HISTORICAL CULTURAL AND PHILOSOPHICAL APPROACHES TO MASSAGE

This essay looks at the history (the roles in the development of massage and the scandals of the 1800s), cultural (Eastern versus Western and Maori techniques), philosophical approaches to massage (body, body-mind, body-mind-spirit) and the development of professional massage in New Zealand.

Comparison of the Development of Massage in the Eastern & Western Traditions
Western massage is based on Swedish massage (which consists of deep and soft tissue) and has a physical, and physiological approach. However, Eastern massage use treatment developed from traditional techniques, based on the holistic approach of physical, emotional, psychological and spiritual. There is generally no use of lubricant and they use compression, stroking and stretching techniques.

History in the Development of Massage in the Western Tradition
Hippocrates of Cos (460 to 375 BC) a Greek physician became known as the “Father of Medicine”. He believed that illness had a physical and rational explanation. He described and recorded medical techniques and practices including many massage techniques. Massage should be directed toward the centre of the body or toward the heart to eliminate waste products from the body.

Galen of Pergamon (c. AD 130 to 200) a Roman physician who studied medicine and who was later a follower of Hippocratic medicine. He was the first to relate anatomy and physiology and contributed much of his early writing on massage.

Ling, Pehr Henrik (1776-1839) a Swedish physiologist and gymnastics instructor, his primary focus was on gymnastics applied to the treatment of disease and injury. He blended massage with physiology. According to Salvo (2007), Ling is regarded as the “Father of Swedish Massage”. Swedish massage and Swedish gymnastics were noted to improve circulation, relieve muscle tension, improve range of motion, and promote general relaxation.

Mezger, Johann (1817-1893) a Dutch physician was responsible for making massage a fundamental component of physical rehabilitation. Being a physician he was able to promote massage using a medical and scientific basis and was successful in getting the medical profession to accept massage as a treatment for disease and illness. The introduction of Effleurage, Petrissage and Tapotment were accredited to Mezger.

Kellogg, John Harvey (1852-1943) wrote numerous articles and books on massage and published “Good Health” magazine. His efforts helped popularize massage in the United States.

Vodder, Dr. Emil a Danish physiotherapist in the 1930’s developed the method of Manual Lymph Drainage, an effective massage technique.

Cyriax, Dr. James was the first to thoroughly and systematically study soft tissue lesions of the orthopedic system, and devise a specific massage technique for their treatment. The technique is also called deep transverse friction and is used for treating muscles, tendons, ligaments, and joint capsules.

Travell, Dr. Janet the first woman ever to serve as the White House Physician pioneered a technique known as “trigger-point” release.

Comparison of Maori Massage – Miri Miri versus Romi Romi

Miri Miri
This traditional Maori approach for wellbeing has been practiced by Maori for over 700 years. It includes elements of spirituality, energy balancing, therapeutic massage, deep tissue massage and relaxation massage and according to Muru (2008) “Koo Miri is the process of Koorerorero (talking) is used to find the ‘core’ emotional bindings that dis-able, dis-empower and keep dis-cord rife. These are mainly emotional experiences behind physical, psychological or mental ailments. Through the use of the third eye one is able to identify issues and bring about change as well as healing. “Taa Miri” according to Muru (2008) is to read and listen to the body. This is mainly where we see the trauma trapped within the body i.e. hip bones – imbalance of energy, male/female energy askew.

Romi Romi
Is the use of elbows, hands, knees, feet, raaku (stick/wood), kohatu/toka (stones) and, moana (seawater), to do very deep tissue body work (McQuillan, 2009)

Massage Scandals of the 1800’s and Impact on the Massage Industry
In the 1890’s massage had become well recognized, and with this growth there was an increase for the need of trained therapists. Consequently, there was an increase in training facilities and the market soon became saturated with therapists. As there were varying educational standards, massage parlors falsely advertised “massage” and exploited those from poor neighborhoods (who were trying to pay debt off from their training) which in turn then became known as prostitutes. This rapidly reduced the reputation of massage.

Development of Professional Massage in NZ
In 1985 Bill Wareham formed MINZ (Massage Institute of New Zealand) from massage therapists called in from the greater Auckland area. Their focus was education, standards and annual conferences for skill development. In 1989 Jim Stanford established NZATMP (New Zealand Association of Therapeutic Massage Practitioners) and as McQuillan (1990) advises “he saw the need for a professional association for therapeutic massage practitioners in New Zealand”. Their focus was education, professional image, distribution of information, and to increase public awareness of massage therapy. In the late 1990’s NZATMP changed its name to TMA (Therapeutic Massage Association). With this came a change of focus to support and represent the needs of the qualified therapist and be a voice for the massage industry (McQuillan, 2009). In 2007 MINZ (Massage Institute of New Zealand) and TMA joined together to form MNZ (Massage New Zealand). Today, educational standards are rising, educational opportunities are increasing and there is a growing acceptance amongst other healthcare professionals.

Contemporary Massage
Contemporary massage has been developed from traditional techniques and a physiological theory. Treatment often focuses on the body (physiological). It is based on Swedish massage including trigger-point release (interaction between nerves and muscles), myofascial release (deep strokes to relieve chronic muscle tension), and Lymphatic Drainage (stimulate the flow of lymph fluid).

Philosophical Approaches to Massage

BODY – “Treatment focuses on the body and on the effects of massage within the body.” (McQuillan, 2009). The mind is not a factor. Healing is more of a physical approach in Western traditions.

BODY-MIND – “Any therapy exercising the effects of consciousness solely within the individual body” (Dossey, 2000). The way we think affects our body e.g techniques such as counseling and hypnosis. The perception you give your client from the initial consultation and the overall experience that goes beyond the physical manipulation.

BODY-MIND-SPIRIT – “The body mind spirit approach often incorporates a spiritual dimension into health. Your actions operate within a spiritual context (e.g. Karma) and may have physical consequences. You may be affected by spiritual beings”. (McQuillan, 2009). Eastern techniques adopt these principles and attempt to affect the person’s energetic state by channeling positive energy to their client through feeling and touch. It also incorporates a spiritual dimension into health.

Massage is a growing industry in our society that is slowly shaking-off an unethical image that was unfortunately inherited from the past. It has been interesting researching how massage has evolved and the techniques used in the Eastern and Western world. Most of the techniques used in the past are still being adopted today, and it is still evolving. We as Massage Therapist’s need to educate people on its many benefits to ensure the health and well-being of our client’s are being maximized.


REFERENCES
Muru, A. (2008). Retrieved June, 09 2009 from http://ata-rangi.com/

Salvo, S. (2007). Massage Therapy Principles & Practice (3rd ed.). A Historical Perspective of Massage. Missouri: Saunders Elsevier

McQuillan, D. (2009). Fundamentals of Massage. Dunedin, New Zealand: Otago Polytechnic.

Dossey, L. (2000). Reinventing Medicine. Element Books Ltd. Shaftesbury, Dorset.

RESOURCES
Suite10.com. Hippocrates & Massage History. Retrieved June, 09 2009 from http://massagetherapy.suite101.com/article.cfm/hippocrates_and_massage#ixzz0HuhzyySq&D

SUSTAINABLE MASSAGE PRACTICE

There are several definitions of sustainability, one understanding of it is “a type of progress that meets the needs of the present without compromising the ability of future generations to meet their needs” (CES, 2006). The following are examples of economic, human, social and environmental sustainability that are relative to me and my massage practice.

From an economic point of view, the reasons I have decided to build my own massage practice are for the following benefits:

* Set my own hours
* Be my own boss
* Focus on approaches to care, or types of treatment that I prefer
* Make more of the money from my massage therapy sessions

The first step requires investment in some supplies and equipment. Determining what type of service I want to offer the Client will allow me to maximize the impact of my purchase. Initially, as I am a student, I want to spend the least amount of money possible on my equipment to get my business off the ground. Running my own massage practice will eventually require earning an appropriate income to keep my practice afloat. To sustain my practice I need to set goals. By balancing the number of appointments, hours booked, pricing for appointments, and practice expenses will determine my income requirement.

The second step will be my training and credentials. Completing my Diploma in Massage Therapy and by becoming a member of MNZ will ensure my clients feel safe in the knowledge that I am following certain ethical standards. By applying the following ethics will help establish a professional practice based on trust and credibility:

* Client-centered care
* Informed consent
* Scope of Practice
* Confidentiality
* Boundaries
* Power Differentials
* Relationships
* Transference & Counter-transference

By reducing pain, relieving stress and cleaning out toxins, to name a few, will have a positive effect on my client and their human relationship with others. Positive people attract positivity. Educating my client to be body aware and encouraging my client to push play, and by giving them stress management/therapeutic exercises, will help to support my clients health and well-being. From an Employers perspective, providing and promoting training to your staff member by managing their workloads and avoiding over-booking, and encouraging self-care training will help to ensure their health needs are being met. This, in turn, will transfer positivity to the client. On the flip side, by good body mechanics, regular exercise, including stretching and strength work and being nutritionally aware will support my own health.

The third step is to form social referral partnerships with key professionals, which is a long-term and sustainable way to build a business. There are two types of referral partnerships: primary & secondary. Primary partnerships are formal, professionally structured relationships. The partnership has to be a win, win, win and has to benefit the therapist, your referral partner and their client. Secondary partnerships are more casual; for example, leaving your business card at a business that can be reciprocated.

Finally, environmental sustainability - “Environmental sustainability is the ability to maintain the qualities that are valued in the physical environment” (CES, 2006). An ideal society satisfies the needs of its people, without depleting or degrading its natural resources. The following are examples of environmental awareness that I am implementing in my massage practice:

* Using energy saver light bulbs.
* Washing linen in cold water, hanging on the line and avoiding the use of a drier. I am now using sheets as a preference to towels as they dry a lot quicker.
* Bio-degradable cleaning products used on my equipment, bathroom and also around the home.

By building relationships with my clients based on trust, and understanding and anticipating their future needs will help me achieve my goal in forming a successful, sustainable massage practice.

REFERENCES

Commissioner for Environmental Sustainability (CES), 2006. What is Environmental Sustainability. Retrieved May 24, 2009, from http://www.ces.vic.gov.au/ces/wcmn301.nsf/Home+Page/Default~newhome?open

TIME MANAGEMENT

Time Management is something we all do as individuals on a daily basis to a certain level, at some point in our lives, even without realizing it. Getting out of bed in the morning, eating, going off to primary school, tertiary education, work, hobbies or sport etc., all require a certain timeframe.

I initially thought my time management skills were reasonably good, but it didn’t take me long to discover what I thought was time management, was only the tip of the iceberg. For me personally, time management is a skill that I have had to learn and still am learning (with the help of the tutorials that have been on offer at Polytech, Elluminate sessions incorporating resource material supplied by David McQuillan and MindTools (1995-2009)). By no means has it come naturally. When I first started the course in Massage Therapy I had no idea of the intensity or balance that was going to be required of me. I don’t really know what I expected, but it certainly has not been to the degree that has unfolded.

Finding the right balance in my life and balancing my study with the busy demands of a young family and my own personal needs has been challenging, to say the least. There is just not enough time in the day! But I am also very aware of over-committing myself. Being the practical person that I am, ideally I would prefer to devote a lot more time to practical massage, which I am only managing to squeeze in here and there. My family is also very important to me, they too have had to make sacrifices due to my new “study” life. Hence, I am mindful of not spending enough quality time with my family (tears coming to my eyes). Stress has not only put a strain on me but my family as a whole. Therefore, time management is something that I am continuously working hard at. I have a daily, weekly and year planner that I am constantly referring to. I am genuinely pretty good at sticking to my daily planner, but it is not always set in concrete. Due to sickness or other matters arising there is a definite need for flexibility.

My daily routine starts at the breakfast table when I consult my schedule to see what muscle I need to learn for the day. Once the boys are at school I try to be seated at my desk by 9am, as if I was in a virtual classroom, ready to start the next assignment on my daily planner (which I have prioritized and incorporated variety). As I have structured my study between the hours of 9am to 3pm I need to be self disciplined. There are times outside of these hours, for instance when I am preparing dinner, for revision of anatomy from the day. I also study at nights or weekends to catch up on or complete a task that has taken me a lot longer than I had anticipated. A “to do list” has also helped me as I have got so much going on in my head that I am forgetting about other commitments outside of my study, which I normally would have remembered.

One of my weaknesses, at present, is procrastination. It is easy to keep putting my study off by doing something else that is more enjoyable/easy. If someone had of said to me 3 months ago that I would be able to write a 1000 word essay I would have laughed and replied “ARE YOU SERIOUS???!!!”. This also comes down to self confidence and belief. Although, once I get started on my study I sometimes find it hard to stop.

This course has been a radical change in my career/life. I understand and know that it is going to take time and patience to develop good study habits. “Investing in time management activities will actually save you time, helping you work smarter, not harder…” (MindTools, 1995-2009). My self-discipline and motivation, together with my time management, is what is going to help me achieve my Diploma. By next term I am anticipating that I will be working a lot “smarter”. This will prepare me even more for the year ahead..


REFERENCES

MindTools. (1995-2009). Time Management. Retrieved May 20, 2009 from http://www.mindtools.com/pages/main/newMN_HTE.htm

THE ETHICS OF PROFESSIONAL PRACTICE

As within any profession, certain ethical and moral standards are set, and none more so to an individual Massage Therapist. As a massage professional, by staying within the boundaries that are set between you and your Client, or a profession as a whole, you can ethically serve clients best by understanding their rights and needs. Ethics is defined, “as a moral principle or set of moral values held by an individual or group” (Collins, 1991). The following are Ethics for a Massage Therapist to consider:

Client-Centered Care
Focusing on the best interests of the Client by providing the highest quality of service possible. Most importantly identifying their goals and aiming to meet those goals will help in the process to make them feel safe and well-attended. By sharing in the decision-making process and the planning of the course of treatment with your client will build a professional relationship based on trust and respect.

Informed Consent
The Client should always consent to any treatment that they receive (defined in the Health & Disability Commissioners Act, 1994) and understand exactly what they are agreeing to e.g. clinical procedures (before, during and after the massage), terms of payment, record taking and assessment and the likely effects of massage. If the Client is a minor, consultation with the care-giver and getting them to observe throughout the treatment process would be advisable. This can also apply to a client with a disability.

Scope of Practice
Knowing our own limits and physical abilities (training and experience) when forming a professional relationship with a client ensures the client safety. If the treatment the client is requiring is outside our knowledge, recognize this and refer a client elsewhere if or when the need arises. “Taking on a client whom we cannot serve well is unethical” (Salvo, 2007).

Confidentiality
The Client’s name, details of their treatment and information shared during sessions must NOT be divulged to anyone (Privacy Act 1993). If a third party (other healthcare provider) is involved and wanting to access the Client’s records, written consent MUST be obtained from the Client first before releasing them. Also, avoid initiating contact with a client in a social setting as this too is a breach of confidentiality.

Boundaries
“Boundaries clarify each person’s role, responsibilities, expectations, and limitations…”. “Being aware of boundaries and limitations is crucial to having healthy relationships…” (Salvo, 2007). By having client and therapist boundaries it defines our personal and professional space – our sense of autonomy. These professional boundaries should be communicated with your client which will promote the trust necessary for a therapeutic relationship.

Power Differentials
Power Differentials can be physical or psychological. If the client is lying down in an inferior position and the therapist is standing in a superior position this can create an impression of authority. This is usually not a problem, however, problems can arise when the therapist uses their power in their own interests rather than the clients. Also, if the client is in a deep state of relaxation the client may not be able to say no easily.

Relationships
The relationship between client and therapist needs to be approached by a treatment plan that acknowledges, respects and focuses on the needs and expectations of the client. Relationships also go beyond client care by encompassing professional relationships with health care providers or physicians from referral.

Transference & Counter-transference
Transference can occur when the client makes the professional relationship personal. They may start thinking of you as more than just a friend. This can be transferred by acts of kindness (gifts), talking about their personal life and asking for advice. They may even ask you on a date. As a therapist you need to deal with transference issues in a mature, ethical manner by setting boundaries. You may even consider referring the client to another therapist. Another option could be to seek help from a professional supervisor.

Counter-transference is when the therapist transfers their feelings towards their client. By having a “bad day” you can subconsciously transfer negative feelings toward your client. Another example is the therapist is unable to separate the therapeutic relationship from their personal feelings surrounding the client by feeling inadequate if the client is not making progress with the treatment they are providing for them.

By demonstrating the commitment to provide the highest quality massage therapy to those who seek our professional service and adhering to the ethical relationship between yourself and client will be important in building a successful practice.

REFERENCES

Salvo, S. (2007). Massage Therapy Principles & Practice (3rd ed.). Missouri: Saunders Elsevier

Collins, (1991). The Collins Dictionary & Thesaurus. Glasgow: HarperCollins Publishers

THE EFFECT OF MASSAGE STROKES

EFFECTS OF MASSAGE ON THE AUTONOMIC NERVOUS SYSTEM

The Autonomic Nervous System (ANS) …”innervates smooth muscle, cardiac muscle, and glands, and it controls the circulation of blood, activity of the gastrointestinal tract, body temperature, respiration rate, and many other functions”. Salvo (2007). Our ANS can be divided into two parts – Sympathetic Nervous System and Parasympathetic Nervous System.

The Sympathetic Nervous System (SNS) serves all parts of the body. It is generally associated with the fight/flight response activating our muscularskeletal system to fight and run away from a threat. Our eyes become aware, heartbeat speeds up, adrenalin secreets, abdomen shuts down and muscles involve. Faster massage techniques such as tapotement and vibrating can speed up the SNS.

The Parasympathetic Nervous System (PNS) is confined to the head and trunk and restores it to the original state it was in prior to sympathetic stimulation. Basically it does the opposite of SNS and rests our digestive system, decreases anxiety and stress hormones which help us to relax and stay calm. By applying a slower stroke like effleurage it can reduce our PNS.

Therefore, massage plays an important part by either releasing stimulation triggers of histamine which causes blood to flow to the area or it can have a soothing effect which reduces stress on our nervous system. Massage is also believed to reduce anxiety, decrease depression and relieve muscle tension.

EFFECTS OF MASSAGE STROKES

The effects of massage strokes can vary depending on the movement – tension or torsion (i.e. stretching or twisting) and compression (light to moderate or deep pressure which helps fluids release into our veins which then travel back to the heart for elimination). These can be broken down to Mechanical - meaning it has a physical effect which breaks down adhesions and moves fluids, and Reflexive - a reflex action which works thru the nervous system affecting your internal, hormone and chemical balance. Below are the various strokes you can apply to your massage:

Touch/Holding
By touching or holding your client can be an introduction at the beginning of the massage to establish contact in a non-threatening way and at the end of the massage to ease off pressure and come to a stop. It can also be used through the massage if you need some processing time.

Effleurage
Effleurage is a continuous, long stroke towards the heart to help increase circulation. It can also be used initially to spread oil. The most common way is the same direction as muscle fibre which stretches the tissues out and flushes out lactic acid depending on the pressure, this is called Longitudinal. It can also be used as a Transverse (90º to Longitudinal) where it is good at breaking apart fascia adhesions. A light to moderate pressure has a relaxing effect and also flushes out the lymphatic. Deep affects the blood flow and helps blood move in and out of arteries.

Petrissage
Strokes involved with Petrissage are cross-overs, kneading and wringing. They can help reduce soreness or stiffness by stimulating the circulation of blood and lymph. Lifting tissues and twisting creates lengthening in tissues. It also helps to squeeze out blood and lymph fluid and creates fresh lymph and blood into the area. It is very intense on your body so should not be used on a regular basis.

Compression
When compressing belly of muscle you are stretching the muscle. A fast compression will stimulate muscle and increase the tension and a slower compression has a more relaxing effect.

Tapotement
Is highly stimulating due to its quick staccato movement and mostly affects your reflexes and puts the body back into Sympathetic mode. Tapotement can be hacking, cupping and pounding. Area to avoid is the kidneys.

Vibration
Vibration is applied with full hands or your fingertips which stimulates circulation. If pressure is applied it can be soothing.

MISCELLANEOUS EFFECTS OF MASSAGE

Blood Flow – increases blood circulation which aids in the delivery of nutrients and oxygen to cells and tissues.

Lymph Flow – the movement of adjacent tissues is important as it transports lymph through the lymphatics which cause it to flow more rapidly thus aid in returning leaked tissue fluids back to the heart.

Muscle Tension – massage enhances blood circulation, increasing the amount of oxygen and nutrients to the muscles which reduces muscle fatigue and soreness. It also relieves muscle tightness and stiffness. By increasing the muscle length it improves flexibility and range of motion.

Connective Tissue – connective tissue provides nutrition and oxygen to itself and nearby tissues i.e. skin and muscle. It can defend the body against disease or support the framework. Under stress they can develop fascia, adhesion and keloid/scar formations. By applying deep massage it can reduce keloid formation, decrease scar and adhesion formation. It can also release fascial restrictions.

Sleep Patterns – Sleep disorder can impair our ability to heal. By massaging, ideally at night, it can enhance a deeper sleep and leave you feeling more rested after waking.

Digestion – massage helps to increase contractions that mix and propel materials in the gastrointestinal tract which helps move the contents of our bowel for elimination. Thus aids constipation, relieves colic and intestinal gas and stimulate digestion.

Blood Pressure – is decreased by the blood vessel dilation.

Pain – massage stimulates endorphins which are pain-relieving substances.

Mood – can help to improve your mood by giving you renewed energy and decreasing anger from dopamine and serotonin release.

Concentration – your mental alertness is increased by relaxing the body and mind and removing stress from increased blood flow due to increased oxygen levels to the brain.

Satiety – touch promotes acceptance which can satisfy the emotional needs of the client.

Bonding – a reciprocal relationship between the client and therapist which is strengthened with touch which is released by the oxytocin hormone.


REFERENCES
Salvo, S. (2007). Massage Therapy Principles & Practice (3rd ed.). Missouri: Saunders Elsevier

Class Notes

The Story of Stuff

To be honest I thought as a family we were doing “our bit” in helping reduce harmful effects on the environment until I watched this video, but now I realise I am just your average consumer sucked into buying the latest and greatest and keeping up with the never ending, changing fashion trends! Up until now our family has always been strict on recycling (incl having our own compost heap), growing our own organic "pesticide free” garden and more importantly reducing our water consumption.

My biggest concern however is WATER, our most valuable resource. In the video it states 40% of the USA’s waterways are undrinkable! Just think of how much we humans are dependent upon clean water. Besides the fact that we drink the water, we use it for electricity, irrigation of farm fields, cooking, washing clothes, flushing toilets, etc. Did you know the Earth's surface is covered by 70% water, so why the fuss of protecting our water? Only 3% of all water is fresh and drinkable and of that 3%, 75% is frozen, which leaves a grand total of only 1% of the Earth's surface water that is readily available for consumption. After taking that fact into account, one can see why the conservation and protection of our remaining water supply is so vital. Water is a necessity of life and it needs to be conserved and protected.

We as consumers need to create a new path and unite to transform and reclaim the linear concept. I will certainly now be thinking twice and more cautiously about throwing out the ‘old’ so I can keep up with the ‘new’. Lets stop wasting our resources so future generations to come can also enjoy a clean, green planet..

Hi from St Clair, Dunedin where I was originally born but I have also resided in Palmerston North, Ashburton & Auckland for a period of 13 years.

My main interests include netball, squash, running and hanging out with my family which includes two busy and sporting young boys.

I am interested in studying massage as I have had alot of sporting injuries over the years and massage was my main treatment that I found the most beneficial. I am interested in the human anatomy and like the idea of being able to heal other people.

After I graduate I would ideally like to set up my own massage clinic from home but also have the flexibility of being mobile.