Massage Therapy as CAM

Transcription

1 Massage Therapy as CAM Massage therapy is a practice that dates back thusands f years. There are many types f massage therapy; all invlve manipulating the muscles and ther sft tissues f the bdy. In the United States, massage therapy is smetimes part f cnventinal medicine. In ther instances, it is part f cmplementary and alternative medicine (CAM). This Backgrunder prvides a general verview f massage therapy used as CAM and suggests sme resurces yu can use t learn mre. Key Pints Peple use massage therapy as CAM fr a variety f health-related purpses, frm treating specific diseases and cnditins t general wellness. Scientists d nt fully knw what changes ccur in the bdy during massage, whether they influence health, and, if s, hw. The Natinal Center fr Cmplementary and Alternative Medicine (NCCAM) is spnsring studies t answer these questins and identify the purpses fr which massage may be mst helpful. There appear t be few risks t massage therapy if it is used apprpriately and prvided by a trained massage prfessinal. Tell yur health care prviders abut any CAM therapy yu are cnsidering r using, including massage therapy. This helps t ensure safe and crdinated care. Cnventinal medicine is medicine as practiced by hlders f M.D. (medical dctr) and D.O. (dctr f stepathy) degrees and by their allied health prfessinals, such as physical therapists, psychlgists, and registered nurses. An example f massage therapy as cnventinal medicine is using it t reduce a type f swelling called lymphedema. CAM is a grup f diverse medical and health care systems, practices, and prducts that are nt presently cnsidered t be part f cnventinal medicine. While sme scientific evidence exists regarding sme CAM therapies, fr mst there are key questins that are yet t be answered thrugh well-designed scientific studies. An example f massage therapy as CAM is using it with the intent t enhance immune system functining.

2 What Massage Therapy Is The term massage therapy (als called massage, fr shrt; massage als refers t an individual treatment sessin) cvers a grup f practices and techniques. There are ver 80 types f massage therapy. In all f them, therapists press, rub, and therwise manipulate the muscles and ther sft tissues f the bdy, ften varying pressure and mvement. They mst ften use their hands and fingers, but may use their frearms, elbws, r feet. Typically, the intent is t relax the sft tissues, increase delivery f bld and xygen t the massaged areas, warm them, and decrease pain. A few ppular examples f this therapy are as fllws: In Swedish massage, the therapist uses lng strkes, kneading, and frictin n the muscles and mves the jints t aid flexibility. A therapist giving a deep tissue massage uses patterns f strkes and deep finger pressure n parts f the bdy where muscles are tight r kntted, fcusing n layers f muscle deep under the skin. In trigger pint massage (als called pressure pint massage), the therapist uses a variety f strkes but applies deeper, mre fcused pressure n myfascial trigger pints knts that can frm in the muscles, are painful when pressed, and cause symptms elsewhere in the bdy as well. In shiatsu massage, the therapist applies varying, rhythmic pressure frm the fingers n parts f the bdy that are believed t be imprtant fr the flw f a vital energy called qi. Massage therapy (and, in general, the laying n f hands fr health purpses) dates back thusands f years. References t massage have been fund in ancient writings frm many cultures, including thse f Ancient Greece, Ancient Rme, Japan, China, Egypt, and the Indian subcntinent. In the United States, massage therapy first became ppular and was prmted fr a variety f health purpses starting in the mid-1800s. In the 1930s and 1940s, hwever, massage fell ut f favr, mstly because f scientific and technlgical advances in medical treatments. Interest in massage revived in the 1970s, especially amng athletes. Mre recently, a 2002 natinal survey n Americans use f CAM (published in 2004) fund that 5 percent f the 31,000 participants had used massage therapy in the preceding 12 mnths, and 9.3 percent had ever used it. Accrding t recent reviews, peple use massage fr a wide variety f health-related intents: fr example, t relieve pain (ften frm musculskeletal cnditins, but frm ther cnditins as well); rehabilitate sprts injuries; reduce stress; increase relaxatin; address feelings f anxiety and depressin; and aid general wellness. Wh Prvides Massage Therapy A persn wh prfessinally prvides massage therapy is mst ften called a massage therapist, althugh there are sme ther health care prviders (such as chirpractrs) wh als NCCAM-2

3 have massage training. This Backgrunder mainly uses the term massage therapist. Mst massage therapists learn and practice mre than ne type f massage. T learn massage, mst therapists attend a schl r training prgram, with a much smaller number training instead with an experienced practitiner. Many students are already licensed as anther type f health care prvider, such as a nurse. There are abut 1,300 massage therapy schls, cllege prgrams, and training prgrams in the United States. The curse f study typically cvers subjects such as anatmy and physilgy (structure and functin f the bdy); kinesilgy (mtin and bdy mechanics); therapeutic evaluatin; massage techniques; first aid; business, ethical, and legal issues; and hands-n practice f techniques. These educatinal prgrams vary in many respects, such as length, quality, and whether they are accredited. Many require 500 hurs f training, which is the same number f hurs that many states require fr certificatin. Sme therapists als pursue specialty r advanced training. At the end f 2004, 33 states and the District f Clumbia had passed laws regulating massage therapy fr example, requiring that massage therapists graduate frm an apprved schl r training prgram and pass the natinal certificatin exam in their field in rder t practice. Cities and cunties may have laws that apply as well. Prfessinal rganizatins f massage therapists have nt agreed upn the standards fr recgnizing that a massage therapist is prperly and adequately trained. Licenses and Certificatins Sme cmmn licenses r certificatins fr massage therapists include: LMT Licensed Massage Therapist LMP Licensed Massage Practitiner CMT Certified Massage Therapist NCTMB Has met the credentialing requirements (including passing an exam) f the Natinal Certificatin Bard fr Therapeutic Massage and Bdywrk, fr practicing therapeutic massage and bdywrk NCTM Has met the credentialing requirements (including passing an exam) f the Natinal Certificatin Bard fr Therapeutic Massage and Bdywrk, fr practicing therapeutic massage What Massage Therapists D in Treating Patients Massage therapists wrk in a variety f settings, including private ffices, hspitals, ther clinical settings, nursing hmes, studis, and sprt and fitness facilities. Sme als travel t patients hmes r wrkplaces t prvide a massage. Massage therapy treatments usually last fr 30 t 60 minutes; less ften, they are as shrt as 15 minutes r as lng as 1.5 t 2 hurs. Fr sme cnditins (especially chrnic nes), therapists NCCAM-3

4 ften advise a series f appintments. Therapists usually try t prvide an envirnment that is as calm and sthing as pssible (fr example, by using dim lighting, sft music, and fragrances). At the first appintment, a massage therapist will discuss yur symptms, medical histry, the results yu (and yur health care prvider, if applicable) desire, and pssibly ther factrs such as yur wrk and levels f stress. She will likely perfrm sme evaluatins thrugh tuch. If she finds nthing that wuld make a massage inadvisable, she will prceed with the massage. At any time, yu can bring up questins r cncerns. During treatment, yu will lie n a special padded table r sit n a stl r chair. Yu might be fully clthed (fr example, fr a chair massage ) r partially r fully undressed (in which case yu will be cvered by a sheet r twel; nly the parts f yur bdy that the therapist is currently massaging are expsed). Oil r pwder helps reduce frictin n the skin. The therapist may use ther aids, such as ice, heat, fragrances, r machines. He may als prvide recmmendatins fr self-care, such as drinking fluids, learning better mvement, and develping an awareness f yur bdy. Why Peple Use Massage Therapy In the 2002 natinal survey n Americans use f CAM, respndents wh used a CAM therapy culd chse frm five reasns fr using the therapy. The results fr massage were as fllws: They believed that massage cmbined with cnventinal medicine wuld help: 60 percent They thught massage wuld be interesting t try: 44 percent They believed that cnventinal medical treatments wuld nt help: 34 percent Massage was suggested by a cnventinal medical prfessinal: 33 percent They thught that cnventinal medicine was t expensive: 13 percent Side Effects and Risks Massage therapy appears t have few serius risks if apprpriate cautins are fllwed. A very small number f serius injuries have been reprted, and they appear t have ccurred mstly because cautins were nt fllwed r a massage was given by a persn wh was nt prperly trained. Health care prviders recmmend that patients nt have massage therapy if they have ne r mre f the fllwing cnditins: Deep vein thrmbsis (a bld clt in a deep vein, usually in the legs) A bleeding disrder r taking bld-thinning drugs such as warfarin Damaged bld vessels NCCAM-4

5 Weakened bnes frm steprsis, a recent fracture, r cancer A fever Any f the fllwing in an area that wuld be massaged: An pen r healing wund A tumr Damaged nerves An infectin r acute inflammatin Inflammatin frm radiatin treatment. If yu have ne r mre f the fllwing cnditins, be sure t cnsult yur health care prvider befre having massage: Pregnancy Cancer Fragile skin, as frm diabetes r a healing scar Heart prblems Dermatmysitis, a disease f the cnnective tissue A histry f physical abuse. Side effects f massage therapy may include: Temprary pain r discmfrt Bruising Swelling A sensitivity r allergy t massage ils. Sme Other Pints T Cnsider Abut Massage Therapy as CAM Massage therapy shuld nt be used t replace yur regular medical care r t delay seeing a dctr abut a medical prblem. Befre yu decide abut having massage therapy, ask the therapist abut: Her training, experience, and any licenses r credentials Any medical cnditins yu have and whether she has had any specialized training r experience with them The number f treatments that might be needed Cst Insurance cverage, if any. If a massage therapist suggests using ther CAM practices (herbs r ther supplements, a special diet, etc.), discuss it first with yur regular health care prvider. Fr findings frm research studies n massage therapy fr varius health cnditins, see Fr Mre Infrmatin. Hwever, the available literature is limited, and mre research is needed t make firm cnclusins. NCCAM-5

6 Hw Massage Therapy Might Wrk Scientists are studying massage t understand what effects massage therapy has n patients, hw it has thse effects, and why. Sme aspects f this are better understd than thers. Fr example, it is knwn that: When certain frces are applied t the muscles, changes ccur in the muscles (althugh thse changes are nt clearly understd r agreed upn). Massage therapy typically enhances relaxatin and reduces stress. Stress makes sme diseases and cnditins wrse. There are many mre aspects that are nt yet knwn r well understd scientifically, hwever. Sme f the prpsed theries are that massage: Might prvide stimulatin that may help blck pain signals sent t the brain (the gate cntrl thery f pain reductin). Might shift the patient s nervus system away frm the sympathetic and tward the parasympathetic. The sympathetic nervus system helps mbilize the bdy fr actin. When a persn is under stress, it prduces the fight-r-flight respnse (the heart rate and breathing rate g up, fr example; the bld vessels narrw; and muscles tighten). The parasympathetic nervus system creates what sme call the rest and digest respnse (the heart rate and breathing rate slw dwn, fr example; the bld vessels dilate; and activity increases in many parts f the digestive tract). Might stimulate the release f certain chemicals in the bdy, such as sertnin r endrphins. Might cause beneficial mechanical changes in the bdy fr example, by preventing fibrsis (the frmatin f scar-like tissue) r increasing the flw f lymph (a fluid that travels thrugh the bdy s lymphatic system and carries cells that help fight disease). Might imprve sleep, which has a rle in pain and healing. Might prvide sme health benefit frm the interactin between therapist and patient. Mre well-designed studies are needed t understand and cnfirm these theries and ther scientific aspects f massage. NCCAM-Spnsred Research n Massage Sme recent examples f NCCAM-spnsred research n massage include: Hw massage affects healthy peple, and whether these effects are different depending n hw many massages are given and hw ften On this tpic, see especially the reference by C.A. Myer et al. NCCAM-6

7 The effects f massage n chrnic neck pain, and cmparing the benefits f cnventinal therapeutic massage with usual medical treatment Massage fr cancer patients at the end f life, t see if massage helps relieve depressin, imprves emtinal well-being and quality f life, and eases the prcess f dying Whether massage given at hme by a trained family member helps reduce pain frm sickle cell anemia. References Surces are primarily recent reviews n the general tpic f massage therapy in the peerreviewed medical and scientific literature in English in the PubMed database, selected evidence-based databases, and Federal Gvernment surces. Alvarez DJ, Rckwell PG. Trigger pints: diagnsis and management. American Family Physician. 2002;65(4): Barnes PM, Pwell-Griner E, McFann K, Nahin RL. Cmplementary and alternative medicine use amng adults: United States, CDC Advance Reprt # Cherkin DC, Sherman KJ, Dey RA, et al. A review f the evidence fr the effectiveness, safety, and cst f acupuncture, massage therapy, and spinal manipulatin fr back pain. Annals f Internal Medicine. 2003;138(11): Crbin L. Safety and efficacy f massage therapy fr patients with cancer. Cancer Cntrl: Jurnal f the Mffitt Cancer Center. 2005;12(3): Dillard MH, Knapp S. Cmplementary and alternative pain therapy in the emergency department. Emergency Medicine Clinics f Nrth America. 2005;23(2): Eisenberg DM, Chen MH, Hrbek A, et al. Credentialing cmplementary and alternative medical prviders. Annals f Internal Medicine. 2002;137(12): Ernst E. The safety f massage therapy. Rheumatlgy. 2003;42(9): Field T. Massage therapy effects. American Psychlgist. 1998;53(12): Gldstne LA. Massage as an rthdx medical treatment past and future. Cmplementary Therapies in Nursing and Midwifery. 2000;6(4): Massage: Bttm Line Mngraph. Natural Standard Web site. Accessed at n August 22, Massage Therapists: Occupatinal Outlk Handbk, Editin. U.S. Bureau f Labr Statistics Web site. Accessed at n August 22, Myer CA, Runds J, Hannum JW. A meta-analysis f massage therapy research. Psychlgical Bulletin. 2004;130(1):3-18. Natinal Center fr Cmplementary and Alternative Medicine. Manipulative and Bdy-Based Practices: An Overview. Bethesda, MD: Natinal Center fr Cmplementary and Alternative Medicine; NCCAM publicatin n. D238. Natinal Institute f Arthritis and Musculskeletal and Skin Diseases. Ostearthritis. Bethesda, MD: Natinal Institute f Arthritis and Musculskeletal and Skin Diseases; NIH publicatin n Natinal Institute f Arthritis and Musculskeletal and Skin Diseases. Osteprsis: Cping With Chrnic Pain. Natinal Institute f Arthritis and Musculskeletal and Skin Diseases Web site. Accessed at n August 31, Sherman KJ, Cherkin DC, Kahn J, et al. A survey f training and practice patterns f massage therapists in tw U.S. states. BiMed Central Cmplementary and Alternative Medicine. 2005;5:13. Weerapng P, Hume PA, Klt GS. The mechanisms f massage and effects n perfrmance, muscle recvery and injury preventin. Sprts Medicine. 2005;35(3): NCCAM-7

8 Fr Mre Infrmatin NCCAM Clearinghuse The NCCAM Clearinghuse prvides infrmatin n CAM and NCCAM, including publicatins and searches f Federal databases f scientific and medical literature. Examples f relevant publicatins include Manipulative and Bdy-Based Practices: An Overview, Selecting a CAM Practitiner, and Cnference n the Bilgy f Manual Therapies, June 9-10, 2005: Cnference Recmmendatins. The Clearinghuse des nt prvide medical advice, treatment recmmendatins, r referrals t practitiners. Tll-free in the U.S.: TTY (fr deaf and hard-f-hearing callers): Web site: nccam.nih.gv inf@nccam.nih.gv PubMed A service f the Natinal Library f Medicine (NLM), PubMed cntains publicatin infrmatin and (in mst cases) brief summaries f articles frm scientific and medical jurnals. CAM n PubMed, develped jintly by NCCAM and NLM, is a subset f the PubMed system and fcuses n the tpic f CAM. Web site: CAM n PubMed: nccam.nih.gv/camnpubmed/ Acknwledgments NCCAM thanks the fllwing peple fr their technical expertise and review f this publicatin: Karen Sherman, Ph.D., M.P.H., Center fr Health Studies, Grup Health Cperative; Jeanette Ezz, Ms.T., M.P.H., Ph.D., Natinal Advisry Cuncil fr Cmplementary and Alternative Medicine; and Partap Khalsa, D.C., Ph.D.; Richard Nahin, Ph.D., M.P.H.; and Linda Rich, M.P.S., C.M.T., NCCAM. This publicatin is nt cpyrighted and is in the public dmain. Duplicatin is encuraged. NCCAM has prvided this material fr yur infrmatin. It is nt intended t substitute fr the medical expertise and advice f yur primary health care prvider. We encurage yu t discuss any decisins abut treatment r care with yur health care prvider. The mentin f any prduct, service, r therapy is nt an endrsement by NCCAM. Natinal Institutes f Health U.S. Department f Health and Human Services Created September 2006 D327