Scientific Support for Massage and Bodywork
© 1996 William Collinge, M.P.H., Ph.D.
(Excepted from The American Holistic Health Associations Complete Guide to Alternative Medicine, Warner Books)
Prior to the advent of pharmaceutical medicine earlier in this century, references to massage therapy and research were not uncommon in the mainstream medical literature. There were over six hundred articles in various journals such as the Journal of the American Medical Association, British Medical Journal, and others from 1813 to 1939. A great deal of research was also conducted in Eastern Bloc countries and China. In this country after World War I, there was a precipitous decline in focus on this field as drugs and other allopathic interventions gained the foreground.
With the renewed interest in natural forms of treatment, research activity in massage and bodywork has again gained momentum. Studies have documented benefits for amputations, arthritis, cerebral palsy, cerebral vascular accident, fibrositis syndrome, menstrual cramps, paraplegia/quadriplegia, scoliosis, acute and chronic pain, acute and chronic inflammation, chronic lymphedema, nausea, muscle spasm, soft tissue dysfunctions, grand mal epileptic seizures, anxiety, depression, insomnia, and psychoemotional stress, which may aggravate significant mental illness. Following are a few examples of recent studies.
Massage in the Elderly. A controlled study showed massage therapy produced relaxation in eighteen elderly subjects. This study demonstrated physiological signs of relaxation in terms of decreased blood pressure and heart rate and increased skin temperature.5
When the Office of Alternative Medicine at NIH invited applications for its initial wave of research grants, eighty-five of the 450 applications were for massage related studies, the largest number of any modality. Of the first thirty grants awarded, the following four dealt with massage therapy:
Thomas Burk,Ph.D., of the Morse Physical Health Research Center in Toledo, Ohio, was awarded a grant to study whether immune functioning could be improved in AIDS patients when massage therapy was used in combination with antiviral drugs.
Denise Matt Tope, Ph.D., of Dartmouth College in Hanover, New Hampshire, was awarded funds to study whether massage therapy can reduce anxiety and depression in bone marrow transplant patients.
Douglas DeGood, Ph.D., at the University of Virginia was funded to study the degree to which massage therapy can reduce anxiety and the need for follow-up care in women undergoing surgery for uterine cancer.
Frank Scafidi, Ph.D., at the University of Miami’s Touch Research Institute is studying the effects of daily massage on growth, cognitive development, and immune function in premature infants born to HIV infected mothers.
A fifth study involves Therapeutic Touch. Melodie Olson of the Medical University of South Carolina in Charleston is using a controlled experiment to examine the effects of Therapeutic Touch on the immune functioning of highly stressed students preparing for professional board exams. Positive findings would have implications for other highly stressed populations including cancer and AIDS patients.
Spinal Pain. A study of the combination of various types of massage in fifty-two patients with traumatically induced spinal pain led to significant reductions in acute and chronic pain and increased muscle flexibility and tone. This study also found massage to be extremely cost-effective in comparison with other pain therapies, with cost savings ranging from 15 to 50 percent.6
Pain Control. Massage has also been shown to stimulate the body’s ability to control pain naturally. One study showed that massage stimulates the brain to produce endorphins, chemicals that control pain.7
Lymphedema. Lymph drainage massage has been found to be more effective than mechanized methods or diuretic drugs to control lymphedema (a form of swelling) caused by radical mastectomy. It can be expected that using massage to control lymphedema will significantly lower treatment costs. This is based on a study comparing massage with the use of sleeve-like pressure cuffs often worn by women with lymphedema.8
Inflammatory Bowel Disease. A study found that massage therapy can have a powerful effect on psychoemotional distress in patients with chronic inflammatory bowel diseases such as ulcerative colitis and Crohn’s disease. Stress can worsen the symptoms of these conditions, which can lead to great pain, bleeding, and hospitalization or death. Massage therapy was effective in reducing the frequency of episodes of pain and disability in these patients.9
Therapeutic Touch and Wound Healing. A controlled trial examined the effects of Therapeutic Touch on healing identical surgically inflicted minor wounds in the shoulders of forty-four male college students. Twenty-three received Therapeutic Touch treatments and twenty-one did not. Neither group was aware of the purpose of the experiment and those treated were not aware they were being treated. After eight days, the treated group’s wounds had shrunk an average of 93.5 percent compared to 67.3 percent for those untreated. After sixteen days the figures were 99.3 percent and 90.9 percent.10
Reflexology and PMS. A controlled clinical study of thirty-eight women with premenstrual syndrome examined the effects of a thirty-minute reflexology treatment weekly for eight weeks. Those receiving the treatment were treated by ear, hand, and foot reflexology. Those in the control group were given placebo or sham reflexology. Based on a daily diary that monitored the severity of thirty-eight premenstrual symptoms, the treated group had a 46-percent reduction, which was a significantly greater reduction than the 19-percent reduction of the control group.
Unlike some of the hormone-altering drugs and antidepressant medications that are often used, the treatment produced no side effects. The researchers concluded that reflexology might work by softening adrenocortical reactivity to stress, which is known to exacerbate symptoms in PMS.11
Touch Research Institute, University of Miami
The most comprehensive program of massage-related research is the University of Miami’s Touch Research Institute. Created in 1991 by the school of medicine, it is the world’s first center for basic and applied research in the use of touch in human health and development. Directed by Tiffany Field, Ph.D., a professor of psychology, pediatrics, and psychiatry, the TRI has a multidisciplinary staff of forty scientists from the fields of medicine, biology, and psychology and another thirty visiting scientists from other universities participating in collaborative studies.
A plethora of studies have demonstrated impressive benefits for integrating massage therapy into medical care. In one study, premature infants treated with daily massage therapy gained 47 percent more weight per day and had shorter hospital stays by six days than those that were not massaged, resulting in cost savings of approximately $3000 per infant.12
Jason, fifty-five, was suffering from pain in both hips, which had become arthritic. He had been very athletic most of his life, running and playing basketball and tennis. He had been told by a physician that he may be facing a hip replacement as his condition had been degenerating over several years—particularly in the right hip.
He sought the help of Bridget Beck, a Rolfer in Santa Rosa, California, who gave him the standard series of ten Rolfing sessions. Beck observed that he had an external rotation of the right leg (turning outward), a rotation of the pelvis, and an unequal distribution of weight on his legs. The rotator muscles in his buttocks were chronically tight in order to support this pattern and all of this resulted in more stress to the hip joints.
The Rolfing balanced the pelvis and brought the right leg back into alignment with the hip joint to allow more proper tracking through the motion of the joint. His weight became properly distributed over both legs.
He also gained more flexibility and balance to all the segments of his body. He reported greater ease of movement, more vitality, and reduction in hip joint pain to where he was able to return to sports activity. At one point he asked if he might be misusing the Rolfing by becoming so active again.
A study of the effects of massage therapy on HIV patients found that those who received a massage five times a week for one month had higher numbers of natural killer (NK) cells, which were also more potent. They also had less anxiety and lower serotonin (stress hormone) levels.
A third study involved giving massage therapy to fifty-two hospitalized depressed and adjustment disordered children and adolescents. A separate comparison group viewed relaxation videotapes. Those receiving the massage therapy were less depressed and anxious and had lower saliva cortisol levels, which is an indicator of less depression.14
Following is a list of other applications of massage therapy currently being studied at TRI:
Newborns of cocaine-addicted mothers
Infants of depressed mothers
Infant sleep disorders
Infants with cancer
Posttraumatic stress disorder after Hurricane Andrew
Pediatric skin disorders
Juvenile rheumatoid arthritis
Depressed teenage mothers
Teenage mothers’ childbirth labor
HIV and improved immune function
Spinal cord injuries
Rape and spouse abuse
Couples’ sex therapy
Volunteer foster grandparents
Chronic fatigue syndrome
Little research has been conducted on the various forms of bodywork. One exception is Rolfing, for which several studies have found interesting effects.
In one controlled study, forty-eight participants were randomly assigned to either the experimental group (Rolfing) or a control group (no Rolfing). A significant decrease in anxiety was found in those who received the treatment over a five-week period. The researchers explained these findings in terms of the theory that the Rolfing caused a release of emotional tension that had been stored up in the muscles, which in turn resulted in lower anxiety scores on a psychological test of state anxiety.15
Other studies of Rolfing have found improvements in muscular efficiency,16 reductions in anxiety,17 decrease in pelvic tilt, and increase in vagal tone (amplitude of respiratory sinus arrhythmia, a heart rate function that corresponds with reduced stress in the body).18
Strengths and Limitations
Massage therapy and bodywork obviously have a very broad, diverse range of applications. Essentially, they can support any health condition that would benefit from greater blood circulation and the release of tension. Psychological conditions also are affected beneficially, as the physiological changes that occur with these kinds of intervention help harmonize and rebalance the nervous and hormonal systems.
There is great potential in using massage to reduce cumulative traumatic disorders in the workplace. For example, chicken cutters in chicken processing plants often develop carpal tunnel problems. Several companies in the chicken processing industry in Virginia have developed worksite massage programs that have shown impressive reductions in these problems. The most frequently used techniques include cross-fiber, deep tissue, and Swedish, concentrated on those muscle groups that are chronically stressed in the work (hands, arms, shoulders, and back). The programs also teach self-massage techniques and the results include better morale and reduced absenteeism.
Contraindications to massage or bodywork are few and may include transmittable skin diseases, unhealed wounds, postoperative conditions, and blood clots. In many cases, of course, such therapy can avoid problem areas in the body, assuming the practitioner is aware of the condition.
Many people wonder about whether massage or bodywork could cause a cancer to metastasize. According to Elliot Greene, “This is an area where research is needed to define the risk. Practitioners are generally taught to err on the side of conservatism. For example, massage is not recommended for someone immediately after chemotherapy or radiation treatment.
“Physiologically, it is not easy to metastasize a tumor from simple pressure and studies have shown that the body has a number of layers of defenses to prevent that from happening simply from touch. It is known, however, that certain kinds of chemotherapies in particular make the tissue fragile for a couple of days and massage immediately after such therapies might irritate the tissues. If there was any danger of metastasizing, it would be more likely to happen closer to the treatment. A conservative response would be to use much lighter forms of massage.”19
In fact, massage therapy is increasingly being incorporated into complementary cancer therapy programs. At the Cancer Support and Education Center in Menlo Park, California, it has been an integral part of a program that resulted in significant improvement in quality of life, even for patients with metastatic disease.20
The ability of massage to reduce anxiety, depression, and stress is a logical counter to the strain a cancer patient must deal with in facing a life-threatening condition and traumatic treatment.
The Practitioner/Patient Relationship
Hands-on therapies naturally foster a kind of intimacy between the practitioner and patient. In many of the approaches, the recipient partially or fully disrobes and lies on a table (though they are draped with a sheet and are never fully exposed), which further contributes to the intimacy and vulnerability that may be felt when using this tradition. Normal boundaries of social interaction are crossed. Hence there is a special need for sensitivity and regard for the client on the part of the practitioner that matches and perhaps even exceeds that of many doctor-patient relationships.
There is a wide range of attitudes among practitioners about how they view their role. Some think of themselves as healers or therapists, working with the whole person through the body. Certain approaches (e.g., the Rosen Method) are explicitly focused on engaging the person on the emotional level and working with emotional issues in the context of the body with subtle verbal suggestions. Others may take a more mechanistic approach toward working with the body. They may not wish to engage the client on the emotional level at all but rather concentrate on physical techniques. Some see themselves as facilitators, some as educators.
There is wide variation among practitioners, even within the specific approaches, as to how much verbal exchange takes place and the degree to which the practitioner is available for emotional or psychological support. Finally, some approaches require a series of sessions over a period of time (e.g., Rolfing, Hellerwork), which naturally fosters a therapeutic relationship and requires communication, instruction, and feedback. On the other hand, many European or Western forms of massage are complete in themselves as one session and do not really require any communication between practitioner and client. It is not unusual to experience an entire massage without a word being spoken.
A Doctor’s Story
A patient was brought to our intensive care unit from another hospital emergency room, where he had been given a hundred milligrams of Thorazine (an antipsychotic drug) intramuscularly. Thorazine has a faster and greater effect when injected than when taken orally, but it also has a greater chance of lowering the blood pressure. This man had been given a very high dosage—and they hadn’t noticed that he was drunk. You never mix alcohol and major antipsychotics because they are additive in effect.
When the patient arrived, the medication was just taking effect. He went under before the eyes of the admitting personnel, becoming less responsive and groggy, then turning gray. When I arrived, the pulse was so weak that I couldn’t feel it and the blood pressure was 40/0, which indicates a coronary arrest with the imminent danger of croaking. By the time we got him into a room, he was totally unresponsive and just whitish gray, like a person looks just before dying due to lack of oxygen.
I put my knuckle into his sternum and dug in hard to elicit a pain reflex and stimulate adrenaline release, which sometimes can revive a person. Nothing. I didn’t have the necessary medical equipment to do some of the things that Western medicine can do because this was a psychiatric unit. Here I was, looking at a guy who was going to have a cardiac arrest at any moment. I could stand by and watch him die or I could do something—anything. I suddenly remembered . . . a primary revival point and the most important one for loss of consciousness. So I pulled the patient’s shoes off and, without explaining to the nurses what I was doing, proceeded to put my thumbs almost through his feet at these points.
It took about two minutes, three at the most. He started moving around a bit at first and then moaning a little. By the end of those few minutes, he had sat up in his chair and was talking to us. He had a strong pulse and a blood pressure of 90/40. There was an amazed look on the nurses’ faces as they asked what I had done. I said I had worked with the acupressure points to mobilize reserve energy. I don’t know if that made any sense to them, but they were amazed and happy that the patient was alive. Meanwhile, by the way, a priority code ambulance—with sirens and lights and the whole bit—was on its way to pick up a supposedly dying patient.21
Evaluating Personal Results
The subjective experience of the client is generally the most important way of evaluating personal results. However, sometimes the change process naturally causes temporary discomfort, which needs to be accepted, so that expectations of feeling good may not always be appropriate.
Practitioners of the various methods can often also give the client feedback based on what they feel through their hands and what they see with their eyes.
Some modalities, particularly those of structural/functional/movement integration, use visual feedback in the form of having clients look at themselves in mirrors or even taking “before and after” photographs. The photographic record is particularly common in Rolfing and Hellerwork as a way of following progress over time.
Some of the movement integration therapies also use videotape to help observe changes in function, posture, and range of motion.
Relationship to Other Forms of Medicine
These modalities tend to be highly complementary to all other medical traditions. They can enhance the effectiveness of other forms of treatment by inducing relaxation, promoting circulation, and their other common benefits. They can also help patients tolerate more invasive approaches and handle the side effects of other treatments.
Costs tend to be higher in urban areas. Generally, the cost of massage therapy will range from $30 to $60 for an hour and will be somewhat lower in less urban environments. Cost of other more specialized modalities may be higher. Rolfing, for example, averages around $75 to $80 for a ninety-minute session and is ordinarily done in a series of ten sessions spaced at least a week apart.
Other modalities tend to fall within these ranges. Most insurance companies do not cover massage and bodywork, although such coverage is much more likely if it is prescribed by a physician. Massage therapy is more likely to be covered than the other methods, although a physician’s prescription and the licenser of the practitioner may help increase the chances.