A Massage School Experience
The author of this article, whose identity is
known to Dr. Barrett, wishes to remain anonymous
In 1996, I started a one-year program consisting of over 500 hours in massage training. Overall, I had a good learning experience, but many of the modalities I learned had questionable validity. Keep in mind, no two massage schools are alike and this report is merely one student's experience. However, the different areas I describe have become fairly mainstream in the massage community. This article is not intended to discourage anyone from receiving a massage. It is to bring an awareness of some recent trends in the field of massage and give a recognition of suspicious practices.
From the first week of school, I noticed quite a few medical claims being made about massage. Our massage textbook offered little physiological explanation to back up the claims. For instance, the textbook claimed massage improves digestion. When I asked an instructor how this claim could be objectively measured, I was told, "People report that they have to go to the bathroom after a massage." That was the only explanation I was given. As my year in school continued, I found few factual answers to my many questions.
"Toxin" removal by massage was a concept I not only heard in school, but read in articles and heard from practicing massage therapists. However, no toxins were clearly defined. Our instructors stated toxins were "things like caffeine," but offered no further explanation of how massage presumably removes these toxins. They also claimed that massage also helps eliminate the body's natural waste products, which some people also refer to as toxins. That statement suggests that the body somehow needs outside help to become cleansed. Some therapists advise their clients to drink large amounts of water following the massage to help them rid their body of toxins released during the massage. The client's need to urinate then supposedly proves that toxins are being removed. Of course, drinking lots of water increases urination whether a massage is given or not.
Since massage causes lymph to flow, it is assumed to be removing toxins. There is even a procedure called lymphatic massage that is purported to significantly improve the detoxifying functions of the lymphatic system. Lymphatic massage is supposed to strengthen the performance of the immune system, benefit internal organs, and again, help get rid of these vaguely described toxins. "Pumping" the lymphatic system by pressing forcefully, up and down on the chest is a technique used to stimulate lymph movement. Again, I don't know how one could objectively measure all the claims made about this particular massage modality or how this "pumping" is proven to do what they say it does. In whatever form I found it, I could not get a consistent explanation of how massage removes toxins. [Note from Dr. Barrett: Manual lymph drainage [MLD] is a legitimate massage treatment for lymphedema, a condition in which arm or leg swelling occurs because fluid accumulates in the lymphatic system. It is performed to reduce swelling, not to "remove toxins."]
An interesting experience was the training we received in craniosacral therapy, by John E. Upledger, D.O. This involves applying noninvasive pressure to "balance" the craniosacral system, which is the network that encloses the cerebrospinal fluid (CSF). This type of therapy claimed to help everything from headaches to hyperactivity in children. The visiting instructor had trained at the Upledger Institute in Florida. We were supposed to be able to feel the "flexion/extension rhythm" of the CSF flow. The claim is that one can feel disruptions in this flow that the practitioner can "correct" as needed. We did this by feeling at the heels, ankles, thighs, chest, and head. I could never feel any pulsations.
On the second day of class, the instructor asked if everyone could feel the "rhythm" the day before. I was the only one who admitted that I couldn't feel anything. (Later, some other people acknowledged outside of class that they didn't feel anything either, but they didn't want to say so in class) She said she would work closely with me that day. I questioned her by asking if we were supposed to be feeling the flow of the CSF. She said, "yes." I pointed out that there was no CSF in the legs, and wanted to know how we could be feeling CSF flow as far down as the ankles? She just said, "Well, you can still feel the rhythm of the flow from the craniosacral system."
Trying to help me feel the rhythm, she put my hands on the client and placed her hands on top of mine. She began moving her hands back and forth slightly, showing me how to feel this flexion/extension rhythm. She stated she could feel the client's rhythm through my hands, even though she was not physically touching the client. I still wasn't convinced, but I went ahead on my own with the procedure. When she came back again later in the day and asked if I felt it, I still said, "no." Exasperated, she replied, "You know it's OK to use your imagination when you're first learning. You need to shut off your left brain more." I couldn't believe it. Use my imagination? After that statement, I decided I had no use for this modality.
Oddly enough, even in Upledger's video, he never clearly explains what he is doing while making these vague "corrections" in the CSF flow. Our instructor would ask us to make the corrections as needed, assuming we felt disruptions. When the instructor demonstrated the technique, it just seemed she was holding slight pressure at different intervals on the client. This was supposed to do something?
Proponents of craniosacral therapy also claim that while working on the head, they can relieve pressure in the skull by moving the skull plates. I never could feel the bones moving. I asked a local osteopathic physician what he thought of the procedure. He said it was taught in osteopathic school, but he did not agree with the theory. He said that paying attention to people by putting your hands on them made them feel better. In other words, it comes across to the client as a good bedside manner.
Another visiting instructor taught foot reflexology. I enjoyed the classes and didn't hear any extreme claims from the instructor. He said that reflexology was based on a "theory." Reflexology assumes the foot has zones that "correspond" to regions and organs throughout the body. By massaging specific areas on the foot, one can allegedly correct abnormalities or imbalances in the corresponding distant organs. I noticed that different foot charts disagreed about which areas correspond to which organs. I was told that the discrepancies depended on where the author studied reflexology.
We trained at a basic level in Touch for Health, a form of muscle testing. A "certified" instructor taught our class. This modality is supposed to help ease stress and everyday aches by balancing the body's energies. Muscle strength is tested by having a tester push on different muscles of the client while the client gently resists the pressure. The tester then decides whether the muscle is strong or weak, based on the amount of resistance felt. Supposedly, you can detect weak muscles and imbalances, and correct them. There are no objective measurements against specific resistance scales or weights. Corrections are done in various ways, usually by pressing or rubbing specific points of the body.
Touch For Health also involves "food sensitivity" testing. We were taught to use the anterior deltoid (shoulder muscle) for test. The instructor would hold a food at the client's chin while the client held an outstretched arm forward. If the instructor would pushed on the client's wrist and the muscle "locked" or held firmly, the food was considered OK. If the muscle didn't lock and the arm moved, the food was supposed to be bad for the person.
Touch for Health also includes "meridian" massage. By holding your hands two inches over the client's body and running over the path of the traditional Oriental meridians, you supposedly can "balance" the person's "vital energy." Our instructor warned us not to go over the heart meridian in the wrong direction unless you carried "paddles" (from a defibrillator) in your back pocket, insinuating that you could stop somebody's heart by simply waving your hands over them incorrectly.
The class studied and practiced reiki, a Japanese energy (described as Universal Life Force) healing technique that involves the laying on of hands. Massage magazines and journals are inundated with information on reiki. It is similar to the Chinese "chi" or Indian "prana." Reiki is promoted as a gift that is passed from one practitioner to another. The therapist is supposed to direct their energy into the client to promote the body's self healing. I never understood how this energy is transferred from one to another. Interestingly, they claim you can never give too much or too little reiki, alleging your body knows what you need and will take what it wants. Students were supposed to be able to feel the energy rise and fall at different times, but many students outside of class stated that they didn't notice any changes.
Our instructor passed out a glossary of reiki treatment procedures with instructions on how to use Reiki to treat medical conditions ranging from arthritis to vaginal yeast infections.
A visiting instructor told us that the healing power of reiki was not bound by time or space. He explained that if you had a genetic disorder, you could use reiki to go back and heal that disorder so it would no longer run in your family. He also believed that you could send reiki anywhere in the world if you knew someone needed it. I never read anything like that in any of the literature I reviewed. However, such fondness for practicing nebulous "energy work" as some call appears to be growing rapidly.
Several students reported peculiar experiences outside of class. One had a massage by a therapist who laid hands on her during the massage and foretold her future. Another claimed someone had put a curse on her table that caused all of her clients to go away. I know of two massage therapists who see or work with angels during their sessions and another who advertises "healing" on his business cards. Unfortunately, situations like this are not rare. For some practitioners, massage has become a spiritual journey.
Another bandwagon some therapists have jumped on is the area of body/mind integration—working with a person in the context of counseling. The goal is said to be facilitating "inner peace." For example, we experimented in class with having a client discuss feelings that come up during a massage. I saw women breaking down and crying during their massages. I do not feel it is wise for a massage therapist to probe and try to manipulate situations like this. I do not believe that this is within the appropriate scope of massage therapy.
We were trained to do ear candling, a home remedy method for removing wax from the ears. I have practiced clinical audiology for almost 10 years, so this was of great interest to me. I took my otoscope (a light used for examining ears) to class to view before and after results. Only one person exhibited a significant amount of wax. Almost everyone else had perfectly clear ears. Nonetheless, the next day over half the people in the class reported that they could hear much better since having the ear candling treatment. This is an impossibility. If they had nothing blocking their ears in the first place, ear candling wouldn't make a difference either way in their actual hearing ability. This was a good example of how much placebo effect influences many of these questionable alternative health treatments.
Interestingly, several students in the class would regularly comment outside of class that they "just didn't get it" or that the various methods "just didn't make sense." Rarely, though, did anyone dispute what was taught or mention in class that they questioned the legitimacy. The underlying sentiment seemed to be that if an instructor spoke about a topic loudly, passionately and with enough conviction, that it must be so. It tended to reflect poorly on the student if they questioned or disputed the taught assertions.
Massage tends to attract mostly people interested in holistic or alternative health. In an effort to diversify and increase income, you may find massage therapists also practicing herbology, aromatherapy, iridology, homeopathy, colonic cleansing, ear candling, light therapy, selling dietary supplements, or other holistic methods. Massage therapists are self proclaiming themselves to be "health care professionals." More medically sounding titles are also popping up. I was discussing massage with a lady who told me proudly that she received her massages from a "myotherapist." I think she was disappointed to learn a myotherapist is no different from a massage therapist. Other trendy terms are massotherapist, physiotherapist, physiologist and bodyworker. Few continue to use the more traditional terms of "masseuse" or "masseur."
There is currently disagreement between massage professionals who see massage as an "art" and those who see it more as a "science." Those who see it as a "science" are pushing to have national standards set that all must comply with. Part of this struggle for recognition is to earn the right to use medical billing codes and obtain third-party reimbursement. Those who view massage as an "art" do not want outside interference and are fighting regulation. At this time, there are no national requirements for practicing massage. Mandates for licensing and certification vary from state to state.
Massage provides an effective way to control pain for some people and may also be an excellent medium to aid in relaxation or stress reduction. For those interested in receiving massage, be aware that technique varies widely from therapist to therapist. It is advisable to shop around to find someone you are comfortable with. I am frequently asked how one finds a good massage therapist. I believe that word-of-mouth is preferable to using advertisements or massage organization referrals. Even those who are licensed or certified often engage in questionable practices. Be wary of any massage therapist who makes specific medical claims or claims to "heal" people.
For Additional Information
- Beck MF. Milady's Theory and Practice of Therapeutic Massage, Second Edition. Albany, NY: Milady Publishing Company, 1994.
- Upledger JE. Your Inner Physician and You. Berkeley, CA, North Atlantic Books; and Palm Beach Gardens, FL: The Upledger Institute, 1991.
- Thie J. Touch For Health: A practical guide to natural health
using acupressure touch and massage, Revised Edition. Marina
del Ray, CA: DeVorss & Company Publisher, 1996.
This article was revised on March 31, 2009.