Ian Holland
Therapeutic Massage

Therapeutic Massage - Past, Present and Future

The Past

I'm always struck by how medicine is regarded as scientific, but in fact it goes through fads just like anything else in society. Treatments wax and wane in popularity for a whole host of reasons often having little to do with their efficacy. For example I must be one of the very few people born in the Fifties to still have his tonsils. Back then, cough once and you were whipped off to hospital for a tonsillectomy. Hundreds of thousands were performed without any great improvement in children's health and eventually it simply died out as a procedure, except in exceptional circumstances.

So with Massage. Until the late 1940's it was firmly part of orthodox medicine, but is now assumed to have always been part of the alternative scene. Fifty years ago I would have been working in the local infirmary employed by the NHS, to treat patients referred by their GP or a consultant, for a whole host of medical conditions. Now I'm seen as offering a very useful treatment for stress, some back pain, general muscular aches and pains and as an aid to recovery from sports injuries.

Browse in any second-hand bookshop and you'll come across tomes with titles like: 'Physical Treatment by Movement, Manipulation and Massage', J B Mennell, 5th edition (1945), 512 pages. This was at a time when paper was rationed because of the war, which shows just how important massage was considered. In it Massage is recommended as a treatment of choice for disorders of the digestive system, the circulatory and the respiratory systems, in obstetrics and gynaecology, as well as in nervous conditions. Most of all, it was used extensively for patients convalescing after surgery or from major illnesses.

So what happened? Well three things I reckon. First was the drug revolution of the Forties and Fifties, starting with the amazing effects of penicillin, which opened up great possibilities of cures of previously recaltriant conditions. This is when steroids were first manufactured and a whole new world of medicine appeared to be opening up. Massage also was obviously labour-intensive and therefore expensive, while drugs could be mass-produced.

Secondly massage metamorphosed into physiotherapy. Tools such as Ultrasound were developed, gadgets were in and human hands out, an attitude memorably satirised by Monty Python in the 'we need the machine that goes beep' sketch. It is easy to scoff and of course some machines are actually very useful and have a role to play in treatment, but I will admit to some lingering feelings of annoyance having been on the receiving end of dismissiveness from the medical profession early in my career, along the lines of, "Oh people still do massage do they", from a doctor in an 'isn't that quaint' tone of voice.

These two developments coalesced in a sense to form the third reason why Massage virtually died out in Britain in the Fifties. Basically it had become old hat. It was over 200 hundred years since Peter Ling and his colleagues had systemised the art of Massage as a medical treatment. Doctors knew what it could do and what it couldn't do (or thought they knew its limitations) and human beings like something new. Medicine is subject to the spirit of the age like everything else and back in the Fifties Massage was a victim, along with Herbalism. In Britain Massage tuition virtually died out in the teaching hospitals, only an increasingly few lecturers still passing on their skills to trainee physios. In the private sector only one school survived, in Blackpool of all places, teaching Massage to diploma standard. Everywhere else closed down, and it wasn't until the early 1970's that demand began to grow again and new private schools emerged.

This situation applied only in Britain, the States and most Western European nations (West Germany was an honourable exception) however. In the Iron Curtain countries, Russia, Poland, Czechoslovakia, Hungary etc. the pre-war situation continued i.e. Massage remained part of orthodox medicine with masseurs working in hospitals and clinics treating genuinely medical conditions. Western arrogance towards the East however, prevented any of the great volume of research carried out in these countries post war, being translated into English, so that advances in the treatment of many, many medical conditions was never made available to practitioners in the West. Of course the ugly question of money was also involved - there's no patents in Massage and so no profits.

The Present

I've run courses in Massage for 20 years and have lost count of the number of Physiotherapy students who have come along and paid their own money to learn Massage techniques, so frustrated are they by the lack of Massage tuition in their courses. It seems ironic that what was once a major tool of physios is now so little regarded by them, whilst the lay public have been re-discovering it in their tens of thousands.

A similar situation has arisen in the midwifery field where Baby Massage has been enthusiastically adopted by the lay population, with a steadily increasing demand for workshops where mothers and fathers can learn these techniques. One might expect the lead here to have come from midwives and health visitors, but in fact the medical profession have shown very little interest in these developments and it has been left to individual practitioners, sometimes nurses or midwives, often lay people, to introduce these methods on their own. It is only now that the midwifery and health visiting professions appear to be showing any 'corporate' interest.

Here the media has been very positive, especially, dare I say it, daytime TV. Often much maligned for obvious reasons, they and women's magazines have shown themselves very open minded to Massage and have popularised it greatly, making it respectable and helping it get away from the rather seedy image of massage parlours which it 'enjoyed' when I started. When I returned to Scotland in 1978 and told people I was a masseur, I never failed to get strange looks. Until 1984 John Smiths bookshop in Glasgow still had Massage filed memorably under 'Fringe Medicine'. I do wish though the media would move on from the slightly superficial approach they usually take. Recently I was asked to do a Massage presentation on TV, which I was happy to do until the researcher emphasized I'd have to "keep it light" I couldn't help but audibly groan when she said this and we agreed not to go ahead.

There is still a lot of public education needing to be done. Most people seem to expect Massage to be entirely pleasurable - they've obviously never experienced Massage from Istanbul east. You feel great three days later! Breaking down areas of deep tension is often painful to a degree, though trying to explain to clients that "the pain is in the muscle" can be tricky. When we are tense for a prolonged period of time, our muscle fibres get gummed together by the waste products of the body, such as lactic acid and urea. In Massage we use our fingers and thumbs to separate these fibres, allowing the wastes to be cleared out of the body via the bloodstream and the lymphatic system. Unfortunately this technique is sometimes painful, though often clients report it's a "good pain, it feels like it needs to happen".

High levels of stress in our culture seem likely to stay for the foreseeable future, with the number of hours worked per week increasing not declining, as we fondly imagined they would back in those halcyon days of the Sixties. Massage is a superb de-stresser, the reduction in physical tension often allowing a concomitant reduction in mental tension, with problems seeming far less intractable. I'm also struck by how much more at ease with their bodies young people are today compared with my generation. There has been a sea change in attitudes to sexuality and enjoying yourself, with the old Calvinist repressive culture distinctly on the wane.

The Future

In the future it seems highly unlikely that demand for Massage will do anything other than increase, with an ageing population and thereby increasing strain on the NHS. People will be looking more and more to the complementary therapies for help. Even Rod Stewart takes his own private masseur on tour. This week saw the publication of the negative effects on people of sitting in front of VDU's, in particular back and neck strain. This certainly ties in with my own experience where about 10 years ago, the ubiquitous lower back pain was replaced as the primary complaint, by people suffering from stiff necks, headaches and sore shoulders which began shortly after they first started work at a computer. The rise of On-Site Massage, Massage in the workplace, is therefore likely to grow apace due to research findings like these.

As a preventative Massage is superb and I reckon operations such as hip replacements could be postponed for years if people got regular massage. Us Scots tend to be very tight in the buttock muscles, though it pains me to say it our English cousins aren't nearly so tense here, and regular massage increasing the blood flow to that area and stopping the build up of waste products, would have very beneficial effects on the mobility of the whole hip region. The same rationale applies to arthritis. It usually starts in the finger joints and the feet where the blood has furthest to be pumped from the heart. Regular hand and foot massage would I believe postpone the onset of arthritis for several years.

When I started in practice in 1979 there was only one massage book on the market in this country, so the author, American George Downing, was able to call it 'The Massage Book' since there wasn't no other. Since that time dozens of massage books have been published, mainly of the 'how to' variety and many of them very good. What's needed even more are videos. Massage is a dynamic art and therefore needs a dynamic medium to represent it. More recently we seem to be almost coming full circle with the appearance of books like Mark Beck's: 'Theory & Practice of Therapeutic Massage' (Milady USA) and Gayle MacDonald's: 'Medicine Hands - Massage therapy for people with cancer' (Findhorn Press). In other words Massage's role in treating more than just general stress and sore muscles is again being advanced.

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