What is Medical Massage?

By Dan Morris DN, Diplomat, LMT

There are many different types of massage therapy and there are many different massage therapy techniques that are practiced today. For the purposes of this discussion we will compare and contrast what is commonly referred to as “medical massage” and what is referred to as “therapeutic massage.” In order to better understand this discussion we need to define the meaning of “soft hand technique” and “homeosomatic system.”

Soft hand technique refers to a system of massage therapy where a relaxed hand is used to apply massage therapy technique. The soft hand or relaxed hand is held parallel to the area of the body that is being massaged or treated by the therapist. Care is taken to prevent stress or strain from occurring in the massage therapist’s hand(s) and wrist(s) while applying massage therapy to the client. By positioning the client on the massage table to achieve maximum relaxation or reduced postural tension within the targeted tissue to be treated (a technique referred to as folding) deep tissue massage can be performed with minimal stress or discomfort to both the therapist and the client receiving the massage.

Homeosomatic system refers to the application of any manual therapy technique which will demonstrate stimulation to the mechanoreceptors and inhibit nociceptor depolarization. Simply put homeosomatic system approach “feels” good. The belief is that the “body” will better respond to technique that “feels” good as compared to technique that causes discomfort or is painful. (Homeosomatic is a word that was created by Dr. Gregory T. Lawton and is trademark protected by him.)

By using a soft hand technique along with postural folding to reduce or eliminate uncomfortable or painful massage therapy technique the goal of homeosomatic system in massage therapy technique can be reached. Homeosomatic system also contends the manual therapy techniques used must also reduce acute and chronic inflammation and restore normal joint complex function. When massage therapy systematically and progressively achieve these goals we refer to this as “medical” massage therapy.

Today there is much debate on exactly what “medical” massage therapy is. Some contend that any massage that has as its focus any goal that is not simply a goal of relaxation is in fact a “medical” massage. But from the above description of medical massage therapy being applied to systematically and progressively reduce acute and chronic inflammation and to restore normal joint complex function can we agree that this is true?

Remember medical massage therapy is a system of strictly delineated clinical protocol. Massage therapy technique that lacks this approach will fail to demonstrate consistent results. Whereas “generalized” effects can be reached by all forms of massage therapy, such as in the temporary lowering of the blood pressure, it is the “specific” effects of reducing pain and inflammation while normalizing or restoring the function of the joint complex that defines medical massage therapy.

Medical massage can be further defined as not being a “general” massage therapy treatment. Instead medical massage is a method or technique which is applied to a specific area of concern or a primary pathology as it relates to the client.

Medical massage is delivered specifically to an anatomical region or area of the body based on the assessment of the soft tissue and the range of motion of the client. Protocols or progressive steps of treatment are followed with the goals of normalizing the tissue and restoring healthy joint movement. Medical massage treats the myofascial tissues and goes on to also treat the joint complex and the specialized structures found within the joint complex. More simply put the purpose and goal of medical massage is to promote soft tissue repair and healing.

This requires the medical massage therapist to have a detailed knowledge of the anatomical structures of the body and the area(s) to be treated. Since the goal of the medical massage therapist is to “normalize” the tissue environment it is also necessary to have detailed knowledge of the histological characteristics of the tissue structure to be treated. The medical massage therapist cannot effectively treat what she or he does not know.

Since medical massage therapy requires the use of a “soft hand” technique, let’s look at why this is important in greater detail. Total client comfort and relaxation during the medical massage therapy treatment will facilitate the overall healing process. The medical massage therapist will work to decrease client apprehension and discomfort during the treatment. This will increase the treatment effectiveness and will encourage the client to return for more therapy.

As already mentioned a very specific hand posture referred to as “soft hand” is used in medical massage. The hand is relaxed but strong. The hand is placed in parallel and full contact with the area being treated. The hand is not tight or rigid but is allowed to “melt” into the tissue below.

This reduces client discomfort and pain while protecting the therapist’s hands from possible stress and injury. Most massage therapists are forced to leave the massage therapy profession within three to five years resulting from injuries occurring from practicing massage with incorrect hand postures. Not only will the massage therapy treatment be more effective for the client by practicing soft hand technique, the massage therapist will benefit, too.

There is no shortcut in this regard. Improper hand postures used during massage therapy treatments will cause pain and apprehension for the client and will eventually cause injury to the therapist. To be a medical massage therapist a soft hand must be used.

This will also allow for deeper penetration into the tissue. Using a soft hand does not mean simply employing effleurage or superficial gliding strokes along the tissue. A soft hand will “melt” into the underlying structures achieving deep penetration. This is further facilitated by “folding” in which the tissue is place in a position which reduces or eliminates postural tension. This is accomplished by moving the attachments of the targeted muscles closer together effectively “folding” the tissue to allow it to go “slack.” When this is accomplished the soft hand can easily slip into the deeper underlying structures to provide “deep tissue massage” which will be very specific to the area(s) needing treatment.

Attempting to penetrate or press through contracted or eccentrically stretched tissue will cause stress and discomfort to both the client and the therapist and may lead to injury or bruising to the client and stress injury to the therapist. To be a medical massage therapist soft hand technique along with postural folding must be learned and properly applied during the massage treatment.

Therapeutic massage as it is practiced today is commonly thought of as being a form of “Swedish Massage” which was developed by Per Henrik Ling (1776-1839). There is much conflicting information surrounding the formation or development of “Swedish Massage.” Per Henrik Ling is hailed as the father of Swedish Massage and according to Mark Beck’s textbook “Theory & Practice of Therapeutic Massage” Fifth Edition page 11 states “The Ling System’s primary focus was on gymnastics as it applied to the treatment of disease and consisted of movements classified as active, duplicated and passive.” This is why Ling is also hailed as the father of physical therapy. The book further goes on to say that it was in 1813 that Ling established the Royal Swedish Central Institute of Gymnastics chartered by the Swedish government. Ling died in 1839 and never published his work. It was many years later that his “students” published “his works” posthumously.

No one knows what the Ling System truly was. He never recorded his work nor did he review the works attributed to him. In an article by Sue Young Histories (Massage Magazine) it is stated: “Ling and his earlier assistants left no proper written account of their treatment, and most of the literature on the subject is repudiated by one set or other of the gymnastics practitioners.”

It wasn’t until, “Johan Georg Mezger (1838-1909) who coined a “reduced set” of maneuvers and techniques of Dr. Ling’s system: the “Swedish massage” system,” that these techniques came to be recorded and then attributed to Ling. (http://sueyounghistories.com/archives/2009/05/04/perhenrik-ling-1776-%E2%80%93-1839/)

What is the significance of this information? The article continues: “[T]here have been two streams of development in the Swedish gymnastics founded on Ling’s beginnings, either in a conservative direction, making certain forms of gymnastic exercises subsidiary to the prescriptions of orthodox medical science, or else in an extremely progressive direction, making these exercises a substitute for any other treatment, and claiming them as a cure for disease by themselves.”

Many of the techniques and principles of modern physical therapy have followed the “first stream of development” as it were. However, Johan Georg Mezger who was from the Netherlands and developed the “reduced set” based on the Ling System never knew or even met Ling. Dr. Ling’s work was based on experience with and was an attempt to heal his own injuries which he received while performing as an athlete. Dr. Ling’s work was also greatly influenced by a system of Chinese medical massage called Tui Na. And whereas many of the techniques of the Ling System were “evidence based” these techniques were later deviated from.

An example of this can be found in the work of Henrik Kellgren (1837-1916), who had a special school and following. Kellgren deviated from the original work of Ling following the “second stream of development” as it were. Kellgren’s manual treatment, as it came to be called, sought to replace the conventional approach to medicine in favor of using his treatments as a replacement to those approaches and claiming them a cure. (http://enacademic.com/dic.nsf/enwiki/1363330)

Yet many sought to create a system that could be duplicated and “franchised” to be taught in other schools hoping to build upon the work that Ling had established. Following this “first stream of development” The Ling System was greatly reduced and generalized and has become the Swedish massage that we know today.

Even the Ling System itself as attributed to Ling was not without criticism. Emil Kleen, M.D., Ph.D., in his book Handbook of Massage published in 1892 wrote, “But, on the other hand, Ling’s activity suffered from certain unfortunate defects. He lacked scientific training, and was ignorant of medicine.” The established medical community of the time, of which Kleen was a part, objected to the use of gymnastics and exercises as a cure for disease.

In his manual Homeosomatic Medical Manual Therapy – General Rehabilitation Protocols – Volume II, Dr. Gregory Lawton states in part, “While massage therapy as a profession does lack the kind of scientific studies called for by medicine, massage therapy technique and treatment enjoys a very long history… which allows for another kind of scientific evidence based on clinical observation.” “Medical massage therapy by the adoption of the qualifying word, medical, should be able when placed under scientific scrutiny to demonstrate clinical results.”

The very specific protocols and progressive steps that are followed by medical massage with the goal of normalizing the tissue environment do in fact meet these criteria. As Dr. Lawton very aptly states in his above mentioned book, “Medical massage therapy is emerging as a manual medicine system of treatment.”

Many times I am asked if medical massage and therapeutic massage are the same. From this discussion it can be said no, they are not. There are many good benefits from either or both forms of massage being discussed here. But they are not the same. I am also asked many times if it is possible to combine the two. Whereas I have to say that anything is possible the goals of medical massage would be defeated by combining the more generalized and non-specific technique of therapeutic massage with medical massage. Remember the most important distinction between medical and non-medical massage is that medical massage is specific in its application.

In conclusion it is my opinion that the massage student cannot go wrong in learning how to practice medical massage. The technique of medical massage will provide a more comfortable and effective massage experience while protecting the client from discomfort by using soft hand technique and postural folding. The therapist is also protected from stress and injury from improper hand postures.

Remember, too. The medical massage therapist can always choose to be non-specific in treatment whereas the therapist not trained to be specific will not be able to perform medical massage if she or he should want to.

Take the time to learn medical massage technique and application. There are no short cuts or “hacks.” Just as Per Henrik Ling found favor by using his form of very specific Swedish “medical massage” called the Ling System with the Royal Society and was sponsored by his government, so too, the medical massage therapist of today is in great demand. Medical massage has never been in greater demand.

References: Theory & Practical of Therapeutic Massage; Fifth Edition, Mark F. Beck – Historical Overview of Massage page 11 Sue Young Histories (Massage Magazine); http://sueyounghistories.com/archives/2009/05/04/per-henrik-ling1776-%E2%80%93-1839/ See also https://www.massagemag.com/magazine-2002-issue100-history100-24026/ Wikipedia Pehr Henrik Ling; http://enacademic.com/dic.nsf/enwiki/1363330 Homeosomatic Medical Manual Therapy – General Rehabilitation Protocols – Volume II, Dr. Gregory Lawton Handbook of Massage; Emil Kleen, M.D., Ph.D. The Elements of Kellgren’s Manual Treatment; Edgar Ferdinand Cyriax

20 Reasons to Take Vitamin C for Immune System Support

by LivOn Labs12/10/2014


White Blood Cells – Image Courtesy of LivOn Labs

The power of Vitamin C immune system supplements are often attributed to the nutrient’s role as an antioxidant. That undersells its value; no other antioxidant can perform the many additional physiological and biological roles that Vitamin C fills. By learning about these 20 critical functions, you’ll understand why so many people take Vitamin C immune system support supplements.

  1. Vitamin C supports the production of interferons. Interferons are produced when the presence of pathogens is detected. They facilitate the ability of cells to launch protective cellular defenses.
  2. Vitamin C enhances the function of phagocytes. Phagocytes are a type of white blood cell that envelops pathogens and other dangerous particles. Once the invaders are captured in this manner, they are enzymatically digested.
  3. Vitamin C supports the cell-mediated immune system response. There are 2 major ways the body can respond to a pathogen: antibody-mediated immunity and cell-mediated immunity. Cell-mediated response refers to the activation of macrophages, natural killer cells, and antigen-specific T-lymphocytes that attack anything perceived as a foreign agent.
  4. Vitamin C neutralizes oxidative stress by acting as an antioxidant. Oxidative stress has been associated with numerous health threats, which is why so many people take Vitamin C for immune system support when dealing with lifestyle factors that cause oxidative stress.
  5. Vitamin C supports a healthy immune response achieved with vaccination.
  6. Vitamin C enhances cytokine production by white blood cells. Cytokines are communication proteins released by certain white blood cells that transmit information to other cells, promoting the immune response.
  7. Vitamin C inhibits various forms of T-lymphocyte death. T-lymphocytes are a type of white blood cell. They are an integral part of the cell-mediated immune defense system. Vitamin C helps to keep these important cells alive and viable.
  8. Vitamin C enhances nitric oxide production by phagocytes. Phagocytes, as discussed in #2, are white blood cells that engulf invading microorganisms. Nitric oxide is produced in large amounts in these cells, and it is one of the agents that will kill captured pathogens.
  9. Vitamin C enhances T-lymphocyte production. As mentioned in #7, these cells are essential to cell-mediated immune responses, and Vitamin C helps them to multiply in number.
  10. Vitamin C enhances B-lymphocyte production. These white blood cells make antibodies as part of the antibody-mediated immune response. Antibodies are formed in reaction to the initial introduction of an invading pathogen or antigen.
  11. Vitamin C inhibits neuraminidase production. Some pathogenic viruses and bacteria create neuraminidase, an enzyme that keeps them from being trapped in mucus, one of the body’s natural lines of defense. Inhibiting neuraminidase helps the body optimize this defensive mechanism.
  12. Vitamin C supports antibody production and activity. Good antibody function is important to a healthy immune system.
  13. Vitamin C supports natural killer cell activity. Natural killer cells are lymphocytes that can directly attack cells, like tumor cells, and kill them.
  14. Vitamin C supports localized generation and interaction with hydrogen peroxide. Vitamin C and hydrogen peroxide can kill microorganisms and can dissolve the protective capsules of some bacteria.
  15. Vitamin C enhances cyclic GMP levels in lymphocytes. Cyclic GMP plays a central role in the regulation of many physiologic responses, including the modulation of immune responses. Cyclic GMP is important for normal cell proliferation and differentiation. It also controls the action of many hormones, and it appears to mediate the relaxation of smooth muscle.
  16. Vitamin C detoxifies histamine. This effect is important in the support of local immune factors.
  17. Vitamin C enhances the mucolytic effect. This property helps liquefy thick secretions, increasing the effectiveness of a healthy immune response.
  18. Vitamin C makes bacterial membranes more permeable to some antibiotics.
  19. Vitamin C enhances prostaglandin formation. Prostaglandins are hormone-like compounds that control many physiologic processes, including regulating T-lymphocyte function.
  20. Vitamin C concentrates in white blood cells. Some of the primary cells in the immune system concentrate Vitamin C as much as 80 times higher than the level in plasma.

Vitamin C immune system support supplements are widely available and of varying quality. Some contain more sugar than they do Vitamin C. Others use revolutionary delivery technology to maximize absorption for more immune system benefits.

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©2014 LivOn Labs. Content adapted from Primal Panacea by Thomas E. Levy, MD, JD.

Reprinted by permission: LivOn Labs Inc.

刮痧 Gua Sha and Medical Massage

By Dan Morris DN, Diplomat, LMT

刮 :Gua meaning: to scrape

痧:Sha meaning: cholera. Taken from the pinyin 砂 meaning sand. The Chinese character or pinyin has been described by Wikipedia to be petechiae which means bruises. Hence the definition according to Wikipedia for gua sha is scraping bruises. However, the word petechiae originates from Italian as in bruising and seems to be inconsistent with the pinyin 砂 sand from which 痧 sha is taken. It would seem more consistent to translate Gua Sha as scraping sand or dirt.

The Chinese would more likely have believed that medical conditions and disease would have the underlying cause of some type of impurity or evil (dirt) that could be removed by “scraping.”

We can see how this would be likely from the teachings of the physician Zhang Feng Kui from the Ming Dynasty who believed that pathogenesis and disease symptoms of “sha” entered the body through the mouth, nose or the pores of the skin and damage the health. As it penetrated deeper into the body it became fierce as it accumulated. Scraping would serve to bring “sha” to the surface of the body where through sweating the toxins or dirt can be excreted thereby restoring good health. (http://www.chinaculture.org/chineseway/2010-10/11/content_399028.htm)

Gua Sha is one of the oldest healing techniques used by man. There is fossilized evidence that “medical” instruments made of stone or bone were used by early man to scrape the skin. Within the discipline of Traditional Chinese Medicine Gua Sha can be used to:

  • Promote Chi
  • Promote Blood Circulation
  • Remove Toxic Heat
  • Remove Stagnant Blood

Gua Sha can be used to treat patients who present with symptoms of:

  • Chronic Pain
  • Systemic Toxicity
  • Poor Blood/Lymph Circulation
  • Slow or Impeded Healing
  • Inflammatory Conditions

Experienced practitioners of Traditional Chinese Medicine use Gua Sha as a primary technique in both treating and preventing disease. Gua Sha can be effective in treating:  

  • Degenerative Joint Diseases
  • Headaches
  • Chronic Neck, Shoulder, and Back Pain
  • Muscloskeletal Disorders
  • Hypertension
  • Vertigo
  • Sinusitis
  • Arthritis
  • Bursitis
  • Neuralgia
  • Asthma
  • Tendonitis
  • Carpal Tunnel
  • Myositis and Myalgia

Gua Sha affects body biochemistry and physiology in the following ways. By:

  • Stimulating mechanoreceptors in the skin
  • Creating a form of counter irritation therapy
  • Increasing blood flow to the treated areas
  • Promoting fluid flow and fluid dynamics in the tissue
  • Stimulating the immune system and white blood cell activity
  • Promoting the release of endorphins
  • Promoting connective tissue growth and repair.

Method of Application:

Gua Sha usually follows Medical Massage Therapy. When using Gua Sha in combination with Medical Massage it will be used as a finishing technique as follows:

  1. Place the client in a neutral position with the area to be treated in a properly folded position and not stretched or tense.
  2. Gather all supplies and materials to be used and have them easily accessible. This should include plenty of towels. (I like to have paper towels available, too.)
  • Drape the client so as to expose the area to be treated being careful to not over expose the client. This will also serve to protect any clothing that may be worn at the time of treatment from medicated oils.
  • Begin kneading and massaging the area to be treated. A medicated oil such as Po Sum On may be used at this time while kneading and massaging.
  • Layer the medicated oil with repeated applications while treating the area with Gua Sha.
  • Use a sterile tongue depressor to gently but firmly scrape the area being treated.  Use more medicated oil as necessary for lubrication. Be sure to be thorough scraping in as many directions as possible. (This scraping is the main treatment technique of Gua Sha.)
  • DO NOT use a non – disposable tool or comb as cross – infections are possible.
  • After the scraping procedure is completed, use a clean towel to pat and vigorously rub the area to remove excess medicated oil. (I use a paper towel first as the oil will stain the towel.) Do not touch the area with your bare hand.
  • After completing these steps the area should be treated by spraying it with a cooling liniment such as Zheng Gu Shui (zen-goo-shwe) or a mixture of one part Witch Hazel to one part Aloe Vera to one half part alcohol. I use 100 proof vodka for the alcohol since rubbing alcohol is toxic.
  • Repeat three times with the cooling liniment allowing the area to air dry in between and then after. Be careful to not allow the liniments to stain the client’s clothing.

After the Gua Sha has been completed the client should feel relaxed and rested. A light warm feeling should be experienced. Any pain that the client may have experienced before the treatment should feel much better.

Gua Sha may be followed and combined with red light therapy or infrared heat lamp. Be sure the infrared is moderate.

The area treated may also be wrapped in a towel and allowed to rest for a few minutes after treatment.

A light bruising may occur but it should not be excessive. The use of Zheng Gu Shui will help prevent bruising. Also the use of a cooling liniment serves to close the pores after treatment and to constrict the blood vessels. There is always a small amount of micro trauma to the surface of the area being treated. This will also cause a small amount of occult blood to be present which will require the need to use caution so as to avoid any cross infection.

Taken from: Zhang Feng Kui- Diseases in the Summertime. Translated by Zhang Min.,  

Also taken from Lecture: Introduction to Acupuncture – Dr. John Ruburto, AMMA 09/19-21/2003