Touch institute of University of Miami.

TRI LINK

Adolescents

Diego, M.A., Field, T., Hernandez-Reif, M., Shaw, J.A., Rothe, E., Castellanos, D., & Mesner, L. (2002). Aggressive adolescents benefit from massage therapy. Adolescence, 37, 597-607.

METHOD: Seventeen aggressive adolescents were randomly assigned to a massage therapy group or a relaxation group to receive 20-minute therapy sessions, twice a week for five weeks. The massaged adolescents had lower anxiety after the first and last sessions. By the end of the study, they also reported feeling less hostile and they were perceived by their parents as being less aggressive. Significant differences were not found for the adolescents who were assigned to the relaxation group.

Alzheimer’s

Rowe, M. & Alfred, D. (1999). The effectiveness of slow-stroke massage in diffusing agitated behaviors in individuals with Alzheimer’s disease. Journal of Gerontology and Nursing, 25, 22-34.

METHOD: Agitated behaviors of individuals with Alzheimer’s disease (AD), often endured or unsuccessfully treated with chemical or physical restraints, markedly increase the stress levels of family caregivers. The Theoretical Model for Aggression in the Cognitively Impaired guided the examination of caregiver-provided slow-stroke massage on the diffusion of actual and potential agitation for community-dwelling individuals with AD. Characteristics and frequency of agitation were quantified by two highly correlated instruments, the Agitated Behavior Rating Scale Scoring Guide and the Brief Behavior Symptom Rating Scale. RESULTS: Expressions of agitation of patients with AD increased in a linear pattern from dawn to dusk. Verbal displays of agitation, the most frequently cited form of agitation in community-dwelling individuals with AD, were not diffused by slow-stroke massage. However, more physical expressions of agitation such as pacing, wandering, and resisting were decreased when slow-stroke massage was applied.

Anorexia

Hart, S., Field, T. & Hernandez-Reif, M., Nearing, G., Shaw, S., Schanberg, S., & Kuhn, C. (2001). Anorexia nervosa symptoms are reduced by massage therapy. Eating Disorders, 9, 289-299.

METHOD: Women diagnosed with anorexia nervosa were given a massage twice per week for five weeks or standard treatment. RESULTS: The massaged women reported lower stress and anxiety levels and showed lower cortisol levels immediately following the massage. Over the five-week treatment period, they also reported decreased body dissatisfaction on the Eating Disorder Inventory and showed increased dopamine and norepinephrine levels. These findings support a previous study on the benefits of massage therapy for eating disorders.

Anxiety

McKechnie, A.A., Wilson, F., Watson, N. & Scott, D. (1983). Anxiety states: A preliminary report on the value of connective tissue massage. Journal of Psychosomatic Research, 27, 125-129.

METHOD: Five patients who presented with symptoms of tension and anxiety were subsequently referred to a physiotherapist and treated with Connective Tissue Massage. Psychophysiological recordings of heart rate, frontalis EMG, skin resistance and forearm extensor EMG were taken before and after treatment. RESULTS: All patients showed a significant response to treatment in one or more of the psychophysiological parameters. Results are discussed in relation to the hypothesis that each individual has a unique stress response pattern.

Field, T., Morrow, C., Valdeon, C., Larson, S., Kuhn, C. & Schanberg, S. Massage reduces anxiety in child and adolescent phychiatric patients. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 125-131.

METHOD: A 30-minute back massage was given daily for a 5-day period to 52 hospitalized depressed and adjustment disorder children and adolescents. RESULTS: Compared with a control group who viewed relaxing videotapes, the massage subjects were less depressed and anxious and had lower saliva cortisol levels after the massage. In addition, nurses rated the subjects as being less anxious and more cooperative on the last day of the study, and nighttime sleep increased over this period. Finally, urinary cortisol and norepinephrine levels decreased, but only for the depressed subjects.

Shulman, K.R. & Jones, G.E. (1996). The effectiveness of massage therapy intervention on reducing anxiety in the work place. Journal of Applied Behavioral Science, 32, 160-173.

METHOD: An on-site chair massage therapy program was provided to reduce anxiety levels of 18 employees in a downsizing organization. 15 control group Ss participated in break therapy. Subjects’ stress levels were measured with the State-Trait Anxiety Inventory, which was administered twice during pretest, post test, and delayed post test to achieve stable measures. RESULTS: Significant reductions in anxiety levels were found for the massage group.

Aromatherapy

Buckle, J. (1993). Aromatherapy. Nursing Times, 89, 32-35.

METHOD: A randomized, double-blind trial was conducted on two essential oils of two different species of lavender, topically applied on post-cardiotomy patients. The emotional and behavioral stress levels of 28 patients were evaluated pre- and post-treatment on two consecutive days. RESULTS: The therapeutic effects of the two lavenders appeared to be different: one was almost twice as effective as the other, thereby disproving the hypothesis that aromatherapy, using topical application of essential oils, is effective purely because of touch, massage or placebo.

Diego, M., Jones, N.A., Field, T., Hernandez-Reif, M., Schanberg, S., Kuhn, C., McAdam, V., Galamaga, R. & Galamaga, M. (1998). Aromatherapy positively affects mood, EEG patterns of alertness and math computations. International Journal of Neuroscience, 96, 217-224.

METHOD: EEG activity, alertness, mood and cortisol levels were assessed in 40 adults given 3 minutes of aromatherapy using two aromas, lavender (considered a relaxing odor) or rosemary (considered a stimulating odor). Participants were also given simple math computations before and after the therapy. RESULTS: The lavender group showed increased beta power suggesting increased drowsiness, they had less depressed mood (POMS) and reported feeling more relaxed and they performed the math computations faster and more accurately following aromatherapy. The rosemary group, on the other hand, showed decreased frontal alpha and beta power, suggesting increased alertness. They also had lower state anxiety scores, reported feeling more relaxed and alert and they were only faster, not more accurate, at completing the math computations after the aromatherapy session.

Fernandez, M., Hernandez-Reif, M., Field, T., Sanders, C., Diego, M., & Roca, A. (2002). EEG during lavender and rosemary exposure in infants of depressed and non-depressed mothers. British Journal of Psychology. In Review.

METHOD: This study investigated whether exposure to pleasant odors would change electroencephalographic (EEG) activity in infants of depressed and non-depressed mothers. Twenty newborns were exposed to a 10% v/v concentration of rosemary oil or lavender oil and their EEG was recorded for 2-minutes each at baseline and during odor exposure. Group inclusion (depressed versus non-depressed) was based on mothers' CES-D scores. RESULTS: Results revealed that the groups did not differ at baseline and that the two odors did not differentially affect the EEG. However, the infants of depressed mothers showed increased relative left frontal EEG activation while infants of non-depressed mothers showed increased relative right frontal EEG activation from baseline to the odor exposure phase. Relative left frontal EEG activation has been associated with an approaching pattern of behavior and response to positive stimuli, while relative right frontal EEG activation has been associated with a withdrawing pattern of behavior and response to negative stimuli. These results suggest that infants of depressed and non-depressed mothers respond differently to odors.

Arthritis

Yurtkuran, M. & Kocagil, T. (1999). TENS, electropuncture and ice massage: Comparison of treatment for osteoarthritis of the knee. American Journal of Acupuncture, 27, 133-140.

METHOD: The purpose of this study was to compare the effectiveness of transcutaneous electrical nerve stimulation (TENS), electroacupuncture (EA), and ice massage with placebo treatment for the treatment of pain. Subjects (n = 100) diagnosed with osteoarthritis (OA) of the knee were treated with these modalities. The parameters for evaluating the effectiveness of treatment included pain at rest, stiffness, 50 foot walking time, quadriceps muscle strength, and knee flexion degree. RESULTS: The results showed (a) that all three methods could be effective in decreasing not only pain but also the objective parameters in a short period of time; and (b) that the treatment results in TENS, EA and ice massage were superior to placebo.

Field, T., Hernandez-Reif, M., Seligman, S., Krasnegor, J. & Sunshine, W. (1997). Juvenile rheumatoid arthritis: Benefits from massage therapy. Journal of Pediatric Psychology, 22, 607-617.

METHOD: Children with mild to moderate juvenile rheumatoid arthritis were massaged by their parents 15 minutes a day for 30 days (and a control group engaged in relaxation therapy). RESULTS: The children’s anxiety and stress hormone (cortisol) levels were immediately decreased by the massage, and over the 30-day period their pain decreased on self-reports, parent reports, and their physician’s assessment of pain (both the incidence and severity) and pain-limiting activities.

Asthma

Field, T., Henteleff, T., Hernandez-Reif, M., Martinez, E., Mavunda, K., Kuhn, C. & Schanberg, S. (1997). Children with asthma have improved pulmonary functions after massage therapy. Journal of Pediatrics, 132, 854-858.

METHOD: Thirty-two children with asthma (16 4- to 8-year-olds and 16 9- to 14-year-olds) were randomly assigned to receive either massage therapy or relaxation therapy. The children’s parents were taught to provide one therapy or the other for 20 minutes before bedtime each night for 30 days. RESULTS: The younger children who received massage therapy showed an immediate decrease in behavioral anxiety and cortisol levels after massage. Also, their attitude toward asthma and their peak air flow and other pulmonary functions improved over the course of the study. The older children who received massage therapy reported lower anxiety after the massage. Their attitude toward asthma also improved over the study, but only one measure of pulmonary function (forced expiratory flow 25% to 75%) improved. The reason for the smaller therapeutic benefit in the older children is unknown; however, it appears that daily massage improves airway caliber and control of asthma.

Attention Deficit Hyperactivity Disorder

Field, T., Quintino, O., Hernandez-Reif, M. & Koslovsky, G. (1998). Adolescents with attention deficit hyperactivity disorder benefit from massage therapy. Adolescence, 33, 103-108.

METHOD: Twenty-eight adolescents with attention deficit hyperactivity disorder were provided either massage therapy or relaxation therapy for 10 consecutive school days. RESULTS: The massage therapy group, but not the relaxation therapy group, rated themselves as happier and observers rated them as fidgeting less following the sessions. After the 2-week period, their teachers reported more time on task and assigned them lower hyperactivity scores based on classroom behavior.

Hernandez-Reif, M., Field, T., & Thimas, E. (2001). Attention deficit hyperactivity disorder: benefits from Tai Chi. Journal of Bodywork and Movement Therapies, 5, 120-123.

METHOD: Thirteen adolescents with Attention Deficit Hyperactivity Disorder (ADHD) participated in Tai Chi classes twice a week for 5 weeks. Teachers rated the children's behaviour on the Conners Scale during the baseline period, after the 5 week Tai Chi session period and 2 weeks later. RESULTS: After the 10 Tai Chi sessions the adolescents displayed less anxiety, improved conduct, less daydreaming behaviours, less inappropriate emotions, and less hyperactivity. These improved scores persisted over the 2-week follow up (no Tai Chi period).

Abrams, S.M. (2000). Attention-deficit/hyperactivity disordered children and adolescents benefit from massage therapy. Dissertation Abstracts International- Section-B: The Sciences and Engineering, 60, 5218.

METHOD: The present study involved 30 children and adolescents between the ages of 7 and 18 (M = 13) diagnosed with attention-deficit/hyperactivity disorder (ADHD). The children were randomly assigned to a wait-list control and a massage group. The latter group received massage therapy for 20 minutes twice per week over the course of one month. RESULTS: Mood state improved for the massage but not the control group based on smiley face and thermometer scales. The massage group also improved in classroom behavior in the areas of the Conners Teacher Rating Scales on anxiety, daydreaming and hyperactivity. The wait-list control group did not show these gains. In sum, the results revealed that massage therapy benefited children and adolescents with ADHD by improving short-term mood state and longer-term classroom behavior.

Autism

Field, T., Lasko, D., Mundy, P., Henteleff, T., Talpins, S., & Dowling, M. (1986). Autistic children's attentiveness and responsitivity improved after touch therapy. Journal of Autism and Developmental Disorders, 27, 329-334.

METHOD: This study investigated the effects of touch therapy on three problems commonly associated with autism including inattentiveness (off-task behavior), touch aversion, and withdrawal. RESULTS: Results showed that touch aversion decreased in both the touch therapy and the touch control group, off task behavior decreased in both groups, orienting to irrelevant sounds decreased in both groups, but significantly more in the touch therapy group, and stereotypic behaviors decreased in both groups but significantly more in the touch therapy group.

Escalona, A., Field, T., Singer-Strunk, R., Cullen, C., & Hartshorn, K. (2001). Improvements in the behavior of children with autism. Journal of Autism and Developmental Disorders, 31, 513-516.

METHOD: Twenty children with autism ranging in age from 3 to 6 years were randomly assigned to massage therapy and reading attention control groups. Parents in the massage therapy group were trained by a massage therapist to massage their children for 15 minutes prior to bedtime every night for one month while the parents of the attention control group read Dr. Seuss stories to their children on the same time schedule. Conners Teacher and Parent scales, classroom and playground observations and sleep diaries were used to assess the effects of therapy on various behaviors including hyperactivity, stereotypical and off-task behavior, as well as sleep problems. RESULTS: Results suggested that the children in the massage group exhibited less stereotypic behavior and showed more on-task and social relatedness behavior during play observations at school, and they experienced fewer sleep problems at home.

Back Pain

Degan, M., Fabris, F., Vanin, F., Bevilacqua, M., Genova, V., Mazzucco, M. & Negrisolo, A. (2000). The effectiveness of foot reflexotherapy on chronic pain associated with a herniated disk. [Italian] Professioni Infermieristiche, 53, 80-7.

METHODS: A group of 40 persons suffering almost exclusively from a lumbar-sacral disc hernia received three treatments of reflexology massage for a week. RESULTS: 25 persons (62.5%) reported a reduction in pain, (rating at 0.75 on a scale of 0-4).

Hernandez-Reif, M., Field, T., Krasnegor, J., Theakston, H. & Burman, I. (2000). Chronic lower back pain is reduced and range of motion improved with massage therapy. International Journal of Neuroscience, 99, 1-15.

METHOD: A randomized between-groups design evaluated massage therapy versus relaxation for chronic low back pain. Treatment effects were evaluated for reducing pain, depression, anxiety and stress hormones, and sleeplessness and for improving trunk range of motion associated with chronic low back pain. RESULTS: By the end of the study, the massage therapy group, as compared to the relaxation group, reported experiencing less pain, depression, anxiety and improved sleep. They also showed improved trunk and pain flexion performance, and their serotonin and dopamine levels were higher.

Pope, M. H., Phillips, R. B., Haugh, L. D., Hsieh, C. Y., MacDonald, L., & Haldeman, S. (1994). A prospective randomized three-week trial of spinal manipulation, trans- cutaneous muscle stimulation, massage and corset in the treatment of subacute low back pain. Spine, 19, 2571-2577.

METHOD: A randomized prospective trial of manipulation, massage, corset and transcutaneous muscle stimulation (TMS) was conducted in patients with subacute low back pain. Patients were enrolled for a period of 3 weeks. They were evaluated once a week by questionnaires, visual analog scale, range of motion, maximum voluntary extension effort, straight leg raising and the Biering-Sorensen fatigue test. RESULTS: The dropout rate was highest in the muscle stimulation and corset groups and lowest in the manipulation group. Rates of full compliance did not differ significantly across treatments. A measure of patient confidence was greatest in the manipulation group. After 3 weeks, the manipulation group scored the greatest improvements in flexion and pain while the massage group had the best extension effort and fatigue time, and the muscle stimulation group the best extension. None of the changes in physical outcome measures (range of motion, fatigue, strength or pain) were significantly different between any of the groups.

Ernst, E. (1999). Massage therapy for low back pain: a systematic revierw [In Process Citation]. Journal of Pain Symptom Management, 17, 65-69.

Massage therapy is frequently employed for low back pain. The aim of this sytematic review was to find the evidence for or against its efficacy in this indication. Four random clinical trials were located in which massage was tested as a monotherapy for low back pain. All were burdened with major methodological flaws. One of these studies suggests that massage is superior to no treatment. Two trials imply that it is equally effective as spinal manipulation or transcutaneous electrical stimulation. One study suggests that it is less effective than spinal manipulation. It is concluded that too few trials of massage therapy exist for a reliable evaluation of its efficacy. Massage seems to have some potential as a therapy for low back pain.

Hernandez-Reif, M., Field, T., Krasnegor, J., & Theakston, H. (2001). Lower back pain is reduced and range of motion increased after massage therapy. International Journal of Neuroscience, 106, 131-145.

METHOD: A randomized between-groups design evaluated massage therapy versus relaxation for chronic low back pain. Treatment effects were evaluated for reducing pain, depression, anxiety and stress hormones, and sleeplessness and for improving trunk range of motion associated with chronic low back pain. Twenty-four adults (M age= 39.6 years) with low back pain of nocioceptive origin with a duration of at least 6 months participated in the study. The groups did not differ on age, socioeconomic status, ethnicity or gender. Twenty-four adults (12 women) with lower back pain were randomly assigned to a massage therapy or a progressive muscle relaxation group. Sessions were 30 minutes long twice a week for five weeks. On the first and last day of the 5-week study participants completed questionnaires, provided a urine sample and were assessed for range of motion. RESULTS: By the end of the study, the massage therapy group, as compared to the relaxation group, reported experiencing less pain, depression, anxiety and improved sleep. They also showed improved trunk and pain flexion performance, and serotonin and dopamine levels were higher.

McNamara, M.E., Burnham, D.C., Smith, C., & Carroll, D.L. (2003). The effects of back massage before diagnostic cardiac catheterization. Alternative Therapies, 9, 50-57.

METHOD: The purpose of this study was to measure the effects of a 20-minute back massage on the physiological and psychological human responses of patients admitted for a diagnostic cardiac catheterization. A randomized clinical trial design was used. Data were compared in a repeated measures design before massage, immediately following the back massage or standard care, and 10 minutes later. Forty-six subjects admitted from home for a diagnostic cardiac catheterization were included in the study. Heart rate, heart rate variability, blood pressure, respiration, peripheral skin temperature, pain perception, and psychological state were the main outcome measures. RESULTS: There was a significant difference between subject effect for group, with a reduction in systolic blood pressure in the treatment group. In addition, main effects were noted for time for diastolic blood pressure, respiration, total Profile of Mood States score and pain perception in both groups.

Behavior Problems

Escalona, A., Field, T., Cullen, C., Hartshorn, K., & Cruz, C. (In review). Behavior problem preschool children benefit from massage therapy. Early Child Development and Care.

METHOD: Twenty preschool children with behavior problems were randomly assigned to a massage group or a story reading attention control group. The sessions occurred for 15-minutes twice a week for a month. Pre and post session ratings were made on the first and last days of the study by teachers who were blind to the child’s group assignment. RESULTS: These revealed that the children in the massage therapy group: 1) were more drowsy, less active, less talkative and had lower anxiety levels after the sessions; and 2) were less anxious and more cooperative by the end of the study.

Blood Flow

Agarwal, K.N., Gupta, A., Pushkarna, R., Bhargava, S.K., Faridi, M.M., & Prabhu, M.K. (2000). Effects of massage & use of oil on growth, blood flow & sleep pattern in infants. Indian Journal of Medical Research, 112, 212-7.

METHODS: The present study was undertaken to investigate if massage with oils commonly used in the community for massage in infancy is beneficial. 125 full term healthy infants were randomly assigned to five groups: (i) herbal oil, (ii) sesame oil, (iii) mustard oil, or (iv) mineral oil for massage daily for 4 wk. The fifth group did not receive massage and served as control. RESULTS: Massage improved the weight, length, and midarm and midleg circumferences as compared to infants without massage. The femoral artery blood velocity, diameter and flow also improved as did their sleep.

Hovind, H., & Nielsen S.L. (1974). Effect of massage on blood flow in skeletal muscle. Scandinavian Journal of Rehabilitation Medicine, 6, 74-77.

METHOD: Skeletal muscle blood flow was measured before, during and after short application of different forms of massage using the local Xenon washout method for determination of blood flow. RESULTS: During maneuvers with tapotement (pounding) an increase in blood flow comparable to exercise hyperemia was observed, and this increase was ascribed to repetitive contractions. During and after petrissage (kneading) the tissue perfusion did not change significantly.

Shoemaker, J. K., Tidus, P. M., & Mader, R. (1997). Failure of manual massage to alter limb blood flow: Measures by Doppler ultrasound. Medicine and Science in Sports and Exercise 1, 610-14.

METHOD: The ability of manual massage to alter muscle blood flow through three types of massage treatments in a small (forearm) and a large (quadriceps) muscle mass was tested in 10 healthy individuals. A certified massage therapist administered effleurage, petrissage, and tapotement treatments to the forearm flexors (small muscle mass) and quadriceps (large muscle mass) muscle groups in a counterbalanced manner. Limb blood flow was determined from mean blood velocity (MBV) (pulsed Doppler) and vessel diameter (echo Doppler). MBV values were obtained from the continuous data sets prior to treatment, and at 5, 10, and 20 s and 5 min following the onset of massage, Arterial diameters were measured immediately prior to and following the massage treatments; these values were not different and were averaged for the blood flow calculations. RESULTS: The MBV and blood flows for brachial and femoral arteries, respectively, were not altered by any of the massage treatments in either the forearm or quadriceps muscle groups. Mild voluntary handgrip and knee extension contractions resulted in peak blood velocities and blood flow for brachial and femoral arteries, respectively, which were significantly elevated from rest. The results indicated that manual massage did not elevate muscle blood flow irrespective of massage type or the muscle mass receiving the treatment.

Blood Pressure

Kurosawa, M., Lundeberg, T., Agren, G., Lund, I., & Uvnas-Moberg, K. (1995). Massage-like stroking of the abdomen lowers blood pressure in anesthetized rats: influence of oxytocin. Journal of the Autonomic Nervous System, 56, 26-30.

METHOD: The aim of this study was to determine how massage-like stroking of the abdomen in rats influences arterial blood pressure. The participation of oxytocinergic mechanisms in this effect was also investigated. The ventral and/or lateral sides of the abdomen were stroked in pentobarbital anesthetized, artificially ventilated rats. Arterial blood pressure was recorded with a pressure transducer via catheter in the carotid artery. RESULTS: Stroking of the ventral or both ventral and lateral sides of the abdomen for 1 minute caused a marked decrease in arterial blood pressure (approx. 50 mmHg). After cessation of the stimulation blood pressure returned to the control level within 1 min. The maximum decrease in blood pressure was achieved at frequencies of 0.083 Hz or more. Stroking only the lateral sides of the abdomen elicited a significantly smaller decrease in blood pressure (approx. 30 mmHg decrease) than stroking the ventral side. The decrease in blood pressure caused by stroking was not altered by an oxytocin antagonist. In contrast, the administration of oxytocin diminished the effect, which was antagonized by a simultaneous injection of the oxytocin antagonist. These results indicate that the massage-like stroking of the abdomen decreases blood pressure in anesthetized rats. This effect does not involve intrinsic oxytocinergic transmission. However, since exogenously applied oxytocin was found to diminish the effect of stroking, oxytocin may exert an inhibitory modulatory effect on this reflex arc.

Breast Cancer

Hernandez-Reif, M., Ironson, G., Field, T., Katz, G., Diego, M., Weiss, S., Fletcher, M., Schanberg, S. & Kuhn, C. (In Review). Breast cancer patients have improved immune functions following massage therapy.

METHOD: Thirty-four women (M age= 53) diagnosed with Stage I or II breast cancer were randomly assigned post surgery to a massage therapy group (to receive 30-minute massages three times per week for 5 weeks) or a standard treatment control group. On the first and last day of the study, the women were assessed on 1) immediate effects measures of anxiety, depressed mood, and vigor, and 2) longer term effects on depression, anxiety and hostility, functioning, body image and avoidant versus intrusive coping style, in addition, to urinary catecholamines (norepinephrine, epinephrine, and dopamine), and serotonin levels. A subset of 27 women (n= 15 massage) had blood drawn to assay immune measures. The immediate massage therapy effects included reduced anxiety, depressed mood, and anger. The longer-term massage effects included reduced depression and hostility, increased urinary dopamine, serotonin values, natural killer cell number and lymphocytes. RESULTS: Avoidance coping was associated with greater NK cell number and intrusive coping with lower dopamine levels. Women with stage 1 and 2 breast cancer may benefit from thrice-weekly massage therapy for reducing depressed mood, anxiety and anger and for enhancing dopamine, serotonin and natural killer cell number and lymphocytes.

Breast Massage

Yokoyama, Y., Ueda, T., Irahara, M., & Aono, T. (1994). Releases of oxytocin and prolactin during breast massage and suckling in puerperal women. European Journal of Obstetrics, Gynecology & Reproductive Biology, 53, 17-20.

METHOD: The responses of prolactin and oxytocin to suckling and breast massage were examined in lactating women. RESULTS: The suckling group showed an increase in frequency of pulsatile release of oxytocin and an increase in the plasma prolactin level. In contrast, the breast massage group showed a significant, but not a pulsatile increase in the plasma oxytocin level and no increase in the plasma prolactin level. These findings suggest that suckling causes both milk production and milk ejection, while breast massage causes only ejection of milk already stored, and that prolactin release is not related to an increase of the oxytocin level itself, but to its pulsatile release.

Bulimia

Field, T., Schanberg, S., Kuhn, C., Field, T., Fierro, K., Henteleff, T., Mueller, C., Yando, R., Shaw, S. & Burman, I. (1998). Bulimic adolescents benefit from massage therapy. Adolescence, 33, 555-563.

METHOD: Twenty-four female adolescent bulimic inpatients were randomly assigned to a massage therapy or a standard treatment (control) group. RESULTS: The massaged patients showed immediate reductions in anxiety and depression (both self-report and behavior observation). In addition, by the last day of the therapy, they had lower depression scores, lower cortisol (stress) levels, higher dopamine levels, and showed improvement on several other psychological and behavioral measures.

Burn

Field, T., Peck, M., Krugman, S., Tuchel, T., Schanberg, S., Kuhn, C., & Burman, I. (1998). Burn injuries benefit from massage therapy. Journal of Burn Care and Rehabilitation, 19, 241-244.

METHOD: Twenty-eight adult patients with burns were randomly assigned before debridement to either a massage therapy group or a standard treatment control group. RESULTS: State anxiety and cortisol levels decreased, and behavior ratings of state, activity, vocalizations, and anxiety improved after the massage therapy sessions on the first and last days of treatment. Longer-term effects were also significantly greater for the massage therapy group including decreases in depression and anger, and decreased pain on the McGill Pain Questionnaire, Present Pain Intensity Scale, and Visual Analogue Scale. Although the underlying mechanisms are not known, these data suggest that debridement sessions were less painful after the massage therapy sessions due to a reduction in anxiety, and that the clinical course was probably enhanced as a result of a reduction in pain, anger, and depression.

Field, T., Peck, M., Hernandez-Reif, M., Krugman, S., Burman, I., & Ozment-Schenck, L. (2000). Postburn itching, pain, and psychological symptoms are reduced with massage therapy. Journal of Burn Care & Rehabilitation, 21, 189-93.

METHOD: Twenty patients with burn injuries were randomly assigned to a massage therapy or a standard treatment control group during the remodeling phase of wound healing. The massage therapy group received a 30-minute massage with cocoa butter to a closed, moderate-sized scar tissue area twice a week for 5 weeks. RESULTS: The massage therapy group reported reduced itching, pain, and anxiety and improved mood immediately after the first and last therapy sessions, and their ratings on these measures improved from the first day to the last day of the study.

Hernandez-Reif, M., Field, T., Largie, S., Hart, S., Redzepi, M., Nierenberg, B., & Peck, M. (2001). Childrens’ distress during burn treatment is reduced by massage therapy. Journal of Burn Care and Rehabilitation, 22, 191-195.

METHOD: Before dressing changes, 24 young children (mean age = 2.5 years) hospitalized for severe burns received standard dressing care or massage therapy in addition to standard dressing care. The massage therapy was conducted to body parts that were not burned. RESULTS: During the dressing change, the children who received massage therapy showed minimal distress behaviors and no increase in movement other than torso movement. In contrast, the children who did not receive massage therapy responded to the dressing change procedure with increased facial grimacing, torso movement, crying, leg movement and reaching out. Nurses also reported greater ease in completing the dressing change procedure for the children in the massage therapy group. These findings suggest that massage therapy attenuates young children's distress responses to aversive medical procedures and facilitates dressing changes.

Cancer

Stephenson, N.L., Weinrich, S.P., & Tavakoli, A.S. (2000). The effects of foot reflexology on anxiety and pain in patients with breast and lung cancer. Oncology Nursing Forum, 27, 67-72.

METHODS: To test the effects of foot reflexology on anxiety and pain in patients with breast and lung cancer. RESULTS: Following the foot reflexology intervention, patients with breast and lung cancer experienced a significant decrease in anxiety. One of three pain measures showed that patients with breast cancer experienced a significant decrease in pain.

Grealish, L., Lomasney, A., & Whiteman, B. (2000). Foot massage. A nursing intervention to modify the distressing symptoms of pain and nausea in patients hospitalized with cancer. Cancer Nursing, 23, 237-43.

METHODS: This article describes the findings of an empirical study on the use of foot massage as a nursing intervention in patients hospitalized with cancer. RESULTS: In a sample of 87 subjects, a 10-minute foot massage (5 minutes per foot) was found to have a significant immediate effect on the perceptions of pain, nausea, and relaxation when measured with a visual analog scale.

Ferrell-Torry, A. T. and Glick, O. J. (1973). The use of therapeutic massage as a nursing intervention to modify anxiety and the perception of cancer pain. Cancer Nursing,16, 93-101.

METHOD: The purpose of this exploratory study was to examine the effects of therapeutic massage (consisting of effleurage, petrissage, and myofascial trigger point therapy) on pain perception, anxiety, and relaxation levels in hospitalized patients experiencing significant cancer pain. Thirty minutes of therapeutic massage were administered on two consecutive evenings to nine hospitalized males diagnosed with cancer and experiencing cancer pain. The subjects' self-reports of pain and relaxation (measured by Visual Analogue Scales) as well as anxiety (measured by the Spielberger State Anxiety Inventory) were recorded before and immediately after the intervention. Heart rate, respiratory rate, and blood pressure were obtained before, immediately after and 10 minutes after the massage intervention. RESULTS: Massage therapy significantly reduced the subjects' level of pain perception (average = 60%) and anxiety (average = 24%) while enhancing their feelings of relaxation by an average of 58%. In addition to these subjective measures, all physiological measures (heart rate, respiratory rate, and blood pressure) tended to decrease from baseline, providing further indication of relaxation. In conclusion, although the exact mechanism is not known, therapeutic massage is a beneficial nursing intervention that promotes relaxation and alleviates the perception of pain and anxiety in hospitalized cancer patients.

Wilkie, D.J.; Kampbell, J.; Cutshall, S.; Halabisky, H.; Harmon, H.; Johnson, L.P.; Weinacht, L.; & Rake-Marona, M. (2000). Effects of massage on pain intensity, analgesics and quality of life in patients with cancer pain: A pilot study of a randomized clinical trial conducted within hospice care delivery. Hospice Journal, 15, 31-53.

METHOD: This randomized controlled clinical trial examined the effects of massage on perceived pain intensity (PI), prescribed intramuscular/ly (im) morphine equivalent doses (IMMSEQ), hospital admissions, and quality of life (QoL). Of 173 hospice patients with terminal cancer, 29 (aged 30-85 yrs) completed the 3-wk pilot study. 14 Ss (controls) were assigned to usual hospice care and 15 Ss were assigned to usual hospice care with massage interventions consisting of 4, twice-weekly massages. Baseline and outcome measurements were obtained before the 1st and after the 4th massages. RESULTS: PI, pulse rate, and respiratory rate were significantly reduced immediately after the massages. At study entry, the massage group reported higher PI which decreased by 42% compared to a 25% reduction in the control group. IMMSEQ doses were stable or decreased for 8 Ss in each group and increased for 8 massage and 6 control group Ss. One massage group and two control group Ss were hospitalized. All initial QoL scores were higher in the massage group than in the control group, but only current QoL was statistically significant. Both groups reported improved global QoL. The control group reported slight improvement in current QoL and satisfaction with QoL whereas these 2 aspects of QoL declined in the massage group.

Rexilius, S.J., Mundt, C., Erickson Megel, M., & Agrawal, S. (2002). Therapeutic effects of massage therapy and handling touch on caregivers of patients undergoing autologous hematopoietic stem cell transplant.
Oncology Nursing Forum, 29, E35-44.

METHOD: This study examined the effects of massage therapy and Healing Touch on anxiety, depression, subjective caregiver burden, and fatigue experienced by caregivers of patients undergoing autologous hematopoietic stem cell transplant. DESIGN: Quasi-experimental repeated measures. SETTING: Oncology/hematology outpatient clinic in a large midwestern city. SAMPLE: 36 caregivers: 13 in the control group, 13 in the massage therapy group, and 10 in the Healing Touch group. Average age was 51.5 years; most participants were Caucasian. All caregivers completed the Beck Anxiety Inventory, the Center for Epidemiologic Studies Depression Scale, the Subjective Burden Scale, and the Multidimensional Fatigue Inventory-20 before and after treatment consisting of two 30-minute massages or Healing Touch treatments per week for three weeks. Caregivers in the control group received usual nursing care and a 10-minute supportive visit from one of the researchers. RESULTS: Results showed significant declines in anxiety scores, depression, general fatigue, reduced motivation fatigue, and emotional fatigue for individuals in the massage therapy group only. In the Healing Touch group, anxiety and depression scores decreased, and fatigue and subjective burden increased, but these changes did not achieve statistical significance.

Cardiovascular

Boone, T., Tanner, M., & Radosevich, A. (2001). Effects of a 10-minute back rub on cardiovascular responses in healthy subjects. American Journal of Chinese Medicine. 29, 47-52

METHODS: This study determined the cardiovascular responses to a 10-minute back rub. Twelve healthy, college-age males and females volunteered to participate as subjects. The subjects were assessed for 10 minutes on a padded plinth lying on one side. During the treatment period, a back rub was administered. Oxygen consumption and cardiac output was determined. RESULTS: The central and peripheral components of oxygen consumption were changed and cardiac output decreased. These results indicate that the back rub was effective in inducing relaxation.

Boone, T. & Cooper, R. (1995). The effect of massage on oxygen consumption at rest. American Journal of Chinese Medicine, 23, 37-41.

METHOD: This study determined the effect of massage on oxygen consumption at rest. Ten healthy, adult males (mean age = 28 years) volunteered to serve as subjects. During the Control Session, each subject was placed in the supine position on a massage table to remain motionless for 30 minutes. During the Treatment Session, each subject received a 30-minute sports massage of the lower extremities. Oxygen consumption was determined via the Beckman Metabolic Measurement Cart, which was upgraded to estimate cardiac output using the CO2 rebreathing (equilibrium) method. RESULTS: The subjects' oxygen consumption did not change with the massage. Also, there were no significant differences in heart rate, stroke volume, cardiac output, and arteriovenous oxygen difference during the massage. These findings indicate that massaging the lower extremities results in neither an increase nor a decrease in the subjects' expenditure of energy at rest.

Lewis, P., Nichols, E., Mackey, G., Fadol, A., Sloane, L., Villagomez, E., & Liehr, P. (1997). The effect of turning and backrub on mixed venous oxygen saturation in critically ill patients. American Journal of Critical Care, 6, 132-140.

METHOD: A repeated-measures design was used to examine the effect of a change in body position (right or left lateral) and timing of backrub (immediate or delayed) on mixed venous oxygen saturation in 57 surgical ICU patients. Mixed venous oxygen saturation was recorded at 1-minute intervals for 5 minutes in each of three periods: baseline, after turning, and after backrub. Subjects were randomly assigned to body position and timing of backrub. Subjects in the immediate-backrub group were turned and given a 1-minute backrub. Mixed venous oxygen saturation was measured at 1-minute intervals for 5 minutes at two points: after the backrub and then with the patient lying on his side. For subjects in the delayed-backrub group, saturation was measured at 1-minute intervals for 5 minutes at two different points: after the subject was turned to his side and after the backrub. RESULTS: Both position and timing of backrub had significant effects on mixed venous oxygen saturation across conditions over time. Subjects positioned on their left side had a significantly greater decrease in saturation when the backrub was started. At the end of the backrub, saturation was significantly lower in subjects lying on their left side than in subjects lying on their right side. The pattern of change differed according to the timing of the backrub, and return to baseline levels of saturation after intervention differed according to body position. Two consecutive interventions (change in body position and backrub) caused a greater decrease in mixed venous oxygen saturation than the two interventions separated by a 5-minute equilibration period. Turning to the left side decreased oxygen saturation more than turning to the ride side did. Oxygen saturation returned to clinically acceptable ranges within 5 minutes of the intervention.

Delaney, J.P., Leong, K.S., Watkins, A., & Brodie, D. (2002). The short-term effects of myofascial trigger point massage therapy on cardiac autonomic tone in healthy subjects. Journal of Advanced Nursing, 37, 364-71.

METHOD: This study investigated the effects of myofascial trigger-point massage therapy to the head, neck and shoulder areas on cardiac autonomic tone.The study involved 30 healthy subjects (16 female and 14 male, aged 32.47 +/- 1.55 years, mean +/- standard error). A 5-minute cardiac interbeat interval recording, systolic and diastolic blood pressure and subjective self-evaluations of muscle tension and emotional state were taken before and after intervention. Autonomic function was measured using time and frequency domain analysis of heart rate variability. RESULTS: Following myofascial trigger-point massage therapy there was a significant decrease in heart rate (P < 0.01), systolic blood pressure (P=0.02) and diastolic blood pressure (P < 0.01). Analysis of heart rate variability revealed a significant increase in parasympathetic activity (P < 0.01) following myofascial trigger-point massage therapy. Additionally both muscle tension and emotional state, showed significant improvement (P < 0.01).

Carpal Tunnel Syndrome

Field, T., Diego, M., Cullen, C., Hartshorn, K., Gruskin, A., Hernandez-Reif, M., & Sunshine, W. (In Review). Carpal tunnel syndrome symptoms are lessened following massage therapy.

METHOD: The objective of this study was to determine the effectiveness of massage therapy for relieving the symptoms of Carpal Tunnel Syndrome (CTS). Sixteen adults with CTS symptoms were randomized to a 4-week massage therapy or control group. Participants in the massage therapy group were taught a self-massage routine that was done daily at home. They were also massaged once a week by a therapist. The participants’ diagnosis was based on a nerve conduction velocity test, the Phalen test, and the Tinel sign test performed by a physician. The participants were also given the State Trait Anxiety Inventory (STAI), the Profile of Mood States (POMS), a visual analog scale for pain and a test of grip strength. RESULTS: Participants in the massage therapy group improved on median peak latency and grip strength. They also experienced lower levels of perceived pain, anxiety, and depressed mood. The results suggest that symptoms of CTS might be relieved by a daily regimen of massage therapy.

Cerebral Circulation

Gusarova, S.A., Kuznetsov, O.F., Gorbunov, F.E., & Maslovskai, S.G. (1998). The characteristics of the effect of point and classical massage on the hemodynamics of patients with a history of transient ischemic attacks in the vertebrobasilar system. Vopr. Kurortol. Foizioter. Lech. Fiz. Kult., 5, 7-9.

METHOD: Clinical and instrumental studies have revealed differences in effects of nerve ending and classic massage on hemodynamics in 41 patients early after transitory ischemic attacks in the vertebrobasilar area. RESULTS: Point massage produced more potent vasotropic effect, contraindications to it are minimal. It can be considered as a pathogenetic therapy aimed at correction of cerebral circulation in patients with vertebrobasilar area applicable early after acute cerebrovascular episodes.

Cerebral Palsy

Hernandez-Reif, M., Field, T., Largie, S., Diego, M., Manigat, N., Seonanes, J., Bornstein, J. & Waldman, R. (In Review). Cerebral Palsy symptoms in children decreased following massage therapy. Journal of Early Intervention.

METHOD: Twenty young children (M age = 32 months) with Cerebral Palsy (CP) recruited from early intervention programs received 30-minutes of massage or reading twice weekly for 12 weeks. RESULTS: The children receiving massage therapy showed fewer physical symptoms including reduced spasticity, less rigid muscle tone overall and in the arms and improved fine and gross motor functioning. In addition, the massage group had improved cognition, social and dressing scores on the Developmental Profile and they showed more positive facial expressions and less limb activity during face-to-face play interactions. These findings suggest that massage therapy attenuates physical symptoms associated with CP, enhances development and should be considered as an early intervention for children with CP.

Chronic Fatigue Syndrome

Field, T, Sunshine, W., Hernandez-Reif, M., Quintino, O., Schanberg, S., Kuhn, C., & Burman, I. (1997). Chronic fatigue syndrome: massage therapy effects on depression and somatic symptoms in chronic fatigue syndrome. Journal of Chronic Fatigue Syndrome, 3, 43-51.

METHOD: Twenty chronic fatigue syndrome subjects were randomly assigned to a massage therapy or a SHAM TENS (transcutaneous electrical stimulation) control group. RESULTS: Immediately following the massage therapy versus SHAM TENS on the first and last days of the study the massage therapy group had lower depression and anxiety scores and lower cortisol levels. Longer-term effects (last day versus first day) suggested that the massage therapy versus the SHAM TENS group had lower depression, emotional distress and somatic symptom scores, more hours of sleep and lower epinephrine and cortisol levels.

Cocaine

Wheeden, A., Scafidi, F.A., Field, T., Ironson, G., Valdeon, C. & Bandstra, E. (1993). Massage effects on cocaine-exposed preterm neonates. Journal of Developmental and Behavioral Pediatrics, 14, 318-322.

METHOD: Thirty cocaine-exposed preterm neonates (mean gestational age 30 weeks, mean birth weight = 1212 g, mean intensive care unit duration = 18 days) were randomly assigned to a massage therapy or a control group as soon as they were considered medically stable. Group assignment was based on a random stratification of gestational age, birth weight, intensive care unit duration, and entry weight into the study. The treatment group (N=15) received massages for three 15-minute periods over 3 consecutive hours for a 10-day period. RESULTS: Findings suggested that the massaged infants (1) averaged 28% greater weight gain per day (33 vs 26 g) although the groups did not differ on intake (calories or volume), (2) showed significantly fewer postnatal complications and stress behaviors than the control infants, and (3) demonstrated more mature motor behaviors on the Brazelton examination at the end of the 10-day study period.

Cognition (Learning)

Cigales, M., Field, T., Lundy, B., Cuadra, A., Hart, S. (1997). Massage enhances recovery from habituation in normal infants. Infant Behavior and Development, 20, 29-34.

METHOD: Four-month-old infants were given either 8 minutes of massage, play, or no stimulation prior to an audiovisual habituation task. RESULTS: Infants who received massage showed response recovery from habituation during test trials, whereas those in the other two conditions did not.

Hart, S., Field, T., Hernandez-Reif, M., & Lundy, B. (1998). Preschoolers’cognitive performance improves following massage. Early Child Development & Care, 143, 59-64.

METHOD: Preschoolers (M age = 4 years, 4 months) were given WPPSI subtests, including Block Design, Animal Pegs and Mazes, before and after receiving a 15-minute massage or spending 15-minutes reading stories with an experimenter. RESULTS: Performance on the Block Design improved following massage and accuracy was greater on the Animal Pegs in the massage group.

Cystic Fibrosis

Hernandez-Reif, M., Field, T., Krasnegor, J., Martinez, E., Schwartzman, M. & Mavunda, K. (1999). Children with cystic fibrosis benefit from massage therapy. Journal of Pediatric Psychology, 24, 175-181.

METHOD: Parents massaged their children with cystic fibrosis to reduce anxiety and their children’s anxiety and to improve the children's mood and peak air flow readings. Twenty children (5-12 years old) with cystic fibrosis and their parents were randomly assigned to a massage therapy or a reading control group. Parents in the treatment group were instructed and asked to conduct a 20-minute child massage every night at bedtime for one month. Parents in the reading control group were instructed to read for 20 minutes a night with their child for one month. On days 1 and 30, the parents and children answered questions relating to present anxiety levels and the children answered questions relating to mood, and their peak air flow was measured. RESULTS: Following the first and last massage session, the children and parents reported reduced anxiety. Mood and peak air flow readings also improved for the children in the massage therapy group.

Dancers

Leivadi, S., Hernandez-Reif, M., Field, T., O'Rourke, M., D'Arienzo, S., Lewis, D., del Pino, N., Schanberg, S., Kuhn, C. (1999). Massage Therapy and Relaxation Effects on University Dance Students. Journal of Dance Medicine & Science, 3, 108-112.

METHOD: Thirty female university dancers were randomly assigned to a massage therapy or relaxation therapy group. The therapies consisted of 30-minute sessions twice a week for five weeks. RESULTS: Both groups reported less depressed mood and lowered anxiety levels. However, saliva cortisol (stress hormones) decreased only for the massage therapy group. Both groups reported less neck, shoulder, and back pain after the treatment sessions and reduced back pain across the study. However, only the massage therapy group showed increased range of motion across the study, including neck extension and shoulder abduction.

Data Review

Cox, T. (2003). A nurse-statistician reanalyzes data from the Rosa therapeutic touch study. Alternative Therapies, 9, 58-64.

This article presents a reanalysis of data used to support the work of Emily Rosa's Therapeutic Touch (TT) science fair project published as an article in the Journal of the American Medical Association (JAMA) in 1998. The purpose of this article is to take a closer look at the assumptions, data, statistical procedures, and conclusions of the JAMA article. This is accomplished by focusing on (1) the conclusion that there was no overall effect of TT, (2) the conclusion that TT practitioners did not perform better depending on which hand was used, and (3) the assumptions about the capability of Rosa's experiment to validate an existing skill. Reanalysis of the Rosa data suggests contradictions to the authors' conclusions. Based on the reanalysis, the authors' recomendations against the use of TT can and should be challenged because of inappropriate design and analysis as well as incorrect statistical assumptions and conclusions.

Field, T. (2002). Massage therapy. Medical Clinics of North America, 86, 163-171.

The author and other investigators have documented improvement in several medical and psychiatric conditions after massage therapy, including growth in preterm infants, depression and addictive problems, pain syndromes, and immune and autoimmune conditions. Although some potential underlying mechanisms have been explored for the massage therapy-improved clinical condition relationship, including decreased stress (and decreased cortisol), improved sleep patterns, and enhanced immune function. Further research is needed in this area.

Dental Pain

Ottoson, D., Ekblom, A., & Hansson, P. (1981). Vibratory stimulation for the relief of pain of dental origin. Pain ,10, 37-45.

METHOD: Vibratory stimulation was used for dental pain in 36 patients. The patients were from a clinic for dental surgery and all had suffered pain from pulpal inflammation, apoical periodontitis or postoperative pain following extraction of an impacted wisdom tooth for more than 2 days. Vibration at 100 Hz was applied to various points in the facial region or the skull. RESULTS: All patients except three experienced an effective reduction in pain intensity. In the patients who experienced pain reduction there was usually a best point at which vibration had a greater pain alleviating effect than at other points. At some points the stimulation added to the pain. In 16 patients the stimulation caused a reduction in pain intensity of 75-100%; out of these, 12 patients reported a complete relief of pain.

Depression

Onozawa, K., Glover, V., Adams, D., Modi, N., & Kumar, R.C. (2001). Infant massage improves mother-infant interaction for mothers with postnatal depression. Journal of Affective Disorders, 63(1-3).

METHOD: Thirty-four primiparous depressed mothers at 4 weeks postpartum were randomly assigned either to an infant massage class and a support group (massage group) or to a support group (control group). Each group attended five weekly sessions. RESULTS: The depression scores fell in both groups. However, improvement of mother-infant interactions was seen only in the massage group.

Field, T., Morrow, C., Valdeon, C., Larson, S., Kuhn, C., & Schanberg, S.(1992). Massage reduces anxiety in child and adolescent psychiatric patients. Journal of the American Academy of Child & Adolescent Psychiatry, 31, 125-131.

METHOD: A 30-minute back massage was given daily for a 5-day period to 52 hospitalized depressed and adjustment disorder children and adolescents. RESULTS: Compared with a control group who viewed relaxing videotapes, the massaged subjects were less depressed and anxious and had lower saliva cortisol levels after the massage. In addition, nurses rated the subjects as being less anxious and more cooperative on the last day of the study, and nighttime sleep increased over this period. Finally, urinary cortisol and norepinephrine levels decreased, but only for the depressed subjects.

Field, T., Grizzle, N., Scafidi, F., & Schanberg, S. (1996). Massage and relaxation therapies' effects on depressed adolescent mothers. Adolescence, 31, 903-911.

METHOD: Thirty-two depressed adolescent mothers received ten 30-minute sessions of massage therapy or relaxation therapy over a five-week period. Subjects were randomly assigned to each group. RESULTS: Although both groups reported lower anxiety following their first and last therapy sessions, only the massage therapy group showed behavioral and stress hormone changes including a decrease in anxious behavior, pulse, and salivary cortisol levels. A decrease in urine cortisol levels suggested lower stress following the five-week period for the massage therapy group.

Dermatitis

Anderson, C., Lis-Balchin, M., & Kirk-Smith, M. (2000). Evaluation of massage with essential oils on childhood atopic eczema. Phytotherapy Research, 14, 452-6.

METHODS: Eight children, born to professional working mothers were studied to test the hypothesis that massage with essential oils (aromatherapy) used as a complementary therapy in conjunction with normal medical treatment, would help alleviate the symptoms of childhood atopic eczema. The children were randomly assigned to a massage and a massage with essential oils group. They received massage once a week by a therapist and every day by the mother over a period of 8 weeks. The preferred essential oils, chosen by the mothers for their child, from 36 commonly used aromatherapy oils, were: sweet marjoram, frankinsence, German chamomile, myrrh, thyme, benzoin, spike lavender and Litsea cubeba. The treatments were evaluated by means of daily day time irritation scores and night time disturbance scores, determined by the mother before and during the treatment, both over an 8 week period. RESULTS: The results showed a significant improvement in the eczema in the two groups of children following therapy, but there was no significant difference in improvement shown between the aromatherapy massage and massage only group. Further studies on the essential oil massage group showed a deterioration in the eczematous condition after two further 8 week periods of therapy, following a period of rest after the initial period of contact. This may have been due to a decline in the novelty of the treatment, or, it strongly suggests possible allergic contact dermatitis provoked by the essential oils themselves.

Schachner, L., Field, T., Hernandez-Reif, M., Duarte, A. & Krasnegor, J. (1998). Atopic dermatitis symptoms decreased in children following massage therapy. Pediatric Dermatology, 15, 390-395.

METHOD: Young children with atopic dermatitis were treated with standard topical care and massage by their parents for 20 minutes daily for a 1 month period. A control group received standard topical care only. RESULTS: The children's affect and activity level significantly improved, and their parents' anxiety decreased immediately after the massage therapy sessions. Over the 1 month period, the parents of the massaged children reported lower anxiety levels in their children, and the children improved significantly on all clinical measures including redness, scaling, lichenification, excoriation, and pruritus. The control group only improved significantly on the scaling measure.

Diabetes

Field, T., Hernandez-Reif, M., LaGreca A., Shaw, K., Schanberg, S., & Kuhn, C. (1997). Massage therapy lowers blood glucose levels in children with Diabetes Mellitus. Diabetes Spectrum ,10, 237-239.

METHOD: Twenty diabetic children were randomly assigned to a touch therapy or relaxation therapy group. The children's parents were taught one or the other therapy and were asked to provide them for 20 minutes before bedtime each night for 30 days. RESULTS: The immediate effects of the touch therapy were reduced parent anxiety and depressed mood and reduced child anxiety, fidgetiness and depressed affect. Over the 30 day period compliance on insulin and food regulation improved and blood glucose levels decreased from 159 to within the normal range (121).

Down Syndrome

Hernandez-Reif, M., Field, T., Bornstein, J. & Fewell, R. (In Review). Children with Down Syndrome improved in motor function and muscle tone following massage therapy. Journal of Early Intervention.

METHOD: Twenty-one moderate to high functioning young children (M age = 2 years) with Down syndrome receiving early intervention (PT, OT and speech therapy) were randomly assigned to also receive two ½-hour massage therapy or reading sessions (control group) per week for two months. On the first and last day of the study, the children were assessed on functioning using the Developmental Programming for Infants and Young Children Scale and muscle tone using a new Likert scale. RESULTS: Children in the massage therapy group experienced developmental gains in fine and gross motor functioning and showed less severe hypotonicity in their limbs. These findings suggest that the addition of massage therapy to an early intervention program may enhance motor and muscle functioning for children with Down syndrome.

Drugs

Ciccone, C. D. (1995). Basic pharmacokinetics and the potential effect of physical therapy interventions on pharmacokinetic variables. Physical Therapy, 75, 343-351.

Pharmacokinetics involves the factors that influence drug absorption, distribution, and elimination. Pharmacokinetic variables determine how a specific dose of a drug will eventually reach target tissues and exert a response. Various factors can influence normal pharmacokinetics, including exercise, application of physical agents, and massage. These interventions produce hemodynamic and other physiologic changes that can potentially alter drug disposition within the body. The magnitude and specific type of pharmacokinetic changes, however, are highly variable depending on the specific intervention and the drug in question. Physical therapy interventions seem to have the greatest potential to affect absorption and distribution of drugs that are administered by transdermal techniques or by subcutaneous and intramuscular injections. Research is needed to determine exactly how physical therapy interventions can affect the pharmacokinetics of various medications, and how the clinical effects of these medications are affected by altered drug disposition.

EEG

Field, T., Ironson, G., Scafidi, F., Nawrocki, T., Gonclaves, A., Burman, I., Pickens, J., Fox, N., Schanberg, S., & Kuhn, C. (1996). Massage therapy reduces anxiety and enhances EEG pattern of alertness and math computations. International Journal of Neuroscience, 86, 197-205.

METHOD: Twenty-six adults were given a chair massage and 24 control group adults were asked to relax in the massage chair for 15 minutes, two times per week for five weeks. On the first and last days of the study they were monitored for EEG before, during and after the sessions. In addition, before and after the sessions they performed math computations, they completed POMS Depression and State Anxiety Scales and they provided a saliva sample for cortisol. At the beginning of the sessions they completed Life Events, Job Stress and Chronic POMS Depression Scales. RESULTS: The results were as follows: 1) frontal delta power increased for both groups, suggesting relaxation; 2) the massage group showed decreased frontal alpha and beta power (suggesting enhanced alertness); while the control group showed increased alpha and beta power; 3) the massage group showed increased speed and accuracy on math computations while the control group did not change; 4) anxiety levels were lower following the massage but not the control sessions, although mood state was less depressed following both the massage and control sessions; 5) salivary cortisol levels were lower following the massage but not the control sessions but only on the first day; and 6) at the end of the 5 week period depression scores were lower for both groups but job stress scores were lower only for the massage group.

Elderly

Fraser, J. & J. R. Psychophysiological effects of back massage on elderly institutionalized patients. Journal of Advanced Nursing ,18, 238-245. 2-1993.

METHOD: Back massage was provided for elderly residents in a long-term care institution. Twenty-one residents were randomly assigned to three groups that received "back massage with normal conversation", "conversation only" or "no intervention". Anxiety was measured prior to back massage, immediately following, and 10 minutes later, on four consecutive evenings. The Spielberger State Anxiety Inventory (STAI), electromyographic recordings (EMG), systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were used as measures of anxiety. RESULTS: With the exception of mean DBP which showed no change from pre-test to post-test and HR which increased from post-test to a delayed time interval, there was a statistically insignificant decrease in mean scores on all variables in the back massage group from pre-test to post-test and from post-test to the delayed time interval. The anxiety (STAI) score decrease was significantly greater for the back massage group versus the no intervention group.

Field, T., Hernandez-Reif, M., Quintino, O., Schanberg, S. & Kuhn, C. (1998). Elder retired volunteers benefit from giving massage therapy to infants. Journal of Applied Gerontology, 17, 229-239.

METHOD: This exploratory within-subjects study compared the effects of elder volunteers giving massage to infants versus receiving massage themselves. Three times a week for 3 weeks, 10 elder volunteers received Swedish massage sessions. For another 3 weeks, three times per week, the same elderly volunteers massaged infants at a nursery school. Receiving massage first versus giving massage first was counterbalanced across subjects. RESULTS: Immediately after the first-and last-day sessions of giving massages, the elder retired volunteers had less anxiety and depression and lower stress hormone (salivary cortisol) levels. Over the 3-week period, depression and catecholamines (norepinephrine and epinephrine) decreased and lifestyle and health improved. These effects were not as strong for the 3-week period when they received massage, possibly because the elder retired volunteers initially felt awkward about being massaged and because they derived more satisfaction from massaging the infants.

Hartshorn, K., Delage, J., Field, T., & Olds, L. (2001). Senior citizens benefit from movement therapy. Journal of Bodywork and Movement Therapies, 5, 1-5.

METHOD: Sixteen senior citizens participated in four, 50-minute movement therapy sessions over a 2-week period and were compared to 16 senior citizens who belonged to a wait list control group who received the movement sessions only after the end of the study. RESULTS: The movement therapy participants improved in their functional motion on the Tinetti scale, and specifically on the gait scale, their leg strength increased, and their leg pain significantly decreased.

Endorphins

Day, J. A., Mason, R. R., & Chesrown, S. E. (1987). Effect of massage on serum level of beta-endorphin and beta-lipotropin in healthy adults. Physical Therapy ,67, 926-930.

METHOD: The effect of massage was evaluated on the levels of endogenous opiates in peripheral venous blood. The results were based on findings from 21 healthy, adult volunteers. The volunteers were assigned randomly to either the Control Group (n = 11) that rested but received no massage or the Experimental Group (n = 10) that received a 30-minute complete back massage. RESULTS: No significant pretreatment or posttreatment difference was found in blood beta-endorphin or beta-lipotropin levels between the groups. The results indicate that massage did not change the measured serum levels of beta-endorphin or beta-lipotropin in these healthy subjects without pain. A follow-up study using patients experiencing acute or chronic back pain is recommended. Massage is used routinely in the treatment of such patients, and endogenous opiates are recognized as a possible mechanism for pain relief

Exercise

Rodenburg, J. B., Steenbeek, D., Schiereck, P., & Bar, P. R. (1994). Warm-up, stretching and massage diminish harmful effects of eccentric exercise. International Journal of Sports Medicine. 15, 414-419.

METHOD: The combination of a warm-up, stretching exercises and massage were assessed for their effects on subjective scores for delayed onset muscle soreness (DOMS) and functional and biochemical measures. Fifty people, randomly assigned to a treatment and a control group, exercised with the forearm flexors for 30 min. The treatment group also performed a warm-up and stretching protocol followed by forearm exercise and massage. Functional and biochemical measures were obtained before, and 1, 24, 48, 72 and 96 hours after exercise. RESULTS: The median values at the five post-exercise time points differed significantly for DOMS measured when the arm was extended. Significant effects for treatment were found on the maximal force, the flexion angle of the elbow and the creatine kinase activity in blood. DOMS on pressure, extension angle, and myoglobin concentration in blood did not differ between the groups. This combination of a warm-up, stretching and massage reduced some negative effects of forearm exercise, but the results were inconsistent, since some parameters were affected by the treatment whereas others were not, despite the expected efficacy of a combination of treatments.

Extremities

Wakim, K. G., Martin, G. M., Terrier, J. C., Elkins, E. C., and Krusen, F. H. (1949).The effects of massage on the circulation in normal and paralyzed extemities. Archives of Physical Medicine, 30, 135-144.

METHOD: The effects of vigorous, stimulating massage and of a modified Hoffa type of deep stroking and kneading massage on the peripheral circulation in normal and diseased extremities were studied by means of the venous occlusion plethysmograph with the compensating spirometer recorder. RESULTS: The data obtained justify the following conclusions: 1. There is no consistent or significant average increase in total blood flow after deep stroking and kneading massage of the extremities, in normal subjects, in those with rheumatoid arthiritis or in those with spastic paralysis of the extremities. 2. There is a moderate, consistent and definite increase in ciculation after deep stroking and kneading massage to the extremities of subjects who have flaccid paralysis. 3. Vigorous, stimulating massage results in consistent and significant increases in the average blood flow of the massaged extremity. 4. Neither deep stroking and kneading massage nor vigorous, stimulating massage of the extremties results in consistent or significant changes in the blood flow of the contralateral unmassaged extremities.

Facial Massage

Yamada, Y., Hatayama, T., Hirata, T., Maruyama, K., et al.(1986). A psychological effect of facial estherapy. Tohoku Psychologica Folia, 45, 6-16.

METHOD: Changes in emotion, level of arousal, and facial skin state were assessed in 24 female undergraduates by the use of 3 types of checklists. RESULTS: Two adjective checklists indicated that on items of both general deactivation and deactivation-sleep factors, many subjective rating scores were heightened after the facial esthetic massage and most subjects in the experimental group showed that the subjective state of their faces was much improved.

Fibromyalgia

Offenbacher, M. & Stucki, G. (2000). Physical therapy in the treatment of fibromyalgia. Scandinavian Journal of Rheumatology - Supplement, 113, 78-85.

METHODS: Fibromyalgia (FM) is a syndrome of unknown etiology characterized by chronic wide spread pain, increased tenderness to palpation and additional symptoms such as disturbed sleep, stiffness, fatigue and psychological distress. While medication mainly focus on pain reduction, physical therapy is aimed at disease consequences such as pain, fatigue, deconditioning, muscle weakness and sleep disturbances and other disease consequences. Based on a review of current treatment options in the treatment of fibromyalgia and evidence from randomized controlled trials, cardiovascular fitness training improves cardiovascular fitness, measures of pain as well as subjective energy and work capacity and physical and social activities. Based on anecdotal evidence or small observational studies, physiotherapy may reduce overloading of the muscle system, improve postural fatigue and positioning, and condition weak muscles. Modalities and whole body cryotherapy may reduce localized as well as generalized pain in the short term. Trigger point injection may reduce pain originating from concomitant trigger points in some FM patients. Massage may reduce muscle tension and may be prescribed as a adjunct with other therapeutic interventions. Acupuncture may reduce pain and increase pain threshold. Biofeedback may positively influence subjective and objective disease measures. TENS may reduce localized musculoskeletal pain in fibromyalgia.

Sunshine, W., Field, T., Schanberg, S., Quintino, O., Kilmer, T., Fierro, K., Burman, I., Hashimoto, M., McBride, C., & Henteleff, T. (1996). Massage therapy and transcutaneous electrical stimulation effects on fibromyalgia. Journal of Clinical Rheumatology, 2, 18-22.

METHOD: Thirty adult fibromyalgia syndrome subjects were randomly assigned to a massage therapy, a transcutaneous electrical stimulation (TENS), or a transcutaneous electrical