Massage therapy is also being investigated as an aide to patients with more neuromuscular disorders, such as multiple sclerosis (MS). A Iranian 2013 study published in Clinical Rehabilitation looked at 48 individuals with MS who participated in a five-week massage experiment. They were assigned to one of four groups: massage therapy, exercise therapy, combined massage-exercise therapy and control group.

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Reflexology practitioners and the professional association have advocated that reflexology is effective for general well-being maintenance and treatment of chronic diseases such as strokes, musculoskeletal disorders, and stress. Due to its soothing massage and non-drug complementary nature, reflexology is widely accepted by general public. Yet, numerous systematic reviews confirmed that strong evidence of the positive effects of reflexology postintervention are lacking despite plenty reported small-scale trial and anecdotal evidence of reflexology for some common ailments. Adequate training of practitioners and reflexology programme accreditation are to ensure correct and consistent services are provided.

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Deep tissue massages are not for everyone, and it’s very important to find a well-trained therapist. If you’re actively healing from surgery, have nerve damage or an existing injury, you’re wearing a cast or brace, or you’re pregnant, then talk to your doctor before seeking a massage therapist. Although it’s rare, massages that are poorly performed can sometimes cause increased pain, inflammation and other complications in high-risk patients. (16)

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A form of massage therapy based on the assertion that there are 7000 to 72,000 nerve endings in the feet for all organs and body regions, and stimulation of these endings can be used to treat a wide variety ailments or disorders. Reflexology consists of manual stimulation with the thumbs and fingers of cutaneo-organ reflex points on the feet, as well as on the ears and hands. Reflexologists believe that the body is divided into 10 distinct energy zones or channels that extend from the head to the feet, and that foot massage increases the flow of healing energy through any or all of these channels; this energy may be blocked by lumps of crystalline material which reflexologists claim to be able to identify during therapy.
When you think of a massage, you probably think of soothing music, a gentle brush of hands softly kneading the stress from your shoulders, maybe even of a loved one offering to rub your back after a long day at work. While some massages can be soothing, and rely on gentle touches to work out a client’s stress or anxiety, there are other massages that have a little more grit to them. For example, the Deep Tissue massage, which is very similar in style to the Swedish massage, utilizes some of the same techniques as its much gentler cousin; Deep Tissue massages, however, are designed to focus on the deeper layers of muscle tissues and fascia, the protective layer that surrounds muscles and joints. Working out these harder to reach muscles will require more pressure, making the Deep Tissue massage slightly uncomfortable, gritty and highly effective.
Similar to Thai massage, in a Swedish massage the client’s joints and muscles are compressed and stretched. This can cause an immediate release of energy that might cause the skin to flush. Clients might also experience a few temporary aches as the body readjusts itself, depending on their level of flexibility and any current physical ailments. For example, a person who arrives at a practitioner’s office with an ultra-tight muscle that has been traumatized may experience some pain while the trauma is massaged out and worked through. In massage, areas of stress and pain can act as blockages to the body’s circulation, energy flow, and overall well-being.
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"Back before we started wearing shoes everywhere, we developed natural stimulus points from the ground [making direct contact] with our feet," Colin says. "By walking and getting that stimuli, we would relieve stress. We don't get that anymore. So the idea of reflexology is going back and mimicking that stimuli to specific points and feeling where that stress sits."
Keep in mind that reflexology is not a substitute for medical treatment, but is a supportive measure. There are two reflexology points on the feet that may help with knee pain: 1) Spine reflex point on the inside portion of the feet from the edge of the heel to the neck of the big toe. 2) Knee reflex point, one inch below the ankle bone in the small, soft triangular section.
Aspects of sports massage therapy are gaining popularity as useful components in a balanced training regimen. Sports massage therapy can be used as a means to enhance pre-event preparation and reduce recovery time for maximum performance during training or after an event. Athletes have discovered that specially designed sports massage promotes flexibility, reduces fatigue, improves endurance, helps prevent injuries and prepares their body and mind for optimal performance.
Expect to work hard breaking into the sports environment. Get additional training and develop your expertise in orthopedic massage and functional assessment, clinical massage, myofascial work and stretching. Start by getting involved with your AMTA chapters’ Sports Massage Team; this provides excellent hands-on experience and each event looks great on a resume.
There is absolutely a time and a place for DTM, the problem is that everyone has a different idea of what this means. Some therapists go after deep fascial layers, some therapists think this means trigger point work, and some just increase pressure as much as they can. If the client and therapist don’t have an open dialogue with clear instructions of when ‘enough is enough’, the client can experience a lot of discomfort and we don’t want that.
Trigger points or stress points may also cause muscle soreness and decreased flexibility. These points are specific spots in muscle and tendons which cause pain when pressed, and which may radiate pain to a larger area. They are not bruises, but are thought by some to be small areas of spasm. Trigger points may be caused by sudden trauma (like falling or being hit), or may develop over time from the stress and strain of heavy physical exertion or from repeated use of a particular muscle.

DTM can be useful to those that are recovering from an injury (once the client/patient is out of the acute phase), for athletes, for people with postural strains, or people with chronic pain. Typically there is an area or a few areas where this type of work is needed. For example, a person who has chronic postural pain/tightness from sitting at a computer, might need DTM to their shoulders, chest, and upper back/neck. They likely, do not need DTM on their whole body. Some therapists might disagree with me here, but I rarely think a full-body, DTM, is needed. It can simply be too much. I would rather see a client more often, for less-intense sessions. It is simply more effective. It is the same as Physical Therapy- it is more effective to do it regularly.
The significant difference in the two approaches is their effect on these layers. A Swedish technique uses lubricant to glide over the layers – whether that be on a superficial layer (light pressure) or a deeper layer (firm pressure). There may also be kneading of the muscles, vibration or percussion to stimulate the muscles, and passive and/or active joint movements. All of these techniques serve to increase circulation of blood and lymph, soften and relax the tissues, reduce cortisol levels in the body (the stress hormone), and provide a generalized sense of relaxation for the client.

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Until better evidence is published in peer reviewed journals, he remains skeptical of claims that by massaging or applying pressure to specific points on the hands or feet, a reflexologist can alleviate problems in corresponding organs or other systems throughout the body. He has seen no evidence showing that reflexology is effective for pain or any health problems unrelated to the feet and hands. He urges caution with regard to claims that reflexology can cleanse the body of toxins, increase circulation, promote weight loss, or successfully treat earaches, hemorrhoids, emphysema, heart disease, thyroid disorders or any other health condition.


This is not only an inaccurate and potentially harmful picture of this type of therapy, but such misguided practices can bruise muscles, elicit a defensive reaction in a client’s body, and worsen pain cycles. Properly executed deep tissue work should not cause the client to grit their teeth in agony as the therapist coerces the body into submission! If you find yourself clenching, shortening or holding your breath, or gritting your teeth, then it’s TOO DEEP. Even when it gets intense, it should not go above about a 7 on the pain scale: enough to “hurt so good,” but not enough that you want to leap off the table (and never come back).
The American Commission for Accreditation of Reflexology Education and Training (ACARET) sets the standards for education required for the reflexology profession. It also credentials those involved with educating students of reflexology. The American Reflexology Certification Board (ARCB) has a three-part examination process to ensure the practitioner has met the standards set by the board. In order to be certified through ARCB, a minimum of 110 hands-on training hours must be completed.

The researchers also note there are psychological benefits for athletes receiving massages, which other research shows can include improved focus and confidence. Although more research is still needed on a long-term scale, both tissue healing and the psychological effects of massages are areas that seem promising for both professional and recreational athletes.

Most deep tissue massages normally focus on major muscle groups — such as the neck or lower back — along with joints and tendons that are susceptible to straining or injuries. Certain areas of the body that tend to tense up in times of stress, including the shoulders, neck and hips, can often benefit the most from this type of deep manipulation. Many people consider “sports massages” to be a form of deep tissue massage, which involves physical treatment primarily to neuromusculoskeletal systems to treat pain and disability, improve muscle recovery and joint mobilization, and prevent injuries.
Another alarmingly common example is the sensation of skin tearing. This has been inflicted on me personally on at least three occasions, and not by poorly trained therapists — quite the opposite, the perpetrators were all well-trained massage therapists doing a kind of “fascial release” therapy that they clearly thought of as an “advanced” technique.7
Accredited sports massage therapists must first complete a course in general massage from a school accredited by the American Massage Therapy Association/Commission on Massage Training Accreditation/Approval (AMTA/COMTAA) or their State Board of Education. They must then complete an additional training program approved by the AMTA National Sports Massage Certification Program. Many sports massage practitioners also complete the National Certification Examination for Therapeutic Massage and Bodywork.
For starters, you bear in mind the things described above that tend to cause ugly pain, and you avoid that kind of therapy like the plague. Then you look for some clues that painful pressure is okay. Here are at least three reasons why unpleasantly intense pressure might be therapeutic — “bad pain,” but not ugly. In each of these situations, it might be acceptable to tolerate sensations so intense and painful that the only thing about them that is pleasant is the part where it stops. 

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Reflexology was introduced into the United States in 1913 by William H. Fitzgerald, M.D. (1872-1942), an ear, nose, and throat specialist who called it "zone therapy." As noted in the diagram to the right, he used vertical lines to divide the body into 10 zones. Eunice D. Ingham (1899-1974) further developed reflexology in the 1930s and 1940s, concentrating on the feet [3] Mildred Carter, a former student of Ingham, subsequently promoted foot reflexology as a miraculous health method [4-6]. A 1993 mailing from her publisher stated:
For about 3000 years, Chinese practitioners have used this reflexology technique to energize a tired person. It was used to improve the vitality and wellbeing in general and to this day, its purpose remains the same. If you are really stressed out these days or want to release tension, then you must go for foot reflexology. In this article, you will get to know all about foot reflexology, from its basics to its complexities.

A form of massage therapy based on the assertion that there are 7000 to 72,000 nerve endings in the feet for all organs and body regions, and stimulation of these endings can be used to treat a wide variety ailments or disorders. Reflexology consists of manual stimulation with the thumbs and fingers of cutaneo-organ reflex points on the feet, as well as on the ears and hands. Reflexologists believe that the body is divided into 10 distinct energy zones or channels that extend from the head to the feet, and that foot massage increases the flow of healing energy through any or all of these channels; this energy may be blocked by lumps of crystalline material which reflexologists claim to be able to identify during therapy.

To understand this difference, it’s helpful to first think of the body’s fascia and muscles in layers. Notice in this image the many overlappinglayers of these tissues. Fascia is a connective tissue which permeates the entire body – literally holding the body together, wrapping around every muscle, nerve, organ, blood vessel, and bone. These wrappings are all interconnected in a three-dimensional maze. The muscle layers run superficial to deep in the body.
Most people feel very relaxed. Some experience freedom from long-term aches and pains developed from tension or repetitive activity. After an initial period of feeling slowed down, people often experience increased energy, heightened awareness, and greater productivity which can last for days. Since toxins are released from your soft tissues during a massage, it is recommended you drink plenty of water following your massage. Massage therapists sometimes recommend a hot Epsom salt bath that encourages the release of toxins that may have been stirred up from the massage treatment.

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Swedish massage helps the body heal itself by physically manipulating and stimulating the body’s circulatory and lymphatic systems. This works to energize and help eliminate toxins in the body. Also, through Swedish massage, a high level of relaxation can often be achieved, and this relaxation can help prepare the body to act as an open, receptive vessel in which healing can more rapidly occur.
It’s important to be open with your massage therapist about the level of pressure and discomfort you wish to endure. This may be different for certain areas and throughout the massage, feel free to communicate with your massage therapist before and during the massage. Some massage therapists find pain to be counterproductive to the process and expect you to speak up if the pain is too much.

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Some possible justifications for painfully intense massage (these aren’t endorsements) include the destruction of motor end plates to “de-activate” trigger points; somatoemotional release (pain often strongly “resonates” with strong emotions like grief); moving tissue fluids; or just creating a strong, novel sensory experiences (which may have many subtle benefits).


Information on this website is provided for informational purposes only and is not intended as a substitute for the advice provided by your physician or other healthcare professional. You should not use the information on this website for diagnosing or treating a health problem or disease, or prescribing any medication or other treatment. Any third party offering or advertising on this website does not constitute an endorsement by Andrew Weil, M.D. or Healthy Lifestyle Brands.

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