Massage is a "hands-on" therapy in which muscles and other soft tissues of the body are manipulated to improve health and well-being. Varieties of massage range from gentle stroking and kneading to deeper manual techniques. Massage has been practiced as a healing therapy for centuries in nearly every culture around the world. It helps relieve muscle tension, reduce stress, and evoke feelings of calmness.

Although massage affects the body as a whole, it particularly influences the activity of the musculoskeletal (muscles, tendons, ligaments, and bones), circulatory (blood flow), lymphatic (waste drainage), and nervous systems.

Are there many types of massage?

There are nearly 100 different massage and body work techniques. Each technique is uniquely designed to achieve a specific goal. Some common types that might help your back pain include:

• Aromatherapy massage: Essential oils from plants are massaged into the skin in order to enhance the healing and relaxing effects of massage.
• Craniosacral massage: Gentle pressure is applied to the head and spine to correct imbalances and restore the flow of cerebrospinal fluid (fluid that surrounds your brain and spinal cord) in these areas.
• Myofascial release: Gentle pressure and body positioning are used to relax and stretch the muscles, fascia (connective tissue), and related structures. Both physical therapists and massage therapists who are appropriately trained use this technique.
• On-site/chair massage: Popular in offices and other public places, on-site massage therapists use a portable chair to deliver brief, upper body massages to fully-clothed people.
• Shiatsu: Gentle finger and hand pressure are applied to specific points on the body to relieve pain and enhance the flow of energy (known as qi in Chinese medicine) through the body's energy pathways (called meridians). Shiatsu is widely used in Traditional Chinese Medicine (TCM).
• Swedish massage: A variety of strokes and pressure techniques are used to enhance the flow of blood to the heart, remove waste products from the tissues, stretch ligaments and tendons, and ease physical and emotional tension.
• Trigger point massage: Pressure is applied to "trigger points" (tender areas where the muscles have been damaged) to alleviate muscle spasms and pain.

How does massage work?

When a practitioner massages soft tissue, electrical signals are transmitted both to the local area and throughout the body. These signals help heal damaged muscle, stimulate circulation, clear waste products via the lymphatic system, boost the activity of the immune system, reduce pain and tension, and induce a calming effect. They may also enhance a general sense of well-being by stimulating the release of endorphins (natural pain-killers and mood elevators) and reducing levels of certain stress hormones.

What happens during a massage therapy session?

At your first massage therapy session, the practitioner will ask you about any symptoms you may have (like low back pain) and will also ask questions about your medical history. The practitioner may also initiate a discussion about what you expect to achieve from the massage session.

The therapist leaves the room while you undress and lay down on the massage table. A sheet is used as a drape during the session and is moved only to expose the part of the body being worked on at any given time. Massage oil or lotion is often used to reduce friction between the practitioner's hands and your skin. The room is kept warm and free of distractions. The therapist may have soft music playing in the background and frequently asks whether he or she is applying too much or too little pressure.

The manner in which a practitioner massages your body depends on the problem being treated. A massage session can last from 15 to 90 minutes and may include a schedule of follow-up visits, depending on the severity of your situation.

What is massage good for?

In general, massage is believed to support healing, boost energy, reduce recovery time after an injury, ease pain, and enhance relaxation, mood, and well-being. It is of value for many musculoskeletal problems, such as:

• Low back pain
• Osteoarthritis
• Fibromyalgia
• Sprains and strains

In addition, massage may:

• Relieve depression in people with chronic fatigue syndrome
• Ease chronic constipation (when the technique is performed in the abdominal area)
• Reduce swelling after a mastectomy (removal of the breast)
• Alleviate sleep disorders
• Improve self-image

In the workplace, massage has been shown to reduce stress and enhance mental alertness.

Studies have found that massage relieves chronic back pain.

Are there any risks associated with massage?

In general, massage is considered relatively safe. Pain or other rare negative side effects are generally caused by an extremely vigorous massage technique.

Women should be cautious about receiving massages during pregnancy. If you are pregnant, be sure to find a therapist specifically trained to perform massages on pregnant women.

Even though massage is a useful technique to help regulate blood sugar over time, if you have diabetes you should check your blood sugar after a massage session because it may be too low just following a treatment. Plus, if you have diabetes and you are receiving massage on a regular basis, you should check your blood sugar frequently to evaluate for any changes over time.

Should anyone avoid massage?

Massage should be avoided by people with:

• Heart failure
• Kidney failure
• Infection of the superficial veins (called phlebitis) or soft tissue (called cellulitis) in the legs or elsewhere
• Blood clots in the legs
• Bleeding disorders
• Contagious skin conditions

If you have cancer, you must check with your doctor before considering massage because you should not receive such treatments under certain circumstances. For example, sometimes massage can damage tissue that is fragile from chemotherapy or radiation treatments.

People with rheumatoid arthritis, goiter (a thyroid disorder characterized by an enlarged thyroid), eczema and other skin lesions should not receive massage therapy during flare-ups. Experts also advise that people with osteoporosis, high fever, few platelets or white blood cells, and mental impairment, as well as those recovering from surgery, may be better off avoiding massage.

Also, be sure to let your massage therapist know any medications you are taking as the treatment may influence absorption or activity of both oral and topical medicines.

How can I find a practitioner?

Certified massage therapists complete a training program of 500 or more hours, take national board exams, and are licensed or registered in more than 30 states and the District of Columbia. To find a massage therapist in your area, visit the American Massage Therapy Association web site at www.amtamassage.org.