Massage in Physiotherapy

Massage therapy has been used by humans for thousands of years, with many ancient cultures using massage to take advantage of its many benefits. The first known text on massage therapy dates back to 2700 BC in China – “The Yellow Emperor’s Classic Book of Internal Medicine”. The classical Greek term for massage is ‘anatripsis” which means ‘rubbing’ or ‘friction’. In fact, Hippocrates (460 BC) was a great advocate of massage therapy.

Anyone wishing to study medicine must master the art of massage - Hippocrates

What about massage for animals?

Humans are not the only mammals that can benefit from massage. When it comes to horses the old adage of “you scratch my back and I’ll scratch yours” rings through. In fact, mutual grooming in horses is a vital part of forming and maintaining social bonds within the herd. Horses will form a strong bond with another horse in the herd, often with a horse of similar age and status in the herd. Horses will strengthen social bonds via mutual grooming – where a pair will stand nose to nail and groom each other’s necks and backs. Usually, both horses groom simultaneously – often when one stops grooming, the other does too. This is massage in its most authentic form. 

Primates will also engage in a form of social grooming which serves to maintain both hygiene as well as establishing and reinforcing social bonds in the family group. The act of grooming can have similar effects as massage in humans. Have you ever received a shoulder rub or a pat on the back after a long day, by a friend, family member or partner? This simple act of a brief massage can have a surprisingly significant impact on our sense of well-being and influence our mood and emotional state.

What is massage?

Massage is perhaps the oldest and simplest form of therapy. It is a living and dynamic experience whereby the hands and fingertips (or sometimes elbows and feet!) are used to palpate, feel, explore and assess the health of the body. Massage therapy is a continual process of assessment and treatment – evolving as skin, fascia and muscle respond to touch and pressure.

A variety of massage techniques exist, choice of which will depend upon the physiotherapists assessment findings and on what the goal of treatment is. The effect of massage will depend on the type of stroke used, depth, speed and duration of treatment. Techniques include:

  • Effleurage

  • Petrissage

  • Rolfing

  • Shiatsu

  • Tapotement

  • Friction

Potential benefits of massage

  • Pain relief

  • Reduce muscle tension and spasm

  • Reduce muscle tone

  • Release myofascial trigger points

  • Improve blood flow and improve circulation

  • Detoxification – aid in the removal of waste products from muscle

  • Improve flexibility

  • Improve joint range of motion

  • Aid in relaxation

  • Release of endorphins - improve sense of well being

  • Reduce stress and anxiety

What is the role of massage in physiotherapy?

Massage is one of the treatment tools of modalities utilised by physiotherapists to address the impairments or dysfunction identified during the assessment.

In physiotherapy, massage is usually combined with a variety of therapeutic treatment techniques (e.g. dry needling, manual therapy or joint mobilisation, therapeutic taping, and perhaps most importantly education and exercise based therapy) with the aim of achieving treatment goals which are set in conjunction with you (the recipient of physiotherapy or carer of the animal receiving physiotherapy). It is of paramount importance to also address the cause of the problem or injury and not just address the signs and symptoms. Massage alone does not address the root cause of a condition or injury.

It is worth noting that there are certain situations when massage is not recommended or contraindicated, including but not limited to the following:

  • Open wounds

  • Haemorrhage Fever

  • Active infection

  • Acute inflammation or haematoma

  • Presence of local cancerous cells

So what does the research tell us?

  • Massage assists in breaking down adhesions within muscle and connective tissue.

  • Massage can improve muscle compliance, improve flexibility and joint range of motion. Human studies have shown that massage, in combination with conventional physiotherapy treatment techniques further improves knee joint range of motion after total knee joint replacement.

  • Massage has an effect on blood and lymph flow and is beneficial in the management of lymphoedema and oedema.

  • Research suggests that massage may assist in the management of DOMS – delayed onset muscle soreness. Studies have shown that in humans, perceived soreness is reduced up to 96 hours post exercise.

  • Massage has been shown to affect the parasympathetic nervous system, resulting in reduced heart rate, reduced respiratory rate and reduced blood pressure. A study on horses showed that the horses heart rate decreases when massage techniques are applied to the wither and mid neck region – the preferred sites for allogrooming, that is when horses choose to groom each other simultaneously. This study concluded that massage can induce a calmer and more relaxed state in the horse.

  • Research suggests that massage in combination with heat may aid in the reduction of cortisol levels and lead to the release of oxytocin.

  • Massage has been shown to reduce the expression of stress behaviour in horses.

  • Massage has been shown to increase hind limb range of motion in horses.

  • Massage has been shown to improve joint range of motion in Labrador dogs suffering from osteoarthritis.

  • Massage has been shown to reduce mechanical nociceptive threshold – that is the minimum amount of pressure needed to produce a pain response in an individual, assessed via algometry.

Don’t hesitate to get in touch via email if you would like any references for the above research.