Remedial Massage

What is it?

Every culture in the world has its own tradition of massage from China to India, Hawaii to Thailand. It is one of the world's oldest recorded forms of medicine dating back to at least Roman times and has been a staple ingredient of all forms of manual therapy.

In the west, Remedial Massage was formulated to distance itself from the massage treatments that might be used in the context of health spas and beauty salons.

The emphasis is on clinical conditions and remedial massage has been widely develop in Sports Therapy, Rehabilitation and Palliative Care. The names clinical massage and orthopaedic massage have been used as alternative names to this branch of massage to indicate this applied approach.

Massage is also used in the context of stress management and mental health.

Massage involves the therapeutic manipulation of body tissues.

Who developed it?

The term Remedial Massage was developed by leading massage schools in this country from the concepts of Swedish Massage widely adopted in professional massage training in Europe and America.

The term Clinical or Orthopaedic Massage has been used in the USA to give an indication of the application of massage to clinical conditions.

What conditions is it good for treating?

As discussed above remedial massage has been used in a wide range of clinical contexts from hospitals to community settings, schools, sports arenas and private practice. The conditions it is used for range from musculo-skeletal pains and pre- and post-operative conditions to relaxation and stress management and learning difficulties.

What is the evidence base that supports its effectiveness?

The evidence base for massage is perhaps one of the most longstanding of the holistic therapies. Since the twenties there has been hospital clinical trial evidence of massage treatment's effectiveness in constipation.

Since this time the level of academic and applied studies has developed significantly. In particular university research departments like the Touch Therapy Institute of the University of Miami has conducted numerous trials in a wide range of clinical contexts; these have been published in journal articles and text books. A key author and investigator is Dr Tiffany Field - her and her colleagues work is reviewed in her book Touch Therapy (2000)

Recently there has been a very interesting debate about the means by which massage therapy achieves its clinical affect in pain studies. It was thought that massage partly had its remedial effects by reducing the amount of stress hormones like cortisol in the body.

However the positive studies have not been always repeated, and whilst the evidence that massage reduces pain levels is not questionned (Moyer et al 2011, Journal of Bodywork and Movement) the precise therapeutic pathway that is being utilised in pain reduction is in question. There are a number of possibilities for the therapeutic action of massage based on basic anatomical and physiological knowledge of the body and the prospect of this research informing us more profoundly about the action of massage on the body is a fascinating prospect.

The evidence for massage ranges from its application in mental health to its use in baby and infant massage. Sometimes the results of evaluation are surprising. For example in the context of baby and infant massage it was found that massage was a a very useful adjunctive therapy in treating post-natal depression (Onozawa et al 2001). With infants Field et al found it useful in symptom relief in juvenile asthma (Field et al 1998). The research data is now at RCCT level and will further accumulate as the ancient art of massage is investigated scientifically.

In this country the Northern Institute of Massage (NIM) Research Group has collated a number of small scale studies showing clinical effectiveness as measured by outcome studies and TSHP has conducted two small studies showing remedial effects in GP referred patients.

Further work generally on collating the evidence base is being conducted by the Research Council of Complementary Medicine (RCCM) www.rcccm.org

What are the risks and benefits of treatment?

In the hands of a skilled, licensed practitioner there are few risks other than temporary tissue soreness. Normal tissue soreness should resolve within 24 to 48 hours. Any contra-indications to treatment are sought at the beginning of therapy to screen out possible complications and Patient Consent is sought at the beginning of each treatment to ensure that the patient understands the risk and benefits of the treatment.

The general health benefits range from increased local circulation, improved lymphatic drainage, improved muscle condition, increased range of pain free movement, and relaxation.

The specific benefits are related to the presenting condition and the agreed treatment outcomes from the treatment.

Are there any side-effects from the treatment?

Massage techniques can range from soft to deeper strokes, sometimes there can be initial tissue soreness if old injuries or tight tense tissue is being addressed. These effects are usually temporary.

How many sessions does it need?

Depending on the condition treatment can be of any duration but usually therapists would hope to see significant benefits from between 6 to 10 sessions. some degenerative or chronic conditions might need weekly or even bi-weekly treatments.

In the context of elite sports people daily massage might be appropriate. In the context of rehabilitation the therapy will only be limited by the balance of costs and benefits for each individual.

The individual client will need to have their needs assessed and contract accordingly with the therapist.

How long do sessions need to be?

For an adult, treatment would be probably 20 to 30 minutes for a particular condition. For a whole body treatment any where up to an hour.

For rehabilitation work upwards of an hour might be needed.

The treatment length would be adjusted for age, frailty and condition.

Follow-up sessions can be for support or maintenance, prevention or general well-being.

How many practitioners need to be available?

Usually one is sufficient though for severe conditions and where more intense treatment is needed, more than one therapist can work together at the same time.

Does it need follow-up support? If so, what, how often and by whom?

Massage can be applied to a particular condition and might need support from other modalities particular those emphasising diet and movement.

Effective Dietary advice can be accessed at low cost through the Arthritic Association ( www.arthriticassociation.org.uk )

How does it work as a self-care tool?

Remedial massage is usually conducted by a trained therapist but elements can be taught in the context of self-massage

What is the best way for teaching the self-care techniques?

This can be done on a one-to-one basis, through videos or visual aids or best through tuition in a group context.

Where can Remedial Massage methods be accessed?

Through TSHP in Merseyside. All Remedial Massage training organisations keep a register of qualified therapists - see for example LCSP (London and Counties Society of Physiologists) at www.LCSP.org.uk and also CNHC (Complementary and Natural Health Council) at www.CNHC.org.uk