When we were studying at the Northern Institute of Massage the then principal, Eddie Caldwell, would often be asked by new students what the difference was and if the Institute taught them. His answer was yes they ran courses for different types of massage but would add “do you know, at the end of the day it’s all skin rubbing”. Now this isn’t strictly true. There are differences, and they don’t just involve rubbing of the skin. But Mr Caldwell’s down-to-earth approach always manages to put things into perspective.

Massage, although an ancient art, is constantly being updated as variations in procedure or new therapeutic techniques are added to the toolbox. Unfortunately these new techniques are often padded out, inflated and given a new name in order to create a whole new therapy. It might be cynical to suggest that the reason for this is for marketing purposes or to sound more scientific and to distance themselves from the word ‘massage’. It’s hard not to think, when meeting such a therapist, ‘get over yourself you are a masseur!’

On the positive side, even if these techniques don’t justify the creation of a whole new therapeutic modality or proprietary brand, they can be useful tools to have at your disposal as a therapist.

Multiple types of massage can be used to treat a patient in the clinic. The skill is deciding what mix of techniques is best suited to an individual patient’s needs. A patient suffering from stress needs a different form of massage to someone with a frozen shoulder. These in turn requires a different treatment plan to an athlete who wants to improve performance. In some ways there are as many different types of massage as there are patients.

So, bearing this in mind, we can define the different types of massage recognising that each represents just one string to the therapist’s bow.

Remedial Massage

remedial : adjective
giving or intended as a remedy or cure. Example ‘remedial surgery’
Remedial masseurs are trained to recognise and treat musculoskeletal conditions such as back pain, stiff neck and shoulders, sciatica and knee injuries. A typical treatment may include massage, mobilisations, tractions, rehabilitation exercises/stretches, postural assessment and a mixture of the techniques described below used for therapeutic effect.

Swedish Massage

The classic massage. A straightforward, no frills but very effective massage for general aches and pains. Also an excellent stress buster. It usually incorporates the neck, shoulders, back and legs.  The term isn’t recognised in Sweden. Not surprisingly they just call it massage. The popularisation of this type of massage is often wrongly accredited to Peter Henry Ling, a Swedish gymnastics teacher in the 1800s. In actual fact, it was Dutch practitioner Johan Georg Mezger who which developed ‘Swedish massage’ as we know it today, and adopted  French names like ‘effleurage’ and ‘petrissage’ to denote the basic strokes that we perform.

Sports Massage

A form of massage geared towards amateur and professional sports people. One of the oldest recorded forms of massage dating from early martial arts in the far east to the ancient Greek and Roman games. Homer writes in the poem The Odyssey of Greek soldiers being rubbed with oils to aid their recovery and regain strength on return from battle.

Deep Tissue Massage

Deep tissue massage is a type of massage aimed at the deeper tissue structures of the muscle and fascia. The term is often used to distance the therapist from the lightweight ‘beauty therapy massage’. A bit unfair to beauty therapists many of whom can give a perfectly decent massage. Getting through the layers of muscle is more subtle than you might imagine and requires persistence and coaxing as well as firm pressure. Just digging in demonstrates inexperience or a lack of training. Many people like a deep massage as the pain produces large amounts of endorphins (the body’s own painkiller) that gives a natural high. However, overdoing it can cause the muscle to react badly causing more tightness than before.

Soft Tissue Release

Soft tissue release (or STR massage) is a technique of assisted stretching of muscle fibres, tendon and fascia. STR involves repeatedly and quickly stretching small areas of the soft tissue. Precise pressure is applied to part of the muscle which is then moved to achieve a very specific stretch. An interesting and popular form of therapy, especially useful if adhesions are present in the tissue.

Trigger Point Therapy

A trigger point (TrP) is a small area of muscle that is exquisitely painful and tender to pressure. When pressed it produces a recognisable and reproducible pattern of referred pain away from the site of the trigger point. We use TrP therapy to get rid of these nasty little blighters.

Neuromuscular Massage

As well as TrP release this also includes the very effective Muscle Energy Techniques (MET) and Positional Release. Neuromuscular techniques are a recommended and powerful skill set for any Remedial masseur.

Lymphatic Massage

A type of massage which encourages the natural drainage of the lymph, which carries waste products away from the tissues.

Myofascial Release

Fascia is a thin, tough, elastic type of connective tissue that wraps most structures within the human body, including muscle. Fascia supports and protects these structures. All types of massage will involve treating the fascia to some degree, it fact it would be hard not to! Myofascial techniques claim to isolate and release fascial tension by using gentle sustained pressure on the tissue.

Although it is a useful exercise to define the different types of massage, I have never understood a therapist defining or limiting themselves to a specific skill set. This would be like a carpenter limiting themselves to just using a hammer. As long as a therapist has taken the time to study and train in the therapy and as long as it is covered by their insurance and recognised by their professional body then there is no reason why a therapist shouldn’t expand their repertoire. The availability of high quality courses makes acquiring new skills and learning new types of massage a natural part of Continuous Professional Development.

The post What is the difference between the various types of massage? appeared first on The Muscle Clinic | Remedial and Sports Massage Plymouth.

We are all aware that poor posture causes neck and shoulder pain, but what are the processes involved?

The fact is we are designed to be hunter gatherers. In the natural state we would spend a good deal of the time standing, walking, running and generally moving about but in the modern world we spend much of our time sat at a desk, driving a car or slumped in front of the TV. Even if we don’t work at a desk, many of us have jobs that involve us looking down or maintaining the same bent over posture for hours on end (including masseurs I might add). Poor posture can also have a psychological root. Poor self esteem, anxiety and depression can result in this postural pattern. Negative emotions are expressed through flexion of the spine – the desire to curl up into a protective ball. Tall people who don’t wish to stand out from the crowd can also develop the slumped forward head posture. Maintaining the same posture causes unrelenting pressure on the same muscle groups and causes muscle fatigue. Naturally under these circumstances we slump forward, develop rounded shoulders and what is called a forward head posture.

Ask a friend to stand up face forward. Stand to their side and imagine a line drawn vertically downward from their ear. This line should pass directly down from the ear through the shoulder, hip and ankle, but it is possible that the line passes in front of them and the head appears forward of the centre of gravity.  When the head is nicely balanced on the neck and shoulders it doesn’t take much effort to hold it in place. The light work of a few ligaments and muscles will maintain stability.  The weight of the average human head is around 5kg but in forward head posture due to a fulcrum effect it can have an apparent weight of more than 15kg. Think of the extra strain involved in holding the head up in this situation. Although the head is forward of the centre of gravity the eyes still want to be horizontal so the head, as well as being forward, also needs to tilt upward. This sets off a cascade of events that, in the long term, can cause a great deal of pain and discomfort.

The typical slumped posture with rounded shoulders and forward head is easily recognisable in modern society and, when maintained persistently, the knock on effects can be very widespread and debilitating. It is the soft tissues that suffer first.

• The muscles of the neck and upper back (including the upper trapezius and neck extensors) are in a sustained isometric contraction and become short and tight. The muscles of the chest (pectorals) also become short and tight. Causing generalised aching and more localised trigger points in the muscle.
• The muscles in the front of the neck, the deep neck flexors, are stretched and become weak and inhibited. A number of mid-back muscles (lower trapezius and rhomboids) plus the serratus anterior muscles are also stretched and become weak and inhibited.
• The shoulder muscles (deltoids) roll forward and develop an abnormal torsion.
• A number of ligaments (nuchal ligament) will be placed under excessive stress.
• The normal curve of the upper back becomes exaggerated (thoracic kyphosis).
• The shoulder blades (scapulae) rotate downwards
• The vital capacity of the lungs is decreased with a diminished thoracic cavity.
• The joints of the cervical spine can become partially compressed and the cartilage is exposed to repeated trauma. This compression could potentially lead to nerve root pressure.
• There is a decreased range of movement of the neck and shoulder.
• Tension where the muscle tendons join the back of the skull (occiput) can initiate headaches.
• Chronic pain and discomfort can result in general irritability and poor sleep patterns.
• There is mixed evidence to suggest that compression of the space above and below the collar bone (clavicle) caused by forward head posture could compress the nerve supply and blood flow into the arm (thoracic outlet syndrome) causing numbness and tingling.
• There is mixed evidence to suggest that a forward head posture can also cause temporomandibular joint (jaw) problems.
• There is mixed evidence to suggest a forward head posture and rounded shoulders may help to create or exacerbate impingement syndrome where the tendons of the rotator cuff in the shoulder become irritated and inflamed as they pass through the subacromial space, the passage beneath the collarbone. This can result in pain, weakness and loss of movement at the shoulder.

This list is long enough but unfortunately it doesn’t stop here. Muscles that are chronically contracted disrupt the symmetry of balanced forces acting on the body. This disruption cannot be maintained indefinitely – the body seeks out stability. Changes in one part of the body lead to adaptive changes in other distant parts of the body. The patient may present with widespread problems such as low back, hip or knee dysfunction as well as shoulder and neck pain.The problem escalates as muscles designed to move bones are now given the task of stabilisation and the body sacrifices flexibility for stability. The body finds a new stable state, albeit a noxious one. The body’s natural healing process stalls. In a sense it is stuck in a rut of chronic pain and requires a gentle nudge to reset the balance.  Given the opportunity the body will heal itself but sometimes just needs a push in the right direction.

The process of rehabilitation involves awareness and education as much as remedial massage. Massage attempts to break the pain-spasm-pain cycle long enough to initiate self healing and repair.

The massage treatment will also attempt to stretch short tight muscle and activate weak inhibited muscle. Once the body has been prepared for repair the original cause, poor posture, will need to be addressed. The Muscle Clinic offer advice on lifestyle and work changes that can be introduced and we have found that a physical fitness and education system such as Pilates works very well for rebalancing the body. We can recommend Body Care Pilates  in Plymouth, Devon. Mixed ability and one-to-one classes are available. Ideal for beginners as well as the more experienced.

In a later article we will discuss in greater depth the Pain-Spasm-Pain cycle and how massage can break this pattern, giving the tissue some much needed breathing space and allows the body to initiate the repair process.

Research and further reading:

Body Care Pilates
http://www.body-care-pilates.co.uk/

Muscle Clinic Blog Post
How Does Stress Cause Neck and Shoulder Pain

Head and shoulder posture affect scapular mechanics and muscle activity in overhead tasks.
http://www.ncbi.nlm.nih.gov/pubmed/20097090

Influence of forward head posture on scapular upward rotators during isometric shoulder flexion.
http://www.ncbi.nlm.nih.gov/pubmed/20850044

Subacromial impingement syndrome: the effect of changing posture on shoulder range of movement.
http://www.ncbi.nlm.nih.gov/pubmed/15773565

Relationship of Forward Head Posture and Cervical Backward Bending to Neck Pain
http://www.ingentaconnect.com/content/maney/jmt/1995/00000003/00000003/art00003

Trigger Points in the Suboccipital Muscles and Forward Head Posture in Tension-Type Headache
http://onlinelibrary.wiley.com/doi/10.1111/j.1526-4610.2006.00288.x/abstract;jsessionid=A9F3071F2B639573397446292320E150.d04t04?deniedAccessCustomisedMessage=&userIsAuthenticated=false

Reliability of measuring forward head posture in a clinical setting.
http://europepmc.org/abstract/MED/8472080

Thoracic outlet syndrome
http://www.ncbi.nlm.nih.gov/pubmed/7808947

Body posture evaluations in subjects with internal temporomandibular joint derangement.
http://www.ncbi.nlm.nih.gov/pubmed/19891257

Global body posture evaluation in patients with temporomandibular joint disorder.

http://www.ncbi.nlm.nih.gov/pubmed/19142549

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