Physical pain that is often chronic goes hand in hand with psychological depression. Often, clients who come for massage for pain relief also suffer from depression. Of course, as massage therapists we do not do psychotherapy. However, depression has major physiological and anatomical components; it is in this area that massage can truly have a significant and profound effect.

It is important to understand depression and how it manifests physically. You also need to understand the different types of depression and physically how they individually respond to massage therapy.

Situational depression: Many clients are situationally depressed. They usually have situations in life that are stressful and appear overwhelming. Situational depression often arises after loss of a loved one is experienced, typically during the mourning process. The good news is when the situations change massage can very effectively support the client moving out of depression.

Family of origin depression: Other forms of depression are more psychological in nature and usually stem from family of origin issues that have been unresolved. Often these clients will have been in therapy to work on these issues and many will be medicated for depression. The seeds of depression will have been around since early childhood, so there has been plenty of time for the body to grow into a depressed and collapsing structure that gets significantly worse when the issues arise. In these situations, there are also endorphin biochemical changes.

Moderate depression, like family of origin depression, will be longer term than situational depression. However, unlike family of origin depression, moderate depression will often be triggered by no discernable event. Often the appearance is cyclic even to the time of the year. These clients are often on long-term medication and in therapy. Because of the longevity and severity of moderate depression there are substantial structural and biochemical changes to the endorphins. It is important that these clients be monitored by mental health professionals during the duration of massage therapy.

Severe depression often requires hospitalization and heavy medication. These clients usually won't be coming for massage until they have had months of both psychological and chemical therapy. Due to the severity of the depression their issues are often profound, and the changes both structurally and biochemically are more severe. It is important for the massage therapist to be working with the psychiatrist and/or psychotherapist to monitor the risk for relapse and potential suicide.

Chronic depression is usually moderate to severe. These clients are being treated by mental health professionals with both medication and therapy. Because of the duration of chronic depression there will be significant structural collapse and changes in the endorphins. They should also be monitored by a mental health professional during the course of massage.

Treatment with Massage

Now let's identify some of the physiological and energetic challenges for those who are depressed. This is where massage therapy can accomplish physical changes that normal psychotherapy or medication cannot. With all the above forms of depression there is a structural collapse in the client. This involves a shortening of the abdominal muscles and a tightening of the diaphragmatic arch which pulls the chest down and forward, limiting its ability to expand during breathing. There is an additional medial rotation of the shoulders and internal rotation of the arms resulting in a kyphosis that further restricts breathing. Without the support of the thoracic region, the head and neck will move forward and down and further into collapse. All this distortion of the upper body will lead to further distortion in the lower body and give the structure an image of being fully collapsed. The degree of structural collapse will depend upon the severity of depression and its duration.

The benefits of massage: Applying massage with the goal of releasing the structural collapse associated with depression will bring the client from a hopeless, helpless collapsed structure to one that is supported and erect. This sense of support will give the client feelings of being stronger and more capable of dealing with the issues of their depression. Key areas to release for structural support are: 1) the abdomen and diaphragmatic arch; 2) the musculature and connective tissue of the front of the chest that cause a sunken chest and medial rotation of the shoulders; 3) the musculature and connective tissue of the anterior shoulder and upper arms that cause an internal rotation of the arms; and 4) the musculature and connective tissue of the anterior neck followed by the posterior neck and top of the shoulders. Follow this by bringing the legs out of hyperextension and more under the body. All of this will result in a significant structural change in a depressed client.

While releasing the structural collapse associated with depression you will also be releasing the breath process which will allow depressed clients to energize their system and have more energy. This additional energy will allow them to take part in their lives and move out of depression.