Module 5: Techniques

In this module, you will learn:

What kind of massage techniques you can use throughout
your career
About the different types of massage strokes that are
used
What other types of therapies can be used alongside
massage techniques
About reflexology and how to treat different parts of
the body
More detail about how massage therapy can help different
systems

5.1 Introduction
Now we get to the real meat: what methods
there are to perform a massage.

This isn’t really a “how-to” guide: by far the best way to

learn massage is by watching somebody else do it and having
them teach you in person. That’s why all the different massage
technique modules in this course are accompanied by a video
tutorial – (videos start from Module 6 onwards).

A little experimentation is not a bad thing, but attempting to

teach yourself a massage can be confusing and potentially even
dangerous.

Above all – if it hurts, stop! Massage isn’t about contorting

the body in unnatural ways, and if you’re hurting somebody,
you’re probably doing something wrong. With that, on to the
techniques

5.2 Massage Strokes

Effleurage
Effleurage is the most common stroke used in massage. It is a
gentle sliding of the hands over the skin.

For the most part, effleurage strokes are pointed towards the
heart. Commonly, effleurage is used at the beginning of a
session, to enable the therapist to get a sense of the
customer’s body: its sensitivity, the placement of the
muscles, and so on. It is also used at the end of treatment as
a gentle ‘wind-down’, and as a filler to move between
different strokes. Simple as it is, effleurage increases blood
flow to the skin and to some muscles.

Variants on the basic pattern of effleurage include:

Shingles. Otherwise known as “alternating hand massage.”

This uses the gliding of both
hands to massage an area of skin, one hand in front of
the other
Bilateral effleurage. This is a back-rub technique, in
which one hand is placed on either
side of the back, and both are used for effleurage.

Tapotement
Tapotement is a massage by hitting.

It’s a general term, covering a number of more specific

techniques – many of which are described in more detail
elsewhere in this text. Tapotement is used particularly
heavily in warm-up massage for athletic events but is
generally an important part of a Swedish massage. It may draw
some of its effects from the way in which air is compressed
against the skin by each blow.

To keep tapotement comfortable, it is important to make sure

that the blows are made at equal strengths and intervals. It
can be quite tricky to get the level of force right. Making
the blows too heavy can be uncomfortable, and hence cause a
‘tensing up’ reaction which isn’t ideal. However, a certain
degree of force seems to be beneficial.

Tapotement is best performed on areas of the skin which do not

have bones or particularly sensitive spots just underneath.
Which areas of the body this includes will depend on the
person being massaged – if you are skinny and bony, you may
benefit less from tapotement.

Hacking
Hacking isn’t a very descriptive term for this technique – put
away those images of woodsmen with axes!

Hacking is a form of very light, rapid tapotement, in which

you hit somebody with the fingers of each hand alternately.
The force comes from the wrist rather than from the arm – not
least as protection against accidentally hitting too hard.

Cupping
Cupping is something like slapping with a cupped palm. If the
hand is not kept bent enough, the result will be as unpleasant
as if you simply slapped the patient.

Beating
Beating lets you use your fists on the patient. Make each hand
into a fist and gently beat on the patient’s skin with the
bottom of each fist alternately. As with other tapotements,
the trick is to avoid getting over-enthusiastic and hurting
the patient. It may help not to concentrate fully on making
contact with the patient. Instead, imagine that you are
tugging on ropes or ringing a bell, and think of the impact of
your fists on the patient’s skin almost as a side-effect.

Pummelling
Pummelling is a “punching” type of action, done rhythmically
and evenly with both hands. Since it can feel more intensive
than most massage strokes, it is generally only performed on
areas with a good covering of flesh. For the same reason,
pummelling isn’t usually performed on easily-harmed patients
such as children and pregnant women. It is supposedly good for
breaking down fatty deposits under the skin.

Petrissage
Petrissage techniques consist of short, circular strokes that
pick up and squeeze the muscles. This improves blood flow to
the muscles, and can also help the muscles to eliminate their
waste products.

Plucking
Plucking involves gently lifting a spot of skin, and then
letting it slowly slide back through the fingers. Think of
your hand as being like the beak of a bird, opening, and
closing.

Raking
Raking is a way of massaging the back and sides by following
the contours of the ribcage.

Nerve Strokes
As I mentioned above, shiatsu massage places great emphasis on
the use of the fingertips. The counterpart to this within
Swedish massage is the ‘nerve stroke’, gently running the
fingertips across an area of skin.

C-Bowing
This stroke gets its name because an area of skin is bent into
the shape of the letter C. You place your two thumbs next to
each other on a patch of skin and grasp the skin with your
fingers. Then you push the thumbs gently into the skin and
pull back with the fingers. The result is that the skin gets
distorted into a “C” shape.

J Stroke
Another stroke named because it makes a shape like a letter.
With all these letters, there’s a whole world of massage
poetry waiting to be explored! Anyway, this stroke is made
with the knuckles of a clenched fist, pressing quite deeply
into the skin and moving in a “J” shape.

Friction
Friction is one of the strokes aimed at the muscles, and so
the practitioner should ignore the skin itself as much as
possible. As well as the usual benefits of increased
circulation, friction strokes can break up knots of muscle.
Variants of friction can use different parts of the hand, and
they are mostly performed quite quickly.

Friction can be performed:

With the palm

With the knuckles
With the fingertips
With the thumbs

5.3 Other Techniques

Ice massage
The technical term for this is cryomassage – but that doesn’t
mean anything more than “cold massage.” The idea is to use ice
packs on the body. Ice used in this way has the same effects
as it does when you put a bag of frozen peas onto a bruise: it
eases pain and reduces inflammation.
The idea of using cold in this therapeutic way is hardly new.
We believe some form of cryotherapy was used in ancient Greece
and Rome, although we would be stretching definitions if we
tried to call this a ‘massage’. Ice baths came, went, and came
again as fads during the 19th century.

Readers of the classic children’s book The Secret Garden may

remember a particularly unpleasant description of such a
treatment being given to an unwilling young boy – hardly the
best recommendation for a massage treatment.

But modern cryotherapy resists the temptation to leap to

extremes. Most therapists will try to avoid anything that
feels unpleasant, both for medical reasons and because hurting
customers is bad for business!

Aquatic massage
Conducting a massage in water opens up doors to methods which
would be impossible in other circumstances. When we are
immersed in water, we are not subject to gravity in the same
way, and a massage therapist can have access to our entire
body while we float gently.

Aquatic massage is particularly suitable for people who have

difficulty moving flexibly – people suffering from arthritis,
for instance. It is also good for pregnant women.

Stone massage
In a stone massage, the therapist will heat basalt stones in
water, and then place them onto your body. The warm (not
painfully hot!) sensation is pleasant, and can also relax
muscles.

Acupressure
Acupressure is acupuncture without needles. That is, it uses
the same model as acupressure to understand the body,
imagining a network of key points with the power to relieve
tension.

Acupuncture tries to manipulate these points with needles,

whereas acupressure uses massage-like pressure from the hands.

Compared to other forms of massage, acupressure can be

distinguished by its whole-body approach. A problem
experienced in one part of the body will not necessarily be
cured by acupressure applied to that body part. Instead, the
therapist will use their knowledge of the acupressure network
in the body to choose a part of the body to work on to solve
the problem experienced.

The theoretical basis of acupressure comes from the Taoist

idea that qi (life force) flows through the body in a set
pattern of ‘meridians’. Manipulating the body in the right way
can balance these meridians, and thus relieve pain.

Cup massage
Cup massage needs to be distinguished from the ‘cupping’
massage technique, which simply involves cupping the hand. Cup
massage, by contrast, involves placing vacuum cups on parts of
the body.

The use of vacuum cups allows the masseur to ‘pull up’ the
skin, something which is very hard to do in other ways. The
lower pressure may also improve circulation.

Shiatsu
“Finger pressure” isn’t a bad description of massage, is it?
That’s what Shiatsu is. The technique, like the words, hails
from Japan, although it is in part a synthesis of concepts
from elsewhere.

Shiatsu was developed in the early part of the last century,

by individuals such as Tenpaku Temai (whose 1915 book Shiatsu
Ryoho brought us the word Shiatsu) and Tokujiro Namikoshi. It
was Namikoshi who brought Shiatsu to the attention of the
world, giving treatments to people as well-known as Marilyn
Monroe, boxer Muhammed Ali, and Japanese Prime Minister
Shigeru Yoshida.

Shiatsu has spawned many variations. In water Shiatsu, often

given the ungainly name watsu, the process takes place
underwater. This reduces the practical difficulties associated
with a massage on dry land. One of its chief proponents (who
holds a trademark on the name “watsu”) was Harold Dull, a
Californian Shiatsu practitioner of recent years.

Ashiatsu
‘Ashiatsu’ means ‘foot pressure’. In Ashiatsu, the therapist
uses his or her feet to massage the patient’s back. Since the
full weight of a therapist on one’s back would be neither
pleasant nor safe, the therapist suspends themselves from a
bar. Hence the full name of the practice: ‘Ashiatsu oriental
bar massage’.

Ashiatsu is one of the more recent additions to the world of

Western massage, arriving only in the 1990s.

Chair massage
A chair massage is performed on somebody when they are seated
in a chair, rather than on a massage table as usual.

It presents some challenges and is unlikely to result in as

satisfying a massage as is possible using a table. Parts of
the body can be hard to reach, and those that can be reached
will often be tensed in ways that are hard to loosen with a
massage. This is true even when the “chair” is really a stool.

With these disadvantages, why would anybody choose a chair

massage? The basic reason is convenience. Chair massage can be
conducted at your place of work, and some companies will
arrange for all or part of their workforce to receive an
occasional chair massage.
Chair massage is often conducted without removing any clothing
– again, something that is suboptimal in terms of the massage
itself, but which makes the massage much more convenient. In
short, chair massage brings the possibility of massage to
stressed, exhausted, overworked people, who might not
otherwise find the time or inclination to get a massage.

It isn’t just for businessmen, though. The spread of massage

to unusual new locations has been driven by chair massage. The
‘massage bars’ which have now colonized airports across the
United States generally make use of chair massage. Some
conferences and similar events provide on-site massage, and
you will read occasional news reports of chair massage being
set up in even more unusual places.

The techniques used in chair massage are constrained by the

awkward body position and the presence of clothing on the
patient.

Effleurage isn’t a good technique in such situations: it tends

to move the clothing over the skin, rather than moving the
clothing itself. Percussive techniques are less affected, and
so assume a slightly more prominent role. But the real stars
of the chair massage are the fingertip-heavy techniques, often
derived from Shiatsu.

5.4 Massage as Part of Other

Therapies
Many massage therapists work within some
wider theoretical context.
They understand the pressure and manipulation that they apply
not simply on the immediate practical level, but as fitting
into a wider framework of how the body works, and how to
maximize its potential.

These theories come from the widest backgrounds imaginable –

Indian and Chinese mysticism, hard-nosed American science, and
everything in between. The following paragraphs summarize some
of these schools of thought.

We will have to venture a little way beyond massage itself in

order to understand them, but the trip should pay for itself
by explaining a lot of the background for massage.

5.5 Massage vs. Bodywork

For the purposes of simplicity, we are
mostly avoiding the term ‘bodywork’, but if
you read elsewhere, you’ll probably find it
cropping up an awful lot.

Essentially, you can think of bodywork as being a slightly

broader term than massage. Massage is understood by some
people in a limited sense, to include only techniques similar
to the basic Swedish massage: pressing and manipulating the
skin, and so on.

Practices such as Rolfing and Reiki which are closer to the

New Age movement and further from the pragmatic, 19th-century
origins of Swedish massage, might not be included. So we have
the term “bodywork” to incorporate this broader context.

The Alexander Technique

The Alexander Technique has its strongest following among
actors and dancers. It is named after its creator, Frederick
Matthias Alexander, who developed it around the start of the
20th century as a systematic process for increasing wellbeing
by improving posture.

Alexander’s insight was to concentrate on the damage done to

our bodies by unthinking physical habits. When we sit, we
slouch. When we lift objects, we exert muscles that are ill-
equipped for the task, while we under-use muscles that could
do the job better. Practitioners of the Alexander Technique
attempt to be continually mindful of the effects of their
posture, and to improve it through this constant awareness.

The Feldenkrais Method

Similar to the Alexander Technique, the Feldenkrais Method is
named after its creator. The eponymous Dr. Moshe Feldenkrais
began from a background in Judo. He wanted to teach people to
know their own bodies, and hence to be able to move in a
powerful, flexible way.

Structural Integration
Structural integration is the brainchild of Dr. Ida Pauline
Rolf – hence it’s an alternate name of Rolfing. It is based
around the idea that muscles become restricted by “fascia”
(connective tissue), and that this fascia can be loosened
through massage. Such treatment, which takes place over 10
sessions, is believed to ‘unlock’ the body.

Breema Bodywork
From the Kurdish culture of southern Turkey comes Breema
bodywork. It takes its name from the village of Breemava, in
which it was practiced before being brought to America.

Schreiber
Turkish massage techniques were one of the original sources
for what has come to be known as ‘Swedish massage’, so it is
hardly surprising that Turkey has something to tell us about
massage. But the Kurdish culture, while connected to Turkey,
is quite distinct. The Kurds, who have their own languages and
live separately in mountainous regions, have produced a form
of massage which emphasizes harmony with nature.

The Breema Center (a Californian organization which claims

trademark control over the word Breema) lists 9 principles of
this harmony:

Body comfortable
No extra
Firmness and gentleness
Full participation
Mutual support
No judgment
Single moment/single activity
No hurry/no pause
No force

These gnomic phrases need some explanation from a Breema

teacher to be understood. But even just reading them gives an
idea of the Breema approach: emphasizing rhythm, continuity,
and balance.

Reflexology
Some massage therapists will base their foot massage on the
theory of reflexology. Reflexology holds that there exists a
connection between each area of the foot and a particular part
of the body. Hence, reflexologists believe it is possible to
treat ailments of the body by manipulating the appropriate
part of the foot.

FACT
65% of patients reported that reflexology helped with the
symptoms of migraines & tension headaches.

Brendstrup & Launse (1997)

Reflexology was introduced to the West in the first half of

the 20th century, primarily by William Fitzgerald and Eunice
Ingham. Here are some of the connections claimed by
reflexologists. Note that different reflexologists will
propose different links between the foot and the body. Also be
aware that neither the points on the foot nor the parts of the
body correspond exactly to the common understanding of them,
but are tied into mystical understandings of anatomy.

Top of head – toenails

Pituitary gland – knuckle of the big toe
Temporal area – side of the big toe
Thyroid glands – the ball of the foot
Manual lymphatic drainage
Manual lymphatic drainage is an example of a massage tailored
to the treatment of a specific group of medical problems. It
aims to improve the operation of the lymphatic system. This
system of ducts across the body is responsible for removing
fluid from parts of the body where it is not needed, for
transporting fat around the body, and for producing immune
cells. In the 1930s, Dr. Emil Vodder developed a message-
related technique to treat immune problems.

5.6: Areas of the Body

The following sections describe how massage can be applied to
particular parts of the body.

Massage techniques for different parts of the body have much

more in common than they have apart, and much of the time it
is enough to be guided by personal intuition as to which
techniques are best suited for each person and for each
situation.

Feet
The foot massage has evolved its own style and foibles. It is
often performed as part of a manicure. The alternative
treatment of reflexology (see above) has attempted to expand
foot massage into therapy for the entire body. But foot
massage can be very beneficial, without using reflexology at
all.

It might include:

Stretching the toes, by pressing them backward or

upwards.
Effleurage on the surface of the feet. This is best done
by expanding the massage beyond the foot itself and
incorporating the lower leg into the effleurage strokes.
 Massaging the ankles. This can be particularly soothing
after somebody has exhausted their feet by walking, and
can also help with circulation problems.

Face
A Belavi facial massage combines a standard massage with
beauty treatments intended to improve the health and
appearance of the facial skin. The linkage between massage and
beauty is a sensible one in the case of the face. When your
face looks puffy and pale, the lymphatic system is likely to
blame. If the lymph ducts do not remove waste products from
the face quickly enough, they will remain under the skin and
give a puffy appearance. Facial massage can stimulate the
lymphatic system, enabling it to remove this waste and make
the face look much more vibrant.

Facial massage also can be a good way of relieving conditions

such as a blocked nose, combining the usual psychological
benefits of massage with an unblocking effect.

Particular considerations when giving a facial massage are:

The muscles in the face are particularly fragile and

close to the surface, and they need to be treated with a
delicate touch.
Similarly, percussive massage is not generally a good
idea with the face. Concentrate on effleurage, and on
Shiatsu-like finger work.
Facial massage should usually be done mainly with the
fingers. The area of skin concerned is too small and too
crowded with other features, to make much use of palms
or fists.
Mind the eyes and the mouth. Be aware not just of where
you are putting your fingers, but of any massage oil you
are using. Use only oils and lotions which are harmless
if they get into the eyes or the mouth. Use only limited
quantities, and apply them in such a way that they will
 not drip into the eyes or mouth.
Don’t forget your neck. If you are giving a facial
massage, it is often best to combine it with a neck
massage. The neck is full of lymph nodes, many of them
connected to the face. Therefore a massage that improves
lymph circulation in the neck will also improve lymph
circulation in the face.

Head
A head massage can build on a facial massage, combining it
with massage of the scalp. This can relieve some of the
symptoms of a headache. It can also be very soothing and
relaxing, especially when you are tired. The scalp can be
massaged somewhat more vigorously than the face itself, but
again effleurage should be the main technique used.

Back
The back is one of the easier parts of the body to massage and
is a good place for beginners to start learning.

Here are some of the peculiarities of that part of the body,

to watch for:

It is generally possible to press quite hard during a

back massage, as the back is fairly robust and hard to
damage.
The exception to this is the spine. The spine is
normally quite resistant, but special care is needed
because the effects of damaging the spine are so
catastrophic. Make sure you know of any back problems
that your customer has experienced, and feel free to
avoid the spine if you are worried about it.
If you are massaging one side of the back, stand on the
other side of the customer.
Use effleurage at the start of a back massage, both to
get a feel for the locations of the muscles and to ease
 your patient gently into the massage.
Try raking of the ribcage, but watch to see how your
customer reacts. Some people find raking an
uncomfortable experience.

Module Summary
Lessons Learned
In this module, you have learned about the different kind of
massage therapies available.

Many clients will have different needs and you can attract a
wider clientele if you know a good range of different
techniques. Massage technique is the foundation of therapy and
if you do not master it, you will not be able to give clients
what they want.

This module has identified the different types of therapies

you can use to assist your massage techniques. You now also
understand how to treat different areas of the body with
proper form.

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