Massage

​

Types of massage

A.  Manual Massage  Massage therapy is one of the mainstays of alternative medicine therapy with a longstanding history of effectiveness in pain control.  There are different types of massage: 

• Swedish with long strokes with oil or lotion medium pressure;

• Shiatsu with point deep pressure over acupuncture/acupressure points-usually no soreness afterwards;

• Deep tissue massage with focus on the deepest layers of muscle tissue, tendons and fascia with often painful massage techniques that leave the person feeling very sore for days; 

• Sports massage focusing on specific areas of injury or pain; 

• Hot stone massage that uses heated smooth stones placed on certain points on the body, warming and loosening tight muscles; 

• Thai massage, like shiatsu uses gentle pressure on specific points, but also compresses and stretches you into a sequence of postures thereby increasing flexibility; 

• Reflexology is a massage of the foot by placing pressure at specific points on the foot that purportedly correspond to organ dysfunction; 

• Myofascial release is a specific massage technique that focuses on specific areas of tightness in muscles that pull the body out of alignment.

• Acupressure uses physical pressure applied to acupuncture points with the aim of clearing blockages in meridians.

• Bowen technique (Neuro-structural Integration)- named for Tom Bowen who died in 1982, a non-medical trained individual selling himself fraudulently as an osteopath, that called his approach a “gift from God”, involves gentle rolling motions along the muscles, tendons, and fascia with minimalist nature of the intervention with pauses incorporated in the treatment.   

• Craniosacral therapy is a technique developed by John Upledger, an osteopath in the 1970s, who believed by concentrating on the suture lines in the skull, he could detect rhythms of the spinal fluid and blood flow underneath these thick bones.  He believed the same about the sacroiliac joint.  It is a relaxing therapy that has apparently no legitimate use other than relaxation as the touted diagnostics by the technique are practically voodoo. (See description elsewhere in this paper)   

• Lomilomi is a technique of Hawaiian massage using the palms, forearms, fingers, knuckles, knees, feet, and sticks and stones to deliver a massage like a cat contracting its paws.  The traditional Lomilomi takes a lifetime to learn but many practitioners today claim to learn it in a few hours.  Traditional lomilomi involves prayer and herbal therapy also;  todays lomilomi is administered usually in homes, away from the offices of massage therapists and chiropractors, and involves dietary counseling.  

• Naprapathy was established in the 1900s by a chiropractor Oakley Smith.  Naprapathic practice means the evaluation of persons with connective tissue disorders through and palpation or treatment of persons by the use of connective tissue manipulation, therapeutic and rehabilitative exercise, postural counseling, nutritional counseling, and the use of the effective properties of physical measures of heat, cold, light, water, radiant energy, electricity, sound and air, and assistive devices for the purpose of preventing, correcting, or alleviating a physical disability. 

• Tui na  is a Chinese manipulative therapy used in conjunction with acupuncture, moxibustion, fire cupping, Chinese herbalism, t’ai chi, and qigong.  It is a hands-on body treatment using Chinese Taoist and martial arts principles where the practitioner may brush, knead, roll/press, and rub the areas between each of the joints, known as the 8 gates, to attempt to open the body’s defensive (wei) chi and get energy moving in meridians or muscles in a gentle to firm movement.  

• Abhyanga massage is an Indian oil massage therapy as part of Ayurvedic medicine.  It uses copious amounts of oil and may be self massage or by a therapist. The benefits touted include increasing circulation to nerve endings, toning of muscles, lubrication of joints, increasing mental alertness, improving elimination of impurities from the body, better sleep, increased stamina.

• Chavutti Thirumal is a massage where the therapist uses their feet to do this deep massage with oil.  The massage therapist stands above the patient holding onto a rope or rails. It was developed 3000 years ago by practitioners of Kalaripayattu, an Indian martial arts form.

• Watsu is a pool massage therapy performed in chest-deep warm water.  A practitioner gently cradles, moves, stretches, and massages a client, and a progression of breath coordination, movement patterns in different position, and massage.  Cradling, rocking, dynamic stretching and mobilization, stillness, and mobilization techniques are focused on the needs of the receiver.

• Manual lymphatic drainage  is a technique used for swelling or edema in extremities and is a gentle massage intended to encourage natural drainage of the lymph system.  It is the primary tool used in lymphedema management with certification available in the treatment.  It has mixed results in treatment of lymphedema, has no effectiveness in breast cancer lymphedema, and has some effect in skeletal muscle cell damage from sports injuries.   

• Rolfing or structural integration is a technique founded by the work of Ida Rolf, a biochemist without any medical training in the 1930s.  Rolfing is performed in a progression of 10 sessions called “the recipe” that provides for the theorized alignment and movement of various body areas. Rolfing uses combinations of active and passive movement retraining. Also, see Structural Integration below.

• Pfrimmer deep muscle therapy was the brainchild of one therapist, Therese C. Pfrimmer, (died in 1980) and subsequently there was a legal battle afterwards about who could teach the technique.  Pfrimmer  believed she was able to “relieve entrapped nerves, move out toxins, and bring lyphatic fluid towards “dry muscles”.  None of these have been scientifically proven.                                      

 

Massage therapy is effective for the treatment of fibromyalgia (PLoS One 2014 Feb 20;9(2). Swedish is more effective than Thai massage as a treatment of chronic low back pain (Complement Ther Med 2014 Feb;22(1):26-33)

PAINBYTES ASSESSMENT:  Other than reflexology and craniosacral therapy, in general massage is given a one thumbs up.  For certain particular therapies for pain situations, two thumbs up can be assigned.   Certain therapies such as Rolfing garner a neutral recommendation while acupressure, and reflexology are assigned a one thumb down due to the lack of science supporting the fundamental principles used in the technique.  Craniosacral is one thumb down due to “diagnostics” that may be erroneous and lead to incorrect or delayed diagnosis.  Deep tissue massage may worsen pain significantly in the chronic pain patient but in some it can be useful, therefore garners a neutral rating.

 

B.   Acoustic massage- uses transducers to induce acoustic or subsonic compression waves used for massage.  The Infratonic Qi-Gong machine was a device that  manufactured by the Infratonic Solutions CHI Institute that claims to have measured “energy vibrations from the hands of the qigong healers in Beijing China, something that apparently no one else seems to have been able to measure.  The company has since developed a series of sound wave machines that generate “noise” or random sound waves within a certain defined frequency range, the latest being the “Infratonic 9” costing $725 and their other machines cost $880.  These are generally not covered by insurance.  They make claims on their website that the 510(K) FDA approved device is useful for treatment of  pain, relieving subluxation (a chiropractic term), facilitate deep massage, enhances local circulation, increases energy level, relieves nerve impingement, relaxes muscles, reduces cellular trauma, dissolves cellular trauma, reduces inflammation, speed muscle cell healing, normalizes biochemical activity for accelerated healing.  They content “the therapy stops cells from sending pain signals and releasing inflammatory enzymes, which helps eliminate pain and inflammation”.  The research they cite are studies on horses, in children with asthma, and small studies of diabetic patients. Most of the studies are simply bizarre such as “Digestive Qi Deficiency in Children” and “Chaos and the College Entrance Exam”.  The authors make some very contentious assertions that seem to create their own science: that the therapy produces a highly unpredictable signal in the range of the brain’s EEG activity that is an important frequency range in which the body’s cells communicate with each other. (Never mind that the EEG is electrical signals while this device is mechanical producing compression waves, not electrical signals).   They also contend the “random signal easily penetrates the tissue’s vibrational defenses and interrupts the cellular communication that encourages inflammation, edema, chronic pain, and other abnormal cellular responses.”   It appears they have a bizarre understanding of physiology as there is no such thing as “vibrational defenses”.   What is highly likely is that making such claims of a device far exceeds the approval given by the FDA that approved the device as a massage device.   The website for these devices is www.soundvitality.com

While the Infratonic device uses white noise (random generated signals) within a frequency range, there are other devices that have been used for acoustical massage including the muscular acoustic modulator (MAM) is a device invented by Sandro Mandolesi a cardiologist.  This device uses a variable frequency of 0-400Hz with what appears to be an acoustic coil as in a loudspeaker, to deliver acoustic massage to painful muscles.  In controlled trials (small) there was a significant decrease in pain, to nearly zero, when the MAM device was used (BMC Geriatrics 2010, 10(Suppl 1):A111). 

Painbytes Assessment: Neutral- there simply aren’t enough high quality studies to demonstrate efficacy yet the technique does hold promise.  There does not appear to be any serious side effects.  This is not a technique in wide spread use.

C.   Graston technique- also known as instrument assisted cross fiber massage (IACRM) is a soft tissue mobilization technique using a series of rods and designed metal devices to deliver pressure across the fibers of the muscles, tendons, and ligaments as opposed to in-line with the fibers direction.  Effectively pressure (sometimes significant mechanical force) is delivered across the predominant soft tissue direction.   Practitioners tell patients they are breaking up scar tissue in tissue that has healed after injury, but frequently no clinically or radiologically detectable scar tissue in the area worked on by the practitioner.   Chiropractors and some physical therapists love these devices, some of which appear to be designed based on medieval tools of torture.  There is level C evidence of clinical effectiveness (weak clinical evidence) and there are some rat studies showing improved tissue perfusion days after the therapy is completed but not during the therapy.  This may suggest the rods and tools used may actually be causing tissue damage since increased vascular perfusion frequently follows soft tissue injury.     Graston is a “proprietary” technique and the practitioner must pay for special classes to become licensed in them and to use their curved tools and rods.  The quality of evidence of inducing the microscopic changes that the Graston practitioners tout is completely lacking in athletes and in humans.  There are a few anecdotal reflections in which the Graston practitioners did a series of treatments on athletes and they got better, but without controls or comparison studies it is impossible to differentiate these results from natural healing processes.  Some pilot studies showed no improvement at all.   Graston has been described by patients as “torture” as it is very painful. 

Painbytes assessment:  one thumb down.  Not enough science behind using very painful methods to break up “scar tissue” that is not detectable or non-existent.

D.  Hivamat therapy (deep oscillation therapy)- is a “massage therapy” that is proprietary and patented, available since 2007.  It is touted to promote faster healing of wounds, reduce cellulite, alleviate pain and swelling, lift and tone facial, bust, and buttock muscles, stimulate cell and collagen production for smooth younger looking skin, and improve skin tissue quality and elasticity.   The therapist massages the target area allowing the pulsed oscillations to penetrate your skin to a depth of 8-12cm through skin, connective tissue, subcutaneous fat, muscle, and blood vessels.  The website states it uses “electrostatic impulses” of 5 to 250 times creating a deep vibrational effect.  It is not clear what difference this is compared to variable frequency TENS units, and that the electrode is manually maneuvered over talc containing skin.  However on the website, it notes alternating current is being used, which is by definition not an electrostatic impulse, therefore there may be a misunderstanding of terminology since it is manufactured in Germany.  There is virtually no scientific proof of effectiveness and the “proof” cited by chiropractors and physical therapists are based on pilot studies that do not qualify as scientific studies.  There is both a unit used in clinics costing from $6,800 to $14,000, and a “personal” unit, the latter of which costs around $3000.  Of course it isn’t covered by some insurers including Aetna.

Painbytes assessment:  one thumbs down- machine expense (passed on to customers) and lack of proof of efficacy.