“Touch is critical to life itself” says Dr Amen a leading American psychiatrist in his book ‘Change your brain, change your life’. He delves deeply into the importance of touch and its effect on the brain - particularly the limbic system. This part of the brain promotes bonding and sets the emotional tone of the mind amongst other functions. Giving or receiving massages on a regular basis will essentially enhance limbic health and bonding.
The results of an inhumane thirteenth century experiment by German Emperor Frederick II highlight the importance of touch. Infants were taken from their mothers and forbidden from being touched,; only fed. Sadly, all infants died before they could speak. Thankfully, the studies that I have touched on below are all ethical. Essentially, these studies indicate that massage holds many benefits for our health and well-being.
What is a massage?
A massage is the stroking, kneading, rolling and pressing of the skin and muscles. There are many different styles and more than 250 variations of massage. Each style has its different origins and aims, but the fundamental reasons for massage are the same - relaxation, rebalancing the body and to improve feelings of well-being.
Why massage therapy?
Massage is no longer thought of as a luxury that is only available to people who can afford it. The treatment is rapidly growing and available to anyone for relaxation purposes and pain relief to sports recovery.
Massage therapy increases parasympathetic nervous system tone, stimulates pressure receptors increasing vagal activity and reduces cortisol levels throughout the body (the stress hormone). Stimulation of the parasympathetic nervous system results in a cascade of events:
1. Decreased heart rate
2. Decreased blood pressure
3. Improved digestion
4. Constriction of bronchial muscles
5. Increased production of saliva and mucus
6. Increased in urine secretion
Studies supporting the use of massage
A systematic research review of a total of 57 studies on the effects of massage on varying conditions was conducted in 2017 by Tiffany Field (2). The findings on some of the health and well-being benefits are as follows:
Children with autism spectrum disorder often have sleep disturbance (1). It was found that when parents massaged their children with autism before bedtime the children’s sleep improved. This was demonstrated by shorter latency to sleep times, longer duration of sleep, and less night-waking (1). In a particular study, mothers massaged their children 20 minutes daily for 3 months followed by a period of no massage for 4 months. Saliva samples were taken before and after each session to measure oxytocin levels – the ‘love hormone’. Both child and mother exhibited higher levels of oxytocin levels during the massage period.
2. Skin conditions
There have been numerous studies looking at the effects of massage on skin conditions but here I pay particular attention to burn and surgical scars – conditions that an average person is likely to come across s in their everyday lives. When looking at burn scars, massage was observed to decrease pain, pruritus (itch) and scar tissue (3).
Another literature review on studies on scar management looked at 30 surgical scares treated with massage and 90% had improved appearance (4).
3. Pain syndromes
Most massage therapy research to date focuses on pain syndromes as most massage therapy clients are receiving massage therapy for pain.
For muscle soreness it was found that massage significantly reduced the amount of pain and increased the range of motion (5, 6).
For arthritic knee pain a randomised controlled study compared two groups (7). One group received massage therapy and an exercise programme while the other just received exercise alone (7). Significant improvements were seen with regards to pain scale, get- up and go test and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The combined exercise and therapy group showed the greatest improvement in the above measures compared to the group that received exercise alone.
In another study a moderate pressure massage – Chinese massage, was performed 3 times a week for 2 weeks (8). There were marked improvements in gait speed, reduced pain and stiffness which are common complaints with anyone suffering from arthritis, especially with the speed of walking.
A study looking at the effect of massage on restorative sleep and substance P found improvements in both. There was an increase in the depth of sleep and reduction in substance P which, when released, causes pain (1).
5. Neck pain
In a study on neck arthritis pain, (9) participants administered self-massage which resulted in a reduction in general pain and improvements in range of motion- associated pain. This is a particularly important outcome as it indicates to therapists the importance of empowering their clients by encouraging the continuation of effective treatments without the therapist present.
6. Back pain
A study (1) comparing massage versus relaxation therapy showed that massage performed for 30 minutes, twice a week led to greater trunk flexion, self-reported diminished pain, anxiety, depression and sleep disturbances.
7. Blood pressure and hypertension
A randomised controlled trial (10) was conducted where whole- body massages were compared to standard coronary care treatment resulting in reduced blood pressure, reductions in both systolic and diastolic pressures, reduced heart rate and reduction in anxiety.
Another study (11) looking at patients in a trauma ICU unit receiving 45 min massages by family members found similar results as the study above. Additional benefits such as improved oxygen saturation, pH and PO2 were noted through arterial blood gas analysis.
Massage is shown to have benefits on a multitude of areas relating to cancer treatment such as reduce feelings of nausea and vomiting in children post chemotherapy (12) to reducing depression and anxiety in breast cancer patients (13). In this study (13) participants were provided with 30-minute massages twice a week. A significant shift in the Th1/Th2 ratio was noted due to an increase in the production Th1 which is an important indicator of immune function. Lower production of cytokines was noted which are pro-inflammatory proteins associated with Th2.
Improvements have been noted due to massage with regards to reduced muscle stiffness, increased shoulder flexion, gait speed, stride length after only one session. These measures continued to improve further with subsequent sessions (14).
In a study which combined the use of massage and ear acupuncture against a control group who did not, positive alterations in behaviour was observed (15). There were reduced sleep disturbances, improved eating and compliance. The treatment was for 3 months and the benefits persisted for as long as 2 months after completing the treatment.
The massage research literature review outlined above typically involved self-reported measures of improvement although there are sophisticated measure technologies available. On the other hand, some of the studies used gold standard medical measures such as blood pressure in hypertension studies and the range of motion in arthritis studies. As much as the use of self-reported measures may have questionable reliability, they still hold significant weight in establishing improvements in well-being. Quite frankly, if a patient feels better after a treatment then they feel better and a greater sense of well-being has been achieved. The excessive use of self-reported measures is likely due to limited funding in Asian countries where most of the massage therapy studies were conducted.
It is clear from the studies that massage has positive effects on a number of conditions. Positive effects are seen from children with autism or cancer to individuals suffering from an age-related problems such as Parkinson’s and dementia. The studies have looked at comparisons between massage therapy groups and standard treatment control groups. Also, some have compared different modalities of massage. Typically, the massage groups have demonstrated more positive effects than the control or comparison groups. This is likely because massage stimulates pressure receptors increasing vagal activity and reducing cortisol levels. We can take from this that participation in regular massage is beneficial to health and well-being.
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