Health Studies 301 Complementary and Alternative Therapies

Study Guide: Unit 6

Massage Therapy, Reflexology, and Related Therapies

Reflexology session in progress. Lubyanka, 2010, CC BY-SA 3.0.

The main focus of Unit 6 is massage therapy. However, we also look briefly at related manual therapies.

Massage therapy is commonly described as a therapeutic tool to loosen and stretch muscles and tissue. Others add assessment and manual application of touch to the soft tissues (muscles, ligaments, and tendons) of the body using the hand, foot, knee, arm, and elbow. Whichever definition is used, massage is a relaxation therapy and has been a method to promote health for centuries.

Learning Objectives

Upon completion of Unit 6, you should be able to

• define massage therapy and discuss the nature of massage therapy.
• identify situations where massage therapy is commonly used.
• state the conditions for which good evidence exists showing the effectiveness of massage therapy.
• describe acupressure, lymph drainage, shiatsu, and sports massage.
• describe reflexology.
• critically evaluate the above therapies based on the claimed rationale and the findings from research studies.

Learning Activities

Study Questions

As you complete the activities for Unit 6, keep the following questions in mind. You may want to use the Personal Learning Space wiki on the course home page and answer these questions as a way of keeping notes to focus your learning.

1. How is the human body both physical and energetic?
2. How does the fascia have an impact on the function of the organs it surrounds and infiltrates? How is the fascial system important in the balance of health in the human body?
3. List the benefits of massage in the health care setting.
4. Describe the premise on which the practice of reflexology is based.

Unit 6 Discussion Forum

When you have completed the other activities for this unit, answer at least one of the questions in the Unit 6 Discussion Forum, and respond to at least one post by a fellow learner.

The more questions you answer, the better prepared you will be for the final exam!

Read

In addition to the notes provided here, read in the textbook:

Micozzi, M. (2019). Fundamentals of Complementary, Alternative, and Integrative Medicine. Read from pages 206 to 207 (to “Concepts of Manual Healing”) and pages 212 to 215.

You will not be tested on the details of the history of massage therapy.

Massage Therapy

Massage has been used as a form of therapy throughout history. Touching, or massage, is often referred to as the foundation of the healing arts. In Eastern cultures as early as 3000 BCE, massage was part of hygiene and health practices. The Bible makes reference to massage as the anointing of the skin with oil.

Physiotherapy, evolving from massage, is a more mainstream form of therapy. Massage is an accepted practice today in sports medicine, physiotherapy, osteopathy, and chiropractic, and in the realm of the esthetics (skin care and beauty) business. Massage is one of the most commonly used types of CAM therapy. Massage therapist has replaced the French terms masseur and masseuse.

Many believe that stress manifests itself in the body as tense muscles, an unhealthy posture, and disrupted physiology—all of which can lead to sleeping disorders, mental illness, immune dysfunctions, and other chronic diseases. Massage therapy is alleged to alleviate and prevent these stress-related problems and illnesses by reducing pain and relaxing muscles.

Practice of Massage Therapy

Pages 215–216 describe the five techniques commonly used in massage. This method is also known as Swedish massage. Page 216 and the left-hand column of page 217 describe variations of these techniques.

Massage is usually practised in private clinics and spas, but can also be practised by nurses more informally, such as by giving a patient a back rub. Massage can be stimulating or sedating; techniques can be vigorous or gentle. Practitioners of massage may use their hands, feet, elbows, and knees to exert friction and pressure; they may use instruments or machines. Some practitioners use oil, creams, lotions, or powders to lubricate the skin and enhance their touch and pressure techniques. Massage therapists typically use a special chair or table that usually includes a face rest or head cradle, which allows the client to be comfortable and supported while face down. Other elements of the massage session may include environmental factors such as lighting, a soundproof room, and the colour of the room. Music helps the client relax and can help the therapist maintain a rhythm with the massage movement.

The scope of practice of massage therapists includes manual treatment of soft tissues for general relaxation or for improving and maintaining health, and general assessment; it may include hydrotherapy and aromatherapy. However, it does not include diagnosis of illness or injury, prognosis, or spinal or joint manipulations.

Massage has had to overcome entrenched notions about the meaning of touch. Thus, massage therapy education includes education on personal and professional boundaries such as the consequence of inappropriate behaviour or sexual misconduct and how to terminate a session when a client behaves inappropriately.

There are several contraindications to the use of massage therapy. These include burns, skin infections, eczema, open wounds, bone fractures, and advanced osteoporosis. Caution should be shown with patients with cancer and those who are pregnant or who feel uncomfortable with close contact.

In Canada, massage therapists must undergo a vigorous training program that consists of a 2200-hour curriculum. After successfully completing this program, the massage therapist may use the designation Registered Massage Therapist (RMT or MT). The parent body of massage therapists in Canada is the Canadian Massage Therapist Alliance. Their website is http://www.crmta.ca/. Most provinces have an association that licenses massage therapists.

Massage is not covered by any provincial health plan. However, many workplace or private extended health care insurance programs have full or partial coverage.

Research Evidence

Massage therapy resembles several other types of CAM therapies in that bold claims of effectiveness are frequently made with little in the way of supporting evidence based on good-quality research studies. However, there is supporting evidence with several conditions. Ernst, Pittler, and Wider (2006) summarized the research evidence for massage therapy as follows:

Adverse effects are extremely rare. Massage seems to have some beneficial effects in a number of conditions such as constipation, back pain, anxiety, depression, and stress. Given the few risks involved when performed by a responsible, well-trained practitioner, it may be worth considering. Its comparative effectiveness against other complementary therapies or against conventional treatment approaches is unclear. Given its relaxing effects, massage therapy may have some, albeit non-specific, beneficial influence on the well-being of most patients.

Learning Activity

Read

Micozzi, M. (2019). Fundamentals of Complementary, Alternative, and Integrative Medicine. See pages listed below.

This material covers several different types of massage therapy. However, some of these are outside the scope of this course. The following indicates the key parts of the text to focus on:

• Pages 217–218 discuss the possible significance of acupuncture points. Acupuncture is the subject of Unit 7.
• Page 218 looks at acupressure, which can be seen as a hybrid of massage therapy and acupuncture.
• Pages 218–220 examine ayurvedic manipulation. This is a part of ayurvedic medicine.
• Page 220 discusses craniosacral therapy, which is yet one more highly controversial variation of massage.
• Pages 220–221 discuss therapies based on energy flow. These were covered in the previous unit.
• Page 222 looks at lymph drainage techniques.
• Pages 226–227 briefly review the use of massage within sports.
• Pages 227–228 and page 230 (right-hand column) summarize the diverse settings where massage therapy is often practised.

The diverse types of massage therapies covered here fall into two broad groups:

• those that claim to work by direct physical action, such as conventional massage therapy (Swedish massage) and lymph drainage, and
• those that claim to work by way of other mechanisms, such as acupressure and changing energy flow.

It is entirely plausible that the former group has direct effects on body function that somehow improve health or relieve pain. However, the second group relies on a version of physiology and anatomy that has little in common with modern biomedical knowledge. So how have acupressure and changing energy flow managed to survive for so long and, indeed, to gain many followers in Western countries? The placebo response may play an important role. In addition, these types of massage may be beneficial as a form of massage, a possibility that we look at later in the unit.

Acupressure has been investigated in a number of research studies (Robinson, Lorenc, and Liao, 2011). The review revealed that several studies have generated positive findings. The authors concluded that the “[s]trongest evidence was for pain (particularly dysmenorrhoea, lower back and labour), post-operative nausea and vomiting. Additionally quality evidence found improvements in sleep in institutionalised elderly.”

Learning Activity

Read

Micozzi, M. (2019). Fundamentals of Complementary, Alternative, and Integrative Medicine. Pages 261–266.

Reflexology

Whenever you read a statement about a controversial subject, it makes good sense to check the background of the author. Authors may inject their personal viewpoints into the writing, even though they may appear to be merely stating facts. We see this very clearly in the chapter on reflexology. Page iv at the start of the textbook informs us that Donald Bisson, the author of this chapter, is with the Ontario College of Reflexology. His close involvement with reflexology is clearly reflected in his very positive views regarding the benefits of the therapy.

Ernst, Posadzki, and Lee (2011) carried out a systematic review of randomized controlled trials (RCTs) on reflexology. They identified 23 trials on a range of medical conditions. Most of these studies were carried out after the year 2000; this reflects the move in recent years to carry out proper scientific studies regarding claims for the effectiveness of CAM therapies. Patients in the control group were mostly given either no treatment or placebo reflexology. The investigators of this review concluded: “The methodological quality of the RCTs was often poor. Nine high-quality RCTs generated negative findings; and five generated positive findings.” This review paper is referred to on page 330 of the textbook.

Even where RCTs did report positive results, we cannot conclude that reflexology is scientifically valid. A much more likely explanation is that therapists administering reflexology were effective at making their patients feel better in comparison with patients in the control group. In other words, positive results may simply reflect a non-specific benefit brought about as a result of massage. Based on this evidence, therefore, we cannot make definitive judgments about the value of reflexology.

Reflexology and Acupressure

It is instructive to compare reflexology with acupressure. There are important differences in the rationales used to explain how these therapies work. However, both are seriously lacking in scientific credibility. Nevertheless, a great many people, both therapists and clients, attest to the benefit of treatment. This is a classic case of evidence based on anecdotal reports. Such evidence falls far short of constituting strong supporting evidence based on well-designed studies.

Nevertheless, we should be cautious before rejecting these therapies as being worthless. It is entirely plausible that these therapies help decrease anxiety and promote relaxation in many patients. They do this in part by the placebo effect (people feel better because they are convinced that the therapies are genuinely effective). In addition, these therapies may induce benefit simply as a result of being a type of massage. In that respect, they are similar to conventional massage therapy.

With acupressure—in contrast to reflexology—another factor may be involved: it may actually work for certain conditions, especially for the alleviation of pain. That would be consistent with the similar results seen with acupuncture, a closely related therapy.

Learning Activity

Self-test Quiz

Do the self-test quiz for Unit 6 as many times as you wish to check your recall of the unit’s main points. You will get a slightly different version of the quiz each time you try it. (This quiz does not count toward your final grade).

If you have trouble understanding the material, please contact your Academic Expert.

References