A good friend of mine came for a visit recently. He’s a massage therapist and structural integrator who works on the East Coast. During his stay, we exchanged massages, and I noticed he didn’t do any Swedish massage strokes. So, I asked him, “What’s the deal?” “Swedish is dead,” he said.

At first, I didn’t believe what he’d said, but then I thought back to the last massage I received at a clinic. The therapist used the smallest amount of effleurage to warm up my tissue and then dug in with detailed treatment work. In fact, all of the massages I’d received in the last few months, even the two I received at a spa, could not be called classic Swedish massage.¹

This started my journey. During the next six months, I set out on a mission to discover if Swedish massage is alive or dead in my town—Boulder, Colorado, a town of 100,000. I went to a total of 15 different massage therapists and asked for a classic Swedish massage.

          
My Data

My husband, who is a scientist, would say my data is flawed, because all of the therapists are working in the same region. (I did ask where therapists went to massage school and, while all of them are now practicing in the same town, only three were trained at the same institution; the majority are transplants from other states.) Yes, my data is flawed, but the findings should give us all something to consider.

• 14 of 15 therapists used effleurage.

• 2 of 15 therapists used petrissage.

• 15 of 15 therapists used friction strokes.

• 0 of 15 therapists used tapotement.

• 1 of 15 therapists used vibration.

• 3 of 15 therapists used joint movements.

• 0 of 15 therapists applied strokes in a classic Swedish progression.

• 15 of 15 therapists incorporated techniques from other massage systems into the massage.

I should point out that I enjoyed the majority of the 15 massages I received, but I marveled at how integrated massage has become. With the exception of one massage that seemed to consist almost entirely of shiatsu point work, none of them was easy to label as X or Y massage modality. Instead, massages were highly eclectic with both Eastern and Western techniques mixed in dynamic ways, based on the personality and interests of the therapists. Still, after these first 15 massages, I had to admit that maybe Swedish massage, in a classic sense, is dead. 

The Demise of Swedish

I shared my results with many of my massage friends, and we speculated about the apparent demise of Swedish. One friend suggested that Swedish is “fluff and buff” and that it died because clients are more informed consumers and want more treatment-oriented work. Another friend hotly defended Swedish as the original physical therapy that’s still viable as treatment work. They went back and forth on the issue, but I have to agree that the roots Swedish as a medically-based health care system, have been forgotten. I also looked in a number of foundational massage textbooks; authors regularly wrote that Swedish massage is also known as relaxation or wellness massage.

One friend pointed to the change in massage curriculum that occurred when states began to adopt the National Certification Board for Therapeutic Massage & Bodywork (NCTMB) exam as a credentialing exam. This friend said that massage school curriculum tended to be more foundational and science-based before the NCBTMB exam was adopted, and that massage students had previously received more hours dedicated to core techniques like Swedish massage. The NCBTMB test caused a reaction in schools, because they wanted to ensure their students could pass the exam.

I was a massage instructor when Washington State adopted the NCBTMB exam as the credentialing exam, and I vividly remember how we cut hours in anatomy and physiology, kinesiology, Swedish massage, and the treatment material in later quarters to teach introductory materials on a number of modalities that were tested by the exam. I doubt it was ever the NCBTMB’s intent to cause massage school curriculum to become less deep and more broad, but this does seem like it could be a contributing factor in the decline of Swedish massage.

Massage therapists tend to like lots of tools in their toolboxes. They often seek different ways of accomplishing massage-related treatment goals for the sheer joy of learning methods and techniques. Massage instructors are usually also massage therapists. Perhaps as they learn new modalities they share their enthusiasm with students who start to view Swedish massage as just a jumping-off point and not as a stand-alone system.

The school where I worked as director of education taught Swedish in the first two quarters and other treatment methods in the last two quarters of the year-long program. In our student clinic, I was hard-pressed to find a student who could remember how to give a basic Swedish massage. Their heads were full of techniques like active isolated stretching, muscle-energy technique, post-isometric relaxation, myofascial release, and neuromuscular technique. I was more likely to get a thorough posture and gait analysis than decent petrissage. Looking back, we should have built a Swedish review into the third- and fourth-term curriculum to ensure that students didn’t forget these skills as graduation neared. I wonder how many schools leave Swedish behind in early course work and never revisit it?

Time for a Revival

The conversations with my friends left me feeling uneasy. I was more determined than ever to find that classic Swedish is alive and well in my town. I scheduled more massage sessions (I got rather addicted to the abundance of bodywork I received), but this time I explained to therapists that I was working on a magazine article about Swedish massage. I asked them to do their very best to leave out other techniques and to follow the progression of a classic Swedish massage. I told them I wanted to feel each of the strokes and how my body felt without treatment-oriented massage work.

Even with this lengthy explanation, friction was the only Swedish technique therapists used consistently. One therapist said, “I know I learned Swedish in massage school—remind me what the strokes are again.” When asked to demonstrate tapotement, petrissage, or vibration, therapists either resisted (one therapist said, “I don’t do tapotement, because my clients don’t want it”) or they performed the strokes poorly. I would not say their massages were of poor quality; oftentimes, the integrated massages I received were very good, even exceptional. I do, however, think that the skills to apply tapotement, petrissage, or vibration effectively were lacking in the majority of the massages I received.

All things considered, good Swedish may be harder to apply than good myofascial release or good neuromuscular therapy. For example, good petrissage requires excellent hand strength to lift tissue, rhythm so that the strokes feel even, and endurance because it is fatiguing. I’ve never been able to deliver a really good, fine vibration myself. Tapotement requires excellent rhythm and palpation skills to apply the strokes at the right depth for the individual client. Maybe Swedish massage gets devalued, because it is really difficult to deliver each of the strokes with fluidity and perfection.

All of these massages gave me ample opportunity for self-reflection. First, I thought about how great my body feels when I get regular massage, and then I thought about my own massage style. I don’t have a private practice anymore, but I do work on my friends who are rock climbers. One in particular comes for regular massage each week. Normally, I open his massage with a bit of effleurage, and then I launch into treatment work, treatment work, and more treatment work. He usually leaves my house with glazed eyes and a drunken expression on his face. “Oh dear!” I suddenly thought to myself. “If Swedish massage is dead, I’m one of the people who killed it!”

I decided to try a little experiment on my friend. I didn’t say anything beforehand, but when he came for his regular massage, I delivered a classic Swedish massage instead of treatment work. I followed the classic Swedish progression of effleurage, petrissage, friction, vibration, tapotement, and joint movement. I didn’t dig my elbow into his traps or pin and stretch his pec muscles until they give in. I kept it Swedish. Firm Swedish, but all Swedish.

At the end of the massage, I asked him how he felt. “That was really different from what you normally do,” he said. “It was great, and I feel energized and loose. I don’t feel like I need to go home and sleep it off. I want more of my massages to feel like that!”

I had to admit that his face was glowing (not drunken) and his eyes were shining (not glazed). I comforted myself with the suspicion that the results from the Swedish massage wouldn’t be as long lasting as the treatment work. I called him a few days later to check in and his enthusiasm for how great his body felt threw me into confusion.

Is it possible that a firm Swedish massage is just as treatment-oriented as a treatment massage? Is it time for a serious Swedish revival? I got a little worked up. What would it take for the massage profession to return Swedish to a place of respect and prominence as a stand-alone massage system in its purest form, without the need to throw in techniques from other systems? I decided to dedicate myself to improving my Swedish massage, first by revisiting its history, then by exploring each of its strokes in a progression with my friends/clients.

Swedish History Revisited

The history of Swedish massage begins with gymnastics. In this case, gymnastics are understood as joint movements, not complicated flipping motions that transport teenage bodies across thick-matted floors.

Geronimo Mercuriali (1530–1606) was an Italian philologist and physician who studied the classical medical literature of the Greeks and Romans. Mercuriali paid special attention to classical approaches to diet, exercise, hygiene, and natural methods of healing disease. He explained principles of physical therapy and resurrected Galen’s second-century views on manual therapy. His publication Art of Gymnastics (1569) is considered the first book on sports medicine and a forerunner of the ideas and practices we now call Swedish massage.²

Advances in the physical sciences, especially the popularity of exercise as a means of achieving health, occurred during the 17th and 18th centuries. Translations of Arab and Chinese texts provided information on new forms of exercise like yoga and martial arts. Greek and Roman ideas about gymnastics became more widely available, and books like the Art of Gymnastics were translated into English.^{3, 4, 5} Progress in chemistry and the development of drugs during this period split health practitioners into two camps: those who favored drugs and surgery, and those who favored movement as a means of preventing disease.⁶ A major proponent of gymnastics for health was Per Henrik Ling (1776–1839). While he is often credited with creating medical gymnastics, he built on the work of many other people to develop a structured movement system.

Born in the South of Sweden, Ling studied theology at both Lund University and Uppsala University and then traveled in Europe teaching languages. Ling became proficient at fencing and began serving as the fencing master at Lund University in 1805. While there, he developed rheumatism and suffered from elbow pain due to the repetitive, one-sided movements of fencing. Exercise was already popular, but Ling wanted to understand the effects of movements and their therapeutic potential. He took anatomy and physiology classes at the university to understand the body and organized the various methods used in gymnastics into a comprehensive system. Ling’s medical gymnastics (joint movements) were classified as active, passive, and active-passive.⁷

Active movements were performed by the patient under the direction of an attendant and were basically an exercise routine. Also, according to Robert Noah Calvert’s The History of Massage, the patients stood in lines and performed lunging and isometric exercises in military fashion. With passive movements, the attendant would move and stretch the patient’s body while the patient relaxed. These relaxed movements helped increase the patient’s freedom of movement and lengthened muscle tissue. Passive treatment also included manipulations of soft-tissue structures that had names like “holding,” “pressing,” “shaking,” “clapping,” and “sawing.” Dr. Johann Mezger (1839–1909) in Holland later classified these manipulations in categories with French names: effleurage (stroking), petrissage (kneading), friction (rubbing), vibration (vibration), and tapotement (tapping). Active-passive movements are now referred to as resisted range of motion; the patient attempted to move in a certain manner while the attendant resisted this movement. This helped to strengthen the patient’s muscles.⁸

Ling’s system came to be known as the Swedish Movements and gained popularity across Europe and America. Later, Mezger promoted soft-tissue manipulations and formed the earliest known association of masseurs—the Dutch Association for Medical Gymnastics and Massage.

In the mid-1800s, the Swedish Movements were gaining acceptance across Europe and physician Mathias Roth, who studied with Ling at the Royal Central Institute, published the first English language book on the subject (The Prevention and Cure of Many Chronic Diseases by Movements). Roth, in turn, taught the Swedish Movement techniques to a New York physician named Charles Taylor, whose brother, George, also studied the Swedish Movements, but in Sweden. These two brothers are responsible for bringing the Swedish Movements to America and for promoting its uses and benefits until their deaths in 1899. Over time, some of the Swedish exercises were either dropped or evolved as part of physical therapy. Massage therapists emphasized the parts of the Swedish Movements that manipulated soft tissue and gradually the system became known as Swedish massage.⁹

Based on this history, I believe massage therapists should stop using the term “relaxation massage” synonymously with Swedish massage. Swedish was the original treatment massage system. It does more—much more—than just relax the body.

Swedish Techniques Revisited

So, how are your Swedish skills? Try the following. Write down a definition of each Swedish stroke and its general effects. I found this little self-test rather difficult (it’s been more than 10 years since massage school), so I did some research and made myself a table for review (see Classic Swedish Techniques, page 41). Then, I practiced each stroke and tried to put them together in a flowing progression without adding any fancy techniques from other massage systems. In my work, I always warm up the client’s body with effleurage, and I use a lot of friction and joint movement, so these strokes came naturally. However, I found that I needed to refine my petrissage, vibration, and tapotement, and then work on the smoothness of the transitions between the strokes. I went right back to Massage 101; it was a great experience. I did my very best Swedish massage on every one of my friends and family members who I work on regularly and I gathered their feedback. All of them were enthusiastic about how revitalized they felt and expressed a desire for more Swedish massage.

Inside Us All

Six months ago, I started on an important journey. I set out to decide if Swedish massage was alive or dead. Along the way, I learned some meaningful lessons about myself as a massage therapist and about our vibrant profession. In the end, I don’t think the integration of techniques occurring in massage is a bad thing. In fact, massage has never been more dynamic, creative, and beautiful. The problem is that we are calling our hybrid massages Swedish, when, in fact, they are something very different. Let’s think of a new term for this integrated massage (hey, what about integrated massage?) and help clients distinguish between Swedish and hybrid systems.

Swedish massage is alive in all of us. We simply need to view it again as a stand-alone system with a particular progression of strokes that doesn’t need to be dressed up with other techniques.

How would it impact the massage profession if we practiced Swedish in its purest form? Think of what that kind of consistency would mean for massage clients let alone the research implications it would have. Right now, Swedish refers to anything and everything; clients can’t depend on it. Let’s give them something to depend on and let’s give ourselves back an art form that is a fundamental part of our massage tradition.

So, here it comes: I challenge each of you to go out and ask for a classic Swedish massage and see what you get. Then, I challenge each of you to give your very best Swedish massage to one of your regular clients (using no techniques from other massage systems) and see what they say. Then, let’s broaden this discussion by sharing our findings on Massageprofessionals.com. Maybe our discussion will help us find ways to keep Swedish alive so that it is still practiced, in a pure form, long after we have left massage to future generations. 

 Anne Williams, BFA, LMP, CHT, founded spa and aromatherapy programs for a number of schools on the East and West Coasts and remains active in massage continuing education, with seminars on stone massage, aromatherapy, spa therapies, reflexology, and ayurveda-inspired bodywork. As ABMP’s director of education, her primary focus is to support massage schools, instructors, students, and professionals with useful tools and resources. Her textbook Spa Bodywork was published by Lippincott Williams & Wilkins (LWW) in 2007 and she spearheaded Teaching Massage for ABMP and LWW in 2008. Contact her at anne@abmp.com.

Notes

1. Swedish massage is a massage system formalized by Per Henrik Ling (1776–1839) of Sweden and Dr. Johann Mezger (1839–1909) of Holland and brought to the United States by Charles and George Taylor in the 1800s. Swedish massage consists of five types of strokes, their variations, and joint movement techniques. The first strokes are effleurage (stroking), petrissage (kneading), friction (rubbing), vibration (a tremor-like oscillating stroke), and tapotement (tapping). Joint movements are categorized as active (the client does the action), passive (the therapist moves the client), and resisted (the therapist resists the client’s movement to build strength). Swedish strokes are applied at a depth and vigor most appropriate for the individual clients to achieve a variety of effects and benefits, including increased relaxation, increased local circulation and lymphatic flow, decreased adhesions, improved muscle tone, and improved range of motion.

2. D. Guthrie, A History of Medicine, 2nd ed. (London: Nelson and Sons, 1958).

3. J. Burckhardt, A History of Greek Culture (Mineola, NY: Dover Publication Inc., 2002).

4. D. Graham, Manual Therapeutics, A Treatise on Massage: Its History, Mode of Application and Effects, 3rd ed. (Philadelphia: J.B. Lippincott, 1902).

5. R. Porter, Cambridge Illustrated History of Medicine (Cambridge, UK: Cambridge University Press, 1996).

6. W. Osler, The Evolution of Modern Medicine (Whitefish, MT: Kessinger Publishing, 2004).

7. Robert Noah Calvert, The History of Massage: An Illustrated Survey from Around the World (Rochester, VT: Healing Arts Press, 2002).

8. K. Ostron, Massage and the Original Swedish Movements (Upsala, Sweden: P. Blakiston’s Son and Company, 1902).

9. R.T. Mckenzie, Exercise in Education and Medicine (Philadelphia: WB Sanders CO, 1909).