Massage Therapy: The Biopsychosocial Framework

My current goal is to promote the value of massage therapy by synthesizing and simplifying noteworthy finds and best available supporting evidence applicable to massage therapy.

Here I have put together a post defining massage therapy as well as an overview outlining potential responses to massage therapy

The Canadian Massage Therapy Alliance defines Massage Therapy as:

"The practice of massage therapy is the assessment of the Musculoskeletal system of the body and the treatment and prevention of physical dysfunction, injury and pain by manipulation, mobilization and other manual methods to develop, maintain, rehabilitate or augment physical function, relieve pain or promote health. Massage therapy is a clinically-oriented healthcare option that helps alleviate the Musculoskeletal disorders associated with everyday stress, physical manifestation of mental distress, muscular overuse and many persistent pain syndromes."

Massage Therapy: A Biopsychosocial Framework

A biopsychosocial framework helps put into context the interconnected and multidirectional interaction between: physiology, thoughts, emotions, behaviors, culture, and beliefs. In terms of clinical responses to massage therapy there are a couple of proposed mechanisms of action, including but not limited to:

• Neurodynamics - “A clinical concept that uses movement (1) to assess increased mechanosensitivity of the nervous system; and (2) to restore the altered homeostasis in and around the nervous system.” (Grieve's Modern Musculoskeletal Physiotherapy).

• Neuroplasticity - Touch can help sharpen the image of the self in our body maps.

• Contextually Aided Responses- The way we present ourselves and present our techniques is tied to clinical outcomes, the magnitude of a response may be influenced by mood, expectation, and conditioning.

• Neuromodulation - Massage has an affect on peripheral and central processes - input from large sensory neurons may prevent the spinal cord from amplifying nociceptive signaling.

• Social Touch - Nervous system regulated by touch helps modulate the activity of neural circuits important for maintaining resting state. This reduced physiological and behavioural reactivity to stressors results in improved mood/affect.

• Mechanotherapy - "Any intervention that introduces mechanical forces with the goal of altering molecular pathways and inducing a cellular response that enhances tissue growth, modeling, remodeling, or repair.” (Thompson et al. 2016).

More to Explore

Best, T. M., & Crawford, S. K. (2017). Massage and postexercise recovery: The science is emerging. British Journal of Sports Medicine.

Best, T.M., Gharaibeh, B., Huard, J. (2013). Stem cells, angiogenesis and muscle healing: a potential role in massage therapies? Br J Sports Med.

Bialosky, J.E., Beneciuk, J.M., Bishop, M.D., ... George, S.Z. (2018). Unraveling the Mechanisms of Manual Therapy: Modeling an Approach. J Orthop Sports Phys Ther.

Bialosky, J.E., Bishop, M.D., Penza, C.W. (2017). Placebo Mechanisms of Manual Therapy: A Sheep in Wolf's Clothing? J Orthop Sports Phys Ther.

Bishop, M. D., Torres-Cueco, R., Gay, C. ... Bialosky, J. E. (2015). What effect can manual therapy have on a patient's pain experience? Pain Management. (OPEN ACCESS) 

Bove, G.M., Chapelle, S.L., Hanlon, K.E., Diamond, M.P., Mokler, D.J. (2017). Attenuation of postoperative adhesions using a modeled manual therapy. PLoS One. (OPEN ACCESS) 

Bove, G.M., Harris, M.Y., Zhao, H., Barbe, M.F. (2016). Manual therapy as an effective treatment for fibrosis in a rat model of upper extremity overuse injury. J Neurol Sci. (OPEN ACCESS)

Boudier-Revéret, M., Gilbert, K.K., Sobczak, S. (2017). Effect of neurodynamic mobilization on fluid dispersion in median nerve at the level of the carpal tunnel: A cadaveric study. Musculoskelet Sci Pract.

Chaitow, L. (2017). What's in a name: Myofascial Release or Myofascial Induction? J Bodyw Mov Ther. (OPEN ACCESS)

Chaitow, L. (2016). Dosage and manual therapies – Can we translate science into practice? Journal of Bodywork and Movement Therapies. (OPEN ACCESS)

Chaudhry, H., Bukiet, B., Ji, Z., Stecco, A., & Findley, T. (2014). Deformations Experienced in the Human Skin, Adipose Tissue, and Fascia in Osteopathic Manipulative Medicine. JAOA. (OPEN ACCESS)

Chen, L., Michalsen, A. (2017). Management of chronic pain using complementary and integrative medicine. BMJ.

Crane, J., Ogborn, D., Cupido, C., Melov, S., Hubbard, A., Bourgeois, J., & Tarnopolsky, M. (2012). Massage Therapy Attenuates Inflammatory Signaling After Exercise-Induced Muscle Damage. Science Translational Medicine.

Courtney, C.A., Fernández-de-Las-Peñas, C., Bond, S. (2017). Mechanisms of chronic pain - key considerations for appropriate physical therapy management. J Man Manip Ther.

Ellingsen, D., Leknes, S., Løseth, G., Wessberg, J., & Olausson, H. (2016). The Neurobiology Shaping Affective Touch: Expectation, Motivation, and Meaning in the Multisensory Context. Frontiers in Psychology. (OPEN ACCESS)

Fryer, G. (2017). Integrating osteopathic approaches based on biopsychosocial therapeutic mechanisms. Part 1: The mechanisms. International Journal of Osteopathic Medicine.

Fryer, G. (2017). Integrating osteopathic approaches based on biopsychosocial therapeutic mechanisms. Part 2: Clinical approach. International Journal of Osteopathic Medicine.

Gilbert, K. K., James, C. R., Apte, G., ... Smith, M. P. (2015). Effects of simulated neural mobilization on fluid movement in cadaveric peripheral nerve sections: Implications for the treatment of neuropathic pain and dysfunction. Journal of Manual & Manipulative Therapy. (OPEN ACCESS) 

Habig, K., Schänzer, A., Schirner, W., ... Krämer, H.H. (2017). Low threshold unmyelinated mechanoafferents can modulate pain. BMC Neurol. (OPEN ACCESS)

Louw, A., Nijs, J., Puentedura, E. (2017). A clinical perspective on a pain neuroscience education approach to manual therapy. Journal of Manual & Manipulative Therapy.

Mancini, F., Nash, T., Iannetti, G.D., Haggard, P. (2014). Pain relief by touch: a quantitative approach. Pain. (OPEN ACCESS)

Mancini, F., Beaumont, A., Hu, L., Haggard, P., & Iannetti, G. D. (2015). Touch inhibits subcortical and cortical nociceptive responses. Pain. (OPEN ACCESS)

Melzack, R. & Wall, P.D. (1965). Pain mechanisms: a new theory. Science.

Miller, B.F., Hamilton, K.L., ... Butterfield, T.A., Dupont-Versteegden, E.E. (2018). Enhanced skeletal muscle regrowth and remodelling in massaged and contralateral non-massaged hind limb. J Physiol.

Morikawa, Y., Takamoto, K., Nishimaru, H., ... Nishijo, H. (2017). Compression at Myofascial Trigger Point on Chronic Neck Pain Provides  Pain Relief through the Prefrontal Cortex and Autonomic Nervous System: A Pilot Study. Front Neurosci. (OPEN ACCESS) 

Newell, D., Lothe, L.R., Raven, T.J. (2017). Contextually Aided Recovery (CARe): a scientific theory for innate healing. Chiropr Man Therap. (OPEN ACCESS)

Nummenmaa, L., Tuominen, L., Dunbar, R., ... Sams, M. (2016). Social touch modulates endogenous μ-opioid system activity in humans. Neuroimage.

Parravicini, G., Bergna, A., (2017). Biological effects of direct and indirect manipulation of the fascial system. Narrative review. Journal of Bodywork & Movement Therapies.

Pelletier, R., Bourbonnais, D., Higgins, J. (2017). Nociception, pain, neuroplasticity and the practice of Osteopathic Manipulative Medicine. Journal of Manual & Manipulative Therapy.

Pelletier, R., Higgins, J., Bourbonnais, D. (2015). Addressing Neuroplastic Changes in Distributed Areas of the Nervous System Associated With Chronic Musculoskeletal Disorders. Phys Ther.

Rabey, M., Hall, T., Hebron, C., Palsson, T.S., Christensen, S.W., Moloney, N. (2017). Reconceptualising manual therapy skills in contemporary practice. Musculoskeletal Science and Practice.

Thompson, W. R., Scott, A., Loghmani, M. T., Ward, S. R., & Warden, S. J. (2016). Understanding Mechanobiology: Physical Therapists as a Force in Mechanotherapy and Musculoskeletal Regenerative Rehabilitation. Physical Therapy. (OPEN ACCESS) 

Vigotsky, A. D., & Bruhns, R. P. (2015). The Role of Descending Modulation in Manual Therapy and Its Analgesic Implications. Pain Research and Treatment. (OPEN ACCESS) 

Walker, S.C., Trotter, P.D., Swaney, W.T., Marshall, A., Mcglone, F.P. (2017). C-tactile afferents: Cutaneous mediators of oxytocin release during affiliative tactile interactions? Neuropeptides. 

Webb, T.R., Rajendran, D. (2016). Myofascial techniques: What are their effects on joint range of motion and pain? - A systematic review and meta-analysis of randomised controlled trials. J Bodyw Mov Ther.