What Do Doulas Do?

doulaGenerally speaking, a doula assists the mother and her family both physically and emotionally during the childbirth process. An informed doula will give the mother all the options available and supports the mother in those choices.  Many times, a doula will be able to give the family information that is not found in many birthing books.  I have asked women who have had a doula during their childbirth if they thought it was a wise decision to spend the money for that service. Their answers were all the same: they couldn’t have done it without them!

There are 3 different types of doulas, for the different phases of child birth: prenatal, childbirth and postnatal doulas. Many times the doula will be with the family in their home taking care of chores and helping the mother have valuable bonding time with her child. The postpartum doula will also help the mom with breastfeeding advice.  Doulas teach how to employ healing modalities that facilitate self-direction in mothers and families. The extra help will take the pressure off of the support people so they can be there for the mom emotionally, without the fear of making wrong decisions based on lack of knowledge.

Doulas look out for the needs of the mother-to-be and their families in both hospital and home births. They are trained in controversial topics and procedures and help provide a nurturing environment in which the mother is comfortable. Many times doctors will want to “facilitate” the process though at times it is not the best option for the mom to be. Doulas can provide a collaborative solution between doctors, midwives and the family when things don’t go as planned. They are there to keep everyone’s nerves calm and to help the mother navigate a smooth birth.

Having a background in massage therapy will be extremely beneficial to those moms who choose The Muscle Relaxers for their doula. Guided meditation and qigong techniques will help the mother focus healing energy inwards and provide strength when needed. When the time is right, pressing on reflexology points on the feet are known to provide a safe induction for the uterus to begin contracting. The knowledge of relaxation and breathing techniques will undoubtedly be invaluable for a smooth transition to motherhood.

The Importance of Regular Massage Therapy

Once upon a time there was a human with a high stress job, a hectic family life and just barely enough  time to exercise their buns off in their spare time. The person created a body of high blood pressure, tight muscles, high shoulders, and inflammation. Regrettably, this person died early. We can all learn a lesson from this fictitious yet very realistic person by simply listening to our bodies and attending to their needs. In this article, I will explain some important reasons why regular massage therapy is an important process to whole body well-being. Relaxation is a process, not just a once-in-a-while activity. It is something we must practice on a regular ongoing basis- some of us more so than others.

How often should you get massage therapy? Well, your ability to relax and let go of unwanted stress and tension might determine the frequency of bodywork you should receive (given there are no chronic physical imbalances.) Generally, the “type A personalities are the hardest type of client to switch over into a relaxed state. These are the people that have a hard time letting go of the muscles that the therapist is working on. For these people, I recommend multiple activities throughout the day for relaxation including deep breathing and meditation. I like to use this very simple site for a quick guided (or not guided) meditation: www.Calm.com . I like to use this site for a more community-oriented meditation (join groups, see who is meditating over the world, has a social aspect if you wish) www.InsightTimer.com. For people with high stress and pain, or physiological imbalances in their bodies, I suggest several massages per month.

So many people are stressed or tense and just don’t know it! Clients come in to get work done on something that is painful (I call these areas “screamers.”) However, when they get on the table they say “oh, I had no idea my shoulders were so tense.” As a therapist who listens to her clients, I like to work on what is their number one concern. Unfortunately, many times there is not enough time to treat everything that is needed. I urge the client to follow up with their other imbalances (the “talking” or ” whispering” areas of the body.) If left untreated, it might be even more difficult to unwind the muscles and connective tissues in these areas. For such cases, a massage every 3-4 weeks should be ideal, given they are stretching and practice other relaxation methods on their own. Click here and here for a plethora of good stretches to try at home.

As you know, the body works in unison and is most happy and efficient in the state of homeostasis (perfect balance.) The musculoskeletal system talks to the nervous system which communicates with the endocrine (hormone) system which speaks to the brain and all feed back to one another to make us who we are. The chemistry and physiology of these interactions are intricate, long to explain and sometimes even mysterious. What I have observed in my 10 years of practice is that the person who receives therapy on a weekly basis tends to have higher immunity, increased vitality, and are the least depressed (click here for the study.)

Don’t feel guilty about getting massage! Massage is one of the oldest forms of healing and our bodies just unravel naturally when touched correctly. The benefits of bodywork are compounded when utilized as a frequent therapy. The more you get, the more you benefit. If you have had a massage from me, you know that it is something naturally healthful to all aspects of living. Talk to me about setting up a schedule this year and invest in yourself the time and budget to keep wellness in your life!

Massage Therapy: An Introduction

On this page:

Massage therapy has a long history in cultures around the world. Today, people use many different types of massage therapy for a variety of health-related purposes. In the United States, massage therapy is often considered part of complementary and alternative medicine (CAM), although it does have some conventional uses. This fact sheet provides a general overview of massage therapy and suggests sources for additional information.

Key Points

  • Scientific evidence on massage therapy is limited. Scientists are not yet certain what changes occur in the body during massage, whether they influence health, and, if so, how. The National Center for Complementary and Alternative Medicine (NCCAM) is sponsoring studies to answer these questions and identify the purposes for which massage may be most helpful.
  • Massage therapy appears to have few serious risks if it is used appropriately and provided by a trained massage professional.
  • Tell your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

History of Massage

Massage therapy dates back thousands of years. References to massage appear in writings from ancient China, Japan, India, Arabic nations, Egypt, Greece (Hippocrates defined medicine as “the art of rubbing”), and Rome.

Massage became widely used in Europe during the Renaissance. In the 1850s, two American physicians who had studied in Sweden introduced massage therapy in the United States, where it became popular and was promoted for a variety of health purposes. With scientific and technological advances in medical treatment during the 1930s and 1940s, massage fell out of favor in the United States. Interest in massage revived in the 1970s, especially among athletes.

Use of Massage Therapy in the United States

According to the 2007 National Health Interview Survey, which included a comprehensive survey of CAM use by Americans, an estimated 18 million U.S. adults and 700,000 children had received massage therapy in the previous year.

People use massage for a variety of health-related purposes, including to relieve pain, rehabilitate sports injuries, reduce stress, increase relaxation, address anxiety and depression, and aid general wellness.

Defining Massage Therapy

The term “massage therapy” encompasses many different techniques (see box for examples). In general, therapists press, rub, and otherwise manipulate the muscles and other soft tissues of the body. They most often use their hands and fingers, but may use their forearms, elbows, or feet.

Types of Massage Therapy: A Few Examples

In Swedish massage, the therapist uses long strokes, kneading, deep circular movements, vibration, and tapping. Sports massage is similar to Swedish massage, adapted specifically to the needs of athletes. Among the many other examples are deep tissue massage and trigger point massage, which focuses on myofascial trigger points—muscle “knots” that are painful when pressed and can cause symptoms elsewhere in the body.

The Practice of Massage Therapy

Massage therapists work in a variety of settings, including private offices, hospitals, nursing homes, studios, and sport and fitness facilities. Some also travel to patients’ homes or workplaces. They usually try to provide a calm, soothing environment.

Therapists usually ask new patients about symptoms, medical history, and desired results. They may also perform an evaluation through touch, to locate painful or tense areas and determine how much pressure to apply.

Typically, the patient lies on a table, either in loose-fitting clothing or undressed (covered with a sheet, except for the area being massaged). The therapist may use oil or lotion to reduce friction on the skin. Sometimes, people receive massage therapy while sitting in a chair. A massage session may be fairly brief, but may also last an hour or even longer.

Research Status

Although scientific research on massage therapy—whether it works and, if so, how—is limited, there is evidence that massage may benefit some patients. Conclusions generally cannot yet be drawn about its effectiveness for specific health conditions.

According to one analysis, however, research supports the general conclusion that massage therapy is effective. The studies included in the analysis suggest that a single session of massage therapy can reduce “state anxiety” (a reaction to a particular situation), blood pressure, and heart rate, and multiple sessions can reduce “trait anxiety” (general anxiety-proneness), depression, and pain. In addition, recent studies suggest that massage may benefit certain conditions, for example:

  • A 2008 review of 13 clinical trials found evidence that massage might be useful for chronic low-back pain. Clinical practice guidelines issued in 2007 by the American Pain Society and the American College of Physicians recommend that physicians consider using certain CAM therapies, including massage (as well as acupuncture, chiropractic, progressive relaxation, and yoga), when patients with chronic low-back pain do not respond to conventional treatment.
  • A multisite study of more than 300 hospice patients with advanced cancer concluded that massage may help to relieve pain and improve mood for these patients.
  • A study of 64 patients with chronic neck pain found that therapeutic massage was more beneficial than a self-care book, in terms of improving function and relieving symptoms.

There are numerous theories about how massage therapy may affect the body. For example, the “gate control theory” suggests that massage may provide stimulation that helps to block pain signals sent to the brain. Other theories suggest that massage might stimulate the release of certain chemicals in the body, such as serotonin or endorphins, or cause beneficial mechanical changes in the body. However, additional studies are needed to test the various theories.

seated massage
© Bob Stockfield

Safety

Massage therapy appears to have few serious risks—if it is performed by a properly trained therapist and if appropriate cautions are followed. The number of serious injuries reported is very small. Side effects of massage therapy may include temporary pain or discomfort, bruising, swelling, and a sensitivity or allergy to massage oils.

Cautions about massage therapy include the following:

  • Vigorous massage should be avoided by people with bleeding disorders or low blood platelet counts, and by people taking blood-thinning medications such as warfarin.
  • Massage should not be done in any area of the body with blood clots, fractures, open or healing wounds, skin infections, or weakened bones (such as from osteoporosis or cancer), or where there has been a recent surgery.
  • Although massage therapy appears to be generally safe for cancer patients, they should consult their oncologist before having a massage that involves deep or intense pressure. Any direct pressure over a tumor usually is discouraged. Cancer patients should discuss any concerns about massage therapy with their oncologist.
  • Pregnant women should consult their health care provider before using massage therapy.

Training, Licensing, and Certification

There are approximately 1,500 massage therapy schools and training programs in the United States. In addition to hands-on practice of massage techniques, students generally learn about the body and how it works, business practices, and ethics. Massage training programs generally are approved by a state board. Some may also be accredited by an independent agency, such as the Commission on Massage Therapy Accreditation (COMTA).

As of 2010, 43 states and the District of Columbia had laws regulating massage therapy. In some states, regulation is by town ordinance.

The National Certification Board for Therapeutic Massage and Bodywork certifies practitioners who pass a national examination. Increasingly, states that license massage therapists require them to have a minimum of 500 hours of training at an accredited institution, pass a national exam, meet specific continuing education requirements, and carry malpractice insurance.

In addition to massage therapists, health care providers such as chiropractors and physical therapists may have training in massage.

Licenses and Certifications

Some common licenses or certifications for massage therapists include:

LMT
Licensed Massage Therapist
LMP
Licensed Massage Practitioner
CMT
Certified Massage Therapist
NCTMB
Has met the credentialing requirements (including passing an exam) of the National Certification Board for Therapeutic Massage and Bodywork, for practicing therapeutic massage and bodywork
NCTM
Has met the credentialing requirements (including passing an exam) of the National Certification Board for Therapeutic Massage and Bodywork, for practicing therapeutic massage

If You Are Thinking About Using Massage Therapy

  • Do not use massage therapy to replace your regular medical care or as a reason to postpone seeing a health care provider about a medical problem.
  • If you have a medical condition and are unsure whether massage therapy would be appropriate for you, discuss your concerns with your health care provider. Your health care provider may also be able to help you select a massage therapist. You might also look for published research articles on massage therapy for your condition.
  • Before deciding to begin massage therapy, ask about the therapist’s training, experience, and credentials. Also ask about the number of treatments that might be needed, the cost, and insurance coverage.
  • If a massage therapist suggests using other CAM practices (for example, herbs or other supplements, or a special diet), discuss it first with your regular health care provider.
  • Tell all your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will ensure coordinated and safe care. For tips about talking with your health care providers about CAM, see NCCAM’s Time to Talk campaign.

NCCAM-Funded Research on Massage Therapy

Recent NCCAM-sponsored studies have been investigating:

  • The effects of massage on chronic neck pain and low-back pain
  • Massage to treat anxiety disorder, alleviate depression in patients with advanced AIDS, and promote recovery in women who were victims of sexual abuse as children
  • Massage to relieve fatigue in cancer patients undergoing chemotherapy, reduce treatment-related swelling of the arms in breast cancer patients, and alleviate pain and distress in cancer patients at the end of life
  • Whether massage improves weight gain and immune system function in preterm infants
  • Whether massage given at home by a trained family member helps reduce pain from sickle cell anemia.

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References

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For More Information

NCCAM Clearinghouse

The NCCAM Clearinghouse provides information on NCCAM and complementary health approaches, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.

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A service of the National Library of Medicine (NLM), PubMed® contains publication information and (in most cases) brief summaries of articles from scientific and medical journals.

Acknowledgments

NCCAM thanks the following people for their technical expertise and review of the content update of this publication: Karen Sherman, Ph.D., M.P.H., Center for Health Studies, Group Health Cooperative; Jeanette Ezzo, Ms.T., M.P.H., Ph.D., JPS Enterprises; and Partap Khalsa, D.C., Ph.D., NCCAM.

Information About Massage Therapy

Massage Therapy as Complementary Health Care

* Introduction
* Massage Therapy – Definition
* Who Provides Massage Therapy
* What Massage Therapists Do in Treating Patients
* Side Effects and Risks
* Some Other Points To Consider About Massage Therapy as CAM
* How Massage Therapy Might Work
* NCCAM-Sponsored Research on Massage
* References

Introduction

Massage therapy is a practice that dates back thousands of years. There are many types of massage: Pressing, rubbing, and moving muscles and other soft tissues of the body, primarily by using the hands and fingers. The aim is to increase the flow of blood and oxygen to the massaged area. therapy; all involve manipulating the muscles and other soft tissues of the body. In the United States, massage therapy is sometimes part of conventional medicine (medicine as practiced by an M.D. (medical doctor) or D.O. (doctor of osteopathy)) and by their allied health professionals such as physical therapists, psychologists, and registered nurses.

In other instances, it is part of complementary and alternative medicine (CAM): A group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. Complementary medicine is used together with conventional medicine, and alternative medicine is used in place of conventional medicine.

CAM is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. While some scientific evidence exists regarding some CAM therapies, for most there are key questions that are yet to be answered through well-designed scientific studies. An example of massage therapy as CAM is using it with the intent to enhance immune system functioning.

* People use massage therapy as CAM for a variety of health-related purposes, from treating specific diseases and conditions to general wellness.
* Scientists do not fully know what changes occur in the body during massage, whether they influence health, and, if so, how. The National Center for Complementary and Alternative Medicine (NCCAM) is sponsoring studies to answer these questions and identify the purposes for which massage may be most helpful.
* There appear to be few risks to massage therapy if it is used appropriately and provided by a trained massage professional.
* Tell your health care providers about any CAM therapy you are considering or using, including massage therapy. This helps to ensure safe and coordinated care.

Massage Therapy- Definitions

The term massage therapy (also called massage, for short; massage also refers to an individual treatment session) covers a group of practices and techniques. There are over 80 types of massage therapy. In all of them, therapists press, rub, and otherwise manipulate the muscles and other soft tissues of the body, often varying pressure and movement. They most often use their hands and fingers, but may use their forearms, elbows, or feet. Typically, the intent is to relax the soft tissues, increase delivery of blood and oxygen to the massaged areas, warm them, and decrease pain.

A few popular examples of this therapy are as follows:

* In Swedish massage, the therapist uses long strokes, kneading, and friction on the muscles and moves the joints to aid flexibility.
* A therapist giving a deep tissue massage uses patterns of strokes and deep finger pressure on parts of the body where muscles are tight or knotted, focusing on layers of muscle deep under the skin.
* In trigger point massage (also called pressure point massage), the therapist uses a variety of strokes but applies deeper, more focused pressure on myofascial trigger points–“knots” that can form in the muscles, are painful when pressed, and cause symptoms elsewhere in the body as well.
* In shiatsu massage, the therapist applies varying, rhythmic pressure from the fingers on parts of the body that are believed to be important for the flow of a vital energy called qiIn traditional Chinese medicine, the vital energy or life force proposed to regulate a person’s spiritual, emotional, mental, and physical health and to be influenced by the opposing forces of yin and yang..

Massage therapy (and, in general, the laying on of hands for health purposes) dates back thousands of years. References to massage have been found in ancient writings from many cultures, including those of Ancient Greece, Ancient Rome, Japan, China, Egypt, and the Indian subcontinent.

In the United States, massage therapy first became popular and was promoted for a variety of health purposes starting in the mid-1800s. In the 1930s and 1940s, however, massage fell out of favor, mostly because of scientific and technological advances in medical treatments. Interest in massage revived in the 1970s, especially among athletes.

More recently, a 2002 national survey on Americans’ use of CAM (published in 2004) found that 5 percent of the 31,000 participants had used massage therapy in the preceding 12 months, and 9.3 percent had ever used it. According to recent reviews, people use massage for a wide variety of health-related intents: for example, to relieve pain (often from musculoskeletal conditions, but from other conditions as well); rehabilitate sports injuries; reduce stress; increase relaxation; address feelings of anxiety and depression; and aid general wellness.

Providers of Massage Therapy

A person who professionally provides massage therapy is most often called a massage therapist, although there are some other health care providers (such as chiropractors) who also have massage training. This Backgrounder mainly uses the term massage therapist. Most massage therapists learn and practice more than one type of massage.

To learn massage, most therapists attend a school or training program, with a much smaller number training instead with an experienced practitioner. Many students are already licensed as another type of health care provider, such as a nurse.

There are about 1,300 massage therapy schools, college programs, and training programs in the United States. The course of study typically covers subjects such as anatomy and physiology (structure and function of the body); kinesiology (motion and body mechanics); therapeutic evaluation; massage techniques; first aid; business, ethical, and legal issues; and hands-on practice of techniques. These educational programs vary in many respects, such as length, quality, and whether they are accredited. Many require 500 hours of training, which is the same number of hours that many states require for certification. Some therapists also pursue specialty or advanced training.

At the end of 2004, 33 states and the District of Columbia had passed laws regulating massage therapy—for example, requiring that massage therapists graduate from an approved school or training program and pass the national certification exam in their field in order to practice. Cities and counties may have laws that apply as well. Professional organizations of massage therapists have not agreed upon the standards for recognizing that a massage therapist is properly and adequately trained.
Licenses and Certifications

Licenses or certifications for massage therapists include:

* LMT Licensed Massage Therapist
* LMP Licensed Massage Practitioner
* CMT Certified Massage Therapist
* NCTMB Has met the credentialing requirements (including passing an exam) of the National Certification Board for Therapeutic Massage and Bodywork, for practicing therapeutic massage and bodywork
* NCTM Has met the credentialing requirements (including passing an exam) of the National Certification Board for Therapeutic Massage and Bodywork, for practicing therapeutic massage

Massage Settings and Typical Sessions

Massage therapists work in a variety of settings, including private offices, hospitals, other clinical settings, nursing homes, studios, and sport and fitness facilities. Some also travel to patients’ homes or workplaces to provide a massage.

Massage therapy treatments usually last for 30 to 60 minutes; less often, they are as short as 15 minutes or as long as 1.5 to 2 hours. For some conditions (especially chronic ones), therapists often advise a series of appointments. Therapists usually try to provide an environment that is as calm and soothing as possible (for example, by using dim lighting, soft music, and fragrances).

At the first appointment, a massage therapist will discuss your symptoms, medical history, the results you desire, and possibly other factors such as your work and levels of stress. She will likely perform some evaluations through touch. If she finds nothing that would make a massage inadvisable, she will proceed with the massage. At any time, you can bring up questions or concerns.

During treatment, you will lie on a special padded table or sit on a stool or chair. You might be fully clothed (for example, for shiatsu or a “chair massage”) or partially or fully undressed (in which case you will be covered by a sheet or towel; only the parts of your body that the therapist is currently massaging are exposed). Oil or powder helps reduce friction on the skin. The therapist may use other aids, such as ice, heat, or therapeutic aromatherapy. He may also provide recommendations for self-care, such as drinking fluids, learning better movement, and developing an awareness of your body.

Why People Use Massage Therapy

In the 2002 national survey on Americans’ use of CAM, respondents who used a CAM therapy could choose from five reasons for using the therapy. The results for massage were as follows:

* They believed that massage combined with conventional medicine would help: 60 percent
* They thought massage would be interesting to try: 44 percent
* They believed that conventional medical treatments would not help: 34 percent
* Massage was suggested by a conventional medical professional: 33 percent
* They thought that conventional medicine was too expensive: 13 percent

Side Effects and Risks

Massage therapy appears to have few serious risks if appropriate cautions are followed. A very small number of serious injuries have been reported, and they appear to have occurred mostly because cautions were not followed or a massage was given by a person who was not properly trained.

Health care providers recommend that patients not have massage therapy if they have one or more of the following conditions:

* Deep vein thrombosis (a blood clot in a deep vein, usually in the legs)
* A bleeding disorder or taking blood-thinning drugs such as warfarin
* Damaged blood vessels
* Weakened bones from osteoporosis, a recent fracture, or cancer
* A fever
* Any of the following in an area that would be massaged:
o An open or healing wound
o A tumor
o Damaged nerves
o An infection or acute inflammation
o Inflammation from radiation treatment

If you have one or more of the following conditions, be sure to consult your health care provider before having massage:

* Pregnancy
* Cancer
* Fragile skin, as from diabetes or a healing scar
* Heart problems
* Dermatomyositis, a disease of the connective tissue
* A history of physical abuse

Side effects of massage therapy may include:

* Temporary pain or discomfort (similar to work-out soreness)
* Bruising
* Swelling
* A sensitivity or allergy to massage oils

Some Other Points To Consider About Massage Therapy as CAM

* Massage therapy should not be used to replace your regular medical care or to delay seeing a doctor about a medical problem.
* Before you decide about having massage therapy, ask the therapist about:
o Her training, experience, and any licenses or credentials
o Any medical conditions you have and whether she has had any specialized training or experience with them
o The number of treatments that might be needed
o Cost
o Insurance coverage, if any
* If a massage therapist suggests using other CAM practices (herbs or other supplements, a special diet, etc.), discuss it first with your regular health care provider.
* For findings from research studies on massage therapy for various health conditions, see “For More Information.” However, the available literature is limited, and more research is needed to make firm conclusions.

How Massage Therapy Might Work

Scientists are studying massage to understand what effects massage therapy has on patients, how it has those effects, and why. Some aspects of this are better understood than others. For example, it is known that:

* When certain forces are applied to the muscles, changes occur in the muscles (although those changes are not clearly understood or agreed upon).
* Massage therapy typically enhances relaxation and reduces stress. Stress makes some diseases and conditions worse.

There are many more aspects that are not yet known or well understood scientifically, however. Some of the proposed theories 3 are that massage:

* Might provide stimulation that may help block pain signals sent to the brain (the “gate control theory” of pain reduction).
* Might shift the patient’s nervous system away from the sympathetic and toward the parasympathetic. The sympathetic nervous system helps mobilize the body for action. When a person is under stress, it produces the fight-or-flight response (the heart rate and breathing rate go up, for example; the blood vessels narrow; and muscles tighten). The parasympatheticnervous system creates what some call the “rest and digest” response (the heart rate and breathing rate slow down, for example; the blood vessels dilate; and activity increases in many parts of the digestive tract).
* Might stimulate the release of certain chemicals in the body, such as serotonin or endorphins.
* Might cause beneficial mechanical changes in the body—for example, by preventing fibrosis (the formation of scar-like tissue) or increasing the flow of lymph (a fluid that travels through the body’s lymphatic system and carries cells that help fight disease).
* Might improve sleep, which has a role in pain and healing.
* Might provide some health benefit from the interaction between therapist and patient.

More well-designed studies are needed to understand and confirm these theories and other scientific aspects of massage.

References

Sources are primarily recent reviews on the general topic of massage therapy in the peer-reviewed medical and scientific literature in English in the PubMed database, selected evidence-based databases, and Federal Government sources.

Alvarez DJ, Rockwell PG. Trigger points: diagnosis and management*. American Family Physician. 2002;65(4):653-660.

Barnes PM, Powell-Griner E, McFann K, Nahin RL. Complementary and alternative medicine use among adults: United States, 2002.* CDC Advance Report #343. 2004.

Cherkin DC, Sherman KJ, Deyo RA, et al. A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal manipulation for back pain*. Annals of Internal Medicine. 2003;138(11):898-907.

Corbin L. Safety and efficacy of massage therapy for patients with cancer.* Cancer Control:Journal of the Moffitt Cancer Center. 2005;12(3):158-164.

Dillard MH, Knapp S. Complementary and alternative pain therapy in the emergency department*. Emergency Medicine Clinics of North America. 2005;23(2):529-549.

Eisenberg DM, Cohen MH, Hrbek A, et al. Credentialing complementary and alternative medical providers*. Annals of Internal Medicine. 2002;137(12):965-973.

Ernst E. The safety of massage therapy*. Rheumatology. 2003;42(9):1101-1106.

Field T. Massage therapy effects*. American Psychologist. 1998;53(12):1270-1281.

Goldstone LA. Massage as an orthodox medical treatment past and future*. Complementary Therapies in Nursing and Midwifery. 2000;6(4):169-175.

Massage: Bottom Line Monograph. Natural Standard Web site. Accessed on August 22, 2006.

Massage Therapists: Occupational Outlook Handbook, 2006-2007 Edition. U.S. Bureau of Labor Statistics Web site. Accessed at http://www.bls.gov/oco/ocos295.htm on August 22, 2006.

Moyer CA, Rounds J, Hannum JW. A meta-analysis of massage therapy research*. Psychological Bulletin. 2004;130(1):3-18.

National Center for Complementary and Alternative Medicine. Manipulative and Body-Based Practices: An Overview. Bethesda, MD: National Center for Complementary and Alternative Medicine; 2004. NCCAM publication no. D238.

National Institute of Arthritis and Musculoskeletal and Skin Diseases. Osteoarthritis. Bethesda, MD: National Institute of Arthritis and Musculoskeletal and Skin Diseases; 2006. NIH publication no. 06-4617.

National Institute of Arthritis and Musculoskeletal and Skin Diseases. Osteoporosis: Coping With Chronic Pain. National Institute of Arthritis and Musculoskeletal and Skin Diseases Web site. Accessed at http://www.niams.nih.gov/bone/hi/osteoporosis_pain.htm on August 31, 2006.

Sherman KJ, Cherkin DC, Kahn J, et al. A survey of training and practice patterns of massage therapists in two U.S. states*. BioMed Central Complementary and Alternative Medicine. 2005;5:13.

Weerapong P, Hume PA, Kolt GS. The mechanisms of massage and effects on performance, muscle recovery and injury prevention*. Sports Medicine. 2005;35(3):235-256.

This article is reproduced from the NCCAM web site and is in the public domain.