A Beneficial Role in Reducing Delayed Onset Muscle Soreness - Research Paper Example

Introduction: Over the decades, the term massage therapy has been defined in several different ways decades and has been used for a variety of therapeutic purposes since time immemorial. Studies have revealed that massage therapy is one of the oldest therapeutic modalities used by man[Ern01] and has also been an important component of sports medicine[Cal93]. By definition, massage therapy refers to ‘soft-tissue manipulation using hands or a mechanical device on any body part[ADF08].’ This paper discusses the effects and benefits of massage therapy on the Muscular and Lymphatic systems of the human body. This report intends to cover in detail the aims and benefits of massage therapy on the body systems specified above. It discusses the existing scientific evidence regarding the proposed physiological mechanisms of how these benefits are achieved and then summarizes how effective this therapy is in the management of various disorders related to the muscular and lymphatic systems. The evidence discussed in this report was collected through an extensive literature search using PUBMED using the keywords massage therapy, muscular system and lymphatic system. This report, however, does have certain shortcomings. Till date, several studies have been conducted to prove the efficacy of massage therapy in certain disorders related to the muscular and lymphatic system, but in the case of some of these disorders, no conclusive evidence of a therapeutic benefit has been found (as discussed below). Moreover, no literature review, however extensive, is exhaustive, and thus, there might have been some studies which might have been missed in the process of review for this report. Background: Massage therapy has been an important component of complementary medicine and is used throughout the world. In the United Kingdom, it is amongst the top three most oft practiced complementary therapy techniques[EEr03]. Massage can be either localized to a particular area of the body or can be performed on the entire body. Several different types of massage have evolved over centuries and in different part of the world, including the Swedish massage (which is also known as the classic massage, Shiatsu, Rolfing, reflexology, deep tissue massage, Aromatherapy, Reflexology and craniosacral therapy[Tsa07] [Can09]. The process of massage itself has several components. For example, Classic massage comprises of stroking, kneading and percussion which are termed as effleurage, petrissage and tapotement, respectively [EEr03]. A variety of therapeutic applications for massage therapy have been implicated including its use in the management of musculoskeletal conditions such as back pain and neck pain, headaches, several pain syndromes, lymphatic system disorders such as lymphedema, and in the pediatric population for the management of asthma and infantile colic[Ger10]. However, as discussed later in this report, conclusive evidence for a beneficial therapeutic effect exists only for a few of the above mentioned conditions. Several studies have been conducted in order to validate the safety and efficacy of massage therapy and it has been found that massage is a fairly safe therapy with relatively few, rare complications[EEr03]. There are, however, a few contraindications for the usage of massage therapy. These include the presence of skin infection, areas of acute inflammation, site of active cancers, presence of a non-consolidated fracture and deep venous thrombosis (since there is a fear of dislodging the thrombus), amongst others[ADF08]. Massage Therapy benefits for the Muscular System: In the United Kingdom, muscular disorders rate the top amongst work related ailments. It was found that during the year 2008-2009, approximately 538 thousand working individuals suffered from a variety of musculoskeletal issues. Such problems not only cause a significant health care burden but also pose an economic burden as they amount to almost 9.3 million cumulative days of work loss per annum[Hea101]. Literature reveals that massage therapy is efficacious for treating a wide variety of musculoskeletal problems ranging from chronic low back pain and neck pain to conditions such as fibromyalgia and myofascial pain syndrome. However, conclusive evidence of therapeutic effectiveness exits only in the case of chronic low back pain and neck pain, as revealed by the UK evidence report[Ger10]. A Cochrane review published in 2003 confirmed that massage therapy is beneficial in the management of patients with non specific low back pain which is either sub-acute or chronic in nature, as an adjunct to exercise. Moreover, it was also found that in comparison to classic massage, acupuncture massage is associated with better patient outcomes; however, further studies need to be conducted to validate these findings[ADF08]. Chronic neck pain, which is a fairly common problem in the UK, with an incidence of approximately 17.9%[Cro01], is one of the most common condition for which people seek complementary and alternative medicine therapies[Kar09]. For decades, massage therapy has been utilized by patients suffering from neck pain but until recently, there was no conclusive evidence of it therapeutic efficacy. However, recently, a randomized control trial carried out by Sherman et al. (2009) revealed that massage therapy is effective in the treatment of chronic neck pain[Kar09]. Thus, it can be seen that ongoing research is unveiling more and more benefits and applications of massage therapy with regard to the musculoskeletal system and thus, massage therapy is gaining popularity as an adjunct to the standard management protocols. The Physiologic Effects of Massage Therapy on the Muscular System: Massage therapy is beneficial in the treatment of the above mentioned diseases due to a variety of physiological effects that it brings about in the body. For example, studies have shown massage to be effective in improving the blood circulation to an organ or specific body part. Massage helps in promoting the blood flow to an organ by causing dilatation of the arterioles and superficial blood vessels. In addition, application of deep massage to a particular area not only causes an increase in the local blood flow to that area but also increases the overall stroke volume. Moreover, the venous return is also increased, which acting via the Frank Starling mechanism, contributes to the increase in stroke volume[Goa94]. The effect of this increase n blood flow is multifold; it helps in improving muscle contractility and endurance[Goa94]. It has also been suggested that it helps in reducing post-exercise soreness and decrease muscle fatigue by faster removal of lactate and other accumulated by products of metabolism[Bri00]. Hilbert et al. (2003) in their study of physiological and psychological effects of massage on delayed onset muscle soreness (DOMS) (See Appendix I), elucidated that the application of massage to the muscles two hours post-exercise, helped in reducing the intensity of delayed onset muscle soreness[JEH03]. Interestingly, it has also been found that application of massage to one limb improves blood flow in the other limb too. This can have important implications in the management of injuries as massage on the non-injured limb would help promote healing and recovery in the other limb which is injured[Goa94]. The mechanical pressure produced by massaging an area, helps in increasing the muscle compliance which consequently helps in decreasing the stiffness in that muscle and increasing the range of motion[PWe05]. Massage also has an important role in producing short term and long term pain control by the ‘pain gate mechanism’ and ‘descending pain suppression mechanism’, respectively[Goa94] (See Appendix I). Other hypotheses which have been formulated to explain pain modulation by massage include the serotonin hypothesis and the restorative sleep hypothesis[Tsa07] (See Appendix I). Moreover, the benefits of massage are not limited to these localized effects. On a systemic level, massage has been shown to increase the overall cardiac output and alter levels of certain hormones such as cortisol which ultimately culminate in producing an anxiolytic response and produce an overall feeling of well-being[PWe05]. Massage Therapy benefits for the Lymphatic System: The lymphatic system serves as a drainage system for the human body which by means of its one-way drainage mechanism helps in removing approximately 2 liters of excess extracellular fluid from all body tissues and returns it to the bloodstream. An important component of the lymphatic system are the lymph nodes which serve to filter all the fluid passing through them and removing circulating micro-organisms and unwanted waste products[Jan06]. One of the most common lymphatic system disorder is Lymphedema, which has been shown to affect almost 100,000 individuals in the United Kingdom[Jan06]. The term lymphedema refers to swelling of the limb due to accumulation of lymphatic fluid which occurs as a result of lymph nodes draining that particular limb[MLM04]. Lymphedema is one of the most common complications of surgery for breast cancer and can cause significant morbidity and functional impairment. Massage therapy has been shown to be an important component of management protocol for lymphedema and has found to be effective. A special form of massage therapy, termed as manual lymph drainage has been shown to be effective in the reduction of breast cancer surgery associated lymphedema. This technique comprises of manually massaging the affected areas, following the natural lymphatic drainage pathways of the body. This helps is augmenting lymphatic drainage and thus, reducing lymphedema[Har011]. Another application of massage therapy is its use in the reduction of sports and exercise related edema[Goa94]. The Physiologic Effects of Massage Therapy on the Muscular System: Massage therapy is useful in reducing edema and lymphedema by promoting lymphatic flow. Since lymphatic channels have valve, massage and manual manipulation help in promoting flow via these one way valves towards the heart. When the lymphatic drainage is improved, the pressure gradient between the tissues and the lymphatic channels favors the flow of more fluid from the tissues to the lymphatic network and ultimately into the systemic circulation[Goa94]. This helps in reducing congestion and promoting blood flow in these tissues. This is how massage therapy functions in reducing lymphatic fluid accumulation in the tissues, as occurs in lymphedema and other edematic states. Conclusion: Massage therapy, which has been one of the oldest complimentary medicine therapy used by mankind, has recently gained renewed popularity. It has been subject to great debate and profound research to establish its efficacy and safety. With this report and analysis of existing literature, it can be concluded that massage therapy, indeed, has specific benefits to the muscular and lymphatic systems. Sufficient evidence exists to establish a beneficial role of massage therapy in the management of musculoskeletal conditions such as chronic low back pain and neck pain, and lymphatic system disorders such as lymphedema. With regard to several other musculoskeletal and lymphatic disorders such as fibromyalgia, chronic pain disorders, etc. the evidence is still limited and the results, inconclusive. Further research thus needs to be conducted to establish the therapeutic benefit of massage in the management of these disorders too. Appendix I Delayed Onset Muscle Soreness (DOMS) Delayed Onset Muscle Soreness or DOMS, as it is commonly referred to as, refers to muscle soreness or pain which results after intense muscle exercise[JEH03]. The individual suffering from DOMS often complains of muscle soreness and stiffness, and localized tenderness on muscle palpation. The timeframe of DOMS is usually around a week after which it settles. The soreness begins immediately after exercise and gradually worsens with peak intensity between 24-48 hours, after which the pain starts subsiding over the period of next 5-7 days[JEH03]. Massage therapy has been shown to have a beneficial role in reducing DOMS. Appendix II The analgesic effect of massage-theories postulating a possible mode of action Hypothesis Mechanism of Action Pain Gate Hypothesis Massage stimulates the cutaneous mechanoreceptors which send signals to the spinal cord through large nerve fibers. This process inhibits the transmission of pain signals arising from the same segment via small nerve fibers. Therefore, pain transmission is interrupted and massage has an analgesic effect[Goa94]. However, this analgesic effect is only short lived. Descending Pain Suppression Hypothesis Massage has also been shown to produce long lasting analgesic effects. These effects can be explained by the descending pain suppression hypothesis whereby massage results in the stimulation of midbrain nuclei and the subsequent release of opiates. These opiates, being inhibitory neurotransmitters, decrease the perception of pain by suppressing the transmission of painful stimuli to the higher centers[Goa94]. Serotonin Hypothesis Massage therapy increases levels of Serotonin which is a pain modulating CNS neurotransmitter and thus helps in alleviating pain[Tsa07]. Restorative Sleep Hypothesis Massage helps in increasing restorative sleep which helps in decreasing the levels of the neurotransmitter, Substance P. Increased levels of Substance P are observed in sleep deprived individuals which increases pain perception. Thus, by increasing restorative sleep, massage results in reduction of circulating Substance P in the CNS and thus decreased pain perception[Tsa07]. Bibliography 1. Ernst, E. The Desktop Guide to Complementary and Alternative Medicine: An Evidence-Based Approach. London : Mosby, 2001. 2. Callaghan, MJ. The role of massage in the management of the athlete: a review. British Journal of Sports Medicine. 1993, Vol. 27, pp. 28-33. 3. Furlan, AD, et al. Massage for low-back pain (Review), Cochrane Database of Systematic Reviews. 2009, CD001929. 4. Ernst, E. The safety of massage therapy. Rheumatology. 2003, Vol. 42, pp. 1101–1106. 5. Tsao, Jennie C.I. Effectiveness of Massage Therapy for Chronic, Non-malignant Pain: A Review. 2007, eCAM, Vol. 4, pp. 167-175. 6. Cancer Research UK. Massage Therapy. CancerHelp UK. [Online] September 28, 2009. Available from: http://www.cancerhelp.org.uk/about-cancer/treatment/complementary-alternative/therapies/massage-therapy. [Accessed: December 22, 2010.] 7. Bronfort, Gert, et al. Effectiveness of manual therapies: the UK evidence report. February 25, 2010, Chiropractic & Osteopathy, Vol. 18. 1746-1340. 8. Health and Safety Executive. Musculoskeletal disorders. Health and Safety Executive. [Online] 2010. Available from: http://www.hse.gov.uk/statistics/causdis/musculoskeletal/scale.htm. [Accessed: December 22, 2010.] 9. Croft, Peter R., et al. Risk factors for neck pain: a longitudinal study in the general population. May 2, 2001, Pain, Vol. 93, pp. 317-325. 10. Sherman, Karen J., et al. Randomized Trial of Therapeutic Massage for Chronic Neck Pain.Clinical Journal of Pain. 2009, Vol. 25, pp. 233-238. 11. Goats, Geoffrey C. Massage - the scientific basis of an ancient art: part 2. Physiological and therapeutic effects. British Journal of Sports Medicine. 1994, Vol. 28, pp. 153-157. 12. Hemmings, Brian, et al. Effects of massage on physiological restoration, perceived recovery, and repeated sports performance. British Journal of Sports Medicine. 2000, Vol. 34, pp. 109-115. 13. Hilbert, J E, Sforzo, G A and Swenson, T. The effect of massage on Delayed Onset Muscle Soreness. British Journal of Sports Medicine. 2003, Vol. 37, pp. 72-75. 14. Weerapong, P, Hume, PA and Kolt, GS. The mechanisms of massage and effects on performance, muscle recovery and injury prevention. Sports Medicine. 2005, Vol. 35, pp. 235-256. 15. Jones, Jane Wigg' Kristina. 5, s.l. : Sutton. Recognising and managing lymphoedema. Practice Nurse. September 22, 2006 , Vol. 32, pp. 22-27. 16. McNeely, ML, et al. The addition of manual lymph drainage to compression therapy for breast cancer related lymphedema: a randomized controlled trial. Breast Cancer Research and Treatmeant. July 2004, Vol. 86, pp. 95-106. 17. Harris, Susan R, et al. Clinical practice guidelines for the care and treatment of breast cancer: II. Lymphedema. Canadian Medical Association. Journal. January 21, 2001, Vol. 164, pp. 191-200. Read More