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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The theory of this course will be delivered in class where the student attendance is compulsory whereas the practice session is home-based study. Diploma course of reflexology from this school covers most aspects needed in reflexology field including professional practices, counselling and communication skills, nutrition and other health modalities, practice management skills, and advanced techniques. This school also provides part-time reflexology course.19

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Currently, the learning centre which provides training for reflexology is very limited. Normally anyone interested to learn reflexology will learn about reflexology through apprenticeship. Recently, Stella In, a local Malaysia training centre offers certification of training in reflexology. This institute was established by the Ministry of Tourism Malaysia as one of the centres of excellent which offers spa therapy training, specifically for Malaysian, with full job guarantee at any officially approved spa organizations. This institute offers certified qualification of national/international diploma in reflexology foot massage course. Learning about the body zones, feet reflexes, and reflexology techniques which can improve blood circulation, removal of toxins from body, and help to increase the energy level are offered in this course. The teaching techniques include theory and practical.14
Similar to Thai massage, in a Swedish massage the client’s joints and muscles are compressed and stretched. This can cause an immediate release of energy that might cause the skin to flush. Clients might also experience a few temporary aches as the body readjusts itself, depending on their level of flexibility and any current physical ailments. For example, a person who arrives at a practitioner’s office with an ultra-tight muscle that has been traumatized may experience some pain while the trauma is massaged out and worked through. In massage, areas of stress and pain can act as blockages to the body’s circulation, energy flow, and overall well-being.
So what should runners book instead? Anna Gammal, a massage therapist who works with elite runners at the Boston Marathon each year and also massaged athletes at the 2004 and 2012 Olympics, recommends either a sports massage (i.e. targeted therapeutic treatment for the unique physical and biomechanical needs of athletes) or a myofascial release massage (i.e. the application of gentle, sustained pressure on soft tissue restrictions). Both specifically target muscle release and will help improve flexibility, reduce pain and increase range of motion.
My massage therapist has been doing massages for 30 years. He is really aggressive. I thought that I was going to die. The pain was so intense that I honestly feel that it was worse than having children. When the massage was complete, I felt relaxed. When I got home I felt exhausted, like I had been in a major accident. Truthfully I feel like crap. I ache from head to toe, what the heck is this? I feel absolutely horrible. I had a bath before bed and it did help somewhat. But this morning I still feel like hell …

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Thank you so much for your article The Pressure Question in Massage Therapy. I just read it all. I went for a sports massage two weeks ago as I was recommended to have one as it was suggested it might help with tight calves, a side effect of some other injuries I have. I’ve been for sports massages many, many times before over the years. This one was one of the most painful experiences of my life — when I got home I was almost sick and felt in shock. My right achilles tendon was raging and it’s been bad ever since. It hurt so much when it was done (like someone was sticking knives in) and I kept asking if it was meant to hurt. I wish I’d just stopped the session or objected but I didn’t. It used to be a bad injury that affected me walking for about 6 months so I’m just devastated about this. I can hardly bear to put shoes on and its all this time on. I know there are good practitioners out there but experiences like this just make me want to stay away. I wish I’d gone to a “gentle” one.
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Referred pain basically just makes trigger point stimulation feel bigger, more important. Press on a small spot … feel it down your entire arm. Wow! Impressive! Even though it’s just a thumb on a trigger point, it feels as though that “itch” is being scratched throughout an entire region. Referred pain amplifies the good pain effect — or the bad pain effect, if the pressure is too intense!

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