The War on Sore--Massage Is All the Rage

In mid-April 2007, the Taiwan Academy of Physical Medicine and Rehabilitation sponsored a survey of more than 600 people over the age of 25 about the use of massage patches. The survey concluded that each year these compresses are applied more than 438 million times to treat soreness caused by bad posture, computer use, strenuous labor, or housework.

Massage equipment suppliers have also discovered that massage chairs, foot massagers, eye massagers and the like have experienced rapid growth of 20-30% per year. Taiwanese, whose average workweek of 43 hours trails only Hong Kong and India, have a soreness index that is second to none.

Although massagers and massage patches offer direct, convenient relief, they are only temporary, superficial solutions. Many among the aching also spend their weekends soaking in hot springs, enjoying hydrotherapy at a spa, or having a session with a chiropractor at a massage studio or a Chinese medical clinic. Exhausting all means to ease their fatigue and pain, they may even take up yoga or taichi.

In 2006 the US firm Nielsen polled 25,408 Internet users in 46 countries about their willingness to pay for various therapies to maintain their appearance, as well as the frequency with which they avail themselves of them. If expense were not a factor, 54% of all men and women said they would choose massage. There were similar results in Taiwan, where 61% most wanted massage.

Media worker Yeh Tzu-ying has been getting massages for 20 years. The stress at work and frequent overtime takes a toll on her psyche and body. Getting on in years, she finds that she can no longer simply wave away her fatigue. More and more sore, and sore in more and more places, she has increased the frequency of her massages from once every two or three months to about once a week. If she gets so busy that she has to skip them, the pain grows more severe, and she ends up feeling totally uncomfortable no matter what she does.

"I've tried massages of all kinds," she says. "I'd love to find some master masseur who could banish my fatigue forever." Oil massage, shiatsu massage, acupressure massage, foot massage, chiropractic therapy, tuina massage... she has sampled them all.

"Some of the masseurs have pretty good technique, and their massages are very effective at first," she says. "But after a few sessions, my body seems to get used to it, and it provides less relief. So I try someplace else." She currently goes to an acupressure masseur, but she hasn't given up on finding someone even better.

Many share Yeh Tzu-ying's experiences. Consequently, more and more types of massage therapy are being offered in Taiwan, and more and more massage studios have opened for business.

So as to compete with sighted masseurs, blind masseurs have left their backroom studios and entered such public areas as large markets and department stores to provide tired shoppers with spur-of-the-moment, abbreviated massages that last only 15 minutes.

Thai-style massage is in

In the evening, after work, high-tech workers from the Chungho Technology Park in Taipei County walk in twos and threes toward the discreetly signed Garden Spa in a nearby residential neighborhood. So regular are their visits that they might as well be entered on their weekly work schedules. The sessions provide an excellent way for colleagues to socialize.

On the outside the Garden Spa looks like a typical residence, but beyond the threshold one enters another world, in which statues of the Buddha, images of deities, and aerated pools for water plants provide a South Sea atmosphere. The proprietor personally selected and brought back all of the decor from Thailand. The bright and spacious rooms matched with exquisite furnishings make one wonder if one hasn't mistakenly entered a high-class hot-springs spa.

The Garden Spa stresses its top-notch service. Customers first soak their feet in a lavender bath, which both relaxes their bodies and promotes circulation. Then the masseurs give them a pedicure, which includes exfoliation. With blood and qi now circulating freely, the customers follow the masseurs into a dimly lit room, where they switch into loose cotton clothes and lie down on mattresses. Here they get a Thai-style massage, which is akin to "passive yoga." After two hours, the customers go to the front room where they enjoy some exquisite sweets with tea. After resting, they take their stress-free bodies home.

With the fashion for Shanghai-style footbaths, foot massage establishments have introduced footbaths, which can soften hard skin, speed the circulation and relax the body, into the massage process.

Doing the yoga for you

In Thai-style massage the masseur applies energy to the sen lines (which roughly correspond to the meridians in Chinese medicine), so as to fully stretch the body. Starting at the feet, they apply pressure, spot by spot, moving toward the middle of the body. Then they massage the arms, the back and finally the head. Through gentle rubbing, pressing and hand chopping, each area is relaxed. Then, the masseur stretches the body in various ways, such as by tugging on the arms to pull back the shoulders. The body is also moved into positions resembling yoga poses, such as the "bridge" and the "plow." The lively quality of this form of massage endears it to the young.

"Almost all of those who get Thai massages are workers in their 20s," says Lin Wei-hui, the Garden Spa's associate manager. Tech workers in particular have to hunch over desks toiling on computers for hours on end, so their upper bodies grow more and more constricted, compressing their internal organs, and they suffer stiff shoulders, poor circulation, and sore and hunched backs. Consequently, they are fond of this kind of massage, which stretches their ligaments and even applies pressure directly to their joints. On the other hand, middle-aged and older customers, perhaps because they are less flexible and tolerant of pain, will sometimes grit their teeth and shout out "Bow! Bow!" (Thai for "softer"). So as to serve these clients, many Thai massage studios still offer traditional Taiwanese-style acupressure massage.

Currently, Taiwan has more than 30 Thai-style massage studios, almost all of which opened over the last three years. Lin Wei-hui suggests that the craze among Taiwanese for traveling to Southeast Asia is behind the trend. Thai-style massage is often on tour itineraries, which has given Taiwanese a liking for it. And there is also a large population of about 90,000 Thai laborers here. Consequently, quick-witted entrepreneurs went to Thailand to learn what they needed to know and then returned to Taiwan to get a piece of the massage market.

"It came into fashion in Taoyuan first, and then gradually spread north and south." Offering two-hour sessions of Thai massage from NT$900 to NT$1,800, these massage studios have sprung up like mushrooms after spring rain. Many were originally oil massage studios. To welcome consumers' taste for things novel, they changed their signs and the kind of massage that they offer. Some have done very well, but quite a few have also quickly gone out of business.

In Chungho the Garden Spa occupies a three-story house of more than 3600 square feet. Currently only two of the floors are used by the business. It has been open for less than a year, and its revenues total NT$600,000 a month. "Our masseurs have been carefully selected to meet high standards," Lin says. The staff includes eight Thai-national masseurs and masseuses. Almost all of them studied at massage schools in Thailand, so their technique is pure and correct. Consequently, they've built up a loyal clientele. It seems that Thai-style massage is indeed putting down roots here.

In an era of global competition, amid high levels of stress, more and more office workers are finding themselves among the ranks of the aching, and they have fueled the popularity of various kinds of massage.

Footing the bill

The Huahsi Street Night Market used to be known as "Snake Alley." People would put on demonstrations of kungfu and sell snake meat to tourists there. In recent years it has gradually become "Massage Alley," with a focus on foot massages. Four or five years ago the short street had only two foot massage studios. In the blink of an eye, now there are eight. And it isn't the only place you'll find these establishments: In the famous old streets of Tanshui, foot massage places have opened one after another. And other areas that are popular with tourists, especially the shopping districts favored by Japanese, also have their share of them.

Back in 1978, a Swiss priest in Taitung named Father Josef Eugster, who used foot massage to ease the pain from arthritis in his knee, began to give massages to churchgoers to help with their conditions. Many people specially went to Taitung to seek treatment or learn techniques from Eugster. At that point foot massage grew in popularity and began to rival traditional Chinese acupressure massage. The wife of the director of the Yu-Min Hospital in Taipei County's Sanchong found relief from her headaches through Eugster's foot massages, and that led to the hospital itself offering a foot massage service and providing training in its techniques. It has nourished the foot massage industry in greater Taipei.

Early on, foot massage was promoted for diffusing the uric acid in the feet. The overemphasis on curative effects raised eyebrows in the medical community, and for a period the treatment was prohibited by the Department of Health (DOH). Proprietors who stayed in business typically hid the studios in residential neighborhoods.

Then in 1993 the government saw that foot massage had become a calling card for the tourism industry, and in response to petitioning from industry, the DOH finally relaxed its position and designated foot massage as a traditional folk treatment, beyond the control of the medical establishment. Its proprietors could finally hang out their shingles again.

So as to protect traditional massage by the blind, the Council of Labor Affairs requested that they not use the term "foot massage" (or literally "sole of the feet massage") on their business signs. Since with Eugster's additions, the realm of foot massage had come to include everything under the knee, and because it had gotten tied up with traditional Chinese theories about yin and yang and the five elements, its name was changed to "foot reflexology treatment."

"Foot massage is used in more than 40 countries, but it is most advanced in Taiwan," says Chen Pi-hsiung, the chairman of the Chinese Foot Reflexology Association, who frequently attends international conferences in the field. Currently, there are about 20,000 people employed in foot reflexology in Taiwan, and a lot of stress is placed on technique. Consequently, Taiwan has become a place where people from other nations come to observe and learn. And the industry comes in third place in terms of attracting spending by foreign tour groups, behind only tealeaves and mullet roe.

Thai masseurs expend a lot of energy stretching the bodies of their customers and can serve only five customers in one day.

Second heart

Cheng Cheng-yu, owner of the Taichitong chain of foot reflexology parlors, has been in the industry for 12 years. When he was young, he suffered from various ailments. After he found that foot massage improved his physical constitution, he started to moonlight as a foot masseur before opening his own studio.

"In truth, it's a hard line of work," he says. "You can't just think of it as taking care of a pair of feet; there is a lot of knowledge involved. And half of the NT$500 a customer gives a masseur for a 30-minute session is taken by the studio.

Cheng explains that people's feet, which are connected to important organs via the cardiovascular and nervous systems, are "sensors" of overall body health. They are especially important because of the push and pull between the heart and the gravitational attraction of the ground, which bring the upward and downward flow of blood out of synch. For this reason, the feet are known as a "second heart." Masseurs use special techniques to stimulate the feet, which excite the nervous system and change its electric potential energy, energizing the cells.

Foot massage used to emphasize the idea of "no pain, no gain." You would often see people crying out like babies and unintentionally kicking their masseurs. Frequent customers would require stronger and stronger pressure to maintain the same level of pain, with the result that the masseurs' fingers would easily grow misshapen and customers' feet could get injured. Consequently, many viewed foot massages as something to dread.

Yet now that way of thinking is out, and the emphasis is on massage that is "slow and easy, deep, and directed." Each movement has to be linked together in a required path of pressure, and each reflex zone must be massaged in a certain order. Jumping around willy-nilly is totally out of the question.

Having worked in Taichitong for six years, Tsai Chi-chia believes that a good masseur must, after coming into contact with a customer's body, be able to determine the appropriate amount of pressure to apply. It is extremely important to listen and observe. If a customer reveals pain and stiffness or hunched, tightened shoulders, one must proceed with caution.

Cheng Cheng-yu observes that most of the big fans of foot massages fall in the 30-45 age group. Their goals are to relieve stress and preserve their health. But some proprietors are moving in the direction of massage as a leisure activity, spending tens of millions of NT dollars to add massage chairs, pump in pure oxygen and generally provide six-star service in an effort to attract younger consumers.

Thai masseurs expend a lot of energy stretching the bodies of their customers and can serve only five customers in one day.

Blind massage awaits renewal

Taipei's Cultural and Educational Foundation for the Blind conducted a survey four years ago of 25,000 people who visited their massage studio. The survey revealed that 84% of Taipei workers suffered from stiff necks and shoulders or sore backs. Next in prevalence were stiffness and heaviness in the waist, buttocks and legs. The survey also sampled 1127 people from around Taiwan and discovered that 76% of respondents had never had a massage, and another 20% only get one to ten massages in six months. The foundation thus concluded that there was much room for growth in the massage market in Taiwan. In truth, although the massage market has grown a lot in recent years, the lion's share has gone to spas, where the masseurs are not visually impaired. On the other hand, more traditional blind masseurs are worried about keeping their jobs.

Near the Taipei Songshan Airport, there is a massage studio hidden amid apartment buildings and lacking a prominent sign. For many businessmen returning from abroad, the studio, which has been in business for 20 years, is a must stop.

It's run by Chang Mao-lung, who is blind. Several years ago, when business was booming, the ten beds in his six rooms would be occupied from 10 a.m until midnight, with hardly ever a vacancy. Even during the SARS outbreak of 2003, Japanese tourists still came in large numbers.

"At our busiest, our eight masseurs had more work than they could handle, and my wife and I would have to help. We'd wear ourselves out serving all the customers."

With the fashion for Shanghai-style footbaths, foot massage establishments have introduced footbaths, which can soften hard skin, speed the circulation and relax the body, into the massage process.

Diagnostic sensors

Chang, who has been a masseur for more than 30 years, can get a first impression of a customer's current health from the nasal sound of their speech or the hoarseness of their voice. Then he asks customers where they feel uncomfortable, and he can gauge the accuracy of his original determinations from their responses.

"The body is like a mirror that faithfully reflects health issues," he says. "But many people lack the time or relevant knowledge to get a sense for it." Many people, for instance, aren't even aware they have digestive tract issues, but he can feel accumulations in the stomach or determine, through tapping, that the belly is congested. Then with light rubbing, kneading, tapping, applying pressure with the heel of the hand, and vibrating, he can dislodge the obstructions, and alleviate the problem. If there is a putrid urine-like aroma and the face is bloated, he will judge that the customer has a kidney problem and urge him to go to a hospital.

Chang remembers when there were no massage studios, and someone who wanted a massage would have to sit at home in the evening and listen for the six notes on a flute that meant a blind masseur was passing by. Customers would then go out and invite the masseur into their homes to work. Those who couldn't wait would go to hotels and ask for massage service at the counter. Otherwise they would go to barber-shop massage parlors or hot-spring spas to get an oil massage or acupressure massage from the sighted. But these establishments became regarded as seedy places of ill repute. It wasn't until the 1970s, as national income began to rise, that massage started gradually to become regarded as a necessary enjoyment amid people's busy modern lives, and the visually impaired, with subsidies from the government, began to go into the business.

During the boom period, many people thought that Chang must have made a lot of money, and they urged him to open multiple studios. In fact, Chang has never made more than enough for his family to get by.

But it has never been his goal to turn a big profit. In addition to giving 67% of the take to the masseurs, he's even allowed his own living area to be used as a massage room, and he has rented two rooms to provide the masseurs with a dormitory. He has also hired someone to cook and clean. Although the business gets a NT$120,000 subsidy from the government each month, that covers only half of the operating expenses. And even during their peak season in the summer, it is hard to reach the 600 hours of massage per month they need break even.

So as to compete with sighted masseurs, blind masseurs have left their backroom studios and entered such public areas as large markets and department stores to provide tired shoppers with spur-of-the-moment, abbreviated massages that last only 15 minutes.

Not lowering standards

"Qualified blind masseurs must have a grounding in anatomy, the energy meridians of acupressure, and the basics of traditional Chinese medical theory," says Chang, who lost his vision when he came down with glaucoma while in the armed services. "Moreover, while giving a massage you also must 'watch, listen, ask questions, and take pulse.' Only by so doing can you get to the heart of the problems and really allow customers to feel good."

It used to be that the blind would receive at least two years of training in massage. Now, laments Chang (who is also an instructor at the Institute for the Blind), the training has been reduced to a year. With insufficient experience, they lose customers' trust. When Chang hires new masseurs for his studio he must set aside three months to give them extra basic training. Unfortunately, the Bureau of Employment and Vocational Training has this year reduced its own training program for masseurs to only three months. That forces inexperienced masseurs to learn on the job and ends up scaring off customers.

With the massage industry in Taiwan diversifying and coming to be viewed more as a form of leisure experience, with a greater emphasis on fancy decor and presentation, his business in recent years has been declining. The sharp drop in Japanese tourists and large numbers of businessmen pulling up stakes and moving to China has cut his clientele. Nevertheless, Chang Mao-lung still employs four masseurs to maintain a basic level of service.

"No matter how bad the economy, people who are used to getting massages will come; it's just that they are fewer in number." He observes that middle- and high-income customers don't get hit as hard by economic downturns. There are even some affluent parents who bring in children preparing for exams so as to relieve their stress.

"The elderly, who get less exercise and whose circulation and metabolism are in decline, need massage the most, but in the current economic climate, they do without." Chang observes that the elderly often lack a means to earn money. Rather than speaking to their children about the situation, they end up ignoring their own needs. Their plight is hard for him to bear. He hopes that this period of stagnation will quickly pass so that blind massage can enter a second spring, and these old customers will once again be able to enjoy the benefits of massage.

In an era of global competition, amid high levels of stress, more and more office workers are finding themselves among the ranks of the aching, and they have fueled the popularity of various kinds of massage.

Doctor's orders

Massage has already become a little something for everyone. People are thinking about how to reduce their stress and what actions to take to protect their own health. It is something to celebrate, but there are dangers.

"Recently, a lot of people have had to seek treatment for massage injuries," says Chien Wen-jen, head of the physical therapy group at Cathay General Hospital. He believes that there is no basis in Western medicine for the claims made about acupressure and reflexology in traditional Chinese massage. Those consumers who piously believe that "if this or that zone of the foot hurts during massage, then there must be something wrong with a corresponding organ" frequently hear the "warnings" of masseurs and come in to check them out-only to get a clean bill of health.

Chien Wen-jen explains that Western recuperative medicine views massage as a means to prevent tissue adhesion after surgery procedures, to promote blood circulation, and to relax the muscles so as to prevent veins and arteries being constricted by tissue. It also uses rubbing, pushing and tapping to loosen muscles, stimulate the nervous system and bring greater suppleness to the joints.

With the fashion for Shanghai-style footbaths, foot massage establishments have introduced footbaths, which can soften hard skin, speed the circulation and relax the body, into the massage process.

Mindful massage

"There is a taboo in massage against using excessive force," he says. "Pain doesn't equate with effectiveness. To the contrary, you must take care not to injure." Some people may find that massage loses its effectiveness once they get used to it. But if they consequently then ask masseurs to apply greater force, they may end up rupturing the cells of muscle fibers, damaging the joints and ligaments, or even injuring the nervous system or blood vessels and causing contusions which, if too large to be fully metabolized, may lead to calcification.

He emphasizes that people whose muscle tissue has been damaged by overly forceful massage should not let the pain keep them from stretching. Some mild stretching is necessary to prevent muscle atrophy, which can be irreversible.

"No matter what kind of massage therapy is used, the highest principle should be 'comfort during the massage, relaxation afterwards.'" Chien Wen-jen reminds those who have "caught the massage bug" that during spare moments at work they ought to do stretching exercises or go outside for a walk. This will alleviate their need for massage and reduce the needed frequency.

Chien believes that it's always better to take a do-it-yourself approach. Stretching exercises are even better at relieving work stress. One can, for instance, simply press on the stomach with one's fingers. Starting from the temples, rub toward the back of the ears, then toward the neck, and finally down to the shoulders. These steps can ease the body's soreness and fatigue.

"Massage is only a supplementary treatment-it can't cure anything by itself," says Chien, reflecting on the surge of interest in massage. "From a psychological standpoint, massage just reflects the need and desire for physical contact with another person amid the alienation of modern life." Sometimes the respect and warm embraces of family members, he believes, can serve as even better forms of treatment.

Points to Watch

◆Keep warm: When getting a massage, you should wear loose and thin clothing and pay attention to keeping warm. If the masseur's fingers are cold, then the massage may cause your muscles to tighten, and pain will be intensified. So as to relax deeply, it is best to have a massage after a bath or a soak in a hot spring.

◆Keep your muscles relaxed and tension dispelled: Because of the intimate nature of massage, as well as the feelings of pain, soreness, or numbness caused by the masseur's pressing, pushing, rubbing and kneading, people may become increasingly tense during a massage. This not only makes it difficult to apply the proper massaging force so that the massage is ineffective; it can even result in injury. At such moments, apart from asking the masseur to ease up, one should also focus on breathing, or imagine that one is floating in a warm pool of water, or that one is falling, unable to put up any resistance against the force of gravity.

◆Don't have a massage while hungry or too full: It's best to avoid having a massage during the 30-60 minutes before and after meals. The best times are in the morning and in the evening. (In the morning it will awaken one's energy, and in the evening it will dispel fatigue.)

◆Detoxify after a massage: Have a cup of warm water after a massage, so as to flush the just-loosened toxins from the body.

◆Be extra careful if pregnant or ill: Pregnant or menstruating women, or people with osteoporosis, diseases of internal organs, cancer, or diseases that make one prone to bleeding (such as diabetes) should consult with a physician before having a massage. Before having an oil massage, one should consider the issue of skin allergies.

Thai masseurs expend a lot of energy stretching the bodies of their customers and can serve only five customers in one day.

Thai masseurs expend a lot of energy stretching the bodies of their customers and can serve only five customers in one day.

The soles of the feet may be small, but they have ample nerves and acupressure points. There are 64 basic techniques of foot massage. And these don't even include the many techniques employed for the areas between the soles of the feet and the knees. The foot massage process has a precise order; it can't be done willy-nilly.

So as to compete with sighted masseurs, blind masseurs have left their backroom studios and entered such public areas as large markets and department stores to provide tired shoppers with spur-of-the-moment, abbreviated massages that last only 15 minutes.