An Introduction to the Evidence of Massage
Research evidence in Massage
Massage involves the manipulation of soft tissues of the body (1), especially muscles, tendons, ligaments and fascia (2). Massage can be adapted to treat athletes and non-athletes alike for many reasons. Massage can be used to treat various musculoskeletal injuries or conditions, ranging from acute to chronic.
Massage is thought to improve circulation, cell metabolism, venous and lymphatic flow, removal of chemical irritants, stretch superficial scar tissue, and alleviate adhesion. As a result, relaxation, pain relief, oedema reduction, increased range of movement, enhanced recovery, and injury prevention can be achieved (3). The growing use by elite athletes suggests there is belief that massage works (4-5), and has an important role to play in prevention, preparation, rehabilitation, and recovery of athletes (6).
Characteristics of a good massage therapist
Like all interventions, massage needs to be based on sound scientific ‘essential principles’. A good therapist, in addition to being competent in manual therapy should have an understanding of human anatomy, physiology, pathology; and the ability to apply this knowledge when practising massage (15). Frequently cited by many authors, therapists must acquire adequate knowledge of the pathophysiology of soft tissue injury and the healing process (15-18). Because, an understanding of tissue healing is fundamental to effective massage as the phases of healing guide clinical decision-making with respect to what, when, and how to apply appropriate massage (3,15). Otherwise, massage may result in poor performance and cause further tissue damage (19). Experience is an essential component in any profession and massage is no exception. For example, a pre-requisite for masseurs applying for major sporting events e.g. Olympics and Commonwealth games require a minimum of 500 hours practical sports massage.
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In a recent study by Moraska (20), the level of therapist training was shown to impact effectiveness of massage as a post-race recovery tool following a 10-Km run. A greater reduction in muscle soreness was achieved by therapists with 950 hours of training as opposed to those with 450 hours. Interestingly, Bramah (5) believes the reason why chartered physiotherapists fail to understand ‘massage’ is because they only receive approx 6 hours of massage training throughout their entire university degree.
What the research literature says
Massage is not without its critics and the lack of robust research on the benefits or otherwise leaves the discipline open to criticism. Research evidence is scarce (6) and when it does exist produces equivocal findings (7). In many studies, authors cite the lack of positive findings is down to flawed methodology and poor design (6-8), in some studies, lack of therapist experience (9). Furthermore, within the literature, treatment styles and descriptions use conflicting or inconsistent terminology (10), which creates more confusion, further adding to the research dilemma.
In support of the continued use of massage
Although often frowned upon by some professions for its poor evidence-base, the lack of robust evidence is not just confined to massage. Watson (11) reports if one looks critically at the full range of physiotherapy treatments, there is simply insufficient evidence to support or reject many of them in all known circumstances. Furthermore, the absence of evidence does not always mean that there is evidence of absence (11). Although we should strive for evidence-based practice, the lack of sound evidence doesn’t mean a treatment doesn’t work in practice (12), or, shouldn’t be used. However, when sound evidence is lacking, treatment should be guided by experience and clinical reasoning (13). Crucially, treatment outcomes can be enhanced by taking opportunity to compliment massage using other suitable interventions, thereby adopting a multi-factorial and/or multi-disciplinary approach (4, 12, 14). Modern therapy encourages a wider approach.
Adapted from: Watson, (2006). Tissue repair: the current state of art The basic response to tissue injury
Repair and Rehabilitation
Therapeutic massage can be used to assist the natural healing and rehabilitation of various soft tissues (muscles, tendons, ligaments) at each successive phase of tissue healing following an induced injury. The phases of healing are universally known as; bleeding, inflammation, proliferation and remodelling. Clinically, the condition of the tissue should drive and dictate when and how to deliver massage. Therefore, it is understandable that a practicing Massage Therapist should possess a sound knowledge of human anatomy, physiology and pathology and the ability to apply it when dealing with injuries. The research literature unequivocally states that the phases of tissues healing should guide clinical reasoning and decision-making with respect to what, when and how to deliver safe and effective massage (21).
Regular, routine Massage Therapy can help injury prevention in various ways. Firstly, regular massage therapy facilitates ongoing dialogue between patient and therapist to discuss potential problems. It is claimed that regular massage improves the general condition of soft tissues, through enhancing tissue elasticity and pliability. Furthermore, regular massage may help prevent formation of adhesion and improve mobility of scar-tissue. This encourages contracted (shortened) muscles to return to their resting length which helps relieve muscle tension by preventing inhibiting antagonist muscles to achieve and restore joint motion.
In today’s society massage therapy is considered useful for every day aches and pains, stresses and strains as a beneficial addition to maintain and support health and well-being thereby promoting a balanced lifestyle.
Physiologically it has been suggested that caring touch helps the flow of blood and lymph around the body. Consequently studies have shown that touch can aid to decrease blood pressure and heart rate, soothe nerves and decrease tension, promoting relaxation and a state of well-being. Furthermore it has been suggested that massage may aid the production of the brain’s chemicals that function as natural painkillers reducing pain and producing a state of mind akin to euphoria.
Although relatively few robust randomised controlled studies exist and much of the research is flawed, a strong belief remains that massage has significant therapeutic benefits. If massage failed to produce benefits, it is unlikely that experienced therapists would have continued its use throughout the decades.
Last updated June 2014
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