MASSAGE THERAPY

The Power of Touch for Pain Relief: Basic Facts

Massage is well known for reducing stress and promoting relaxation. And, a growing body of research also shows that massage therapy is effective for relieving and managing chronic and acute pain, a significant national health problem. According to the National Institute for Health, more than one-third of all Americans will suffer from chronic pain at some point in their lives, and approximately 14 percent of all employees take time off from work due to pain. Increasingly, massage therapists are being incorporated into pain management programs of hospitals and health care organizations. The Joint Commission on Accreditation of Healthcare Organizations has suggested massage therapy as one means to manage pain without use of pharmaceuticals.
According to a recent American Hospital Association survey about their use of CAM (complementary and alternative medicine) therapies, among the 1,007 hospitals responding, nearly 82 percent of the hospitals offering CAM therapies included massage therapy among their health care offerings -- with more than 70 percent utilizing massage therapy for pain management and relief. In a recent consumer survey commissioned by AMTA, 91 percent of respondents agreed that massage can be effective in reducing pain, and nearly half of those polled (47 percent) have had a massage specifically for the purpose of relieving pain.

Consider recent clinical research on the efficacy of massage for pain relief:

• Massage therapy is more effective for chronic back pain than other complementary therapies.
  
• Massage therapy promotes relaxation and alleviates the perception of pain and anxiety in cancer patients.
  
• Massage therapy reduces post-traumatic headaches better than cold pack treatments.
  
• A pilot study conducted at Cedars-Sinai Medical Center in Los Angeles found that massage, as part of hospital-based surgery treatment, reduces pain and muscle spasms in patients who have undergone heart bypass surgery.
  
• Massage stimulates the brain to produce endorphins.

How does massage relieve pain?

• A simple and direct strategy: working from the external, outer mechanisms of pain to the primary, root cause.
  
• Focuses on the entire body system and its relationship to soft tissue - not solely on the site of pain.

Benefits of massage for pain relief

• Helps patients become more aware of their bodies and the sources of pain.
  
• Better familiarizes patients with the pain they experience.
  
• Has an impact on the patient by virtue of human touch.
  
• Improves confidence by encouraging patients to effectively cope with their pain.

The American Massage Therapy Association, the professional association representing the field of massage therapy, wants to help navigate the process of linking pain specialists with massage therapists. Finding a qualified massage therapist is paramount; only 33 states and the District of Columbia regulate the profession of massage therapy.

Massage Tips for Consumers

What should someone expect during a massage?

• The massage therapist will ask questions about what prompted you to get a massage.
  
• The massage therapist will want background information about your physical condition, medical history, lifestyle, stress levels and any painful areas.
  
• The massage therapist will ask what your health goals are and will discuss how massage may help you achieve those goals.
  
• During a one-on-one massage, you will be asked to remove clothing to your level of comfort. Clothing is not removed during "chair" massages.

Consumers also should consider the following tips to help them find a massage therapist who is trained and qualified.

• Are you licensed to practice massage? (33 states have passed legislation to regulate massage therapy)
  
• Are you a member of the American Massage Therapy Association?
  
• Are you Nationally Certified in Therapeutic Massage and Bodywork?
  

Trained massage therapists are happy to share their credentials with clients. AMTA professional members have demonstrated a level of skill and knowledge through education and/or testing and are required to meet continuing education requirements to retain membership.

How to Find a Qualified Massage Therapist

It's essential that you trust the person who will be touching you. You should feel confident and comfortable with your massage therapist.

The place to start is with credentials. Regarding state regulation, 30 states and the District of Columbia now regulate massage therapists. If you are in one of these states you will want to find out if your prospective massage therapist is licensed, though in some states it is referred to as state certification or registration. Some local governments may also have some form of regulation.

The primary national credential is the designation Nationally Certified in Therapeutic Massage and Bodywork, which is designated by the initials NCTMB. Professional certification differs from governmental regulation because it is private (i.e., non-governmental) and not compulsory. The designation NCTMB is awarded by the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB), which is a non-profit corporation. The Board is elected by the people who are nationally certified.

People earn the designation NCTMB by meeting certain requirements, generally involving education and experience, to take an exam. If they pass it, they become nationally certified for 4 years. They must then complete certain requirements to re-certify every 4 years.

What is especially significant for the consumer is the national certification program has been accredited by the National Commission for Certifying Agencies (NCCA), located in Washington, D.C. This means the national certification program has been thoroughly evaluated by an outside agency according to very rigorous standards. AMTA is proud to have been a primary contributor to the creation of the national certification program

Another criteria is education. The minimum number of hours of training AMTA recommends looking for is 500 hours, which is the standard followed by most of the states regulating massage therapists, though the required number of hours is increasing in some places. AMTA recommends you look for a graduate of a training program that has been accredited by the Commission on Massage Therapy Accreditation (COMTA) or an agency with equivalent standards. Why? To become accredited by COMTA a training program must offer a curriculum that meets certain requirements, submit an extensive self-evaluation, undergo a site visit inspection by a team of experts, and be evaluated by an independent accreditation board. This means a training program accredited by COMTA has qualified faculty to teach, proper equipment and classrooms, required teaching subjects, and other features needed to adequately train students in massage therapy. In turn, you the consumer can have some assurance about a massage therapist's training if your prospective massage therapist graduated from an accredited training program.

Another factor to consider is whether a prospective massage therapist belongs to a credible professional association, such as AMTA. Of course, this being AMTA's website, we're partial to AMTA .... and for reasons that are also good for consumers and the public. To belong to AMTA, a massage therapist must either pass the national certification exam, graduate from a training program accredited or approved by COMTA, or have a current AMTA accepted state, provincial, or city license. AMTA has practice standards that promote the highest standards in the profession. AMTA members must also follow a strict Code of Ethics, to which AMTA members are held accountable. Violations are subject to grievance procedures. AMTA is a non-profit organization whose leaders are democratically elected by its members, so its dedication to high standards and advancing the profession remains strong.

Next, you might want to ask about your prospective massage therapist's approach to massage therapy. While some massage therapists may only use one or two types of massage, most massage therapists employ a variety of techniques in their practice. What you want to find out is if what the massage therapist offers is compatible with what you need. You can find out more about the various types of massage by looking at the glossary of definitions. The more specific your needs, the more important the massage therapist's approach and specific skills may be. You could also ask about how many years experience the massage therapist has. By the way, some massage therapists with many years experience may have started out in an era when there weren't as many training programs around and many of the profession's standards were not yet in place. You can, if you wish, take their experience into account when considering their credentials.

Finally, you may find just the "right" massage therapist for you the first time you try. However, you may also need to try several massage therapists to find the "right fit" for you, because, besides credentials, there is also a personal element to massage. Personality fit is important too, so is trust. You should feel confident and comfortable with your massage therapist. Communication is an important element in massage therapy. Don't be afraid to discuss any apprehensions or concerns.

We have a way to make finding a massage therapist a little easier .... the AMTA's Find A Massage Therapist® national locator service! By using the this service, you can receive the names of several qualified massage therapists near you. If you or someone you know needs to find a massage therapist, the AMTA's Find A Massage Therapist® national locator service is available on this website to assist you.

Questions to Ask When Looking for a Massage Therapist

• Are you currently licensed as a massage therapist in this state? (If you are in one of the 30 states or the District of Columbia which regulates massage therapy)
  
• Are you a graduate of a training program accredited or approved by the Commission on Massage Therapy Accreditation (COMTA), OR
  
• Are you certified by the National Certification Board of Therapeutic Massage & Bodywork?
  
• Where did you receive your massage therapy training? How many hours of training did you complete?
  
• Do you have advanced training in any specific massage techniques?
  
• Are you a member of AMTA?
  

What to Expect At Your Massage Session

If you haven't had much experience with massage therapy, you might be wondering what to expect. This article will give you some ideas about what takes place during a "typical" massage session.

If it's your first time seeing the massage therapist, he or she will likely ask you some questions. The massage therapist might ask about the reasons you are getting a massage, current physical condition, medical history, life style and stress level, experiences with specific areas of pain, and whether there is any specific need you want addressed during the massage. First and foremost, the massage therapist needs to make sure there aren't any conditions present that rule out having a massage due to any health risks. Second, the massage therapist needs to know what your needs are regarding the massage and be sure both of you are clear about what your expectations and goals for the session are. Third, the information you provide helps the massage therapist determine what techniques to use and how to structure the session.

Next, you will be asked to remove your clothing. The therapist will either leave the room or otherwise provide privacy while you undress. You should take off only as much as you are comfortable removing. A sheet or towel is provided for draping during the massage. The therapist will uncover only the part of the body being massaged, insuring that modesty is respected at all times. The draping also keeps the person receiving the massage warm. You should also remove any jewelry or other articles that might interfere with the massage.

The massage takes place on a comfortable, padded massage table. The massage therapist will tell you what position to lie in on the table. The table may have some extra attachments or cushions, such as a face rest (which allows you to lie in a face down position without turning your head and neck). If you don't like using any attachments, ask the massage therapist to remove it or not use it.

Expect a peaceful and comfortable environment for the massage. The massage therapist may play music during the massage. Some people find music playing to be relaxing, some find it distracting. If you don't like music playing, ask the massage therapist to change the music or turn the music off.

Before the massage begins, the massage therapist may offer some advice that will improve the quality of your massage. A common one is to breathe, especially if a sensitive area is being massaged.

The massage therapist may use oil or lotion, which reduces drag on the skin while performing the massage strokes. If you are allergic to some oils or lotions, be sure to tell your massage therapist so you both can make sure the ingredients in the oil or lotion do not bother you. Some massage therapists will use a powder instead of oil if you are allergic.

Depending on your needs, the massage therapist will massage either the full body or only specific areas that need attention. For example, general relaxation or stress reduction sessions usually include all the major areas of the body, while a session for a localized injury, pain, or tightness will be focused on a specific area. It is possible to spend most of an entire session on only one area. If there is anything that does not feel comfortable or right or you do not like, you have the right to ask the massage therapist to stop.

After the massage is finished, you will once again be provided with privacy in order to get dressed. If there is time to do so, you may ask the massage therapist any questions you have. The usual length of a session is an hour. A massage session on a table generally should be a minimum of 30 minutes and maximum of 90 minutes.

An exception to the above description would be a seated massage. In this case, you sit in a specially designed massage chair. The chair supports the front of the body, which allows access to most of the body. You remain clothed and oil or lotion is not used. Seated massages are usually shorter sessions that typically run from 10 to 30 minutes. Since the chairs are highly portable, seated massages can take place in a variety of settings, including the workplace.
Please let your massage therapist know in advance if you need to cancel your appointment. Many massage therapists require a 24 hour notice.

How to Get the Most From Your Massage back

1. Be as receptive and open to the process as possible.
   
2. Do not eat just before a massage session.
   
3. Be on time. If you arrive in a frenzied, rushed state, it will take longer to get to a relaxed state. Please let your massage therapist know in advance if you need to cancel. Many massage therapists require a 24 hour notice.
   
4. If you do not want to remove all your clothing, wear clothing that you will be comfortable wearing during the massage and will allow the massage therapist to touch and move the areas of your body you expect will need to be worked on.
   
5. Give the massage therapist accurate health information.
   
6. Good communication is very important. Before the session, let your massage therapist know what your needs are. During the massage session, report any discomfort, whether it is from the massage or due to any problems or distractions related to the environment, e.g., room temperature, music volume, lighting, etc. Feel free to give feedback to the massage therapist regarding the massage, e.g., amount of pressure, speed of movement, etc.
   
7. Don't be afraid to discuss any apprehensions or concerns. It is important that you be as comfortable as possible during your massage. Your massage therapist is a professional dedicated to do his or her best to help you feel at ease.
   
8. Some massage therapists like to play music during the massage session and may have music specially composed for relaxation and other effects. Others may find music distracting. Let you massage therapist know if you have any preferences regarding music if it is available.
   
9. Some people like to talk during a massage session, while others remain silent. If your massage therapist encourages you to talk or not talk, it is usually based on whether or not it seems to help let go of tension and getting in touch with oneself. Sometimes talking can be a way of unburdening oneself or opening up. Sometimes being silent can be a way of letting go of thoughts or concentrating. On the other hand, talking can be a way of "being in the head" and out of touch with one's body or feelings; and being silent can be a way of holding back or not opening up.
   
10. Breathing helps to facilitate relaxation. People often stop or limit their breathe when they feel anxious or a sensitive area is massaged. If you realize you are stopping your breathing, let yourself breathe.
    
11. Tightening up, i.e., contracting or hardening your muscles during the massage is counterproductive. If you are able to, relax those muscles. Let your massage therapist know this is happening. They may need to adjust the massage technique being used. They may also be able to help you relax the affected area.
    
12. If you find your thoughts are racing during the massage, one way to be more body-centered and to quiet the mind is to follow the hands of the massage therapist and focus on how the touch feels.
    
13. If anything is happening during the massage that you dislike or seems improper, you have the right to ask the massage therapist to stop. If necessary, you also have the right to end the session.
    
14. If you are dizzy or light headed after the massage, do not get off the table too fast.
    
15. Drink extra water after a massage.
    
16. Allow for some open, quiet time after your massage session if possible. Sometimes one needs a little time to integrate or absorb the results of the massage session or needs some "re-entry" time.
    
17. Massage has its greatest benefits over time. The therapeutic effects of massage are cumulative, so the more often a person gets a massage, the better he or she will feel and the more quickly one's body will respond. From one session to the next, relaxation deepens as the chronic patterns of stress in the body are affected and released. These changes are readily felt in day-to-day life as well, which adds another dimension of reinforcement. If you are getting massage to address chronic muscular tension or recovery from a soft tissue injury, more than one session is usually needed, so be prepared to schedule several sessions.
    

Credentials for the Massage Therapy Profession

Credentials are a very important component of professionalism. Reliable and credible credentials help the public and consumers know that individuals offering massage therapy to the public are qualified and competent. After all, you need to trust the person who will be touching you. Knowing your massage therapist meets the standards established for his or her profession should help you feel more confident and comfortable. This article will explain what the major credentials for the massage therapy profession are and what each one is for, along with its significance. The different types of credentials are often confused with each other, so take this link to see an explanation of the differences between certification, licensing, and accreditation.

Licensing: Thirty three states and the District of Columbia regulate massage therapists. To see a list of these states, go to Regulation. In these states, massage therapists must meet certain standards that the state establishes. Each state law is different and has different requirements, so a massage therapist may be referred to as licensed, state certified, or registered. In most cases, only those individuals who have the state designation may perform massage and/or use a title indicating that person does massage.

Certification: As is the case with many other healthcare professions, there is a national certification exam for massage therapists. It is administered by the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB). Individuals who meet standards of education, training and/or experience and pass the national certification examination are entitled to use the designation Nationally Certified in Therapeutic Massage and Bodywork and its initials, NCTMB. National certification protects the consumer, the profession and employers by ensuring that individuals who obtain this credential possess core skills, abilities, knowledge and attributes to practice safely and competently.

The NCBTMB is a non-profit, independent organization and is governed by a Board of Directors elected by the certificants. It is accredited by the National Commission for Certifying Agencies (NCCA), which is a national independent agency, operated by the National Organization for Competency Assurance based in Washington, D.C., that sets standards for professional certification programs. The fact that the NCBTMB program is accredited by NCCA means that it meets the highest existing standards for testing and gives it great credibility.

Education and Training: A graduation certificate or diploma from a training program is another form of credential. What is important is the extent and quality of the training someone completes to earn their certificate or diploma, but this can vary widely amongst massage schools. Standards for education and training can assist the consumer in knowing whether a training program offers adequate preparation. AMTA recommends a minimum of 500 hours of in-class training in subjects including a specified number of hours in anatomy and physiology, the theory and practice of massage therapy, and elective subjects.

One way of knowing whether a training program provides a nationally recognized standard level of education is to see if it is accredited by a credible agency, i.e., one that follows the guidelines of the U.S. Department of Education, requires an extensive evaluation report, a site inspection by a team of experts, and an evaluation by an independent board or commission. The AMTA established the Commission on Massage Training Accreditation (COMTA), an independent accreditation agency, in order to provide a system for assuring that training programs meet such standards. Training programs that are accredited by COMTA offer a minimum of 500 in-class hours of training in required subjects and have the faculty, staff, equipment, classrooms, and other attributes needed to provide adequate training in massage therapy.

Among other credible accreditation agencies that have accredited massage training programs are the Accrediting Commission of Career Schools and Colleges of Technology and the Accrediting Council for Continuing Education and Training. However these agencies are more general and institution-oriented in their scope and do not specialize in accrediting massage therapy training programs.

Membership in a Professional Association: Membership in a credible professional association that requires meeting meaningful standards in order to belong to the association serves as a credential because it is an indication of professional preparation and accountability. AMTA fits this description because to belong to AMTA an individual must either pass the national certification exam, graduate from a training program accredited or approved by COMTA, or have a current AMTA accepted state, provincial, or city license. To keep AMTA membership, an individual must also complete a certain number of hours of continuing education. AMTA members must also uphold the Code of Ethics.

Another factor regarding AMTA's credibility is that AMTA is a non-profit, democratically run organization whose leaders are elected by its members. Therefore, AMTA's standards are established by a large body of professionals, rather than a tiny group of owners. AMTA believes its non-profit status allows it to maintain and uphold high standards and devote resources to activities that benefit the public and profession, although they may not generate revenue.

There also are a number of credible associations that represent individuals who practice a specific modality. Some examples are the American Organization for Bodywork Therapies of Asia, American Polarity Therapy Association, The Feldenkrais Guild, International Somatic Movement Education & Therapy Association, Rolf Institute, and the United States Trager Association.

What are Certification, Licensing, and Accreditation?

The term certification is often used as a catch-all term for several different activities that apply to the credentialing of individuals and institutions. This fuzziness of definition has resulted in confusion when it comes to discussing credentials. This article is intended to provide more clarity on the subject.

Certification is essentially the process of publicly attesting that a specified quality or standard has been achieved or exceeded. We see this in an informal way all around us nearly every day. For example, when a product has the Good Housekeeping Seal of Approval, it means that the item has been attested to meet the standard set for it. Whenever we make a recommendation or referral to a colleague or client we are informally certifying the competence of the person or the quality of the item being recommended.

Professional certification uses a formal process to identify and acknowledge individuals who have met a recognized standard. Usually this standard includes education, experience, and an exam of knowledge, skills, and abilities needed to perform the job. When an individual meets the standard, he or she receives certification from a certifying agency. The credibility and integrity of the certifying agency determines whether the agency's certification means anything to the public, and therefore, ultimately, its value. Accordingly, certification agencies may seek out recognition by an outside agency that will, in turn, attest to the certifying agency meeting a standard. Generally, this standard involves the qualification requirements to take the exam, whether the exam meets accepted psychometric standards for exam development, how the exam is given and scored, how the agency is administered, and whether its rules are fair. The National Organization for Competency Assurance operates the National Commission for Certifying Agencies for that purpose.

Professional certification is a voluntary process by which a non-governmental professional organization grants recognition to an individual who has met certain qualifications. It is a credential which attests that the individual has demonstrated a certain level of mastery of a specific body of knowledge and skills within the relevant field of practice. Certification should not be confused with either licensing or accreditation. While each involves some type of evaluation and the awarding of some type of credential, they are quite different from one another and the terms should not be used interchangeably.

Licensure is a non-voluntary process by which an agency of government regulates a profession. It grants permission to an individual to engage in an occupation if it finds that the applicant has attained the degree of competency required to ensure the public health, safety, and welfare will be reasonably protected. Licensing it always based on the action of a legislative body. Once a licensing law has been passed it becomes illegal for anyone to engage in that occupation unless he or she has a license. The health care professions are typically licensed at the state and/or local level, but not usually at the federal level.

Two regulatory variations are state certification (not to be confused with professional certification referred to elsewhere in this article) and registration. These generally are somewhat less restrictive than licensing, but how each is defined exactly can vary from state to state.

Certification differs from licensing in that it is nearly always offered by a private, non-governmental agency. Such agencies are usually outgrowths of professional associations which create certifying agencies to identify and acknowledge those who have met a standard. Another contrast with licensure is that, under a licensing law, practitioners of the licensed occupation must have a license in order to practice. It is involuntary. On the other hand, certification is voluntary. One does not have to be certified in order to practice. An individual takes the certification exam because they want to enjoy the benefits of certification. However, to use the title and initials copyrighted and associated with the professional certification, one must be certified.

Accreditation is a non-governmental, voluntary process that evaluates institutions, agencies, and educational programs, (i.e., institutions that grant certificates or diplomas) while certification and licensing involves individual practitioners. Accreditation is defined as the process whereby an agency or association grants public recognition to a school, institute, college, university, or specialized program of study (such as a massage training program) for having met certain established qualifications or standards as determined through initial and periodic evaluations that usually involve submitting a self-evaluation report, site inspection by a team of experts, and evaluation by an independent board or commission.

Glossary of Terms

Cranio-Sacral - is a technique for finding and correcting cerebral and spinal imbalances or blockages that may cause sensory, motor or intellectual dysfunction.

Deep Tissue - releases the chronic patterns of tension in the body through slow strokes and deep finger pressure on the contracted areas, either following or going across the grain of muscles, tendons and fascia. It is called deep tissue, because it also focuses on the deeper layers of muscle tissue.

Effleurage - is a stroke generally used in a Swedish massage treatment. This smooth, gliding stroke is used to relax soft tissue and is applied using both hands.
Friction - is the deepest of Swedish massage strokes. This stroke encompasses deep, circular movements applied to soft tissue causing the underlying layers of tissue to rub against each other. The result causes an increase in blood flow to the massaged area.

Myofascial Release - is a form of bodywork that is manipulative in nature and seeks to rebalance the body by releasing tension in the fascia. Long, stretching strokes are utilized to release muscular tension.

On-site Massage (also known as chair massage or corporate massage) - is administered while the client is clothed and seated in a specially designed chair. These chairs most often slope forward allowing access to the large muscles of the back. On-site massage usually lasts between 15 and 30 minutes and is intended to relax and improve circulation.

Petrissage (also called kneading) - involves squeezing, rolling and kneading the muscles and usually follows effleurage during Swedish massage.

Reflexology - massage based around a system of points in the hands and feet thought to correspond, or "reflex," to all areas of the body.

Rosen Method - utilizes gentle touch and verbal communication to help clients to release suppressed emotions and subsequently muscular tension in some instances.

Shiatsu and Acupressure - Oriental-based systems of finger-pressure which treat special points along acupuncture "meridians" (the invisible channels of energy flow in the body).
Sports Massage - massage therapy focusing on muscle systems relevant to a particular sport.

Swedish Massage - a system of long strokes, kneading and friction techniques on the more superficial layers of the muscles, combined with active and passive movements of the joints.

Tapotement - is executed with cupped hands, fingers or the edge of the hand with short, alternating taps to the client.

Trigger Point Therapy (also known as Myotherapy or Neuromuscular Therapy) - applies concentrated finger pressure to "trigger points" (painful irritated areas in muscles) to break cycles of spasm and pain.