Fundamentally, massage is a touch therapy. McCarthy (1998) hypothesised that because the sense of touch is inextricably linked with the skin, touch is an innate life-sustaining sense, which is context-dependent, a means of communication, and most notably a ‘healing medium’. Indeed, massage is the oldest known form of therapy; it has been indicated for restoration of physical health and relief of psychological stress throughout history, and in most cultures (De Domenico and Wood 1997; Salvo 2003).
The type of massage that is often termed ‘aromatherapy massage’ in the UK, Australia and New Zealand is derived from the system developed by Marguerite Maury in the 1950s and 1960s. The massage is carried out with a blend of three or more essential oils – essential oils are rarely used singly. However, it is apparent that different training establishments have adopted different styles, and
aromatherapy massage is now a diverse practice. Aromatherapy massage could be considered a hybrid, incorporating manipulations and techniques from distinct bodywork disciplines such as Swedish massage, acupressure and lymph drainage massage, and also styles such as Esalen massage, which is characteristically slow and rhythmical. However, whatever the style and techniques used, aromatherapy massage is usually holistic in nature, generally non-specific, and embraces the principles of therapeutic massage – focusing on the recipient’s well-being rather than specific complaints, illness or injury.
Many individuals seek aromatherapy massage to alleviate ‘stress’. Stress has many causes; however, an almost inevitable physical consequence is myofascial stress. There is a predictable sequence of events that occurs when the muscles and their associated connective tissues are subject to stress (see Fritz, Paholski and Grosenbach 1998). This sequence is summarised below.
Localised oedema → pain → pain/spasm/pain cycle → chronic irritation and inflammation → hyperactivity in the tissues → microphages and fibroblasts activated → connective tissue production increases → fascia shortens → affecting nerves, blood vessels, lymph, muscles → muscles develop chronic hypertonicity → fibrotic changes
→ increased tension in a muscle causes inhibition of agonists and facilitates synergists → postural muscles shorten and phasic/motion muscles weaken, ischaemia in tendons → periosteal pain develops → abnormal biomechanics and body-wide compensatory patterns develop
→ joint restriction/imbalance → fascial shortening and immobility increases → trigger points develop → generalised fatigue due to energy being used to maintain unproductive patterns → sleep patterns interrupted → sympathetic arousal heightened, generalising the pattern
→ immune response inhibited → more serious systemic problems may develop…
Aromatherapy massage can be very effective in interrupting this sequence and promoting physical and emotional well-being, as well as aiding healing of soft tissue injuries. The term ‘massage’ includes a wide range of techniques, and in the West most practitioners will use manipulations derived from classical ‘Swedish’
massage, developed by Pehr Henrik Ling (1776–1839), a Swedish fencing master and founder of the Central Institute of Gymnastics in Stockholm. The manipulations in common use today include effleurage (which encompasses stroking and gliding), petrissage and kneading, friction, vibration and tapotement (percussion). These manipulations elicit a whole range of physical, physiological and psychological effects. There are two mechanisms that produce these effects;
the physician James Mennell first identified these in 1917. He classed the effects of massage as either mechanical effects or reflexive effects.
Mechanical effects are directly due to the massage manipulation affecting the soft tissues by direct force. Examples of mechanical effects are changes in venous return, fluid displacement, tissue fluid exchange, creation of heat causing vasodilation, stretching of muscle fibres, hyperaemia and minor cellular damage, which in turn brings about biochemical effects and their consequences. Reflexive mechanisms elicit effects via the nervous system. Reflexes are rapid responses to changes in the environment, which help maintain homoeostasis. Many massage manipulations stimulate reflex response. Reflexes take priority in a sensory signal, and their stimulation will result in a shift in homoeostasis. Many of the therapeutic responses of massage are reflexive effects.
Reflexive responses also include biochemical effects, where there is a release of chemicals from disrupted or irritated cells. For example, mast cells will release histamines, which are vasodilators that also increase the permeability of blood capillaries. Reflexive responses can also work via the autonomic nervous system and endocrine system.
Massage incorporates elements of touch, pressure and vibration. These are stimuli that affect sensory receptors, which in turn results in a shift in homeostasis.
For example:
• Light touch stimulates root hair plexuses, free nerve endings, Type 1 cutaneous mechanoreceptors and Meissner’s corpuscles.
• Compression and deep stroking stimulate pressure receptors, Pacinian corpuscles and Type 2 cutaneous mechanoreceptors.
• Vibration and tapotement stimulate touch corpuscles and Pacinian corpuscles.
• Muscle spindles respond to manipulations that stretch the tissues and muscle fibres.
• Proprioceptors, located in skeletal muscle, tendons and joint capsules are affected by manipulations that involve stretching or active/passive/assisted movement.
• Thermoreceptors detect hot and cold stimuli. (There are more receptors for cold.)
Reflexive effects include changes in muscle tone, muscular relaxation or contraction, vasodilation (the CNS acting as a mediator of autonomic nervous system responses) and analgesia – for example, hyperstimulation analgesia, counter-irritation and the pain gate mechanism.
In reality it is difficult to separate the mechanical and reflexive mechanisms, when considering the effects of specific massage manipulations. Often there will be elements of both. However, the outcome and effects of the massage will depend
on the location and application of the strokes. Each movement within a massage routine should have a specific purpose, and the routine should be tailored to meet the needs of the individual.
Salvo (1999) gives a comprehensive overview of the therapeutic effects of massage and their mechanisms. Massage stimulates the skin, and this includes the stimulation of sebaceous gland and vasomotor activity. The increased sebum production and vasodilation in turn increase cell nutrition, resulting in a general improvement in skin condition. Skin stimulation and the resultant warmth and vasodilation will probably enhance essential oil absorption during aromatherapy massage.
Both blood and lymphatic circulation can be positively affected by massage.
For example, venous return is stimulated, circulation is enhanced and blood pressure can be temporarily decreased. Even the oxygen carrying capacity of red blood cells is increased, and the number of white blood cells in the capillaries is also increased. Lymphatic circulation is stimulated, and so metabolic waste and cell debris can be eliminated more rapidly. It is also believed that massage can strengthen the immune system by increasing the numbers and activity of natural killer cells. This, in conjunction with the immuno-stimulant actions of some essential oils, may explain why aromatherapy massage appears to support the immune system.
Massage can affect the soft tissues of the body, especially the fascia and muscles, by relieving adhesions, restrictions, tightness and spasm. The effects on the nervous system are also considerable – both stimulation and sedation are possible, and pain relief can often be achieved. Massage can increase delta wave activity, which is associated with deep sleep, increase alpha wave activity, which is associated with a relaxed, meditative state, and decrease beta wave activity, which is associated with mental alertness and stress. Studies that have demonstrated the effects of essential oils on brain activity (Diego et al. 1998; Moss et al. 2003b) have already been mentioned; again, it is possible that in some circumstances we are witnessing a synergistic effect between touch/massage and essential oils, perhaps explaining why essential oils enhance the therapeutic effects of massage and vice versa.
Massage can also stimulate the parasympathetic nervous system and so promote the relaxation response, slow down the rate of respiration and relieve stress and perhaps depression, because dopamine and serotonin levels may be elevated following massage. It has been demonstrated that some essential oils, such as lavender, can stimulate the parasympathetic system (Ludvigson et al. 1989;
Diego et al. 1998; Moss et al. 2003a; Lehrner et al. 2005), which again suggests that there may be a mutually enhancing action between essential oils and massage.
Stimulation of the parasympathetic nervous system will also stimulate digestion. The digestive process can be further enhanced by abdominal massage,
which will encourage peristalsis, and also increase urine output by stimulating capillary circulation and promoting lymphatic drainage. The excretion of some metabolic wastes, such as nitrogen, inorganic chlorine and phosphorus, is increased after massage (Salvo 1999).
The effects of massage are not limited to the physical and physiological domains; it is ‘not limited by anatomical boundaries but involves the abstract world of the imagination, emotions, thoughts and full-life experience of the individual’
(Lederman 1997, p. 157). Thus massage can elicit psychological changes too, including mood changes, behavioural changes and changes in self-perception. In conjunction with essential oils, these effects may be positively enhanced.
Even without essential oils, holistic, non-specific massage is of considerable therapeutic value. However, when appropriate essential oils are included, the therapeutic potential is amplified. Some recent studies that have investigated the effects of aromatherapy massage, illustrate this.
Kuriyama et al. (2005) conducted an investigation into the immunological and psychological effects of aromatherapy massage. This study compared the effects of aromatherapy massage using essential oils of lavender, cypress and sweet marjoram in sweet almond oil with massage using sweet almond oil only, on eleven healthy adults. Both types of massage were shown to induce relaxation and decrease the state anxiety score; no differences were noted. There was a reduction in the serum cortisol levels after aromatherapy massage, but not after the control – however, this difference was not statistically significant. However, there was an increase in the numbers of total, CD8+ and CD16+ lymphocytes after the aromatherapy massage (with a significant increase in CD8+ cell counts), but not after the control massage.
It was concluded that aromatherapy massage is a valuable technique for reducing anxiety and stress, and was beneficial to the immune system. This study supported the hypothesis that essential oils can stimulate the function of white blood cells.
Dobetsberger and Buchbauer’s 2011 review highlights eleven robust studies that indicate that aromatherapy massage can reduce anxiety in cancer patients, at both the pre-operative and the post-operative stage. One of the studies (Imanishi et al. 2009) also demonstrated that the immunological state of the participants was improved. Dobetsberger and Buchbauer also commented that:
…if an aroma massage with an EO or an EO mixture is able to significantly reduce the anxious feelings of cancer patients (either before surgical intervention or especially afterwards during the healing process wished for), in particular, then all arguments against such an aromatherapeutic treatment have lost their justification. (Dobetsberger and Buchbauer 2011, p. 305) The same review paper also includes studies that demonstrate the ability of aromatherapy massage to reduce stress, and no less important, its potential to provide stimulation and promote alertness. Many of the studies on anxiety and
stress reduction have focused on the essential oils with a reputation for these actions, such as lavender, neroli, rose and citrus peel oils like bergamot, sweet orange and lime. Researchers look to oils that are often described as stimulating and activating for studies exploring cognitive functions, vigour and alertness – especially rosemary, peppermint, eucalyptus and jasmine. Again, the studies cited support the established aromatherapeutic uses of these oils in conjunction with transdermal absorption and massage.