NAMING CONVENTIONS

a list of candidate techniques for the neck pain study. Each candidate technique included a mechanical description of the stroke using neutral descriptive language, notes regarding appropriate application (eg. anatomic locations and types of con- ditions) and examples of massage styles that might use this technique. This docu- ment was then refined through discussion with eight other massage therapists involved in the study.

Results The proposed taxonomy was conceptualised as a system with three levels (Box 1): 1) principal goals of treatment 2) styles

3) techniques.

At the most general level, four principal treatment goals were elucidated: 1) to promote relaxation and wellness (relaxation massage) 2) to address specific health complaints (clinical massage) 3) to enhance posture, movement and body awareness (movement re-education) 4) to balance and move subtle energy (energy work).

Each of these goals can be accomplished using a number of different styles of mas- sage, some of which are trademarked (eg. Rolfing®). In a typical massage therapy regimen, more than one goal is addressed and more than one style of massage is used in a course of treatments and even within a single treatment session. Finally, a single style of massage may be used to address different goals. For example, struc- tural integration can be used to enhance athletic performance (relaxation massage), address a health condition such as tendinitis (clinical massage) or improve posture (movement re-education).

Typically, massage students are taught a sample of styles in their basic massage training and then enhance their skills and learn other styles through continuing edu- cation workshops. Styles are commonly distinguished by a unique combination of techniques, and by the underlying intent of when and why to apply the techniques. Specific techniques, which refer to physi- cal manipulations of the tissue, are the most fundamental and specific level of classification and are the building blocks of each style (Table 2). Specific techniques

BOX 1: PRINCIPAL TREATMENT GOALS OF MASSAGE - “INTENT”

■ Relaxation massage is specifically given to relax the body and promote wellness. Relaxation massage has the intention of mov- ing body fluids (such as lymph and blood), nourishing cells, removing wastes from cells, relaxing muscles and diminishing pain. In the US, the most widely taught and practiced style of relaxation massage is Swedish massage (1,3), which employs five basic strokes: effleurage (gliding), petrissage (kneading and lifting), friction (moving the tissue layers underneath the skin), vibration, and percussion. Spa and sports massage are two other styles that can be used primarily for relaxation. When massage styles that are more commonly used to address non-relaxation goals are applied with the intent to relax the body, they can be considered relaxation massage. For example, lymphatic drainage, commonly used to reduce inflammation (clinical massage), is also believed to effectively stimulate the parasympathetic nervous system to promote relaxation.

■ Clinical massage involves more focused manipulation of the muscle and/or surrounding fascia and may address other systems in the body such as lymphatic, circulatory and nervous systems (3). Its intent is to relieve pain and restricted movement. Popular styles of clinical massage are myofascial trigger point therapy, myofascial release, neuromuscular therapy and structural integra- tion or Rolfing® . They differ from relaxation massage because they include focused therapeutic goals (eg. releasing muscle spasms, strengthening, or stretching specific muscles and remodelling fascia). Clinical massage may include styles of massage often used for other principal goals. For example, muscle energy technique, often used for enhancing ease of movement (move- ment re-education), can also be used as a clinical technique, for example, to reduce muscle spasms or pain in a patient with whiplash.

■ Movement re-education emphasises using movement to enhance posture, body awareness and movement (3). Movement re-edu- cation is generally intended to induce a sense of freedom, ease and lightness in the body. Some styles of movement re-educa- tion focus on active exercises to teach healthier ways of moving (eg. Alexander technique, Trager® , Feldenkrais® ). These styles may be used by non-massage therapists. Other styles focus on tablework in which the practitioner induces, assists or resists move- ment for a patient (eg. proprioceptive neuromuscular facilitation (PNF), muscle energy technique (MET), strain-counterstrain). Some styles of massage commonly used for a different treatment goal, can be used to increase function and movement (eg. sports massage).

■ Energy work (also called subtle energy techniques or body-mind therapies) are believed to “assist the flow of energy in the body” by employing light to sometimes deep touch or by holding the hands just above the skin (6). These include therapeutic touch as well as massage traditions derived from Asian cultures, such as shiatsu, Reiki, Polarity, and Jin shin do. The intention of ener- gy work is to move stagnant or blocked “energy” so it can circulate freely throughout the body.

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are commonly used in more than one style of massage and in real life may be prac- ticed by a range of professionals, such as physiotherapists, osteopaths and move- ment educators. Principal goals, styles and techniques are discussed in Table 1.

TWO STYLES AND THEIR COMPONENT TECHNIQUES In this section, we introduce the com- plexity of describing two popular styles of massage used for addressing specific health complaints: myofascial release and neuromuscular therapy. Barnes (6) defines myofascial release as a “whole body, hands-on approach for the evaluation and treatment of the human structure. Its focus is to optimise the function of the fascial system.”

Component techniques of myofascial release include three techniques also used in craniosacral therapy (compression - static; listening to and following the cran- iosacral rhythm; still point), in addition to cross-fibre friction, deep gliding, hold- ing, J-stroke, manual stretching, traction, skin rolling, rocking, jostling, shaking and vibration (6,14) (see Table 2).