Ah yes, massage! One of life’s splendid pleasures. (Especially if you’re at the receiving end.) Massage is currently a multi-billion dollar industry in the U.S. with annual 2014 estimated sales of $11.7 billion (this according to American Massage Therapy Association statistics available on amtamassage.org.) Same source estimates at least 300,000 therapists currently working in the U.S. That makes almost one out of every thousand Americans a massage therapist! A.M.T.A. also claims that between July 2013 & July 2014 approximately 32.6 million Americans experienced at least one massage at an average cost of $68 per hour. (Keep in mind, of course, that these are industry statistics which may be biased in favor of their activity.) The list of stated reasons given by survey respondents for getting massaged included: (1) relaxation & stress reduction (2) relief of soreness & stiffness (3) recovery from an injury (4) general pain relief, etc. Almost all respondents agreed with the statement that “the experience  felt good”.

Primary massage methods

If you follow online advertising, you already know there are dozens of different massage techniques offered by practitioners. Here’s a breakdown based on recent survey results by the Association of Bodywork & Massage Professionals (A.B.M.P.) that appeared on massagetherapy.com.

(1) Swedish massage (33.8% of all)

(2) Deep tissue (33.6%)

(3) “Energy healing”, which includes Reiki and polarity “therapy”. (4.2%)

(4)Myofascial release (3.5%)

(5) Sports massage (2.4%)

(6) Trigger point (2.4%)

(7) other (unstated) (20.1%)

If this survey is accurate, Swedish and Deep Tissue are the most popular. Just in case you’re a massage neophyte, as I was, Swedish massage entails five different styles of stroking: sliding or gliding. kneading, tapping, friction, & vibration. Swedish is frequently performed in the nude (the customer is nude, that is) with either scented or unscented oil. Deep Tissue is similar to Swedish, but  involves deeper pressure in order to focus on the deepest layers of muscle tissue, tendons, and fascia. Fascia are connective tissue fibers composed primarily of collagen which separate muscles and internal organs. Energy healing is a bit controversial. The most common form is Reiki which means “universal life energy” in Japanese. The Reiki therapist supposedly places her hands over bodily “energy centers” and internal organs. Myofascial release involves stretching of the fascia and releasing bonds between fascia with pain elimination as the goal. In a sports massage, kneading and muscle manipulation is performed with the intended purpose of treating pain and physical disability. Trigger point is intended to loosen so-called “trigger points” which are tight areas within muscle tissue believed to cause pain in other bodily locations. In this respect, it shares a philosophical perspective with accupressure therapy.

Among those in the “other”category, and currently more popular in Asia than the  U.S., is so-called Thai massage. Traditional Thai is a deep, feet up, full-body massage that supposedly focuses on the bodies “energy lines”. It draws heavily upon Yoga, accupressure, and reflexology, the belief that there are reflexes in our hands and feet that relate to every gland, organ, and bodily system. Thai massage advocates believe that it stimulates blood and lymph flow throughout the body by clearing”blockages”.

Claimed massage medical benefits

We’ve already covered a few of the claimed benefits of massage in the previous section. The information web site webmd.com, which Spanking FIT has high regard for, believes that in addition to helping in relieving tension, massage can also heal muscle injury including back sprains, prevent muscle injury, and treat headaches and osteoarthritis. Another popular site, livestrong.com, claims that in addition to reducing inflammation, massage can break up scar tissue thereby rehabilitating past injuries. They further imply that massage contributes to enhanced athletic performance by reducing D.O.M.S. (delayed onset muscle soreness) Despite the prevalence of popular claims such as these, an enormous body of conflicting scientific research exists on the subject. A few researchers go so far as to insinuate that alleged massage benefits, including soreness and stiffness relief,  are nothing more than a “placebo” effect. In our current investigation, Spanking FIT decided to concentrate on the specific claim made by some that massage enhances the human immune system and has the potential to possibly prevent and cure disease.

Does massage therapy enhance the immune system?

We reviewed more than fifty research studies published within the last ten years in “reputable” peer-reviewed journals.  Several of them turned out to be cited by the popular internet websites above. However, the vast majority were of a “preliminary investigative” nature only. (I’m not criticizing these attempts. I am well aware of the enormous costs associated with conducting medical research on a large scale.) We narrowed it down to three studies which , in our opinion, are the most relevant and detailed:

(1) “Massage-like stroking boosts the immune system in mice” by B. Major published in Scientific Reports 5, #109134 (2015)

Published in a prestigious online journal by nature.com, this technically advanced project sought to resolve the massage question through rodent experimentation. (Alright, we know what you’re saying: Most men are not mice; but, important genetic similarities do exist.) Eighteen mice of the same variety were randomly assigned to one of three groups: (1) controls (no treatment) (2) stroking with a brush for an hour a day for eight days. (3) hand stroking with a rubber glove for an hour a day for eight days. The researchers reported “a statistically significant increase” in two varieties of T cells (thymic & splenic) in group 3 only. Both lymphocyte types play an important role in mice and human immunity. A major weakness of this study was the use of so-called parametric statistical tests for data analysis, in lieu of non-parametric ones. The analysts used one-way A.N.O.V.A.. Bonferroni, and Newman-Keuls parametric testing. In performing a parametric test it is necessary, especially in dealing with small sample sizes which was definitely the case, to make certain assumptions regarding the type of distribution that data originate from. In their case, it was necessary to assume that it was “normal”, or shaped like the famous “bell curve” from Statistics. Employed tests may be demonstrated to be quite “robust” in most cases; nevertheless, it is always preferable to employ non-parametric tests such as Kruskal-Wallis under the circumstances. The fact that the experiment was replicated four times with similar results does not indemnify the analysis either, in our opinion. The researchers did put forward an interesting hypothesis regarding why massage possibly enhances the immune system: massage may decrease nerve stimulation of lymphoid organs and counteract the immunosuppresive effects of hydrocotisone on thymocytes and splenocytes. All results need to be reproduced  either with larger rodent samples, or preferably, with humans.

(2) “A preliminary study of the effects of repeated massage on hypothalamic-pituitary-adrenal and immune function in healthy individuals: a study of mechanisms of action and dosage.”by M.H. Rapaport pub. in Journal of Alternative & Complementary Medicine 2012 Aug. 18 (8).

This is the study most widely quoted by the online massage advocates. It was conducted at Emory University Med Center in Atlanta, with statistical support provided by Cedars Sinai Med Center in L.A.  In it, 53 healthy volunteers were randomly assigned to one of four groups.: (1) Swedish massage once a week for five weeks (2) Swedish massage twice a week for five weeks. (3) Touch (control) once a week for five weeks (4) Touch (control) twice a week for five weeks.

The results were “a statistically significant 24.3% increase” in total lymphocyte count for subjects massaged once a week, only. For subjects massaged more often, practically the opposite occurred: a statistically non-significant 9% drop in the lymphocyte count occurred.  Again, parametric testing was performed with small samples, so these somewhat paradoxical “findings” could be due to statistical noise. (Researchers do concede that at least some of the data violated parametric requirements.) Non-parametric tests were either not explored, or their results went unreported, for some reason. Disappointing findings, given all the media “hype” this study received.

(3) “Effectiveness of aromatherapy with light Thai massage for cellular immunity improvement in colorectal cancer patients” by S. Khiewkhern pub. in Asian Pacific Journal of Cancer Prevention 2013;14 (6)

This study out of Thailand was unique in so far as the researchers actually used sample sizes large enough for legitimate statistical comparisons to made.  Sixty colorectal patients at Phichit Hospital in Thailand were randomly assigned to treatment massage or “standard supportive care”. The massage given consisted of “light” Thai administered three times per week for one week with ginger and coconut oil. The post assessment was conducted one to two days after last massage in treatment group to determine if the effects were sustained. Amazingly, the massaged group had a statistically significantly larger lymphocyte population than the control group did by 11%.. Researchers used a statistical technique known as Analysis of Covariance (A.N.C.O.V.A.) with pre-assessment values as covariate. The authors did not state explicitly whether normality and other requirements were tested; nevertheless, the fact that Statistical Package for the Social Sciences (S.P.S.S.)  was employed suggests they were. (S.P.S.S. has built in capabilities for testing required assumptions prior to performing A.N.C.O.V.A.)

The results of this study are encouraging for recommending  traditional Thai massage, not as a cure for illness, but as a possible adjunct to other prudent health practices, including diet and exercise, for illness prevention. Science also supports the claim that moderate nude sunbathing  may improve immunity. (See:”Nude Sunbathing-It Does a Body Good!“; Spanking FIT, Aug. 2015) Of course, our investigation does not imply that all the other forms of massage are ineffective for this purpose. There just appears to be a paucity of well-designed research regarding them in our part of the world, for some reason.

Massage Evaluation Conclusion

Spanking FIT‘s comprehensive massage evaluation concluded: “the jury is still out” on alleged health and medical benefits of different varieties of massage therapy. University research on the subject, with a few exceptions, is poorly designed and makes use of flawed analysis. As usual, the world wide web has “jumped the gun” in proclaiming them. Nevertheless, it is comforting to know that something that feels so good, and is not inexpensive, probably is also good for us. Enjoy! Dr. Garrett

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