The Study Question

Does massage therapy or other forms of physical relaxation reduce occupational stress for health care workers?

Chronic exposure to work related stressors such as long hours and job strain is well known to have negative effects on physical and mental health. Health care workers are an especially vulnerable group, with stressful environments and work pressure often leading to burnout, a situation exacerbated during the Covid-19 pandemic.

While cognitive approaches such as mindfulness and cognitive behavioral therapy have demonstrated benefits for stress reduction, physical approaches such as yoga, progressive muscle relaxation, and massage therapy have not been studied as extensively. This study provides an updated systematic review and meta‐analysis of all randomized controlled trials using physical methods of relaxation in healthcare workers on occupational stress reduction.

The Study Methods

This meta‐analysis was conducted using PRISMA (Preferred Reporting Items for Systematic Review and Meta‐analyses) guidelines. Inclusion criteria were randomized controlled trials employing physical relaxation methods compared to non‐intervention control or other physical relaxation methods for occupational stress in health care workers, with change from baseline or both pre‐ and post‐intervention stress data at any duration of follow‐up.

Physical relaxation was defined as any method that involved light muscular tension and relaxation, including movement‐based techniques such as yoga and related exercises, stretching, and walking, as well as passive techniques such as massage and progressive muscle relaxation. Vigorous exercise, such as heavy aerobic activity and weightlifting, was excluded. Techniques devoid of muscular activity, such as aromatherapy without massage and music therapy, were also excluded.

The PubMed, SCOPUS, Web of Science and the Cochrane Library databases from inception to February 21, 2021, were searched. A manual search of references in pertinent review articles in this area was also conducted. Exclusion criteria were non‐randomized-controlled trials such as quasi‐randomized and quasi‐experimental studies, lack of non‐intervention or another physical relaxation comparison group, lack of stress assessment data or data that was otherwise insufficient for extraction, studies involving rigorous physical exercise or strength training, studies on subjects with preexisting mental illness, articles without full‐text, and non‐English manuscripts.

Two authors independently extracted data from all studies deemed eligible for inclusion, with disagreements addressed through discussion until a consensus was reached. For the primary outcome of stress, mean changes of stress scores and standard deviation from baseline for both arms were used. When multiple scales were used, preference was given to measures more specific for stress and those more commonly used in other identified studies, including the Perceived Stress Scale (PSS), the Maslach Burnout Inventory for emotional exhaustion (MBI‐EE), and the Nursing Stress Scale (NSS). A secondary outcome was mean changes in assessments examining mental and physical health.

Two authors independently assessed the quality of included RCTs with the Cochrane Collaboration’s Risk of Bias tool. Manuscripts were evaluated on five domains of bias: randomization process, deviations from intended interventions, missing outcome data, measurement of the outcome, and selection of the reported result. Disagreements were resolved through discussion until a consensus was reached. Statistical analysis was performed with the meta‐package in RStudio version 1.4.1106. To compare various methods of physical relaxation to each other, a random‐effects frequentist network meta‐analysis was conducted with the R package netmeta.

The Results

The authors identified 3414 articles from databases, with another 37 through manual searching of review articles. After screening, 15 studies were included in the final analysis. A total of 688 subjects were enrolled across the 15 studies, with 341 participants having undergone physical relaxation compared to 347 non‐intervention controls. Of those, 139 were involved in yoga or a yoga like exercise (tai chi and qigong); 167 received some type of massage therapy; 15 were engaged in progressive muscle relaxation (PMR); and 20 performed stretching exercises. All studies were assessed as having some degree of bias. Massage protocols used in these studies ranged from a single session of a 10-minute seated massage to multiple 90-minute sessions of aromatherapy massage over 6 weeks. The most common health care profession represented was nursing.

Pooled results show that all interventions involving yoga (seven trials), massage therapy (six trials), PMR (one trial), and stretching exercises (one trial) significantly reduced measures of occupational stress at the longest duration of follow‐up vs baseline compared to non‐intervention controls, with p < .00001. Yoga was found to rank the highest in effectiveness, followed by massage therapy, PMR, stretching and finally no intervention. In the network analysis, both yoga alone and massage therapy alone significantly reduced measures of occupational stress compared to a non‐intervention control at the longest duration of follow‐up vs. baseline.

Limitations of the Study

A wide variety of massage approaches and lengths were included across the different studies, which may have made statistical effects harder to demonstrate. No information regarding the training or experience of the massage practitioners was included.

Implications for Evidence-Informed Practice

Systematic reviews and meta-analyses of RCTs are considered to be among the strongest types of studies to show a cause-and-effect relationship. A massage therapist could credibly cite this study in support of a massage program for nurses in the workplace as part of an organization’s effort to reduce stress and avoid burnout.

According to PTSD United, an organization dedicated to providing support and resources for people who suffer from PTSD, roughly 24.4 million people are dealing with PTSD at any given time. Although nearly everyone experiences a traumatic event at some time or another, the difference for people who develop PTSD is that their reactions to the trauma continue instead of resolving naturally over time. Often, people with PTSD will feel stressed even when they aren’t in danger.

“People experience PTSD when their choices over what happens to their bodies are taken from them,” says Pamela Fitch, the author of Talking Body, Listening Hands: A Guide to Professionalism, Communication and the Therapeutic Relationship, and a massage therapist with extensive experience working with clients with PTSD. “When actions are taken that they have no control over, then no place or person feels safe. Add to this the context of how a person was loved or not loved, and the more strikes against them, the harder it is to overcome the trauma.”

What Are the Symptoms?

PTSD is highly individualized, meaning that few people are going to experience PTSD in exactly the same way. Being familiar with some of the primary symptoms, however, will help you better understand how massage therapy may prove helpful. According to Fitch, symptoms usually manifest in some of the following ways:

Hyperarousal

Generally speaking, hyperarousal refers to an increased psychological and physiological tension. For example, the person might feel anxious or tired, or suffer from insomnia. Additionally, their tolerance for pain might decrease while their startle responses become exaggerated. Here, too, personality traits might become accentuated.

Hypervigilance

Abnormal awareness of environmental stimuli, or being alert and attentive to potential threats, are signs of hypervigilance. You might also notice clients holding their breath or clenching their fingers, for example.

Guilt and shame

Clients who suffer from PTSD may also feel guilty or shameful, faulting themselves for what happened or having feelings of humiliation and unworthiness.

Dissociation

Dissociation describes how a person might distance themselves from a traumatic event. Some may detach emotionally or appear absent or unconscious. Other people suffering from PTSD might “lose time” and be unable to remember significant aspects of the trauma, for example. Panic, nausea and fear can also be aspects of dissociation.

Intrusive thoughts

Recurrent, unwanted and distressing memories of the traumatic event might also occur, along with upsetting dreams or flashbacks. According to the Mayo Clinic, PTSD symptoms typically begin within three months of the trauma occurring, although it’s also possible for years to pass before symptoms surface.

No matter how symptoms manifest and when they appear, the one constant for many people dealing with PTSD is that their symptoms significantly affect their daily lives, sometimes making it difficult to work and develop and maintain personal and professional relationships.

Remember, however, that even with an understanding of symptoms, you absolutely must stay within your scope of practice when working with clients with PTSD. “It is not within a massage therapist’s scope of practice to actively engage in conversation about the trauma, other than to listen, support and refer,” says Fitch.

Treatment for PTSD

Similar to other mental health diagnoses, like depression or anxiety, PTSD is commonly treated with an integrative approach that may include both medication and some form of psychotherapy, with the goal being to help the person effectively work through the trauma.

Cognitive therapy, for example, is a type of talk therapy that focuses on helping the person recognize patterns in their thinking that keep them “stuck,” like misinterpreting normal situations as threatening. Exposure therapy, where a person works to re-enter the setting where trauma was experienced, sometimes through the use of virtual reality, aims to help people suffering from PTSD safely confront what they find threatening or frightening so they can learn to more effectively cope with the traumatic event.

Many times, talk therapy (such as cognitive therapy) and exposure therapy are used in combination, along with anti-depressants or anti-anxiety medication, in some cases.

For clients with PTSD seeking massage therapy, Fitch believes working through their trauma history with an experienced psychologist or psychotherapist is a must. “If clients with PTSD seek massage therapy before they have done some reflection with a psychotherapist, they could be at risk of worsening their symptoms, becoming triggered by the touch, or feeling depressed or angry,” she explains.

How Can Massage Therapy Help Clients with PTSD?

Stess relief, decreasing anxiety, reducing depression¹ and improving personal mood are all positive outcomes massage may provide clients. Additionally, a 2012 study focusing on how integrative therapies can help promote reintegration among veterans found that those participants who received massage therapy reported significant reductions in physical pain, tension, irritability, anxiety/worry and depression.²

Another recent study of Somali women refugees with chronic pain—the majority of whom reported military and/or sexual trauma—found that massage therapy provided enormous relief for distressing physical and psychological symptoms largely attributed to the exposure to trauma,³ according to Cynthia Price, a research professor at the University of Washington and massage therapist.

Research also indicates massage therapy may be effective for those clients who experience dissociation as a symptom of PTSD,^4,5 allowing these clients to experience a more coherent sense of self, which for some is a primary reason they initially seek out massage therapy .^6,7

While almost all studies on the subject point to the positive effects of massage therapy, making sweeping generalizations about its effectiveness for PTSD would be unwise.

“Given that the studies to date have involved small samples, we do not know the magnitude of these effects, nor do we know how massage facilitates health in trauma recovery,” says Price. “However, research findings suggest that dissociation reduction, i.e., a more coherent sense of self, may play an important role in positive massage therapy effects.”

There are aspects of massage therapy, too, that appear to provide some unique benefits to clients with PTSD—mainly giving these clients a feeling of comfort, safety and control they often can’t achieve on their own.

According to Fitch, some of the massage therapist’s most powerful tools come from how the massage therapy session itself is handled, from the informed consent and opportunity for a client to ask questions that start each session to the therapist’s ability to respond to the individual’s needs during a session, whether that’s stopping altogether, changing positioning or adapting levels of pressure. “All of these actions ensure that clients are safe and know they can stop the treatment at any time, providing them a safe environment to experience touch,” she explains.

Massage therapists can also provide clients with self-care strategies to help prolong the positive benefits achieved, not only in massage therapy sessions, but with other integrative treatment approaches as well. “People who have been traumatized are no longer at home in their bodies,” Fitch says. “Massage therapists can teach clients safe and effective ways of self-soothing and stress management.”

Article Source:

Brown Menard, Ph.D., LMT, M. (2023, August 1). Massage for occupational stress: Massage therapy journal; American Massage Therapy Association. https://www.amtamassage.org/publications/massage-therapy-journal/massage-and-aromatherapy-benefits3/

Clients with PTSD may find relief from stress, anxiety, and depression with massage therapy. 

According to the National Institute of Mental Health, post-traumatic stress disorder (PTSD) develops in some people who have seen or lived through an event that is shocking, scary or dangerous. These events might be combat related, for example, or involve violence, abuse or trauma.

According to PTSD United, an organization dedicated to providing support and resources for people who suffer from PTSD, roughly 24.4 million people are dealing with PTSD at any given time. Although nearly everyone experiences a traumatic event at some time or another, the difference for people who develop PTSD is that their reactions to the trauma continue instead of resolving naturally over time. Often, people with PTSD will feel stressed even when they aren’t in danger.

“People experience PTSD when their choices over what happens to their bodies are taken from them,” says Pamela Fitch, the author of Talking Body, Listening Hands: A Guide to Professionalism, Communication and the Therapeutic Relationship, and a massage therapist with extensive experience working with clients with PTSD. “When actions are taken that they have no control over, then no place or person feels safe. Add to this the context of how a person was loved or not loved, and the more strikes against them, the harder it is to overcome the trauma.”

What Are the Symptoms?

PTSD is highly individualized, meaning that few people are going to experience PTSD in exactly the same way. Being familiar with some of the primary symptoms, however, will help you better understand how massage therapy may prove helpful. According to Fitch, symptoms usually manifest in some of the following ways:

Hyperarousal

Generally speaking, hyperarousal refers to an increased psychological and physiological tension. For example, the person might feel anxious or tired, or suffer from insomnia. Additionally, their tolerance for pain might decrease while their startle responses become exaggerated. Here, too, personality traits might become accentuated.

Hypervigilance

Abnormal awareness of environmental stimuli, or being alert and attentive to potential threats, are signs of hypervigilance. You might also notice clients holding their breath or clenching their fingers, for example.

Guilt and shame

Clients who suffer from PTSD may also feel guilty or shameful, faulting themselves for what happened or having feelings of humiliation and unworthiness.

Dissociation

Dissociation describes how a person might distance themselves from a traumatic event. Some may detach emotionally or appear absent or unconscious. Other people suffering from PTSD might “lose time” and be unable to remember significant aspects of the trauma, for example. Panic, nausea and fear can also be aspects of dissociation.

Intrusive thoughts

Recurrent, unwanted and distressing memories of the traumatic event might also occur, along with upsetting dreams or flashbacks. According to the Mayo Clinic, PTSD symptoms typically begin within three months of the trauma occurring, although it’s also possible for years to pass before symptoms surface.

No matter how symptoms manifest and when they appear, the one constant for many people dealing with PTSD is that their symptoms significantly affect their daily lives, sometimes making it difficult to work and develop and maintain personal and professional relationships.

Remember, however, that even with an understanding of symptoms, you absolutely must stay within your scope of practice when working with clients with PTSD. “It is not within a massage therapist’s scope of practice to actively engage in conversation about the trauma, other than to listen, support and refer,” says Fitch.

Treatment for PTSD

Similar to other mental health diagnoses, like depression or anxiety, PTSD is commonly treated with an integrative approach that may include both medication and some form of psychotherapy, with the goal being to help the person effectively work through the trauma.

Cognitive therapy, for example, is a type of talk therapy that focuses on helping the person recognize patterns in their thinking that keep them “stuck,” like misinterpreting normal situations as threatening. Exposure therapy, where a person works to re-enter the setting where trauma was experienced, sometimes through the use of virtual reality, aims to help people suffering from PTSD safely confront what they find threatening or frightening so they can learn to more effectively cope with the traumatic event.

Many times, talk therapy (such as cognitive therapy) and exposure therapy are used in combination, along with anti-depressants or anti-anxiety medication, in some cases.

For clients with PTSD seeking massage therapy, Fitch believes working through their trauma history with an experienced psychologist or psychotherapist is a must. “If clients with PTSD seek massage therapy before they have done some reflection with a psychotherapist, they could be at risk of worsening their symptoms, becoming triggered by the touch, or feeling depressed or angry,” she explains.

How Can Massage Therapy Help Clients with PTSD?

Stess relief, decreasing anxiety, reducing depression¹ and improving personal mood are all positive outcomes massage may provide clients. Additionally, a 2012 study focusing on how integrative therapies can help promote reintegration among veterans found that those participants who received massage therapy reported significant reductions in physical pain, tension, irritability, anxiety/worry and depression.²

Another recent study of Somali women refugees with chronic pain—the majority of whom reported military and/or sexual trauma—found that massage therapy provided enormous relief for distressing physical and psychological symptoms largely attributed to the exposure to trauma,³ according to Cynthia Price, a research professor at the University of Washington and massage therapist.

Research also indicates massage therapy may be effective for those clients who experience dissociation as a symptom of PTSD,^4,5 allowing these clients to experience a more coherent sense of self, which for some is a primary reason they initially seek out massage therapy .^6,7

While almost all studies on the subject point to the positive effects of massage therapy, making sweeping generalizations about its effectiveness for PTSD would be unwise.

“Given that the studies to date have involved small samples, we do not know the magnitude of these effects, nor do we know how massage facilitates health in trauma recovery,” says Price. “However, research findings suggest that dissociation reduction, i.e., a more coherent sense of self, may play an important role in positive massage therapy effects.”

There are aspects of massage therapy, too, that appear to provide some unique benefits to clients with PTSD—mainly giving these clients a feeling of comfort, safety and control they often can’t achieve on their own.

According to Fitch, some of the massage therapist’s most powerful tools come from how the massage therapy session itself is handled, from the informed consent and opportunity for a client to ask questions that start each session to the therapist’s ability to respond to the individual’s needs during a session, whether that’s stopping altogether, changing positioning or adapting levels of pressure. “All of these actions ensure that clients are safe and know they can stop the treatment at any time, providing them a safe environment to experience touch,” she explains.

Massage therapists can also provide clients with self-care strategies to help prolong the positive benefits achieved, not only in massage therapy sessions, but with other integrative treatment approaches as well. “People who have been traumatized are no longer at home in their bodies,” Fitch says. “Massage therapists can teach clients safe and effective ways of self-soothing and stress management.”

Key Points From American Massage Consumers In A National Survey

Choosing the right massage therapist is vital to a positive massage experience. In a recent annual survey conducted by the American Massage Therapy Association®, American massage consumers view massage therapists who are members of (AMTA) are considered more credible, knowledgeable, and respected compared to those of other organizations or businesses.

Some key points made by consumers of massage therapy in the survey:

• Consumers prefer their massage therapist to be a member of AMTA four to one over any other national massage organization or business.
• AMTA remains the most trusted name in massage therapy by a ratio of more than 5-1 among adults who have had a massage in the past year.
• Consumers see AMTA as having the best-trained and educated massage therapists.
• Twice as many massage consumers in the past year looked for an AMTA massage therapist compared to members of any other group.
• 21 percent of consumers surveyed reported receiving a massage from a professional massage therapist in the past year.

Finding a professional massage therapist is vital to a positive massage experience. AMTA massage therapists have demonstrated a level of ability through education and/or testing, adhere to a code of ethics, and must meet continuing education requirements.

Chrissy Stites, LMT is an active member of the American Massage Therapy Association®. As a licensed Massage Therapist, Chrissy has demonstrated the highest level of experience and knowledge in the practice of massage and medicupping therapies. Client’s rank Chrissy Stites, LMT is the most experienced and valued massage therapist in Longboat Key, Florida. If you are planning on visiting Longboat Key Florida for vacation and are considering getting a relaxing massage, visit chrissystiteslmt.com for more information and booking. 

Healthcare Professionals Recommend Massage and Medi-Cupping. 

Massage therapy’s role in integrative health care has become widely accepted in major hospitals and medical practices. There is significant evidence supporting the inclusion of massage therapy for many important patient health conditions, including those for chronic pain management, behavioral health treatment, rehabilitation, physical training, and acute medical conditions. Medicupping is also widely accepted and practiced among healthcare professionals.

Cupping Therapy (CT) is an ancient method and is currently used in the treatment of a broad range of medical conditions. Nonetheless, the mechanism of action of (CT) is not fully understood. This review aimed to identify possible mechanisms of action of (CT) from a modern medical perspective and offer possible explanations of its effects. English literature in PubMed, Cochrane Library, and Google Scholar was searched using keywords. Only 223 articles were identified, 149 records were screened, and 74 articles were excluded for irrelevancy. Only 75 full-text articles were assessed for eligibility, and included studies in this review were 64. Six theories have been suggested to explain the effects produced by cupping therapy. Pain reduction and changes in biomechanical properties of the skin could be explained by “Pain-Gate Theory”, “Diffuse Noxious Inhibitory Controls” and “Reflex zone theory”. Muscle relaxation, changes in local tissue structures, and an increase in blood circulation might be explained by “Nitric Oxide theory”. Immunological effects and hormonal adjustments might be attributed to “Activation of immune system theory”. Releasing of toxins and removal of wastes and heavy metals might be explained by “Blood Detoxification Theory”. These theories may overlap or work interchangeably to produce various therapeutic effects in specific ailments and diseases. Apparently, no single theory exists to explain the whole effects of cupping. Further research are needed to support or refute the aforesaid theories, and also develop innovative conceptualizations of (CT) in the future.

Explore the latest science on massage therapy as a nonpharmacological approach for pain relief. 

As the United States struggles with an epidemic of opioid use and its devastating effects on lives, society and the economy, AMTA believes it’s important to consider the role massage therapy can play in relieving pain. 

A recent economic modeling analysis indicates that as many as 5 million people in the United States could potentially benefit from massage therapy for pain relief, while reducing the number of people with addiction disorder by over 100,000 per year. 

Prescription opioids carry serious risk of addiction, abuse, and overdose, in addition to a number of side effects, even when taken as directed. According to the Centers for Disease Control and Prevention (CDC), deaths from prescription opioids—drugs like oxycodone, hydrocodone, and methadone—have more than quadrupled since 1999. For that reason, a number of health organizations and governmental agencies are looking at new ways to manage pain. 

We are dedicated to this issue, investing membership dollars back into the profession for research, advocacy and promotion of massage for pain management.

A growing body of research supports the positive impact of massage therapy for relieving stress, anxiety, and depression. 

In the United States, almost half of adults will experience a mental health challenge during their lifetime. A growing body of research is supporting the positive impact of massage therapy for relief of stress, anxiety, and depression. In fact, many studies indicate it can provide benefits similar to psychotherapy for certain conditions. Read on to learn more about the ways massage can improve mental health and well-being.

Massage Therapy Can Relieve Stress

Stress is prevalent in today’s fast-paced world and can negatively affect people’s health and well-being. Massage therapy has shown to significantly reduce stress on both physical and psychological levels. While massage therapists know from experience that massage reduces stress, there is also considerable research that validates our experience.

Related Studies

• In a study on the effects of trigger point therapy, there was a significant decrease in heart rate, systolic blood pressure, and diastolic blood pressure.
• Measures of oxygen consumption, blood pressure, and salivary cortisol levels were all lower after a 10-to-15 minute chair massage in controlled studies.
• Research shows that massage for nurses during work hours can help to reduce stress and related symptoms, including headaches, shoulder tension, insomnia, fatigue, and muscle and joint pain.

Massage Therapy for Anxiety

According to the National Institute of Mental Health, over 40 million adult Americans suffer from anxiety disorders. Anxiety can negatively shape the quality of life for individuals affected. Massage therapy can be an effective treatment by elevating neurotransmitters associated with lowering anxiety and decreasing hormones associated with increasing anxiety.

Related Studies

• Research supports that massage can relieve stress in psychiatric patients, those with chronic pain, cancer patients, children with illnesses, patients with generalized anxiety disorder, the elderly, and healthy adults.
• Research published in Applied Nursing Research shows that back massage given during chemotherapy can significantly reduce anxiety and acute fatigue.
• A study published in Military Medicine reports that military veterans indicated significant reductions in ratings of anxiety, worry, depression, and physical pain after massage. The analysis also suggests declining levels of tension and irritability following massage.

Massage Therapy for Depression + Seasonal Affective Disorder

For many who suffer from depression, the first solution is psychotherapy, where a person sees a trained mental health professional to talk (and at times medication is prescribed). Now, people are also beginning to better understand how a combination of treatment options can be beneficial, and massage therapy is showing great promise in alleviating depression and Seasonal Affective Disorder.

Related Studies

• The effect of massage therapy on trait anxiety and depression is virtually the same as those routinely found in the research studies of psychotherapy for people with the same conditions.
• Research indicates that massage can improve mood and reduce depression in those living with chronic pain, as well as in cancer patients, pregnant women, and people living with chronic disease.
• One in five Americans are impacted by Seasonal Affective Disorder; leaving many people feeling depressed and lethargic. Studies show that regular massages can improve mood and reset circadian rhythms, leading to improved mood, better sleep, and more energy.