Leveraging Massage for Nervous System Regulation

Massage and the Nervous System  

When you think about massage therapy, often you think about how your sore muscles will be provided with relief from the repetitive tasks that you take on in a day, whether it’s sitting at a desk, standing on your feet, or helping to manage other physical conditions. And as these benefits will leave you feeling pretty good post-massage, we often don’t think about the physiological reason for why we have a euphoric, ultra relaxed feeling for hours or days post massage. This euphoric state is due to massage impacting your nervous system positively by increasing your feel-good hormones and downregulating your stress hormones. Studies show that even after two weeks post-massage, cortisol and norepinephrine levels are significantly decreased (Lee, et. al, 2011). 

The Value of Touch

Touch is an important aspect of human’s ability to thrive. It encourages positive social interactions and has been shown to help buffer stress and has calming effects (Eckstein, et. al, 2020). Post pandemic, work-from-home, mindful distance, and social media have created a world where we are experiencing fewer face-to-face interactions, and less opportunities for touch and connection. Less human connection and increased exposure to a world filled with chaos and uncertainty leads to increased stress.

Impact of Chronic Stress

Cortisol and norepinephrine are important hormones that are a part of your sympathetic nervous system (your fight-or flight response or your body’s alert system). It helps you wake in the morning, and it also helps you respond to danger. But when you have elevated levels over time (chronic stress), these hormones impact the gut-brain axis and are reported to cause systemic inflammation and gut dysbiosis and increases in proinflammatory cytokines, causing further dysregulation to the immune system (Perelli, et. al, 2024) which may leave you managing other conditions like cardiovascular diseases, diabetes, mental health disorders, and auto-immune conditions (Mariotti, 2015). Elevated stress hormones, over time, can cause symptoms of depression and other mood disorders, with additional correlation between major depression disorders and a 60% increased risk of developing Type 2 Diabetes. (Perelli, et. al, 2024)

 The Feel-Good Hormones

 Serotonin, oxytocin, endorphins, and dopamine are “feel good” hormones with serotonin being responsible for mood, sleep, digestion, and memory and your ability to learn. Oxytocin is the “love” hormone and aids in promoting trust, empathy and bonding, which can be increased through the means of physical touch, such as massage (Raypole, 2022). Endorphins help to alleviate pain, improve mood, and manage stress by regulating the release of cortisol. Lastly, dopamine is your “Reward center” and is released during pleasurable experiences like achieving goals, sex, eating, and touch.

 How Does Massage Help Good/ Stress Hormones?

 No, massage therapy alone cannot fix any of these chronic stress conditions, but it can aid in alleviating symptoms of many conditions, including anxiety, depression, and inflammatory responses by helping to decrease stress hormones and increasing happy hormones like serotonin, endorphins, dopamine, and oxytocin. In a study published by the International Journal of Neuroscience, recipients of massage realized an average of a 31% decrease in cortisol, and 28% increase in serotonin and a 31% increase in dopamine (Field, et. al, 2009)

 If your body is stuck in sympathetic (fight or flight), massage can help you relax enough to shift back to a more natural and desired parasympathetic state of being (Meier, et. al, 2020). Ideally, the more frequently we can shift back into a relaxed state of being, the more we can balance our fight-or-flight response and better manage our stress.

 Other Ways to Manage Stress

 Massage is a great way to intentionally give yourself a dedicated hour (or more) to bring awareness back into your body, regulate your breathing, and become more centered while bringing attention to your muscle aches and pains, but there are many other ways to help regulate your stress response.

1.     Meditation

2.     Sunshine exposure

3.     Exercise

4.     Socializing with Friends

5.     Sleep

6.     Listen to and Dance to Music

7.     Eating nutrient-dense food

Dopamine, 2025. Retrieved from: https://my.clevelandclinic.org/health/articles/22581-dopamine

Eckstein, M., Mamaev, I., Ditzen, B., & Sailer, U. (2020). Calming Effects of Touch in Human, Animal, and Robotic Interaction-Scientific State-of-the-Art and Technical Advances. Frontiers in psychiatry, 11, 555058. https://doi.org/10.3389/fpsyt.2020.555058

Field, T., Hernandez-Reif, M., Diego, M., Schanberg, S., & Kuhn, C. (2005). Cortisol decreases and serotonin and dopamine increase following massage therapy. The International journal of neuroscience, 115(10), 1397–1413. https://doi.org/10.1080/00207450590956459

Lee YH, Park BN, Kim SH. The effects of heat and massage application on autonomic nervous system. Yonsei Med J. 2011 Nov;52(6):982-9. doi: 10.3349/ymj.2011.52.6.982. PMID: 22028164; PMCID: PMC3220246.

Mariotti A. (2015). The effects of chronic stress on health: new insights into the molecular mechanisms of brain-body communication. Future science OA, 1(3), FSO23. https://doi.org/10.4155/fso.15.21

Maria Meier, Eva Unternaehrer, Stephanie J. Dimitroff, Annika B. E. Benz, Ulrike U. Bentele, Sabine M. Schorpp, Maya Wenzel, Jens C. Pruessner. Standardized massage interventions as protocols for the induction of psychophysiological relaxation in the laboratory: a block randomized, controlled trial. Scientific Reports, 2020; 10 (1) DOI: 10.1038/s41598-020-71173-w

Perrelli, M., Goparaju, P., Postolache, T. T., del Bosque-Plata, L., & Gragnoli, C. (2024). Stress and the CRH System, Norepinephrine, Depression, and Type 2 Diabetes. Biomedicines, 12(6), 1187. https://doi.org/10.3390/biomedicines12061187

Raypole, C. (2022). How to Hack your Hormones for a Better Mood. Healthline. Retrieved from https://www.healthline.com/health/happy-hormone#:~:text=Serotonin%3A%20This%20hormone%20and%20neurotransmitter,and%20strong%20parent%2Dchild%20bonding.

University of Konstanz. "Ten minutes of massage or rest will help your body fight stress." ScienceDaily. ScienceDaily, 18 September 2020. <www.sciencedaily.com/releases/2020/09/200918104305.htm>.

Katszen Wellness is Moving February 1st

February 1st, 2021 we will be moving to a new studio in the same location. We will still be at 3137 Hennepin, but are moving upstairs to Suite #207.

What’s changing?

• Additional hours including weekends and evenings

• New, online services including Zoom stretch sessions, Zoom Guided Massage Lesson, and Zoom Plant-Based Cooking Instruction, and Zoom Health Coaching

Massage FAQ

What should I expect during my first massage therapy visit?

Your massage therapist may require you to fill out a health history form. Afterward the therapist will begin by asking you general questions to establish what areas you would like worked on, if there are any conditions needing to be addressed, and to determine if massage is appropriate for you.

It is important to list all health concerns and medications so the therapist can adapt the session to your specific needs without doing any harm. It is also important to list any allergies so the therapist is aware if he/she needs to use a different oil or lotion during the session.

Do I have to be completely undressed?

You should undress to the level you are comfortable. For a full body massage, most get completely undressed. However, if you will be more comfortable during the session if you leave your underwear on, that's fine. The therapist will work around the clothes you left on as best as he/she can. If removing all your clothes makes you too nervous and unable to relax, then you are not getting the optimal benefit from the session.
Your massage therapist will give you privacy to undress and get comfortable on the table.

If you prefer to stay fully clothed, then I recommend you explore the many other types of bodywork that are performed clothed.

Do I have to cover myself with a sheet or towel?

This is known as draping and depends on the therapist and in some cases, the law. The vast majority of therapists will insist on draping. Once you are undressed and on the table under the drape, the therapist will only uncover the part of your body being worked on.

What do I do during a massage treatment?

Make yourself comfortable. If your therapist wants you to adjust your position, she/he will either move you or will ask you to move what is needed. Otherwise, change your position anytime to make yourself more comfortable.
Many people close their eyes and relax completely during a session; others prefer to talk. It's up to you. It is your massage, and whatever feels natural to you is the best way to relax. Do not hesitate to ask questions at any time.

How long will a massage treatment last?

The average full-body massage treatment lasts approximately one hour. A half-hour appointment only allows time for a partial massage session, such as neck and shoulders, back or legs and feet. Many people prefer a 60 to 90-minute session for optimal relaxation. Always allow relaxation time prior to and after the session.


Will the massage hurt?

This depends on the type of massage and the depth of the strokes. A light, relaxing massage that doesn't probe very deep into the muscles, shouldn't hurt. With that being said, there is a 'feels good' hurt and an 'ouch, stop it' hurt. A good massage, even a really deep tissue massage, should always stay in the 'feels good' hurt range.
Pain can be an indication that the muscle is possibly injured or inflamed and pressure should be adjusted. Also, pain can cause you to tighten up and negate the relaxing effects of the massage. The most effective and deepest massage always works with your body's natural response, not against it.



How often should I get a massage?

"Some is better than none."
What does that mean? Well, it varies from person to person. If you are just looking for some occasional relaxation, then a session every 3-6 weeks may be fine for you.
However, if you are looking to address a specific condition, then it is recommended to go more frequently at first and then slowly taper down to a maintenance schedule. Sometimes more frequent 30-minute sessions can be effective until your goals are met and a maintenance schedule is in place. 
Frequency of sessions should be discussed with your massage therapist after your treatment when he/she has a better hands-on understanding of your particular muscular issues.

If I want a really deep massage shouldn't I see a male therapist?

The answer is NO. There is a perception that men give deeper massages than women. This is a myth. While some men do give a deeper massage, there are men who prefer to not work so deep. The same holds true for women.
It is a matter of style, training, and therapist preference. Some therapists prefer not to give really deep sessions while others specialize in this area. If you are looking for a deep massage, it is best to simply ask the therapist if she/he does this type of work. And of course, during your session it is perfectly ok to give the therapist feedback if you would like a lighter/deeper pressure. It's your session!
And remember, massage does not have to hurt to be effective.


Can I talk during my session?

Sure, if you'd like to talk go right ahead. The important thing to remember is that this treatment is all about you relaxing and enjoying the experience. Many therapists discourage talking in hopes that you will relax, let your mind float free and enter a state of massage bliss.
In many instances, people may feel more relaxed starting off talking, and as the massage progresses, enter quiet states of relaxation.

The important issue here is that there are times when you need to speak up. If the therapist is doing anything to make you uncomfortable, you should let her/him know immediately. Also, let him/her know if you get too warm or too cold, if the room is too bright, or if the pressure needs to be changed (lighter or deeper). If something is not working for you - speak up! It's OK!

Do I have to listen to whale calls or flutes during my massage?

No. (Not that there's anything wrong with that.)
While many therapists play slower, quieter, 'new age' type music, you can choose to have different music or no music at all. Studies have shown that music at under 60 beats-per-minute has a calming, relaxing effect on the body and therefore can enhance your experience.

However, while this may be true, any music you like to listen to while you relax can be listened to while you get a massage. If it relaxes you and you enjoy it at home, why wouldn't it do the same during your treatment? Ask your therapist what music he/she has to offer or if it is ok to bring your own from home.


How will I feel after my massage treatment?

Most people feel very relaxed. Some experience a significant decrease or freedom from long-term aches and pains. Many feel a little slowed down for a short period and then notice an increase of energy, heightened awareness and increased productivity which can last for days.

If you received a deep massage, you may be slightly sore the next day - much like a good workout at the gym. Sometimes a hot shower, or an Epsom salt soak in the tub can ease this soreness.

After your session you should increase your water intake a bit. Just a glass or two more than normal is usually fine. This helps keep your body's tissues hydrated and healthy.

How many sessions will I need?

Every person is unique and every condition is unique to each person. It may take one session, or it may take several. You and your therapist will be able to talk more specifically about this after your first session and he/she has had a chance to evaluate your body's tissues.


When should I not get a massage?

In my opinion, there are few conditions which would prevent you from enjoying massage. You should not book a massage if you have a fever, cold/flu, or contagious skin infection. That's it. 

There are many other conditions in which your therapist may need to adapt his/her techniques (i.e. arthritis or osteoporosis) or avoid an area completely (i.e. cuts or burns). With some conditions it is a good idea to get an approval from your physician before you receive massage (cancer, certain heart conditions, pregnancy). This doesn't mean you can't get massage. But it’s always better to err on the side of caution.
Your therapist can advise you about your specific needs.

What if I get an erection during my massage?

Sometimes it happens. Yet, most men avoid massage for fear this will happen to them. Or, they get a massage but are unable to relax because of this fear. But there is no reason to be embarrassed.

Sometimes men get an erection during a non-sexual, therapeutic, full body massage. Touch administered to any part of the body can activate the parasympathetic nervous system, which can result in a partial or complete erection.

An educated, professional massage therapist understands this and it will not be an issue for him/her. If you are still concerned, I recommend wearing more fitted underwear (briefs or boxer briefs) which provide more support than traditional boxers.

Note: If the therapist feels that the session has turned sexual for the client, male or female, he/she may stop the session to clarify the client's intent, and may decide to end the session immediately.

 The information presented here is for general educational purposes only and is not intended to replace the advice of your physician.

Adaptogen Herbs and Benefits

We all have stress. And we all know that there are things that we can do at home in order to combat stress effectively. Get enough sleep. Meditate.  Eat nutritious foods. Exercise. I know, I know!

But what if I am doing all the right things and I am still struggling?

Adaptogen Herbs? What is it?

To be considered an adaptogen herb, it must be nontoxic and serve a broad range of benefits for health, specifically to aid with mental and physical stress. Basically, adaptogenic herbs help you adapt.

I started to learn about adaptogenic herbs a couple years ago when I was looking for a natural remedy to aid with my complexion. I was fighting a war with my hormones and couldn’t quite get them to balance out right, which was wreaking havoc on my face.

After a very serious complication with a prescription medication that destroyed my joints, made me lethargic, and inhibited my range of motion (therefore my exercise routine), I was determined to find a natural solution. That’s when I came across adaptogen herbs. Ashwaganda, Holy Basil, and Chaste Berry were the three that seemed to be most effective for what I was trying to resolve. And they did help my skin. Remarkably.

So, how does this work?

Adaptogens aid your body’s ability to manage stress effectively. Whether that is dealing with abrupt changes in temperature, noises, tri-atholons, high altitudes, traffic jams or screaming children, adaptogens help to defend the body so that you can ease in and out of stressors without the heavy impact that stress can leave on your body.

What impacts does stress have on the body?

Stress can impact all the major systems in your body. Your Musculoskeletal system, cardiovascular system, Gastrointestinal system, and Endocrine system are all impacted by stress. Chronic stress can increase your chances of tension headaches, muscle fatigue, insomnia, high blood pressure, stroke, and more.

Acute stress causes your heart rate to increase while releases adrenaline, noradrenaline, and cortisol to be released. If your body is working under these conditions for too long, it can cause inflammation in your circulatory system, which can lead to long-term problems for heart and blood vessels.

 

Benefits of Adaptogen Herbs

1. Boost immunity 

Adaptogens like chaga mushroom have high levels of beta glucans, a soluble dietary fiber that has been linked to improving cholesterol and heart health.

2. Balance Hormones

Adaptogens support the hormone system and promote relaxation in periods of stress while helping to boost energy when you’re feeling physically and emotionally exhausted.

3. Promotes Cognitive Functions

When there is balance between blood sugar and hormone levels, concentration and focus increase. Siberian ginseng is a great adaptogen that helps to increase focus, concentration, and memory and mental clarity.

4. Powerful Antioxidant

Most adaptogen herbs are packed with antioxidants, phytonutrients, and anti-inflammatory compounds which can assist with athletic recovery and help to protect your heart while lowering cholesterol.  

What kinds of Adaptogens are there and where do I find them?

Adaptogenic herbs typically come in powder or supplement form and can be found at your local co-op, nutrition store, online, or at some health care practitioners’ offices.

Here are some of awesome Adaptogen Herbs:

1.     Panax Ginseng

2.     Holy Basil

3.     Ashwaganda

4.     Astragalus Root

5.     Licorice Root

6.     Rhodiola Rosea

7.     Cordycep Mushroom

8.     Chasteberry (Vitex Berry)

9.     Maca Root

I love my adaptogen herbs. I do feel more balanced, refreshed, and able to cope with everyday stressors when I am consistently adding these to my routine with healthy nutrition and exercise. I didn’t initially notice the impact on my stress health until after I stopped taking for a few days. Immediately, my coping skills and patience seemed to take a swan dive.

So, if you’re feeling a little slow, tired, or foggy, try implementing some herbs into your daily routine and see how they work for you!

Medicine Hunter. Adaptogens. Retrieved from http://www.medicinehunter.com/adaptogens

Stress Effects on the Body. (2018) Retrieved from http://www.apa.org/helpcenter/stress-body.aspx

Zolubaite, M. (June, 2017) 4 Incredible Effects of Adaptogens. Retrieved from:

https://www.indigo-herbs.co.uk/blog/4-incredible-benefits-of-adaptogens

Anderson A.D (2008) Assessment and Nutraceutical Management of Stress-induced Adrenal Dysfunction. Integrative Medicine 7(5) 

https://books.google.co.uk/books?id=5NbXBhyQGUkC&printsec=frontcover&dq=adaptogen+stimulate+sedate&hl=en&sa=X&redir_esc=y#v=onepage&q=stimulate&f=false

http://www.nature.com/nri/journal/v13/n5/abs/nri3430.html

http://www.herbalreality.com/herbs/shatavari/

https://www.ncbi.nlm.nih.gov/pubmed/19016404

https://link.springer.com/article/10.1007/s13225-012-0151-3

http://biomedj.cgu.edu.tw/pdfs/2014/37/6/images/BiomedJ_2014_37_6_345_138318.pdf

Vitamin D-ficiency

We live in the “Bold North”. The winters are long and sometimes we don’t see the sun for days. Many of us suffer from Seasonal Affective Disorder, which basically means that the winter and lack of sunshine literally depresses many of us.

Some of us are fortunate enough to be able to fly away for a vacation and the term “snowbird” is something we all understand, but what about those of us that are stuck in the frozen tundra until it thaws and gives way to longer days filled with sunshine?

What does Vitamin D do?

Vitamin is important for absorbing calcium and maintaining healthy bones and teeth Vitamin D supports a healthy immune system, brain and nervous systems as well as lung function and cardiovascular health.

It’s also reported to reduce the risk of multiple sclerosis, heart disease, and depression and aids those managing fibromyalgia.

Do I really need Vitamin D?

The fact of the matter is that there are only TWO ways to get vitamin D:

1.     Sunshine

2.     Supplements

You can, indeed, get vitamin in certain foods, but it’s pretty much impossible to consume the amount of vegetables required to gain your daily allowance of vitamin D.

What about sunscreen?

In order to gain the benefit of Vitamin D absorption, you should avoid using sunscreen. But don’t worry, D3 (cholecalciferol) is produced quickly and you can easily gain your daily D3 being in the sun for about half the time it would normally take your skin to burn. Sunshine is, without a doubt, the best way to get your Vitamin D. In the short time you spend in the sun’s rays, you can expect to gain about 10,000- 25,000 IU of Vitamin D!

Other factors to consider:

There are many factors that go into how your body absorbs Vitamin D.  For example:

The darker your skin tone, the longer it takes your body to produce vitamin D. Additionally, your location matters- the closer to the equator you are and the amount of skin you expose, the faster your body is able to produce Vitamin D.

Can you overdose on Vitamin D supplements?

Yes! The recommended allowance of vitamin D is about 600 IU a day. Taking too much vitamin D can cause a rare, but potentially serious condition called hypervitaminosis D, which is a build up of calcium in your blood. Another reason that getting the real thing is the favored option, when available.

Happy Sunshine!

As with everything else, enjoy in moderation. If you know you will be in the sun all day, sunscreen is still recommended, but be sure to let the sun kiss you before applying!

1.     American Association for Cancer Research (AACR). “Oral vitamin D supplements reduced levels of Ki67 in prostate cancer cells.” ScienceDaily, 31 Mar. 2012.

2.     Cannell JJ, Vieth R, Willett W, Zasloff M, Hathcock J, White JH, Tanumihardjo SA, Larson-Meyer E, Bischoff-Ferrari HA, Lamberg-Allardt CJ, Lappe JM, Norman AW, Zittermann A, Whiting SJ, Grant WB, Hollis BW and Giovannucci E. Cod Liver Oil, Vitamin A Toxicity, Frequent Respiratory, Infections, and the Vitamin D Deficiency Epidemic. Annals of Otology, Rhinology & Laryngology Volume 117, No. 11. 2008.

3.     Chen TC, Lu Z, and Holick MF. Photobiology of Vitamin D. In Vitamin D: Physiology, Molecular Biology and Clinical Applications by Holick MF. Humana Press, 2010.

4.     Cusano NE, Thys-Jacobs S and Bilezikian JP. “Hypercalcemia Due to Vitamin D Toxicity.” In Vitamin D, Third Edition, by Feldman D, Pike JW and Adams JS. Elsevier Academic Press, 2011.

5.     Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM; Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011 Jul;96(7):1911-30.

6.     Holick MF. Photobiology of Vitamin D. In Vitamin D, Third Edition, by Feldman D, Pike JW and Adams JS. Elsevier Academic Press, 2011.

7.     Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: National Academy Press, 2010.

8.     Plum LA and Deluca HF. The Functional Metabolism and Molecular Biology of Vitamin D Action. In Vitamin D: Physiology, Molecular Biology and Clinical Applications by Holick MF. Humana Press, 2010.

9.     Reichrath J and Reichrath S. Hope and challenge: the importance of ultraviolet radiation for cutaneous vitamin D synthesis and skin cancer. Scandinavian Journal of Clinical and Laboratory Investigation, 2012.

10.  Smolders J, Hupperts R, Barkhof F, Grimaldi LM, Holmoy T, Killestein J, Rieckmann P, Schluep M, Vieth R, Hostalek U, Ghazi-Visser L, Beelke M. Efficacy of vitamin D(3) as add-on therapy in patients with relapsing-remitting multiple sclerosis receiving subcutaneous interferon beta-1a: a Phase II, multicenter, double-blind, randomized, placebo-controlled trial. J Neurol Sci. 2011 Dec 15;311(1-2):44-9. Epub 2011 May 28.

11.  Tang, JY and Epstein Jr, EH. Vitamin D and Skin Cancer. In Vitamin D, Third Edition by Feldman D, Pike JW, and Adams JS. Elsevier Academic Press, 2011.

12.  Terushkin V., Bender A., Psaty E.L., Engelsen O., Wang S.Q., Halpern A.C. Estimated equivalency of vitamin D production from natural sun exposure versus oral vitamin D supplementation across seasons at two US latitudes. J Am Acad Dermatol. 2010 June; 62 (6): 929.e1-9.

13.  https://www.vitamindcouncil.org/about-vitamin-d/how-do-i-get-the-vitamin-d-my-body-needs/

 

Why Massage

Massage has been a practice that dates back thousands of years with origins in China, Egypt, and India. Each culture believed in the vast medical benefits that massage could provide including the ability to heal injuries, relieve pain, and the ability to prevent and cure illnesses. 

Although therapeutic massage has been in practice for thousands of years, it has only been within the last fifty years that massage has been considered therapy in the West and has become increasingly accepted as a form of alternative medicine. Massage and alternate healing is now commonly integrated into people's daily lives as part of a healthy lifestyle regime and is even becoming more and more accepted by insurance carriers and medical practitioners. 

We are becoming an increasingly aware society that is more mindful of the things that we put into our bodies and the paths that we take to recovery on a physical, mental and emotional level. Massage has been proven to provide an Ayurvedic and holistic path to wellness and according to the American Massage Therapy Associate (AMTA) can provide the following: 

• Relieve stress
• Relieve postoperative pain
• Reduce anxiety
• Manage low-back pain
• Help fibromyalgia pain
• Reduce muscle tension
• Enhance exercise performance
• Relieve tension headaches
• Sleep better
• Ease symptoms of depression
• Improve cardiovascular health
• Reduce pain of osteoarthritis
• Decrease stress in cancer patients
• Improve balance in older adults
• Decrease rheumatoid arthritis pain
• Temper effects of dementia
• Promote relaxation
• Lower blood pressure
• Decrease symptoms of Carpal Tunnel Syndrome
• Help chronic neck pain
• Lower joint replacement pain
• Increase range of motion
• Decrease migraine frequency
• Improve quality of life in hospice care
• Reduce chemotherapy-related nausea (AMTA, 2017)

(AMTA, March 16, 2018). 25 Reasons to Get a Massage. American Massage Therapy Association. Retrieved from https://www.amtamassage.org/articles/1/News/detail/3124/25-reasons-to-get-a-massage