Massage History

Medical Gymnastics

Prior to 1913, Swedish massage did not exist in a formal capacity. While medical gymnastics sometimes used massage in treatment, it was a minor part of the practice. 

Per Henrik Ling created medical gymnastics and founded the Royal Central Gymnastics Institute in 1813, now known as the Swedish School of Sport and Health Sciences.

His goal was to help people exercise in as many balanced, holistically harmonious ways possible. Inspired by Greek philosopher-physicians, he divided his method into four elements, which makes sense since this was the age of the four humors.

• Education: The purpose was to integrate physical training with mental and moral development. It fostered discipline, health, and character through structured exercises that promoted the values of Enlightenment philosophy.
• Military: Due to the era’s emphasis on military preparedness, this element focused on improving the strength, agility, endurance, coordination, and discipline of soldiers.
• Medical: This element’s purpose was to help cure and treat illness and physical suffering.
• Aesthetic: This element was to help people perform expressive movements to convey feelings and emotions. It combined exercise with physical expression to encourage grace, harmony, and natural flow. 

Ling’s approach to diagnosing and treating illness was very similar to the four humors. However, instead of seeking harmony between the fluids of blood, phlegm, yellow bile, and black bile, he used the three forms. 

• Mechanical: Represented by our strength.
• Chemical: Represented by the food we eat the medicines we consume.
• Dynamic: Represented by our spiritual and mental aspects.

Henrik Ling believed the best way to treat illness was through exercise and cultural recreation, rather than prescribing medicine. Other treatments included circulation techniques and passive stretching, with manual manipulation, which may include beating, kneading, pounding, and pressure.

Legacy of Medical Gymnastics

Ling had several successors, including Lars Gabriel Branting, Tuls Johan Hartelius, Anders Wide, and Johan Arvedson.

Lars Gabriel Branting

Lars Gabriel Branting was Per Henrik Ling’s first successor and was known as a marketing genius, especially in developing the reputation and growth of medical gymnastics.

• He convinced the medical academy and the Swedish nobility to classify medical gymnastics as a medical science that could cure most illnesses.
• He earned medical gymnastics international recognition and was responsible for its geographic spread and reputation.
• He systemized Ling’s teachings, quite the feat since Ling left behind very little written material.
• He improved upon Ling’s work and kept meticulous handwritten records about his patients.

Tuls Johan Hartelius

Tuls Johan Hartelius was appointed head teacher in 1864, and remained until 1887. He compiled, systematized, and clarified Branting’s handwritten, disorganized notes, then published them in the Lärobokisjukgymnastik in 1870. Also known as the Swedish Movements or Medical Gymnastics, this book became the basis for future textbooks in the field.

It appears that Hartelius broke away from Ling’s view of health and illness. Rather than treating sickness through the three forms, he adopted current scientific theories.

He believed people were neither ill nor healthy; instead, a combination of the two. Sickness germinated within healthy cells until they became dysfunctional.

He believed his approach encouraged cells to remain healthy through movement, categorized by their effects: strengthening, invigorating, calming, sleep-inducing, draining, or evacuating.

Anders Wide & Johan Arvedson

Anders Wide is briefly mentioned simply because he compiled, further systematized, and clarified medical gymnastics.

Johan Arvedson established an affiliate school of the Royal Central Gymnastics Institute in 1887 that taught medical gymnastics and massage.

He often argued that massage was a distinct practice from medical gymnastics because, toward the end of the 19th century, gymnastics consisted of active movements performed by the patient and passive movements performed by the gymnast.

Massage, by contrast, entailed only passive movements, primarily in the form of manual therapy. In Arvedson’s medical texts, he distinguished the difference between Swedish Massage and Medical Gymnastics.

• Swedish Massage was defined as “a handling of the soft tissues by movable pressure in the form of stroking, rubbing, pinching or kneading, as well as striking and beating performed with a therapeutic aim.” Comprised of the four main strokes: effleurage, friction, petrissage, and tapotement.
• Medical Gymnastics was defined as “the treatment of a patient while exercising musculoskeletal organs.” Comprised movements and positions.

Although Georg Mezger codified medical gymnastics movements into standardized techniques using French terminology. Arvedson further defined them.

• Effleurage involved strokes directed toward the heart, with the intention to improve circulation and help with lymph flow. There were two kinds of Effleurage strokes. The first type started lightly and quickly moved along a line of 15–25 cm. The second was performed slowly with more pressure. Averdson stated the second type was used for swelling and edema, or could be used to lessen tension pain, reduce inflammation, improve metabolism, or rejuvenate fatigued muscles.
• Friction was meant to break down pleural thickenings and inflammatory products and was performed with firm pressure. The gymnast was taught to remain aware of the patient’s reaction to monitor their discomfort.
• Petrissage has a similar purpose to friction, in that it was designed to break down pleural thickenings and inflammatory products. This stroke tended to cause pain as it entailed pinching and kneading.
• Tapotement included techniques similar to striking and prodding, and included hacking, beating, pounding, shaking, and vibration.

George Herbert Taylor and Charles Fayette Taylor

Charles Fayette Taylor was taught by Mathias Roth, the first person to publish a textbook in English on the Ling’s system. He and his brother George Herbert Taylor introduced Medical Gymnastics to the United States in 1858

 George Taylor wrote the first American book on the Ling system: Exposition of the Swedish Movements.

What Happened to Medical Gymnastics?

The Karolinska Institutet and other physicians argued that medical gymnastics was not grounded in scientific evidence and should operate under the supervision of the medical community. The Karolinska Institutet awarded the Nobel Prize in Physiology and Medicine.

In response, the Royal Central Gymnastics Institute (the headquarters of Ling gymnastics) argued that physiotherapists were practicing medical gymnastics without proper training or certification.

Medical gymnastics could not compete with scientific advances in vaccines, surgical treatments, hospitals, medical training, specialization, and medical research. Sweden followed the Western push to adopt the biomedical system, gradually replacing traditional medicine in the 19th century.

Eventually, the feud between medical gymnastics and the medical system culminated in the Royal Central Gymnastics Institute being absorbed by the Karolinska Institutet in 1934.

Medical gymnasts became known as physiotherapists and were placed under the supervision of physicians. Over time, the esteem associated with being a physiotherapist degraded as they lost their autonomy and became dependent on the medical community.

Massage History

Medical Gymnastics influenced the development of massage, as many techniques used in this practice were adopted into Swedish massage in the 20th century.