the Western world during the early
in the prevention of, and recovery from, injury. It makes 20th century (mainly due to the efforts of nurses who
perfect sense then for these trainers/therapists to offer saw the benefits it offered to patients), its popularity
the services of massage therapy to their clients to aug- within the Western system of medicine dwindled as a
ment the training programs they recommend. Regular direct result of distrust and dissuasion of its use by doc-
massage may speed the process of recovery from rigor- tors (Martyr 2002).
ous training sessions and promote optimum musculosk- The development of the pharmaceutical industry
eletal function so that clients will get more out of their and the associated fascination with the potential of
exercise schedules. the ‘magic bullet’ (miracle drugs) was another factor.
It wasn’t until the 1960s when physiotherapy became
MASSAGE AND THE BIOMEDICAL a registered profession, that massage or manipulative
MODEL OF HEALTH CARE therapy regained any sort of approval from the orthodox
It seems strange when every other culture on the planet medical profession.
has included massage therapy in its traditional system The 1970s saw the recognition of massage’s value
of medicine that Western society chose in the past to as part of a holistic approach to health care. Its increase
abandon, and even discourage, the use of it for healing. in popularity outside of the orthodox health system
A brief look at the history of Western medicine seems to brought about greater general interest and enquiry. Early
indicate that the exclusion of massage therapy from that research explored its potential for enhancing health.
system had more to do with tradition than with reason. With more research, and greater awareness of its many
Dr Johann Mezger, the Dutch physician (see Chap- benefits, renewed interest in the inclusion of massage
ter 2), established massage as a credible part of main- in mainstream health care is occurring. Nursing homes
stream medical practice in the mid-19th century. Its use and some private hospitals have introduced massage
then spread throughout Europe with such famous physi- therapy as a form of complementary care. While there
cians as Lucas-Championnière and Charcot, in France, is still considerable resistance from some doctors and
promoting its use. Lucas-Championnière published the hospital administrators, support for massage therapy’s
textbook Massage and Mobilisation in the Treatment inclusion in the mainstream medical system is substan-
of Fractures for the use of fellow physicians (Lucas- tial. It seems certain that before long the doors will open
Championnière 1895). But by the late 1800s, doctors and tactile therapies, including massage, will be seen as
in Britain were already expressing an unwillingness another branch of orthodox medical care.
to administer such a manual procedure themselves, In the USA, therapeutic touch (a subtle energy
and were advocating the training of nurses (female) to approach to healing) is widely administered by nurses
deliver massage treatments, under their close supervi- to patients in hospital settings. Therapeutic touch,
sion, in the hospitals. developed by nurses for nurses, stemmed from the reali-
It seems that this led to an increase in the popularity sation that hospital patients were usually touch deprived
and demand for massage and women other than nurses and that their recovery could be significantly enhanced
undertook private training in the art of massage. See- through some form of tactile therapy. Nurses are ide-
ing such unsupervised practice as a threat to their own ally suited to delivering tactile therapy to patients in
livelihood and status as healers, British doctors issued hospital wards, as they are familiar with the patient’s
copyright law.
a warning, via The British Medical Journal (1894), health condition, his or her personal likes and dislikes,
against young women training in massage as a career. and have (in most cases) gained the patient’s trust and
The article stated (p 88) that there was no demand for acceptance.
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At a time when hospital budgets are severely effective and safe and that GPs were willing to recom-
restricted and nurses struggle to deliver even the basic mend massage for their patients (Cohen et al 2005).
services to patients due to time and staffing constraints, Similar studies in the UK and Canada also suggest
it seems unlikely that tactile therapy in any form (e.g. an increase in GPs’ acceptance and confidence in refer-
relaxation massage, reiki, touch for health, remedial ring patients for complementary therapies including
massage) will become commonplace in public hospi- massage (Marwick 2003).
tals. However, some hospitals have introduced massage With advances in scientific understanding, and as
services to patients, and experience suggests that the more is learnt about how the human organism functions,
outcomes (in terms of patient wellbeing and recovery) massage and manipulation therapy is once again emerg-
are positive. More research (in particular, clinical trials) ing as a legitimate and desirable (perhaps essential)
is needed to explore the potential benefits of massage health care modality. Its inclusion in the mainstream
or other tactile therapy in the hospital wards. It is only biomedical health care model is inevitable. How long
as a result of positive research findings that authorities this will take is perhaps the only uncertainty.
may be willing to examine the possibility of providing According to sociological surveys, Australians are
massage therapy (whether for relaxation or remedial no longer satisfied with the system of health care they
purposes) to hospital patients. have been offered to date (Siahpush 1998). To satisfy
The prospect of massage therapy being performed the demands of the Australian public it is clear that an
prior to and after surgery, as an adjunct to the process integrative model of health care is necessary.
of recovery, is an inspiring one. However, it is not an
original notion. In the fourteenth century the esteemed CONCLUSION
French physician Guy de Chauliac published a book on An integrative model is one that provides choice in the
surgical procedure, Inventorium sive collectorium in range of therapeutic options it can offer. It also pro-
parte chirurgiciali medicin. It became a standard text vides an approach that views the human being as a
throughout Europe for the next 200 years. The book unity of body, mind, emotions and spirit, and appreci-
described the administration of various methods of mas- ates the need for addressing each of these aspects as a
sage and manipulation to augment surgical procedures. means of promoting, restoring and maintaining opti-
mum health.
WHY PEOPLE USE MASSAGE Massage therapy has a vital role to play as part of
THERAPY an integrative model of health care. It complements the
In a 2002 national survey on Americans’ use of comple- benefits of other therapeutic modalities and, in itself, has
mentary and alternative medicine (CAM), respondents positive benefits for each of the four aspects of health
who used a CAM therapy could choose from five rea- (i.e. body, mind, emotions and spirit). These benefits
sons for using the therapy. The results for massage were have been established empirically due to the inclusion
as follows: of massage therapy in the majority of traditional sys-
1 They believed that massage combined with conven- tems of healing as practised by the indigenous people of
tional medicine would help: 60% the planet’s many cultures.
2 They thought massage would be interesting to try: An integrative system of medicine also requires that
44% the practitioners of the various therapies that comprise
3 They believed that conventional medical treatments it are broad-minded and tolerant of each other’s prin-
would not help: 34% ciples and philosophies. Furthermore, they must have
4 Massage was suggested by a conventional medical a general understanding and appreciation of how other
professional: 33% therapies work and what they are attempting to achieve.
Massage therapists therefore must be prepared to study
5 They thought that conventional medicine was too
the basic principles of other healing modalities — those
expensive: 13%
that comprise what is currently described as the Western
(Barnes et al 2004) biomedical or mainstream approach to medicine, as well
These survey results indicate that the majority of US as those that comprise the natural therapies approach.
consumers of massage therapy believe that the integra- This is in no way to suggest that massage therapists who
tion of conventional medical treatment with massage gain a broad understanding of other healing modalities
therapy is helpful. The results also indicate that a sig- or health care approaches should attempt to practice
nificant number of conventional medical practitioners them or to incorporate them in their clinic, without
suggested or recommended massage therapy to their gaining a full qualification in any of those modalities.
patients. Working outside of one’s scope of practice is risky and
In a 2004 New Zealand study, 74% (55) of gen- may result in negligent practice that causes harm to the
eral practitioners surveyed stated that they had recom- client.
mended patients to see a massage therapist in the past 12 A willingness to work cooperatively with thera-
months (Lawler & Cameron 2004). A 2005 Australian pists of other modalities, to refer when necessary, and
copyright law.
study, which surveyed general practitioners’ (GPs’) atti- to always place the interests of the client first — these
tudes toward complementary therapies, found that most are the other requirements of an integrative approach to
Australian GPs regarded massage therapy as highly healing.
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Questions and activities British Medical Journal 1894, p 88

1 Briefly describe your experiences of mainstream Chaitow L 2001 Muscle Energy Techniques. Churchill
health care and holistic health care, and identify Livingstone, London
Cohen M, Penman S, Pirotta M, Da Costa C 2005 The
if you have a personal preference for one over the
integration of complementary therapies in Australian
other in any situations.
general practice: results of a national survey. The
2 A client has recently read a newspaper article on the Journal of Alternative and Complementary Medicine,
emergence of integrative medicine and asks you to 11(6):995–1004
explain what it is. How would you respond? Dacher E 2001 The development of an integrated medical
3 You are seeking employment as a massage therapist model. In: M Micozzi S, (ed.) Fundamentals of
in a clinic. You approach four different clinicians Complementary and Alternative Medicine. Churchill
seeking work at their clinic: an acupuncturist; an Livingstone, Philadelphia
osteopath; a chiropractor; and a physiotherapist. Hale A 2002 Survey Data of the Australian Traditional
Describe what you would say to each therapist Medicine Society as Part of the Uniform National
about the way in which massage therapy may be Registration Systems Project for Suitably Qualified
integrated with his or her practice. Practitioners in Naturopathy, Herbal Medicine and
4 You are enjoying an academic debate with a Acupuncture. University of Sydney, Sydney
medical practitioner at a dinner party about the Johnson D 1985 Touch Starvation in America. Rayid
value of massage. The medical practitioner agrees Publications, Santa Barbara
Juhan D 1998 Job’s Body: A Handbook for Bodywork.
with you that massage therapy has a role to play
Station Hill Publishers, Barrytown, New York
in the country’s health care system, but is not sure
Kaptchuk T, Croucher M 1986 The Healing Arts — A
how it could occur. Prepare a response to this query, Journey Through the Faces of Medicine. British
describing what you believe to be important for the Broadcasting Corporation, London
re-inclusion of massage therapy into the Western Lawler SP, Cameron LD 2004 Massage therapy: attitudes
biomedical health care system. and use among General Practitioners and patients in
Auckland. New Zealand Family Physician, 31(4):229–38
Recommended reading Lindlahr H 1975 Philosophy of Natural Therapeutics
Grossinger R 1995 Planet Medicine: Modalities (6th edn). (edited and revised edition). Maidstone Osteopathic
North Atlantic Books, New York Clinic, Kent
Leskowitz E 2003 Complementary and Alternative Lucas-Championnière J 1895 Massage and Mobilisation
Medicine in Rehabilitation. Churchill Livingstone, in the Treatment of Fractures. Paris
New York Martyr P 2002 Paradise of Quacks, an Alternative History
Micozzi MS (ed.) 2001 Fundamentals of Complementary of Medicine in Australia. Macleay Press, Sydney
and Alternative Medicine. Churchill Livingstone, New Marwick C 2003 Acceptance of alternative therapies
York slowly growing in United Kingdom. Journal of the
Novey DW 2000 Clinician’s Complete Reference to National Cancer Institute, 95(20):1503–4
Complementary and Alternative Medicine. Mosby, Miller S 1998 Essential aspects of brief therapy. In: Brief
St Louis Therapy: Lasting Impressions. Conference, Milton H.
Peters D, Chaitow L, Harris G, Morrison S 2002 Erikson Foundation, New York
Integrating Complementary Therapies in Primary Siahpush M 1998 Postmodern values, dissatisfaction with
Care: A Practical Guide for Health Professionals. conventional medicine and popularity of alternative
Churchill Livingstone, London therapies. Journal of Sociology, 34(1):58–70
Robson T (ed.) 2004 An Introduction to Complementary World Health Organization (WHO) 1998 Traditional
Medicine. Allen & Unwin, Sydney Medicine. WHO Publications, Geneva, Switzerland
References
Allen RE 1995 The Australian Concise Oxford Dictionary
(8th edn). Oxford University Press, South Melbourne
Barnes PM, Powell-Griner E, McFann K, Nahin RL 2004
Complementary and alternative medicine use among
adults: United States CDC. Advance Report #343
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copyright law.
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the importance of touch

Sheena Worrall chapter 4
LEARNING OUTCOMES
l Explain why touch is important for human beings
l Identify how research supports the importance of touch
l Outline the ways in which people experience touch and how it affects their self-concept
and emotions
l Demonstrate an understanding of critical factors in effective touch therapy
l Develop an understanding of the mechanisms of healing energy transmission through touch
INTRODUCTION a marked decrease in their heart rate when nurses held

Most people love to touch and be touched. This is evi- their hands (Bredfeldt, Ripaini & Cuddeback 1987, in
dent in how often individuals touch one another, their Bowers 2000). Researchers from the universities of Vir-
children, their pets and themselves. Touch can com- ginia and Wisconsin-Madison found that nervous sys-
municate emotion and caring in ways that make words tem, emotional and behavioural responses of women
seem clumsy in comparison. The fact that so many under threat of electric shock were reduced when they
people are now actively seeking out touch in the form held the hand of their husband (Coan, Schaefer & Rich-
of massage therapy is a clear indication that this is an ardson 2006: 1032). A more limited but observable
important need that seeks to be fulfilled. In addition, the positive response was obtained when they held the hand
use of touch in therapy is increasingly being recognised of a stranger. Even patients in a deep coma from severe
by mainstream medicine as a powerful healing tool. brain injury have been shown to demonstrate significant
Touch plays an essential role in the social lives of changes in heart and respiratory rates when stimulated
many species. Ants and bees ‘continuously subject through touch (Gruner & Terhaag 2000: 585).
each other to sessions of intense palpation’, according The importance of touch to humans is evident in
to Christopher Smith of Aston University’s Vision Sci- the way people use touch and skin references in their
ences department (Smith 2000: 92). He states that the day-to-day language. When people talk about emotions,
use of touch is crucial in the lives some of the social such as joy, happiness, sadness, anger or depression,
mammals too, and that some monkey groups spend up they refer to them as ‘feelings’. A deeply felt experi-
to 20% of their time performing mutual grooming activ- ence is one that ‘touches’ us. When people want to be
ities. Although originally designed to rid the primates of close to other humans they get ‘in touch’ or ‘in contact’
ecto-parasites, these activities have evolved into social with them. People talk about ‘handling’ certain people
bonding activities. Smith states that this kind of tactile with care. Someone who is not communicating well
interaction has profound effects on the neuroendocrine might be said to be ‘out of touch’. If they are struggling
system, making it possible for animals that are natu- they are said to have ‘lost their grip’. A person with no
rally excitable and aggressive to live calmly in close compassion might be described as ‘unfeeling’.
proximity to one another (Smith 2000: 92). Like other Increasingly in this low-touch society, people are
primates, humans also seem to find touch an important turning to massage and other ‘hands-on’ therapies to
way to bond, communicate and enjoy positive experi- meet this need for comfort and physical nurturing, as
ences together. well as for healing. The profession of massage is a car-
copyright law.
An act of touch as simple as holding someone’s hand ing one. Massage therapy addresses the need for posi-
can have a major impact on their physiological and psy- tive sensory experience and comfort. Physical contact
chological state. Patients in a coronary care unit showed through positive touch may foster a powerful sense of
31
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32 Section 1 A Framework for massage practice
connection and caring. This sense of connection with afferent nerves activate the insular region of the brain,
the environment and other people may be an important and may well turn out to underlie emotional, hormonal
source of strength and comfort for humans. Massage and affiliated responses to gentle, caress-like skin-to-
therapy can help with this. Whilst this may be the case, skin contact between individuals (Olausson et al 2008:
it is important for the therapist to note that not all people 135–40). These discoveries could well help explain
respond to or interpret touch in the same way, and with why babies need touching and why most of us find mas-
the same feelings (Dossey et al 2000: 112). sage so soothing. The insula cortex has, in recent years,
Physiotherapy educator Gjertrud Roxendal claims been found to play a vital role in our subjective emo-
that massage is communication. She believes that the tional experience and ability to empathise with others.
therapist, in caring for the client, is sending messages Because of this, the impact of touch on its development
via the skin, especially the question: ‘How are you?’ and function needs to be carefully investigated.
The client receives the care and in turn answers via Skin has 20 other known functions ranging from
changes to breathing, muscle tension and skin reac- protection from trauma, foreign organisms and the ele-
tions. Roxendal also believes that massage confirms the ments, to regulation of body temperature and blood
receiver through the body. The fact that the therapist is pressure, regeneration of tissue, excretion of waste,
prepared to touch the client confers on them acceptance synthesis of vitamin D and other important compounds.
and validation as a person (Roxendal 1990). The pur- Awareness of these functions is important as it helps
pose of this chapter is to explore the notion of touch, therapists to appreciate how touching the skin (or not
and to discuss the benefits of touch as a form of therapy. touching it) can produce remarkable physiological
changes in humans and other species.
SKIN AND OUR TACTILE SENSE
Touch is the most extensive, important and yet neglected TOUCH AND HUMAN DEVELOPMENT
of our senses. People can survive without eyes, ears, or Dr Tiffany Field of the Touch Research Institute (TRI)
a sense of taste or smell, but without a sense of touch in the US, has conducted numerous studies concern-
they are in constant physical and psychological danger. ing the importance of touch to the healthy develop-
Touch stimulation is essential to people at all stages of ment of babies. Her studies have shown that premature
life and touch deprivation leads to reduced levels of the babies who received 15 minutes of massage, 3 times a
neuroendocrine substances necessary for health and day gained 47% more weight and were discharged an
wellbeing (Field 2000; Montagu 1986). average of 6 days earlier than babies who were only
The entire human body is covered with skin, which touched when they were fed or had their nappy changed
even turns inward and lines the gastrointestinal tract. (Hoffman et al 1998).
When in the womb, the skin is the first sensory organ As well as benefiting digestion, positive touch can
to develop in the foetus. Even at six weeks, when the also benefit the nervous system. Increased handling
human embryo is only about three centimetres long, of infants has been shown to increase oxygenation of
gentle stimulation of the new skin on the upper lip or growing brain cells (Weiss 1979, in Bowers 2000).
wings of the nose will cause the embryo to bend away A study on the effect of maternal contact on babies sug-
from the source of stimulation (Montagu 1986: 4). This gests that the rate at which brain cells degenerate and
occurs long before the embryo develops eyes and ears. die is doubled when infants are neglected, thus greatly
Through the skin people receive signals about touch, impeding their development. Curiously, the area of
pressure, pain and heat, from the environment and the the brain most affected by neglect is the hippocampal
people in it. This information is conveyed to the nervous region, the part of the brain where many of our emo-
system. As an extension of the brain and nervous sys- tions are evaluated (Staerker 1999). Further studies are
tem, skin is very rich in nerve endings. An adult male currently being undertaken to determine the effects of
has about 19 000 square centimetres of skin, which con- this nerve cell death (through neglect) on later adult
tains some 5 million sensory cells, each relaying impor- physical and social development. Because touch stimu-
tant information to the nervous system. About half a lates the nervous system it consequently enhances gen-
million of these nerve receptor cells send information eral wellbeing in body systems affected by the nervous
back to the spinal cord and brain via individual nerve system.
pathways, providing information about texture, shape, Studies undertaken by the TRI suggest that tactile-
tension, heat, vibration, and pressure. A staggering 30% kinaesthetic stimulation in the form of massage benefits
or more of these are located in the skin covering our newborn babies by contributing to (Field 2000):
hands. Fingertips have more than 160 nerve endings per l greater weight gain
square centimetre (Fritz et al 1999).
l increased motor activity
Recent research at Sahlgrenska University Hospi-
l improved alertness
tal, Sweden, indicates that humans may be hard-wired
l better organised sleep patterns
to enjoy a caress of the skin. Nerve fibres have been
found in human hairy skin that pick up only gentle l less fussiness and more positive emotional response
copyright law.
touches and convey them to one of the brain’s major l more mature motor performance on the Brazelton
emotional centres where they activate pleasurable scale

emotional and social responses. These unmyelinated l fewer postnatal complications
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4 The importance of touch 33
l reduction of stress behaviours and levels of stress to peers who never experienced these kinds of stress-
hormones ful and positive touch impoverished circumstances
l enhanced response to social stimulation (University of Wisconsin-Madison 2009).
l enhanced general wellbeing and reduced stress in
cocaine-exposed infants PSYCHOSOCIAL DEVELOPMENT
l reduced deterioration in HIV exposed infants. AND TOUCH
Findings of studies presented by Anthony Auger and The bond formed between parents and their child in the
colleagues at the University of Wisconsin to the Soci- early months of life forms the foundation for the child’s
ety of Neuroscience in November 2008 have shown that subsequent emotional and social development. A per-
chemical caps (known as methyl groups) are attached to son’s experiences in these early months of life help
the DNA of baby rats when their mothers lick their bel- shape not only their brain structures and other aspects of
lies for a few hours a day. This action has been found to their physical development, but also their beliefs about
affect the brain development of the baby rats, reducing life, love and self. If all their needs are met they grow
the number of oestrogen receptors in the hypothalamus up confident that they are lovable, that they will be able
region of the brain. Stating that ‘Sex may not be just to cope in life and that the world is a pleasurable place
genes and hormones’, Celia Moore at the University of to be.
Massachusetts suggests that further research is needed According to chiropractor Paul Staerker, touching
to discover whether a human mother’s behaviour has a or ‘stroking’ is the fundamental act of recognition for
similar effect on the brain development of a baby after the young child (Staerker 1999). Through it, humans
it is born (Powell 2009). learn the physical outline and shape of their body, and
Certainly touching can make a difference to the size whether they are loved and cared for. Capable, confi-
of a baby’s brain. Alice Honig PhD reports research that dent, mentally healthy adults develop from babies who
shows that babies who are rarely touched have brains have been given plenty of positive experience of touch.
that are 20% smaller than babies who are touched a Massage is a powerful and gentle way of providing this
lot (Honig 2005: 32). Touch also promotes the growth positive touch.
of the myelin sheath that insulates and protects nerve Endorphins are neuropeptides that tell the cell to
fibres, allowing them to function properly. Research ‘feel’ blissful. Oxytocin is a neuropeptide that not only
consistently shows that positive touch is vital for healthy tells uterine cells to contract in childbirth but also has
growth in infants. In the nineteenth century, more than a strong role to play in bonding and fostering positive
half of all infants in their first year of life died from maternal behaviour, promoting positive social interac-
a disease called Marasmus, a Greek word for ‘wasting tion and emotions, and cementing relationships in both
away’. Doctors later discovered that this wasting dis- males and females (Uvnäs-Moberg 1998: 819). Clinical
ease was caused by a lack of touch. Babies not touched trials where blood samples were taken before and after
on a regular basis would literally starve themselves to massage therapy have shown that serum levels of both
death (Wood 2009). endorphins and oxytocin increase after massage (Fritz
Babies that are deprived of touch show decreased 2000). This research sheds light on why massage not
growth hormone levels and some may develop what only gives people a natural ‘high’ but also makes them
is known as psychosocial dwarfism, or psychosocial feel emotionally warmer and more connected to those
short stature (PSS), a condition where children fail to around them. According to Fritz, massage also has a
grow properly and are found to be around one-third distinct effect on serum levels of other neuropeptides
shorter in height than most children their age. PSS is such as growth hormone, dopamine, serotonin, adren-
associated with emotional deprivation, a pathological alin and cortisol, depending on the type of technique
psychosocial environment, or both. A disturbed rela- applied and the duration.
tionship between the child and his or her caregiver is Because positive touch in the form of massage
usually noted. The pathophysiology of PSS is com- therapy has been shown to release ‘feel good’ and ‘feel
plex, involving some nutritional and endocrine factors; close’ neuropeptides, it is not hard to see that either an
however, the physiological deficits mostly involve psy- insufficient or negative experience of touch might lead
chological and environmental conditions, affecting the to abnormal emotional and social behaviours. Devel-
growth and development of the child. Linear growth is opmental neuropsychologist James Prescott believes
obviously delayed, with growth arrest lines observed that violence has its roots in deprivation of pleasurable
in long bones, and some temporary widening of the touch during childhood. In the 1960s Prescott and his
sutures of the cranium. Cognitive and other psychologi- associates discovered that lack of affectionate, intimate
cal function impairments, sleep disturbances, and an contact and bonding between mothers and their babies
inability to feel pain in a normal way are some of the during the most sensitive periods of brain development
other signs and symptoms these children present with could result in permanent brain abnormalities, particu-
(Sirotnak 2008). larly in the pleasure systems of the brain. These abnor-
Most recent studies on the immune systems of chil- malities were found to be associated with juvenile and
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dren have found that adolescents who, as youngsters, adult patterns of aggression and violence, depression,
experienced either physical abuse or time in an orphan- substance abuse and eating disorders (Mendizza 2003).
age, suffer impaired immune function, when compared Cultural anthropologists support this view too. A 1975
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study of 49 tribal cultures revealed that societies which levels of cortisol, resulting from neglect, and in particu-
give their babies the greatest amount of physical affec- lar a lack of touch, have also been linked to impaired
tion have the lowest levels of theft, killing, torture and development and psychological disturbance in infants.
mutilation (Prescott 1975). In her studies of institutionalised children in Romania,
This earlier research into the importance of touch is neuroscientist Mary Carlson (a former student of touch
further supported by the work of University of Wiscon- researcher Harry Harlow) found abnormally high stress
sin researchers Harry and Margaret Harlow. The Har- levels in these children on an ongoing basis, with associ-
lows found that female baby rhesus monkeys who were ated developmental retardation and autistic behaviours.
separated from their mothers at birth were neglectful Carlson claims that the lack of touching and attention
and, in many cases, violently abusive towards their own the children received, due to seriously inadequate insti-
young (Harlow & Harlow 1969). Drs Steel and Pollock tutional care, had both stunted the children’s growth
of the University of Colorado found that human par- and adversely affected their behaviour (Cromie 1998;
ents who abused their children also had frequently been Carlson 1997).
deprived of physical affection as children themselves Researchers at the Douglas Mental Health Univer-
(Montagu 1986). sity Institute in Montreal have found that suicide victims
More recent studies conducted by researchers at with a history of early childhood neglect or abuse have
Harvard University medical school’s McLean Hospital clear genetic changes to their brains, when compared to
clearly demonstrate that childhood neglect and maltreat- those who died from other causes and were not abused
ment may produce permanent changes in both the struc- or neglected. This research offers insights into how
ture and function of the brain. The McLean research neglect and abuse can perpetuate unhealthy behaviour
team found that neglect and trauma led to a number through the generations (McGowan et al 2008: e2085).
of changes in the brain — brainwave abnormalities, The genetic changes involved a chemical process called
arrested development of the left hemisphere, a reduc- methylation, which is involved in turning genes on and
tion in the size of the corpus callosum and increased off, and which some researchers believe may account
cerebellar vermis activity (which can result in dramatic for genetic memory.
mood and personality swings) (McLean Hospital 2000). In his preface to Touching: The Human Significance
Graham (2004) points out that a crucial contributing of the Skin, Ashley Montagu observed that humans have
factor to significant and persistent antisocial behaviour become a race of ‘untouchables’, avoiding all forms of
in childhood and the teen years is the development of ‘unnecessary’ physical contact, and becoming increas-
some degree of brain dysfunction. He states that from ingly lonely and afraid of intimacy (Montagu 1986).
at least the age of three, many troubled children have an A number of factors have contributed to this, including
unusual number of abnormalities of their nervous sys- ‘no touch’ policies in schools, institutional care settings
tem, such as clumsiness, squints, unequal reflexes, jerky and the workplace. Technological advances are also
eye movements, language delay and personality diffi- playing their part in contributing to low levels of touch
culties. More male children than female children exhibit in society as people increasingly interact with machines
these neurological abnormalities. Graham (2004) also rather than other people. Because people have trouble
states that although some of these children’s problems touching one another, literally and figuratively, they
undoubtedly have a genetic basis, it is also quite pos- have come to rely heavily on verbal and written com-
sible that some degree of brain dysfunction comes about munication and their non-verbal communication has
because of the way each child is raised, pointing to the suffered. This is causing a consequent impoverishment
fact that mothers tend to talk to and handle male babies of experience and feeling.
less than female ones, encouraging them to be more
physically active. TOUCH FOR PSYCHOLOGICAL
Under the direction of developmental biopsychia- DISORDERS
trist Martin Teicher, researchers at McLean Hospital The positive impact of healing methods of touch on
have also examined animal studies that showed that psychological conditions is gaining increasing atten-
neglect and trauma increased production of cortisol and tion from psychiatrists, psychologists and counsellors.
decreased production of thyroid hormone. According Although this field is relatively new, benefits of safe,
to Teicher, this effect on hormones and neurotransmit- caring touch therapy are being identified for clients suf-
ters resulted in brain remoulding so that the individual’s fering the effects of depression, anxiety, anorexia, post-
nervous system was ‘wired’ to respond with fear, anxi- traumatic stress disorder, physical and sexual abuse,
ety and stress. He proposes that this finding is likely to and a number of other conditions.
be true of people too (McLean Hospital 2000). Studies produced at the TRI have shown that mas-
These, and other recent discoveries in developmen- sage therapy is beneficial in a variety of psychological
tal neuroscience, clearly support Prescott’s findings; disorders and University of California researchers sug-
that is, insufficient early positive touch may result in gest that patients with schizophrenia, social anxiety and
the kinds of brain abnormalities that are associated a variety of other disorders may benefit from treatment
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with juvenile and adult impulse control problems, with the so-called ‘love hormone’ oxytocin, the brain
depression, substance abuse, aggression and violence neuropeptide released with touches and hugs (Univer-
(Prescott 1975; Prescott 1997; Mendizza nd). High sity of California 2009). Serotonin is one of the brain
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chemical transmitter substances that is implicated in need in order to operate in the physical, psychological,
feelings of happiness and satisfaction, and this neuro- spiritual and social worlds (Libster 2001). Much of a
chemical has been found to be significantly reduced person’s self-concept and self-consciousness is deter-
under conditions of failed mother–infant affectionate mined by sensations felt in the body. In infancy there
bonding, with dire behavioural consequences (Prescott is no sense of separation between the self and the sur-
1997). Future research is likely to vindicate massage rounding world. A baby’s ability to differentiate himself
as a way of naturally raising levels of this crucial sub- or herself from the surrounding environment or another
stance in the body. person develops largely as a result of acting with, and
TRI studies lend strong support to the use of touch feeling sensation in, his or her body. Therefore, the
therapies to decrease depression and anxiety, and lower sense of self initially relies on the information systems
stress hormone levels in the body. Electroencephalo- provided by both the skin and the proprioceptors, which
graph (EEG) activity following massage in depressed tell people what their body feels like from the inside.
adolescent mothers revealed that the shifts into more In explaining how people create their own body
positive mood states following massage were accom- image, psychologists Bermudez, Marcel and Eilan
panied by shifts from activation of the right–front sec- (1995) indicate that the sense of touch or inner feeling
tions of the brain (normally associated with feeling sad leads to:
emotionally) to activation of the left–front sections of l one’s conscious experience of the body at a particular
the brain (normally associated with happy feelings). time
A 20 minute massage served to shift the brain activation l a changing non-conscious record of the momentary
(as revealed by the EEG) into a more symmetrical (and relative disposition of, and space occupied by, one’s
therefore balanced) pattern, thereby reducing feelings body parts
of depression (Jones et al 1997). A systematic review of l emotional attitudes towards one’s body, some of
randomised controlled trials of paediatric massage has which are tacit and socially determined.
revealed that a single treatment can cause a significant It seems that people define themselves, to a large
reduction to anxiety in infants and children (Beider & extent, by the sensations experienced in their bod-
Moyer 2006: 23). ies or their memory of them. So if their experience of
Autism is a condition that appears to respond well being in a body is pleasurable and positive then it is to
to massage touch therapy. Autistic children and adults be expected that they will feel good about themselves.
are generally described as disliking physical touch and This perhaps may help them to understand why mas-
being extremely sensitive to touch stimulus. However sage might be of benefit in assisting to normalise the
the TRI has found that autistic preschool children show self-concept of a person with an eating disorder such as
little aversion to being massaged. Field suggests that bulimia or anorexia.
this may be because massage is predictable, unlike The physical senses, including touch, generally
some social forms of stimulation. The TRI studies show become less sensitive during later adulthood, lead-
that the children who receive massage decrease their ing to a range of psychological consequences for how
off-task behaviour in the classroom and increasingly the elderly interact with other people. Baltes and Lin-
interact socially with teachers (Hoffman et al 1998). denberger found a strong connection between sensory
Similar results have been observed in TRI studies functioning and intelligence in old age (Baltes & Lin-
with children exhibiting attention deficit hyperactivity denberger, in Hewstone, Fincham & Foster 2005: 216).
disorder (ADHD). The onset and impact of biological decline varies from
Some TRI studies have focused on the treatment of one person to another, yet it is probable that our ability
anorexia and bulimia, two eating disorders considered to obtain information through our sense of touch could
to be psychological in origin. After 5 weeks of twice- be extended well into our later years with regular touch
weekly massage therapy treatments administered for or massage, just as strength and fitness have been found
30 minutes at a time, anorexia sufferers reported less to decline less in people who exercise regularly. The old
body dissatisfaction on the Eating Disorder Inventory. ‘use it or lose it’ principle seems likely to apply here too.
Urine analysis revealed higher levels of dopamine and Massage therapists and other bodywork specialists
lower levels of stress hormones, and this corresponded have long claimed that the body can resolve emotional
with reports of lower anxiety and improved mood in traumas and shocks if it is assisted, through touch thera-
the massaged women (Field 2000). The TRI studies of pies, to release its patterns of chronic tension and blocked
bulimia produced similar results and the eating hab- emotional energy. Such eminent psychotherapists and
its of massaged bulimic adolescents improved, along bodyworkers as Wilhelm Reich, Ida Rolf and Gerda
with their self-concept. Kirsty Davison, physiothera- Boyensen have developed a number of massage systems.
pist at the Mental Health Unit in Coney Hill Hospital, Their methods appear to release repressed emotions and
Gloucester, uses massage in the treatment of patients related patterns of muscle tension as well. Body tension
with anorexia. She claims that it can be used to encour- may also develop as a defence against undesirable touch
age the patient with a distorted body image to feel ‘in and this may result in ‘body armour’, as Reich termed it
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touch’ with themself (Trevelyan & Booth 1994). (Kellerman 1985). Massage can help to release the long-
Finding and creating a sense of self is an important held patterns of physical tension that arise from repressed
part of developing a sense of identity, which people emotion and painful or undesirable touch.
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Traumatic experiences of the ‘wrong’ kind of touch more intimate, acceptance of the touch declined. Men
(such as abuse or torture) can be healed in a particularly and women were found to be more accepting of com-
powerful way by the sensitive and careful application of forting touch from female practitioners, and acceptance
the ‘right’ kind of touch. According to Ford (1989: 12), of all comforting touch declined markedly when the
a chiropractor who specialises in healing emotional doctor was unfamiliar to the patient, regardless of that
trauma through touch: practitioner’s gender.
touch also creates a powerful therapeutic alliance, so Different types of touch are identified by different
vital to the healing process. Reaching out to touch receptors on the client’s skin which relay this informa-
someone is a lasting symbol of what it means to be tion to the nervous system. The client will unconsciously
human, and a universal sign of healing. be registering the therapist’s touch and evaluating it.
The amount of pressure applied in light touch is sensed
However, experiences of the ‘wrong’ kind of touch
by different receptors to those that detect deep pressure
frequently lead to touch aversion, thereby making it dif-
and each evokes a different emotional response. Touch
ficult for a therapist to make physical contact in the first
can be pleasurable, uncomfortable or even painful. If it
place. In these cases the client must be approached with
is pleasurable people usually seek to prolong the expe-
particular care. Informed consent must be emphasised
rience. We touch more frequently and intimately when
and ‘safe’ areas of the body for touching must be estab-
in love according to Guerrero (1997). If touch causes
lished in consultation with the client. The client must
physical or psychological discomfort, distress or pain,
have a strong sense of being able to control what hap-
people will withdraw from it as quickly as they can.
pens and feel he or she can stop it at any time. By giving
Slow, light touch is often interpreted as communi-
the client control of the proceedings, a sense of safety
cating compassion or intimacy. Slow, deep touch evokes
and confidence in the therapist develops. For example,
feelings of confidence, and as such is usually associated
in the first session the client’s hands or feet may be the
with safety and relaxation (Fritz et al 1999). A study of
only parts of the body touched. Later the lower leg or
the effects of touch on seriously ill patients revealed that
arm might be included, when the client feels ready.
touch is useful for establishing rapport within a short
Progressively more and more areas of the body may
period of time, and that gentle pressure on the hands of
be touched, at first with clothing on and later, possibly,
dying patients in moments of silence was reported as
without. Great care must be taken to be sensitive to the
being the most meaningful nurse–patient communica-
client’s experience and anxiety levels.
tion for these patients (McCorkle 1974, in Bowers 2000).
A lot of the psychological benefits of massage
Communication through touch is known as ‘hap-
therapy seem to relate to the establishment of a close
tics’. Touch is perhaps the first of our senses to develop
and trusting relationship between client and therapist.
and be used as babies in the womb can be stimulated
Positive touch engenders a sense of confidence in the
by touch. According to Jones and Yarbrough, touch may
therapist (De Domenico & Wood 1997) and demon-
communicate five major meanings:
strates caring and concern. Massage can evoke feelings
l Positive emotions — touch can be used to express
of acceptance and respect for the body and psyche of
the person being touched (McCabe 2001). It is therefore support, appreciation, inclusion, sexual interest
easy to understand how people with an altered body or intent, affection, composure, immediacy, trust,
image, lowered self-esteem or those who are dependent, similarity, quality, informality, and to facilitate self-
anxious or dying would benefit from positive messages disclosure
l Playfulness — touch can be affectionate or aggres-
coming in the form of touch. Elderly clients experienc-
ing physical and social isolation and sensory impair- sive, and used to de-emphasise the emotion and to
ments are one group which appears to benefit greatly tell the other person that it’s not to be taken seriously
from the caring effect of massage (Vortherms 1991). l Control — touch can be used to control the behav-
iours, attitudes, or even the feelings of the other per-
son, and to convey status and dominance
TOUCH AS COMMUNICATION
l Ritualistic — this is touch that focuses on greetings
As the practice of massage therapy is all about touch- and departures, such as shaking hands, hugging,
ing another person, it is vital that therapists consider not kissing or putting an arm around another person
only the physical/mechanical impact they are having l Task-related — touch here is associated with the
on their clients, but also the mental/emotional effects. performance of a function, like helping someone
Acceptance of a therapist’s touch by clients is a crucial out of a car, or doing a job that involves touching
factor in the success of a tactile therapist. Although lit- others.
tle research has been undertaken regarding acceptance
of touch by massage therapists, some data is available (Jones & Yarbrough 1985, in De Vito 2007: 171–3)
concerning comforting touch in medical practice. One A receiver’s perception of the intentions of the per-
study, conducted in Canada, found that most patients son doing the touching largely determines whether the
believed that touch could be comforting (66.3%) and touch is received in a positive, neutral or negative man-
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healing (57.9%) (Osmun et al 2000: 2411–16). Women ner. Obviously touch that is perceived to be caring will
were found to be more accepting of comforting touch be received differently to touch perceived to be aggres-
than men in all scenarios, however as touch became sive, angry, or even indifferent.
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Task-related touch seems generally to be positively countries that have been identified as non-contact cul-
regarded. We can see this in the results of studies on tures. Contact cultures include those of southern Europe
this subject. Book-borrowers were found to have a more and the Middle East. In these societies members of the
positive attitude towards the library and the librarian culture maintain close distances, touch one another in
when touched lightly, and waitresses who touched din- conversation, face each other more directly, and make
ers on the shoulder or hand when being given change focused eye contact for longer. Non-contact culture
were more likely to be tipped than those who did not members touch each other rarely, if at all, avoid facing
(Marsh 1988, Crusco & Wetzel 1984, and Stephen & each other directly, maintain greater distance, and main-
Zweigenhaft 1986 in De Vito 2007). tain little direct eye contact. Depending on your culture
Although most humans have a strong need for of origin, you may well be perceived by others as either
pleasurable touch, not all humans respond well to pushy, aggressive and inappropriately intimate, or cold,
touch stimuli. Childhood disorder researchers have distant and uninvolved.
been trying to understand why approximately 5% of In some cultures, task-related touching may be
children over-respond to sensory information, exhib- viewed negatively and should be avoided. For exam-
iting unpleasant and sometimes painful reactions to ple, among Koreans it is considered disrespectful and
normally pleasant or neutral kinds of touching. Chil- overly intimate for a store owner to touch a customer
dren with this kind of sensory sensitivity often exhibit when handing back change (De Vito 2007: 187). As
behavioural or emotional problems. Researchers from they grow older, Muslim children are taught that they
the University of Wisconsin-Madison have found that must not touch members of the opposite sex outside the
moderate exposure to alcohol and stress during preg- family, and therapists will often find Muslim patients
nancy can lead to touch sensitivity in rhesus monkey expecting a same-sex therapist to treat them. For all the
babies. Positron emission tomography, or PET, scans of reasons cited, finding appropriate ways to demonstrate
the brain show that the monkeys’ sensitivities to touch caring touch and to perform therapeutic touch with
were related to changes in dopamine levels in an area of each client can be a unique challenge for the health care
the brain called the striatum (Schneider et al 2008). If professional.
you are working with a child with sensory-integration
difficulties when it comes to touch, you may be strok- ENSURING A POSITIVE EXPERIENCE
ing too softly. Some babies respond better to firm pats OF TOUCH FOR CLIENTS
and strokes, if a light, feathery touch seems to be irritat- Massage therapists need to understand that any touch,
ing them (Honig 2005: 34). or even the breaking of skin contact with the client, will
People who fear oral communication have been trigger the release of neurochemicals, such as oxytocin,
found to score highly on touch avoidance tests. Touch serotonin and cortisol, that control various functions in
avoidance levels are also high among those who self- the different systems of the body via the nervous system.
disclose very little, or who do not wish to get close to The way in which a therapist touches their clients has a
others (Anderson & Liebowitz 1978, in De Vito 2007: great power to influence how the client feels on virtually
173). As people age, decreasing levels of touching may all levels and this means therapists must always touch
lead to an avoidance of touch. Males generally score with the greatest of integrity and care.
higher than females on same-sex touch avoidance tests, Therapists have to take great care that their clients’
while females have higher touch avoidance scores for first experience of therapeutic touch is positive in every
opposite-sex touching than men. way. The best time for the therapist to prepare himself
or herself and the client for this first physical contact
CULTURAL DIFFERENCE AND TOUCH is well before the event. Careful planning and prepa-
Culture is another strongly influential factor governing ration will have an enormous positive influence on the
the response of individuals to touch received from oth- outcome of the first contact. Even before clients arrive
ers, and it should be kept in mind that the findings of for their appointment, they will feel much more confi-
many Western studies on touch may not be transferable dent and safe if they think the therapist has their best
to members of other cultural groups. Some cultures are interests at heart and will treat them with courtesy,
‘high touch’ and some are not, or have strict rules about respect and gentleness. Because of this, all care should
who can touch whom. In examining touch incidence be taken, even during phone conversations, to convey an
in different countries, one researcher observed 180 image of caring and respect for each client.
touches on average occurring between pairs of acquain- Simple strategies such as shaking hands with the
tances spending an hour together in Puerto Rico, 110 in client at the first meeting, or a light touch on the hand
France, less than 2 in Florida, and none at all in England or forearm to make contact in a safe way, will invoke
(Burton & Dimbleby 2006). confidence if combined with good eye contact and a
In one study on touch, in which college students in friendly demeanour. If the therapist is unsure how soon
Japan and the US were surveyed, American students they can initiate contact with their client, they should
reported being touched twice as much as their Japa- try to establish what physical distance is comfortable
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nese counterparts (Barnlund 1975, in De Vito 2007: for the client when they meet for the first time or are
188). Strong taboos exist against strangers touching in taking a case history. People will naturally position
Japanese society, as they do in some northern European themselves at a comfortable distance from others while
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they establish how safe they are. This individual per- and touched. Touch must be used for psychological or
sonal distance is often an arm’s length, but this distance therapeutic purposes alone, and must not ever be used
may be greater or smaller depending on that person’s to satisfy the emotional, social, or sexual needs of the
family background, cultural background, life experi- therapist.
ence and other factors.
When the client’s case history is taken, questions TOUCH AS ENERGY HEALING
should be asked that will clearly indicate what experi- In nearly every culture and medical tradition on earth
ence of massage the client has had, and what did and did there is some form of hands-on healing that involves
not feel comfortable for the client on these occasions. sending energy into the body, balancing existing ener-
At this time clear consent must be obtained from the gies, or drawing excessive or undesirable energies out of
client for the therapist to uncover any areas of skin and the body. Anecdotal reports indicate that many massage
touch the client’s body, either directly on the skin or therapists experience sensations of energy movement
through clothing. when they massage clients. Some even report being able
Because some individuals will involuntarily inter- to feel energies in and around the body when they pass
pret any touch as threatening, regardless of their inten- their hands over the body without actually touching it.
tion to receive massage, it is important for the therapist Those who practice these methods claim that there is
to be on the lookout for warning signs in the form of more to who and what people are than just a physical
adverse body language. If a client shrinks from touch, body. They believe that there are subtle bodies of finer,
the therapist should advise the person that they noticed higher vibrational matter which interpenetrate an indi-
them moving away when touched and ask why. The vidual’s physical body. These subtle energy aspects of
therapist should never suppose that they know the rea- humans are believed to relate to their emotions, mental
son for any reaction from the client. It may simply be functioning and spiritual experience (Gerber 1996).
that the therapist’s hands are cold, that there is pain Often associated with religious and spiritual tradi-
in the area, or that the client didn’t hear the therapist tions, hands-on healing has been described in the Bible
come into the room, or was falling asleep and was sur- and other religious texts, and there are many references
prised by the therapist’s touch. It is worth noting that to hands-on healing by religious and political figures.
University of Colorado Assistant Professor Lawrence Druids were said to breathe on parts of the body and
Williams has found that people trust others more when touch certain areas, in conjunction with rituals and
they experience physical warmth (University of Colo- prayer. Saint Patrick is claimed to have helped to heal
rado at Boulder 2008). Cold patients are likely to judge the blind, and Saint Bernard to have healed the deaf and
the therapist as less caring and warm, so clients should lame with touch. Saints Margaret, Katherine, Elizabeth,
be warm and well covered when massage or other touch and Hildegarde also had a number of miraculous heal-
therapies are being administered. ings of this kind attributed to them. Roman Emperors
The subjects of much discussion in Chapters 5 and 6, Vespasian and Hadrian, and King Olaf of Norway, were
the ethical aspects of therapist touch and the establish- said to be practitioners of a hands-on healing tradition
ment of boundaries with patients, are essential reading that came to be known as ‘the King’s Touch’ (Eliopou-
for the therapist in training and a firm commitment to los 2004: 235; Novelguide.com 2001).
the highest standards of ethical practice must be made if The ‘laying on of hands’ healing method, practised
massage, remedial therapy and more advanced forms of by Jesus and continued by the early Christian church,
tactile therapy, such as musculoskeletal therapy, are to has its modern-day adherents in some churches and
be highly regarded in our society. In the helping profes- cathedrals. Other versions of these methods may be
sions the potential for therapist touch to become abusive found in practices such as reiki, polarity therapy, qi
is a serious issue, with Spinelli claiming that between gong therapy and some aspects of applied kinesiology.
5% and 11% of all therapists engage in sexual contact Therapeutic touch and healing touch are two systems
with their clients (Spinelli 1994, in Woolfe, Dryden & employing energy healing principles and methods,
Strawbridge 2003). In 80% of these cases the perpetra- which are taught in many nursing schools and hospi-
tor was a male therapist and in 80% of cases the sexual tals (Quinn 1984; Kreiger 1975; Quinn & Strelkauskas
relationship was engaged in beyond a single instance. 1993). University of Cincinnati researchers have under-
To prevent these problems, therapists must comply taken a study on the effects of healing touch, to see if it
with all laws pertaining to the physical and psycho- can offer a cost-effective way of reducing the need for
logical health of those in their workplace (clients, staff sedatives and improving care at the university’s teach-
members and others). In addition, they must comply ing hospital (University of Cincinnati 2008). Results
with all codes of conduct established by their profes- seem promising.
sional association, and the ethical principles that apply Over the last 400 years a bitter controversy about
to all health workers and business owners more gener- subtle energies has raged between vitalists and mecha-
ally, particularly with regard to physical touch. Clear nists. Vitalists believe that there is some kind of mys-
contracting with clients and obtaining informed consent terious and invisible life-force energy in all things.
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are essential, so that they understand and agree to the Mechanists maintain that a phenomenon cannot be real
body contact interventions to be used, knowing how unless it complies with basic laws of physics and chem-
they will be draped and what areas will be uncovered istry and is measurable with current technologies.
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With recent discoveries of the electrical and mag- For the benefits of touch therapy to be enjoyed by
netic energy fields that surround the body, scientific clients, therapists must remain mindful and respectful
exploration of bioenergy fields has become an impor- of individual differences. This means handling clients
tant and expanding branch of biomedical research with sensitivity and complying with informed consent
(Gerber 1996). Biomedical researchers are increas- procedures (see Chapter 5). When this is done, a high
ingly investigating practitioners of traditional energy degree of trust and confidence in the therapist will
therapies. Dr John Zimmerman of the University of develop and maximum benefits will be achieved. To be
Colorado School of Medicine, for example, has found sure that therapists are part of the solution and not the
that some healing energy therapists emanate exception- problem, they must look deep into their own psyches to
ally strong, large biomagnetic energy fields from their understand their own experiences and attitudes concern-
hands, especially when relaxed and in a meditative ing touch. By healing themselves and getting their own
frame of mind. In a recent study conducted by Zimmer- touch needs met, therapists can be far more effective and
man it was recorded that therapeutic touch practitioners sensitive in caring for others and helping them to heal.
emitted a signal, which ranged from 0.3 Hz to 30 Hz,
with most of the activity in the range of 7–8 Hz. The Questions and activities
signal appears to ‘sweep’ or ‘scan’ through a range of 1 You have recently opened a clinic and have been
frequencies (Oschman 2000). In Zimmerman’s studies, fortunate enough to secure an interview on the
non-practitioners were unable to produce these pulses. local community radio station. The presenter of the
Further information on this research can be found in program recalls that as a small child they loved to
James Oschman’s book, Energy Medicine: The Sci- have their scalp massaged by their parent when they
entific Basis (2000) and Richard Gerber’s Vibrational were having difficulty getting to sleep or when they
Medicine (1996). were sick. Detail how you would respond to this
recollection, and convey to listeners the importance
CONCLUSION of touch to humans, and the significance of touch to
It is clear that from the moment of birth people need the development of infants.
positive experiences of touch if they are to develop and 2 It has been claimed that massage can positively affect
maintain high levels of health and wellbeing throughout emotional states and people’s self-perceptions.
their lives. As the body, thoughts and emotions are inti- Describe the types of clients who may present for
mately interconnected, the pleasurable tactile stimulus massage and benefit from such effects.
of massage therapy can enhance self-esteem and reduce 3 For a professional massage therapist it is paramount
feelings of anxiety, depression and social isolation. For that the intent of their touch is appropriately
a person to feel lonely, pessimistic, agitated or violent conveyed to the client. How would you ensure that
when their body is awash with pleasurable sensations is this is true of your touch in clinical practice?
difficult indeed. 4 A client makes comment one day that they feel you
Therefore it is not unreasonable to expect that not have a healing touch. For a massage therapist, what
only individuals can be healed of a variety of physical is the impact of healing energy on touch therapy?
and psychological maladies with massage therapy, but
that perhaps society as a whole may benefit. It is likely, Recommended reading
given the profound importance of touch to emotional
experience and behaviour, that therapists may begin to Field T 2000 Touch Therapy. Churchill Livingstone,
solve some of the huge social problems besetting the London
Montagu A 1986 Touching: The Human Significance of the
world at present if we could disseminate this informa-
Skin (3rd edn). HarperCollins, New York
tion more widely (Prescott 1975; Harlow & Harlow Nathan B 1999 Touch and Emotion in Manual Therapy.
1969; McLean Hospital 2000; Carlson 1997). Each Churchill Livingstone, London
individual has a part to play in creating a better world, Oschman JL 2000 Energy Medicine: The Scientific Basis.
and massage therapists can do much to educate their Churchill Livingstone, London
community about the importance of touch in shaping Sayre-Adams J, Wright SG 2001 Therapeutic Touch: Theory
healthy, happy individuals. and Practice (2nd edn). Churchill Livingstone, London
Whilst the studies discussed in this and other chapters
clearly indicate a broad range of positive touch benefits, References
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copyright law.
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copyright law.
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SECTION 2
5
scope of practice, ethics and law
in massage therapy practice
Janine Tobin chapter
LEARNING OUTCOMES
l Define the massage therapist’s scope of practice
l Describe the massage therapist’s limits of practice
l Know when it is appropriate to refer a client to another health care professional
l Explain why ethics are important to massage practice
l Discuss the principles of autonomy, beneficence, non-maleficence and justice
l Explain the four main principles of a negligence action
l Explain the elements of informed consent
l Decide if a client can provide informed consent for a massage
INTRODUCTION Scope of practice defines the type of professional

Over the years the role of the massage therapist has con- service that the law and professional regulations enti-
tinuously evolved. As described in Chapters 2 and 3, tle a massage therapist to provide in their professional
massage once formed a critical part of the mainstream capacity. The scope of practice is limited by legislation
medical and nursing professions, and was also the basis that regulates other health professions and in doing so
of the practice of physiotherapy. Massage therapy is limits the procedures a massage therapist may perform.
incorporated today in many practices including natu- The level of education attained by a massage therapist
ropathy and osteopathy. This in itself raises the question also defines their scope of practice. This chapter will
as to what role massage therapy plays in today’s health identify the scope of practice of a massage therapist,
care system and who determines this role. including the relationships between massage therapists
The qualified massage therapist who is a member and other health care professionals. It will also explore
of a professional massage association largely drives the limits of practice and discuss the right time to refer
the modern day practice of massage. Such practitio- clients to other health care professionals.
ners should have knowledge and understanding of their Ethics relate to determining what in a moral sense is
scope of practice as well as the ethics and the law that professionally right and wrong and how people should
informs the legal aspects of a clinical practice. This act in a particular circumstance (van Hooft et al 1997).
chapter examines the scope of practice for massage Ethics encompass the application of moral principles in
therapists and discusses registration of therapists, limits guiding professional relationships between the massage
of practice for a massage therapist and the referral of therapist, the client, the client’s family, other health pro-
clients to other members of the health care team. Also fessionals and the general public (Anderson et al 1998).
discussed are the ethical principles that guide a thera- This chapter will introduce the fundamental ethical
pist throughout their professional life. In addition, the principles of autonomy, beneficence, non-maleficence
importance of common law, torts and negligence are and justice. When applied correctly these principles can
described for massage therapists. The importance of help guide the therapist in resolving ethical dilemmas
consent before any massage therapy commences is also that arise in professional practice.
discussed. Once understood, such topics provide the Having a working knowledge of the relevant princi-
copyright law.
massage therapist with a general working knowledge ples of law as they pertain to massage practice is essen-
of the legal and ethical issues related to the practice of tial to guide a therapist in their legal aspects of practice.
massage therapy. This chapter will discuss the two principal sources of
43
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44 Section 2 The professional therapist
law: case law and legislation. It will also address the two
distinct areas of criminal and civil law. One of the most Box 5.1 Health professionals with registration
important areas of civil law for the massage therapist is status in Australia
known as the law of civil wrongs, or law of torts. The
aspect of the law of torts that is most often the source l acupuncturists (Vic only)
of potential legal action for all health care profession- l Chinese herbal dispensers (Vic only)
als is negligence (Staunton & Chiarella 2008). This l Chinese herbal medicine practitioners (Vic only)
chapter will discuss the four main principles of a negli- l chiropractors
gence action: duty of care; standard of care; breach of l dentists

that standard of care causing damage or injury; and that l dental technicians
the risk of injury is foreseeable (Staunton & Chiarella l medical practitioners
2008). l nurses
A massage therapist would seek consent to perform l occupational therapists
therapy from the client before commencing massage l opticians optometrists
therapy. Such consent provides protection for the cli- l osteopaths
ent and the massage therapist. This chapter will address l pharmacists
the legal importance of gaining valid consent from the l physiotherapists
client. Valid consent consists of the following three ele-
l podiatrists
ments: that any consent from a client is given freely and
l psychologists
voluntarily; that any consent given is informed; and that
l radiographers
the client giving consent has the legal capacity to give
l speech pathologists
such consent (Staunton & Chiarella 2008).
As a massage therapist, the elements of scope of (Source: adapted from Forrester & Griffiths 2005: 283;
and Weir 2007: 69)
practice, professional ethics, and codes of practice and
duty of care to the client should guide professional
conduct. Adherence to these elements at all times is
of utmost importance for any professional health care
provider. Each state and territory in Australia (refer to Box 5.2)
and New Zealand (refer to Box 5.3) is unique in its leg-
islation and therapists should refer to their local legis-
SCOPE OF PRACTICE
lation (or professional association) to determine what
Scope of practice — the types of services that may applies in their state or territory. Although massage
be provided by a professional. therapy in Australia is self-regulated, and not subject
The scope of practice for a massage therapist defines to registration like doctors, nurses, chiropractors and
the knowledge base and type of professional service osteopaths; practicing massage therapists still need to
that can or cannot be provided. All health profession- be aware of government legislation.
als have a unique knowledge base, yet also share com- Qualified massage therapists, as unregistered health
mon knowledge and methodology. Along with this practitioners in Australia, may choose to become a
shared knowledge, the lines defining scope of practice member of a professional massage association; for
are not always clear and can overlap (Fritz 2004). To example, the Australian Association of Massage
clarify scope of practice, health care professionals are Therapists Ltd (AAMT) (www.aamt.com.au) or the
governed by specific legislation, or Acts/Statutes made Australian Traditional Medicine Society Ltd (ATMS)
by parliament. (www.atms.com.au). Likewise in New Zealand, quali-
In Australia, the relevant Acts provide for the regis- fied massage therapists may become members of a pro-
tration of many health care professionals. In those professional massage association such as Massage New
fessions where registration is required (refer to Box 5.1) Zealand (MNZ) (www.massagenewzealand.org). In
it is often an offence to practice or perform specified addition, unregistered health practitioners in the UK
acts (i.e. spinal manipulation) without registration (For- may become members of The Scottish Massage Thera-
rester & Griffiths 2005). Some professional registration pists’ Organisation (SMTO) (www.scotmass.co.uk)
statues limit specific activities to registered profession- covering Scotland, parts of England and Wales.
als and penalise unregistered practitioners who trespass These professional associations provide guidelines
into the scope of practice of a registered profession for practice. These guidelines are often known as a ‘code
(Weir 2007). of practice’ or ‘scope of practice’ (refer to Box 5.4).
Massage therapists in Australia, New Zealand and the
UK are not required by law to be registered to practice. Guidelines for scope of practice
However in Canada, massage therapists are regulated
by the Regulated Health Professions Act 1991: Massage The Australian Federal Government Department of Edu-
Therapists Regulation 2006 (www.qp.gov.bc.ca) and the cation, Employment and Workplace Relations is respon-
copyright law.
Massage Therapy Act 1991 (www.gov.ns.ca/legislature sible for Vocational Education and Training in Australia,
and www.e-laws.gov.on.ca). and through state and territory governments ensures
quality delivery and assessment according to guidelines
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5 Scope of practice, ethics and law in massage therapy practice 45
Box 5.2 Legislative requirements in Australia for consideration by massage therapists
Federal Queensland
National Health Act 1953 Public Health Act 2005
The Privacy Act 1998 Health Quality and Complaints Commission
Therapeutic Goods Act 1989 Act 2006
Australian Workplace Safety & Standards Act 2005 Workplace Health & Safety Act 1995 and Regulations
and Regulations 2005 2008
New South Wales South Australia
Public Health Act 1991 Health and Community Services Complaints Act 2004
Health Legislation Amendment (Unregistered Health Occupational Health, Safety & Welfare Act 1986 and
Practitioners) Act 2006 Regulations 1995
Health Care Complaints Act 1993 Western Australia
Health Records and Information Privacy Act 2002 Health Services (Conciliation and Review Act) 1995
Occupational Health & Safety Act 2000 and Information Privacy Bill 2007
Regulations 2001 Occupational Safety & Health Act 1984 and
Australian Capital Territory Regulations 1996
Health Act 1993 Tasmania
Health Records (Privacy and Access) Act 1997 Health and Community Services Complaints Act 1998
Health Complaints Act 1993 Health Professionals Registration (Miscellaneous
Occupational Health & Safety Act 1989 and Amendments) Act 2008
Regulations 1991 Northern Territory
Victoria Health & Community Services Complaints Act 2007
Health Records Act 2001 Workplace Health & Safety Act 2007
Health Services (Conciliation and Review Act) 1987 (Source: www.nla.gov.au/oz/law.html & www.weblaw.edu.au)
Occupational Health & Safety Act 2004
Box 5.3 Legislative requirements in New Zealand l apply knowledge on infection control
l understand duty of care, consent and the principles
There are numerous pieces of legislation of negligence
(www.nzlii.org/nz) that impact upon the practice of
l apply informed consent according to the local and
massage in New Zealand. These include (but are not
limited to) the following:
national regulations and legal requirements
l maintain current, complete, accurate and relevant
l Health Practitioners Competence Assurance Act
2003 records for each client
l The Physiotherapy Act 1949 l uphold ethical professional care considering cli-
l Privacy Act 1993

ents’ cultural, social and religious needs
l Medical Practitioners Act 1995 l apply knowledge of anatomy, physiology and
l The Health and Disability Commissioner

pathophysiology
Amendment Act 2007 l apply knowledge of possible reactions and contra-
l Health and Safety Employment Act 1992 indications to treatment

l Consumer Guarantees Act 1993 l apply methods of therapy including effleurage,
l Fair Trading Amendment Act 2006. pétrissage, passive joint movement and neuromus-
cular techniques
l recognise limits of personal competence and the
need for referral to other complementary therapy
established for registered training organisations that and allopathic professionals.
offer massage courses within the endorsed Health Train- This list of the skills and knowledge required is by
ing Package (www.deewr.gov.au/deewr/Training/). no means exhaustive, but it shows how massage courses
The package (www.ntis.gov.au) outlines, amongst provide the knowledge required for therapists to work
other things, the knowledge and skills as well as the leg- responsibly within their scope of practice.
islative responsibilities necessary to work legally, safely A similar regulatory body exists in New Zealand.
and effectively as a massage therapist. The required This body is the New Zealand Qualifications Authority
skills and knowledge include the ability to: (NZQA). The NZQA oversees the accreditation of tertiary
l implement and monitor compliance with legal and
copyright law.
education awards. In 2002, through consultation with the

ethical issues massage industry, the NZQA registered two national
l identify, assess and control workplace health and qualifications for massage therapists — the National
safety Certificate in Massage (Relaxation Massage) (Level 4)
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Box 5.4 Associations for massage therapists and their codes of practice
The Australian Traditional Medicine Society’s Code the massage therapist (AAMT 2004) in their practice, it
of Conduct (ATMS 2006) highlights a therapist’s includes:
responsibility towards: l maintaining confidential private and accurate
l ethical principles records
l duty of care l a safe hygienic healthy environment for practice
l standards of professional conduct l compliance with national state and local
l the professional relationship between practitioner government laws

and client l working within the scope of a massage therapist’s
l appropriate professional boundaries role and referring if necessary

l management of the patient’s personal information l guidelines for informed consent for adults, minors
and confidentiality and clients with mental incapacity

l guidelines for advertising. l continued professional development for the therapist
The Australian Association of Massage Therapists has l guidelines for advertising that must not imply false
a Code of Ethics and Standards of Practice to guide misleading or fraudulent claims.
and the National Diploma in Massage (Therapeutic Mas- n umber of health care professionals, in a multidisci-
sage) (Level 6). Registered training organisations may plinary approach, may be required to provide the best
register to deliver these nationally recognised awards, or quality holistic care for the client. The multidisciplinary
provide training in their own accredited programs. team may consist of the naturopath, osteopath, physio-
therapist, counsellor, medical practitioner and others. In
Limits for the scope of practice the multidisciplinary environment it is important to be
able to communicate effectively with other professionals
Under the law in Australia, the scope of practice of an
with whom the therapist works or to whom the therapist
unregistered massage therapist is determined by statu-
refers clients. The massage therapist needs to be famil-
tory limitations, along with recognition provided by a
iar with medical terminology to be able to communicate
professional association, depending on the level of edu-
professionally about client care. This is part of the reason
cation completed by the massage therapist. The statutory
why the therapist will find that reputable training insti-
limitations for massage therapists are determined by
tutions also teach Western health science as part of the
other registered allied health professionals’ (i.e. medical
underpinning knowledge that supports particular mas-
practitioners, physiotherapists, osteopaths, podiatrists
sage techniques and practices. In addition to the mas-
and chiropractors) regulatory statutes. For the unregis-
sage therapist’s professional boundaries, their ethical
tered massage therapist, statutory limitations in Australia
boundaries are also important in their scope of practice.
were affected by physiotherapy legislation that meant, in
some situations, the provision of massage therapy might
ETHICS
be considered to represent the practice of physiotherapy.
This concern has now been alleviated by amendments to Ethics — the moral principles by which our actions
legislation. The result is that the use of therapeutic mas- are guided.
sage is no longer considered a breach of this legislation For a massage therapist ethics will guide the mak-
(Weir 2007 & 2008). Accordingly, massage therapists ing of right and wrong decisions within their profes-
and other bodywork therapists should be aware of recent sional life. Therapists are in a unique position to provide
changes to legislation. The best protection for a massage care and give advice to clients, the client’s family, other
therapist is to ensure they stay within the standard scope health professionals and the general public. A therapist
of practice of their professional association. has ethical obligations to these people and is account-
According to Weir (2007), depending on current able for them, and will need to make ethically sensitive
local statutes and regulations, the effect of the scope of decisions that are acceptable to all concerned (van Hooft
practice on registered health professionals may exclude et al 1997). The ethical principles of autonomy (the obli-
massage therapists from: gation to respect the decision-making capacities of indi-
l indicating that they diagnose illness viduals), beneficence (doing good), non-maleficence
l prescribing or advising the use of medications, vita- (refraining from doing harm) and justice (the obligation
mins, minerals or herbs of fairness in the distribution of benefits and risks) when
l spinal or joint manipulations applied correctly will guide a therapist in making deci-
l treatment or cure of a wide variety of illnesses sions for clients (Mathes 2000; Wiley 1994).
l counselling clients.
copyright law.
A massage therapist should ensure their clients Autonomy

understand their scope of practice and what professional Autonomy — the personal freedom to make moral
service they offer. In some cases, the expertise of a decisions and act upon them.
Account: s8715057
The everyday meaning of ‘autonomy’ is that a per-

son has the right to make his or her own decisions and Box 5.5 Case study 1
to act independently. As applied to clinical practice
this means that a therapist should respect their client’s A therapist in a remedial massage therapy practice
entitlement to make their own decisions about their charges $50 for an hour-long session involving
health care. Autonomy implies that clients have a right massage, aromatherapy and stretching. For clients
to decide on the type of treatment they receive, and have who are pensioners a charge of $35 is applied. A
client who arrives in a BMW would appear more
a right to consent to or refuse treatment (Hawley 1997).
affluent, therefore is charged $80 for the same
In multicultural societies, it is especially important for
therapy.
the massage therapist to consider therapy from the client’s Question — is this an ethical practice?
unique cultural perspective (see Chapter 6). A client’s per- Answer — no this practice is not ethical. It does
sonal values and beliefs will influence the decisions they not show ethical practice in regard to the fairness
make in regard to the type of therapy and massage they of its approach (justice) and the potential for
wish to receive. Cultural values will influence approaches exploitation (non-maleficence). It may also be a
to many aspects of health care, spirituality or sex roles breach of statutory provisions about false and
(Lee 1999). Similarly, the therapist will have his or her misleading practices (Salvo 1999). However, state
own beliefs, expectations, and personal feelings depen- and territory laws do not require massage therapists
dent on cultural background, education and life experi- to charge a fee for a given service or to charge every
ence (Geldard 1993). As Parsons (1990: 130) states: client equally — assuming the pricing is not on
Some health professionals feel discomfort at what discriminatory grounds (i.e. race, religion, etc). The
they regard as an uncaring attitude, or an excessive therapist is free to offer discounts to pensioners,
emotional display, without realising it is simply their children or financially disadvantaged individuals.
own cultural expectations that generate the discomfort.
Remember both the client and the massage therapist
will bring their worlds into the clinical practice. duty of non-maleficence also requires that the massage
By encouraging a client to make his or her own therapist refrains from treating clients when their abili-
decisions, and respecting those decisions, the massage ties are impaired due to personal or emotional difficul-
therapist is respecting the client’s autonomy. ties, illness, physical disability, alcohol or drugs (Stone
2002).
Beneficence
Justice
Beneficence — a good or charitable act aimed at
proving a beneficial outcome. Justice — the fair and reasonable manner in which
people are treated or decisions regarding them are made.
The ethical principle of beneficence implies that the
therapy provided is aimed at what is appropriate for the Justice refers to society’s expectations of what is
wellbeing of the client; the delivery of therapy or inter- fair and right in the clinical setting. It would suggest the
ventions that have a beneficial outcome (Hawley 1997). need to provide the appropriate massage therapy for all
The massage therapist has an ethical obligation to do clients, regardless of socio-economic status, race, sex
everything within his or her scope of practice and pro- or religion (Hawley 1997). It is not possible to provide
fessional ability to enhance a client’s health and wellbe- equal health care to all clients, but it is possible to view
ing. The duty of beneficence requires that: the massage massage as a service that everyone in the community
therapist recognises the limitations of their competence; should have equal access to, in accordance with their
does not prolong therapy which is not having a benefi- needs. For example, ‘massage therapists should avoid
cial effect; and refers clients where appropriate (Stone making professional decisions based on discrimina-
2002) tory grounds, or for personal reasons of convenience or
financial advantage’ (Weir 2000: 14). See Box 5.5 for a
case study.
Non-maleficence
Non-maleficence — to do no harm. LAW
The ethical principle of non-maleficence means, The Australian legal system, as it currently exists, was
above all, do no harm. Non-maleficence not only inherited from the English legal system through the pro-
involves a duty of care to avoid actual harm to a cli- cess of colonisation. The legal system is the framework
ent but also to avoid the risk of harm (Hawley 1997). of rules or law that regulates our society.
Therefore, the massage therapist shall not knowingly In Australia there are two sources of the law. The
perform any therapy that could adversely affect the first is legislation passed by the parliaments at both state
health of a client. For example, overriding the client’s and federal levels. The second is common (or case) law
autonomy, by disregarding their expressed wishes,
copyright law.
(Chisholm & Nettheim 1992). According to Forrester

would constitute harming them (Stone 2002). In addi- and Griffiths (2001) ‘common law is the accumulated
tion to physical harm, non-maleficence applies to finan- body of law made by judges (judge made law) as a result
cial exploitation and emotional harm (Weir 2000). The of decisions in cases that come before the courts’ (p 7).
Account: s8715057
As such, common law results from rules of law created Law of torts
by the courts rather than by legislation enacted by par- Tort law is concerned with civil wrongs. Generally, torts
liament (Chisholm & Nettheim 1992). Australia is often are not defined within specific statute or legislation and
referred to as a common law country, as is New Zealand, have evolved through judge-made law, or common law.
the UK and Canada. All these countries have common However, each state has also created statutes to over-
law and statutory law (Forrester & Griffiths 2005). Law ride the common law, especially in the areas of negli-
can be classified into different types, such as public law gence, personal injuries and defamation (www.en.wik
versus private law, common law versus statute law, state ipedia.org/wiki/Tort). Negligence is the civil wrong of
versus federal law and criminal versus civil law. greatest significance as a source of potential legal action
for health professionals (Staunton & Chiarella 2008).
Criminal versus civil law Clinical situations that may lead to a negligence action
include: a client fall resulting in injury, where oil has
Criminal law provides the rules of behaviour that affect been spilt creating a slippery floor; a client falling off a
our wider community. Criminal law deals with crimi- massage table that has collapsed due to faulty manufac-
nal punishment for taking another person’s property, turing; or a client suffering injury as a result of incorrect
assault or breaches of the road traffic regulations. application of massage techniques.
Criminal law prosecution is initiated by the state or
territory, in the form of the police or the public pros- Negligence action
ecutor, against a private citizen or other entity such as
a company. The prosecution needs to prove that the The negligence action depends on the existence of a
accused is guilty beyond reasonable doubt (Staunton & breach of duty of care owed by one person to another. A
Chiarella 2008). client (who is injured) or relatives of clients are entitled
Civil law on the other hand has nothing to do with to seek financial compensation for not only a negligent
the police force and punishment; it relates to the enforce- act but also an omission of an act that has caused or will
ment of the rights of individuals. Civil law relates to those continue to cause personal injury, pain and financial
legal proceedings between private citizens or private and loss (Forrester & Griffiths 2005; Staunton & Chiarella
public bodies, usually with the aim of obtaining compen- 2008). For the massage therapist to be found negligent,
sation, which the court is able to order. For example, a the plaintiff must prove four things:
client can bring an action against a health professional or 1 that the therapist owed a duty of care to the client
a hospital. (Dimond 1998; Forrester & Griffiths 2005). 2 that the therapist failed to adhere to appropriate
Civil wrongs are categorised as ‘torts’ and include negli- standards of care
gence, trespass, nuisance and defamation. 3 as a consequence of the therapist’s breach of the
It should be noted that one incident could give rise to appropriate standards of care, the client suffered
both civil and criminal law proceedings. For example, injury
if a massage therapist was to examine a client without 4 that the risk of injury was reasonably foreseeable by
consent, that could constitute both trespass to the person the therapist.
in civil law and be grounds for the criminal charge of If the client is unable to demonstrate that all of
assault (Dimond 1998). these conditions existed, then the negligence action
Box 5.6 Tips for safeguarding against negligence
l Maintain your competency through continuing l Treat each client as you would like to be
education (CE): read journals, attend educational treated — show respect for your clients,
seminars and earn CE points normally offered involve them in decisions, educate them
through the professional association. and answer their questions. Clear and open
l Know your clinic’s policies on adverse incidents; communication is vital to a sound client–therapist
know your responsibilities and meet them. relationship.
l Learn about other health professionals who are l Report to your clinic manager any problems that
part of your multidisciplinary team; for example, may endanger your client. Failure to do so may
physiotherapists, occupational therapists, diabetes lead to negligence actions.
counsellors, breast cancer nurses and chiropractors, l If an incident occurs, follow your clinic’s
and utilise their services when appropriate. procedures for reporting, and document any
l Know where drug, herb, vitamin and mineral incident correctly.
references and other resources are located l When you document an incident, be factual,
and keep them up to date. Purchase your own accurate, complete and timely.
references if necessary.
copyright law.
l Maintain a hygienic clinic, with well-maintained

l If you don’t understand a condition, consult other equipment.
appropriate health professionals. Ask for help. (adapted from Showers 2000)
Account: s8715057
will not succeed (Showers 2000; Staunton & Chiarella therapists would be consulted as to what they consider
2008). (See Box 5.6 regarding safe-guarding against should establish a standard of care in the same or simi-
negligence.) lar circumstances to the case in question. These people
would be respected members of the profession, such as
Duty of care the president of the massage association or a scholar
A duty of care is a duty that exists when one person can from an academic institution. In such instances, the
reasonably foresee that their actions or omissions could court would ask ‘What should the ordinary reasonable
cause harm to another person. In other words, liability massage therapist do in this situation?’ (Dimond 1998;
can arise as much from failure to do an act as it can from Staunton & Chiarella 2008).
doing it and doing it incorrectly (Staunton & Chiarella
2008). Breach of the standard of care
A duty of care always exists between a massage Once the court has established the standards by which
therapist and a client. The duty commences at the point to evaluate the massage therapist, the prosecutor then
a referral is accepted or there is an agreement between needs to demonstrate that the therapist breached those
the therapist and the client for provision of services. In standards (Showers 2000). A therapist would breach a
addition, the client/therapist is not the only relationship duty of care by falling below the reasonable standard of
where a duty of care exists, as the massage therapist care. Examples of a breach of duty may be:
also owes a professional duty of care to the following l failure to maintain all equipment to a safe standard
people: l use of oil that the client was allergic to
l any person who enters the premises l failure to maintain the clinic to a safe standard, such as
l any person to whom advice is given allowing slippery floors or loose rugs on which to trip
l any person to whom instruction is provided (includ- l failure to act on a contraindication to treatment
ing over the telephone, the internet or in printed form) l failure to maintain the client’s confidentiality
l any person treated l failure to maintain adequate hygiene.
l any persons related to a client (See Box 5.7 for a case study.)
l any employees.
This list is by no means exhaustive. As can clearly Foreseeability

be seen, the massage therapist owes a duty of care There is a duty of care owed to a person if it can be
to a great deal of people (Dimond 1998; Forrester & reasonably foreseen that the person might be injured by
Griffiths 2001). negligent actions. For example, when driving a motor
vehicle, the driver is responsible for driving with due
Standard of care care, and if they fail to observe certain rules it can
We have established that a duty of care exists between be reasonably foreseen that somebody may get hurt
a massage therapist and a client and sometimes other (Staunton & Chiarella 2008). A massage therapist may
people concerned with that client. In court, to establish fail to ask a client about sensitivities to lubricants, which
what standard of care should be provided, evidence is expected of a reasonably competent practitioner. If
would be sought from experts. Professional massage the client subsequently develops an allergic reaction to
Box 5.7 Case study 2
Following a manual handling incident Todd was (or would have applied other techniques) then liability
referred to a remedial massage therapist by his general for negligence could be found against the massage
practitioner. After several months of attendance, an therapist. Liability would only accrue if it could be
orthopaedic surgeon has told Todd that the remedial demonstrated that treatment was the cause of further
massage was not an appropriate treatment for the injury. If Todd had suffered harm, over and above the
injury sustained and the massage has caused additional original injury, he may claim damages for:
permanent damage. l medical costs
Question — can Todd claim compensation? l pain and suffering
Answer — the general practitioner that referred Todd l present and future economic loss
to the inappropriate massage therapy might possibly l special damages; for example, items such as
be jointly liable for the referral for inappropriate medication or special transportation.
treatment. If it could be shown that a reasonably
These damages can be quite expensive. In some cases
competent massage therapist would not have provided
copyright law.
settlements made for injuries have amounted to very

the type of massage given and would have referred
substantial sums.
back to the doctor because of the risk of further injury
(adapted from Dimond 1998)
Account: s8715057

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Copyright © 2010. Churchill Livingstone Australia. All rights reserved.

May not be reproduced in any form

‘health’ — from the Old English health, meaning a state of wholeness,

Sydney Edinburgh London New York Philadelphia St Louis Toronto

Elsevier Australia. ACN 001 002 357

Text © 2010 Endeavour College of Natural Health

National Library of Australia Cataloguing-in-Publication Data

Foundations of massage / Lisa Casanelia; David Stelfox.

Publisher: Sophie Kaliniecki

Cover design by Stan Lamond

Section 4 Making initial contact with

13 Pharmacological considerations for massage

Heather Morrison, PhD, BSc (Hons)

and different interpretations.

Table 1.1 Categories of massage therapy

Subtle energy practices Relaxation methods Remedial approaches

egy, along with nutrition, massage, flower essences

to ‘herbal medicine’. Herbal remedies were one of the Nutrition therapy

clients and their individual health condition. The health

manipulative therapy has always been of importance in

Chiropractic manipulative techniques l­ifestyle management advice to their clients (Kleyn-

muscle weaknesses; used to diagnose vertebral

Remedial massage therapy Questions and activities

body is an integral part of remedial massage. While this

l Identify how historical events have led to current philosophies

wall painting suggests that techniques used in this form

­ aterial was not written and, in most of Europe, Christi-

­ ssociation (AMA) and Peters was an integral influence

Indigenous tribes use touch as

Asclepius uses ‘Father of

Figure 2.2 Time line of historical events

Section 1 A framework for massage practice

AN: 448482 ; Casanelia, Lisa, Stelfox, David.; Foundations of Massage

Questions and activities Calvert RN 2002 The History of Massage — An Illustrated

l Define integrative medicine

INTRODUCTION shamanic practice were also common features. Such

Among indigenous people, massage or manipulative

a holistic practitioner. described as provincial.

Questions and activities British Medical Journal 1894, p 88

the importance of touch

l Identify how research supports the importance of touch

l Develop an understanding of the mechanisms of healing energy transmission through touch

INTRODUCTION a marked decrease in their heart rate when nurses held

emotional centres where they activate pleasurable scale

l Describe the massage therapist’s limits of practice

l Know when it is appropriate to refer a client to another health care professional

l Explain why ethics are important to massage practice

l Discuss the principles of autonomy, beneficence, non-maleficence and justice

l Explain the four main principles of a negligence action

l Explain the elements of informed consent

l Decide if a client can provide informed consent for a massage

INTRODUCTION Scope of practice defines the type of professional

chapter will discuss the four main principles of a negli- l chiropractors

gence action: duty of care; standard of care; breach of l dentists

Box 5.2 Legislative requirements in Australia for consideration by massage therapists

l Privacy Act 1993

l The Health and Disability Commissioner

l Health and Safety Employment Act 1992 indications to treatment

education awards. In 2002, through consultation with the

l standards of professional conduct l compliance with national state and local

l the professional relationship between practitioner ­government laws

l appropriate professional boundaries role and referring if necessary

and confidentiality and clients with mental incapacity

A massage therapist should ensure their clients Autonomy

13 Pharmacological considerations for massage

Chiropractic manipulative techniques lifestyle management advice to their clients (Kleyn-

l Identify how historical events have led to current philosophies

aterial was not written and, in most of Europe, Christi-

ssociation (AMA) and Peters was an integral influence

l Define integrative medicine

l Identify how research supports the importance of touch

l Develop an understanding of the mechanisms of healing energy transmission through touch

l Describe the massage therapist’s limits of practice

l Know when it is appropriate to refer a client to another health care professional

l Explain why ethics are important to massage practice

l Discuss the principles of autonomy, beneficence, non-maleficence and justice

l Explain the four main principles of a negligence action

l Explain the elements of informed consent

l Decide if a client can provide informed consent for a massage

chapter will discuss the four main principles of a negli- l chiropractors

gence action: duty of care; standard of care; breach of l dentists

l Privacy Act 1993

l The Health and Disability Commissioner

l Health and Safety Employment Act 1992 indications to treatment

l standards of professional conduct l compliance with national state and local

l the professional relationship between practitioner government laws

l appropriate professional boundaries role and referring if necessary

l Maintain a hygienic clinic, with well-maintained