Massage Therapy and Postoperative Care

postoperative massage therapy

The use of massage therapy has been shown to improve outcomes in post-operative patients.

One recent paper published in the journal PM&R, looked at the use of fascial manipulation following total hip arthroplasty (Busato et al. 2016). In this study 2 treatment sessions were are able to significantly improve functional outcomes in patients when used in addition to usual treatment. 

Another recent study published in The Journal of Knee Surgery looked at the effect that soft-tissue treatments with hand-held instruments have on post-surgical knee stiffness (Chunghtai et al. 2016). In the study soft-tissue treatments was shown to improve knee flexion deficits by 35° and knee flexion contractures by 12° in a small cohort of individuals who had failed to respond to traditional rehabilitation and manipulation under anesthesia. 

So like I have posted in a number of posts before (here, here, here, here) massage therapy is simple to carry out, economical, and has very few side effects. In this post I will highlight a few ways to massage therapy may be used to improve outcomes in postoperative patients.


What is the the rationale for using massage therapy?

The body of knowledge to support the use of massage therapy continues to grow, understanding the basic science behind what we do and the guiding principles of adaptability enable us to apply this work to a number of pathological conditions.

Postoperative Pain Management
The responses to massage therapy are complex and multifactorial - physiological and psychological factors interplay in a complex manner. Research has looked at neuroimmune responses at both the peripheral and central levels elicited by massage therapy treatments.

In short - Massage has a modulatory affect on peripheral and central processes via mechanoreceptors. Input from large sensory neurons activate spinal cord interneurons that prevents the spinal cord from amplifying the nociceptive signal. This anti-nociceptive effect of massage therapy can help ease discomfort in post surgical patients (Bishop et al. 2015, Vigotsky et al. 2015).

Postoperative Fibrosis
Additionally, massage therapy may improve healing after trauma and in some cases ameliorate the degree of postoperative fibrosis. 

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.”

Fibrosis is a potential complication of surgery or trauma, it is characterized by the production of excessive fibrous scar tissue, which may result in decreased movement. Understanding the cellular effectors and signaling pathways that drives the accumulation of fibrotic deposition, helps therapists optimize treatment protocols for patients suffering from post-surgical fibrosis and guide specific prophylactic treatments.

TGF-Β1 PLAYS A ROLE IN TISSUE REMODELING, AS A THERAPEUTIC INTERVENTION MASSAGE THERAPY HAS THE POTENTIAL TO ATTENUATE TGF-Β1 INDUCED FIBROBLAST TO MYOFIBROBLAST TRANSFORMATION DAVIS'S LAW, ATTRIBUTION: WWW.FASCIALNET.COM

TGF-Β1 PLAYS A ROLE IN TISSUE REMODELING, AS A THERAPEUTIC INTERVENTION MASSAGE THERAPY HAS THE POTENTIAL TO ATTENUATE TGF-Β1 INDUCED FIBROBLAST TO MYOFIBROBLAST TRANSFORMATION

DAVIS'S LAW, ATTRIBUTION: WWW.FASCIALNET.COM

In the normal wound healing response, the cascade of biological responses is tightly regulated. Fibrotic development is characterized by a lack of apoptosis in the proinflammatory phase, resulting in an imbalance between synthesis and degradation. Persistent transforming growth factor-β (TGF-β) secretion and downstream responses are thought to contribute to a sustained inflammatory response (Cheuy et al. 2017).

Manual mobilization is a promising strategy that is used to attenuate adhesion formation and minimize the loss of mobility due to fibrosis. Recent studies have looked at the effect of modeled massage therapy on tissue levels of TGF-β1 (Bove et al. 2016). In this study it was demonstrated manual therapy attenuated the increased fibrosis and tissue levels of TGF-β1, this may play a role in disease development by reducing the contractile activity of myofibroblasts.

In short - The rationale is that the application of appropriate shear force and pressure impart a mechanical stimulus that may attenuate tissue levels of TGF-β1. 


Summary Points

The use of prophylactic massage therapy may help patients manage postoperative pain. It may also affect the development of fibrosis by mediating differential cytokine production.

The next step for researchers is to look into what sort of dosage and duration would be needed to optimize the effects of this non-pharmacological approach. 


More to Explore

Related Links
• Traumatic Muscle Fibrosis:  From pathway to prevention 
• Massage Therapy and Compartment Syndrome 
• The Role of Massage in Scar Management 
• Research on Massage and Cancer 
• Sports Massage - The Science is Emerging 
• Massage Therapy and Dupuytren's Disease 
 

Research Links
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Alvira-Lechuz, J., Espiau, M. R., & Alvira-Lechuz, E. (2017). Treatment Of The Scar After Arthroscopic Surgery On A Knee: A Case Study. Journal of Bodywork and Movement Therapies.
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Chughtai, M., Mont, M.A., Cherian, C., Cherian, J.J., Elmallah, R.D., Naziri, Q., Harwin, S.F., Bhave, A. (2016). A Novel, Nonoperative Treatment Demonstrates Success for Stiff Total Knee Arthroplasty after Failure of Conventional Therapy. J Knee Surg.
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