Pain-Free Living

The Benefits of Massage

by Linda Richards, RD, MS

As alternative therapies for arthritis become more popular, people with arthritis are turning to massage to address both the pain and stiffness of their condition and their general well-being. Perhaps you haven’t tried massage yet because you don’t know what to expect, are not sure that massage is a good idea for your joint pain and inflammation, or don’t know where to find a good massage therapist. This article takes a look at these valid concerns and shows how massage can be an important part of effective arthritis management.

What is massage?

In massage, a trained professional known as a massage therapist presses, rubs, strokes, kneads, and otherwise manipulates the muscles and soft tissues of your body. Massage is one of the oldest healing arts. The ancient Chinese, Egyptians, and Greeks are all known to have practiced it. Massage became accepted in the United States in the mid-1800’s, only to wane in the following century and not revive until the 1960’s and 1970’s.

Today, there are well over 100,000 massage therapists at work in the United States. They practice massage in many settings, from hospitals to health clubs to private studios. People go to them for many different reasons: to ease pain, to rehabilitate from injury, to reduce stress, to ease anxiety and depression, and to improve general well-being.

While there are more than 250 varieties of massage techniques, most practitioners use one or more of a few basic methods. Many use a form of Swedish massage, which employs long, flowing strokes meant to be calming and relaxing. As your body becomes relaxed, the massage therapist can also apply focused pressure to relieve areas of muscular tension. Other popular forms of massage include deep tissue massage, which features strong pressure on deeper layers of tissue, and myofascial release, in which long, stretching strokes release tension in the fascia (the connective tissue around the muscles). There are also the Asian techniques of acupressure and shiatsu, which use finger pressure on specific points on the body, and the technique called reflexology, which holds that rubbing certain points on the feet, hands, or ears has a positive effect on various body parts.

How massage can help

Massage carries numerous benefits, including for people with chronic conditions. Done correctly, massage can provide a wonderful respite from the stress of living with arthritis or another stressful condition. It can aid in relaxation, which in itself promotes healing and reduces stress. It can also reduce pain, improve joint movement, relax tense muscles, and stimulate blood flow. However, massage for people with arthritis should be approached as a complementary therapy — that is, one that is used in conjunction with (and not to replace) other regular medical treatment such as pain medicine or physical therapy. The following are some of the ways massage can benefit you, whether you have arthritis or not.

Relaxation. “The biggest benefit is relaxation — that’s number one. Massage should bring a sense of well-being to the body,” says Mary Kathleen Rose, a certified massage therapist in Colorado. After 25 years of experience, much of it working with people with chronic conditions, Rose developed a style of massage she calls Comfort Touch that is characterized by slow, broad, and encompassing pressure. It is not known exactly why or how massage encourages relaxation. Some speculate that massage triggers the body’s parasympathetic nervous system, which encourages the body’s restorative processes — muscle tension is improved, the heart rate slows, and the fight-or-flight response is reversed.

Circulation changes. While the mechanism is not well understood, massage is also thought to encourage the flow of lymph in the body. (Lymph is a fluid that circulates throughout the body; the cells in lymph help fight infection and disease.) Massage can also increase the flow of blood. However, exercise actually has a greater effect on increasing circulation than massage does. And during a relaxing massage, local circulation may increase, but systemic circulation actually slows down, as evidenced by lowered blood pressure, decreased body temperature, and slower breathing. This explains why many people actually become cooler during massage.

Pain relief. There is some evidence that massage can bring pain relief. The people getting massages certainly think it does. In a study by the American Massage Therapy Association, 93% of people who tried massage felt it was effective for pain relief. There are many theories for why massage eases pain. For example, some researchers speculate that massage encourages the release of pain-relieving hormones or that massage may block pain signals that are sent to the brain.

Improved joint movement. Through direct pressure, massage affects the muscles and connective tissues in the body, increasing mobility. Especially for people with arthritis, this can help increase the range of motion in the joints and lessen stiffness in the muscles, tendons, and ligaments.

Psychological benefits. Massage’s psychological benefits are well documented. Massage can alter mood, alleviating anxiety and depression and enhancing feelings of well-being and safety. Many people turn to massage for just this reason.

Choosing a massage therapist

Before looking for a massage therapist, it’s important to talk with your doctor about whether massage is a good idea for you. People with certain conditions, such as dermatomyositis or severe osteoporosis (bone thinning), may be advised not to try massage, as may those on blood-thinning drugs. Once you have cleared the decision with your doctor, you should make sure to choose a massage therapist with the necessary education and licensing. It may also be a good idea to find one who has experience working with people who have arthritis. But it is just as important to find a therapist with whom you feel comfortable.

Kate Guilford has lived with rheumatoid arthritis (RA) for more than 15 years and finds that her regular massages with Mary Rose are deeply relaxing and tension-releasing. Kate also has a background in massage therapy and body-centered psychotherapy, so she offers a unique perspective on selecting a therapist. She says that the person you choose should be someone you feel safe with, safe enough to state your needs and preferences. “Know that it is OK to give feedback if something doesn’t feel right or is uncomfortable or causes pain,” she adds. A good massage therapist, she says, “will question you about your current medical condition and ask if you are experiencing a flare-up, or about the severity and frequency of your symptoms, such as pain or level of function. She or he may ask, ‘How are you today? Are you experiencing any pain?’ or ‘Are there things in your daily life that you can’t do or have difficulty doing?’”

Avoid therapists who make claims suggesting that massage will fix or cure your arthritis. In addition, you can seek either a male or female massage therapist. To some people, whether the therapist is a man or woman is important.

You should make sure to choose a massage therapist who has been properly trained and certified. The gold standard for certification is the National Certification Board for Therapeutic Massage & Bodywork (NCBTMB). To be certified by the NCBTMB, a massage therapist has to have had at least 500 hours of instruction and have passed a national exam. Also, the majority of states require that massage therapists be licensed in the state before they practice. State licenses may be even more difficult to get than NCBTMB licenses and usually have to be renewed every couple of years. In addition, you may want to investigate whether the training program your massage therapist attended was accredited by the Commission on Massage Therapy Accreditation (COMTA).

The following are some sources that can help you find a massage therapist:

• Integrative medicine centers, especially those affiliated with academic centers or hospitals
• Referrals from friends, particularly any whose condition is similar to yours
• Senior centers, which usually have a network of practitioners, including massage therapists, who can make house calls
• Professional organizations (see “Finding a Massage Therapist” for particular organizations)

Avoiding pain

No matter who your massage therapist is or what type of massage you get, the massage should not hurt. People with arthritis are already in enough pain and don’t need any more. Before having a massage, therefore, it is important to think about whether any of the following suggestions apply to you.

Avoid certain areas. In general, the massage should avoid places that are very painful or limited in function. That means you will need to let your massage therapist know about your current condition before the massage and continually update him or her on how you’re feeling during the massage. Your therapist should also avoid techniques such as deep tissue work that might aggravate painful areas. Generally, where there’s arthritis in specific joints, it’s best to avoid direct, deep pressure. Your therapist should also use broad, full-hand contact pressure instead of the gliding and kneading strokes of classic Swedish massage.

Avoid uncomfortable positions. For example, if you have arthritis of the neck, you may not want to lie face down. Instead, lie with your face up or on your side with a pillow under your head. If you have trouble climbing up on the table, the therapist can lower the table or provide a stool to help you climb up. There are also massage therapists who do home visits so that the massage can be tailored to your unique situation.

OA or RA specifics. If you have osteoarthritis (OA), the massage therapist should avoid direct contact on the areas of pain, that is, the affected joints themselves. Gentle and broad pressure to muscles surrounding the joints can bring relief. People with RA should also avoid direct pressure on areas of pain or inflammation. A technique that uses slower movements can bring relief to areas of tension surrounding the affected areas.

Simple holding of an area while letting the warmth of the therapist’s hands penetrate the tissues can be very soothing. For example, the therapist can encompass your hands with his or her hands, holding through several complete breaths. Also, the massage therapist can gently move your arm to help encourage local circulation of blood and lymph and promote greater mobility.

When to cancel. If you’re having a flare-up, it’s probably best to avoid massage. As you become more familiar with your responses to touch, you will gain a better idea of when is the right (and wrong) time for a massage.

What to expect during the visit

You already discussed your medical condition with your therapist before making the appointment, but the therapist should ask about any special areas of concern just before the session. If it’s your first time, let the massage therapist know that you’ve never had a massage before or even that you’re nervous. Tell the therapist what you want to get out of the session, and discuss which parts of your body require the most attention. A typical full body massage includes the back, arms, legs, feet, hands, head, neck, and shoulders, but you can exclude any of these, or ask for more time on certain areas. For example, if you like having your feet massaged, ask for more time there.

The cost of a massage can vary widely, ranging from $30 to $120 (and up) per hour. It may be covered by insurance if ordered by your physician, so be sure to check with your provider. The average full-body massage lasts approximately one hour, but you may have the option of a half-hour partial-body massage. You might want to begin with a short 20-to-30-minute session and see how your body responds.

Massages are usually done while you lie on a table but can be tailored to your situation. Massages are also usually done with oil, but they don’t have to be. Because some people react to scented oils, you may want to ask your massage therapist to use unscented lotions instead of essential or aromatic oils, especially for areas of inflammation. Also, most massages are done unclothed, but you can disrobe to your level of comfort. The practitioner will leave the room while you undress and get yourself on the table, covered with a clean sheet. You should be properly draped at all times to keep you warm and comfortable with only the area being worked on exposed. My mother, Valera Richards, prefers to leave on her underclothes. She received her first massage 12 years ago, at age 76, after her chiropractor suggested that it might relieve some chronic back pain. He recommended a local therapist who had experience with older patients. My mother has loved massage ever since, and she says that the resulting relaxation helps both her OA and her occasional fibromyalgia. She prefers half-hour massages and misses them when she doesn’t get them on her normal once-every-three-weeks schedule.

Self-massage

While not nearly as relaxing as traditional massage, self-massage techniques can still help ease pain and tension. Hands, arms, legs, and feet are good, easy-to-access areas that can benefit from self-massage. But you should avoid inflamed joints. Your therapist can show you some techniques unique to your situation. The following are a few more general suggestions for self-massage:

• Place one hand on a joint in your leg, and use your other hand to press down on the placed hand. This strategy uses the hand’s warmth to penetrate the joint.
• Knead a spot for a short time — 15 to 20 seconds is often sufficient. Grasp the muscle area between your palm or thumb and your fingers. Lift it slightly and squeeze as if you were kneading dough. Work into the muscle with slow, regular squeeze-and-release motions.
• Cup your hand over a tense muscle. Glide your hand firmly over the length of the muscle in slow repeated movements. Apply various amounts of pressure to find what feels best.

Last Reviewed August 4, 2010

Linda Richards is a freelance health writer based in Redlands, California.

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