Massage Therapy Classifications

There are many challenges to conducting valid and replicable research in the field of massage. One of the challenges in conducting research on massage therapy and other styles of bodywork is the lack of consistent terminology for describing the treatments given by massage therapists. A classification system could help to provide a consistent description of massage actions across a wide range of settings. A system similar to this was developed for research into the use of massage in the treatment of neck pain.

A three level classification system:

Principal goals of treatment
Massage style
Massage Techniques.

Four categories described the principal goal of treatment (relaxation massage, clinical massage, movement re-education and energy work). Each principal goal of treatment could be met using a number of different styles, with each style consisting of a number of specific techniques. A total of 36 distinct techniques are used in this attempt at classification many are used in more than one massage style.

Massage Therapy Taxonomy interventions.

Background
Massage therapy is one of the oldest forms of medicine known to mankind and has been practiced worldwide since ancient times. Today, more than 80 different forms of massage have been identified, many developed in the last 30 years.

Although massage is used for a variety of specific reasons (e.g., relaxation, comfort at the end of life, relieving pain, enhancing athletic performance), it is undertaken with the general goal of helping the body achieve or increase health and well-being. Touch given with the intention of healing, the common factor in many forms of massage, is believed by many therapist to have beneficial effects on tissue, body fluids and other systems of the body.

Many massage therapists believe the healing power of touch, is a fundamental factor in their success in assisting their clients’ goals for health. With the burgeoning interest in complementary and alternative medicine in developed countries has come increased scientific interest in undertaking studies of related therapies, including massage. One consequence of their training is that many massage therapists do not believe that a "placebo" massage exists and thus researchers who wish to study massage within its own worldview would need to design studies with more appropriate controls than, for example, light touching.

One of the challenges in conducting research in the field of massage and bodywork is the lack of consistent terminology for describing the treatments practitioners employ. This absence of a common language makes it difficult to ensure that different massage therapists are consistently describing what they are actually doing in treatment sessions and that the research methods for massage studies are reproducible.

The lack of a common language is made worst by the numerous trademarked styles of massage that have been developed and taught by individuals who use unique terms to describe common component techniques. Some massage styles with different names may be essentially the same such as Structural Integration and Rolfing.

However, some commonly used styles of massage therapy, including "deep tissue" and neuromuscular therapy, are not consistently defined. For example, some practitioners consider "deep tissue" work to be a synonym for neuromuscular therapy, while others consider "deep tissue" to mean the application of Swedish massage strokes with strong pressure, the application of acupressure, or the use of myofascial release techniques.

Finally, the same technique or stroke is often given different names in different styles (e.g., deep effleurage, muscle sculpting, and longitudinal friction are the same), so massage therapists with different training may not realize when they are applying the same technique.

Massage Therapy Classification

At the most general level, four principal goals of treatment can be described:

1) To promote relaxation and wellness (relaxation massage),

2) To address clinical concerns (clinical massage),

3) To enhance posture, movement and body awareness (movement re-education)

4) To balance and "move" subtle energy (energy work).

Each of these goals can be accomplished using a number of different styles of massage, some of which are trademarked (e.g., Rolfing®). In a typical massage therapy session, more than one goal is addressed and when addressing the broad goals described above, more than one style of massage is used in a course of treatments and even within a single treatment session. Finally, a single style of massage may be used to address different goals. For example, Structural Integration, can be used to enhance athletic performance (relaxation massage), address a clinical condition such as scoliosis (clinical massage) or improve posture (movement re-education).

Typically, massage students are taught a sample of styles in their basic massage training and then enhance their skills and learn other styles through continuing education workshops.

Specific techniques, which refer to physical manipulations of the tissue, are the most fundamental and specific level of classification and are the building blocks of each of the styles. Styles, consisting of a number of distinct techniques, are commonly distinguished by a unique combination of these techniques, and by the underlying intent of when and why to apply the techniques.

Specific techniques are commonly used in more than one style of massage and may be practiced by other professionals, such as osteopaths, physiotherapists, and movement educators. Principal goals, styles and techniques are discussed in more detail below.

Principal Goals of Massage Therapy

Relaxation Massage

Relaxation massage is massage that is specifically given to relax the body and promote wellness. Relaxation massage has the intention of moving body fluids (such as lymph and blood), nourishing cells, removing wastes from cells, relaxing muscles and diminishing any pain. In the US, the most widely taught and practiced style of relaxation massage is Swedish massage , which employs five basic strokes: effleurage (gliding), petrissage (kneading and lifting), friction (moving the tissue layers underneath the skin), vibration, and percussion.

Relaxation massage may include styles of massage that are more commonly used to address non-relaxation goals if such styles are applied with the intent to relax the body. For example, lymphatic drainage, commonly used as part of clinical massage (e.g., to reduce inflammation), is believed to be effective in stimulating the parasympathetic nervous system to promote relaxation.

Clinical massage

Clinical massage involves more focused manipulation of the muscle and/or surrounding fascia and may address other systems in the body such as lymphatic, circulatory and nervous systems . Its intent is to relieve pain and restricted movement. Popular styles of clinical massage are myofascial trigger point therapy, myofascial release, neuromuscular therapy and Structural Integration or Rolfing®. They differ from relaxation massage because they include focused therapeutic goals (e.g., releasing muscle spasms, strengthening or stretching specific muscles and remodeling fascia). Clinical massage may include styles of massage often used for other principal goals. For example, Muscle Energy Technique, often used for enhancing ease of movement (movement re-education), can also be used as a clinical technique, for example, to reduce muscle spasms in a patient with whiplash.

Movement re-education

Movement re-education emphasizes using movement to enhance posture, body awareness and movement . Movement re-education is generally intended to induce a sense of freedom, ease and lightness in the body. Some styles of movement re-education focus on active exercises to teach healthier ways of moving (e.g, Alexander technique, Trager®, Feldenkrais®). These styles may be used by non - massage therapists.

Other styles focus on tablework in which the practitioner induces, assists or resists movement for a patient (e.g., Proprioceptive Neuromuscular Facilitation, Muscle Energy Technique, strain counterstrain). Some styles of massage commonly used for a different treatment goal, can be used to increase function and movement (e.g., sports massage).

Energy Work

Energy work (also called subtle energy techniques or body-mind therapies) are believed to "assist the flow of energy in the body" by employing very light touch or by holding the hands just above the skin. These include Reiki, Polarity and Therapeutic Touch as well as massage traditions deriving from Eastern cultures, such as acupressure, Amma, Shiatsu and Tuina. The intention of energy work is to move stagnant or blocked "energy" so it can circulate freely throughout the body.

Two Clinical Massage Therapy Styles

Myofascial Release and Neuromuscular Therapy

Myofascial release is a style of manual therapy that Barnes defines as a "whole body, hands-on approach for the evaluation and treatment of the human structure. Its focus is to optimize the function of the fascial system." Component techniques of myofascial release includes the following techniques:

Compression - static
Listening to and following the craniosacral rhythm
Still point pressure

These are also components of craniosacral therapy.

Cross-fiber friction
Deep gliding
Holding
J-stroke
Manual stretching
Traction
Skin rolling
Rocking
Jostling
Shaking and vibration.

Neuromuscular Therapy

Neuromuscular therapy focuses on relieving local dysfunctions of the tissue, including trigger points, ischemia, inflammation, muscle hypertonia, and nerve impingement. It includes 15 component techniques: application of cold and heat, compression, cross-fiber friction, direct pressure, friction, J-stroke, manual stretching, percussion with stretch, scraping, stripping, and vibration focused on trigger points, and three types of resistive stretching: lengthening, contracting the agonist; lengthening the agonist, contracting the antagonist; and lengthening the agonist, contracting agonist and antagonist.

Techniques

Techniques are the "building blocks" of a massage treatment session. Techniques are listed in alphabetical order and include descriptions as well as examples of styles wherein these techniques have been commonly used.

In some cases, techniques may be related, either because they are similar in how they are performed (e.g., rocking, jostling, shaking, vibration) or because they are components of a single style of massage (e.g., circular compression and rebound are techniques used in lymph drainage).

Techniques may be used with different intentions that depend on the circumstances in which they are performed. For example, the technique of direct pressure may be used in trigger point therapy to release trigger points and in neuromuscular therapy to soften adhesions and make them more pliable. The technique of holding could be used

In Swedsh Massage to relax the tissues
In Myofascial Release to warm tissues before stretching
In Polarity therapy to "balance sublte energies"

Finally, the technique of positional release is used in sports massage to restore normal muscle length and in Aston patterning to convey a sense of ease and comfort and body awareness.

This taxonomy is a first step in enabling researchers and massage therapists to more clearly communicate about the nature of the massage treatments they are giving by using common language describing specific techniques that may have originally been learned as part of training in different styles of massage.

Even though many challenging issues regarding design and conduct of studies of massage therapy remain a clear taxonomy would improve standardization of massage interventions and increase the ability of researchers to replicate studies in an effort to confirm findings.

Taxonomy of Massage Therapy

Principal Goals of Treatment	Relaxation Massage	Clinical Massage	Movement Re-education	Energy Work
Intention	Relax muscles, move body fluids, promote wellness	Accomplish specific goals such as releasing muscle spasms	Induce sense of freedom, ease and lightness in body	To free energy blockages
Commonly Used Styles	Swedish massage, spa massage Sports massage	Myofascial trigger point therapy Myofascial release Strain counterstrain	Proprioceptive Neuromuscular Facilitation Strain counterstrain Trager	Acupressure Reiki Polarity Therapeutic Touch Tuina
Commonly Techniques	Gliding Kneading Friction Holding Percussion Vibration	Direct pressure Skin rolling Resistive stretching Stretching – manual Cross-fiber friction	Contract-relax Passive stretching Resistive stretching Rocking	Direction of energy, Smoothing, Direct pressure Holding, Rocking, Traction

Techniques, Mechanics and Uses

Technique (similar methods are color coded)	Mechanics of stroke	Application notes ( anatomic locations, conditions, pressure)	Example styles where used
Application of cold	Local application of cold/ice (e.g. compress, ice pack) over protected body part, Includes ice massage.	Used over areas of acute inflammation, pain or stiffness. Generally not used over areas of chronic inflammation.	Spa Massage; Sports Massage
Application of heat	Local application of heat (e.g. compress, poultice) over protected body part,	Used for chronic inflammation. Not used over areas of acute inflammation.	Spa Massage; Sports Massage, Stone Massage
Application of cold and heat (Vascular flush)	Alternating application of cold with application of heat.	Used for subacute inflammation.	Neuromuscular Therapy; Sports Massage; Spa Massage
ROM –Resistive stretching: lengthening, contracting the agonist	Lengthen muscle until the first resistance barrier, then coach patient to voluntarily resist AGAINST the lengthening	Recommended for subacute and chronic conditions. May be used for acute conditions with mild resistance.	Muscle Energy Technique (MET); Proprioceptive Neuromuscular Facilitation (PNF)
ROM –Resistive stretching: lengthening the agonist, contracting the antagonist (Reciprocal Inhibition)	Lengthen muscle until the first resistance barrier, then coach patient to voluntarily lengthen the muscle against resistance	Used in acute conditions. If contracting the agonist is painful, use this technique because the antagonist is the one doing the contractions.	MET; PNF
ROM - Resistive stretching: lengthening the agonist, contracting agonist and antagonist	A third type of resistive stretching that alternates contracting the agonist and contracting the antagonist through a series of barriers..	Recommended for subacute and chronic conditions. May be used for acute conditions with mild resistance	MET; PNF
Compression - pumping	Usually pumping the muscle and surrounding fascial layer against the bone – rhythm and force vary with the resistance of the soft tissues. .	Generally used over muscles and bone. Avoid the face and kidney. Can also be used for fluid movement with a light touch.	Joint Mobilization; Myofascial Release; Tuina
Compression – Static (origin – insertion technique; sutural releases; unwinding)	Mechanically shortening a muscle or fascia or joint by pressing on it. Can involve following the body’s natural movement	Everywhere. In craniosacral therapy, involves very light traction or compression	Craniosacral; Myofascial Release; Sports Massage
Listening and following the craniosacral rhythm	Hands meld with the client's cranium or sacrum therapist feels the movement of their hands.	Everywhere.	Craniosacral
Still point	Monitor the craniosacral rhythm at the client’s cranium or sacrum or other body area and the movement of the craniosacral rhythm is resisted by compression or traction.	Everywhere.	Craniosacral
Directed breathing	Instructions on the length of inhalation and exhalation, often including instruction to relax while exhaling	Used in conjunction with manual or manipulative techniques.	Acupressure; MET; Shiatsu; Swedish
Direction of energy (e.g., holding with hands on or off the body; V-spread)	Send positive, healing, balancing intent to a targeted area. May either be focused on a specific physiological intent.	Everywhere .	Craniosacral; Reiki; Polarity
Smoothing	Pass the hands over the patient's body (without physical contact) to smooth the energy of the aura so it is the same density and thickness throughout	Everywhere.	Reiki; Polarity; Therapeutic Touch
Cross-fiber Friction (transverse friction)	A type of friction that involves moving the patient's skin over the underlying tissue perpendicular to the muscle fibers.	Used in localized areas only, most commonly musculotendinous junctions, tinoperiosteal junction, muscle belly and tendons.	Neuromuscular Therapy; Cyriax Friction
Direct pressure/ static friction	Presses or leans deeply into an area without moving the hands	Nearly everywhere, including trigger points, except the face and areas of acute inflammation.	Acupressure; Neuromuscular Therapy; Shiatsu; Swedish
Friction	Pressing into the skin and moving it over the underlying tissues. Fingers do not glide or grasp. Motions can be circular (ellipsoidal) or in the same direction as the muscle fibers (longitudinal).	Everywhere. Use caution on the face and tender areas.	Neuromuscular Therapy; Swedish; Tuina
Gliding – Deep	A type of friction that involves pressing into the skin and moving it over the underlying tissues. Motion follows the direction of the muscle fibers.	Everywhere. Use caution on the face.	Myofascial Release; Sports Massage;
Scraping	A type of friction that involves scraping bony or ligamentous areas with thumb, knuckles, fingers, or massage tool - smoothing the surface, as if shaving ice.	Joints, bony or ligamentous areas. Avoid the face. . Use caution in tender areas.	Neuromuscular Therapy; Structural Integration
J-stroke	A type of friction that involves pressing into the skin to underlying tissue and hook that tissue in a J motion.	Use in localized areas, but everywhere on the body, except the face. Use caution on tender areas.	Neuromuscular Therapy; Mysofascial Release; Structural Integration
Gliding (effleurage)	"to skim", to touch lightly on" - palm, knuckles, fingers, or backs of hands glide gradually over client's body. Can be used to move blood and lymph	Everywhere. If moving lymph, long light gliding strokes should be performed in the direction of the heart	Swedish; Lymphatic Drainage
Hand rolling	Rotating wrist on body with knuckles as contact point.	Everywhere, except the face.	Lomi-lomi; Sports Massage; Tuina
Holding	Static, broad contact (e.g., whole hand) to warm, relax or mobilize tissues.	Everywhere.	Myofascial Release; Polarity; Reiki; Swedish
Kneading (petrissage)	"to knead" - rhythmic lifting , kneading and squeezing of the soft tissue. Can also be used to “milk” lymph fluid and move it toward the heart.	Everywhere. When working on limbs begin proximally. When moving lymph fluid, apply kneading with a light touch.	Sports Massage; Swedish; Tuina
Skin rolling	A specific type of petrissage where the superficial fascia is grasped between thumb and forefingers (or between other parts of the therapist's body), continuously lifted and rolled over the underlying tissue in a wave-like motion.	Everywhere there are subcutaneous fascial adhesions.	Myofascial Release; Sports Massage
Compression - circular	Light to deep circular movements over lymph nodes.	At watershed areas (e.g., axilla, inguinal).	Lymphatic Drainage
Pumping	Contacting and moving fluid through the lymph vessels (back to the heart) using repetitions of a pumping or kneading movement.	Along lymph vessels.	Lymphatic Drainage
Rebound	Patient inhales slowly and the therapist gradually increases pressure to target area During patient’s exhale, the pressure is rapidly released.	Abdomen, primarily.	Lymphatic Drainage; Visceral Massage
Percussion (Tapotement)	Series of brisk blows, rapidly following each other.	Everywhere, except the throat, breasts, abdomen, bony prominences, kidneys, back of knee, spine or any area of endangerment.	Sports Massage; Swedish;
Percussion with stretch	A series of brisk blows, rapidly following each other applied while muscle is placed/held in the lengthened position.	Used on trigger points and muscle bellies. Use with caution on tender areas.	Sports Massage; Neuromuscular Therapy
ROM -Passive stretching	Taking patient's muscle into a position of lengthening by moving a joint without any effort on their part.	Arms, legs, trunk and neck.	Sports Massage; Swedish gymnastics
ROM -Positional release	Passively placing the body in a position of maximal comfort. Can use point tenderness as a guide to positioning.	Everywhere.	Aston patterning; Craniosacral; Strain counterstrain
Stretching –manual – direct	Mechanically lengthening the muscle and/or fascia between your hands without moving a joint. Does not need to be applied parallel to fiber direction.	Everywhere, except not appropriate for face.	Sports Massage; Neuromuscular Therapy; Myofascial Release
Traction	Mechanically lengthening muscle and fascia by pulling on joints.	Everywhere.	Craniosacral; Sports Massage; Structural Integration
Flopping	Limb is lifted and bounced (with support for joints) on the table.	Arms and legs.	Sports Massage; Swedish; Trager
Rocking or jostling	Slower rhythmic type of vibration applied to the whole body in conjunction with the patient’s body rhythm.	Everywhere.	Swedish; Trager; Tuina; Shiatsu
Shaking	A type of vibration, using a lifting or pulling of the skin or a limb and then rhythmically shaking it.	Everywhere, except the face.	Swedish; Trager
Vibration	Continuous shaking or trembling movement made by hands, fingers or mechanical tool that is focused on a specific area of the body.	Everywhere.	Swedish; Tuina