Effects of Massage on the HPA axis and Immune Function
Soft tissue therapy can be an important modality for enhancing stress resistance when used appropriately within the training program. Rapaport and colleagues have now published two papers looking at the effect general Swedish massage can have on the hypothalamic-pituitary-adrenal axis and immune function.
A Single Massage Session
Their first paper (2010) looked at the effects of a single Swedish massage session compared to a session of light touch therapy – both treatments lasting 45min in duration. Fifty-three healthy subjects, aged 18-45, participated in the study and were randomly assigned to either a Swedish massage group or a light touch therapy group (control group). In both cases the subjects started the session prone and finished in supine lying. The Swedish massage session consisted of effleurage, petrissage, kneading, tapotement, and thumb friction while the light touch session consisted of the therapist lightly stroking the skin with the back of their hand. Blood samples were collected at 5 and 1 minute prior to treatment and then 1, 5, 10, 15, 30, and 60min post treatment. Salivary cortisol was collected immediately before and 20min after the massage treatment and a psychological self assessment questionnaire was taken 15min before and 15min after the treatment session.
The results of the study showed a large decrease in arginine-vasopressin for the Swedish massage group compared to the light touch group and a small decrease in cortisol. Arginine-vasopressin (aka vasopressin or anti-diuretic hormone) is a hormone released from the posterior pituitary gland which is active during the stress response to inform the kidneys to reabsorb water into the blood stream. Thus a shift in arginine-vasopressin may indicate a positive shift away from a sympathetic state and more towards a relaxed or parasympathetic state. Additionally, massage was shown to increase the number of circulating lymphocytes, indicating a potential boost in immune system function. Both massage and light touch showed small decreases in cortisol and only light touch showed a decrease in corticotropin (ACTH), a hormone released from the pituitary which signals the adrenal cortex to release glucocorticoids.
These results were interesting and show that there may be potential biological effects with Swedish massage. Of course more research needs to be conducted to determine the best application of massage and how these sort of changes are brought about in the body during a massage treatment.
The next immediate question is, “What happens when we do more frequent massage sessions?”, which is what Rapaport and colleagues set out to do with their most recent study.
Repeated Massage Sessions
In their second paper (2012) Rapaport again investigated Swedish massage therapy versus light touch therapy (using the same 45min protocol above) in 45 subjects who were assigned to either a Swedish massage or light touch therapy session performed either once or twice a week for a 5-week treatment period. The same neuroendocrine, immune, and salivary cortisol samples were collected as in the first study in the same time frequencies as well.
The results of the study indicated that weekly Swedish massage for 5-weeks was effective at increasing circulating lymphoctes and decreasing cytokine production – similar to those results seen in single massage treatment study above. Additionally, the once a week Swedish massage produced a decrease in ACTH, arginine-vasopressin, and cortisol. The result of a twice-weekly massage for 5-weekas showed a different response by increasing oxytocin levels – a hormone that may potentially explain the interpersonal relationship that forms between therapist and client – and larger decreases in salivary cortisol. Interestingly there was only a small change change seen in oxytocin levels with the once a week treatment protocol and no change in oxytocin seen in the single session of Swedish massage performed in the prior study.
Perhaps, when the athlete is asked, “Why do you get a massage every week?”, and they reply,”Because it feels good!”,there is much more going on internally than just the psychological perception of relaxation and comfort.
Hopefully more research will continue down the road of looking at the biological outcomes of massage therapy as I believe there is a lot to be understood in this field.
What these two studies do show us is that the frequency of massage matters if we are looking to influence the athlete’s physiological system and enhance stress resistance. Additionally, the duration of the massage is important as it takes time to get the athlete relaxed, wind them down, and create physiological changes. The “10min flush” is probably not going to get the job done and longer durations of massage may be needed (>/= 45min). Finally, these papers show the importance of massage therapists in the sports training environment understanding how to perform Basic Massage Therapy and general massage approaches to facilitate a specific response from the body. Instead of thinking about using soft tissue therapy only for injured athletes or when someone is complaining about something, a more proactive approach should be taken to use these modalities at the correct time in the training and competitive environment to ensure the desired result.
Rapaport MH, et al. A preliminary study of the effects of a single session of swedish massage on hypothalamic-pituitary-adrenal and immune function in normal individuals. J Alter Comple Med 2010; 16(10): 1-10.
Rapaport MH, et al. A preliminary study of the effects of repeated massage on hypoathlamic-pituitary-adrenal and immune function in healthy individuals: A study mechanisms of action and dosage. Journal of Alternative and Complementary Medicine 2012; 18(8): 1-9.