Massaging babies and infants can reduce pain associated with teething, constipation and colic, as well as inducing sleep (Auckett 1981). Studies carried out on preterm infants showed without doubt that massage was beneficial to their growth and development (Field et al. 1987). The babies were massaged for 15 minutes three times a day for 10 days in an incubator. Compared with the control group, 47% of the treated infants gained more weight and were hospitalized for 6 days less.

Patient benefits

Whether the causes of ill-health are biomechanical, psychosocial, biochemical or a combination of these, massage seems to be able to exert a beneficial influence (Chaitow 2000). Touch itself is a basic human behavioural need (Sanderson, Harrison & Price 1991) and ‘may be the only therapy which is instinctive; we hold and caress those we wish to comfort; when we hurt ourselves, our first reaction is to touch and rub the painful part’ (Vickers 1996).

As research and scientific developments in the efficacy of drugs forged ahead, close patient contact diminished and by the 1960s massage had more or less lost its therapeutic status in medical care. However, in the late 1980s and 1990s there was renewed interest by nurses in the value of touch, and now many hospitals and hospices are using massage to benefit their patients; during this time massage has been enhanced by the addition of essential oils, transforming the treatment into aromatherapy (Buckle 1997) (see Box 8.1). The benefits are further enhanced by the choice of essential oils used (Wilkinson 1995) – increased energy levels, reduced side effects from drugs, symptoms not treated by the hospital relieved and emotional problems eased. The effects can last longer than those of massage alone, owing to the therapeutic action of the essential oil components (see Chs 10–15).

Box 8.1 The Experiences and Meaning of Touch among Parents of Children with Autism attending a Touch Therapy Programme

Barlow and Cullen (2002) instigated a touch therapy programme aiming to enhance parents’ perceptions of closeness with their children and provide them with an alternative to verbal communication to promote the latter. Parents of children with autism were taught simple massage techniques over 8 weeks. Having practised massage with their children, parents reported that the children tolerated the massage and not only were routine tasks such as dressing tolerated more easily, but the children appeared generally more relaxed. Parents reported feeling closer to their children and that touch therapy had opened a communication channel between them.

Patients can benefit from a massage (simple or involved) given by any of the following:

• a physical therapist – without essential oils

• a physical therapist using essential oils ready blended by an aromatherapist

• a nurse with no professional massage experience, but with a sound knowledge of essential oils

• a nurse using essential oils under the direction of an aromatherapist

• a nurse using touch and gentle non-manipulative massage movements, without essential oils (see Introducing massage, below).

The most important thing to remember is that nothing can replace hands-on, when the giver (whether or not a qualified masseur/se) is caring and works within his/her capabilities, combining gentle touch with a loving attitude. With the right approach, beginning with a small non-intrusive movement, both the giver and the receiver can come to enjoy the care they are sharing, making it easier for the receiver to open up and become more relaxed in body and happier in mind (Worrell 1997). Authors agree that it is not necessary to spend an hour on a massage for it to be effective – people also benefit from a short period of dedicated time.

Physiological benefits

Massage increases the circulation of both blood and lymph, helping in the elimination of toxins from the body; it slows down the pulse rate, lowers blood pressure, releases muscle tension, tones underworked or weak muscles and relieves cramp.

Psychological benefits

Although these are perhaps not so easy to evaluate, they are significant and play their part in the holistic healing effect: relaxing an apprehensive mind, uplifting depression and despair, relieving panic or anger and, importantly, giving a person the feeling that someone cares enough to spend time giving the specialized contact brought by touch and massage.

Massage and aromatherapy – therapies in their own right

Professional massage

Several colleges run short courses that are not sufficiently comprehensive to confer a recognized massage qualification. To meet professional standards and be competent to give a full, professional massage,

Case study 8.1 Anxiety

N. Darrell

Aromatologist

Client assessment

Kay, a 42-year-old woman working in a family business, was referred for treatment by her GP, with severe anxiety and stress. Over the past 3 weeks, owing to business problems, she had become increasingly withdrawn and anxious. She was experiencing panic attacks (which left her clammy and freezing) in crowded places and also at night, which was disturbing her sleep pattern, thus she found it hard to wake up in the morning. She had extreme tension in her neck and shoulders, suffering headaches as a consequence. Her breathing tended to be shallow and rapid, and she had lost more than a stone in weight over the 3 weeks, partly due to lack of appetite.

Intervention

Because of the amount of anxiety she was experiencing she was taken through some breathing exercises before a full body massage, which was carried out using:

• 3 drops Chamamaelum nobile [Roman chamomile] – antispasmodic, calming, sedative

• 1 drop Rosa damascena [rose otto] – neurotonic

• 3 drops Origanum majorana [sweet marjoram] – analgesic, calming, neurotonic, respiratory tonic

• 10 mL grapeseed carrier oil

Kay opted for treatment twice a week and after the first treatment said she felt much calmer and more relaxed. She was standing upright rather than being bent over with the shoulder tension, and said that her head felt much clearer.

She was given a blend of the following neat essential oils to use at home in the bath, and as an inhalant if required:

1 mL Valeriana officinalis [valerian] – sedative, tranquillizing

1 mL Chamaemelum nobile – properties as above

2 mL Lavandula angustifolia [lavender] – analgesic, balancing, calming and sedative, tonic

2 mL Origanum majorana – properties as above

3 mL Cananga odorata [ylang ylang] – balancing, calming, sedative

On her next visit Kay reported that she found inhaling the oils when particularly anxious had relieved the hyperventilation and helped her to relax; she had also started to incorporate breathing exercises into her routine.

After six treatments over 3 weeks, Kay felt sufficiently confident to go shopping without anxiety. She had also been able to resolve some of the problems at work. She was beginning to put weight back on and her appetite had returned to normal.

She therefore decided to reduce her treatments to once a week, and after 3 more weeks she felt able to resume some of her work duties, when she reduced her treatments to once a month. She had not ceased taking her medication during her aromatherapy treatment time, but 6 months after first commencing aromatherapy, her doctor felt he could reduce her medication over the next 3 months.

At this time, she found she was able to carry out her normal work schedule and once again enjoy social activities. … She now goes for aromatherapy treatments when she feels the need.

the therapist must know anatomy and physiology, understand the relationship between the structure and function of the tissues being treated, and be knowledgeable in pathology, as well as being skilled in the proper manipulation of tissues (Beard & Wood 1964 p.1).

Massage and aromatherapy

It would prevent misunderstanding of the word aromatherapy if the qualification in massage were totally separate from that of essential oil knowledge. As Vickers (1996 p. 15) so rightly says, ‘massage and aromatherapy should be judged on their own merits’. This ‘combined’ situation arose because aromatherapy was originally aimed at and studied by beauty therapists only, and massage is part of their training.

Aromatherapy schools in the 1970s taught their own specialized massage to beauty therapists; many placed too much emphasis on the massage and barely any on the essential oils. This situation has been regulated to a certain degree by the Aromatherapy Council (AC), which stipulates the number of hours to be spent on massage, anatomy and physiology and on essential oil knowledge in order for an aromatherapy course to be accredited by them (see Ch. 17).

Because the aromatherapy and massage are linked, neither is taken to its full potential: the massage training of aromatherapists is not as thorough as that of a physical therapist and the essential oil training is not as deep as that of an aromatologist (therapist qualified in aromatic medicine) and member of the Institute of Aromatic Medicine (see Ch. 9).

Beneficial effects of massage

Massage is widely recognized as providing the following benefits; it:

• induces deep relaxation, relieving both mental and physical fatigue

• releases chronic neck and shoulder tension and backache

• improves circulation to the muscles, reducing inflammation and pain

• relieves neuralgic, arthritic and rheumatic conditions

• helps sprains, fractures; breaks and dislocations heal more readily

• promotes correct posture and helps improve mobility

• improves, directly or indirectly, the function of every internal organ

• improves digestion, assimilation and elimination

• increases the ability of the kidneys to function efficiently

• flushes the lymphatic system by the mechanical elimination of harmful substances (especially toxins due to bacteria) and waste matter

• helps to disperse many types of headache (or migraine) originating from the gallbladder, liver, stomach and large intestine, and also those of emotional origin (including premenstrual syndrome or PMS)

• stimulates both body and mind without negative side effects

• helps to release suppressed feelings, which can be shared in a safe, confidential setting

• is a form of passive exercise, partially compensating for lack of active exercise.

These combined benefits not only result in increased body awareness, but also produce better overall health. Studies carried out in hospitals and private practice have shown that massage with essential oils greatly enhances and prolongs the health-giving effects.

Simple massage skills

The most easily acquired massage skills are:

• Stroking, which comes under the heading of effleurage movements (perhaps the most important for hospital use), for which the whole of both hands from fingertips to wrist should be used. Stroking is simply an extension of touch and, as well as being one of the simplest, is one of the most important movements in massage.

• Frictions, which come under the heading of petrissage (a deeper and more energetic series of movements than effleurage), and in which either the thumb or one or more fingers are employed. ‘Rubbing it better’ is a simple friction movement. The Hippocratic writings (from the Hippocratic collection 460–357 BC) remarks that ‘the physician must be experienced in many things, but assuredly also in rubbing, for rubbing can bind a joint that is too loose and loosen a joint that is too hard’.

Case study 8.2 Depression

L. Bischoff

Aromatherapist

Client assessment

After suffering a major depressive episode where she had brief reactive psychosis, Miss L was hospitalized for 1 week.

Shortly after her return from hospital she stopped taking her medication. She was advised against this, as it is possible for a relapse to occur, but she was adamant as she said it was making her feel worse. She also suffered from lower back pain through sitting for long periods at her knitting machine – an improved posture for knitting was suggested, although Miss L had not felt able to do any since leaving hospital. She used to do aerobics, but again, not since leaving hospital. She was not sleeping well and had PMS before her periods.

Outcome

She experienced great relief after the first massage and that night had a good night’s sleep, feeling relaxed for several days afterwards.

After the second one her back felt much better – she was able to move more freely, although her sleeping pattern was not back to normal. It was therefore decided to give Miss L the same essential oils to use at home, in two blends:

1.5 mL of each oil in a 10 mL bottle, 6–8 drops of which was to be put into a bath at least 2–3 times a week

3 drops of each oil in 50 mL in oil of Vitis vinifera [grapeseed], to massage into her shoulders and neck every night before retiring

By the fourth treatment, Miss L had recommenced her aerobic classes, as her back felt so much better all the time. She was also sleeping as well as before her illness.

Because of this, a month was left before each of the remaining two treatments, the improvements remaining stable.

Everyone has an innate ability to perform these two movements correctly and safely without the need for long training; both are taught thoroughly on aromatherapy courses.

Three further techniques, requiring greater skill and best learned on an accredited massage course, are:

• Kneading (a form of petrissage), involving use of the palm, the palmar surface of the fingers, the thumb, or thumb and fingers working together, is a squeezing and ‘pulling’ movement, often used on the shoulders and the thighs.

• Percussion, where the outside of the hands and fingers continually make and break contact with the body in a definite rhythm, is not normally used in aromatherapy.

• Lymph drainage is only briefly covered in an aromatherapy training programme. It is fully covered on a Vodder technique course.

Effleurage

Effleurage is the basis of all good massage. It can be used on its own, at the beginning and ending of a massage and also in between other types of movement. It consists of two types of stroking, using the whole hand or hands, which should mould themselves to the shape of the part of the body being massaged. The strokes are either deep (i.e. with pressure) or superficial (without pressure). Sometimes only part of the hand is used – perhaps only two fingers on a small area or on a baby.

Deep stroking with both hands is accomplished by moving up the part of the body being massaged with pressure towards the heart; its purpose is to assist the venous and lymphatic circulation by physical effect on the tissues.

Superficial stroking is effected without pressure and in any direction (the pressure is so light that the circulation is not directly affected). The perfection of this technique can require skill and long practice. In simple massage, superficial effleurage is mostly used as the return movement of deep effleurage, moving away from the heart back to the starting position.

Effleurage is used mainly to relax the recipient both mentally and physically and to improve the vascular and lymphatic circulation. Many different types of strokes come under this heading, but all should follow the basic principles above.

Frictions

Frictions are another form of compression massage, or kneading. They may be performed with the whole or the proximal part of the palm of the hand or with the thumb and fingers to carry out circular movements over a restricted area. There are two types of frictions:

1. Fixed frictions move the superficial tissues over the underlying structures, i.e. the part of the hand used is ‘stuck’ firmly to the client’s skin, which is moved over the tissues beneath by making circles.

2. Gliding frictions move over a small area of the skin surface and may also progress along a specific path.

Frictions are primarily used to break down fibrous knots, loosen adherent skin, loosen scar tissue, relieve tension nodules in the muscles and increase the circulation in a specific area.

Other factors

Learning the different movements is only part of massage training. Equally important is the way in which these movements are performed. Essential factors to consider are contact, the direction of movement, the amount of pressure, the rate and rhythm of the movements, the medium used, the position of both patient and therapist, and the duration and frequency of the treatment (Beard & Wood 1964 pp. 37–40). Further factors include the need for full contact with the patient and complete relaxation of the masseur’s own hands and arms because hard, tense hands transfer tension (and possibly pain) to the recipient. The mind should be cleared of any intruding, disruptive thoughts: the wellbeing of the client and how he/she can benefit must be uppermost.

The following principles need to be absorbed at the same time as the actual movements are learned.

Contact

No part of the human body is flat; nevertheless, when using effleurage (stroking movements) there should be full hand contact with every part of any large area to be massaged (Price 1999). Nothing breaks the relaxing effect of massage more than the repeated lifting off and replacing of hands. Fully relaxed hands and fingers maintain this contact by following the body’s contours closely, draping themselves over the body like silk. The hands should remain in contact with the body for both outward and return journeys of all movements made in sequence: lifting off disrupts the flow of the massage as a whole (Price 2000 p. 203).

Pressure

In effleurage on a large area pressure should always be concentrated on the palm of the hand (Price 2000 p. 201). The fingers should be kept completely relaxed because pressure from fingers is not relaxing – finger pressure should be used in friction movements only. Normally, palm pressure should be applied only when moving towards the heart, with none on the return journey. One of the aims of massage is to stimulate the circulation (the return of venous blood is not easily accomplished by the heart – pressure towards the heart increases the rate of circulation. The lymphatic flow is also increased, ridding the body more quickly of any harmful substances.

Pressure in frictions using the thumb or finger pads needs to be firm, but care must be taken to use the whole finger pad and not to dig in with the tip.