March 26, 2014

Dosage Affects Immune and Endocrine Response to Massage

By Massage Therapy Foundation Contributor and Massage Today, Contributed By Derek R. Austin, MS CMT, Jolie Haun, PhD EdS LMT, Sandra K. Anderson, BA, LMT, ABT

If a weekly massage is helpful for stress relief and immune function, then two weekly massages must be twice as beneficial, right? The results might surprise you.
The Massage Therapy Foundation's previous monthly research columns have reported research suggesting massage may reduce pain, stress, depression, anxiety and cortisol levels, and enhance certain immune function parameters. However, how massage produces these outcomes remains a largely unanswered question. In a new study published in The Journal of Alternative and Complementary Medicine, Dr. Mark Rapaport and his colleagues investigated the mechanisms of repeated massage.

The authors compared once and twice-weekly Swedish massage to two equivalent doses of light touch. Fifty-three participants were randomized to one of four intervention groups: five weeks of Swedish massage once-weekly or twice-weekly, or control light-touch once-weekly or twice-weekly. Eight of the 53 participants did not complete the five-week protocol for reasons unrelated to the study intervention, leaving 45 participants (22 male and 23 female). Therapy sessions of 45 minutes were performed by licensed massage therapists using a standardized, specified protocol with nonaromatic oils. The light-touch condition followed the same protocol as the Swedish massage except that the therapist used only light touch with the back of the hand. Blood neuroendocrine and immune samples and salivary cortisol samples were collected prior to and following the therapy sessions.
The twice-weekly massage group demonstrated greater changes in oxytocin, arginine vasopressin, ACTH, and cortisol than the twice-weekly touch group. Twice-weekly massage also increased mean pretreatment levels of CD56+ cells, but decreased all other circulating immune markers. Changes in pretreatment levels of cytokines in the once-weekly group were similar to the authors' previous study showing sustained decreases in many pro-inflammatory and other cytokines. Interestingly, these decreases in markers of inflammation were not observed in the twice-weekly intervention groups. The authors note that the weekly massages were separated by 7 to 8 days, while the twice-weekly sessions were separated by 3 to 4 days; therefore, observed differences may represent differences in length of time between sessions. Heart rate variability was also measured, but no differences were found between the groups. This is not surprising, since young, healthy (i.e. relatively unstressed) sample participants were studied.

March 06, 2014

Patients with Fibromyalgia Find Comfort in Massage Myofascial Release Therapy

By Massage Therapy Foundation Contributor

A recent article published in the journal, Evidence-Based Complementary and Alternative Medicine, described the "Benefits of Massage-Myofascial Release Therapy on Pain, Anxiety, Quality of Sleep, Depression, and Quality of Life in Patients with Fibromyalgia."

This article, authored by Castro-Sanchez and colleagues, defined fibromyalgia as "a chronic syndrome characterized by generalized pain, joint rigidity and intense fatigue. Other frequently associated symptoms are sleep alterations, headache, spastic colon, anxiety and depression." The authors suggest fibromyalgia often leaves patients feeling incapable of performing basic daily life activities, even resulting in painful symptoms and conditions such as, "myofascial trigger points, degenerative joint disease, inflammatory joint disease, bursitis, tendinitis, development alterations, hypermobility syndrome, neuropathic pain, injuries, traumas, repeated muscle pulls, visceral pain, disk herniation, spinal stenosis and recurrent cephalalgia (headaches)."

To date, there is no known cure for fibromyalgia, thus treatment is focused on symptom control. Myofascial release therapy is commonly used to treat the symptoms of fibromyalgia. Myofascial release therapy, a soft tissue therapy, uses palpatory feedback to release myofascial tissue (the fascia that surrounds and separates layers of muscle). This accomplishes increased circulation, lymphatic drainage and relaxation of contracted muscles by stimulating the stretch reflex of muscles and overlying fascia. The purpose of this study was to "determine the benefits of massage-myofascial release therapy on pain, anxiety, quality of sleep, depression, and quality of life in patients with fibromyalgia".

Castro-Sanchez and colleagues conducted a two-group (i.e., treatment and control) randomized controlled trial to determine the benefits of massage-myofascial release therapy in patients with fibromyalgia. Of the 64 fibromyalgia patients recruited, 59 participants completed the study; 30 in the treatment group and 29 in the control group. The treatment group received a 90-minute massage-myofascial release therapy session, weekly for 20 weeks. The treatment consisted of "massage-myofascial release at insertion of the temporal muscle, release of falx cerebri by frontal lift, release of tentorium cerebelli by synchronization of temporals, assisted release of cervical fascia, release of anterior thoracic wall, release of pectoral region, lumbosacral decompression, release of gluteal fascia, transversal sliding of wrist flexors and fingers and release of quadriceps fascia." The control group received a weekly 30-minute session of disconnected magnetotherapy for 20 weeks. Patients in the control group were unaware they were receiving a sham treatment.

Pain, anxiety, quality of sleep, depression, and quality of life were measured at baseline, after the last treatment session, and at one and six months after finishing treatment. Changes in scores for anxiety, pain, depression and quality of life were analyzed for group differences between the treatment and control group. After the twenty weeks of treatment, and when measured again one month post-treatment, anxiety levels, quality of sleep, pain and quality of life were significantly improved in the treatment group over the control group. At six months post intervention, there were only significant improvement in the quality of sleep measure.

Castro-Sanchez and colleagues demonstrated the effects of a 20-week massage-myofascial release treatment program for fibromyalgia patients, with significant improvements in pain, anxiety, quality of sleep and quality of life. Findings indicate the treatment reduced sensitivity to pain, particularly at the lower cervicals, gluteal muscles and near the greater trochanters. In this study the treatment resulted in no changes in depression scores.