Massage Explained

To give laymen a good picture about massage, here are the basics:

We have five senses – sight, hearing, smell, taste and touch.  (Some consider psychic powers to be the sixth sense.)  Each of the five senses is VERY important for our survival.  But, because we are “social animals”, loss of sight and/or hearing need not to be fatal – other members of our society will assist the handicapped ones.  The sense of touch helps us to navigate through our surrounds in total darkness and to recognize objects just by touching and handling them.  But touching and being touched by another person are also extremely important to our physical and emotional health and well-being.

Physical pain and depressed moods generate lots of negative energies in one’s body.  Physical touch allows the flow of energies from one person to another. Thus a healthy and a cheerful person can reduce the intensity of physical pain and uplift the mood of an ill and depressed individual merely by touching and hugging.  This effect is most noticeable between mothers and their children.  A mother can kiss away hurts and sooth a distressed child with hugs and caresses.

Studies have shown that touch therapy, including massage, contributes to a healthy weight gain, enhanced growth and social development in infants. The newborn has the same need for touch as for food. (Studies on blind children have shown that they develop normally if they have plenty of body contact and movement stimulation.)

In the same way the adults need it, whether they acknowledge it or not.  It has been discovered that after prolonged physical contact such as a massage, the hypothalamic area of the brain experiences a reduction of activity, decreasing the body’s level of stress hormones, and increasing the level of endorphins. Some scientists suggest that human beings need a few hugs a day for a healthy emotional life.  Teutonic (and a few other) cultures have developed a negative reaction to touch. Touch is considered an invasion in their privacy and too often associated with sex. Touch is not only sexual – most other cultures have kept a healthier level of touch interaction. They shake hands more often; they hug and kiss more often, like south Europeans, Southeast Asians and some Polynesians.

In India, South-East and Far-East Asia massages are a way of life.  In Middle-East and Near-East hardly any, but there are references to massages on Sumerian clay tablets discovered near Babylon.  In Africa even today massages are “only for the elite”.  Some Amerindian cultures did practice some simple massage techniques.  Pacific islanders had various levels of development of massage techniques – Hawaiian being the most developed.  In Australia, along the NW coast, the aboriginals came into contact with fishermen from SE Asia and learnt the skills from them, so there is a hybrid of several SE Asian massages.  The inland and southern people are reluctant to be massaged, because they consider it too intimate.   In Europe massage was born rather recently – early 18th century in Sweden, though Hippocrates knew of the benefits some 2,500 years ago – “The physician must be experienced in many things, but assuredly in rubbing.   For rubbing can bind a joint that is too loose, and loosen a joint that is too rigid.”

Primates grooming each other

Primates grooming each other

Blind massage is probably the second oldest profession.  Primates are well known for grooming each other.  While socializing, they also stroke each other with open palms and stretched out fingers.  Blind people are well known for their incredible tactile sensitivity.  A primate gradually going blind would very likely notice a gradual increase in the sensitivity of his/her touch.  They would also pick up very quickly some abnormalities in the soft tissues of the person they were stroking/grooming.  It wouldn’t take them long to observe that if some abnormalities were rubbed harder, there would be a positive feedback with indications that the hard rubbing brought relief and/or the problem was corrected.  This would earn them the reputation of a healer and gratitude of the fellows they helped.  They would be rewarded with a proportion of food hunted or gathered by healthy members of the tribe.  Thus they earned their living with their sensitive hands.

Blind animals in nature don’t survive long – they can’t see a predator coming, they can’t fight back, they can’t escape fast, they can’t find food for them selves, they can’t hunt.  If other members of their group don’t give the blind some food and lead them to sources of drinking water, they will certainly die within a week or two.  Most people accept that the humanity was born when the first stone tool was created.  The oldest stone tool is about 2.5 million years old.  Blind massage could be even older.  Field studies of primates have confirmed time and time again that they care about each other – when one is in distress, others come to their help.  So it is with food – if some members of a troop find something to eat, they signal to the rest of the troop about their discovery and it is shared.  Good deeds are remembered and favours returned.  And they learn very fast – monkeys see, monkeys do, though I never heard of anybody ever observing monkeys or apes doing anything resembling a massage.

There are 15,000 years old cave paintings depicting a massage.  In a Chinese cave they found a bone doll with markings of most acupuncture points known today.  It is about 7,000 years old.  I don’t think anyone will argue if I will say that acupuncture has its roots in massage.  What happened between 2.5 million and 15,000 years ago is anybody’s guess.

There is evidence of massage being used in ancient Egyptian healthcare from as early as 4000 BC, when the mortal goddess Queen Isis included massage as treatment for health and healing. There is no evidence from the other ancient river valley cultures of any female healers, so it is probable that she was the first. She also trained her priestesses to perform the duties of a physician, massage being one of them.

Cong-Fu of the Toa-Tse was written about 3000 BC and it is the oldest known book written about massage.  Legend has it that in oral form it was passed down from a legendary culture, known as the “Sons of Reflected Light” some 14000 years ago. It taught scholarship, meditation and alchemy. The Nei Ching is a Chinese medical text and it has the earliest recorded reference of massage, written about 2750 BC.  Other old surviving Chinese writings (5,000 years+) say that the warlords kept professional warriors.  They also employed folk healers to keep the warriors in the best possible health.  Taking care of the soft tissue problems was the domain of the blind masseurs.  Even today the blind play major role in Chinese health industry.  There are some 6 million visually impaired individuals in China and about 50,000 of them are registered massage therapists.

In Japan, massage was a traditional occupation for the blind since 1600’s.  Today approximately 24,000 blind and visually impaired workers engage in massage therapies.  Japanese colonialists introduced the monopoly for blind masseurs in Korea in 1913. It was abolished in 1946 by the post-war U.S. military government but reinstated in 1963 and in 2008 South Korea’s Constitutional Court confirmed the monopoly. In a country where social prejudice and a lack of official support long restricted the opportunities of the disabled, the visually impaired have fiercely defended their exclusive right to the business

The 7100 blind people working in over 1000 massage centers are the only legally registered masseurs in South Korea. But they hardly meet the demand for massages. So tens of thousands of “sports massage” centers, skin-care salons, barber shops, hotels and public bath houses all hire sighted – and technically illegal – massage workers. Estimates of their number range from 150,000 to 700,000 for a population of 48 million.  (Compare that with Australian numbers – some 14,000 massage workers for a population of almost 23 million)

Thailand's school for blind massage

Thailand’s school for blind massage

In Thailand it takes three to four months for any average trainee, blind or sighted, to be trained in Thai massage service.  There are approximately 120 massage shops owned by blind people, employing around 1,000 blind masseurs and masseuses. The rest (around 3,000 people) are self-employed, employed by blindness vocational training centers or employed by other non-blind massage shops/clinics.

There are almost as many massage styles or modalities, as there are masseurs.  Unless you are a religious follower of your teacher and your teacher is dogmatic, you will adopt the best of what you learnt from your teacher.  Then you will try many different styles and select the elements that you like most and incorporate them in your massage sequence.  Our founder’s teacher calls his style “Chi massage”.  On Internet we found one site giving brief summaries of 291 massage modalities, but none of them came close to describing our modality.  There is a book by Dr. Greg Fors “Why we hurt”.  It is about “trigger point therapy” and his description of “ah shi” massage is almost perfect description of what we do.

“The recognition of therapeutic tender points in the body was described as far back as the Tang Dynasty (AD 618 – 978) in China by the renowned physician Sun Ssu-Miao.  In his textbook he actually describes tender points not fixed in position or running along acupuncture meridians but appearing on the body when it is stressed, diseased or injured.  Sun Ssu-Miao wrote that these points were found in tissues that looked normal but were spontaneously tender, and when detected by palpation the patient would cry out “aah shi”, or äh shi”, meaning “hurts good”.  Today in the East, these trigger points are still referred to as “ah shi” points. This description of stressed or injured myofascial tissue parallels the modern understanding of trigger points, or what I refer to as the neuromyofascial lesion.”  (p. 102)

 Google’s translation of Ah Shi is “Oh, yes”.  In a Chinese writing from almost 3000 BC, anmo was their word for massage.  It was derived from “an” which means “to press” and “mo” meaning “rubbing”.  Indeed, Ah shi massage is pressure rubbing that hurts good.  Blind people are so well suited for Ah shi massage because of their tactile sensitivity.  Repeatedly we are amazed how quickly our students discover the smallest trigger points in the soft tissues of the massaged person.

Google search for “Ah shi” brings out thousands of websites, but those few dozens that we had a look at are repeating only the things that are found in Dr. Fors’ book with a few minor changes of words.  The writers describe Ah Shi as a Chinese variation of Dr. Janet Travell’s trigger points.  Those claiming to be practitioners of Ah Shi massage seem to be following the standard western approach – a client comes and shows the masseur where he hurts.  The masseur then tries to find the trigger points and diffuse them.

The teacher of our founder has the traditional Chinese approach to health care (and the Chinese can be VERY dogmatic) – clients used to pay a doctor regularly (just like we pay monthly health insurance) for the doctor to keep the client healthy.  If the client became ill, he didn’t pay any fees until the doctor cured him.  The traditional Chinese medicine practitioners had blind masseurs in their employ.  When the client came for a regular check-up, the blind masseur would also perform a full body exploratory massage.  The masseur was feeling for ah shi points – tight muscle bands, “ropes”, “knots”, or, to use a modern term, “trigger points”.  The masseur then tried to massage them away.  There is a noticeable improvement even after one massage, but it can take anything between five and ten sessions to fix the problem.

In China the masseurs are instructed to apply as much pressure as they feel fit for the maximum benefit, even if the client is screaming with pain.  Vlado once said  “My teacher never paid any attention to the cries of agony when he was massaging me.  I have to agree that the problems were improving much quicker, even though I kept telling him that I’d rather come more times and suffer less pain.”  The Chinese accept the pain as a part of the treatment, but westerners will seldom return to the masseur if he doesn’t adjust the pressure to the pain threshold of the client.  The tomb of Ankhmahor, dated somewhere around 2350 BCE, has images of massage.  The hieroglyphs accompanying the pictograph have been translated with the patient saying “Do not cause pain,” and the therapist responding “I will act so you shall praise me”.  It sounds like a reference to the pain of massaging the tight muscle bands, “ropes”, “knots”, or trigger points release.  Our students are told to take note if clients wince and writhe with discomfort, and ease on the pressure.  Clients are asked for feedback

Trigger points in the back

Trigger points in the back

There are numerous theories about the causes of the trigger points.  Dr. Greg Fors gives one of the best explanations:  Trigger points are caused by physical, nutritional, emotional and/or chemical stress to one’s body. This stress can be acute, as in a car accident, or chronic from nutritional deficiencies. Either way, this stress can reach a breaking point where changes take place in the muscle tissues and their nerve endings creating irritable and painful spots. The presence of many trigger points can cause chronic and debilitating pain.

Others think that most of the ah shi points form when there is an imbalance of electrolytes in your body, but here we need to back it up with a brief anatomy lesson.  Skeletal muscles do they work only when they contract.  Sarcomeres are the smallest functional contractile units of a myofibril.  They are like the electromagnet and core of a doorbell, or the segments (annuli) of an earthworm.  Earthworms contract a few of the annuli at a time.  When a muscle contracts, all the sarcomeres in all the fibers of that muscle will contract.

The contractions are controlled by electrochemical impulses from brain through motor neurons.  All motor neurons leading to skeletal muscles have branching axons, each of which terminates in a neuromuscular junction with a single muscle fiber.  Nerve impulses passing down a single motor neuron will thus trigger contraction in all the muscle fibers at which the branches of that neuron terminate. This minimum unit of contraction is called the motor unit.  The size of the motor unit is small in muscles over which we have precise control. For example, the motor units of the muscles controlling the larynx are as small as 2–3 fibers per motor neuron, a single motor neuron triggers fewer than 10 fibers in the muscles controlling eye movements.  In contrast, a single motor unit for a muscle like the calf muscle may include 1000–2000 fibers, scattered uniformly through the muscle.  The thickest muscle fibres in big animals can be up to 1/10 of mm in diameter.

Even at rest, most of our skeletal muscles are in a state of partial contraction called tonus. Tonus is maintained by the activation of a few motor units at all times even in resting muscle. As one set of motor units relaxes, another set takes over.

The intensity of a contraction is controlled like a light dimmer controls the intensity of light.  When some of your muscles twitch, the electrolytes are out of balance and there is a minute short circuit, or a power leakage.  When you wake up with the most excruciatingly painful cramp of your calf muscle, the switches of all the motor units were flicked full-on.

Pain is an indicator to your brain that at the source of the pain some damage is being done to your body. Then the brain will organize a preventive or a corrective action.  The intensity of the pain will depend on the speed that damage is being done to your body.  You can be in a bath where the temperature is over 44 degrees Centigrade and millions of your skin cells will be cooked, but you will not feel any pain – the speed of damage is very slow.  But stick a pin in your finger and the pain will be very sharp, because the few affected cells were damaged very quickly.  Before you feel any pain, the pain signals have to pass through two signal filters.  One (dorsal root ganglion) is just before the spinal cord and the other is at the base of the brain (basal ganglion).  Just like a smoke alarm will sound only when the smoke reaches certain concentration in the surrounding air, so the pain signals have to be serious enough to pass through the two filters

Some of the motor units can control a bundle of fibres that can be 10 mm in diameter.  If that one single motor unit malfunctions and the entire bundle contracts, a masseur will feel it like a pebble or a rope under your skin.   A hard massage of that area will be painful.  When you exercise hard and if you sweat excessively, you are loosing lots of salt, throwing the balance of your electrolytes out of whack.  Then you are likely to get muscle twitches or cramps.

Blood capillaries and nerves run between the bundles of muscle fibres.  If the fibres will contract and form ah shi points, they may squeeze the nerves and you will get numbness in the area; or the blood flow will be restricted, if the blood vessels are squeezed.  If a masseur will release the ah shi points, the blood flow will be restored and the numbness will disappear too.  If you will eat and/or drink items rich in micronutrients and electrolytes, the ah shi points may loosen up without outside help.  Often they will loosen up within 24 hours.  Sometime a masseur can help by applying pressure with his thumb on the ah shi point for one minute to stop the blood flow.  When he lifts the thumb fast, blood will rush into the area, may clear the blockage and release the contraction.  Sometime the contracted bundles will loosen up if you will fully stretch the muscle for one minute and then relax it (in yoga it is recommended that you hold each position for one minute; I don’t know if the yoga stretches weren’t invented to release the trigger points). But occasionally the ah shi point will freeze and stay contracted for the rest of your life.  Sometime “Guillain Barre” cramps and spasms (see youtube) can be triggered by electrolites imbalances

During intensive work or exercise, some myofibrils will snap.  But in the healing process the ends don’t join back, they fuse with the surrounding fibers, creating scar tissue, which reduces the efficiency of the whole bundle. The frozen contraction and the scars in the bundles are some of the reasons for the muscular weakness of the old people

When clients come to us for a massage, they may not be aware of any soft tissue problems, but within a minute or two we are discovering many ah shi or trigger points.  Our founder observed in Philippines that the blind are taught to give a relaxing massage only.  These days in China the masseurs are directed to massage westerners without giving them pain. The founder’s daughter is a myotherapist and she was told in school not to give pain to their clients. The Ah Shi massage can be incredibly soothing and relaxing, but if we come across a problem that can be corrected with massage, then a certain level of pain is unavoidable. And clients are aware of it – they all say that they recognize it as “good pain”.  The people in Philippines used to say to Vlado “Masakit ng masarap” – painful, but nice. Every day we are amazed just how many different pains and aches you can massage away yourself. You become so much more aware of what is happening in the soft tissues of your body. So many surgeries are totally unnecessary – the problems can be massaged away. 85% of population gets lower back pains. Majority of the problems can be massaged away very quickly and then kept away with a daily 3-minute exercise. Tense muscles cause most headaches and migraines. You can learn how to massage them away. Just about all soft tissue pains and aches can be massaged away, unless the pains were caused by injuries.

The founder has several grand nieces and grand nephews. They are all pre-teenagers and whenever he visits them they LOVE to be massaged. A masseur can learn a lot from massaging children – most of them have very little fat under their skin, so it is easy to get to all surface muscles, as well as to most muscles in the deeper layers. Their soft tissues respond fast to corrective manipulations.  We spoke to several masseurs about our experience with children and they agreed – parents and grandparents massaging their own children or grandchildren were often amazed just how bonding these massages were. It brought them closer together than just about anything else before; and couples too. From a therapeutic massage it is easy to switch to relaxing, or sensuous, or erotic massage.