Friction strokes work on deeper muscles than the techniques previously described. The friction technique is a pressure stroke and is the deepest that is used in Swedish massage. The massage therapist applies pressure by placing the weight of his or her body on the flat of the hand and the pads of the thumbs, knuckles, fingers, or the back of the forearms, and then releases the pressure slowly and gently. This movement should be a continuous sliding motion or a group of alternating circular motions.
In Malaysia, reflexology has been applied widely but without any certification and qualification from the Ministry of Health. Tighter control is needed to overcome this problem. Practitioners who conduct this therapy may not have the accurate knowledge about reflexology and may lead to any contraindication for certain conditions. The government should take serious enforcement about this practice among practitioners who are not certified. Each practitioner must have a proper training. The ministry of education could provide vocational training in the local community colleges throughout Malaysia to upgrade the skills and knowledge of reflexology practitioners.
Headaches. Severe headaches and migraines are the second most common pain conditions in the U.S. (15 percent) according to the AAPM, and Everhart says that massage therapy can oftentimes help in these cases. The Migraine Relief Center (MRC) indicates that the reason this modality works is that it eases muscle spasms, improves blood flow and circulation, relieves tension, and increases relaxation. The MRC shares that it is also especially helpful when it comes to tension and vascular headaches.
In Germany massage is regulated by the government on a federal and national level. Only someone who has completed 3,200 hours of training (theoretical and practical) can use the professional title "Masseur und Medizinischer Bademeister" or Medical Masseur and Spa Therapist. This person can prolong his training depending on the length of professional experience to a Physiotherapist (1 year to 18 months additional training). The Masseur is trained in Classical Massage, Myofascial Massage, Exercise and Movement Therapy. During the training they will study: Anatomy, Physiology, Pathology, Gynecology, Podiatry, Psychiatry, Psychology, Surgery, and probably most importantly Dermiatry and Orthopedics. They are trained in Electrotherapy, and Hydrotherapy. Hydrotherapy includes: Kneipp, Wraps, underwater Massage, therapeutic washing, Sauna and Steambath. A small part of their training will include special forms of massage which are decided by the local college, for example: Foot reflex zone massage, Thai Massage etc. Finally a graduate is allowed to treat patients under the direction of a doctor. He is regulated by the professional body which regulates Physiotherapists. This includes the restriction on advertising and oath of confidentiality to clients.[citation needed]

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