Massage

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Massage is to work and act on the body with pressure. Massage techniques are commonly applied with hands, fingers, elbows, knees, forearms, feet, or a device. The purpose of massage is generally for the treatment of body stress or pain. People who are professionally trained to give massages were traditionally known as masseurs or masseuses, but the term massage therapist has been promoted.

In professional settings, clients are treated while lying on a massage table, sitting in a massage chair, or lying on a mat on the floor. In amateur settings, a general purpose surface like a bed or the floor is more common. Aquatic massage and bodywork is performed with recipients submersed or floating in a warm-water therapy pool.

Video Massage

Etymology

The word comes from the French massage "friction of kneading", or from the Arabic word massa meaning "to touch, feel" or from Latin massa meaning "mass, dough", from the Greek verb ????? (mass?) "to handle, touch, to work with the hands, to knead dough". In distinction the ancient Greek word for massage was anatripsis, and the Latin was frictio.

Maps Massage

History

Ancient and medieval times

Archaeological evidence of massage has been found in many ancient civilizations including China, India, Japan, Korea, Egypt, Rome, Greece, and Mesopotamia.

BC 2330: The Tomb of Akmanthor (also known as "The Tomb of the Physician") in Saqqara, Egypt depicts two men having work done on their feet and hands, presumably massage.

BC 722-481: Huangdi Neijing is composed during the Chinese Spring and Autumn period (the beginning of recorded history). The Nei-jing is a compilation of medical knowledge known up to that date, and is the foundation of Traditional Chinese Medicine. Massage is referred to in 30 different chapters of the Nei Jing. It specifies the use of different massage techniques and how they should be used in the treatment of specific ailments, and injuries. Also known as "The Yellow Emperor's Inner Canon", the text refers to previous medical knowledge from the time of the Yellow Emperor (approx 2700 BC), misleading some into believing the text itself was written during the time of the Yellow Emperor (which would predate written history).

BC 700 Bian Que, the earliest known Chinese physician uses massage in medical practice.

BC 500 J?vaka Komarabh?cca, also known as Shivago Komarpaj, the founder of Traditional Thai massage (Nuad Boran) and Thai medicine. According to the P?li Buddhist Canon, Jivaka was Shakyamuni Buddha's physician. He codified a healing system that combines acupressure, reflexology, and assisted yoga postures. Traditional Thai massage is generally based on a combination of Indian and Chinese traditions of medicine. Jivaka is known today as "Father Doctor" in Thailand.

BC 493: A possible biblical reference documents daily "treatments" with oil of myrrh as a part of the beauty regimen of the wives of Xerxes (Esther, 2:12).

BC 460: Hippocrates wrote "The physician must be experienced in many things, but assuredly in rubbing".

BC 300 Charaka Samhita believed to be the oldest of the three ancient treatises of Ayurvedic medicine, including massage. Sanskrit records indicate that massage had been practiced in India long before the beginning of recorded history.

AD 581: Dr Sun Si Miao introduces ten new massage techniques and systematized the treatment of childhood diseases using massage therapy.

AD 581: China establishes a department of massage therapy within the Office of Imperial Physicians.

Middle-Ages: Medical knowledge, including that of massage, made its way from Rome to Persia in the Middle Ages. Many of Galen's manuscripts, for instance, were collected and translated by Hunayn ibn Ishaq in the 9th century. Later in the 11th century copies were translated back into Latin, and again in the 15th and 16th centuries, when they helped enlighten European scholars as to the achievements of the Ancient Greeks. This renewal of the Galenic tradition during the Renaissance played a very important part in the rise of modern science.

One of the greatest Persian medics was Avicenna, also known as Ibn Sina, who lived from 980AD to 1037AD. His works included a comprehensive collection and systematisation of the fragmentary and unorganised Greco-Roman medical literature that had been translated Arabic by that time, augmented by notes from his own experiences. One of his books, Al-Q?n?n f? a?-?ibb (The Canon of Medicine) has been called the most famous single book in the history of medicine in both East and West. Avicenna excelled in the logical assessment of conditions and comparison of symptoms and took special note of analgesics and their proper use as well as other methods of relieving pain, including massage.

AD 1150: Evidence of massage abortion, involving the application of pressure to the pregnant abdomen, can be found in one of the bas reliefs decorating the temple of Angkor Wat in Cambodia. It depicts a demon performing such an abortion upon a woman who has been sent to the underworld. This is the oldest known visual representation of abortion.

AD 1776: Jean Joseph Marie Amiot, and Pierre-Martial Cibot, French missionaries in China translate summaries of Huangdi Neijing, including a list of medical plants, exercises and elaborate massage techniques, into the French language, thereby introducing Europe to the highly developed Chinese system of medicine, medical-gymnastics, and medical-massage.

AD 1776 Pehr Henrik Ling, a Swedish physical therapist, and teacher of medical-gymnastics is born. Ling has often been erroneously credited for having invented "Classic Massage" aka "Swedish Massage", and has been called the "Father of Massage".

AD 1779: Frenchman Pierre-Martial Cibot publishes 'Notice du Cong-fou des Bonzes Tao-see' also known as "The Cong-Fou of the Tao-Tse", a French language summary of medical techniques used by Taoist priests. According to Joseph Needhan, Cibot's work "was intended to present the physicists and physicians of Europe with a sketch of a system of medical gymnastics which they might like to adopt--or if they found it at fault they might be stimulated to invent something better. This work has long been regarded as of cardinal importance in the history of physiotherapy because it almost certainly influenced the Swedish founder of the modern phase of the art, Per Hendrik Ling. Cibot had studied at least one Chinese book, but also got much from a Christian neophyte who had become expert in the subject before his conversion."

AD 1813 The Royal Gymnastic Central Institute for the training of gymnastic instructors was opened in Stockholm, Sweden, with Pehr Henrik Ling appointed as principal. Ling developed what he called the "Swedish Movement Cure." Ling died in 1839, having previously named his pupils as the repositories of his teaching. Ling and his assistants left little proper written account of their methods.

AD 1878: Dutch massage practitioner Johan Georg Mezger applies French terms to name five basic massage techniques, and coins the phrase "Swedish massage system". These techniques are still known by their French names (effleurage (long, gliding strokes), petrissage (lifting and kneading the muscles), friction (firm, deep, circular rubbing movements), tapotement (brisk tapping or percussive movements), and vibration (rapidly shaking or vibrating specific muscles)).

Modern times

China

Massage has developed continuously in China for over 5000 years. Western ideas are considered within the traditional framework. It is widely practiced and taught in hospital and medical schools and is an essential part of health maintenance and primary healthcare.

United States

Massage started to become popular in the United States in the middle part of the 19th century and was introduced by two New York physicians based on Per Henrik Ling's techniques developed in Sweden.

During the 1930s and 1940s massage's influence decreased as a result of medical advancements of the time, while in the 1970s massage's influence grew once again with a notable rise among athletes. Until the 1970s, nurses used massage to reduce pain and aid sleep. The massage therapy industry is continuously increasing. In 2009, U.S. consumers spent between $4 and $6 billion on visits to massage therapists. In 2015, research estimates that massage therapy was a $12.1 billion industry.

United Kingdom

Massage is popular in the United Kingdom today and gaining in popularity. There are many private practitioners working from their own premises as well as those who operate from commercial venues.

Sports, business and organizations

Massage developed alongside athletics in both Ancient China and Ancient Greece. Taoist priests developed massage in concert with their Kung Fu gymnastic movements, while Ancient Greek Olympians used a specific type of trainer ("aleiptes") who would rub their muscles with oil. Pehr Ling's introduction to massage also came about directly as a result of his study of gymnastic movements.

The 1984 Summer Olympics in Los Angeles was the first time that massage therapy was televised as it was being performed on the athletes. And then, during the 1996 Summer Olympics in Atlanta massage therapy was finally offered as a core medical service to the US Olympic Team. Massage has been employed by businesses and organizations such as the U.S. Department of Justice, Boeing and Reebok. Notable athletes such as Michael Jordan and LeBron James have personal massage therapists that at times even travel with them.

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Types and methods

Active Release Techniques

Active Release Techniques (ART) is a form of deep tissue manipulation patented by Dr. P. Michael Leahy in which specified techniques are used to release what are presumed to be soft tissue adhesions.

The ART curriculum also includes various nerve slide, or flossing, protocols and adjacent muscle interface work.

Acupressure

Acupressure [from Latin acus "needle" (see acuity) + pressure (n.)] is an alternative medicine technique similar in principle to acupuncture. It is based on the concept of life energy which flows through "meridians" in the body. In treatment, physical pressure is applied to acupuncture points with the aim of clearing blockages in those meridians. Pressure may be applied by fingers, palm, elbow, toes or with various devices.

Some medical studies have suggested that acupressure may be effective at helping manage nausea and vomiting, for helping lower back pain, tension headaches, stomach ache, among other things, although such studies have been found to have a high likelihood of bias.

Aquatic bodywork

Aquatic bodywork comprises a diverse set of massage and bodywork forms performed in water. This includes land-based forms performed in water (e.g., Aquatic Craniosacral Therapy, Aquatic Myofascial Release Therapy, etc.), as well as forms specific to warm water pools (e.g., Aquatic Integration, Dolphin Dance, Healing Dance, Jahara technique, WaterDance, Watsu).

Ashiatsu

In ashiatsu, the practitioner uses their feet to deliver treatment. The name comes from the Japanese, ashi for foot and atsu for pressure. This technique typically uses the heel, sesamoid, arch and/or whole plantar surface of foot, and offers large compression, tension and shear forces with less pressure than an elbow, and is ideal for large muscles, such as in thigh, or for long-duration upper trapezius compressions. Other manual therapy techniques using the feet to provide treatment include Keralite, Barefoot Lomi Lomi, Chavutti Thirumal.

Ayurvedic massage

Ayurvedic Massage known as Abhyangam in Sanskrit is one of the most common and important Ayurvedic therapies. According to the Ayurvedic Classics Abhayngam is an important dincharya (Daily Regimen) that is needed for maintaining a healthy lifestyle. The massage technique used during Ayurvedic Massage is known to stimulate the lymphatic system to expel the toxins out from the body. The Ayurvedic Massage also stimulates production of lymphocytes which play a vital role in maintaining the immunity in human body. Thus regular Ayurvedic Massage can lead to better immunity and also help in body de-toxification. The other benefits of regular Ayurvedic Massage include pain relief, reduction of fatigue, prevention of ageing and bestowing longevity.

Burmese Massage

Known in Myanmar as Yoe Yar Nhake Nal Chin, meaning "traditional massage", Burmese massage has its ancient origins from Thai, Chinese and Indian medicine. Currently, Burmese massage also includes the use local natural ingredients such as Thanaka, which helps to promote smooth skin and prevents sunburn.

Burmese massage is a full body massage technique that starts from head to toes, drawing on acupuncture, reflexology, and kneading. Signature massage strokes include acupressure using the elbows, quick gentle knocking of acupressure points, and slow kneading of tight muscles. The massage is aimed to improve blood circulation and quality of sleep, while at the same time help to promote better skin quality.

Bio-mechanical stimulation (BMS) massage

Biomechanical stimulation (BMS) is a term generally used for localised biomechanical oscillation methods, whereby local muscle groups are stimulated directly or via the associated tendons by means of special hand held mechanical vibration devices. Biomechanical oscillation therapy and training is offered in a variety of areas such as competitive sports, fitness, rehabilitation, medicine, prevention, beauty) and used to improve performance of the muscles and to improve coordination and balance. It is often used in the Myofascial trigger point therapy concept to invoke reciprocal inhibition within the musculoskeletal system. Beneficial effects from this type of stimulation have been found to exist, the efficacy of the BMS Matrix therapy was proven in an independent study. carried out by TÜV-Süd which was commissioned by German health insurer BKK Gesundheit.

Biodynamic massage

Biodynamic massage was created by Gerda Boyesen as part of Biodynamic Psychotherapy. Practised as a stand-alone therapy, it is a combination of physical and energy work and also uses a stethoscope to hear the peristalsis.

Craniosacral therapy

Craniosacral therapy (CST) is a gentle approach that releases tensions deep in the body by applying light touch to the skull, face, spine, and pelvis.

Foot massage

While various types of reflexology related massage styles focus on the feet, massage of (usually) the soles of the feet is often performed purely for relaxation or recreation. It is believed there are some specific points on the feet that correspond to different organs in the body. Stimulation of these points during foot massage can cause significant reduction in pain. Studies also suggest that foot reflexology massage can reduce fatigue and promote better sleep.

Lomilomi and indigenous massage of Oceania

Lomilomi is the traditional massage of Hawaii. As an indigenous practice, it varies by island and by family. The word lomilomi also is used for massage in Samoa and East Futuna. In Samoa, it is also known as lolomi and milimili. In East Futuna, it is also called milimili, fakasolosolo, amoamo, lusilusi, kinikini, fai'ua. The M?ori call it roromi and mirimiri. In Tonga massage is fotofota, tolotolo, and amoamo. In Tahiti it is rumirumi. On Nanumea in Tuvalu, massage is known as popo, pressure application is kukumi, and heat application is tutu. Massage has also been documented in Tikopia in the Solomon Islands, in Rarotonga and in Pukapuka in Western Samoa.

Lymphatic drainage

Manual lymphatic drainage is a technique used to gently work and stimulate the lymphatic system, to assist in reduction of localized swelling. The lymphatic system is a network of slow moving vessels in the body that carries cellular waste toward the heart, to be filtered and removed. Lymph also carries lymphocytes, and other immune system agents. Manual lymphatic drainage claims to improve waste removal and immune function.

Medical massage

Medical Massage is a controversial term in the massage profession. Many use it to describe a specific technique. Others use it to describe a general category of massage and many methods such as deep tissue massage, myofascial release and triggerpoint therapy as well as osteopathic techniques, cranial-sacral techniques and many more can be used to work with various medical conditions.

Massage used in the medical field includes decongestive therapy used for lymphedema which can be used in conjunction with the treatment of breast cancer. Light massage is also used in pain management and palliative care. Carotid sinus massage is used to diagnose carotid sinus syncope and is sometimes useful for differentiating supraventricular tachycardia (SVT) from ventricular tachycardia. It, like the valsalva maneuver, is a therapy for SVT. However, it is less effective than management of SVT with medications.

A 2004 systematic review found single applications of massage therapy "reduced state anxiety, blood pressure, and heart rate but not negative mood, immediate assessment of pain, and cortisol level", while "multiple applications reduced delayed assessment of pain", and found improvements in anxiety and depression similar to effects of psychotherapy. A subsequent systematic review published in 2008 found that there is little evidence supporting the use of massage therapy for depression in high quality studies from randomized controlled trials.

Myofascial release

Myofascial release refers to the manual massage technique that claims to release adhered fascia and muscles with the goal of eliminating pain, increasing range of motion and equilibrioception. Myofascial release usually involves applying shear compression or tension in various directions, cross fiber friction or by skin rolling.

Reflexology

Reflexology also known as "zone therapy", is an alternative medicine involving application of pressure to the feet and hands with specific thumb, finger, and hand techniques without the use of oil or lotion. It is based on a pseudoscientific system of zones and reflex areas that purportedly reflect an image of the body on the feet and hands, with the premise that such work effects a physical change to the body.

Shiatsu

Shiatsu (??) (shi meaning finger and atsu meaning pressure) is a type of alternative medicine consisting of the fingers and palm pressure, stretches, and other massage techniques. There is no convincing data available to suggest that shiatsu is an effective treatment for any medical condition.

Structural Integration

Structural Integration's aim is to unwind the strain patterns residing in the body's myofascial system, restoring it to its natural balance, alignment, length, and ease. This is accomplished by deep, slow, fascial and myofascial manipulation, coupled with movement re-education. Various brands of Structural Integration are Rolfing, Hellerwork, Guild for Structural Integration, Aston Patterning, Soma, and Kinesis Myofascial Integration.

Swedish massage

The most widely recognized and commonly used category of massage is the Swedish massage. The Swedish massage techniques vary from light to vigorous. Swedish massage uses five styles of strokes. The five basic strokes are effleurage (sliding or gliding), petrissage (kneading), tapotement (rhythmic tapping), friction (cross fiber or with the fibers) and vibration/shaking. Swedish massage has shown to be helpful in reducing pain, joint stiffness, and improving function in patients with osteoarthritis of the knee over a period of eight weeks. The development of Swedish massage is often inaccurately credited to Per Henrik Ling, though the Dutch practitioner Johann Georg Mezger applied the French terms to name the basic strokes. The term "Swedish" massage is actually only recognized in English and Dutch speaking countries, and in Hungary. Elsewhere the style is referred to as "classic massage".

Clinical studies report that Swedish Massage can effectively reduce low back pain and the effectiveness can last for as long as 15 weeks. One study reported that Swedish Massage caused reduction in salivary cortisol indicating its role in management of stress and improvement in mood.

Thai massage

Known in Thailand as ??????????? (Nuat phaen boran, IPA: [nû?t p???:n bo:ra:n]), meaning "ancient/traditional massage", traditional Thai massage (Nuad Boran) is generally based on a combination of Indian and Chinese traditions of medicine.

Thai massage - or Nuat Thai - combines both physical and energetic aspects. It is a deep, full-body massage progressing from the feet up, and focusing on sen or energy lines throughout the body, with the aim of clearing blockages in these lines, and thus stimulating the flow of blood and lymph throughout the body. It draws on yoga, acupressure and reflexology.

Thai Massage is a popular massage therapy that is used for management of conditions such as musculoskeletal pain and fatigue. Thai Massage involves a number of stretching movements that improve body flexibility, joint movement and also improve blood circulation throughout the body. In one study scientists found that Thai Massage showed comparable efficacy as the painkiller ibuprofen in reduction of joint pain caused by osteoarthritis (OA) of the knee.

Traditional Chinese massage

Massage of Chinese Medicine is known as An Mo (??, pressing and rubbing) or Qigong Massage, and is the foundation of Japan's Anma. Categories include Pu Tong An Mo (general massage), Tui Na An Mo (pushing and grasping massage), Dian Xue An Mo (cavity pressing massage), and Qi An Mo (energy massage). Tui na (??) focuses on pushing, stretching, and kneading muscles, and Zhi Ya (??) focuses on pinching and pressing at acupressure points. Technique such as friction and vibration are used as well.

Trigger point therapy

Sometimes confused with pressure point massage, this involves deactivating trigger points that may cause local pain or refer pain and other sensations, such as headaches, in other parts of the body. Manual pressure, vibration, injection, or other treatment is applied to these points to relieve myofascial pain. Trigger points were first discovered and mapped by Janet G. Travell (President Kennedy's physician) and David Simons. Trigger points have been photomicrographed and measured electrically and in 2007 a paper was presented showing images of Trigger Points using MRI. These points relate to dysfunction in the myoneural junction, also called neuromuscular junction (NMJ), in muscle, and therefore this technique is different from reflexology, acupressure and pressure point massage.

Tui na

Tui na is a Chinese manual therapy technique that includes many different types of strokes, aimed to improve the flow of chi through the meridians.

Watsu

Watsu, developed by Harold Dull at Harbin Hot Springs, California, is a type of aquatic bodywork performed in near-body-temperature water, and characterized by continuous support by the practitioner and gentle movement, including rocking, stretching of limbs, and massage. The technique combines hydrotherapy floating and immersion with shiatsu and other massage techniques. Watsu is used as a form of aquatic therapy for deep relaxation and other therapeutic intent. Related forms include WaterDance, Healing Dance, and Jahara technique.

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Facilities, equipment, and supplies

Massage tables and chairs

Specialized massage tables and chairs are used to position recipients during massages. A typical commercial massage table has an easily cleaned, heavily padded surface, and a horseshoe-shaped head support that allows the client to breathe easily while lying face down and can be stationary or portable, while home versions are often lighter weight or designed to fold away easily. An orthopedic pillow or bolster can be used to correct body positioning.

Ergonomic chairs serve a similar function as a massage table. Chairs may be either stationary or portable models. Massage chairs are easier to transport than massage tables, and recipients do not need to disrobe to receive a chair massage. Due to these two factors, chair massage is often performed in settings such as corporate offices, outdoor festivals, shopping malls, and other public locations.

Warm-water therapy pools

Temperature-controlled warm-water therapy pools are used to perform aquatic bodywork. For example, Watsu requires a warm-water therapy pool that is approximately chest deep (depending on height of the therapist) and temperature-controlled to about 35 °C (95 °F).

Dry-water massage tables

A dry-water massage table uses jets of water to perform the massage of the client's muscles. These tables differ from a Vichy shower in that the client usually stays dry. Two common types are one in which the client lies on a waterbed-like mattress which contains warm water and jets of water and air bubbles and one in which the client lies on a foam pad and is covered by a plastic sheet and is then sprayed by jets of warm water, similar to a Vichy shower. The first type is sometimes seen available for use in malls and shopping centers for a small fee.

Vichy showers

A Vichy shower is a form of hydrotherapy which uses a series of shower nozzles which spray large quantities of water over the client while they lie in a shallow wet bed, similar to a massage table, but with drainage for the water. The nozzles may usually be adjusted for height, direction, and temperature to suit the client's needs.

Cremes, lotions, gels, and oils

Many different types of massage cremes, lotions, gels, and oils are used to lubricate and moisturize the skin and reduce the friction between skin (hands of technician and client).

Massage tools

A body rock is a serpentine-shaped tool, usually carved out of stone. It is used to amplify the therapist's strength and focus pressure on certain areas. It can be used directly on the skin with a lubricant such as oil or corn starch or directly over clothing.

Bamboo and rosewood tools are also commonly implemented. They originate from practices in southeast Asia, Thailand, Cambodia, and Burma. Some of them may be heated, oiled, or wrapped in cloth.

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Medical and therapeutic use

The main professionals that provide therapeutic massage are massage therapists, athletic trainers, physical therapists and practitioners of many traditional Chinese and other eastern medicines. Massage practitioners work in a variety of medical settings and may travel to private residences or businesses. Contraindications to massage include deep vein thrombosis, bleeding disorders or taking blood thinners such as Warfarin, damaged blood vessels, weakened bones from cancer, osteoporosis, or fractures, bruising, and fever.

Practitioner associations and official recognition of professionals

The US based National Center for Complementary and Alternative Medicine recognizes over eighty different massage techniques. The most cited reasons for introducing massage as therapy have been client demand and perceived clinical effectiveness.

Associated methods

Many types of practices are associated with massage and include bodywork, manual therapy, energy medicine, and breathwork. Other names for massage and related practices include hands-on work, body/somatic therapy, and somatic movement education. Body-mind integration techniques stress self-awareness and movement over physical manipulations by a practitioner. Therapies related to movement awareness/education are closer to dance and movement therapies. Massage can also have connections with the New Age movement and alternative medicine as well as holistice philosophies of preventative medical care, as well as being used by mainstream medical practitioners.

Beneficial effects

Peer-reviewed medical research has shown that the benefits of massage include pain relief, reduced trait anxiety and depression, and temporarily reduced blood pressure, heart rate, and state of anxiety. Additional testing has shown an immediate increase and expedited recovery periods for muscle performance. Theories behind what massage might do include blocking nociception (gate control theory), activating the parasympathetic nervous system, which may stimulate the release of endorphins and serotonin, preventing fibrosis or scar tissue, increasing the flow of lymph, and improving sleep, but such effects are yet to be supported by well-designed clinical studies.

Massage is hindered from reaching the gold standard of scientific research, which includes placebo-controlled and double blind clinical trials. Developing a "sham" manual therapy for massage would be difficult since even light touch massage could not be assumed to be completely devoid of effects on the subject. It would also be difficult to find a subject that would not notice that they were getting less of a massage, and it would be impossible to blind the therapist. Massage can employ randomized controlled trials, which are published in peer reviewed medical journals. This type of study could increase the credibility of the profession because it displays that purported therapeutic effects are reproducible.

Single-dose effects

Pain relief: Relief from pain due to musculoskeletal injuries and other causes is cited as a major benefit of massage. A 2015 Cochrane Review concluded that there is very little evidence that massage is an effective treatment for lower back pain. A meta-analysis conducted by scientists at the University of Illinois at Urbana-Champaign failed to find a statistically significant reduction in pain immediately following treatment. Weak evidence suggests that massage may improve pain in the short term for people with acute, sub-acute, and chronic lower back pain.
State anxiety: Massage has been shown to reduce state anxiety, a transient measure of anxiety in a given situation.
Blood pressure and heart rate: Massage has been shown to temporarily reduce blood pressure and heart rate.

Multiple-dose effects

Pain relief: Massage may reduce pain experienced in the days or weeks after treatment.
Trait anxiety: Massage has been shown to reduce trait anxiety; a person's general susceptibility to anxiety.
Depression: Massage has been shown to reduce subclinical depression.

Neuromuscular effects

Massage has been shown to reduce neuromuscular excitability by measuring changes in the Hoffman's reflex (H-reflex) amplitude. A decrease in peak-to-peak H-reflex amplitude suggests a decrease in motoneuron excitability. Others explain, "H-reflex is considered to be the electrical analogue of the stretch reflex...and the reduction" is due to a decrease in spinal reflex excitability. Field (2007) confirms that the inhibitory effects are due to deep tissue receptors and not superficial cutaneous receptors, as there was no decrease in H-reflex when looking at light fingertip pressure massage. It has been noted that "the receptors activated during massage are specific to the muscle being massaged", as other muscles did not produce a decrease in H-reflex amplitude.

Massage and proprioception

Proprioceptive studies are much more abundant than massage and proprioception combined, yet researchers are still trying to pinpoint the exact mechanisms and pathways involved to get a fuller understanding. Proprioception may be very helpful in rehabilitation, though this is a fairly unknown characteristic of proprioception, and "current exercises aimed at 'improving proprioception' have not been demonstrated to achieve that goal". Up until this point, very little has been studied looking into the effects of massage on proprioception. Some researchers believe "documenting what happens under the skin, bioelectrically and biochemically, will be enabled by newer, non-invasive technology such as functional magnetic resonance imaging and continuous plasma sampling".

Regulations

Because the art and science of massage is a globally diverse phenomenon, different legal jurisdictions sometimes recognize and license individuals with titles, while other areas do not. Examples are:

Registered Massage Therapist (RMT) Canada
Remedial Massage Therapist (RMT) New Zealand
Certified Massage Therapist (CMT) New Zealand
Licensed Massage Practitioner (LMP)
Licensed Massage Therapist (LMT)
Licensed Massage and Bodywork Therapist (LMBT) North Carolina
Therapeutic Massage Therapist (TMT) South Africa

In some jurisdictions, practicing without a license is a crime.

Canada

In regulated provinces massage therapists are known as Registered Massage Therapists, in Canada only four provinces regulate massage therapy: British Columbia, Ontario, Newfoundland and Labrador, and New Brunswick. Regulated provinces have, since 2012, established inter-jurisdiction competency standards. Quebec is not provincially regulated. Massage therapists may obtain a certification with one of various associations operating. There is the Professional Association of Specialized Massage Therapists of Quebec, also named Mon Réseau Plus, which represents 6,300 massage therapists (including orthotherapists, naturotherapists and others), the Quebec Federation of massage therapists (FMQ), and the Association québécoise des thérapeutes naturels; however, none of these are regulated by provincial law.