Health: Aaaah, there's the rub

When we hurt ourselves, we often try to alleviate the pain by rubbing the affected area. Massage therapy works on exactly the same principle. In part six of his series on complementary medicine, Professor Edzard Ernst explains its benefits

More often than not, when we hurt ourselves, we rub the injured spot. Massage is like a reflex whereby we alleviate pain. It is hardly surprising therefore that massage therapy has existed at all times in virtually all cultures - massage is probably the oldest of all medical interventions.

Today, several forms of massage exist (see Box 1). In Europe, the classic muscular massage, often called "Swedish massage", is the most popular method. It employs a variety of manual techniques to treat muscles, subcutaneous tissue, tendons and ligaments. Usually, the aim is to loosen up these structures in order to decrease pain and increase mobility. Swedish massage is entirely mainstream on the European continent while, in the UK, it still falls under the umbrella of complementary medicine.

Lymph drainage is an extremely gentle stroking massage applied over the lymph nodes and vessels to increase the flow of lymphy fluid which in turn deflates tissues and is claimed to increase health and well-being in several ways.

Lymph drainage can be particularly helpful in certain cases of swelling, for example, after breast operations which damaged or removed the lymph nodes in the area of the armpit.

There are also several Asian variations of the massage theme. Shiatsu, for instance, is a unique Japanese cross of acupressure and massage. Shiatsu therapists stimulate acupuncture points by applying strong physical pressure. The rationale for this therapy is based on the principles of acupuncture, as outlined in part one of this series.

What happens during a massage session?

After the therapist has assessed the complaint, they will ask the patient to undress. Depending on the type of massage therapy, treatment can be moderately painful, but more often than not, the sensation is strangely agreeable and the experience is intensely relaxing.

People who panic at close physical contact with relative strangers could find massage therapy distressing. For others, such proximity may be a basis for establishing a good therapeutic relationship. Much of what massage therapists achieve therapeutically might be mediated through this mechanism.

Therapists would normally advise patients to come back for more. A typical series of treatments would comprise 6-12 sessions, each of which last between 20-30 minutes and cost pounds 30-pounds 50.

Today, about 3,500 massage therapists practise in Britain. Many are well- trained and belong to responsible professional bodies. But unfortunately, there are no guarantees.

To avoid problems, it is advisable to ask therapists about their training, experience and indemnity cover. It is also recommended to inform the GP about massage, or any other complementary therapy. Not many will have in-depth knowledge about this type of treatment to give further advice. Most physiotherapists are trained in massage and are a good source of information.

During recent years, the nursing profession has also developed a keen interest in massage.

What is it for?

There is reasonably good research demonstrating numerous effects of classical massage therapy (see box 2). These findings are interesting but they do not readily translate into clinical effectiveness. For instance, if experimental data suggest that massage therapy increases the endorphin (natural painkiller of the body) levels, this does not necessarily mean that massage eases clinical pain. Too often, researchers - of either complementary or mainstream medicine - are interested in physiological effects, while patients simply want to get better.

On the European continent, massage therapy is used predominantly for musculoskeletal problems, particularly back pain. A recent survey from Germany showed that pain sufferers rate massage as one of the most effective treatments to reduce pain - more effective than most mainstream analgesics.

This notion is also backed up by several clinical trials. Unquestionably, we need more trials to be sure but the best evidence to date suggests that classical massage treatment is an effective way to reduce musculoskeletal pain.

Anybody who has ever received a massage will confirm that it relaxes both the mind and the body. Clinical trials show that it helps against muscle stiffness, for instance after physical over-exertion. For this reason, massage is often used in sports medicine.

More importantly, research from the US shows that massage can be helpful in treating anxiety disorders, in reducing stress and alleviating the symptoms of depression. Other indications are listed in Box 3.

More exotic massage techniques, such as shiatsu, are far less evidence- based. There are few clinical trials to draw firm conclusions about their effectiveness.

What are the potential risks?

If done correctly, massage incurs very few risks indeed. Too forceful a technique has caused tissue injuries, such as bruising or bone fractures, but these are extreme rarities. As with all complementary therapies, harm may be done when the therapist is not fully aware of the limits of massage therapy.

Even for relatively well-established indications, such as back pain or anxiety, massage is not a cure in itself, but has a role as a symptomatic treatment. This means that it might temporarily ease the complaint but cannot eliminate its underlying cause. Whenever massage is advocated as a cure, there is a considerable potential for doing harm.

Massages should not be applied in the presence of traumatic or infectious skin lesions. They are also contra-indicated in cases of plebitis or other serious venous problems. It goes without saying that severely ill patients are usually not well suited for massage treatments.

Conclusion

Massage therapy can be a helpful treatment for several types of musculoskeletal problems including back pain. Massage can also alleviate anxiety and depression. Furthermore, it is largely devoid of unwanted side-effects and is usually agreeable and relaxing. If you can afford it, you might give it a try.

Some professional organisations

The London and Counties Society of Physiologists

330 Lytham Road

Blackpool FY4 IDW

Fellowship of Sports Masseurs and Therapists

B M Soigneur

London

WC1N 3XX

n `People are Pets', by Hunter J and Kayne S, which was mentioned in last week's article on homoeopathy, is available from the British Homoeopathic Association, 27a Devonshire Street, London, W1N 1RJ

Physiological Effects

Increases blood and lymph flow.

Alters the composition of blood.

Increases endorphin levels.

Enhances immune defence mechanisms of the body.

Changes certain hormone levels in the body.

Reduces muscle tone.

Useful reading:

Vickers A, Massage and Aromatherapy, Chapman Hall, London 1996 (for those with prior knowledge);

Downing G, The Massage Book. Penguin, 1974.

Types of Massage Therapy

Classical muscular massage.

Colon massage (gentle massage over the abdomen to regulate bowel movements).

Connective tissue massage (to influence internal organs).

Lymph drainage.

n Rolfing (American technique applying intense pressure, often painful).

n Shiatsu (Japanese acupressure point massage).

n Underwater massage (use of water pressure instead of manual techniques).