Massage Therapy – Literature Review 2003

There is a paucity of scientific data on massage therapy (Lovas et al. 2002). The few studies performed using objective measurements have methodological flaws. Scientific evidence currently does not support nor refute claims made by massage advocates. Although many studies find that massage may be beneficial, researchers also discuss the lack of objective measures and scant evidenced based aspects of massage therapy and state that further investigation is required (Oppel 2000; Sedergreen 2000; Preyde 2000). Fontanarosa and Lundberg (1998) discuss the need for convincing data on safety and therapeutic efficacy and comment on problems with methodological quality in previous research. Tiidus (2000) noted that there is virtually no scientific information available on equine massage. His own studies on humans with DOMS found that massage does not alter whole limb blood flow. Importantly however, he used a Doppler ultrasound technique that did not measure localized blood flow specific to one muscle being massaged, and therefore failed to isolate the effect of massage. Ernst’s (1998) meta-analysis on massage therapy found that most of the research conducted to date had serious methodological flaws resulting in conflicting results. However, his conclusion was that most research suggests that post-exercise massage may alleviate symptoms of DOMS.

Increased blood flow to injured tissue provides oxygen and nutrients and removes breakdown products from the muscle (Newman 2002; McAllister 1995). However, attempts to demonstrate increased skeletal muscle blood flow during local skeletal muscle injury have failed primarily due to methodological errors because whole limb measurements have been made during the study of localized tissue responses. Whole limb measurement techniques lack sensitivity in the studies examining the effects of massage on muscle injury. MT validation for healing tissue requires measuring localized blood flow change to the muscle being massaged.

Delayed onset muscle soreness (DOMS) peaks 24 to 48-hours following unaccustomed exercise (Vickers 2001). DOMS is due to the physical and biochemical muscle fiber degradation that occurs during and after the activity and is followed by a two to three-week repair period. During the repair phase there is a proliferation of myogenic stem cells and increased stem cell activation resulting in the differentiation of new muscle fibers. Massage therapy (MT) is an accepted and used primary treatment option for DOMS. However, MT lacks validity as a medical modality because its effects have yet to be scientifically established.



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Boushel, R. & Piantadosi, C. A. (2000). Near-infrared spectroscopy for monitoring muscle oxygenation. Acta Physiol Scand . 168, 615-622.

Ciurczak, E. W. & Drennen, J. K. (2002). Pharmaceutical and Medical Applications of Near-Infrared Spectroscopy Marcel Dekker,Inc., New York.

Ernst, E. (1998). Does post-exercise massage treatment reduce delayed onset muscle soreness? A systematic review. Br.J.Sports Med. 32, 212-214.

Fontanarosa, P. B. & Lundberg, G. D. (1998). Alternative medicine meets science. JAMA 280, 1618-1619.

Hawke, T. J. & Garry, D. J. (2001). Myogenic satellite cells: physiology to molecular biology. J.Appl.Physiol 91, 534-551.

Lovas, J. M., Craig, A. R., Raison, R. L., Weston, K. M., Segal, Y. D., & Markus, M. R. (2002). The effects of massage therapy on the human immune response in healthy adults. Journal of Bodywork and Movement Therapies 6, 143-150.

Mancini, D. M., Bolinger, L., Li, H., Kendrick, K., Chance, B., & Wilson, J. R. (1994). Validation of near infrared spectroscopy in humans. J.Appl.Physiol 77, 2740-2747.

McAllister, R. M., Delp, M. D., Thayer, K. A., & Laughlin, M. H. (1995). Muscle blood flow during exercise in sedentary and trained hypothyroid rats. Am.J Physiol 269, H1949-H1954.

Newman, J. M., Rattigan, S., & Clark, M. G. (2002). Nutritive blood flow improves interstitial glucose and lactate exchange in perfused rat hindlimb. Am.J Physiol Heart Circ.Physiol 283, H186-H192.

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Preyde, M. (2000). Effectiveness of massage therapy for subacute low-back pain: a randomized controlled trial. CMAJ. 162, 1815-1820.

Pringle, J., Roberts, C., Art, T., & Lekeux, P. (2000). Assessment of muscle oxygenation in the horse by near infrared spectroscopy. Equine Vet.J. 32, 59-64.

Ramey, D. W. T. P. M. (2002). Massage Therapy in Horses: Assessing Its Effectiveness from Empirical Data in Humans and Animals. COMPENDIUM on Continuing Education for the Practicing Veterinarian 24, 418-423.

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Sedergreen, C. (2000). Is massage therapy genuinely effective? CMAJ. 163, 953-954.

Shoemaker, J. K., Tiidus, P. M., & Mader, R. (1997). Failure of manual massage to alter limb blood flow: measures by Doppler ultrasound. Med.Sci.Sports Exerc. 29, 610-614.

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Tiidus, P. M. (1999). Massage and ultrasound as therapeutic modalities in exercise-induced muscle damage. Can.J.Appl.Physiol 24, 267-278.

Tiidus, P. M. (2000). A Review of Human Massage Therapy: Assessing Effectiveness Primarily from Empirical Data in the Human Species. American Association of Equine Practitioners, AAEP Proceedings 46, 302-305.

Tiidus, P. M. & Shoemaker, J. K. (1995). Effleurage massage, muscle blood flow and long-term post-exercise strength recovery. Int.J.Sports Med. 16, 478-483.

Vickers, A. J. (2001). Time course of muscle soreness following different types of exercise. BMC.Musculoskelet.Disord. 2, 5. Part F: Facilities and Resources