Full Title: Evaluation of Applied Kinesiology meridian techniques by means of surface electromyography (sEMG): demonstration of the regulatory influence of antique acupuncture points

BACKGROUND: The use of Applied Kinesiology techniques based on manual muscle tests relies on the relationship between muscles and acupuncture meridians. Applied Kinesiology detects body dysfunctions based on changes in muscle tone. Muscle tonification or inhibition within the test setting can be achieved with selected acupoints. These acupoints belong to either the same meridian or related meridians. The aim of this study is to analyze muscle sedation and tonification by means of surface electromyography. METHODS: Manual muscle tests were carried out using standard Applied Kinesiology (AK) techniques. The investigation included basic AK procedures such as sedation and tonification with specific acupoints. The sedation and tonification acupoints were selected from related meridians according to the Five Elements. The tonification effect of these acupoints was also tested while interfering effects were induced by manual stimulation of scars. The effects of selective neural therapy, i.e. individually tested and selected anesthetic agent, for the treatment of scars were also studied. The characteristics of muscle action were documented by surface electromyographys (sEMG). RESULTS: The sEMG data showed a diminution of signal intensity when sedation was used. Graded sedation resulted in a graded diminution of signal amplitude. Graded increase in signal amplitude was observed when antique acupuncture points were used for tonification. The tactile stretch stimulus of scars localized in meridian-independent places produced diminution of signal intensity on a reference muscle, similar to sedation. These changes, however, were not corrected by tonification acupoints. Correction of these interferences was achieved by lesion specific neural therapy with local anesthetics. CONCLUSION: We demonstrated the central working principles, i.e. sedation and tonification, of Applied Kinesiology through the use of specific acupoints that have an influence on manual muscle tests. Sedation decreases RMS signal in sEMG, whereas tonification increases it. Interfering stimuli from scars were corrected by selective neural therapy.

Chin Med. 2009 May 29;4:9. Moncayo R, Moncayo H. WOMED, Innsbruck, Austria. anmeldung@womed.at

OBJECTIVES: To determine whether massage therapy improves postoperative mood, pain, anxiety, and physiologic measurements; shortens hospital stay; and decreases occurrence of atrial fibrillation. METHODS: Two hundred fifty-two adults undergoing cardiac surgery were randomized to usual postoperative care (n=126) or usual care plus two massages (n=126). Assessments of mood, depression, anxiety, pain, physiologic status, cardiac rhythm, and hospital length of stay were completed. Logistic and linear regressions were performed. RESULTS: Preoperative pain, mood, and affective state scores were positively associated with postoperative scores; however, there were no postoperative differences between groups for any measures (P=.11 to .93). There were no differences in physiologic variables except lower postoperative blood pressure after massage (P = .01). Postoperative atrial fibrillation occurrence (P = .6) and median postoperative hospital length of stay (P = .4) were similar between groups. CONCLUSION: Massage therapy is feasible in cardiac surgical patients; however, it does not yield therapeutic benefit. Nevertheless, it should be a patient-selected and -paid option.

Heart Lung. 2009 Nov-Dec;38(6):480-90. Epub 2009 Jun 28. Albert NM, Gillinov AM, Lytle BW, Feng J, Cwynar R, Blackstone EH. Nursing Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.

Full Title: Massage therapy reduces tension, anxiety, and pain in patients awaiting invasive cardiovascular procedures

Objectives: (1) To assess the efficacy of a 20 minute massage therapy session on pain, anxiety, and tension in patients before an invasive cardiovascular procedure. (2) To assess overall patient satisfaction with the massage therapy. (3) To evaluate the feasibility of integrating massage therapy into preprocedural practices. Experimental pretest-posttest design using random assignment. Medical cardiology progressive care units at a Midwestern Academic Medical Center. Patients (N=130) undergoing invasive cardiovascular procedures. The intervention group received 20 minutes of hands on massage at least 30 minutes before an invasive cardiovascular procedure. Control group patients received standard preprocedural care. Visual analogue scales were used to collect verbal numeric responses measuring pain, anxiety, and tension pre- and postprocedure. The differences between pre- and postprocedure scores were compared between the massage and standard therapy groups using the Mann-Whitney Wilcoxon's test. Scores for pain, anxiety, and tension scores were identified along with an increase in satisfaction for patients who received a 20-minute massage before procedure compared with those receiving standard care. This pilot study showed that massage can be incorporated into medical cardiovascular units' preprocedural practice and adds validity to prior massage studies.

Prog Cardiovasc Nurs. 2009 Dec;24(4):155-61. Wentworth LJ, Briese LJ, Timimi FK, Sanvick CL, Bartel DC, Cutshall SM, Tilbury RT, Lennon R, Bauer BA. Department of Nursing Administration, Mayo Clinic, Rochester, MN 55905, USA. wentworth.laura@mayo.edu

Full Title: Depression, mood, stress, and Th1/Th2 immune balance in primary breast cancer patients undergoing classical massage therapy

PURPOSE: Cancer patients frequently suffer from psychological comorbidities such as depression and elevated stress. Previous studies could demonstrate that cancer patients benefit from massage therapy on the physical and psychological level. This pilot study investigates the effects of massage on depression, mood, perceived stress, and the Th1/Th2 ratio in breast cancer patients. METHODS: Thirty-four breast cancer patients were randomly assigned to a massage group (n = 17) and a control group (n = 17). Patients of the massage group received two 30-min classical massages per week for 5 weeks. At baseline, at the end of the intervention period, and 6 weeks after the end of intervention, patients of both groups completed the Perceived Stress Questionnaire (PSQ), the Patient Health Questionnaire (PHQ), and the Berlin Mood Questionnaire (BFS) and blood was withdrawn for determining cytokine concentrations and the Th1/Th2 ratio. RESULTS: Twenty-nine patients were included in the statistical analysis. Depression (PHQ) and anxious depression (BSF) were significantly reduced immediately after massage compared to the control group. Stress (PSQ) and elevated mood (BSF) did not show significant alterations after massage therapy. Changes of cytokine concentrations and Th1/Th2 ratio were insignificant as well, although there was a slight shift towards Th1 in the massage group over time. CONCLUSIONS: Massage therapy is an efficient treatment for reducing depression in breast cancer patients. Insignificant results concerning immunological parameters, stress, and mood indicate that further research is needed to determine psychological and immunological changes under massage therapy.

Support Care Cancer. 2010 Jul 20. Krohn M, Listing M, Tjahjono G, Reisshauer A, Peters E, Klapp BF, Rauchfuss M. Department of Psychosomatics and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany, michaela.krohn@charite.de.

Full Title: Back massage therapy promotes psychological relaxation and an increase in salivary chromogranin A release

Massage therapy promotes psychosocial relaxation, reduces stress and has been reported to improve the immune function. As such, massage therapy is currently used in palliative care for the relief of anxiety and pain. Although psychosocial status has been evaluated using subjective psychological tests, such as State-Trait Anxiety Inventory (STAI), subjective psychological tests are of limited value if the subjects fail to report reliably. Salivary biomarkers have been recently suggested as useful objective markers for assessing psychosocial status. To determine whether salivary biomarkers are useful objective indices for assessing the effects of back massage on the mental status of 25 young healthy female volunteers, we measured heart rate and salivary biomarkers (alpha-amylase activity, cortisol, and chromogranin A) and assessed the STAI score before and after the back massage. Back massage significantly reduced the heart rate and STAI; however, salivary amylase and cortisol levels did not change. In contrast, the level of salivary chromogranin A significantly increased. We therefore conclude that changes in the salivary biomarkers tested here may not indicate changes in psychological status following massage therapy. However, the increase in chromogranin A release may contribute to the immunologically beneficial effects of massage therapy as chromogranin A has antibacterial and antifungal activity.

J Anesth. 2010 Aug 5.Noto Y, Kudo M, Hirota K. Department of Nursing, Hirosaki University Graduate School of Health Sciences, Hirosaki, 036-8563, Japan.

Full Title: Massage therapy improves neurodevelopment outcome at two years corrected age for very low birth weight infants

BACKGROUND: Long term effects of massage therapy in very preterm newborns infants are still to be described. Few studies evaluated neurodevelopment just at six months, and included late preterm infants. OBJECTIVE: To study the effect of massage therapy on neurodevelopment of very low birth weight infants at two years corrected age. STUDY DESIGN: Newborns with birth weight between >or= 750 and Early Hum Dev. 2010 Jan;86(1):7-11. Epub 2009 Dec 22. Procianoy RS, Mendes EW, Silveira RC. Department of Pediatrics, Medical School, Universidade Federal do Rio Grande do Sul and Newborn Section, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil. renatosp@terra.com.br

Full Title: Differences in practitioners' proficiency affect the effectiveness of massage therapy on physical and psychological states

OBJECTIVE: An examination was made of how differences in the proficiency of massage practitioners had different physical and psychological effects on clients. METHOD: Eight healthy 50-year-old females, suffering from chronic neck and shoulder stiffness, were recruited and four interventions were conducted: three 40-minute massage therapy interventions, one each by a freshman and a sophomore student studying massage therapy, and one by their instructor, and one rest on the massage table. Visual analogue scale score for muscle stiffness in the neck and shoulder, state anxiety score, and salivary cortisol concentration levels and secretory immunoglobulin A, were measured pre- and post- interventions. RESULTS: Visual analogue scale of neck and shoulder stiffness after massage by the instructor was significantly lower than that after the other interventions, and the score of state anxiety was lower than that after resting. (c) 2009 Elsevier Ltd. All rights reserved.

J Bodyw Mov Ther. 2010 Jul;14(3):239-44. Epub 2009 Feb 20. Donoyama N, Shibasaki M. Course of Acupuncture and Moxibustion, Department of Health, Faculty of Health Sciences, Tsukuba University of Technology, 4-12-7, Kasuga, Tsukuba 305-8521, Ibaraki, Japan. donoyama@k.tsukuba-tech.ac.jp

Integrative therapies such as massage have gained support as interventions that improve the overall patient experience during hospitalization. Cardiac surgery patients undergo long procedures and commonly have postoperative back and shoulder pain, anxiety, and tension. Given the promising effects of massage therapy for alleviation of pain, tension, and anxiety, we studied the efficacy and feasibility of massage therapy delivered in the postoperative cardiovascular surgery setting. Patients were randomized to receive a massage or to have quiet relaxation time (control). In total, 113 patients completed the study (massage, n=62; control, n=51). Patients receiving massage therapy had significantly decreased pain, anxiety, and tension. Patients were highly satisfied with the intervention, and no major barriers to implementing massage therapy were identified. Massage therapy may be an important component of the healing experience for patients after cardiovascular surgery. Copyright 2009 Elsevier Ltd. All rights reserved.

Complement Ther Clin Pract. 2010 May;16(2):70-5. Epub 2009 Jul 14. Bauer BA, Cutshall SM, Wentworth LJ, Engen D, Messner PK, Wood CM, Brekke KM, Kelly RF, Sundt TM 3rd. Division of General Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. bauer.brent@mayo.edu

Burn can be among the most severe physical and psychologic traumas a person may face. Patients with burns commonly have severe itching and pain. Severe itching has also been associated with anxiety, sleep disturbance, and disruption of daily living activities. The addition of complementary treatments to standard care may lead to improved pain management and may offer a safer approach for reducing pain and procedural anxiety for patients with burns. The authors conducted an experimental study to examine whether the effects of massage therapy reduced burned adolescents' pain, itching, and anxiety levels. Sixty-three adolescents were enrolled in this study shortly after admission (mean days = 3 +/- 0.48) at a burn unit in a large university hospital from February 2008 to June 2009. The measures including the pain, itching, and state anxiety were collected on the first and last days of the 5-week study period. The participants had an average age of 14.07 +/- 1.78 years and came usually from the lower socioeconomic strata. The authors observed that massage therapy reduced all these measures from the first to the last day of this study (P < .001). In most cultures, massage treatments are used to alleviate a wide range of symptoms. Although health professionals agree on the use of nonpharmacologic method for patients with burns, these applications are not yet common.

J Burn Care Res. 2010 May-Jun;31(3):429-32. Parlak Gürol A, Polat S, Akçay MN. Department of Pediatric Nursing, Faculty of Health Sciences, Atatürk University, Erzurum, Turkey.

BACKGROUND: Infection with human immunodeficency virus (HIV) and acquired immunodeficency syndrome (AIDS) is a pandemic that has affected millions of people globally. Although major research and clinical initiatives are addressing prevention and cure strategies, issues of quality of life for survivors have received less attention. Massage therapy is proposed to have a positive effect on quality of life and may also have a positive effect on immune function through stress mediation. OBJECTIVES: The objective of this systematic review was to examine the safety and effectiveness of massage therapy on quality of life, pain and immune system parameters in people living with HIV/AIDS. SEARCH STRATEGY: A comprehensive search strategy was devised incorporating appropriate terms for HIV/AIDS, randomised controlled trials (RCTs), massage therapy and the pertinent measures of benefit. All electronic databases identified were searched in November 2008, including Cochrane Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, SCIENCE CITATION INDEX, AIDSLINE, AIDSearch, CINAHL, HEALTHSTAR, PsycLIT, AMED, Current Contents, AMI, NLM GATEWAY, LILACS, IndMed, SOCIOFILE, SCI, SSCI, ERIC and DAI. We also reviewed relevant published and unpublished conference abstracts and proceedings andscrutinised reference lists from pertinent journals. There were no language or date restrictions. SELECTION CRITERIA: Studies were identified by two reviewers based on trial design (RCTs) and participants (ie, people of any age with HIV/AIDS, at any stage of the disease) who had undergone an intervention that included massage therapy for the identified aims of improving quality of life and activity and participation levels, improving immune function, reducing pain and improving other physiological or psychological impairments. DATA COLLECTION AND ANALYSIS: Two reviewers independently identified included studies and extracted relevant data. Two other reviewers independently reviewed the included studies for risk of bias. All data and risk of bias judgements were entered into Revman (v5) and meta-analyses were conducted where appropriate. MAIN RESULTS: Twelve papers were identified, from which four were included. The remaining eight papers were excluded predominantly due to inappropriate methodology. The four included studies were highly clinically heterogenous, investigating a range of age groups (ie, children, adolescents and adults) across the disease spectrum from early HIV through late-stage AIDS. The settings were either community or palliative care, and the outcome measures were a combination of quality of life and immunological function. The trials were judged to be at moderate risk of bias mostly because of incomplete reporting. For quality of life measures, the studies reported that massage therapy in combination with other modalities, such as meditation and stress reduction, are superior to massage therapy alone or to the other modalities alone. The quality of life domains with significant effect sizes included self-reported reduced use of health care resources, improvement in self-perceived spiritual quality of life and improvement in total quality of life scores. One study also reported positive changes in immune function, in particular CD4+ cell count and natural killer cell counts, due to massage therapy, and one study reported no difference between people given massage therapy and controls in immune parameters. Adverse or harmful effects were not well reported. AUTHORS' CONCLUSIONS: There is some evidence to support the use of massage therapy to improve quality of life for people living with HIV/AIDS (PLWHA), particularly in combination with other stress-management modalities, and that massage therapy may have a positive effect on immunological function. The trials are small, however, and at moderate risk of bias. Further studies are needed using larger sample sizes and rigorous design/reporting before massage therapy can be strongly recommended for PLWHA.

Cochrane Database Syst Rev. 2010 Jan 20;(1):CD007502. Hillier SL, Louw Q, Morris L, Uwimana J, Statham S. Centre for Allied Health Evidence, University of South Australia (City East), North Terrace, Adelaide, SA, Australia, 5000.

OBJECTIVE: To systematically investigate the treatment effects of massage therapy in depressed people by incorporating data from recent studies. DATA SOURCES: A meta-analysis of randomized controlled trials (RCTs) of massage therapy in depressed people was conducted using published studies from PubMed, EMBASE, PsycINFO, and CINAHL electronic database from inception until July 2008. The terms used for the search were derived from medical subheading term (MeSH) massage combined with MeSH depression. Hand searching was also checked for bibliographies of relevant articles. Retrieval articles were constrained to RCTs/clinical trials and human subjects. No language restrictions were imposed. STUDY SELECTION: We included 17 studies containing 786 persons from 246 retrieved references. Trials with other intervention, combined therapy, and massage on infants or pregnant women were excluded. DATA EXTRACTION: Two reviewers independently performed initial screen and assessed quality indicators by Jadad scale. Data were extracted on publication year, participant characteristics, and outcomes by another single reviewer. DATA SYNTHESIS: All trials showed positive effect of massage therapy on depressed people. Seventeen RCTs were of moderate quality, with a mean quality score of 6.4 (SD = 0.85). The pooled standardized mean difference in fixed- and random-effects models were 0.76 (95% CI, 0.61-0.91) and 0.73 (95% CI, 0.52-0.93), respectively. Both indicated significant effectiveness in the treatment group compared with the control group. The variance between these studies revealed possible heterogeneity (tau(2) = 0.06, Cochran chi(2)(16) = 25.77, P = .06). CONCLUSIONS: Massage therapy is significantly associated with alleviated depressive symptoms. However, standardized protocols of massage therapy, various depression rating scales, and target populations in further studies are suggested. © Copyright 2010 Physicians Postgraduate Press, Inc.

J Clin Psychiatry. 2010 Mar 23. Hou WH, Chiang PT, Hsu TY, Chiu SY, Yen YC. Department of Physical Medicine and Rehabilitation, Kaohsiung, Taiwan.

Full Title: Itching, Pain, and Anxiety Levels Are Reduced With Massage Therapy in Adolescent Having Burn

Burn, a person may face, is one of the statuses, which can be a most severe physical and psychologic trauma. Patients with burns commonly have severe itching and pain. Severe itching has also been associated with the anxiety, sleep disturbance, and disruption of daily living activities. The addition of complementary treatments to standard care may lead to a greater pain management and may offer a safer approach for reducing pain and procedural anxiety for patients with burns. The authors conducted an experimental study to examine whether the effects of massage therapy reduced burned adolescents' pain, itching, and anxiety levels. Sixty-three adolescents were enrolled in this study shortly after admission (mean days = 3 +/- 0.48) at a burn unit in a large university hospital from February 2008 to June 2009. The measures including the pain, itching, and state anxiety were collected on the first and last days of the 5-week study period. The participants had an average age of 14.07 +/- 1.78 years and came usually from the lower socioeconomic strata. The authors observed that massage therapy reduced all these measures from the first to the last day of this study (P < .001). In most cultures, massage treatment are used to alleviate a wide range of symptoms. Although health professionals agree on the use of nonpharmacologic method for patients with burns, these applications are not yet common.

J Burn Care Res. 2010 Mar 31. Parlak A, Polat S, Nuran Akçay M. From the *Department of Pediatric Nursing, Faculty of Health Sciences, Atatürk University, Erzurum; daggerDepartment of Pediatric Nursing, Bozok University, School of Health, Yozgat; and double daggerDepartment of General Surgery, Medical Faculty, Atatürk University, Erzurum, Turkey.

The efficacy of classical massage on stress perception and cortisol following primary treatment of breast cancer

To investigate the efficacy of classical massage on stress perception and mood disturbances, 34 women diagnosed with primary breast cancer were randomized into an intervention or control group. For a period of 5 weeks, the intervention group (n = 17) received biweekly 30-min classical massages. The control group (n = 17) received no additional treatment to their routine health care. The Perceived Stress Questionnaire (PSQ) and the Berlin Mood Questionnaire (BSF) were used and the patients' blood was collected at baseline (T1), at the end of the intervention period (T2), and 6 weeks after T2 (T3). Compared with control group, women in the intervention group reported significantly lower mood disturbances, especially for anger (p = 0.048), anxious depression (p = 0.03) at T2, and tiredness at T3 (p = 0.01). No group differences were found in PSQ scales, cortisol and serotonin concentrations at T2 and T3. However, perceived stress and cortisol serum levels (p = 0.03) were significantly reduced after massage therapy (T2) compared with baseline in the intervention group. Further research is needed to validate our findings.

Arch Womens Ment Health. 2010 Apr;13(2):165-73. Epub 2010 Feb 19. Listing M, Krohn M, Liezmann C, Kim I, Reisshauer A, Peters E, Klapp BF, Rauchfuss M. Center for Internal Medicine and Dermatology, Department of Psychosomatics and Psychotherapy Berlin, Charité-Universitätsmedizin Berlin, Luisenstr. 13a, Berlin, Germany. miriam.listing@charite.de

Full Title: Comparison between massage and music therapies to relieve the severity of labor pain

BACKGROUND: During labor, women experience a high level of intense, stressful and steady pain that may negatively affect both mothers and neonates. Painkillers have previously been used for childbearing women, but nowadays, owing to some well-known limitations and serious side effects, nonpharmacologic methods such as massage and music therapies are being broadly recommended. The present clinical trial was conducted to compare the effects of massage and music therapies on the severity of labor pain in the Ilam province of western Iran. MATERIALS & METHODS: Overall, 101 primigravidae who were hospitalized for vaginal delivery were recruited and randomly stratified into two groups of either massage (n = 51) or music (n = 50) therapies. Pain was measured using the visual analog scale and the two groups were compared in terms of pain severity before and after the interventions. RESULTS: Mothers in the massage therapy group had a lower level of pain compared with those in the music therapy group (p = 0.009). A significant difference was observed between the two groups in terms of pain severity after intervention (p = 0.01). Agonizing, or most severe, labor pain was significantly relieved after massage therapy (p = 0.001). CONCLUSION: Massage therapy was an effective method for reducing and relieving labor pain compared with music therapy and can be clinically recommended as an alternative, safe and affordable method of pain relief where using either pharmacological or nonpharmacological methods are optional.

Womens Health (Lond Engl). 2010 May;6(3):377-81. Taghinejad H, Delpisheh A, Suhrabi Z. Ilam University of Medical Sciences, Ilam, Iran.

Massage therapy is widely used by patients with fibromyalgia seeking symptom relief. We performed a review of all available studies with an emphasis on randomized controlled trials to determine whether massage therapy can be a viable treatment of fibromyalgia symptoms. Extensive narrative review. PubMed, PsychInfo, CINAHL, PEDro, ISI Web of Science, and Google Scholar databases (inception-December 2009) were searched for the key words "massage", "massotherapy", "self-massage", "soft tissue manipulation", "soft tissue mobilization", "complementary medicine", "fibromyalgia" "fibrositis", and "myofascial pain". No language restrictions were imposed. The reference lists of all articles retrieved in full were also searched. The effects of massage on fibromyalgia symptoms have been examined in two single-arm studies and six randomized controlled trials. All reviewed studies showed short-term benefits of massage, and only one single-arm study demonstrated long-term benefits. All reviewed studies had methodological problems. The existing literature provides modest support for use of massage therapy in treating fibromyalgia. Additional rigorous research is needed in order to establish massage therapy as a safe and effective intervention for fibromyalgia. In massage therapy of fibromyalgia, we suggest that massage will be painless, its intensity should be increased gradually from session to session, in accordance with patient's symptoms; and the sessions should be performed at least 1-2 times a week.

Rheumatol Int. 2010 Mar 20. Kalichman L. Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva, 84105, Israel, kleonid@bgu.ac.il.

In this paper, preterm infant massage therapy studies are reviewed. Massage therapy has led to weight gain in preterm infants when moderate pressure massage was provided. In studies on passive movement of the limbs, preterm infants also gained significantly more weight, and their bone density also increased. Research on ways of delivering the massage is also explored including using mothers versus therapists and the added effects of using oils. The use of mothers as therapists was effective in at least one study. The use of oils including coconut oil and safflower oil enhanced the average weight gain, and the transcutaneous absorption of oil also increased triglycerides. In addition, the use of synthetic oil increased vagal activity, which may indirectly contribute to weight gain. The weight gain was associated with shorter hospital stays and, thereby, significant hospital cost savings. Despite these benefits, preterm infant massage is only practiced in 38% of neonatal intensive care units. This may relate to the underlying mechanisms not being well understood. The increases noted in vagal activity, gastric motility, insulin and IGF-1 levels following moderate pressure massage are potential underlying mechanisms. However, those variables combined do not explain all of the variance in weight gain, highlighting the need for additional mechanism studies. Copyright 2010 Elsevier Inc. All rights reserved.

Infant Behav Dev. 2010 Apr;33(2):115-24. Field T, Diego M, Hernandez-Reif M. Touch Research Institutes, University of Miami Medical School, Miami, FL 33101, United States. tfield@med.miami.edu

OBJECTIVES: To assess the role of massage therapy in the cardiac surgery postoperative period. Specific aims included determining the difference in pain, anxiety, tension, and satisfaction scores of patients before and after massage compared with patients who received standard care. DESIGN: A randomized controlled trial comparing outcomes before and after intervention in and across groups. SETTING: Saint Marys Hospital, Mayo Clinic, Rochester, Minnesota. SUBJECTS: Patients undergoing cardiovascular surgical procedures (coronary artery bypass grafting and/or valvular repair or replacement) (N=58). INTERVENTIONS: Patients in the intervention group received a 20-minute session of massage therapy intervention between postoperative days 2 and 5. Patients in the control group received standard care and a 20-minute quiet time between postoperative days 2 and 5. OUTCOME MEASURES: Linear Analogue Self-assessment scores for pain, anxiety, tension, and satisfaction. RESULTS: Statistically and clinically significant decreases in pain, anxiety, and tension scores were observed for patients who received a 20-minute massage compared with those who received standard care. Patient feedback was markedly positive. CONCLUSIONS: This pilot study showed that massage can be successfully incorporated into a busy cardiac surgical practice. These results suggest that massage may be an important therapy to consider for inclusion in the management of postoperative recovery of cardiovascular surgical patients. Copyright 2009 Elsevier Ltd. All rights reserved.

Complement Ther Clin Pract. 2010 May;16(2):92-5. Epub 2009 Nov 14. Cutshall SM, Wentworth LJ, Engen D, Sundt TM, Kelly RF, Bauer BA. Department of Surgery, Mayo Clinic, Rochester, Minnesota, United States.

Full Title: Quantitative application of transverse friction massage and its neurological effects on flexor carpi radialis

The purpose of the study was to determine the effects of transverse friction massage (TFM) on flexor carpi radialis (FCR) motoneuron (MN) pool excitability. Twenty-eight healthy subjects were randomly assigned into massage and control groups. Pre- vs post-TFM H-reflex data were collected. Controls received a rest period instead of massage. Massage dose was standardized by a novel electronic method which recorded the massage rate, momentary pressure and total cumulative pressure (energy). Two-way ANOVA of H/M ratios derived from maximal amplitudes of Hoffman reflexes (Hmax) and motor responses (Mmax) was used to analyze neurological effects and group differences. Analysis of pressure/time curve data showed: mean massage rate was 0.501+/-0.005 Hz; mean duration of massage sessions was 184.6+/-26.4s; mean peak pressure was 4.990+/-1.006 psi. Hmax/Mmax ratios declined from 14.3% to 10.3% for massage (P<0.01) but showed no change for controls (P>0.05). In conclusion a novel quantitative approach to the study of massage has been demonstrated while testing the effects of TFM on FCR MN pool excitability. TFM appears to reduce MN pool excitability. The novel method of quantifying massage permits more rigorous testing of client-centered massage in future research.

Man Ther. 2009 Oct;14(5):501-7. Epub 2008 Nov 22. Lee HM, Wu SK, You JY. Department of Physical Therapy, I-Shou University, Kaohsiung, Taiwan, ROC. hmlee@isu.edu.tw

Full Title: Use of sonographic elastography of the masseter muscles for optimizing massage pressure: a preliminary study

To examine the stiffness of the masseter muscle using sonographic elastography and to investigate its relationship with the most comfortable massage pressure in the healthy volunteers. In 16 healthy volunteers (10 men and 6 women), the Masseter Stiffness Index (MSI) was measured using EUB-7000 real-time tissue elastography. They underwent massages at three kinds of pressures using the Oral Rehabilitation Robot (WAO-1). A subjective evaluation regarding the comfort of each massage was recorded on the visual analogue scale. Elastography was also performed in two patients with temporomandibular joint dysfunction with the myofascial pain. The mean MSI of the right and left muscles in the healthy volunteers were 0.85 +/- 0.44 and 0.74 +/- 0.35 respectively. There was no significant difference between the right and left MSI in the healthy volunteers. The MSI was related to massage pressure at which the healthy men felt most comfortable. The two temporomandibular disorder patients had a large laterality in the MSI. The MSI was related to the most comfortable massage pressure in the healthy men. The MSI can be one index for determining the massage pressure.

J Oral Rehabil. 2009 Sep;36(9):627-35. Epub 2009 Jul 7. Ariji Y, Katsumata A, Hiraiwa Y, Izumi M, Iida Y, Goto M, Sakuma S, Ogi N, Kurita K, Ariji E. Department of Oral and Maxillofacial Radiology, Aichi-Gakuin University School of Dentistry, Chikusa-ku, Nagoya, Japan. yoshiko@dpc.agu.ac.jp

Full Title: The existential experiences of receiving soft tissue massage in palliative home care--an intervention

BACKGROUND: Soft tissue massage is currently used in palliative care for the relief of anxiety and pain. Only few studies have focused on patients' deeper experience of receiving the massage. AIM: The purpose of this study was to explore how patients with cancer in palliative home care experienced soft tissue massage. MATERIALS AND METHODS: Twenty-two patients received soft tissue massage (hand or foot) nine times over a period of 2 weeks. Each session lasted for 25 min. Following the last massage session, a qualitative interview was conducted. The analysis was performed using a hermeneutic approach. FINDINGS: Soft tissue massage generated feelings of existential respite with perceptions of being released from illness for a while. Two categories constituted the basis of the experiences: (1) "an experience of thoughtful attention" and (2) "a sensation of complete tranquility" resulting in the overarching theme "A time of existential respite." CONCLUSION: The patients experienced the massage to give meaning and to be important as it generated feelings of an inner respite. RELEVANCE TO CLINICAL PRACTICE: Soft tissue massage appears to be an appreciated source of support to dying patients in palliative home care. The method is easy to comprehend and relatively short (25 min) which may imply that it is a suitable complement in nursing care for this patient group.

Support Care Cancer. 2009 Sep;17(9):1203-11. Epub 2009 Jan 28. Cronfalk BS, Strang P, Ternestedt BM, Friedrichsen M. Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden. berit.cronfalk@ki.se

This paper describes an observational study describing how Tactile Massage (TM) was integrated into Swedish clinical medical care, the impact of this initiative suggests a foundation for future research. Subjects completed three questionnaires pre- and post-tactile massage. These were: Sense of Coherence (SOC), an enlarged Health Index (HI) and the Borg CR10 scale. RESULTS: A convenience sample of forty-three subjects (37 women and 6 men) were referred to TM treatment for a range of problems including for pain, sleep disorders, inability to move, headache and tense body. Patients received 10 TM treatments, each lasting approx. 1h in length. The enlarged HI questionnaire indicated that eleven out of fourteen parameters were significantly affected according (p-values between 0.0015 and <0.001). These included energy, mood, tiredness, sleep, pain, movement, health, general health and physical health. Pain reduction was also significantly reduced using the Borg CR10 scale (p<0.001). CONCLUSION: TM seems to affect several dimensions of health, and this should be explored more fully in future research.

Complement Ther Clin Pract. 2009 Aug;15(3):158-60. Andersson K, Törnkvist L, Wändell P. Center for Family and Community Medicine, Karolinska Institutet, SE-141 83 Huddinge, Sweden. katarina.andersson5@comhem.se

Full Title: The culture of massage therapy: valued elements and the role of comfort, contact, connection and caring

OBJECTIVE: To explore the attributes of the therapy encounter valued by repeat users of health-related massage therapy. DESIGN: A qualitative design with telephone focus group methodology was used. A total of 19 repeat users of massage therapy participated in three telephone focus groups where audiotaped semi-structured interviews were conducted. SETTING: Telephone focus group with massage clients from a range of provincial and urban regions in New Zealand. MAIN OUTCOME MEASURES: Summary of reported themes of the massage experience. Data were thematically analysed using the general inductive approach. RESULTS: Six valued elements of the massage encounter (time for care and personal attention, engaging and competent therapist, trust partnership, holism and empowerment, effective touch and enhancing relaxation), four modulators (comfort, contact, connection and caring) and two themes relating to adding experiential value (enjoyment, escapism) characterize the massage therapy culture. CONCLUSIONS: The culture of massage therapy care incorporates a number of characteristics that are congruent with the complementary and alternative medicine approach to health. In addition, massage specific factors were identified. The humanistic aspects of the therapy encounter valued by clients offer insight into the growing use of massage therapy and the success of massage therapy outcomes.

Complement Ther Med. 2009 Aug;17(4):181-9. Smith JM, Sullivan SJ, Baxter GD. Massage Department, Southern Institute of Technology, Private Bag 90114, Invercargill 9840, New Zealand. jo.smith@sit.ac.nz

Full Title: Might massage or guided meditation provide "means to a better end"? Primary outcomes from an efficacy trial with patients at the end of life

This article reports findings from a randomized controlled trial of massage and guided meditation with patients at the end of life. Using data from 167 randomized patients, the authors considered patient outcomes through 10 weeks post-enrollment, as well as next-of-kin ratings of the quality of the final week of life for 106 patients who died during study participation. Multiple regression models demonstrated no significant treatment effects of either massage or guided meditation, delivered up to twice a week, when compared with outcomes of an active control group that received visits from hospice-trained volunteers on a schedule similar to that of the active treatment arms. The authors discuss the implications of their findings for integration of these complementary and alternative medicine therapies into standard hospice care.

Palliat Care. 2009 Summer;25(2):100-8. Downey L, Diehr P, Standish LJ, Patrick DL, Kozak L, Fisher D, Congdon S, Lafferty WE. Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, University of Washington, Seattle, Washington, USA.

Full Title: Massage for Low Back Pain: An Updated Systematic Review Within the Framework of the Cochrane Back Review Group

STUDY DESIGN.: Systematic Review. OBJECTIVES.: To assess the effects of massage therapy for nonspecific low back pain. SUMMARY OF BACKGROUND DATA.: Low back pain is one of the most common and costly musculoskeletal problems in modern society. Proponents of massage therapy claim it can minimize pain and disability, and speed return to normal function. METHODS.: We searched MEDLINE, EMBASE, CINAHL from their beginning to May 2008. We also searched the Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, issue 3), HealthSTAR and Dissertation abstracts up to 2006. There were no language restrictions. References in the included studies and in reviews of the literature were screened. The studies had to be randomized or quasi-randomized trials investigating the use of any type of massage (using the hands or a mechanical device) as a treatment for nonspecific low back pain. Two review authors selected the studies, assessed the risk of bias using the criteria recommended by the Cochrane Back Review Group, and extracted the data using standardized forms. Both qualitative and meta-analyses were performed. RESULTS.: Thirteen randomized trials were included. Eight had a high risk and 5 had a low risk of bias. One study was published in German and the rest in English. Massage was compared to an inert therapy (sham treatment) in 2 studies that showed that massage was superior for pain and function on both short- and long-term follow-ups. In 8 studies, massage was compared to other active treatments. They showed that massage was similar to exercises, and massage was superior to joint mobilization, relaxation therapy, physical therapy, acupuncture, and self-care education. One study showed that reflexology on the feet had no effect on pain and functioning. The beneficial effects of massage in patients with chronic low back pain lasted at least 1 year after the end of the treatment. Two studies compared 2 different techniques of massage. One concluded that acupuncture massage produces better results than classic (Swedish) massage and another concluded that Thai massage produces similar results to classic (Swedish) massage. CONCLUSION.: Massage might be beneficial for patients with subacute and chronic nonspecific low back pain, especially when combined with exercises and education. The evidence suggests that acupuncture massage is more effective than classic massage, but this need confirmation. More studies are needed to confirm these conclusions, to assess the impact of massage on return-to-work, and to determine cost-effectiveness of massage as an intervention for low back pain.

Spine (Phila Pa 1976). 2009 Jun 25. Furlan AD, Imamura M, Dryden T, Irvin E. From the *Institute for Work & Health, Toronto, ON; daggerDepartment of Medicine, University of Toronto, Toronto, ON; double daggerToronto Rehabilitation Institute, Toronto, ON; section signDivision of Physical Medicine and Rehabilitation, Department of Orthopaedics and Traumatology, University of São Paulo School of Medicine, São Paulo, Brazil; and paragraph signCentennial College, Applied Research Centre, Toronto, ON.

BACKGROUND: Associated with decreases in quality of life, constipation is a relatively common problem. Abdominal massage appears to increase bowel function, but unlike laxatives with no negative side effects. Because earlier studies have methodological flaws and cannot provide recommendations, more research is needed. OBJECTIVE: This study investigates the effects of abdominal massage on gastrointestinal functions and laxative intake in people who have constipation. DESIGN: Randomized controlled trial. PARTICIPANTS AND METHOD: A sample of 60 people with constipation was included and randomized in two groups. The intervention group received abdominal massage in addition to an earlier prescribed laxative and the control group received only laxatives according to earlier prescriptions. Gastrointestinal function was assessed with Gastrointestinal Symptoms Rating Scale (GSRS) on three occasions; at baseline, week 4 and week 8. The statistical methods included linear regression, Wilcoxon sign rank test, and Mann-Whitney U-test. RESULT: Abdominal massage significantly decreased severity of gastrointestinal symptoms assessed with GSRS according to total score (p=.003), constipation syndrome (p=.013), and abdominal pain syndrome (p=.019). The intervention group also had significant increase of bowel movements compared to the control group (p=.016). There was no significant difference in the change of the amount of laxative intake after 8 weeks. CONCLUSIONS: Abdominal massage decreased severity of gastrointestinal symptoms, especially constipation and abdominal pain syndrome, and increased bowel movements. The massage did not lead to decrease in laxative intake, a result that indicates that abdominal massage could be a complement to laxatives rather than a substitute.

Int J Nurs Stud. 2009 Jun;46(6):759-67. Lämås K, Lindholm L, Stenlund H, Engström B, Jacobsson C. Department of Nursing, Umeå University, Umeå, Sweden. kristina.lamas@nurs.umu.se

Full Title: Massage and mobilization of the feet and ankles in elderly adults: Effect on clinical balance performance

The aim of this study was to evaluate the effects of a session of plantar massage and joint mobilization of the feet and ankles on clinical balance performance in elderly people. A randomized, placebo-controlled, cross-over trial was used to examine the immediate effects of manual massage and mobilization of the feet and ankles. Twenty-eight subjects, aged from 65 to 95 years (78.8+/-8.5 years - mean+/-SD) were recruited from community nursing homes. Main outcome measures were the performances in three tests: One Leg Balance (OLB) test, Timed Up and Go (TUG) test and Lateral Reach (LR) test. Results demonstrated a significant improvement after massage and mobilization compared with placebo for the OLB test (1.1+/-1.7s versus 0.4+/-1.2s, p<0.01) and the TUG test (0.9+/-2.6s versus 0.2+/-1.2s, p<0.05). Conversely, performances in the LR test did not improve significantly. These results emphasise the positive impact of a single session of manual therapy applied to the feet and ankles on balance in elderly subjects.

Man Ther. 2009 May 7.Vaillant J, Rouland A, Martigné P, Braujou R, Nissen MJ, Caillat-Miousse JL, Vuillerme N, Nougier V, Juvin R. Laboratoire Santé Plasticité Motricité, Université Joseph Fourier-Grenoble 1, Grenoble, France; Ecole de Kinésithérapie du Centre Hospitalier Universitaire de Grenoble, France; Service de Rhumatologie du Centre Hospitalier Universitaire de Grenoble, France.

Environmental enrichment (EE) was shown recently to accelerate brain development in rodents. Increased levels of maternal care, and particularly tactile stimulation through licking and grooming, may represent a key component in the early phases of EE. We hypothesized that enriching the environment in terms of body massage may thus accelerate brain development in infants. We explored the effects of body massage in preterm infants and found that massage accelerates the maturation of electroencephalographic activity and of visual function, in particular visual acuity. In massaged infants, we found higher levels of blood IGF-1. Massage accelerated the maturation of visual function also in rat pups and increased the level of IGF-1 in the cortex. Antagonizing IGF-1 action by means of systemic injections of the IGF-1 antagonist JB1 blocked the effects of massage in rat pups. These results demonstrate that massage has an influence on brain development and in particular on visual development and suggest that its effects are mediated by specific endogenous factors such as IGF-1.

J Neurosci. 2009 May 6;29(18):6042-51. Guzzetta A, Baldini S, Bancale A, Baroncelli L, Ciucci F, Ghirri P, Putignano E, Sale A, Viegi A, Berardi N, Boldrini A, Cioni G, Maffei L. Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico Stella Maris, I-56128 Calambrone, Pisa, Italy.

OBJECTIVE: The aim of this study was to evaluate the effects of massage with or without kinesthetic stimulation on weight gain and length of hospital stay in the preterm infant. STUDY DESIGN: A prospective randomized clinical trial was conducted evaluating the effects of massage with or without kinesthetic stimulation (KS) on weight gain and length of stay (LOS) in medically stable premature (<1500 g and/or and <1000 g) was also performed. RESULT: A total of 60 premature infants were recruited for this study; 20 infants in each group. Average daily weight gain and LOS were similar between the groups after controlling for covariates. For infants with BW>1000 g, average daily weight gain was increased in the intervention groups compared to control. This effect was mainly attributable to the M/KS group. CONCLUSION: Massage with KS is a relatively simple and inexpensive intervention that can improve weight gain in selected preterm infants. Length of hospital stay is not impacted by massage with or without KS. Further studies are needed to evaluate the effect of massage in the extremely low BW(<1000 g) infant.

J Perinatol. 2009 May;29(5):352-7. Massaro AN, Hammad TA, Jazzo B, Aly H. Department of Neonatology, Children's National Medical Center, Washington, DC 20010, USA. anguyenm@cnmc.org

Full Title: The effect of massage on immune function and stress in women with breast cancer - A randomized controlled trial

OBJECTIVES: To examine the short-term effects of light pressure effleurage on circulating lymphocytes by studying the number and activity of peripheral blood natural killer (NK) cells in patients with breast cancer compared to a control group. Furthermore, the effect of light pressure effleurage on salivary cortisol levels, heart rate and blood pressure was studied. DESIGN: Single centre, prospective, randomized and controlled study. METHODS: Thirty women, aged 50 to 75 years (mean 61 sd=7.2) with breast cancer undergoing radiation therapy in a hospital in southwestern Sweden were enrolled in the study. They were allocated to either receive massage in the form of a full-body light pressure effleurage treatment, or a control visit where they were given an equal amount of attention. Blood samples, saliva, notation of heart rate and blood pressure were collected before and after massage/control visit. Differences in change over time between groups were analyzed by Student's t-test. RESULTS: Light pressure effleurage massage decreased the deterioration of NK cell activity occurring during radiation therapy. Furthermore it lowered heart rate and systolic blood pressure. No effects were demonstrated on cortisol and diastolic pressure. CONCLUSIONS: A single full-body light pressure effleurage massage has a short-term effect on NK cell activity, systolic blood pressure and heart rate in patients with breast cancer. However, the long-term clinical importance of these findings needs to be further investigated.

Auton Neurosci. 2009 Apr 17. Billhult A, Lindholm C, Gunnarsson R, Stener-Victorin E. Institute of Neuroscience and Physiology/Physiotherapy, The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden; Research and Development Unit in Primary Health Care, Södra Alvsborg County, Sweden.

Full Title: Effects of the intelligent-turtle massage on the physical symptoms and immune functions in patients with chronic fatigue syndrome

OBJECTIVE: To evaluate the effects of the intelligent-turtle massage on the physical symptoms and immune functions in patients with chronic fatigue syndrome (CFS). METHODS: 182 cases of CFS were randomly divided into an experimental group of 91 cases treated by the intelligent-turtle massage, and a control group of 91 cases treated with the conventional massage method. After 2 courses of treatment, the therapeutic effects were statistically analyzed with the accumulated score for the improved clinical symptoms; and the changes of IgA, IgM and IgG were compared in 96 cases. RESULTS: There was a significant difference between the two groups in the accumulated scores for improvement of the symptoms (P<0.05). A remarkable difference was found in the therapeutic effect. And there was a significant difference in the IgA, IgM and IgG levels between the two groups (P<0.05). CONCLUSION: The intelligent-turtle massage is an effective therapy for relieving the physical symptoms of CFS, and it may show certain effects on the immune functions.

J Tradit Chin Med. 2009 Mar;29(1):24-8 Wang JH, Chai TQ, Lin GH, Luo L. The First Hospital Affiliated to Guangzhou TCM University, Guangzhou 510405, China.

Full Title: Effects of therapeutic massage on the quality of life among patients with breast cancer during treatment

OBJECTIVE: Therapeutic massage has demonstrated positive physical and emotional benefits to offset the effects of treatments associated with breast cancer. The goal of this study was to assess the impact of therapeutic massage on the quality of life of patients undergoing treatment for breast cancer. DESIGN: Using a pre/post intervention assessment design, this prospective, convenience sample pilot study measured anxiety, pain, nausea, sleep quality, and quality of life. Treatment consisted of one 30-minute treatment per week for 3 consecutive weeks. OUTCOME MEASURES: Instruments selected for this study were used in previous massage therapy studies to measure quality of life/health status and have documented validity and reliability. RESULTS: Participants experienced a reduction in several quality of life symptom concerns after only 3 weeks of massage therapy. Respondents' cumulative pre- and post-massage mean for state anxiety, sleep quality, and quality of life/functioning showed significant improvement. Among study participants, there was variability in reported episodes of nausea, vomiting, and retching; although participants reported decreased pain and distress, changes were non-significant. CONCLUSIONS: Therapeutic massage shows potential benefits for ameliorating the effects of breast cancer treatment by reducing side affects of chemotherapy and radiation and improving perceived quality of life and overall functioning.

J Altern Complement Med. 2009 Apr;15(4):373-80. Sturgeon M, Wetta-Hall R, Hart T, Good M, Dakhil S. Integrative Therapies Inc., Wichita, KS, USA.

Full Title: Effects of a full-body massage on pain intensity, anxiety, and physiological relaxation in Taiwanese patients with metastatic bone pain: a pilot study

Bone involvement, a hallmark of advanced cancer, results in intolerable pain, substantial morbidity, and impaired quality of life in 34%-45% of cancer patients. Despite the publication of 15 studies on massage therapy (MT) in cancer patients, little is known about the longitudinal effects of MT and safety in cancer patients with bone metastasis. The purpose of this study was to describe the feasibility of MT and to examine the effects of MT on present pain intensity (PPI), anxiety, and physiological relaxation over a 16- to 18-hour period in 30 Taiwanese cancer patients with bone metastases. A quasi-experimental, one-group, pretest-post-test design with repeated measures was used to examine the time effects of MT using single-item scales for pain (PPI-visual analog scale [VAS]) and anxiety (anxiety-VAS), the modified Short-Form McGill Pain Questionnaire (MSF-MPQ), heart rate (HR), and mean arterial pressure (MAP). MT was shown to have effective immediate [t(29)=16.5, P=0.000; t(29)=8.9, P=0.000], short-term (20-30 minutes) [t(29)=9.3, P=0.000; t(29)=10.1, P=0.000], intermediate (1-2.5 hours) [t(29)=7.9, P=0.000; t(29)=8.9, P=0.000], and long-term benefits (16-18 hours) [t(29)=4.0, P=0.000; t(29)=5.7, P=0.000] on PPI and anxiety. The most significant impact occurred 15 [F=11.5(1,29), P<0.002] or 20 [F=20.4(1,29), P<0.000] minutes after the intervention. There were no significant time effects in decreasing or increasing HR and MAP. No patient reported any adverse effects as a result of MT. Clinically, the time effects of MT can assist health care providers in implementing MT along with pharmacological treatment, thereby enhancing cancer pain management. Randomized clinical trials are needed to validate the effectiveness of MT in this cancer population.

J Pain Symptom Manage. 2009 Apr;37(4):754-63. Jane SW, Wilkie DJ, Gallucci BB, Beaton RD, Huang HY. Department of Nursing, Chang Gung Institute of Technology, Tao-Yuan, Taiwan. swjane@gw.cgit.edu.tw

Full Title: Massage therapy for cancer palliation and supportive care: a systematic review of randomised clinical trials

INTRODUCTION: Massage is a popular adjunct to cancer palliation. This systematic review is aimed at critically evaluating all available randomised clinical trials of massage in cancer palliation. MATERIALS AND METHODS: Six databases were searched to identify all trials of classical massage for cancer patients. Studies of other types of massage, e.g. reflexology, aromatherapy, were excluded. Fourteen trials met all inclusion criteria. DISCUSSION: Collectively, they suggest that massage can alleviate a wide range of symptoms: pain, nausea, anxiety, depression, anger, stress and fatigue. However, the methodological quality of the included studies was poor, a fact that prevents definitive conclusions. CONCLUSION: The evidence is, therefore, encouraging but not compelling. The subject seems to warrant further investigations which avoid the limitations of previous studies.

Support Care Cancer. 2009 Apr;17(4):333-7. Ernst E. Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, 25 Victoria Park Road, Exeter EX2 4NT, UK. Edzard.Ernst@pms.ac.uk

This was a prospective study designed to examine the potential of massage to reduce agitation in cognitively impaired nursing home residents. Subjects were identified as susceptible to agitation by nursing home staff or by Minimum Data Set (MDS) report. Data was collected during baseline (3 days), intervention (6 days), and at follow-up. Five aspects of agitation were assessed: Wandering, Verbally Agitated/Abusive, Physically Agitated/Abusive, Socially Inappropriate/Disruptive, and Resists Care. At each observation, agitation was scored 5 times during the 1-hour window of observation. Subjects' agitation was lower during the massage intervention than at baseline (2.05 vs. 1.22, P < .001), and remained lower at follow-up. Of the 5 agitated behaviors examined in this study, massage was associated with significant improvement for 4: Wandering (0.38 vs. 0.16, P < .001), Verbally Agitated/Abusive (0.59 vs. 0.49, P = .002), Physically Agitated/Abusive (0.82 vs. 0.40, P < .001), and Resists Care (0.10 vs. 0.09, P = .022). When analysis was restricted to residents with significant levels of agitation at baseline, the observed effects of massage on agitation increased. Massage is an accessible, easily learned intervention that is effective in controlling some types of agitation in elders with cognitive impairment. Massage should be studied further as a nonpharmacological intervention in such patients.

Geriatr Nurs. 2009 Mar-Apr;30(2):108-17. Holliday-Welsh DM, Gessert CE, Renier CM. Holliday Welsh & Associates, Duluth, MN, USA.

by Ernesto Ortiz LMT, CST

Bamboo is one of the must multifaceted plants in our planet. It has earned its reputation from its noble and soft appearance as well as its perseverance under harsh conditions. In the Orient, bamboo symbolizes strength, fertility, youth, prosperity and peace.

Bamboo is certainly one of the most versatile plants. It has spiritual, mythological and many practical applications. It is eaten, used in home construction and decoration, as well as for the creation of utensils and herbal remedies.

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The effectiveness of massage for postexercise recovery remains unclear, despite numerous studies on this issue. The aim of this study was to determine the effect of massage on endocrine and immune functions of healthy active volunteers after intense exercise. After repeated Wingate tests, the effects of whole-body massage and placebo on salivary cortisol, immunoglobulin A (IgA), and total protein levels were compared using a between-group design. Sixty healthy active subjects (23 women, 37 men) underwent 2 exercise protocol sessions at least 2 weeks apart and at the same time of day. The first session familiarized participants with the protocol. In the second session, after a baseline measurement, subjects performed a standardized warm-up followed by three 30-second Wingate tests. After active recovery, subjects were randomly allocated to massage (40-minute myofascial induction) or placebo (40-minute sham electrotherapy) group. Saliva samples were taken before and after the exercise protocols and after recovery. In both groups, the exercise protocol induced a significant increase in cortisol (p < 0.001), decrease in salivary IgA (sIgA) (p < 0.001), and increase in total proteins (p = 0.01) in saliva. Generalized estimating equations showed a significant effect of massage on sIgA rate (p = 0.05), a tendency toward significant effect on salivary total protein levels (p = 0.10), and no effect on salivary flow rate (p = 0.55) or salivary cortisol (p = 0.39). The sIgA secretion rate was higher after the recovery intervention than at baseline among women in the massage group (p = 0.03) but similar to baseline levels among women in the placebo group (p = 0.29). Massage may favor recovery from the transient immunosuppression state induced by exercise in healthy active women, of particular value between high-intensity training sessions or competitions on the same day.

J Strength Cond Res. 2009 Mar;23(2):638-44. Arroyo-Morales M, Olea N, Ruíz C, del Castilo Jde D, Martínez M, Lorenzo C, Díaz-Rodríguez L. Department of Physical Therapy, University of Granada, High Performance Sports Center at Altitude, Sierra Nevada, Granada, Spain. marroyo@ugr.es

Massotherapy, the therapeutic use of massage, is used to treat various chronic pain syndromes. One type of massotherapy, pressure stimulus applied over trigger points (TPs), is reported to have excellent therapeutic effects. Its effect is possibly mediated through changes in the autonomic nervous system although little research has been conducted to assess autonomic activity during TP compression. We have investigated how compression applied over TPs affects the autonomic nervous system. Six healthy young adult females whose daily working routine was carried out predominantly in a standing position were enrolled in the study cohort. After a day's work, the subjects were asked to rest supine, and electrocardiograms (ECGs), instantaneous lung volume (ILV) and systolic and diastolic blood pressures (SBP, DBP) were measured before and after pressure application over the TPs in those lower limb muscles where the subjects felt muscle fatigue or discomfort. The subjects were also asked to coordinate breathing with the beeping sounds. The therapeutic effects of TP compression were assessed by a subjective fatigue scale. Parasympathetic nervous activity was also assessed by spectral analysis of heart rate (HR) variability. The transfer function from ILV to HR was evaluated using linear analysis. The results indicated that TP compression (1) decreased HR, SBP and DBP, (2) increased parasympathetic activity, (3) increased the gain from ILV to HR, and (4) improved the fatigue scores. These findings suggest that an increase in parasympathetic nervous activity after the TP compression induced a reduction of fatigue. The therapeutic mechanisms of TP compression to enhance parasympathetic nervous system are discussed.

J Physiol Sci. 2009 Feb 21. Takamoto K, Sakai S, Hori E, Urakawa S, Umeno K, Ono T, Nishijo H. System Emotional Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Sugitani 2630, Toyama, 930-0194, Japan.

Generalised anxiety disorder (GAD) is common in the western world with a lifetime prevalence of 4.3 to 5.9% and is twice as common in women as in men. GAD can have a decisive impact on a patient's everyday life as it is surrounded by unfocused worries and the severe anxiety may interfere with normal social functions. The treatments include cognitive behavioural therapy and/or psychopharmacological drugs. In previous studies the positive effects of massage on anxiety have been shown. The present study described the experience of receiving massage for eight patients with GAD. Findings revealed that the patients were able to rediscover their own capacity during the massage period. This was illuminated by the experience of being relaxed in body and mind, the experience of unconditional attention, the experience of decreased anxiety and the experience of increased self-confidence. The paper ends with a discussion of clinical implications.

Complement Ther Clin Pract. 2009 May;15(2):96-101. Billhult A, Määttä S. FoU-enheten i Södra Alvsborg, Sven Eriksonsplatsen 4, S- 503 38 Borås, Sweden.

Heart rate (HR) responses to the removal of a monitoring lead were assessed in 56 preterm infants who received moderate pressure, light pressure or no massage therapy. The infants who received moderate pressure massage therapy exhibited lower increases in HR suggesting an attenuated pain response. The heart rate of infants who received moderate pressure massage also returned to baseline faster than the heart rate of the other two groups, suggesting a faster recovery rate.

Infant Behav Dev. 2009 Apr;32(2):226-9. Epub 2009 Jan 30. Diego MA, Field T, Hernandez-Reif M. Touch Research Institute, Department of Pediatrics, University of Miami School of Medicine, Miami, FL 33101, USA. mdiego@med.miami.edu

This randomized controlled trial investigated the short-term effects of massage therapy on youth with SCD and their parents. METHODS: Thirty-four children and adolescents, and their parents were assigned to a massage therapy or an attention control group. Parents were trained in massage in their homes once a week for 4 weeks, with instructions to provide nightly massages. Families in the control group were visited weekly by a research assistant. Participants completed measures of depression and anxiety, functional status, pain intensity, medication use, and service utilization. RESULTS: Parents in the massage therapy group reported higher levels of depression and anxiety following the intervention. Youth in this group showed higher levels of functional status, and lower levels of depression, anxiety, and pain. Health service utilization rates were unchanged from pre- to post-intervention. CONCLUSIONS: These results offer preliminary support for parent-delivered massage therapy as an intervention for SCD pain.

J Pediatr Psychol. 2009 Mar 12. Lemanek KL, Ranalli M, Lukens C. Ohio State University College of Medicine and Children's Hospital of Philadelphia.