The question may prompt an answer from two viewpoints: that of the client and that of the therapist.
For the client, the answer may be, "Because it feels good." or "Because my doctor prescribed it."
For the therapist, the question has a different slant: It might be stated, "Why choose massage therapy to make the client feel or function better?" The pragmatic answer might be, "Because it gets results." However, two deeper questions pertain: "What makes massage therapy a way to get those results?" and "Are the same or better results possible by other means?"
These questions call for a deeper understanding of the mechanisms by which massage therapy and other "tissue-manipulative" approaches get the results they do.
For the first question -- how does it get those results -- one might answer, "Through different techniques: rubbing, kneading, cross-fiber manipulation, stretching, myofascial release, etc., one induces tissue changes, improves circulation, etc."
This might seem to be a sufficient answer, but again, a more pertinent and functional answer awaits understanding. It helps to adopt another viewpoint and to restate the question: "How does it work?" or "Why does it work the way it does?" -- questions inquiring into the very processes massage therapy seeks to affect, questions not usually asked or answered. Deeper than that question is another, "behind the scenes" question pertinent to all massage and bodywork: "What is a therapist's intention when ministering to the client -- to create bodily changes for the client or to enable the client to change themselves for the better?" -- or both?
At this point, a underlying (but obvious) assumption may emerge: "The client (or patient) cannot change themselves; someone must do it for them."
We will now take a fresh look at that underlying assumption and delve into these deeper questions -- because it makes a difference how we choose to solve the problems for which people come to massage therapy.
The Two Approaches and The Case for Self-Change
There are two approaches applied by therapists: "working on the client" and "working with the client." Working on the client pre-supposes that the client cannot help themselves; working with the client pre-supposes that the client has some practical responsibility for, and ability to change, their own condition.
Let's consider "working on the client". Of particular relevance is the use of massage for muscular relaxation. Tight muscles are induced -- or forced -- to relax through various techniques. What is actually occurring in that process?
Let's begin with a premise from the study of physiology: muscles have no behavior of their own; they obey the nervous system, which has two major divisions: sensory (sensation) and motor (movement). Habitual tension reveals the presence of conditioned postural reflexes (motor actions), which form part of the familiar sensation of "oneself"-in-action. An area is involuntarily contracted because the nervous system is keeping it contracted from a level outside the person's voluntary control.
A therapist's touch and handling may (1) sooth the client so that they relax ("relaxation massage"). This approach amounts to distracting the client from their usual life by means of pleasurable sensations -- or -- (2) induce relaxation by pressure, stretching, or other forms of manipulation (therapeutic massage). This approach is, at best, corrective, and at worst, coercive (depending on the therapist); relaxation occurs via momentary submission to the therapist's touch and handling, rather than by changing long-term habits of tension and movement. To the degree that the therapist forcibly induces relaxation, they put a person into a condition -- i.e, a more relaxed way of operating -- by overpowering their habitual conditioning. In returning to daily life, the person contracts again into the same pattern -- usually in a few hours or days -- because that is their usual habit and state. This experience is typical of massage -- and also of other passive-manipulative techniques -- the exception being contraction patterns that have not yet become deeply entrenched (habituated), and so are relatively superficially held.
At the point where touch serves more to induce awareness than to force relaxation, that touch becomes more akin to palpation than to massage. (Examples: Jin Shin Jyisu, Jin Shin Do, Acupressure, Shiatsu, Polarity Therapy). It explores and inquires of the state of soft tissue by contact and pressure, inviting the client, in the process, to become more aware of their own state. It communicates with the person.
But passive manipulative techniques address only half of the sensory-motor nervous system -- the sensory half; the change of motor-response is not an adaptation, but a momentary change of behavior -- a concession to manipulation and pressure. Pre-existing motor (movement) patterns tend to reappear; changes of movement habits induced by manipulation succumb to prevailing habits within hours or days -- the more deeply entrenched the motor habit, the faster its return. That's why people getting massage tend to need the same treatment again and again. In general, lasting changes of motor function (new adaptation) depend upon the same learn-by-doing process by which we learn any movement for the first time. Only recently-formed and superficially held motor habits yield to manipulative techniques in a lasting way.
Muscles obey the nervous system, where "muscle memory" resides. The sensations produced by touch and handling produce their result not by affecting muscles directly, but by affecting the brain, which responds by reducing muscle tone. It's akin to someone being persuaded of something against their will; they yield, for the moment, but still hold to and generally return to their position. This is the nature of "giving in," and also "buyer's remorse" after interacting with a high-pressure salesperson. That experience is analogous to what happens when muscles are forcibly stretched or massaged to relaxation.
Because the contracted state feels normal (familiar) to the client, forcible manipulation and stretching may create both the psychological pain of being "invaded" and the physical pain of sore muscles being forced to lengthen -- sometimes leading to protective contraction that the therapist must somehow overcome, sometimes traumatizing the client in the process. More than that, forcible relaxation (temporarily) disrupts the conditioned movement patterns that underlie the person's coordination; it "takes a person apart," rather than "putting them together" (which is why Olympic athletes at the Games generally requested "light", rather than "deep" massage).
Now, for contrast, let's consider "working with the client". In that approach, the therapist deliberately creates various sensations by manipulating tissue while the client moves in certain ways. The process awakens the client's sensory awareness of the interrelation of sensation and movement. To emphasize the point the client responds in a participatory way by moving in relation to (under) the practitioner's touch. This combination of touch and responsive movement was how Ida Rolf worked and how she taught her students to work (though many Rolfers have regressed by "passive tissue work" with their clients).
Done passively, tissue manipulation evokes (calls forth) a gradual deepening of the client's awareness and control of their muscular actions, but this deepening is greatly limited by the lack of sensory feedback that active movement provides. Tissue manipulation done with active participation by the client evokes more than relaxation and flexibility: Because the client has enhanced awareness of the connection between sensation and movement, their control of movement (e.g., strength, resting tension level, and coordination) improves much faster.
Doing it "to" or Doing it "With"
Every massage stroke is one or the other: doing it to the person or doing it with them; it is either forcing them to relax or helping them discover that they are contracting and teaching them to relax when, until then, they had forgotten how.
Somatic Education -- Another Approach Altogether
There are other approaches that use movement without direct manipulation of muscles -- more direct approaches to training the nervous system -- to achieve the same or better improvements of muscular control. Examples include Hanna Somatic Education®, Aston Patterning®, The Alexander Technique®, Feldenkrais Functional (or Somatic) Integration® and Trager Psychophysical Integration®. These approaches change motor-function (movement) without any need to touch the involved muscles whatsoever. Muscular function changes through sensory-motor-learning -- movements that induce sensory stimulation sufficient to induce sensory-motor learning, with touch serving only to enhance sensory-awareness to speed motor learning.
Why Massage Therapy?
Now, the question, "Why massage therapy?" takes on a new meaning. Is it to do something for or to the client, or is it to help instill a new, healthier pattern of self-control? Is it to (temporarily) induce relaxation, improve circulation, etc., (at which point pain and boundaries enter the picture as issues)? Or is it to improve self-control (at which point responsibility enters the picture)? Which is the approach of choice in a given situation?
Can massage be adapted to teaching natural self-control? Would it still be "massage" as the term is commonly understood?
The difference is one of principle, as well as practice, of intention, as well as technique. Are we manipulating or teaching? Are we "giving someone a fish" or "teaching them to fish"?
At this point, the question, "Why massage therapy?" has new significance that may lead one to modify ones practices.
