Spa: A Comprehensive Introduction | Chapter 6.3 | Types of Massage Therapists

There are scores of massage therapies, based on different needs, techniques, and materials used. Some of the better-known massage therapies are explained here.


a.  Western Based Massage Therapies

The following massage techniques are rooted in Western medical thought about the body, its systems, and how they work and interact. These techniques work with muscles, joints, tendons, fascia, and lymph systems to maintain or restore health.

Swedish. This style of massage is what most people think of when they hear the word “massage.” This traditional massage technique was developed in the 1800s by Per Henrik Ling, a professor and physiologist at the University of Stockholm. Using information contained in letters written from China by Jesuit missionaries describing massage techniques they witnessed in Asia, Ling created and practiced a system of massage movements. Swedish massage uses five movements or strokes—effleurage, petrissage, friction, vibration, and tapotement. The therapist delivers the strokes in a firm, but gentle manner with the grain of the muscle tissue. This kind of massage is ideal for first-time spa-goers and for people seeking relaxation.

Deep Tissue. While Swedish massage is used for relaxation, deep tissue massage is used for conditions that include chronic pain, limited mobility, recovery from injury, repetitive strain, postural problems, muscle tension or spasms, and fibromyalgia.

Deep tissue massage works to realign deeper layers of muscle tissue. It uses slower massage strokes and deep pressure on affected areas, working across the grain of the muscle tissue. The therapist applies deep pressure with the thumb or fingers, although he or she may also use the palm of the hand and knuckle or elbow. Deep tissue massage is helpful for tense areas such as stiff necks, shoulders, and the lower back. Because it focuses on specific areas, clients experience some discomfort and pain as the therapist works to release tension and toxins from the muscles. The goal of the deep tissue massage is to loosen muscle tissues, release toxins that have built up, and increase blood and oxygen flow through the muscle tissues. Clients usually experience some muscle stiffness or pain after a deep tissue massage, which subsides in a day or two.

Sports Massage. Sports massage has been popular in the United States only since the early 1980s, but it has been practiced in Europe for more than a century. The techniques were developed in Finland around 1900 as an adaptation of Swedish massage. Finnish sports massage received attention in 1924, when Finnish runner Paavo Nurmi won five gold medals at the Olympic games in Paris, including two in one day in events held only 30 minutes apart. Nurmi gave credit to sports massage as one of the key components of his training program.

Also in the 1920s, Dr. I.M. Sarkisov-Sirasini developed the concept for Russian Sports Massage, which he taught at the Central Institute of Physical Therapy in Moscow. In the United States, interest in sports massage was popularized with the 1980 publication of Jack Meagher’s book, Sportsmassage: A Complete Program for Increasing Performance and Endurance in Fifteen Popular Sports.

The goal of sports massage is to keep athletes injury-free during training. It is typically performed following a workout or athletic event, treating the areas that received the greatest stress during that workout. It may also be performed before a workout or athletic performance to prepare the muscles for the work they are about to do. Sports massage can release built-up lactic acid and waste products in muscles and increase the flow of blood and oxygen to the muscles, helping to repair them.


The benefits of sports massage may include: 

  •  Faster recovery from damage and trauma to muscles from workouts
  • Increase in flexibility and range of motion
  • Relief from fatigue
  • Reduction of repetitive motion strain
  • Reduction in healing time from injuries

Myofascial Massage. Fascia is the name for loose connective tissue that surrounds every muscle, nerve, blood vessel, and organ. It holds the body together and gives it shape. Myofascial massage releases tension in the fascia to help properly align the body. The massage strokes stretch fascial sheets, break fascial adhesions, and release tensions that are causing the client pain, poor posture, and limited mobility. Developers of various myofascial massage techniques include Elizabeth Dicke, a German whose system of Connective Tissue Massage (CTM) was developed in the 1920s and 1930s, and John Barnes, an American physical therapist who developed myofascial release in the 1980s.

Craniosacral. This therapy was originally part of the body of osteopathic medicine, and is based on work done by William Sutherland, D.O., in the 1940s. Since 1983, Dr. John Upledger has been the chief advocate of this therapy, which requires specialized training to perform correctly. In craniosacral therapy, the therapist assesses the client and performs therapeutic moves by holding the skull and “listening” to the rhythms as the body moves. It is a restful technique for both the client and the therapist, and is noninvasive. The theory behind craniosacral therapy is that restrictions in the craniosacral hydraulic system of the body produce dysfunction in the central nervous system. Practitioners of craniosacral therapy claim that this therapy balances the cranium, spine, and sacrum so that cerebral-spinal fluid flows more freely and improves nervous system function. Some people with autism spectrum disorders have benefited from craniosacral massage.

Manual Lymphatic Drainage. This technique is also called Vodder Lymph Drainage, after Dr. Emil Vodder, the German doctor who developed the practice in Denmark during the 1930s. This gentle massage technique focuses on the body’s lymph system, a network of one-way capillaries that collect fluids from tissue spaces and move them into one of two main lymph ducts and ultimately back into the blood. The fluids pass through nodes that are lined with cells that devour bacteria and filter waste products and other foreign substances.

Manual lymphatic drainage encourages the lymphatic system’s ability to clear away debris, fat, and unwanted substances and to reduce edema (swelling) resulting from trauma or connective tissue restrictions such as post-surgical scarring. This procedure is particularly useful for cancer patients and cancer survivors who often experience lymphedema, a swelling or increase of lymph fluids.

In this type of massage, the therapist applies gentle massage strokes in the direction of lymph flow to unblock lymph vessels and encourage lymph flow to move more freely to rid the body of wastes. Strokes used include fingertip stationary circles or spirals along the neck and face; a pumping technique in which the therapist makes oval strokes with fingers and thumb; a rotary motion performed with the palms down; and scoop stroke performed with the palms up and fingers outstretched.

Neuro-Muscular Therapy (NMT). Neuro-Muscular Therapy (NMT), also known as trigger point therapy, was developed in the 1920s by Stanley Lief, who operated a natural healing resort in Hertfordshire, England. His soft tissue manipulation techniques focus on targeting specific spots, or trigger points, where taut bands of tissue around muscles and tendons cause direct and/or referred pain.

In the United States, trigger point therapy received attention in the 1950s, when it was used by Janet Travell, M.D., to help ease the pain of then-Senator John F. Kennedy, who was injured in World War II. Travell later served as White House physician for both Kennedy and Lyndon Johnson. She used a form of trigger point therapy in which she injected a saline solution into the trigger points.


In the late 1970s, American physical fitness educator Bonnie Prudden developed a systematic approach to trigger point therapy called Myotherapy.10 The techniques of compressing and stretching muscles at the trigger points of pain are thought to benefit people who experience repetitive stress injuries, such as athletes, musicians, artists, and physical laborers, as well as for those who work at a computer or drive long distances. In addition to their hands, therapists may use elbows, feet, or tools to apply direct pressure to the trigger points. 

There are several forms of NMT or trigger point therapy used currently. They include:

  • Myofascial trigger point therapy (manual)
  • Myotherapy (deep pressure or massage)
  • Mechanical vibration
  • Pulsed ultrasound
  • Electrostimulation
  • Ischemic compression
  • Injection
  • Dry needling
  • Spray and stretch
  • Stretching techniques


b.  Asian Bodywork Therapy and Energy Work 

Several types of massage have their roots in traditional Chinese and Asian medicine. These techniques, whether practiced as they were developed in Asia, or derived from Asian practices with the addition of Western influences, have in common the goal of using massage to balance and enhance the client’s flow of qi, or energy, through the body’s meridians. The term energy work is often used to describe these therapies, because of their focus on balancing and freeing a person’s energy flow. 

Acupressure. This is a Western adaptation of the branch of Chinese medicine known as acupuncture. In acupuncture, needles are inserted along meridian lines in the body that correspond with body parts and functions to stimulate and control the energy flow through the body. In acupressure, the massage therapist applies pressure and small circular strokes to touch points that correspond to various areas of the body, adding pressure to the point and rubbing it for three to ten seconds. Well-developed muscles might take pressure for up to two minutes. Acupressure is well suited to treating aches and pains, stress, menstrual cramps, asthma, and arthritis.

Shiatsu. Shiatsu is the Japanese method of acupressure, although it is not identical to the Chinese method. In shiatsu, the therapist puts pressure on the points with the pads of the finger or thumb for two to five seconds. Over time, practitioners have developed routines for the whole body designed to reduce common symptoms. Shiatsu is usually done on a floor mat in a treatment room, but many spas offer “table shiatsu,” which is performed on a massage table.

Ashiatsu. Not to be confused with shiatsu, ashiatsu, or “foot pressure,” is an ancient form of bodywork or massage therapy first practiced by Buddhist monks. Therapists perform an intense massage by manipulating muscles with their feet, while supporting themselves with bars hung from the ceiling. Because the therapist can potentially use his or her full body weight to provide pressure, this therapy may be ideal for athletes or people suffering from chronic pain.

Reflexology. While foot massage is an ancient art practiced in China, India, and Egypt, modern reflexology was developed by American Dr. W.H. Fitzgerald in 1915. He identified areas of the feet connected to ten energy zones running from the top of the head to the feet. Putting pressure on a reflex or energy zone is said to affect organs and tissues within that zone. The zones are similar to the energy meridians of Chinese medicine, and reflexology massage keeps energy flowing freely through the zones. Eunice Ingham of New York, another early proponent of reflexology, believed that the practice dissolved crystalline deposits in the feet that were thought to interfere with nerves and blood supply to various parts of the body.

Tuina (or Tui Na). Tuina is a Chinese word that means “push-grasp,” and is a massage therapy that dates back to the Shang Dynasty (1700 BCE). By 700 CE, Tuina was offered as a course of study at the Imperial Medical College. In the seventeenth century, Tuina merged with a technique called Anmo to become close to the modern experience of this massage technique. (In Japan, Anmo still refers to this technique, while Tuina is used in China and elsewhere.)

Tuina consists of a series of pressing, tapping, and kneading that stimulates the flow of chi and blood to promote healing and to open the energy flow from the body’s meridians. Because the techniques range from light stroking to deep tissue work, this is not considered a recreational massage. It can be quite powerful or even painful, and practitioners often use herbal compresses to assist the healing process.

Jin Shin Do. Translated as “the way of the compassionate spirit,” this massage therapy was developed by American Iona Marsaa Teeguarden in the late 1970s.11 More than just massage, Jin Shin Do combines the theories and techniques of acupressure, acupuncture, breathing exercises, Taoist philosophy, and modern psychology as a way to restore balance to a client’s body, mind, and spirit. The therapist uses gentle pressure to release muscle tension and relieve stress. Because there is no movement of the client’s body, only the application of pressure, this practice can benefit people who cannot be moved or for whom moving certain body parts is difficult.

Thai. Thai massage, known as Nuad bo-Rarn (“ancient massage” in Thai) works to open the body’s meridians to free their energy by using stretches, massage strokes, and body movements. It is done on a floor mat and the client remains clothed. Although associated with Thailand, this style of massage originated in India and was part of the Buddhist religion. A monk named Komparaj, a personal physician to Buddha, is regarded as the first person to develop the technique.12 As Buddhism spread to Thailand, this massage technique did as well. Along the way, the technique incorporated elements of both Ayurvedic and traditional Chinese medicine.

Originally performed only by Buddhist monks, Thai massage has grown in popularity and is now taught to other practitioners. In Thailand, the Ministry of Education oversees and regulates certification and training programs that teach Thai massage, and many spa owners send their therapists to Thailand for training. While it is considered a healing art in Thailand, most Western spa-goers choose Thai massage for its relaxing effects.

Reiki. Not truly massage, Reiki is a healing technique that originated in Tibet more than 2,500 years ago. The word Reiki means “universal life force.” This life force or energy is Ki (also written Qi or Chi), the energy that in Japanese and Chinese cultures makes up all living things. Reiki was introduced to the Western world in the 1970s. In Reiki, the practitioner places his or her hands on or slightly above a person with the intent for healing to occur as hand placement enhances the flow of energy. The therapist doesn’t actually massage the body at all. In fact, the touch is very light—if at all—as it focuses on the client’s aura, the two or three feet of space surrounding a person’s body and containing a subtle energy field. Practitioners believe that Reiki can relieve pain, boost the immune system, and relieve physical expressions of pain that are often linked to a person’s emotional, mental, and spiritual states.


c.  Other Massage Techniques

The following massage styles are neither Western nor Asian, but unique traditions or combinations of other techniques.

Lomi Lomi. This ancient Polynesian massage is considered to be a Hawaiian massage technique. In 1803, a visitor to Hawaii wrote about his experience of Lomi Lomi, which he found “very lulling and pleasing when gently performed.” In 1893, however, the new government of Hawaii outlawed all native spiritual traditions, including the healing art of Lomi Lomi. The tradition continued to be passed down within families until the 1970s, when laws were changed and Hawaiians were again allowed to practice their spiritual traditions publicly. In 1973, Margaret Machado, a respected Hawaiian kupuna (elder) began teaching Lomi Lomi to people outside her family who wanted to learn the art.

The specific techniques of Lomi Lomi massage include circular thumb strokes done in a one-two-three rhythm, knuckle strokes on larger, denser muscles in the same rhythm, followed by forearm strokes delivered in a continuous rhythmic motion. The therapist also performs gentle stretches of the body and gentle rotations of joints to help release tensions and energy flow, returning the client to balance and harmony. Lomi Lomi also includes a spiritual element, in which the therapist begins the massage with a quiet blessing, asking for whatever healing is needed to take place during the massage. The therapist may ask the client to set their intention for any healing they want to receive.

Aromatherapy. In aromatherapy massage, the therapist applies essential oils to the skin, mixed with massage oil or another carrier. The oils are absorbed into the skin in small quantities, resulting in deep relaxation or other effects, such as reduced anxiety, elimination of headaches, or calming asthma. Many massage therapists create their own blends of essential oils and will match the oils they use to the client’s purpose for a massage. Aromatherapy can be incorporated into Swedish, Ayurvedic, or other massage techniques.


Hot Stone. While stones have been used in healing arts for centuries, hot stone massage as it is known today was developed in Arizona in the early 1990s, and is now offered on most spa treatment menus. Stones used in this treatment are usually smooth river rock made of basalt. The stones’ rich iron content helps them retain heat. Stones are sanitized and heated to between 120 to 150 degrees Fahrenheit before the client arrives. The therapist places the warm stones on specific points on the back and on points thought to be energy centers of the body. The goal is to improve energy flow through the body and to warm the muscles. The therapist then uses traditional Swedish massage strokes while holding heated stones. As the stones cool, the therapist replaces them with others. Many people find the hot stones to be soothing. They also relax the muscles, which helps the therapist to work them more effectively without using deep pressure. 

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