Being constantly on the look-out for new, good quality articles on alternative therapy which suggest that a treatment might actually work, I was excited to find not just one or two but four recent publications on an old favourite of mine: massage therapy.
The first paper described a study aimed to investigate the effect of whole body massage on the vital signs, Glasgow Coma Scale (GCS) scores and arterial blood gases (ABG) in trauma ICU patients.
In a randomized, double-blind trial, 108 trauma ICU patients received whole body massage or routine care only. The patients vital signs; systolic blood pressure (SBP), diastolic blood pressure (DBP), respiratory rate (RR), pulse rate (PR), Temperature (T), GCS score and ABG parameters were measured in both groups before the intervention and 1 hour and 3 hours after the intervention. The patient in experimental group received full body massage in 45 minute by a family member.
Significant differences were observed between experimental and control groups in SBP 1 hour and 3 hours after intervention, DBP, RR and PR 1 hour after intervention, and GCS 1 hour and 3 hours after intervention. Significant differences were also observed between experimental and control groups in O2 saturation, PH and pO2. No significant differences between experimental and control groups were noted in Temperature, pCO2 and HCO3.
The authors concluded that massage therapy is a safe and effective treatment in intensive care units to reduce patient’s physical and psychological problems. Therefore the use of massage therapy is recommended to clinical practice as a routine method.
The second paper reported a clinical trial on 66 male and female nurses working in intensive care units of Isfahan University of Medical Sciences, Iran.
Patients were randomly divided into experimental and control groups. The Occupational Stress Inventory (OSI) (Osipow and Spokane, 1987) was completed by participants of the two groups before, immediately after, and 2 weeks after the intervention. Swedish massage was performed on participants of the experimental group for 25 min in each session, twice a week for 4 weeks.
Results showed a significant difference in favour of the massage therapy in overall mean occupation stress scores between experimental and control groups two weeks after the intervention.
The authors concluded that it is recommended that massage, as a valuable noninvasive method, be used for nurses in intensive care units to reduce their stress, promote mental health, and prevent the decrease in quality of nursing work life.
The third paper described a randomized controlled trial evaluating the effects of post-operative massage in patients undergoing abdominal colorectal surgery.
One hundred twenty-seven patients were randomized to receive a 20-min massage or social visit and relaxation session on postoperative days 2 and 3. Vital signs and psychological well-being (pain, tension, anxiety, satisfaction with care, relaxation) were assessed before and after each intervention.
Post-operative massage significantly improved the patients’ perception of pain, tension, and anxiety, but overall satisfaction was unchanged.
The authors concluded that massage may be beneficial during postoperative recovery for patients undergoing abdominal colorectal surgery. Further studies are warranted to optimize timing and duration and to determine other benefits in this clinical setting.
The fourth paper reported a systematic review was to evaluate the effectiveness of massage on the short- and long-term outcomes of pre-term infants.
Literature searches were conducted using the PRISMA framework. Validity of included studies was assessed using criteria defined by the Cochrane Collaboration. Assessments were carried out independently by two reviewers with a third reviewer to resolve differences.
Thirty-four studies met the inclusion criteria, 3 were quasi-experimental, 1 was a pilot study, and the remaining 30 were RCTs. The outcomes that could be used in the meta-analysis and found in more than three studies suggested that massage improved daily weight gain by 0.53 g, and resulted in a significant improvement in mental scores by 7.89 points. There were no significant effects on length of hospital stay, caloric intake, or weight at discharge. Other outcomes were not analyzed either because the units of measurement varied between studies, or because means and standard deviations were not provided by the authors. The quality of the studies was variable with methods of randomization and blinding of assessment unclear in 18 of the 34 trials.
The authors concluded that massage therapy could be a comforting measure for infants in the NICU to improve weight gain and enhance mental development. However, the high heterogeneity, the weak quality in some studies, and the lack of a scientific association between massage and developmental outcomes preclude making definite recommendations and highlight the need for further RCTs to contribute to the existing body of knowledge.
I am not saying that these articles are flawless, nor that I agree with all of their conclusion. What I am trying to indicate is that we finally have here an alternative therapy that is promising.
Alternative?
When I worked in Germany and later in Austria, massage was considered to be entirely mainstream. It was only after I had moved to the UK when I realised that, in English-speaking countries, it is mostly considered to be alternative. Perhaps this classification is wrong?
Perhaps we should differentiate according to what type of massage we are talking about. In the realm of alternative medicine – and not just there, I suppose – this seems good advice indeed.
The above papers are about classical massage therapy, but there are some types pf massage which are less than conventional: aura-massage, Marma massage, Indian head massage, shiatsu etc. etc. the list seems endless. These are alternative in more than one sense, and they have one thing in common: there is, as far as I can see, no good evidence to show that they do anything to human health.
My conclusion therefore is that, even with something as common as massage therapy, we need to be careful not to be roped in by the charlatans.
11 Responses to Four new papers on a promising ‘alternative’ therapy: massage
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Massage is jolly nice. And more so if in the context of nice smells, soft lights and charming staff.
It probably does have physiological and psychological effects which are beneficial – but there is no effect as far as I can see on any specific disease.
Nor on chakras, auras, innate intellegence, vital forces and the like.
IMHO ‘massage’ is a mainstream part of caring for patients and of therapy, but is not an alternative to medicine and should not be bundled with CAM. It is ‘hand holding’ writ large.
If masseurs do claim to effect esoteric unidentified flying forces and other woo constructs outside plausible rational precepts, then they are members of the ‘alternative’ camp.
Depends on what they claim to be doing – and selling!
As far as I know, classical massage in Latvia is mainstream for musculoskeletal problems, but it is also used for conditions like chronic constipation , muscle hypertonus (a local equivalent of “colic”) or to improve link between mother and baby (which probably is not that alternative, because it functions as showing affection)…..
It is good to learn that massage has received some systematic scientific investigation, but I find the results unsurprising. There are few people who do not enjoy a massage, given to any part of the body with care and sympathy. This is not medicine, mainstream or alternative. No masseur claims to cure any disease: they just make people feel better. Massage occupies the same place in medicine as an empathetic chat with hospital staff or visitors, a good cuddle at a time of stress, even a bit of grooming in the form of hairdressing or a manicure. Many forms of contact and comfort can be offered to somebody with a medical problem.
Sadly, several of the woo-based alternatives to medicine, such as reiki, reflexology, acupressure, shiatsu and others, are in truth little more than massages, but they come dressed up with a lot of pseudoscientific theoretical baggage and they make extravagant claims to cure all types of disease. This moves the potential value of their massage component into the realm of misleading patients.
It would seem that as a general rule the more exotic the name, the more questionable, the therapy. It is my understanding that most forms of active muscle manipulation will cause muscle relaxation for up to 4 hours. This would be pleasing even if it did not directly affect “health”. Are there any risks associated with massage? If not than the primary question is more about costs and who should pay for an enjoyable experience.
the risks were reviewed by us here http://www.ncbi.nlm.nih.gov/pubmed/12777645 ;
they are generally minor.
I do have to wonder about the “strangulation of the neck incident” listed as complication. Since much of the treatment was by laymen, the word “massage” loses it’s meaning.
I’ll cheerfully admit to being prescribed regular massage – the mainstream sort – for musculoskeletal problems. Since it does tend to relax contracted muscles, it does seem to break a vicious circle of pain.
Not convinced it’s any good for epicondylitis or oedema (unless maybe the patient is confined to bed), both of which I’ve also had it prescribed for.
Great results, and well written up. I do have one question though: how do you give a massage to a trauma patient? I used to work in a level 1 trauma center and these people were very very sick with lots of tubes and sutures and fractures and all kinds of things that would seem to preclude a nice full body massage.
I would like to know what kind of technique is available to those wanting to give a trauma patient a good massage. This is not out of skepticism, but pure interest.
SteveG said:
Very carefully?
As a clinician of 38 years I will admit that, in the past, I’ve surfed waves of ‘latest trends’ in treatment. However any clinician will agree that a confident, happy, relaxed, engaged person, probably someone who perceives they have an element of control of their management, is the optimal state we desire in someone we work with, to help their recovery.
My training, 38 years ago, here in the UK, as a Physiotherapist included a qualification in massage. It was part of our basic skills training to understand the feel of normal tissue, to put a hand on a person, gain their trust, discover how to position them to be comfortable, to reduce tension, take a few minutes to explain and gain rapport.
It’s not ‘new’ news that people who are highly stressed, fearful, distressed and anxious dont heal so well and are more difficult to manage. Crack that aspect and a whole cascade of natural healing starts to take place inside the person.
In the past 18 months some Physiotherapists have become increasingly aggressive and vocal, questioning the place of massage / manual therapy even as something which should be a core pillar of practice in the physiotherapy profession. Thank you for publishing this blog post, because it reminds me to always be mindful of my patients state and position them at the centre of their own healing