People want to know why I chose massage therapy as a profession. This is usually the first question a new client asks me.
There is something about massage therapy. It’s got a certain luxurious caché. It’s a popular profession, yet there aren’t many of us. When people find out what I do for a living, they raise their eyebrow, smile, maybe laugh and point hopefully at their shoulders. I get offered discounts on things, like I’m some kind of good cause. Dogs like me.
Looking at it one way, massage therapy is the most natural and obvious healing method in the world: the laying on of hands. At the same time, it seems foreign and exotic. We live in a touch-deprived culture, after all. Compared to a visit to your doctor, an appointment with your massage therapist is long and personal. What a strange line of work! People are curious.
So why do I do it?
The simple answer is, because I love it. And I love it because it works, because it moves me. When I get a good massage, I am a changed man. I get off the table and float on a cloud for days. It wakes me up at the same time that I sleep better. It’s like someone focused the world and made the colours brighter.
Really, I’m a massage therapist because I want to do that for other people. It’s my job to be the best hour in your day. But that’s just the tip of the iceberg. Massage therapy feels fabulous for a reason. It works. It is physiologically and psychologically potent. If you read only one thing on this website, read this. Let me share with you the depth of my enthusiasm for massage therapy …
Message from the future
I first wrote this article in about 2001. I’m writing this brief update in 2013. A lot has changed! On the one hand, I’m vastly more educated and cynical about manual therapy, and there’s a bunch of stuff in here that seems hilariously naive and simplistic to me today. On the other hand, I still really love massage. Rather than trying to revise this article and keep it updated and consistent with my fancy modern views, I’m letting it stand as something of a nostalgic record of what I used to think. But if you want to know what I think now, you can also read a very different article: Does Massage Therapy Work? A review of the science of massage therapy … such as it is.
Massage therapy is preventative health care
In pre-Communist China, wealthy families hired physicians to keep them in good health. The physician was paid a retainer as long as his clients were healthy. If they became sick, the payments stopped.
There’s nothing like that today, not in alternative medicine or mainstream. Everyone wants to get paid up front. Doctors have a bad rap for neglecting “prevention,” but the truth is that prevention is just hard. All decent doctors do indeed try to convince their patients to take up healthy habits and quit the dangerous ones, but mostly it’s up to us.
Massage therapy actually has some potential to prevent some serious pain problems, head them off at the past. The science of massage and analysis of the evidence for and against it is covered in another article. This article has a more relaxed, philosophical approach to the topic.
Another Day, Another Fracture
I know an old farmer, an eighty-something acquaintance from Ontario. He is one of those guys who just won’t quit: he’ll work until he’s dead, or work himself to death. He was fixing his roof a couple years back, and he fell a dozen feet and was immobilized by pain at the foot of his ladder. He refused help, however.
“I haven’t been to see a doctor in thirty years, and I’m not starting today!”
Fortunately, he couldn’t put up much of a fight, and his sons pretty much carried him into town, where his x-rays revealed something surprising. Not only had he fractured his spine, it was clear that he had done it six times before over the years. Without noticing. He had “worked through” every accident.
One of my clients was a professional snow boarder for several years: an intensely active and fearless man, paid good money to travel around the world leaping off cliffs for television cameras. In a decade, he broke nearly every bone in his body, many of them several times. Most people don’t absorb this much punishment in a lifetime, yet he is one of the healthiest people I know.
How does that work? How does a farmer fail to notice six spinal fractures? How does an athlete heal completely from injuries that would cripple most of us? What’s the difference between the people who bounce back from almost anything, and the rest of us?
Fit as a Caveman
Travel in time for a moment. Picture a prehistoric individual. Let’s call him Thag. Thag isn’t going to live long. Without antibiotics and surgery, something will take him out of the gene pool by the age of thirty. But Thag is tough. Very tough.
Thag gets about six hours of hard exercise per day, more or less. The rest of the time, he spends snacking on dozens of types of plants and hanging out with the tribe. There are no chemicals added to his food. He hardly ever inhales anything toxic, except for a bit of woodsmoke. And at the end of the day, he goes to sleep for at least eight to ten hours, because it’s usually dark for at least that long.
I wouldn’t want to be Thag — I like showers and modern dentistry. However, I do believe that humans, for most of history, probably enjoyed much greater physical fitness than we usually give them credit for.
Consider your own modern life for comparison. You’re probably going to live a long time, but you are not — let’s face it — very tough. Chances are, your lifestyle is the polar opposite of Thag’s. You probably get about six hours of sleep every night, spend eight to twelve hours per day in a chair (or the equivalent), you inhale pollutants of every description, and eat a contaminated diet of almost ridiculous simplicity and excess compared to your ancestors.
Only a handful of modern people, if any at all, are blessed with the kind of physical toughness that our ancestors earned by their lifestyle. We are more vulnerable than we should be, more vulnerable than we have to be. More to the point, we have a low pain threshold.
The Pain Threshold
The pain threshold is the point at which your body cannot absorb any more punishment without painful consequences. We are adaptable creatures, but there is only so much that we can take. Every time you get hurt, physically or emotionally, you hold yourself a certain way to avoid the pain or minimize the stresses, as well as both real and imagined threats.
Soon these patterns feel normal, and the adaptation becomes a new limitation. Do this a few times per year, as everyone does, and it starts adding up.
When you’re a kid, you can get away with anything: fall off the roof, ski into a tree, even break a leg and you can bounce right back. That’s youth, right? But the adaptations are accumulating and turning into limitations, year after year. Meanwhile you are increasingly poisoned, exhausted, malnourished, and kept in chairs by our modern lifestyle. By the time you are forty, chances are good that you’re running out of ways to avoid feeling the pain, no matter how much you twist and squirm. This is aging.
How well you respond to an injury has everything to do with how tense you’ve been for the last ten years. As you approach the pain threshold, all it takes is a little nudge to push you over the edge. Someone bumps into the back of your car at 25 kph, and suddenly you’re in pain for six years and up to your eyeballs in ICBC and WCB claims, ambulance-chasing lawyers, and doctors who think you’re just trying to make an easy buck.
Most people are a serious injury waiting to happen. Or rather, a minor injury with serious consequences. Chances are good that you are in that category. If you can’t get through a day (or a night) without your neck stiffening up, what are your chances of bouncing right back from a car accident? I see it every single working day: people who were merely “stiff” last year can no longer play golf, work at a computer, or walk the dog.
The aches and pains of today are the life-changing disasters of tomorrow. But massage therapy can pull you back from the edge.
Better than sex?
One of my favourite clients — an intelligent physician and a great conversationalist — came to see me because she thought that some massage therapy would be “pleasant.” She didn’t think she had any medical need for it; she just wanted a relaxing rubdown. But to her surprise, the benefits of her first massage lasted all week.
“I didn’t expect that,” she told me after several more massages. “I thought that it would just feel good for an hour. But massage is actually helping me! I feel better all the time now.”
“Imagine that,” I said, smiling.
It amuses me that anyone would be surprised by the perceived potency of massage. Skillfully manipulating and stimulating all of your skin, muscles, nerves, connective tissues, and joints is going to have some kind of effect on an organism. How could it not?
Like the rest of you, a muscle is mostly water. It shouldn’t hurt at all when you press on it. If it does hurt — and it often does — something is wrong. Stiff and sore muscles are sick muscles: they have a pathology called “myofascial pain syndrome.” They are full of junk molecules, the waste products of metabolism. They are irritated and choking off their own blood supply, starving for oxygen, nutrients and clean tissue fluids, and unable even to exercise to save themselves. Massage can break this vicious cycle, pulling you back from the edge simply by squeezing sick muscles like used sponges. (That’s an oversimplification, for sure. It may not really work quite like that. But it’s a good descriptive working theory.)
Breaking that cycle is only one of the most basic physiological effects of massage, however. There are more mysterious benefits, more difficult to prove in scientific journals. Massage therapy works, in general, because it is a kind of passive exercise and stimulant for your skin and muscles — enormous and complex tissues, with stunningly complex neurology. One covers us, the other holds us together and upright. If they don’t feel good, we don’t feel good. Massage wakes them up physiologically, stirs the forces that keep them fit and vital.
The human body is designed to work perfectly with a minimum of maintenance. The healthiest people alive are the ones who simply get plenty of fresh air, exercise, rest and high quality food. Give the body what it needs, and it thrives. Something else the body needs — especially if the basics are missing — is plenty of tactile stimulation. Unfortunately, we are all touch-deprived, and most people today suffer from a kind of numbness of the skin and deadness of the muscles. Baby mammals literally die without touch — it is essential for the development of our nervous systems. We are tactile beings. To have this simple biological need answered is profoundly soothing, the sensation of relief so intense that it changes lives. I have lost count of the number of times that people have told me that massage therapy is “better than sex.”
Massage reminds people what it feels like to feel good.
Not all therapy is relaxing, but all relaxation is therapy. As that relief sinks in, people sleep better and exercise more comfortably, which in turns makes everything else in life easier. It becomes possible to move and feel in ways long forgotten, to regain some of that adaptability lost over the years. Injury becomes less likely as your reflexes wake up and your coordination is stimulated. Finally, and most importantly, the consequences of stress and injury become less severe as you retreat from the pain threshold.
Three years of agony
Four years ago a middle-aged woman came into my office. She was a salt-of-the-earth type, a sensible and practical mother of three, weary with her burdens but stoic, even cheerful. I noticed immediately that her arms hung at her sides like dead weights. Her handshake was weak and cold.
“What can I help you with?” I asked her.
“I can’t use my arms anymore,” she said. “And the doctors don’t know what to do with me.”
I was surprised to see her smiling. Her arms had simply started to hurt several years before. They were injured easily and healed slowly. Eventually, they were nearly useless. I asked her if she could still lift her arms. She raised one perhaps twenty degrees, and smiled again.
“There. See? It’s dead. No sensation at all.”
Indeed, her pulse completely disappeared every time she raised her arms even slightly. They were the colour of skim milk. She could barely sleep for the pain in her shoulders and neck, and she had been like this for about three years. She had lost her job, couldn’t get another one, couldn’t cook a meal for herself, couldn’t drive or play a sport … and couldn’t even get a WCB claim approved.
This woman probably had an unusually nasty case of “thoracic outlet syndrome.” In this controversial, complex condition, circulation to the arms may be strangled by tight muscles in the chest and neck. The arms literally starve for oxygen and nutrients and become fragile, prone to injury, and slow to heal. It’s important to point out that this is simply an intense and localized version of what often happens to peoples’ entire bodies in the modern lifestyle.
It appear that I was able to give her significant temporary relief, but her condition was too advanced for cure. If only she had come to me five years before, I might have been able to spot the warning signs and perhaps saved her career and spared her three years of agony. (Many years later, that sentence sounds a little arrogant and overconfident to me, but I’ll keep it around for perspective! — Paul)
The first time people come to me, it is usually because something has already gone wrong. That’s the way our system works: when you break, you look for help. Often, people end up knocking on my door because they’ve discovered that the medical system doesn’t really know what to do with them. Indeed, that system usually does not understand even the ordinary aches and pains that account for the majority of visits to doctors’ offices — something doctors themselves often admit. Aches and pains are not something that was ever on medical “radar” until surprisingly recently in history.
But my profession is devoted to those aches and pains.
Years after treating that first terrible case of thoracic outlet syndrome, a much younger woman walked into my office and showed me the early warning signs of the same condition.
It's a Lot Like Your Car
This young woman could have been the daughter of my client with the dead arms. She was twenty, a vibrant optimist, and ready for anything. A brilliant pre-med student, she had me laughing in moments, showing a familiar sense of humour in the face of adversity. She also played golf competitively.
“She’s the best player in my line-up,” her coach told me. “One of the best young golfers I’ve seen in many years.”
But after two years of slouching over her textbooks at UBC, her arms started to hurt for lack of oxygen. One day she swung a club and something went wrong. The pain made her drop the club and cry, and she hadn’t been able to pick it up again for a year. Just like everyone I’ve ever seen with thoracic outlet syndrome, a long series of doctors and physiotherapists had already been stumped by her slow healing. But this time, it was still relatively early. There was still a chance for her to heal completely!
In six challenging but successful treatments, she was out of pain from day to day. She could turn taps, lift books, study and sleep without discomfort. Although she still can’t swing a club, she is ecstatic with her progress. The stage has been set for a complete recovery, and a triumph of early intervention. She is now continuing with massage therapy, and seems likely to be playing competitive golf again by next year.
What if she had stopped coming as soon as the worst of the symptoms were resolved? This is a common scenario, unfortunately. Just as people don’t seek help until something goes wrong, they often stop as soon as the worst of the symptoms are resolved.
Unfortunately, massage therapy does not usually work miracles in batches of six treatments. It can get you over the hump. It can take the edge off, and that can be worth every penny. But it can’t fix you up so well that you become magically immune to five more years of slouching in your office chair for ten workaholic hours per day. Chronic pain and stress require chronic care.
Preventative health care for your body is not much different than preventative maintenance for a car. You have a choice: you can spend a hundred dollars on a widget for your car now, or you can buy a whole new engine in a year. Most people have no trouble understanding that equation. For some reason, many people have a different attitude about the human body. In fact, most people spend significantly more on their cars each year than they do on their own health care!
Invest in your health! Whether you are healing from a major accident, or simply trying to slow the downward slide into the rigidity and fragility of aging, massage therapy is most effective when it is used as preventative medicine. And preventative health care is simply the best kind of health care there is. It is easier to keep you healthy than it is to fix you once you are broken. And if you think massage therapy is expensive … try chronic pain.
A pound of prevention
We know that an ounce of prevention is worth a pound of cure … but perhaps you didn’t know that massage therapy is a pound of prevention.
I estimate that massage therapists spend more time with their clients than any other health care professionals, with the exception of the psychologists and psychiatrists. And most of that is spent with hands on, as well as in conversation. I have the time to share my expertise with you. I have the time to listen, to answer all your questions. To teach you whatever you need to know. To be thorough. To notice things that other health care professionals might miss. A massage therapist makes a great watchdog for your health: we know the warning signals for all kinds of disease and dysfunction, and we are likely to spot the need for a visit to a physician.
Massage therapists in British Columbia are health care professionals, the best trained massage therapists in the world. I can tell you something interesting about every muscle in your body, and I am practiced in dozens of manual therapies, not to mention exercise therapy, postural correction and ergonomics, and nutrition.
Imagine the things that you learn about people after your hands have been on thousands of people, for thousands of hours!
No bitter pill
Massage feels good, and it keeps you feeling good. What more could you ask for in a “therapy”?
Acute care is a root canal. Preventative medicine is brushing your teeth. Which one would you rather do? Prevention is always more gentle than reaction. But massage therapy shines even among preventative therapies: it actually feels terrific.
Massage therapy is no bitter pill to swallow. All day long, I work with happy people. People who are having the best hour of their day. People who think of my office as an oasis, practically a holiday.
For many people who have already been thrown across the pain threshold, massage therapy is a matter of survival. It keeps them in life. It is the one thing that keeps their chronic pain from being chronic disability. But even when the stakes aren’t so high, you can’t put a price tag on feeling good. The satisfied physician I mentioned above said to me, “I feel better all the time now.”
How much is that worth to you?
About Paul Ingraham
I am a science writer in Vancouver, Canada. I was a Registered Massage Therapist for a decade and the assistant editor of ScienceBasedMedicine.org for several years. I’ve had many injuries as a runner and ultimate player, and I’ve been a chronic pain patient myself since 2015. Full bio. See you on Facebook or Twitter.
- Does Massage Therapy Work? — A review of the science of massage therapy … such as it is
- The Chiropractic Controversies — An introduction to chiropractic controversies like aggressive billing, treating kids, and neck manipulation risks
- The Complete Guide to Trigger Points & Myofascial Pain — An extremely detailed guide to the unfinished science of muscle pain, with reviews of every theory and treatment option