Massage therapy is one of the oldest forms of treatment in the world, having first been prescribed in China during the second century B.C. and soon after in India and Egypt. Hippocrates, in 400 B.C., defined medicine as “the art of rubbing.” It’s an instinctive art of rubbing, influenced by humans natural instinct to stroke and rub areas of the body that hurt. In many ancient countries, it was widely adopted by men and women to heal injuries, relieve pain, and help produce a sense of peace and well being. As times change, massage therapy disappeared from the American medical scene at approximately the time of the pharmaceutical revolution of the 1940s (M. Field )
Today, massage is defined as the manipulation of the soft tissue of the body by such movements as rubbing, kneading, pressing, rolling, and tapping, for therapeutic purposes such as promoting circulation of the blood and lymph, relaxation of muscles, relief from pain, restoration of metabolic balance, and other benefits both physical and mental (M. Field ). It has become commonly recognized by healthcare specialists as a sensible alternative to Western medicine. If massage therapy is done correctly and regularly, it can heal and minimize musculoskeletal problems, high blood pressure, headaches, anxiety, and many more health related issues without the use of drugs or surgeries. Over the years, massage therapy has progressively evolved, adopting a variety of different therapeutic techniques that could help improve an individual's health and well being. The current literature review outlines possible mechanisms of massage (biomechanical, physiological, neurological and psychophysiological), and evaluates the evidence for the benefits of massage in research. improving performance, enhancing recovery or preventing muscular injury (Weerapong, Hume, and Kolt., 2005)
Massage therapy was shown to be significantly beneficial for athletes through its biomechanical, physiological, neurological and psychological mechanisms. In the past 11 years, massage treatment was administered for approximately 45% of the total time in physiotherapy treatment. However, the practice of massage therapy is becoming more prominent in sports events, because many athletes and coaches believe that massage provide numerous benefits, such as increased blood flow, reduced muscle tension and neurological excitability, and an increased sense of well being. Unfortunately, there’s limited scientific evidence to support the effects of massage on sports performance, recovery from injury, or prevention of musculoskeletal problems. The purpose of this literature is to review the possible mechanisms of massage, and present current studies relating to the effect of massage on athletic performance, and how it’s beneficial for athletes (Weerapong, Hume, Kolt., 2005).
In order to determine which papers were relevant to the review, three computer databases (PubMed, SPORT Discus and Proquest 5000 International) in addition to manual journal searches were used. By using the computer databases, the researchers had access to biomedical and sports-related journals, books, theses, and related articles. Utilizing the key search phrases such as ‘sports injury’, ‘delayed onset muscles soreness,’ ‘injury prevention,’ ‘range of motion,’and ‘muscle stiffness,’ helped to narrow down the search results. The criteria for inclusion were: healthy participants (age,sex, and fitness differences were not excluding factors), the article must have used Swedish-type massage as an intervention (effleurage and petrissage were not excluding factors), and the article may have discussed the possible mechanisms of massage in relation to biomechanics and/or neuromuscular properties (muscle, sports performance, rate of injury, and muscle soreness).
The possible mechanisms of massage were based solely on speculations, by authors with limited evidence. Nonetheless, the speculations were still needed for further research to establish the true mechanisms and effects of massage. To determine the biomechanical mechanisms, a summary of the evidence for the effects of massage on muscle-tendon unit compliance as measured by passive stiffness, active stiffness and joint range of motion, was based on 4 studies.
The first and only study to examine the effect of massage on passive stiffness, performed 10-minutes of effleurage on 19 healthy subjects and compared with a 10- minute rest. The results showed no significant effects, because effleurage is a light gliding technique that doesn’t use enough pressure to produce mechanical or reflexive effects. As for active stiffness, there was no research on the effects of massage active stiffness. In joint range of motion, all four studies were used to examine the effects. The first study was a random control trial, consisted of 30 dance students, divided into two groups. The first group received a full body massage (effleurage, petrissage, friction). The second group did progressive muscle relaxation exercise (30 min session, twice a week, five consecutive weeks. The results showed decrease in anxiety showed decrease in anxiety (both groups), decrease in cortisol (massage group), increase in ROM (massage group). In the following study, 25 normal subjects received Swedish and Hoffa massage on the back and the back of lower limbs for 30 minutes. The results showed increase in lumbar range of motion. The final study included 8 healthy males, divided into four groups (warm-up, legs massage, warm-up and massage, warmup and stretching). The results showed increase in dorsiflexion, and decrease in quadriceps and hamstring.
The effect of massage on physiological mechanisms, included increased in skin and muscle temperature, and increased in blood flow. Massage is also believed to stimulate sensory receptors and decrease muscle tension or spasm after massage application, by reducing neuromuscular excitability (neuromuscular mechanisms). As for the psychological mechanism, all four studies have presented decrease in anxiety, and increase in relaxation. Regardless of limited evidence on possible mechanisms of massage, massage is still believed to benefit athletes through its biomechanical, physiological, neurological and psychological mechanisms.
In recent years, the practice of massage therapy has become increasingly prominent in the healthcare industry, especially in physical therapy. Massage therapy is usually applied by a physical therapist, either before the patient begins the exercise program or after the patient is finished. Physical therapists utilize massage as a form of manual therapy to help decrease pain, increase circulation, decrease muscle spasm, and increase muscle flexibility.
When I first started my internship at a physical therapy office, I was given the opportunity to observe the application of massage therapy by a physical therapist aid. It was honestly mesmerizing to watch the movements of her hands, as she deeply work her way into the soft tissues. The patient receiving the massage therapy was in the process of recovering from a knee replacement surgery. On the patient’s knee was a long scar that runs slightly down the middle. When the physical therapist aid begins massaging the knee, she started off with light, smooth strokes around and on the scar. This technique is also known as Effleurage, a massaging technique that’s often applied at the beginning to help prepare the muscles for deeper tissue techniques. Following that technique, she transitioned over to Petrissage, a massage technique that consist of the physical therapist aid squeezing the muscles around the knee and rolling it under her hands, this is also known as kneading. The purpose of both techniques was to help increase venous and lymphatic return, which in return helped the swelling around the patient’s knee to decrease. Now, in order to understand the benefits and effects of massage, it’s important to acknowledge the two main effects involved in massage, such as mechanical and reflexive.
The mechanical effects is the mechanical or histological changes in myofascial structure, as a result of the pressure and movement applied to the soft tissues. The mechanical techniques are most often directed at deeper tissues, such as adhesions, or any restrictions in muscles, tendons, and fascia. In response to the physiological effect, blood flow to the skeletal muscle increases, muscle atrophy following injury will delay, in addition to stretching and breaking down the fibrous scar tissue.
As for the reflexive effect, it affects the sensory and motor nerves locally and some central nervous system response. The reflexive techniques attempt to exert effects through the skin and superficial connective tissues. Contact through the skin would stimulate cutaneous receptors, causing reflexive effects that included pain, circulation, and metabolism. The effects on pain is regulated by both the gate control theory and release of endorphins, while the effect on circulation increase blood and lymphatic flow, and finally, the effects on metabolism doesn’t alter the general metabolism. Rather it helps assist in removal and speeds up resynthesis of lactic acid. The mechanical and reflexive effects has played an important in role in contribution to the benefits and effect of massage therapy.