For RasWriter only

Almost 38% of hospitals in 2007 were offering massage therapy. The most prescribed indications were stress reduction, pain man- agement, cancer patient support, pregnancy massage, as part of physical therapy rehabilitation, mobility/movement training, and palliative care. Massage therapy may be given in many ways. Movement tech- niques in massage therapy include stroking or gliding (effl eurage), kneading or compression (petrissage), striking or percussion (ta- potement), and shaking (vibration). Depending on the type of ma- nipulation, several different types of massage have gained popularity, including Swedish and shiatsu massage, sports massage, deep tissue massage, Ayurvedic massage, Thai massage, and hot stone massage. Besides the common use of massage in spas and other locations to relieve stress and tired muscles, therapeutic massage has many estab- lished uses. Massage may reduce the need for painkillers by 36% in patients with back pain. Osteoarthritis patients report improvement in pain, stiffness, and function. Another type of pain, headache, also responds well to massage, reducing migraines and promoting bet-

ter sleep. Massage therapy helps reduce cancer symptoms like pain and depression or side effects of treatment like nausea and fatigue. Massage therapy has been shown to positively modulate levels of neurotransmitters, thereby reducing depression and anxiety. Its use is also now well established in sports injuries, reducing discomfort and improving function. There are several cautions that need to be observed with massage therapy. Patients with bleeding disorders or who are on warfarin should not be given vigorous massage. It should be avoided in ar- eas with blood clots, fractures, open or healing wounds, skin infec- tions, or weakened bones or where there has been a recent surgery. Caution should be exercised in areas with stents, prosthetic devic- es, or sensitive skin. Massage should not be performed directly on tumors or predictable sites of metastasis in cancer patients. Proper

advice should also be taken from the health care provider before giving massage therapy to pregnant women. Complications are rare and include internal bleeding, nerve damage, or allergic reactions to oils or lotions. In general, massage therapy is extremely safe when administered by a well-trained massage professional. Massage therapy is a healing modality, and nobody should feel uncomfortable during this process. Proper ethics ensure this trust. Ethics is defi ned by Webster’s as the study of standards of conduct and moral judgment; the system or code of morals of a particular person, religion, group, profession, etc. Practitioners of massage should obtain an informed consent and understand that patient has a right to refuse or terminate treatment at any time. Massage therapy practitioners should avoid giving false assurances about the benefi t of massage in conditions where there is no evidence-based benefi t. Further, practitioners should be vigilant that the correct underlying diagnosis—for example, pain due to a ligament tear or cancer—has not been missed. In the same vein, massage therapy should be com- plimentary and not a substitute for established medical therapies. Massage therapy should also be performed professionally, and not transgress beyond accepted limits of emotional or physical bound- aries. Boundary violations usually begin quietly, little by little, and may erode the professional relationship. This may result in trans- ference and cross transference and needs to be proactively avoided. Insurance billing should be able to prove “medical necessity” for the services provided. And fi nally, confi dentiality has to be honored. There are approximately 1,500 massage therapy schools and train- ing programs in the United States. These provide professional certi- fi cations. The National Certifi cation Board of Therapeutic Massage and Bodywork also certifi es practitioners who pass a national exami- nation. There were 38 states and the District of Columbia as of 2007 that were regulating massage therapy. Most of these states require massage therapists to have a minimum of 500 hours of training at an accredited institution, pass the NCBTMB exam, meet specifi c continuing education requirements, and carry malpractice insurance.

soUrces: National Center for Complementary and Alternative Medicine: “Massage Thera-

py as CAM.” U.S. Department of Labor Bureau of Labor Statistics: “Massage Therapists.” American Massage Therapy Association: “2008 Massage Therapy Industry Fact Sheet.” American Massage Therapy Association: “Choosing a Type of Massage.” American Massage Therapy Association: “Glossary of Massage Terms.”

ABOUT THE AUTHOR shashi k. aGarWal is a board-certifi ed inter- nist and cardiologist and a member of the Execu- tive Advisory Board of the American Association of Integrative Medicine. He is certifi ed by the Board of Holistic Medicine and Anti-aging Medicine. He maintains an active practice in several offi ces and hospitals in New Jersey. He has published over 500 health-related articles and has recently published his book, Healthy Heart—Naturally. He is a speaker

for the American Heart Association and is actively involved in clinical re- search. He is listed in Marquis’s Who’s Who in America and the World.

InteGrAtIVeHEALTH

providing the healing power of touch has been an honorable profession since ancient times. the hands-on-healing known as massage therapy encompasses pressing, rubbing, or otherwise ma- nipulating the muscles and other soft tissues of the body. therapists use their hands and fi ngers, but they may also use their forearms, elbows, or feet. occasionally, a mechanical device may be used. Massage therapy dates back thousands of years, appearing in writings from ancient China, India, Japan, and many other nations. Hippocrates defi ned medicine as “the art of rubbing.” It became popular in Europe dur- ing the Renaissance and reached the United States during the mid-19th century. Massage therapy is now a popular form of complementary and alternative medicine in the United States. It is the fi fth-most-used CAM therapy in this country, accounting for almost 95.3 million visits to massage practitioners. An estimated 18 million U.S. adults and 700,000 children received mas- sage therapy in 2006. The main uses were for relieving pain, reducing stress, reducing anxiety and depression, and rehabilitating sports injuries. It is also commonly used for maintaining general wellness.

The credentialed art of

By Shashi K. Agarwal, MD, FAAIM

Massage therapy helps reduce cancer symptoms like pain and depression or side

effects of treatment like nausea and fatigue.

MASSAGE THERAPY

InteGrAtIVeHEALTH

There are approximately 1,500 massage

therapy schools and training programs

in the United States.

48 SPRING 2011 Annals of Psychotherapy & Integrative Health www.aaimedicine.com Annals of Psychotherapy & Integrative Health SPRING 2011 49 (877) 718-3053

Almost 38% of hospitals in 2007 were offering massage therapy. The most prescribed indications were stress reduction, pain man- agement, cancer patient support, pregnancy massage, as part of physical therapy rehabilitation, mobility/movement training, and palliative care. Massage therapy may be given in many ways. Movement tech- niques in massage therapy include stroking or gliding (effl eurage), kneading or compression (petrissage), striking or percussion (ta- potement), and shaking (vibration). Depending on the type of ma- nipulation, several different types of massage have gained popularity, including Swedish and shiatsu massage, sports massage, deep tissue massage, Ayurvedic massage, Thai massage, and hot stone massage. Besides the common use of massage in spas and other locations to relieve stress and tired muscles, therapeutic massage has many estab- lished uses. Massage may reduce the need for painkillers by 36% in patients with back pain. Osteoarthritis patients report improvement in pain, stiffness, and function. Another type of pain, headache, also responds well to massage, reducing migraines and promoting bet-

ter sleep. Massage therapy helps reduce cancer symptoms like pain and depression or side effects of treatment like nausea and fatigue. Massage therapy has been shown to positively modulate levels of neurotransmitters, thereby reducing depression and anxiety. Its use is also now well established in sports injuries, reducing discomfort and improving function. There are several cautions that need to be observed with massage therapy. Patients with bleeding disorders or who are on warfarin should not be given vigorous massage. It should be avoided in ar- eas with blood clots, fractures, open or healing wounds, skin infec- tions, or weakened bones or where there has been a recent surgery. Caution should be exercised in areas with stents, prosthetic devic- es, or sensitive skin. Massage should not be performed directly on tumors or predictable sites of metastasis in cancer patients. Proper

advice should also be taken from the health care provider before giving massage therapy to pregnant women. Complications are rare and include internal bleeding, nerve damage, or allergic reactions to oils or lotions. In general, massage therapy is extremely safe when administered by a well-trained massage professional. Massage therapy is a healing modality, and nobody should feel uncomfortable during this process. Proper ethics ensure this trust. Ethics is defi ned by Webster’s as the study of standards of conduct and moral judgment; the system or code of morals of a particular person, religion, group, profession, etc. Practitioners of massage should obtain an informed consent and understand that patient has a right to refuse or terminate treatment at any time. Massage therapy practitioners should avoid giving false assurances about the benefi t of massage in conditions where there is no evidence-based benefi t. Further, practitioners should be vigilant that the correct underlying diagnosis—for example, pain due to a ligament tear or cancer—has not been missed. In the same vein, massage therapy should be com- plimentary and not a substitute for established medical therapies. Massage therapy should also be performed professionally, and not transgress beyond accepted limits of emotional or physical bound- aries. Boundary violations usually begin quietly, little by little, and may erode the professional relationship. This may result in trans- ference and cross transference and needs to be proactively avoided. Insurance billing should be able to prove “medical necessity” for the services provided. And fi nally, confi dentiality has to be honored. There are approximately 1,500 massage therapy schools and train- ing programs in the United States. These provide professional certi- fi cations. The National Certifi cation Board of Therapeutic Massage and Bodywork also certifi es practitioners who pass a national exami- nation. There were 38 states and the District of Columbia as of 2007 that were regulating massage therapy. Most of these states require massage therapists to have a minimum of 500 hours of training at an accredited institution, pass the NCBTMB exam, meet specifi c continuing education requirements, and carry malpractice insurance.

soUrces: National Center for Complementary and Alternative Medicine: “Massage Thera-

py as CAM.” U.S. Department of Labor Bureau of Labor Statistics: “Massage Therapists.” American Massage Therapy Association: “2008 Massage Therapy Industry Fact Sheet.” American Massage Therapy Association: “Choosing a Type of Massage.” American Massage Therapy Association: “Glossary of Massage Terms.”

ABOUT THE AUTHOR shashi k. aGarWal is a board-certifi ed inter- nist and cardiologist and a member of the Execu- tive Advisory Board of the American Association of Integrative Medicine. He is certifi ed by the Board of Holistic Medicine and Anti-aging Medicine. He maintains an active practice in several offi ces and hospitals in New Jersey. He has published over 500 health-related articles and has recently published his book, Healthy Heart—Naturally. He is a speaker

for the American Heart Association and is actively involved in clinical re- search. He is listed in Marquis’s Who’s Who in America and the World.

InteGrAtIVeHEALTH

providing the healing power of touch has been an honorable profession since ancient times. the hands-on-healing known as massage therapy encompasses pressing, rubbing, or otherwise ma- nipulating the muscles and other soft tissues of the body. therapists use their hands and fi ngers, but they may also use their forearms, elbows, or feet. occasionally, a mechanical device may be used. Massage therapy dates back thousands of years, appearing in writings from ancient China, India, Japan, and many other nations. Hippocrates defi ned medicine as “the art of rubbing.” It became popular in Europe dur- ing the Renaissance and reached the United States during the mid-19th century. Massage therapy is now a popular form of complementary and alternative medicine in the United States. It is the fi fth-most-used CAM therapy in this country, accounting for almost 95.3 million visits to massage practitioners. An estimated 18 million U.S. adults and 700,000 children received mas- sage therapy in 2006. The main uses were for relieving pain, reducing stress, reducing anxiety and depression, and rehabilitating sports injuries. It is also commonly used for maintaining general wellness.

The credentialed art of

By Shashi K. Agarwal, MD, FAAIM

Massage therapy helps reduce cancer symptoms like pain and depression or side

effects of treatment like nausea and fatigue.

MASSAGE THERAPY

InteGrAtIVeHEALTH

There are approximately 1,500 massage

therapy schools and training programs

in the United States.

48 SPRING 2011 Annals of Psychotherapy & Integrative Health www.aaimedicine.com Annals of Psychotherapy & Integrative Health SPRING 2011 49 (877) 718-3053

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Copyright of Annals of Psychotherapy & Integrative Health is the property of American Psychotherapy Association, Inc and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.