The effects of massage are wide and varied with clients having differing individual experiences to the same “treatment”, whether it’s a relaxing therapeutic treatment or a directed therapy towards rehabilitation from an injury. Although commonly people will describe benefits such as reduced stress, improved sleep, increased range of movement and reduced stiffness, reduced pain/ discomfort, increased awareness within their bodies, less anxious and depressed, an increased well being, increase confidence and more relaxed.
However, the “same treatment” isn’t exactly the same as there are a lot more things that influence the outcome. These effects of massage are a result of a holistic therapy (working on the body as a whole, not just physically) affecting the body on many levels and systems. There is complex interplay between the mechanical/ physiological and psychological factors that need to be considered why these effects occur.
It was thought that the majority of the benefits were from physical effects, or mechanical factors, of massage but these less than once thought and slowly we are seeing, through research, that the benefits are coming from a combination of the mechanical factors (physiological changes as a result from massage), neurological factors, contextual factors and affective touch within the therapeutic encounter in which the therapeutic massage occurs. A model put forward by Richard Lebert (2021) has tried to contextualise the possible interplay of these factors which occurs within the therapeutic encounter and will form therapeutic alliance, which is the working relationship between the therapist and client.
Mechanical/physiological factors or the effects of massage techniques like effleurage and petrissage increases micro circulation within tissues but not to any significance that we once thought. It can help local metabolic processes and aid flow of lymph but the main effect is potentially at the fascial level where we are moving and working the continuous fascia that surrounds all soft tissues and allowing it to glide with less ‘stick’ between these structures. The physiological factors/mechanisms were once claimed / thought to be main reason for the benefits of why massage worked so well but with a lack of support from more robust rigorous controlled scientific research we know only a small part of the benefits of massage can only be due to the mechanical interventions we are having on the physiology.
It has been proven that neurological factors are influenced by massage/touch and therefore muscle tension and tone can be reduced by direct interaction with the skin and indirectly the nervous system. This is done by mechanoreceptors in the soft tissues that send information to the brain, central nervous system, and as a result a reduction in muscle tone/ tension via the motor nerves. So the effect of effleurage, rhythmical stroking can have a calming effect on the muscles tone by reducing the sympathetic nervous system and as a result increases the parasympathetic nervous system (reducing the breathing rate, heart rate etc).
Affective touch is a key factor in therapeutic massage and we have more than likely underestimate its power. A number of studies (Chen et al., 2020; Rapaport et al., 2012; Vigotsky et al., 2015; Walker et al., 2017) have shown that socially appropriated touch to stimulate the release of neurochemicals that are associated with relaxation and pain relief. This interaction of “touching nicely” with the right intent and can produce physiological changes that lead to psychological changes, like reduced depression and anxiety. Also the client may react differently to environmental stressors, not perceiving them as threatening as before due to a calmed state, therefore having positive behavioural effects.
The Contextual factors within the therapeutic encounter, between client and therapist, are seen as the physical environment, psychological and social aspects that we can influence. For example the treatment room, heat, music, smell, light; our own appearance, our language & vocabulary, tone and body language when interacting with the client and knowing the clients expectations and working with them rather than just prescribing. These contextual factors play a big roll in forming a comfortable “safe” environment for the client where they feel supported, comfortable to explore movements and touch in a non threatening way and leading to a safe healing environment. This interaction will be different for each client and the therapist will use have to individualise their approach based on client personality and expectations to achieve success.
Overall we need to consider massage therapy is both hands on, applied techniques, intensions & considerate movements etc along with non-hands on aspects such as movement & self care education, a supporting environment (physical & non-physical) and good communication to build an effective relationship, trust and confidence between the client and partitioner. The right combination of these small and varied factors, if right for the individual and therapist, will lead to positive and successful outcomes.