resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Let's Clear Up the Collection Confusion
This is an often-misunderstood practice swirling with misinformation. First, a few basics: Insurance is a contract between the patient and the insurance company. The insurance company is simply making a payment for services or care on behalf of the patient.
Shoulder Rehab: Start With the Scapula
The scapula is an incredible display of elegance and movement within the biomechanics of human motion. It's evolved for mobility and stability in the scapulo-thoracic region, giving us the ability to do things that are uniquely human, such as throwing with accuracy.
Five Branches University Has First Hospital TCM Residency
Established in 1984, Five Branches University (FBU) has campuses in Santa Cruz and San Jose, Calif., which serve the communities of Santa Cruz, the Monterey Bay, and Silicon Valley.
The winter season is upon us and offers unique challenges for the clinician and patient alike. To effectively navigate through the winter season there are two main TCM medicinals, Huang Qi and Gan Jiang, to consider, as well as two important formulas which feature these two TCM treasures.
Anti-Aging With Dr. Ping Zhang
Jennifer Waters, TCM practitioner and writer of the Acupuncture Today column, "Talking With the Masters" sat down with Dr. Ping Zhang to discuss aniti-aging with acupuncture.
Acupuncture Points: Broadening Our Scope and Diagnostic Work
As every practitioner knows, the correct diagnosis is everything. Most healing disciplines rely on the use of symptomatology for their treatment implementation. Beyond symptomatology, we have clinical tests to provide more objective findings.
Qigong for Substance Abuse
It is commonly believed that substance abuse, in addition to harming one’s physiological state, hurts the spirit. There is also a belief that one’s spirit does not weaken due to substance abuse, but rather, the person finds solace in addiction due to an already weak spirit.
Scar Reduction With Acupuncture & Microneedling (Part 2)
Protocols & treatment Timing
The Case Report: A Valuable Tool
Case reports are a valuable form of descriptive research. The most basic form of practice-based research, a case report is a detailed account of the history, presenting symptoms, assessment, observations, treatment and follow-up of an individual patient, discussed in the context of prior and potential future research.
A Conversation With Dr. Betty Edmond
This month's column is an exclusive interview with Betty Edmond MD, newly elected CEO/President of the AOMA Graduate School of Integrative Medicine in Austin, Texas.
Low Back Pain in Running Athletes
After 7 million years of adapting to upright postures, the lumbar spine and pelvis have become remarkably adept at managing ground-reactive forces associated with running.
An Education in Gluten Sensitivity
A relatively new syndrome officially documented as non-celiac gluten sensitivity (NCGS) or gluten sensitivity (GS) was officially recognized and published in the new list of gluten-related disorders in 2012.
A New Year and Vision for the ACA
Inadequate pain management coupled with the epidemic of prescription opioid overuse and abuse has taken a severe toll on the lives of millions of people in the United States. Every day, more than 1,000 people are treated in the ER for misusing prescription opioids.
Prepare for the End, From the Beginning: Wealth Building and Retirement with the Tao
Yin and yang flow into and out from one another continually. Beginnings become endings and endings become beginnings again. Wholeness and cycles are the nature of Tao.
An Opportunity & a Responsibility
Nearly 80 Americans die from an opioid-related overdose every day, and spine-related pain is one of the principle drivers of opioid use. This unfortunate situation creates both an opportunity and a responsibility.
Nutrition for Menopause: Front-Line Therapy for All Phases
Of all the changes women experience during their reproductive life, there is no doubt the most dreaded are the three phases of menopause. This is not surprising since all of the symptoms associated with menopause are replete with unpleasantness.
True Practice Mobility for the Chiropractic Profession
When natural disasters occur, chiropractors can literally travel to the other side of the world to offer humanitarian relief in less than a day. The chiropractor's license to legally practice, however, can't make it past the state line.
Flirting With Alternative Therapies
There are about as many adjunct therapies being marketed to acupuncturists as there are acupuncturists. While some may remain purist in their application of traditional Chinese medicine, others choose to explore new horizons of treatment.
We Get Letters & Email
Our Country Needs Us Between Elections, Too; Continuing Care: We Aren't There Yet; Our Associations Need to Do More.
The Acupuncture Channel System (Part 1)
The earliest Chinese reference to channels is in the Mawangdui Medical Manuscripts,1 which are dated to the Warring States period of the Zhou Dynasty (475 BC-221 AD). The text presents 11 channels. There are no acupuncture points listed in those channels.
Another Step Forward for Chiropractic
Chiropractic is now available to 86,000-plus Latter-Day Saints missionaries and you are invited to become a provider. LDS membership in not required; our only concern is that our missionaries get the best quality care available.
Crow Like the Rooster
As we welcome in the Year of the Rooster, we look at some of its major characteristics: confidence and communication, which suits the image we have of the Rooster...strutting in the farmyard, crowing to the others that it's time to wake up.
December, 2015, Vol. 15, Issue 12
Massage and the Stress Response
Making Sense of the Existing Literature
By Massage Therapy Foundation Contributor
Contributed by Beth Barberree, BA, RMT; April Neufeld, BS, LMT; and S. Pualani Gillespie LMT, MSN, RN, BCMTB
Massage has long been seen as a way for people to decrease their stress levels. With the growing number of people seeking massage therapy care in recent years, it becomes increasingly important to understand if it is effective in managing the negative health consequences of stress. In this month's article review, we explore work from a team of experienced researchers who provided a review of the existing literature in this area.
Albert Moraska, Robin Pollini, Karen Boulanger, Marissa Brooks, and Lesley Teitlebaum in their 2008 article, "Physiological Adjustments to Stress Following Massage Therapy: A Review of the Literature," provided a critical evaluation of peer-reviewed research that had investigated the relationship between massage therapy and physiological measures of stress. The authors emphasized that reviews like this one are important to understanding the effectiveness of massage therapy in the management of the health impacts of stress.
In this literature review, massage therapy was defined as "the manipulation of soft tissues for the purpose of producing physiological effects on the vascular, muscular or nervous systems of the body." Only studies where massage therapy was applied within the context of this definition were included, so any studies involving light touch modalities were excluded. The research group only included studies where the massage was provided by trained therapists, and those with adults as the participants. This process of deciding what studies will be included and excluded is called setting the inclusion criteria.
With these criteria in mind, the research team conducted a broad and extensive search of several electronic research databases, along with the researchers' own libraries, for articles that pertained to "stress" in combination with "massage," "bodywork," "physiotherapy," and "manual therapy." Articles were included when "presenting dependent variables of stress that included the hormones cortisol, epinephrine, norepinephrine, or physical measures of blood pressure (BP) and heart rate." Of the initial 1032 citations reviewed that met the search parameters, only "25 articles were found to meet all inclusion criteria."
The research team found that the 25 studies employed a diversity of experimental methods. There was large variability in session duration, "from 5 to 90 minutes, with over half (52%) of the studies having a session duration between 20 and 30 minutes." Commonly, 6 to 10 treatments were delivered, but data was most often collected following the first session. The researchers chose not to report on specific massage techniques used as the specific techniques used were reported in varying degrees of detail and those studies had varied results.
"Study populations were varied and included sexually abused women, patients with eating disorders, pain conditions, hypertension, HIV positive diagnosis, cancer, post-operative patients, critical care patients, healthy adult populations, and some specific disease states." Hormones that are markers for stress response were also noted by the researchers in this review.
Salivary cortisol is easy to collect from the mouth and non-invasive, so massage therapy studies frequently use this method for assessing cortisol levels. Of those studies that measured reductions in salivary cortisol it appears that the decrease, although significant, may be short term. There does not appear to be a cumulative reduction in salivary cortisol levels with multiple massage treatments. The subject populations in these studies were highly varied, "which suggests that many groups may experience an immediate benefit from massage therapy for this variable. . . However, most study participants were either healthy adults or experiencing chronic life stress."
Urinary cortisol has been used to assess changes following multiple massage treatments. The studies that assessed urinary cortisol did so at baseline and after 5 weeks of twice-weekly massage and found evidence of a cumulative reduction in urinary cortisol.
"Epinephrine (adrenaline) is produced mainly from the adrenal medulla and reflects the subject's sympathomedullar activity" [activity from this gland]. "Epinephrine output is mainly influenced by mental stress."
"Norepinephrine (noradrenaline) is considered an indicator of sympathoneuronal [sympathetic nervous system] activity as most of the circulating norepinephrine is released from sympathetic nerve endings. This hormonal defense reaction is aimed at routing energy from organs to muscles for the muscles" and "is more responsive to physical activity" than to mental stress. However, the authors state a decrease in either of these hormones "may indicate a physiological reduction in stress" routing circulation from organs to muscles.
Cardiovascular responses reported in 16 of the studies were blood pressure and heart rate. "Increases in blood pressure, respiration and heart rate are all physiological manifestations of the sympathetic nervous system's response to stressful events." There were mixed results in the studies reporting these responses, with the differences including what body parts were massaged, the massage techniques applied, overall health of the study participants, duration of the massage session, and single session versus multiple sessions. No studies reported an increase in blood pressure. Also the effect of massage on heart rate, although not sustainable, seemed to be repeatable as decreases following massage occurred one visit after the next.
It was noted by the research team that their review was based on the outlined inclusion criteria. The authors contrasted their review with a meta-analysis completed by Moyer et al. (2004). Results of the two reviews were not consistent. The two reports differed with respect to levels of salivary cortisol and blood pressure; the Moyer et al. (2004) report found no massage sessions that affected salivary cortisol and did find a change for blood pressure. The authors of the current review conclude that the difference in findings reveals more about the current state of massage therapy research than about the clinical effects of massage therapy on stress measures. Overall, "the studies reviewed showed a variety of methodological shortcomings."
Of significant interest to readers is the authors' conclusion that, "to date, the research on massage therapy and stress has not progressed to demonstrate efficacy in a trial of sufficient size or methodological rigor to make definitive statements about its efficacy in reducing stress as measured by physiological variables in any particular patient population." It is unfortunate that the evidence does not support making strong conclusions about the impact of massage therapy on physiological stress indicators. It is also unclear why there is no mention of heart rate and blood pressure in the key words listed as search criteria in the current review, even though these non-hormonal markers of stress were included in the review. This may lead to difficulty in having this review come up in other literature searches.
The authors identify opportunities for future studies to examine the effectiveness of massage therapy. Based on the diversity among the studies in the current review, the authors emphasized the need for research that employs methodological rigor including large sample sizes, detailed and reproducible treatment protocols, and reporting of clinical and statistical significance.
The Massage Therapy Foundation continues to support and promote research as seen in this month's review. The Foundation is currently accepting scientific submissions for our 2016 International Massage Therapy Research Conference (IMTRC) that will be held in Seattle, Washington, May 12-15. More information about the conference as well as the submission guidelines are now available on our website at www.massagetherapyfoundation.org.
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