The Benefits of Massage for Relieving Arthritic Pain

The Benefits of Massage for Relieving Arthritic Pain

By Paula Ng and Gill Tree

Joint pain is nothing new. Arthritis, in its many guises, was described by ancient Egyptian medical texts, Hippocrates (the father of western medicine) and an Ayurvedic medicine text from 123 AD respectively. 

Today, more than 10 million adults in the UK, (6 million women and 4 million men), consult their GP each year with arthritis and related conditions, and 7.5 million working days were lost in 2011/2012 due to musculoskeletal conditions. 

What is arthritis?

Arthritis is inflammation of the joints. There are well over 100 types of arthritis, the two most common being osteoarthritis and rheumatoid arthritis.

Until recently, osteoarthritis was considered a primarily degenerative disorder caused by general wear and tear. It is now believed to be far more complex with genetics and nutrition, particularly, Vitamin D deficiency, playing a part.

Rheumatoid arthritis is an auto-immune disease that results in joint inflammation. There is no cure for this condition so management is by symptomatic control.

The physical signs of inflammation for most sufferers are:

• pain
• redness
• swelling
• stiffness and decreased movement
• warmth to the touch.

The pain, in particular, contributes to the £442 million that the NHS spent on painkillers in 2010-2011. Arthritis Research UK, a leading UK charity raising awareness and funds for the fight against arthritis, recently launched new initiatives to address the underestimated problem of chronic pain from the condition. 

"Pain relief is essential but, as well as drugs, people with arthritis can help themselves by keeping active and mobile, keeping their weight down, and benefiting from physiotherapy and other non-drug treatments,"

Massage can certainly be viewed as one such ‘non-drug treatment’.

How massage can help - 

Patients are frequently concerned about side effects associated with prescribed drugs. Different people tolerate the side effects of conventional treatments in different ways and it can be a hard, frustrating search to find effective relief. For many, symptoms can restrict simple daily activities to such an extent that health deteriorates further due to stress and tension. These symptoms can have such a debilitating effect that arthritis is the most common condition for which people receive Disability Living Allowance (DLA). 

Massage can help sufferers take control by managing their symptoms in a positive, nurturing forum, either with or without other treatment methods.

The effects of massage - 

The holistic approach of massage therapy is ideally suited to conditions such as arthritis. The entire body is massaged, not just the site of pain, ensuring that both mind and body can welcome the healing touches of the ‘relaxation response’ and the mechanical response.

The ‘relaxation response’, as first defined by Dr Herbert Benson is physiologically different from sleep or simply resting. It is ‘a state of deep relaxation in which the heart rate, blood pressure and breathing rate decrease. Muscle tension relaxes, stress hormone levels fall, and the mind becomes tranquil’.

The mechanical response refers to the two major physical effects of massage, namely increase in blood and lymph circulation and normalisation of the soft tissue.

Relaxation Response - 

Massage has the ability to relax the body, but also to soothe and quiet the mind. In a relaxed state, the perception of pain is altered, often alleviated, and a person may feel more empowered to cope with their pain and address the anxiety caused by the frustration of their situation.

Massage has a powerful effect on the endocrine system. It increases levels of the neurotransmitters serotonin, dopamine and oxytocin. In a study on massage therapy by the Touch Research Institute at the University Of Miami School Of Medicine, serotonin levels in the test subjects increased by 28 percent, dopamine by 31 percent. 

Serotonin – This hormone positively affects emotions and thoughts. It is a neurotransmitter that has a calming effect on the brain and body functions, producing a general sense of well-being. The ‘happy hormone’.

Dopamine – This neurotransmitter helps regulate mood, attention, learning and sleep and is vital in the body’s control of movement. It is also believed to release endorphins, chemicals that allow us to feel pleasure. The ‘feel good hormone’.

Oxytocin – This has been dubbed the "hugging hormone," as it produces feelings of calm and contentment. The initial feeling of well-being from a massage is produced by the release of oxytocin from the posterior pituitary. Oxytocin imparts a feeling of being ‘unstressed’, loved and loving.

Whilst massage causes an increase in these neurotransmitters, it also decreases the levels of less desirable chemicals; cortisol (9) and substance P.

Cortisol - Stress affects the brain by releasing cortisol, often referred to as "the stress hormone", which negatively affects many systems throughout the body. It is secreted into the bloodstream during the body’s ‘fight or flight’ response to stressful situations. Long term exposure to cortisol can result in sleep problems, depression, increased heart rate, affecting heart, lungs, circulatory and digestive systems and is also associated with a weakened immune system.

Substance P - This is a protein found in the brain and spinal cord that transmits pain signals from sensory nerve ending to the central nervous system, i.e. its function is to cause pain. It has been implicated in inflammatory conditions and is believed to be involved in the regulation of pain, stress and anxiety. Massage has been shown to decrease substance P levels (10), contributing to pain relief.

Mechanical response - 

In fundamental terms, massage is physical manipulation of soft tissue which positively affects the circulatory system and the state of soft tissues.

It is believed that massage can enhance oxygen and nutrient delivery to cells by improving blood and lymph circulation.  As tissues begin to function more efficiently, more waste products are removed, excess fluid absorption may increase and thus reduce swelling; a central part of arthritis care.

Many arthritis sufferers complain of painful muscle contractions and spasms. These may be caused by a number of factors, but anxiety and tension are certainly contributing factors. Massage relaxes muscle tissue, tendons and ligaments, reducing muscle contractions, and lessening nerve compression. Even though deep tissues cannot be directly massaged, the release of superficial muscular tension will assist in deep muscle realignment and improve mobility.

The significance of pressure

For massage to have a symptom-relieving effect, moderate pressure appears to be vital. Tiffany Field of the Touch Research Institute in Miami highlighted in a study that what matters most is level of pressure used in a massage. The study demonstrated that pressure receptors under the skin’s surface need to be stimulated with moderate pressure in order to convey pain-reducing signals to the brain. (11)

 “The critical thing is using moderate pressure,” says Field. “Light pressure, just touching the surface of the skin or brushing it superficially, is not getting at those pressure receptors. Light pressure can be stimulating, not relaxing.”

Specific research - 

One key study carried by Tiffany Field and her associates, documenting the reduction of hand arthritis pain by massage therapy. The massage therapy group was massaged on the affected wrist/hand once a week for a 4-week period and, highly significantly, were also taught self-massage on the wrist/hand that was to be done daily at home. This element of self- help reinforces the holistic approach that can be so empowering.

The results were very encouraging – ‘The massage therapy group versus the control group had lower anxiety and depressed mood scores after the first and last sessions, and that group reported less pain and greater grip strength after their sessions. The massage therapy group showed greater improvement than the control group on all of these measures across the study period’ (12).

Arthritis Research UK wrote a report on complementary therapies and after considering the results of several trials concluded that “while there’s only a little evidence that massage is effective in osteoarthritis, there’s consistent evidence from a number of trials to suggest that it’s effective in treating some of the symptoms of fibromyalgia and low back pain. 13)

Contraindications - 

Whilst massage can greatly benefit the symptoms of arthritis, deep pressure or compression to the arthritic joints would be contraindicated. Physical manipulation of soft tissue may aggravate the condition and increase discomfort. It is wise to avoid massaging a sufferer of rheumatoid arthritis during a flare up as the condition may be aggravated causing further distress.

Arthritic joints can be very sensitive so it is critical to communicate well with a client to establish levels of tolerance.

What does the future hold?

Many sufferers and healthcare professionals would welcome a more holistic approach to the management of arthritis. Currently, enough research has been carried out to substantiate the potential impact of massage on pain management and specialised units now do exist in hospitals, clinics and home care schemes to offer massage.

It may be that massage becomes the non-pharmacological treatment of choice or indeed it may prove to be most effective when used in combination with other treatment methods. Nonetheless, more clinical research is clearly needed if the positive contribution of massage in the management of arthritis is to be widely accepted.

“Our prime purpose in this life is to help others. And if you can't help them, at least don't hurt them.”

Dalai Lama 

References

Stetka, B., Wei, N., 2013. Arthritis, Then and Now, Medscape Rheumatology.

Health & Safety Executive Report, Health and Safety Statistics 2011/2012.

Sun BH, Wu CW, Kalunian KC. New developments in osteoarthritis. Rheum Dis Clin North Am. 2007;33:135-148

McAlindon T, LaValley M, Schneider E, et al. Effect of vitamin D supplementation on progression of knee pain and cartilage volume loss in patients with symptomatic osteoarthritis: a randomized controlled trial JAMA. 2013;309:155-162.

http://www.arthritisresearchuk.org/news/general-news/2011/november/nhs-spends-442m-on-painkiller-prescriptions.aspx

Department for work and pensions. Disability Living Allowance - cases in payment Caseload (Thousands): Main Disabling Condition by Gender of claimant. http://83.244.183.180/100pc/dla/disabled/ccsex/a_carate_r_disabled_c_ccsex_nov07.html [Date accessed: 1-5-2008].

Dr Herbert Benson, MD and Miriam Z. Klipper.  The Relaxation Response, HarperCollins 2009.

Field T, Hernandez-Reif M, Diego M, Schanberg S, Kuhn C. Cortisol decreases and serotonin and dopamine increase following massage therapy.

 International Journal of  Neuroscience. 2005 Oct;115(10):1397-413. 

Touch Research Institutes, University of Miami School of Medicine, Miami, Florida 33101, USA. tfield@med.miami.edu

Journal of Bodywork & Movement Therapy. 2011 Jan;15(1):3-14. doi: 10.1016/j.jbmt.2010.06.001. Epub 2010 Jul 2. Does massage therapy reduce cortisol? A comprehensive quantitative review. Moyer CA, Seefeldt L, Mann ES, Jackley LM.

Touch Research Institute. Authors: Tiffany Field, Ph.D., Miguel Diego, Christy Cullen, Maria Hernandez-Reif, Ph.D., William Sunshine and Steven Douglas. Originally published in the Journal of Clinical Rheumatology, April 2002, Vol. 8, No. 2, pp. 72-76. 

Tiffany Field; Miguel Diego; Maria Hernandez-Reif (Profiled Authors: Miguel Angel Diego; Tiffany M. Field) International Journal of Neuroscience. 2010;120(5):381-385. Moderate Pressure is Essential for Massage Therapy Effects. May 2010, Vol. 120, No. 5 , Pages 381-385
 Field, T., Diego, M., Hernandez-Reif, M., Shea, J. (2007). Hand arthritis pain reduced by massage therapy. Journal of Bodywork and Movement Therapies, 2, 21-24.

Arthritis Research UK; Practitioner-based complementary and alternative therapies for the treatment of rheumatoid arthritis, osteoarthritis, fibromyalgia and low back pain, Pages 32-33