In Defense of the Relaxation Massage

Given that I am a massage practitioner who thoroughly enjoys doing therapeutic work with clients—releasing “knotted” muscles, alleviating aches and pains, and so on—it is probably not surprising that a fairly high percentage of my clients come to me exclusively or nearly exclusively for therapeutic work. Some, I would venture to say, feel they can only justify coming in for a massage, in fact, when they are hurting.

There are other reasons, of course, for relegating massage sessions solely to times when pain relief is the goal, but one of those reasons should not be that relaxation (or Swedish) massage is just pampering and, therefore, a luxury expense. Because in its own way, Swedish massage can be just as therapeutic as deep tissue and trigger point massages.

Though definitely more gentle in its application, Swedish massage reduces anxiety levels, lowers blood pressure, reduces heart rate, increases range of motion, and improves mood. It also reduces the stress hormone cortisol, about which I’ve written previously.

If you are still thinking to yourself, “Well, that’s all nice, but I wouldn’t call any of that essential,” consider for a moment how heart rate affects both your athletic performance and your daily life. A lower resting heart rate keeps stress levels in check, improves heart health, and allows quicker recovery after strenuous exercise. In addition, the reduction in cortisol production is huge. Reduced stress levels have been shown to increase one’s sense of happiness, promote weight loss, protect against cancer, make your sleep sweeter, help you live a longer life, improve your memory, and, gosh darn it, just give you a better outlook on life! Now I’m not saying that if you get a regular relaxation massage, you’re not going to get cancer and you’re going to live to be 120. But anything you can do to reduce your stress level is bound to enhance the quality of your life.

Those of you who are athletes have probably heard that sports performance is 80 percent mental. If, in fact, “a lot of performance is psychological based,” as researcher Michael Tschakovsky and others say, then it stands to reason that “if you feel better, if you feel you’re in a better situation to do something, [massage] probably has the ability to affect performance.” Furthermore, if science is still at a bit of a loss to explain just how massage does work, at the same time, research hasn’t proven that massage in any way hinders performance and recovery. In short, there is no downside to getting a massage that will help you feel rejuvenated both physically and mentally.

Of course, not all relaxation massages are created equal. I have heard complaints about the light touch used some relaxation massages being “too tickly” or so feather light as to leave muscles relatively unchanged. Though even a very light massage, depending on the person’s needs and wants, can be psychologically and physically valuable, it is helpful to know that the basic strokes used in traditional Swedish massage—kneading, gliding, circular pressure, and so on—can be applied more firmly for those wanting something gentler than deep tissue or trigger point massage but also wanting to feel as though they’ve actually been massaged and not just brushed with butterfly wings.

So as they used to say in the sixties, if it feels good, do it. Let your Puritan ethic relax a little, set aside your no-pain, no-gain mentality, and get a massage for the pure enjoyment of it. (But feel free, if you must, to remind yourself of all the suspected and proven therapeutic benefits of a “nontherapeutic” relaxation massage!)

Circulating Rumors?

Virtually every document promoting massage contends that massage improves circulation. It’s what I was taught in massage school, it’s what I read in countless other sources—it’s what I put it in my private-practice brochure. An article that recently appeared in the New York Times, however, calls this claim into question, reporting that a study by Michael Tschakovsky published in the June issue of the journal Medicine and Science in Sports and Exercise found that not only did massage fail to increase blood flow to tired muscles—it actually decreased it.

Does this mean that I, and every other massage therapist, have been misleading our clients, albeit unintentionally? Yes and no. It depends, it would seem, on where and how that blood flow is measured. An earlier article, published in that same science journal (August 2004), determined that while massage did not increase blood flow to the femoral artery in the quadriceps it did increase blood flow to the skin. The latter effect is, in fact, easily verifiable with the naked eye: look at anyone’s skin after a vigorous massage, and you can see the redness brought on by the increased circulation of blood to the surface. So massage does increase circulation.

But—but—that same article concluded that any increase in blood flow to the skin “is potentially diverting flow away from recovering muscle. Such a response would question the efficacy of massage as an aid to recovery in postexercise settings.” That seems fairly clear, right? But yet another article published that same year, in Medical Science Monitor, concurred with the findings about increased blood flow to the skin but also detected increased blood flow to the muscle and a decrease in muscle fatigue, as subjectively evaluated by the experiment’s subjects.

So how is one to reconcile all of this conflicting information? And what does it mean for the efficacy of massage for relieving muscle soreness? To begin with, according to an article by Whitney Lowe, LMT, in Massage Today (September 2009), “rarely do these studies investigate circulation through small capillaries in muscle tissue and skin. Increases in small capillary blood flow bring fresh oxygenated blood to muscle tissue.” The study reported on in the New York Times, for instance, measured blood flow by “catheter inserted directly into the deep vein that drains the muscle”—that is, not in the capillaries. So perhaps there are, in fact, circulation benefits to massage as has been claimed.

In any case, massage provides other benefits that aid in the reduction of muscle soreness. A 2005 study in the Journal of Athletic Training, for instance, suggests that massage can help reduce delayed-onset muscle soreness (DOMS) and swelling associated with certain kinds of high-intensity exercise. Massage also clearly can release very tense muscles. I have felt this happen in my own work, with muscles that were once tight as piano wire becoming soft and pliable. In addition, recent studies indicate that massage may “improve the rate of healing in damaged tendons and reduce the symptoms of tendonitis.”

Scientists concur that there is much yet they don’t understand about how and why massage works and that more research is needed. And even as more data is released concerning the efficacy of massage, it will likely take time before the results of such findings are incorporated into the practice of massage. As Lowe notes, “A recent study investigating knowledge translation in medical practice noted that it takes about 20 years for advances in medical knowledge to be incorporated into clinical practice.” Plus, the sheer volume of work being published and the difficulty with understanding scientific jargon make this task even more formidable.

It may be that in the long run I and other massage therapists will find it prudent to strike “improves circulation” from the list of massage’s benefits. Or we may find that we can let that claim stand. But in the meantime, it bears keeping in mind that, as Tschakovsky stated when he presented his findings at a May sports medicine meeting, massage “feels good, that’s the truth of it. A lot of performance is psychological-based so if you feel better, if you feel you’re in a better situation to do something, it probably has the ability to affect performance.”

Boost Your Immunity with Massage—No Kidding

If you are someone who works out a lot, you can be especially susceptible to viruses owing to the fact that physical exertion can upset the regulation of cortisol. More commonly, increased cortisol production is linked to stress. Whether the stress is physical, psychological, chemical, biochemical, environmental, or even imaginary, the adrenal glands are hardwired to intensify their production of cortisol.

So what the heck is cortisol? Cortisol destroys the body’s natural killer cells, which are key to the immune system’s defense against invading illnesses. Because massage reduces the amount of cortisol in the body—as demonstrated by several studies that measured cortisol in subjects' saliva before and after massage sessions—“your immune cells get a boost,” according to Tiffany Field, director of the Touch Research Institute at the University of Miami School of Medicine. Even in people with severely compromised immune systems, such as those with breast cancer, massage has been shown to suppress cortisol and give the immune system a lift.

Cortisol levels that are chronically elevated, incidentally, can also lead to an accumulation of abdominal fat. This is because glycogen stored in the liver and in muscle tissue is mobilized to raise blood sugar level and because digestion is inhibited as a response to the perceived threat. Such blood sugar imbalances can also interfere with the ability of cells to be nourished by the glucose in one’s diet and can increase the permeability in the intestinal wall, both of which can leave you nutritionally deprived, further weakening one’s immunity.

It is not advisable to get a massage if you are in the throes of a cold or the flu because of the way massage can spread viruses through the body more quickly than would happen naturally. If you aren’t sick, though, but have been exercising vigorously or have been experiencing any other kind of stress, regular massage can help bolster your immune system.

Fight Colds and Flu:

Lie Down on a Massage Table

Headache Pain: It’s Not All in Your Head

Though we can be fairly certain that headaches do not come from birds using your hair to make a nest, as North Carolina folk wisdom would have us believe, it can sometimes be difficult to determine from where, exactly, that head pain does come. The location of your pain on your head, however, provides a lot of clues as to how to treat it. Sometimes a muscle or some other structure in the head can be the culprit, but it is just as likely that any of several neck muscles could be causing your head pain.

One of the muscles situated on the head itself, the aforementioned masseter muscle, may be the culprit if you feel pain in your sinuses, eyebrow, and ear, as well as your jaw. The masseter muscle can be stressed by, for instance, tension, grinding your teeth in your sleep, chewing gum, and crunching ice with your teeth. Treatment for this kind of headache could include applying sustained pressure to the tender spots in your jaw in attempt to get the tight spots there to loosen. Work that is myofascial (i.e., work on the fascia, or connective tissue, of the muscle) can also be helpful. Allow your finger or thumb to sink into the muscle just below the cheekbone and slide very slowly to the jaw.

Of course, pain in your sinuses can also be a sinus headache! One way to determine the difference is if bending makes the pain feel worse, it is likely the sinuses. Acupressure points can be very effective in treating sinus issues.

Another muscles situated on the head that may be painful in and of itself is the temporalis muscle, which stretches from the joint in your jaw across part of your skull above your ear. Tightness in temporalis can cause pain in a tooth, along the eyebrow, behind your eye, and on the side of your head. Many of masseter’s stressors also affect temporalis. Rubbing across the several fiber directions of this muscle can help loosen it.

If you feel pain that penetrates inside the skull and seems to be all over, four little muscles at the base of your skull might be the cause. The suboccipitals can become stressed if you have been gazing upward for an extended period of time, with your head titled back, for instance, or if you’ve been doing a lot of typing while reading copy from a flat surface.

Pain directly on top of your head—sometimes known as a dome headache—could be caused by a muscle in your neck that crosses from below your ear to the vertebrae of lower neck and upper back. Splenius capitis can be strained as a result of cold air blowing on the neck, whiplash, or painting a ceiling.

A headache that spreads from the scalp to the eye region might be the result of tightness in semispinalis capitis, which goes from the base of the head to vertebrae in the neck and upper back. Sustained flexion of the neck, how you sleep, improper adjustment of eyeglasses, and lack of lumbar support when sitting can all be contributing factors. Active assisted stretching and hydrotherapy can be excellent ways to treat this type of pain.

Finally, the muscle that stretches from your collarbone and top of your sternum to just under the ear generally sends pain to the forehead, around the eyes, to the back and the top of the head, and to the cheek. This pattern mimics the classic migraine arc. (Migraine headaches, by the way, are not muscular in nature but, instead [according to the National Institutes of Health], changes in nerve pathways and chemicals in the brain.) The sternocleidomastoid, or SCM, can be adversely affected by lying on your side while reading, prolonged driving, collars or neckties that are too tights, and drooping shoulders. Pincer compression and stretching are both helpful in alleviating SCM pain.

Not all headache pain can or should be treated by a massage therapist, of course. Any of the following accompanying signs or symptoms should have you considering consulting a physician: vomiting with no nausea, visual disturbance, a headache that starts when you’re lying down, especially if it wakens you from sleep, a headache that pulses synchronously with your heartbeat, headaches that get worse when you’re active, numbness, altered sense of taste, smell, or hearing, or loss of coordination.

But if your headache is free from such additional symptoms, tell me where it hurts, and I’ll help relieve the pain—whether it originates in your head or somewhere else.

Your Abs Deserve a Little Love, Too!

One part of the body that routinely gets neglected during a massage is the abdomen. Often, people feel uncomfortable displaying their abs and/or having them touched. Because of that, I stopped promoting abdominal work to my clients but I think this is a mistake on my part: there are many good reasons to have your abs massaged, starting with the facts that it feels nice and is relaxing. But there are genuine health benefits to abdominal massage as well.

Actually, there is even a Taoist Chinese massage technique, chi nei tsang (CNT), that focuses entirely on the abdomen and the internal organs there. Chinese Taoists believe that the belly, as the repository of our emotional life, is the “organ” of happiness. Given that, the goal of CNT is to restore happiness and well-being. Both CNT and shiatsu intend to influence the internal organs, but the difference is that shiatsu works through acupressure to meridian points while CNT works directly on specific organs. Among the claims of CNT are relief from chronic constipation and diarrhea, spastic colon, gastritis, ulcers, abdominal pains, and menstruation issues. (If you’d like to learn more about CNT, a good place to start is http://www.holisticlocal.com.au/articles/view/362/Chi+Nei+Tsang+Abdominal+Massage+-+Healing+from+Within.)

While I am not myself a CNT specialist, I do have experience with abdominal massage, the benefits of which include:

• Promoting digestion
• Relieving constipation, bloating, and flatulence
• Improving circulation of blood in abdominal muscles and organs
• Preventing adhesions and scar tissue formation postoperatively in the area (once tissues have healed)
• Alleviating gastric upsets
• Helping align pelvic bones

So next time you come to the spa at FFC Union Station, consider having me include the abdomen in your massage. Your belly will thank you. And who doesn’t want a happy belly?

Congestion

If you tend to get congested in the face cradle during a massage, let the massage therapist know. They may not be able to offer help with that but then again they may. I, for instance, have Breathe Right strips that clients can use or I can put eucalyptus oil on a towel to inhale, which can help keep your sinuses open.

If you find yourself congested at home, there are a number of things you can do about it, beyond taking pharmaceuticals. These include:

• Nasal irrigation (which you can read more about at a number of places on the Internet, including at http://sinucleanse.com/nasal/nasal.htm?link_id=1)
• Breath steam—boil some water, pour it into a bowl, and tent your head and the bowl with a towel; for even more benefit, two or three drops of eucalyptus oil can be added to the water
• Put a hot, moist washcloth across your eyes to bring blood to your sinuses and relieve sinus pain
• Press the sinus acupressure points with your finger- or thumb tips: on either side of your nose under the eyebrow ridge and the sides of the bridge of the nose—feel free to ask me to demonstrate this for you if I haven’t already

The Art of Breathing?

Most of us have been breathing since the day we were born, so you’d figure we’d be pretty good at it. In fact, however, many of us (myself included!) do not breathe as well as we could and should. You might think this is a function of your body or your sinuses and not something you can do anything about.

But in fact, breathing is the only bodily function that we perform both voluntarily and involuntarily. If you have done yoga, you are probably aware that it is possible to consciously use breathing to influence the involuntary nervous system, which regulates blood pressure, heart rate, circulation, and digestion, among other bodily functions. With the help of breathing exercises, it is possible to influence those functions that we generally do not control consciously.

While the connective and muscular tissue in your chest can become restricted as a result of chronic stress—resulting in decreased range of motion of the chest wall—you can retrain yourself to breathe more efficiently. The first step is to see whether you are, in fact, a “chest breather.” Chest breathing is the result of rapid, shallower breathing, which causes the chest to expand less and prompts much of the air exchange to occur at the upper end of the lung tissue. To see whether this is the sort of you do, place your right hand on your chest and your left on your abdomen. If your right hand rises more as you breathe, you are a chest breather, while if your left goes up more, you are an abdomen or diaphragmatic breather.

Why does the type of breather you are matter? Chest breathing results in less oxygen being transferred to the blood and, subsequently, fewer nutrients being delivered to the tissues because the rapid, shallow breaths and chest constriction that characterize it limit blood flow to the lower lobes of the lung, where the greatest amount of blood flow should occur. In contrast, diaphragmatic breathing improves the blood flow to the heart, as well as the flow of lymph, which is laden with immune cells. These increases improve stamina in athletic activity and help prevent infection in the lung and elsewhere in the body. Perhaps best of all, though is that it is a great way to stimulate the relaxation response, which prompts a decrease in tension and creates a general sense of well-being.

So how do you retrain yourself to become a diaphragmatic breather if you are a chest breather? Like many things, it takes practice. The breathing exercise below (taken from the amsa.org website) should be done at least twice a day, as well at times you find yourself brooding over things that distress you or when you are in pain.

o Place one hand on your chest and the other on your abdomen. When you take a deep breath in, the hand on the abdomen should rise higher than the one on the chest. This insures that the diaphragm is pulling air into the bases of the lungs.

o After exhaling through the mouth, take a slow deep breath in through your nose imagining that you are sucking in all the air in the room and hold it for a count of 7 (or as long as you are able, not exceeding 7)

o Slowly exhale through your mouth for a count of 8. As all the air is released with relaxation, gently contract your abdominal muscles to completely evacuate the remaining air from the lungs. It is important to remember that we deepen respirations not by inhaling more air but through completely exhaling it.

o Repeat the cycle four more times for a total of 5 deep breaths and try to breathe at a rate of one breath every 10 seconds (or 6 breaths per minute). At this rate our heart rate variability increases which has a positive effect on cardiac health.

In general, exhalation should be twice as long as inhalation. The use of the hands on the chest and abdomen are only needed to help you train your breathing. Once you feel comfortable with your ability to breathe into the abdomen, they are no longer needed.

A guide I have sometimes used to work on my own breathing is the audio CD Breathing: The Master Key to Self Healing (Sounds True, 1999; ISBN: 156455726X) by Andrew Weil. After a discussion of the health benefits of breathing, Weil directs the listener through eight breathing exercises.