Deep tissue massage therapies provide health benefits beyond tissue repair, benefitting the whole health

Research into the benefits of deep tissue massage therapy, called Tui Na in Traditional Chinese Medicine, is proving that these therapies can be very beneficial to overall health beyond the obvious benefits of improved healing of deep tissue musculoskeletal pathology. An article in the New York Times on September 20, 2010, reported on a clinical trial by the Cedars-Sinai Medical Center in Los Angeles, California, sponsored by the National Institutes of Health (NIH) (see the article link below), where randomly assigned patients were tested for physiological changes during either light massage or deep tissue therapies. To the surprise of the researchers, the beneficial physiological changes measured in the deep tissue physiotherapy group were dramatic. The researchers noted significant decreases in the circulating cortisol, vasopressin, increased immune response, increases in oxytocin, and decreases in adrenal corticotropin hormone. Similar beneficial effects were noted in studies of the active metabolites measured in saliva samples. These findings imply that myofascial syndromes and deep tissue inflammatory disorders are linked to hormonal homeostasis strongly, as well as healthy immune function, and that this type of deep tissue therapy can significantly reduce physiological stress and improve one's overall health.

To explain these findings, let's look at what they mean to our health. Cortisol, also known as hydrocortisone, is a steroid hormone produced continuously by the adrenal gland, which is part of the kidneys. Cortisol is called the stress hormone because it functions to counter the ill effects of acute physiological stress in the body, not because it reduces nervous tension or emotional stress. Cortisol is continuously released in a feedback system that responds to a variety of factors related to physiological stress, including decreased blood sugars (hypoglycemia), excess immune, or inflammatory responses, blood loss, fever or tissue burns, and hormonal changes associated with emotional alarm. Cortisol is not only a hormone that reacts to sudden changes in physiological stress, but also to chronic physiological stress. Cortisol is continuously excreted in a tightly contolled manner that has a diurnal pattern, or changes according to the cycle of wake and sleep. Chronic cortisol excesses and deficiencies are seen within this diurnal pattern when a number of chronic physiological stressors are present. It has been demonstrated that abnormal cortisol levels occur with thyroid disorder, anxiety and depressive disorders, insulin disorder, gastric hypofunction, electrolyte imbalances, chronic inflammatory syndromes and diseases, sleep disorders, and even with chronic use of some medications, such as oral contraceptives. Because cortisol is diurnally fluctuating normally, the question is not always of a simple excess or deficiency, but rather of inappropriate cortisol levels within the diurnal phasing. For instance, adrenal insufficiency may result in a sluggish cortisol response, leaving the patient with excess cortisol at night and deficient cortisol during the day. This results in insomnia and non-restful sleep, as well as daytime sluggishness and poor tissue repair. When we look at the subject of cortisol, we must look at how to normalize the cortisol homeostasis.

Patients with excess stimulation of cortisol may develop a variety of chronic health problems. Deep tissue therapies were shown to reduce the triggers for this chronic cortisol excess release, and thus the body needed less cortisol, as measured in the study. The deep tissue physiotherapy thus targeted the cause of the problem, not the effect. Now, synthetic corticosteroids are also widely prescribed today, as well, and in fact, can be purchased in many drugstore medications without prescription. These synthetic cortisols are called cortisone, which is closely related to corticosterone, a steroid hormone very similar to cortisol, but that has limited effects, and is mainly important as an intermediate in the transformation of pregnenelone to aldosterone, which regulates blood pressure and mineral, or electrolyte, excretion in the kidneys. Synthetic corticosteroid, or cortisone, is very similar to cortisol and is used to suppress immune responses, reduce acute inflammation and pain, mediate allergic reactions, and control asthma. Cortisone has been shown to have an effect on adrenal cortisol, and potentially has a variety of side-effects, especially with chronic use, such as high blood sugars, insulin resistance, diabetes, osteoporosis, anxiety, depression, gastritis, colitis, high blood pressure, erectile dysfunction, hypothyroidism, retinopathy, menstrual cessation, and other health problems. Many of these side effects may be attributed to the effects of synthetic cortisones on the adrenal production of cortisol. Healthy cortisol responses in the body would protect the patient from many of these health problems. Deep tissue physiotherapy has been shown to benefit the cortisol homeostasis and reduce the need for excess cortisol response.

Vasopressin, or antidiuretic hormone (ADH), is a peptide hormone that regulates blood pressure and plays a key role in homeostasis, contributing to the regulation of levels of water, glucose and salt in the blood circulation. Vasopressin is released by the hypothalamus and pituitary complex. Abnormal levels of vasopressin may create excess water retention or dehydration of tissues and cells. Vasopressin has also been shown to have a variety of neurological effects, influencing relationship bonding and feelings of reward. Decreasing excess vasopressin may help lower the blood pressure and normalize homeostasis. Oxytocin is another hormone of the brain, only oxytocin acts primarily as a neurotransmitter. It was origninally found to be associated with female reproduction, labor, and breastfeeding, but research in the last few decades has revealed an extensive role in the body. Oxytocin has been shown to significantly influence orgasm, pair bonding, anxiety, maternal behaviors, and social recognition, influencing many of our daily social interactions, both in males and females. Sufficient oxytocin has been shown to evoke feelings of calmness, contentment and security. Deep tissue physiotherapy has been shown to increase oxytocin. Oxytocin action in the brain is mediated by G-protein coupled receptors that require sufficient magnesium and cholesterol. This is one reason why many patients find that they feel better, and function better, when they take magnesium supplement. Inhibition of cholesterol production may also have a negative effect on oxytocin action. Stimulating proper levels of oxytocin may not only result in better homeostasis and emotional well being, but may help with fertility and conception as well. Synthetic oxytocin is used to induce labor in the hospital, and deep tissue physiotherapy may help reduce the need for a high dosage of this drug when proceeding to labor.

Immune responses were found to be significantly aided by deep tissue physiotherapy as well. The patients in the clinical trial were found to have higher levels of circulating lymphocytes (CD25+, CD4, CD56+, and CD8), and decreased levels of cytokines (IL-1beta, IL-2, IL-4, IL-5, IL-6, IL-10, IL-13, and IFNgamma) that are associated with many chronic inflammatory and autoimmune diseases, as well as neurodegenerative disease. The deep tissue physiotherapies were found to decrease the key pathogenic cytokines to baseline levels, thus exerting a normalizing, or modulating effect. The lead author of this study, Dr. Mark Rapaport, chairman of the department of psychiatry and behavioral neurosciences at Cedars-Sinai, which is associated with the David Geffen School of Medicine at the University of California, Los Angeles (UCLA), stated that he was a skeptic, and very impressed by these findings.

While numerous studies in the past 20 years have shown that the massage, or physiotherapy, utilized in Traditional Chinese Medicine, is proven to be beneficial for soft tissue healing and pain relief, applying randomized and placebo-controlled trials to actual physiotherapy is, of course, difficult in design. Like acupuncture, designing a placebo and blinding the patient and therapist to the real and sham technique is impossible. For this reason, medical journals in the United States, dominated by the pharmaceutical industry, for which placebos and blinding the patient and administrator to which is real and which is a sham pill, is not a problem, continue to state that physiotherapy is not proven to be beneficial by these standards. Of course, with this criteria, surgery in not proven to be effective either. We do know, though, that physiotherapies, as well as surgery, can be effective, if performed properly. These studies in recent years take a more realistic look at scientific validation of physiotherapy, and we see that TCM physicians were correct in their observation that deep tissue therapies, such as Tui Na and Shiatsu, provide benefits even beyond the local improvement in soft tissue healing.

When these deep tissue therapies are combined with acupuncture, other physiotherapies of Traditional Chinese Medicine, topical herbal medicines, and herbal and nutrient medicines taken internally, the overall benefits to one's whole health are considerable. In a complete practice, the TCM physician is also able to instruct the patient in self-administered therapeutic routines and correct postural mechanics and habits. We see that our immune, neurological and hormonal health is highly variable and affected daily by healthy routines and therapies. Adopting TCM therapeutics into your life does much to insure that you will lead a healthy, productive and happy life, and prevent many common diseases.

A high incidence of vertebral fractures in the aging population and the need for mobilization of the spine and surrounding soft tissues

Tui na, or soft tissue mobilization, encompasses a wide array of physiotherapy techniques in Traditional Chinese Medicine. Mobilization of the spine and surrounding soft tissue is central to the practice of Tui na, and modern studies of the incidence of vertebral fractures in the aging population show how important this therapy is. A large study of the incidence of vertebral fracture, which often goes undiagnosed, but produces back pain, was conducted in Europe in 2002, and published in the Journal of Bone Mineral Research (Apr 17(4);716-724). Over 14,000 men and women were recruited in 29 European centers and their spines were analyzed with X-ray. The incidence of vertebral fracture in women was almost twice that of men, with almost 11 women per 1000 experiencing vertebral fractures each year. An article in the June 18, 2011 New York Times Science section, stated that by age 80, 2 of every 5 women have had one or more vertebral fractures. Multiple vertebral fractures were found in 20 to 30% of these cases studied. In most cases of vertebral fracture, the pain is either minimal or attributed to a muscle spasm. Most of these cases go undiagosed, and even when seen on X-ray studies, most of these vertebral fractures are ignored by the physician and patient.

While osteoporosis and osteopenia present increased risk of vertebral fractures, immobility of the spine, chronic inflammation, poor circulation to the bone, calcified ligaments and joint capsules, and loss of vertebral disc height all play an important role in the incidence of vertebral fracture. When there is poor spinal mobility, there is inhibition of circulation and poor bone maintenance. With calcified soft tissues and chronically contracted muscles, aging bones may face acute stress more easily, and a simple movement or fall may result in excess force applied to the bone. While active excercise and postural correction is important, passive mobilization of the spine and surrounding soft tissue, and myofascial release, is very important to maintaining a healthy spine that can react with sufficient movement to avoid a fracture. Soft tissue and spinal mobilization gently breaks up inflammatory adhesions, improves circulation, and stimulates improved cell growth. Osteopenia and osteoporosis itself is largely due to the poor turnover of cartilage and the vertebral plates adjacent to the discs. Hardening of these tissues prevents circulation and bone remodeling, a constant process in the body. Weight bearing exercise is often insufficient to restore vertebral endplate circulation, especially if the spine is not mobile. Passive mobilization by a professional, performed lying down, allows the tissues to be mobilized that weight bearing exercise prevents.

Of course, the high incidence of vertebral fractures in aging postmenopausal women reflect the high incidence of hormonal deficiency and imbalance in this population. These hormonal challenges inhibit normal bone maintenance as well as soft tissue repair and maintenance. Deep tissue massage, such as Tui na, not only helps to mobilize the spine and surrounding soft tissues to keep them healthy, but also acts to improve the hormonal balance to aid tissue repair and maintenance. The Licensed Acupuncturist is able to provide Tui na, instruction in postural mechanics and targeted stretch and exercise, acupuncture, and herbal and nutrient medicines in the therapeutic procotol. All of these protocols are important and act synergistically to help the body maintain soft tissue and bone health to avoid vertebral fractures with aging. Herbal and nutrient medicines can help with hormonal balance and bone density, correcting or preventing osteoporosis and osteopenia. Periodic supplementation with bone strengthening supplements, such as strontium, will also help to prevent vertebral fractures. This complete package of care provides assurance that you are doing all that you can to avoid this painful aspect of aging.

Information Resources

The New York Times reported in September of 2010 on an NIH sponsored clinical trial of physiological effects of deep tissue massage therapy, commonly called Tui Na in Traditional Chinese Medicine: The above mentioned clinical trial of deep tissue massage therapy was reported in the Journal of Alternative and Complementary Medicine on September 1, 2010: Clinical trials and studies with randomly assigned patients in recent years have also proven that acupressure, or Tui Na / Shiatsu, is more effective in relieving low back pain than standard physical therapy, as reported in articles in the British Medical Journal: Studies of the physiological benefits of deep tissue myofascial techniques at the University of Granada in Spain, showed that a significant modulation of anxiety, heart rate and systolic blood pressure was observed following treatment:


Massage Therapy

Massage therapy has a long history in cultures around the world. Today, people use many different types of massage therapy for a variety of health-related purposes.  People use massage for a variety of health-related purposes, including to relieve pain, rehabilitate sports injuries, reduce stress, increase relaxation, address anxiety and depression, and aid general wellness. 

Typically, the patient lies on a table, either in loose-fitting clothing or undressed (covered with a sheet, except for the area being massaged). The therapist may use oil or lotion to reduce friction on the skin. Sometimes, people receive massage therapy while sitting in a chair. A massage session may be fairly brief, but may also last an hour or even longer.  In Swedish massage, the therapist uses long strokes, kneading, deep circular movements, vibration, and tapping. Sports massage is similar to Swedish massage, adapted specifically to the needs of athletes. Among the many other examples are deep tissue massage and trigger point massage, which focuses on myofascial trigger points—muscle “knots” that are painful when pressed and can cause symptoms elsewhere in the body.

Although scientific research on massage therapy—whether it works and, if so, how—is limited, there is evidence that massage may benefit some patients.  A 2008 review of 13 clinical trials found evidence that massage might be useful for chronic low-back pain.  According to one analysis, research supports the general conclusion that massage therapy is effective and can reduce “state anxiety” (a reaction to a particular situation), blood pressure, and heart rate, and multiple sessions can reduce “trait anxiety” (general anxiety-proneness), depression, and pain.


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