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Massage: Could it be your next doctor’s prescription?
By: Allison Trecker
November 13, 2008
The Big Question: Is there more to massage than just how great it feels? Does massage therapy really result in all the health benefits that many people claim it does?
Massage: The Background
The art of massage has a long history. Evidence shows the Chinese using massage to treat many ailments at least 3,000 years ago, along with the ancient Hindus, Persians, and Egyptians. (http://www.massagetherapy.com/learnmore/index.php). In the United States, however, it was not until the mid-1800s that massage therapy (MT) became popular and was promoted for health. In the 1930s and 1940s, scientific and technological advances in medicine caused the popularity of massage to decline. Nonetheless, in the 1970s, massage began to resurface, especially among athletes. (http://nccam.nih.gov/health/massage/)
Massage can be defined as “the application of soft-tissue manipulation techniques to the body, generally intended to reduce stress and fatigue while improving circulation.” The techniques applied in massage include “stroking, kneading, tapping, compression, vibration, rocking, friction, and pressure to the muscular structure or soft tissues of the human body” (http://www.massagetherapy.com/learnmore/index.php).
Among the more than 80 different types of massage, the most popular forms are Swedish, deep tissue, trigger point, and shiatsu. Swedish massage aids in flexibility. Deep tissue massage focuses on layers of muscle deep under the skin. Trigger point massage focuses deep pressure on “knots” in the muscles that cause pain and symptoms in other body parts. Shiatsu massage focuses on the flow of “vital energy” or “life force” that is believed in traditional Chinese medicine to “regulate a person’s spiritual, emotional, mental, and physical health and to be influenced by the opposing forces of yin and yang” (http://nccam.nih.gov/health/massage/).
Massage therapy can be applied as part of conventional medicine when practiced by M.D.s, D.O.s, physical therapists, psychologists, and registered nurses. An example of this is the use of MT in the reduction of swelling called lymphedema. On the other hand, MT is often part of complementary and alternative medicine (CAM), which is a group of diverse health care systems, practices, and products that are not currently viewed as conventional medicine. Complementary medicine is used in conjunction with conventional medicine, while alternative medicine substitutes conventional medicine. An example of massage as CAM is its use to enhance immune system functioning. (http://nccam.nih.gov/health/massage/)
Massage therapists practice in many settings, such as private offices, hospitals, nursing homes, fitness facilities, and patient’s homes or workplaces. The treatment is usually 30 to 60 minutes long, and for some conditions, therapists recommend a series of appointments. The environment of massage therapy is calm and peaceful, which is achieved through the use of dim lighting, soothing music, and aromatherapy. Therapists also often uses oils, ice, heat, or machines. (http://nccam.nih.gov/health/massage/)
Massage: The Benefits
Most people view massage as a way to relax and reduce stress, anxiety, and muscle soreness since massage relieves tension. However, there are many other claims about the benefits of massage. Massage is said to:
-boost the immune system
-reduce anxiety and withdrawal symptoms in adults tying to quit smoking
-reduce pain in people with fibromyalgia, migraines, recent surgery, and back pain
-aid during pregnancy and labor by lessening stress and anxiety, relaxing the muscles, and reducing pain
-increase weight gain in premature babies and reduce the number of days in the hospital
-cause children with diabetes to be more likely to stick to their medication and diet, which in turn reduces blood glucose levels
-increase the number of natural killer cells, which defend the body from viral and cancer cells
-lessen anxiety, pain, and fatigue in people going through cancer treatment
-improve range of motion
-shorten labor for pregnant women
-ease medication dependence
-enhance immunity by stimulating the lymphatic (natural defense) system
-exercise and stretch weak, tight, or atrophied muscles
-help athletes prepare for and recover from vigorous exercise
-improve the condition of the skin
-increase joint flexibility ( help with arthritis)
-promote tissue regeneration, reduce scar tissue and stretch marks
-reduce post-surgery adhesions and swelling
-reduce spasms and cramping
-release natural painkillers (endorphins)
-enhance sleep quality
What is the rationale behind this long list of benefits of massage? The simplest explanation is that since it is estimated that more than 90% of disease today is stress-related, it would make sense that massage, which reduces stress by ease muscle tension, would correlate with overall greater health. (http://www.massagetherapy.com/learnmore/benefits.php)
Massage: The Risks
If massage is done correctly, severe injuries rarely occur. However, massage is not without its risks; it can cause internal bleeding, nerve damage, or temporary paralysis. (http://www.revolutionhealth.com/healthy-living/relationships/stress/relaxation/massage?s_kwcid=benefits of massage|1156166064) Massage could also have side effects, including temporary pain, bruising, swelling, or allergic reaction to massage oils. (http://nccam.nih.gov/health/massage/)
Massage: The Evidence
A lot of the claims about the benefits of massage found on the World Wide Web have very little concrete evidence to support them. Also, many times, these claims come from people, such as massage therapists, who have a great incentive to persuade readers to believe in the many the benefits of massage. So what does the scientific research say about massage therapy? As it turns out, the results are mixed.
Evidence supporting benefits of massage:
In a randomized controlled trial (RCT), Lawler and Cameron (2006) examined the effects of massage therapy on migraines, which are usually caused by stress and poor sleep. The participants in the massage and control groups recorded migraine experiences and sleep patterns for 13 weeks, with the massage group receiving weekly massage therapy during weeks 5 to 10. The results of this study showed that, compared to the control group, massage participants had less frequent migraines and better sleep quality during the intervention weeks and the 3 follow-up weeks. The massage therapy lessened perceived stress and improved coping efficacy during the intervention weeks. During the massage sessions, state anxiety, heart rate, and cortisol were decreased (Lawler & Cameron, 2006). The quality of this study seems to be relatively good, especially since it is a RCT, the gold standard of research studies.
Huth, Zink, and Van Horn (2005) did a literature review covering research over 20 years to examine the effectiveness of massage therapy for people with cystic fibrosis (CT). About 30,000 people in the U.S. have this genetic disorder—a life-threatening condition resulting in severe lung disease, pancreatic insufficiency and reproductive problems due to thick secretions. Massage therapy is thought to help with the chest, head, back, limb, and abdominal pain that people with CF experience. Although their review did show preliminary support for the use of massage therapy to help with CF, since it does seem to improve the individuals’ quality of life, much more research in needed. The studies that were reviewed had multiple methodological limitations, were inconsistent in their results, and had relatively small sample sizes (Huth, Zink, & Van Horn, 2005).
Field (2008) did a literature review spanning research from the last five years on the most popular complementary and alternative therapies used during pregnancy and labor. Massage therapy is one of the most common alternative therapies recommended by providers of prenatal healthcare, as well as the most popular among pregnant women. Field (2008) found two studies by The Touch Institute that proved MT to be effective during pregnancy. In both studies, participants who received MT, in contrast to the control group, reported decreased depression, anxiety, and pain in their legs and backs. MT also caused a decrease in cortisol levels, excessive fetal activity, and rate of prematurity in the massage group. MT was found effective during labor as well. Field’s (2008) review of several studies showed that massage lessened the intensity of pain during labor, shortened the labor time, and lessened the need for medication. Field (2008) does point out however, that it is impossible to do double-blind or placebo-controlled studies when researching massage (Field, 2008). This is a limitation that affects all of the studies presented in this paper.
Billhult, Stener-Victorin, and Bergbom (2007) did a qualitative study describing the experience of massage therapy in patients during chemotherapy treatment for breast cancer. Ten patients were given five MT treatments and then interviewed. Their experience is described as a lessening of uneasiness toward chemotherapy, which is very valuable to them. MT served to distract them from the frightening process of chemotherapy, make their experience more positive, and enable them to relax and feel cared for (Billhult, Stener-Victorin, & Bergbom, 2007). The most obvious limitation of this study is its incredibly small sample size, and consequently, its results should be “taken with a grain of salt.”
Currin & Meister (2008) examined the effects of Swedish massage therapy on the perceived level of distress in oncology patients in a nonrandomized single-group pre- and post design study of 251 volunteer patients over a 3-year period at a university hospital in Georgia. The study found a statistically significant decrease in pain, physical discomfort, emotional discomfort, and fatigue, regardless of gender, age, ethnicity, or cancer type (Currin & Meister, 2008). The fact that his was not a randomized controlled study is a serious limitation for the merit of this evidence.
Evidence against the benefits of massage:
Coelho, Boddy, and Ernst (2007) did a literature review to assess the claim that massage therapy is an effective treatment for depression. Frequently, people with depressive disorders or subsyndromal symptoms of depression (SSD) use complementary and alternative therapies, such as massage therapy (MT). In order to evaluate the effectiveness of multiple sessions of Swedish MT to treat depression, they looked at four RCTs and concluded that there is currently a lack of evidence that MT is an effective treatment for depression (Coelho, Boddy, & Ernst, 2007).
Jönhagen, Ackermann, Eriksson, Saartok, and Renström (2004) performed a prospective randomized clinical trial of 16 subjects to assess whether sports massage improves recovery after eccentric exercise. They found that MT made no impact on the level or duration of pain or the loss of strength or function on the muscles after exercise. Although the study was a randomized clinical trial, the gold standard of research, the small sample size is a great limit to the generalizability of this study. Similarly, Howatson, Gaze, and Van Someren (2005) examined the effects of ice massage on muscle damage and function of athletes after intense exercise using a within-subjects cross-over design of 12 males. However, there were no significant differences between the control and experimental groups, showing that ice massage is ineffective at reducing muscle damage and promoting recovery of muscle functions after exercise. Again, the small and single gender sample limits the results of this study.
Clearly, much more research needs to be done in order to more clearly prove what health problems massage therapy is and is not effective in treating. The rationale behind why massage therapy should improve health seems relatively simple and solid, and there are numerous studies supporting its health benefits. On the other hand, most of the studies proving benefits of massage have fundamental flaws, and there have also been many studies concluding that massage has no effect whatsoever in treating certain health problems. Thus, if you are thinking about massage as a form of complementary or alternative therapy, your best bet is to try it out for yourself and determine if it benefits you, personally.
The Not-So-Satisfying-Answer: Yes and no. There is currently a lack of evidence pointing in either direction.
1) Billhult, A., Stener-Victorin, E., Bergbom, I. (2007). The experience of massage during chemotherapy treatment in breast cancer patients. Clinical Nursing Research, 16(2), 85-99.
2) Coelho, H. F., Boddy, K., Ernst, E. (2007). Massage therapy for the treatment of depression: a systematic review. International Journal of Clinical Practice, 62(2), 325-333.
3) Currin, J., Meister, E. A. (2008). A hospital-based intervention using massage to reduce distress among oncology patients. Cancer Nursing, 31(3), 214-221.
4) Field, T. (2008). Pregnancy and labor alternative therapy research. Alternative Therapies in Health and Medicine, 14(5), 28-34.
5) Howatson, G., Gaze, D., Van Someren, K. A. (2005). The efficacy of ice massage in the treatment of exercise-induced muscle damage. Scandinavian Journal of Medicine & Science in Sports, 15(6), 416-422.
6) Huth, M. M., Zink, K. A., Van Horn, N. R. (2005). The effects of massage therapy in improving outcomes for youth with cystic fibrosis: an evidence review. Pediatric Nursing, 31(4), 328-332.
7) Jönhagen, S., Ackermann, P., Eriksson, T., Saartok, T., Renström, P. A. F. H. (2004). Sports massage after eccentric exercise. American Journal of Sports Medicine, 32, 1499-1503.
8) Lawler, S. P., Cameron, L. D. (2006). A randomized, controlled trial of massage therapy as a treatment for migraine. Annals of Behavioral Medicine, 32(1), 50-59.
9) Melancon, B., Miller, L. H. (2005). Massage therapy versus traditional therapy for low back pain relief: implications for holistic nursing practice. Holistic Nursing Practice, 19(3), 116-121.
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