To Annette, with love. For Churchill Livingstone: Editorial Director:Mary Law Project Development Manager:Claire Wilson Project Manager:Ailsa Laing Designer:Judith Wright Illustrations Manager:Bruce Hogarth Illustrators:Zoë Harrison and Marie Cornall CHURCHILLLIVINGSTONE An imprint of Elsevier Limited ©Mario-Paul Cassar 1999 ©2004, Elsevier Limited. All rights reserved. The right of Mario-Paul Cassar to be identified as author of this work has been asserted by him in accordance with the Copyright, Designs and Patents Act 1988. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without either the prior permission of the publishers or a licence permitting restricted copying in the United Kingdom issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London W1T 4LP. Permissions may be sought directly from Elsevier’s Health Sciences Rights Department in Philadelphia, USA: phone: (+1) 215 238 7869, fax: (+1) 215 238 2239, e-mail: [email protected]. You may also complete your request on-line via the Elsevier Science homepage (http://www.elsevier.com), by selecting ‘Customer Support’ and then ‘Obtaining Permissions’. First edition 1999 Reprinted 2000 Second edition 2004 ISBN 0443 07349 X British Library Cataloguing in Publication Data Acatalogue record for this book is available from the British Library Library of Congress Cataloging in Publication Data Acatalog record for this book is available from the Library of Congress Note Medical knowledge is constantly changing. Standard safety precautions must be followed, but as new research and clinical experience broaden our knowledge, changes in treatment and drug therapy may become necessary or appropriate. Readers are advised to check the most current product information provided by the manufacturer of each drug to be administered to verify the recommended dose, the method and duration of administration, and contraindications. It is the responsibility of the practitioner, relying on experience and knowledge of the patient, to determine dosages and the best treatment for each individual patient. Neither the Publisher nor the editors assumes any liability for any injury and/or damage to persons or property arising from this publication. The Publisher The publisher's policy is to use paper manufactured from sustainable forests Printed in China Foreword The message of massage is universal: you can use each other. Massage is formalized touch; giving your hands to help literally anyone. Massage is us a licence to touch within clearly defined one of the simplest ways to help us achieve and boundaries. maintain good health, to show someone that we I am often asked where massage fits into the care, to comfort and soothe. overall picture of complementary therapies, but In the 1960s, when I started as a professional the fact is that massage is sui generis (of its own therapist, massage was barely used in this coun- kind). Massage is an independent therapy. For try. At that time massage, in many people’s thousands of years it has been a central factor in minds, was connected with the pampered rich or medical and psychological practice around the with burly footballers. Nowadays that picture is world. In this it is surely unique. We in the pro- transformed and massage is in the mainstream. fession do not ally it to, or divorce it from, any Massage therapy is now one of the fastest grow- other procedure or practice. However, with the ing professions, with reports that at least 20% of trend of integration of massage and other com- the population now use complementary medi- plementary therapies into mainstream health- cine. Massage is to be found in hospitals and hos- care, the benefits are being scrutinized. The fact pices, in offices and in sports and health centres. that (almost without exception) people feel better With this growing interest in massage, and the after a massage is not enough. There is now a increased use of massage in the medical setting, need for research-based evidence that these ther- comes a need for increased professionalism and apies work. Examples of research are given knowledge. Mario-Paul Cassar’s book addresses throughout the book, addressing this need and this need. giving credibility to the use of massage. Massage is probably one of the oldest healing Massage is a generic term for a wide variety of therapies known to mankind. It is an extension of techniques and this book has been designed to a basic instinct seen in animals and humans ensure that the techniques are easy to follow. alike; apes groom each other, animals lick their They are well illustrated and clearly described, wounds, humans rub away their aches and with explanations of how and when the different pains. The basis of massage is touch – the most techniques should be used. fundamental of human needs. Touch is so essen- In addition to the well-known effects of relax- tial that if it is absent or withdrawn all sorts of ation and emotional support that massage offers, problems can ensue, ranging from a failure its benefits influence a number of body processes. to thrive in babies to irritability and bad behav- In this book, Mario-Paul Cassar has described the iour in children and depression in adults. One of application of massage as it relates to the various the many reasons for its increased popularity systems of the body, and deals in depth with the isthat massage allows us to reach out and touch application of massage for common disorders x FOREWORD and malfunctions. He also looks at ways to help dom to move. In this book the author discusses the practitioner assess the suitability of the mas- the various postures for massage and throughout sage treatment and guidance is given on the use the text there are examples of the correct posture of the appropriate techniques for each region of for the technique described. the body, and their use as an adjunct to conven- I have known Mario-Paul Cassar for many tional treatment. Contraindications to massage years and was delighted to be asked to write treatment are highlighted throughout the text, this Foreword. I read every chapter of this book emphasizing the need for safe and effective with great interest and imagine that it will treatment. become a well-thumbed reference for practising It is a common mistake to assume that a good massage therapists, as well as an excellent text- massage requires only that the massage therapist book for those learning the art of massage. In has strong hands and considerable physical short, this book is a cornucopia of information, strength. In reality, the most significant requisite to be used as thoroughly as a favourite cook- for an effective massage is good technique book. It should inspire and encourage all of us applied with the minimum of effort. To achieve for whom massage is more than just a job, but is this it is essential that the therapist uses the cor- a way of life. rect posture and uses body-weight instead of strength. Agood posture is one in which the ther- Claire Maxwell-Hudson apist feels well grounded while having the free- London 2004 Preface In this volume I have retained the theme of my this array of terminology, I have given an intro- previous text, Handbook of Massage Therapy, and duction and a simple classification of the mas- continued to explore the application of clinical sage techniques in Chapter 2. This is by no means massage. The particular utilization of clinical comprehensive and may vary from other catego- massage is, of course, its specific application in rizations. It is worth pointing out that while the treatment of disease, dysfunctions and mus- opinions may differ about the terminology, the culoskeletal imbalances, whether it is carried out effect and safety of massage movements take as an adjunct to conventional or complementary precedence over their classification. medicine or as a holistic treatment by itself. As in other fields of complementary medicine, Taking a medical approach does not undermine the efficacy of clinical massage has to be backed the benefits of the primary effect of massage, i.e. by research. I have cited research material in sup- relaxation. Indeed relaxation through massage is port of the discussions on the effects of massage often used very effectively (as some of the cur- on the systems of the body (Chapter 3). The value rent research shows) to instigate a therapeutic of research is that it provides information on the response, such as the lowering of stress hor- physiological effects of massage at the biochemi- mones and promoting parasympathetic activity. cal or tissue level, for example effects on the The history of massage is always of interest peripheral circulation or changes in hormonal and frequently included in most massage books, activity. Research data had been rather limited in however, this subject has become extensive due the past and this has meant that, in some to the magnitude of data now available. I have instances, the only available material was pub- consequently narrowed the history to a short sec- lished some years ago and, in some cases, lacked tion on the clinical use of massage and given any conclusive evidence. Some of the investiga- examples when it was of significant interest in tive information from the past does, however, the past. serve the purpose of identifying the connections Massage movements and techniques have between the nerves, organs, muscles and soft tis- been developed over many years and there are sues. Updated research into the effects of mas- now a great number of methods that are very sage is now more widely available and references similar or even identical in implementation, but from this data have been quoted accordingly which are described in differing terms. throughout the text. For instance, The Touch Petrissage, for example, is used by some authors Research Institutes (University of Miami School to describe kneading, wringing, rolling, picking of Medicine and Nova Southeastern University, up and shaking, while in other texts these move- Florida, USA), headed by Tiffany Field PhD, ments are classified under soft-tissue and com- have carried much valuable and detailed pression techniques. In an attempt to simplify research into the effects of massage. xii PREFACE The clinical application of massage considers sional and safe. As noted earlier, the contraindi- the most common conditions pertaining to each cations to the massage are of equal importance to of the body systems (Chapter 4). Support for its its benefits. Accordingly, I have listed the general efficacy has been based on research material and contraindications in Chapter 1 and wherever clinical experience. My intention is not to present appropriate throughout the text, including those massage as a complete cure but rather to high- precautions that apply to the regions of the body light its beneficial effects and indeed its con- (Chapters 5–10). traindications. In the absence of research data on As with my previous publication, this book is the efficacy of massage for a specific disorder, its aimed at students and practitioners of massage, appropriateness of application can be based on bodywork and associated manipulative thera- the studies carried out into its effects at the bio- pies. However, it is assumed that the reader, at chemical or tissue level. For instance, as massage whatever level of learning, is already familiar has been shown to improve the circulation, it can with anatomy and physiology, basic pathology be applied in a condition where enhancing the and regional anatomy of muscles. These subjects circulation would be of benefit, for example in are essential to massage therapy and yet too vast the region of arthritic joints. This is only one to include in this text. I hope that this book will hypothesis of course, among many others. As in stimulate as well as inform, and that it will any other therapy, there are many differing view- encourage both students and practitioners to points on the application of clinical massage. carry out research, to discuss the many aspects of Treatment of a ‘reflex zone’ with massage is dis- this modality, to experiment and develop their couraged by some authors for instance, as it is own techniques, and to further the accomplish- postulated that it would stimulate reflex activity. ments of clinical massage. Others would argue that it helps to normalize reflex activity without over-stimulating the Mario-Paul Cassar organs. What matters most in the end is that the London 2004 patient benefits and that the treatment is profes- Acknowledgements During the many years I have been teaching I Stratton, April Martin, Ruth Adams, Jocelyn have met many wonderful students from Banks, Alison Peggs and Trevor Wicks. England, America, Japan, Canada, Australia and I am extremely grateful for the cooperation many other countries. Many have established and encouragement I have received from the pro- themselves as highly regarded practitioners, duction office at Elsevier; so many thanks to some have also turned out to be excellent tutors, Mary Emerson Law, Katrina Mather, Claire while others still, I am happy to say, have become Wilson, Sarah Beanland, Ailsa Laing, Barbara colleagues and friends. Furthermore, they have Muir and the rest of the production team. I been a great source of information, support and would also like to express my gratitude to my much appreciated critique of my work. I would friends who have supported me in my work and therefore like to show my appreciation to, among who kindly propped up my personal life in time others: Dr Patrick Lincoln, Carol Jordan, Indrajit of need. They include Judith Kane, Hazel Garai and James Earles (my apologies go to all Stratton, Pam and Tony Parkinson, Leslie the others I have left out). Cuozzo, Chris Hanson, Alan Jones, Liz Hunt and Contributors I would like to thank are Marie Ken Gallichan. Cornall for some of the illustrations, Paul Finally I would like to thank all my family for Forrester for his excellent photography, Penny their continuous support that is sincerely appre- King, and the models Nick Wooley, Hazel ciated. 1 The massage treatment THE HISTORY OF MASSAGE The history of massage is extensive and has gen- erated a profusion of literature. Some of the his- torical facts are common knowledge, and the need to repeat them could almost be contested. None the less, the history of massage remains an important subject for students and practitioners alike and, accordingly, merits a mention in every book on massage therapy. In keeping with the theme of this book, the history of massage in this section gives a brief account of the application of massage for ‘medical’ conditions. It is by no means comprehensive but the aim of this section is merely to highlight some of the early pioneers and concepts of massage therapy. The practice of massage dates back to prehis- toric times, with origins in India, China, Japan, Greece and Rome. Massage has been mentioned in literature dating back to the ancient times, with the earliest recorded reference appearing in the Nei Ching, a Chinese medical text written before 2500 BC. Later writings on massage came from scholars and physicians such as Hippocrates in the fifth century BC and Avicenna and Ambroise Pare in the 10th and 16th (some say 17th) centuries AD, respectively. A very famous book on massage, The Book of Cong-Fou, was translated by two missionaries named Hue and Amiot, and this created great interest and influ- enced the thinking of many massage practitioners. The word therapeutic is defined as ‘of or relat- ing to the treatment or cure of a disorder or dis- ease’. It comes from the Greek therapeutikos, and relates to the effect of the medical treatment 1 2 HANDBOOK OF CLINICAL MASSAGE (therapeia). The word massagealso comes from the of exercises and movement for the preservation Greek masso, meaning to knead. Hippocrates and restoration of health. Fuller died in 1706, but (480 BC) used the term anatripsis, meaning to rub his work on gymnastics was in print until 1771. down, and this was later translated into the Latin A similar system of medical gymnastics was frictio, meaning friction or rubbing. This term developed by Tissot, who used very little mas- prevailed for a long time, and was still in use in sage except for some friction movements, and a the USA until the middle of the 1870s. The book on his work was published in 1780 (Licht expression for massage in India was shampooing; and Licht, 1964). These two pioneers preceded in China it was known as Cong-Fou, and in Japan the Swedish physician, Per Henrik Ling, and as Ambouk. It is usual to record the history of very probably influenced his thinking on massage chronologically, but rather than follow gymnastics. this format it is of interest to consider some of its Per Henrik Ling (1776–1839) developed the historical applications as a therapeutic medium. science of ‘gymnastics’, which was a form of treat- ment combining massage and exercise. The mas- sage component of the therapy was not Relaxation particularly emphasized by Ling as it was only Relaxation, which itself has a therapeutic value, part of the overall treatment, and he placed more is perhaps the effect most freely associated with importance on the exercises that were carried out massage. As long ago as 1800 BC the Hindus in by the patient and the ‘gymnast’ (massage practi- India used massage for weight reduction and to tioner). Ling’s system was known as the Swedish help with sleep, fatigue and relaxation. Over the Movement, or the Movement Cure. Years later, centuries the relaxation aspect of massage has after his death, the massage aspect was taken out been used to treat many conditions, such as of context and practised on its own as Swedish hysteria and neurasthenia (a form of postviral massage. Similarly, changes took place concern- syndrome). ing the goals of the treatment. Ling had also advocated the Swedish Movement to improve hygiene and to prevent ill health, but by the late General health 19th century physicians were only interested in Massage, in combination with exercise, has Ling’s method as a treatment for disease. Ling’s always been advocated for general health. system of massage was introduced to England in Artifact discoveries indicate that prehistoric man 1840, soon after his death. used ointments and herbs to promote general In 1850, Dr Mathias Roth wrote the first book wellbeing and to protect against injury and infec- in English on the Swedish Movement. He also tion. The potions that were rubbed into the body translated an essay by Ling on the techniques would also have had a healing effect, especially if and their effects. Between 1860 and 1890, George the ‘rubbing’ was carried out by a religious or H. Taylor MD of New York published many arti- medical ‘healer’. In the Indian art of Ayurveda cles on the Swedish Movement Cure, which he medicine, the patient was expected to undergo a had learned from Per Henrik Ling. His brother, process of shampooing or massage every morn- Charles Fayette Taylor, was also an ardent writer ing after bathing. The health-promoting proper- on the subject (Van Why, 1994). During the latter ties of massage, exercise and hydrotherapy were years of the 19th century, when massage was mentioned in the writings of the Arabic physi- widely used, it was claimed that the Swedish cian and philosopher Ali Abu Ibn Szinna Movement Cure had many positive effects on (Avicenna) in the 10th century AD. general health and in the treatment of disease. Exercises, or ‘gymnastics’, were again endorsed These claims were described and supported by for health in the 18th and early 19th centuries. case histories in the writings of George Taylor. Francis Fuller in England and Joseph-Clement Some of them, as mentioned here, continue to be Tissot in France advocated an integrated system valid today.