Massage for stress management

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David McQuillan (2008). Otago Polytechnic

Stress reduction

Massage therapy is a fantastic stress reduction option for many people.

Joan Borysenko, a medical scientist and co-founder of the Mind/Body Clinic at Harvard Medical school has been quoted as saying (Borysenko, 1999 as cited in Parker, 2006)…

"Often times people are stressed in our culture. Stress-related disorders make up between 80-and-90 percent of the ailments that bring people to family-practice physicians. What they require is someone to listen, someone to touch them, someone to care. That does not exist in modern medicine.

One of the complaints heard frequently is that physicians don't touch their patients any more. Touch just isn't there. Years ago massage was a big part of nursing. There was so much care, so much touch, so much goodness conveyed through massage. Now nurses for the most part are as busy as physicians. They're writing charts, dealing with insurance notes, they're doing procedures and often there is no room for massage any more.

I believe massage therapy is absolutely key in the healing process not only in the hospital environment but because it relieves stress, it is obviously foundational in the healing process any time and anywhere."

The benefits of massage

Massage can provide different benefits to people affected by the stress response. The most important benefits are

  • Balance of the autonomic nervous system
  • Reducing muscular tension and lengthening contracted muscles
  • Trigger point release
  • Restoring circulation to ischemic tissues

Working to balance the autonomic nervous system

Massage can affect the balance of the autonomic nervous system (ANS) in two ways. Depending on how it is applied, massage application can have a relaxing, sedating effect (increasing parasympathetic dominance) or a stimulating effect (increasing sympathetic dominance).

Parasympathetic stimulation

(Relaxing, sedating)

Sympathetic stimulation


Slow strokes Fast strokes
Rhythmical Arrythmic
Flowing Not flowing
Pain-free Painful
Moderate pressure Light or heavy pressure
Short-term tapotment or shaking

Massage and the General Adaptation Syndrome

Your client may require slightly different things from your massage depending on the stage of the stress response.

Alarm phase

In the alarm phase, the client exhibits with symptoms of increased sympathetic dominance – muscle tension, altered breathing patterns, and other stress-related symptoms. However the signs of longer-term stress are probably not apparent – trigger points, fascial adhesion.

This is the healthy stage of the stress response. The client is unlikely to be experiencing any stress-related pain, or other discomfort, and as a result is unlikely to need or require massage to help manage their stress.

Adaptation phase

In the adaptation phase, the effects of stress are starting to build up in the body. Muscular tension has become sustained, and the soft tissues are starting to adapt in line with Chaitow's local adaptation syndrome. The client may present with upper chest breathing. Sleep patterns may be disturbed.

The appropriate focus of your massage at this stage is general relaxation. Your aim is to reduce sympathetic arousal, increase parasympathetic activity, and relieve any built-up tension that is developing.

Massage for the Adaptation phase

  • Moderate pressure
  • Slow strokes
  • Avoid stimulating strokes (e.g. tapotment, vibration)
  • Avoid painful techniques
  • Identify and work to release areas of muscular tension
  • If insomnia is a factor, massage should be scheduled at the end of the day where possible to help facilitate healthy sleep patterns

Exhaustion phase

In the exhaustion phase, the effects of stress are negatively affecting the function of the body. Clients are likely to present with stress-related pain from chronic muscle tension, breathing pattern disorder, and/or other medical conditions associated with their stress.

The client may present at this stage with one or more contraindications which relate to their stress.

The client is in need of both relaxation and remedial massage to relieve chronic muscle tension and pain related to the effects of local adaptation syndrome. Massage in the exhaustion phase must balance the benefits of relaxation massage with the benefits of remedial work. While it is possible to perform relaxing remedial work, the relaxation effect is typically not as great as that achieved through a pure relaxation massage. Some therapists alternate therapeutic treatments with relaxation treatments, whereas others aim for a more consistent approach to treatment, and try to find the appropriate balance between therapy and relaxation for each client.

Massage for the Exhaustion phase

  • Some mixture of
    • Relaxation massage to rebalance the autonomic nervous system
    • Remedial massage to relieve pain and chronic muscular tension
  • Work with specific areas of tension
  • Identify and work to release areas of muscular tension
  • If insomnia is a factor, massage should be scheduled at the end of the day where possible to help facilitate healthy sleep patterns

Massage, stress & emotional release

Stress is often associated with a build-up of emotional charge in the body. Sometimes when working with a client, a release of muscular and/or fascial tension can be associated with a release of emotional energy as well. This emotional release may come in a number of forms. Tears and sadness are probably the most common, followed by anger, but any emotion can be released including laughter (I. Hundleby, personal communication August 11, 2008). Emotional release is most likely when working with clients who are under a lot of stress.

It's common for a therapist to feel like they've done something wrong the first time a client has an emotional release with them. Don't. A client in general will not have an emotional release with you unless they're very comfortable with you. If a client trusts you enough to open up to you at this depth, you're obviously doing something right.

However it's also common for a client to be confused by what's going on.

Supporting clients through their emotional release

Your client may not understand why this happening to them, and may be embarrassed at their loss of composure. They may also worry that you'll think that they're having this reaction because of something that you've done in the massage.

It's important to explain to them that it's actually a fairly common experience and to explain to them that they're experiencing some stored emotion being released from their body, and that it's a healthy process to go through.

Allow them the space to have their experience, and to express their emotion.

Ask if they would like the massage to be stopped, or continued.

Remain supportive and empathetic to their needs – do you feel that they need a hand on their shoulder, or more space than that?

After the session, it's a good idea to encourage them to take some time to look after themselves after the session – perhaps a walk along the beach, or a hot bath.


Parker, S. (2006) Therapeutic massage research findings. Retrieved February 1, 2006 from