Could massage therapy early on lead to improved outcomes in postoperative patients?

 Could massage therapy early on lead to improved outcomes in post-operative patients?

Could massage therapy early on lead to improved outcomes in post-operative patients?

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 pathologies.

The goal of rehabilitation is to improve physical function and manage pain.

Following an ACL injury muscle length often remains unchanged, however there is other pathophysiological responses. A recent paper published in The Journal of Bone and Joint Surgery commented on the physiological alterations in the quadriceps following reconstruction and rehabilitation of the ACL.

“The persistence of the increase in extracellular matrix and decrease in satellite cell content despite surgical reconstruction and rehabilitation demonstrate the need to intervene early following an ACL tear to prevent changes at the cellular level that may ultimately limit muscle adaptation during rehabilitation.” (Noehren et al. 2016). 

My question from this would be, in an interdisciplinary program could massage therapy be used as a specific hands-on technique to expedite tissue healing, leading to improved outcomes.

Massage Therapy in various forms may influence tissue and cell physiology

A study from Geoffrey Bove published in The Journal of Neurological Sciences looked at the effect of modeled massage therapy on TGF-β1 induced fibroblast to myofibroblast transformation (Bove et al. 2016). This is potentially impactful in postoperative rehabilitation because TGF-β1 plays a key role in tissue remodeling and fibrosis.

One of these physiological changes following an ACL injury is a decrease in satellite cells. Satellite cells play a large role in muscle repair and regeneration, mitigating the loss of these cells may enhance the muscle’s ability to respond to subsequent rehabilitation. A recent study published in The Journal of Physiology found that compression massage enhanced satellite cell numbers, and protein synthesis (Miller et al. 2017). 

Summary Points

Following trauma there are often a number of pathological adaptations in the cellular composition of muscle, which may impair the muscle’s ability to respond to subsequent rehabilitation.

Massage therapy may play a role in promoting enhanced muscle regrowth and reducing postoperative fibrosis. Which may improve outcomes later in the rehabilitation process as therapy shifts towards regaining strength.


More to Explore

Berrueta, L., Muskaj, I., Olenich, S., Butler, T., Badger, G. J., Colas, R. A., . . . Langevin, H. M. (2016). Stretching Impacts Inflammation Resolution in Connective Tissue. Journal of Cellular Physiology.
https://www.ncbi.nlm.nih.gov/pubmed/28158149

Bialosky, J.E., Beneciuk, J.M., Bishop, M.D., ... George, S.Z. (2017). Unraveling the Mechanisms of Manual Therapy: Modeling an Approach. J Orthop Sports Phys Ther.
https://www.ncbi.nlm.nih.gov/pubmed/29034802

Bijlard, E., Uiterwaal, L., ... Huygen, F.J. (2017). A Systematic Review on the Prevalence, Etiology, and Pathophysiology of Intrinsic Pain in Dermal Scar Tissue. Pain Physician.
https://www.ncbi.nlm.nih.gov/pubmed/28158149

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.
https://www.ncbi.nlm.nih.gov/pubmed/28734168

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. 
https://www.ncbi.nlm.nih.gov/pubmed/26810536

Cholok, D., Lee, E., ... Levi, B. (2017). Traumatic muscle fibrosis: From pathway to prevention. J Trauma Acute Care Surg.
https://www.ncbi.nlm.nih.gov/pubmed/27787441

Fisher, P., Zhao, Y., Rico, M., Massicotte, V., Wade, C., Litvin, J., . . . Barbe, M. (2015). Increased CCN2, substance P and tissue fibrosis are associated with sensorimotor declines in a rat model of repetitive overuse injury. Journal of Cell Communication and Signaling. (OPEN ACCESS)
https://www.ncbi.nlm.nih.gov/pubmed/25617052 

Fry, C.S., Johnson, D.L., Ireland, M.L., Noehren, B. (2017). ACL injury reduces satellite cell abundance and promotes fibrogenic cell expansion within skeletal muscle. J Orthop Res.
https://www.ncbi.nlm.nih.gov/pubmed/27935172

Laumonier, T., & Menetrey, J. (2016). Muscle injuries and strategies for improving their repair.Journal of Experimental Orthopaedics. (Open Access)
https://www.ncbi.nlm.nih.gov/pubmed/27447481

Miller, B.F., Hamilton, K.L., ... Butterfield, T.A., Dupont-Versteegden, E.E. (2017). Enhanced skeletal muscle regrowth and remodelling in massaged and contralateral non-massaged hind limb. J Physiol.
https://www.ncbi.nlm.nih.gov/pubmed/29090454

Noehren, B., Andersen, A., ... Damon, B. (2016). Cellular and Morphological Alterations in the Vastus Lateralis Muscle as the Result of ACL Injury and Reconstruction. J Bone Joint Surg Am.
https://www.ncbi.nlm.nih.gov/pubmed/27655981 

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)
https://www.ncbi.nlm.nih.gov/pubmed/26637643