Stress Management and Massage Therapy

by John Katomski, LMT

There is nearly universal agreement that one of the greatest benefits of massage therapy is its ability to reduce feelings of stress and anxiety. Thanks to the pioneering work of scientists who first studied the effects of stress on the body, we are now able to provide data-based evidence that supports the sense of well being after a massage.

In classical terms, stress is an applied force that tends to deform a body or alter its existing equilibrium. Walter Cannon, M.D. first applied the concept of stress in physiology during the l920's and 30's. He was the first to refer to the relatively steady state of the body as homeostasis and described stress as anything which disturbed it. Everyday stresses of living, which are routine and essential, are compensated for by normal homeostatic mechanisms. However, when we use the word stress today, we are usually referring to a stimulus so strong or prolonged that the body cannot maintain normal homeostasis. When the internal environment shifts to adapt to stress it creates dramatic changes in neural, endocrine, immunological, emotional, behavioral, psychological and cognitive functions.

From the 1930's to the 1970's, Hans Selye, M.D., further developed physiological responses to stress. He described three stages of the stress response, which he termed the general adaptation syndrome (GAS). The first stage is the alarm reaction, mediated primarily by the autonomic nervous system. It is marked by an increase of norepinephrine, a hormone that increases blood pressure by vasoconstriction. The second stage is the resistance reaction, regulated by the hypothalamic-pituitary-adrenocortical axis. This results in increased levels of cortisol, a hormone with anti-inflammatory effects. The third stage is the exhaustion phase, characterized chiefly by potassium depletion and adrenal insufficiency.

While some stress is necessary, even beneficial, unresolved stress can lead to illness. Selye proposed that "an ever-increasing proportion of the human population dies from the so-called wear and tear diseases, or degenerative diseases, which are primarily due to stress."(1)

Studies at Universities and National Institutes

Today, most researchers who study stress recognize that it involves much more than just hormonal indicators. Contemporary research into how stress affects the body and mind focuses on several key indicators—levels of salivary cortisol and urinary norepinephrine, (which rise under stress), immunologically potent blood cells (which diminish under stress), and insulin regulation. In addition, certain behavioral profiles are assessed, including depression, anxiety, task performance and pain. Measuring these markers before and after an intervention—such as massage therapy—helps to determine the therapeutic value of a treatment.

The Touch Research Institute (TRI), located at the University of Miami in Florida, has been a leader in massage therapy research. Opened in 1992, it is the first center in the world devoted to the scientific study of touch therapy. Under the leadership of Tiffany Field, Ph.D., the Touch Research Institute has opened the way for respected exploration into the benefits of massage.

Most of the studies at TRI have been fairly small (involving twenty to thirty participants) so the results are preliminary, but highly suggestive. In a typical study an experimental group receives a thirty-minute massage five times a week for four weeks, while a control group receives either standard care or a comparable complementary treatment such as progressive muscle relaxation. The two groups are then compared to see what changes occur in the biochemical indicators, behavior, or symptoms being studied.

Results point to some consistent benefits of massage therapy—with measurable reductions in cortisol, decrease in sympathetic tone and increase in parasympathetic tone (associated with "rest and digest" response) and enhanced function of the immune system. Every one of these indicators shows a decreased stress response.

Psychological assessments show improvements in alertness, performance and social functioning. Other studies demonstrate a positive effect on specific conditions such as asthma, diabetes mellitus, rheumatoid arthritis, and postpartum depression. In all likelihood, many of these benefits accrue because of the ability of massage therapy to enhance stress adaptation mechanisms.

The National Institute of Mental Health (NIMH), the American Massage Therapy Association (AMTA) Foundation and the National Institutes of Health (NIH) have also supported research into stress and the effects of massage therapy, and have recently begun some large scale clinical studies.

Reading the Research Literature

A good place to start any journey into the research literature of massage therapy and stress is with Tiffany Field's Touch Therapy. Two classics in the field of stress are Walter Cannon's Wisdom of the Body, and Hans Selye's The Stress of Life. The peer- reviewed Journal of Bodywork and Movement Therapies provides quality articles relevant to massage therapy research.

Much needs to be learned, as the basic effects of massage therapy are still not well understood. Research is expensive and time consuming, but must be undertaken so practitioners can be objective in evaluating their work. This is not to say that every detail of what is valued about massage must be scrutinized from a scientific perspective. However, research can help develop evidence-based treatment strategies, as well as provide support when describing the benefits of massage therapy.

John Katomski, .LM.T. (MT '89) teaches Advanced Western Techniques, Clinical Strategies, and Assessment in the Massage Therapy Program, and Biomedical Pathology in Acupuncture Program.

Reference

1. Hans Selye, M.D., The Stress of Life (New York: McGraw Hill Book Company, 1956), p.275.