It is widely accepted that massage therapy feels good, but why does it work?
Massage in one form or another has been used by most societies throughout history to treat people with illnesses and disabilities. It is widely accepted that massage feels good, but it is only recently that scientists began asking, how does massage therapy work?
The beneficial effects of massage therapy can be described as a collection of interconnected responses.
In the past treatments may have been based on a biomedical model. Looking forward, the biopsychosocial model of health and disease provides a practical paradigm for investigating the complex interplay between massage therapy and clinical outcomes.
Combing through the available evidence it is clear that the best way to describe the effects of massage therapy, is not in a single unified response. As the responses to massage therapy are multifactorial (physiological and psychological factors interplay in a complex manner).
Here are four science backed ways massage helps you feel better
Based off the biopsychosocial model, investigation into mechanisms of action should extend beyond local tissue changes and include peripheral and central pain modulation. An observed favorable outcome may be explained by a number of overlapping responses in the periphery, spinal cord, and brain, including but not limited to:
• Affective Touch - Interpersonal touch and therapeutic stimulation of somatosensory nerves (C-tactile afferent) mediates the release of oxytocin and endogenous opioids. Which can result in reduce physiological and behavioral reactivity to stressors and improved mood/affect.
• Contextual Factors - A positive therapeutic encounter is tied to clinical outcomes; the magnitude of a response is influenced by mood, expectation, and conditioning.
• Endogenous Pain Modulation - Input from somatosensory nerves (Aβ, Aδ and C fibers) inhibits nociceptive processing and activate descending inhibitory mechanisms. This influences neuroimmune processes correlated with the experience of pain.
• Mechanical Factors - Applied forces induce a molecular response that helps diminish intraneural edema and expedite clearance of noxious biochemical by-products (pro-inflammatory cytokines, and creatine kinase).
A Summarized Contemporary Framework of Massage Therapy
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Bialosky JE, Beneciuk JM, Bishop MD, Coronado RA, Penza CW, Simon CB, George SZ. Unraveling the Mechanisms of Manual Therapy: Modeling an Approach. J Orthop Sports Phys Ther. 2018 Jan;48(1):8-18.
Bishop MD, Torres-Cueco R, Gay CW, Lluch-Girbés E, Beneciuk JM, Bialosky JE. What effect can manual therapy have on a patient's pain experience? Pain Manag. 2015;5(6):455-64.
Boudier-Revéret M, Gilbert KK, Allégue DR, Moussadyk M, Brismée JM, Sizer PS Jr, Feipel V, Dugailly PM, Sobczak S. Effect of neurodynamic mobilization on fluid dispersion in median nerve at the level of the carpal tunnel: A cadaveric study. Musculoskelet Sci Pract. 2017 Oct;31:45-51.
Bove GM, Harris MY, Zhao H, Barbe MF. Manual therapy as an effective treatment for fibrosis in a rat model of upper extremity overuse injury. J Neurol Sci. 2016 Feb 15;361:168-80.
Bove GM, Delany SP, Hobson L, Cruz GE, Harris MY, Amin M, Chapelle SL, Barbe MF. Manual therapy prevents onset of nociceptor activity, sensorimotor dysfunction, and neural fibrosis induced by a volitional repetitive task. Pain. 2018 Nov 16.
Chen L, Michalsen A. Management of chronic pain using complementary and integrative medicine. BMJ. 2017 Apr 24;357:j1284.
Chimenti RL, Frey-Law LA, Sluka KA. A Mechanism-Based Approach to Physical Therapist Management of Pain. Phys Ther. 2018 May 1;98(5):302-314.
Courtney CA, Fernández-de-Las-Peñas C, Bond S. Mechanisms of chronic pain - key considerations for appropriate physical therapy management. J Man Manip Ther. 2017 Jul;25(3):118-127.
Crane JD, Ogborn DI, Cupido C, Melov S, Hubbard A, Bourgeois JM, Tarnopolsky MA. Massage therapy attenuates inflammatory signaling after exercise-induced muscle damage. Sci Transl Med. 2012 Feb 1;4(119):119ra13.
Damien J, Colloca L, Bellei-Rodriguez CÉ, Marchand S. Pain Modulation: From Conditioned Pain Modulation to Placebo and Nocebo Effects in Experimental and Clinical Pain. Int Rev Neurobiol. 2018;139:255-296.
Diego MA, Field T. Moderate pressure massage elicits a parasympathetic nervous system response. Int J Neurosci. 2009;119(5):630-8.
Dupuy O, Douzi W, Theurot D, Bosquet L, Dugué B. An Evidence-Based Approach for Choosing Post-exercise Recovery Techniques to Reduce Markers of Muscle Damage, Soreness, Fatigue, and Inflammation: A Systematic Review With Meta-Analysis. Front Physiol. 2018 Apr 26;9:403.
Ellingsen DM, Leknes S, Løseth G, Wessberg J, Olausson H. The Neurobiology Shaping Affective Touch: Expectation, Motivation, and Meaning in the Multisensory Context. Front Psychol. 2016 Jan 6;6:1986.
Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977 Apr 8;196(4286):129-36.
Espejo JA, García-Escudero M, Oltra E. Unraveling the Molecular Determinants of Manual Therapy: An Approach to Integrative Therapeutics for the Treatment of Fibromyalgia and Chronic Fatigue Syndrome/Myalgic Encephalomyelitis. Int J Mol Sci. 2018 Sep 9;19(9).
Gilbert KK, Roger James C, Apte G, Brown C, Sizer PS, Brismée JM, Smith MP. Effects of simulated neural mobilization on fluid movement in cadaveric peripheral nerve sections: implications for the treatment of neuropathic pain and dysfunction. J Man Manip Ther. 2015 Sep;23(4):219-25.
Gilbert KK, Smith MP, Sobczak S, James CR, Sizer PS, Brismée JM. Effects of lower limb neurodynamic mobilization on intraneural fluid dispersion of the fourth lumbar nerve root: an unembalmed cadaveric investigation. J Man Manip Ther. 2015 Dec;23(5):239-45.
Howick J, Moscrop A, Mebius A, Fanshawe TR, Lewith G, Bishop FL, Mistiaen P, Roberts NW, Dieninytė E, Hu XY, Aveyard P, Onakpoya IJ. Effects of empathic and positive communication in healthcare consultations: a systematic review and meta-analysis. J R Soc Med. 2018 Jul;111(7):240-252.
Lloyd DM, McGlone FP, Yosipovitch G. Somatosensory pleasure circuit: from skin to brain and back. Exp Dermatol. 2015 May;24(5):321-4.
Louw A, Farrell K, Landers M, Barclay M, Goodman E, Gillund J, McCaffrey S, Timmerman L. The effect of manual therapy and neuroplasticity education on chronic low back pain: a randomized clinical trial. J Man Manip Ther. 2017 Dec;25(5):227-234.
Mancini F, Beaumont AL, Hu L, Haggard P, Iannetti GD. Touch inhibits subcortical and cortical nociceptive responses. Pain. 2015 Oct;156(10):1936-44.
McGlone F, Wessberg J, Olausson H. Discriminative and affective touch: sensing and feeling. Neuron. 2014 May 21;82(4):737-55.
Miller BF, Hamilton KL, Majeed ZR, Abshire SM, Confides AL, Hayek AM, Hunt ER, Shipman P, Peelor FF 3rd, Butterfield TA, Dupont-Versteegden EE. Enhanced skeletal muscle regrowth and remodelling in massaged and contralateral non-massaged hindlimb. J Physiol. 2018 Jan 1;596(1):83-103.
Moraska AF, Hickner RC, Rzasa-Lynn R, Shah JP, Hebert JR, Kohrt WM. Increase in lactate without change in nutritive blood flow or glucose at active trigger points following massage: A randomized clinical trial. Arch Phys Med Rehabil. 2018 Aug 6. pii: S0003-9993(18)30922-5.
Morikawa Y, Takamoto K, Nishimaru H, Taguchi T, Urakawa S, Sakai S, Ono T, Nishijo H. 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. 2017 Apr 11;11:186.
Morrison I, Löken LS, Olausson H. The skin as a social organ. Exp Brain Res. 2010 Jul;204(3):305-14.
Morhenn V, Beavin LE, Zak PJ. Massage increases oxytocin and reduces adrenocorticotropin hormone in humans. Altern Ther Health Med. 2012 Nov-Dec;18(6):11-8.
Pelletier R, Higgins J, Bourbonnais D. Addressing Neuroplastic Changes in Distributed Areas of the Nervous System Associated With Chronic Musculoskeletal Disorders. Phys Ther. 2015 Nov;95(11):1582-91.
Rapaport MH, Schettler P, Bresee C. A preliminary study of the effects of repeated massage on hypothalamic-pituitary-adrenal and immune function in healthy individuals: a study of mechanisms of action and dosage. J Altern Complement Med. 2012 Aug;18(8):789-97.
Rossettini G, Carlino E, Testa M. Clinical relevance of contextual factors as triggers of placebo and nocebo effects in musculoskeletal pain. BMC Musculoskelet Disord. 2018 Jan 22;19(1):27.
Rulleau T, Toussaint L. Massage can (re-)activate the lower limb sensorimotor representation of older adult inpatients. Psychol Aging. 2018 Aug;33(5):832-840.
Santos FM, Silva JT, Rocha IRC, Martins DO, Chacur M. Non-pharmacological treatment affects neuropeptide expression in neuropathic pain model. Brain Res. 2018 May 15;1687:60-65.
Vigotsky AD, Bruhns RP. The Role of Descending Modulation in Manual Therapy and Its Analgesic Implications: A Narrative Review. Pain Res Treat. 2015;2015:292805.
Walker SC, Trotter PD, Swaney WT, Marshall A, Mcglone FP. C-tactile afferents: Cutaneous mediators of oxytocin release during affiliative tactile interactions? Neuropeptides. 2017 Aug;64:27-38.
Waters-Banker C, Dupont-Versteegden EE, Kitzman PH, Butterfield TA. Investigating the mechanisms of massage efficacy: the role of mechanical immunomodulation. J Athl Train. 2014 Mar-Apr;49(2):266-73.
Zhu GC, Tsai KL, Chen YW, Hung CH. Neural Mobilization Attenuates Mechanical Allodynia and Decreases Proinflammatory Cytokine Concentrations in Rats With Painful Diabetic Neuropathy. Phys Ther. 2018 Apr 1;98(4):214-222.
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