Community massage therapists as research personnel on an NIH funded effectiveness stud

Katie Stewart, LMT, RCST, Margaret Love, PhD, Gaza Bruckner, PhD,
Kevin Pearce, PhD, and William G. Elder, PhD
University of Kentucky- Department of Family and Community Medicine

Introduction: Few NIH funded studies give community massage therapists the opportunity to become study personnel. A recent NIH/NCCAM funded study investigating Chronic Low Back Pain (CLBP) recruited, trained, and utilized community licensed massage therapists (LMTs) as study personnel.

Objective: Determine whether health-related outcomes for CLBP improve when patients are referred from primary care to clinical massage therapy (CMT) or progressive muscle relaxation therapy. Massage practice driven study objectives included: a) Identify challenges and solutions to recruiting and retaining ample community LMTs, b) Develop a practice informed protocol reflecting real world CMT, c) Identify challenges and solutions to utilizing LMT descriptors, assessment, and treatment notes as data, and d) Determine the extent to which community LMTs comply to rigorous research methodology in their clinical practices as study personnel.

Methods: Eligible LMTs in urban and rural Kentucky counties were identified through licensure board records, professional organizations, and personal contact opportunities. Interested LMTs completed 6 hours of research and Human Subjects Protection training and agreed to comply with a study protocol reflecting CMT as practiced. Once trained, study LMTs were matched with study participants to provide and document up to 10 massage therapy sessions per participant.

Results: Utilizing prominent massage therapy community members proved invaluable to recruitment and protocol development. LMT recruitment challenges included lack of interest, low number of available rural LMTs, busy clinic schedules, and compensation. Ethics CE credits encouraged LMT interest. A total of 28 Kentucky LMTs with 5-32 years experience completed study training. N=127 CLBP patients consented to participate (n=104 for CMT). Twenty-three LMTs provided 1-10 treatments for 91 study participants. Treatment documentation was provided by LMTs for 95% of treatments provided.

Conclusion: When recruitment, retention, and protocol compliance challenges are met, community LMTs are valuable study personnel for practice based research reflecting real world CMT practice.

AWARD TYPE:  Past Poster Presenter

Community Massage Therapists as Research Personnel on an NIH Funded Effectiveness Study

Katie Stewart, LMT, RCST, Margaret Love, PhD, Gaza Bruckner, PhD,
Kevin Pearce, PhD, and William G. Elder, PhD
University of Kentucky- Department of Family and Community Medicine

Introduction: Few NIH funded studies give community massage therapists the opportunity to become study personnel. A recent NIH/NCCAM funded study investigating Chronic Low Back Pain (CLBP) recruited, trained, and utilized community licensed massage therapists (LMTs) as study personnel.

Objective: Determine whether health-related outcomes for CLBP improve when patients are referred from primary care to clinical massage therapy (CMT) or progressive muscle relaxation therapy. Massage practice driven study objectives included: a) Identify challenges and solutions to recruiting and retaining ample community LMTs, b) Develop a practice informed protocol reflecting real world CMT, c) Identify challenges and solutions to utilizing LMT descriptors, assessment, and treatment notes as data, and d) Determine the extent to which community LMTs comply to rigorous research methodology in their clinical practices as study personnel.

Methods: Eligible LMTs in urban and rural Kentucky counties were identified through licensure board records, professional organizations, and personal contact opportunities. Interested LMTs completed 6 hours of research and Human Subjects Protection training and agreed to comply with a study protocol reflecting CMT as practiced. Once trained, study LMTs were matched with study participants to provide and document up to 10 massage therapy sessions per participant.

Results: Utilizing prominent massage therapy community members proved invaluable to recruitment and protocol development. LMT recruitment challenges included lack of interest, low number of available rural LMTs, busy clinic schedules, and compensation. Ethics CE credits encouraged LMT interest. A total of 28 Kentucky LMTs with 5-32 years experience completed study training. N=127 CLBP patients consented to participate (n=104 for CMT). Twenty-three LMTs provided 1-10 treatments for 91 study participants. Treatment documentation was provided by LMTs for 95% of treatments provided.

Conclusion: When recruitment, retention, and protocol compliance challenges are met, community LMTs are valuable study personnel for practice based research reflecting real world CMT practice.

AWARD TYPE:  Past Poster Presenter

Effect of Massage Therapy on Symptoms of Cervical Nerve Impingement

Beth Barberree, MA, BA, MT

Introduction: Injured soft tissue structures can become hypertonic and develop adhesions. Although a client may experience discogenic nerve root compression, interventions that lengthen soft tissue structures could minimize nerve root irritation and reduce symptoms.

Objective: Evaluate whether Massage Therapy decreases anesthesia in a client with cervical nerve impingement.

Case Presentation: Treatment began in April 2005 and at present continues every few months for symptom management. A 28 year old nurse presented with intermittent left hand anesthesia, specifically digits I and II. Medical imaging indicated disc herniation impinging the C6 nerve root as the source. Symptoms were present since neck injury occurred in July 2004. Although the pain was manageable, symptoms of anesthesia were of primary concern. The initial treatment plan was one 30 or 60 minute session every 3 to 4 days for 3 weeks. An exhaustive search for a ‘numbness scale’ was not successful, so client description in terms of percentage was utilized to describe symptoms, with 100% indicating no feeling, 50% moderate and 0% asymptomatic. The client reported on symptoms before and after each treatment. Eight treatments over 3 weeks were delivered, focusing on lengthening soft tissue structures that could be compressing cervical joint space and trigger points mimicking left arm neuralgia.

Interpretation: A decrease in symptoms pre to post treatment occurred each session. Gradual recurrence of symptoms occurred as early as the next day and up to one week post treatment. Prior to his last session, the client reported no numbness whatsoever in digit II and digit I symptoms at half of prior treatment levels.

Implications: Based on this case, Massage Therapy seems to be a promising option for managing symptoms of anesthesia due to disc compression. Further investigation of similar cases, integrating more robust measurement tools, is necessary.

AWARD TYPE:  Past Poster Presenter

Integrating Massage and KinesioTaping for Advanced Rheumatoid ArthritisÑA Descriptive Case Report a 59 Year-Old Female Professional Musician

John Balletto, LMT, CKTP
Center for Muscular Therapy, Inc.

Introduction: Rheumatoid arthritis (RA) is a chronic systemic inflammatory autoimmune disorder. KinesioTaping (KT) is a rehabilitative intervention that uses a unique, patented, medical grade elastic tape specifically designed for treating muscular problems and reducing lymphedema. There was no reported use of KinesioTaping for management of RA symptoms in the current literature.

Objective: To study the combined effects of massage therapy and KT on RA symptoms of pain, swelling, restricted range of motion and performing endurance in the right arm of a 59 year-old, female professional oboeist.

Results: The addition of KT applications to massage sessions provided a reduction of joint pain (from 8 to 4 on a 10-point scale) within the first three applications. Relief duration extended from 24-48 hours to 4-5 days. Extent of practice time increased to 40 minutes per session after KT application 1. By the fourth KT application, practice time increased to 60 minutes per session; by KT application 9, two 60-minute practice sessions per day.

Implications: Complementing traditional massage applications with KT appears to yield positive result in pain reduction, functional mobility, and duration affect. Further investigation with additional outcome measures is indicated.

AWARD TYPE:  Past Poster Presenter

Massage Therapy for Essential Tremor: Quieting the Mind

Nicole Riou
Grant MacEwan University, Edmonton, AB, Canada

Introduction: Essential tremor (ET) is a neurological disorder resulting in rhythmical shaking of part of the body. The condition is known to have an inheritable tendency and can present in more than one family member, known as familial tremor. Treatment of the disorder is commonly by way of prescription medication. ET is progressive and in its mildest form can be sensed internally and/or observed when performing simple motor skills or activities of daily living.

Objective: To evaluate the effects of massage therapy on the severity of ET using an activity-based rating scale pre and post treatment.

Methods: The study period included five consecutive weekly sessions. The subject, a 63-year old female, indicated her hands and head as the primary areas affected by ET. The treatment aim was to reduce sympathetic nervous system firing; therefore the massage techniques implemented were relaxation-based. Methods included Swedish massage, hydrotherapy, myofascial release, diaphragmatic breathing, remedial exercise education and affirmative symptom management recommendations. Comparison drawings of an Archimedes spiral pre and post treatment provided an objective, visual representation of tremor intensity affecting fine motor control. Goniometric measurements were taken to mark changes in cervical range of motion.

Results: Tremor severity decreased after each session; demonstrated by improved fine motor manipulation skills. The client also reported an increased functionality in cervical range, which was documented during the first and last visits.

Conclusion: The results suggest that tremors, symptomatic to ET, can be eased through initiatives that encourage a parasympathetic response. Massage therapy has shown to be a valuable method of treatment for ET. Tremor severity can present in an irregular pattern due to subjective individual triggers; therefore further controlled research is required to lessen the variability between subjects and to validate these findings.

AWARD TYPE:  Past Poster Presenter

Massage treatment improves NTOS symptoms and mobility: A case study on neurogenic thoracic outlet syndrome

Robin Sarah Streit, BA, LMT, NCTMB

Introduction: Neurogenic thoracic outlet syndrome (NTOS) is a neuromuscular condition affecting brachial plexus functionality due to compression in the thoracic cavity. NTOS is characterized by paresthesia, pain, muscle fatigue and muscle spasms, restricting mobility in the upper extremity.

Objective: The objective of this study is to quantify the viability of massage therapy as a treatment for NTOS.

Method: A 24-year-old female was diagnosed with NTOS following a motor vehicle accident. Eight 75-minute massage therapy sessions were administered over a 35-day period. Myofascial release addressed fascial restrictions in the upper trapezius and levator scapulae, involving deep stripping from the muscles’ origin to insertion. Sustained compression was applied to release the trigger points found at the insertion of the levator scapulae and origin of subscapularis. Gentle passive stretching addressed hypertonicity of the scalene and sternocleidomastoid muscles. Pre and post treatment assessments measured symptomatic intensity and range of motion.

Results: Massage therapy rendered a 49% decrease in muscle fatigue, 45.7% increase in external shoulder rotation, and a 13.5% improvement in shoulder abduction. Therapy yielded a limited change in muscular spasm severity, frequency, and muscular strength.

Conclusion: Results suggest massage is a useful treatment for NTOS patients by managing primary symptoms and improving mobility in the affected area.

AWARD TYPE:  Past Poster Presenter

Myofascial Therapy for the Treatment of Fibromyalgia

Renee Stenbjorn, BS, LMT
Director of Education, Albuquerque School of Massage Therapy

Background: Fibromyalgia is a syndrome characterized by pain-producing musculoskeletal changes and Central Nervous System sensitization to pain. Most patients live with chronic pain and additional symptoms such as anxiety, depression, and irritable bowel syndrome. Several studies have revealed the effectiveness of massage therapy for fibromyalgia. Swedish and myofascial massage techniques have found to be mildly successful in reducing symptoms. This pilot study will focus on the use of the Fascial Abrasion Technique tool (FAT-tool), a myofascial massage tool for treatment of fibromyalgia pain. The FAT-tool has been anecdotally reported to decrease fibromyalgia pain. This study will evaluate the effects on pain immediately after a treatment and, as a follow up, three days later.

Methods: Five clients, all diagnosed with fibromyalgia and currently under doctor’s care, were each seen for one half-hour session. Due to the short treatment time, the body region treated was limited to an area between the occiput and the elbow. The client and therapist determined which segment of the region of the body would be treated at the appointment. Using a Visual Analog Scale (0 – 10 scale), each client reported their current pain levels in general and in the specific treatment area before their treatment, immediately after and again three days later. The treatment focus was myofascial therapy. The tissue was warmed with effleurage strokes and myofascial dysfunction of the region was treated with the Fascial Abrasion Therapy Tool (FAT-tool). Each session lasted approximately 20 minutes.

Results: After one short treatment session, 4 out of 5 fibromyalgia patients reported a significant reduction in pain. The average pain level before the treatment was 7, immediately after the session, the average was reduced to 3.6. There was no decrease in the average general pain three days after the treatment session.

Conclusions: This study shows that myofascial therapies may be very effective in the treatment of fibromyalgia pain and should be further investigated. The clients responded favorably to myofascial treatment with the FAT-tool, demonstrating the effectiveness of this method of myofascial work in short-term pain relief. Further studies could investigate the effectiveness of long-term myofascial treatment on overall pain levels of fibromyalgia patients.

AWARD TYPE:  Past Poster Presenter

Relationship between non-specific muscle pain and sleep practices

Susan Davis RN, BHSc, MClSc, RMT
Southern Cross University Lismore, NSW Australia- Masters Research Project

Introduction: Sleep problems and pain are widely experienced in the general population. Research has shown a relationship between chronic pain and poor sleep and between no pain and sleep. This research aims to investigate the relationship of mild pain and sleep problems.

Methods: Sixty seven (67) patients from an established remedial massage centre completed questionnaires. The majority (79%) of the respondents were female. The questionnaire was a combination of three aspects: general demographics and alcohol consumption; an edited version of the Brief Pain Index; and the 12 question MOS Sleep Scale (revised). Sleep results were produced from the MOS software that compared the participants to the large population (mainly USA) recorded to date. Pain was reported as a 0-10 score (10 being the most pain). Those individuals scoring over 7 were excluded from the survey. The age range was from 20-85 years. Correlational analyses were then made using Microsoft Excel, ANOVA.

Results: The overall results showed a small, but insignificant relationship. Isolating the female results produced a significant relationship, with coincidental movements of pain experience and sleep problems. This outcome is in line with previous studies on chronic pain and serious sleep problems. In the female group (n = 53), 59% fell below the average of 50 set by the MOS Sleep Problem Index (below 50 indicating sleep problems). 41% showed mild pain experience. Correlational analysis showed that increases in pain coincided with decreases in sleep quality. Correlation was r = 0.41 with a p value < 0.05 indicating a statistical significant result.

Conclusions: Although only a small study with limited detail in the questionnaires, it is concluded that the results encourage the need for further research. This research shows that there may be a progressive line of pain before the development of chronic problems that could be detection through the inclusion of sleep assessment in mild pain patients and vice versa. This has important implications for the ongoing treatment of mild pain and the methods of practice for professions that deal with mild pain such as massage therapists.

AWARD TYPE:  Past Poster Presenter

The Effects of Massage Therapy in Conjunction with Exercise Training on Weight

Mark Blegen, PhD, FACSM
St. Catherine University, St. Paul, MN
$30,000

Obesity rates are at epidemic levels in the United States, and novel techniques are needed to combat the issue. Sometimes overweight individuals discontinue exercise programs and fail to reach their weight loss goals. The present study builds on previous research; suggesting weekly massage therapy sessions, as a reward, promote weight management. This research will investigate the intersection of massage therapy with structured and monitored exercise to promote weight management in an overweight population. Participants will be randomly assigned into one of four groups: weekly massage therapy only, weekly massage therapy and structured exercise, structured exercise only, and control. Measures such as bodyweight, body fat percentage, status of emotional eating, salivary cortisol (a physical measurement of stress levels), and psychological measures of stress, anxiety, and mood will be evaluated.

AWARD TYPE:  Research Grants

Use of Therapeutic Massage to Treat Chemotherapy-Induced Peripheral Neuropathy (CIPN)

Joan E. Cunningham, PhD
Medical University of South Carolina, Charleston, SC
$29,986
Funded by a grant from the Palmer Foundation

Chemotherapy-induced peripheral neuropathy (CIPN) is a common debilitating side effect of many standard drugs used in cancer treatment. Research supporting the use of effective treatments for CIPN is lacking and the underlying physiologic mechanisms of CIPN are poorly understood. This one-year feasibility study will test the effects of therapeutic massage in relieving symptoms associated with CIPN. This work will provide the groundwork for clinical trials focused on the physiological processes involved in CIPN, and establish the feasibility of using massage to treat the symptoms of this condition. This non-randomized controlled study will be conducted with 15-18 patients with cancer. The protocol includes 12 therapeutic massage treatments in a 5-week period. Patient changes in CIPN signs, symptoms, pain and quality of life will be measured. Statistical methods will include standard summary statistics, multivariate generalized linear models and correlations between changes in outcome measures.

AWARD TYPE:  Research Grants