Therapeutic Massage

5/10/2018

Facilitating the Body’s Natural Healing Ability during Stress, Illness, and Pain

Therapeutic Massage

2700 BCE: First known Chinese text ”The Yellow Emperor’s Classic Book of Internal Medicine” Published into English 1949. A staple in massage therapy training as well as acupuncture, acupressure, and herbology.

2500 BCE: Egyptian tomb paintings show massage was part of their medical tradition.

1500 and 500 BCE: First known written massage therapy traditions come from India. The art of healing touch was used in their practice of Ayurvedic (life health) medicine. Ayurveda is regarded as the originating basis of holistic health combining, massage, meditation, relaxation, and flower essence.

1800’s Dr Ling, a Swedish physician, educator, and gymnast, developed a method of movement that became known as the Swedish Movement System which became the foundation for Swedish massage commonly used in the West. Johan Mezger is credited with defining the basic hand strokes used in Swedish Massage.

1 5/10/2018

Therapeutic Massage in Medicine and Nursing

Late 1800’s. Hundreds of care givers trained in Swedish Movement and Massage for patients in Sanitariums

1900’s Nursing students trained in basic back, arm, hand, and scalp/head massage.

Late 1980’s routine massage included in PM care provided by nurses begins to disappear and is fazed out in the curriculum of Nursing Education

1990’s Medical and Nursing Care move from High Touch to High Tech

Benefits of Therapeutic Massage

Relieves pain

Relaxes painful muscles, tendons, and joints

Relieves stress and anxiety

Possibly helps to “close the pain gate” by stimulating competing nerve fibers and impeding pain messages to and from the brain. (Harvard Medical School, Harvard Health Publishing 7/2016)

2 5/10/2018

American Nurse Today, Journal of the American Nurses Association

Creates relaxation

Aids in lymphatic drainage, improves circulation

Reduces stress response

Lowers BP

Boosts immune response

Improves one’s sense of well being

Reduces pain

Research NIH (National Institute of Health) NCCIH (National Center for Complementary and Integrative Health

While there are preliminary or conflicting studies on massage, there is scientific evidence that massage may help with:

Back pain

Improve the quality of life for people with depression, cancer, and HIV/AIDS

Massage Therapy appears to have few risks if it’s used appropriately and provided by a trained massage professional. www.ncbi.nim.nih.gov/pubmed www.cochranelibrary.com

3 5/10/2018

Considerations

Training standards and requirements for massage therapists can vary significantly from state to state as well as counties within a state.

CA and most states requires a minimum of 500 hours of training from an accredited training program.

The National Certification Board for Therapeutic Massage and Bodywork certifies practitioners who pass a national exam and fulfill other requirements. Choose a therapist who has graduated from an accredited school

Ask for referrals from your Health Care Providers, physician,nurse, physical therapist, chiropractor, osteopath, health club, spas, etc.. Ask about their training, types of massage offered, experience, credentials, and references.

It is important that YOU feel comfortable with the therapist and the massage. You are the consumer. Immediately give feedback to the therapist if you are uncomfortable, with pressure applied, music being used, temperature of the room, etc.

If you are more comfortable with clothes on, then you may opt for a therapist who gives a chair massage or foot (reflexology) massage.

Reiki

Reiki is a Japanese technique for stress reduction, relaxation and healing. Based on the idea that an unseen life force energy flows through us.

Reiki is made of 2 words: REI which means God’s wisdom or higher power and KI which is life force energy, present in all living things.

Mikado Usui, created the Reiki system of natural healing in the late 1920’s.

Brought to Hawaii in 1937 by Hawayo Takata, a dedicated student of Usui’s. Reiki is activated in the student by a Reiki Master using a ancient ceremony known as attunement.

Students learn a simple set of 12 hand positions.

Although often considered a spiritual practice, it is not religious.

4 5/10/2018

1. Reiki Level 1: The First Degree

Level 1 is a practitioner's initiation into Reiki and is open to anyone. The focus during Level 1 is on opening the energy channels on a physical level, allowing the practitioner to connect to the universal life force energy, which flows from the cosmos through the crown of the head and down to the heart and hands.

Many Reiki Masters emphasize self-Reiki as the goal of the Level 1 designation, encouraging students to focus on practicing Reiki on themselves, thereby working through their own obstacles.

Many experience physical symptoms of energy in their palms after the first attunement — including

Level 1 course also includes an overview of the history of Reiki, hand placements and self and group practice.

2. Reiki Level 2: Second Degree

Level 2 is a focus on practicing Reiki on others, and an expanded opening of the energy channels.

Students receive the "Reiki symbols" and

The Reiki symbols allow the practitioner to connect more deeply to the universal energy, as well as draw on the qualities that the symbols represent: the ability to send healing energy to individuals wherever they may be.

These Reiki Symbols may be used to clear energy blockages across time, as well as physical locations. Due to the intensity of the attunement process, some Reiki Masters recommend that at least 21 days to a full three months pass between receiving the Level 1 and Level 2 attunements (Level 1 is required to receive Level 2).

Level 2 also includes practice in drawing the symbols, invoking their qualities, as well as distance healing.

5 5/10/2018

3. Reiki Level 3: Third Degree & Reiki Master

In many courses, the Third Degree and Reiki Master are the same designation.

Some teachers separate Level 3 from Reiki Master, in order to emphasize the difference between receiving the Master attunement, from being trained in attuning new

The Reiki Master Level is traditionally considered the teacher's level — a practitioner who has received the energy and knowledge to attune new Reiki practitioners.

Reiki is viewed by many as an effective alternative practice in mainstream USA.

1.2 million adults have tried Reiki According to UCLA study (2014)

More than 60 US hospitals have adopted Reiki as part of patient services.

Reiki education is now offered at over 800 hospitals

6 5/10/2018

Therapeutic Touch

Delores Krieger, PhD, RN, professor emeritus of Nursing at New York University, and Dora Kunz, a gifted energy healer, developed and standardized the technique of Therapeutic Touch with in the 1970s.

This standardization facilitates research and evaluation of treatment effects while simultaneously creating standard protocols for Therapeutic Touch Practitioners and Instructors

A typical session lasts approximately 15 to 30 minutes. Person is seated in a chair or lies down fully clothed. Practitioner begins by discussing your goals for healing. Therapeutic Touch practitioners generally follow these steps during the session: Center themselves in the present moment and bring themselves to a calm, quiet state of consciousness. Use light touch and/or sweeping hand motions above the skin surface to assess and balance the energy in and around the body. Clear and mobilize the client's energy field, direct energy to achieve wholeness, and balance the field. Evaluate and close the treatment. Ask for feedback and answer client questions.

7 5/10/2018

Therapeutic Touch is based on the following assumptions:

The human being is an open energy system composed of layers of energy that are in constant interaction with self, others, and the environment.

Illness is an imbalance in an individual's energy field.

Clearing or balancing the energy field promotes health.

All humans have natural abilities to heal and enhance the healing in others.

The Therapeutic Touch Response

Therapeutic Touch facilitates relaxation and a sense of well-being. Research shows that Therapeutic Touch is effective in: Decreasing anxiety, Mobilizing the individual’s own healing energies to restore balance. Facilitates the body’s natural healing processes :wound healing, mending fractures ,fighting infections. Stress Symptoms are particularly responsive to Therapeutic Touch: Signs of tension release during a treatment, such as perspiration, crying, slowing and deepening of breathing, relaxation or a decrease in heart rate. Therapeutic Touch has been shown to stimulate the body’s immune system, and can decrease the side effects of chemotherapy and radiation.

Response to treatment is individualized. You may notice an immediate change, or it may occur hours or even days later. One treatment can be sufficient. However, it is usually helpful to have regular treatments, especially for chronic problems, as the response can be cumulative. Because Therapeutic Touch facilitates relaxation, it can be useful in health maintenance and is therefore is not limited to treatment of an illness.

8 5/10/2018

Healing Touch

Healing Touch is an energy therapy in which practitioners consciously use their hands in a heart centered and intentional way

Janet Mentgen, RN, BSN was an energetically sensitive nurse. Her drive was to deepen and expand the connection between nurses and their patients. She saw the positive effect of touch while using various energy techniques and modalities. Janet began using her energy based healing skills in 1980.

In 1989, Janet formally created Healing Touch as an energy medicine program, which is down from 30 different healing techniques It began in 1990 as the Healing Touch certificate program sponsored through the American Holistic Nurses Association (AHNA) as well as providing CEU’s for nurses by the Colorado Nurses Association. In 1993, certification of Healing Touch Practitioners began and was administered by AHNA. That same year, Janet formed The Colorado Center for Healing Touch dedicated to bringing Healing Touch to millions of people throughout the world.

Healing Touch is endorsed by the AHNA and CHNA.

Practitioners and Instructors are certified through an independent certification process.

When one completes the Healing Touch Program, after Level 5, they may apply for certification.

Healing Touch Certified Practitioners are recognized internationally as having achieved a professional level of energetic therapy competence.

Healing Touch Certified Practitioner (HTCP) credential has become the first Energy Medicine profession to achieve accreditation through the National Commission for Certifying Agencies (NCCA), the accrediting body of the Institute for Credentialing Excellence (ICE).

9 5/10/2018

Community Hospital’s Hospice of the Central Coast

January to December 2017, Hospice of the Central Coast

Energy Modalities and Therapeutic Massage Statistics

Massage, Reiki, Healing Touch, and Therapeutic Touch volunteers worked with 47 patients, made 167 visits with a total of 267 hours of therapy given.

Similarities of Energy Based Therapies

All work with the biofield or energy field of the client

Light or no touch is used

All sessions are done with clients fully clothed

All sessions may be done with clients either sitting in a chair or lying down

Practitioners center themselves and provide heart centered compassionate sessions

10 5/10/2018

Differences Between Massage Therapy and Energy Based Therapies

Therapeutic massage is a hands on modality. All types of massage use varying degrees of pressure and hand strokes

While relaxation and potential pain decrease are usually achieved with massage, it is achieved with different types of hand movement and pressure

Typically it is a clothes off modality. (Chair massage, hand and feet massage the exceptions)

The “Why” for Touch therapies

Evaluation and research: Patient satisfaction (85 percent) seems to be the metric of choice in the evaluation of CAM services, followed by volume (57 percent). Outcomes research is definitely a weakness of hospital CAM efforts: Only 42 percent of hospitals are conducting any kind of outcomes assessments. The greatest challenges faced by hospitals in implementing programs are reported to be budgetary constraints (75 percent) and lack of evidence-based studies (43 percent).

With regard to the future, of those hospitals that are not currently offering any CAM services, 7 percent stated there were plans to do so. Of those respondents who had previously offered CAM programs but had discontinued them, the reasons they offered were poor financial performance (42 percent), general cuts in nonessential programs (29 percent), lack of medical staff support (29 percent) and lack of community interest (29 percent).

Whole Person Health

Clearly, hospitals are paying close attention to the needs and desires of their communities and patients when choosing to offer CAM services and, if so, choosing which therapies to offer. Many hospitals include community health and "whole person" health in their mission statements, making CAM services a natural fit.

"The rise of complementary and alternative medicine reflects the continued effort on the part of hospitals and caregivers to broaden the vital services they provide to patients and communities," says Nancy Foster, vice president for quality and patient safety at the American Hospital Association. "Hospitals have long known that what they do to treat and heal involves more than just medications and procedures. It is about using all of the art and science of medicine to restore the patient as fully as possible."

11 5/10/2018

Whole Person Health Clearly, hospitals are paying close attention to the needs and desires of their communities and patients when choosing to offer CAM services and, if so, choosing which therapies to offer. Many hospitals include community health and "whole person" health in their mission statements, making CAM services a natural fit. "The rise of complementary and alternative medicine reflects the continued effort on the part of hospitals and caregivers to broaden the vital services they provide to patients and communities," says Nancy Foster, vice president for quality and patient safety at the American Hospital Association. "Hospitals have long known that what they do to treat and heal involves more than just medications and procedures. It is about using all of the art and science of medicine to restore the patient as fully as possible."

The most popular therapies offered on an outpatient basis are massage therapy (64 percent), acupuncture (42 percent) and guided imagery (32 percent).

On an inpatient basis, the top therapies are pet therapy (51 percent), massage therapy (44 percent) and music/art therapy (37 percent).

"At Mayo Clinic, we saw a real 'snowball' with massage therapy in the hospital," says Brent Bauer, M.D., director of the complementary and integrative medicine program at the Rochester, Minn., clinic. "One small study in cardiovascular surgery patients showed a significant reduction in anxiety, pain and tension." When a second study confirmed this, the cardiovascular surgery division hired certified massage therapists to make massage therapy a routine part of the care following open-heart surgery. This soon was followed by similar efforts in other areas such as colorectal surgery and thoracic surgery. Now, he says, massage therapy is considered a routine part of the care for those surgical patients at Mayo who want it.

12 5/10/2018

Key reasons hospitals gave for offering CAM

Demand (85 percent)

Clinical effectiveness (70 percent)

Reflecting organizational mission (58 percent).

In choosing which therapies to offer:

Patient demand (87 percent)

Evidence based (59 percent)

Practitioner availability (58 percent)

Samueli Institute Exploring the Science of Healing

A systematic review of clinical studies with a variety of biofield therapies, such as Reiki, therapeutic touch, and healing touch, supported findings of moderate to strong evidence for reducing pain intensity

Participation in a complementary medicine intervention including healing touch and guided imagery resulted in a clinically significant reduction in PTSD and related symptoms in a returning, combat-exposed active duty military population

Reiki therapy may be effective for pain and anxiety in adults, some patients report improvements in mood and quality of life, and no side effects have been reported

A randomized control trial demonstrated that Tai chi training appears to reduce balance impairments in patients with mild-to-moderate Parkinson’s disease, with additional benefits of improved functional capacity and reduced falls compared to resistance training or stretching

A 2005 study showed that when external bioenergy was applied to cells, the concentration of calcium increased by 30% and the effect lingered for 24 hours.

13 5/10/2018

Samueli Institute (2)

We can measure the electrical activity in our hearts using electrocardiographs (EKGs) and our brains using EEGs, PETs and MRI scanning. This type of traditional energy is used in sound, light and magnetic therapies, which are commonly accepted forms of “healing” using energy.

Less familiar, are subtle energy therapies including therapeutic touch, healing touch, Reiki, and qi gong. Energy medicine describes harnessing the power of subtle energy to create healing. These types of “energies” have been described and used by ancient systems of medicine such as Traditional Chinese Medicine and Traditional Indian Medicine for thousands of years.

Energy medicine has not just been touted by enthusiasts of complementary and alternative medicine (CAM). Many hospital systems including the Cancer Treatments Centers of America have integrated energy medicine into their treatment options for patients, and self-care for hospital staff. Reiki, a form of energy healing that balances the body, is used on military bases to assist veterans coping with post-traumatic stress and addiction. Treatments decrease pain and anxiety, and improve relaxation and sleep.

Growing research indicates that the popularity of complementary and integrative medicine in the United States has increased dramatically in recent years. Studies by Eisenberg and his colleagues have documented that 42 percent of adults in the United States (82 million) routinely use complementary medical therapies to treat their most common medical conditions. In 1997, Americans made an estimated 629 million office visits to complementary therapy providers and spent an estimated $27 billion out-of-pocket on complementary care. Research conducted at the BIDMC Center for Alternative Medicine Research and Education has also documented that most Americans use complementary and alternative medicine therapies as adjuncts to – and not as replacement for – conventional medical care.

14 5/10/2018

Dana‐Farber Cancer Institute Boston Integrative therapies

acupuncture, massage, and Reiki,

exercise and nutritional consultations.

Research conducted by Dana-Farber investigators:

when used in conjunction with traditional cancer care, complementary therapies can help ease cancer-related symptoms and improve your quality of life.

Medical experts worldwide now view integrative therapies as an effective complement to surgery, chemotherapy, and radiation.

How integrative therapies can help

Adult and pediatric patients treated at the Zakim Center credit the Center's range of integrative therapies with helping them increase their quality of life and ease symptoms such as nausea, reduce pain, and lessen the anxiety associated with their treatment.

All Dana-Farber patients are eligible to take advantage of the Zakim Center's one-on-one offerings and free group classes to ease their symptoms and feel better during treatment. We also offer lectures and educational seminars on topics related to integrative therapies and cancer treatment, which patients, their families, and their caregivers are invited to attend.

Massachusetts General Hospital

At the MGH-Wellness Center, we provide affordable wellness programs that can help you prevent certain medical problems, and may also help you to better deal with health problems that may already exist.

Individual Services:

Massage- $45 for one hour

Acupuncture: $35 initial visit; $30 Individual visit and $20 Group/Community visit

Specialty Groups:

Mind Body groups for Stress Management and Resiliency (offered through mental health ~ billable to most insurance)

Parenting Support Group (offered through mental health ~billable to most insurance)

Sleep Well Be Well (offered through mental health ~billable to most insurance)

Mindful Movement:

Chair & Gentle Standing Yoga

Tai Chi/Chi for Health

Our Clinical staff of acupuncturists, massage therapists, and movement instructors are all licensed and/ or certified through the state of Massachusetts and credentialed through MGH.

Wellness services are available to patients receiving primary care through an MGH provider. Pre-registration is required.

Individuals can join at any time and may self refer or be referred by a clinician via the CRMS . Many of the services are not covered by insurance . We make every effort to make our services affordable.

15 5/10/2018

Northwestern University Comprehensive Cancer Center

Integrative Medicine

The Osher Center for Integrative Medicine at Northwestern University offers a full range of complementary and integrative therapies to engage the mind, body, spirit and community with a focus on lifestyle choices.

Services include:

Integrative medicine consultations to develop a wellness plan

Naturopathic and functional nutrition consultations

Traditional Chinese medicine/acupuncture

Mind-body therapies such as relaxation therapies, biofeedback, guided imagery and cognitive-behavioral therapy with trained health psychologists

Energy therapies, including reiki and healing touch

Massage therapies, including deep tissue, relaxation, craniosacral therapy and manual lymphatic drainage

Dietary supplements, herbal therapy and homeopathy

Top US Hospitals/Clinics that Incorporate Complementary Modalities

Cleveland Clinic Yale USCF Stanford Harvard Mayo Clinic Johns Hopkins MD Anderson University of Pennsylvania NYU Beth Israel Deaconess Hospital Dana Farber

16 5/10/2018

“The intuitive mind is a sacred gift and the rational mind is a faithful servant. We have created a society that honors the servant and has forgotten the gift.”

~ Albert Einstein

non nocere!

17 5/10/2018

References

www.takingcharge.csh.umn.edu www.cancernetwwork.com/oncology-nursing/energy-therapies www.health.harvard.edu www.NCCAM.NIH.Gov www.NCCIH.NIH.Gov/health www.SamueliInstitute.org www.therapeutictouch.org www.healingbeyondborders.org Guarneri MD FACC, Mimi, The Heart Speaks. New York: Touchstone 2006 Taylor PhD, Jill Bolte, My Stroke of Insight. New York: Plume 2009 Sputo MD, Len, A Return to Healing. San Rafael: Origin Press2009 Hover-Kramer EdD RN, Dorothea, et all, Healing Touch, A resource for Health Care Professionals. Albany: Delmar Publishers 1996

Bibliography

Becker, Robert. Cross Currents: The Promise of Electromedicine, the Perils of Electropollution. Los Angeles: Tarcher, 1990. Becker, Robert. The Body Electric. New York: Quill 1985 Brennan, Barbara Ann. Hands of Light: A Guide to Healing Through the Human Energy Field. New York: Bantam, 1993. Bruyere, Roslyn L. Wheels of Light: A Study of the Chakras. New York: Simon & Schuster, 1994. Burmeister, Alice, with Tom Monte. The Touch of Healing: Energizing Body, Mind, and Spirit with the Art of Jin Shin Jyutsu ®. New York: Bantam Books, 1997. Campbell, Don. The Roar of Silence: Healing Powers of Breath, Tone & Music. Wheaton, Ill.: Theosophical Publishing House, 1989. Chan, Luke. 101 Miracles of Natural Healing: ChiLelTM Qigong. Video recording available from www.chilel.com. Chopra, Deepak. Quantum Healing: Exploring the Frontiers of Mind Body Medicine. New York: Bantam, 1990 Co, Master Stephen and Eric B. Robins with John Merryman. Your Hands Can Heal You: Pranic Healing Energy Remedies to Boost Vitality and Speed Recovery from Common Health Problems. New York: Free Press, 2002. Cohen, Ken. The Way of Qigong: The Art and Science of Chinese Energy Healing. New York: Ballantine Books, 1997.. . Dossey, Larry. Healing Words: The Power of Prayer and the Practice of Medicine. San Francisco, Calif.: Harper San Francisco, 1993.

18 5/10/2018

Eden, Donna, with David Feinstein. Energy Medicine: Balance Your Body's Energies for Optimal Health, Joy, and Vitality. New York: Jeremy P. Tarcher/Putnam, 1998.

Guarneri MD FACC, Mimi, The Heart Speaks. New York: Touchstone 2007

Gerber, Richard. A Practical Guide to Vibrational Medicine: Energy Healing and Spiritual Transformation. New York: Quill, 2001, 2000.

Goldberg, Group Burton, Alternative Medicine the definitive Guide. Washington: Future Medicine Publishing,1993

Gordon, Richard, Quantum-Touch the Power to Heal. Berkeley: North Atlantic Books 1999

Grossman, Warren, To Be Healed by the Earth. New York: Seven Stories Press, 1998.

Macrae, Janet, Therapeutic Touch. New York: Alfred K Knoph 1988

Motz. Julie. Hands of Life: An Energy Healer Reveals the Secrets of Using Your Body's Own Energy Medicine for Healing, Recovery, and Transformation. New York: Bantam Books, 1998.

Myss, Caroline. The Energetics of Healing. Boulder, Colo.: Sounds True Video, 1997. Videocassette (two part).

Myss, Caroline. Why People Don't Heal and How They Can. New York: Harmony Books, 1997.

Nhat Hanh, Thich. The Miracle of Mindfulness: A Manual of Meditation. Boston: Beacon Press, 1987.

Oschman PHD, James, Energy Medicine Therapeutics and Human Performance. Dover : Butterworth Heinemann , 2003

Saputo, Len MD, Return to Healing. San Rafael: Origin Press, 2009

Wardell PHD RN, Diane, Healing Touch: Enhancing Life Through Energy Therapy.Bloomington:iUniverse 2014

Research

Int J Behav Med. 2010 Mar; 17(1): 1–16. Published online 2009 Oct 24.

Biofield Therapies: Helpful or Full of Hype? A Best Evidence Synthesis: Shamini Jain and Paul J. Mills

Biofield therapies (such as Reiki, therapeutic touch, and healing touch) are complementary medicine modalities that remain controversial and are utilized by a significant number of patients, with little information regarding their efficacy.

Purpose

This systematic review examines 66 clinical studies with a variety of biofield therapies in different patient populations.

Method

We conducted a quality assessment as well as a best evidence synthesis approach to examine evidence for biofield therapies in relevant outcomes for different clinical populations.

Results

Studies overall are of medium quality, and generally meet minimum standards for validity of inferences. Biofield therapies show strong evidence for reducing pain intensity in pain populations, and moderate evidence for reducing pain intensity in hospitalized and cancer populations. There is moderate evidence for decreasing negative behavioral symptoms in dementia and moderate evidence for decreasing anxiety for hospitalized populations. There is equivocal evidence for biofield therapies' effects on fatigue and quality of life for cancer patients, as well as for comprehensive pain outcomes and affect in pain patients, and for decreasing anxiety in cardiovascular patients.

19 5/10/2018

Healing Touch Therapy : Alternative therapies relax heart patients

Published: October, 2005

BOSTON, MA – Some medical centers are integrating alternative treatments known as "touch therapies" into their cardiac care practices, reports the October Harvard Heart Letter. And several studies of these treatments have shown positive results in people hospitalized for heart trouble.

Some touch therapies involve massage, while others aim to change the body's "energy fields." Among the more promising approaches are these:

Healing touch. Practitioners use their hands above or on the body, using a gentle touch, with the intent of affecting the body's energy fields. One study found that patients had shorter hospital stays if they received healing touch before and after open-heart surgery. Reiki. This centuries-old practice involves light touch over different parts of the body in an ordered sequence. In one study, people who underwent Reiki sessions before cardiac catheterization reported feeling more confident, and their cardiologists said these patients were more relaxed and cooperative. Massage therapy. Massage uses various techniques to manipulate the body's soft tissues through pressure and movement. A study found that systolic blood pressure dropped significantly in individuals who received massage therapy compared with those who had not.

The Heart Letter points out that there's one form of touch therapy that almost everyone is familiar with—hugging. Recent research found that women who often hug their partners have lower blood pressure than those who do so infrequently.

Therapeutic massage for pain relief

Massage used to be considered an indulgence, but it's now recognized as a legitimate therapy for some painful conditions.

Published: July, 2016

Therapeutic massage may relieve pain by way of several mechanisms, including relaxing painful muscles, tendons, and joints; relieving stress and anxiety; and possibly helping to "close the pain gate" by stimulating competing nerve fibers and impeding pain messages to and from the brain.

Therapeutic massage is an active area of research. In particular, it has been studied for its effect on pain in the back, hands, neck, and knees, among other areas. A study published in Complementary Therapies in Clinical Practice showed a reduction in hand pain and an improvement in grip strength among people who had four weekly hand massage sessions and did self-massage at home. They also slept better and had less anxiety and depression than people in the control group who didn't receive hand massage.

A study published in Annals of Family Medicine in 2014 found that 60-minute therapeutic massage sessions two or three times a week for four weeks relieved chronic neck pain better than no massage or fewer or shorter massage sessions.

Massage therapy can involve varying degrees of pressure. Some people find certain forms of massage, such as deep tissue massage, to be painful. Massage doesn't have to be painful to be therapeutic, so be sure to tell your therapist the type of touch you prefer (light touch, firm pressure, hard pressure). Lighter may be more relaxing and therefore more beneficial, depending on your situation. People with certain pain conditions such as fibromyalgia or chronic fatigue syndrome may only be able to tolerate light pressure.

There are no data to suggest that massage is harmful, but there are some specific situations where it is not recommended: massaging an inflamed area of skin, for example, can make it worse by causing irritation. One should not have massage to an area of infection, as it might spread the infection. The American Massage Therapy Association lists heart problems, infectious disease, phlebitis, and some skin conditions as reasons to avoid massage. Choose a licensed therapist; your PT may be able to make a recommendation.

20