REVIEW OF RELATED LITERATURE AND STUDIES
This chapter presents a review of related literature and studies, both local and foreign, that are relevant to this study.
Rubbing is probably a universal instinct. Humans and mammals know it helps sore limbs and that touch is comforting. Massage therapy is a versatile craft which grew from this instinct. It may well be one of mankind’s earliest therapies.
The Association of Massage Therapists in Australia define massage as the systematic and scientific manipulation of the soft tissues of the body for therapeutic purposes. As both a healing art and a science it can benefit every body. Massage has been found to possess the richest and most ancient heritage of all the healing arts. From these origins, scientific evidence both supports and explains the beneficial effects of massage which has developed into a sophisticated and specialized tool in today’s treatment of muscle, tendon, ligament and joint injuries.
History of Massage
Massage therapy is one of the oldest methods in the gallery of health care practices dating back up to 4,000 years. References to massage are found in Chinese medical texts 4,000 years old. Massage has been advocated in Western health care practices in an almost unbroken line since the time of Hippocrates, the “father of medicine.” In the 4th century B.C., Hippocrates wrote, “The physician must be acquainted with many things and assuredly with rubbing” (the ancient Greek and Roman term for massage).
Some of the greatest physicians in history advocated massage, including Celsus (25 B.C.-50 A.D.), who wrote De Medicinia, an encyclopedia of Roman medical knowledge that dealt extensively with prevention and therapeutics using massage; Galen (131-200), the most influential physician in the ancient, medieval, and Renaissance worlds, who addressed techniques and indications for massage in his book De Sanitate Tuenda (which is translated as The Hygiene, meaning prevention); and Avicenna (980-1037), a Persian physician who wrote extensively about massage in his Canon of Medicine, which was considered the authoritative medical text in Europe for several centuries. A sampling of other noted advocates includes Ambrose ParJ, who wrote the first modern textbook of surgery; William Harvey, who demonstrated the circulation of the blood; and Herman Boerhaave, who introduced the clinical method of teaching medicine.
People in most ancient cultures practiced some form of therapeutic touch or massage. Evidence from many countries suggests that prehistoric people massaged their muscles and rubbed plants, herbs, oils, and various substances on their bodies to heal and protect. In many cultures, special healers were said to have powers of healing by touch.
Egypt had a well-developed social structure 5,500 years ago and people may have used massage then. Imhotep, the physician and architect recorded his knowledge of aromatic oils or unguents, made by mixing aromatic plants, resins and gums with oils or fats. Middle Kingdom Egyptians used bassi massage which induced trance.
Massage possibly came to India from China. Between 1,800-500 BCE, the Vedic people developed Ayurvedic medicine. The 2,500 year old Ayurveda describes body massage with oil.
Massage is recorded in China in 3,000 B.C.Ein The Yellow Emperors Classic of Internal Medicine and Cong-Fou of the Tao-Tse. Amma was developed using pressure points. The first Chinese massage exam was in the 1st century CE at Schools of Occult Studies.
In the 6th century, Chinese techniques spread to Japan (via Korea), where Shiatsu developed. For years, blind people were the main masseurs. Thai massage is over 2,500 years old. (Today’s Chinese method is Tui-na.)Sensual massage is recorded: erotic sculptures at Khajuraho and KarmaSutra. Tantric massage is used with breathing and yoga.
In Tibet, medicine is a blend of traditional Indian and Chinese medicine and Bon (the indigenous culture’s medicine). Its practice has been endangered since the 1950’s with the Chinese communist invasion. Remnants survive in Mongolia and Russia. Tibetan remedial massage uses a herbal medicated oil or butter and is an important therapy for stress disorders
Traditional medicine of Thailand dates back some 2500 years. As with many indigenous peoples, the Thai people created their own blend of traditions and techniques, linking Ayurvedic medicine, Buddhist spiritual practice, Chinese medicine and Yoga, as well as indigenous healing practices of ancient Siam. They treated disease and disharmony of physical, emotional, and spiritual origins. Nuad Bo’Rarn is the traditional medical massage. In Kurdistan, Breema developed – similar to Thai Massage.
Assyria is an ancient country of Asia, noted for art and architecture. Assyrians developed massage treatments using garlic, tamarisk, hellebore, mandrake, cypress, resins and gums.
Greece used Egyptian massage knowledge. Receivers included athletes, women and soldiers. Writers on massage include Homer, Aesculapius, Herodotus and Hippocrates. In 326 BCE the Greeks learned Ayurvedic medicine from India.
Rome gained massage from Greece, and it spread through the ancient world. Romans liked bathing and full body massage. Roman massage writers include Asclepiades, Celsus and Galen. Receivers include Pliny and Julius Caesar, who was massaged to relieve epilepsy
By the end of the Roman empire, massage was associated with indulgence. Emperor Constantine abolished baths and gymnasia, suspecting sexual abuses. Massage study stopped in Europe, but many of Galen’s books were translated in Persia by Hunayn ibn Ishaq in the 9th century. In medieval Islam, the medic/philosopher Ibn Sina, or Avicenna included massage in his treatments.
Islanders of the South Pacific have used massage in and out of water for hundreds of years. Lomilomi is an ancient Hawaiian healing massage. Each morning families would Lomi each other to start their day in Lokahi (balance) with mind, body and spirit. Knowledge of this art was held within the family, so distinct styles have developed across the major islands. Today, Hawaiian medical massage is known for its stress relieving power.
In the Philippines, traditional medicine includes the “albularyo” or herbalist, spiritual healer; “hilot” or traditional birth attendant, bone setters and massager.
In the Sandwich Islands, kings were massaged after meals to aid digestion.
People of the Peruvian Amazon use the oil of Andiroba for massages for muscle pain and for skin disorders. It is also used in urban Brazil as a massage oil, especially by martial arts practitioners and massage therapists.
Native Americans use heat and massage with herbs to treat various problems. The Cherokee, Penias and Navaho rubbed warriors before they went to war and when they returned. Massage eases labor pains, infant colic and many other ailments. The Acoma and Laguna massaged muscles with crushed plants for cramps, the Blackfoot used an infusion of roots to massage sore breasts with warm stones and the Forest Potawatomi infused roots with lard to massage sore muscles and tendons
From the mid 1800’s, massage skills from Sweden, Germany and France were brought to the US. Therapists worked with European techniques at sanatoriums. Dr. Charles Fayette Taylor’s New York orthopedic practice specialized in Swedish massage.
In the early 20th century, massage was considered disreputable. Wilhelm Reich caused outrage by using it with psychotherapy. Diet, exercise and massage gave way to medical routine and drugs. In Britain, some massage was used for rehabilitation in Forces hospitals, and from 1945 in athletic clubs and YMCAs.
Massage therapy, as we know it today, grew from the 1960’s, emerging as a profession in the 1970’s and 80’s from schools such as the Esalen Institute in Big Sur, California.
The later 20th century has seen the creation of a range of massage techniques, including applications for personal growth, emotional release, and balance of mind-body-spirit, in addition to traditional Swedish massage. Many are American techniques from the late 1960s onward, though some appeared in the 1920s. As the health care system in the United States became more influenced by biomedicine and technology in the early 1900s, physicians began assigning massage duties (which were also labor-intensive, requiring more time to be spent with patients) to assistants, nurses, and physical therapists. In turn, in the 1930s and 1940s, nurses and physical therapists lost interest in massage therapy, virtually abandoning it. However, a small number of massage therapists carried on until the 1970s, when a new surge of interest in massage therapy revitalized the field, albeit in the realm of alternative health care. That interest has continued to the present ( 1986).
Massage therapy is the scientific manipulation of the soft tissues of the body to normalize those tissues. It consists of a group of manual techniques that include applying fixed or movable pressure, holding, and/or causing movement of or to the body, using primarily the hands but sometimes other areas such as forearms, elbows, or feet. These techniques affect the musculoskeletal, circulatory-lymphatic, nervous, and other systems of the body. The basic philosophy of massage therapy encompasses the concept of vis medicatrix naturae — that is, aiding the ability of the body to heal itself — and is aimed at achieving or increasing health and well-being.
Touch is the fundamental medium of massage therapy. While massage methods can be described in terms of a series of techniques to be performed, it is important to understand that touch is not used solely in a mechanistic way in massage therapy; there is also an artistic component. Because massage usually involves applying touch with some degree of pressure, the massage therapist must use touch with sensitivity to determine the optimal amount of pressure appropriate for each person. Touch used with sensitivity also allows the massage therapist to receive useful information about the body, such as locating areas of muscle tension and other soft-tissue problems. Because touch is also a form of communication, sensitive touch can convey a sense of caring, which is an essential element in the therapeutic relationship, to the person receiving massage. Using the wrong kind of touch — sometimes thought of as “toxic touch” — is counterproductive, tending to render a technique ineffective and to cause the body to defend or guard itself, which in turn introduces greater tension ( 1986).
Some 80 different methods may be classified as massage therapy, and approximately 60 of them are less than 20 years old. There are several reasons why this is the case.
The period of the 1940s to the mid-1970s was relatively dormant for the massage therapy profession. Little standardization was established in the field. Then in the 1970s, stimulated by changes in society such as greater interest in fitness, healthier lifestyles, personal improvement, and alternative methods of health care to complement conventional medicine, interest in massage therapy increased. An influx of new practitioners brought with them a wave of new ideas and creativity regarding ways to use hands-on techniques. Since there was little standardization, these techniques sometimes developed into freestanding methods rather than being incorporated into an existing system of classification.
Another source of new techniques was the various forms of massage native to most cultures around the world but not previously described outside each culture. For example, many of the forms of massage that come from Asia are based on concepts of anatomy, physiology, and diagnosis that differ from Western concepts.
The proliferation of methods has slowed. It is expected, as has happened in the development of other professions, that as the development of standards and credentials continues, there will be some consolidation and integration of methods.
The forms of massage therapy described in this section are either among the most widely used or representative of a group of similar practices. Several forms that include additional techniques besides massage are listed briefly here and discussed in more detail in the following sections. In actual practice, many massage therapists use more than one method in their work and sometimes combine several.
Swedish massage uses a system of long gliding strokes, kneading, and friction techniques on the more superficial layers of muscles, generally in the direction of blood flow toward the heart, sometimes combined with active and passive movements of the joints. This system is used to promote general relaxation, improve circulation and range of motion, and relieve muscle tension. Swedish massage is the most common form of massage.
Deep-tissue massage is used to release chronic patterns of muscular tension using slow strokes, direct pressure, or friction directed across the grain of the muscles with the fingers, thumbs, or elbows. It is applied with greater pressure and to deeper layers of muscle than Swedish massage.
Sports massage uses techniques that are similar to Swedish and deep-tissue massage but are specially adapted to deal with the needs of athletes and the effects of athletic performance on the body.
Neuromuscular massage is a form of deep massage that is applied specifically to individual muscles. It is used to increase blood flow, release trigger points (intense knots of muscle tension that refer pain to other parts of the body), and release pressure on nerves caused by soft tissues. It is often used to reduce pain. Trigger point massage and myotherapy are similar forms.
Manual lymph drainage improves the flow of lymph by using light, rhythmic strokes. It is primarily used for conditions related to poor lymph flow, such as edema, inflammation, and neuropathies.
The reflexology, zone therapy, tuina, acupressure, rolfing (structural integration), Trager, Feldenkrais, and Alexander methods are addressed in the following sections.
The various methods of massage therapy can be divided into two major groupings:
- Traditional European methodsbased on traditional Western concepts of anatomy and physiology, using five basic categories of soft-tissue manipulation: effleurage (gliding strokes), petrissage (kneading), friction (rubbing), tapotement (percussion), and vibration. Swedish massage is the main example.
- Contemporary Western methodsbased on modern Western concepts of human functioning, using a wide variety of manipulative techniques. These may include broad applications for personal growth; emotional release; and balance of the mind, body, and spirit in addition to traditional applications. These methods go beyond the original framework of Swedish massage and include neuromuscular, sports, and deep-tissue massage; and myofascial release, myotherapy, Bindegewebsmassage, Esalen, and manual Lymph Drainage.
In addition, there are structural, functional, and movement integration methods that organize and integrate the body in relationship to gravity through manipulating the soft tissues or through correcting inappropriate patterns of movement; methods that bring about a more balanced use of the nervous system through creating new, integrated possibilities of movement. Examples are Rolfing, Hellerwork, Aston patterning, Trager, Feldenkrais, and Alexander ( 1986).
Benefits of Massage
Massage gives people a roadmap of stress areas in their bodies. Many times people don’t know how much stress they’re carrying until they have a massage; then they’re able to feel it and let go of it. As the massage therapist stretches and loosens muscles and connective tissues, stress and muscular tension are released. Once a person has an awareness of where stress lodges in his body, he can begin to do something about it. Neuromuscular massage, often prescribed for injuries and conditions of pain, works at softening the muscles so that the therapist can move in more deeply to break up adhesions. This allows muscles to become really elastic, the way they should be. The body then may be freed of spasm and pain, increase its range of motion, and have the ability to avoid injury.
Massage has many benefits. On the physical level, it gives deep relaxation and stress reduction, relief of muscle tension and stiffness, reduces muscle spasm and tension, relief from entrapment of nerves in muscle, greater joint flexibility and range of motion, increases ease and efficiency of movement, promotes deeper and easier breathing, gives better circulation of both blood and lymph fluids, reduces blood pressure, relieves tension-related or eye-strain headaches healthier, better nourished skin, improved posture, faster healing from pulled muscles and sprained ligaments, reduces pain, swelling, and formation of scar tissue following injury and provides general health maintenance.
On the mental level, it provides a relaxed state of alertness, reduced mental stress, a calmer mind, greater ability to monitor stress signals and respond appropriately, and increased capability for clearer thinking.
On the emotional level, it gives a feeling of well-being, reduced levels of anxiety, increased awareness of mind-body connection, enhanced self image, and a sense of being unified and in harmony (http://www.bucklandmassage.com).
The Association of Massage Therapists in Australia mentions the following benefits to massage therapy, among them, the maintenance of skin health, especially for older people with frail skin. It improves oxygenation and nutrition to the basal layer of skin. It increases skin flexibility and elasticity and loosens scar tissue to maintain skin health and movement. It improves sebaceous secretion to lubricate the skin, improving its condition and texture. It relaxes the fascia on the scalp, decreasing tension and some forms of headache.
Massage Therapy maintains muscle health. It helps to maintain muscles in the best possible state of nutrition, flexibility and vitality. This speeds up muscle recovery after activity or injury. It relieves muscle restrictions, tightness, stiffness and spasm which may limit full movement. It delays muscle wasting due to disuse, for example, after a stroke or during lengthy bed rest. It encourages better muscle activity through increased movement of nutrients and removal of waste products. It relaxes muscles and other tight tissues. For example tight muscles can press on nerves causing pain and nerves can also become trapped in connective tissue. Massage relaxes muscles and other soft tissues decreasing pain due to nerve entrapment.
Massage therapy affects the cardiovascular system. It Increases local blood flow without putting additional strain on the heart. It mechanically propels blood towards the heart in sedentary people and those on long term bed-rest. It stimulates nerves which control blood vessels. Widening the blood vessels can increase blood circulation and lower blood pressure in some cases. It increases delivery of oxygen to muscle and other tissue cells and removal of waste products and decreases accumulation of metabolic waste and by-products from tissue damage and inflammation thereby assisting healing. Moreover, it also decreases heart rate through decreased stimulation of the sympathetic nervous system (“relaxation response”).
Massage therapy aids in respiration. It may slow down the rate of respiration via reduced stimulation of the sympathetic nervous system. It may also increase lung capacity and pulmonary function if these are decreased by tight primary and secondary muscles of respiration.
Massage Therapy assists the Lymphatic System. It:
- Stimulates the lymphatics when the person is immobile due to pain or when injury interferes with lymphatic drainage.
- Reduces some forms of swelling (lymphoedema) by mechanically stimulating circulation.
- Decreases swelling after injury which encourages repair and faster return to activity.
- Increases presence of natural killer cells and their activity, suggesting that massage may strengthen the immune system.
Massage therapy influences the nervous and endocrine Systems. It provides a sedating and relaxing effect on the body by normalizing nerve activity. It stimulates muscle activity through specific forms of massage. It promotes relaxation, decreasing insomnia and improving sleeping patterns by stimulation of the parasympathetic nervous system. It decreases pain with release of pain-reducing neurochemicals. It can provide stimuli to modulate pain perception and decrease pain directly with some massage techniques. It decreases stress levels by activation of the relaxation response. The many physical stress-related problems of everyday life can be soothed away by slow rhythmic massage. Massage recipients show an increase in dopamine and serotonin levels which suggests a decrease in stress levels and depression.
Massage therapy assists the digestive system. It increases movement of the large intestine, helping to relive colic and intestinal gas. It promotes activation of the parasympathetic nervous system which also stimulates digestion. It decreases constipation by stimulating the parasympathetic nervous system and by direct movement of fecal material around the bowel. This will aid in elimination without drugs.
Finally, massage therapy influences other soft tissues. It assists proper alignment of connective tissue fibres after injury. It may increase movement at a joint by decreasing muscle tension and connective tissue thickening and rigidity.
The Filipino “Hilot
The hilot has been described in many different ways. (1999) described them as indigenous community resources or cultural healers who help to “protect” the body and treat supernaturally with herbal/medicinal treatments, incantations, and offerings. The hilot is a type of ancient tribal priestess. Babaylan, a common Filipino indigenous practitioner, uses three types of treatment: prayers and rituals, herbal plants, and massage/manipulation of bones and body tissues. A hilotusually is respectful of the value of medical care. An arbularyo (herbalist) has special treatment skills with liquid infusion and dietary measures.
Solivas (2001) pointed out that traditional medicine is slowly finding its niche in modern medicine. World Health Organization (WHO) statistics show that while 40-80% of the population of third world countries depends on traditional medicine to meet their health care needs, there has been a growing interest in traditional and alternative systems of medicine in many developed countries. In fact, the World Health Assembly accepted the realities that many adhere to traditional medicine for primary health care, traditional healers are potentially important resource for the delivery of health care and that medicinal plants are of great importance to the health of individuals and communities. Moreover, as an aftermath of the Alma Ata Conference on Primary Health Care in 1978, the Philippine government encouraged use of a number medicinal plant preparation. This paved the way for more scientific studies on traditional medicinal plants. Nowadays, WHO confirms that medicinal plants are vital elements in pharmacological research and drug development not only when plant constituents are used directly as therapeutic agents, but also when they are used as basic materials for the synthesis of drugs or as models for pharmacologically active compounds.
The presence of the arbularyo and hilot as “traditional healers” in many Filipino communities are similar to the inevitability of acupuncture in Chinese medicine and ayurvedic medicine in India. These approaches to health care falls under the category of traditional medicine, which the WHO refers to the “sum total of the knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable, or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness“.
On Using Modules
(1990) wrote about modules wherein he emphasized that modular instruction is one workable form of individual instruction which is applicable in the elementary, secondary, and tertiary levels of education. The use of modules in teaching is cost effective, and it makes the teachers become resourceful and creative. At the same time, the students’ time is maximized.
(1973), as cited by (1995) concerning teaching methods and techniques, described the use of modules as modernizing the teaching process by using a set of modules suited to each student who is given a chance to advance at his own best rate though by passing unnecessary instruction and satisfying his particular needs and he will thus in individual cases be able to earn his degree in a considerably short time. Garcia wrote that programmed instructions involving modules, self-learning kits, and the correspondence courses represent well the emerging non-traditional and unconventional teaching styles. This type of instructions easily breaks the space-time syndrome closely associated with traditional teaching, in which both the teacher and the students stay together in one place, usually the classroom, at the same time in order that the teaching-learning process can conveniently proceed. Under the programmed instruction, students can continue learning by themselves even without the presence of the teacher.
However,(1995), in her book about principles and methods of teaching, mentioned that there are also difficulties in connection with modules. Since a module involves self-study, the student needs self-discipline to work toward mastering a module. How many students have self-discipline or the will power to study on their own? The school may lack the facilities that the instructional activities call for. Preparing a module is not an easy task. Teachers may also find it hard to change the traditional role they are accustomed to.
The following studies reflect the versatility of massage therapy and its broad and diverse range of applications.
Premature infants treated with daily massage therapy gain more weight and have shorter hospital stays than infants who are not massaged. A study of 40 babies with low birth weight found that the 20 massaged babies had 47-percent greater weight gain per day and stayed in the hospital an average of 6 fewer days than 20 similar infants who did not receive massage; the cost saving was approximately $3,000 per infant ( 1986). Cocaine-exposed preterm infants given massages three times daily for a 10-day period showed significant improvement. Results indicated that massaged infants had fewer postnatal complications and exhibited fewer stress behaviors during the 10-day period, had 28-percent greater daily weight gain, and demonstrated more mature motor behaviors at the end of the 10-day course of massage therapy (1993).
A study comparing 52 hospitalized depressed and adjustment-disorder children and adolescents with a control group that viewed relaxation videotapes found that the massage therapy subjects were less depressed and anxious and had lower saliva cortisol levels (an indicator of less depression) (1992).
Another study showed that massage therapy produced relaxation in 18 elderly subjects. This study demonstrated physiological signs of relaxation in measures such as decreased blood pressure and heart rate and increased skin temperature ( 1987).
A combination of Swedish massage, shiatsu, and trigger point suppression in 52 subjects with traumatically induced spinal pain led to significant alleviations of acute and chronic pain and increased muscle flexibility and tone. This study also found massage therapy to be extremely cost-effective in comparison with other therapies, with savings ranging from 15 percent to 50 percent (1992a, 1992b). Massage has also been shown to stimulate the body’s ability to control pain naturally; in one study, massage stimulated the brain to produce endorphins, the neurochemicals that control pain (1989). Fibromyalgia, a painful type of inflammation, is an example of a condition that may be favorably affected by this mechanism.
A pilot study of five subjects with symptoms of tension and anxiety found a significant response to massage therapy based on one or more psychophysiological parameters, including heart rate, frontalis and forearm extensor electromyograms, and skin resistance; these changes denote relaxation of muscle tension and reduced anxiety (1983).
Another study found that massage therapy can have a powerful effect on psychoemotional distress in persons suffering from chronic inflammatory bowel disease. Stress can worsen the symptoms of ulcerative colitis and Crohn’s disease (ileitis), which can cause great pain and bleeding and even lead to hospitalization or death. Massage therapy was effective in reducing the frequency of episodes of pain and disability in these patients ( 1983).
(1983) did a comparative study of the hilots’ pressure points and acupuncture points taking into consideration the following aspects: general characteristics, location, indications, uses, technique (amount of pressure applied, duration of application of pressure, method of massage, frequency of treatment, medium used in massage and precautions and contraindications). Five hilots residing in Lipa City and Davao City were observed at five different sessions each, while treating patients. Instruments used were an interview schedule, a checklist, anatomical drawings and validation by the researcher. A descriptive analysis of the data gathered was done after the findings had been collated and summarized.
The study discovered that pressure areas of the “hilots”, like acupuncture points are tender and sore in a diseased state. These pressure points of the “hilots” are hard and leather-tough on palpation. In terms of size, they are actually more of areas rather than points. Nomenclature of these pressure points is dependent on the part of the body where they are located, e.g. likod(back), dibdib (chest), etc. Another finding was that the location of pressure areas of the “hilots” depends on where the bara (blockage) has been determined. Location, therefore, of the points is not fixed. These pressure points were found, however, to coincide with acupuncture points.
Moreover, the study found out that the pressure areas of the “hilots” have generally no specific indication, although it is generally indicated for pilay or pasma. Also, pressure areas are mainly used for treatment and the use of pressure areas for preventive and diagnostic purposes was not observed. Finally, in terms of techniques, the “hilots” do not have any specific directions for massage nor do they have any definite time for treatment. The amount of pressure applied on body areas is dependent on what the patient can tolerate. The frequency of treatment is one to three sessions, usually every other day, regardless of whether the ailment is acute or chronic. The “hilots” refrain from applying pressure in the following conditions: full or empty stomach, hypertension and rheumatism.