Massage therapy research review

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Highlights

  • Massage therapy has positive effects on many different groups with varying conditions.

  • These effects may derive from stimulation of pressure receptors leading to enhanced vagal activity and reduced cortisol levels.

  • Some of these studies did not include treatment comparison groups and several were limited by the exclusive use of self-report measures.

Abstract

In this review, massage therapy has been shown to have beneficial effects on varying conditions including prenatal depression, preterm infants, full-term infants, autism, skin conditions, pain syndromes including arthritis and fibromyalgia, hypertension, autoimmune conditions including asthma and multiple sclerosis, immune conditions including HIV and breast cancer and aging problems including Parkinson's and dementia. Although many of the studies have involved comparisons between massage therapy and standard treatment control groups, several have compared different forms of massage (e.g. Swedish versus Thai massage), and different active therapies such as massage versus exercise. Typically, the massage therapy groups have experienced more positive effects than the control or comparison groups. This may relate to the massage therapy providing more stimulation of pressure receptors, in turn enhancing vagal activity and reducing cortisol levels. Some of the researchers have assessed physical, physiological and biochemical effects, although most have relied exclusively on self-report measures. Despite these methodological problems and the dearth of research from the U.S., the massage therapy profession has grown significantly and massage therapy is increasingly practiced in traditional medical settings, highlighting the need for more rigorous research.

Section snippets

In vitro fertilization (see Table 1 for a listing of these studies and their primary results)

In vitro fertilization is probably the earliest developmental research involving massage therapy. In an in vitro fertilization study, oscillating vibrations were used prior to the transfer of the embryo [2]. The positive effects included greater pregnancy rates based on urine assays and ongoing pregnancies measured by fetal heartrate and birth rates as well as miscarriage rates. The problem with this study, however, was that only those who were willing to undergo the massage treatment were

Reducing prematurity by decreasing prenatal depression (see Table 1)

We have conducted several studies showing that massage therapy by a therapist and by significant others reduces prenatal depression and in turn increases gestational age and birthweight (see Field 2014 for a review) [1]. In a recent study, massage therapy was compared to yoga, with yoga being considered a form of self-massage [3]. Both groups of prenatally depressed women became less depressed and their newborns were greater gestational age and birthweight. Despite the positive findings for

Growth measures

The most frequently reported effects for massage therapy with preterm infants are their greater weight gain and earlier hospital discharge. In a recent study, massage therapy was performed twice daily for two weeks for 15 min per session [4]. In this study, weight gain, height and head circumference were significantly increased. In addition, the frequency of pre-feed gastric residual was decreased and the number of bowel movements was increased in the group who received massage therapy. The

Full-term infants (see Table 1)

Massage therapy has rarely been studied with full-term infants. This probably relates to weight gain not being a concern for full-term infants. However, increasing numbers of full-term newborns are receiving massage as it has been known to reduce irritability and sleep problems which are the most frequent complaints made by parents to pediatricians. In a recent study, healthy newborns were provided massage for 15 min a day and maternal attachment was assessed [14]. In this study the group who

Infants with gastroesophageal reflux disease (GERD)

Infants with GERD have significant reflux problems. In one study a massage therapist taught mothers to massage their GERD infants [18].

The infants were randomly assigned to either a massage therapy or a non-massage control group and the massages were 30 min twice a week for six weeks. By the end of the study the cortisol levels of the massage group had significantly decreased while the cortisol levels in the non-massage control group had increased. These researchers also observed the

Autism (see Table 1)

Children with autism spectrum disorder often have sleep problems. In a recent review of the literature eight studies were identified that explored non-behavioral and non-pharmacological approaches to managing sleep problems in these children [21]. Positive outcomes were reported for massage therapy. We noted in an earlier study that when parents massaged their children with autism before bedtime, the children's sleep improved (shorter latency to sleep, longer sleep time and fewer nightwakings)

Cleft-lip scars

Massage therapy has been used to reduce several skin problems including cleft-lip scars, burn scars, post-surgery scars and ulcers. In a study on cleft-lip scars, five weeks of massage including kneading and intra-oral massage was applied to individuals with cleft-lip [23]. Following the five-week treatment, the researcher reported increased range of motion and strength and increased symmetry. The problem with this study is that the sample was small and it lacked a control or treatment

Pain syndromes (see Table 3)

The lion's share of massage therapy research continues to relate to pain, probably because most massage therapy clients are receiving the therapy for pain syndromes. Therefore the massage therapist community is most interested in the research on pain. Since the last review approximately 20 randomized controlled trials have been conducted on pain syndromes including pain from muscle injury, labor pain, foot pain, knee pain, pelvic pain, low back pain, carpal tunnel syndrome pain, shoulder pain,

Blood pressure and hypertension (see Table 4)

The effects of massage therapy on blood pressure have been studied in a number of different situations/conditions. These include recent studies on coronary care, hospitalization for trauma, prehypertension, essential hypertension and exploring potential underlying mechanisms for the reduction of blood pressure following massage therapy.

Auto-immune conditions (see Table 5)

Several auto-immune conditions have been studied for massage therapy effects including asthma, diabetes, dermatitis, and multiple sclerosis [1]. The auto-immune research of the last few years has focused primarily on asthma and multiple sclerosis. These studies are summarized here.

Immune disorders (see Table 5)

Immune conditions that have been studied since our last review on massage therapy research [1] have included HIV and cancer. The HIV studies summarized here include a study on HIV-exposed infants and another on HIV in adults. Breast cancer has been the most frequently researched cancer in the recent studies on massage therapy.

Aging (see Table 6)

Very few studies have focused on the effects of massage therapy on aging conditions. Recent studies on its effects on postmenopausal women, on Parkinson's and on dementia are summarized here.

Limitations of the therapy protocols

Massage therapy has typically been compared to a standard treatment control group. As massage therapy is increasingly noted to be therapeutic, an ethical question is whether a control group can be denied therapy. Increasing numbers of studies are therefore using waitlist control groups or comparison treatment groups. The waitlist control group would receive the same massage therapy at the end of the waitlist period. And treatment comparison groups would be given a similar therapy. The problem

Limitations of the measures

The massage research reviewed here as compared to that reviewed in 2014 [1] has typically involved self-report measures even though measurement technology has become increasingly sophisticated. For example, in the earlier studies on breast cancer, immune measures were the primary measures, but in some of the recent studies on breast cancer, immune measures were not even reported. Gold standard medical measures have been used in some studies as, for example, blood pressure measures in

Limitations of the conditions studied

Pain syndromes continue to receive the lion's share of the research, probably because the most frequent massage therapy clients are those with pain syndromes, highlighting the importance of that research. Massage therapy research has also increasingly focused on hypertension and breast cancer. In contrast, some conditions that are also very prevalent in this country have not been assessed for massage therapy effects including obesity and diabetes (both conditions being NIH funding priorities)

Summary

In this review, massage therapy has been shown to have beneficial effects on many different groups and conditions including prenatal depression, preterm infants, full-term infants, autism, skin conditions, pain syndromes including arthritis and fibromyalgia, hypertension, autoimmune conditions including asthma and multiple sclerosis, immune conditions including HIV and breast cancer and aging problems including Parkinson's and dementia. Although many of the studies have involved comparisons

Acknowledgements

I would like to thank my collaborators, the individuals who participated in these studies and the research associates who assisted us. This research was supported by funding from Johnson and Johnson and Massage Envy to the Touch Research Institute. Correspondence and requests for reprints should be sent to Tiffany Field, Ph.D., Touch Research Institute, University of Miami Medical School, P.O Box 016820, Miami, Fl 33101. [email protected].

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