I’m a big fan of massage, both giving and receiving (though generally you’ll find a lot more people willing to be on the receiving end!) It is the oldest described medical technique, being expounded in 4700-year-old tome The Yellow Emperor’s Book of Medicine. Hippocrates also said that all physicians should be familiar with “rubbing”. As a family doctor, I decided to take this dictum to heart a few years ago and familiarize myself with this ancient art.
Before I go further I should state that an RMT or Registered Massage Technician is the perfect way to go for top-notch professional massages. Many of them have special training in areas such as lymphatic drainage for cancer patients and I am a very frequent referrer to RMTs. Just remember one thing, the word “masseuse” refers only to female practitioners whereas the male practitioner should be more appropriately called a “masseur”.
Using a my medical training, extensive reading plus some hands-on in parts of the world as varied as the Wat Pho Healing Temple in Thailand, the Yucatan Peninsula (Mayan arvigo or abdominal massage) and the Mizpe Hayamim overlooking the Sea of Galilee in Israel, I’ve started to do massage myself for family and friends and I occasionally offer brief simple therapy for patients who can’t afford an RMT.
I don’t practice any Thai techniques, but I do know there have been recent advances in the treatment of autism using this ancient art. Thai massage is an amalgam of both Ayurvedic (ancient Hindu) and Buddhist techniques incorporating sen lines which are much like acupuncture meridians. The Wat Pho Healing Temple features ancient murals depicting these lines and their distribution (as well as a massive reclining Buddha not to be missed).
Thai massage is very different from the more traditional Swedish massage in that many of the moves look more like wrestling holds or even two-person gymnastic exercises. I should know, having partaken of a Thai massage at the Wat Pho. One move involved the masseur putting his foot in my arm pit and yanking, which is identical to a technique used to replace dislocated shoulders! I sure felt great afterwards though.
Personally, I stick more to the techniques developed by 19th-century Swedish physiologist and fencing-master Per Ling. With its combination of gliding, kneading, rubbing, friction and pressing, this technique is what most people think of and receive when going for a massage — the so-called Swedish Massage.
One of the most important things in massage practice is setting the mood for a relaxing experience. I like to use low light, pleasant music and a careful choice of oil. Oil come in two forms, the non-volatile carrier such as sweet almond oil and the volatile essential oils. The latter are highly concentrated and a few drops in the carrier oil go a long way.
A few years ago I was traveling in Nubia and found a vendor who extracted blue lotus oil by leaving the petals buried in clay amphorae in the desert for months. The plant was sacred to the ancient Egyptians and is often depicted being sniffed in ancient reliefs, possibly for mood elevating or health giving effects. The plant is exceedingly rare. Needless to say, I part with this treasure very sparingly but have others such as essence of frankincense and myrrh I also purchased in Nubia.
Everyone approaches giving a massage differently. Scalp, neck and back massage can be done just about anywhere and a fight usually breaks out among my office staff if I have a break in my day and offer my services.
More localized massage can be done if certain areas are afflicted by spasm or tension. It’s important not to massage areas with varicose veins, skin infections or lesions and certain types of injures such as nerve impingements where massage could actually aggravate the problem.
A full body massage should be done with the individual appropriately draped and in a warm room. For the more modest you can work around a fair number of garments in a reasonably efficient manner.
I usually start with the feet and work up, though many would commence in the back and neck area. Using the appropriate oil, if available, or even lotion in a pinch a little, I begin with gliding or effleurage across the soles of the feet to warm the tissue. After this comes thumb turns and individual toe massage (followed by effleurage and kneading or petrissage) of the calf muscles. I also give similar treatment to the hamstring, abductors and adductors of the upper leg and the “glutes” (gluteus muscles, the largest and sometimes most abused muscle group of the body).
It is crucial to massage towards the heart as the idea is to move blood and lymph-containing toxins such as lactic acid away from muscle to the central circulation. Massage also relaxes muscle directly by activating a stretch reflex in individual muscle fibers.
Moving to the low back, I use gliding to warm the paraspinal muscles, thumb circles up and down the spine, then kneading or petrissage. Around the shoulders and traps especially you may find muscular “knots” which can be pressed out. It’s an amazing feeling when a hard knot simply melts away.
The neck should be massaged very gently as it is a sensitive and delicate portion of the body. I use gliding and gentle thumb circles mainly, then move up to gently massage the scalp with my fingertips.
Next get your client to roll over on their back, again ensuring they are appropriately covered or draped. From here I start with the quadriceps muscles on the front of the upper leg.
If your subject has constipation or irritable bowel syndrome (NOT inflammatory bowel disease) then gentle abdominal massage can also help. The Maya of Central America and the Yucatan have a technique called arvigo massage dedicated totally to the abdomen.
I find it helpful to visualize the colon as an inverted U about three feet long starting in the right lower abdomen, moving up and across above the belly-button and then down to the lower left side. Gentle circles and gliding ALWAYS moving in the direction of digestion can be helpful.
The main muscles of the chest are the pectoralis major and minor. These muscles can take a lot of abuse and every once in a while I’ll see in my office what I call the “gravel shoveler’s heart attack”. Some poor guy or gal comes in with severe left sided chest pain and think they are dying. After a bit of history you discover they decided to singlehandedly shovel and spread several tons of gravel on their driveway the previous day, stressing the left pec major unmercifully. Fortunately this “heart attack” settles with some ice and anti-inflammatories (warning: always see a doctor with this type of pain; don’t self diagnose).
Massaging the pectoralis muscles is easier in men than women due to the fact that these muscles are in close proximity to the breasts; however, depending on the level of endowment this obstacle can usually be overcome with mutual cooperation, repositioning and sometimes a bit of a sense of humor.
Massage of the breast bone or sternum can be helpful for the sterno-costal joints where the ribs attach to the breast bone. I see a lot of costo-chondritis or inflammation of these oft-abused joints. Gliding and light thumb turns seem to work well here.
Finally the hands and arms are massaged in a manner similar to the legs but more gently. I finish with a very gentle fingertip massage of the facial muscles and a forehead press which I simply hold for five to ten seconds.
My advice afterwards is to drink a glass of cool mineral water and take a few minutes to “feel the glow”.
This article first appeared in “Family Practice”