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CHURCHILLLIVINGSTONE
An imprint of Elsevier Limited
©Mario-Paul Cassar 1999
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First edition 1999
Reprinted 2000
Second edition 2004
ISBN 0443 07349 X
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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.
THE MASSAGE TREATMENT 3
Blood circulation was no knowledge of the blood circulation at the
time.
There was a positive improvement in the blood
During the Renaissance (1450–1600), massage
circulation following the gymnastics and mas-
was very popular with royalty. In France, for
sage application, and this benefit was said to be
example, physician Ambroise Pare (1517–1590)
systemic as well as specific to a region. With the
was sought after by the royal household for his
increased circulation the tissues were nourished
massage treatments. His main interest was the
and the secretions of the glands increased. The
use of massage, and especially friction move-
venous return was also enhanced, thereby reduc-
ments, in the treatment of dislocated joints.
ing congestion.
John Grosvenor (1742–1823), an English sur-
geon and professor of medicine at Oxford, was
Respiration
extremely enthusiastic about the results that were
being achieved with massage and took on the
The expansion of the chest was considerably
work of Per Henrik Ling and his contemporary,
increased as a result of the exercise and massage.
Dr Johann Mezger of Amsterdam. Grosvenor
Respiration improved as a consequence of this
demonstrated the benefits of massage in the
change and served as effective prevention
relief of stiff joints, gout and rheumatism.
against diseases such as consumption (tuberculo-
However, he did not include exercise as part of
sis). Furthermore, the improved respiration cre-
his treatment because he was mostly interested
ated a more efficient elimination of toxins and,
in the healing of tissues and joints by the action
accordingly, the level of fatigue was reduced and
of friction or rubbing. He claimed that this tech-
the overall condition of the body improved.
nique abolished the need to conduct operations
Deformities of the rib cage were also corrected
in many diseases. William Cleobury MD, a mem-
with the system of exercises and massage.
ber of the Royal College of Surgeons, also used
massage for the treatment of joints. He followed
Digestive organs
the practice of John Grosvenor MD, and used
Diseases of the digestive organs could be treated friction and rubbing to treat contraction of joints
by means of suitable exercises together with the and fluid in the knee.
necessary dietary changes and correct hygiene. In New York, Charles Fayette Taylor (1826–1899)
Improving the flow of blood to the skin and published volumes of material on the Swedish
extremities helped to reduce congestion, and Movement throughout the 1860s. His writings
appropriate movements and massage were used covered many topics of medicine, but he wrote a
to stimulate elimination. great deal about the treatment of spinal curva-
tures. Charles Taylor had studied the Swedish
Movement in London under the guidance of
Fitness and joint function
Dr Mathias Roth, who was a prominent homeo-
Claims for the effects of massage date back to pathic orthopod and a great believer in Ling’s
physicians such as Herodicus (fifth century BC), system of treatment. Although Taylor returned to
who professed to have great success in prolong- New York after only 6 months he was very com-
ing lives with a combination of massage, herbs mitted to the Swedish Movement system. His
and oils. One of his pupils, Hippocrates (the brother, George Taylor, was also keen to show the
father of medicine, who lived around 480 BC), effects of the system for curvatures of the spine,
followed suit and claimed he could improve joint and gave sample case histories in his writings.
function and increase muscle tone with the use of
massage. He also stated that the strokes of mas-
Rheumatism
sage should be carried out towards the heart and
not towards the feet. This must have been an In 1816, Dr Balfour successfully treated rheuma-
intuitive statement or a wild guess, since there tism using percussion, friction and compression.
