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Massage Today
March, 2012, Vol. 12, Issue 03

The Relationship Between Doctors and Massage: A Look at the Past

By Judi Calvert, LMP

In 1888, a practicing physician in Carlsbad, Bohemia, by the name of Emil Kleen MD, PhD, wrote a book called the Handbook of Massage in his Swedish language. Dr. Kleen's work was translated into several languages.

German writers of that time also began to write books on the subject of massage. Kleen wrote his book as an introduction for younger students of medicine to the indications and contraindications of massage. It was Kleen's "desire to combat the oft-expressed inclination to advance massage to the dignity of an exclusive method of treatment."

Kleen wanted the students and readers of his book to, "look upon massage as I do myself, viz., as a remedial measure, among many, that is capable of being frequently employed, but which is seldom to be resorted to by itself alone."

There were not many illustrations in Kleen's first book because he did not think they would be necessary, considering there were centers teaching massage at the time. His second book, published in 1921, was essentially the same text with some revisions and additions, along with several illustrations. Both books have wonderful chapters titled, "Massage to Diseases of the Joints and Eyes," "Massage for Frostbite," and "Contraindications to Massage."

Kleen's books were intended to support the continuation of manual therapy work that was so successful during World War I. The physicians of Europe, as well as Kleen, believed that manual therapies were very important as a part of their medical practice. Thus, he wrote about the benefits of massage to bring awareness to other doctors around the world. Kleen was a critic of lay practitioners. He and most physicians at the time believed massage was only valuable when performed by physicians and under their direction.

In Kleen's first book, he distinguishes between massage and gymnastics--a recurrent theme in his writings that drew criticism. His distinction was important when it came to applying either massage or gymnastics to the specific medical conditions. Kleen's description of massage was, "a mechanical action which if performed on the soft tissues, for a therapeutical purpose, by means of certain manipulations, namely, stroking, rubbing, kneading and striking."  His definition of gymnastics was, "it involves the exercise of the organs of motion." Both forms of treatment he felt had, "many points in common." Kleen felt that most of the writers of the time did not distinguish the difference between these treatments. For the sake of being consistent, he thought it best to, "speak of the manipulations of massage, and of the movements of gymnastics." He felt that both practices were "branches of mechano-therapy, along with orthopaedeics." The conception of massage, in its entirety, embraces not only the manipulation of massage, but also their modes of action."

Here's a question for readers: Do you think that mechano-therapy came first or massage? Dr. Kleen felt that, based on his readings of history that, "on the whole, gymnastics have emerged within the domain of science earlier than massage, since the scientific requirements of the first are much more easily fulfilled than those of the latter." To prove his point, Kleen includes a time line in his book and wrote about several countries that pioneered mechano-therapy and massage.

Of those renowned physicians mentioned in Kleen's book were the Greeks. Kleen, "acclaims Asclepiaedes as the Father of mechano-therapy, for the invention of several devices designed to produce fluid movement through swinging, vibration or violent motion." Asclepiades was a Greek physician who practiced and taught medicine from 124-40 BC.  Asclepiades also used massage extensively in his practice.

In the 1860's, Kleen felt that it was Dr. Mezger, of Amsterdam, who achieved fame in spreading the "impulse" of massage. Mezger convinced the public how important massage was and through his teachings to German and Scandinavian students, he had a great influence on the standing of massage by introducing it to the medical world.

The Technique of Massage

Kleen felt that "massage was an easy art, requiring less practice and skill than many other mechanical procedures which recur frequently in our calling, in which we all demand a certain amount of dexterity of ourselves--- as, for instance, in using the laryngoscope or the catheter, the performance of ordinary surgical operations, etc.  To be a good masseur one must study anatomy and physiology and pathology." This was the difference that Dr. Kleen felt between a trained or untrained masseur.

The masseur had to have, "normal upper extremities, that are not too weak — the hands especially should not be too lean or small — and some aptness for mechanical work." So I guess people whose hands were either too big or too small were simply out of luck and had to find another career. Kleen believed that students of massage should spend time with an "expert teacher" to learn the correct techniques. When the student gets out on his own, Dr. Kleen felt that each student should, "work out his own technique which soon becomes as characteristic as his own handwriting."

Developing the skills required for accurate palpation tools is the hardest thing to achieve for the masseur, both then and now. This may have been where the phrase, "practice, practice and more practice" came about. Dr. Kleen felt that massage was usually best when given with the hand. He did mention that other masseurs used a variety of tools along with massage done by the hand. The hand techniques performed by the masseur were classified by the Mezger's School using the French terms "Effleurage," "Frictions," "Petrissage," and "Tapotement." I laughed my head off when I read that the Mezger School taught their students to use hog lard as a medium on the skin of massage patients.

Some things never change over time with beginners in massage. Using too much force is something all of them have in common. Dr. Kleen felt that, "on the other hand, professional masseurs go to the other extreme." Kleen felt that in some cases greater force with the hands to the tissues was necessary and if it caused, "spots to show up," the effect was minor and disappears quickly. Dr. Kleen wanted to correct statements some writers made that masseurs should, "not be too energetic as to cause sugillations or discolorations of the skin and that every spot of that sort is a reproach to the masseur."

What was great to learn from Dr. Kleen's book was that masseurs were using hypnotism and hypnotic suggestions with their patients along with massage. They were having wonderful results, but Dr. Kleen wanted to wait a few years before he would discuss it further. I have used hypnotism in my massage practice for a short period of time and also had good results. It was a research project that I did on clients who had been in a bad car accident. Dr. Kleen's book is a wonderful reference from the past, full of valuable information that is relevant today about massage, shared by doctors who had the courage to step out of their box to study, learn and teach massage along with the medicine that they practices in the late 1800's.


  1. Handbook of Massage by Emil Kleen, MD, PhD, 1892.
  2. Massage and Medical Gymnastics by Emil Kleen, 1921.
  3. The History of Massage by Robert Calvert, 2002.

Click here for previous articles by Judi Calvert, LMP.


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