1.1: How to study this course 

Simply
reading this course will not make you a competent therapist.

To get the most out of this course you will need to apply what you learn and proceed in a conscientious manner:

* Study the elements at a sensible pace, do not rush, take your time.

* Read each element carefully and make sure that you understand it before you move on to the  next element.

* Make notes as you go along, underline any paragraphs and sentences which you feel you  would like to remember.

These are very simple guidelines, but if you follow them then you are sure to get the maximum possible benefit from this course. Apply yourself and you will learn more and enjoy this course more than you ever expected.

1.2: Introduction to Massage Therapy

*Find a quiet place to study your course.
Distractions will not be conducive
to progress.

Massage has been used since thousands of years in different cultures around the world and is one of most ancient healing techniques.

History records in China
documents suggest the use of massage as far back as 3,000 years ago. Details
regarding massage techniques and pressure points were explained  in the book called 'Con Fou by Lao Tse'. This
book formed the basis of holistic healing therapies like acupressure and
massage which are extensively used today.
 
As a matter of fact, the evidence
of cavemen drawings shows that massage was used thousands of years ago as a
sensual as well as caring activity. Massage was also extensively used in India,
Persia, Japan Greece, Rome and Egypt as a form of relaxation as well as for
healing various ailments. The Romans, in particular, were well-known for being
the earliest to introduce the concept of hot/cold rooms, steam baths and
massage rooms. Massage has been used since several centuries as a beauty aid,
for general well-being, to boost suppleness and flexibility as well as to
promote recovery from illness and injury.
 
Hippocrates had recommended
massage as necessary for the 'rubbing of joints and the circulatory system'. He
also gained insight into the fact that upward massage was extremely beneficial
as it helped stimulate blood flow towards the heart.

Unfortunately, although massage
continued to flourish in eastern cultures, its usage dwindled in the West. It resurfaced during the period of the renaissance. Massage, as  we know the technique
today, was referred
to conventionally as a 'Swedish massage' and began to emerge in the 18th century.

In the UK, the first structured massage proponents
were a group of women called 'The Society of
Trained Masseuse'. The aim was to establish
massage as a healing modality
and their services
were extensively used during World War 1. Their massage therapy
proved very helpful
in easing pain and was used in the treatment of nerve damage,
shell shock and so on. The Society
of Trained Masseuse
was transformed later into the 'Chartered Society of Massage and Medical Gymnastics'.

Research in Europe at this time indicated
that manual pressure and zone therapy (early reflexology) were effective in releasing psychological and physical tension.
It was at the same time that researchers became aware of the use of essential
oils in massage.  Since  essential 
oils  were  also found to have a soothing effect on stress, essential oils began to be used as a medium in massage therapy.
Until the 60's, massage was regarded more of a luxury than a healing
treatment.

Today, massage is widely used all over the world and is accepted as a form of alternative or holistic therapy.
Several clinics, hospitals
and healthcare centres
in the UK offer  massage 
as  a complementary therapy in the aftermath
of surgery and other conventional treatments. Massage is now accepted
as an effective healing technique that helps alleviate pain, reduce stress,
rehabilitate sports injuries,
induce relaxation and promote overall wellness.

It's
now an integral part of physical rehabilitation programs and is extensively used in the treatment of a wide spectrum of health conditions
including back ache, arthritis, fatigue, depression, infertility and diabetes among several others.

1.3  : What is Massage Therapy?

In general, massage
includes a number of techniques that involve rubbing, kneading, pressing or manipulation of soft tissue and muscular
structure.

In other words, massage includes
touch, movement and re-patterning therapies (collectively referred to as
bodywork therapies) that are aimed at affecting structural changes to the body.
Similarly, since the technique treats both the mind and body, it's also
considered as a 'somatic therapy'.

Although massage therapists commonly use fingers
and hands, they are also known to use elbows, feet and forearms. Massage therapy utilises
somatic therapies that include but may not be limited to tapping,
kneading, pressing, rubbing,
compression, stroking and rocking  friction. 
There  are  more than 250 variations of massage therapy techniques.

 1.4  : How does Massage Work?

Massage is responsible for introducing physiological changes in the body through
two main types of responses: The relaxation response
and the mechanical response.

The two responses work together to produce physical as well as mental benefits.

Relaxation Response

A relaxing massage calms down
your breathing and slows down your heart beat. This is referred to as a
'relaxation response'. The relaxing sensation in turn boosts the level of a
hormone called 'serotonin'. Serotonin has a positive impact on our emotions and
feelings. This is why one experiences an overall feeling of wellbeing during
and after a massage session.

Mechanical Response

The
manual manipulation in massage therapy has two major effects on the body:

It increases
blood and lymph circulation: Massage promotes manipulation of soft tissue which in turn boosts blood and lymph flow. This results in improved
supply of oxygen and nutrients
to the cells. Enhanced cellular
health leads to improved functioning of tissues which in turn leads to effective elimination of waste products.
In addition, there is reduction
of swelling in soft tissues.

Relaxation of soft tissue (which includes tendons, muscles,
ligaments and connective
tissue). The normalisation of soft tissue also helps release deep connective tissue and nerves.Massage geared towards manipulation of connective tissue
is called 'rehabilitative massage'.

Massage therapy helps minimise
painful muscular spasms and contractions. It also helps alleviate nerve
compression. To explain this further, muscles have a tendency to squeeze the
nerves around them when they contract. This is called 'nerve compression'. When
nerves are compressed, they are no longer able to transmit messages to the
brain in an efficient manner.

Once the nerves are relaxed, they
are able to transmit messages and consequently, the brain is able to control
the organs more effectively. All organs in the body share common neurological
pathways that carry 'pain signals'. They share these pathways with other
nerves, bones and muscles. Hence, when nerves get compressed, organs often
display signs of distress and dysfunction. Massage helps soft tissues find
improved alignment and balance.

1.5  : Physical and Psychological Benefits
of Therapeutic Massage

Massage therapy has a host of benefits to offer. Not only does it help relieve physical
symptoms but it is also instrumental in relieving stress.

Stress and Tense Muscles

Almost all of us have experienced
muscular aches, pains and spasms at some point. Physical and mental stress can both result in muscular tension.

For example

We may experience pain after a slip or a fall. Repetitive typing and constantly peering at a computer
monitor all day long (all too common these days) can likewise lead to a sore
shoulder, neck and back. Such muscular tensions are referred to as 'repetitive stress injuries' or RSIs.

Similarly mental stress also leads to tense muscles. When we experience stress, the body reacts immediately with a 'fight or flight' response. The heart beats, faster, your breathing becomes shallower and your muscles become tenser.
Your body is gearing you up either to run (as fast as possible)
or fight. Once the stress is over, your body's physiological reactions
return to normal.

However, if you experience
prolonged periods of stress, your muscles are subject to excessive 'fight or
flight' responses repeatedly. These muscles then begin to experience permanent
strain or tension. Even the frown or scowl from worrying over your tax returns
can strain the facial muscles and result in a tension headache. Feeling
stressed over long traffic  queues  and 
craning  your  neck 
in  the process often leads to
neck stiffness. The skeletal muscular system is composed of more than four
hundred muscles.

 Prolonged stress can injure or
fatigue any of these leading to pain, tension and stiffness over time. The
underlying concept is that a muscle under sustained tension needs alternate
relaxation phases in order to maintain its functionality. The lack of a
relaxation phase leads to tightness and strain.

Massage is extremely beneficial
in helping to relieve muscular tension and reducing inflammation. Recent
research indicates that massaging tired or injured muscles results in the
suppression of chemicals called 'cytokines'. Massaging also stimulates
'mitochondria' or tiny hair-like structures found in cells that convert glucose
into energy. The increase in mitochondrial stimulation and suppression of pain
pathways helps ease muscular stress. As a matter of fact, massage techniques
work in a way quite different from conventional drugs and painkillers.

Painkillers suppress muscular
pain but not promote internal healing. On the other hand, massage helps relieve
pain as well as promote cell recovery.A recent research study conducted
by Cedars Sinai Medical Centre, Los Angeles, indicates that massage results in
the decrease of cortisol, a stress hormone. This study actually shows that
massage therapy is effective in mitigating the physiological effects of stress.

There are several significant
benefits associated with therapeutic massage beyond the instant feeling of
relaxation and wellbeing.

 1.6  : The advantages
of massage

The emotional benefits

Massage is pleasant.
Hardly a revelation, but it's important
to remember this when we delving into the medical
literature, or into heated debates
over the benefits
of massage. The good feeling
that you get after a massage is hard to test and quantify, but no less real for that.

The medical
benefits

Medical studies have found that massage therapy does help patients in many ways1. Studies haven't been able to reproduce
all the benefits claimed by massage and bodywork practitioners, but they have shown enough to conclude
that massage isn't entirely useless.

The placebo effect

The most important, and least controversial, benefit, is the placebo effect.
This refers to the fact that if you are receiving treatment,
you are more likely to get better – even if the treatment does nothing to you. This form of 'mind over body'
health improvement (your health improves because you think your health is improving) is powerful, and
has been demonstrated in clinical trials. It is particularly significant in areas such as pain relief,
where the symptoms experienced are a blend of the physical and psychological.

Among other articles, see Moyer et al,
2004, A meta-analysis of massage therapy research. Psychological bulletin 130(1):3-10

So, any form of treatment
in which the patient believes
can benefit them. But massage
probably has advantages beyond this. When we feel
pain, our instinct is to touch the affected part of the body – and this seems to bring at least a minimal
level of relief. If touch can relieve pain in this context, then why not also in massage.

Neurological effects

Slightly different again
from the psychological effects are the neurological effects.
This refers to the effect massage has on the low-level nervous
system. Depending on the form of massage
used, it can make the nervous system either more or less excitable, leading
to greater or lesser responses
to stimuli. This can be measured by testing !”Hoffman's sign” - the reflex motion of the thumb when a fingernail is flicked.

Mechanical effect

Mechanical pressure on muscles increases
the flexibility of those muscles,
and decreases their stiffness. This is a purely mechanical effect, dependent on the physical
structure of the muscles.

The lymphatic system

 Your body drains waste away from muscles and other tissue through the lymphatic
system. This is far from perfect, and when it slows down your body can be left feeling (and looking) puffy and unpleasant. This tends to happen overnight,
when the entire lymphatic system slows down, and it is also worsened by poor diet.

Fortunately, the circulation of lymph can be improved
by manual manipulation – that is, by massage.

Circulatory system

Of the physical effects of massage, perhaps the clearest are on the circulatory system. When you touch, squeeze
or press any part of your body, you increase
the circulation to that area. Massage takes this effect,
and systematically applies
it. As a result, massage is a good way to deal with minor problems of the circulatory system.

Meanwhile, massage will be having
other effects on the central
circulatory system, reducing
blood pressure and heart rate. Why this happens isn't fully understood, but i seems to be a reaction
to changing levels of hormones
circulating in the body.

Hormonal system

Massage can measurably alter the levels of certain
hormones circulating in the body. Cortisol,known as a 'stress hormone',
is reduced by a massage. Meanwhile a good massage raises the levels of dopamine and seratonin circulating around the body. Dopamine and seratonin make you feel good – they relax your heart, they reduce your sensitivity to pain, and they reduce blood pressure.

In the longer term, low levels of dopamine and seratonin are associated with depression. That doesn't mean massage can cure depression, but it does highlight the link between
having a back-rub
and feeling good.

So, here is one mechanism
by which massage makes you feel good. It isn't clear why massage has these effects
on the hormones, but that doesn't stop it being a good thing.

Fact

No wonder massage feels so good - There are approximately 5 million touch receptors in our skin

Source: Heart Prints Wellness

 1.7  : A deeper look at the history
of massage

Many people would argue that massage has been practiced
for thousands of years, and that we can find evidence of it in the earliest recorded civilizations.

As we will see, there is a large element of truth in this, but perhaps also an element of wishful thinking.
We can be fairly sure that in the ancient world – China and India, Greece and Rome –some 'massage-like' activities were known.

This doesn't mean that they were doing anything identical
to modern massage,
and certainly not that they thought of it in the same way.

Egypt

The evidence for massage in Egypt is based on interpretations of Ancient Egyptian 
art.  This  is naturally an imperfect science, but there are tomb paintings which appear to show some form of massage in progress. Proponents of reflexology have gone further:
on the basis of a painting which shows one Egyptian touching
the feet of another, they have claimed that reflexology was practiced in this culture.

India

India is a good example
of how massage-like activities can be carried
out without being thought of as massage.
Ancient Indian traditions
held close to what a Roman might call mens sana in corpore sano– a healthy mind in a healthy body. That is to say, the physical and the philosophical were intricately linked. Many philosophies saw the body as a microcosmic reflection of the entire universe, or as a manifestation of a divine or transcendental power, constrained only by unawareness of the true nature of man. Realizing
this inner nature would allow for magical powers, or wealth, or escape from the cycle of reincarnation, depending on the wishes of the practitioner.

Where does the massage come into this, you might well ask. Well, once you have accepted the human body as linked to the divine, a natural next step is to start manipulating the body to control, or to experience, the divine. This approach bring us to yoga and tantra, both of which contain substantial elements of massage and bodywork.

If this explains
the prominence of 'religious' massage,
India also encountered massage at the other end of the spectrum, in erotic handbooks
like the kama sutra. This taught ways of stroking
and manipulating the body which seem very massage-like.

China

China probably shows the clearest evidence of the practice of massage. Our understanding of the early history of medical and bodywork practice
in China remains 
poor  –  but 
whereas  in  Egypt, Greece and Rome this is because of a shortage of written evidence,
with China almost the opposite
is true. Scholars
of ancient China are buried under the wealth of documents, let alone the range of evidence which can be gleaned from archaeological research
across China. On this basis, we believe
that massage in China can be dated back as far as the second, or possibly
even the third, millennium BC.

These earliest dates, cannot, however,
be proved on the basis of written
evidence from the time, since writing not developed in China until perhaps 1400BC.Because of the continuity of
Chinese culture over the millennia, we can also tell something of the nature of
ancient practices by looking at what continues to this day. Traditional Chinese
Medicine is the form of these ancient practices which is used today, having
been codified and condensed under the control of the Chinese Government during
the 20th century.This Government control is hardly a new thing. China was the
location for what are almost certainly the first massage tests – in around the
first century CE.

Central to ancient Chinese
massage practices was Tui na. Tui na is first mentioned at around 200BC by the
medical writer Zhang Zhongjing in his book "Prescriptions of the golden
cabinet" (jing gui yao le). 'Tui na' literally means 'poking and
pinching'. In the currently-known form, tui na is very similar to modern
Swedish massage. Although this may be partly due to modern influence from other
world massage traditions, it is safe to say that many elements of tui na have
remained constant for hundreds or thousands of years. Moreover, tui na and
related techniques probably had their own influence on Japanese and Korean
massage, which in turn influenced the West.

Greece and Rome

Some of the practices which went on in Roman baths appear quite close to massage,
although they do not appear to have been conceptualized in this way.

Even Julius Caesar, the man
regarded as one of Rome's greatest emperors, after whom are named Kaisers,
Czars, and even the month of June, benefited from massage. Caesar probably
suffered from epilepsy. According to the ancient historian Pliny, he had
himself pinched all over the body on a daily basis – a process which certainly
sounds like a basic form of massage.

Another eminent ancient
proponent of massage was Hippocrates. Hippocrates is regarded
as one of the greatest
early doctors, and his name lives on in the 'Hippocratic oath' which guides doctors in the ethics of their craft. Hippocrates wrote of the benefits of anatripsis and friction. Frictio gives us the modern word 'friction', while 'anatripsis' literally
means 'rubbing up'. Such treatments, Hippocrates writes, brought
benefits including relaxing,
constricting, thickening, or 
thinning, depending on the way in which they were conducted. In much the same way as modern massage has found a home in sports medicine,
the Greeks would perform massage
on athletes.

Swedish massage

So-called Swedish massage
is the massage equivalent of vanilla ice-cream. It's the basic massage, the kind that you're likely to get if nothing else is specified.

'Why Sweden?' you might be wondering. All the other sources of massage seem to be in the Far East or around the ancient
Mediterranean. Sweden, beautiful
as it may be, doesn't
feel like somewhere
you would expect to find a massage tradition.

So, in the work of Ling and his followers
we can see the core of 'Swedish massage'. Ling didn't invent all this himself, but for a long time historians have had difficulty untangling his sources.
Some of his ideas probably
came from Turkey.

1.8  : Regulation

The regulations that affect massage therapists vary according to your local jurisdiction.

Please select your location from the list below to find out more about how regulation will effect you. [tabby title="UK"]

Regulation of massage
therapists UK

As of 2008 the UK government has enforced a policy of extending public protection by encouraging
voluntary regulations for complementary therapy- this also includes massage therapy.

The Regulation of massage therapy
is a process that can ensure that practitioners will be trained
and fully qualified
to a proper standard. A register is held for the public to check who qualified
therapists are and so that people can make formal complaints if necessary.

Registration of therapists is voluntary and people can still practise
massage therapy even if they are not registered. If somebody qualified
before the new act was out in place, one can demonstrate their skills and prove they are up to date with therapy and still be able to join the register.

Guidelines of the MT1 CORE CURRICULUM MASSAGE THERAPY as of August
2011

The GCMT stands for General
Council for Massage
Therapies. They aim to ensure that  the 
best practises are upheld within the industry and set out to maintain agreed objectives within the council.

They are-

*Promoting the adoption of the highest standards of practise in all things concerned with massage therapy.
Offering members of the public a way to access treatment to the highest
possible standard.

*Establish a nationwide professionally recognised standard of training and conduct and competence. This is to protect the public.

*Act as a unifying
body and bring different organisations together, promoting good will between
all who engage and represent
the teaching of massage therapy.

Establish standards
that continue to improve overall professional development.

*A core curriculum
was established by members of the GCMT to help the UK achieve a high standard
throughout the industry.
The structure of the core curriculum has been based upon and focuses on the principles of the National
Occupational Standards for Massage Therapy/
Bodywork.

*The Prince of Wales Foundation for Integrated Health has also provided much funding towards
the GCMT to help keep it up and running.

*“Massage therapy is the systematic use of classic
massage and other massage techniques to try and improve physical
health and mental wellbeing. Massage therapists should be suitably
trained with enough experience to apply this type of therapy.

[tabby title="RZA"]

 Massage
therapy regulations in South
Africa

If one wishes to practise Therapeutic Massage Therapy in South Africa then you have to be legally
registered with the AHPCSA (Allied
Health Professionals of South Africa- website www.ahpcsa.co.za

All therapies classed
under this organization include holistic massage
therapy, sports massage
and relaxation massage therapy. A typical training
course takes 2 years to complete in TMT and the subjects
will cover chemistry, physiology, anatomy, pathology, pathophysiology, theory of massage, studying
the practise of massage, business studies, counselling and nutrition.

One can contact
the AHPCSA for further details
on different training
institutions. After you have graduated
you must register
with the AHPCSA and ensure that your diploma meets full registration rules and requirements. This is done by completing
the Council Registration Examination or CRE. The exams are only held twice every year.

The South African Qualifications Authority
has a full list of qualifications in massage therapy and the complimentary therapy industry.please check www.saqa.org.za

 [tabby title="Can"]

Massage therapy
regulations in Canada

Massage therapy regulations in Canada are held in place by each individual
province or territory.

Standards and practises
can vary between
each province, it is a regulated profession in 4 different
Canadian provinces, whereas
the other provinces
are still en route to becoming self-regulated.

So massage therapy
does not have current regulations outside of the 4 current
provinces. The 4 that currently have their own regulations are British Columbia,
Newfoundland, Ontario and most recently – New Brunswick, which achieved regulation in 2013 that is upheld by the College of Massage Therapists of New Brunswick.

As of April 2009, all regulated health professionals including
massage therapists should try and reciprocate over regulated provinces.
For those who live in regulated provinces, one should research
directories of the province to check their code of conduct in massage therapy.
For therapists who are in a good stance with one province
it is possible for them to work in another regulated province
as long as they complete
a Jurisprudence Examination. If you plan to move to one of the 4 regulated
provinces or different
country- each college
will have their own policies
and rules.

Other Canadian provinces
are not regulated by the provincial government. Massage therapists are expected to follow standards
of practise that are set out in each jurisdiction set out by provincial associations. If you are moving to one of these provinces
then you are expected to follow their standards as a guideline
for professional behaviour.

Alberta, Saskatchewan, Manitoba,
Nova Scotia, and Prince Edward
Island all have associations that are not yet under legal regulation.

 [tabby title="Ire"]

 Massage
therapy regulations in Ireland

The Irish Massage Therapy Association was founded in 1990 and has been a long standing member of complimentary healthcare in Ireland since.