Touch and Massage Therapy
Arguably, the importance of touch is often underrated within our culture. Generally, we all like it, crave it to varying extents, but if we’re unwell or feeling a bit blue, we tend to look to pharmacological remedies rather than say, going for a massage. However, there is a growing body of evidence that suggests that touch and massage, although by no means a cure, can significantly benefit people in a broader sense than just alleviating sore muscles or tension. Numerous examples exist in the literature regarding the fundamental role that interpersonal touch plays in human development and the negative connotations that a lack of touch can entail, from Harlow and Zimmerman’s (1959) Rhesus monkeys, to the extreme touch deprivation experienced by children in Romanian orphanages in the previous century. So how important is touch and how does it affect us? Are there any therapeutic benefits of touch and how has touch, in the form of massage therapy been viewed and used over the years as a method to treat various conditions? Following is a brief exploration of touch, in particular massage, and the largely overlooked potential benefits that it can offer.
So just how can being touched help with conditions like depression or Multiple Sclerosis? Firstly, let’s look at our skin. Our skin is an amazing organ. Primarily acting as a barrier to keep stuff out and other stuff in, it also acts as a conduit through which we receive information about our surroundings and a means to facilitate social communication, both through tactile stimulation and touch. Broadly speaking, there are two types of nerves responsible for touch in the skin, ‘slow’ and ‘fast’ mechanosensitive nerves. The slow nerves respond optimally to low velocity stroking movements and respond preferentially to skin temperature stimuli as opposed to warm or cool stimuli. It just so happens that the stimuli that evoke the response of these nerves are those that are deemed ‘most pleasant’ and induce feelings of relaxation and reduced stress, i.e. the same movements and pressure used in massage. This gentle touch can radically benefit a person’s affective state, as well as providing more body-centred psychophysiological benefits (McGlone et al., 2017). Unsurprisingly the benefits of massage are frequently identified as increased relaxation, improved sense of well-being and mood.
Typically, a person seeks out a massage for pain complaints; however, recent research suggests that massage can be effective in improving the growth of premature infants, and when used alongside other more conventional approaches, it can help in treating ADHD and depression (Field, 2014). Hospitalised patients who received massage therapy treatment attributed greater mobility, energy, motivation to engage in treatment and faster recovery to massage therapy (Smith et al., 2009). Touch in the form of massage is commonly used approach in palliative cancer care for relief of pain, nausea, fatigue, anxiety; improvement in mood and sleep disturbances; and enhanced quality of life (Collinge et al., 2013). To delineate whether if it is specifically massage or interpersonal touch that elicits the most benefit for cancer patients experiencing acute pain and low mood, Kutner et al., 2008, compared the two and found that massage was more effective than simple-touch for acute pain and mood lability. And caregivers for those undergoing cancer treatments have reported significant decreases in levels of stress, anxiety, depression and emotional and motivational fatigue after receiving massage treatment twice a week for three weeks (Rexilius et al. 2002).
In general, massage therapy is recommended for the management of pain when compared to no treatment; however, research gaps exist in determining the best in terms of the type of massage and duration/frequency of treatment (Crawford et al., 2016). Massage has been used for treatment for patients with Multiple Sclerosis and found to lower anxiety and decrease depression immediately following the treatments (Hernandez-Reif et al., 1998). More importantly perhaps, is the reported improvements the patients identified following the massage therapy study trial of improved self-esteem, better body image, more positive feelings regarding the progression of the disease and enhanced social functional status, adding overall to an improvement in their quality of life (Hernandez-Reif et al., 1998). Regardless of the population investigated, touch and massage therapy can be seen to potentially increase the capacity of the client to heal themselves and improve their self-efficacy (Smith et al. 2009).
Possibly my favourite (and oldest) article that I came across is from 1886 by William Murrell, a doctor and lecture in Pharmacology and Therapeutics. In it he laments the underuse of massage as a scientific and therapeutic tool and advocates its use as an effective approach in treating many ailments. He mentions how widely used and accepted it was as a therapeutic modality by the Ancient Romans and Greeks, that even Plato’s writings were littered with references to the widespread benefits of massage. Murrell goes on to give personal professional examples of how massage, prescribed like standard medication, was effective in alleviating the symptoms of patients with chronic constipation, nervous fatigue and period pain, amongst other examples, and genuinely encouraged its use over pharmacological approaches that were proving ineffective. In 1886! I wish doctors nowadays prescribed massages more than pills…
There are measurable biochemical benefits of touch and massage therapy too. Looking at an array of populations, from those living with chronic pain, depression, asthma and cancer, Field et al., 2010, concluded that the application of massage therapy significantly altered the levels of hormones in the body, namely a decrease in cortisol (associated with stress and often high in patients with depression) and an increase in serotonin and dopamine (the ‘happy’ hormones). Serotonin is a bit like the body’s natural anti-pain neurotransmitter and is released at higher rates during/after massage, as too is oxytocin, another hormone that plays a role in facilitating social bonding (Morhenn et al., 2012; Field, 2014). An increase in these hormones coupled with the decrease in cortisol following medium-pressure massage therapy is suggested to help in the treatment of depression (Field, 2014).
Easily one of the most fascinating areas of research, which I didn’t know existed until I began exploring touch and its benefits, is the field of touch and wearable haptic technology! I find this amazing, yet somewhat bittersweet, in that there is a need for such technology owing to the lack of staff, support services and increased alienation and loneliness that is widespread in our societies. One of the devices, which looks like a large fashionable scarf, is purported to provide the emotional and physical benefits of touch to the wearer (Bonanni et al., 2006). There are too many other examples in the literature (e.g. Vaucelle et al., 2009; Huisman et al., 2013; Sumioko et al., 2013) exploring the potential for using such technology to provide the benefits of touch – trust me, I spent a good couple of hours down this rabbit hole. I find this area particularly exciting as touch can be so beneficial for the elderly who often, owing to pain and decreased skin integrity, can find receiving a massage tricky. The ability to wear a technology, in scarf form as described by Bonanni et al., would be of huge benefit for isolated elderly people who are able to gain so much from touch. There is much evidence to suggest that massage and touch may be beneficial to those with dementia in regard to management of behavioural and psychological symptoms, including depressive symptoms (Hansen et al., 2006; Margenfeld et al., 2019). Another review article however, found that although massage was positively related to a decrease in aggressive behaviour, it could not conclude that massage improved anxiety, sadness or anger in dementia patients (Wu et al. 2017) and advocated for further research as the number of quality research articles was small. Moyle et al. 2012 found limited evidence to support the use of massage for decreasing agitation in persons with dementia. So, the jury is still out on just exactly what benefits touch and massage therapy have in the elderly population; however, the biochemical effects of massage, i.e. the increased serotonin and oxytocin and decreased cortisol, would still apply, regardless of one’s age, so I’d argue that massage is still a useful modality in assisting in improving the quality of life for the elderly in our society.
And on the other end of the lifespan spectrum, babies can benefit greatly from massage too! The benefits of massage therapy for preterm infants include improved weight gain and reduced jaundice (Ferber et al. 2002). The effect of touch has been shown to be important from a young age for neurodevelopment and lowering one’s physiological responses to stress events (Smith et al. 2009). Perhaps of most interest for new mothers: gentle touch and massage has been shown to reduce sleep problems in babies (Field & Hernandez-Reif, 2001).
The research into the area of using touch and massage therapy to treat various conditions and the technology that is being explored is expanding, mostly because the consensus seems to be that touch has been overlooked historically, and its potential is increasingly being tapped. As an interesting side note, massage therapists also receive benefit from giving massages, in the form of reduced subjective anxiety (Jensen et al. 2012). Getting a massage is a win-win for everyone! J
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Bonanni, L., Vaucelle, C., Lieberman, J., & Zuckerman, O. (2006). TapTap: A haptic wearable for asynchronous distributed touch therapy. CHI ’06 Extended Abstracts on Human Factors in Computing Systems, 580–585. https://doi.org/10.1145/1125451.1125573
Collinge, W., Kahn, J., Walton, T., Kozak, L., Bauer-wu, S., Fletcher, K., Yarnold, P., & Soltysik, R. (2013). Touch, Caring, and Cancer: Randomized controlled trial of a multimedia caregiver education program. Supportive Care in Cancer; Heidelberg, 21(5), 1405–1414. http://dx.doi.org.dbgw.lis.curtin.edu.au/10.1007/s00520-012-1682-6
Crawford, C., Boyd, C., Paat, C. F., Price, A., Xenakis, L., Yang, E., & Zhang, W. (2016). The Impact of Massage Therapy on Function in Pain Populations—A Systematic Review and Meta-Analysis of Randomized Controlled Trials: Part I, Patients Experiencing Pain in the General Population. Pain Medicine: The Official Journal of the American Academy of Pain Medicine, 17(7), 1353–1375. https://doi.org/10.1093/pm/pnw099
Ferber, S. G., Kuint, J., Weller, A., Feldman, R., Dollberg, S., Arbel, E., & Kohelet, D. (2002). Massage therapy by mothers and trained professionals enhances weight gain in preterm infants. Early Human Development, 67(1), 37–45. https://doi.org/10.1016/S0378-3782(01)00249-3
Field, T. (2010). Touch for socioemotional and physical well-being: A review. Developmental Review, 30(4), 367–383. https://doi.org/10.1016/j.dr.2011.01.001
Field, T. (2014). Massage therapy research review. Complementary Therapies in Clinical Practice, 20(4), 224–229. https://doi.org/10.1016/j.ctcp.2014.07.002
Field, T., & Hernandez‐Reif, M. (2001). Sleep Problems in Infants Decrease Following Massage Therapy. Early Child Development and Care, 168(1), 95–104. https://doi.org/10.1080/0300443011680106
Hansen, N. V., Jorgensen, T., & Ortenblad, L. (2006). Massage and touch for dementia. Cochrane Databsae of Systematic Review, 4. https://doi.org/10.1002/14651858.CD004989.pub2.
Harlow, H. F., & Zimmermann, R. R. (1959). Affectional Responses in the Infant Monkey. Science, 130(3373), 421–432. JSTOR.
Hernandez-Reif, M., Field, T., Field, T., & Theakston, H. (1998). Multiple sclerosis patients benefit from massage therapy. Journal of Bodywork and Movement Therapies, 2(3), 168–174. https://doi.org/10.1016/S1360-8592(98)80009-0
Huisman, G., Darriba Frederiks, A., Van Dijk, B., Hevlen, D., & Kröse, B. (2013). The TaSSt: Tactile sleeve for social touch. 2013 World Haptics Conference (WHC), 211–216. https://doi.org/10.1109/WHC.2013.6548410
Jensen, A. M., Ramasamy, A., Hotek, J., Roel, B., & Riffe, D. (2012). The Benefits of Giving a Massage on the Mental State of Massage Therapists: A Randomized, Controlled Trial. The Journal of Alternative and Complementary Medicine, 18(12), 1142–1146. https://doi.org/10.1089/acm.2011.0643
Kutner, J. S., Smith, M. C., Corbin, L., Hemphill, L., Benton, K., Mellis, B. K., Beaty, B., Felton, S., Yamashita, T. E., Bryant, L. L., & Fairclough, D. L. (2008). Massage Therapy versus Simple Touch to Improve Pain and Mood in Patients with Advanced Cancer: A Randomized Trial. Annals of Internal Medicine, 149(6), 369. https://doi.org/10.7326/0003-4819-149-6-200809160-00003
Margenfeld, F., Klocke, C., & Joos, S. (2019). Manual massage for persons living with dementia: A systematic review and meta-analysis. International Journal of Nursing Studies, 96, 132–142. https://doi.org/10.1016/j.ijnurstu.2018.12.012
McGlone, F., Cerritelli, F., Walker, S., & Esteves, J. (2017). The role of gentle touch in perinatal osteopathic manual therapy. Neuroscience & Biobehavioral Reviews, 72, 1–9. https://doi.org/10.1016/j.neubiorev.2016.11.009
Morhenn, Beavin LE, & Zak PJ. (2012). Massage increases oxytocin and reduces adrenocorticotropin hormone in humans. Alternative Therapies in Health & Medicine, 18(6), 11–18.
Moyle, W., Murfield, J. E., O’Dwyer, S., & Van Wyk, S. (2013). The effect of massage on agitated behaviours in older people with dementia: A literature review. Journal of Clinical Nursing, 22(5–6), 601–610. https://doi.org/10.1111/j.1365-2702.2012.04234.x
Murrell, W. (1886). Massage as a Therapeutic Agent. British Medical Journal; London, 1(1324), 926. http://dx.doi.org.dbgw.lis.curtin.edu.au/10.1136/bmj.1.1324.926
Rexilius SJ, Mundt CA, Megel ME, & Agrawal S. (2002). Therapeutic effects of massage therapy and healing touch on caregivers of patients undergoing autologous hematopoietic stem cell transplant. Oncology Nursing Forum, 29, E35-44. https://doi.org/10.1188/02.ONF.E35-E44
Smith, J. M., Sullivan, S. J., & Baxter, G. D. (2009). The culture of massage therapy: Valued elements and the role of comfort, contact, connection and caring. Complementary Therapies in Medicine, 17(4), 181–189. https://doi.org/10.1016/j.ctim.2009.05.003
Sumioka, H., Nakae, A., Kanai, R., & Ishiguro, H. (2013). Huggable communication medium decreases cortisol levels. Scientific Reports, 3(1), 1–6. https://doi.org/10.1038/srep03034
Vaucelle, C., Bonanni, L., & Ishii, H. (2009). Design of haptic interfaces for therapy. Proceedings of the SIGCHI Conference on Human Factors in Computing Systems, 467–470. https://doi.org/10.1145/1518701.1518776
Wu, J., Wang, Y., & Wang, Z. (2017). The effectiveness of massage and touch on behavioural and psychological symptoms of dementia: A quantitative systematic review and meta-analysis. Journal of Advanced Nursing, 73(10), 2283–2295. https://doi.org/10.1111/jan.13311