{"id":2230,"date":"2019-12-10T09:00:47","date_gmt":"2019-12-09T22:00:47","guid":{"rendered":"https:\/\/blog.amt.org.au\/?p=2230"},"modified":"2019-12-11T10:32:08","modified_gmt":"2019-12-10T23:32:08","slug":"mythbusting-massage-reduces-cortisol","status":"publish","type":"post","link":"https:\/\/blog.amt.org.au\/index.php\/2019\/12\/10\/mythbusting-massage-reduces-cortisol\/","title":{"rendered":"Mythbusting: Massage Reduces Cortisol"},"content":{"rendered":"\n

By Daniel Wonnocott<\/h2>\n\n\n\n

What\nis Cortisol? <\/strong><\/h4>\n\n\n\n

Cortisol\nis a stress hormone produced by the adrenal gland that essentially helps fuel\nthe \u201cfight or flight\u201d response that we so often hear about. However, unlike\nadrenaline, which spikes in high stress environments, cortisol has a slow\nburning effect and is responsible for the management of inflammation, blood\npressure, blood sugar and energy levels amongst other important bodily\nfunctions. <\/p>\n\n\n\n

How\nDoes It Work? <\/strong><\/h4>\n\n\n\n
\"\"<\/figure>\n\n\n\n

What\nCan Go Wrong?<\/strong><\/h4>\n\n\n\n

Normally once a threat or stressful situation passes, cortisol levels go back down to normal and all is well. However, some people are constantly in high stress or threatening environments, forcing them to constantly redistribute\/reprioritise resources to help deal with the stress. As time continues, other vital areas that haven\u2019t been afforded the resources required begin to show symptoms and a declined level of health as a result (anxiety, depression, heart disease, weight gain, memory function etc.).<\/p>\n\n\n\n

So,\nWhat About the Claim That Massage Reduces Cortisol?<\/strong><\/h4>\n\n\n\n

\u201cMassage reduces cortisol\u201d is a very specific claim and given that cortisol levels can be measured (saliva\/blood\/urine), finding some evidence that cortisol levels decreased post-treatment should do the trick and we can all carry on claiming \u201cwhat we always knew\u201d.<\/p>\n\n\n\n

But wait! it\u2019s also really important that we compare these treatment levels to a control group so we can see if it was the massage that made the difference in the levels measured and it wasn\u2019t just a natural regression.<\/p>\n\n\n\n

What\nCan Be Found in The Research to Help Us Examine This Claim?<\/strong><\/h4>\n\n\n\n

Field 1998, Massage therapy effects<\/a><\/em><\/p>\n\n\n\n

This paper\nwas one of the first narrative reviews on the effects of massage therapy and is\nlargely based around the many works of the author (she was involved in 39 of\nthe 66 referenced works).<\/p>\n\n\n\n

The original assertion that massage is beneficial at reducing cortisol comes from this influential paper. However, the findings this claim is based upon are all from the same laboratory<\/strong> (The Touch Research Institute or TRI) and, given the narrative format, a number of crucial details surrounding the studies and findings are not explored in this paper. <\/p>\n\n\n\n

Moyer et al, 2004 A meta-analysis of massage therapy research<\/a><\/em><\/p>\n\n\n\n

The team of Christopher Moyer and co decided to up the game in 2004 and produce a meta-analysis of the massage therapy research. They sacrificed their sanity and went as far as collating the results to produce a standardised mean difference effect size so that the effects of MT could be compared against control treatments. Hell, they even accounted for significant results that may have been influenced by publication bias. <\/p>\n\n\n\n

Talk\nabout taking one for the team to help clean up the mixed bag of studies so that\nwe can see quantifiable, objective and replicable results. This is what they\nfound. <\/p>\n\n\n\n

\u201cOnly seven studies that assessed the effect of MT on cortisol with data sufficient for meta-analysis were located; six of these seven studies were from TRI. Meta-analytic results indicate that MT recipients, on average, had cortisol levels that were only 0.14 standard deviations lower than recipients who had experienced a wait-list condition or a comparison treatment (e.g., engaging in progressive muscle relaxation), a small and nonsignificant (95% CI = \u22120.10, 0.38) effect. The authors concluded that cortisol levels were not significantly reduced by MT, and noted that this conclusion differs markedly from that reached by Field (1998)).\u201d<\/em><\/p><\/blockquote>\n\n\n\n

Field et al Return Serve <\/strong><\/h4>\n\n\n\n

Field et al., 2005 Cortisol decreases and serotonin and dopamine increase following massage therapy.<\/a><\/em><\/p>\n\n\n\n

This time they doubled down on the claim and implied that massage therapy can decrease cortisol levels on average by 31%. They came to this figure by identifying 17 studies from research performed at their own institute (Touch Research Institute), which examined the effect of massage on cortisol and calculated the average percentile decrease in cortisol levels.<\/p>\n\n\n\n

On\nthe surface this sounds fantastic and I can understand why therapists continue\nto preach this as gospel. BUT there are some warning lights flashing on the\ncredibility dashboard when you look at how they got to this number.<\/p>\n\n\n\n

\"\"<\/figure><\/div>\n\n\n\n

Warning\n1: They only used studies they conducted. (When a mining company insists on\nusing their environmental impact study and excluding an independent report \u2013\nwould you accept it on face value?)<\/p>\n\n\n\n

\"\"<\/figure><\/div>\n\n\n\n

Warning 2: Regardless of the number of participants in a study, each was weighted the same. They also could have used a more rigorous approach to calculate effect sizes rather than manipulating averages which doesn\u2019t give you an accurate story. <\/p>\n\n\n\n

If you pick your groups right and manipulate how you report the data, you can make anything sound great … or gross. For example, here is some research on the number of massage therapists who love massaging hairy backs:<\/p>\n\n\n\n

\"\"
Therapists who love massaging hairy backs<\/strong> <\/figcaption><\/figure>\n\n\n\n

90%+75%+10% = 175% > > > 175%\/3= 58.3%<\/p>\n\n\n\n

Over 50% of massage therapists love massaging hairy\nbacks!!<\/strong><\/p>\n\n\n\n

Vs<\/p>\n\n\n\n

214ppl\/32ppl = 6.68%<\/p>\n\n\n\n

6% of therapists have a secret fetish for hairy\nbacks!!<\/strong><\/p>\n\n\n\n

\"\"<\/figure><\/div>\n\n\n\n

Warning\n3: Control group data was omitted, so it is impossible to tell if the effect is\nbetter than the control and the changes, if present, are attributable to the\nintervention provided. <\/p>\n\n\n\n

For\nexample:<\/p>\n\n\n\n

Claim\n\u2013 My moon dance has a 100% success rate at making the sun go down. <\/p>\n\n\n\n

Evidence\n\u2013 I dance every night and the sun has never failed to go down.<\/p>\n\n\n\n

^Sounds\nLegit ^<\/strong><\/p>\n\n\n\n

Control\ngroup \u2013 No dancing. Sun still went down. <\/p>\n\n\n\n

^Moon\ndance boy has slick moves but he doesn\u2019t make the sun go down^<\/strong><\/p>\n\n\n\n

The Studies, Reviews and Updates Continue<\/strong><\/h4>\n\n\n\n

Beider and Moyer, 2007 Randomized controlled trials of pediatric massage: a review<\/a><\/em><\/p>\n\n\n\n

This review focused only on two studies that measured salivary cortisol in paediatric samples who had received massage. Post-massage test results displayed a small and non-significant effect, which reflects the results in adults highlighted in Moyer et al (2004).<\/p>\n\n\n\n

Field et al, 2007 Massage therapy research<\/a><\/em><\/p>\n\n\n\n

Despite\nno change in methodology to address the limitations of the 1998 paper, the\nauthors published this updated paper and came to the conclusion that \u201cwe can\nconfidently say that stimulating pressure receptors under the skin leads to a\ncascade of events including \u2026 decreasing cortisol, which may facilitate immune\nfunction\u201d.<\/em><\/p>\n\n\n\n

Without taking into consideration studies which have\nconflicting findings to their own, it is hard to use this finding as a\nsupporting argument to the claim that massage therapy reduces cortisol. <\/p>\n\n\n\n

Moraska et al., 2008 Physiological adjustments to stress measures following massage therapy: a review of the literature<\/a><\/em><\/p>\n\n\n\n

Moraska\net al took a look at the physiological adjustments to stress measures following\nmassage therapy. They performed a review of the literature in 2008 that\nincluded a larger number of studies as there was no exclusion of studies that\nhad insufficient data for the calculation of effect size.<\/p>\n\n\n\n

Whilst\nthe review of the literature takes a look at the findings of the included\nstudies, it does not conduct a detailed review of how the studies were designed\nand conducted, which leaves it susceptible to findings which may not be as\ncredible when the methodology is broken down and accounted for. When reading\nstatements such as the one below taken from the review discussion and\nconclusions section, we need to keep in mind the quality of information being\nreviewed. <\/p>\n\n\n\n

\u201cOur review of the literature indicated that massage therapy may have a beneficial effect on several physiological variables, specifically salivary cortisol and heart rate, when assessed immediately pre-post massage, but is null or inconclusive for the multiple-treatment effect on physiological indices of stress. A reduction in salivary cortisol was evident following a single massage treatment, yet salivary cortisol returns to initial values when assessed at a later time point, even if massage therapy was administered during the interim timeframe. The single-treatment effect, however, recurred as successive massage sessions also showed to be generally effective at lowering salivary cortisol.\u201d<\/em><\/p><\/blockquote>\n\n\n\n

Moyer et al. 2011 Does massage therapy reduce cortisol? A comprehensive quantitative review<\/a><\/em><\/p>\n\n\n\n

Not\nto leave any stone unturned, Moyer et al revisited the question and performed a\ncomprehensive quantitative review of the topic. <\/p>\n\n\n\n

In a non-conventional approach, they opted to review the literature using a percentage of change methodology as done by previous groups, as well as a conventional meta-analytic approach which is more rigorous and addresses the many confounds (other variables that are not being directly manipulated by the researchers) which are overlooked when using the percentage of change approach. <\/p>\n\n\n\n

Overall, massage therapy\u2019s ability to reduce cortisol\nresulted in mostly small and non-significant changes. However, they did find\nstatistically significant changes in cortisol reduction when looking at the\nmultiple-dose effect on children, although there were only 3 studies to draw\nfrom. <\/p>\n\n\n\n

Interestingly, when they looked at the within-group\npercentage, they generally found smaller reductions than previous reviewers\nusing this approach. But these results were still inconsistent with the\nfindings of the more rigorous approach to assessing treatment effects.<\/p>\n\n\n\n

Should\/Can\nWe Continue to Claim That Massage Reduces Cortisol?<\/strong><\/h4>\n\n\n\n

Based on the current body of evidence, there isn\u2019t much to support this claim. <\/p>\n\n\n\n

Small changes may be seen but given how clinically insignificant they are, it is a stretch to suggest massage therapy has any real, direct effect on cortisol levels. <\/p>\n\n\n\n

The\nargument for cortisol reduction often gets linked to the proven effect massage\nhas on state and trait anxiety and depression but this is not the case and\nperpetuating such a claim without the supporting evidence often tarnishes our\nprofessional credibility. <\/p>\n\n\n\n

\"\"<\/figure><\/div>\n\n\n\n

As a profession that is continually looking for better recognition and acceptance of the wider medical community, it is important that we appraise the available research to the same standards that they will look to hold us to. Although it can be challenging to accept that many claims made previously about massage simply do not have the support of the evidence base, good research helps to guide further research. Every therapist can attest to the positive changes our clients have sought and received through massage therapy, and they will continue to vote with their feet. The current trend to overstate, glorify and outright make crap up in an effort to garner attention and generate business at the expense of professional credibility makes us no better than modern day snake oil salesman. <\/p>\n\n\n\n

Those\nwho came before us made huge advances on our behalf with very limited resources\n(imagine manually searching for research and having to travel to meet and talk\nwith fellow therapists) but a strong desire to better understand what they were\ndoing for the people who sought their help. We need to ask the tough questions,\nembrace the unknown and, most of all, be open to change as a profession so that\nthe potential for further integration of our services in the health space\ncontinues to grow. <\/p>\n\n\n\n

Let\u2019s\nbe better. <\/p>\n\n\n\n

Further Reading\/Watching<\/strong><\/h4>\n\n\n\n

Short\nvideo clip(s) from Christopher Moyer explaining the results of his 2004\nmeta-analysis:<\/p>\n\n\n\n

Part 1<\/a><\/p>\n\n\n\n

Part 2<\/a><\/p>\n\n\n\n

About the Author<\/strong><\/h4>\n\n\n\n
\"\"<\/figure><\/div>\n\n\n\n

Daniel Wonnocott is a RMT based out of Brisbane & Ipswich. He\nis always learning from the mistakes of those who take his advice and is\nstruggling to come to terms with the realisation that yoda’s first word\nprobably came after his second word. <\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Massage reduces cortisol levels! Or does it? Dan Wonnocott returns to bust another massage myth.<\/p>\n","protected":false},"author":1,"featured_media":2236,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[110,30,2],"tags":[526,403,197,194,509],"class_list":["post-2230","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-clinical-practice","category-massage","category-professional-practice","tag-cortisol","tag-daniel-wonnocott","tag-massage-myths","tag-mythbusting","tag-myths"],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2019\/12\/Dan7.jpg.png?fit=1200%2C628&ssl=1","jetpack_likes_enabled":true,"jetpack_sharing_enabled":true,"jetpack-related-posts":[{"id":3608,"url":"https:\/\/blog.amt.org.au\/index.php\/2022\/05\/25\/meet-daniel-wonnocott-amt-board-member\/","url_meta":{"origin":2230,"position":0},"title":"Meet Daniel Wonnocott – AMT Board Member","author":"admin","date":"25\/05\/2022","format":false,"excerpt":"Think you already know a lot about the newest member of the AMT Board, Daniel Wonnocott? Think again!","rel":"","context":"In "AMT"","block_context":{"text":"AMT","link":"https:\/\/blog.amt.org.au\/index.php\/category\/amt\/"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2021\/08\/Meet-the-Board.png?fit=1200%2C628&ssl=1&resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2021\/08\/Meet-the-Board.png?fit=1200%2C628&ssl=1&resize=350%2C200 1x, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2021\/08\/Meet-the-Board.png?fit=1200%2C628&ssl=1&resize=525%2C300 1.5x, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2021\/08\/Meet-the-Board.png?fit=1200%2C628&ssl=1&resize=700%2C400 2x, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2021\/08\/Meet-the-Board.png?fit=1200%2C628&ssl=1&resize=1050%2C600 3x"},"classes":[]},{"id":2121,"url":"https:\/\/blog.amt.org.au\/index.php\/2019\/10\/23\/mythbusting-massage-removes-lactic-acid\/","url_meta":{"origin":2230,"position":1},"title":"Mythbusting: Massage Removes Lactic Acid","author":"admin","date":"23\/10\/2019","format":false,"excerpt":"Does a massage remove lactic acid? Or is that simply a myth? Daniel Wonnocott takes a look at the facts and history to give us the answer.","rel":"","context":"In "Clinical Practice"","block_context":{"text":"Clinical Practice","link":"https:\/\/blog.amt.org.au\/index.php\/category\/clinical-practice\/"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2019\/10\/CFS.png?fit=1200%2C628&ssl=1&resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2019\/10\/CFS.png?fit=1200%2C628&ssl=1&resize=350%2C200 1x, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2019\/10\/CFS.png?fit=1200%2C628&ssl=1&resize=525%2C300 1.5x, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2019\/10\/CFS.png?fit=1200%2C628&ssl=1&resize=700%2C400 2x, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2019\/10\/CFS.png?fit=1200%2C628&ssl=1&resize=1050%2C600 3x"},"classes":[]},{"id":2213,"url":"https:\/\/blog.amt.org.au\/index.php\/2019\/12\/05\/top-7-articles-of-2019\/","url_meta":{"origin":2230,"position":2},"title":"TOP 7 ARTICLES OF 2019","author":"admin","date":"05\/12\/2019","format":false,"excerpt":"Revisit 7 of the best articles we've featured on AMT's blog in 2019. Which was your favourite?","rel":"","context":"In "AMT"","block_context":{"text":"AMT","link":"https:\/\/blog.amt.org.au\/index.php\/category\/amt\/"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2019\/12\/top.jpg?fit=953%2C454&ssl=1&resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2019\/12\/top.jpg?fit=953%2C454&ssl=1&resize=350%2C200 1x, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2019\/12\/top.jpg?fit=953%2C454&ssl=1&resize=525%2C300 1.5x, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2019\/12\/top.jpg?fit=953%2C454&ssl=1&resize=700%2C400 2x"},"classes":[]},{"id":2394,"url":"https:\/\/blog.amt.org.au\/index.php\/2020\/02\/18\/mythbusting-does-massage-therapy-flush-toxins\/","url_meta":{"origin":2230,"position":3},"title":"Mythbusting: Does Massage Therapy Flush Toxins?","author":"admin","date":"18\/02\/2020","format":false,"excerpt":"This blog, the latest in our mythbusting series, was a long time in the making. It involved hours of careful research synthesis and an unparalleled attention to detail. We recommend you make a cuppa and settle in for an engaging read.","rel":"","context":"In "Clinical Practice"","block_context":{"text":"Clinical Practice","link":"https:\/\/blog.amt.org.au\/index.php\/category\/clinical-practice\/"},"img":{"alt_text":"May or may not be an image of Rebecca Barnett. 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