Understanding Massage:How Massage Therapy Can Enhance

Self-Care and Vocal Health

Alissa Deeter

The body is the inherent host ofthe vocal instrument and its physiolog-ical and emotional health has a directrelationship to the'well-being of thevoice. Stressors may be physical orpsychological and often involve a com-bination of both. Either may interferewith optimal vocal technique. Massagetherapy is a body-centered therapythat can have profound impact on thebody, mind, and emotions and couldbe considered a valuable element ofself-care along with good nutrition,proper rest, and exercise.

DEFINITION OF MASSAGE

The American Massage TherapyAssociation (AMTAD) defines mas-sage as manual soft tissue manipula-tion and includes holding, causing

movement, and/or applying pressureto the body. The AMTAP defines mas-sage therapy (MT) as a profession inwhich the practitioner applies man-ual techniques, and may apply ad-junctive therapies, with the intentionof positively affecting the health andwell-being of the client. There are anumber of techniques in existence,and usage depends on the experienceof the therapist and the intended ben-efits desired.

A BRIEF HISTORY OF MASSAGE

The history of massage is both an-cient and global. In Chinese medicine,records of touch as a means of healingdate back to 500 BCE. Other ancientcultures that practiced massage ther-apy included civilizations in Greece,Rome, Turkey, and India. Hippocrates(450-377 BCE), the Greek physicianwho is often referred to as "the fa-ther of medicine," wrote about thebenefits of frictions and rubbing onsprains and injuries. Aristotle (384-322 BCE), Greek philosopher and tu-tor of Alexander the Great, recom-mended rubbing with oil and wateras a remedy against weariness. Sportswere a principal entertainment in an-cient Greece, and gymnasiums werecenters that contained facilities forexercises, massages, and baths. TheRomans borrowed many of the fea-tures of the Greek gymnasia to cre-ate the Roman baths. The Romanwriter and philosopher Seneca (4BCE) wrote a description of the noiseof the Roman bath where he was try-

ing to study: "Or perhaps I noticesome lazy fellow, content with a rub-down, and hear the crack of the pum-meling hand on his shoulder varyingin sound according as the hand is laidon flat or hollow."' Julius Caesar hadhis body "pinched" every day to in-crease blood circulation as a treat-ment for neuralgia. Turkey adoptedthe concepts of the Roman bath intoits own Turkish bath. The ancienttraditions of the Greek gymnasia,Roman baths, and Turkish baths areseen in modem health clubs contain-ing the basic format of exercise space,swimming pool, showers, steam room,sauna, whirlpool, and massage room.The ancient medicine of India, calledAyur-veda (knowledge of long life),dates back at least to the fifth centuryBCE. Included in the Indian healthpractices were movements, breathingexercises, meditation, and massage.

There were very few advances inmassage until the early 1800s, whenPehr Henrik Ling (1776-1839) of Swe-den, a fencing master, poet, and edu-cator, developed a series of movementsknown as the "Swedish movementcure." The movement cure consistedof passive and active movements thatincluded techniques described as shak-ing, hacking, pressing, stroking, pinch-ing, and squeezing. Ling's movementcure became well established in theUnited States by the late nineteenthcentury. John Mezger (1838-1909),a physician in Amsterdam, also be-lieved in the healing power of move-ment. Mezger is credited with cate-gorizing the methods of soft tissue

MAY/JUNE 2006

Journal of Singing, May/June 2006Volume 62, No. 5, pp. 541-545Copyright 2006National Association of Teachers of Singing

541

manipulation into four broad vari-eties: effleurage, petrissage, friction,and tapotement. For the last century,various forms of soft tissue manipula-tion have continued to be developed,and present Western therapies includemodalities from all over the world.

MASSAGE TODAY

Although MT has been practicedfor thousands of years, the acceptanceof it as a viable form of therapy in pres-ent society is still relatively new. Sincethe 1970s the popularity of alterna-tive medicine, defined as the practiceof medicine without drugs, has beena growing trend. Therapies of alter-native disciplines include massage,chiropractic, bodywork, acupuncture,relaxation techniques, herbal reme-dies, energy healing, hypnosis, andmeditation. People looking for non-invasive therapies often turn to mas-sage, and institutions in the medicalcommunity are acknowledging thebenefits of touch therapy. HarvardMedical School provides informationto its traditional healthcare providersto help them guide patients in theiruse of alternative medicine, includ-ing massage.2 In fact, sixty-four medi-cal schools in the United States, in-cluding Harvard, Yale, Stanford,Georgetown, and Johns Hopkins,now offer courses in alternative med-icine, up from twenty-seven in 1995.3Alternative medicine received offi-cial validation from the United Statesgovernment with the establishmentof the Office of Alternative Medicine(OAM) as a branch of the NationalInstitutes of Health.

EFFECTS OF MASSAGE THERAPY

Massage is a holistic therapy. Holis-tic refers to those approaches that takeinto account the wholeness of human

beings, that is, the body, mind, andemotions. In this model, massage isapplied to the physical body, yet it in-fluences all other components of thewhole person. MT affects the body's bi-ological, physiological, neurological,and psychophysiological mechanisms,and its results are most likely pro-duced by more than one mechanism.

Effects of MT throughBiological Mechanisms

MT involves the application of me-chanical pressure on the muscle tissuein order to decrease tissue adhesion.Mobilizing and elongating shortenedor adhered connective tissue is be-lieved to achieve increased muscleand connective tissue pliability. Con-nective tissue is the most abundanttissue in the body, existing in skin,membranes, muscles, bones, nerves,and all internal organs. Fibrous con-nective tissue makes up the thick,tough ligaments and tendons that holdjoints together and muscles to bone.Fascia is the connective tissue thatsurrounds all muscles, bones, and or-gans and helps to give them shape; itliterally holds the body together andcan be thought of as a continuous sheetof connective tissue that surroundsthe entire body and its contents. Con-nective tissue is ideally pliable andfree moving, but with stress, tension,disease, and injury it can become thick-ened and rigid, sticking to other tis-sues and forming adhesions. MT canhelp restore connective tissue pliabil-ity by breaking up the adhesions.

Effects of MT throughPhysiological Mechanisms

An anticipated benefit to MT is theincrease in blood circulation. The cir-culatory system's function is to pumpblood through the body's environ-ment. It is a transportation system,supplying a means of transit for the

dozens of substances in the blood thatneed to travel throughout the body.Because MT aids the venous returnofblood, it enhances the movement ofnutrients into an area, as well as re-moving metabolic waste products.

MT can increase parasympatheticactivity. This system controls visceralresponses that include slowing theheartbeat, increasing digestive juices,activating the relaxation response,and increasing relaxation substancessuch as endorphins.

Effects of MT throughNeurological Mechanisms

MT is believed to stimulate sen-sory receptors and decrease muscletension by reducing neuromuscularexcitability. MT can be helpful in de-fusing the extremes of sensory habit-uation and sensitization; because itis itself a specific form of sensory in-put, it can both alter previously es-tablished synaptic tendencies andcondition newer, more appropriateones.

4

Effects of MT through Psycho-physiological Mechanisms

The majority of research in the psy-chological area has reported that MTprovided positive affects on anxiety,an expected result of triggering therelaxation response and stimulatingthe parasympathetic nervous system.A study performed by Touch ResearchInstitutes and reported in AlternativeTherapies in Health and Medicine sug-gests that MT may help decrease stressand improve mental clarity. Becauseof the considerable amounts of jobstress, healthcare workers are candi-dates for high stress levels. Negativejob stress symptoms can include mem-ory deterioration, increased distracti-bility, decreased concentration, andcan contribute to anxiety and depres-sion. The immediate effects of brief

JOURNAL OF SINGING542

massage therapy were assessed in 100hospital employees at a major publichospital. These therapies were ex-pected to reduce anxiety as reported onthe State Anxiety Inventory (STAI)and to reduce depression, fatigue, andconfusion and increase vigor as re-ported on the Profile of Mood States(POMS). Prior to the session the sub-jects were given the STAI, a twenty-item scale that measures the transi-tory level of anxiety, and the POMS,where the subject rates how well anadjective such as "happy" or "gloomy"describes his or her feelings. Thesescales were given again immediatelyfollowing the therapy. The procedurefor the study included two groups:one that received therapy at thenurses' stations and one that receivedmassage therapy in a separate room.Subjects were given a ten-minute mas-sage by trained massage therapists.The massage therapy was given in achair with subjects' heads resting com-fortably on a pillow on the table di-rectly in front of them. The treatmentincluded stroking and circular mo-tions on the back, neck, and arms per-formed with moderate pressure. Bothgroups reported lower anxiety, de-pression, fatigue, and confusion, andgreat vigor following the massage ther-apy session.5

BENEFITS OF MASSAGETHERAPY FOR VOCALISTS

The vocal instrument functionsbest when certain conditions exist.The voice depends on the reciprocityof its intrinsic, extrinsic, and surround-ing structures. Indeed, the functionalunity of the entire body furnishes theoptimal setting for phonation and animbalance in physical systems canbring about those conditions that canlead to vocal dysfunction. Skeletaland muscular equilibrium is the com-

mon denominator in ideal vocal foldfunction, laryngeal position, respira-tion, and resonation. Improving and/or maintaining healthy body mechan-ics can aid in the elimination of unnec-essary tension, making it easier to ini-tiate phonation, breathe efficiently,and tune the resonators. It is obviousthat the physical components of thevocal mechanism can be affected se-riously by excessive muscle tension.The benefits of massage can aid inbringing the body back into balance,allowing the vocal mechanism to func-tion efficiently without any undueexpenditure of energy.

The manifestation of emotionalanxiety can be both cognitive andphysical. Emotional vocal presenta-tions of anxiety vary, ranging fromdepression to agitation and includingan impairment of concentration.Physical transmission of mental stressoften results in muscle hypertension.MT can help regulate psychologicalanxiety, contributing to a more posi-tive sense of emotional and mentalclarity. Physical well-being can be anessential emotional asset to a singer.Good poise, strong presence, and theconfidence of health often furnish apsychological boost.

MODALITIES OFMASSAGE THERAPY

MT has a rich and diverse past,and the massage techniques that haveendured through history are calledclassic. Classic Western massage refersto those techniques used tradition-ally in Europe and the United Statessince the late nineteenth century.Numerous MT modality techniques,including those of acupressure, trig-ger-point, reflexology, and shiatsu of-ten are used to complement the meth-odology of classic Western massage.The classic Western massage tech-

niques that are traditionally used in-clude the following:Effleurage: Movements that glide

over the body with a smooth con-tinuous motion.

Petrissage: Movements that lift,wring, or squeeze in a kneadingmotion; pressing or rolling the softtissues under or between the hands.

Friction: Movements that rub onesurface over another repeatedlyand include superficial and deepfriction.

Tapotement: Brisk percussive move-ments that are performed in rapidrhythmic fashion.

Vibration: Oscillating, quivering, ortrembling movements; movementof soft tissues back and forth, orup and down, performed quicklyand repeatedly.There is a proliferation of different

terms, titles, and systems of massage,with over 200 recognized modalitiesof massage therapy and bodywork.For the sake of clarity, the term mas-sage or massage therapy as used inthis article refers to the manual ma-nipulation of the soft tissues. Keep inmind that every modality should in-clude some form of kneading, pressing,or stroking with the use of pressureand movement, no matter how slightthe touch or how often it is used. Thefollowing lists some of the more pop-ular massage modalities:1) Acupressure is an ancient Asianhealing art that uses the fingers topress key points on the surface of theskin to stimulate the body's immunesystem and create self-healing.2) Cranial-Sacral Therapg focuseson a gentle, hands-on technique usedto evaluate and enhance the functionof the cranial-sacral system (the phys-iological body system comprised ofthe membranes and cerebrospinalfluid that surround and protect thebrain and spinal cord).

MAY/JUNE 2006 543

3) Deep Tissue Massage uses a slowdeep pressure to help release triggerpoints in affected areas to release ten-sion and return the muscle to its nor-mal range of motion. This techniquebegins gently and progresses deeplyas the outer muscle fibers relax, al-lowing the second and third layer ofmuscle to be addressed.4) Myofascial Release applies gentlepressure to connective tissues or fas-cia, so that normal alignment andfunction can be restored.5) Neuromuscular Therapy utilizesstatic pressure on specific myofascialpoints to relieve pain. This techniquemanipulates the soft tissue of thebody to balance the central nervoussystem.6) Ref1exology applies firm pressureto specific points on the feet, hands,or ears. Reflexology is based on theprinciple that reflexes the areas thatcorrespond to every part, gland, andorgan of the body.7) Rolfing, also called structural inte-gration, maintains that when one partof the body is out of balance or mis-aligned, the rest of the body attemptsto compensate until the entire struc-ture is weakened. By manipulating themyofascial tissue in a ten session se-ries, each building on the previousone, the method gradually "unlocks"tension and reintegrates the body.8) Shiatsu means "finger pressure."Shiatsu is a form of physical manip-ulation applied through a system ofenergy channels or "meridians" asused in acupuncture to cover a greaterbody area.9) Swedish Massage consists of con-tinuous effleurage strokes, deep knead-ing and stretching and generally work-ing in the direction of the heart toassist venous blood flow.10) TrigerPoints/Myotherapy is themovement of myofascidal tissue throughsoft, deep contact with pressure. Myo-

therapy is the diffusion of triggerpoints in muscles to retrain those mus-cles and relieve pain.

MASSAGE THERAPY EDUCATIONFOR THE CONSUMER

Most states in the United Statesmandate a certain number of educa-tion hours and a required level of com-petency in that education before grant-ing a massage therapy license. Not allstates, however, have adopted licen-sure requirements for massage ther-apy. Thirty-three states and the Districtof Columbia now regulate massagetherapists, and some local govern-ments also may have a form of regu-lation.The National CertificationBoard for Therapeutic Massage andBodywork (NCBTMB) grants aNational Certification credential tothose practitioners who have metstringent education and training cri-teria. Nationally Certified massagetherapists strive for professional ex-cellence through regular assessmentof personal strengths, limitations, andeffectiveness and by continued edu-cation and training. The NCBTMBStandards of Practice were developedto assist the professional massage ther-apist in providing safe, consistent care,determining the quality of care to beprovided, supporting and preservingthe basic rights of the recipient andprofessional massage therapist, andassisting the public to understandwhat to expect from a professionalmassage therapist The Code of Ethicsis a statement of the standards bywhich massage therapists agree toconduct their practices and is a dec-laration of the general principles ofacceptable, ethical, professional be-havior.

In addition to state and local reg-ulations and National Certification,massage therapists can qualify for

membership in a number of profes-sional associations. AMTA6 repre-sents more than 52,000 massage ther-apists in twenty-seven countries.AMTA6 works to establish massagetherapy as integral to the maintenanceof good health and complementaryto other therapeutic processes, ad-vancing the profession through ethicsand standards, certification, schoolaccreditation, continuing education,professional publications, legislativeefforts, public education, and foster-ing the development of members.Associated Bodywork and MassageProfessionals (ABMP) is devoted topromoting ethical practices, protect-ing the rights of practitioners, and ed-ucating the public as to the benefitsof massage, bodywork, and somatictherapies. The IMA Group, Ina (Inter-national Massage Association), agrassroots massage organization, man-ages fifteen wellness associations,with over 63,000 members joining itto date.

Choosing the right therapist ulti-mately is the responsibility of theconsumer. In order to gather the ap-propriate information about a spe-cific practitioner, investigate the fol-lowing:"* Check for appropriate credentials.

Look for state/local licensure, cer-tification, and/or registration (ifapplicable), active National Certifi-cation, and credible professionalassociation affiliations.

"* Ask aboutyour prospective massagetherapist's approach to massage ther-apy. The more specific your needs,the more important the massagetherapist's approach and specificskills will be.

"* Inquire about the therapist's fee.Typically a massage will last onehour, but it is a good idea to askhow long the massage will last andwhat the fee is. Be sure to ask what

JOURNAL OF SINGING5"4

form of payment is acceptable andwhether he/she has any promo-tions, discounts, or specials.

* Inquire aboutfacilities. You may pre-fer to be seen in an office settingrather than in the home of the mas-sage therapist Some therapists bookoutcaR appointments at your home.For more information about mas-

sage therapy, see the following web-sites:"• www.ncbtmhcom (National Certifi-

cation Board for Therapeutic Mas-sage and Bodywork)

"• www.amtamassage.org (AmericanMassage Therapy Association)

"• www.abmp.com (Associated Body-work and Massage Professionals)

"* www.imagroup.com (InternationalMassage Association)

"* www.miami.edu/touch-research(Touch Research Institutes, Univer-sity of Miami School of Medicine)

"* www.massagetherapyfoundation.org (Massage Therapy Foundation)

ENDNOTES

1. Barry Cunliffe, The Roman Baths: AGuide to the Baths and Roman Museum(City of Bath: Bath Archeological Trust,1978), 16.

2. Margaret Mason, "Centering on Alter-natives," Washington Post (April 3,1995): D, 5.

3. The data cited here are derived froma report issued by The Rosenthal Cen-ter, Columbia University, New York,NY (October, 1995), as published inthe pamphlet Trends in Complemen-

tary Health Care, by the American Mas-sage Therapy Association (Evanston,IL: AMTA, 1999).

4. DeaneJuhan,Job's Body (Barrytown:Station Hill Press, 1987), 300.

5. Tiffany Field, et al., "Job Stress Reduc-tion Therapies," Alternative Therapiesin Health and Medicine 3 (July 1997):54-56.

BIBLIOGRAPHY

American Massage Therapy Association.Trends in Complementary Health Care.Evanston, IL: AMTA, 1999.

Bunch, Meribeth. Dynamics of the SingingVoice, 4th ed. New York: Springer-Verlag,1993.

Cunliffe, Barry. The Roman Baths: A Guideto the Baths and Roman Museum. City ofBath: Bath Archeological Trust, 1978.

Field, Tiffany, Olga Quintino, Linda Wells-Keife, and Gilda Delucchino-Feinberg."Job Stress Reduction Therapies." Alter-native Therapies in Health & Medicine 3,(July 1997).

Juhan, Deane. Job's Body. Barrytown:Station Hill Press, Inc., 1987.

Mason, Margaret. "Centering on Alterna-tives." Washington Post, see. D, p.5 (April3, 1995).

"Massage helps lower stress of working,taking final exams." Massage Magazine62 (July/August 1996).

Sapolsky, Robert. Why Zebras Don't GetUlcers. New York: W. H. Freeman andCompany, 1998.

Tappan, Frances M., and PatriciaJ. Ben-jamin. Tappan's Handbook ofHealingMassage Techniques, 3rd ed. Stamford:Appleton & Lange, 1998.

Weerapong, Pornratshanee, Patria A.Humel, and Gregory S. Kolt. "The Mech-anisms of Massage and Effects on Perfor-mance, Muscle Recovery and Injury Pre-vention." SportsMedicine 35, no. 3 (2005).

Alissa Walters Deeter is the Coordinatorof Vocal Activities at San Francisco StateUniversity with responsibilities that includeprivate voice, vocal literature, voice peda-gog, and opera workshop. She received herBachelor of Music in Vocal Performancefrom Central Michigan University and boththe Master of Music in Opera Performanceand the Doctor of Music in Vocal Perfor-mance from Florida State University.

A Metropolitan Opera National CouncilAuditions Southeast Regional Finalist,soprano Deeter was a studio artist at Cen-tral City Opera and an apprentice at SantaFe Opera. She has performed numerousoperas with regional houses across the coun-try and also keeps an active recital sched-ule nationally. She has staged numerousopera, operetta, and music theater pieces,and most recently music directed Mozart'sDie Zauberfifte for the SFSU Opera.

Dr. Deeter is a certified massage therapistinterested in the study of proprioceptionand kinesiology and is a leader in inno-vated body-awareness techniques. She is indemand for workshops, lectures, and mas-ter classes across the country.

MAY/JUNE 2006 545

COPYRIGHT INFORMATION

TITLE: Understanding Massage: How Massage Therapy CanEnhance Self-Care and Vocal Health

SOURCE: J Singing 62 no5 My/Je 2006WN: 0612109175007

The magazine publisher is the copyright holder of this articleand itis reproduced with permission. Further reproduction of this article inviolation of the copyright is prohibited.

Copyright 1982-2006 The H.W. Wilson Company. All rights reserved.