A group of medical scientists from the US in 2006, reported results of a pilot study of massage therapy for osteoarthritis (OA) of the knee. Subjects with OA of the knee were randomized to biweekly (4 weeks), then weekly (4 weeks) Swedish massage (1 hour sessions) or wait list. Subjects receiving massage therapy demonstrated significant improvements in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), pain, stiffness, and physical functional disability domains and visual analog pain scale, compared to usual care. Notably, the benefits persisted up to 8 weeks following the cessation of massage.
In a new trial, the scientists now want to identify the optimal dose of massage within an 8-week treatment regimen and to further examine durability of response. Participants were 125 adults with OA of the knee, randomized to one of four 8-week regimens of a standardized Swedish massage regimen (30 or 60 min weekly or biweekly) or to a Usual Care control.
Their results showed that the WOMAC Global scores improved significantly in the 60-minute massage groups compared to Usual Care at the primary endpoint of 8-weeks. WOMAC subscales of pain and functionality, as well as the visual analog pain scale also demonstrated significant improvements in the 60-minute doses compared to usual care. No significant differences were seen in range of motion at 8-weeks, and no significant effects were seen in any outcome measure at 24-weeks compared to usual care. A dose-response curve based on WOMAC Global scores shows increasing effect with greater total time of massage, but with a plateau at the 60-minute/week dose.
The authors concluded that Given the superior convenience of a once-weekly protocol, cost savings, and consistency with a typical real-world massage protocol, the 60-minute once weekly dose was determined to be optimal, establishing a standard for future trials.
Many surgeons recommend postoperative scar massage to improve aesthetic outcome, although scar massage regimens vary greatly. Scientists from Ohio conducted a review on the efficacy of scar massage. The review was published in Dermatology Surgery Journal.
After searching through a large scientific database, ten studies including 144 patients who received scar massage were examined in the review. Time to treatment onset ranged from after suture removal to longer than 2 years. Treatment protocols ranged from 10 minutes twice daily to 30 minutes twice weekly. Treatment duration varied from one treatment to 6 months. Overall, 65 patients (45.7%) experienced clinical improvement based on Patient Observer Scar Assessment Scale score, Vancouver Scar Scale score, range of motion, pruritus, pain, mood, depression, or anxiety. Of 30 surgical scars treated with massage, 27 (90%) had improved appearance or Patient Observer Scar Assessment Scale score.
However the authors concluded that although there are several studies showing the effectiveness, the evidence for the use of scar massage is weak, regimens used are varied, and outcomes measured are neither standardized nor reliably objective, although its efficacy appears to be greater in postsurgical scars than traumatic or postburn scars. Although scar massage is anecdotally effective, there is scarce scientific data in the literature to support it.
Physiological and clinical changes after therapeutic massage of the neck and shoulders
Little is known regarding the physiological and clinical effects of therapeutic massage even though it is often prescribed for musculoskeletal complaints such as chronic neck pain. A study from Auburn University investigated the influence of a standardized clinical neck/shoulder massage intervention on physiological measures assessing α-motoneurone pool excitability, muscle activity; and the clinical measure of range of motion (ROM) compared to a light touch and control intervention. Flexor carpi radialis (FCR) α-motoneurone pool excitability (Hoffmann reflex), electromyography (EMG) signal amplitude of the upper trapezius during maximal muscle activity, and cervical ROM were used to assess possible physiological changes and clinical effects of TM.
Sixteen healthy adults participated in three, 20 min interventions: control, light touch and therapeutic massage. The statistical analysis indicated a decrease in FCR α-motoneurone pool excitability after massage, compared to both the light touch or no interventions. EMG signal amplitude decreased after massage by 13% , when compared to the control, and 12% as compared to light touch. The massage intervention produced increases in cervical ROM in all directions assessed: flexion, lateral flexion, extension, and rotation. Massage of the neck/shoulders reduced the α-motoneurone pool excitability of the flexor carpi radialis, but not after light touch or no interventions. Moreover, decreases in the normalized EMG amplitude during MVIC of the upper trapezius muscle; and increases in cervical ROM in all directions assessed occurred after massage, but not after the light touch or no interventions.
Cold water baths reduce muscle soreness
Plunging into cold water after exercise may be an effective way to reduce muscle soreness, but it is unclear whether there are harmful side effects. These are the conclusions of a new systematic review of cold water immersion interventions published in The Cochrane Library.
Delayed onset muscle soreness (DOMS) is associated with stiffness, swelling and soreness a day or more after exercise. One increasingly popular method that both elite and amateur athletes use to try to prevent or reduce soreness is immersing themselves in cold water or ice baths. The claim is that this cold water immersion technique, sometimes referred to as cryotherapy, reduces muscle inflammation and its ensuing effects. The researchers wanted to assess the strength of clinical evidence about how well it works, and whether there is any evidence of harm.
The authors included 17 small trials involving 366 people in their review. Participants were asked to get into a bath or container of cold water after running, cycling or resistance training. In most trials, participants spent five to 24 minutes in water that was between 10ºC and 15ºC, although in some cases lower temperatures were used or participants were asked to get in and out of the water at set times. In the studies that compared cold water immersion to resting or no intervention, there was a significant reduction in soreness one to four days after exercise. However, few studies compared cold water immersion to other interventions.
"We found some evidence that immersing yourself in cold water after exercise can reduce muscle soreness, but only compared to resting or doing nothing. Some caution around these results is advisable because the people taking part in the trials would have known which treatment they received, and some of the reported benefits may be due to a placebo response," said the lead author of the study, Chris Bleakley of the Health and Rehabilitation Sciences department at the University of Ulster in Country Antrim, Northern Ireland. "There may be better ways to reduce soreness, such as warm water immersion, light jogging or using compression stockings, but we don't currently have enough data to reach any conclusions about these interventions."
The range of different exercises, temperatures and timings employed by the various studies made it difficult to establish any clear guidelines for safe and effective cold water immersion. There was also a lack of evidence about any harm that could be caused by the intervention, as most studies failed to report ill effects. The authors say higher quality studies are needed.
"It is important to consider that cold water immersion induces a degree of shock on the body," said Bleakley. "We need to be sure that people aren't doing anything harmful, especially if they are exposing themselves to very cold water for long periods."
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