By Dan Morris DN, Diplomat, LMT
There are many different types of massage therapy and there are many different massage therapy techniques that are practiced today. For the purposes of this discussion we will compare and contrast what is commonly referred to as “medical massage” and what is referred to as “therapeutic massage.” In order to better understand this discussion we need to define the meaning of “soft hand technique” and “homeosomatic system.”
Soft hand technique refers to a system of massage therapy where a relaxed hand is used to apply massage therapy technique. The soft hand or relaxed hand is held parallel to the area of the body that is being massaged or treated by the therapist. Care is taken to prevent stress or strain from occurring in the massage therapist’s hand(s) and wrist(s) while applying massage therapy to the client. By positioning the client on the massage table to achieve maximum relaxation or reduced postural tension within the targeted tissue to be treated (a technique referred to as folding) deep tissue massage can be performed with minimal stress or discomfort to both the therapist and the client receiving the massage.
Homeosomatic system refers to the application of any manual therapy technique which will demonstrate stimulation to the mechanoreceptors and inhibit nociceptor depolarization. Simply put homeosomatic system approach “feels” good. The belief is that the “body” will better respond to technique that “feels” good as compared to technique that causes discomfort or is painful. (Homeosomatic is a word that was created by Dr. Gregory T. Lawton and is trademark protected by him.)
By using a soft hand technique along with postural folding to reduce or eliminate uncomfortable or painful massage therapy technique the goal of homeosomatic system in massage therapy technique can be reached. Homeosomatic system also contends the manual therapy techniques used must also reduce acute and chronic inflammation and restore normal joint complex function. When massage therapy systematically and progressively achieve these goals we refer to this as “medical” massage therapy.
Today there is much debate on exactly what “medical” massage therapy is. Some contend that any massage that has as its focus any goal that is not simply a goal of relaxation is in fact a “medical” massage. But from the above description of medical massage therapy being applied to systematically and progressively reduce acute and chronic inflammation and to restore normal joint complex function can we agree that this is true?
Remember medical massage therapy is a system of strictly delineated clinical protocol. Massage therapy technique that lacks this approach will fail to demonstrate consistent results. Whereas “generalized” effects can be reached by all forms of massage therapy, such as in the temporary lowering of the blood pressure, it is the “specific” effects of reducing pain and inflammation while normalizing or restoring the function of the joint complex that defines medical massage therapy.
Medical massage can be further defined as not being a “general” massage therapy treatment. Instead medical massage is a method or technique which is applied to a specific area of concern or a primary pathology as it relates to the client.
Medical massage is delivered specifically to an anatomical region or area of the body based on the assessment of the soft tissue and the range of motion of the client. Protocols or progressive steps of treatment are followed with the goals of normalizing the tissue and restoring healthy joint movement. Medical massage treats the myofascial tissues and goes on to also treat the joint complex and the specialized structures found within the joint complex. More simply put the purpose and goal of medical massage is to promote soft tissue repair and healing.
This requires the medical massage therapist to have a detailed knowledge of the anatomical structures of the body and the area(s) to be treated. Since the goal of the medical massage therapist is to “normalize” the tissue environment it is also necessary to have detailed knowledge of the histological characteristics of the tissue structure to be treated. The medical massage therapist cannot effectively treat what she or he does not know.
Since medical massage therapy requires the use of a “soft hand” technique, let’s look at why this is important in greater detail. Total client comfort and relaxation during the medical massage therapy treatment will facilitate the overall healing process. The medical massage therapist will work to decrease client apprehension and discomfort during the treatment. This will increase the treatment effectiveness and will encourage the client to return for more therapy.
As already mentioned a very specific hand posture referred to as “soft hand” is used in medical massage. The hand is relaxed but strong. The hand is placed in parallel and full contact with the area being treated. The hand is not tight or rigid but is allowed to “melt” into the tissue below.
This reduces client discomfort and pain while protecting the therapist’s hands from possible stress and injury. Most massage therapists are forced to leave the massage therapy profession within three to five years resulting from injuries occurring from practicing massage with incorrect hand postures. Not only will the massage therapy treatment be more effective for the client by practicing soft hand technique, the massage therapist will benefit, too.
There is no shortcut in this regard. Improper hand postures used during massage therapy treatments will cause pain and apprehension for the client and will eventually cause injury to the therapist. To be a medical massage therapist a soft hand must be used.
This will also allow for deeper penetration into the tissue. Using a soft hand does not mean simply employing effleurage or superficial gliding strokes along the tissue. A soft hand will “melt” into the underlying structures achieving deep penetration. This is further facilitated by “folding” in which the tissue is place in a position which reduces or eliminates postural tension. This is accomplished by moving the attachments of the targeted muscles closer together effectively “folding” the tissue to allow it to go “slack.” When this is accomplished the soft hand can easily slip into the deeper underlying structures to provide “deep tissue massage” which will be very specific to the area(s) needing treatment.
Attempting to penetrate or press through contracted or eccentrically stretched tissue will cause stress and discomfort to both the client and the therapist and may lead to injury or bruising to the client and stress injury to the therapist. To be a medical massage therapist soft hand technique along with postural folding must be learned and properly applied during the massage treatment.
Therapeutic massage as it is practiced today is commonly thought of as being a form of “Swedish Massage” which was developed by Per Henrik Ling (1776-1839). There is much conflicting information surrounding the formation or development of “Swedish Massage.” Per Henrik Ling is hailed as the father of Swedish Massage and according to Mark Beck’s textbook “Theory & Practice of Therapeutic Massage” Fifth Edition page 11 states “The Ling System’s primary focus was on gymnastics as it applied to the treatment of disease and consisted of movements classified as active, duplicated and passive.” This is why Ling is also hailed as the father of physical therapy. The book further goes on to say that it was in 1813 that Ling established the Royal Swedish Central Institute of Gymnastics chartered by the Swedish government. Ling died in 1839 and never published his work. It was many years later that his “students” published “his works” posthumously.
No one knows what the Ling System truly was. He never recorded his work nor did he review the works attributed to him. In an article by Sue Young Histories (Massage Magazine) it is stated: “Ling and his earlier assistants left no proper written account of their treatment, and most of the literature on the subject is repudiated by one set or other of the gymnastics practitioners.”
It wasn’t until, “Johan Georg Mezger (1838-1909) who coined a “reduced set” of maneuvers and techniques of Dr. Ling’s system: the “Swedish massage” system,” that these techniques came to be recorded and then attributed to Ling. (http://sueyounghistories.com/archives/2009/05/04/perhenrik-ling-1776-%E2%80%93-1839/)
What is the significance of this information? The article continues: “[T]here have been two streams of development in the Swedish gymnastics founded on Ling’s beginnings, either in a conservative direction, making certain forms of gymnastic exercises subsidiary to the prescriptions of orthodox medical science, or else in an extremely progressive direction, making these exercises a substitute for any other treatment, and claiming them as a cure for disease by themselves.”
Many of the techniques and principles of modern physical therapy have followed the “first stream of development” as it were. However, Johan Georg Mezger who was from the Netherlands and developed the “reduced set” based on the Ling System never knew or even met Ling. Dr. Ling’s work was based on experience with and was an attempt to heal his own injuries which he received while performing as an athlete. Dr. Ling’s work was also greatly influenced by a system of Chinese medical massage called Tui Na. And whereas many of the techniques of the Ling System were “evidence based” these techniques were later deviated from.
An example of this can be found in the work of Henrik Kellgren (1837-1916), who had a special school and following. Kellgren deviated from the original work of Ling following the “second stream of development” as it were. Kellgren’s manual treatment, as it came to be called, sought to replace the conventional approach to medicine in favor of using his treatments as a replacement to those approaches and claiming them a cure. (http://enacademic.com/dic.nsf/enwiki/1363330)
Yet many sought to create a system that could be duplicated and “franchised” to be taught in other schools hoping to build upon the work that Ling had established. Following this “first stream of development” The Ling System was greatly reduced and generalized and has become the Swedish massage that we know today.
Even the Ling System itself as attributed to Ling was not without criticism. Emil Kleen, M.D., Ph.D., in his book Handbook of Massage published in 1892 wrote, “But, on the other hand, Ling’s activity suffered from certain unfortunate defects. He lacked scientific training, and was ignorant of medicine.” The established medical community of the time, of which Kleen was a part, objected to the use of gymnastics and exercises as a cure for disease.
In his manual Homeosomatic Medical Manual Therapy – General Rehabilitation Protocols – Volume II, Dr. Gregory Lawton states in part, “While massage therapy as a profession does lack the kind of scientific studies called for by medicine, massage therapy technique and treatment enjoys a very long history… which allows for another kind of scientific evidence based on clinical observation.” “Medical massage therapy by the adoption of the qualifying word, medical, should be able when placed under scientific scrutiny to demonstrate clinical results.”
The very specific protocols and progressive steps that are followed by medical massage with the goal of normalizing the tissue environment do in fact meet these criteria. As Dr. Lawton very aptly states in his above mentioned book, “Medical massage therapy is emerging as a manual medicine system of treatment.”
Many times I am asked if medical massage and therapeutic massage are the same. From this discussion it can be said no, they are not. There are many good benefits from either or both forms of massage being discussed here. But they are not the same. I am also asked many times if it is possible to combine the two. Whereas I have to say that anything is possible the goals of medical massage would be defeated by combining the more generalized and non-specific technique of therapeutic massage with medical massage. Remember the most important distinction between medical and non-medical massage is that medical massage is specific in its application.
In conclusion it is my opinion that the massage student cannot go wrong in learning how to practice medical massage. The technique of medical massage will provide a more comfortable and effective massage experience while protecting the client from discomfort by using soft hand technique and postural folding. The therapist is also protected from stress and injury from improper hand postures.
Remember, too. The medical massage therapist can always choose to be non-specific in treatment whereas the therapist not trained to be specific will not be able to perform medical massage if she or he should want to.
Take the time to learn medical massage technique and application. There are no short cuts or “hacks.” Just as Per Henrik Ling found favor by using his form of very specific Swedish “medical massage” called the Ling System with the Royal Society and was sponsored by his government, so too, the medical massage therapist of today is in great demand. Medical massage has never been in greater demand.
References: Theory & Practical of Therapeutic Massage; Fifth Edition, Mark F. Beck – Historical Overview of Massage page 11 Sue Young Histories (Massage Magazine); http://sueyounghistories.com/archives/2009/05/04/per-henrik-ling1776-%E2%80%93-1839/ See also https://www.massagemag.com/magazine-2002-issue100-history100-24026/ Wikipedia Pehr Henrik Ling; http://enacademic.com/dic.nsf/enwiki/1363330 Homeosomatic Medical Manual Therapy – General Rehabilitation Protocols – Volume II, Dr. Gregory Lawton Handbook of Massage; Emil Kleen, M.D., Ph.D. The Elements of Kellgren’s Manual Treatment; Edgar Ferdinand Cyriax
