Complementary medicine: Massage is a useful addition to care

Massage can be helpful for patients suffering from constipation, anxiety or stress. Professor Edzard Ernst looks at the evidence

Massage is a method of manipulating the soft tissue of whole body areas. Massage uses various manual techniques, applying pressure and traction to manipulate the soft tissues of the body. Touch is fundamental and allows the therapist to locate areas of muscle tension.

The friction of the hands and the mechanical pressure exerted on cutaneous and subcutaneous structures affect the body.

Circulation of blood and lymph can be enhanced, resulting in increased oxygen supply and the removal of waste products. Direct mechanical pressure and effects mediated via the nervous system normalise areas of increased muscular tension.

Massage techniques

In the UK, massage therapists treat conditions such as anxiety, back pain, constipation, depression, musculoskeletal problems and stress.

During an initial session, the therapist should take a medical history and screen for contraindications. Duration of sessions varies and depends on the condition. Typically, about 30 minutes are required. Massage is often performed on a specially designed couch.

Therapists may use oil to facilitate movement of their hands over the patient’s body.

The five fundamental techniques are effleurage, petrissage, friction, tapotement and vibration. Sessions can be followed by treatments such as hot packs, or relaxation. Most patients are advised to rest for about 20 minutes after treatment. Usually, one to two sessions per week for a treatment period of four to eight weeks are recommended.

Evidence

A Cochrane review concluded that massage might benefit patients with subacute and chronic non-specific lower back pain, especially when combined with exercise and education.

However, reviews of massage for upper extremity work-related disorders, tendinitis (employing deep transverse friction massage), and asthma found insufficient evidence for any conclusions. In addition, evidence on massage for promoting growth and development of preterm and/or low birth-weight infants is weak.

Massage appears to be less effective than spinal manipulative therapy for treating cervicogenic headache, while reduced levels of pain and anxiety have been demonstrated in stroke patients. A meta-analysis suggests the largest effects of massage therapy are on trait anxiety and depression.

Vibratory massage might benefit musculoskeletal pain, while abdominal massage could be a promising treatment option for constipation.

Further trials suggest positive effects on anxiety during labour for post-burn symptoms, on well-being of patients who have undergone coronary artery bypass surgery, and on breast cancer patients.

Massage did not affect the level or duration of pain, or the loss of strength or function following exercise and seemed less effective than swaddling for infants with cerebral injuries. In fibromyalgia, massage has been suggested to relieve pain and depression and improve quality of life.

Contraindications

There are some contraindications and cautions (see box above), and massage should generally be considered as an adjunct to conventional care.

Adverse effects are rare, although serious adverse events such as bone fractures have been reported.

Massage seems to have considerable potential for treating conditions such as constipation, anxiety, depression and stress. When performed by responsible, well-trained practitioners, risks are minimal.

Professor Ernst is director of complementary medicine at the Peninsula Medical School, Universities of Exeter and Plymouth

Adverse effects
Contraindications

Phlebitis, deep vein thrombosis.

Burns, open wounds.

Skin infections, eczema.

Bone fractures, advanced osteoporosis.

Caution

Cancer.

MI.

Osteoporosis.

Pregnancy.

Patients uncomfortable with close contact.

References

Furlan A D, et al. Massage for low back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine 2002; 27:1,896–910. 

Hondras M A, et al. Manual therapy for asthma. Cochrane Library. Issue 2, Chichester; Wiley: 2005.

Moyer C A, et al. A meta-analysis of massage therapy research. Psycho Bull 2004; 130: 3–18.

Hatton J, et al. The impact of foot massage and guided relaxation following cardiac surgery: a randomized controlled trial. J Adv Nurs 2002; 37: 199–207.

Lemstra M, Olszynski W P. The effectiveness of multidisciplinary rehabilitation in the treatment of fibromyalgia: a randomized controlled trial. Clin J Pain 2005; 21: 166–74.

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