The Difference Between "Swedish" and "Therapeutic" Massage
Education for Spa Managers Series, episode 001
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© 2015 by Patrick Moore LMT http://meltingmuscles.com
What's the Problem?
I remember when I worked in Scottsdale, meeting a man who had signed up for a "therapeutic massage," I asked him, "What would you like me to do for you today? Do you have any aches or pains, or what is your chief complaint?" He looked at me as if I were stupid, and said, "Don't you know how to give a massage? Just give me a massage." I felt angry but I did give him a good Swedish massage and he was satisfied.
Now, when I tell this story to massage therapists, they all nod sagely. When I tell this story to non-massage therapists, they are probably shaking their heads--they don't get it. This is nobody's fault. It's just that massage therapists are given a year of training on what massage therapy is, and how to give this therapy, and the general public, including spa managers, has not received this education. The only thing that needs to happen to solve this, is for the public, and for spa managers to be educated on what therapy is.
I worked in a luxury spa in Scottsdale from 1999 to 2004 and I was frequently frustrated that the "Menu" of services always portrayed Swedish and "therapeutic" massage incorrectly. First thing a person would notice, reading through the menu was that therapeutic would cost them more money. Second would be the justification for this extra cost: the therapist works harder, giving more pressure and generally making it a better massage. People reading these menus are left with the impression that Swedish means "basic" and Therapeutic means "deluxe." Since it is a "menu," reading it you get the idea that Swedish is like a plain burrito, and therapeutic is like a burrito supreme that has lettuce, tomatoes and sour cream.
The other 16 years of my massage therapy career have been as a subcontractor or self-employed, so I am no longer frustrated by the way managers wrongly describe therapeutic and Swedish massage. However, I am a continuing education provider for massage therapists, and many of my students are still frustrated about this. Just yesterday one of the students who works at a luxury spa said her manager knows nothing about massage, and because of this, makes frequent bad decisions about how to manage massage therapists and clients, which frustrate her to no end. She said that once the door is closed, she explains to people what therapy she can offer, and that she's going to give the best massage she can regardless of whether they paid for the higher or lower cost massage. I suggested she write something for how to train spa managers, and she gave the suggestion back to me, so here I am writing it.
Why is it called massage "Therapy"?
Therapy is only given to those who have a complaint, an ailment, a loss of function a medical, physical or mental diagnosis. You wouldn't give chemotherapy to someone who doesn't have cancer. You wouldn't give physical therapy to someone who doesn't have a physical issue they are recovering from. You wouldn't give mental therapy to someone who has no complaints about life, or some professional diagnosis. The situation is the same with massage therapy.
Therapeutic massage is only given to those who have:
· A loss of function, for example,
o "I can't turn my head to see oncoming traffic when I am driving."
o "I can't put all my weight on this one leg without a sharp pain."
o "I can't play tennis or golf anymore because of this shoulder, elbow or wrist pain."
o "This ailment is stopping me from doing my job."
· A loss of range of motion, for example, the shoulder is not able to medially rotate the full ninety degrees or laterally rotate the full one hundred five degrees.
· Pain. For example, low back pain, neck pain, joint pain, foot pain, elbow pain or wrist pain.
· Nervy sensations like pins and needles or zinging, or the opposite, numbness, as a result of the sensory nerve being pinched by tight muscles upstream.
· A hand, arm or leg "going to sleep", or other sensation of fullness because the venous blood is blocked from returning by tight muscles upstream.
· A medical diagnosis. For example:
o Tension headaches.
o Plantar fascitis.
o Golfer's or Tennis Elbow.
o "Rotator cuff" diagnoses.
o "Hip" diagnoses short of "degenerative".
o Thoracic Outlet Syndrome.
· Diagnoses of the autonomic nervous system (which governs the Fight/Flight/Play Dead responses), for example:
o Excessive tension in local areas or bodywide.
There are many other ailments that massage therapy may address, these are just the ones that come quickly to my mind.
My first point is, that therapy may only be applied to a problem, a diagnosis, a loss, an ache or pain, an issue or a complaint. You can't receive a therapeutic massage unless there is something wrong that you want changed. If there is nothing wrong, and you just want a massage, that would be a Swedish massage.
Second, therapy is rarely complete in one session. In the first session there is more talking to get clear about the complaint, its effects, signs, symptoms and consequences, if the person knows how it happened, what the person has tried so far, what has worked and what has not worked, what the person is doing on their own to make a difference, or is the person still doing the very things that caused it (like golfing). With other forms of therapy there may not be any technique applied during the first session but with massage therapy there is. At the end of the first session there is another talk, to decide together on a treatment plan. The plan clearly describes the problem, and when the problem is gone, the therapy will be over. Therapy is complete when the complaint, ailment, issue, pain or loss has been reversed, resolved, transcended or embraced. They don't have it any more. On that day, the therapist says "goodbye, I hope I don't see you again," with a smile that means I hope your life is so healthy you don't need therapy again.
How many sessions will this take? This depends on many factors:
- The techniques, skills, understanding and experience of the therapist.
- What else the person is doing on his or her own, to assist the positive changes.
- Whether the person is continuing to do the things that created the negative changes in the first place, or has suspended those things.
- Factors beyond both the therapist and the suffering person, such as toxins in the air or water, temperature or weather, "accidents," positive coincidences and so forth.
Of these four factors, the therapist has influence over only one of the four. So it is tricky for the therapist to predict in advance how many sessions will be sufficient to reach the therapeutic goal. Instead of these predictions it is more realistic to show the person, this was your assessment when you first came, this is your assessment now, and this is what we are shooting for. The partnership includes not only ways the therapist can see and measure progress, but also ways the person can see and measure progress him or herself.
When progress is not being made in one or two consecutive sessions, the two should have a discussion and figure out why. If they can't figure out why, or if they know why and can't change this, then ethically, they should stop therapy. The person should seek a different therapist or a different route of healing. Termination of the therapeutic relationship is the responsibility of the therapist. If he is ethical he must assure therapy does not continue when no progress is being made, even if this reduces his income or self-image.
Therapists who recognize that therapy most likely requires more than one session, offer pricing based on packages of numbers of sessions.
I could go on and on but you see the point by now.
I do not blame spa managers for portraying therapeutic massage as just a deluxe massage, because nobody ever told them. The massage schools also do not do enough to make this distinction clear. They don't because nobody ever told them. I think the misinformation is simply an indicator that our profession is still in its infancy, and we are still learning what it is and how to describe it.
What is Swedish Massage?
Swedish is when the recipient removes clothing and lies horizontal on a table. A sheet is placed over the person to preserve their privacy. The practitioner pulls back the sheet to expose one body part at a time: the leg, the arm or the back, while the rest of the body remains covered. The practitioner uses oil or lotion, applying this to his hands and then glides his lubricated hands over the bare skin. Three strokes define Swedish: Efflourage, Petrissage and Friction. They are applied in that order on the way in, and in reverse order on the way out. Efflourage is a long gliding stroke over the skin, gradually using more pressure until the muscles below the skin are also engaged. Petrissage is a kneading stroke where the muscles are lifted from the bones beneath and squeezed in a rhythm, with about two squeezes per second for slow petrissage and three for fast. Friction is pressure into one particular muscle. Friction can be cross-fiber, longitudinal, or static. Cross-fiber friction first detects the direction of this muscle fiber, and strokes it perpendicularly, like crossing a guitar string back and forth. The muscle sort of twangs under the giver's fingers. The crossing stroke has an amplitude that crosses the muscle fiber completely so it is from a quarter inch to several inches in its back-and-forth travel. Longitudinal friction is still pressure into muscle fiber, but the strokes are parallel rather than perpendicular. This motion stretches the muscle locally, in both directions. Static friction is where the muscle fiber is detected, and pressed. The pressure is held without moving for several seconds.
Swedish is a recipe. This is good news for corporate spas that want for the massage experience to be the same every time, like restaurants want their eggplant parmesan to taste the same every time. A full-body Swedish can be accomplished in 50 minutes rushing, and in 80 minutes more thoroughly. Swedish should be a similar experience across the Nation, across the World.
The Benefit of Swedish
Reduces Fight/Flight? Yes. Research shows touch reduces blood pressure. We are social animals so touch has many benefits, calming the autonomic nervous system and allowing the body to return from a fight/flight alert to a rest/digest mode. If Swedish has one therapeutic or health value, this is it. And let's not underrate it! Swedish is soothing, and soothing reduces your heart rate, your belly grumbles because digestion resumes, and you may go to sleep. For people who are sleep deprived or always on alert, this may be the only time they let down their guard. Swedish can save lives.
But you don't have to be nude to get this benefit. Clothed massage from a massage therapist provide the same, or better sedation of the over-active nervous system. Friends and family can also offer healthy touch that sooths and restores nervous system balance through hugs, pats on the back, stroking hair, friendly back rubs through clothes, foot rubs, the contact of dancing, and other social interactions that do not require touch but other forms of trust building.
For those people who have not yet found more natural ways to rebalance their nervous systems, it makes sense for them to pay for Swedish massage. However, I would begin to wonder if it was a service to this person long term, if the person found they could get all their relaxation from the massage practitioner, so they don't have to discover their own ways to relax and rebalance. This would create a dependence which does not serve the recipient in the long run. However I have spoken with many spa managers who deliberately attempt to create this sense of need and dependence, because it is good for business. Shame!
The Questionable Benefits of Swedish Massage
Circulation? No. They say it increases circulation of fluids but research has not confirmed that. Research shows that any person would get ten times more circulation of fluids by walking during the time they would have received a massage. Walking is far more effective than even the best massage, for increasing circulation. In particular, the active flexing and extending of the ankle during walking or jogging, literally pumps blood out of the legs as the veins in the lower legs have valves in them that are only used during this flexing and extending. Walking is the ideal way to flex and extend the foot--cycling and eliptical machines do not usually allow the foot to flex and extend so these exercises, while good for the heart, do not pump fluid out of the legs. Massage does not increase circulation. While Swedish has strokes that really look like they ought to shove fluids out of the limbs and back to the heart, the fact that tense muscles and closed capillary valves upstream, prevent this movement of fluid. Swedish looks circulatory, but it is an illusion.
Nurturing? Yes, the actions of a Swedish massage are very similar to what a mother would do for her baby. It is very similar to what mothers of many species do for their babies--licking their fur, soothing their fears, grooming them. Young birds, mammals and other animals fear being eaten by predators that prey on young morsels. If they see a hawk circling above, they shake with fear. While the mother is there, she is large enough to fight away the hawk. Her presence alone makes the baby safer. Then she grooms and sooths the feathers or fur, which stimluates the skin, which floods the brain with sensation interpreted as pleasurable. This flood of sensation overpowers the worries. So for the duration of the soothing strokes, the baby animal is no longer afraid of the hawk. Safety is felt and assured through nurturing. However, this sense of safety disappears the moment the mother stops the strokes. And as soon as the mother flies away to find food, the babies are again exposed to predators, so the safe feeling does not last even a minute after the nurturing stops.
Mothering? Yes. But why? I personally enjoyed the thousands of nurturing massages I gave earlier in my career. But there came a day when I no longer wished to be a professional mother/nurturer. I continue to provide therapeutic massage with clothed recipients but I no longer provide nurturing massage to bare skin. I think it is good and appropriate for mothers to do this with their children until they are "fledged," but I question the need for massage practitioners to stroke lubricated bare skin for the benefit of nurturing. Adults who didn't get enough nurturing from their mothers, should probably talk with their mothers, or a counselor, rather than trying to make up for lost nurturing by getting it from a massage practitioner.
Relaxation? Yes, but only for the duration of the experience. For the minutes that a massage practitioner's hands are gliding and stroking our skin, our brains are flooded with pleasant sensation. As long as the giver's hands never stop moving, the pleasure distracts us from our fears, worries and stresses. But the moment the hands stop moving, this effect stops--the magic disappears.
The relaxation that occurs with therapeutic massage is measurable. The therapist assesses or measures the range of motion before and after, so there is evidence when relaxation occurs. During a Swedish massage, however, the giver cannot risk stopping even for a minute to do assessments, because the nurturing effect stops as soon as the skin gliding stops. Swedish may rightly claim to be relaxing, but it is only relaxing for the duration of the experience. Swedish makes no claims to be therapeutic. Swedish makes no claims that benefits build with each session. Swedish makes no claim that one day your therapeutic goal will be met, and then you won't need therapy any longer. Those who offer Swedish would be happy to give you one massage a week, or daily, for the rest of your life.
Pampering? Luxury? Exclusivity? Queen for a Day? Yes, yes, yes and yes. Many spa managers wish to create the illusion that guests are royalty. This illusion is created by calling the licensed therapists "techs" to lower their status in comparison to the queen, the techs speaking only when spoken to, calling guests only by their last names to show deference, and so forth. "Exclusive" is a term seen in many spa brochures, which means some people are excluded. If you come to this spa, you are one of the few who is entitled, not one of the many rabble who are excluded. Your status is higher than normal people. You deserve luxury pampering, from someone who is not your equal in status, and this defines you as greater than others who cannot come to have a spa day. Does this serve? Well, the guests certainly like it and pay well for this privilege. But it creates a sense of entitlement--modern thinkers say that entitlement is dividing our society and harming our earth. Superiority of the guest, goes against the philosophy that "All are created equal."
The illusion that the guest is royalty, demeans therapists because they must pretend to be servants. Many therapists are willing to do it, because the money is good and there are higher tips. (Therapeutic massage does not need tips--therapists do not work to please the person but to make progress toward therapeutic goals, even at the expense of comfort and pleasure so the expectation of tipping would be counterproductive). Therapists who work in luxury spas cannot maintain the illusion of guest superiority for long, without developing bitterness and resentment that come out in ways that endanger their long-term employment. Or if they manage to keep their mouths shut, the resentment turns into health problems of their own--rashes, I developed a lesion on my tongue that required surgery to remove while I worked at that spa in Scottsdale, back pain, wrist pain or shoulder pain that threatens to force the therapist to quit the profession.
One awful consequence of making guests entitled, royal superiors, is that they then think they may have whatever they want, including sexual massage. Many guests at luxury spas hint, suggest or order massage therapists to do sexual things to them. Since they are already nude, and then adding the sense they are royalty, above others, perhaps these factors combine to encourage their minds to "go there." I imagine many "therapists" at luxury spas do indulge people this way. This activity would be kept secret from the spa managers of course. But the management is part of the problem when they encourage the idea that guests are entitled, superior royals who deserve to have their nude skin lubricated by people who defer to their every want and whim.
Price Difference? Not Justified.
Therapeutic massage is not more effort to give, than Swedish. Therapeutic is not necessarily deeper pressure. More pressure does not get more results. On the contrary, some of the most effective techniques are the gentlest. Muscles are not material that can be physically manipulated to be softer, like tenderizing meat. Muscles only relax when the brain turns down the voltage to the muscle. More pressure, is not more convincing to the brain. The brain is convinced by safety, not by intensity of sensation. Those who want to receive really deep pressure may think they want therapy, but all they really want is very intense sensation—perhaps because this experience entertains them, or because it distracts them better from the kind of worries, fears and thoughts they wish to escape during the hour. Yes, giving a deeper, harder massage is more effort for the therapist who needs to be fit and work hard to keep up that amount of force. But the increased force, in no way makes the results more therapeutic. Deep pressure could be priced higher than light pressure, for the reason that the practitioner must work harder. That would be justified. Just don’t call deeper pressure “therapeutic.” Call it “deep tissue.”
If there is a justification for making “therapeutic” massage a higher price, it would be that therapists who are good at therapeutic massage, have probably taken more CE classes. They have paid more, or higher prices for classes that offer greater than average education, and it would make sense that these therapists could be reimbursed for their higher costs of their education, or for their greater skill and effectiveness.
What to Expect from a Therapeutic Massage
A therapeutic massage is not for the purpose of pleasure. It is not for entertainment, or for the experience. It is not helpful for the recipient to tell the therapist how they want it done, once they have agreed on the results that are wanted. The therapist is the one with the education and experience, who knows how to achieve the results. The session may not be pleasurable (because therapeutic techniques are not designed to create pleasure). But it shouldn’t hurt or trigger the person to increase their guarding. You should see results within a half hour, and the therapist should be telling you and showing you these results. You should see results after each session and these should build on previous results so that you’re making actual progress. Tipping is unhelpful because it implies you will give more money if you’ve had a pleasurable experience—this expectation distracts the therapist from focusing on therapeutic change. There is rarely need to expose bare skin, with the exception of ice therapy for tendinits, and then it is only the one shoulder, elbow, or foot that needs to be exposed. Therapeutic massage often works just as good, or better, when the recipient is clothed. You should expect the therapist to treat you as an equal partner, consulting your values for what results you want, and letting you know their findings and allowing you to renegotiate the therapeutic contract frequently. The therapist should be neither superior to you as Doctors are, nor subservient to you, but on your level. The therapist will expect you to do half of the work for getting better—after all it is your body, shouldn’t you participate in your cure?
I could go on and on but I think this is enough on the subject as a brief introduction about the difference between Swedish and therapeutic massage. If you have comments, please post them here and I will respond. Thanks.