1 Massage in context

The philosophy of massage

A practitioner of massage may choose to be either a technician or a therapist. A technician is competent to administer massage as a manual skill. A therapist, in addition to being competent in the manual techniques, understands human anatomy, physiology, pathology and psychosocial issues, and will apply this knowledge when practising massage. For the therapist, massage is one tool available for her to choose when, following a full assessment of the client’s needs, an evaluated problem-based treatment plan is designed. This book is intended for those who aspire to be therapists.

The image of massage, as frequently presented in the media, is of a mystical technique which is practised by intuition. Experienced therapists may appear to work intuitively but they are, in reality, applying previously learned and internalised knowledge. It is that vast pool of clinical experience which a proficient therapist draws on during her working day, expanding and modifying her internal memory base as new knowledge is acquired. In its real sense, ‘intuition’ means immediate unreasoned perception; to state that massage is intuitive is to imply that it can be practised by the use of instinctive actions in the absence of any reasoning.

Instinctual massage is not the way of the professional therapist, whose skills are grounded upon both sound biological and scientific principles and experience gained in clinical practice. This does not invalidate the ‘feel-good’ factor of massage, which can be as important as any therapeutic effect—massage can both feel good and be of therapeutic value: there is no reason why these two objectives should be mutually exclusive. Of course, these principles need apply only to the professional therapist. Family members, friends and participants in group therapy may have other objectives, such as the giving and receiving of caring touch to promote interaction and feelings of well being. These aims may also apply to massage with certain client groups, such as people with learning disabilities.

Massage and holism

Holistic health care practice is an approach to treatment which recognises the inseparable wholeness of the human organism and views it in the context of its environment, the implication being that every aspect of human functioning interacts with every other aspect and that to isolate one component for therapeutic purposes means that their complex interactions are ignored. Holism is the antithesis of the dualistic Cartesian division of mind and body, which has been integral to the development of Western medicine. Although the concept of holism is not new in global terms, it is only relatively recently that it has been accepted in the West and, in common with other new converts to a cause, we have embraced the idea with enthusiasm without always being aware of the implications. Therapists who work holistically must, by definition, have a detailed knowledge of all the body systems to enable them to coordinate the responses of these systems with a therapeutic intervention. Clearly, this is the opposite of working instinctively and in the absence of a broad knowledge base; massage in those circumstances restricts both the recipient and the therapist to an emotional level only, which is not considered to be holistic.

Properly trained and experienced therapists are able to influence the health of the whole person by using appropriate techniques to achieve the desired effect. For example, they will decide at which interface in the tissues it is necessary to work, light pressure affecting only the epidermis while heavier pressure affects progressively the dermis, fascia, muscle, tendon, ligament, viscera, periosteum of bone and their attendant reflexes. The technique to be utilised will be determined by thorough assessment of the patient, together with the employment of intellectual and clinical skills that are sensitive to both psychosocial and physical needs.

Complementary or orthodox?

Is massage a complementary or an orthodox therapy? Certainly there is ample evidence that massage has been used, at least since the early twentieth century, as part of mainstream medicine for orthopaedic rehabilitation. In England in 1895 the Society of Trained Masseuses was founded to increase the status of massage and of the professionals who practised the technique under the supervision of medical doctors. In 1907, Araminta Ross, the principal of the Dublin School of Massage, wrote The Masseuse’s Pocket Book, a small textbook describing the various strokes of massage and how they are to be used for various medical conditions. British-trained physiotherapists (physical therapists) have practised massage as a ‘core skill’ since the inception of physiotherapy as a profession. Despite this history, in many areas of medicine, in the UK massage is now regarded as a complementary therapy. In palliative care, for example, it is a therapy usually administered by massage/complementary therapists who often train specifically for that purpose (MacDonald 1999). The answer to the question may lie in the definition of complementary therapy: ‘[it] is diagnosis, treatment and/or prevention which complements mainstream medicine by contributing to a common whole, by satisfying a demand not met by orthodoxy, or by diversifying the conceptual frameworks of medicine’ (Ernst et al 1995). This definition was adopted by the Cochrane Collaboration (Ernst et al 1998). Perhaps it is not the technique or the therapy which is either mainstream or complementary, but the context in which it is used and the perceived status of the therapist using it—in other words, the system of medicine in which it resides and the approach of the individual therapist. Medical systems are embedded in a cultural framework which has an overriding influence on the scientific perspective. For example, there are many similarities among Chinese, Thai and Japanese traditional medicines; therapies which have been regarded as mainstream in the East for centuries are looked upon as complementary in the West because they do not easily or immediately fit into the Western cultural medical framework.

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