Research over the past couple of years has found that massage therapy boosts immune function in women with breast cancer, improves symptoms in children with asthma, and increases grip strength in patients with carpal tunnel syndrome. Giving massages to the littlest patients, premature babies, helped in the crucial task of gaining weight.
The benefits go beyond feelings of relaxation and wellness that people may recognize after a massage. The American College of Physicians and the American Pain Society now include massage as one of their recommendations for treating low back pain, according to guidelines published in 2007.
New research is also starting to reveal just what happens in the body after a massage. While there have long been theories about how massage works—from releasing toxins to improving circulation—those have been fairly nebulous, with little hard evidence. Now, one study, for example, found that a single, 45-minute massage led to a small reduction in the level of cortisol, a stress hormone, in the blood, a decrease in cytokine proteins related to inflammation and allergic reactions, and a boost in white blood cells that fight infection.
There's been a surge of scientific interest in massage. The National Center for Complementary and Alternative Medicine, part of the National Institutes of Health, is currently spending $2.7 million on massage research, up from $1.5 million in 2002. The research is being driven, in part, by massage therapy's popularity. About 8.3% of American adults used massage in 2007, up from 5% in 2002, according to a National Health Statistics report that surveyed 23,393 adults in 2007 and 31,044 adults in 2002, the latest such data available. Massage was expected to be a $10 billion to $11 billion industry in 2011 in the U.S., according to estimates by the American Massage Therapy Association, a nonprofit professional organization. "There is emerging evidence that [massage] can make contributions in treating things like pain, where conventional medicine doesn't have all the answers," said Jack Killen, NCCAM's deputy director.
Massage is already widely used to treat osteoarthritis, for which other treatments have concerning side effects. A study published in the Archives of Internal Medicine in 2006 showed that full-body Swedish massage greatly improved symptoms of osteoarthritis of the knee. Patients who had massages twice weekly for four weeks and once a week for an additional four weeks had less pain and stiffness and better range of motion than those who didn't get massages. They were also able to walk a 50-foot path more quickly.
"If [massage] works then it should become part of the conventionally recommended interventions for this condition and if it doesn't work we should let [patients] know so they don't waste their time and money," says Adam Perlman, the lead author of the study and the executive director of Duke Integrative Medicine in Durham, N.C.
In a small study published in the journal Science Translational Medicine last month, a 10-minute massage promoted muscle recovery after exercise. In the study, 11 young men exercised to exhaustion and then received a massage in one leg. Muscle biopsies were taken in both quad muscles before exercise, after the massage and 2½ hours later.
The short massage boosted the production of mitochondria, the energy factory of the cell, among other effects. "We've shown this is something that has a biological effect," says Mark Tarnopolsky, a co-author of the study and a professor of pediatrics and medicine at McMaster University Medical Center in Hamilton, Ontario.
A 2010 study with 53 participants comparing the effects of one 45-minute Swedish massage to light touch, found that people who got a massage had a large decrease in arginine-vasopressin, a hormone that normally increases with stress and aggressive behavior, and slightly lower levels of cortisol, a stress hormone, in their blood after the session. There was also a decrease in cytokine proteins related to inflammation and allergic reactions.
Mark Hyman Rapaport, the lead author of the study and the chairman of psychiatry and behavioral science at the Emory University School of Medicine in Atlanta, says he began studying massage because, "My wife liked massages and I wasn't quite sure why. I thought of it as an extravagance, a luxury for only people who are very rich and who pamper themselves." Now, Dr. Rapaport says he gets a massage at least once a month. His group is now studying massage as a treatment for generalized anxiety disorder.
Conventional thought on ACL injury mechanism challenged Combination of factors cause ACL to rupture
Landing from a jump can cause a non-contact anterior cruciate ligament (ACL) injury. But evidence presented at the Orthopaedic Research Society 2012 Annual Meeting demonstrates that the injury mechanism that causes that ACL injury involves a combination of factors rather than a single factor as some have claimed. Many hold the view that an athlete ruptures the ACL via a single plane motion -- the tibia moving forward due to a large quadriceps contraction.
According to Timothy E. Hewett, PhD, FACSM, Director of Research, Ohio State University Sports Health and Performance Institute and Cincinnati Children's Sports Medicine Biodynamics Center, that injury occurs due to a tri-planar multi-dimensional combination of factors. "Sometimes in science we have a lot of clinical expertise and a lot of engineering expertise but we don't have much—what I call--'common sense-pertise'."
"Is it just anterior translation that strains and tears the ACL? Is it just knee abduction or that inward motion that tears the ACL? Is it just internal rotation that tears the ACL? Our study demonstrates that each one of these factors can strain the ACL. But it is the combination of anterior translation, abduction and internal rotation that likely ruptures the ACL," Dr. Hewett stated. Contrary to conventional thought, his study demonstrated abduction strained the ACL more than anterior translation; internal rotation was equal to that of anterior translation.
The researchers also had a novel finding about internal rotation torque. "We showed abduction increased the load on the ACL just as much as anterior translation did. Internal rotation increased load just as much as anterior translation did. But most importantly, when all three are combined, there was an additive effect in all three planes," he explained.
Dr. Hewett and his colleagues conducted simulated jump landings on nineteen models. There were 17 (89.5%) ACL failures using a custom designed drop-stand. The models were divided into two loading groups: without anterior shear and with anterior shear.
They tested the effects of anterior tibial shear, abduction and internal rotation under dynamic axial loading on ACL biomechanics. They found that single-axis abduction increased average ACL strain from 5.8 to 9.8 percent. In both groups, the addition of abduction or internal rotation increased ACL loading—with abduction loading the ACL more than internal rotation.
Under axial impact, the combination of abduction, internal rotation and anterior shear the average ACL strain significantly increased. "Data from this study indicates that the most critical dynamic condition that leads to ACL failure is a combination of anterior shear, abduction and internal rotation under axial impact," Dr. Hewett concluded.
Neural correlates of a single-session massage treatment
A new study from Canada investigated the immediate neurophysiological effects of different types of massage in healthy adults using functional magnetic resonance imaging (fMRI). The study suggested that that qualitatively different aspects of massage, such as the nature of human touch, can selectively modulate the activity of certain brain regions.
The researchers looked at the problem from, the resting state of the brain, which has been referred to as the default mode network and has received much attention for its importance in the generation of consciousness. These regions (i.e. insula, posterior and anterior cingulate, inferior parietal and medial prefrontal cortices) have been postulated to be involved in the neural correlates of consciousness, specifically in arousal and awareness. The researchers posit that massage would modulate these same regions given the benefits and pleasant affective properties of touch.
Healthy participants were randomly assigned to one of four conditions: 1. Swedish massage, 2. reflexology, 3. massage with an object or 4. a resting control condition. The right foot was massaged while each participant performed a cognitive association task in the scanner.
They found that the Swedish massage treatment activated the subgenual anterior and retrosplenial/ posterior cingulate cortices. This increased blood oxygen level dependent (BOLD) signal was maintained only in the former brain region during performance of the cognitive task. Interestingly, the reflexology massage condition selectively affected the retrosplenial/posterior cingulate in the resting state, whereas massage with the object augmented the BOLD response in this region during the cognitive task performance.
The most robust fMRI changes were observed with the Swedish massage treatment, which involves long and smooth strokes with an applied pressure geared towards relaxation. The impact of reflexology, which is focused upon applying pressure to specific reflex points to invoke a beneficial response at distant body regions, was restricted to the RSC/PCC brain region. In contrast, the massage with a wooden object, which involved pressure and strokes along the same areas of the foot as applied in the Swedish massage, had no significant effect on the BOLD signal in either of the brain regions. This latter finding is particularly noteworthy since it suggests the possibility that the human touch component (as opposed to the same pattern of massage with an object) had a profound influence upon the impact of the treatment.
These findings should have implications for better understanding how alternative treatments might affect resting state neural activity and could ultimately be important for devising new targets in the management of mood disorders.
BRAIN IMAGING AND BEHAVIOR Volume 6, Number 1, 77-87, DOI: 10.1007/s11682-011-9146-z
Researchers find yoga helps ease stress related medical and psychological conditions
An article by researchers from Boston University School of Medicine (BUSM), New York Medical College (NYMC), and the Columbia College of Physicians and Surgeons (CCPS) reviews evidence that yoga may be effective in treating patients with stress-related psychological and medical conditions such as depression, anxiety, high blood pressure and cardiac disease. Their theory, which currently appears online in Medical Hypotheses, could be used to develop specific mind-body practices for the prevention and treatment of these conditions in conjunction with standard treatments.
It is hypothesized that stress causes an imbalance in the autonomic nervous system (parasympathetic under-activity and sympathetic over-activity) as well as under-activity of the inhibitory neurotransmitter, gamma amino-butyric acid (GABA). Low GABA activity occurs in anxiety disorders, post-traumatic stress disorder, depression, epilepsy, and chronic pain. According to the researchers, the hypothesis advanced in this paper could explain why vagal verve stimulation (VNS) works to decrease both seizure frequency and the symptoms of depression.
"Western and Eastern medicine complement one another. Yoga is known to improve stress-related nervous system imbalances," said Chris Streeter, MD, associate professor of psychiatry at BUSM and Boston Medical Center, who is the study's lead author. Streeter believes that "This paper provides a theory, based on neurophysiology and neuroanatomy, to understand how yoga helps patients feel better by relieving symptoms in many common disorders."
An earlier study by BUSM researchers comparing a walking group and a yoga group over a 12-week period found no increase in GABA levels in the walking group, whereas the yoga group showed increased GABA levels and decreased anxiety. In another BUSM 12-week study, patients with chronic low back pain responded to a yoga intervention with increased GABA levels and significant reduction in pain compared to a group receiving standard care alone.
In crafting this neurophysiological theory of how yoga affects the nervous system, Streeter collaborated with Patricia Gerbarg, MD, assistant clinical professor of psychiatry at NYMC, Domenic A. Ciraulo, MD, chairman of psychiatry at BUSM, Robert Saper, MD MPH, associate professor of family medicine at BUSM, and Richard P. Brown, MD, associate clinical professor of psychiatry at CCPS. They are beginning test these theories by incorporating mind-body therapies such as yoga in their clinical studies of a wide range of stress-related medical and psychological conditions.
Cupping therapy effective for treating neck pain
Research from University of Jena in Germany by a PhD candidate Romy Lauche investigated the effect of cupping therapy in the treatment of chronic non-specific neck pain. The approach is inspired by a previous study conducted by Lorimer Moseley in 2008 who found that patients with chronic low back pain showed body image distortions. His patients were unable to designate their whole bodily contours and there was a tendency for displacement of the spine towards painful area. The new study adapted the design of the body image drawings for the neck area and the study patients who suffered from chronic neck pain were asked to draw the neck area as they felt it. The drawings themselves indicated that body image was disturbed in neck pain patients too. Parts of the contours were missing, others were very prominent and in most drawings we found a discrepancy between the bodies drawn and normal body physique, for examples shoulders were elevated and at the same height as the ears.
They also used interviews and the study patients themselves interpreted their own drawings. They further asked them about their body image, their coping and daily life and their experiences with cupping therapy. As a result patients reported that pain was the predominant sensation, it hindered them from sensing the non-painful parts of the neck area. The neck area also felt altered, e.g. swollen or magnified, one also described “having shoulders like an anvil”. Patients’ coping strategies were mostly passive, they tried to endure or distract from the pain. If that did not work they would try to get fixed by their physician instead.
The study found that cupping therapy has an effect on body perception; patients reported not only less pain, but also a more differentiated pain and body perception and a feeling of less weight and tension which also expressed in the drawings with a smaller neck and shoulders with rounder edges. A more surprising result was that the drawings itself and the interview had some impact on body perception when patients drew their attention to the “blind spots”. Coping strategies on the other hand did not change, which is probably the most common finding with passive therapies. Altogether this study showed that pain and body image distortions are also present in patients with chronic neck pain and that cupping might actually reduce pain and influence the body image. In order to change coping strategies more active treatments are needed.