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Clinical Study: Massage on Lower Back Pain
Study Design: A randomized between-groups design evaluated massage therapy versus relaxation for chronic low back pain.
Objectives: Treatment effects were evaluated for reducing pain, depression, anxiety and stress hormones, and sleeplessness and for improving trunk range of motion associated with chronic low back pain.
Summary of Background Data: Twenty-four adults (M age = 39.6 years) with low back pain of nociceptive origin with a duration of at least 6 months participated in the study. The groups did not differ on age, socioeconomic status, ethnicity or gender.
Methods: Twenty-four adults (12 women) with lower back pain were randomly assigned to a massage therapy or a progressive muscle relaxation group. Sessions were 30 minutes long twice a week for five weeks. on the first and last day of the 5-week study participants completed questionnaires, provided a urine sample and were assessed for range of motion.
Results: By the end of the study, the massage therapy group, as compared to the relaxation group, reported experiencing less pain, depression, anxiety and improved sleep. They also showed improved trunk and pain flexion performance, and their serotonin and dopamine levels were higher.
Conclusions: Massage therapy is effective in reducing pain, stress hormones and symptoms associated with chronic low back pain.
Massage Increases Serotonin, Decreases Cortisol
In this article the positive effects of massage therapy on biochemistry are reviewed including decreased levels of cortisol and increased levels of serotonin and dopamine. The research reviewed includes studies on depression (including sex abuse and eating disorder studies), pain syndrome studies, research on auto-immune conditions (including asthma and chronic fatigue), immune studies (including HIV and breast cancer), and studies on the reduction of stress on the job, the stress of aging, and pregnancy stress. In studies in which cortisol was assayed either in saliva or in urine, significant decreases were noted in cortisol levels (averaging decreases 31%). In studies in which the activating neurotransmitters (serotonin and dopamine) were assayed in urine, an average increase of 28% was noted for serotonin and an average increase of 31% was noted for dopamine. These studies combined suggest the stress-alleviating effects (decreased cortisol) and the activating effects (increased serotonin and dopamine) of massage therapy on a variety of medical conditions and stressful experiences.
Study: Massage for Neonatal Pain and Stress
Nonpharmacologic interventions for prevention or relief of neonatal pain and stress are numerous and widely publicized in the medical literature. These interventions have been used either as the sole method of pain control or in combination with pharmacologic interventions. No one would argue with the statement that neonatal intensive care is associated with stress, pain, and discomfort. Because opioid analgesia and sedation have not been proved to be efficacious and may possibly be harmful, alternative methods of pain and stress relief need to be evaluated for efficacy and safety. A variety of approaches have been investigated. As stated clearly by Golianu et al (2007), “These therapies may optimize the homeostatic mechanisms of the infant, thereby mitigating some of the adverse consequences of untreated pain, as well as facilitating healthy physiologic adaptions to stress.” However, widespread adoption of specific techniques is not consistent.
Maternal skin-to-skin contact (also termed kangaroo care) is associated with greater physiologic stability and reduced responses to acute pain (Bergman et al, 2004; Fohe et al, 2000; Gray et al, 2000; Johnston et al, 2003; Ludington-Hoe and Swinth, 1996). Kangaroo care can decrease Neonatal Infant Pain Scale scores after vitamin K injections (Kashaninia et al, 2008). Maternal rocking has been shown to diminish neonatal distress (Jahromi et al, 2004). Breastfeeding reduces the physiologic and behavioral responses to acute pain and stress in neonates and has been recommended as the first line of treatment (Osinaike et al, 2007; Shah et al, 2006).
Nonnutritive sucking with pacifiers reduces pain responses to heel prick, injections, venipuncture, and circumcision procedures (Sexton and Natale, 2009; Shiao et al, 1997; South et al, 2005). Infant massage has been demonstrated to decrease plasma cortisol and catecholamine levels in preterm infants (Acolet et al, 1993; Kuhn et al, 1991).
Massage for Sports Performance and Recovery
Background—Despite massage being widely used by athletes, little scientific evidence exists to confirm the efficacy of massage for promoting both physiological and psychological recovery after exercise and massage effects on performance.
Aim—To investigate the effect of massage on perceived recovery and blood lactate removal, and also to examine massage effects on repeated boxing performance.
Methods—Eight amateur boxers completed two performances on a boxing ergometer on two occasions in a counterbalanced design. Boxers initially completed performance 1, after which they received a massage or passive rest intervention. Each boxer then gave perceived recovery ratings before completing a second performance, which was a repeated simulation of the first. Heart rates and blood lactate and glucose levels were also assessed before, during, and after all performances.
Results—A repeated measures analysis of variance showed no significant group differences for either performance, although a main effect was found showing a decrement in punching force from performance 1 to performance 2 (p<0.05). A Wilcoxon matched pairs test showed that the massage intervention significantly increased perceptions of recovery (p<0.01) compared with the passive rest intervention. A doubly multivariate multiple analysis of variance showed no differences in blood lactate or glucose following massage or passive rest interventions, although the blood lactate concentration after the second performance was significantly higher following massage (p<0.05).
Conclusions—These findings provide some support for the psychological benefits of massage.
Sleep Disturbance & Lower Back Pain Reduced After Massage
Summary: A randomized between-groups design was used to evaluate massage therapy versus relaxation therapy effects on chronic low back pain. Treatment effects were evaluated for reducing pain, depression, anxiety and sleep disturbances, for improving trunk range of motion (ROM) and for reducing job absenteeism and increasing job productivity. Thirty adults (M age=41 years) with low back pain with a duration of at least 6 months participated in the study. The groups did not differ on age, socioeconomic status, ethnicity or gender. Sessions were 30 min long twice a week for 5 weeks. On the first and last day of the 5-week study participants completed questionnaires and were assessed for ROM. By the end of the study, the massage therapy group, as compared to the relaxation group, reported experiencing less pain, depression, anxiety and sleep disturbance. They also showed improved trunk and pain flexion performance.
Massage for Relief of Pregnancy Pain and Insomnia
Research dating back two decades began to confirm the benefits of massage therapy during pregnancy, with a 1999 study in the Journal of Psychosomatic Obstetrics & Gynecology finding reduced anxiety, improved mood, better sleep and less back pain among expectant mothers who received massage twice weekly for five weeks. Such results don’t surprise experts like Gail Pezzullo-Burgs, M.D., an obstetrician in Boca Raton, Florida, whose practice incorporates massage therapy.
“We’re firm believers in stress-reduction techniques, and massage therapy increases the sense of well-being,” Dr. Pezzullo-Burgs says. “And pregnant women often have complaints of pain and decreased circulation that massage therapy really helps.”
Dr. Pezzullo-Burgs began incorporating massage and other integrative therapies into her practice about six years ago when transitioning into a wellness center approach. “Pain is probably the main thing that drives patients to get massage, such as sciatica from the extra weight or position of the baby,” Dr. Pezzullo-Burgs explains. “People go through pregnancy in different mindsets, and some are more anxious than others, but I think it also helps reduce their anxiety even if they’re not having pain.”
Additional early research added even more insight into massage’s role in facilitating a healthier pregnancy. A small 2006 study in the Scandinavian Journal of Caring Sciencesshowed massage was a solid integrative treatment for severe pregnancy- related nausea and vomiting, while a 2009 study in the Journal of Bodywork and Movement Therapies on 112 pregnant women diagnosed with depression suggested those receiving psychotherapy plus massage over a six-week period experienced greater drops in depression than those getting psychotherapy alone.
Meanwhile, a 2009 study in Infant Behavior & Development also focused on pregnant women with depression, finding those undergoing massage therapy not only experienced less depression at the end of 12 weeks, but also carried that benefit into the postpartum period. And a 2010 literature review in Expert Reviews in Obstetrics and Gynecology showed massage therapy decreased depression, anxiety, and leg and back pain in pregnant women, also indicating those in labor used less pain medication and had labors averaging three hours shorter than average.
“Women today are often told in their pregnancy they must ‘just deal’ with any ache, pain or discomfort that comes up . . . but this is where massage can help them,” says Kimberly Corpus, an educator in pregnancy and infant massage and massage therapist from Rochester, New York, who frequently works with pregnant clients. She notes that massage can also reduce swelling, lessen sciatic pain and ease insomnia.
“The No. 1 benefit is obviously relaxation,” says Stephen Abate, a massage therapist from Washington, D.C., who has been working with pregnant clients since 2015. “One of the big issues for moms-to-be is sleeping, so it’s a chance to close their eyes and be truly comfortable.”