January 18th: The Debut Session of the Massage Therapy Journal Club

Wednesday, January 18th 2017 at 6:30 EST / 3:30 PST will be the debut session of the Massage Therapy Journal Club. This is a new project which will attempt to present a seminar-style journal club on the internet.

I, along with seven participants from the massage therapy profession, will get together using Google Hangouts to discuss the seminal massage therapy research article entitled “Massage Therapy Effects” by Tiffany Field.  Our discussion will be broadcast live on my YouTube channel, and will also be posted for later viewing. The planned duration for the session is 90m.

I am in the process of creating the structure to have these regularly, with each session having a new set of participants and focusing on a different article. This first session is the real deal, but it is also going to be a test of the format. I plan to use what I learn from this session to tailor things going forward.  I can admit that I am both excited and a little nervous.

I prepared an outline from the article that will help me in hosting the session, but I expect the most important input, questions, and perspective will come from my esteemed participants. Nevertheless, I present the outline below in case it is of interest.

I hope you will either join us live, or view the session after it is completed.  I also hope that you may join us for one or more of the sessions I am planning for the future.

-CM

Field, T. (1998). Massage therapy effects. American Psychologist, 53, 1270-1281

Background

Currently the most-cited massage therapy research article (506 citations in Google Scholar)

One of the earliest massage therapy research articles to appear in a major journal

Article type = narrative review

Article appeared when I was a college senior preparing for graduate school

Why choose this article to kick off the Journal Club?

Introduction

Brief history of massage

Growing popularity is asserted and (casually) linked to the “alternative medicine movement”

Scant research – Medline database search yields only 200 articles across prior 30 years

That research suffers from “classic methodological problems” (p. 1270)

Few clinical trials

Studies often lack control groups, instead rely on within-group design

Studies often fail to use random assignment

Samples/groups often very small

Massage often part of a combination treatment

Failure to account for initial ‘level’ of symptom or clinical variable

“The use of inappropriate statistics” (p. 1270)

Likely publication bias in existing body of studies (positive results published, negative results go unpublished)

Asserts that these shortcomings motivated the Touch Research Institute (TRI) research program

TRI studies always used “deep tissue manipulation” (p. 1270) based on presumption that pressure receptors must be stimulated for there to be clinical effect

Effects organized into five categories: facilitating growth; reducing pain; increasing alertness; diminishing stress, anxiety, and depression; and enhancing immune function

Enhancing growth

Schanberg & colleagues finding that rat pups grow in response to stimulation that resembles mother rat’s licking, pinching, and carrying behaviors; results suggest a touch-growth relationship

Studies by Meaney et al. suggest handling modulates impact of the stress hormone cortisol

Weight gain in infants in response to massage across several studies

Hospital cost savings of $10,000 per premature infant

Norepinephrine and epinephrine levels increased compared with controls

Better performance on infant behavior assessment scale

Similar pattern of results reported for cocaine-exposed infants, HIV-exposed infants, and full-term infants

Pregnant women who received massage reported lower anxiety and depression, had lower stress hormone (cortisol, norepinephrine) levels, less pain, and fewer complications

Pain reduction

Positive results reported for childbirth labor, burn treatment, postoperative pain, juvenile rheumatoid arthritis, fibromyalgia, lower back pain, and migraine headache

Three ‘models’ for this set of effects are offered:

Gate theory, briefly explained as having a stimulus that competes with and overrides or interrupts a ‘pain stimulus’ (nociception)

Increase of the neurotransmitter serotonin, which may inhibit nociception

Promotion of sleep, because persons deprived of sleep show increased propensity for pain, possibly due to decreased somatostatin and increased substance P

Reduction of neuromuscular problems

Positive outcomes for multiple sclerosis

Positive outcomes for spinal cord injury

Enhancing attentiveness

Positive outcomes for autism

Positive outcomes for attention-deficit hyperactivity disorder

Enhanced alertness and better performance on a math task in medical school faculty and staff who received workplace massage – EEG patterns associated with this are mentioned but not detailed

Alleviation of stress, depression, and anxiety

Positive outcomes reported for/with:

Post-traumatic stress disorder

Child and adolescent psychiatric patients

Adolescent women with eating disorders

Chronic fatigue

Depressed elderly volunteers who massaged infants

Models offered for alleviation of stress, anxiety, and depression:

“Depressed mood was decreased, and anxiety levels and stress hormones (norepinephrine, epinephrine, cortisol) were reduced in all of the above studies” (p. 1276)

EEG shift

Increase in vagal activity: “The nucleus-ambiguous branch of the vagus (the “smart” vagus) stimulates facial expressions and vocalizations, which contribute to less depressed affect” (p. 1277)

Cardiovascular symptoms of stress – this section briefly highlights some findings that massage appears to lower blood pressure

Autoimmune disorders

Because vagal activity and insulin levels may be linked, a study of massage therapy for diabetic children was warranted

Anxiety and depressed mood lowered

Parents’ assessment of insulin and food regulation is improved

Children’s glucose levels decreased

Asthmatic children showed general (anxiety, mood) and specific (pulmonary measures) improvements in response to massage

Immune disorders

“Immune disorders might be expected to benefit from massage therapy because of the decrease in cortisol levels noted in several previous studies” (p. 1277)

Positive results reported for HIV+ men, and for women with breast cancer, are reported

Summary

In addition to condition-specific effects, “across studies, decreases were noted in anxiety, depression, stress hormones (cortisol), and catecholamines” (p. 1278)

“Increased parasympathetic activity may be the underlying activity for these changes” (p. 1278)

Asserts that pressure is critical (possibly to activate vagus) and that light stroking is “generally aversive” (p. 1278)

Among future directions: Are any particular massage therapy techniques more effective than others?

In relation to massage therapy effects in healthy individuals, some discussion of sports/athletic massage

A “mixed-results literature” (p. 1278)

Some discussion of whether massage should be expected to diminish inflammation, or not, with no clear consensus

Some discussion of mechanical vibration as a therapeutic intervention and whether massage therapy parallels this

Some discussion of effect of massage on blood flow

“In summary, these questions highlight the need for further research”

“There will need to be a shift in the social-political attitude toward touch [for massage therapy to be more widely used and benefitted from]”

“A larger body of methodologically sound research is needed”

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