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 stimulation no-current group (Sham TENS) for 30-minute treatment sessions two times per week for 5 weeks. RESULTS: The massage therapy subjects reported lower anxiety and depression, and their cortisol levels were lower immediately after the therapy sessions on the first and last days of the study. The TENS group showed similar changes, but only after therapy on the last day of the study. The massage therapy group improved on the dolorimeter measure of pain. They also reported less pain the last week, less stiffness and fatigue, and fewer nights of difficult sleeping. Thus, massage therapy was the most effective therapy with these fibromyalgia patients.

Waylonis, G. W. and Perkins, R. H. (1994). Post-traumatic fibromyalgia. A long-term follow-up. American Journal of Physical Medicine & Rehabilitation, 73, 403-412.

METHOD: This report describes a follow-up study of 176 individuals seen between 1980 and 1990, in whom a diagnosis of post-traumatic fibromyalgia was made. Sixty-seven people completed a lengthy questionnaire and underwent a confirmatory physical examination using the American College of Rheumatology Criteria to confirm or deny the presence of fibromyalgia at the time of follow-up. A total of 60.7% noted the onset of symptoms after a motor vehicle accident, 12.5% after a work injury, 7.1% after surgery, 5.4% after a sports-related injury and 14.3% after other various traumatic events. Fifty-six of 67 individuals had 11 or more tenderpoints (average, 13.5), 3 had 10 tenderpoints, and 7 had fewer than 10 or no tenderpoints. Study subjects were asked to compare the use of the following for the first 2 yr after onset as well as the year preceding the current evaluation: biofeedback, medications, physical therapy, manipulation, massage therapy and tenderpoint injections. In addition, we asked detailed questions regarding symptoms commonly seen in association with fibromyalgia (fatigue, sleep disturbance, etc.). Symptoms of traumatically induced fibromyalgia are quite similar to spontaneous fibromyalgia. RESULTS: There was a dramatic reduction in the use of all forms of physical treatments. Fifty-four percent continued to use over-the-counter pain medications, and 39% were on antidepressants. Eighty-five percent of the patients continued to have significant symptoms and clinical evidence of fibromyalgia.

Field, T., Diego, M., Cullen, C., Hernandez-Reif, M., & Sunshine, W. (2002). Fibromyalgia pain and substance P decreases and sleep improves following massage therapy. Journal of Clinical Rheumatology.

METHOD: To determine the effects of massage therapy versus relaxation therapy on sleep, substance P and pain in fibromyalgia patients, twenty four adult fibromyalgia patients were randomly assigned to a massage therapy or relaxation therapy group. They received 30-minute treatments twice a week for five weeks. RESULTS: Both groups showed a decrease in anxiety and depressed mood immediately after the first and last therapy sessions. However, across the course of the study only the massage therapy group reported an increase in the number of sleep hours and a decrease in their sleep movements. In addition, substance P levels decreased and the patients' physicians assigned lower disease and pain ratings and rated fewer tenderpoints in the massage therapy group.

Genetics

Schanberg, S. (1995). Genetic basis for touch effects. T. Field (Ed.). Touch in Early Development. Hillsdale: Lawrence Erlbaum Associates, Inc.

Data from the rat model suggests that a gene for growth needs to be triggered by touch for growth to occur.

Growth

Pauk, J., Kuhn, C., Field, T., & Schanberg, S. (1986). Positive effects of tactile versus kinesthetic or vestibular stimulation on neuroendocrine and ODC activity in maternally deprived rat pups. Life Science, 39, 2081-2087

METHOD: Previous studies in our laboratory have shown that even short-term separation of preweanling rat pups from the mother produces adverse effects in the pup. These include alterations in ornithine decarboxylase activity and in the secretion of growth hormone and corticosterone. The present study demonstrates that while intermittent heavy stroking effectively reverses or prevents all the changes associated with maternal deprivation neither kinesthetic nor vestibular stimulation affects these responses. RESULTS: The results verify earlier findings from this laboratory indicating that tactile interactions between rate pups and their mother modulate pup physiology and provide experimental support for the hypothesized role of tactile stimuli on early infant development.

H-Reflex

Morelli, M, Seaborne, D. E., & Sullivan S.J. (1991). H-reflex modulation during manual muscle massage of human triceps surae. Archives of Physical Medicine & Rehabilitation, 72, 915-919.

METHOD: The effect of a six-minute manual muscle massage on the excitability of the spinal reflex pathway was assessed in 20 subjects. H-reflex recordings were obtained from the right soleus muscle, which was the site being massaged. Skin temperature and antagonist activity were monitored. An A-B-A interrupted-time series design was used consisting of two pretreatment, two treatment (massage), and two posttreatment conditions. RESULTS: H-reflex amplitudes recorded during both massage conditions were significantly reduced in comparison to all other (before and after) conditions. This decrease could not be explained conclusively by changes in skin temperature, nerve conduction velocity, or antagonist recruitment, thus indicating a decrease in spinal reflex excitability attributable to massage.

Sullivan, S. J., Williams, L., Seaborne, D. E., & Morelli, M. (1991). Effects of massage on alpha motoneuron excitability. Physical Therapy ,71, 555-560.

METHOD: The purpose of this study was to investigate the specificity of the effects of massage (petrissage) on spinal motoneuron excitability as measured by changes in the peak-to-peak amplitude of H-reflex recordings. H-reflexes (and M-responses) were recorded from the distal aspects of the right triceps surae muscle of 8 men and 8 women, aged 20 to 37 years, with no neuromuscular impairments of the lower extremities. The H-reflexes were recorded during five control and four experimental conditions (20 trials at each condition). The control conditions preceded and followed each experimental condition, providing a measure of the stability of the H-reflex. Each experimental condition consisted of a 4-minute period of massage of the ipsilateral and contralateral triceps surae and hamstring muscle groups. RESULTS: The mean peak-to-peak amplitude of the H-reflex was found to be stable across the five control conditions. H-reflex amplitudes recorded during the experimental conditions indicate that massage of the ipsilateral triceps surae resulted in a reduction of the H-reflex in comparison with the pretest control condition and the remaining experimental conditions. Subsequent analyses indicated a specificity of the effects of massage on the muscle group being massaged.

Headache

Hernandez-Reif, M., Field, T., Dieter, J., Swerdlow. & Diego, M., (1998). Migraine Headaches are Reduced by Massage Therapy. International Journal of Neuroscience, 96, 1-11.

METHOD: Twenty-six adults with migraine headaches were randomly assigned to a massage therapy group, which received twice-weekly 30-minute massages for five consecutive weeks or a wait-list control group. RESULTS: The massage group reported fewer distress symptoms, less pain, more headache free days, fewer sleep disturbances and taking fewer analgesics. They also showed increased serotonin levels.

Quinn, C., Chandler, C., & Moraska, A. (2002). Massage therapy and frequency of chronic tension headaches. American Journal of Public Health, 92, 1657-1661.

METHOD: Examined the effects of massage therapy on chronic, nonmigraine headache. Four chronic tension headache sufferers (aged 18-55 yrs) received structured massage therapy treatment directed toward the neck and shoulder muscles during a 4-wk period. Collected data included headache frequency, duration, and intensity prior to and during the treatment period. RESULTS: Massage therapy was effective in reducing the number of weekly headaches. Headache frequency was significantly reduced within the initial week of massage treatment, and continued for the remainder of the study. A trend toward reduction in average duration of each headache event between the baseline period and the treatment period was also observed. Headache intensity was unaffected by massage treatment. It is concluded that the muscle-specific massage therapy used in this study has the potential to be a functional, nonpharmacological intervention for reducing the incidence of chronic tension headache.

HIV

Scafidi, F. & Field, T. (1996). Massage therapy improves behavior in neonates born to HIV positive mothers. Journal of Pediatric Psychology, 21, 889-898.

METHOD: Neonates born to HIV-positive mothers were randomly assigned to a massage therapy or control group. The treatment infants were given three 15-minute massages daily for 10 days. RESULTS: The massaged group showed superior performance on almost every Brazelton newborn cluster score and had a greater daily weight gain at the end of the treatment period unlike the control group who showed declining performance.

Ironson, G., Field, T., Scafidi, F., Hashimoto, M., Kumar, M., Kumar, A., Price, A., Goncalves, A., Burman, I., Tetenman, C., Patarca, R., & Fletcher, M. A. (1996). Massage therapy is associated with enhancement of the immune system's cytotoxic capacity. International Journal of Neuroscience, 84, 205-217.

METHOD: Twenty-nine gay men (20 HIV+, 9 HIV-) received daily massages for one month. A subset of 11 of the HIV+ subjects served as a within subjects control group (one month with and without massages). RESULTS: Major immune findings for the effects of the month of massage included a significant increase in Natural Killer Cell number, Natural Killer Cell Cytotoxicity, soluble CD8, and the cytotoxic subset of CD8 cells. No changes occurred in HIV disease progression markers (CD4, CD4/CD8 ratio, Beta-2 microglobulin, neopterin). Major neuroendocrine findings, measured via 24 hour urines included a significant decrease in cortisol, and nonsignificant trends toward decreased catecholamines. Decreased anxiety and increased relaxation were significantly correlated with increased NK cell number.

HIV in Adolescents

Diego, M.A., Hernandez-Reif, M., Field, T., Friedman, L. & Shaw, K. (2001). HIV adolescents show improved immune function following massage therapy. International Journal of Neuroscience, 106, 35-45.

METHOD: HIV+ adolescents (M CD4= 466mm3) recruited from a large urban university hospital’s outpatient clinic were randomly assigned to receive massage therapy (n= 12) or progressive muscle relaxation (n= 12) two-times per week for 12 weeks. To assess treatment effects, participants were assessed for depression, anxiety and immune changes before and after the 12 week treatment period. Adolescents who received massage therapy versus those who experienced relaxation therapy reported feeling less anxious and they were less depressed and showed enhanced immune function by the end of the 12 week study. Immune changes included increased Natural Killer cell number (CD56) and CD56 = CD3-. In addition, the HIV disease progression markers CD4/CD8 ratio and CD4 number showed an increase for the massage therapy group only.

Hospice

Meek, S. S. (1993).Effects of slow stroke back massage on relaxation in hospice clients. Journal of Nursing Scholarship, 25, 17-21.

METHOD: Slow stroke back massage was provided for 30 hospice patients. RESULTS: The massage was associated with decreases in systolic BP, diastolic BP, and heart rate and with an increase in skin temperature.

Hospitalized Patients

Smith, M.C., Stallings, M.A., Mariner, S., & Burrall, M. (1999). Benefits of massage therapy for hospitalized patients: a descriptive and qualititative evaluation. Alternative Therapies in Health & Medicine, 5, 64-71.

METHOD: The objective of this study was to uncover and elucidate a range of patient outcomes of a therapeutic massage program within an acute care setting. One hundred thirteen patients received 1 to 4 massages during the course of their hospital stay. RESULTS: The most frequently identified outcomes were increased relaxation (98%), a sense of well-being (93%), and positive mood change (88%). More than two thirds of patients attributed enhanced mobility, greater energy, increased participation in treatment, and faster recovery to massage therapy. Thirty-five percent stated that benefits lasted more than 1 day.

Hypertension

Hernandez-Reif, M., Field, T., Krasnegor, J., Theakston, H., Hossain, Z., & Burman, I. (2000). High blood pressure and associated symptoms were reduced by massage therapy. Journal of Bodywork and Movement Therapies, 4, 31-38.

METHOD: High blood pressure is associated with elevated anxiety, stress and stress hormones, hostility, depression and catecholamines. Massage therapy and progressive muscle relaxation were evaluated as treatments for reducing blood pressure and associated symptoms. Adults who had been diagnosed as hypertensive received ten 30-minute massage sessions over five weeks or they were given progressive muscle relaxation instructions (control group). RESULTS: Sitting diastolic blood pressure decreased after the first and last massage therapy sessions and reclining diastolic blood pressure decreased from the first to the last day of the study. Although both groups reported less anxiety, only the massage therapy group reported less depression and hostility and showed decreased urinary and salivary hormone levels (cortisol). Massage therapy may be effective in reducing diastolic blood pressure and symptoms associated with hypertension.

Immunology

Ironson, G., Field, T., Scafidi, F., Hashimoto, M., Kumar, M., Kumar, A., Price, A., Goncalves, A., Burman, I., Tetenman, C., Patarca, R., and Fletcher, M. A. (1996). Massage therapy is associated with enhancement of the immune system's cytotoxic capacity. International Journal of Neuroscience, 84, 205-217.

METHOD: Twenty-nine gay men (20 HIV+, 9 HIV-) received daily massages for one month. A subset of 11 of the HIV+ subjects served as a within subject control group (one month with and without massages). RESULTS: Major immune findings for the effects of the month of massage included a significant increase in Natural Killer Cell number, Natural Killer Cell Cytotoxicity, soluble CD8, and the cytotoxic subset of CD8 cells. There were no changes in HIV disease progression markers (CD4, CD4/CD8 ratio, Beta-2 microglobulin, neopterin). Major neuroendocrine findings, measured via 24 hour urines included a significant decrease in cortisol, and nonsignificant trends toward decrease of catecholamines. There were also significant decreases in anxiety and increases in relaxation which were significantly correlated with increases in NK cell number. Thus, there appears to be an increase in cytotoxic capacity associated with massage. Implications for HIV+ men as those with other illnesses, particularly cancer, are discussed.

Zeitlin, D.; Keller, S.E; Shiflett, S.C; Schleifer, S.J; Bartlett, J.A. Immunological effects of massage therapy during acute academic stress. Psychosomatic Medicine, 62, 83-84.

METHOD: Examined the immunological effects of massage therapy as a stress-reduction intervention in 9 medically-healthy female medical students (aged 21-25 yrs). Ss received a 1-hr full body massage 1 day before an anxiety-provoking academic examination. Blood samples, self-report data (the State component of the State-Trait Anxiety Inventory and a visual analogue scale of perceived stress), and vital signs (respiratory rate, BP, pulse, and temperature) were obtained immediately prior to and after the message. Cell phenotypes of the major cells of the immune system, natural killer cell activity (NKCA), and mitogen-induced lymphocyte stimulation were assessed by standard techniques. RESULTS: A significant decrease in respiratory rate occurred from pre- to post-massage. Mean anxiety scores decreased from 52.8 to 26.7 and mean scores on the visual analogue scale decreased from 75.6 to 34.6 from pre- to post-massage. No significant pre- to post-massage lymphocyte responses to mitogens were found, but a significant increase in NKCA occurred post-massage. NKCA correlated negatively with both perceived stress and anxiety. Results suggest that massage reduces subjective and somatic signs of anxiety and that massage may have health benefits beyond and unrelated to its stress-reduction potential.

Infants

Field, T., Grizzle, N., Scafidi, F., Abrams, S., & Richardson, S. (1996). Massage therapy for infants of depressed mothers. Infant Behavior and Development 19, 109-114.

METHOD: Forty full-term 1- to 3-month-old infants born to depressed adolescent mothers who were low socieconomic status (SES) and single parents were given 15 minutes of either massage or rocking for 2 days per week for a 6-week period. RESULTS: The infants who experienced massage therapy compared to infants in the rocking control group spent more time in active alert and active awake states, cried less, and had lower salivary cortisol levels, suggesting lower stress. After the massage versus the rocking sessions, the infants spent less time in an active awake state, suggesting that massage may be more effective than rocking for inducing sleep. Over the 6-week period, the massage-therapy infants gained more weight, showed greater improvement on emotionality, sociability, and soothability temperament dimensions and had greater decreases in urinary stress catecholamines/hormones (norepinephrine, epinephrine, cortisol).

Uvnas-Moberg, K., Widstrom, A. M., Marchini, G., and Winberg, J. (1987). Release of GI hormones in mother and infant by sensory stimulation. [Review]. Acta Paediatrica Scandinavia, 76, 851-860.

It is well established that sensory stimulation is of great importance for the growth of and for the physiological and psychological development of infants. Supplementary sensory stimulation such as non-nutritive sucking and tactile stimulation has been shown to increase the growth rate and the maturation of premature infants. In human neonates non-nutritive sucking has a vagally mediated influence on the levels of some gastrointestinal hormones. In animal experiments afferent electrical stimulations of the sciatic nerves at low intensity leads to an activation of the vagal nerves and to a consequent release of vagally controlled gastrointestinal hormones such as gastrin and cholecystokinin. We therefore assume that both non-nutritive sucking and tactile stimulation trigger the activity of sensory nerves which leads to a release of vagally regulated gut hormones. Since gut hormones stimulate gastrointestinal motor and secretory activity and the growth of the gastrointestinal tract, and enhance the glucose-induced insulin release, they may contribute to the beneficial effects on maturation and growth caused by sensory stimulation. In the breast-feeding situation, the sucking of the child elicits similar reflexes in the mother leading to an activation of the maternal gut endocrine system and a consequent increase in energy uptake. These data indicate that many types of neurogenic reflexes induced in mother-infant interactions are of importance for the energy economy of both mother and child.

Field, T. (1995). Massage therapy for infants and children. [Review]. Journal of Developmental & Behavioral Pediatrics, 16, 105-111.

Data are reviewed on the effects of massage therapy on infants and children with various medical conditions. The infants include: premature infants, cocaine-exposed infants, HIV-exposed infants, infants parented by depressed mothers, and full-term infants without medical problems. The childhood conditions include: abuse (sexual and physical), asthma, autism, burns, cancer, developmental delays, dermatitis (psoriasis), diabetes, eating disorders (bulimia), juvenile rheumatoid arthritis, posttraumatic stress disorder, and psychiatric problems. Generally, the massage therapy has resulted in lower anxiety and stress hormones and improved clinical course. Having grandparent volunteers and parents give the therapy enhances their own wellness and provides a cost-effective treatment for the children.

Scafidi, F. and Field, T. (1996). Massage therapy improves behavior in neonates born to HIV-positive mothers. Journal of Pediatric Psychology, 21, 889-897.

METHOD: Assigned randomly 28 neonates born to HIV-positive mothers to a massage therapy or control group. The treatment infants were given three 15-minute massages daily for 10 days. RESULTS: The massaged group showed superior performance on almost every Brazelton newborn cluster score and had a greater daily weight gain at the end of the treatment period unlike the control group who showed declining performance.

Field,T. & Hernandez-Reif, M. (2001). Sleep problems in infants decrease following massage therapy. Early Child Development and Care, 168, 95-104.

METHOD: Infants and toddlers (M age = 1.5 years) with sleep onset problems were given daily massages by their parents for 15 minutes prior to bedtime for one month. RESULTS: Based on parent diaries the massaged versus the control children (who were read bedtime stories) showed fewer sleep delay behaviors and had a shorter latency to sleep onset by the end of the study. Forty-five minute behavior observations by an independent observer also revealed more time awake, alert and active and more positive affect in the massaged children by the end of the study.

Cullen, C., Field, T., Escalona, A. & Hartshorn, K. (2000). Father-infant interactions are enhanced by massage therapy. Early Child Development and Care, 164, 41-47.

METHOD: Fathers gave their infants daily massages 15 minutes prior to bedtime for one month. RESULTS: By the end of the study, the fathers who massaged their infants were more expressive and showed more enjoyment and more warmth during floor-play interactions with their infants.

Scholtz, K., & Samuels, C. A. (1992). Neonatal bathing and massage intervention with fathers: Behavioral effects 12 weeks after birth of the first baby. International Journal of Behavioral Development,15, 67-81.

METHOD: Australian families with first-born babies were studied for effects of a 4-week-postpartum training program (demonstration of baby massage and the Burleigh Relaxation Bath technique), with emphasis on the father-infant relationship. 16 families were assigned to the treatment group and 16 served as controls. RESULTS: At the 12-week home observation, the treatment group infants greeted their fathers with more eye contact, smiling, vocalizing, reaching, and orienting responses and showed less avoidance behaviors. During a 10-min observation, the treatment group fathers showed greater involvement with their infants.

Field, T. (2000). Infant massage therapy. In Zeanah, Charles H. Jr. (Ed), Handbook of infant mental health (2nd ed.). (pp. 494-500). New York, NY, US: Guilford Press.

The author describes infant massage as a therapeutic intervention. She points to its worldwide popularity and to a small but growing body of literature suggesting its efficacy. Her review makes clear that it provides ample opportunities for infant-caregiver change. This approach may be a primary intervention in some settings and a useful adjunct in others.

Field, T. (2001). Massage therapy facilitates weight gain in preterm infants. Current Directions in Psychological Science, 10, 51-54.

METHOD: Studies from several labs have documented a 31 to 47% greater weight gain in preterm newborns receiving massage therapy ( 3 15-min. sessions for 5-10 days) compared with standard medical treatment. Although the underlying mechanism for this relationship between massage therapy and weight gain has not yet been established, possibilites that have been explored in studies with both humans and rats include (1) increased protein synthesis, (2) increased vagal activity that releases food-absorption hormones like insulin and enhances gastric motility, and (3) decreased cortisol levels leading to increased oxytocin. In addition, functional magnetic resonance imaging studies are being conducted to assess the effects of touch therapy on brain development. Further behavioral, physiological, and genetic research is needed to understand these effects of massage therapy on growth and development.

Ferber, S.G., Laudon, M., Kuint, J., Weller, A., & Zisapel, N. (2002). Massage therapy by mothers enhances the adjustment of circadian rhythms to the nocturnal period in full-term infants. Journal of Developmental and Behavioral Pediatrics, 23, 410-415.

METHOD: Investigated the effect of massage therapy on phase adjustment of rest-activity and melatonin secretion rhythms to the nocturnal period in full-term infants. Rest-activity of infants (measurement 1, n=16) were measured by actigraphy before and after 14 days of massage therapy (starting at approximately age 10 days) and subsequently at 6 and 8 wks of age. 6-Sulphatoxymelatonin (6-SM) was assessed in urine samples of 6, 8, and 12 wks of age (measurement 2, n=21). RESULTS: At 8 wks the controls revealed 1 peak of activity at approximately 12 midnight and another one at approximately 12 nood, whereas in the treated group, a major peal was early in the morning and a secondary peak in the late afternoon. At 12 wks, nocturnal 6-SM excretions were significantly higher in the treated infants. It is concluded that massage therapy by mothers in the perinatal period serves as a strong time cue, enhancing coordination of the developing circadian system with environmental cues.

Mainous, R.O. (2002). Infant massage as a component of developmental care: past, present, and future. Holistic Nursing Practice, 16, 1-7.

Infant massage has been practiced for centuries by segments on the continents of Africa and South America and in the Far East. Infant masage is a relatively new modality in North America. Nurmerous studies support its use in preterm infants, who have exhibited decreased stress levels, increased weight gain, and improved motor function when compared with non-massaged controls. Research has recently turned to the benefits of massage in the cocaine-exposed population and in those with human immunodeficiency virus. Massage in ill preterms has been targeted for clinical testing.

Bond, C. (2002). Baby massage: a dialogue of touch. Journal of Family Health Care, 12, 44-47.

The significance and benefits of touch and massage for preterm infants in Neonatal Intensive Care Units and in the community are discussed. The article emphasizes the value of massage in helping parents to bond with their baby and as part of family-centred care.

Intensive Care

Dunn, C., Sleep, J., & Collett, D. (1995). Sensing an improvement: An experimental study to evaluate the use of aromatherapy, massage and periods of rest in an intensive care unit. Journal of Advanced Nursing ,21, 34-40.

METHOD: In this study 122 patients admitted to a general intensive care unit were randomly assigned to either massage, aromatherapy using lavender, or a period of rest. Both pre- and post-therapy assessments included patients' evaluation of their anxiety levels, mood and ability to cope with their intensive care experience. RESULTS: Although no physiological changes occurred, those patients who received aromatherapy reported significantly greater improvement in their mood and perceived levels of anxiety. They also felt less anxious and more positive immediately following the therapy.

Job Stress

Field, T., Ironson, G., Scafidi, F., Nawrocki, T., Goncalves, 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: Analyses revealed the following: 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 the job stress score was lower only for the massage group.

Cady, S. H., & Jones, G. E. (1997). Massage therapy as a workplace intervention for reduction of stress. Perceptual & Motor Skills, 84, 157-158.

METHOD: The effectiveness of a 15-min. on-site massage while seated in a chair was evaluated for reducing stress as indicated by blood pressure. 52 employed participants' blood pressures were measured before and after a 15-min. massage at work. RESULTS: Analyses showed a significant reduction in participants' systolic and diastolic blood pressure after receiving the massage.

Field, T., Quintino, O., Henteleff, T., Wells-Keife, L., & Delvecchio-Feinberg, G. (1997). Job stress reduction therapies. Alternative Therapies in Health and Medicine, 3, 54-56.

METHOD: The immediate effects of brief massage therapy, music relaxation with visual imagery, muscle relaxation, and social support group sessions were assessed in 100 hospital employees at a major public hospital. RESULTS: Each of the groups reported decreases in anxiety, depression, fatigue, and confusion, as well as increased vigor following the sessions. That the groups did not differ on these variables suggests that these particular therapies, when applied for short periods of time, are equally effective for reducing stress among hospital employees.

Juvenile Rheumatoid Arthritis

Field, T., Hernandez-Reif, M., Seligman, S., Krasnegor, J., Sunshine, W., Rivas-Chacon, R., and Schanberg, S. (1997). Juvenile rheumatoid arthritis: benefits from massage therapy. Journal of Pediatric Psychology, 22, 607-617.

METHOD: Studied children with mild to moderate juvenile rheumatoid arthritis who 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.

Labor Pain

Field, T., Hernandez-Reif, M., Taylor, S., Quintino, O., & Burman, I. (1997). Labor pain is reduced by massage therapy. Journal of Psychosomatic Obstetrics and Gynecology, 18, 286-291.

METHOD: Twenty-eight women were recruited from prenatal classes and randomly assigned to receive massage in addition to coaching in breathing from their partners during labor, or to receive coaching in breathing alone (a technique learned during prenatal classes). RESULTS: The massaged mothers reported a decrease in depressed mood, anxiety and more positive affect following the first massage during labor. In addition, the massaged mothers had significantly shorter labor, a shorter hospital stay and less postpartum depression.

Leukemia

Field, T., Cullen, C., Diego, M., Hernandez-Reif, M., Sprinz, P., Beebe, K., Kissel, B., & Bango-Sanchez, V. (2001). Leukemia immune changes following massage therapy. Journal of Bodywork and Movement Therapies, 5, 271-274.

METHOD: Twenty children with leukemia were provided with daily massage therapy by their parents and were compared to a standard treatment control group. RESULTS: Following a month of massage therapy, depressed mood decreased in the children's parents, and the children's white blood cell and neutrophil counts decreased.

Lower Back Pain

Cherkin, D.C., Eisenberg, D., Sherman, K.J., Barlow, W.,,Kaptchuk, T.J., Street, J. & Deyo, R.A. (2001). Randomized trial comparing traditional Chinese medical acupuncture, therapeutic massage, and self-care education for chronic low back pain. Archives of Internal Medicine, 161, 1081-8.

METHODS: 262 patients who had persistent back pain received Traditional Chinese Medical acupuncture, therapeutic massage, or self-care educational materials for up to 10 massage or acupuncture visits over 10 weeks. RESULTS: At 10 weeks, massage was superior to self-care on the symptom scale and the disability scale. Massage was also superior to acupuncture on the disability scale. The massage group used the least medications and had the lowest costs of subsequent care.

Kalauokalani, D., Cherkin, D.C., Sherman, K.J., Koepsell, T.D., & Deyo, R.A. (2001). Lessons from a trial of acupuncture and massage for low back pain: patient expectations and treatment effects. Spine, 26, 1418-24.

METHODS: 135 patients with chronic low back pain who received acupuncture or massage were studied. Study participants were asked to describe their expectations regarding the helpfulness of each treatment on a scale of 0 to 10. The primary outcome was level of function at 10 weeks as measured by the modified Roland Disability scale. RESULTS: Improved function was observed for 86% of the participants with higher expectations for the treatment they received, as compared with 68% of those with lower expectations. Patients who expected greater benefit from massage than from acupuncture were more likely to experience better outcomes with massage than with acupuncture, and vice versa.

Kolich, M., Taboun, S.M., & Mohamed, AI. (2000). Low back muscle activity in an automobile seat with a lumbar massage system. International Journal of Occupational Safety & Ergonomics, 6,113-28.

METHODS: This investigation was conducted to determine the effects of a massaging lumbar support system on low back muscle activity. The apparatus was a luxury-level automobile seat massage. The dependent variable was the change in the root mean square variation of the EMG signal. RESULTS: One minute of lumbar massage every 5 min was found to have a beneficial effect on low back muscle activity (as compared to no massage).

Ginsberg, F. and Famaey, J. P. (1987). A double-blind study of topical massage with Rado-Salil ointment in mechanical low-back pain. Journal of International Medical Research, 15, 148-153.

METHOD: Forty patients with acute mechanical low-back pain were treated in a double-blind manner with either Rado-Salil or placebo for 14 days. RESULTS: Statistically significant improvements in spontaneous pain, muscular contracture and in both the patient's and physician's opinions occurred by day 3. These improvements persisted at day 14 and, in addition, there were statistically significant improvements in the finger-floor distance and the degree of lumbar extension. Treatment with Rado-Salil also allowed significant reduction in the use of oral analgesics. Only a few localized transient side-effects, requiring no specific treatment, were observed.

Pope, M. H., Phillips, R. B., Haugh, L. D., Hsieh, C. Y., MacDonald, L., and Haldeman, S. (1994). A prospective randomized three-week trial of spinal manipulation, transcutaneous 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. The authors determined the relative efficacy of chiropractic treatment to massage, corset, and TMS. Although all of these treatments are used for subacute low back pain treatment, there have been few comparative trials using objective outcome criteria. 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 Biering-Sorensen fatigue test. 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. RESULTS: 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 review. (In press citation). Journal of Pain Symptomology Management, 17, 65-69.

Massage therapy is frequently employed for low back pain (LBP). The aim of this systematic review was to find the evidence for or against its efficacy in this indication. Four randomized clinical trials were located in which massage was tested as a monotherapy for LBP. All were burdened with major methodological flaws. One of these studies suggests that massage is superior to no treatment. Two trials imploy that it is equally effective as spinal manipulation or transcutaneous electrical stimulation (TENS). 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 LBP. More investigations of this subject are urgently needed.

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: 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 their serotonin and dopamine levels were higher. Massage therapy is effective in reducing pain, stress hormones and symptoms associated with chronic low back pain.

Furlan, A.D., Brosseau, L., Imamura, M., & Irvin, E. (2000). Massage for low back pain. Cochrane Database of Systematic Reviews, (2):CD001929.

METHOD: This study assessed the effects of massage therapy for non-specific low-back pain. Two reviewers blinded to authors, journal and institutions selected the studies, assessed the methodological quality using the criteria recommended by the Cochrane Back Review Group, and extracted the data using standardized forms. The studies were analysed in a qualitative way due to heterogeneity of population, massage technique, comparison groups, timing and type of outcome measured. RESULTS: Nine publications reporting on eight randomized trials were included. Three had low and five had high methodological quality scores. One study was published in German and the rest in English. Massage was compared to an inert treatment (sham laser) in one study that showed that massage was superior, especially if given in combination with exercises and education. In the other seven studies, massage was compared to different active treatments. They showed that massage was inferior to manipulation and TENS; massage was equal to corsets and exercises; and massage was superior to relaxation therapy, acupuncture and self-care education. The beneficial effects of massage in patients with chronic low-back pain lasted at least one year after the end of the treatment. One study comparing two different techniques of massage concluded in favour of acupuncture massage over classic (Swedish) massage.

Lymphatics

Eliska, O., & Eliskova, M. (1995). Are peripheral lymphatics damaged by high pressure manual massage? Lymphology 28, 21-30.

METHOD: Massage of the foot in men and the hindpaw in dogs was performed by applying external pressures of 70-100 mmHg for a period of one, three, five, and ten minutes with a frequency of 25 strokes per minute. This protocol was performed on individuals without edema, on dogs with experimental lymphedema and men with post-thrombotic venous edema. RESULTS: After ten minutes of forceful massage, focal damage of lymphatics was present. In a group of dogs with lymphedema and men with post-thrombotic venous edema, the alteration of lymphatics was greater than in normal individuals and evident only after 3 to 5 minutes of massage. At first, the forceful massage affected the endothelial lining of the initial lymphatics. Alterations of lymphatic collectors were visible later. The fluid in lymphedema was translocated by massage using high pressure from the interstitium into the lumen of lymphatics by means of the open junctions and by artificial cracks that develop from injury to the lymphatic wall. Vigorous massage in lymphedema also produces loosening of subcutaneous connective tissue, formation of large tissue channels and release of lipid droplets that enter the lymphatics. By this mechanism, massage helps reduce the amount of fat cells in the lymphedematous leg.

Massage Therapists

Lee, A.C. & Kemper, K.J. (2000). Practice patterns of massage therapists. Journal of Alternative & Complementary Medicine, 6, 527-9.

METHODS: To describe the practice patterns of licensed massage therapists (LMTs). One hundred and twenty-six (126) massage practices were randomly selected from the Greater Boston Area yellow pages. RESULTS: Most respondents were Caucasian (95%) and female (80%). Their mean age was 41 years old. Half held a college degree; on average, practitioners received 1000 hours of training in massage therapy. The majority were in group practices (59%) and saw an average of 20 patients per week. The typical visit lasted 50-60 minutes; the cost was $60 and rarely covered by insurance (5%). Half of the respondents offered sliding scales to patients, but only 11% accepted Medicaid patients. Respondents reported less than 1 visit per week from pediatric and adolescent patients (<21 years old).

Mind-body interface

Ireland, R. (1985).Total satisfaction massage. Hakomi Forum Winter, 37-38.

Describes the application of the principles of Hakomi therapy to massage work. It is contended that the whole procedure of massage operates out of the principles of Hakomi therapy and that the whole process uses a mind-body interface that assumes a belief in mind-body holism.

Motoneuron

Sullivan, S. J., Williams, L., Seaborne, D. E., and Morelli, M. (1991). Effects of massage on alpha motoneuron excitability. Physical Therapy, 71, 555-560.

METHOD: The purpose of this study was to investigate the specificity of the effects of massage (petrissage) on spinal motoneuron excitability as measured by changes in the peak-to-peak amplitude of H-reflex recordings. H-reflexes (and M-responses) were recorded from the distal aspects of the right triceps surae muscle of 8 men and 8 women, aged 20 to 37 years, with no neuromuscular impairments of the lower extremities. The H-reflexes were recorded during five control and four experimental conditions (20 trials at each condition). The control conditions (C1-C5) preceded and followed each experimental condition, providing a measure of the stability of the H-reflex. Each experimental condition consisted of a 4-minute period of massage of the ipsilateral and contralateral triceps surae and hamstring muscle groups (ITS, CTS, IHS, and CHS, respectively). RESULTS: The mean peak-to-peak amplitude of the H-reflex was found to be stable (range=1.91-1.95 mV) across the five control conditions. H-reflex amplitudes recorded during the experimental conditions indicate that massage of the ITS resulted in a reduction of the H-reflex (0.83 mV) in comparison with the pretest control condition (C1) and the remaining experimental conditions (range=1.77-2.23 mV) This difference was significant, and subsequent Newman-Keuls tests indicated a specificity of the effects of massage on the muscle group being massaged.

Multiple Sclerosis

Hernandez-Reif, M., Field, T., & Theakston, H. (1998). Multiple sclerosis patients benefit from massage therapy. Journal of Bodywork and Movement Therapies, 2, 168-174.

METHOD: Twenty-four adults with multiple sclerosis were randomly assigned to a standard medical treatment control group or a massage therapy group that received 45-minute massages twice a week for 5 weeks. RESULTS: The massage group had lower anxiety and less depressed mood immediately following the massage sessions and by the end of the study they had improved self-esteem, better body image and image of disease progression, and enhanced social functioning.

Obstetrics

Ueda, W., Katatoka, Y., & Sagara, Y. (1993). Effect of gentle massage on regression of sensory analgesia during epidurals. Anesthesia & Analgesia, 76, 783-785.

METHOD: Epigastric massage was used to assess the regression of the sensory analgesia of the epidural block. Sixteen patients, who underwent minor obstetric or gynecologic surgery under epidural block with lidocaine, were divided into two groups. Group A was the control group and Group B received gentle massage of the epigastric area for 30 min. RESULTS: The regression of sensory analgesia in Group B was significantly faster than in Group A 30 min after the massage. The authors concluded that peripheral sensory stimulation as weak as gentle massage may initiate a series of indirect mechanisms that lead to accelerated regression of sensory analgesia.

Oil vs. No Oil

Field, T., Schanberg, S., Davalos, M., & Malphurs, J. ( 1996). Massage with oil has more positive effects on normal infants. Pre- and Perinatal Psychology Journal, 11, 75-80.

METHOD: Sixty one-month-old normal infants were randomly assigned to a massage group with oil and a massage group without oil. Massage had a soothing/calming influence on the infants, particularly when given with oil. RESULTS: The infants who received massage with oil were less active, showed fewer stress behaviors and head averting, and their saliva cortisol levels decreased more. In addition, vagal activity increased more following massage with oil versus massage without oil.

Oxytocin

Matthiesen, A.S., Ransjo-Arvidson, A.B., Nissen, E. & Uvnas-Moberg, K. (2001). Postpartum maternal oxytocin release by newborns: effects of infant hand massage and sucking. Birth, 28, 13-9.

METHODS: Hand movements and sucking behavior were studied in healthy term newborns who were placed skin-to-skin on their mothers' chests, and maternal oxytocin release. Ten vaginally delivered infants whose mothers had not been exposed to maternal analgesia were video-recorded from birth until the first breastfeeding. RESULTS: Infants used their hands to explore and stimulate their mother's breast in preparation for the first breastfeeding. When the infants were sucking, the massagelike hand movements stopped and started again when the infants made a sucking pause. Periods of increased massagelike hand movements or sucking of the mother's breast were followed by an increase in maternal oxytocin levels.

Agren, C., Lundeberg, T., Uvnas-Moberg, K., & Sato, A. (1995). The oxytocin antagonist 1-deamino-2-D-Tyr-(Oet)-4-Thr-8-Orn-oxytocin reverses the increase in the withdrawal response latency to thermal, but not mechanical nociceptive stimuli following oxytocin administration or massage-like stroking in rats. Neuroscience Letters, 18, 49-52.

METHOD: In this study the effect of exogenous oxytocin and of massage-like stroking on the withdrawal latency responses to heat and mechanical nociceptive stimulation were investigated in rats. A hot-plate test was used to assess withdrawal responses. RESULTS: Exogenous oxytocin and stroking (a low frequency mechanical stimulation) significantly increased the withdrawal latencies in response to mechanical and to thermal nociceptive stimuli. The effect of oxytocin and of stroking on the hot-plate test was reversed by an oxytocin antagonist directed against the uterine receptor. In contrast, the antagonist did not affect the prolonged response latency in the mechanical nociceptive stimulation test following either exogenous oxytocin or stroking. These results support the view that (1) oxytocin administration affects directly nociceptive related behaviour in response to heat stimulation, and (2) massage-like stroking may have an anti-nociceptive effect via activation of oxytocinergic mechanisms. Since the response to mechanical stimulation was not blocked by the antagonist the mechanisms mediating the withdrawal latency to heat and mechanical stimulation could be different.

Kurosawa, M., Lundeberg, T., Agren, G., Lund, I., and 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 at a speed of 20 cm/s with a frequency of 0.017-0.67 Hz in pentobarbital anesthetized, artificially ventilated rats. Arterial blood pressure was recorded with a pressure transducer via a catheter in the carotid artery. RESULTS: Stroking of the ventral, or both ventral and lateral sides of the abdomen for 1 min with a frequency of 0.67 Hz 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 s.c. administration of an oxytocin antagonist (1-deamino-2-D-Tyr-(Oet)-4-Thr-8-Orn-oxytocin, 1 mg/kg) directed against the uterine receptor. In contrast, the administration of 0.1 mg/kg 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.

Pain

Kubsch, S.M., Neveau, T., & Vandertie, K. (2000). Effect of cutaneous stimulation on pain reduction in emergency department patients. Complementary Therapies in Nursing & Midwifery, 6, 25-32.

METHODS: Tactile stimulation was used with 50 emergency department patients to relieve pain. Another objective was to determine the effect of tactile stimulation on blood pressure and heart rate. RESULTS: Following stimulation, subjects reported significantly reduced pain, and demonstrated reduced heart rate, and blood pressure readings.

Mobily, P.R., Herr, K.A., & Nicholson, A.C. (1994). Validation of cutaneous stimulation for pain management. International Journal of Nursing Studies, 31, 533-544.

METHOD: The purpose of this study was to identify and validate pain management interventions including heat and cold application, massage and Transcutaneous Electrical Nerve Stimulation (TENS). A two-round Delphi survey was completed by nurses selected for their expertise in pain management. RESULTS: Data analyses revealed that consistently high scores were obtained by the raters for each intervention and activity.

Nixon, M., Teschendorff, J., Finney, J., & Karnilowicz, W. (1997). Expanding the nursing repertoire: The effect of massage on post-operative pain. Australian Journal of Advanced Nursing, 14, 21-26.

METHOD: A treatment group of 19 patients and a control group of 20 patients were compared on the impact of massage therapy on patients’ perceptions of post-operative pain. RESULTS: Controlling for age, the results indicated that massage produced a significant reduction in patients’ perceptions of pain over a 24 hour period.

Lundeberg, T. (1984). Long-term results of vibratory stimulation as a pain relieving measure for chronic pain. Pain, 20, 13-23.

METHOD: 267 patients with chronic neurogenic or musculoskeletal pain were given vibratory stimulation for their pain. The patients were observed for 18 months or until they terminated the treatment. RESULTS: About half of the successfully relieved patients (59% of the total number of patients) reported more than 50% pain relief, as scored on a visual analogue and an adjective scale. Seventy-two percent of these patients reported increased social activity and greater than 50% reduced intake of analgesic drugs after 12 months of home treatment.

Lundeberg, T., Abrahamsson, P., Bondesson, L., & Haker. E. (1987). Effect of vibratory stimulation on experimental and clinical pain. Scandinavian Journal of Rehabilitation Medicine, 20, 149-159.

METHOD: The effect of vibratory stimulation on experimental pain of the skin overlying the right and left extensor carpi radialis longus muscle induced by electrical stimulation was studied in 16 healthy subjects and in 18 patients suffering from chronic epicondyalgia of the right elbow. RESULTS: In the healthy subjects there were no side differences whereas in the patients, the skin pain threshold over the painful right muscle was lower than that of the left unaffected side under resting conditions. After vibratory stimulation, the skin pain threshold increased bilaterally by 1.1-1.6 times the pre-stimulation threshold in the healthy subjects and by 1.2-2.3 times this threshold in the patients. In 8 of the healthy subjects there was an increase in peripheral blood flow during stimulation and in 8 there was a small decrease. In 13 patients the change in pain threshold was seen in phase with the local increase and peripheral decrease in peripheral blood flow. In all individuals, the pain thresholds were regained within 45 minutes of cessation of stimulation. This was in contrast to the general subjective pain in the patients; 12 patients reported that the relief of pain lasted for a period of 1-7 hours.

Lundeberg, T., Abrahamsson, P., & Haker, E. (1987). Vibratory stimulation compared to placebo in alleviation of pain. Scandinavian Journal of Rehabilitation Medicine, 19, 153-158.

METHOD: The placebo effect of vibratory stimulation was studied in 72 patients with chronic pain syndromes in a double-blind crossover trial using a vibrator and a "placebo unit". RESULTS: Pain alleviation was reported by 48% of the patients during vibratory stimulation compared with 34% for placebo treatment.

Melzack, R. and Wall, P. D. (1965). Pain Mechanisms: A New Theory. Science, 150, 971-978.

A gate control system modulates sensory input from the skin before it evokes pain perception and response. The nature of pain has been the subject of bitter controversy since the turn of the century. There are currently two opposing theories of pain: (i) specificity theory, which holds that pain is a specific modality like vision or hearing, "with its own central and peripheral apparatus" and (ii) pattern theory, which maintains that the nerve impulse pattern for pain is produced by intense stimulation on nonspecific receptors since "there are not specific fibers and no specific endings". Both theories derive from earlier concepts proposed by von Frey and Goldscheider in 1894, and historically they are held to be mutually exclusive. Since it is our purpose here to propose a new theory of pain mechanisms, we shall state explicitly at the outset where we agree and disagree with specificity and pattern theories.

Katz, J., Wowk, A., Culp, D., & Wakeling, H. (1999). Pain and tension are reduced among hospital nurses after on-site massage treatments: a pilot study. Journal of Perianesthesia Nursing, 14, 128-133.

METHOD: Tension and pain are common occupational hazards of modern-day nursing, especially given recent changes to the health care system. The aims of the pilot study were (1) to evaluate the feasibility of carrying out a series of eight 15-minute workplace-based massage treatments, and (2) to determine whether massage therapy reduced pain and stress experienced by nursing staff at a large teaching hospital. Twelve hospital staff (10 registered nurses and 2 nonmedical ward staff) working in a large tertiary care center volunteered to participate. Participants received up to eight, workplace-based, 15-minute Swedish massage treatments provided by registered massage therapists. Pain, tension, relaxation, and the Profile of Mood States were measured before and after each massage session. RESULTS: Pain intensity and tension levels were significantly lower after massage (p<.01). In addition, relaxation levels and overall mood state improved significantly after treatments (p<.01). The results of this pilot study support the feasibility of an eight-session, workplace-baed, massage therapy program for pain and tension experienced by nurses working in a large teaching hospital. Further research is warranted to study the efficacy of workplace massage in reducing stress and improving overall mood.

Parkinson’s

Hernandez-Reif, M., Field, T., Largie, S., Cullen, C., Beutler, J., Sanders, C., Weiner, W., Rodriguez-Bateman, D., Zelaya, L., Schanberg, S. & Kuhn, C. (In Press). Parkinson's disease symptoms are reduced by massage therapy and progressive muscle exercises. Journal of Bodywork and Movement Therapies.

METHOD: Sixteen adults diagnosed with idiopathic Parkinson’s Disease, (M age =58) received 30-minute massage therapy or progressive muscle relaxation sessions twice a week for five weeks (10 sessions total). RESULTS: Physicians rated massage therapy participants as improved in daily living activities by the end of the study. Participants also rated themselves as improved in daily functioning, having more effective and less disturbed sleep.

Perineal Massage

Labrecque, M., Eason, E., & Marcoux, S. (2001). Women's views on the practice of prenatal perineal massage. British Journal of Obstetrics & Gynaecology, 108, 499-504.

METHODS: 763 women received perineal massage during pregnancy. Based on a factor analysis, 17 of the questions were classified into four categories: acceptability of perineal massage (8 items); preparation for birth (4 items); relationship with the partner (2 items); and effect of massage on delivery (3 items). The last two questions asked whether women would perform the massage in their next pregnancy and whether they would recommend perineal massage to another pregnant woman. RESULTS: On average, perineal massage was felt to be quite acceptable. Pain and technical problems reported during the first week or two of massage tended to disappear after a few weeks. Women's assessment of the effect of massage on preparation for birth and on delivery was positive. Women's views about the effect on their relationship with their partner were either positive or negative and were proportional to the partner's participation with the massage. Most women said they would massage again if they were to have another pregnancy and would recommend it to another pregnant woman.

Davidson, K., Jacoby, S., & Brown, M.S. (2000). Prenatal perineal massage: preventing lacerations during delivery. JOGNN - Journal of Obstetric, Gynecologic, & Neonatal Nursing, 29, 474-9.

METHODS: To investigate the associations between perineal lacerations and 13 variables associated with the incidence of perineal lacerations 368 women were assessed. RESULTS: When parity was controlled, the only factors independently associated with the seriousness of lacerations were parity and prenatal perineal massage. Thus, this study supports the conclusion that teaching perineal massage.

Labrecque, M., Marcoux, S., Pinault, J.J., Laroche, C., & Martin, S. (1994). Prevention of perineal trauma by perineal massage during pregnancy: A pilot study. Birth, 21, 20-25.

METHOD: Although the performance of perineal massage by a woman or her partner during the last weeks of pregnancy may help to prevent perineal trauma at delivery, the technique has never been evaluated rigorously. This study examined the feasibility of a randomized, controlled trial, and more specifically assessed the participation rate, the acceptability of the intervention, and whether or not an attending physician could remain blind to the participants’ groups. Thus, this pilot study was a single-blinded, randomized, controlled trial. Nulliparous women, 32 to 34 weeks pregnant, were recruited. Women assigned to the intervention group practiced daily 10-minute perineal massage and completed a diary, and those in the control group had standard care. Women and attending physicians completed a questionnaire about the aspect of blindness. Among the 174 women who delivered during the study period, 68% were approached by a midwife and 26% were randomized. 91% of the 22 women in the massage group returned their perineal massage diaries. RESEARCH: Based on the postpartum questionnaire, 20 women practiced the technique at least four times a week for three weeks or longer. No woman in the control group practiced massage. The attending physician was aware of the woman’s group in only 7% of cases. Based on the results of this pilot study, a randomized, controlled trial to evaluate the efficacy of perineal massage in preventing perineal trauma at birth appears feasible.

Physicians’ Perspectives

Verhoef, M.J., & Page, S.A. (1998). Physicians' perspectives on massage therapy. Canadian Family Physician, 44, 1018-40.

METHOD: The purpose of this study was to examine the knowledge, opinions, and referral behavior of family physicians with respect to massage therapy and to explore factors associated with referral. Three hundred family physicians were mailed a survey containing questions about sociodemographic and practice characteristics, perceived knowledge of massage therapy, opinions about the usefulness and legislation (government regulations) of massage therapy, and referral behavior. RESULTS: Fifty-four percent of physicians completed the questionnaire. Sixty-eight percent of respondents indicated they had minimal or no knowledge. Of the remaining most (83%) believed massage therapy was a useful adjunct to their own practice. Moreover, 71% had referred patients to massage therapists and most (72%) perceived increasing demand from their patients for massage therapy. Approximately half of the physicians surveyed supported government regulation of massage therapy. Thus, the physicians demonstrated a discrepancy between their knowledge of massage therapy and their opinions of, and referrals to, the profession. Physicians who referred patients to massage therapists generally held more positive opinions and had more knowledge of the discipline.

Posttraumatic Stress

Field, T., Seligman, S., Scafidi, F., & Schanberg, S. (1996). Alleviating posttraumatic stress in children following Hurricane Andrew. Journal of Applied Developmental Psychology, 17, 37-50.

METHOD: Massage therapy was evaluated for the reduction of anxiety and depression levels of children as measured by behavioral observations, their drawings, and their cortisol levels. Sixty 1st-5th graders who showed classroom behavior problems following Hurricane Andrew were randomly assigned to a massage therapy or a video attention group. RESULTS: Scores on the Posttraumatic Stress Disorder Index suggest that the subjects were experiencing severe posttraumatic stress. Subjects who received massage reported being happier and less anxious and had lower salivary cortisol levels after the therapy than the video subjects. The massage group showed more sustained changes as manifested by lower scores for anxiety, depression, and self-drawings. The massage therapy subjects were also observed to be more relaxed.

Pregnancy

Field, T., Hernandez-Reif, M., Hart, S., Theakston, H., Schanberg, S., Kuhn, C. & Burman, I. (1999). Pregnant women benefit from massage therapy. Journal of Psychosomatic Obstetrics & Gynecology, 20, 31-38.

METHOD: Twenty-six pregnant women were assigned to a massage therapy or a relaxation therapy group for 5 weeks. The therapies consisted of 20-min sessions twice a week. RESULTS: Both groups reported feeling less anxious after the first session and less leg pain after the first and last session. Only the massage therapy group, however, reported reduced anxiety, improved mood, better sleep and less back pain by the last day of the study. In addition, urinary stress hormone levels (norepinephrine) decreased for the massage therapy group, and the women had fewer complications during labor and their infants had fewer postnatal complications (e.g., less prematurity).

Premenstrual Syndrome

Hernandez-Reif, M., Martinez, A., Field, T., Quintero, O., & Hart, S. (2000). Premenstrual syndrome symptoms are relieved by massage therapy. Journal of Psychosomatic Obstetrics & Gynecology, 21, 9-15.

METHOD: Twenty-four women with premenstrual syndrome were randomly assigned to a massage therapy or a relaxation therapy group. RESULTS: The massage group showed decreases in anxiety, depressed mood and pain immediately after the massage sessions. In addition, by the last day of the study the massage therapy group reported a reduction in menstrual distress symptoms including pain and water retention. These data suggest that massage therapy is effective for treating premenstrual syndrome.

Preschool Massage

Field, T., Kilmer, T., Hernandez-Reif, M. & Burman, I. (1996). Preschool children's sleep and wake behavior: Effects of massage therapy. Early Child Development and Care, 120, 39-44.

METHOD: Preschool children received 20-minute massages twice a week for five weeks. RESULTS: The massaged children as compared to children in the wait-list control group had better behavior ratings on state, vocalization, activity and cooperation after the massage sessions on the first and last days of the study. Their behavior was also rated more optimally by their teachers by the end of the study. Also, at the end of the 5 week period parents of the massaged children rated their children as having less touch aversion and being more extraverted. Finally, the massaged children had a shorter latency to naptime sleep by the end of the study.

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

METHOD: Examined the effects of massage therapy on the cognitive performance of preschool students. 20 preschool students (aged 3.3-5.5 yrs) were rated by their teacher on a temperament checklist. Additionally, Ss completed the Block Design, Animal Pegs, and Mazes subtests of the Wechsler Preschool and Primary Scale of Intelligence (WPPSI) prior to and following some Ss receiving a 15-min massage. RESULTS: Subjects' scores on the Block Design test of abstract reasoning improved following massage. In contrast, scores of control Ss did not improve. On the Animal Pegs matching task, Ss maintained the levels of accuracy they had shown on the pretest, while control Ss became less accurate. Massage was particularly beneficial to Ss rated as high-strung and anxious. Compared with Ss rated by their teachers as calm and easygoing, anxious Ss showed greater improvements on the Block Design and maintained greater accuracy on Animal Pegs subtests. Cognitive performance of control Ss did not differ by temperament.

Preterm Infants

Whipple, J. (2000). The effect of parent training in music and multimodal stimulation on parent-neonate interactions in the neonatal intensive care unit. Journal of Music Therapy, 37, 250-68.

METHODS: This study examined the effects of parent training in music and multimodal stimulation on the quantity and quality of parent-neonate interactions and the weight gain and length of hospitalization of premature and low birthweight (LBW) infants in a Neonatal Intensive Care Unit (NICU). Twenty sets of parents and premature LBW infants participated in the study. Parents in the experimental group received approximately one hour of instruction in appropriate uses of music, multimodal stimulation including massage techniques, and signs of infant overstimulation and techniques for its avoidance. Parent-neonate interactions, specifically parent actions and responses and infant stress and nonstress behaviors, were observed for subjects in both groups. RESULTS: Infant stress behaviors were significantly fewer and appropriateness of parent actions and responses were significantly greater for experimental infants and parents than for control subjects. Parents in the experimental group also reported spending significantly more time visiting in the NICU than did parents of control infants.

Dieter, J., & Emory, E. (1997). Supplemental stimulation of premature infants: A treatment model. Journal of Pediatric Psychology, 22, 281-295. (A review).

Effects of vestibular, tactile/kinesthetic, auditory, and oral stimulation were examined with respect to their similarity to the intra- or extra- uterine environment. Long-standing theoretical and methodological problems are discussed, and a "sequential multimodal treatment model" is introduced in this paper.

Scafidi, F. A., Field, T., & Schanberg, S. M. (1993). Factors that predict which preterm infants benefit most from massage therapy. Journal of Developmental & Behavioral Pediatrics,14, 176-180.

METHOD: Ninety-three preterm infants (M gestational age = 30 wks; M birthweight = 1204 g; M ICU duration = 15 days) were randomly assigned to a massage therapy group or a control group once they were considered medically stable. The treatment group (N = 50) received three daily 15-minute massages for 10 days. RESULTS: The massage therapy infants gained more weight per day (32 vs. 29 g) than the control infants. The treatment and control groups were divided into high and low weight gainers based on the average weight gain for the control group. Seventy percent of the massage therapy infants were classified as high weight gainers whereas only 40% of the control infants were classified as high weight gainers. Discriminant function analyses determining the characteristics that distinguished the high from the low weight gainers suggested that the control infants who, before the study, consumed more calories and spent less time in intermediate care gained more weight. In contrast, for the massage therapy group, the pattern of greater caloric intake and more days in Intermediate care before the study period along with more obstetric complications differentiated the high from the low weight gainers, suggesting that the infants who had experienced more complications before the study benefited more from the massage therapy. These variables accurately predicted 78% of the infants who benefited more from the massage therapy.

Field, T., Scafidi, F., and Schanberg, S. (1987). Massage of preterm newborns to improve growth and development. Pediatric Nursing, 13, 385-387.

The data reviewed here suggest that the growth and development of preterm neonates can be facilitated by tactile-kinesthetic stimulation. Greater weight gain and superior performance on developmental assessments persisted across the first 6 months for the group of infants that received the massage treatment. Field (1986) has suggested that these enduring effects may be mediated by better parent-infant interactions. Heightened responsiveness of the neonate may enhance the early parent-infant relationships which may, in turn, contribute to optimal growth and development at later stages in infancy.

Field, T. and Schanberg, S. M. (1990). Massage alters growth and catecholamine production in preterm newborns. Gunzenhauser, N., Brazelton, T. B., and Field, T. Johnson & Johnson. Advances in Touch. Skillman, N. J.

METHOD: Forty medically stable preterm nenonates received tactile/kinesthetic stimulation for three 15-minute periods during three consecutive hours every day for ten days. RESULTS: Despite similar formula and caloric intake, the treatment infants averaged a 21 percent greater daily weight gain than the control infants over the treatment. In addition, the treatment group showed superior performance on the NBAS on the habituation cluster following the treatment period, and less time in active sleep and less facial grimacing, mouthing/yawning, and clenched fists.

Kuhn, C., Schanberg, S., Field, T., Symanski, R., Zimmerman, E., Scafidi, F., and Roberts, J. (1991). Tactile kinesthetic stimulation effects on sympathetic and adrenocortical function in preterm infants. Journal of Pediatrics, 119, 434-440.

METHOD: The purpose of our study was to investigate the neuroendocrine response in preterm infants to a pattern of tactile-kinesthetic stimulation that facilitates their growth and development. Preterm infants (mean gestational age 30 weeks, mean birth weight 1176 gm) received normal nursery care or tactile-kinesthetic stimulation for three 15 minute periods at the start of three consecutive hours each day for 10 days. On day 1 and day 10 of the study, a 24-hour urine sample was collected for norepinephrine, epinephrine, dopamine, cortisol, and creatinine assay and a blood sample was taken by heel stick for cortisol and growth hormone assay. RESULTS: Urine norepinephrine and epinephrine values increased significantly only in the stimulated babies. Urine dopamine and cortisol values increased in both groups, and serum growth hormone decreased in both groups. Individual differences in urine norepinephrine, epinephrine, dopamine, and cortisol values were highly stable across the 10 days despite a 10-fold range of values among the infants. The results of this study suggest that tactile-kinesthetic stimulation of preterm infants has a fairly specific effect on maturation and/or activity of the sympathetic nervous system. In addition, this study has defined catecholamine and cortisol secretion across gestational age in normal preterm infants. Finally, these data suggest that highly stable individual levels of catecholamine and cortisol secretion are established by birth in humans.

Morrow, C. J., Field, T., Scafidi, F. A., Roberts, J., Eisen, L., Larson, S.K., Hogan, A.E., & Bandstra, E.S. (1991). Differential effects of massage and heelstick procedures on transcutaneous oxygen tension in preterm neonates. Infant Behavior and Development, 14, 397-414.

METHOD: Investigated the effects of heelsticks and tactile-kinesthetic massage on transcutaneous oxygen tension (TcPO-sub-2) in 47 stabilized preterm neonates (average gestational age 30 wks). RESULTS: During the heelstick procedure, TcPO-sub-2 significantly declined an average of 14 mmHg. When compared with the tactile-kinesthetic massage, TcPO-sub-2 levels during the heelstick were significantly lower than during the stimulation. Mean TcPO-sub-2 levels remained clinically safe during 4 massage sessions evaluated. The TcPO-sub-2 levels during kinesthetic stimulation were somewhat more varied, and movement and pressurization of the TcPO-sub-2 electrode were investigated as possible artifactual explanations for this phenomenon. Overall, findings indicate that social forms of touch such as tactile-kinesthetic massage do not appear to have a medically compromising effect on TcPO-sub-2 in the preterm neonate. Findings are evaluated in relation to the "minimal touch" policy.

Morrow, C., Field, T., Scafidi, F., Roberts, J., Eisen, L.,Hogan, A.E., & Bandstra, E.S. (1990). Transcutaneous oxygen tension in preterm neonates during neonatal behavioral assessments and heelsticks. Journal of Developmental and Behavioral Pediatrics, 11, 312-316.

METHOD: This study evaluated the effects of neonatal behavioral assessments and heelsticks on transcutaneous oxygen tension (TcPO2) in 37 preterm neonates from a neonatal intensive care unit. Two behavioral assessments were evaluated, the Brazelton Neonatal Behavioral Assessment Scale (BNBAS) and the Neurobehavioral Assessment for Preterm Infants (NAPI). TcPO2 during heelsticks was used as a comparison because reliable decreases have typically been noted during heelsticks. RESULTS: Although the heelsticks resulted in significant declines in TcPO2, the behavioral assessents led to only negligible changes in TcPO2. Observed changes during the behavioral assessments occurred in a small number of infants, primarily during the few test procedures administered to the infants outside of their isolettes. Thus, time outside the isolette and associated temperature changes may be more critical variables than the assessments per se.

Field, T. (1992). Interventions in early infancy. Special Section: Australian Regional Meeting: Attachment and the relationship between the infant and caregivers. Infant Mental Health Journal, 13, 329-336.

Describes 3 interventions to help infants of high-risk pregnancies and deliveries facilitate attachment both to and from their caregivers. Prenatal intervention includes giving high-risk pregnant women video feedback during prenatal ultrasound, which reduced maternal anxiety, obstetric complications, and fetal activity and improved neonatal outcome (increased weight gain, better performance on the Brazelton Neonatal Behavioral Assessment Scale, and decreased irritability). Intervention aimed at reducing stress in the neonatal intensive care unit includes providing preterm neonates nonnutritive sucking opportunities to reduce stress during heelsticks and gavage feedings and providing preterm neonates and preterm cocaine-exposed neonates massage therapy, which facilitated weight gain and better performance on the Brazelton scale. Following improved neonatal behavior, infants would be expected to have better interactions with their caregivers.

Field, T., Schanberg, S., Scafidi, F., Bauer, C., Vega-Lahr, N., Garcia, R., Nystrom, J., & Kuhn, C. (1986). Tactile/kinesthetic stimulation effects on preterm neonates. Pediatrics, 77, 654-658.

METHOD: Tactile/kinesthetic stimulation was given to 20 preterm neonates (mean gestational age, 31 weeks; mean birth weight, 1,280 g; mean time in neonatal intensive care unit, 20 days) during transitional ("grower") nursery care, and their growth, sleep-wake behavior, and Brazelton scale performance was compared with a group of 20 control neonates. The tactile/kinesthetic stimulation consisted of body stroking and passive movements of the limbs for three, 15-minute periods per day for 10 days. RESULTS: The stimulated neonates averaged a 47% greater weight gain per day (mean 25 g versus 17 g), were more active and alert during sleep/wake behavior observations, and showed more mature habituation, orientation, motor, and range of state behavior on the Brazelton scale than control infants. Finally, their hospital stay was 6 days shorter, yielding a cost savings of approximately $3,000 per infant. These data suggest that tactile/kinesthetic stimulation may be a cost effective way of facilitating growth and behavioral organization even in very small preterm neonates.

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

METHOD: Thirty preterm cocaine-exposed preterm neonates (mean gestational age 30 wks, 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 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 in intake (calories or volume), (2) showed significantly fewer postnatal complications and stress behaviors than did control infants, and (3) demonstrated more mature motor behaviors on the Brazelton examination at the end of the 10-day study period.

Scafidi, F., Field, T., Schanberg, S., Bauer, C., Vega-Lahr, N., & Garcia, R. (1986). Effects of tactile/kinesthetic stimulation on the clinical course and sleep/wake behavior of preterm neonates. Infant Behavior and Development, 9, 91-105.

METHOD: Forty preterm neonates treated in an intensive care nursery (M gestational age = 31 weeks, M birthweight = 1274 gms) were randomly assigned to a treatment or control group. The treatment infants received tactile/kinesthetic stimulation (body massage and passive movements of the limbs) for three 15-minute periods during three consecutive hours for a 10-day period. At the end of the treatment period the behavioral states and activity level of the neonates were monitored during sleep/wake behavior observations. In addition, neonatal behaviors were assessed on the Brazelton scale. RESULTS: The treated infants averaged a 47% greater weight gain per day (25 vs. 17 grams), and spent more time awake and active during sleep/wake behavior observations. On the Brazelton scale the treated infants showed more mature orientation, motor, habituation, and range of state behaviors. Finally, the treated infants were discharged 6 days earlier, yielding hospital cost savings of $3,000 per infant.

Scafidi, F.A., Field, T.M., Schanberg, S.M., Bauer, C.R., Tucci, K., Roberts, J., Morrow, C., & Kuhn, C.M. (1990). Massage stimulates growth in preterm infants: A replication. Infant Behavior and Development, 13, 167-188.

METHOD: Forty preterm infants (M gestational age = 30 weeks; M birthweight = 1176 gms; M duration ICU care = 14 days) were assigned to treatment and control groups once they were considered medically stable. Assignments were based on a random stratification of gestational age, birthweight, intensive care duration, and study entrance weight. The treatment infants (n = 20) received tactile/kinesthetic stimulation for three 15-minute periods during 3 consecutive hours per day for a 10-day period. Sleep/wake behavior was monitored and Brazelton assessments were performed at the beginning and at the end of the treatment period. RESULTS: The treated infants averaged a 21% greater weight gain per day (34 vs. 28 gms) and were discharged 5 days earlier. No significant differences were demonstrated in sleep/wake states and activity level between the groups. The treated infants’ performance was superior on the habituation cluster items of the Brazelton scale. Finally, the treatment infants were more active during the stimulation sessions than during the nonstimulation observation sessions (particularly during the tactile segments of the sessions). Although these data confirm the positive effects of tactile/kinesthetic stimulation, the underlying mechanisms remain unknown.

Field, T. (2001). Massage therapy facilitates weight gain in preterm infants. Current Directions in Psychological Science, 10, 51-54.

Studies from several labs have documented a 31 to 47% greater weight gain in preterm newborns receiving massage therapy (three 15-minute sessions for 5-10 days) compared with standard medical treatment. Although the underlying mechanism for this relationship between massage therapy and weight gain has not yet been established, possibilities that have been explored in studies with both humans and rats include (a) increased protein synthesis, (b) increased vagal activity that releases food-absorption hormones like insulin and enhances gastric motility and (c) decreased cortisol levels leading to increased oxytocin. In addition, functional magnetic resonance imaging studies are being conducted to assess the effects of touch therapy on brain development. Further behavioral, physiological, and genetic research is needed to understand these effects of massage therapy on growth and development.

Dieter, J.N.I., Field, T., Hernandez-Reif, M., & Emory, E.K. (In Review). Preterm infants gain more weight following five days of massage therapy. Acta Pediatrica.

METHOD: To demonstrate that a shorter course of massage therapy leads to greater weight gain in grower nursery preterm infants. Massage therapy (body stroking and passive limb movement for three, 15-minute periods per day for five days) was provided for 14 preterm neonates (mean gestational age, 30.2 weeks; mean birthweight, 1,215 grams) and their weight gain, formula intake, kilocalories, and stooling, were compared with a group of 14 control infants (mean gestational age, 31.3 weeks; mean birthweight, 1,392 grams). RESULTS: A repeated-measures MANOVA yielded a significant group by day interaction effect for weight gain, F = 3.6, p<.05. Massaged infants gained 47% more weight per day than control infants, (Massage M = 37.1 grams; Control M = 25.2 grams). No significant group differences were found in formula and kilocalorie intake, stooling, or number of family visits during participation. Conclusion: Preterm infants gained more weight with just five days of massage, in contrast to 10 days in previous studies. Results support the continued use of massage as a cost-effective therapy for preterm infants.

Ferber, S.G. Kuint, J., Weller, A., Feldman, R., Dollberg, S., Arbel, E., & Kohelet D. (2002). Massage therapy by mothers and trained professionals enhances weight gain in preterm infants. Early Human Development, 37, 37-45.

METHOD: This study replicated the results of increased weight gain in the course of "massage therapy" in preterm infants, and utilize a new, cost-effective application of this method by comparing maternal to nonmaternal administration of the therapy. The study comprised 57 healthy, preterm infants assigned to three groups: two treatment groups--one in which the mothers performed the massage, and the other in which a professional female figure unrelated to the infant administered the treatment. Both these groups were compared to a control group. RESULTS: Over the 10-day study period, the two treatment groups gained significantly more weight compared to the control group (291.3 and 311.3 vs. 225.5 g, respectively). Calorie intake/kg did not differ between groups.

Field, T. (2002). Massage therapy. Medical Clinics of North America, 86, 163-71.

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.

Jones, E., Dimmock, P.W., & Spencer, S.A. (2001). A randomised controlled trial to compare methods of milk expression after preterm delivery. Archives of Disease in Childhood Fetal & Neonatal Edition, 85, F91-95.

METHOD: The objective of this study was to compare sequential and simultaneous breast pumping on volume of milk expressed and its fat content. Thirty six women were analyzed; 19 women used simultaneous pumping and 17 used sequential pumping. Women were randomly allocated to use either simultaneous (both breasts simultaneously) or sequential (one breast then the other) milk expression. Stratifcation ws used to ensure that the groups were balanced for parity and gestation. A crossover design was used for massage, with patients acting as their own controls. Women were randomly allocated to receive either massage or non-massage first. RESULTS: Milk yield per expression was: sequential pumping with no massage, 51.32 g (95% confidence interval (CI) 56.57 to 46.07); sequential pumping with massage, 78.71 g (95% CI 85.19 to 72.24); simultaneous pumping with no massage, 87.69 g (95% CI 96.80 to 78.57); simultaneous pumping with massage, 125.08 g (95% CI 140.43 to 109.74). The fat concentration in the milk was not affected by the increase in volume achieved by the interventions.

Mathai, S., Fernandez, A., Mondkar, J., & Kanbur, W. (2002). Effects of tactile-kinesthetic stimulation in preterms: a controlled trial. Indian Pediatrics, 38, 1091-1098.

METHOD: The objective of this study was to determine the effects of tactile-kinesthetic stimulation to preterms on physiologic parameters, physical growth and behavioral development. Forty eight well preterms with birth weights between 1000-2000 grams were systematically allocated into test and control groups. Test babies received tactile-kinesthetic stimulation in theh form of a structured baby massage from day 3 to term corrected age. They were observed for changes in vital parameters (heart rate, respiration, temperature and oxygen saturation) during the first few days of stimulation in hospital. Thereafter, massage was continued at home. Changes in weight, length and head circumference and neuro-behavior (Brazelton Neuro-Behavioral Assessment Scale) were assessed in both groups before, during and after the study period. RESULTS: An increase in heart rate (within physiologic range) was seen in the test group during stimulation. This group also showed a weight gain of 4.24 g/day more than controls, which was statistically significant. On the Brazelton Scale the test group showed statistically significant improved scores on the "orientation", "range of state", "regulation of state" and "autonomic stability" clusters at follow-up. No significant complications were noted. A positive correlation was found between the duration of stimulation in days and the weight gain in grams but this did not reach statistical significance.

Dieter, J.N.I. (1999). The effects of tactile/kinesthetic stimulation on the physiology and behavior of preterm infants. Dissertation Abstracts International: Section B- The Sciences and Engineering, 60, 2335.

METHOD: Examined were the effects of 10 days of preterm infant tactile/kinesthetic stimulation (T/K: massage and limb flexion-extension) on state and motor behavior, heart and respiration rate, cardiac vagal tone (CVT), weight gain, and neurobehavioral adaptation. Medically stable 'grower nursery' infants were randomly assigned to the T/K (n=15) and control (n=15) groups. RESULTS: During T/K, infants showed higher heart rates (p<.01) and CVT (p=.05), increased yawning (p<.05), crying (p<.01) vocalizations (p<.01) active sleep (p<.01), multiple limb (p<.05) and gross body movements (p<.01) than observed during baseline. These effects did not diminish over the 10 days. No difference was found in heart and respiration rates when T/K was compared to physical exams/diaper changes. T/K infants exhibited higher heart rates than control infants prior to and during physical exams/diaper changes (p<.01). T/K infants demonstrated greater, weight gain than control infants during the first week (p<.05). Curve estimate analyses revealed a linear relationship between the amount of time an infant spent in the quiet alert state during T/K and subsequent weight gain (p<.05). A quadratic relationship was found between CVT during T/K and total week 1 weight gain (p<.05). No group differences were observed in formula and kilocalorie intake. T/K infants exhibited a greater volumetric output (p<.01) and number of bowel movements (p<.05), than control infants. T/K infants were more alert during bottle-feeding (p<.05) than control infants. The duration of bottle feeds was longer for T/K infants than for control infants (p<.05). At the end of participation, there were no group differences on the Brazelton exam. T/K appears no more stressful than standard hospital care, increases alertness, and may lead to earlier discharge by promoting weight gain.

Reflexology

Kesselring, A. (1994). Fussreflexzonenmassage. Schweizerische Medizinische Wochenschrift - Supplementum, 62, 88-93.

Foot reflexology is defined as massage of zones on the feet which correspond to different parts of the body. A medline search yielded no literature in the field of foot reflexology. Indications for and results of foot reflexology have been extrapolated from case-descriptions and two pilot studies with small samples. One study (Lafuente et al.) found foot reflexology to be as helpful to patients with headaches as medication (flunarizine), yet foot reflexology was fraught with less side-effects than medication. In a second study (Eichelberger et al.) foot reflexology was used postoperatively on gynecological patients. The intervention group showed a lesser need for medication to enhance bladder tonus than did the control group. The literature describes foot reflexology as enhancing urination, bowel movements, and relaxation.

Reviews

Field, T. (1998). Massage therapy effects. American Psychological Association, 53, 1270-1281.

Massage therapy is older than recorded time, and rubbing was the primary form of medicine until the pharmaceutical revolution of the 1940's. Popularized again as part of the alternative medicine movement, massage therapy has recently received empirical support for facilitating growth, reducing pain, increasing alertness, diminishing depression, and enhancing immune function. In this article studies are reviewed that document these effects, and models are proposed for potential underlying mechanisms.

Goats, G. C. (1994). Massage--the scientific basis of an ancient art: Part 2. Physiological and therapeutic effects. [Review]. British Journal of Sports Medicine, 28, 153-156.

Manual massage is a long established and effective therapy used for the relief of pain, swelling, muscle spasm and restricted movement. Latterly, various mechanical methods have appeared to complement the traditional manual techniques. Both manual and mechanical techniques are described systematically, together with a review of indications for use in sports medicine.

Goats, G. C. (1994). Massage--the scientific basis of an ancient art: Part 2. Physiological and therapeutic effects. [Review]. British Journal of Sports Medicine, 28, 153-156.

The physiological and therapeutic effects of massage are frequently questioned. This article reviews previous research into the effects of massage on blood flow and composition, oedema, connective tissue, muscle and the nervous system. Although further investigations are clearly required in certain areas, the discussion demonstrates that the use of massage in sports medicine can be justified according to orthodox scientific criteria. [References: 57]

Sexual Abuse

Field, T., Hernandez-Reif, M., Hart, S., Quintino, O., Drose, L., Field, T., Kuhn, C., & Schanberg, S. (1997). Sexual abuse effects are lessened by massage therapy. Journal of Bodywork and Movement Therapies, 1, 65-69.

METHOD: Women (mean age = 35 years) who had experienced sexual abuse, were given a 30-minute massage twice a week for 1 month. RESULT: Immediately after the massage the women reported being less depressed and less anxious and their salivary cortisol levels decreased following the session. Over the 1-month treatment period the massage therapy group experienced a decrease in depression and in life event stress. Although the relaxation therapy control group also reported a decrease in anxiety and depression, their stress hormones did not change, and they reported an increasingly negative attitude toward touch.

Sexuality

van der Riet, P. (1995). Massage and sexuality in nursing. Nursing Inquiry, 2, 149-156.

This paper draws upon data from a students' massage workshop, focuses on the students' discourse as they positioned themselves as masseurs and considers relationships between nursing discourses and genderized self-hood. For some students, there was a conflation of sex and massage. Massage was more heavily laden with implicit sexual meaning for male students than for female students. The latter were able to negotiate the ambiguities of working with people's bodies in a more comfortable way. This research has implications for teaching students of nursing, particularly in relation to massage, and also nursing practice that involves care for the patient's body.

Sleep

Richards, K.C. (1998). Effect of a back massage and relaxation intervention on sleep in critically ill patients. American Journal of Critical Care, 7, 288-299.

METHOD: Critically ill patients are deprived of sleep and its potential healing qualities, although many receive medications to promote sleep. No one has adequately evaluated holistic nonpharmacological techniques designed to promote sleep in critical care practice. This study determined the effects of (1) a back massage and (2) combined muscle relaxation, mental imagery, and a music audiotape on the sleep of older men with a cardiovascular illness who were hospitalized in a critical care unit. Sixty-nine subjects were randomly assigned to a 6-minute back massage (n=24); a teaching session on relaxation and a 7.5 minute audiotape at bedtime consisting of muscle relaxation, mental imagery, and relaxing background music (n=28); or the usual nursing care (controls, n=17). Polysomnography was used to measure 1 night of sleep for each patient and the sleep efficiency index was the primary variable of interest. RESULTS: The analyses showed improved quality of sleep in the back-massage group.

Field, T., Kilmer, T., Hernandez-Reif, M. & Burman, I. Preschool Children's Sleep and Wake Behavior: Effects of Massage Therapy. Early Child Development and Care, 120, 39-44.

METHOD: Preschool children received 20-minute massages twice a week for five weeks. RESULTS: The massaged children as compared to the children in the wait-list control group had better behavior ratings on state, vocalization, activity and cooperation after the massage sessions on the first and last days of the study. Their behavior was also rated more optimally by their teachers by the end of the study. Also, at the end of the 5 week period parents of the massaged children rated their children as having less touch aversion and being more extraverted. Finally, the massaged children had a shorter latency to naptime sleep by the end of the study.

Smoking

Hernandez-Reif, M., Field, T., & Hart, S. (1999). Smoking cravings are reduced by self-massage. Preventive Medicine, 28, 28-32.

METHOD: Attempts at smoking cessation have been correlated with severe withdrawal symptoms, including intense cigarette cravings, anxiety, and depressed mood. Massage therapy has been shown to reduce anxiety and stress hormones and improve mood. Twenty smokers were randomly assigned to a self-massage treatment or a control group. The treatment group was taught to conduct a hand or ear self-massage during three cravings a day for 1 month. Self-reports revealed lower anxiety scores, improved mood, and fewer withdrawal symptoms. In addition, the self-massage group smoked fewer cigarettes per day by the last week of the study. These findings suggest that self-massage may be an effective adjunct treatment for attempting smoking cessation, to alleviate smoking-related anxiety, reduce cravings and withdrawal symptoms, improve mood, and reduce the number of cigarettes smoked.

Spinal Cord Injuries

Diego, M.A., Field, T., Hernandez-Reif, M., Hart, S., Brucker, B., Field, Tory, Burman, I. (2002). Spinal cord patients benefit from massage therapy. International Journal of Neuroscience, 112, 133-142.

METHOD: The study assessed the effects of massage therapy on depression, functionality and upper body muscle strength and range of motion on spinal cord injury patients. Twenty spinal cord injury individuals recruited from a medical school outpatient clinic were randomly assigned to a massage therapy or a control group. Patients in the massage therapy group received two-40-minute massage therapy sessions per week for five weeks. Patients in the control group practiced a range of motion exercise routine targeting the arms, neck, shoulders and back two times per week for five weeks. RESULTS: Although both the massage and exercise group appeared to benefit from treatment, only the massage group showed lower anxiety and depression scores and significantly increased their muscle strength and wrist range of motion.

Sports

Bell, G.W. (1999). Aquatic sports massage therapy. Clinical Sports Medicine, 18, 427-435. (Review).

Athletic trainers are continually bombarded with requests to assist aquatic athletes with the management of musculoskeletal concerns involved with training and overtraining. The trainer has options for initial training management through the administration of massage, cryotherapy, thermotherapy, and injury-preventative strengthening exercises. This article describes and illustrates athletic training techniques such as massage, cryotherapy or cold applications, thermotherapy or heat applications, and proprioceptive neuromuscular facilitation or strengthening exercise.
Callaghan, M. J. (1993). The role of massage in the management of the athlete: a review. [Review]. British Journal of Sports Medicine, 27, 28-33.

Massage has been a therapeutic modality in all cultures since early civilization and has had a long tradition of use in the sporting context. However, there has been a paucity of scientific evidence of the physiological, psychological and therapeutic effects of commonly used massage techniques. This paper reviews the early and more recent studies on the effects of massage and also the more recent literature on its use on the sports person. Little agreement was found in English publications of the efficacy of massage and there were contradictory findings as to the optimum technique and length of time of application. It is clear that the role of massage - a time-consuming technique for a physiotherapist to perform - needs to be evaluated further in order to resolve some contentious issues arising about this mode of treatment and to justify its use.

Smith, L. L., Keating, M. N., Holbert, D., Spratt, D. J., McCammon, M. R., Smith, S. S., and Israel, R. G. (1994). The effects of athletic massage on delayed onset muscle soreness, creatine kinase, and neutrophil count: a preliminary report. Journal of Orthopaedic & Sports Physical Therapy, 19, 93-99.

METHOD: It was hypothesized that athletic massage administered 2 hours after eccentric exercise would disrupt an initial crucial event in acute inflammation, the accumulation of neutrophils. This would result in a diminished inflammatory response and a concomitant reduction in delayed onset muscle soreness (DOMS) and serum creatine kinase (CK). Untrained males were randomly assigned to a massage (N = 7) or control (N = 7) group. All performed five sets of isokinetic eccentric exercise of the elbow flexors and extensors. Two hours after exercise, massage subjects received a 30-minute athletic massage; control subjects rested. Delayed onset muscle soreness and CK were assessed before exercise and at 8, 24, 48, 72, 96, and 120 hours after exercise. Circulating neutrophils were assessed before and immediately after exercise, and at 30-minute intervals for 8 hours; cortisol was assessed before and immediately after exercise, and at 30-minute intervals for 8 hours; cortisol was assessed at similar times. RESULTS: A trend analysis revealed a significant (p < 0.05) treatment by time interaction effect for 1) DOMS, with the massage group reporting reduced levels; 2) CK, with the massage group displaying reduced levels; 3) neutrophils, with the massage group displaying a prolonged elevation; and 4) cortisol, with the massage group showing a diminished diurnal reduction. The results of this study suggest that sports massage will reduce DOMS and CK when administered 2 hours after the termination of eccentric exercise. This may be due to a reduced emigration of neutrophils and/or higher levels of serum cortisol.

Viitasalo, J. T., Niemela, K., Kaappola, R., Korjus, T., Levola, M., Mononen, H. V., Rusko, H. K., and Takala, T. E. (1995). Warm underwater water-jet massage improves recovery from intense physical exercise. European Journal of Applied Physiology & Occupational Physiology, 71, 431-438.

METHOD: The effects of warm underwater water-jet massage on neuromuscular functioning, selected biochemical parameters (serum creatine kinase, lactic dehydrogenase, serum carbonic anhydrase, myoglobin, urine urea and creatinine) and muscle soreness were studied among 14 junior track and field athletes. Each subject spent, in a randomized order, two identical training weeks engaged in five strength/power training sessions lasting 3 days. RESULTS: The training weeks differed from each other only in respect of underwater water-jet massage treatments. These were used three times (20 min each) during the treatment week and not used during the control week. During the treatment week continuous jumping power decreased and ground contact time increased significantly less (P < 0.05) and serum myoglobin increased more than during the control week. It is suggested that underwater water-jet massage in connection with intense strength/power training increases the release of proteins from muscle tissue into the blood and enhances the maintenance of neuro-muscular performance capacity.

Tiidus, P. M. and Shoemaker, J. K. (1995). Effleurage massage, muscle blood flow and long-term post-exercise strength recovery. International Journal of Sports Medicine, 16, 478-483.

METHOD: Manual massage is commonly assumed to enhance long term muscle recovery from intense exercise, partly due to its ability to speed healing via enhanced muscle blood flow. We tested these assumptions by daily (for four days) massaging the quadriceps muscles of one leg on subjects who had previously completed an intense bout of eccentric quadriceps work with both legs. RESULTS: Immediate post-exercise isometric and dynamic quadriceps peak torque measures had declined to approximately 60-70% of pre-exercise values in both legs. Peak torques for both the massage and control leg tended to slowly return toward pre-exercise values through the subsequent four days (96 hrs). There was no significant difference between the isometric and dynamic peak torques between massage and control legs up to 96 hours post-exercise. Leg blood flow was estimated by determining femoral artery and vein mean blood velocities via pulsed Doppler ultrasound velocimetry. Massage of the quadriceps muscles did not significantly elevate arterial or venous mean blood velocity above resting levels, while light quadriceps muscle contractions did. The perceived level of delayed onset muscle soreness tended to be reduced in the massaged leg 48-96 hours post-exercise. It was concluded that massage was not an effective treatment modality for enhancing long term restoration of post-exercise muscle strength and its use for this purpose in athletic settings should be questioned

Tiidus, P. M. (1997). Manual massage and recovery of muscle function following exercise: a literature review. [Review]. Journal of Orthopaedic & Sports Physical Therapy, 25, 107-112.

There is currently little scientific evidence that manual massage has any significant impact on the short- or long-term recovery of muscle function following exercise or on the physiological factors associated with the recovery process. In addition, delayed onset muscle soreness may not be affected by massage. Light exercise of the affected muscles is probably more effective than massage in improving muscle blood flow (thereby possibly enhancing healing) and temporarily reducing delayed onset muscle soreness. This paper reviews current scientific evidence on the use of manual massage to affect: 1) muscle damage caused by eccentric muscle action; 2) retention and recovery of muscle strength and performance following "eccentric-mechanical" muscle damage; 3) reduction of delayed onset muscle soreness following "eccentric-mechanical" muscle damage; and 4) recovery of muscle strength and performance following anaerobic exercise. Because manual massage does not appear to have a demonstrated effect on the above, its use in athletic settings for these purposes should be questioned.

Stress

Meaney, M. J., Aitken, D. H., Bhatnagar, S., Bodnoff, S. R., Mitchell, J. B., and Sarriau, A. (1990). Neonatal Handling and the development of the adrenocorticol response to stress. Gunzenhauser, N. Advances in Touch. 11-22. Johnson & Johnson. Pediatric round table series.

In the early 1960s, Seymour Levine, Victor Denenberg, and their colleagues published a series of papers describing the effects of postnatal handling on the development of behavioral and endocrine responses to stress. The handling procedure involved removing rat pups from their cages, placing them in small containers, and 15 to 20 minutes later returning them to their cages and reuniting them with their mothers. This manipulation was peformed once a day for the first 21 days of life. As adults, those rats that had been handled (H) exhibited less fear in novel environments and a less pronounced increase in the secretion of the adrenal glucocorticoids in response to a variety of stressors than rats that had not been handled (NH). These findings clearly demonstrated that the development of rudimentary adaptive responses to stress could be modified by environmental events. In the studies described here, we have followed on the earlier handling studies, examining the way in which early environmental events alter the development of specific biochemical systems in the brain. We have shown how early handling influences the neurochemical development of certain brain regions that regulate the endocrine response to stress. Neonatal handling increases the efficiency of adaptive endocrine responses to stress, shielding the animal from excessive exposure to the highly catabolic adrenal steroids. In later life, this effect appears to protect the animal from potentially damaging effects of these steroids, ensuring more efficient cognitive functioning.

Substance P

Morhenn, V.B. (2000). Firm stroking of human skin leads to vasodilatation possibly due to the release of substance P. Journal of Dermatological Science, 22, 138-44.

METHODS: Eight individuals were given a face massage and skin temperature was measured. In seven of eight humans tested, an elevation in the skin's temperature was documented after massaging of the cheeks of the face. The elevation of the skin's temperature reached a plateau after about 40 min of massaging and was correlated to visible erythema. This effect could be inhibited by repeated pretreatment of the skin with topical capsaicin, a chemical that results in the release of substance P from peripheral nerve endings. Thus, it appears that the temperature elevation induced by stroking of human skin is controlled, at least in part, by release of the neurotransmitter, substance P. RESULTS: The release of neurotransmitter(s) may be the survival advantage that grooming confers to animals

Surgery

Kim, M.S., Cho, K.S., Woo, H., & Kim, J.H. (2001). Effects of hand massage on anxiety in cataract surgery using local anesthesia. Journal of Cataract & Refractive Surgery, 27, 884-90.

METHODS: This study comprised 59 patients having cataract surgery. The patients were divided into those having a hand massage 5 minutes before surgery and those not receiving a hand massage. Patients' anxiety levels were measured using the Visual Analog Scale and by assessing systolic blood pressure, diastolic blood pressure, and pulse rate before and after the hand massage and 5 minutes before the end of surgery. Epinephrine, norepinephrine, cortisol, blood sugar levels, neutrophil, and lymphocyte percentages in white blood cells were also measured. RESULTS: After the hand massage, the psychological anxiety levels, systolic and diastolic blood pressures, and pulse rate were significantly lower than before the massage. The hand massage significantly decreased epinephrine and norepinephrine levels in the experimental group while epinephrine, norepinephrine, and cortisol levels increased in the control group.

Hattan, J., King, L., & Griffiths, P. (2002). The impact of foot massage and guided relaxation following cardiac surgery: a randomized controlled trial. Journal of Advanced Nursing, 37, 199-207.

METHODS: This study investigated the impact of foot massage and guided relaxation on the well-being of patients who had undergone coronary artery bypass graft surgery. Twenty-five subjects were randomly assigned to either a control or one of two intervention groups. Psychological and physical variables were measured immediately before and after the intervention. A discharge questionnaire was also administered. RESULTS: Increased calm scores occurred for the massage group. There was a clear (nonsignificant) trend across all psychological variables for both foot massage and, to a lesser extent, guided relaxation to improve psychological well-being. Both interventions were well received by the subjects.

Antoniv, V.R. (2002). Effect of neck massage therapy on the soft tissues after thyroid surgery. Likarska Sprava, 93-96.

Our objectives in this study were to establish validated methods of massotherapy of the neck, to determine its action on the neck structures, and to conduct a comparative evaluation of results of the control and study groups after performing massotherapy. It has been found out that in 80 (85%) patients the skin comes to be tinged with healthy pink, the cutaneous-and-muscle tone getting improved, which event makes the skin smooth and elastic following the above massage. Over the first ten days of the massoprocedures 44 (48%) subjects demonstrated resolution of the edema and swelling, with the thickened skin fold as a roller disappearing by the end of the second month. Dispelling of hypthyrosis phenomena made for reduction of dosages of hormonal preparations. We consider it mandatory that massotherapy of the neck be instituted in all those patients who had undergone operation on the neck and thyroid.

Techniques

Westland, G. (1993). Massage as a therapeutic tool: I. British Journal of Occupational Therapy, 56, 129-134.

Defines massage and outlines various of the systems of massage. Structural systems of massage are ones that see the body in a reductionistic and mechanistic manner. Energy systems of massage tend to derive from either Eastern healing traditions or the work of W. Reich (e.g., 1961). Emotional systems of massage work with the anatomical structure, the energy structure and the emotional life of the body. Problems arising in the choice of the system of massage are discussed. The legal context of massage in regard to massage outside statutory agencies and registration of professionals is addressed. The benefits of massage are attributed to the value of touch and the importance of skin. Touch for the fetus, touch during labor, touch for babies, and touch in the parent-infant bonding process are discussed. Touch in adult life is addressed briefly.

Westland, G. (1993). Massage as a therapeutic tool: 2. British Journal of Occupational Therapy, 56, 177-180.

Reviews findings on studies of massage as pain relief, massage for general medical conditions, and massage in anxiety management. Inappropriate use of touch can have particular implications for psychotic or depressed people, some of those who have panic attacks, anorexics, and sexually abused people. Massage performed inexpertly can increse anxiety, provoke anger without resolution in the session, provoke depersonalization and fragmentation, and actually exacerbate psychosis. However, massage can also bring psychotic patients more into contact with reality and alleviate states such as hypomania, frustration, and potential violence.

Russell, J. K. (1994). Bodywork--the art of touch. Nurse Practitioner Forum, 5, 85-90.

Massage, neuromuscular therapy, Trager, and Bowen work reduce stress, relieve pain, rebalance the body, and restore a sense of general well-being. They can be used by themselves to promote physical and emotional health or with conventional medical care to restore health. This article examines the differences and similarities among these four therapies and concludes with case histories to illustrate the use of bodywork in primary care.

Transplants

Doering, T.J., Fieguth, H.G., Steuernagel, B., Brix, J., Konitzer, M., Schneider, B. & Fischer, G.C. (1999). External stimuli in the form of vibratory massage after heart or lung transplantation. American Journal of Physical Medicine Rehabilitation, 78, 108-110.

METHOD: The aim of this pilot study was to examine the influence of manual vibratory massage on the pulmonary function of postoperative patients who were receiving mechanical ventilation, with special interest being focused on pulmonary ventilation and perfusion and cerebral blood flow velocity. Manual vibratory massage was performed postoperatively in the intensive care unit on eight patients: three patients had undergone heart transplantation, three had undergone lung transplantation, and two had undergone coronary artery bypass grafting (mean age 54 yrs). Changes of respiration parameters and cerebral blood flow velocity (measured by transcranial Doppler sonography) were examined. The vibratory massage was performed with a frequency of 8 to 10 vibrations/s for 15 min, 7.5 min on each side of the thorax, starting from the lower costal arch and progressing to the upper thoracic aperture. For 10 min before, during, and 10 minutes after the massage, the parameters of peripheral oxygen saturation, central venous pressure, mean arterial pressure, heart rate, lung resistance and compliance, tidal volume, respiration rate, and cerebral blood flow velocity were recorded at 2-min intervals. Moreover, before and after vibratory massage, arterial blood gases were determined. RESULTS: In four of the eight patients, it was possible to determine pulmonary arterial pressure, pulmonary capillary wedge pressure, as well as pulmonary vascular resistance. During the vibratory massage, mean tidal volume increased by 30%. Percutaneous oxygen saturation also increased, from 92 to 94%. Central venous pressure decreased by 11%, and pulmonary vessel resistance was reduced by 18%. Pulmonary resistance decreased by the end of the observation period. Thus, vibratory massage seemed to improve pulmonary mechanism and perfusion, thus, reducing ventilation perfusion mismatch and increasing oxygen saturation.

Smith, M.C., Reeder, F., Daniel, L., Baramee, J., & Hagman, J. (2003). Outcomes of touch therapies during bone marrow transplant. Alternative Therapies, 9, 40-49.

METHOD: This study investigated the effects of Therapeutic Touch and massage therapy on the outcomes of engraftment time, complications, and perceived benefits of therapy during bone marrow transplant. Subjects were adult patients on the bone marrow transplant unit of a large urban tertiary care center. Subjects were randomly assigned to 1 of 3 treatment groups: Therapeutic Touch, massage therapy, and a control group called the friendly visit. Subjects (N=88) were stratified by type of transplant (allogeneic or autologous). Twenty-seven subjects received massage therapy; 31 received therapeutic touch; and 30 received a friendly visit. Nurses with expertise in the 2 touch therapies administered them. The interventions of massage therapy, therapeutic touch, and friendly visit were administered according to standardized protocols every third day beginning the day chemotherapy began until discharge from the program. Time for engraftment, complications, and patient perceptions of benefits of therapy were the main outcome measures. Analysis of variance and analysis of covariance were used to determine significant differences among the 3 groups with respect to time of engraftment. RESULTS: A signficantly lower score for central nervous system or neurological complications was noted for subjects who received massage therapy compared with the control group; however, no differences were found among the 3 groups with respect to the other 10 complication categories or in the total mean score for complications. Patients' perception of the benefits of therapy (total score) was significantly higher for those who received massage therapy compared with the friendly visit control group. The mean scores on the comfort subscale were significantly higher for patients receiving both massage therapy and therapeutic touch with the friendly visit control group.

Voice Disorders

Ternstrom, S., Andersson, M., & Bergman, U. (2000). An effect of body massage on voice loudness and phonation frequency in reading. Logopedics, Phoniatrics, Vocology, 25, 146-50.

METHODS: The effect of massage on voice fundamental frequency and sound pressure level was investigated. Subjects were recorded while reading a 3-min passage of prose text. Then, a 30-min session of massage was administered. Sixteen subjects were given the massage, while 15 controls rested, lying in silence for the same amount of time. The subjects were then recorded reading the same passage again. RESULTS: In the post-massage recordings, subjects had lowered their fundamental frequency and sound pressure level.

D'Antoni, M. L., Harvey, P. L., and Fried, M. P. (1995). Alternative medicine: does it play a role in the management of voice disorders? Journal of Voice, 9, 308-311.

Alternative medicine has begun to receive the attention of the legitimate medical community. Recent evidence reveals that 34% of American adults interviewed reported using at least one unconventional therapy during 1994. A 3-month survey of patient inquiries, conducted at The Voice Center, Beth Israel Hospital, Boston, MA, U.S.A. revealed that 41% of patients made inquiries about the potential use of "unconventional approaches" in the management of their voice disorders. Alternative medicine, while largely unproven for efficacy, represents a rapidly growing approach. The present article defines several alternative medical practices, describes their theories and potential impact on the management of voice disorders, and calls for empirical studies to follow. The alternative practices discussed are limited to behavioral therapies such as massage therapy, creative visualization, Alexander, mindfulness, and meditation.