Research on touch, massage
and other interesting topics

Here you will find interesting (in my humble opinion) research news, some of it also published in the Massage Message.

On-site massage preventing burnout

Burnout syndrome (BS) is thought to result from long-term, unresolvable job stress. It can be thought of as our body's response to chronic stress. Burnout leads to physical and emotional exhaustion, cynicism and detachment, and/or feelings of ineffectiveness and lack of accomplishment. When in the throes of full-fledged burnout, we are no longer able to function effectively on a personal or professional level. However, burnout doesn't happen suddenly, and rather creeps up on us. And it can be prevented. One such strategy is – surprise, surprise – on-site massage.

A recent study looked at the role of massage in preventing burnout in employees of large corporations. Forty-eight employees were divided into 3 groups of 16 each: Control, massage in massage chair and massage lying down on a massage table. The Maslach Burnout Inventory (MBI – 22 questions tried and tested over 35 years to measure five different aspects of burnout) and the State–Trait Anxiety Inventory (STAI – 40 tried and tested questions about anxiety, 20 on state anxiety, or anxiety about an event, and 20 on trait anxiety, or anxiety level as a personal characteristic) were used.

The mean score of emotional exhaustion, depersonalization, and reduced sense of personal achievements (aspects of the MBI) decreased significantly in both massage groups. It appears that the results for the chair massage group were even more promising than those for the 16 employees receiving lying down massage. Massage on a chair is a better solution in terms of reducing symptoms of burnout among workers of large corporations. (Complement Ther Clin Pract. 2017 Nov;29:185-188.).

Out of interest, here is a selected list of tell tale signs of burnout:

Signs of physical and emotional exhaustion: chronic fatigue, insomnia, forgetfulness/impaired concentration and attention. Physical symptoms may include chest pain, heart palpitations, shortness of breath, gastrointestinal pain, dizziness, fainting, and/or headaches (if you get these, see your doctor to check for other causes), increased illness, loss of appetite, anxiety, depression and anger.

Signs of cynicism and detachment include loss of enjoyment, pessimism and isolation.

Signs of ineffectiveness and lack of accomplishment: feelings of apathy and hopelessness, increased irritability, lack of productivity and poor performance.

If you have a number of these symptoms, it might be a good idea to have a loving, long look at your life to see how you can reduce stress and care for yourself better. You may even need to ask for help! What a thought.

Massage after the birth

As exhilarating as new parenthood is, an outstanding feature for me was tiredness. When I woke up in the morning my first thought was “when can I go to bed again?”

A study from Japan wanted to find out whether aromatherapy hand and forearm massage could help new mothers to relax and decrease fatigue. Women completed a questionnaire before and after the treatment. It was found that women were significantly more relaxed after the treatment, and new mothers were significantly less fatigued (both P<0.001). And, not surprisingly, the treatment was well received. (Int J Community Based Nurs Midwifery. 2017 Oct;5(4):365-375).

Breastfeeding can be challenging to establish, perhaps even more so after a caesarian birth. As study from China wanted to find out whether breast massage soon after a caesarian birth would aid lactation. Eighty women were divided into 4 groups, one did not receive any massage, the other three groups received breast massage starting 2, 12 and 24 hours after delivery, each of the 60 women received 3 breast massages with the different starting times noted. Blood was taken to determine the level of serum prolactin. Within 24 hour of delivery 10 out of 20 women who received breast massage starting 2 hours after birth were lactating, compared with only 2 out of 20 from the control group. 18/20 and 8/20 respectively were successfully breastfeeding within 48 hours of the birth. The prolactin levels in the blood also showed that breast massage has a positive impact on milk production after a caesarian birth. Or, with the words of the authors: “Breast massage beginning from 2 hours after caesarean section can effectively improve the lactation status of delivered women.” (Zhonghua Yu Fang Yi Xue Za Zhi. 2017 Nov 6;51(11):1038-1040).

Manual therapy for plantar heel pain

Heel pain is surprisingly common, between 4% and 7% of people have heel pain at any given time, and about 80% of these cases are due to plantar fasciitis (Foot Ankle Surg. 2014 Sep;20(3):160-5). Approximately 10% of people have it at some point during their life (Swiss Med Wkly. 2013 Jul 7;143). It is often treated with joint or soft (mostly the tissues in question are not soft!) tissue mobilizations, but is still not scientifically proven whether these methods actually work. Anyhow that is what the authors of a critical review claim. They wanted to find out what all the studies about manual therapy for heel pain taken together say. Manual therapy in this case is deep massage, myofascial release or joint mobilization.

They looked for relevant papers using randomised controlled trials (RCTs – the gold standard), and found six relevant RCTs. The quality of all these studies was moderate to high.

It was found that soft tissue mobilization is an effective method for treating plantar heel pain, the evidence is not so clear on joint mobilizations. (Foot (Edinb). 2017 Aug 5;34:11-16) 

Aromatherapy for knee osteoarthritis?

When I have clients with knee issues, I generally get two responses: “work on my legs, it might help my knees” or “I have arthritis, there is nothing that can be done”. I get good results with massage and myofascial release. The following study shows that aromatherapy might help, too.

The study looked at the effect of aromatherapy massage on knee pain and function in people with osteoarthritis. They compared three groups of 30 people each: aromatherapy massage, conventional massage and control group. They used various measures to assess pain and function. Compared with the control group, the people receiving aromatherapy massage did best (a “significant” difference), followed by the massage group (but not “significantly”). Aromatherapy massage reduced knee pain scores, decreased morning stiffness, and improved physical functioning. The authors conclude that as long as the aromatherapists are properly trained, aromatherapy can be recommended for routine use in physical therapy units, hospitals and homes (Pain Manag Nurs. 2018 Mar 5).

MLD and exercise prevent oedema?

I often get asked whether manual lymphatic drainage (MLD) can prevent lymphoedema after treatment for breast cancer. My answer has been that there is no evidence, but I might have to change it to “it depends”. A recent study looked at whether MLD or active exercise (AE) is associated with shoulder range of motion (ROM), wound complication and changes in the lymphatic measurements after breast cancer surgery. They also wanted to find out if there is an association between these and the development of lymphoedema later on.

106 women took part in the trial after radical breast cancer surgery (unilateral mastectomy with lymph node dissection). The women were matched for staging of the cancer, age and body mass index and were allocated to receive AE or MLD, 2 sessions per week for a month, starting within 48 hours of surgery. The wound was evaluated 2 months after surgery. ROM, upper limb circumference measurement and upper limb lymphoscintigraphy (visualising lymphatic flow) were performed before surgery, and 2 and 30 months after surgery.

Incidence of seroma (fluid build up), closure of the wound and infection were similar in both groups. Both groups had not regained flexion (lifting arm forward) and abduction (lifting arm sideways) of the shoulder in the second month after the surgery, and had not gained full movement of the shoulder even after after 30 months. Almost a quarter of women got lymphoedema (23.8%), this was similar for both groups. Interestingly, when looking at the lymphoscintigraphy before and after the surgery, it was possible to predict whether a women was likely to develop lymphoedema within two years of surgery. This again, applied to both groups.

In this study younger women (under 40) were more likely to develop lymphoedema. For women older than 39, obesity increases the chance of developing lymphoedema. In women over 39 years old, women treated with MLD were at a significantly higher risk of developing lymphoedema, implying that they also need to develop strength with active exercise.

This study shows that manual lymphatic drainage is as safe and effective as exercise in rehabilitation after breast cancer surgery. In younger women, obesity seems to be the major player in lymphoedema development, and actions devoted to reduce body weight may be of great benefit. Women over 40 also benefit from MLD, but they also need to improve their muscle strength, and this has shown to be important in preventing lymphoedema. (PLoS One. 2018 Jan 5;13(1)). Tweo points to note: the women received intensive treatment post-surgery, and this study excluded women who had undergone radiotherapy, in my experience the majority of women have radiotherapy as part of their breast cancer treatment. And radiotherapy is a risk factor for developing lymphoedema, and it does not help with the shoulder movement, either.

 

Complex Decongestive Therapy is the gold standard of lymphoedema therapy, and consists of compression, skin care, MLD and exercise. It has been shown to help with lymphoedema, but does it also help with other issues after breast cancer treatment? The following study was designed to answer this question, more specifically: does CDT help with arm and shoulder mobility, the severity of pain, and quality of life? How do sociodemographic and clinical characteristics affect arm and shoulder mobility?

Thirty-seven women with breast cancer-related lymphoedema (BCRL) (aged 28-72) had intensive CDT, including meticulous skin care, manual lymphatic drainage, remedial exercises, and compression bandages. The arm volume was measured before and after the course of treatment. The women answered various questionnaires pre-and post treatment: a baseline questionnaire, short Form-36 (SF-36), Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and Visual Analog Scale (VAS) for pain and heaviness were used as clinical assessment scales.

All the measures were significantly improved by the CDT. Quite amazing: a smaller limb, more shoulder and arm mobility, less heaviness and pain and better quality of life! The response was particularly marked if the women came to the treatment sooner after the development of oedema. The authors summarise: “CDT provides enhancement of upper extremity functions and quality of life in patients with BCRL. The reduction in lymphoedema volume, pain, and heaviness and the improvement in shoulder mobility may be the contributed factors.”(Lymphat Res Biol. 2018 Jan 22.).

Melting stress

Massage, particularly the “cloud nine” kind, are marvellous for stress relief, so is foot massage and reflexology. This has been found in a recent study, which compared fascia therapy, reflexology, hypnosis and music therapy. 308 (more or less) healthy individuals chose one of the above therapies and had a single session. On another occasion the same individuals had a rest period, which served as a control “treatment” to compare to. It was found that anxiety decreased in all treatments, including resting. In terms of overall stress reduction, fascia therapy, reflexology and hypnosis were effective.(Int J Ther Massage Bodywork. 2017 Sep 13;10(3):4-13).

Preventive chair massage

When I sit for prolonged periods at the computer, I certainly feel it in my neck and shoulders, particularly when things don’t go to plan. From on-site massage experience I can confirm that this is true for others. A recent study looked at whether on-site massage or listening relaxing music would help with neck and shoulder tension in white collar workers. 124 office workers in their mid-thirties were randomly assigned to chair massage, relaxing music sessions or control group for four weeks. Pain perception was measured using the algometer (remember from the last Massage Message) and relaxation levels were assessed using changes in the pulse rate before and after the programme. It was found that listening to relaxing music was – well – relaxing, but the level of general tension and the pain threshold stayed about the same. The control group remained unchanged. In the on-site massage group, the pain perception went down, so did the general tension level, thus the relaxation level went up. (Adv Exp Med Biol. 2017 Jul 19).

Tennis elbow, carpal tunnel and shoulder issues

A recent study looked at the various treatment options of lateral epicondylitis, commonly known at a tennis elbow, both, in the short (6-12 weeks post-treatment) and longer term (6 month after treatment). Study participants were randomly allocated one of three treatments: splinting and stretching, a cortisone (steriod) injection, or a lidocaine (local anaesthetic) injection with deep friction massage. They measured pain reported, disabilities in the arm, shoulder and hand (the DASH scale), and grip strength. In the short term all three groups reported a decrease in pain. DASH and grip strength improved in the short term in the deep friction massage and cortisone injection group. In the longer term all measurement improved significantly only in the deep friction massage group. The authors conclude that “deep friction massage is an effective treatment for lateral epicondylitis and can be used in patients who have failed other nonoperative treatments, including cortisone injection.” (J Phys Ther Sci. 2017 Mar;29(3):511-514).

A review of studies on carpal tunnel syndrome found that there is no evidence (due to lack of studies) for long-term benefit for any conservative (non-surgergy) treatment. There was (moderate) evidence for electrical therapies in the medium and short term. For myofascial release and trigger point therapy there was evidence for short term improvement, studies looking at longer-term improvements are lacking – and expensive. (Arch Phys Med Rehabil. 2017 Sep 20). If these therapies are shown to work in the longer term, surgery could be avoided more often.

I have longstanding issues with carpal tunnel and trigger finger on my right hand. At my last massage session Regina spent time massaging muscles around my thumb and my wrist. It definitely made a difference on how sore my hand feels during the day. I feel I have slightly more movement in the joints.” Hazel, Beeston.

Another study of studies (meta-analysis) looked at whether massage is an effective treatment for shoulder pain. The analysis included 15 studies with a total of 635 participants. It was found that massage is an effective treatment for shoulder pain, both in the short and long term. (J Phys Ther Sci. 2017 May;29(5):936-940) 

Massage in pregnancy and labour

Massage is good for stress relief, and that is particularly so for Aromatherapy massage in pregnancy. I would have appreciated being in the treatment group of the clinical trial showing this: 24 pregnant women received a 70 minute aromatherapy (with 2% lavender essential oil) massage every two weeks for a total of 10 sessions. For comparison 28 women received standard anti-natal care. They measured cortisol and immunoglobulin A (IgA) levels in the saliva for stress and immune function respectively. It was found that the stress hormone was down and immune function was up immediately after treatment, and in the longer term. Thus this trial shows that aromatherapy massage significantly reduces stress and enhances immune function in pregnant women. (J Altern Complement Med. 2017 Aug 7).

I have written a few times about massage relieving labour pain, I offer a training session for birth partners on how to support women during birth (and before and after) using massage. A recent review of studies shows that massage during labour indeed reduces pain. (Iran J Nurs Midwifery Res. 2017 Jul-Aug;22(4):257-261). Not only does back massage reduce pain during labour, but it also shortens the birth and helps women to feel satisfied with the birth experience. (Complement Ther Clin Pract. 2017 Aug;28:169-175).

Tiffany Field, Director of the Touch Research Institute in Miami published a review on depression during pregnancy. Risk factors for pre-natal depression include demographic measures (lower socioeconomic status, less education, non-marital status, non-employment, less social support and health locus of control, unintended pregnancy, partner violence and history of child abuse) and physiological variables (cortisol, amylase, and pro-inflammatory cytokines and intrauterine artery resistance). She found that massage, psychotherapy, peer support, yoga, tai chi, and aerobic exercise are effective in preventing pre-natal depression. Interestingly, prenatal antidepressants (specifically SSRIs) can to have negative effects such as internalizing problems and a greater risk for autism spectrum disorder. (J Pregnancy Child Health. 2017 Feb;4(1)).

Surgery for neck pain?

A review in the BMJ looked at the evidence for different neck pain treatments. It was found that surgery was more effective than conservative treatments in the short term, but not in the long term for most of the people studied. Exercise has the strongest evidence to help with neck pain, and there is some evidence that massage, acupuncture, yoga and spinal manipulation helps, too. Muscle relaxants and non-steroidal anti-inflammatory drugs are effective for acute neck pain. (BMJ. 2017 Aug 14;358:j3221). Another study found that myofascial release is more effective in the short term for people with neck pain than a physiotherapy programme. (Am J Phys Med Rehabil. 2017 Jul 3).

Compression at trigger points in the neck can provide immediate relief of pain and reduce the sympathetic nerve activity that exacerbates chronic pain. A recent study looked at what is happening during trigger point therapy with the nervous system and found that the treatment “alters the activity of the autonomic nervous system via the prefrontal cortex to reduce subjective pain”. (Front Neurosci. 2017 Apr 11;11:186).

Fibromyalgia and MFR

Over the years I have seen people with fibromyalgia (fibro as they call it), who have been recommended exercise as the sole treatment. A study compared exercise alone with exercise plus connective tissue massage, a form of myofascial release (MFR). Forty people were divided into two groups, both had an exercise programme but 20 also received MFR twice a week for six weeks. The study suggested that exercises with and without MFR might be effective in helping with pain, fatigue and sleep problem and increasing overall health and quality of life. Adding the MFR to exercise is even better in improving pain, fatigue, sleep problem, and role limitations due to physical health. (Rheumatol Int. 2017 Aug 24).

Deep Oscillation stretches hamstrings

In the sports world tight hamstrings are usually treated with stretching, foam rolling, massage or similar. All of which can involve a certain level of discomfort as the muscle and fascia are loosened. A novel way of increasing the flexibility of the hamstrings is Deep Oscillation Therapy, or DOT, as the researchers call it (I like that abbreviation!). This study was performed on 29 young (23 years), healthy and sporty (minimum 200 minutes exercise a week) people. They received DOT for 28 minutes. Participants were assessed pre- and post DOT for hip flexion, issues with hips and groin, and perception of change after treatment. Hamstring flexibility did indeed increase after DOT. This increase was positively correlated with the participants perception of the effectiveness of the treatment. In other words, the “objective” measurement and the clients’s perception did match. (J Sport Rehabil. 2017 Jul 17:1-25). DOT is certainly more relaxing and comfortable than foam rolling or stretching with tight hamstrings. And tight hamstrings need to be loosened, as they are risk factor for injuries and back problems.

MLD for recovering after exercise?

Some physical methods are reported to help with skeletal muscle regeneration, decreasing muscle soreness, and shortening of the recovery time after exercise. The evidence I have seen is thin on the ground. A recent study assessed how various types of MLD affect the recovery after exercise. Eighty Martial Arts athletes were divided into four groups: MLD, Bodyflow therapy (a type of lymph drainage) and MLD using deep oscillation. They looked at the re-generation of the forearm muscles after exercise. They measured various parameters on the muscles (strength, tension, pain threshold, venous blood flow), as well as markers of muscle recovery in the blood, before and after a muscle fatigue test, immediately, 20 minutes, 24 and 48 hours after the test. Not surprisingly, the maximal strength of the muscles decreased in all subjects after the muscle fatigue test. However, in all three treatment groups maximal muscle strength was higher after recovery time. The athletes were less tense after MLD. It was found that manual methods of lymphatic drainage with or without deep oscillation, improves post-exercise regeneration of muscles. (Clin J Sport Med. 2017 Aug 16.).




List of treatments
Myofascial Release (MFR) - Saving Hands massage -
-
Arvigo Techniques of Maya Abdominal Therapy® - ATMAT -
- Seated Acupressure - Indian Head Massage - Pulsing - Reiki -
- Reflexology - Tsuboki Foot Massage - Hopi Ear Candles -
-
Hot and Cold Stone Massage -
-
Aromatherapy Massage - Aromatherapy Lymphatic Massage (ALM) -
- Fertility Massage - Pregnancy Massage - Post-natal Massage -
- Dorn Method - Breuss Massage -
- Manual Lymphatic Drainage (MLD) - Deep Oscillation -
- Holistic Facial - Face Vitality - Total Detox -


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