A heads up, I’m a big proponent of massage therapy as an aid for pain, relaxation, and as preventive medicine. A day at the spa shouldn’t be seen as a frivolous thing. St. Hildegard, I’m sure, would agree. (Long post ahead.)

Hildegard-related massage

In Return to Harmony: Health care according to St. Hildegard of Bingen, Alfreda Walkowska describes early morning dry brushing of the whole body, which has a “stimulating effect on the blood and lymphatic circulation.” She notes that St. Hildegard described various treatments that combine “hygienic, medicinal and personal care. These include washing the body, compresses, baths, and saunas.”

Dr. Sebastian Liew, in My Healing Life: The Most Important Work in Life, writes about the “Touch of Love”. Dr. Liew is best known for pioneering German herbal medicine in Asia. He has been actively promoting European Hildegard medicine there. He has

“witnessed the tremendous benefits of therapeutic touch…By reducing stress, your body repairs itself internally – physically and emotionally…Instead of suggesting – “We have a stressful day, let us go for a drink”, why not suggest “Let us go for a massage session.”

Here’s my take on massage and why I think it’s important:

Massage therapy as prevention in mainstream medicine and not just for relaxation

More than just a luxury treatment, massage therapy should be used as a preventative medical treatment covered by insurance; its effects on both the mind and body go beyond mere relaxation and often include pain relief—so much so that it decreases the need for pain medication or more invasive treatments. Additionally, when done routinely, its benefits have also been shown to aid in overall well-being. Therefore, it shouldn’t be viewed as only a pricey out-of-reach treatment, but rather something that the medical insurance community should take seriously as a prospective treatment.

I trained and was certified as a massage technician in 2007, however, I only worked as one for a few months. It turns out I’d rather receive the treatment than perform it. I had my first massage back in 1990. At the time, I was working as a transcriptionist and that required typing on a computer my whole workday which in turn induced chronic pain and stiffness in my neck and shoulders. When I found out my local small gym offered massage, I decided to give it a try. 

I was hooked. I went back as regularly as I could afford to treat the neck and shoulder pain that accumulated over time. Once I finished working as a transcriptionist, I remained a faithful massage client. And years later, when I wanted a job option with flexible hours, I trained in it.

Massage therapy is already being used in hospital settings, albeit sometimes only to facilitate research. Recent research by Zhang, Yueyue, et al. has shown positive results in using massage therapy as an alternative method to reduce cancer pain in patients. The International Journal of Therapeutic Massage & Bodywork found that plantar reflexology is a safe and non-invasive alternative for managing headaches. International researchers, Yelverton, Christopher, et al. found that cross-friction massage, a technique that places pressure across soft tissue to break down scar tissue, and stretching improved movement and reduced pain for patients with plantar fasciitis.

I can add my personal testimony as I was treated by a chiropractor around 2005 who used cross-friction massage and heat to break up scar tissue on my feet. After a few short sessions in the chiropractor’s office, the plantar fasciitis pain stopped. While the treatment was effective and worthwhile, I paid out of pocket because my health insurance didn’t cover chiropractic treatments. 

Plantar fasciitis is more than just a pain issue—it affects how you walk, most especially if you’re walking with pain. Doctors often prescribe Ibuprofen, cortisone injections, physical therapy, special shoes and inserts—things I was able to avoid simply by choosing the chiropractic massage therapy method. However, I admit that the same treatment might not work for everyone.

Massage through touch provides stress relief, relaxation, lessens anxiety, depression, and produces mind-body balance. Sandy and Luke Fritz explain that, in Mosby’s Fundamentals of Therapeutic Massage, “Some health benefits of massage have been validated by research…clinical experience or are historically supported by many cultures over centuries of practice.” Some of the main focuses of massage in the medical care environment are: 

•          Breathing

•          Circulation support (blood and lymph)

•          Comfort and pleasure

•          Swelling and fluid imbalance management

•          Lowered stress and heart rate levels

•          Pain management

•          Better relaxation

•          Better sleep and less fatigue

•          Aid to muscles and connective tissues

The mind and body are deeply connected, so that massage therapy can send transmitters straight to your brain. The mind, Sandy and Luke Fritz say, “interprets physical sensations and sets physical responses in motion. Emotions seem to be the result of the connection between body and mind. Behavior is the action that results from the physical-emotional-cognitive combination.” The authors go on to report that the spirit is also affected during massage therapy. It can create such a strong reaction that it helps build “strength, hope, faith, and love that create a reason for being.” 

Touch-based therapy goes back to ancient times. Although massage can be found in documents dating back to the times in B.C., new research is still ongoing, and much needed. Daniel Kopf in a study on “Massage and touch-based therapy” found that there’s a newly discovered biological connection between touch and the regulation of emotions, and that might explain the benefits of massage therapy on general well-being and the reduction of stress. 

An example of the importance of skin-to-skin contact is shown between a mother and her newborn. That immediate touch with the baby promotes safety and well-being of the infant. A 2016 study by Moore, Elizabeth, et al.of early skin-to-skin contact for mothers and their healthy newborn infants found that, “Skin-to-skin contact (SSC) begins ideally at birth and should last continually until the end of the first breastfeeding.” A 2021 study from the Journal of Clinical Medicine found that massage therapy during the pregnancy stage has benefits for both mother and baby, in part due to “reduced stress, back and leg pain, depression and anxiety; increased immune response; increased serotonin and dopamine levels; higher fetal birth weight and reduced risk of preterm delivery”. 

But it’s not only babies that need skin-to-skin contact. We need touch throughout our lives. Ryan Jay Hoyme, in The Complete Guide to Modern Massage, confirms that touch is a basic human need, but we tend to still neglect it. As mentioned above, infants need touch when they’re born; “…it’s an instinctive desire and a way of communicating love, nurturance, trust, caring, comfort, safety, and more.” As we grow into adulthood, that need for touch continues. Sandy and Luke Fritz point out that our skin—the largest sensory organ—is more important than we think and plays a large role in how we survive. Our bodies require skin-on-skin touch, and our skin communicates that to us, when we feel so much more relaxed post-massage therapy.

Massage also affects our mood. Touch Research Institutes’ reports that massage therapy leads to decreases in cortisol levels, instead boosting serotonin and dopamine—important since normal serotonin levels are needed for the body to heal, sleep, and maintaining a steady mood and dopamine is known as the brain chemical that makes us feel happy. 

Massage is natural and something we often resort to on our own, such as when we rub our own hurts or sores. It’s free when we try to lessen the pain ourselves, but the cost of going to a spa can be quite high. And some think of it as an extravagance rather than a medical treatment, or pre-treatment (a preventative). Walking into a luxury spa might intimidate some and make them feel like they are pampering themselves rather than treating their bodies to much-needed care. Yet, DIY massage, although free, doesn’t always produce the best benefits. 

How do you switch massage from a luxury item to a necessary medical preventative treatment? You bring it into the medical community, hospitals, treatment centers, and clinics. You put massage therapy in its rightful place as a healing modality, not an unnecessary expense. It’s not like buying a fancy car, but that’s often the category it’s placed into. That it’s something only the wealthy do. And it’s true that the cost can only be for the rich as some spas are outrageously expensive. Ordinary folk can’t always afford such high-end facilities. And finding reputable reasonable massage locations can be iffy. Granting the practice more credibility within the medical field could potentially allow ordinary people more access to it.

The truth is the price of a massage is not more costly than some prescription medications and it often costs much less. According to Thervo.com, an average 60-minute massage costs between $60 to $150. Pricing depends on the type of massage, the therapist’s experience, and the location (venue, yes, but also city/state). Prices for massages done in the home can vary as well. Compared to ongoing prescription costs for pain medications—not to mention their side effects—massage therapy costs seem minor.

In San Francisco, we have low-cost options for massage. Of course, these aren’t high-end spas; a good reputable massage therapist doesn’t need to be in one. It’s the quality of the massage and the results that count. Even so, I can’t afford to go very often. If my medical insurance covered the cost, or even part of it, I would go more regularly for body maintenance and stress reduction. I believe that would eliminate possible adverse conditions that are caused by stress and more. Making massage therapy an essential component to our health and well-being can make it more accessible so that cost is not a hindrance to treatment.

However, change is slow to come for the massage therapy field, as a profession and a practice. Yet, alternatively, physical fitness is widely touted. Back in 1960, President John F. Kennedy emphasized the importance of physical fitness and that fortunately started an interest in sports massage. Sandy and Luke Fritz write that it led to “a movement toward preventative medicine.” As of today, massage therapy as a preventative medicine is still not fully utilized and the profession itself has never been standardized in the U.S. with across-the-board training or licensing. Perhaps more legitimization of the profession will lead to better acceptance of massage therapy as part of the medical field itself.

According to SeniorsInfo.org, Medicare doesn’t cover therapeutic massage unless it’s medically necessary and done by a qualified healthcare provider, “…general relaxation massages or those intended purely for therapeutic relief outside of a medical treatment plan are not covered.” And that, “Diagnostic tests performed by a chiropractor, such as X-rays or other services like massage therapy, are not covered by Medicare.”

Massage care doesn’t report to be a cure all. Massage supports the medical team, and even mental health providers. And it allows the body to heal itself naturally.

According to Sandy and Luke Fritz, “However, many people are not necessarily cured with medical care interventions such as medication or surgery; instead, their condition is managed, a situation that puts a major strain on the medical care delivery system…Massage offers benefits for the management of many chronic medical conditions in a potentially cost-effective manner.” 

There needs to be a cultural and medical shift around massage therapy so that its benefits—and accessibility—are matched by that of fitness. For example, many insurance carriers provide gym membership discounts to promote healthy practices. The same could be done for massage therapy. The same way gym membership reimbursement can prevent premature aging, obesity, diabetes, and other possible ailments, massage therapy can too. 

According to Healthcare.gov: “Health insurance covers essential health benefits critical to maintaining your health and treating illness and accidents.” Where does massage therapy fit in with that benefit? When you make massage essential too. Massage therapy helps maintain your health and aids the medical team in treating illness and aftercare. It can be a preventative to needing future major care, or costly medications. Once massage is considered preventative care, it too can be included for free as are vaccines, screenings, and check-ups. And it can be given the same validation that fitness has for maintaining good health and not just be thought of as a relaxation perk.

Do you agree?