Effectiveness of Massage Therapy
A new meta-analysis, published in a peer-reviewed
scientific journal earlier this year,3 has taken a fresh look at the
effectiveness of massage therapy in the adult population, and has
concluded that it offers a wide range of physical and psychological
benefits similar to those seen using other forms of care.
Date: 09/02/04
Source: Massage Today
New Study Reviews Effectiveness of Massage Therapy:
Researchers Draw Interesting Parallels Between Massage and
Psychotherapy By Michael Devitt, senior associate editor Massage
therapy is one of the fastest growing forms of alternative medicine
in the country.
A 1998 study found that visits to massage therapists increased 36
percent between 1990 and 1997.1 More recently, a study published by
the National Center for Complementary and Alternative Medicine this
May2 found that massage was the ninth most popular form of
alternative medicine in the country, with an estimated 5 percent of
the adult American population using massage therapy at least once in
the past 12 months. While the use of massage continues to rise, so
has interest in massage research. While several meta-analyses of
massage studies have been conducted in the past, each of them has
been limited in scope, preferring to look at specific patient groups
or types of massage.
A new meta-analysis, published in a peer-reviewed scientific
journal earlier this year,3 has taken a fresh look at the
effectiveness of massage therapy in the adult population, and has
concluded that it offers a wide range of physical and psychological
benefits similar to those seen using other forms of care. In the
analysis, researchers began with 144 studies that fit their
definition of massage, which was defined as "the manual manipulation
of soft tissue intended to promote health and well-being." To
qualify for inclusion, each study had to have been conducted on
adults; studies on infants, or those employing therapeutic touch,
ice massage, self-massage or massage with mechanical devices were
eliminated.
In addition, each study had to (a) compare a massage therapy
group with at least one non-massage therapy control group; (b)
randomly assign subjects to groups; and (c) report data sufficient
enough for a between-groups effect to be generated on at least one
variable being studied. Results Thirty-seven studies met the above
criteria and were used in the meta-analysis. The studies involved a
total of 1,802 participants, including 795 who received massage
therapy. The average number of participants per study was 48.7; the
average age of a participant was 40.6. In some studies, massage was
delivered only once; in others, it was performed multiple times. On
average, participants received 21.7 minutes of massage therapy per
treatment application. Sixty-five percent of the studies reported
using a trained massage therapist (or therapists) to provide care;
22 percent reported using a "minimally trained" person or persons;
and 14 percent did not indicate the level of training by the person
(or persons) administering massage. Nine specific effects were
measured in the studies.
In studies in which patients received a single application of
massage therapy, anxiety state, blood-pressure levels, heart rate,
negative mood, and immediate assessment of pain and cortisol levels
were examined. In multiple-application studies, trait anxiety,
depression and delayed assessment of pain were investigated. In the
single-application studies, massage therapy (MT) produced
"statistically significant" positive results for three effects
compared to patients receiving a placebo or a different therapy.
According to the researchers: "... the average participant
receiving MT experienced a reduction of state anxiety that was
greater than 64 percent of participants receiving a comparison
treatment. MT was also more effective than comparison treatments in
reducing blood pressure and heart rate. The average MT participant
experienced a reduction in blood pressure that was greater than 60
percent of comparison group participants, whereas for heart rate,
the reduction resulting from MT was greater than 66 percent of
comparison group participants." In a surprise finding, massage did
not reduce cortisol levels significantly, a result that differed
from conclusions obtained in previous studies. In addition, massage
therapy did not exhibit any effect on the immediate assessment of
pain or a patient's negative mood.
Despite these contrasting results, the scientists noted that "the
significant finding for the cardiovascular variables suggests that
future research should examine whether MT might have an enduring
effect on blood pressure such that it could be used in treating
hypertension." In the multiple-application studies, "some of MT's
largest and most interesting effects" were observed. While massage
didn't appear to affect one's immediate assessment of pain, "a
significant effect" was found for delayed assessment of pain.
Specifically, patients who received a course of massage therapy and
were assessed several days or weeks after the last treatment session
"exhibited levels of pain that were lower, on average, than 62
percent of comparison group participants," a finding that lends
credence to the theory that massage may promote the reduction of
pain by allowing restorative sleep to take place more easily.
The most significant effects of massage therapy were seen when
measuring anxiety and depression levels. According to the
researchers, "The average MT participant experienced a reduction of
trait anxiety that was greater than 77 percent of comparison group
participants, and a reduction of depression that was greater than 73
percent of comparison group participants." So great were these
reductions that the scientists considered massage therapy almost as
effective as traditional psychotherapy in the treatment of anxiety
and depression.
Massage: The Psychotherapy of the 21st Century?
The results of the meta-analysis dealt a blow to some commonly
held beliefs about the effectiveness of massage therapy. For
instance, the failure of massage to provide a significant effect on
the immediate assessment of pain "contradicts the theory that MT
provides stimuli that interfere with pain consistent with gate
control theory." In addition, while the reductions in blood pressure
and heart rate supported existing beliefs that massage promotes a
response in the parasympathetic nervous system, the authors noted
that "if this theory is true, it would also be expected that a
significant reduction in cortisol levels would have occurred, which
did not."
One new theory the researchers put forth was that massage therapy
"may provide benefit in a way that parallels the common-factors
model of psychotherapy." In this model, the specific mode of
psychotherapy delivered is secondary to other factors, such as a
client's positive expectation for treatment, a therapist who is warm
and has a positive regard for the client, and the relationship
between the therapies and the client. "The same model can be
extended to MT, given the possibility that benefits arising from it
may come about more from factors such as the recipient's attitude
toward MT, the therapist's personal characteristics and
expectations, and the interpersonal contact and communication that
take place during treatment, as opposed to the specific form of MT
used or the site to which it is applied," the authors suggested.
Given the proposed similarities between massage therapy and
psychotherapy, one might think that the benefits derived from
massage are, in layman's terms, "all in your head." As the
researchers asserted in their conclusion, this is hardly the case,
but it does lead to intriguing possibilities for future massage
research.
"The idea that MT has significant parallels with psychotherapy,
and that perspectives gained from psychotherapeutic research should
be applied to future research, is not meant to suggest that MT
delivers effects entirely by psychological means," the scientists
explained. "Clearly MT is at least partially a physical therapy, and
some of its benefits almost certainly occur through physiological
mechanisms. In fact, one of the most interesting aspects of MT is
that it may deliver benefit in multiple ways." "... However, whether
researchers wish to study MT as a physical therapy, as a
psychological one, or as both, new research should examine not
merely the effects resulting from MT, but also the way in which
these effects come about," they advised. "It is only by testing MT
theories that a better understanding of this ancient practice will
result."
References
1. Eisenberg DM, Davis RB, Ettner SL, et al. Trends in alternative
medicine use in the United States, 1990-1997: Results of a follow-up
national survey. Journal of the American Medical Association
1998;280:1569-1575.
2. Barnes P, Powell-Griner E, McFann K, et al. CDC Advance Data
Report #343. Complementary and Alternative Medicine Use Among
Adults: United States, 2002. Published May 27, 2004. Available at
http://nccam.nih.gov.
3. Moyer CA, Rounds J, Hannum J. A meta-analysis of massage therapy
research. Psychological Bulletin January 2004;130(1):3-18.
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