Once reserved for the posh and pampered, massage therapy is increasingly being used as a healing tool. "The field has broadened enormously in the last 25 years," said Kelly Russell, a massage therapist and owner of SoMatrix Institute in Hampden. "There has been an incredible renaissance" in massage therapy.
Swedish? Shiatsu? Hot stone? There are several dozen massage techniques -- and their variations -- to choose from. Benefits, according to practitioners, include strengthening immunity, lowering blood pressure, reducing stress, relieving pain and speeding healing.
Massage, said Brenda Griffith, president of the American Massage Therapy Association, "releases endorphins -- it's a natural painkiller."
Some types of massage, including the popular Swedish massage, have become so mainstream that hospitals offer it as part of pain-management programs.
"I refer patients for a variety of conditions," said Gabriel Martinez, a physician specializing in pain management at Baltimore's Mercy Medical Center.
Studies during the past few years, including one by Harvard Medical School's Center for Alternative Medicine Research, support the use of massage as a healing tool. The studies showed that massage can effectively relieve some patients' pain.
Insurance companies, including Aetna, Blue Cross Blue Shield and Cigna, are beginning to cover some massage therapies. Russell said that many of his clients see him along with their regular doctor.
Massage has become big business in the United States. Research from the American Massage Therapy Association, an industry trade group, shows that about 20 million Americans seek massage annually and spend between $4 billion and $6 billion in the process. It is the third most common form of alternative medicine in the country, the group said.
John Smith, a Baltimore martial arts instructor and conditioning coach, believes massage helped him heal. For two decades, Smith, 49, suffered from calf and lower-back pain. About four years ago, he turned to massage. After a year of weekly sessions, Smith's calf problem disappeared. And he says his back is nearly pain-free.
"People look at their bodies as if they are cars: If you have a broken part, you get someone to fix it. That's not the way it works," he said. "You have to fix the whole body, ... and massage has been really beneficial to me."
In Baltimore, a one-hour massage costs about $75. Smith said he was lucky because he "clicked" with the first therapist he found, Betsy Granek, a registered nurse and Hampden massage therapist.
"It's such an intimate connection. You really have to trust somebody," Granek said.
Doctors and therapists recommend that people seek only licensed practitioners, such as those certified by the National Certification Board for Therapeutic Massage and Bodywork, whose headquarters is in McLean, Va.
Maryland licenses therapists separately. It requires a national certification, 60 college credits, 500 hours from an accredited massage school and the successful completion of a written exam.
Therapists say that clients may have to try several massage styles before they find one that suits them.
"Most people don't know what they want or need," Granek explained.
Almost everyone understands that massage feels good, but the reason it feels good isn't exactly clear. The National Institutes of Health defines massage as the manipulation of muscles and connective tissue to promote relaxation and well-being.
Granek said massage triggers the parasympathetic nervous system, which cues relaxation and stimulates immunity.
Mercy Hospital's Martinez recommends massage to patients for everything from pain management to swelling reduction.
Swedish massage, one of the most common techniques, typically is used for relaxation. Russell practices the Feldenkrais Method, which incorporates massage, stretching and exercise. Russell said his clients, who include athletes and artists, are looking for higher levels of performance in addition to resolving pain.
Caution for sick people
Yet while massage may melt knots and ease pain from overworked muscles, even a skilled practitioner's touch could mean trouble if a client is feeling under the weather.
"If something is going on, you could get sicker faster," said Garnet Adair, chairwoman for the National Certification Board for Therapeutic Massage and Bodywork. "I have sent people home who had a cold."
Practitioners and doctors say consumers should see a doctor or at least use caution before deciding to get a massage.
People with colds or fevers, for example, might reconsider keeping an appointment, Adair said, because massage can stress a weakened immune system.
Some cardiac patients and those with high blood pressure are also advised to be cautious about massage. In addition, Griffith said, bruising can occur in people taking certain medications or who have circulatory conditions.