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Maintaining Standards in Massage and Bodywork

by Mario-Paul Cassar(more info)

listed in bodywork, originally published in issue 88 - May 2003


Maintaining Standards in Massage and Bodywork Therapy

A 72-year-old woman phoned to ask if I did 'home visits' as she had severe lumbar pain brought on by lifting some boxes two weeks previously. She had been advised to keep moving her back rather than resting it. However, the pain was worsening and the prescribed pain-killers were having no effect. I did visit her and diagnosed a strained muscle. Having advised her to rest and having given her some treatments, she started to recover within a few days.

A middle-aged male runner received treatment from a manipulative therapist (in this context someone who manipulates the spines) for pain in the leg, which he (the runner) understood to be sciatica. After several visits the pain was still present and, if anything, getting worse, to the extent that he had to stop his sporting activity. Having decided to get a second opinion, he came to me for a consultation. I assessed muscle imbalances relating to contracted and fibrotic hamstrings, knee dysfunction as well as pes planus of the feet. After a few sessions of 'bodywork' treatment, advice on exercise and stretching and correction of the mechanical dysfunctions, he was able to resume his running activity.

These are examples of someone suffering unnecessary pain because they didn't know whom to approach to receive the appropriate treatment, particularly when it comes to musculo-skeletal problems.

Unfortunately this is a very common occurrence as the general public are still puzzled by the available treatments (including complementary therapies) and the conflicting advice they are often given.

The responsibility for this failing lies within conventional as well as alternative therapies. A patient suffering from musculoskeletal problems may receive the wrong advise from a general practitioner who is not conversant with mechanical dysfunctions and soft tissue injuries. They may receive an effective 'electrotherapy' treatment from a physiotherapist but may still need to have the spine adjusted by manipulation. A visit to a massage/bodywork therapist who is not sufficiently trained in soft tissue injuries may also prove to be a waste of time. And even treatment from a manipulative therapist, who will 'click' the spine several times but does not address the soft tissues, could be equally ineffective.

So can we change this to a more positive scenario? In the first place, the 'alternative' and 'complementary' therapies must provide the necessary information to the public. The associations representing the various therapies, in our case those representing massage and bodywork, can help a great deal, for instance, by allocating sufficient funding for advertising and for supplying the relevant information to the public.

Colleges and schools can help by undertaking to continue to raise the standard of tuition. The growing number of schools offering tuition in alternative therapies has also meant an increase in the commercial competition. Unfortunately, in some cases, this can lead to profits and cut backs taking precedence over the standard of tuition. We are still a long way off from some standards achieved long ago in other countries, particularly in the USA, but we can get there if there is the right collaboration between the associations, the therapy councils and the colleges and schools. The introduction of compulsory CPD training for members of some associations is helping to raise the standards and encourage the therapists to advance their knowledge in their subject, and indeed in other therapies.

Massage has almost become synonymous with bodywork, and under these headings there is a range of methods and approaches that the 'massage/bodywork' therapist should endeavour to be proficient in, if we are to achieve our goal of raising the standards and meet the public's expectation of our profession. Palpatory and assessment skills are at the forefront of this list. Massage/bodywork therapists often lack the ability to assess and treat, for instance, the minor muscle strains that are so commonly presented.

Hypersensitive zones, nodules and trigger points are also frequent indicators that need to be addressed. Fibromyalgia, myofascial pain syndrome, contractures and fibrotic tissue are similar examples of symptoms that necessitate the appropriate assessment and treatment. Equally important are gait analysis, joint mobility and muscle hypertonicity/flaccidity. Nutritional influences as well as psychosocial factors would also need to be considered in the case history analysis and treatment.

Familiarity with these common conditions and dysfunctions should go hand-in-hand with the awareness and utilization of the contemporary treatment modalities such as neuromuscular technique (NMT), muscle energy technique (MET), positional release technique (PRT), myofascial release technique (MRT), ischaemic compression and integrated neuromuscular inhibition technique (INIT). A 'good standard' treatment is not complete without the appropriate advice on exercise and self-improvement programmes.

The utilization of these 'bodywork' modalities does not mean that we must forget massage and its functions. 'Massage therapy' is one and the same as therapeutic and applied massage. The principal function and emphasis of the therapy is its specific application in a condition of disease. Such utilization goes beyond the `casual relaxation' effect usually associated with massage, albeit that this may take preference in some situations. When massage is used as a therapy it is important to differentiate between the use of massage for 'casual relaxation' and seeking to promote relaxation for therapeutic purposes i.e. with the aim of instigating a therapeutic response such as a lowering of stress hormones. Massage can therefore be very effectively used in conjunction with bodywork to treat not only musculo-skeletal problems, but dysfunctions of organs, glands and whole systems.

Maintaining and improving the standard of treatment necessitates the massage/bodywork therapist to attend postgraduate courses, learn about other complementary therapies, read the work of the advocates of bodywork such as Chaitow,[1],[2],[3] Field,[4],[5] Lewit,[6] Travell and Simons,[7] and study the vast amount of research that is available in journals and on the internet.

Associations, schools, colleges and therapists should all collaborate to achieve these goals so that a person seeking help, for example, for hamstring pain relating to a strain, contracture or fibrois, would be well informed of where to go and would receive the necessary assessment and treatment. This is even more important when they approach a massage/bodywork therapist.


1. Chaitow L. Muscle Energy Techniques. Churchill Livingstone. New York. 1996.
2. Chaitow L. Modern Neuromuscular Techniques. Churchill Livingstone. New York. 1996.
3. Chaitow L.and Walker DeLaney J. Clinical Application of Neuromuscular Techniques - Volumes 1 & 2. Churchill Livingstone. 2002.
4. Field T. Massage therapy effects. American Psychologist. 53: 1270-1281. 1998.
5. Field TM. Touch Therapy. Churchill Livingstone. Edinburgh. 2000.
6. Lewit K. Manipulative Therapy in Rehabilitation of the Locomotor System. Butterworth-Heinemann. Oxford. 1991.
7. Travell JG and Simons DG. Myofascial Pain and Dysfunction - Vol. I. Williams and Wilkins. Baltimore. 1983.


Cassar M-P. Handbook of Massage Therapy. Butterworth-Heinemann. Oxford. 1999.
Ebner M. Connective tissue massage. Physiotherapy. 64: 209-10. 1978.
Janda V. Muscle Function Testing. Butterworth. London. 1983.
Rich JG ed. Massage Therapy: The Evidence For Practice. Mosby. Edinburgh. 2002.
Russell IJ et al. Cerebrospinal fluid Substance P is elevated in fibromyalgia syndrome. Arthritis and Rheumatism. 36: 223. 1993.


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About Mario-Paul Cassar

Mario-Paul Cassar DO ND is well established as a practitioner and teacher in osteopathy, bodywork, clinical massage and sports therapy. He has also written several article and books including the Handbook of Clinical Massage published by Churchill Livingstone available from Elsevier or direct from the author who may be contacted via

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