The Evolution of Massage Therapy in the Medieval and Renaissance Periods

Introduction

In the first part of this series, we explored the roots of massage therapy during the classical era, where figures like Hippocrates and Galen laid the groundwork for understanding the body and health. Moving forward into the medieval and Renaissance periods, massage therapy evolved further, influenced by the interplay of cultural, religious, and scientific developments. From the meticulous classifications of Avicenna to the groundbreaking work of Ambroise Paré, this era highlights the resilience and innovation of massage as both an art and science. Join me to uncover how massage therapy persisted, adapted, and ultimately flourished during these transformative centuries.

Avicenna (980–1037): Foundational Insights

Avicenna's The Canon of Medicine dedicated an extensive chapter to massage under "Preservation of Health" in its first volume. This section outlined various types of massage, categorising them into preparatory friction (applied before exercise to warm the body), restorative friction (used post-exercise to alleviate exhaustion and reduce fatigue), and therapeutic techniques designed to improve circulation, reduce excess fat, and enhance overall vitality. Avicenna’s detailed classification included hard friction for strengthening, gentle friction to relax the body, and repeated friction to refine health. He also advocated for the use of oils to facilitate smooth movements and improve the effects of massage on the skin and muscles. The techniques were believed to balance bodily humours, aligning with the medical theories of Hippocrates and Galen (Çetkin, Bahşi and Orhan, 2019).

In addition to his scientific classifications, Avicenna provided insights into the psychological benefits of massage. He suggested that therapeutic touch could calm the mind, reduce stress, and improve sleep quality. His inclusion of mental health considerations highlights the holistic nature of his approach to medicine. Furthermore, Avicenna’s extensive use of aromatic oils and heated stones in massage therapy provided both physical and sensory benefits, marking a sophisticated understanding of multisensory healing.

Constantine the African (1020–1087): Bridging Medical Traditions

Constantine the African was instrumental in translating Arabic medical texts into Latin, thereby introducing advanced therapeutic practices, including massage, to European audiences. Drawing from sources like Avicenna and Haly Abbas, Constantine highlighted the use of massage to stimulate circulation, relieve tension, and restore physical balance. He translated texts such as the Pantegni, which included detailed discussions on manual therapies and their role in addressing both physical and psychological ailments. His emphasis on integrating oils and herbal compresses reflected the sophisticated medical practices of the Islamic world (Kaltio, 2023; Green, 2023).

Constantine’s translations also introduced tools such as wooden rollers and padded gloves to enhance massage techniques. His work underlined the integration of manual therapy with dietary regulation and herbal remedies, showcasing a holistic approach to patient care.

Hildegard of Bingen (1098–1179): Spiritual and Physical Harmony

Hildegard of Bingen’s approach to health was deeply rooted in her philosophy of cosmic harmony. In her works Physica and Causae et Curae, she highlighted the interplay between spiritual, mental, and physical well-being, asserting that health relied on balance within the body and alignment with divine forces. Hildegard’s methods included gentle rubbing to stimulate blood flow, often accompanied by the application of herbal oils to invigorate the skin and muscles. She believed in the therapeutic power of touch not only to restore physical health but also to soothe the soul (Walker-Moskop, 1985; Sweet, 1999).

Hildegard further recommended specific massage techniques for different conditions. For muscle stiffness, she suggested long, firm strokes combined with warming oils infused with herbs like lavender and rosemary. For ailments of the spirit, she advocated rhythmic, circular massages to “restore the divine flow” within the body. Her approach underscored the interconnectedness of body, mind, and soul.

Trotula of Salerno (11th–12th Century): Women’s Health Pioneer

Trotula of Salerno, one of Europe’s earliest known female physicians, advanced women’s healthcare through her works, including De curis mulierum (On Treatments for Women). Her writings emphasised massage and bathing for alleviating gynaecological issues, alongside warm compresses and oils to promote relaxation and relieve pain. Trotula’s expertise extended to childbirth and postpartum recovery, where she advocated manual techniques like kneading and circular motions (Güli, 2023).

Trotula provided detailed instructions on preparing herbal oils, such as blending chamomile and calendula to enhance healing properties. Her integration of these practices marked a significant advancement in gender-specific therapeutic approaches, establishing her as a pioneer in holistic women’s health.

The Decline of Massage in Europe: Spiritual Dominance

During the Middle Ages, the Church’s spiritual framework for understanding illness led to the decline of physical therapies like massage. Manual treatments were often viewed as distractions from divine intervention. Nevertheless, some monastic communities preserved herbal and manual therapies. Monks and nuns combined massage techniques with prayers and medicinal oils, often focusing on palliative care (Sweet, 1999).

Monastic practices included tools like wooden sticks wrapped in cloth for deep muscle work. Herbal poultices paired with gentle massage were commonly used to treat joint pain and inflammation, ensuring the survival of therapeutic knowledge.

Guy de Chauliac (c. 1300–1368): Surgical Integration

Guy de Chauliac referenced massage in his seminal work Chirurgia Magna, advocating its use in managing pain and aiding recovery. He recommended kneading and compressing techniques to reduce swelling and improve circulation, particularly in post-surgical care. Guy’s work marked a turning point, blending practical and holistic approaches to rehabilitation (Çetkin, Bahşi and Orhan, 2019).

Guy’s texts also included instructions on using oils infused with myrrh and frankincense to speed up healing. His advocacy for massage highlighted its growing acceptance as a legitimate medical practice.

Revival During the Renaissance (16th–17th Centuries)

The Renaissance revived massage therapy, with Ambroise Paré (1510–1590) leading its integration into modern medicine. Paré categorised massage movements into gentle, medium, and vigorous frictions based on their effects. He also recommended using oils and poultices to enhance outcomes, particularly in reducing scar tissue and improving flexibility (Markatos et al., 2017).

Paré promoted daily massages for the elderly to improve circulation and joint flexibility, as well as for athletes to optimise performance. His innovative reduction techniques for dislocations, combining massage with bandages and ointments, solidified his role as a pioneer in rehabilitative medicine.

Conclusion

This exploration of massage therapy during the medieval and Renaissance periods demonstrates its enduring value and adaptability across eras. Building on the classical foundations discussed in the first post of this series, we see how figures like Avicenna, Constantine, and Trotula preserved and advanced massage practices amidst cultural and scientific shifts. By the time of the Renaissance, pioneers like Ambroise Paré brought these traditions back into the spotlight, shaping the foundation for modern therapeutic practices.

Stay tuned for the next post in this series, where I delve into how the Enlightenment and Industrial Age transformed the art of healing touch into a structured medical discipline.

References

• Çetkin, M., Bahşi, İ. and Orhan, M. (2019) 'The Massage Approach of Avicenna in the Canon of Medicine', Acta Med Hist Adriat, 17(1), pp. 103-114.

• Güli, Ö. (2023) 'Trotula, The First Female Physician of Europe', Lokman Hekim Journal, 13(2), pp. 314-324.

• Kaltio, O. (2023) 'Switching Style towards Ease in a Medieval Textbook of Medicine: Revision of Constantine the African’s Pantegni', The Library, 24(4), pp. 415-440.

• Markatos, K., Karamanou, M., Tsourouflis, G., Androutsos, G. and Mavrogenis, A. F. (2017) 'Ambroise Paré (1510–1590): On the Diagnosis and Treatment of Shoulder Dislocations', International Orthopaedics (SICOT), 42(2), pp. 215-218.

• Sweet, V. (1999) 'Hildegard of Bingen and the Greening of Medieval Medicine', Bulletin of the History of Medicine, 73(3), pp. 381–403.

• Walker-Moskop, R. M. (1985) 'Health and Cosmic Continuity: Hildegard of Bingen's Unique Concerns', Mystics Quarterly, 11(1), pp. 19-25.