If you know someone who's getting ready to go into surgery, consider holding off on the get-well-soon balloons, and start looking for a good massage therapist instead. A new study published in the December issue of the American Medical Association's Archives of Surgery found that massage, in conjunction with regular pain medication, significantly improved patient pain and anxiety after major surgery.

The study, which was funded by the Department of Veterans Affairs (VA) and lasted from 2003 to 2005, involved 605 veterans — most of whom were white men with an average age of 64, who had chest or abdominal surgery. All patients received routine postoperative care. Two experimental groups, however, received additional individual attention from a massage therapist: One group got a 20-minute visit, during which the patient and the therapist talked but no massage was given, and another group received a 20-minute back massage for up to five days following their operations. The massage group, the study found, reported markedly less intense and less unpleasant pain and less anxiety than patients who got standard pain medication or individual attention but no massage. Dr. Daniel Hinshaw, a surgeon in the VA Ann Arbor Healthcare System and one of the study's co-authors, says that when asked a day after surgery, some patients reported that massage delivered about as much pain relief as a dose from a morphine drip. Hinshaw suggests that massage functions by creating a competing sensation to block pain or by generating endorphin-like chemicals in the body, which reduce pain and promote a sense of well-being. He also notes the crucial — and often forgotten — role of touch in medicine: Human touch can help alleviate anxiety and ease pain. "Patients crave contact," says Hinshaw. "They want some kind of comforting presence."

The new findings come at the end of an eventful year for massage-therapy research. In March, researchers at the University of California, San Francisco, School of Medicine's Osher Center for Integrative Medicine published a study finding that Swedish massage, shiatsu foot massage, and acupuncture helped reduce pain and depression in postoperative cancer patients. An October 2007 pilot study by the Mayo Clinic showed that massage significantly reduced pain levels in patients recovering from heart surgery, prompting the internationally renowned treatment center to bring a full-time massage therapist onboard. That same month, the American Massage Therapy Association published a survey in which 30% of all respondents who had received a massage in the last five years did so for medical reasons — including pain relief, injury recovery, soreness and control of migraines — compared with 22% who sought relaxation and 13% who were merely indulging themselves. The survey also found that nearly one in five respondents had discussed massage therapy with their doctors, and of those who did, the majority said their doctors had encouraged them try it.

Of course, massage is hardly a breakthrough treatment — it's been used for centuries in traditional healing. The UCLA Center for East-West Medicine, which has incorporated traditional Chinese medicine (TCM) and western medicine since 1993, uses massage for most of its 14,000 or so patients each year, who come for treatment of conditions ranging from post-surgical pain to migraines. Dr. Ka-Kit Hui, the center's founder and director, says massage is safe and effective across the board, reflecting one of the core concepts of TCM: using physical methods to help stimulate the body to correct its own chemical flow. "Muscle spasm is not normal," says Hui, whether it's in a recovering cancer patient or an insomniac. "When you take care of that, other conditions can be helped."

It was, in fact, a moment of medical nostalgia that prompted the pilot study that became the foundation for the VA trial. Recalling his days as a surgical resident in the 1970s, Hinshaw says older nurses would regularly give massages to frail, elderly patients prone to delirium on postoperative drugs. The treatment — standard at the time — helped those patients. "But now most of the nurses who practice it are retired," he says, and, now, medical training adheres more strictly to quantitative means of evaluating patient progress. So, patients' individual concerns and worries are sometimes swept aside in the process, preventing them from receiving proper pain diagnoses, while certain holistic treatments are less likely to be accepted than conventional western practices. "We'd have to stop practicing medicine" if everything doctors did required back-up by evidence from trials, says Hinshaw, "but we have that evidence for massage. We can see a real effect."

Getting the larger health care system to buy into the idea is another matter. Currently some, but not all, U.S. health insurers cover some form of massage therapy. To gain broader, more mainstream acceptance, Hinshaw says, the treatment will have to prove cost-effective as a pain-reliever. But, in most hospitals, where patients are cycled through intensive care units in a "highly choreographed sequence," there's not a lot of time or imagination to squeeze in massage therapy. Further research, perhaps showing that massage can shorten patients' hospital stays or reduce their analgesics use, may prompt hospitals to include massage more routinely in patient care. In the meantime, patients who want the health industry to think outside the box have to say so: If patients demand massage, Hinshaw says, "hospitals will listen."

Massage Today
February, 2004, Vol. 04, Issue 02 http://www.massagetoday.com/archives/2004/02/04.html

Massage Cupping Therapy for Health Care Professionals

By Anita J. Shannon, LMBT

The modern world of healing has embraced another wonderful ancient technique that has powerful results. Massage cupping is a modified version of "cupping therapy," which has been used extensively in Chinese medicine for several thousand years.

By creating suction and negative pressure, massage cupping is used to drain excess fluids and toxins; stimulate the peripheral nervous system; bring blood flow to stagnant muscles and skin; and loosen adhesions, connective tissue and stubborn knots in soft tissue.

How Is Cupping Accomplished?

A cotton ball is clamped in hemostats and soaked with about five to 10 drops of alcohol. The cotton is lit, then inserted into the glass cup to create the vacuum. Move the cup over the area to be treated, remove the cotton ball and invert the cup onto the body. If using a manual vacuum set, place the cup on the body and activate the pump to remove the air.

There are two main cupping techniques: stationary and moving. Stationary cups are placed on the skin and left for a period of five to 15 minutes in one location, or four to six cups may be applied and removed cyclically in a technique called "flash cupping." These are the methods most commonly used in Chinese medicine. Moving (or "massage cupping") is the more commonly used form of cupping among massage therapists and other health care practitioners. Prior to applying the cup, oil is administered to the skin to facilitate smooth movement and palpably discover the areas of tension and congestion. Create the vacuum and place the cup on the affected area, then glide it over the surface. A cup may be "parked" for a short time on stubborn knots or over inflamed joints or tissue. Cupping can be used on the neck, shoulders, back, sacral area, hip, abdomen, thigh, upper arms and calves.

The sensation of cupping is often characterized as deep warmth and tingling, long after the treatment has ended. Cupping is not an irritant to the skin or body. It draws the inflammation out yet does not add to it, and is excellent when used as a contrast therapy with cold compresses or liniments. Massage cupping is often used on the broad areas of the back, which is a wonderful addition to any massage. The treatment is sedating, and people will often descend into a profound state of relaxation. (A deep snore is common!) Larger cups may be used on the back; the strong vacuum will mimic the rolling action of deep tissue massage without the discomfort. The movement may be long and draining, or circular and stimulating, for stubborn knots and areas of rigid tissue.

The skin will redden with strong massage cupping, indicating that circulation has been brought to the surface. Application of liniments, analgesics, plant hydrosols or essential oils immediately following a cupping treatment will aid absorption deep into the tissue. The increased local blood supply will nourish the muscles and skin and allow toxins to be carried away.

Massage cupping is also effective in treating cellulite. A light suction provides drainage, while heavier application can be used to stimulate circulation and loosen adhesions or "dimpling." The thigh and hip region should be treated prior to a wrapping procedure to enhance the absorption of product.

One of the most enjoyable aspects of this technique is the subtle nuance of the movements. Creativity provides a variety of methods, and alteration of pressure and speed produces different sensations. For example, the edge of the cup can be used to "scoop" in a cross-fiber movement, while vigorous circles feel marvelous on the hips, thighs and shoulders. Long strokes down the sides of the spine and along the ribs provide ease to rib cage expansion and breathing.

Stubborn neck tension is soothed using a slow, deep approach with small cups. This is not a technique with limitations - its applications are endless. Clients have often reported that the massage cupping experience stayed with them longer than other treatments and that results are cumulative with consistent sessions. Massage cupping therapy is also easier on the practitioner because it enables the therapist to go deeper without discomfort to the client or themselves.

Massage cupping can be integrated into almost any modality. The equipment is inexpensive (and easily cleaned and stored), practitioners can become proficient quickly with proper training, and it is really fun to do!

Author's note: Photos courtesy of Adam Larson and Davon Embler.

Anita Shannon has been in the beauty and spa industries for over 20 years as a practitioner and national educator. She is registered as a continuing education provider and lives in Asheville, NC.

Self-Care for Heel Spurs and/or Plantar Fasciitis

Post-Op Rx: Get a Massage

Massage Cupping Therapy for Health Care Professionals