One of the oldest and simplest forms of medical care is used to ease pain and anxiety and promote good health. Anne Woodham explains the techniques

Massage is the kneading and stroking of the body's soft tissues - the skin and muscles - with varying degrees of pressure, and is incorporated in a number of traditional health systems such as Ayurveda and Chinese Medicine. Practitioners of modern complementary therapies like aromatherapy and reflexology use various massage techniques.

What does it do?
Gentle massage affects the nervous system through nerve endings in the skin, stimulating the release of endorphins, the body's natural 'feel good' chemicals, to help induce relaxation and a sense of well-being, to relieve pain and reduce levels of stress chemicals such as cortisol and noradrenaline. It helps reverse the damaging effects of stress by slowing heart rate, respiration and metabolism and lowering raised blood pressure.

Stronger massage stimulates blood circulation to improve the supply of oxygen and nutrients to body tissues and helps the lymphatic system to flush away waste products. It eases tense and knotted muscles and stiff joints, improving mobility and flexibility.

The most common massage techniques include effleurage, a light, firm and gentle stroking; petrissage, firm kneading and rolling of the tissues; frottage, or friction, deep direct pressure to release muscle tension; tapotement, hacking, tapping and clapping over the muscles and fleshy parts of the body.

Despite widespread use of massage techniques in ancient Greek and Roman civilisations, the Christian Church's ambivalence about intimate body contact and pleasure led to the practice acquiring a shady reputation linked with 'massage parlours.' Some people still regard it as a self-indulgent luxury. But Per Henrik Ling, a Swedish gymnast in the early 19th century, based his 'Swedish movement treatment' on anatomy. His methods were developed into physiotherapy and put therapeutic massage on the road to medical respectability.

Massage is used more and more frequently in conventional healthcare to relieve anxiety and reduce pain in the elderly and patients with cancer, AIDS, heart attacks and stroke. Over 90 per cent of UK hospices offer some form of touch-based therapy and it is often available in drug rehabilitation and pain clinics and increasingly through NHS GP practices. Family members are taught to give simple massage to seriously ill or dying friends and relatives.

Beauty clinics, health clubs and sports centres routinely offer massage therapy and private practitioners can come to your home or workplace for on-site neck and shoulder massage.

Common types of massage

• Classical Swedish massage: kneading and stroking the body's soft tissue with varying degrees of pressure. practitioners use oil on bare skin.
• Aromatherapy massage. massage, usually Swedish, using aromatic essential plant oils.
• Shiatsu: a combination of massage and pressure on the acupoints, key spots on the meridians (energy channels) that run through the body, according to Chinese and Japanese traditional medicine. Without oil through clothing
• Acupressure: pressure applied to the acupoints, as in shiatsu.
• Tuina: a Chinese therapeutic massage similar to shiatsu, but more vigorous.
• Reflexology: pressing and massaging the soles and toes to 'unblock energy' and restore 'balance' to the body. Uses talcum powder on bare feet.
• Deep tissue massage: slow, intense strokes and deep finger pressure or friction. Oil on bare skin.
• Sports massage: a combination of Swedish and deep tissue movements to improve performance, relieve muscle tension or treat sports-related injuries.
• Manual lymph drainage (MLD): light, rhythmic strokes of body areas with lymphatic ducts to expel toxins and drain excess fluid. Without oil on bare skin.
• Hellerwork and Rolfing: extremely deep tissue massage to re-align the body, combined with instruction on movement and breathing. No oil, light clothing.

How does it work?
Touch is our first sensual experience and remains, along with smell, the most immediate and evocative link between mind and body. The skin is the body's largest sensory organ and thousands of specialised receptors in the dermis, the second layer of skin, react to external stimuli such as heat, cold and pressure by sending messages through the nervous system to the brain. Massage is said to increase activity of the vagus nerve, one of ten cranial nerves, which affects the secretion of food absorption hormones as well as heart rate and respiration.

What is it good for?
Studies at the Touch Research Institute at the University of Miami, Florida, show that massage reduces anxiety and depression, relieves back pain and muscle pain, lowers high blood pressure, eases PMS symptoms, re-energises stressed office workers and boosts the immune system which fights infection. A recent multicentre study in the American Medical Association's Annals of Internal Medicine showed that therapeutic massage was an effective treatment for persistent low back pain, out-performing acupuncture.

Massage is also commonly used to help insomnia, headaches and other stress-related conditions, as well arthritis and digestive disorders like constipation.

What to watch out for

• Massage of the abdomen should be avoided in the first three months of pregnancy
• Consult a doctor before having a massage if you have phlebitis, thrombosis, varicose veins, acute back pain, cancer, a personality disorder, psychotic illness or any undiagnosed pain, lumps or bumps
• Do not massage bruises, fractures or skin infections

How can I find it?
The British Massage Therapy Council
Umbrella body representing UK massage schools and associations
Email: info@bmtc.co.uk
www.bmtc.co.uk