Therapeutic Massage Podcast: Episode #2
Contextualizing Diverse Modalities of Massage & Bodywork
Author: Zefire Skoczen, LMP, LAc, MTCM
Disclaimer: This is a script for spoken word…so, don’t expect the grammar of a written essay. Since this is
just a script and not an essay please forgive my not adding copyright symbols after modality names. I did not talk
about every modality. This omission was just in the interest in time, and is not meant as disrespect of any
modality. It was my intention to convey my love for the full diversity of the field of massage and bodywork.
Introduction:
Today, I’d like to help you begin to understand the broad field of massage and
bodywork. This is no small feat. It’s hard to even count all of the modalities of massage and
bodywork, let alone understand all of them.
There is something in the neighborhood of a 100 different modalities. No one could
master all of them.
Actually, that’s one of the things I love about massage. As soon as you master one
aspect, there are a lot of different directions to continue learning.
Whether you are new to the field or an experienced practitioner, you may already be
wondering, “What can I possibly tackle in one little introductory episode?”
I’m so glad you asked. Even though it can take awhile to even recognize the names of
dozens of massage modalities, yet alone truly understand them, I think it’s important to be a
knowledgeable, well-rounded practitioner.
We owe it to our clients, because no one modality is the best for every client.
While, we can’t figure out everything in one day, we can begin to understand the
diverse field of massage and bodywork by stepping back and looking at the big picture. What
sort of approach do different modalities have? What do they have in common?
A great place to start is by discussing different ways that we can categorize modalities,
so we can have a context to understand each modality. I know for many people, categorizing
may not sound that exciting… but I’m going to introduce you to ideas that will make it a lot
easier for you to gain a perspective of this truly amazing field.
Have you ever seen one of those photo mosaics, where when you step back, it is one
picture, but when you look closely, the picture is made of hundreds of different, smaller
pictures? I think this is a good analogy for the field of massage, with the little pictures
representing the different modalities of bodywork, like Reflexology, Polarity Therapy, Jin Shin
Do and Myofascial Release. Each modality is a complete picture in itself, unique and healing…
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Together, all of the modalities make up a masterpiece… one that can help every person on this
planet.
Let’s clarify some terms. In any discussion of massage, you are bound to hear the words
bodywork and modalities. What do these terms mean? Bodywork and modalities are basically
umbrella terms that include diverse forms of hands-on therapy. Some forms of hands-on
therapy can be considered a massage modality or a modality of bodywork, such as Shiatsu.
However, some forms of hands-on therapies are not considered massage, but are forms of
bodywork, like Rolfing. Other modalities fall into disputed grey areas, regarding whether the
modality is a form of massage or a separate form of bodywork.
Which brings us to another important concept, Scope of Practice. All health care
practitioners have a unique scope of practice. Scope of Practice is basically what different
health care practitioners can and cannot do. In the purest, most ideal sense, Scope of Practice
is meant to protect patients, so that they can receive safe, effective care from appropriately
trained health care providers. So, for example, your massage practitioner doesn’t prescribe
medications or do chiropractic manipulations. Scope of practice is another concept that
deserves more discussion, so we’ll come back to this.
Since I have mentioned health care practitioners in general, on several occasions, this
would be a good time to step back and briefly mention the field of Complimentary Alternative
Medicine, or CAM therapies. CAM therapies include all bodywork modalities, and also the
broader field of holistic therapies, like acupuncture and naturopathic medicine. We’ll discuss
what holistic means later this episode, and learn more about CAM therapies over the next 9
months.
Let’s start categorizing different forms of bodywork. Right after a brief disclaimer. In a
diverse field like massage and bodywork, there are a lot of different opinions. Even on ways to
categorize bodywork modalities. So, while I’m going to introduce you to different ways to
categorize modalities, it’s possible to categorize things differently. And while different
explanations can get a bit confusing at times, it’s completely understandable, with such a rich,
broad field.
If you give this episode a listen or two, I hope I can help you understand the broad field
of hands-on therapies. I cover a lot of ground quickly. So, I recommend taking a little break
after each section and mull over what I talk about. Or talk about it with a friend. One of my
favorite things about podcasts is that you can listen on the go. You might enjoy listening to this
on a walk, or during some other invigorating exercise outside.
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Relaxation and Wellness Massage
Many bodywork modalities can help clients relax and feel better. I talked about a basic,
relaxing massage quite a bit in Episode 1, What is Massage? If you haven’t already, go ahead
and check it out. That episode focuses on a Swedish Massage, but also talks about how
important it is to facilitate the relaxation response in all massage, and how 80-90% of
conditions are stress related.
While Swedish Massage is probably used for general relaxation the most often, many
modalities can trigger the relaxation response. Actually, with a clear intention and approach, it
is quite easy to make many sessions profoundly relaxing, even if there is a treatment
focus…even with deep tissue work.
I can’t even count the number of clients who have dozed off during a session, or just
entered a wonderful place… sometimes to just get a much needed rest which give the body a
chance to heal…sometimes for a little vacation…and sometimes, when people enter a deeply
relaxed place, they have profound insights that are catalysts to help them make major life
changes.
However, some modalities are used for general relaxation more frequently than others,
for example, those typically offered on a spa menu like hot stone massage. Speaking of spas,
some people would consider spa treatments to be a category on its own. There are different
types of spas, and a number of spa treatments, so we’ll come back to this topic later, when we
study hydrotherapy and spa applications.
Who can mention relaxation without thinking about Hawaii? Did you know that there is
an amazing modality from Hawaii, called Lomi Lomi? It is as relaxing as the islands. Although,
as we’ll see with many of the modalities, it doesn’t just fall under one category. Lomi lomi can
also be used for treatment work and it is a holistic modality.
In addition to wanting to just relax, people often want to work out some of their specific
muscle tension, sore and painful areas. Many people can’t really relax unless they’ve had some
deeper trouble spots worked out and their pain resolved. Think about it this way. Headaches
and low back pain are incredibly common. How relaxed can your clients get if they are still in a
lot of pain at the end of the session?
Many clients want to feel more balanced, have more energy and otherwise just feel
better. Many different modalities can work well on this level, and it depends a lot on the
client’s situation. For example, if a client just wants a quick tune-up in the middle of the work
day, obviously a seated massage is going to be a great option.
A client who isn’t getting enough sleep because of her busy schedule may benefit from a
wide variety of modalities as long as the approach is slow and gentle, allowing her to get in a
good rest, rather than trying to work out every tight spot intensely.
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A client who wants ‘balancing’ work who is suffering from post traumatic stress disorder
would benefit from an experienced practitioner who can work on a lot of different levels. Some
of the modalities that might be particularly helpful in this case could be CranioSacral Therapy,
Jin Shin Do, Bowen Therapy, and tuning fork modalities like Acutonics and Ohm Therapeutics.
As you can see, I can really start to talk about many modalities when considering the
different levels that someone may want to approach their stress management, relaxation,
wellness and balancing. To keep it simple, think about relaxation and wellness massage as the
foundation on which all other therapies should be built. Therefore, a therapist with strong skills
should be able to bring this to every session. Certainly, all holistic modalities and all energetic
modalities, both of which would include all Asian modalities…so, I’m jumping ahead.
Steven Schenkman’s book, Massage Therapy: What it is and How it Works has a great
section about massage therapists practicing at three different levels, with Relaxation and
Wellness massage as the foundation. With more experience and training, massage therapists
can work up to the treatment level and then after even more training and experience, working
up to the holistic level.
Clinical Massage, Orthopedic Massage and Medical Massage
Each of these terms is used a little differently, but basically Clinical Massage, Orthopedic
Massage and Medical Massage all refer to treatment oriented massage.
Many clients get massages to treat specific conditions. People often turn to massage as
a therapeutic modality to treat musculoskeletal disorders and other problems. A study in 2005
found that around 60% of visits to massage practitioners were for musculoskeletal
symptoms…and it seems like there has been an increasing number of people seeking massage
to treat specific conditions, so I would venture to guess that this percentage has increased.
Based on a consumer survey in 2007, there are over 100 million visits to massage practitioners
each year for the treatment of musculoskeletal disorders.
Usually, when people talk about Clinical Massage and Orthopedic Massage, they are
referring to the treatment of neuromuscular conditions like Temperomandibular Joint disorder
or TMJ and sport’s injuries…whereas the term medical massage tends to encompass the
treatment of all conditions, or conditions which are not neuromuscular, like cancer.
However, there isn’t one meaning for the term Medical Massage that everyone agrees
on. In fact, while Medical Massage is quite popular, the whole topic is discussed, rather
heatedly in some circles.
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Basically Medical Massage is an integrative approach of treatment oriented bodywork.
When people use the term, Medical Massage, they are usually talking about treating specific
conditions that have been diagnosed and prescribed by a Physician; treatment which is most
often covered by insurance, and as such treatment that follows current procedures regarding
charting and billing.
However, one of the reasons that people debate what medical massage is, and whether
massage practitioners should even use the term, is that there isn’t any regulation or even
standard, really. In most areas, massage practitioners can claim to do medical massage right
out of school, even after a short 300 or 500 hour program. There isn’t a licensing standard,
because there isn’t a separate licensing requirement to be a medical massage practitioner, or
even standards regarding massage programs or classes which offer certification in Medical
Massage.
However, to give you a rough estimate about what type of minimum training and
experience someone should have before they claim to do medical massage, I think it would
take a minimum of 1,000 hours of training and several years of serious practice before a
practitioner is going to develop the sort of skill set and knowledge that someone treating
specific conditions should have. This is just my opinion, and a rough estimate. Each
practitioner is going to vary in the length of time they need to develop an appropriate skill set
and knowledge base.
Keep in mind that practitioners who want to do clinical work, will need to have an in-
depth understanding of Kinesiology, Pathology and Pharmacology, as well as strong assessment
and clinical reasoning skills, and strong skills in a variety of treatment modalities.
There isn’t one set standard of the types of modalities which need to be used in medical
massage, but many times people use modalities like myofascial release, neuromuscular
therapy, manual lymphatic drainage, muscle energy techniques like Reciprocal Inhibition,
rehabilitative stretching procedures and friction, often with an emphasis on cross fiber friction
Like Medical Massage, Orthopedic Massage and Clinical Massage are also integrative,
which means that they use a number of different modalities within the same session… In fact,
Orthopedic Massage and Clinical Massage use the same type of modalities.
Ideally, there isn’t one set recipe for each condition, but rather, a knowledgeable
practitioner, should integrate different techniques based on each individual client. We’ll get
much more specific in our study of treatment oriented modalities as well as approaches to
specific conditions in the second quarter.
I mentioned that people use the term Orthopeodic Massage in a similar way to Clinical
Massage and Medical Massage. However, Orthopeodic Massage, typically has a more specific
meaning that is agreed upon throughout the industry.
Orthopedic Massage refers to the treatment of orthopedic issues with an integrative
approach of the types of treatment modalities that I mentioned. Orthopedic Massage refers to
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a specific, logical process whereby the practitioner formulates treatment strategies using
clinical reasoning based on a systematic assessment and in-depth knowledge of soft tissues.
What are orthopedic conditions? Great question! Orthopedic problems are basically
pain or injury in locomotive structures like muscles, fascia, bones, joints, ligaments and
cartilage.
As I mentioned, in Orthopedic Massage, the therapist does an assessment to make
informed clinical choices about treatment approaches. We will talk about assessment in much
greater detail later, but as a brief introduction, the therapist is going to determine what tissues
are involved and what type of injury is involved. Is it a muscle strain or nerve compression?
What is a safe, treatment approach that is likely to be most effective?
Of course, massage practitioners do not diagnose, but combining a physician’s diagnosis
with the practitioner’s assessment tools like taking a thorough health history, doing a postural
and gait analysis, palpating and doing a variety of tests like range of motion and resistance tests
can help the practitioner get a clear picture of how to match their treatment strategies to the
specific injury.
The last defining feature of Orthopedic Massage is that the practitioner follows a
specific strategy, the rehabilitative protocol to help people achieve full recovery of their injured
tissues.
We’ll be studying assessment and treatment strategies in much more detail during the
second quarter. To summarize and reiterate, while Orthopedic Massage is similar to Clinical
Massage, in the sense that it is an integrative approach to treating pain and injuries, Orthopedic
Massage is a much more clearly defined, systematic approach involving four primary aspects.
1. Orthopedic Assessment
2. Matching the physiology of the tissue injury with the physiologic effects of the
treatment
3. Treatment technique variety
4. Appropriate use of the rehabilitation protocol
Since I can’t list all of the modalities that can be used to treat specific conditions in a
brief overview, I think it would be good to talk about a clinical example.
I recently worked with a client who has had migraines on and off since she was 5 years
old. She came in on a bout with a migraine that had been going on for 2 days. By the end of
the session she felt great. She wasn’t in pain anymore. She looked wonderfully rested and
calm and said she felt incredible. It’s so nice to be able to help someone in pain feel
better…and this is the type of response that is quite easy to facilitate with a number of
techniques. In case you’re curious, for this session, we did the CranioSacral 10 Step protocol,
released the tension in her scalp with Swedish massage and Myofascial Release, checked for
trigger points in her SCM, scalenes and traps, and finished with foot reflexology and a few
acupressure points on her ankles and lower legs. It isn’t always necessary or better to combine
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so many modalities, but with this client I thought combination of modalities would help delay
the onset of another migraine.
And on a little technical note, I feel like I should mention that migraine headaches are
not typically caused by muscle tension. However, as we’ll learn when we study trigger points,
several muscles can have trigger points which cause migraine-like pain…and whenever you
experience pain in a certain area, it is a super common, natural reaction to tense up the area
that is in pain. So, if you’ve got muscles in your neck causing a migraine-like pain, it’s likely that
the muscles and fascia of the scalp is going to get tight. We’ll discuss the different types of
headaches and how to treat them in our Injury Evaluation and Treatment class in the second
quarter.
And, to recap, many people get massages to treat specific conditions. There are a
number of modalities that work well. Often times the best approach is to integrate a variety of
techniques. And whether you call it clinical massage, Orthopeodic Massage or Medical
Massage, it’s important to have the solid knowledge and experience and do thorough
assessment to come up with appropriate treatment plans.
Structural Bodywork
Structural bodywork helps optimize the body’s position and movement; for example,
helping improve posture and range of motion. It can be thought of as a subcategory within
treatment massage. A lot of clients may not begin their sessions requesting structural
bodywork or wanting to improve their posture, but after assessing their situation, you may
realize this will be a critical part of meeting their goals.
There are a lot of reasons clients may need structural bodywork. A client may want to
improve his golf swing to be more competitive or to stop throwing out his back. Maybe your
client wants to dance more gracefully or work at the computer without injuring herself.
Poor posture often contributes to many problems, like carpal tunnel syndrome, low
back pain and sciatica.
Posture is a magic word. When people hear the word posture, they usually try to sit up
straight. While it’s not surprising that most of our attempts to sit up straight only lasts a minute
or two, what may surprise you, is that when people try to sit up straight, they usually aren’t
achieving a particularly optimal posture. We’ll discuss this in a lot more detail when we get to
Myofascial Release and postural analysis, but basically when we spend a lot of time sitting and
standing with poor posture, some of our muscles and fascia become chronically shortened and
our body has to lay down extra support which is similar to scar tissue. Other muscles become
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weak, or atrophied. And many structures which should glide across one another smoothly,
become stuck together inhibiting easy, graceful movement.
Therefore, in order to sit up straight, or move with the poise of a dancer or the ease and
spontaneity of a child, we need some focused, structural bodywork and/or functional bodywork
to be able to move our bodies well. And that’s just the structural or biomechanical side of
things.
Ah, gravity…our constant companion.
Many of us also have other reasons for our poor posture, like feeling burdened with the
weight of the world on our shoulders…or other emotional reasons like traumas or accidents.
Many forms of massage and bodywork can be effective structurally, such as myofascial
release, cross fiber friction and positional release techniques like Ortho-Bionomy. However,
just because a practitioner is using one of these techniques, doesn’t mean that the work will
facilitate profound improvements structurally. A lot depends on the knowledge, skill and
intention of the practitioner and, of course, on the actual treatment approach.
For example, if an inexperienced practitioner applies myofascial release haphazardly,
wherever he or she stumbles across shortened or adhered fascia, it isn’t very likely to result in
significant, lasting improvements in posture and movement. However, if a practitioner does a
thorough assessment of the client; for example, looking at their posture, movement, injuries,
and limitations she can work with the client strategically to help him reach his goals.
In structural bodywork modalities, rather than working with the body symmetrically,
with the same techniques applied on both sides of the body, different techniques are often
utilized on the left and right sides of the body. The work often focuses on muscles, fascia, and
joints as well as other structures like nerves and visceral organs.
The practitioner often lengthens shortened muscles and fascia and works with the client
to do specific movements to strengthen long, weak muscles. The practitioner also separates
structures that have become glued together into an undifferentiated mass, like a lump of
clay…into distinct, functional parts.
Getting rid of trigger points can also be a helpful part of improving posture and
movement, since muscles that harbor trigger points are short. Trigger points are basically knots
that refer tenderness or pain to an area away from the affected muscle.
You might get a clear idea of this, even if you’ve never done massage, if you picture
Olympic Athlete’s or dancers thighs, compared to the thighs of an inactive ‘couch potato.’
Many different structures can become a disorganized, gluey mess, but this is a very common
phenomenon that’s easy to see and feel with many people’s thighs.
Which modalities tend to be the most effective structurally? I’m going to briefly
introduce you to a few of the techniques that many practitioners turn to. Keep in mind that
many of these techniques can be used independently, or integrated with other techniques.
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Myofascial Release was developed from Rolfing or Structural Integration which can be
thought of as one of the grandmothers of structural techniques. There are variations of
myofascial release, but basically it unwinds and lengthens fascia and separates structures.
Fascia is a connective tissue that is like a web connecting the entire body. We’ll be
giving fascia a lot of specific attention when we study myofascial release, but to give you a quick
idea of how pervasive this tissue is, if you removed everything in the body except fascia, people
would still look basically the same, or at least have the same basic shape.
Craniosacral Therapy can be effective structurally. Cransiosacral therapy works with
very light touch, often as light as the weight of a nickel, but affects the body on deep levels.
One of the main systems that it works with is the craniosacral system, around the brain and
spinal cord…but it also works with the fascia throughout the body, such as specific lines of
fascial tension called diaphragms.
Positional Release techniques like Ortho-Bionomy, Strain-Counterstrain and Structural
Relief Therapy can all be effective structurally. These are very gentle techniques in which the
practitioner puts the client’s body in a position of ease with respect to a structural problem, to
facilitate profound structural shifts.
Most people can relate to a classic chiropractic manipulation. If a vertebra is
sublexated, or just a little out-of-whack, let’s say rotated a little to the right, a typical
chiropractic thrusting, adjustment would basically place a quick force in the opposite direction
to directly push the structure back into place.
By comparison, Positional Release Techniques work gently with the direction of the
rotation, whether it’s a vertebra, a rib, a sacrum or other structure… gently encouraging the
position that the body is in. Each positional release modality has slight variations in the exact
technique, but basically by adding some very specific support in the position that the body is in,
the problem is able to unwind and self correct, very likely by working with the proprioceptors.
There are often many structures involved when an imbalanced posture or gait is part of
the issue. For example, nerves are often compressed or otherwise inhibited, in which case the
technique of Nerve Mobilization can be helpful. Similarly, organs are often involved when
there are structural issues, in which case Visceral Manipulation is in order.
SOMA Neuromuscular Integration and Hellerwork are two modalities that work with the
body structurally, with similar foundational framework as Rolfing and Structural Integration.
However, these modalities work much more specifically and consciously with modern
psychology and emotional milieu.
Another very important category of techniques which can have profound effects
structurally are Movement Techniques like Feldenkrais and Alexander technique. These can
also be called Functional Techniques; because while they most definitely effect structure, they
do so by focusing on function, or movement. Structure and Function are like two sides of the
same coin. Movement techniques can be utilized as modalities on their own, or along with
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other techniques to help people learn how to move their bodies more efficiently; to move with
less effort, more gracefully.
And this isn’t just for dancers or athletes who are very conscious of graceful and optimal
performance. We can all benefit from learning how to move more easily. By comparison, many
of us have learned defensive, compensatory movements. After our injuries and tough life
lessons. Rather clumsy, lumbering movements that aren’t just inefficient, but also, put us at
much greater risk for injury…even during every day activities. Many of us have kind of set the
stage to the point where we can easily injure ourselves just picking up a bag of groceries or
stepping off a curb wrong.
Combining very specific stretches and resisted movements can be another highly
effective way to teach the body how to move more efficiently, like with Active Isolated
Stretching and Muscle Energy Techniques.
You may have noticed that even within this one category of structural bodywork, I
talked about the subcategory of Positional Release Techniques as well as the closely related
category of Movement Techniques….and you may recall that Structural Bodywork can be seen
as a part of, or a specific category within Treatment Bodywork.
Holistic Modalities
Holistic is a basic concept in the field of massage and CAM therapies, but I learned early
in teaching that many beginning students of massage don’t know what it means. There are two
primary ways to look at holistic modalities, the philosophy and the treatment approaches.
First, holistic modalities seek to treat the person as a whole. Put simply, your client’s
carpal tunnel syndrome isn’t caused just by muscles, ligaments, nerves and other physical
structures. What is going on with the whole person? Our body is affected by our emotions and
thoughts. This is often called the mind-body connection, or mind-body-spirit.
Obviously, our illnesses don’t occur in a vacuum. We can look to our entire being, our
relationships and many lifestyle factors like exercise, diet and sleep. Which leads to the
treatment approaches of holistic modalities, which tend to involve a multi-faceted approach
with the client needing to take an active role in their self care, through specific diet, exercise
and attention to other aspects of their life.
Each holistic modality has a specific approach to these lifestyle factors. But, no matter
how knowledgeable you may be in a particular area, be sure to stay within the Scope of Practice
as laid out in your area’s licensing laws. For example, when I am doing acupuncture, it is within
my Scope of Practice to give nutritional advice from the perspective of Traditional Chinese
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Medicine, as well as prescribe Chinese Herbs. However, when I am practicing massage, I can’t
give nutritional or herbal advice.
Not long ago, holistic concepts and approaches to medicine were largely reserved for
the field of CAM, like Asian, Ayurvedic and Naturopathic medicine. However, over the last
couple of decades there has been a popular scientific study of mind-body connections, such as
the interdisciplinary field of Psychoneuroimmunology. Since there is increasing evidence of
scientific research, the medical community has become increasingly aware of holistic ideas such
as addressing diet, exercise and stress management. CAM practitioners are still often the
experts in holistic approaches, but very often what is needed is a team approach to health care.
Each modality that can be thought of as holistic has a unique approach to work
with the mind-body-spirit. For example, certain modalities work very directly with the body,
while also working with the emotions, like SOMA Neuromuscular Integration and Hellerwork.
Other holistic modalities work with more of an energetic focus, like Asian
Modalities, which are rooted in a whole energy based system.
Oftentimes, the focus depends on the training and experience of the
practitioner. For example, CranioSacral therapy usually has a holistic approach, but depending
on the practitioner, the work may focus more on the body, or emotionally, or energetically.
Basically, each modality, as well as the way each practitioner works with each modality, works
with a different blend of the mind-body-spirit focus.
Asian Bodywork
Asian Bodywork includes dozens of diverse, holistic modalities. Some Asian modalities
have been practiced in a similar way for thousands of years, like Ayurvedic medicine from India
and Thai massage from Thailand.
However, I need to qualify a statement like that, because each technique is, of course,
shaped by the culture and time in which it is practiced. For example, while Ayurvedic massage
is part of the holistic, traditional medicine of India, and can be profoundly therapeutic, it has
become very popular in spas nowadays; not to say that spa treatments can’t be therapeutic,
because they can, but that is oftentimes that’s not the focus or training of the practitioner.
And Thai Massage, which is traditionally performed on the ground on a mat, is now
often modified to perform similar stretches on a massage table. In case you are not familiar
with Thai massage, imagine the practitioner assisting the client with yoga poses, (although to
be clear, it isn’t yoga). The practitioner moves the client into incredible stretches, like a pretzel,
then a bridge, in a way that the practitioner gets into wonderful stretches themselves.
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Many Asian modalities have ancient roots, but have had different styles branch off over
the years, like the many forms of Shiatsu.
Some forms of Asian Bodywork blend traditional and modern theories and techniques, like Jin
Shin Do, which has Japanese roots coupled with modern psychology.
Massage practitioners borrow and often modify some of our best techniques from
different health care providers. This is true of massage cupping, which is very similar to cupping
practiced by acupuncturists. Well, not only acupuncturists… cupping is still used around the
world, as folk medicine, often by family members; basically, cupping uses fire or a suction pump
to create a vacuum in a cup. It’s sort of like a reverse massage, instead of using pressure, the
practitioner uses suction.
Another very interesting use of tools in Asian Bodywork modalities is tuning forks.
Acutonics and Ohm Therapeutics are both very modern techniques, which are rooted in the
most ancient Asian medical theories. We’ll get to tuning forks later…well, they are one of my
favorite tools – well, tuning forks and hot stones…and I’m getting way ahead of myself to tell
you how amazing they work together!
Many people think about Asian Modalities as being useful primarily for promoting
wellness and balancing, like a self care, maintenance routine and preventative medicine.
However, they can also be quite brilliant in medical work, alongside western modalities or
utilized independently.
Modalities for Special Populations
The last category that we’re going to talk about today is modalities for special
populations; for example pregnancy massage, pediatric massage, sport’s massage and animal
massage. These aren’t true modalities in the sense of being a unique combination of
techniques, but rather, they are integrative approaches that pay particular attention to the
treatment considerations and approaches based on each population.
For example, practitioners of pregnancy massage need to understand physiological
changes during pregnancy and how this informs massage protocols. Different massage
techniques can be utilized, but with particular modifications to work safely. In the example of
pregnancy massage, using particular positioning, like the side-lying position, is one of the main
considerations…as well as knowing signs and symptoms that the practitioner can help with as
well as those of high risk pregnancies which signal the need for referral to the patient’s health
care provider. For some groups, the massage protocols are quite different than you’d expect in
a typical, kind of Swedish Massage. For example, Infant Massage is almost always taught to the
parents or other care providers, so that they can give little mini sessions at optimal timing for
the babies, rather than the typical one hour sessions with a massage practitioner.
Other specialized approaches and considerations include Geriatric Massage, Hospice
Care and Cancer Massage. For each specialized population it is important to receive training,
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and be particularly aware of considerations that are unique to each group, like cautions and
contraindications. In some instances, a separate license is required. Practitioners should
always check the licensing requirements for their area. For example, and for rather obvious
reasons, Animal Massage often requires a separate license. This modality has some of the
same characteristics of these special population modalities in the sense that each practitioner
of Animal Massage utilizes a unique combination of modalities; anything from Bowen Therapy
to Asian Modalities & hydrotherapy.
I was amazed how well my sister’s 15 year old arthritic dog responded to bodywork in a
warm pool. She would leave the treatments jumping around like a puppy. Even if you don’t
have any interest in doing Animal Massage, I recommend reading the book, “A Walrus On My
Table.” It’s a fun, fascinating little romp highlighting one practitioner’s work with a lot of
different animals, including a ferret, a penguin, and yes, a Walrus… although, most practitioners
who do animal massage work largely with dogs and cats or horses.
We’ll spend time with pregnancy massage, sport’s massage and focus on other special
populations in the second quarter.
Conclusion
I’ve covered a lot of ground rather quickly. If you want to continue to broaden and
deepen your understanding of massage and bodywork, I’ve got a few ideas. For starters, you
might want to listen to this episode more than once.
Of course, there’s nothing like experiencing a modality and taking hands-on courses to
truly understand it… but this can get really time consuming and expensive, so I’ve got a few
additional recommendations.
I highly recommend signing up for the World Massage Conference. You can listen to
aver 40 CEUs worth of leading experts in the field at your leisure. I know with my schedule, I
love the flexibility of squeezing in a great education during my commute, while taking a walk or
even getting the dishes done.
I also recommend attending AMTA conventions. In addition to getting a taste of many
modalities over a weekend, it’s a great way to stay connected with the massage community.
You can use things like the World Massage Conference and AMTA conventions to give
you ideas about which modalities you want to study more. Then, of course, it’s ideal to take
more in-depth continuing education courses as well as experience the work from experts.
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It’s great to receive a lot of massage, and it’s nice to experience different modalities.
As you know, many massage practitioners combine diverse modalities in an integrative
approach. While this is often highly effective, and may give you some excellent ideas about
how you may want to integrate different modalities in a practice, it can be extremely beneficial
to experience a modality on it’s own also, rather than integrated with other modalities. You’ll
get a much clearer sense of the modality, if you experience it independently. Then you can see
how it’s mixed in the ‘real world.’
However, every practitioner approaches bodywork with their own unique style. We are
all individual artists, really… so, don’t expect any two practitioners’ treatments to be exactly the
same, even in a modality where the treatment protocol is quite specific.
While we can’t really lean massage just from a book, many massage books can be quite
helpful…particularly now that many of them have helpful on-line resources and/or videos. For
example, if you want to learn how to use tuning forks with Ohm Therapeutics, you can see
video demonstrations with the book, Sound Healing: Vibrational Healing with Ohm Tuning
Forks. If you want a great video resource that accompanies a book, covering 30 modalities by
many leading experts in the field I recommend, Modalities for Massage and Bodywork by Elaine
Stillerman.
Oftentimes, you can get a nice feel for the personality of a modality with a book, even if
it doesn’t have videos, pictures or specific techniques. For example, Upledger’s Your Inner
Physician and You, is a terrific, quick read that will give you a nice understanding of part of
Upledger’s journey. If you want to get more technical, and start studying CranioSacral therapy
seriously, Upledger wrote quite a few much more technical books.
I won’t go on and on about books all day, though. I’d like to leave you with an image to
work with to continue to contextualize bodywork modalities.
Picture a tree with one thick trunk, like an old oak tree. Each major branch off the trunk
is a category of bodywork, like structural bodywork, energetic bodywork, clinical massage,
relaxation and wellness, etcetera. And you could even picture branches off of the branches…
so, for example you could have the Positional Release Techniques branching off of the
treatment branch. Picture the modalities like leaves, so Hot Stone Massage and Swedish
Massage would be leaves on the Relaxation and Wellness branch.
This image can be helpful to work with understanding the categories. …
And despite there not being one and only one Massage Tree that everyone would agree
on, I think it is such a useful way to conceptualize the different forms of bodywork, that I would
encourage you to come back to this image as you learn more and more modalities. You can
sketch out your own tree and keep it with a notebook and add leaves as your understanding of
bodywork broadens.
Thank musicians: (all found on Magnatune.com) All available via a creative commons
license for non commercial use.
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Intro to episode: Alma Nova on CD Alma Nova. Song: Alma Nova
Intro to Relaxation: Cheryl Ann Fulton on CD the Once and Future Harp. Song: Love
and Light
Intro to Structural & Functional bodywork: Vito Paternoster on the CD Bach Cello
Suites. Song: Suite I Sol Maggiore
Intro to Energetic Bodywork: Saros on CD Aqua Delphinidae. Song: Aqua Delphinidae
Intro to Holistic Modalities and Closing Credits: Jami Sieber on the CD Hidden Sky.
Song: Hidden Sky
Intro to Massage for Special Populations: Drop Trio on the CD Cezanne. Song:
Wallawalla
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