ChiroACCESS Article



Massage and the Immune System



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December 2, 2010

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MassageThe 2010 Job Analysis of Chiropractic, produced by the National Board of Chiropractic Examiners, found that 38% of chiropractic assistants perform massage for chiropractic patients.  Nearly 70% of chiropractors also perform some form of massage therapy according to the survey.  Most of the research related to the effects of massage during the last decade has centered primarily on both cancer patients and those with compromised immune systems due to AIDS.  Although the rigor varies and the proverbial caveat is ever present “more rigorous research is still needed” there has emerged a fairly clear and consistent picture that massage bolsters the immune system. 

Multiple forms of massage including Swedish massage, myofascial induction, “standard massage”, “skin rubdown with a dry towel”, and other forms all demonstrate positive immunological changes.  However, in one study where light touch was used as a control, there was no change in biomarkers suggesting there is some minimal pressure threshold that must be met before immune function is modulated.  Study groups varied in age from children to the aged and from immunologically compromised AIDS and cancer patients to healthy subjects yet the outcomes were similar.  In addition to improving immune function there is evidence that massage reduces stress, pain, depression, anger, and improves sleep.

Note:  These mini-reviews are designed as updates and direct the reader to the full text of current research.  The abstracts presented here are no substitute for reading and critically reviewing the full text of the original research.  Where permitted we will direct the reader to that full text.

Leg massage therapy promotes psychological relaxation and reinforces the first-line host defense in cancer patients.  [LINK]

J Anesth. 2010 Oct 26. [Epub ahead of print]

Noto Y, Kitajima M, Kudo M, Okudera K, Hirota K.
Division of Health Sciences, Hirosaki University Graduate School of Health Sciences, Hirosaki, 036-8564, Japan.

PURPOSE: Patients with cancer suffer a wide range of physical symptoms coupled with psychological stress. Moreover, cancer chemotherapy induces immunosuppression and consequently causes respiratory infections. Massage therapy has been reported to reduce symptoms in cancer patients via an increase in psychosocial relaxation and to enhance and/or improve immune function.

METHODS: In the present study, we determined whether leg massage could induce psychosocial relaxation and activate the first line of the host defense system. To assess effects of rest and leg massage, 15 healthy volunteers rested on a bed for 20 min on the first day, and 3 days later the subjects received a standardized massage of the legs for 20 min with nonaromatic oil. Twenty-nine cancer patients also received the same standardized massage of the legs. Anxiety/stress was assessed before and just after the rest or the massage using the State-Trait Anxiety Inventory (STAI-s) and visual analogue scale (VAS). To evaluate oral immune function, salivary chromogranin A (CgA) and secretory immunoglobulin A (sIgA) levels were measured.

RESULTS: In healthy volunteers, rest significantly reduced VAS by 34% and increased sIgA by 61%. In contrast, leg massage significantly reduced both STAI-s and VAS by 24% and 63%, and increased both sIgA and CgA by 104% and 90%, respectively. In cancer patients, leg massage significantly decreased both STAI-s and VAS by 16% and 38%, and increased both salivary CgA and sIgA by 33% and 35%, respectively.

CONCLUSION: Leg massage may promote psychosocial relaxation and reinforce a first-line host defense with an increase in secretion of antimicrobial peptides.

Back massage therapy promotes psychological relaxation and an increase in salivary chromogranin A release.  [LINK]

J Anesth. 2010 Aug 5. [Epub ahead of print]

Noto Y, Kudo M, Hirota K.
Department of Nursing, Hirosaki University Graduate School of Health Sciences, Hirosaki, 036-8563, Japan.

Massage therapy promotes psychosocial relaxation, reduces stress and has been reported to improve the immune function. As such, massage therapy is currently used in palliative care for the relief of anxiety and pain. Although psychosocial status has been evaluated using subjective psychological tests, such as State-Trait Anxiety Inventory (STAI), subjective psychological tests are of limited value if the subjects fail to report reliably. Salivary biomarkers have been recently suggested as useful objective markers for assessing psychosocial status. To determine whether salivary biomarkers are useful objective indices for assessing the effects of back massage on the mental status of 25 young healthy female volunteers, we measured heart rate and salivary biomarkers (alpha-amylase activity, cortisol, and chromogranin A) and assessed the STAI score before and after the back massage. Back massage significantly reduced the heart rate and STAI; however, salivary amylase and cortisol levels did not change. In contrast, the level of salivary chromogranin A significantly increased. We therefore conclude that changes in the salivary biomarkers tested here may not indicate changes in psychological status following massage therapy. However, the increase in chromogranin A release may contribute to the immunologically beneficial effects of massage therapy as chromogranin A has antibacterial and antifungal activity.

A Preliminary Study of the Effects of a Single Session of Swedish Massage on Hypothalamic-Pituitary-Adrenal and Immune Function in Normal Individuals.  [LINK]

J Altern Complement Med. 2010 Sep 1. [Epub ahead of print]

Rapaport MH, Schettler P, Bresee C.
1 Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center , Los Angeles, CA.

Abstract Objectives: Massage therapy is a multi-billion dollar industry in the United States with 8.7% of adults receiving at least one massage within the last year; yet, little is known about the physiologic effects of a single session of massage in healthy individuals. The purpose of this study was to determine effects of a single session of Swedish massage on neuroendocrine and immune function. It was hypothesized that Swedish Massage Therapy would increase oxytocin (OT) levels, which would lead to a decrease in hypothalamic-pituitary-adrenal (HPA) activity and enhanced immune function. Design: The study design was a head-to-head, single-session comparison of Swedish Massage Therapy with a light touch control condition. Serial measurements were performed to determine OT, arginine-vasopressin (AVP), adrenal corticotropin hormone (ACTH), cortisol (CORT), circulating phenotypic lymphocytes markers, and mitogen-stimulated cytokine production. Setting: This research was conducted in an outpatient research unit in an academic medical center. Subjects: Medically and psychiatrically healthy adults, 18-45 years old, participated in this study. Intervention: The intervention tested was 45 minutes of Swedish Massage Therapy versus a light touch control condition, using highly specified and identical protocols. Outcome measures: The standardized mean difference was calculated between Swedish Massage Therapy versus light touch on pre- to postintervention change in levels of OT, AVP, ACTH, CORT, lymphocyte markers, and cytokine levels. Results: Compared to light touch, Swedish Massage Therapy caused a large effect size decrease in AVP, and a small effect size decrease in CORT, but these findings were not mediated by OT. Massage increased the number of circulating lymphocytes, CD 25+ lymphocytes, CD 56+ lymphocytes, CD4 + lymphocytes, and CD8+ lymphocytes (effect sizes from 0.14 to 0.43). Mitogen-stimulated levels of interleukin (IL)-1ss, IL-2, IL-4, IL-5, IL-6, IL-10, IL-13, and IFN-gamma decreased for subjects receiving Swedish Massage Therapy versus light touch (effect sizes from -0.22 to -0.63). Swedish Massage Therapy decreased IL-4, IL-5, IL-10, and IL-13 levels relative to baseline measures. Conclusions: Preliminary data suggest that a single session of Swedish Massage Therapy produces measurable biologic effects. If replicated, these findings may have implications for managing inflammatory and autoimmune conditions.

Effects of the intelligent-turtle massage on the physical symptoms and immune functions in patients with chronic fatigue syndrome.  [LINK]

J Tradit Chin Med. 2009 Mar;29(1):24-8.

Wang JH, Chai TQ, Lin GH, Luo L.
The First Hospital Affiliated to Guangzhou TCM University, Guangzhou 510405, China.

OBJECTIVE: To evaluate the effects of the intelligent-turtle massage on the physical symptoms and immune functions in patients with chronic fatigue syndrome (CFS).

METHODS: 182 cases of CFS were randomly divided into an experimental group of 91 cases treated by the intelligent-turtle massage, and a control group of 91 cases treated with the conventional massage method. After 2 courses of treatment, the therapeutic effects were statistically analyzed with the accumulated score for the improved clinical symptoms; and the changes of IgA, IgM and IgG were compared in 96 cases.

RESULTS: There was a significant difference between the two groups in the accumulated scores for improvement of the symptoms (P<0.05). A remarkable difference was found in the therapeutic effect. And there was a significant difference in the IgA, IgM and IgG levels between the two groups (P<0.05).

CONCLUSION: The intelligent-turtle massage is an effective therapy for relieving the physical symptoms of CFS, and it may show certain effects on the immune functions.

Massage after exercise--responses of immunologic and endocrine markers: a randomized single-blind placebo-controlled study.  [LINK]

J Strength Cond Res. 2009 Mar;23(2):638-44.

Arroyo-Morales M, Olea N, Ruíz C, del Castilo Jde D, Martínez M, Lorenzo C, Díaz-Rodríguez L.
Department of Physical Therapy, University of Granada, High Performance Sports Center at Altitude, Sierra Nevada, Granada, Spain. marroyo@ugr.es

The effectiveness of massage for postexercise recovery remains unclear, despite numerous studies on this issue. The aim of this study was to determine the effect of massage on endocrine and immune functions of healthy active volunteers after intense exercise. After repeated Wingate tests, the effects of whole-body massage and placebo on salivary cortisol, immunoglobulin A (IgA), and total protein levels were compared using a between-group design. Sixty healthy active subjects (23 women, 37 men) underwent 2 exercise protocol sessions at least 2 weeks apart and at the same time of day. The first session familiarized participants with the protocol. In the second session, after a baseline measurement, subjects performed a standardized warm-up followed by three 30-second Wingate tests. After active recovery, subjects were randomly allocated to massage (40-minute myofascial induction) or placebo (40-minute sham electrotherapy) group. Saliva samples were taken before and after the exercise protocols and after recovery. In both groups, the exercise protocol induced a significant increase in cortisol (p < 0.001), decrease in salivary IgA (sIgA) (p < 0.001), and increase in total proteins (p = 0.01) in saliva. Generalized estimating equations showed a significant effect of massage on sIgA rate (p = 0.05), a tendency toward significant effect on salivary total protein levels (p = 0.10), and no effect on salivary flow rate (p = 0.55) or salivary cortisol (p = 0.39). The sIgA secretion rate was higher after the recovery intervention than at baseline among women in the massage group (p = 0.03) but similar to baseline levels among women in the placebo group (p = 0.29). Massage may favor recovery from the transient immunosuppression state induced by exercise in healthy active women, of particular value between high-intensity training sessions or competitions on the same day.

Impact of a massage therapy clinical trial on immune status in young Dominican children infected with HIV-1.  [LINK]

J Altern Complement Med. 2006 Jul-Aug;12(6):511-6.

Shor-Posner G, Hernandez-Reif M, Miguez MJ, Fletcher M, Quintero N, Baez J, Perez-Then E, Soto S, Mendoza R, Castillo R, Zhang G.
Division of Disease Prevention, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA. gshor@med.miami.edu

PURPOSE: The effectiveness of massage therapy on immune parameters was evaluated in young Dominican HIV+ children without current access to antiretroviral therapies.

METHODS: Eligible children, who were followed at the Robert Reid Cabral Hospital (San Domingo, Dominican Republic), were randomized to receive either massage treatment or a control/friendly visit twice weekly for 12 weeks. Blood was drawn at baseline and following the 3-month intervention for determinations of CD4, CD8, and CD56 cell counts and percentage, along with activation markers (CD25 and CD69).

RESULTS: Despite similar immune parameters at baseline in the two groups, significantly more of the control group exhibited a decline in CD4 cell count (>30%, p = 0.03), postintervention. The decrease was particularly evident in older (5-8 years) children in the control arm, who demonstrated a significant reduction in both CD4 and CD8 cell counts compared to massage-treated older children who remained stable or showed immune improvement. Additionally, a significant increase in CD4+CD25+ cells was observed over the 12-week trial in the massage-treated older children (p = 0.04) but not in the control group. In younger massage-treated children, (2-4 years old), a significant increase in natural killer cells was shown.

CONCLUSION: Together these findings support the role for massage therapy in immune preservation in HIV+ children.

Natural killer cells and lymphocytes increase in women with breast cancer following massage therapy.  [LINK]

Int J Neurosci. 2005 Apr;115(4):495-510.

Hernandez-Reif M, Field T, Ironson G, Beutler J, Vera Y, Hurley J, Fletcher MA, Schanberg S, Kuhn C, Fraser M.
Touch Research Institutes, University of Miami School of Medicine, Miami, FL 33101, USA. mhernan4@med.miami.edu

Women diagnosed with breast cancer received massage therapy or practiced progressive muscle relaxation (PMR) for 30-min sessions 3 times a week for 5 weeks or received standard treatment. The massage therapy and relaxation groups reported less depressed mood, anxiety, and pain immediately after their first and last sessions. By the end of the study, however, only the massage therapy group reported being less depressed and less angry and having more vigor. Dopamine levels, Natural Killer cells, and lymphocytes also increased from the first to the last day of the study for the massage therapy group. These findings highlight the benefit of these complementary therapies, most particularly massage therapy, for women with breast cancer.

Cortisol decreases and serotonin and dopamine increase following massage therapy.

Int J Neurosci. 2005 Oct;115(10):1397-413.

Field T, Hernandez-Reif M, Diego M, Schanberg S, Kuhn C.
Touch Research Institutes, University of Miami School of Medicine, Miami, Florida 33101, USA. tfield@med.miami.edu

In this article the positive effects of massage therapy on biochemistry are reviewed including decreased levels of cortisol and increased levels of serotonin and dopamine. The research reviewed includes studies on depression (including sex abuse and eating disorder studies), pain syndrome studies, research on auto-immune conditions (including asthma and chronic fatigue), immune studies (including HIV and breast cancer), and studies on the reduction of stress on the job, the stress of aging, and pregnancy stress. In studies in which cortisol was assayed either in saliva or in urine, significant decreases were noted in cortisol levels (averaging decreases 31%). In studies in which the activating neurotransmitters (serotonin and dopamine) were assayed in urine, an average increase of 28% was noted for serotonin and an average increase of 31% was noted for dopamine. These studies combined suggest the stress-alleviating effects (decreased cortisol) and the activating effects (increased serotonin and dopamine) of massage therapy on a variety of medical conditions and stressful experiences.

Breast cancer patients have improved immune and neuroendocrine functions following massage therapy.

J Psychosom Res. 2004 Jul;57(1):45-52.

Hernandez-Reif M, Ironson G, Field T, Hurley J, Katz G, Diego M, Weiss S, Fletcher MA, Schanberg S, Kuhn C, Burman I.
Touch Research Institutes, University of Miami School of Medicine, 1601 NW 12th Avenue, Room 7037, Miami, FL 33136, USA. mhernan4@med.miami.edu

OBJECTIVES: Women with breast cancer are at risk for elevated depression, anxiety, and decreased natural killer (NK) cell number. Stress has been linked to increased tumor development by decreasing NK cell activity. The objectives of this study included examining massage therapy for women with breast cancer for (1) improving mood and biological measures associated with mood enhancement (serotonin, dopamine), (2) reducing stress and stress hormone levels, and (3) boosting immune measures.

METHODS: Thirty-four women (M age=53) diagnosed with Stage 1 or 2 breast cancer were randomly assigned postsurgery to a massage therapy group (to receive 30-min massages three times per week for 5 weeks) or a control group. The massage consisted of stroking, squeezing, and stretching techniques to the head, arms, legs/feet, and back. On the first and last day of the study, the women were assessed on (1) immediate effects measures of anxiety, depressed mood, and vigor and (2) longer term effects on depression, anxiety and hostility, functioning, body image, and avoidant versus intrusive coping style, in addition to urinary catecholamines (norepinephrine, epinephrine, and dopamine) and serotonin levels. A subset of 27 women (n=15 massage) had blood drawn to assay immune measures.

RESULTS: The immediate massage therapy effects included reduced anxiety, depressed mood, and anger. The longer term massage effects included reduced depression and hostility and increased urinary dopamine, serotonin values, NK cell number, and lymphocytes.

CONCLUSIONS: Women with Stage 1 and 2 breast cancer may benefit from thrice-weekly massage therapy for reducing depressed mood, anxiety, and anger and for enhancing dopamine, serotonin, and NK cell number and lymphocytes

The effects of therapeutic back massage on psychophysiologic variables and immune function in spouses of patients with cancer.

Nurs Res. 2003 Sep-Oct;52(5):318-28.

Goodfellow LM.
Duquesne University School of Nursing, Pittsburgh, Pennsylvania 15282, USA. goodfellow@duq.edu

BACKGROUND: Spouses of patients with cancer are at risk for stress-related disorders and may experience a reduction in immune function. Therapeutic back massage (TBM) has been shown to enhance relaxation and thus, may reduce stress associated with caring for an ill partner.

OBJECTIVES: To determine if TBM's influences on psychosocial, physiologic, and immune function variables in spouses of patients with cancer, and explore the relationships between psychosocial variables and immune function in spouses of patients with cancer.

METHODS: This group experimental design measured the effects of a 20-minute TBM at three time points (preintervention, immediately postintervention, 20 minutes postintervention) on spouses of patients with cancer (N= 42) randomly assigned to either the experimental or control group. The major dependent variables including natural killer cell activity (NKCA), heart rate, systolic and diastolic blood pressure, mood, and perceived stress were measured at the three time points to examine the effects of TBM. Data collected on measures of mood and perceived stress were correlated with NKCA to examine their relationships. Prior to hypotheses testing, data collected on measures of depressive mood, loneliness, marital disruption, and health practices were also correlated with NKCA to ascertain any possible confounding variables.

RESULTS: Two-way repeated measures analysis of variance tests determined the effects of TBM over the two postintervention time points and resulted in significant group x time interactions on mood (F [2, 40]= 14.61, p=.0005) and perceived stress (F [2, 40]= 28.66, p=.001). Significant inverse relationships were found between mood and NKCA (r= -.41, p=.009, N= 42) and perceived stress and NKCA (r= -.37, p=.017, N= 42).

DISCUSSION: Findings suggest that TBM may enhance mood and reduce perceived stress in this population. Insight was gained into the psycho-immunologic relationships studied.

Massage therapy.

Med Clin North Am. 2002 Jan;86(1):163-71.

Field T.
Touch Research Institutes, Department of Pediatrics, University of Miami School of Medicine, Miami, Florida, USA. tfield@med.miami.edu

The author and other investigators have documented improvement in several medical and psychiatric conditions after massage therapy, including growth in preterm infants, depression and addictive problems, pain syndromes, and immune and autoimmune conditions. Although some potential underlying mechanisms have been explored for the massage therapy-improved clinical condition relationship, including decreased stress (and decreased cortisol), improved sleep patterns, and enhanced immune function, further research is needed in this area.

Skin rubdown with a dry towel activates natural killer cells in bedridden old patients.

Med Sci Monit. 2002 Sep;8(9):CR611-5.

Iwama H, Akama Y.
Department of Anaesthesiology, Central Aizu General Hospital, Aizuwakamatsu, Japan. iwama@onchikai.jp

BACKGROUND: Skin rubdown using a dry towel to scrub the whole body is a traditional procedure. Because massage therapy is effective in improving cellular immunity, skin rubdown may also have the similar effects.

MATERIAL/METHODS: Sixteen bedridden old patients, who had suffered a cerebral stroke, were studied. Skin rubdown for about 10 minutes was added for 10 days. Blood was collected at noon on the day before skin rubdown, 5 and 10 days after initiation and 5 days after completion, and the neutrophil count, lymphocyte count, serum gamma-globulin and C-reactive protein (CRP) levels and natural killer cell activity were measured. In 9 of these 16 patients, B, T, CD4 and CD8 lymphocyte counts were additionally measured on the same days.

RESULTS: There were no significant changes in the time course of the lymphocyte count, gamma-globulin or CRP levels. The neutrophil count increased 10 days after initiation of the skin rubdown, and natural killer cell activity increased 5 and 10 days after initiation, and returned to the baseline level 5 days after completion. Although there were no changes in the time course of the B, T, CD4 and CD8 lymphocyte counts, the CD4/CD8 ratio showed an increase 5 days after initiation and completion.

CONCLUSIONS: Skin rubdown activates natural killer cells, which may be attributed to the effect of certain mediators released from the T lymphocytes and/or the stimulated effect on the sympathetic nerves. This technique may be used to reduce a variety of complications caused by the decreased immunity observed in bedridden old patients.

HIV adolescents show improved immune function following massage therapy.

Int J Neurosci. 2001 Jan;106(1-2):35-45.

Diego MA, Field T, Hernandez-Reif M, Shaw K, Friedman L, Ironson G.
Touch Research Institutes, University of Miami School of Medicine, Miami, FL 33101.

HIV+adolescents (M CD4=466 mm3) recruited from a large urban university hospital's outpatient clinic were randomly assigned to receive massage therapy (n=12) or progressive muscle relaxation (n=12) two-times per week for 12 weeks. To assess treatment effects, participants were assessed for depression, anxiety and immune changes before and after treatment the 12 weeks treatment period. Adolescents who received massage therapy versus those who experienced relaxation therapy reported feeling less anxious and they were less depressed, and showed enhanced immune function by the end of the 12 week study. Immune changes included increased Natural Killer cell number (CD56) and CD56+CD3-. In addition, the HIV disease progression markers CD4/CD8 ratio and CD4 number showed an increase for the massage therapy group only.
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