In The Concise Encyclopedia of World History, editor John Bowle states that the first physicians in Rome were slaves. Most were of Greek heritage, many of them freed slaves originally taken from Greece when Rome conquered it. Because of their heritage, the social standing of Roman physicians was quite low. Also, as many early physicians were charlatans, offering ineffective cures, there was a deep mistrust of doctors. One citizen commented that the new doctor in town was previously an undertaker and that what he was doing as a doctor wasn’t much different than his work as an undertaker. Another contended that the doctor charged too much, used worthless medicines and drugs, and attempted to treat diseases for which he had no training or understanding.

Before the Greek physicians arrived, medicine was dispensed by a variety of Roman practitioners. Healing cures and surgery were administered by family slaves, often trained only by experience; by barber-surgeons, who used bleeding as a common practice; by priests, who exorcised or cajoled demons from the patient; and even by the slave masseurs, known as aleiptes. This latter category, like the family slave, was knowledgeable only through experience. These were times with no licensing (medical licensing would not arrive until 200 C.E.), and anyone who was willing to wield a scalpel did. The “masseur,” working without limits and established within the gymnasium or the facilities of a rich householder, was able to dally in the medical sciences without much fear of reprisal, except a diminished reputation if he failed too often.

Into this environment came the astute and educated Greek physicians, who eventually took over the treatment of Roman citizens and their leaders. But their rise to acceptance was not an easy one. It wasn’t until Julius Caesar “granted freedom to all freeborn Greek physicians practicing in Roman territory” in 46 B.C.E., wrote Douglas Guthrie, in A History of Medicine, that they were able to escape from the domination of their rich-household owners and the general scorn of the Romans, and rise to the heights of social and professional status.

Clear evidence of the role of massage in Roman medical treatment can be found in a letter to the emperor from Pliny the Elder (C.E. 23–79), a physician, telling about how his life was saved by the ministrations “of a medical practitioner who cured many of his patients by the process of rubbing and anointing.” He derived so much benefit “from the remedy that he asked the emperor to grant the physician, who was either a Jew or a Greek, the freedom of the city and the privileges of Roman citizenship,” wrote Douglas Graham, in Manual Therapeutics.

The influence of Hippocratic medical practice, including massage, continued in the work of a number of prominent Greek and Roman physicians. Thus medical practices of the time were built, as exemplified by the Hippocratic model, upon observation, trial and error, and especially on prescriptions for rest and proper diet. The theory of the four humors was still a working concept for most physicians, and the effects of massage fit well into their theories of circulation.

The Roman physician’s knowledge of anatomy was very limited, since the study of anatomy through human dissection was prohibited in the Roman Empire. (Dissection of animals was allowed, however.) Whatever human dissection was performed at the time was done primarily in Egypt, under the authority of the conquering ruler, Alexander the Great. A man named Marinus, of Alexandria, is most often cited as the expert dissector of these times.

At the beginning of the third century B.C.E. the bodies of condemned criminals were made available to physicians, such as Herophilus and Erasistratus in Rome. The nervous system, and especially the human brain, received the greatest attention, and it was during this time that many advances were made in the knowledge of human anatomy. Despite these early studies of anatomy, there is no evidence that anatomical knowledge played any part in the physicians’ use of massage, and anatomy was certainly unknown and irrelevant to those working in the baths and gymnasiums, since they received no medical education, nor did they treat any diseases.

Asclepiades (124–40 B.C.E.) was a Greek physician who settled in Rome to practice and teach medicine just before the dawn of the Christian era. Asclepiades was a most favored son of Greece and Rome; he was not a follower of Hippocrates and did not subscribe to Hippocrates’ natural medicine. A famous story about Asclepiades is one in which he supposedly brought back to life a Roman citizen being carried to his grave in a coffin. His cure for the apparent dead man has been described as “several minutes of manipulation,” wrote Sir William Osler in The Evolution of Modern Medicine. Perhaps Asclepiades’ success is related to his “corpuscular theory”; Asclepiades believed that life was the result of atoms constantly on the move within the body. Disease or death were caused by an obstruction of this movement. Thus his manipulation may well have been a simple jostling massage which woke up the “sleeping atoms” to bring his patient back to life. In writing about Asclepiades, Sir William Osler states, “Diet, exercise, massage, and bathing were his greatest remedies.”

Herman L. Kamenetz, writing in Manipulation, Traction and Massage, reports that massage was the third-most-important therapy used by Asclepiades, “after hydrotherapy and exercise … for abdominal pains Asclepiades said that the suffering parts should be rubbed with oil long and energetically to tolerance. To dispel the frigid torpor he advised that the parts be massaged with warm hands and then wrapped in cloth. For convulsions he rubbed the vertebral column day and night in the hope of dissipating spasms. He did not advise massage in fever except during its remission, but he prescribed it in dropsy and leucophlegmasia.”

John Harvey Kellogg, M.D., founder of the Battle Creek Sanitarium at the turn of the century, claims that Asclepiades, “held the practice of this art in such esteem that he abandoned the use of medicines of all sorts, relying exclusively upon massage, which he claimed effects a cure by restoring to the nutritive fluids their natural, free movement. It was this physician who made the discovery that sleep might be induced by gentle stroking.” Emil G. Kleen, a physician and author of Massage and Medical Gymnastics, acclaims Asclepiades as the father of “mechano-therapy” for the invention of several devices designed to produce fluid movement through swinging, vibration or violent motion.

The Roman encylopedist Aulus Cornelius Celsus (25 B.C.E.–57 C.E.), writing about Asclepiades, said, “Asclepiades speaks of friction as if he were the inventor of it. According to him there are only three therapeutic agents: first is friction, to which he devotes most space, then water and gestation [meaning to bear or carry, not pregnancy]. No doubt we should not take away from the young the glory of their discoveries, but that is no reason for not leaving to the older what they have established in their writings. Assuredly, no one has presented more precisely and clearly than Asclepiades how and at which parts of the body friction[s] are to be applied. However, in this respect he has added nothing to what Hippocrates expressed.”

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Robert Noah Calvert is the founder and CEO of Massage Magazine. The material for this column comes from the World of Massage Museum’s collection and Calvert’s book, The History of Massage, published in February 2002 by Healing Arts Press.

Aulus Cornelius Celsus (25 B.C.E.–57 C.E.) is credited with scribing the first organized medical history, tracing the development of healing practices from the simple remedies of “barbarous” nations to Hippocrates and Alexandrian medicine. He was a faithful follower of Hippocrates, and was known less for his medical practice than for the advice he recorded as a medical encyclopedist. He wrote about many subjects, especially agriculture and medicine, but only his De medicina, libri octo (”book about medicine”) has survived. He “divided therapy into three forms: dietetic, pharmaceutics and surgical, wrote Douglas Guthrie, M.D., in A History of Medicine (J.B. Lippincott Co., 1946). Massage was considered a part of the last form. Surgery composes quite a bit of the text, osteology is covered, and detailed descriptions of amputation are given. Celsus also wrote about therapeutics; his advice in cases of phthisis (pulmonary tuberculosis or atropic diseases) includes “light massage, and warm baths.” He also recommended a long trip to Egypt, which would have been by sea, advice often given well into the 19th century and called “climatotherapy.” His therapeutic remedy for headaches, to which he devoted quite a bit of attention, includes massage in addition to an exacting diet, bleeding and mustard plasters. His other recommendations incorporating massage included remedies for weight and stomach problems. Celsus provides the following remark, quoted by Herman L. Kamenetz in Manipulation, Traction and mustard plasters, which expresses the thoughts of Hippocrates regarding massage: “Vigorous friction’s [sic] harden the fiber, light friction’s loosen it. When pursued a long time, weight is lost; applied with moderation they increase weight.” Then Celsus adds the following thoughts of his own, clearly based on Hippocratic anatripsis, and provides many of the details not found in the general aphorisms of Hippocrates:
“Consequently, friction’s are indicated to strengthen relaxed organs, to relax those which are too tense, to dissipate detrimental plethora or to add weight to lean subjects without strength. If we try to determine how these different results are produced (which is beyond the physician’s realm) we see that they all consist in the removal of the noxious principle. Indeed, tightening occurs with elimination of the cause of relaxation. Relaxation of the parts results after what made them hard is removed. Gain of weight does not result directly from friction’s but with the help of friction of the skin, which becomes more supple, becomes more permeable to nutritious substances. The difference among these results depends upon the procedure used. Both inunction [rubbing in of ointment] and light friction may be used in acute disease of recent onset provided they be applied during the remission and with an empty stomach. However, prolonged friction’s are contraindicated in acute diseases, particularly during their anabasis [advance], except as a soporific for a madman. By contrast they are useful in chronic diseases during remission … Friction’s are as favorable when the disease is beginning to decline as they are detrimental when fever is increasing. Thus, as far as is possible we should, before using them, wait for the fever to subside or at least for a moment of remission. Friction’s are applied either to the whole body, as when we wish to invigorate a debilitated person, or only to a part, in order to remedy the weakness of a limb or some other local condition. Friction’s may alleviate inveterate headaches, provided that the treatment is not applied at the acme [height of development]. Friction’s also give strength to the palsied limb. Most often, however, we should apply friction’s at a distance from the painful regions; thus, when we wish to draw matter from the upper or middle parts of the body we rub the lower limbs.”

“It is difficult to determine the exact number of friction’s to apply to a person since this will depend upon the strength of the individual. A weakened subject might not stand more than fifty, while a more vigorous one might take two hundred … Thus, we must be more careful in applying them to women than to men and to children and older people more than to young adults.”

“Finally, if we rub certain limbs, we proceed vigorously for a long time, for, acting on one of its parts, we do not fear to weaken the body soon, and the noxious matter should be resolved as much as possible, be it to remove it from the limb we treat or to divert if from another area. However, if a weak constitution necessitates friction’s of the entire body, we rub for a shorter time and less vigorously with the thought of softening the skin so that it can draw new material from the nutrients taken more easily. I have already noted as untoward signs the chilling of the surface while heat and thirst are experienced internally. The only thing to do in such a case is to rub the patient, and after having succeeded in producing warmth exteriorly, we can then apply other therapeutic agents.”

Galen
According to medical historians, the greatest physician of antiquity, second only to Hippocrates, was Galen (130–201 C.E.), a Roman. He wrote many volumes of medical and philosophical texts and was an ardent disciple of Hippocrates. He had extensive experience dissecting animals, even the Barbary ape, and was one of the first to correlate anatomy and physiology, which is an ongoing theme in his writings. At age 28 he was physician to the gladiators of Rome, and gained a considerable reputation for his treatment of open wounds and tendon injuries. Later he was physician to a number of Roman emperors. His work on anatomy is his greatest contribution, especially his descriptions of bones and muscles and their attendant tissues, such as ligaments and tendons. One medical historian tells that Galen had the rare opportunity during his career to observe the beating heart in two live patients.

A brief remark in Galen’s book Hygiene reveals his deep feelings toward massage and his disdain for those who would attribute a less-than-professional - in this case, sexual - meaning to its use. This quote is taken from the opening paragraph of the chapter titled “Morning and Evening Massage”: “It still remains, therefore, to discuss morning and evening massage, but not, verily, in the manner in which they say Quintus replied to a gymnast who enquired what was the value of anointment, ‘It makes you take off your tunic.’” Galen responds by writing, “These are all wanton witticisms, not at all befitting a man learned in so august an art.”

Galen elaborated upon Hippocrates’ simple description of anatripsis, including the variety of possible hand directions: “And the rubbings should be of many sorts, with strokes and circuits of the hands, carrying them not only from above down and from below up, but also subvertically, obliquely, transversely and subtransversely … But I direct that the strokes and circuits of the hands should be made of many sorts, in order that so far as possible all the muscle fibers should be rubbed in every direction.” Many other references to massage can be found in R.M. Green’s 1951 publication, A Translation of Galen’s Hygiene, such as the following:

“If, therefore, he is completely rested, it is superfluous to massage or anoint him, unless it were necessary to overcome extreme cold; for then we shall prepare him with massage, just like those who are going to employ cold bathing … But if there should be any sense of fatigue, it has been said before that then it is necessary to anoint and to massage gently. And so also if he were drier than desirable, he should be anointed with sweet oil; for this moistens the dry skin. And he should be massaged little, but with neither firm nor gentle massage. For we want the administration only to favor digestion, not to change the condition of the skin or of the flesh [muscle], nor to eliminate any of the excrements in them. But gentle massage does both, and firm massage the former, for it thickens and toughens the skin, whereas gentle massage purges and makes the body relaxed and soft.”

Galen wrote much more on this subject, describing the details of preparatory massage, the duration of massage at each stage of exercise, and finally “the rubbing of the body - which ought always to follow the exercises.” He concludes with an application of massage techniques and their staged applications to the health and well-being of non-athletes, or those exercises not for competition but for health.

Galen was a student of Hippocratic medicine, and his writings, as they relate to massage, can be considered as representing five centuries of Greco-Roman anatripsis theory and practice.
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Robert Noah Calvert is the founder and CEO of Massage Magazine. The material for this column comes from the World of Massage Museum’s collection and Calvert’s book, The History of Massage, published in February 2002 by Healing Arts Press.

It was the Greeks who first gave significance to the bath by combining it with cultural activities and the gymnasium. Theirs was the inspiration for Roman bathing, which came later. Of the many Greek gymnasiums, only some had baths associated with them, their overall functions being far more diverse. Aside from the Romans, nowhere else in ancient civilizations did the bath take on such meaning as with the Greeks. But the story of baths in antiquity must begin with the Greek gymnasium.
The gymnasium was first built as an institution for military and athletic training of the young Greek citizens. A free-born citizen’s education also included intellectual and artistic subjects, all taught at the public gymnasia. The gymnasium developed into the center of Greek social activity, which included lectures on philosophy, medicine and poetry. Cults of the traditional gods of the gymnasia were worshipped at these facilities as well.

The Greek gymnasium had humble beginnings. The first were mostly found in open fields located on the outskirts of town, usually near a stream, river, or body of water to provide easy access for bathing after strenuous exercise and games. As these games became more popular they were developed into park-like facilities. Sporting activities were the first use of these open spaces. Ball games, wrestling, running and jumping were the most popular sporting activities, but it wasn’t long before the peaceful atmosphere attracted orators, teachers and picnickers.

Small buildings were erected, large numbers of trees were planted, running tracks were built and the open spaces became smaller. As the cities increased in population and territory, many of them with high walls built around them, sometime around 400 BC, these open spaces were encroached upon even more. There was no longer room to hold running races, and so they were conducted on the streets of the city. These changes all led to the building of huge gymnasium buildings more toward the city center or near the seashore. And in turn, these buildings changed the character of the Greek gymnasium.

An interesting side note regarding the financing and administration of the Greek gymnasium is worth mentioning. The gymnasium was a public institution, open to all citizens 18 years of age or older. Administration of the many gymnasiums in a city was provided by distinguished citizens. Usually one person handled one facility. Their official title was gymnasiarch. They selected and scheduled the gymnasium’s teachers, trainers and lecturers. Even the heating expenses and maintenance of the hot baths, found in some of the gymnasiums, was the duty of the gymnasiarch, as was the entire maintenance of the building. These citizens needed to be wealthy, because they were responsible for paying for all the operating expenses of the gymnasium - even the religious and sacrificial rites, sporting games and the prizes for athletic competitions. The city government did little to help, nor were there funds available from their citizens except when the administrator was able to solicit support from royal or private patrons of the facility. The gymnasiarch, as a result of this position, was also a person of considerable authority in the community. There are several stories in Greek history that tell about the ruin of the gymnasium administrators because expenses became too much for them to handle. One story relates that the most costly expense was providing free oil for the athletic patrons of the gymnasium.

The buildings were palatial, with a grand central courtyard for exercising, lecturing and holding gatherings. Usually situated within high walls accompanied by massive columns inside, the interior held classrooms, libraries, and when they had them, baths with changing rooms. There were cold-water washing rooms, sweating rooms and a room for oiling the body, which also stored the oils. It was here that athletes and citizens discussed the politics and games of the day, rested, and as one account claims, massaged each other.

Properly named the Esclapeion, Greek gymnasiums were everywhere, more than 300 in the country at one time. A comparison with today’s hospitals dramatizes their place in the culture of the time. Ours are places of medical sterility, tile and stainless steel, and from which we want to leave as soon as possible. The Greek Esclapeion were built in an environment composed of a natural setting dedicated to healing, education and public discourse, a place where one would want to stay. Even though there was an elite social class, the gymnasium was a public place open to all free-born citizens, even those living outside the city’s boundaries. The common citizen practiced his exercises, bathed and competed alongside the sons of noblemen and political leaders. Each shared in the spiritual, mental and physical possibilities available at the Greek gymnasium.

The Greek gymnasiums at their height of success, though, were primarily devoted to exercises, frictions and baths. The exercises were wrestling, jumping, boxing, running and throwing, and games played with balls, to name a few. To prepare the young men for exercise, refresh them afterward and along with or after their bath, frictions were applied. In his 1866 book, The Anatriptic Art, Walter Johnson describes the use of frictions in detail, and perhaps the first-ever description of sports massage is provided by the ancient physician Galen (130-201 AD), as reported by Johnson.

Johnson writes, “The usual routine was this: The youth was first rubbed by the paidotribes with oil; this process was called the preparatory rubbing - tripsis paraskeuastike. He then proceeded to some of the lighter exercises, as playing at ball; after which he sprinkled himself with Egyptian dust, and sought a companion (sungumnaste) to wrestle with. When sufficiently exercised, he passed into the room of the anointer (aleiptes), who by aid of the stlengis, a curved instrument with a handle used to scrape the skin of oils and debris after exercise or competition, or strigil, as the Romans called it, helped him to scrape off his dust, oil and sweat, and then rubbed him again with oil, which process was called apotherapeia. This done, he entered the warm bath, and after a short stay proceeded to the cold bath, and from the cold bath he returned to the aleiptes, who anointed him a second time, and sent him about his business. It ought never to be forgotten that the aleiptes regulated the diet of every pupil, prescribing in the exact quantity and quality and time of every meal. It is not my intention to enter into details on the subject of the gymnasium; but I am compelled thus briefly to allude to it in order to render intelligible what remains to be said about gymnastic friction. Gymnastic or hygienic friction, then, consisted in the preparatory friction - tripsis paraskeuastike - and the friction which followed the exercises - apotherapeia.

“The former is thus described by Galen:
‘Hence if anyone, immediately after undress, proceed to the more violent movements before he has softened the whole body, and thinned the excretions, and opened the pores, he incurs the danger of breaking or spraining some of the solid parts. [Galen refers here to pre-event massage meant to warm the muscles by activity and increased circulation, which in turn loosens them to help avoid injury from the muscles being cold.]

“‘There is danger also of the excretions, in the rush of moving spirits, blocking up the pores. But if beforehand you gradually warm and soften the solids and thin the fluids, and expand the pores, the person exercising will run no danger of breaking any part, nor of blocking up the pores. [Again, increasing circulation, but here also opening the pores so elimination can occur without obstruction through the process of sweating.] Hence, in order to insure this result, it is proper, by moderate rubbing with a linen cloth, to warm the whole body beforehand, and then to rub with oil. For I do not counsel the immediate application of the grease before the skin is warmed and the pores expanded, and, generally speaking, before the body is prepared to receive the oil; and this will be accomplished by a very few turns of the hands, without pain and moderately quick, having in view to warm the body without compressing it; for you will perceive while this is being done a blooming redness running over the whole skin; and then is the time to apply the grease to it, and rub with bare hands, observing a medium hardness and softness, in order that the body may not be contracted and compressed, nor loosened and relaxed beyond the fitting extent, but be kept in its natural state. [The application of oil after warming the skin was to help absorb the healing qualities of the oil.]

“‘And one should at first rub quietly, and afterwards gradually increasing it, push the strength of the friction so far as evidently to compress the flesh, but not to bruise it. But it is not proper to apply such strong friction for a long time, but once or twice to each part; for we do not rub so as to harden the body of the boy, whom we are now training for the exercises, but to excite it to activity and augment its tone, and contract its porousness; for it is proper to preserve his body in a medium state, and by no means to make it hard or dry, lest we should by chance check somewhat of the natural growth. [This is classic pre-event sports massage - not too much massage to soften or relax, just enough to heighten the body for activity, but not overexcite it so it loses energy.] But in the process of time, when the youth is entering upon manhood, then we shall use harder friction and cold baths, after the gymnastic exercises; but of this we will speak again. In using friction preparatory to the gymnastic exercises, the use of which is to soften the body, the middle quality between hard and soft should prevail, and all else should take its fashion accordingly. And in the imposition and circumflexion of the hands the rubbing should be very varied, and not merely directed from above to below, nor from below to above, but also slanting and oblique, transverse and sub-transverse … and it will make no difference whether you use the expression, tripsis (rubbing), or anatripsis (rubbing up, or as we should say, rubbing down), seeing that the latter is more usual among the ancients and the former among the moderns … ["ancients" refers to those who came before the Greek physicians, "moderns" to those since Hippocrates.] Rubbing which prepares for gymnastic exercises, and that which follows the same, is subservient to the exercises. The former heats and moderately opens the pores, and liquefies the excretions retained in the flesh, and softens the solid parts, and this is termed preparatory or paraskeuastic rubbing. But the other is termed after-ministering (apotherapeutic); and as it is applied with a larger amount of oil, it at the same time moistens by means of the grease, and softens the solid parts and carries off what is contained in the pores … ” [The term flesh meant muscles.]

If you are familiar with the pre-event and post-event concepts of modern-day sports massage, Galen’s descriptions are so close to our own one might think we’ve copied his techniques. For those not familiar with the theory of sports massage as practiced today, I’ll explain it briefly. Competitive athletes organize their training session according to a schedule of competitions throughout the year or season. They train to advance through a series of events most often leading to a championship of some kind. Bicycling is a good example, and since I’ve raced at the national and contended for the Olympic level in this sport, as well as trained others to do sports massage on these athletes, I have personal experience of the subject.

Cyclists race mostly on weekends, similar to runners, and so their training is oriented to a weekly schedule most of the time. They might eat protein-heavy diets on Wednesday and Thursday; with carbohydrate loading on Friday and Saturday during the race days; and then on Monday eat fresh fruits, vegetables and a more normal diet. The diet is coordinated with the workout regimen of light work on Monday, to recover from the weekend of racing; a bit heavier or maybe a longer ride on Tuesday; and then on Wednesday and Thursday the ride is very hard, probably with added wind sprints and hill-climbing to build tissue and increase endurance and reflexes. Weekend riding is, of course, very strenuous because it is competitive.

Massage is applied in ideal conditions in accordance with the diet and workout regimen. Ideally racers receive massage at the end of each race day; preferably just before bed time. If this is not possible, and for most athletes it is not, Monday is the next best time. The massage is not vigorous or deep but soothing, with long slow strokes used to milk the muscles of the excess waste products manufactured from burning up immense amounts of energy. If these wastes are left in the system they can cause stiffness, soreness and decreased efficiency for several days afterward.

Massage is usually given each day, or during the week every other day, to professional riders. The massage given the day before a race, the pre-event massage, or in the morning before a race in the afternoon, is somewhat vigorous, but not too deep. The legs must not be relaxed so much as to lose their tone, or peak condition, but just enough to stimulate them. Deep massage, or stripping, is usually done at midweek or, if there is a several-week period off from competition this is a much more ideal time to get the stripping massage done.

To summarize, pre-event massage stimulates but does not relax the muscle tissues; post-event massage soothes and moves toxins out of the muscles; and massage applied between competitions is often deeper to work on the problem areas of toxin build-up, connective-tissue adhesions, and aches and pains.

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There is much more Galen wrote on this subject, as he continued to describe the details of preparatory massage, the duration of massage at each stage of exercise and finally “the rubbing of the body - which ought always to follow the exercises.” Galen concludes by presenting an application of massage techniques, staged in sequence, for the non-athlete who is not in competition, for their better health. Galen was a student of Hippocratic medicine, and his writings can be considered for the most part, as they relate to massage, as representing five centuries of Greco-Roman anatripsis theory and practice.
Robert Noah Calvert is the founder and CEO of Massage Magazine. The material for this column comes from the World of Massage Museum’s collection and Calvert’s book, The History of Massage, published in February 2002 by Healing Arts Press.

The Greek bath was a revivifying experience not limited to the bath tub. A hot bath was prepared at home with boiling water from a copper cauldron steaming on an open fire and cool well water, usually followed by anointing with olive oil, a clean tunic and a relaxing meal. Oil was applied to counteract the effects of the searing sun, and prevent stiffness after drying off. Bathing in the ocean was a popular activity thought to calm the nerves. Over time, bathing took on an almost ritual significance, so much so that Greek literature quite often warns against it becoming a public custom, even though it was a widely practiced private one.

Public baths
The style of bathing practiced by the Spartans (around 750 B.C.) was done in cold water only. This approach represented a frugal philosophy toward the body. On the other side were the Greek upper class, who followed the immoderate tradition of past aristocrats. Greek philosopher Plato (427—347 BC) provides the necessary perspective. During his time, he wrote, hot bathing was a privilege reserved for the kings and their aristocratic court. During the ensuing three or four centuries, the growing number of high-class citizens in Greek society emulated their royal habits. It was from these social habits of the Greeks that the Romans inherited their love of the bath.

It was in the loutron of the Greek gymnasium that washing and bathing took place. This was an open-air space, and exclusively used for this purpose. Roman vase paintings depict scenes from the loutron involving men and women (although not together) showering, washing, rubbing, scraping their skin with strigils, and anointing each other. The loutron was nearly always a cold-water bathing room.

Later, during the Roman era, hot bathing became available. The concamerata sudatio, laconicum and calda lavatio were specialized rooms added to the gymnasium as hot baths rose in popularity. These were, respectively, a wet-steam room, dry-steam room and warm bathing room.

The first Greek gymnasiums did not have bathing facilities, as they were civic facilities devoted primarily to academic and institutional purposes. Many of the original Greek gymnasiums were later renovated to include hot-water facilities such as those mentioned above. Bathing facilities during the early Greek period were, when they were built, made separate from the gymnasium and were usually public baths. Greek literature provides evidence of sharp criticism aimed at Greek youth who spent their time chit-chatting at the public baths instead of exercising at the gymnasium. Slowly, though, the heated baths at public facilities and the gymnasium replaced the home bath and its ritual was lost.

The aleipterion, well-known within the first Roman bath facilities, were dry, heated rooms also used in the early days of the Greek gymnasium. It was here that warm-oil massage was given after exercise in the gymnasium. Architectural historians studying Greek and Roman baths believe the Greek aleipterion served as the prototype for the technologically advanced facilities made later for heated rooms and hot-water bathing by the Romans.

Massage at the baths
At one time there were actually three sites where baths were found, that is, after bathing in one’s home had been virtually replaced by the other facilities. Along with the baths associated with the gymnasiums and the public baths, which became more and more popular as thermal technology advanced, were baths in the religious sanctuaries of ancient Greece. Hot-bath facilities are said to have existed in these locations as early as 600 B.C. These were not, however, extravagant bathing facilities. They were small, windowless rooms with charcoal heaters and poor ventilation. The earliest baths are known to have used red-hot rocks for heating and steam making. Thermal-heating systems developed during the ensuing five or six centuries became efficient and technically advanced. No evidence has been found which might point to massage being offered at the sanctuary baths, although anointing with oil was a common ritual practice, even with priests and pilgrims who visited these places.

Some evidence from architectural remains points to a table made of marble, slate or other stone, being used for massage. It seems evident that Greek baths, even the later ones which were quite large and palatial, provided massage within the steam rooms, hot-bath rooms, or the lounge areas where skin scraping and anointing with oil and powder were offered. Some earlier baths contained tubs that were only a few feet deep, with steps leading out of the water or ledges along their sides. Perhaps the aliptae, as the slave massager was called, worked on patrons while they were standing in the water or sitting or lying on the ledges or steps as well.

Towels were commonly used and taken to the bath. One school boy’s notebook tells about how he grabs his towel, follows his slave and meets up with his friends on the way to the bath. Towels were also used to apply friction by rubbing the body with them; the course texture of the towel reddened the body, after which oil was applied for remedial purposes.

Greek anatripsis
It was the Greeks who first took the idea of exercise to its highest form. Greek physicians were well-schooled in all the magico-religious cures, but found them inconsistent with the emerging new philosophies of rational thought. Hippocrates was the first to separate the physician from the historical roots of cosmological speculator and philosopher of nature. Hippocrates narrowed the focus of the physician away from magic, ritual and speculation to strictly medicine marked by keen observation, logical thought, principles of diagnosis and treatment and a humble relationship with the patient.

Hippocrates used the word anatripsis to designate the process of rubbing. Douglas Graham, M.D., cites the following quote from writings attributed to Hippocrates: “The physician must be experienced in many things, but assuredly also in rubbing (his word, anatripsis).” The complete text containing this quote is said by Graham to be “the earliest definite information about massage.”

Hippocrates described anatripsis as stroking the extremities upward (toward the heart) and returning with a light stroke back up again to push the venous and lymph upward toward the heart. These strokes could be hard, soft or moderate, depending on the condition of the tissues and the effect desired.

Graham comments, “The observations of Hippocrates must have been very accurate to discern that rubbing upward in the case of the limbs had a more favorable effect than rubbing downward, and doubtless in this manner he had experience in promoting the resorption of effusions; for it is now well known that upward friction on the limbs favors the return of the circulation, relieves blood stasis, and makes more room in the veins and lymphatics for the carrying away of morbid products. This affords an illustration of ‘science following art with limping pace,’ which so frequently happens in the practice of medicine.”

This simple description of anatripsis by Hippocrates appears to be nothing more than effleurage, except when we keep in mind the variety of hand directions given by Claudius Galenus (Galen). He writes, “The rubbings should be of many sorts, with strokes and circuits of the hands, carrying them not only from above down and from below up, but also subvertically, obliquely, transversely and subtransversely … But I direct that the strokes and circuits of the hands should be made of many sorts, in order that so far as possible all the muscle fibers should be rubbed in every direction.”

Massage, or rubbings, were also performed in Greek culture during the time of Hippocrates as part of the ritual preparation for incubation or temple sleep, whereby the ailing person would sleep in the temple and dream that the mythical god Aesculpius and his daughters Hygiea and Panacea would appear to cure him.

The following two accounts are from the Greek temple-cure tradition. The first comes from an interpretation of an inscription found within one Roman temple. A Cretan woman “thanks Asklepios the Savior, having got a severe ulceration on her little finger and being cured when the god ordered her to apply an oyster shell burnt and powdered with rose salve and to anoint it with mallow mixed with olive oil. And so he cured her.” Even more miraculous is the case of Heraieus of Mytilene: “He did not have hair on his head, but a great deal on his chin. Being ashamed because he was laughed at by others, he slept in the shrine. And the god, anointing his head with a drug, made him grow hair.”

Robert Noah Calvert is the founder and CEO of Massage Magazine. The material for this column comes from the World of Massage Museum’s collection and Calvert’s book, The History of Massage, published in February 2002 by Healing Arts Press.

Douglas Graham, M.D., an early-20th-century American physician from Boston, provides his commentary upon the words of Hippocrates as they apply to massage treatments. Graham examines numerous statements by Hippocrates on massage and puts them into a more modern context.

“The wisdom of the ancients appears to great advantage in some of their remarks about rubbing, and it requires years of practical acquaintance with massage in order to fully appreciate them. Thus the aphorisms of Hippocrates (460 to 380 B.C.) on this subject embodied the wisdom of the past and presaged the development of the future to a greater extent than most ancient or modern writers on massage have shown any evidence of understanding. ‘The physician must be experienced in many things,’ says Hippocrates, ‘but assuredly also in rubbing; for things that have the same name have not always the same effects. For rubbing can bind a joint that is too loose and loosen a joint that is too rigid … Rubbing can bind and loosen; can make flesh [here Hippocrates believes that massage can help build muscle tissue] and cause parts to waste. Hard rubbing binds; soft rubbing loosens; much rubbing causes parts to waste; moderate rubbing makes them grow.’”

Graham also writes, “By appropriate massage, passive and resistive movements, atrophied muscles, tendons, and ligaments would have their circulation accelerated and increased, and consequently their nutrition and innervation improved, so that they would become larger and firmer, thus binding closer a joint too lax and making it stronger. By the same means involuntary tension of the muscles, adhesions, effusions, and hyperplastic tissue may be removed, so that a joint stiff from such causes would become more flexible.

“Therefore, the saying of Hippocrates, that anatripsis will bind closer a joint that is too lax and relax a joint that is too rigid, is not so paradoxical as it seems. These remarks also in part refer to the fact that ‘rubbing can make flesh and cause parts to waste’ in its local application; but in its general application the same effects have been observed and much more fully referred to by S. Weir Mitchell in Fat and Blood, and How to Make Them. People who have a normal quantity of adipose tissue sometimes lose much of it, to their detriment, by the excessive use of massage.

“But even this feature can sometimes be utilized to advantage in cases where fat is super-abundant, soft, and flabby, with a want of tone and tension in the areolar tissue, and in these it will be found that hard rubbing binds. ‘Soft rubbing loosens’ not only abnormally tough and matted conditions of the skin and superficial fascia, but also involuntary tension of muscles, both of which conditions, if looked for, may often be found generally as well as locally in overtaxed and debilitated people.

“Such a state of these tissues would seem to be a physical expression of too-great mental tension that the patient, like his muscles, is unable to relax. And here comes the necessity of a careful discrimination; for if a patient whose condition corresponds to this should receive such vigorous rubbing as often passes for massage in these days, and the vigor of which would really seem to be necessary to relax the tenseness of the tissues, the trouble would in all probability be aggravated, for reflex action and consequently still greater tension would be excited by the pressure of rough friction and manipulation upon terminal nerve-filaments, which are already in a state of irritation.

“Though it does not appertain to the history of massage, yet it may not be amiss to say here that an admirable preliminary measure in such cases is a warm bath, which is grateful and soothing to the patient, solicits the blood to the surface, softens the cuticle, and removes the epithelial debris, and also relaxes the skin and to some extent the tissues beneath it. ‘Moderate rubbing makes parts grow’ implies that the tissues to be rubbed are insufficiently nourished, and that if they be immoderately rubbed, their vitality will be lessened, their natural nervous irritability exhausted, and a state of congestion induced highly unfavorable to their proper nutrition.

“These brief sayings of Hippocrates on anatripsis serve partly to show at the same time why he was considered a man of transcendental genius and justly styled the ‘Father of Medicine,’ who, having raised the art from a system of superstitious rites practised wholly by the priests to the dignity of a learned profession, was then accused by his jealous contemporaries of having made too free use of the writings of others, and of having burned the collection to conceal his plagiarism’s. [sic] It was supposed that he had ample opportunity to do this in his capacity as librarian of the famous medical school of Cos, of which he was also chief.”

The prevailing medical doctrine of Hippocrates’ time was called the humoural theory. This elaborate doctrine, known commonly as the Four Humours, had endured for centuries and was central to the tenets of the Hippocratic Corpus. Based on the four elements of Earth, air, fire and water—and their constituent elements in man, phlegm, blood, yellow bile and black bile, the Four Humours had to be in balance for health to exist. Further, these humours were related to the four seasons and the four elements.

Walter Libby, in his 1922 book, The History of Medicine, offers this composite view, “blood is hot and moist like air, phlegm is cold and moist like water, yellow bile is hot and dry like fire, and black bile is cold and dry like earth … Similarly in the Hippocratic physiology, health depended on the crasis, or blending, of the four juices of the body. Unless they duly blend, there is a state of dyscrasia, or crudity, the humours, like raw food, acting as irritants. Health must be restored by a process of coction (or pepsis) wherein the internal heat of the body cooks the crude humours.

“Upon this follows a crisis—a separation, or elimination—of the superfluous substance. The elements may be restored to a state of harmony and equilibrium by the remedial power of Nature. It was faith in this vis medicatrix naturae which led Hippocrates to adopt an expectant attitude in the treatment of many of his cases, to abstain at times from surgical interference, and to prescribe drugs and cooling drinks as auxiliaries of Nature in the expulsion of the morbific matter after a fever crisis.”

Perhaps this statement by Libby helps bring a better understanding about why Hippocrates believed massage was a valuable therapeutic tool. “Nature acts without masters,” wrote Hippocrates. He firmly believed that the body was capable of curing itself, and that disease symptoms, particularly fever, were simply expressions of that capability. The Four Humours remained the mainstay of medicine in Europe for more than 2,000 years after Hippocrates.

The Hippocratic Corpus contains very few references to massage. The treatise on fractures contains only five minor mentions of any of the ancient words usually associated with massage.

Anoint is used three times. First, “The swellings which arise in the ham, at the foot … should be well wrapped in unscoured and carded wool, washed with wine and oil, and anointed with cerate.” Cerate is an “unctuous substance containing wax and of such consistency that it may be spread easily at ordinary temperature … and yet not so soft as to liquefy and run when applied to the skin.” Second, “and the parts around are to be anointed with white cerate.” And third, “To the sore itself a compress, anointed with white cerate, will be sufficient … ”

Rubbed is used in two occasions. First, “And when they are extended, the physician should apply the palms of the hands, and adjust the fractured parts and then having rubbed the parts with cerate, but not in large quantity so that the bandages may not come off, it is to be bound up in this state … ” And second, “But this form of bandaging must not be used unless there be danger of vesications or blackening in the swelling, and nothing of the kind occurs unless the fracture be bound too tight, or unless the limb be allowed to hand, or it be rubbed with the hand, or some other thing of an irritant nature be applied to the skin.” The first use of the word “rubbed” is explained as a preparation for applying bandages, to lubricate the skin so that when the bandages are removed they won’t stick to the area around the fracture.

These statements are hardly a resounding call for massage as a therapeutic device in the treatment of fractures, as some authors have claimed.

Robert Noah Calvert is the founder, CEO and publisher of MASSAGE Magazine. The material for this column comes from the World of Massage Museum’s collection and Calvert’s book, The History of Massage (2002, Healing Arts Press).

Massage therapists across the nation worked to raise the profile of massage therapy Oct. 21-27, with events commemorating the 10th annual National Massage Therapy Awareness Week. The Week is sponsored by the American Massage Therapy Association.

Following is a roundup of events nationwide, compiled from MASSAGE Magazine special reports and information covered in the mainstream press:

ARKANSAS: Massage therapists provided massage Oct. 25 in the rotunda of the state capital and Oct. 26 at Arkansas Children’s Hospital in Little Rock, according to NWAnews.com.

CALIFORNIA: Members of the AMTA’s California chapter and local units were involved in various events to promote the week according to chapter President Terri Mongait:
• The Greater Sacramento Area Unit offered chair massage on the steps of the state capitol. Therapists worked for four hours, providing approximately 300 massages to the legislature, staff and other employees.
• The Los Angeles/South Bay Unit offered chair massage to staff and volunteers at Aveson charter school in Altadena.
• The Redwood Empire Unit offered massage to staff at the Fulton Campus of Memorial Hospital.
• The Orange County Unit provided sports massage for the Golden State Athletic Conference Championships in Costa Mesa.

CALIFORNIA: Diamond Massage & Wellness Center in San Francisco provided more than $2,000 worth of complimentary 30-minute massages for any schoolteacher living or working in San Francisco.

CONNECTICUT: Members of the AMTA’s Connecticut chapter fanned out across the state to provide hundreds of complimentary seated massages to students, faculty and staff at six colleges and universities, said Lee Stang, chapter president. Students learned how massage will assist them in their focus and clarity of thinking as midterms approach, and student athletes learned why massage should be incorporated into their overall training programs.

DELAWARE: Chair massages were given to members of the Modern Maturity Center, in Dover, according to AMTA-Delaware chapter President Wade Carey. More than 30 people were provided information about massage, including the pamphlet, What to Expect on My First Massage.

FLORIDA: The Florida Department of Health and the Florida Board of Massage Therapy both recognized Oct. 21-27 as National Massage Therapy Awareness Week.

MASSACHUSETTS: The students from Bancroft School of Massage Therapy performed seated massage for 200 staff and visitors at St. Vincent Hospital in Worcester, Massachusetts, on Oct. 23, under the director of Sr. Pat Dowler, National Massage Therapy Awareness Week chair for the AMTA’s Massachusetts Chapter (AMTA-MA). Other AMTA-MA Chapter therapists participated in special events throughout the state, Dowler said.

NORTH CAROLINA: Massage therapists at Signature Spas provided free massages on Oct. 25, according to The Charlotte Observer.

TENNESSEE: Members of the AMTA’s Tennessee chapter boarded riverboats in Nashville and Knoxville on Oct. 21 to provide chair massage and raise money for Susan G Komen For the Cure breast-cancer foundation, according to chapter President Vicki Winston. Additionally, the mayor of Knoxville issued a proclamation for National Massage Therapy Awareness Week.

WASHINGTON: The AMTA-Washington, Olympic Peninsula Unit members planned to offer complimentary seated massages and distribute brochures on the benefits of massage on Oct. 27 at the Farmer’s Market in Port Angeles, Washington.

—Karen Menehan, MASSAGE Magazine editor in chief

Infants who receive massage with oil show fewer stress behaviors, have lower cortisol levels and are more relaxed than infants massage without oil, according to a research study.

The study was conducted by researchers from the Touch Research Institute at the University of Miami School of Medicine, and was first published in the Pre-and Perinatal Psychology Journal in 1996. The goal of the study was to determine the benefits of massage on infants with and without oil. Results showed that infants massaged with oil had fewer stress behaviors, were more relaxed, showed a more significant decrease in the stress-related hormone cortisol and a greater increase in vagal activity (indicating a slowing down of physiological processes) than infants massaged without oil.

Sixty infants were randomly placed in one of two groups: a massage-with-oil group and a massage-without-oil group. The infants were healthy and about one month old. The same massage therapist massage all the infants.

Each infant received a 15-minute massage between naps. The infant was first placed on a mat covered with a cotton blanket. The massage therapist began with gentle strokes on the sides of the infant’s face, and (in the case of the massage-with-oil group) applied baby oil with long strokes from hip to foot. The lower legs were squeezed lightly with a wringing motion, and the feet were massaged using the thumb over the entire bottom of the foot. The upper legs were rubbed in a milking fashion, ending with long strokes on both legs.

The torso was then massaged in a hand-over-hand, paddle-wheel fashion, starting high and moving down. The chest was stroked with flat fingers, moving outward from the middle. The stroking continued over the shoulders to include both the chest and shoulders. More oil was applied and the arms were massaged with long, gentle strokes from shoulders to hands, repeating the procedure used on the legs. The massage was completed with strokes along with the face and forehead, circular motions over the jaw, and finger rubs of the nose, cheeks, chin and ears.
Several measurements were taken before and after the massage, and the infants were videotaped during the massage. Measurements included a vagal tone (an indicator of parasympathetic activity) taken from the heart-rate recording, an EKG reading before and during the massage, and a salvia sample to show cortisol levels. The videotape was coded for infant limb movements, stress behaviors such as facial grimaces or clenched fists and aversion behaviors such as looking away.

The measurements results showed that infants who were massaged with oil spent more time being quiet, showed fewer stress behaviors, and had fewer head aversions, indicating a more relaxed state. Their cortisol levels decreased more than the group massaged without oil.

“The greater effectiveness of massage with oil versus no oil is probably also not surprising given that the lubricity of oil means less friction for the therapist and the infant. With oil the stroking movements can be smoother and more rhythmic, which may further enhance the effects inasmuch as infants are readily soothed/pacified by rhythmic stimulation,” the study stated.

Massage with oil enhances parasympathetic activity and therefore encourages relaxation in infants, according to the research. “These findings tentatively suggest that massage, especially with oil, can reduce the stress levels of normal infants. The therapy procedure is easy to learn and may contribute to shorter hospitalizations as it has in high-risk infants. Thus, massage would be a cost-effective procedure for caregivers to learn and then teach to parents so the positive benefits can continue across infancy.”

- Source: Touch Research Institute, Research originally published in the Pre- and Perinatal Pyschology Journal, 1996, Winter 11(2).

Stimulation of the autonomic nervous system (ANS) through massage may enhance infant performance on cognitive tasks, according to a research study by the Touch Research Institute at the University of Miami School of Medicine.

A study published in the journal Infant Behavior and Development in 1997 showed that infants who received massage prior to a infant performance task performed better than infants who were not massaged prior to the task.

The habituation task is used to measure cognitive abilities by presenting a visual image to an infant and then documenting the time it takes the infant to become accustomed, or habituated, to the image. Habituation is measured by tracking eye movement: an infant will look away after becoming habituated to an image. The amount of time it takes to achieve habituation is thought to reflect how quickly an infant processes information. The image is then changed slightly and presented again, for a calculation of response recovery rate, or the amount of time it took for an infant to recognize that something has changed.

Fifty-six healthy 4-month-old infants were randomly placed in either a massage group or a play group. In the massage group, the infants were given an eight-minute massage with baby oil. The infants received gentle, deep rubbing and stroking on their chest, legs, feet, arms, hands, neck, head and back.

Infants in the play group were entertained with a red teething ring that was playfully waved back and forth in front of them by an experimenter for eight minutes. Infants were permitted to touch the ring.

At the end of each eight-minute session, the infant was placed in front of a video monitor. A control image of a wind-up toy with fluttery arm movements was shown on the monitor to initially arouse the infant’s interest. Then a film was shown of two toy hammers, a red hammer against a black background and a blue hammer against a gray background. Both hammers were tapping out the same rhythm, but one had a faster tempo than the other. Once an infant became habituated, which meant looking away from the image for 1.5 continuous seconds, a slightly different film was shown, depicting the opposite-color hammer tapping out the faster tempo.
Results showed that although massage did not affect the time it took the infants to habituate to an image, it did help the infants to discriminate differences in the film images more quickly than those in the play group. Thus, massage helped the infants’ rate of response recovery.

“It is possible that massage facilitated response recovery from habituation by enhancing arousal associated with increased ANS activity,” according to the study.

The study authors suggested future research into the relationship between massage and ANS activity of infants, and the inclusion of developmentally delayed or at-risk infants.

- Source: Touch Research Institute. Originally printed in the journal Infant Behavior and Development, Vol. 20 (1), 1007, pp. 29-34

Researchers have shown that lavender and rosemary administered through aromatherapy positively affect psychological and physiological functioning. In a study conducted by the Touch Research Institute at the University of Miami Medical School, first published in the International Journal of Neuroscience, researchers assessed the effect of lavender and rosemary on alertness, mood and the brain’s electrical activity, and on subjects’ ability to perform math computations.

In the study, 40 adult faculty and staff members of the University of Miami Medical School were randomly placed into one of two groups, and were asked to inhale the scent of either lavender or rosemary essential oil for three minutes. Those in the lavender group were expected to show an increase in alpha and beta band activity, suggesting relaxation. Those in the rosemary group were expected to have a decrease in alpha and beta band activity, suggesting greater alertness.

Results showed that study expectations were correct: Participants in the lavender group experienced an increase in beta band activity, suggesting drowsiness; an improvement in mood; a feeling of greater relaxation; and better performance on math computations.The rosemary group showed a decrease in alpha and beta power, suggesting alertness and lower levels of anxiety; and were faster but not more accurate at performing math computations.

Subjects first took three assessment tests: an anxiety-inventory questionnaire, a profile-of-mood-states questionnaire and a series of timed math computations. While seated in a massage chair, each subject was then given a vial containing a dental swab soaked in a grapeseed-oil base with three drops of either lavender or rosemary essential oil. The subjects were instructed to sit quietly and breathe normally through the nose with their eyes closed. After three minutes of aromatherapy, the subjects again took the two self-report tests and did the math computations. For three minutes before, during and after the aromatherapy, EEG readings were taken through a cap worn on participants’ heads to measure the electrical activity of their brains.
Results of the self-assessment test data indicated that both the lavender and rosemary groups experienced lower levels of anxiety and felt more relaxed after the aromatherapy. Only the lavender group reported a significantly better mood. The rosemary group reported feeling more alert.

Math test results showed that the lavender group experienced an increase in drowsiness, while the rosemary group showed EEG patterns that reflected a greater state of alertness.

- Source: Touch Research Institute, Originally reported in the International Journal of Neuroscience, 1998, Vol. 96, pp. 217-224.

A combination of acupressure and breath awareness may help people with diabetes, according to a study originally published in the journal Health & Social Work. The study showed that a short stress-relief program including touch could lower blood sugar and improve health in diabetic patients.

Researchers at the New Mexico State University’s social work department (now the School of Social Work) observed a high incidence of diabetes among Mexican-Americans in southern New Mexico. They believed that the use of a short relaxation program could have beneficial effects on the health of those with diabetes and their families.

In cooperation with the San Miguel clinic, a study was designed that provided 15 minutes of breath work and acupressure with the goal of relieving stress for both the patient and the patient’s family. Two students in the social work department were chosen to conduct the exploratory research study. A one-group, pre-test/post-test design was used. The group size was 12.

At the start of the project, clinic staff and patients were introduced to holistic health practices, such as breathing techniques, acupressure and stress management.

Once a week for six weeks, the patients came to the clinic for a “15-minute stressout,” which had three components:
First, the patient and researcher both focused on their breath throughout the 15-minute session, in order to maintain emotional balance and empathy.

Second, the researcher applied gentle touch: applying feather strokes on the back, shoulders and arms, squeezing the arms, stretching the hands, and gripping the wrists and fingers.

Third, the researcher used acupressure on points on the patient’s hands, shoulders, back, neck and head.

There were three dependent variables measured in the study: stability of metabolic control, measured with blood sugar levels; persistence of physical symptoms, as measured by the Dartmouth COOP charts ( a question-and-answer test that assesses health and functioning); and self-perception of well-being, using post-session interviews, more COOP charts, and a “stressout survey” that measured perceived benefits of the sessions to the patients and their family and friends.

Patients experienced an overall reduction in blood sugar, anxiety, headaches, depression, and work stress and anger. They also slept better and had improved relations with their families. Patients also reported an inclination to continue with a healthier lifestyle after the project’s conclusion.

Because of limitations to the study in terms of validity and reliability (lack of a control group, and the concurrent standard medical treatment for diabetes, which may have also accounted for improvements), the authors made no claims of statistical significance. However, they said, “These limitations notwithstanding, the authors believe there is sufficient evidence to support that this alternative health practice holds promise for this population and warrants further study.” They continued, “The results of this research project support the need to integrate holistic health concepts and practices into rural area health-care systems.”

- Source: Professor Gerald W. Vest, New Mexico State University of Social Work.
Originally published in Health & Social Work, 1997, Vol. 22, pp. 95-100