Illustration of a man in profile looking ahead, in front of a blue brick wall.

Many people don’t realize massage therapy is so much more than simply touch.  It is the integration of touch with the knowledge of the science of systems of the body that makes massage an effective part of health care.

As an entry-level massage therapist, we learn the basic structure (anatomy), function (physiology), movement (kinesiology), medications (pharmacology) and pathologies of the human body. When we are able to continue and dig deeper into the science, as we advance, we can become even better at applying the art of touch.

First and foremost, just as the Hippocratic Oath states, we do no harm. By being able to identify endangerment and cautionary sites, we know what structures to avoid when treating clients. We can adjust the treatment in a particular area or check in with our clients to verify that there is no discomfort.

Your Knowledge of Pathology

As we continue to grow and learn more about how the body functions in its normal limits, we can understand pathology and how it disrupts the normal physiological processes.  We are better prepared to deal with injuries and to understand the effects of medication on the body. With this knowledge we can adjust our treatments accordingly, sometimes even in the middle of the session.

Learning about each system of the body helps us understand normal function, which helps identify when there is pathology. Massage may have a negative effect on pathologies of every system of the body.

As massage therapists we must have an understanding of areas to avoid for the safety of our clients and also our own safety. For example, working with a client who has an airborne illness may result in that illness being transmitted to the therapist who may then transmit it to other clients or their family.

Your Knowledge of Movement

It is kinesiology, the study of how the body moves, which I find the most fascinating aspect of being a massage therapist. Understanding the anatomy of the muscles, their location, attachments to bone and function; understanding how the body moves in activities of daily living as well as in sports — has led me to further my education in massage with athletes.

What muscles are recruited for throwing a ball or running? What happens when we overuse or misuse these muscles? What happens when we are sitting at our computer for too long or lifting heavy boxes all day? How does the body respond, positively or negatively, to the stresses we place upon it every single day?

Massage is applied to the soft-tissue structures of the body, and it is the response of the fascia, the muscles and the tendons that intrigues me the most as a sports massage practitioner. By diving into my knowledge of how the body moves by knowing the muscles that are most likely influenced by an activity, by knowing how to locate those muscles and the nerve innervations, and by understanding my toolbox of massage modalities and techniques, I can create an effective treatment for my clients.

From the runner who did not realize how working with the muscles in her hips would make her more efficient in her long runs, to the bodybuilder who appreciated the stretching and lengthening to his latissimus dorsi, knowing my anatomy helped me appease many clients and assist them in their recovery, allowing them to train and perform to their optimal level.

Your Knowledge of Anatomy

Many people seek massage to increase relaxation.  Understanding the autonomic nervous system, including the balance between the rest and digest of the parasympathetic nervous system with the fight- flight-freeze reactions of the sympathetic nervous system, is vital for creating the correct massage experience.

When the main goal of the client is to relax, the strokes used should promote relaxation.  Those are typically long, slower strokes to increase parasympathetic activity.  Quicker strokes tend to increase the sympathetic nervous system. 

If the wrong techniques are used, the client’s goals would not be met and the session would not be successful.  I certainly would not want to put a football player to sleep just moments before he needs to warm-up for the game nor would I want to deny someone a well-earned rest on my table when they are escaping for an hour from their hectic life.

Asking questions regarding pain quality and quantity is important in establishing the role of massage therapy in  health care. Muscle pain and soreness are much different than nerve pain. I will refer an athlete with burning or “electric” pain to a primary  health care provider or a neurologist rather than try to work on something to which I might cause more damage. I also understand nerve impingement from soft tissue can be relieved by massage and the client would not need to see his primary  health care provider.

Due to stress, increasingly more clients are developing digestive issues. Massage is indicated for many but contraindicated for some. A massage therapist must be able to identify a client with acute ulcerative colitis verses constipation. Both are painful but massage is only indicated for constipation. The client should be referred to her primary health care provider for acute ulcerative colitis.

As for the circulatory system, there have been some previous myths about the influence of massage on deep circulation that have been disproven by research.  It is important that massage therapists continue to learn throughout their career so they can dispel the myths they may have learned in school. Only through research and testing have myths been dispelled.

The influence of massage on normal circulation also leads into understanding how massage can be contraindicated for certain pathologies. Expanding on the basic education and understanding of fluid dynamics and movement through the body, many massage therapists have advanced their education in manual lymph drainage (MLD) to help their clients.

Modalities such as MLD require advanced knowledge of the circulatory and lymphatic systems to become effective and cannot be applied by most entry-level therapists.

Board Certified massage therapists are being hired to work in hospitals alongside other health care professionals. They have demonstrated advanced knowledge of systems of the body, pathologies, terminology, indications and contraindications. To pass the NCBTMB Board Certification exam, a massage therapist must demonstrate knowledge in such various areas as pathologies of the respiratory system, or how to maneuver around and perform MLD on a patient with cancer in a hospital bed.

With this knowledge they may be asked, for example,  to position a patient correctly and perform percussive techniques on someone with pneumonia or with cystic fibrosis. Many massage therapists work with oncology patients and have advanced training in types of cancer and treatments so they can identify when massage might be contraindicated to either the patient or the massage therapist.

Your Understanding of Medication

Understanding these principles is paramount when a client comes in with a list of medications or a history of pathologies. The massage therapist can rely on their education to sort through any contraindications or precautions necessary. An example of a massage precaution would be someone on blood thinners.

Massaging too deeply may cause the client to bruise. The massage therapist may have to adjust pressure during the massage and inform the client that bruises may appear after the massage. This is not a contraindication, but massage therapists must be able to critically think and understand the effects of massage, and how to inform clients taking different medications.

Many of my clients have experienced positive results after treatments because I spend time researching and educating myself on techniques that work for different needs. School taught me the basics of massage, but it was only after I began practicing, reading and asking questions, I mastered the art of massage.

The Case for Board Certification

I am Board Certified, and that tells my clients I have advanced my knowledge, I understand the researched effects of massage on the systems of the body, and I will continue to learn and grow through continuing education to better serve my clients.

Even with this knowledge, massage cannot be practiced in a textbook, which is where the art meets the science. The element of touch helps bridge this gap. The human body amazes me every time I am privileged enough to place my hands on someone’s anatomy. With the understanding of how the human body works I can create the massage that the client requests, which at the end of the session is what is important for us both.

This is Part Two of a special multi-part series on professional development from the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB). This series covers areas that NCBTMB Board Certified massage therapists possess.  Read Part One, “Brick by Brick: 3 Ways Professional Communication Helps You Build Your Practice”; and read “Brick by Brick: The Value of Adding Assessment to Massage Therapy Sessions on Sept. 10.

Portia Resnick, PhD, ATC, BCTMB, LMT, wrote this article for MASSAGE Magazine on behalf of the National Certification Board for Therapeutic Massage & Bodywork (NCBTMB). She has over 20 years of experience in sports medicine.  She was educated at the Somerset School of Massage Therapy and taught at the school until 2010. In 2017 she completed her PhD in Kinesiology at the University of Hawaii, Manoa.  She is an assistant professor at California State University, Long Beach. Listen to a conversation on Applied Science between Portia Resnick and Donna Sarvello, NCBTMB’s VP of Educational Support.