When Amy Buttell separated from her husband in 2005, her anxiety spiked off the charts. A suddenly single mother, Buttell didn’t have a lot of money to throw around. Still, in the wake of her marital upheaval, she made massage a priority. It helped her weather the storm, she says, and today, she still finds that getting one or two massages a month helps keep stress at bay. And that helps her defend against physiological tension, too.
“When I’m anxious, I feel all clenched up,” says the 49-year-old marketing communications director from Erie, Pa. “My massage therapist untangles my knots.” Like many people, Buttell values not only the hands-on healing but also the opportunity to power down her brain and nervous system for an hour or so. “Even if I’m short on money,” she says, “I find a way to make it happen.”
Buttell is not alone. Despite massage’s reputation as a self-indulgent luxury, an increasing number of people are embracing it — not just as a “spa treatment,” but as a powerful therapeutic tool.
Americans currently log more than 114 million trips to massage therapists every year. Massage therapists are the second most visited complementary and alternative medicine providers behind chiropractors. All told, Americans spend up to $11 billion a year on massage. And statistics from the American Massage Therapy Association project that over the next five years, that number is likely to grow considerably.
What we’re getting for our money, whether we realize it or not, is an access code of sorts — a healing key capable of opening the body’s stickiest locks.
Scrunching our shoulders, craning our necks, sitting for hours, driving in rush-hour traffic — such mundane activities can create patterns of muscle tension (referred to as “holding”) in the body. And when muscles are chronically tense or tweaked, it can have a nasty effect on both our bodies and our minds.
Persistent musculoskeletal tension can restrict blood circulation and nutrient supplies to the body’s organs and tissues. As the weblike connective tissue (fascia) that envelops the muscles gets increasingly dense and less mobile, it can negatively affect posture and breathing. The experience of low-grade, habitual tension can contribute to chronic hormonal, biochemical and neurological problems of all kinds.
Massage interrupts such stress-inducing patterns, and helps nudge the body back into a natural state of balance.
So what is massage, exactly? Scientists who study its health benefits often use the therapy’s broadest definition: “The manipulation of soft tissue for the purpose of producing physiological effects.”
That clinical definition hardly does massage justice, though. So read on to find out more about the subtleties of various types of massage, and the powerful healing potential they might hold for you.
In conventional medicine, double-blind, placebo-controlled studies are the gold standard. But massage and most other forms of bodywork don’t lend themselves well to such studies. Therefore, scientific “proof,” both for massage’s efficacy and its means of function, runs a little thin. But convincing clinical evidence is accumulating.
For example, in 2004, Christopher Moyer, PhD, a psychologist at the University of Wisconsin–Stout, published a meta-analysis on massage therapy research and found that, on average, research subjects who received massage had a lower level of anxiety than those who did not.
“My research consistently finds that massage does have an impact on anxiety,” says Moyer. “We don’t know exactly why, but people who get massage have less anxiety afterward.”
One popular explanation is that massage lowers the body’s levels of cortisol, the hormone notorious for triggering the body’s fight-or-flight response. “No matter how we measure cortisol — in saliva or urine — or how often, we always find that massage has a beneficial effect,” says Tiffany Field, PhD, a researcher at the Touch Research Institute at the University of Miami’s Miller School of Medicine.
Although Moyer is yet to be convinced of the cortisol connection, both he and Field agree that massage is potentially very therapeutic for what’s known as “state” anxiety. Unlike generalized anxiety disorders, state anxiety is a reaction to something you can pinpoint, such as a troubling or traumatic event, circumstance, or setting.
Although more research is needed, says Moyer, “some experts posit that the reported alleviation of state anxiety could be a result of something as simple as the social and psychological environment where massage takes place.”
Relieve Lower-Back Pain
Aside from stress, if there’s one thing that drives people to the massage table in droves, it’s pain. Especially lower-back pain, which up to 85 percent of Americans experience at some point during their lives.
In 2008, the Cochrane Collaboration (a global, independent, nonprofit organization that reviews the usefulness of healthcare interventions) published an examination of the evidence linking massage to relieving lower-back pain. Reviewing 13 clinical trials, they found massage to be a promising treatment.
“Physical pain is like the alarm system of a house,” says Andrea Furlan, PhD, a clinical epidemiologist who specializes in massage at the Institute for Work & Health in Toronto. “With acute pain, like a burn or a broken bone, the pain signal indicates something is wrong. But, if you have pain every day, like chronic back pain, the alarm is malfunctioning. Massage may not be able to turn off the alarm, but it can lower the volume.”
Theories abound on how massage interrupts the body’s pain loop. One of the oldest and most well-regarded explanations is called the gate-control theory. Proponents surmise that pain signals to the brain are muffled by competing stimuli. More specifically, pain travels on small-diameter nerve fibers, while massage stimulates large-diameter ones. Larger nerve fibers relay messages to the brain faster than smaller ones. In essence, says Furlan, the sensation of the massage “wins” over the sensation of pain.
One word of advice from fitness experts, though: You’ll get more lasting, long-term relief of lower-back pain by supplementing massage with isometric core exercises, such as planks, that focus on strengthening the muscles that support and guide the spine’s movements.
Soothe Tension Headaches
Tension leads to headaches, so it follows that massage would help ease them. And for many, trigger-point therapy can prove particularly effective.
“A trigger point is an area of tightly contracted muscle tissue,” says Albert Moraska, PhD, a researcher focused on complementary medicine at the University of Colorado in Denver. “Trigger points in the shoulder and neck refer [relay] pain to the head. By reducing the activity of trigger points, we can reduce headaches.”
Moraska’s work, funded by the National Center for Complementary and Alternative Medicine, explores how massaging the neck and shoulders can ease tension-type headaches. “We think massage can disrupt trigger points by forcing apart the tightly contracted sarcomeres (proteins responsible for contraction) within the muscle cells; as a result, the cells relax and subsequently muscle tension dissipates.”
Restore Deep Sleep
Roughly one in five Americans suffers from sleep deprivation, according to the American Academy of Sleep Medicine. That’s a problem, because lack of sleep alters the body’s biochemistry, making it more vulnerable to inflammation and lowered immunity, and more sensitive to pain.
“The relationship between pain and sleep deprivation is a vicious cycle,” says Tiffany Field. “Your body doesn’t get the rest it needs to heal.”
Although studies of massage therapy and sleep quality are few, the findings suggest that massage can promote deeper, less disturbed sleep, especially in people with painful chronic conditions such as fibromyalgia. Massage therapy indirectly promotes good sleep by relieving pain and encouraging relaxation.
Because massage therapy stimulates the body’s parasympathetic “rest-and-relax” nervous system (the opposite of its sympathetic “fight-or-flight” response), it counters both physical and mental stresses — giving you a better shot at enjoying the sleep you need to repair tissue during the night and to cope better during the day.
Reduce Symptoms of Depression
It may seem surprising that physically manipulating the body can help counter a malady we associate with the brain. But, in his oft-cited 2004 review, Christopher Moyer found that depression is particularly responsive to massage.
The average research subject who received massage had a level of depression that was lower than 73 percent of those who did not. These findings are on par with more conventional approaches to treating depression, including psychotherapy.
Field’s research on depression shows that massage boosts the body’s natural levels of serotonin, a substance that works “much like Prozac” in the brain. Her studies show that massage also encourages the brain to release the neurotransmitter dopamine, a mood enhancer, as well as oxytocin, a hormone that generates feelings of contentment.
While the exact mechanisms are unclear, it seems evident that a good massage has a variety of positive psychological implications as well, from receiving nurturing touch from another person, anticipating that the experience will be beneficial, or feeling empathy from the therapist.
Lower Blood Pressure
Given how positively it affects the rest of the body and mind, and how well it moderates stress, it probably comes as no surprise that massage therapy can also benefit the heart — in part by reducing blood pressure. In his meta-analysis, Moyer found that massage significantly lowers blood pressure, at least temporarily.
He notes that the findings are consistent with the theory that massage can trigger the body’s parasympathetic nervous system, which helps prompt the body to return to biochemical balance and emotional ease after enduring a stressful event.
But perhaps the bigger takeaway here is that massage can help unlock the body’s healing potential not by any one means, but rather by many. As epidemiologist Andrea Furlan points out, “Well before drugs or surgical procedures were developed, people used massage to treat almost everything.” Still, today, she notes, “when we get hurt, our first instinct is to rub.”
Amy Buttell, for one, doesn’t need any more evidence than her own transformation. “I don’t know if it’s the touch, the warm table, or the fact that I get to turn my phone off for an hour, but I do know that massage is worth every penny.”
Multiple Modalities: What Kind of Massage Is Right for You?
Not so long ago, available massage styles in most U.S. cities were fairly limited. Today, bodywork modalities abound, from familiar basics like Swedish to more exotic options like Hawaiian Lomi Lomi and Chinese Tui Na. Wondering which style of massage is right for you? Read on for a rundown of some of the most popular options. Some massage styles are more physically intense than others, but keep in mind, you always have a role in guiding your therapist about how much pressure feels good to you and where it’s applied.
Abhyanga: Based on the principles of Ayurveda, one or more therapists apply herb-infused oils to usher the body into a state of relaxation and balance.
Acupressure: Working with the same theory of acupuncture (but without the needles), acupressure stimulates points on the body to release energetic congestion and open the body’s energy pathways.
Craniosacral therapy: A gentle, noninvasive form of massage in which a therapist uses a light touch to work the cranial bones, the spinal column and the sacrum (a triangular bone at the base of the spine) to balance energy, treat headaches and reduce mental stress. Mild enough for infants, as well as the elderly.
Deep tissue: Targeting chronic patterns of holding, deep-tissue relies on slow strokes and targeted pressure, often with a finger, thumb or elbow.
Hot stone: Smooth, warm stones are placed on the body and become focal points of relaxation as the heat penetrates and soothes tense muscles.
Lomi Lomi: An ancient Polynesian practice, this style is characterized by the practitioner’s rhythmic use of the hands, forearms and elbows. Long, broad strokes invite relaxation.
Myofascial release: A light, sustained pressure is applied to constrictions in the body’s fascia, or connective tissue, to elicit elongation and release.
Reflexology: Stimulates pressure points on the hands, feet and ears. Each point is believed to correspond to other, less-accessible parts of the body, such as the organs.
Shiatsu: A Japanese style, shiatsu directs pressure to lines of energy (meridians) considered important for health and well-being.
Sports: Often used before and after athletic activity, the focus is on reducing inflammation, keeping joints flexible and enhancing performance.
Swedish: A combination of long, gliding strokes, as well as kneading, stretching and tapping. Swedish massage is thought to enhance health by increasing blood flow to the muscles.
Thai: Performed on the floor with clothes on and no oils, a Thai massage involves being stretched into yoga-like positions.
Trigger-point therapy: Trigger points often show up as “knots” in the muscles, most often in the shoulders, upper back and neck. Trigger points are different from acupressure points because they actually feel like lumps. Trigger-point therapy (also known as neuromuscular therapy) uses pressure to dissolve the knots.
Tui Na: A vigorous kneading and pulling of the body, Tui Na (meaning push and grab) is a component of Traditional Chinese Medicine. Like other Eastern approaches, such as Thai massage and acupressure, the goal is to open up the flow of Qi through the body’s energy pathways or meridians.
How to Choose a Massage Therapist
Finding a truly great massage practitioner — one whose skills, style and personality all suit you — can make the difference between a merely nice (or worse, ho-hum) experience and the kind of transformative healing dynamic that keeps you coming back for more.
You won’t know for sure until you get on the table, but here are some key questions to help you decide whether a therapist is right for you.
1. Are you nationally certified?
More than 300 schools and programs in the United States offer accreditation for massage therapists. To become nationally certified, a person must have a basic set of skills, pass an exam, adhere to certain ethical guidelines, and take part in continuing education.
2. Are you state certified?
Every state is different, but most of them (42, plus the District of Columbia) offer certification for massage therapists; some are voluntary, and others are mandatory. Seek out a massage therapist who is state certified, which typically means he or she met a minimum number of training hours and passed an exam.
3. How many hours of training have you completed?
This is a helpful question, especially in states lacking strict oversight of who can call themselves a massage therapist. The answer you’re looking for is a minimum of 500 hours. According to the American Massage Therapy Association, the average practitioner has 633 hours of training. A massage therapist with less than 500 hours of training can still be good, but consider the number a benchmark.
4. Do you have any special or advanced training?
The best massage therapists spend years developing specialties and honing a specific skill set. The massage therapist who is passionate about Chinese meridians and spends several weeks a year going to special trainings may have an edge over the generalist who hasn’t evolved beyond the basic moves she learned in massage school. The same goes if you have special needs. For instance, a massage therapist who emphasizes sport massage might be a good bet if you have a weekend-warrior injury, but not if you have fibromyalgia.
5. How much do you charge?
Expect to pay roughly $1 a minute for a chair massage at the mall or airport. At an upscale spa or studio, massage rates range from about $60 to $120 an hour, plus a 15 to 20 percent tip. (Sometimes, packages of four or six massages are available at a discount.) If you have health insurance, ask your provider if you are eligible for either a discount (available with some plan-approved therapists) or if you can pay for massage with money from a flexible spending account. Unless you have the Mercedes-Benz of healthcare plans, preventive massage is probably not covered 100 percent, but if your doctor or chiropractor recommends massage therapy, your plan might cover a specific number of sessions.
One final tip: Get a referral.
It’s OK to be picky about who puts their hands on your body. If you’re feeling spontaneous and want to book a one-time massage at a local spa, great. But if you’d like to explore massage as a long-term investment in your body, or if you have some tenacious kinks to work out and you think you might need a series of treatments, talk to your friends about whom they like and why. If your friends don’t get massage, ask for a recommendation at your local yoga studio, health club, acupuncture center or chiropractor’s office. More often than not, these folks are plugged in to the local “who’s who” of bodyworkers and can steer you in the right direction
This article has been updated. It originally appeared in the July/August 2011 issue of Experience Life magazine.