Massage techniques

Massage is sold under a long list of names, and the list mixes three different things together: genuine technical differences, distinct traditions with their own theories behind them, and marketing. Separating the three makes choosing much easier.

What actually varies between one massage and another is fairly short: how much pressure, how fast, whether oil is used, whether clothes stay on, and whether the aim is general relaxation or work on one particular area. Almost everything else is a matter of which tradition a therapist trained in.

The basic strokes, which nearly every style uses

These are the vocabulary rather than the styles. Most named approaches are combinations of them in different proportions.

• Effleurage — long, gliding strokes with a flat hand, following the contours of the body. Used to spread oil, warm the area, and open and close a session.
• Petrissage — kneading: lifting, squeezing and rolling muscle between the hands. Slower and more localised than effleurage.
• Friction — small circular or crosswise pressure applied to one spot with thumbs or fingertips, for working a specific tender area.
• Tapotement — percussion. Cupping, hacking and tapping, brisk and stimulating rather than relaxing, often used briefly at the end.
• Vibration and shaking — rocking a limb or muscle group, used to settle an area that resists being worked directly.

The named styles, and how they genuinely differ

Swedish massage is the Western default, and the thing most people mean by a massage: oil, towels, moderate pressure, effleurage and petrissage over the whole body, usually about an hour. Everything below is a departure from this.

Deep tissue is not the same massage applied harder, which is how it is usually sold. The difference is slowness and specificity — sustained pressure held on one area, working through layers rather than gliding over them. Which leads to the most useful correction in this whole subject: more pressure is not more effective. A massage does not have to hurt to work, and pain severe enough to make someone tense up against it is working against the point of the exercise.

Sports massage is a mixture of the above applied around training, with some attention to the muscle groups a given sport loads. The techniques are not unique to it; what differs is the timing and the focus. The evidence is dealt with separately below, because the gap between claim and finding is wider here than anywhere else.

Shiatsu is not, as it is often described, simply firmer pressure. It is a different system with a different premise: Japanese in origin, worked through clothing on a mat rather than with oil on a table, using thumb and palm pressure at points along what the tradition describes as energy channels, together with stretching and joint mobilisation. The channels are the same concept underlying acupuncture, and they are not an anatomical description of anything — which does not stop the treatment feeling good, but is worth knowing before accepting an explanation framed in those terms.

Thai massage is also clothed and on a mat, and is the most vigorous of the common styles: assisted stretching, with the practitioner using forearms, knees and feet to apply leverage. Enjoyable for people who like being stretched, and the one style where forceful manipulation has produced documented injuries, so it suits a flexible body in good repair rather than a sore back of uncertain cause.

Hot stone massage uses smooth heated basalt stones placed on the body and used as tools. The heat is pleasant and relaxing and that is the whole of the claim. The one real caution is burns, which makes it a poor choice for anyone with reduced sensation in the skin — from diabetes, nerve damage or some medications — because the usual warning system is the person saying it is too hot.

Manual lymphatic drainage is the odd one out, and deserves not to be lumped in with the rest. It uses very light, specific, repetitive strokes, and in trained hands it is a genuine medical treatment for lymphoedema, provided through NHS services. It is not a general wellbeing treatment and it does not drain anything out of a healthy body.

Aromatherapy massage is usually Swedish massage with essential oils added to the carrier oil. The massage is doing the work; the oils affect how the room smells and carry their own precautions, which are under using essential oils safely.

Reflexology is frequently offered alongside massage and rests on a different claim again — that areas of the feet correspond to organs elsewhere in the body. No such mapping exists anatomically. A thorough foot massage is a pleasant thing in its own right, and that is the honest description of what is on offer.

Trigger points, and where that idea actually stands

A trigger point, in the usual account, is a tender nodule within a taut band of muscle which produces pain felt somewhere else — the classic example being a point in the shoulder that produces a headache. The idea is in wide clinical use, and a great deal of massage is sold on it.

Its difficulty is empirical rather than philosophical. When examiners are asked independently to find trigger points in the same people, they do not reliably agree with one another on where they are. Systematic reviews of palpation for identifying them have found inter-examiner agreement generally unacceptable, and the physical entity itself has not been confirmed by imaging or tissue study. Older writing on the subject asserts the opposite — that trained therapists locate them consistently in independent trials, which is taken as proof of a real underlying thing. That has the finding backwards.

One other piece of evidence often cited deserves naming for what it is. The theory's originator, Janet Travell, was physician to President Kennedy and described his back pain as responding to the treatment. That is a testimonial from the person who proposed the idea, about her own patient — the weakest available form of support for a theory, not a confirmation of it.

What survives all of that is worth keeping, because it is the part that matters in practice: pressing firmly on a tender spot in a tight muscle very often relieves it, whatever the correct explanation turns out to be. Pain science has moved away from knots in tissue and towards the sensitivity of the nervous system supplying it, and that shift does not make the sore spot imaginary or the relief fake.

On technique, two corrections. Sustained moderate pressure held for a period is what is generally used, not percussion — tapotement is a brisk tapping stroke and is not the method for this. And pressure firm enough to bruise is too firm, which applies with particular force to anyone using an elbow to generate it.

Sports massage, and what the trials found

This is the area where the claims are strongest and the evidence weakest, so it is worth being specific.

A meta-analysis pooling twenty-nine studies of sports massage, with around a thousand participants in total, looked at performance and recovery outcomes. It found no significant effect on strength, on jump performance, on sprint performance, or on fatigue. It found small significant benefits for flexibility and for delayed-onset muscle soreness — the ache that arrives a day or two after hard training — with the soreness reduction reported at around thirteen per cent.

Two caveats attach to even those two positive findings. Both were heavily influenced by single outlying studies, so the true size is uncertain. And both were measured against doing nothing at all, rather than against some other pleasant intervention, with soreness and fatigue assessed by people's own ratings, which are open to the effect of having been looked after for an hour.

So the honest position: a sports massage will not make anyone faster or stronger, will not speed the recovery of strength, and may modestly reduce how sore the next two days feel. It is pleasant, it is not a performance aid, and claims that it flushes lactic acid or repairs muscle fibres are not supported.

What does not happen, in any style

Four claims recur across almost all massage writing and none of them holds:

• Toxins are not released. There are no toxins involved, nothing is flushed, and no extra water is needed afterwards.
• Muscles are not lengthened by hand. They relax, which feels like lengthening and is not the same thing.
• Fascia is not reorganised by manual pressure. The forces required to deform connective tissue are far greater than hands can apply.
• Circulation improves locally and briefly, which is a modest and real effect, rather than a systemic improvement in oxygen delivery, digestion or immunity.

Choosing, which is simpler than the list suggests

Describing what is wanted works better than selecting a style name. "Firm but not painful, and most of the time on my neck and shoulders" gives a therapist more to work with than any label, and a good one will adapt whatever they trained in accordingly.

Beyond that: oil and a table for whole-body relaxation; clothed and on a mat for shiatsu or Thai; a chair massage for twenty minutes of neck and shoulders without undressing. What to expect at a first appointment, and the health conditions that mean asking a doctor first, are under booking a first massage.

See also massage.