Responses to Massage Therapy are Multifactorial
/What is Massage Therapy
Massage therapy is a clinically-oriented multi-modal approach based on a biopsychosocial model and on the three pillars of evidence based practice.
Physicians, now more than ever, are recommending conservative evidence based treatment including massage, acupuncture and exercise as part of a multi-modal approach for patients suffering from low back pain, headaches, anxiety and stress.
Why Does Massage Therapy Work
As part of the evolution of the profession is important to have a working knowledge of the myriad of mechanisms of action that may be at play.
The mechanism by which massage therapy alleviates pain and improves function is not clear, biological factors (physiology), psychological (i.e. thoughts, emotions, and behaviors) and social (i.e. culture, and beleifs) factors play a significant role in the experience and reduction of pain. In terms of clinical responses to massage therapy there are a couple of proposed mechanisms of action:
Contextually Aided Recovery
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 (Bialosky et al. 2017).
Neuromodulation
Massage has an affect on peripheral and central processes - input from large sensory neurons may prevent the spinal cord from amplifying nociceptive signaling (Bishop et al. 2015, Vigotsky et al. 2015).
Nervous system regulated by touch (social grooming) 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 (Ellingsen et al. 2016, Moyer et al. 2004, Walker et al. 2017).
An Increase in Parasympathetic Activity
Studies have demonstrated an increase in parasympathetic activity following local compression of triggerpoints. This alteration within the autonomic nervous system result in changes to regional perfusion (Takamoto et al. 2009, Morikawa et al. 2017 ). It is proposed that improved perfusion and oxygen delivery to the muscle, encourages the removal of cellular exudates and drainage of metabolic waste (Moraska et al. 2013).
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.” (2015) Grieve's Modern Musculoskeletal Physiotherapy.
Attenuating intraneural edema - Massage therapy may diminish intraneural edema by mobilizing neural tubes “the use of repetitive motion, neural mobilization techniques may promote a healthy nerve environment by improving axonal transport and blood flow, and reducing detrimental chemical and mechanical components resulting from intraneural edema” (Gilbert et al. 2015).
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)
- The skin, adipose tissue, and fascia are not isolated; rather, they form 1 block of layered tissue on a base of muscle and bone." Soft tissue treatments often engage the skin and underlying tissues. (Chaudhry et al. 2014).The application of appropriate shear force and pressure impart a mechanical stimulus that may attenuate tissue levels of TGF-β1. (Bove et al. 2016).
- Mechanical stimulation can trigger fibroblasts to express pro-/anti-inflammatory cytokines respectively (Zein-Hammoud et al. 2015).
- Research also suggests that the application of massage induces a phenotype change, prompting the transition of M1 macrophages into the M2 macrophages which play a role in tissue remodeling, immune regulation and efficient phagocytic activity. (Waters-Banker et al. 2014).
More to Explore
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