A Year in the Life of a Massage Research Curriculum

AWARD TYPE: Past Poster Presenter

Michael Hamm, LMP, CCST
Cortiva Seattle

The focus of the project was to examine the effects of massage on cancer recovery and chemotherapy-induced peripheral neuropathy. The purpose of working with an individual with these conditions was to see if weekly mini-reflexology sessions, stretching and massage would relieve the symptoms. Before each session, an evaluation of the client’s state was made, with documentation of the clients’ progression. I researched cancer and the prescribed treatments to learn how these treatments affected the body. I recorded my findings with SOAP notes and also graphed my clients progresses over a four week period. I tracked the progress of my clients four chief complaints: the restriction of movement she felt upon rising, level of flexibility, numbness, and pain my client was experiencing in her feet and legs. After four weeks my client did show improvement in all areas. It has been about eight months since last working with my client for these specific conditions, some of her symptoms have returned and she is currently evaluating her continued medicinal treatments to see if they are the cause of her discomfort. I feel that if I had begun treatment with her sooner that some of her symptoms would not have been so severe. I hope that with continued treatments my client will have sustained improvement of her symptoms.

ADD Massage to Your Life

AWARD TYPE: Past Poster Presenter

Dr. Wanda I. Bonet-Gascot, PhD
Quality Massage and Wellness Research

Attention deficit-hyperactivity disorder (ADD/ADHD) is the most commonly diagnosed behavioral disorder of childhood, estimated to affect between 3% and 5% of school aged children. The core symptoms of ADD/ADHD include inattention, hyperactivity and impulsivity. In 2003, The Touch Research Institute published the study based on observation: Massage Therapy improves mood and behavior of students with ADD/ADHD, showing that relaxation and massage techniques reduce anxiety and activity levels in children and adolescents.

The purpose of this case report is to determine if massage techniques improves the behavior of a third grade boy, which was recommended by his teacher to receive ADD/ADHD medical attention. The boy was a candidate to take behavioral medicated drugs. The teacher indicated symptoms of inattention, and hyperactivity and low grades.

The boy received 20 minutes massage including head, neck, and hands / 4 times a week for 8 weeks. After each massage session, a basic questionnaire was answered by the boy. His behavior was observed by his mother, and teacher.

After the 8 week treatment, the teacher indicated a significant improvement in his student behavior and grades. The boy reported improvement in his quality of life and self esteem. The mother of the boy reported satisfaction and mental peace about the fact that his son’s behavior improved without the need of medications. The boy’s behavior was monitored after the eight weeks, and he received massages periodically.

Based on the results of this case report, massage is recommended for kids with ADD/ADHD for behavioral improvement. There are additional implications of this case report: 1) the foundation to conduct further research studies on this topic; 2) massage therapy not only beneficial the receiver also offers satisfaction and reduce stress to caregivers.

Client Perceptions of Massage Effects: A MassageNet Study

AWARD TYPE: Past Poster Presenter

Jerrilyn Cambron, LMT, DC, MPH, PhD,
Jennifer Dexheimer, LMT, BS,
Dana Madigan, BS
Nicole Brod, BS
National University of Health Sciences

Introduction: There are still questions regarding who seeks massage, why massage is sought, and what effects are experienced post-massage.

Purpose: The purpose of this IRB-approved study was to describe the treatment characteristics of Illinois massage therapists and their clients’ perceived outcomes of care.

Methods: All Illinois massage therapists enrolled in the MassageNet practice-based research network who previously indicated interest in research participation were approached regarding this study. Each therapist, up to a total of 50, was asked to participate and if interested was asked to approach 20 consecutive clients. Before and after the massage, the clients were asked about their pain and stress levels. Immediately after the massage and 24 hours later the clients were asked to indicate any change in certain physical, mental, or emotional functions. The therapists were also asked to complete questions regarding the type and duration of the massage.

Results: Twenty-eight massage therapists and 379 clients participated. The most common form of massage included in therapy sessions was Swedish. The majority of clients were female with an average age of 53. Immediately after massage, clients reported a downward trend in levels of both pain (3.7 to 1.6 out of 10) and stress (3.5 to 1.5 out of 10). Physical, mental, and emotional improvements were reported immediately after and 24 hours after massage, with the greatest improvements being muscle tension (99%, 89% respectively), relaxation (96%, 81%), and serenity/peace (93%, 81%). Additional non-musculoskeletal improvements included circulation (67%, 48%), ability to breathe (53%, 39%), and digestion (30%, 29%). A minimal number of clients reported aspects that worsened after massage, with the most common being physical in nature.

Conclusion: Clients overwhelmingly reported improvements in their physical, mental, and emotional well-being. These improvements were noted immediately after the massage as well as 24 hours later. Few aspects were found to have worsened.

Cortisol Reductions in Response to Massage Therapy: A Comprehensive Qualitative Review

AWARD TYPE: Past Poster Presenter

Christopher A. Moyer, PhD, Lacey Seefeldt, Eric S. Mann, & Lauren M. Jackley
University of Wisconsin – Stout

Introduction: It is frequently asserted that massage therapy (MT) reduces cortisol levels, and that this mechanism is the cause of MT benefits including relief from anxiety, depression, and pain, but reviews of MT research are not in agreement on the existence or magnitude of such a cortisol reduction effect, or the likelihood that it plays such a causative role.

Objectives: Completion of a definitive quantitative review of MT’s effect on cortisol.

Methods: After first performing a comprehensive literature search and retrieval, we use rigorous and conventional meta‐analytic methods for calculating between‐groups effect sizes. As a point of comparison, we also replicate an unconventional approach taken by other reviewers, in which MT recipients’ within‐group cortisol reductions are quantified as a percentage of change, despite the fact that this introduces numerous confounds not addressed by the first approach.

Results: Resultant between‐groups effect sizes are almost all small (ds = 0.05 to 0.30) and nonsignificant. The lone exception is MT’s multiple‐dose effect in children, which is larger (d = 0.52) and statistically significant, but which is based on only three studies and vulnerable to the file‐drawer effect. Within‐group percentage reductions of cortisol in MT recipients are generally smaller than those found by other reviewers, and are generally inconsistent with the more rigorous between‐groups results, which illustrates the unsuitability of this unconventional approach to assessment of treatment effects.

Conclusion: MT’s effect on cortisol is generally very small and, in most cases, not statistically distinguishable from zero. As such, it cannot be the cause of MT’s well established and statistically larger beneficial effects on anxiety, depression, and pain. We conclude that other causal mechanisms, which are still to be identified, must be responsible for MT’s clinical benefits.

Foundations of Evidence Informed Practice for Massage Therapy

AWARD TYPE: Past Poster Presenter

Sarah Weaver, MFA, M.Om, L. Ac., NCTMB,
Sarah Gottfried, B.A., NCTM
Louise Delagran, MA, MEd
Michele Maiers, D.C., MPH
Roni Evans, D.C., MS
Northwestern Health Sciences University

Introduction: Northwestern Health Sciences University (NWHSU) is a multidisciplinary university that educates professionals in massage therapy, chiropractic, and acupuncture and Oriental medicine. In 2007, NWHSU in collaboration with the University of Minnesota received a grant from the National Center for Complementary and Alternative Medicine (R-25AT003582). The purpose of the grant was to integrate research into NWHSU’s academic curricula and enhance students’ research literacy.

Purpose: The purpose of this presentation is to describe a new course introducing massage therapy students to health care research in the context of an evidence-informed practice (EIP) model. This model emphasizes the tripartite relationship between client presentation, clinical experience, and evidence from scientific research.

Methods: A multidisciplinary team of educators and clinicians was assembled to meet the unique learning needs of massage therapy students. The ADDIE (Analysis, Design, Develop, Implement, Evaluate) model of instructional design was used. An initial analysis of student and faculty views of research was performed, as well as an assessment of the existing massage therapy curriculum, and the COMTA research competencies. A 1-credit, course was designed based on 8 broad EIP competencies adopted by NWHSU. Teaching strategies include classroom and online strategies. Lesson plans emphasize practical application of concepts introduced in online learning modules and focus on the specific needs of massage therapy students. Assessment includes online quizzes, online discussions, written exercises and in- class exams. A competency based survey assessing self reported EIP skills and behaviors is given at the beginning and end of each course.

Results: A new course, “Foundations of Evidence Informed Practice for Massage Therapy” was implemented in the final trimester of the massage therapy curriculum. It has been administered to 7 cohorts, reaching over 100 massage therapy students. Recent assessments indicate students believe it is important to be able to use research in massage therapy practice. Results of the surveys show general increases in student self-reported EIP skills and behaviors (e.g. discussing research with others, accessing summary resources, applying the EIP model). Challenges have included the low-credit load, and placement of the course at the end of the massage therapy program.

Conclusion: Despite some challenges, overall, we feel the implementation of the new course has been successful. Students are gaining important research-related skills that will enable them to participate responsibly and more fully in the health care system. Ideally, the foundational related principles related to “evidence-informed practice” would be offered early, and consistently throughout the entire massage therapy curricula. NWHSU faculty are working towards this goal.

Inpatient Massage Services at St. Peter’s Hospital

AWARD TYPE: Past Poster Presenter

Alicia Recore, PhD
St. Peter’s Hospital, Albany, NY

Introduction: An eighteen month project providing massage services to acute and chronic care patients was conducted at St. Peter’s Hospital inAlbany,New York. Funded by an anonymous donor, it was a collaboration between the hospital and the local Center for Natural Wellness School of Massage Therapy.

Objective: The purpose was to evaluate the impact of these services on patients’ symptoms during short and long term stays.

Method: Acute and chronic patients were referred to contracted Licensed Massage Therapists by staff on the Oncology, Stroke/Orthopedic, Rehabilitation, Pulmonary, Cardiac, Ante/Postpartum and Dialysis units. Acute care patients received up to three consecutive 30 minute sessions per week. One to two sessions per patient per week, (six sessions maximum) were offered to patients with chronic disease related symptoms and projected stays of up to two months.

Results: Pre/post measures gauging clinical benefit and patient satisfaction were documented on 625 sessions, involving 268 acute care patients. Clinical Care Unit Coordinators were surveyed on perceived benefit to both patients and staff.

Positive outcomes for acute patients included 70% pain reduction; 53% anxiety reduction; 65% heart rate reduction; 64% blood pressure reduction; 51% respiration rate reduction. Patient Reported Satisfaction scores indicated that over 57% felt massage to be very beneficial in relieving pain/anxiety, improving sleep/mood, and increasing comfort; 100% of all respondents said they would recommend it for other patients. The Coordinators also reported beneficial outcomes, recommending continuation of the program.

While long term evaluation for chronic patients could not be consistently measured due to barriers, the following significant outcomes were recorded for 11 patients over 40 sessions:

Rehabilitation (3): 80% decreased pain; over time significant decrease in depression reported

Oncology (2): 67% decreased pain; 67% decreased anxiety

Complicated Cardiac (5): 90% decreased pain, 47% decreased anxiety; 75% – 95% decreased blood pressure and heart/respiration rates

Dialysis (1): 60% decreased pain, 80% decreased anxiety

In addition to Cardiac patients, 50% of all other patients showed decreased blood pressure and heart/respiration rates; sleep status shifted from awake to drowsy/asleep.

As massage later became integrated into the Labor and Delivery Unit per physicians’ and patients’ requests, outcomes indicated intervals between contractions decreasing by minutes (69%) with duration of contractions increasing by seconds (69%). Progression of labor quickened with patients showing marked physical signs of transition (100%).

Conclusion: The program has since been incorporated into the hospital’s Complementary Therapy Department where it continues to be highly successful six years running.

Massage Impact on Chronic Pain in Opioid Dependent Patients

AWARD TYPE: Research Grants

Katharina Wiest, PhD, MSPH
CODA, Inc., Portland, OR

Katherina Wiest was interviewed about her research study for Massage Today. Click here for the article.

Chronic pain is a common cause of health care utilization and represents a major health concern. For patients beginning substance use treatment, chronic pain is more prevalent among patients with opioid dependence relative to patients with other dependences. Previous scientific research has not connected massage, chronic pain and substance use treatment success. Although massage has been demonstrated to alleviate chronic pain symptoms, its use as an adjunctive therapy to modify chronic pain during opioid treatment is absent from the literature. Given the strong biologic basis for the efficacy of massage and the high level of massage acceptance in opioid dependent patients, this trial may provide insight into massage’s potential as a non-pharmacologic chronic pain treatment. The study uses a prospective, randomized, intent-to-treat, clinical trial to assess the relative efficacy of Swedish massage on chronic pain in opioid dependent adult patients receiving methadone treatment. The primary aim is to measure the effect of massage on pain intensity. Eligible participants will be randomized to either (1) intervention arm of 8 weekly 1 hour Swedish massage sessions + treatment as usual (TAU) (n=25) or (2) TAU alone (n=25). At 4 weeks after the last study visit for both massage and TAU groups, a follow-up assessment is conducted to assess durability of treatment effect. Data elements pertaining to pain and potential confounders are collected and analyzed. Findings from this trial should be viewed as preliminary. Massage may offer an exciting non-pharmacologic option as part of the treatment arsenal for opioid dependence.

Massage Induced Changes in Stature and State Anxiety are Strongly Correlated: Consistent Results in Two Clinical Case Studies

AWARD TYPE: Past Poster Presenter

Kim Goral, Meghan Thomason, & Christopher A. Moyer, PhD
University of Wisconsin – Stout

Introduction: Massage therapy (MT) reduces anxiety, but how it produces this effect is not known. We theorized that MT relaxes and lengthens an anxious recipient’s muscles and connective tissues enough to produce a pattern of peripheral nervous system feedback that is incompatible with a state of high anxiety, and that the relaxation of the muscles and connective tissues will be able to be assessed by precise measurement of a recipient’s stature.

Methods: We conducted a pair of clinical case studies, in which two participants diagnosed with anxiety disorders each received a series of 60‐minute sessions of full‐body MT administered by trained massage therapists. Assessments of stature and state anxiety were made immediately before and after each MT session.

Results: Participants’ stature increased (mean increases of 12 and 9 mms) and state anxiety decreased (mean decreases of 10.6 and 14.8 points on the state portion of the State‐Trait Anxiety Inventory) in response to MT sessions. In both cases increased stature was strongly and consistently predictive of lower state anxiety (rs = ‐.73 and ‐.74).

Conclusions: These uniform results are consistent with the theory that MT reduces anxiety by relaxing and lengthening muscles and connective tissues to produce a pattern of peripheral nervous system feedback that is incompatible with a state of high anxiety.

Massage therapists’ collection of health history and client conditions encountered: A MassageNet survey

AWARD TYPE: Past Poster Presenter

Jerrilyn Cambron, LMT, DC, MPH, PhD,
Jennifer Dexheimer, LMT, BS,
Dana Madigan, BS,
Nicole Brod, BS,
Tracy Walton, LMT, MS
National University of Health Sciences

Introduction: No known research exists on the type or amount of information collected by massage therapists regarding clients’ past medical history.

Purpose: The purpose of this IRB-approved study was to determine whether massage therapists collect health history from their clients, what conditions are inquired about, and what conditions are thought to be frequently encountered in practice.

Methods: Massage Therapists were recruited through the MassageNet practice-based research network and a massage news release. This survey was conducted online using SurveyMonkey. The questions inquired about (1) collection of health histories in various practice settings, (2) frequency of collection of information regarding 26 different medical conditions, (3) occurrence of these conditions within their client population, and (4) interest in further education related to these conditions.

Results: A total of 130 therapists responded to survey questions. All therapists reported taking some form of medical history when working in the following settings: client’s home/office, gym/fitness facility/sports organization, massage clinic or office, other healthcare clinic/office, and spa/salon/resort. However, 15% of those working onsite/event massage (10 of 65) and 6% of those working at a hospital/hospice/nursing home (2 of 32) reported not taking any health history prior to the massage. Of the 26 listed conditions, the most common conditions that therapists always inquired about included: heart disease, hypertension, and diabetes mellitus. Over 80% of all responding therapists have seen at least one client with fibromyalgia, asthma, hypertension, and breast cancer. When asked about interest in further education, the most common of the 26 conditions included fibromyalgia and spinal cord injury.

Conclusion: The majority of massage therapists collect health histories regardless of their practice setting and report knowing that their clients have various medical conditions. Interest in further education was not limited to the primary care conditions confronting most therapists.

Massage Therapy Produces Long-Term Modulation of Postural Control and Sensorimotor Measures in Older Persons

AWARD TYPE: Past Poster Presenter

JoEllen Sefton, PhD, ATC, CMT,
Ceren Yarar,
Jack Berry
Auburn University

Objectives: Falls are a leading contributor to death/injury in older persons. Clinical evidence suggests massage therapy (MT) may influence balance. A non-pharmacological intervention for balance could enhance seniors quality of life. Understanding the long-term effects of MT on balance is vital for developing safe, effective MT treatment protocols.

Purpose: investigate the long-term effects full-body MT on postural control and nervous system measures in healthy, older adults.

Methods: Thirty-five healthy volunteers (19 male and 16 female; ages 62.9±4.6 years) participated. The treatment group received a 60-minute, full-body MT treatment for 6 weeks; the control group rested quietly. Testing sessions took place the 1st, 6th and 7th weeks. Outcome measures: Pre-treatment; immediate post, 20 min. post, and 60 min post-treatment center of pressure (COP) measures [rectangular and effective areas, average velocity (Vavg)]; and motoneuron pool excitability measures: Hmax/Mmax, paired reflex depression (PRD), and recurrent inhibition (RI) during single and double leg stance with eyes-open and closed.

Results: A 2×4 ANCOVA revealed significant treatment effects for COP measures in eyes-open double-legged (rectangular: F1,33= 10.3, p£ 0.01; effective: F1,33= 7.2, p= 0.01; Vavg: F1,33= 7.54, p£ 0.01) , eyes-closed double-legged (rectangular F1,33= 9.59, p= £; effective F1,33= 10.6, p£ 0.01; Vavg: F1,33= 5.15, p£ 0.05), and eyes open single-legged stance (effective: F1,33= 5.47, p£ 0.05; Vavg= F1,33= 6.56, p= 0.01) 7 weeks post-MT in treatment group. A significant treatment effect was found for the Hmax/Mmax ratio (F1, 33= 11.4; p£ 0.05), with a lower mean in the treatment group (treatment x= 0.19±0.02; control x= 0.30±0.02).

Conclusion: Long-term MT may improve static and functional balance for up to a week after treatments have ceased. Reduced Hmax/Mmax ratio suggests inhibition of motoneuron pool excitability which may have a direct influence on muscle activity, which suggests a physiological mechanism for improved ability to maintain upright stance.