According to the Centers for Disease Control and Prevention, arthritis is the leading cause of disability, reduced quality of life and high health care costs. Of the 46 million Americans who suffer from arthritis, nearly half say that arthritis limits their normal activities. The good news is that recent studies suggest that massage can help reduce pain and increase mobility in those who suffer from arthritis.
The December 11, 2006, issue of the Archives of Internal Medicine, reports on a study done by researchers at the Yale Prevention Research Center and the University of Medicine and Dentistry of New Jersey (UMDNJ). It was a 16-week clinical trial with 68 participants who have osteoarthritis of the knee, the joint most commonly affected by osteoarthritis. Those in the massage group received a standard one-hour Swedish massage twice a week for four weeks, followed by Swedish massage once a week for the next four weeks. After the eight weeks of massage therapy, participants had improved flexibility, less pain and improved range of motion. It’s the first clinical trial of its kind in this country. And, it validates what many massage therapists have experienced anecdotally.
“Ultimately, massage may be shown to lessen a patient’s reliance on medications and decrease health care costs,” says researcher Adam Perlman, MD, executive director of the Institute for Complementary and Alternative Medicine at the UMDNJ-School of Health Related Professions. “Our hope is to show that this treatment is not only safe and effective, but cost effective. That could serve to change practice standards so that massage is a more common option for the many patients with osteoarthritis of the knee.”
What is Arthritis?
Arthritis is an umbrella term that unifies diseases that affect the musculoskeletal system. According to the Arthritis Foundation, these conditions can be localized—in one joint or an area of the entire body—or generalized, affecting many joints and organs. Those that are localized can affect soft tissues around the joint and include ailments such as tendinitis and bursitis. Localized conditions that affect one or more joints include osteoarthritis. Generalized conditions include fibromyalgia, gout and lupus.
According to Patience White, MD, MA, chief public health officer of the Arthritis Foundation, osteoarthritis is the most common form of arthritis, affecting some 21 million Americans.
“People at risk are those who have had prior injuries,” explains White. “Genetic susceptibility is also a factor. If you’re overweight, you’re more likely to get osteoarthritis in lower extremities.”
Lower back, neck, hands and wrists are other areas of the body affected by arthritis. White agrees that massage is helpful because it increases motion and stimulates the flow of blood in areas that are tight. But perhaps more importantly it can relax people and help break cycle of pain, which is the most common complaint of those suffering from arthritis.
Massage Brings Relief, Relaxation & Sleep
A study conducted by the Touch Research Institute (TRI) at the University of Miami School of Medicine and funded by Biotone looked at 22 adults with wrist/hand arthritis. Those in the massage group received massage on the affected area once a week for four weeks and also did self-massage daily. A cooling massage therapy lubricant was used in the arthritis study. It served as a natural analgesic and stimulant to soothe inflamed and swollen tissue.
The massage therapy group showed lower anxiety and depressed mood scores after the first and last sessions, and by the end of the study reported less pain and greater grip strength.
Tiffany Field, PhD, is director of the Touch Research Institute at the School of Medicine, Miami. The institute has done many pain studies and Field finds that a common thread in those with pain issues is lack of deep sleep.
Field says that when you are deprived of deep sleep, certain kinds of pain chemicals are released. “What massage does is help organize your sleep,” says Field. “You’re getting more deep sleep. It’s the deep sleep that’s really important because that is where the restorative process is happening.”
The institute study, like the Yale study, found that patients with arthritis experienced relief when they were massaged. But how the massage is done is important, according to Field.
“We’re finding the critical thing in massage is you need to stimulate the pressure receptors in the skin. In something like Swedish massage, you have a number of techniques that apply moderate pressure because without that you don’t get the whole cascade of events happening biochemically,” says Field.
Sandy Saldano, owner of Therapeutic Kneads in Highland Park, Illinois, works with women who have fibromyalgia. Saldano’s experience concurs with Field’s findings that sleep deprivation is an issue and that some pressure, rather than very light touch, is needed when working with these clients. How much pressure is the right amount varies and is subjective. “We don’t do deep tissue even if they request it,” says Saldano, referring to fibromyalgia sufferers. “On a 1 to 10 scale, we start on a four pressure.”
Michelle Bart, who suffers from rheumatoid arthritis and fibromyalgia, agrees that Swedish massage is a good choice for her conditions. And she is well-educated about her needs, having founded an arthritis support group in her community to help others. She has invited massage therapists to the meetings so that arthritis sufferers could experience the benefits of a chair massage and so massage therapists also could learn more about the needs of arthritis sufferers. “Massage therapists would also speak at the meetings,” says Bart. “With the support of the Arthritis Foundation, we would give arthritis self-help books to our speakers so they could better understand the conditions.”
Learn What Your Clients Need
Education is key, according to Bart. She suggests massage therapists attend industry conferences such as those by the Arthritis Foundation and the National Fibromyalgia Association. Local arthritis support groups also are excellent ways to learn more and can be a way to build business, too.
Massage therapist Beth Miller, owner of Advanced Therapeutics in Ft. Lauderdale, Florida, also works with arthritic clients. She stresses that massage therapists should understand that there are many forms of arthritis, it’s a chronic condition and there’s no cure. “It’s painful and debilitating,” Miller explains. “Be empathetic, understand tolerance levels and always get feedback during, before and after.”
Also, make sure you create the right kind of environment. Kitty White, a 92-year-old woman with rheumatoid arthritis, gets Swedish massages weekly. She says that making the massage room a peaceful place helps her relax before the massage session even begins. Her therapist’s room has soothing music and pretty flowers. “The relaxation helps my joints and adds comfort to my life,” says White.
Knowing several massage modalities will help you adapt to different needs. Some clients, such as Helene Colussy, have had hip replacements because the arthritis eroded the joint so badly. She found Myofascial Release® to be especially helpful right at the incision site.
“They cut the muscle to go in,” explains Colussy, “and the muscle goes back together but not necessarily in the same place. The Myofascial Release was beneficial to separate the tissue and made it feel so much better.”
No matter which type of arthritis a client may have, the most important factor is communication. The more massage therapists communicate with arthritic clients before and during therapy, the more successful the session will be. Add education and a lighter touch and you have a great starting point for working with these clients. Estimates state that one out of three people have some kind of arthritis. Promoting your services directly to this population can help people in need.
For more information, conferences, and advocacy activities in your area, visit the Arthritis Foundation’s website at www.arthritis.org. You’ll also find the Arthritis Foundation's most recent drug guide, where you can familiarize yourself with common medications used to treat arthritis so you can research any possible massage contraindications.
Types of Arthritis
Arthritis is not a single disease; rather there are many different types. All affect the musculoskeletal system, specifically the joints. They include the following:
Osteoarthritis, a degenerative joint disease in which the cartilage that covers the ends of bones in the joint deteriorates, causing pain and loss of movement as bone begins to rub against bone. It’s one of the oldest forms of arthritis and is the most prevalent form of it.
Rheumatoid arthritis is mainly characterized by inflammation of the lining of the joints. It’s a systemic disease, meaning it can affect other organs of the body, and is chronic. It’s also one of the most serious and disabling types of arthritis.
Gout occurs when needle-shaped monosodium urate crystals build up in joints and tissues, resulting in joint inflammation. It’s one of the most treatable forms of arthritis and can almost always be controlled with medication and changes in diet.
is considered a rheumatic condition because it impairs the joints and/or soft tissues and causes chronic pain. It affects mostly women, and is characterized by widespread pain that affects the muscles and attachments to the bone.