Classification of Massage Modalities

Abridged from: Development of a taxonomy to describe massage treatments for musculoskeletal pain. Karen J Sherman, Marian W Dixon, Diana Thompson, and Daniel C Cherkin. BMC Complement Altern Med. 2006; 6: 24. doi: 10.1186/1472-6882-6-24.

There are more than 80 styles of massage, Sherman et al. (2006) proposed a classification system to describe what a therapist do when giving a massage. The system has three levels of detail: principal goals of treatment, styles and techniques (see Table below). . At the most general level, there are four principal goals of treatment: 1) to promote relaxation and wellness (relaxation massage), 2) to address clinical concerns (clinical massage), 3) to enhance posture, movement and body awareness (movement re-education), and 4) to balance and "move" subtle energy (energy work). Each of these goals can be accomplished using a number of different styles of massage.

Principal goals of treatment

Intention

 

Example of modalities

Commonly used Techniques

Relaxation Massage

 

Relax muscles, move body fluids, promote wellness

Swedish massage,

Spa massage,
Sports massage

Gliding (effluerage)
Kneading (petrisage)
Friction
Holding
Percussion
Vibration

Clinical Massage

 

Accomplish specific goals such as releasing muscle spasms

Myofascial release

Trigger point therapy,

Neuromuscular Therapy,

Structural Integration,
Strain counterstrain,

Manual Lymphatic Drainage

Direct pressure
Skin rolling
Resistive stretching
Stretching – manual
Cross-fiber friction

 

Movement Re-education

Induce sense of freedom, ease and lightness in body

Proprioceptive Neuromuscular Facilitation,
Strain counterstrain

(Positional Release),
Trager

Contract-relax
Passive stretching
Resistive stretching
Rocking

 

Energy Work

 

 

Hypothesized to free energy blockages

 

Acupressure,

Shiatsu,
Reiki,
Polarity Therapy,
Therapeutic Touch
Tuina,

Direction of energy
Smoothing
Direct pressure
Holding
Rocking
Traction

 

Principal goals of treatment
Relaxation massage is massage that is specifically given to relax the body and promote wellness. Relaxation massage has the intention of moving body fluids (such as lymph and blood), nourishing cells, removing wastes from cells, relaxing muscles and diminishing any pain. Relaxation massage may include styles of massage that are more commonly used to address non-relaxation goals if such styles are applied with the intent to relax the body. For example, lymphatic drainage, commonly used as part of clinical massage (e.g., to reduce inflammation), is believed to be effective in stimulating 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. Its intent is to relieve pain and restricted movement. They differ from relaxation massage because they include focused therapeutic goals (e.g., releasing muscle spasms, strengthening or stretching specific muscles and remodeling 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 (movement re-education), can also be used as a clinical technique, for example, to reduce muscle spasms in a patient with whiplash.

Movement re-education emphasizes using movement to enhance posture, body awareness and movement. Movement re-education is generally intended to induce a sense of freedom, ease and lightness in the body. Some styles of movement re-education focus on active exercises to teach healthier ways of moving (e.g, 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 movement for a patient (e.g., Proprioceptive Neuromuscular Facilitation, Muscle Energy Technique, strain counterstrain).

Energy work are believed to "assist the flow of energy in the body" by employing very light touch or by holding the hands just above the skin. These include Reiki, Polarity as well as massage traditions deriving from Eastern cultures, such as acupressure, Shiatsu and Tuina. The intention of energy work is to move stagnant or blocked "energy" so it can circulate freely throughout the body.

 

Techniques

There are 36 massage techniques that can be identified (see Table below). Techniques are the "building blocks" of a massage treatment session. Techniques are listed in alphabetical order and include descriptions as well as examples of styles wherein these techniques have been commonly used. In some cases, techniques may be related, either because they are similar in how they are performed (e.g., rocking, jostling, shaking, vibration) or because they are components of a single style of massage (e.g., circular compression and rebound are techniques used in lymph drainage).

 

Technique

Mechanics of stroke

Application notes (e.g, anatomic locations, conditions, pressure)

Example styles where used

Application of cold

Local application of cold/ice (e.g. compress, ice pack) over protected body part, often for 15 minutes or less.  Includes ice massage.

Used over areas of acute inflammation, pain or stiffness. Generally not used over areas of chronic inflammation.

Spa Massage; Sports Massage

Application of heat

Local application of heat (e.g. compress, poultice) over protected body part, often for 5 minutes or less.

Used for chronic inflammation. Not used over areas of acute inflammation.

 

Spa Massage; Sports Massage

Application of cold and heat (Vascular flush)

Alternating application of cold (e.g., 3 minutes) with application of heat (e.g., 1 minute).

Used for subacute inflammation.

Neuromuscular Therapy; Sports Massage; Spa Massage

APR-ROM –Resistive stretching: lengthening, contracting the agonist (includes contract – relax and “Post Isometric Relaxation”**)

Lengthen muscle until the first resistance barrier, then coach patient to voluntarily resist AGAINST the lengthening for 5-15 seconds.  Allow the patient to relax for 5-15 seconds and then either repeat the resistance against the lengthening at the first barrier or lengthen the muscle until you reach the next resistance barrier  and repeat the process. This process can be repeated a total of 2-4 times. You want to end with a stretch at the end range of motion.

Recommended for subacute and chronic conditions. May be used for acute conditions with mild resistance.

Muscle Energy Technique (MET);

Proprioceptive Neuromuscular Facilitation (PNF) 

 

APR-ROM –Resistive stretching: lengthening the agonist, contracting the antagonist  (“Reciprocal Inhibition”**)

Lengthen muscle until the first resistance barrier, then coach patient to voluntarily lengthen the muscle against resistance for 5-15 seconds.  As patient relaxes, take the muscle into a greater lengthening and repeat the process 2-4 times. End with a stretch at the end range of motion.

Used in acute conditions.  If contracting the agonist is painful, use this technique because the antagonist is the one doing the contractions.

MET; PNF

 

APR-ROM -

Resistive stretching: lengthening the agonist, contracting agonist and antagonist (Contract Relax Antagonist Relax)

A third type of resistive stretching that alternates contracting the agonist and contracting the antagonist through a series of barriers. End with a stretch at the end range of motion.

Recommended for subacute and chronic conditions. May be used for acute conditions with mild resistance

MET; PNF

 

Compression - pumping

 

Usually pumping the muscle (and surrounding fascial layer) against the bone – rhythm and force vary with the resistance of the soft tissues. Can also use light pumping to contact and move fluid through the lymph vessels toward the heart.

Generally used over muscles and bone. Avoid the face and kidney. Can also be used for fluid movement with a light touch.

Joint Mobilization; Myofascial Release;

Tuina

Compression – Static (origin – insertion technique; sutural releases;

unwinding)

Mechanically shortening a muscle or fascia or joint by pressing on it (origin – insertion technique). Can involve following the body’s natural movement (e.g., unwinding, direction of ease)

Everywhere. In craniosacral therapy, involves very light traction or compression (approximately a dime’s worth or less of  pressure) applied in a specific direction determined by the suture between the relevant cranial bones.

Craniosacral;

Myofascial Release; Sports Massage

CS - Listening and following the craniosacral rhythm

Hands meld with the client's cranium (or sacrum) or other body area and massage therapist feels the movement of their hands.

Everywhere.

Craniosacral

CS - Still point

 

Monitor the craniosacral rhythm at the client’s cranium or sacrum or other body area and the movement of the craniosacral rhythm is resisted by compression or traction of the therapist’ hands (approximately a dime’s worth or less of pressure).

Everywhere.

Craniosacral

Directed breathing

Instructions on the length of inhalation and exhalation, often including instruction to relax while exhaling

Used in conjunction with manual or manipulative techniques.

Acupressure; MET; Shiatsu; Swedish

E - Direction of energy (e.g., holding with hands on or off the body; V-spread)

Send positive, healing, balancing intent to a targeted area. May either be focused on a specific physiological intent or on nondirected good will. Many massage therapists send positive intent whenever they perform a massage, even when using clinically oriented techniques.

Everywhere .

 

Craniosacral; Reiki; Polarity

E - Smoothing

Pass the hands over the patient's body (without physical contact)  moving toward their feet or towards their head.  Imagine the person with an "aura" and try to smoothe the energy of the aura so it is the same density and thickness throughout (can use a tool, e.g., a feather).

Everywhere.

Reiki; Polarity; Therapeutic Touch

F – Cross-fiber Friction (transverse friction)

A type of friction that involves moving the patient's skin over the underlying tissue perpendicular to the muscle fibers.

Used in localized areas only, most commonly musculotendinous junctions, tinoperiosteal junction, muscle belly and tendons. Not appropriate for face, use caution if over acute inflammation or tender areas.

Neuromuscular Therapy; Cyriax Friction

F - Direct pressure/

static friction

 

Presses or leans deeply into an area without moving the hands

 

 

Nearly everywhere, including trigger points, except the face and areas of acute inflammation. Use caution on tender areas.

Acupressure; Neuromuscular Therapy; Shiatsu;

Swedish

F - Friction

Pressing into the skin and moving it over the underlying tissues.  Fingers do not glide (as in effleurage) or grasp (as in petrissage). Motions can be circular (ellipsoidal) or in the same direction as the muscle fibers (longitudinal).

 

EverywhereUse caution on the face and tender areas.

Neuromuscular Therapy; Swedish; Tuina

F - Gliding – Deep (deep effleurage, longitudinal friction, stripping)

A type of friction that involves pressing into the skin and moving it over the underlying tissues. Motion follows the direction of the muscle fibers.

Everywhere. Use caution on the face.

Myofascial Release; Sports Massage;

F - Scraping

A type of friction that involves scraping bony or ligamentous areas with thumb, knuckles, fingers, or massage tool - smoothing the surface, as if shaving ice.

Joints, bony or ligamentous areas. Avoid the face. . Use caution in tender areas.

Neuromuscular Therapy; Structural Integration

F - J-stroke

A type of friction that involves pressing into the skin to underlying tissue and hook that tissue in a J motion.

Use in localized areas, but everywhere on the body, except the face. Use caution on tender areas.

Neuromuscular Therapy; Mysofascial Release;

Structural Integration

Gliding (effleurage)

Fr "to skim", to touch lightly on" - palm, knuckles, fingers, or backs of hands glide gradually over client's body. Can be used to move blood and lymph

Everywhere. If moving lymph, long light gliding strokes should be performed in the direction of the heart

Swedish; Lymphatic Drainage

Hand rolling

Rotating wrist on body with knuckles as contact point.

Everywhere, except the face.

Lomilomi; Sports Massage; Tuina

Holding

Static, broad contact (e.g., whole hand) to warm, relax or mobilize tissues.

 

Everywhere.

Myofascial Release; Polarity; Reiki; Swedish

Kneading (petrissage)

Fr "to knead" - rhythmic lifting , kneading and squeezing of the soft tissue.  Can also be used to “milk” lymph fluid and move it toward the heart.

Everywhere. When working on limbs begin proximally. When moving lymph fluid, apply kneading with a light touch.

Sports Massage; Swedish; Tuina

K - Skin rolling

A specific type of petrissage where the superficial fascia is grasped between thumb and forefingers (or between other parts of the therapist's body), continuously lifted and rolled over the underlying tissue in a wave-like motion.

Everywhere there are subcutaneous fascial adhesions.

Myofascial Release; Sports Massage

LD  -Compression  - circular

Light to deep circular movements over lymph nodes.

At watershed areas (e.g., axilla, inguinal).

Lymphatic Drainage

LD - Pumping

Contacting and moving fluid through the lymph vessels (back to the heart) using repetitions of a pumping or kneading movement.

Along lymph vessels.

Lymphatic Drainage

LD - Rebound

Patient inhales slowly and the therapist gradually increases pressure to target area (e.g. lymph nodes in viscera). During patient’s exhale, the pressure is rapidly released.

Abdomen, primarily.

Lymphatic Drainage; Visceral Massage

Percussion (Tapotement)

Series of brisk blows, rapidly following each other.

Everywhere, except the throat, breasts, abdomen, bony prominences, kidneys, back of knee, spine or any area of endangerment. Use caution on the face (e.g. light tapping only)

Sports Massage;

Swedish;

Percussion with stretch

A series of brisk blows, rapidly following each other applied while muscle is placed/held in the lengthened position.

Used on trigger points and muscle bellies. Use with caution on tender areas.

Sports Massage;

Neuromuscular Therapy

P-ROM -Passive stretching

Taking patient's muscle into a position of lengthening by moving a joint without any effort on their part.

Arms, legs, trunk and neck.

Sports Massage; Swedish gymnastics

P-ROM -Positional release

Passively placing the body in a position of maximal comfort. Can use point tenderness as a guide to positioning.

Everywhere.

Aston patterning; Craniosacral;Strain  counterstrain

Stretching –manual – direct 

 

 

Mechanically lengthening the muscle and/or fascia between your hands without moving a joint. Does not need to be applied parallel to fiber direction.

Everywhere, except not appropriate for face.

Sports Massage; Neuromuscular Therapy; Myofascial Release

Traction

Mechanically lengthening muscle and fascia by pulling on joints.

Everywhere.

Craniosacral; Sports Massage; Structural Integration

V- Flopping

Limb is lifted and bounced (with support for joints) on the table.

Arms and legs.

Sports Massage; Swedish; Trager

V - Rocking or jostling

Slower rhythmic type of vibration applied to the whole body in conjunction with the patient’s body rhythm.

Everywhere.

Swedish; Trager; Tuina; Shiatsu

V – Shaking

A type of vibration, using a lifting or pulling of the skin or a limb and then rhythmically shaking it.

Everywhere, except the face.

Swedish; Trager

V – Vibration

Continuous shaking or trembling movement made by hands, fingers or mechanical tool that is focused on a specific area of the body. Vibration can be applied to the entire back by moving the hands, fingers, or tool systematically across it.

Everywhere.

Swedish;

Tuina