By Susan Bernstein
Like many people with arthritis, Connie DeIanni has days when her pain is hard to manage. One tactic she uses to fight her pain, as well as the stress that comes along with it, is a soothing massage.
“I’ve used massage as a therapy, but more for the sore muscles that are compromised due to flares,” says DeIanni, a Farmington, Utah, bank employee and college student who has rheumatoid arthritis. “There’s a calming effect on the tension and stress of the constant pain that is rewarding.”
Massage, whether conducted in a softly lit day spa or a treatment room at a physical therapy clinic, is something many people use to soothe sore joints and muscles, to ease anxiety or to help them sleep better. The National Center for Complementary and Alternative Medicine (NCCAM), part of the National Institutes of Health, reports that massage is one of the most popular complementary therapies used by Americans, with close to nine percent of adults using it. Until recently, little was known about why massage seemed to work, but recent research suggests that massage can affect the body’s production of certain hormones linked to blood pressure, anxiety, heart rate and other key vital signs. But is massage safe and effective for people with arthritis?
Massage and Arthritis
Regular massage of muscles and joints, whether by a licensed therapist at a spa or by self-massage at home, can lead to a significant reduction in pain for people with arthritis, according to Tiffany Field, PhD, director of the Touch Research Institute at the University of Miami School of Medicine, who’s conducted a number of studies on the benefits of massage, including on people with arthritis. In Field’s research and other recent studies on the effects of massage for arthritis symptoms, regular use of the simple therapy led to improvements in pain, stiffness, range of motion, hand grip strength and overall function of the joints.
While most research on massage examines its effects on the general population, not specifically people with arthritis, recently more studies are underway to study the effectiveness of massage for people with arthritis. For example, one 2006 study conducted at the University of Medicine and Dentistry of New Jersey examined 68 adults with knee osteoarthritis receiving two Swedish massages per week for eight weeks, compared to a group who received no massage. The massage group reported significant improvements in knee pain, stiffness, function, range of motion and walking, the researchers found.
Massage also benefits people with painful hand or wrist arthritis, Field concluded in another 2006 study that she conducted with colleagues in Miami. Twenty-two adults, mostly women, diagnosed with hand or wrist arthritis were given four weekly massages from a therapist and taught to massage their sore joints daily at home. Just a 15-minute, moderate pressure massage per day led to reduced pain and anxiety, and increased grip strength for the participants as measured on comparative pre- and post-therapy tests.
Most people who try complementary therapies, including massage, do so to address back and neck pain, according to a 2007 NCCAM report. A number of studies confirm the effectiveness of massage for back and neck pain, including one published in 2011 in the Annals of Internal Medicine that looked at the effectiveness of massage therapy on 401 people with chronic low back pain. The researchers found that massage did reduce their pain, and the benefits lasted at least six months. They also concluded that the type of massage wasn’t that important – different types worked about the same.
In fact, says Field, what matters most is the level of pressure used in the massage – preferably moderate to light. Her 2010 study, published in the International Journal of Neuroscience, showed that stimulating pressure receptors, or nerves under the skin that convey pain-reducing signals to the brain, with moderate pressure leads to reduced symptoms.
“The critical thing is using moderate pressure,” says Field. “Light pressure, just touching the surface of the skin or brushing it superficially, is not getting at those pressure receptors. Light pressure can be stimulating, not relaxing.”
How Does Massage Work?
While some studies show that massage can reduce pain and anxiety for people with arthritis, how exactly does massage make these results happen? Research has shown that massage can lower the body’s production of the stress hormone cortisol, and boost production of serotonin, which, in turn, can improve mood. Additionally, massage can lower production of the neurotransmitter substance P, often linked to pain, and improve sleep as a result.
In 2010, researchers at the University of California, Los Angeles, School of Medicine and the nearby Cedars-Sinai Medical Center studied 53 healthy adults receiving just one Swedish massage therapy session and found that the participants’ levels of key hormones and white blood cells were positively affected. For example, the hormone arginine-vasopressin, which may lower blood pressure, was decreased, along with some inflammatory cytokines like IL-4 and IL-10. Cortisol levels were reduced by massage in this study as well, although not significantly.
Massage’s mechanism for reducing stress is still unclear, says Christopher Moyer, PhD, a psychologist at the University of Wisconsin in Stout, Wis. “We know that massage reduces anxiety quite well and can reduce certain painful conditions rather well. But we don’t know how those things are happening,” says Moyer, a former competitive cyclist who uses massage to ease his own muscle aches.
In his study published in 2010, Moyer and his colleagues determined that massage therapy could slightly reduce levels of cortisol. However, this reduction was so slight that the researchers determined that its effects on cortisol levels was not the reason why massage seemed to reduce anxiety and stress.
“Cortisol is a key stress hormone, but it doesn’t mean that if we know a person’s cortisol level, we know how much stress this person is having,” he says. “Massage must be working in some other way.”
There are many variables involved in how massage may work to ease pain, stiffness and anxiety, says Rosemary Chunco, a licensed massage therapist in Plano, Texas, who treats many patients with arthritis and related diseases. “The actual mechanism that comes into play is still under investigation. For example, a more restful sleep that results from a massage may help with arthritis pain.”
Best Types of Massage for Arthritis
If you’re interested in trying one of the many types of massage as a way to ease your arthritis symptoms, it’s important to consult your rheumatologist or primary-care physician first to ensure that massage is safe for you. Some techniques may involve strong pressure to sensitive tissues and joints, or moving limbs into various positions that may be difficult for someone with damaged joints from a disease like rheumatoid arthritis or ankylosing spondylitis.
Use caution when considering massage if you have:
- Damaged or eroded joints from arthritis
- Flare of inflammation, fever or a skin rash
- Severe osteoporosis (brittle bones)
- High blood pressure
- Varicose veins
“It’s always a good idea to get the thumbs up or down from a doctor if you are having even the slightest worry about using massage for your condition,” says Chunco. “It’s also very important to tell the therapist if you are experiencing pain or if you are uncomfortable with the work that she is doing. A good therapist will want feedback on what you are feeling during the session.”
Be sure to have a conversation with your massage therapist beforehand about your arthritis, and what parts of your body are most affected by the disease, advises Field.
“Therapists should be very cognizant and careful, as they all have a list of contraindications for massage in their brains already,” she says. “They can usually tell if you have an area of inflammation” but it’s wise to discuss it first, she says. In addition, if you have any concerns about the therapist using scented oils or lotions that might cause a rash, speak up – these lubricants are commonly used but are probably not necessary.
Your goals for massage may vary. You may be interested in relieving anxiety and stress caused by dealing with arthritis, or you may be seeking relief for pain and stiffness in a specific area of your body. Talk openly with your massage therapist about your goals for the session so she can adjust the technique accordingly. There is no set way to perform a massage; she should be flexible to your needs.
Most importantly, massage should make your arthritis pain and stiffness feel better, not worse, says Veena Ranganath, MD, a rheumatologist at the University of California, Los Angeles Department of Medicine. “I do tell my patients that if it hurts, don’t do it,” says Dr. Ranganath. Your doctor also can refer you to a massage therapist, which may not only lead you to a qualified professional, but also help you qualify for reimbursement if your insurance policy covers massage treatments.
Massage is not medicine. It’s a complement to your doctor-prescribed arthritis treatment. You should enjoy experiencing a massage, and it should not increase your pain or anxiety. Communication with your doctor and massage therapist beforehand can ensure that massage is right for you and help you achieve beneficial results.