Focus on Research – May Edition

by Rebecca Barnett

It may not surprise you to hear that I read a fair amount of research on an ongoing basis. But not all of this research is specifically about massage therapy so these quarterly blog updates are a bit of a personal godsend, focusing my mind on familiar home turf in a way that is entirely gratifying and inevitably exciting.

Checking in on published massage therapy research at least every quarter also gives me a sense of trends and patterns. I am happy to confirm that the strong emerging 2020 trend of research devoted to massage and constipation continues apace, apparently undeterred by the ravages of COVID-19.

My prize this quarter for the weirdest study that PubMed throws up when you search for massage therapy goes to:

Effects of Substitution of Corn with Ground Brown Rice on Growth Performance, Nutrient Digestibility, and Gut Microbiota of Growing-Finishing Pigs

I hope all those piggies enjoy their brown rice and massages.

Too Much Sport Is Barely Enough

The standout piece for me from this past quarter is a narrative review that nearly made my head come off (insert a million exploding head emojis please Ed).

It features the kind of indepth mechanobiology that is extremely hard for a bear of very little brain like me to fully comprehend.

I give you:

Sport Performance and Manual Therapies: A Review on the Effects on Mitochondrial, Sarcoplasmatic and Ca2+ Flux Response

Now, before you are put off by the terrifying title, let me explain in plain English why this paper should matter to us.

When I was studying massage in a former century known as the 20th, we were taught that certain types of massage strokes evoked very particular physiological effects and we were meant to know them. At the time, it didn’t occur to me that what I was learning was essentially based on zero actual evidence. It was taught with conviction so I guess I naturally assumed it was true.

I was also taught about massage for particular contexts, such as sports, which leaned pretty heavily on a “different strokes for different effects” narrative.

An entire industry has grown up around sports massage. It’s based on a lot of assumptions about the benefits of massage for sporting/athletic performance. And entire pre, post and inter event protocols have also evolved, many of which may well be biologically plausible but are not necessarily supported by evidence.

So what the authors of this narrative review propose is that we investigate the cellular influence of mechanical stimuli to determine not only what the implications are for athlete performance but also which kinds of manual input are appropriate at different stages of training.

“ … knowing the mechano–chemical effects of manual techniques could allow therapists to accompany and support athletes in the best possible way during every stage of their training.”

This means actually unpicking the specific cellular effects of particular manual techniques so we stop talking about “massage” in general terms and start thinking about particular strokes/pressure etc. Dan Wonnocott toured this kind of terrain from a neurophysiological perspective in his excellent and entirely accessible presentation at AMT’s Virtual Conference 2020, which you can enjoy again:

Obviously, what I have written above is a monstrous oversimplification of this paper but hopefully we can feature a more comprehensive, plain English blog post that unpicks it in far more detail and written by someone with a far bigger brain than mine. It’s still worth tackling the paper now for the bullet point summary of what we know so far about the mechanobiological effects of manual therapy.

In a related study, a group of researchers investigated the contraction time, maximal displacement and stiffness and tone in gastrocnemius following massage (1 min of high frequency effleurage; 1 min of high frequency petrissage; 1 min of high frequency vibrations; 1 min of high frequency petrissage; and 1 min of high frequency effleurage).

The authors posit that, given the observed effects of pre-competition massage on contraction time, stiffness and tone, that treatment needs to be tailored to the demands posed by the particular sport. For starters, they make a clear distinction between high-speed sports and endurance sports.

Massage For Hospitalised COVID-19 Patients

Have I got your full attention?

A brief hypothesis published in the International Journal of Therapeutic Massage and Bodywork somewhat unsurprisingly drew my attention: The Case for Therapeutic Massage as an Adjuvant in Hospitalized COVID-19 Patients. Sounds promising, right?

The author argues that massage therapy has a role in reducing pain and anxiety, reducing cortisol levels, and improving immune responses. The arguments and logic sound pretty convincing but this hypothesis really underscores the problem of using research that has been thoroughly debunked as the centrepiece of your argument. The emphasis is firmly on cortisol reduction and the Field et al study that is cited has indeed been thoroughly and systematically debunked. As much as I wanted to love this article, it’s far from convincing.

Is There A Role For Telehealth?

For obvious reasons, there is a lot of research emerging around telehealth. An Australian study of allied health clinicians (82% physiotherapists) really underscores the barriers to tele-consultation that we know anecdotally prevented the majority of massage therapists from diving in. Most of the 817 respondents who took part felt that they lacked adequate training to deliver telehealth services, and that telehealth was less effective than face-to-face care and undervalued by patients.

As a counterpoint, I would like to finish this quarterly update with a series of patient quotes from an Israeli study, Being in touch: narrative assessment of patients receiving online integrative oncology treatments during COVID-19.

“It is important to me to that I can be in touch with you, talk to you… that we have not disconnected… that you remained with me despite what’s happening all around with the Corona…The sense of support has been very important to me…that I am not alone.”

62-year-old female patient undergoing palliative care for recurrent metastatic ovarian cancer

“You give me balance, you are there for me; and when we moved to the home setting because of the Corona it continues to harmonize me, providing confidence and serenity, with each Skype call.”

32-year-old female patient undergoing neoadjuvant chemotherapy for breast cancer

“The online self-acupuncture treatment feels just as it did when I was being treated in your clinic. I do not see a difference, since in any case you accompany and guide me on the phone. I feel that it helps me a lot and gives me the confidence that I have an address for any problem … The fact that I have a listening ear and can pick up the phone, it’s already three quarters of the cure.”

71-year-old female patient undergoing neoadjuvant chemotherapy for localised breast cancer

I have an address for every problem. God I love that.

Is it possible that being in touch is almost as important as providing touch during a pandemic? Is it possible that some of those glorious non-specific effects of massage can find their way through a phone line or a computer screen?

Perhaps there is a rationale for massage therapists to explore online consultation in a pandemic world.

About the Author

Rebecca Barnett is the CEO of the Association of Massage Therapists. Her brain hurts.