Massage, aromatherapy and reflexology

Therapeutic massage is very much a part of many different traditional medical systems, particularly those originating in Asia. It involves various, usually gentle, manual techniques directed at muscles and connective tissue. It is usually applied to the whole body but can concentrate on specific areas of tenderness or soreness. The aim is to provide general physical relaxation as well as to treat quite specific problems such as neck or low back pain.

The massage techniques that relate to traditional Chinese medicine are almost all centred around the manual stimulation of acupuncture points and the muscles that sur­round them. This includes techniques such as shiatsu and acupressure.

Traditional European massage techniques were rationalised by Per Hendrik Ling of Sweden, who used vigorous massage of the muscles in the eighteenth century to increase healing and stimulate the circulation of blood and lymph.

Modern Western massage techniques cover a variety of therapies including aromatherapy and reflexology.

In some therapies that involve a ‘hands-on’ approach, it forms the initial basis through which a physiotherapist may work with your emotional distress.

MASSAGE TECHNIQUES

The so-called ‘Swedish massage’ developed by Per Hendrik Ling has a number of quite specific techniques associated with it. An experienced masseur will use these techniques to heal or improve muscular function, particularly if there has been some injury to a muscle or its attachments.

Some of these techniques, particularly deep friction, are part of conventional physiotherapy. It is difficult to decide whether massage in this context should be considered to be a conventional or complementary medical technique.

Acupressure and shiatsu both involve the treatment of acupuncture points with manual stimulation. A variety of different techniques, which have their origins in acupuncture, are used to treat both acupuncture points and the meridians (energy pathways). The point prescriptions used by therapists will come from both clinical experience and traditional Chinese medicine. It is difficult to decide whether these approaches should be considered as part of acupuncture or part of massage.

AROMATHERAPY

Aromatherapy involves using essential oils extracted from plants. A French chemist, Monsieur Gattefosse, is said to have burned his hand in a laboratory accident and then plunged it into a vat of lavender oil. He found that the wound healed remarkably quickly without any scarring and coined the term ‘aromatherapy’ in 1931 to describe this new treatment.

The use of aromas to treat illness appears to have originated with the Australian Aborigines. They had already identified that tea tree oil, an essential oil used in modern aromatherapy, was an excellent antiseptic. The ancient Egyptians used herbal oils for embalming, while their priests used herbs and oils for the treatment of a whole variety of illnesses. Aromatherapy was first publicised in the twentieth century by Dr Valnet, a Frenchman who intro­duced the use of aromatherapy massage in the 1960s.
Essential oils can be inhaled or may be dropped into a hot bath and absorbed through the skin. Probably the most common use of aromatherapy is to dilute by about one in 10 the essential oil, such as lavender, in a simple vegetable oil base (for example, sweet almond oil) and then use the subsequent mixture for massage – an aroma­therapy massage.

The oils themselves are very fat soluble and quickly enter the body either through the skin or by inhalation. Some of the common oils that you may come across include lavender (which is said to help burns and shock, and to aid relaxation and sleep), tea tree oil (which has both anti-bacterial and anti-fungal effects) and neroli (which is said to be particularly useful for anxiety).

Although there has been some research into the specific therapeutic properties claimed for the oils, almost all their usage is based on the clinical experience of practitioners over the last 40 or 50 years.
It is important when using the oils to remember that they should be diluted, because neat oils may damage your skin. If you use the oils for massage, make sure they are diluted by about 90 per cent with a vegetable oil. If you place them in your bath, use only 5 to 10 drops and stay in the bath for no more than 10 minutes.

REFLEXOLOGY

Reflexology, or reflex zone therapy as it was originally called, can be applied to almost any area of the body, but it is usually applied to the feet. The feet are said to have various areas that represent the whole structure of the body. This is very similar to some specialist acupuncture techniques. Although there is some good evidence that reflex zones exist in the ear, there is no evidence that they also exist in the feet. Having said this, many reflexologists are able to make surprising diagnoses based on the specific tender areas that exist in the feet.

Although there is much reference to reflex zone therapy in some of the ancient Chinese and Indian texts, modern reflexology was initially developed by Dr William Fitzgerald, an American ear, nose and throat specialist. Fitzgerald mapped the reflex zones on the hands and feet and, in association with Dr Edwin Bowers, published this in 1917. In 1920, another doctor, Joseph Reilly, further developed these techniques and published a book on reflex zone therapy.

Reflexology became popular in the 1960s in the UK through the efforts of Doreen Bailey who met one of Joseph Reilly’s assistants and developed the technique.

Reflexology involves applying pressure through the practitioner’s hands to the patient’s feet, initially for diagnosis. The identification of tender areas can tell the qualified reflexologist which organs might be causing problems. The reflexologist will then massage these tender areas on the feet, sometimes causing quite a lot of pain, in order to treat and rebalance any dysfunction. A diagnosis based on reflexology may not be accurate and should never be assumed to correlate directly with a conventional medical diagnosis. You will need both types of diagnostic approach in order to be sure that nothing has been missed.

Reflexology usually involves applying pressure on the bottom, sides and top of the foot and massaging the painful or tender zones deeply with thumb and finger pressure. The treatment itself has a similar range of uses to acu­pressure, shiatsu and other forms of massage. It can help to induce a general state of relaxation, and can also be of value in the treatment of pain and a number of other conditions.
However, although some therapists believe that reflexology can be of assistance in a wide range of conditions, there is unfortunately very little clinical research within this area. Reflexology treatments are applied on the basis of clinical experience, and it is not realistically possible to recommend reflexology as an effective treatment for any specific condition.

The treatment will usually take about 45 minutes to one hour. If you are going to experience benefit, you will know in the first three or four sessions. The number of treatments you should have, as with all massage therapies, depends on why you went in the first place. Some people like to visit a therapist on a weekly basis just to create their own ‘space’ and relax, whereas others use it as a maintenance therapy in a chronic illness or to treat pain. Once you know that reflexology is effective for you, it is really up to you and the therapist to decide how many treatments you require.

WHAT CAN MASSAGE TREAT?

All massage therapies have powerful relaxing and anti-anxiety effects. This may be partially induced by the actual act of massage, or it may have a much deeper, more comforting effect. For instance, someone who is suffering from terminal cancer may have had some disfiguring operations and could feel very embarrassed about being held or touched by those they love. Massage can offer a physical reassurance for someone’s very human needs, and perhaps that is why massage-based therapies are now such a popular part of palliative cancer care. Premature babies who receive regular massage seem to thrive more than their contemporaries who do not have massage.

We are not exactly sure how the various massage therapies work, although we do know that essential oils contain specific and possibly therapeutic chemicals. It is possible that reflexology works in a similar way to acupuncture. However, the actual act of massage in both reflex­ology and aromatherapy probably shares many of the non-specific mechanisms underlying the general effects of massage therapies.

The scope of these various therapies has not been clearly defined by research. The claims of the various massage therapists would indicate that they all feel that the uses of these particular techniques are very broad. There is no doubt that massage can be an important factor in fostering verbal communication, both in people with emotional problems and in children with disabilities.

Both reflexology, through its zone therapy effect, and aroma­therapy, possibly through the chemical effect of some of the oils, claim quite well-defined specific therapeutic effects for various illnesses.

IS MASSAGE THERAPY SAFE?

In general, massage therapy is very safe. However, massage should not be used on areas of the body that are damaged, for instance a healing scar or burn. There are no known reasons not to massage people with cancer or those who have had heart attacks.

However, the safety of essential oils is an important issue that is yet to be addressed properly. There is no evidence of any adverse reaction to essential oils other than occasional skin sensitivity, but they are absorbed into the body and have a physiological effect. To date, there is no evidence that these oils can trigger cancer or harm people in any way when they are used correctly. However, essential oils are now being used by people in their own homes and they should be monitored carefully by the professionals using them for any possible long-term adverse reactions. At present, there is no formal reporting system for adverse reactions to essential oils.

Massage-based therapies should not be used diagnostically, as they are not reliable techniques for diagnosing illness.

If you see a massage therapist, you will be in close physical contact with them. This carries some risk, so it is important that you make sure the practitioner is properly registered.

THE PRACTICE OF MASSAGE TECHNIQUES

Massage techniques are practised in many different environments. Many aromatherapists and reflexologists either practise from their own home or visit your home. Massage techniques are also practised in dedicated complementary medical centres within the NHS, particularly in hospices providing palliative care, as well as in some doctors’ surgeries and in environ­ments caring for people with psychological problems.
The practice of these massage techniques should be carried out in a clean and professional environ­ment, whether it is in a hospital or in the community.

WHOM SHOULD I CONTACT?

Various organisations provide massage. The Aromatherapy Consortium represents professional registered aromatherapists (see Useful addresses, page 101). There is no specific organisation for reflex­ologists; the two largest organis­ations within the reflexology world are the Association of Reflexologists and the International Federation of Reflexologists (pages 105–6).

The massage organisations generally provide both training and registration for their practitioners. Massage skills may be learned by someone who is a qualified nurse or physiotherapist or by someone without any medical background who is simply interested in these techniques. The International Therapy Examination Council (ITEC) holds examinations in massage and related therapies, and it is these examinations that are accepted by most organisations. A practitioner who is a member of one of the proper massage bodies will be regulated and will stick to a proper code of ethics.