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2018 Massage Master Scholarship Winner

Patricia Guillen, Living Arts Institute

Patricia Guillen- 6-2018

Patricia Guillen is a veteran, a certified yoga therapist (C-IAYT), and a massage therapist in training. After 10 years of service in the US Navy, she separated to pursue a degree in accounting and inadvertently discovered the mental and emotional benefits of yoga, as well as the physical and physiological benefits of massage therapy. After 2 years of grad school, she earned her Masters of Science in Yoga Therapy and now encourages clients to notice their body-breath-mind connection, to practice self-care, self-compassion and gratitude.

She is passionate and enthusiastic about helping people connect to their wholeness, innate freedom and peace; and plans on doing this through massage and yoga therapy—two Complementary and Integrative Health (CIH) approaches to health and wellbeing. Populations with a special place in her heart include: veterans, first responders, older adults, caregivers and underserved communities.


 Effectiveness of Massage Therapy as Treatment for Stress

 

Stress affects all body systems (e.g. neuromuscular, cardiovascular, respiratory and endocrine), resulting in psychological and physiological changes. Allostasis, the active process of responding and adapting to challenges, involves the following mediators: autonomic, cortisol, immune/inflammatory, metabolic, and neuromodulators within the brain. These interact with each other and promote adaptation in the short run; as long as they are turned on efficiently when needed and turned off promptly when no longer needed.

The autonomic nervous system (ANS) is responsible for monitoring, regulating, and coordinating almost all the systems in the body—temperature, pH, oxygen levels, levels of blood, blood pressure, intake of food, digestion and absorption of food and water, and excretion of waste products. The response of the ANS to a stressor is the fight-or-flight response, through the sympathetic nervous system (SNS). The fight-or-flight response can be divided into two stages: 1) short-term fight-or flight response and 2) long term fight-or-flight response.

The short-term fight-or flight response or sympathetic adrenomedullary (SAM) system is the primary system that is triggered within us in response to short-term threats. Electrical impulses from the hypothalamus, travel along nerves that directly connect to the adrenal glands and stimulate the release of stress hormones adrenaline and noradrenaline (Fritz, S. (2017). The body cannot sustain this short-term fight-or-flight response for too long, because it would become exhausted. The second stage is the long-term fight-or-flight response or hypothalamic-pituitary-adrenal (HPA) axis. The longer-term fight-or-flight response is triggered hormonally and involves the hypothalamus, pituitary and adrenal gland. The adrenal cortex releases stress hormones like cortisol. The chronic activation of this longer-term fight-or-flight response can be a factor in causing several psychological and physiological health problems (Fritz, S. 2017).

The other response controlled by the ANS is the rest-and-digest response through the parasympathetic nervous system (PSNS). The PSNS reverses the fight-or-flight response, by returning the body to a non-alarm state and restoring body resources. When this relaxation response is active, it regulates digestive processes, slows down heart rate, constricts eye muscles to focus on near vision, increases glandular secretions, constricts the bronchioles in the lungs, and slows breathing (Fritz, S. 2017). This balancing and harmonious dance between the PNS and PSNS, maintains and supports good health to all body systems. Thus, homeostasis, or the condition in which the body’s internal environment remains relatively constant within physiologic limits, is controlled by adaptive responses.

Stress symptoms affect the body, thoughts, feelings and behavior. Common effects of stress on the body include: headaches, muscle tension or pain, fatigue, chest pain, upset stomach, and sleep problems. Common effects of stress on mood comprises of: anxiety, restlessness, lack of motivation or focus, anger, sadness or depression and feeling overwhelmed. Furthermore, common effects of stress on behavior are: overeating, undereating, angry outburst, drug and/or alcohol abuse, tobacco use, and social withdrawal (Mayo Clinic Staff. 2018). Chronic stress may lead to or exasperate peptic ulcers, ulcerative colitis, coronary heart disease, rheumatoid arthritis (if hereditarily susceptible), asthma, diabetes mellitus, schizophrenia and psychoses (Salleh, M.R. 2008).

Effective management of stress and stressors include meditation/mindfulness, deep breathing, exercise, sleep, practicing gratitude and massage therapy. Massage therapy is manual manipulation of the soft tissues of the body for the purpose of establishing and maintaining good health and promoting wellness (Salvo, S. 2016). Massage has taken an important role in modern healthcare because it has been shown beneficial in reducing stress, increasing lymph flow, decreasing pain, promoting sleep, reducing swelling, enhancing relaxation, lessening depression and anxiety, recovering from exercise-induced soreness and increasing joint range of motion. A research review published in 2014 on the journal of Complementary Therapies in Clinical Practice, found that moderate pressure massage led to “increased vagal activity and decreased cortisol levels” (Field, T. 2014). Data from functional magnetic resonance imaging suggested that moderate pressure massage, affects areas of the brain involved in stress and emotion regulation. As mentioned earlier, decreased cortisol levels are an effect of PSNS regulation, or “rest-digest-restore” response.

A study conducted on female office workers, aged 20-49, tested the effects of a scalp massage on the stress hormone, blood pressure and heart rate. Massages were performed for 15 minutes/session for group 1 and 25 minutes/session for group 2, twice a week, for 10 weeks. Results showed significant differences in norepinephrine, cortisol and blood pressure (Kim, I. H., Kim, T. Y., & Ko, Y. W. 2016). Positive effects were observed on subjects. This type of massage therapy seems the most convenient for workplace settings, as part of or in addition to chair massage.

Research on psychological stress have also been conducted. A 2008 pilot study evaluated the effect of relaxation massage therapy on stress, anxiety and aggression in a young adult psychiatric inpatient unit. The method used for this study was a prospective, non-randomized intervention study comparing the treatment as usual (TAU) with TAU plus massage therapy intervention over consecutive 7 week blocks. The therapy consisted of 20-minute massage therapy session offered daily to patients during their period of hospitalization. The results showed a significant reduction in self-reported anxiety, resting heart rate and cortisol levels immediately following treatments (Garner et al. 2008). Additionally, significant improvements in hostility and depression scores. Another possible research would be the effect of massage therapy on the healthcare professionals working in psychiatric inpatient units.

A randomized clinical trial, aimed to evaluate the effectiveness of massage and Reiki to reduce stress and anxiety. The study was conducted on clients at the Institute for Integrated and Oriental Therapy in Sao Paulo, Brazil. Sample size consisted of 122 subjects divided into 3 groups: 1) Massage and rest, 2) Massage and Reiki, 3) and a control group without intervention; intervention was conducted in 8 sessions. There were statistical differences amongst groups 2 and 3 on the Stress Systems List and the Trace Anxiety Inventory and concluded that massage and Reiki (group 2) produced better results amongst the groups (Kurebayashi et al. 2016) . A concern of the authors was that there is a long journey to be made for the scientific community to recognize the effects of Reiki on its own. Reiki is a Japanese form of energy work and it is based on the idea that an unseen life force energy flows through us and is what causes us to be alive. Treatment consists of hands being placed just off the body or lightly touching the body.

Researchers investigated the immediate effects of Traditional Thai Massage (TTM) on salivary alpha-amylase levels (sAA), heart rate variability (HRV), autonomic nervous system (ANS) function, and plasma renin activity (PRA), on 29 participants. The study, a crossover randomized controlled trial, found that stress index and psychological stress were decreased and stress resistance was increased after TTM. Thus, TTM could increase parasympathetic activity, leading to relaxation and reduced stress. Researchers were excited to investigate plasma renin activity after TTM because it is not a common measure that has been explored. Thai massage is a form of Asian Bodywork Therapy that consists of stretching and compressive massage techniques along energy pathways and on points to balance energy and restore health. Practitioners work very slowly and in a quiet, meditative state.

Lastly, a 2017 study aimed to verify if a massage therapy program during three months can influence cortisol concentrations, perceived stress index, intensity of pain and quality of life of patients with Fibromyalgia syndrome (FMS). The technique used was Swedish massage, a modality that uses gentle touch and may be an important alternative treatment for patients with FMS, which have excessive muscle tension. Twenty-four participants aged between 26 and 59 years, with a sedentary lifestyle completed the study. Additionally, volunteers were not using any medication to treat FMS. Patients underwent 24 sessions of Swedish massage therapy in the whole body, lasting 40 min, two sessions per week, for a period of three months (Oliveira et al. 2018). Swedish massage is one of the best-known bodywork therapies performed today; one of the primary goals is to relax the entire body. This pilot suggested that patients with FMS, who participated in a Swedish massage therapy program for three months, had improved quality of life, reduced perceived stress index and reduced pain.

Massage is generally considered part of complementary and alternative medicine and it is increasingly being offered along with standard treatment for a wide range of medical conditions and situations. Significant advantages of massage therapy include: non-invasiveness, non-drug and affordability. Evidence suggests that massage therapy may help reduce stress related hormones, pain and perceived stress; it increases vagal activity, and improves quality of life. Effective modalities and techniques used in the research presented here included: moderate pressure, scalp massage, relaxation massage, Reiki, Thai and Swedish massage.

Isolating research to stress alone is complex or nearly impossible because stress affects all body systems, it influences people at chemical-physical-psycho-emotional-spiritual levels, it is present in many or all illnesses and disease conditions, and it is a unique experience on all individuals. Research weaknesses discovered during the creation of this essay include the lack of research conducted in the United States, insufficient evidence to draw strong conclusions on the long-term benefits of massage therapy, short research duration, small sample sizes, and interestingly, stress studies were focused mainly on women.

 

References

Field, T. (2014). Massage Therapy Research Review. Complementary Therapies in Clinical Practice. 20(4): 224–229. doi:10.1016/j.ctcp.2014.07.002

Fritz, S. (2017). Mosby’s Essential Sciences for Therapeutic Massage: Anatomy, Physiology, Biomechanics, and Pathology. St. Louis, MO: Elsevier

Garner, L., Phillips, L. J., Schmidt, H. M., Markulev, C., O’Conner, J., Berger, G. E…McGorry, P. D. (2008). Pilot Study Evaluating the Effect of Massage Therapy on Stress, Anxiety and Aggression in a Young Adult Psychiatric Inpatient Unit. Australian and New Zealand Journal of Psychiatry. 42. 414-422. doi: 10.1080/00048670801961131

Kim, I. H., Kim, T. Y., & Ko, Y. W. (2016). The Effect of a Scalp Massage on Stress Hormone, Blood Pressure, and Heart Rate of Healthy Female. The Journal of Physical Therapy Science. 28. 2703-2707. doi: 10.1589/jpts.28.2703

Kurebayashi, L. F., Turrini, R. N., Souza, T. P., Takiguchi, R. S., Kuba, G., and Nagumo, M. T. (2016). Massage and Reiki Used to Reduce Stress and Anxiety: Randomized Clinical Trial. Revista Latino-Americana de Enfermagem. doi: 1 0.1590/1518-8345.1614.2834

Mayo Clinic Staff. (2018). Stress Management. Retrieved from https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stresssymptoms/art-20050987?p=1

Oliveira, F. R., Goncalves, L. C., Borghi, F., Silva, L. G., Gomes, A. E., Trevisan, G…Crege, D. R. (2018). Massage Therapy in Cortisol Circadian Rhythm, Pain Intensity, Perceived Stress Index and Quality of Life of Fibromyalgia Syndrome Patients. Complementary Therapies in Clinical Practice. doi: 10.1016/j.ctcp.2017.12.006

Salleh, M. R. (2008). Life Event, Stress and Illness. The Malaysian Journal of Medical Sciences. EFFECTIVENESS OF MASSAGE THERAPY AS TREATMENT FOR STRESS 9 Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3341916/

Salvo, S. (2016). Massage Therapy: Principles and Practice. St. Louis, MO: Elsevier