It’s estimated that more than 51 million American adults discussed massage therapy with their doctors or health care providers in 2015.1
Stats like these tell us that more clients than ever view massage therapy as an integral part of their health care regime. In response, it’s essential that you understand when massage is indicated or contraindicated for specific pathologies.
How essential? Consider this: 20 years ago, massage for cancer patients was categorically judged unwise for fear that it accelerated the spread of the cancer.2 However, recent studies reverse this opinion, highlighting specific instances where massage is both indicated and highly beneficial for cancer patients. Similarly, researchers now feel that patients with any of the following five chronic medical conditions—or pathologies—can benefit from massage therapy.
The most common form of arthritis, osteoarthritis (OA) is a chronic disease of the joints that affects more than 30 million Americans.3 Most people over age 60 have OA to some degree, which
occurs as the protective cartilage on the ends of your bones wears down.4 Bones most often affected are in the hands, spine, and knee and hip joints, with symptoms including pain, stiffness, swelling and decreased range of motion.
Specific to osteoarthritis in the knee, a research study funded by the National Center for Complementary and Integrative Health (NCCIH) found that a 60-minute “dose” of Swedish massage therapy performed once a week for pain was both optimal and practical.5
The study’s 125 participants, all with OA of the knee, were randomly assigned to one of four different eight-week regimens based on standardized Swedish massage performed 30 or 60 minutes/weekly or biweekly. The control group received “usual care” without massage. Researchers assessed the participants’ pain, function, joint flexibility and other measures at the start of the study and at eight, 16 and 24 weeks thereafter.
At eight weeks, participants in weekly and biweekly 60-minute massage groups reported significant improvements in knee pain, function and stiffness when compared to participants receiving usual care, although range of motion was not significantly affected by usual care or massage.
At 24 weeks, the clinical benefits had reduced for all groups, suggesting that consistency of massage therapy may be indicated.
With an estimated 7,000 baby boomers turning 65 every day,6 many massage therapists are turning their attention to treating age-related conditions, which include osteoarthritis. “It’s a strong opportunity to expand my client base,” explains Rita Snow, a massage therapist located in Goshen, Kentucky. Serving this population is all about adjusting massage techniques, Snow advises. For example, she avoids trigger point and deep tissue massage for this demographic. “Deep pressure is too intense,” she says. “But I do see improvements in pain when I move to a firm but gentle, rhythmic touch.”
Gentle manipulation is essential, Snow emphasizes. This demographic, she adds, often has thin, delicate and fragile skin due to age as well as medications, such as blood thinners and/or arthritic medications.
Type 2 Diabetes
Affecting 29.1 million Americans, Type 2 diabetes (T2D) accounts for 90 to 95 percent of all diabetes cases diagnosed.7 This chronic disease affects how the body metabolizes sugar, or glucose, by either resisting the effects of insulin, a hormone that regulates the movement of sugar into your cells, or not producing enough insulin to maintain a normal glucose level. In either case, an important source of fuel is compromised.8
A common T2D complication is peripheral neuropathy, which is nerve damage caused by chronically high blood sugar. Symptoms include numbness; loss of sensation; pain in the feet, legs or hands; and, specific to diabetic peripheral neuropathy in the feet, impaired balance.9
Two recent clinical studies report that patients with diabetic peripheral neuropathy in their feet can significantly benefit from foot massage. Each study relied on a different massage technique, although both shared similarly positive conclusions.
A 2015 study, including 60 patients with T2D, suggests that Thai foot massage “is a viable alternative treatment for balance performance, range of motion of the foot and the foot sensation in diabetic patients with peripheral neuropathy.”10
Thai foot massage, somewhat similar in theory to acupressure massage, is a form of deep massage using thumb pressure applied along the meridian lines of the foot and leg. The application of pressure on particular areas of the soles of the feet is said to produce a reflex action in other parts of the body.
A smaller study, conducted in 2016, investigated the effect of manual foot plantar massage, a classic friction massage, on functional mobility level, balance and functional reach in patients with T2D. Results indicated that application of plantar massage in these patients improved balance, functional mobility and functional reach values. The conclusion states, “Foot massage to be added to rehabilitation exercise programs of [Type 2 diabetes] patients will be important in improving balance and mobility of patients.”11
If diabetic peripheral neuropathy interests you, Susan Salvo, author, educator, massage therapist and doctoral candidate, suggests that advanced classes in oncology massage therapy could provide “a natural bridge between knowledge and skill that will serve to increase your therapeutic value.” An integral part of continuing education concerning massage therapy and oncology care focuses on the study of chemotherapy-induced peripheral neuropathy (CIPN), a side effect of commonly used cancer treatments and a condition that overlaps with diabetic peripheral neuropathy.
In a study presented at the 2016 Palliative Care in Oncology Symposium, massage was shown to greatly decrease CIPN-associated symptoms, increase skin temperature in fingers and toes, and generally improve quality of life in persons affected by chemotherapy-induced peripheral neuropathy.12
Alzheimer's Disease and Dementia
Alzheimer’s disease and dementia are often mistakenly used interchangeably. Let’s set the record straight: Dementia is a group of signs and symptoms that affect mental cognitive tasks such as thinking, memory and communicating. It is not a disease but rather an umbrella term that covers multiple progressive neurodegenerative diseases with similar clinical profiles. Alzheimer’s is under that umbrella. Therefore, research that investigates how and when massage therapy can positively affect dementia may be applied to individuals diagnosed with Alzheimer’s disease—or as it’s also called, Alzheimer’s dementia. Here’s a brief list of dementia symptoms that apply to Alzheimer’s:15
- Trouble focusing
- Difficulty performing ordinary activities
- Feeling confused or frustrated, especially at night
- Dramatic mood swings—outbursts of anger, anxiety and depression
- Feeling disoriented and getting lost easily
- Physical problems, such as an odd walk or poor coordination
- Trouble communicating
A six-week study identified that a soft, tactile hand massage improved physical relaxation, significantly decreased aggressiveness, reduced stress levels and increased psychological well-being among elderly patients with dementia.16
A 40-patient pilot study found that a pre-bedtime, three-minute, slowstroke back massage on elderly patients with dementia and sleep disturbances increased overall sleep time by 36 minutes when compared to a control group. Results led study authors to strongly recommend further investigation.17
A 22-patient pilot study provided preliminary evidence that a short-duration foot massage reduced agitation and related behavioral problems in older people with dementia living in a long-term care facility. Reduced behavioral issues included verbal aggression, wandering and repetitive movements. A randomized controlled trial will need to confirm these initial findings.18
For hand, slow-stroke back and foot massage techniques with clients in the later stage of life, consider these tips from Ann Catlin, OTR, LMT, founder of the Center for Compassionate Touch, LLC (merged with AGE-u-cate Training Institute, LLC, in 2015). Catlin outlines these massage techniques—and many more insights—in a white paper she penned called “How Skilled Human Touch Can Transform Person-centered Dementia Care.” 19
- A five-minute hand massage relies on gently pressing the client’s palm and rubbing the knuckles in therapeutic motions.
- The slow-stroke back massage uses effleurage, or moving the palm of the hand in long, rhythmic, firm strokes. Some massage therapists apply effleurage in a figure-eight formation on both sides of the back.
- A foot massage comes down to slow, gentle movements. Work with light pressure from the palm rather than pressing with your fingertips. Take care that your lotion and hands are warm.
Cancer defies a simple, singular definition due to hugely positive advancements in the study and treatment of tumors. However, the disease as a category continues to bring with it some degree of pain, anxiety and depression. In these areas, numerous research reviews and clinical studies suggest that at least for the short term, massage therapy can help reduce discomfort, promote relaxation and boost mood.
That said, oncology massage requires a qualified therapist with knowledge of the disease, cautions Jacki Sellers, a massage therapist with a specialty in oncology massage. Currently located in Orange County, California, Sellers has seen instances where massage therapy helped reduce painful side effects of chemotherapy, such as nerve damage; fatigue; and anxiety and/or depression linked to cancer diagnosis, treatment and recovery.
The National Center for Complementary and Integrative Health emphasizes that massage therapists must take specific precautions with cancer patients and avoid massaging the following areas:13
- Open wounds, bruises or areas with skin breakdown
- Directly over the tumor site
- Areas with a blood clot in a vein
- Sensitive areas following radiation therapy
With these precautions in mind, a collaborative meta-analysis of research on massage therapy for pain conducted by Samueli Institute and commissioned by the Massage Therapy Foundation, with support from AMTA, assessed the quality of massage therapy research and evidence for its efficacy in treating quality of life in cancer populations.14
While additional research is necessary before definitive statements can be released, more studies are indicating that massage therapy is effective in treating pain, fatigue and anxiety for cancer populations.
“You have to constantly modify and adapt for the cancer patient. For instance, I always ask if the client has had any lymph nodes removed, radiated or biopsied. If ‘yes,’ then I know that this client has a lifelong risk for lymphedema—which a deep massage could trigger. So I’m always modifying and adapting,” Sellers says.
Another example of modification concerns massage pressure on aching body parts. “Rubbing or kneading can make some painful side effects of chemotherapy even more painful. I’m always checking to see if I need to lighten the pressure. In some cases, I go with what’s called a still touch, or therapeutic hold,” Sellers says.
Mood disorders, as defined by Salvo, “are emotional disturbances consisting of prolonged periods of excessive sadness or excessive elation, or both, that significantly impair the person’s capacity to function.” It’s a somewhat open-ended definition—and intentionally so, Salvo adds. “A mood disorder, such as major depressive disorder, can be a disease onto itself. On the flip side, depression as a symptom may be part of the clinical profile of other pathologies, such as cancer or Alzheimer’s disease. There may be overlap in treatments for major depressive disorder, cancer and Alzheimer’s disease because of this common thread.”
What is clear is that studies large and small have shown that massage therapy can help soothe stand-alone and symptomatic mood disorders. “Research suggests and clients report that massage therapy can reduce pain and improve quality of life,” Salvo says. In addition, Salvo writes in her textbook Mosby’s Pathology for Massage Therapists / Edition 3, “Although massage does not eliminate stress, it often helps us cope with it better and alleviates some symptoms.”20
Several studies suggest a strong link between therapeutic massage and healthier capabilities to deal with mood disorders.
- A meta-analysis of 17 controlled and published studies—all investigating the effects of massage therapy in depressed people—concludes, “Massage therapy is significantly associated with alleviated depressive symptoms.” However, the analysis suggests a need for standardized protocols of massage therapy, various depression rating scales and target populations in further studies. 21
- A study conducted at the Department of Psychiatry and Behavioral Neurosciences at Cedars-Sinai Medical Center in Los Angeles indicates that massage therapy reduces symptoms of depression for individuals with HIV. 22
- A study published in Applied Nursing Research presents data showing that when a back massage is
given to cancer patients during chemotherapy, the patients report a significant reduction in acute fatigue and anxiety, both during the massage and after chemotherapy.23
- A study conducted by Scripps and Samueli Institute administered healing touch therapy to veterans suffering post-traumatic stress disorder (PTSD) for eight weeks. After the study concluded, subjects reported decreased pain and physical tension; reduced overall anxiety, stress, worry and irritability; and “significant improvements” from depression and PTSD. In addition, veterans with partners who participated in the study also reported improvements in self-compassion, depression and worry.24
- A study reported in the Journal of Clinical Nursing finds that slowstroke back and hand massage on the elderly promotes increased relaxation and decreased stress.25
Here are two abbreviated clinical tips offered by Salvo. Each tip can help the massage therapist create a nurturing and emotionally safe environment for a client prone to or diagnosed with mood disorders.26
- Clients in counseling or psychotherapy are more likely to experience emotional releases. In such cases, Salvo recommends approaching the moment with an attitude of total acceptance and calmly asking clients if they want to continue the session, take a break or discontinue the massage.
- If there is an emotional release, refrain from engaging the client in conversation or exercises that directly address the human psyche. As Salvo emphasizes, a massage therapist is not trained to help clients process emotions and could unintentionally cause the client harm.
With a wealth of clinical studies linking health and well-being to therapeutic massage, it makes sense that so many Americans view massage from a new perspective. Instead of seeing it as a feel-good self-indulgence, they’re blending the power of massage into their traditional medical care. For this reason, massage therapists who understand when massage is indicated or contraindicated for specific pathologies are likely seeing an uptick in business. Of course, it’s nice to know that studies suggest you’re also improving the quality of life for clients challenged by chronic health conditions.