Submitted Successfully!
To reward your contribution, here is a gift for you: A free trial for our video production service.
Thank you for your contribution! You can also upload a video entry or images related to this topic.
Version Summary Created by Modification Content Size Created at Operation
1
Rosa Cabanas-Valdés
 + 1491 word(s) 1491 2021-04-29 10:11:33 |
2 format correct
Karina Chen
 Meta information modification 1491 2021-04-30 11:34:25 |

Video Upload Options

Do you have a full video?
Send video materials Upload full video

Confirm

Are you sure to Delete?
Yes No
Cite
If you have any further questions, please contact Encyclopedia Editorial Office.
Cabanas-Valdés, R. Massage Therapy for Post-Stroke. Encyclopedia. Available online: https://encyclopedia.pub/entry/9228 (accessed on 18 April 2024).
Cabanas-Valdés R. Massage Therapy for Post-Stroke. Encyclopedia. Available at: https://encyclopedia.pub/entry/9228. Accessed April 18, 2024.
Cabanas-Valdés, Rosa. "Massage Therapy for Post-Stroke" Encyclopedia, https://encyclopedia.pub/entry/9228 (accessed April 18, 2024).
Cabanas-Valdés, R. (2021, April 30). Massage Therapy for Post-Stroke. In Encyclopedia. https://encyclopedia.pub/entry/9228
Cabanas-Valdés, Rosa. "Massage Therapy for Post-Stroke." Encyclopedia. Web. 30 April, 2021.
Massage Therapy for Post-Stroke
Edit
This entry is adapted from the peer-reviewed paper 10.3390/ijerph18094424

Stroke is a leading cause of long-term adult disability. The individuals that have suffered from a stroke present various upper motor neuron syndrome, signs and symptoms, including weakness, spasticity, lack of coordination and agonist antagonist co-contraction, with up to 50% of survivors being chronically disabled. They involve together in impairments and functional problems that can lead to costly complications. Physical therapy may contribute to the improvement of disabilities and quality of life in these individuals.

massage therapy stroke motor function spasticity Tuina soft manipulation

1. Introduction

Manual therapeutic massage is the most applied type of passive physical therapy and it is one of the oldest forms of medicine known to humanity, having been practiced worldwide since ancient times [1]. All massage manipulations introduce mechanical forces into the soft tissues by means of “mechanotransduction” [2]. Massage can increase muscle mass temperature and blood flow, and this might help to increase muscle compliance and minimize muscle stiffness [3]. There are several kinds of therapeutic massage. The most common type of massage in the Western world is Swedish massage. This is one of the common treatments for provide optimal performance among athletes, and is based on the Western concepts of anatomy and physiology [4]. It involves the systematic application of manual pressure and the movement of soft tissue, with rhythmical pressure and stroking to obtain or maintain health [5]. Another type is Chinese massage (Tuina). This involves various strokes, shaking stretching and joint movement along energy channels to balance the body’s energy, as well as physical and emotional system [6]. Indian massage (Dalk) includes the manipulation of body tissues with the hands. In Unani medicine, Dalk is based on the principle of tanqiyah (expulsion) and imāla (diversion) [7]. Finally, Thai massage is a form of deep massage involving brief sustained pressure on the muscles. Pressure point massage along the body’s hypothesized 10 major energy channels or Sen Sib is believed to release blocked energy and to increase awareness and vitality [8].

2.The Effectiveness of Massage Therapy for Improving Sequelae in Post-Stroke Survivors

The main findings of this systematic review and meta-analysis are that therapeutic Chinese massage (Tuina) combined with conventional physiotherapy is an effective method to improve motor function and to reduce spasticity in stroke survivors, especially in subacute stage. The combination of Tuina massage plus acupuncture also improves the symptoms. The results of this review are important, because the therapeutic massage intervention was mostly performed in the subacute stage of the stroke, with positive results in upper/lower limbs motor function. Recovery of upper limbs function remains a major scientific, clinical and patient priority [9].

Surprisingly this review only found one study that used the Swedish massage as an intervention. It was used to decrease anxiety. This was unexpected to us, because Swedish massage is today the most popular and best-known type of massage in the Western world [10]. We expected to find more studies as other authors had used Swedish massage to improve spasticity and motor function in multiple sclerosis [11][12] and cerebral palsy [13][14]. Scientific publications in Europe, America, Africa or Australia were not found, they were only found in Asian countries, and especially in China.

The upper and lower limbs motor function was the outcome most evaluated, followed by spasticity the two outcomes are linked [15]. Motor impairments in stroke survivors can be described by a cycle of overactivity-contracture-overactivity evolving in parallel with the continuum of paresis-disuse-paresis. Both cycles must be disrupted to optimized motor recovery and function [16]. In fact, a more complete restoration of motor function is achieved when spasticity is absent [17]. It is important to reduce spasticity before the patient performs the voluntary movement in order to obtain a movement with some quality since this will influence the neuroplasticity of the individuals and their recovery [18]. According to several authors [15][19][20] the sensory system has an important role in spasticity mitigation and is the most important predictor for severe spasticity.

The mechanism behind elastic modulus changes in spastic muscle in stroke survivors is still under discussion. One possible hypothesis might be related to structural alterations in the muscle after a stroke. Shortened muscle fascicle length in the upper limb [21] and lower limb [22] has been observed. These results suggest that altered muscle morphology of the paretic muscle may contribute to abnormal muscle elastic properties during passive stretching [23].

As a result of damages to the motor cortex and its descending pathways and the subsequent unmasking of inhibition, there is evidence of upregulation of reticulospinal tract projections excitability on the contralesional side in stroke survivors [24]. Reticular nuclei receive sensory input from the periphery and neck proprioceptors. In addition to sensorimotor integration, the reticular formation also seems to play a role in preparation for a voluntary movement [25]. Therapeutic massage increases blood flow and parasympathetic activity, releases relaxation and stress hormones, and inhibits muscle tension, and neuromuscular excitability [26]. It could reduce the hyperexcitability of the reticulospinal tracts. The various types of therapeutic massage modalities could be most useful for the therapist to reduce muscle overactivity to enable other therapeutic interventions.

The results obtained for daily living activities, gait, balance, quality of life and stroke severity were inconclusive. The trend is positive when Tuina is used in addition to the conventional therapy or acupuncture. Regarding pain, our results are consistent with the literature available [27]. There is growing evidence to support the concept of an interactive network between the cutaneous nerves, the neuroendocrine axis and the immune system [28]. Therapeutic massage is reported to have several beneficial effects, including activation of the relaxation and growth response has been suggested to be mediated by oxytocin [29]. Stroke patients suffer from anxiety and massage could be helpful for relaxation to ease the patients’ suffering [30]. The results of this review show positive effects, as it reduced anxiety in stroke survivors. Surprisingly, no study evaluated the range of motion as an important aspect to take into account when reducing spasticity [31].

Functional magnetic resonance imaging data have suggested that moderate pressure massage with movement is represented in several brain regions, including the amygdala, the hypothalamus and the anterior cingulate cortex, which are all areas involved in stress and emotion regulation [32][33]. Findings from the whole-brain meta-analysis of right-hand tactile stimulation highlight the importance of taking bilateral activation into consideration, particularly in the secondary somatosensory cortex [34].

Most of the articles in this systematic review used Tuina massage for improving outcomes. This is one of the four main branches of traditional Chinese medicine. However, although its roots in China are ancient, it is still relatively new in the West [6]. Tuina massage was originated from China over 5000 years ago and is commonly known today as “the grandfather of all therapeutic massage therapies”. It follows the meridian theory and works on the organs, energy channels in muscle groups and points on the body using the same principles as acupuncture, except hands and fingers are used instead of needles [35]. It is combined with anatomical and pathological diagnosis in order to achieve dredging meridian, removes pathogenic factors and has a curative effect of a harmonic balance of Yin-Yang [36]. Tuina can act on the subcutaneous muscular layer; enhance local blood circulation, lymph circulation, tissue metabolism of the skin, can regulate physiological and pathological states, unblock meridians, and harmonize Qi (total life energy). In Chinese medicine, Qi disorder and Yin-Yang imbalance account for balance disturbances following stroke. It corrects an imbalance in the yin and yang and qi (energy) which when translated into Western medical terminology, can also been understood as the “modulation of the imbalance between parasympathetic and sympathetic activity”. Yin-Yang imbalance also contributes to upper and lower limb spasticity following stroke, manifesting as ‘flaccidity of Yang and spasm of Yin’ [37].

Tuina massage encompasses techniques as grasping, pressing, rolling, round rubbing, holding-twisting, rub rolling, pushing, kneading, rotating, shaking, wiping, vibrating, digital striking, knocking, chapping, pressing, acupressure, myofascial release, reflexology, stretching techniques and joint mobilizations applied to specific body points [38]. Tuina is a functional massage and it can input substantial proprioceptive sensory impulses to the central nervous system through muscle, tendon and joint motion [39].

No study reports adverse events, but massage therapies are not totally devoid of risks. The incidence of adverse events is unknown, but is probably low [40]. The massage itself does not increase a person’s risk of stroke, but some precautions need to be taken with certain individuals. If the individual has blood clots, there is a small chance they could be dislodged by massage. Individuals on blood thinner medication bruise more easily, so deep tissue massage should be avoided. Care should be taken around the neck area in the region of the carotid artery, but this should not be an issue with an experienced massage therapist.

Further investigations are required at both the experimental and clinical levels to compare therapeutic Chinese massage (Tuina) versus Swedish massage in stroke survivors. Surprisingly, therapeutic massage is not on the list of recommendations in Western stroke management guides. Rehabilitation therapy based on integrated Chinese and Western medicine could be effective for stroke survivors [41]. Finally, touch a patient has a therapeutic value and it has many benefits [42].

 

References

  1. Pettman, E. A History of Manipulative Therapy. J. Man. Manip. Ther. 2007, 15, 165–174.
  2. Eubanks, J.E.; Chang Chien, G.C.; Atchison, J.W. Manipulation, Mobilization, Massage and Traction in Pain Manage-ment. In Pain; Springer International Publishing: New York, NY, USA, 2019; pp. 1047–1049.
  3. Gasibat, Q.; Suwehli, W. Determining the Benefits of Massage Mechanisms: A Review of Literature. Artic. J. Rehabil. Sci. 2017, 2, 58–67.
  4. Mustafa, K.; Furmanek, M.; Knapik, P.A.; Bacik, B.; Juras, G. The Impact of the Swedish Massage on the Kinesthetic Differentiation in Healthy Individuals. Int. J. Ther. Massage Bodyw. 2015, 8, 2–11.
  5. Barreto, D.M.; Batista, M.V.A. Swedish Massage: A Systematic Review of its Physical and Psychological Benefits. Adv. Mind Body Med. 2017, 31, 16–20.
  6. Pritchard, S. Tui na: A Manual of Chinese Massage Therapy, 2nd ed.; Singing Dragon: London, UK, 2015.
  7. Fazil, M. A Review on Dalk (Massage) with Special Reference to the Prescribed Medications. Trad Integr. Med. Mar. 2017, 2, 39–52.
  8. Buttagat, V.; Eungpinichpong, W.; Chatchawan, U.; Kharmwan, S. The immediate effects of traditional Thai massage on heart rate variability and stress-related parameters in patients with back pain associated with myofascial trigger points. J. Bodyw. Mov. Ther. 2011, 15, 15–23.
  9. Pollock, A.; George, B.S.; Fenton, M.; Firkins, L. Top 10 research priorities relating to life after stroke—Consensus from stroke survivors, caregivers, and health professionals. Int. J. Stroke 2014, 9, 313–320.
  10. Gholami-Motlagh, F.; Jouzi, M.; Soleymani, B. Comparing the effects of two Swedish massage techniques on the vital signs and anxiety of healthy women. Iran. J. Nurs. Midwifery Res. 2016, 21, 402–409.
  11. Backus, D.; Manella, C.; Bender, A.; Sweatman, M. Impact of massage therapy on fatigue, pain, and spasticity in people with multiple sclerosis: A pilot study. Int. J. Ther. Massage Bodywork Res. Educ. Pract. 2016, 9, 4–13.
  12. Negahban, H.; Rezaie, S.; Goharpey, S. Massage therapy and exercise therapy in patients with multiple sclerosis: A randomized controlled pilot study. Clin. Rehabil. 2013, 27, 1126–1136.
  13. Hernandez-Reif, M.; Field, T.; Largie, S.; Diego, M.; Manigat, N.; Seoanes, J.; Bornstein, J. Cerebral palsy symptoms in children decreased following massage therapy. Early Child Dev. Care 2005, 175, 445–456.
  14. Mahmood, Q.; Habibullah, S.; Babur, M.N. Potential effects of traditional massage on spasticity and gross motor function in children with spastic cerebral palsy: A randomized controlled trial. Pak. J. Med Sci. 2019, 35, 1210–1215.
  15. Wissel, J.; Verrier, M.; Simpson, D.M.; Charles, D.; Guinto, P.; Papapetropoulos, S.; Sunnerhagen, K.S. Post-stroke Spasticity: Predictors of Early Development and Considerations for Therapeutic Intervention. PM&R 2014, 7, 60–67.
  16. Gracies, J.-M. Pathophysiology of spastic paresis. I: Paresis and soft tissue changes. Muscle Nerve 2005, 31, 535–551.
  17. Ryu, J.S.; Lee, J.W.; Lee, S.I.; Chun, M.H. Factors Predictive of spasticity and their effects on motor recovery and functional outcomes in stroke patients. Top. Stroke Rehabil. 2010, 17, 380–388.
  18. Li, S. Spasticity, motor recovery, and neural plasticity after stroke. Front. Neurol. 2017, 8, 120.
  19. Urban, P.P.; Wolf, T.; Uebele, M.; Marx, J.J.; Vogt, T.; Stoeter, P.; Bauermann, T.; Weibrich, C.; Vucurevic, G.D.; Schneider, A.; et al. Occurence and clinical predictors of spasticity after ischemic stroke. Stroke 2010, 41, 2016–2020.
  20. Pundik, S.; Falchook, A.D.; McCabe, J.; Litinas, K.; Daly, J.J. Functional brain correlates of upper limb spasticity and its mitigation following rehabilitation in chronic stroke survivors. Stroke Res. Treat. 2014, 2014, 1–8.
  21. Li, L.; Tong, K.Y.; Hu, X. The Effect of poststroke impairments on brachialis muscle architecture as measured by ultrasound. Arch. Phys. Med. Rehabil. 2007, 88, 243–250.
  22. Gao, F.; Grant, T.H.; Roth, E.J.; Zhang, L.-Q. Changes in passive mechanical properties of the gastrocnemius muscle at the muscle fascicle and joint levels in stroke survivors. Arch. Phys. Med. Rehabil. 2009, 90, 819–826.
  23. Leng, Y.; Wang, Z.; Bian, R.; Lo, W.L.A.; Xie, X.; Wang, R.; Huang, D.; Li, L. Alterations of Elastic Property of Spastic Muscle With Its Joint Resistance Evaluated From Shear Wave Elastography and Biomechanical Model. Front. Neurol. 2019, 10, 736.
  24. Li, S.; Chen, Y.-T.; Francisco, G.E.; Zhou, P.; Rymer, W.Z. A unifying pathophysiological account for post-stroke spasticity and disordered motor control. Front. Neurol. 2019, 10, 468.
  25. Baker, S.N. The primate reticulospinal tract, hand function and functional recovery. J. Physiol. 2011, 589, 5603–5612.
  26. Zeng, H.; Butterfield, T.A.; Agarwal, S.; Haq, F.; Best, T.M.; Zhao, Y. An engineering approach for quantitative analysis of the lengthwise strokes in massage therapies. J. Med. Devices Trans. ASME 2008, 2, 041003.
  27. Miake-Lye, I.M.; Mak, S.; Lee, J.; Luger, T.; Taylor, S.L.; Shanman, R.; Beroes-Severin, J.M.; Shekelle, P.G. Massage for pain: An evidence map. J. Altern. Complement. Med. 2019, 25, 475–502.
  28. Mescher, A.L.; Neff, A.W.; King, M.W. Inflammation and immunity in organ regeneration. Dev. Comp. Immunol. 2017, 66, 98–110.
  29. Uvnäs-Moberg, K.; Handlin, L.; Petersson, M. Self-soothing behaviors with particular reference to oxytocin release induced by non-noxious sensory stimulation. Front. Psychol. 2015, 5, 1529.
  30. Alimohammad, H.S.; Ghasemi, Z.; Shahriar, S.S.; Morteza, S.; Arsalan, K. Effect of hand and foot surface stroke massage on anxiety and vital signs in patients with acute coronary syndrome: A randomized clinical trial. Complement. Ther. Clin. Pract. 2018, 31, 126–131.
  31. Biering-Sørensen, F.; Nielsen, J.B.; Klinge, K. Spasticity-assessment: A review. Spinal Cord 2006, 44, 708–722.
  32. Cassileth, B.R.; Vickers, A.J. Massage therapy for symptom control: Outcome study at a major cancer center. J. Pain Symptom Manag. 2004, 28, 244–249.
  33. Lindgren, L.; Westling, G.; Brulin, C.; Lehtipalo, S.; Andersson, M.; Nyberg, L. Pleasant human touch is represented in pregenual anterior cingulate cortex. NeuroImage 2012, 59, 3427–3432.
  34. Lamp, G.; Goodin, P.; Palmer, S.; Low, E.; Barutchu, A.; Carey, L.M. Activation of bilateral secondary somatosensory cortex with right hand touch stimulation: A meta-analysis of functional neuroimaging studies. Front. Neurol. 2019, 9, 1129.
  35. Goats, G.C. Massage—The scientific basis of an ancient art: Part 1. The techniques. Br. J. Sports Med. 1994, 28, 149–152.
  36. Guo, T.; Zhu, B.; Zhang, X.; Xu, N.; Wang, H.; Tai, X. Tuina for children with cerebral palsy. Medicine 2018, 97, e9697.
  37. Zheng, Q.; Tang, B. Differentiation of Yin–Yang and Prescriptions for Some Common Diseases. In Handbook of Traditional Chinese Medicine; World Scientific Publishing Co.: Singapore, 2014; pp. 869–922.
  38. Fang, L.; Fang, M. Research progress on the standardization of Chinese Tuina therapy: A short review. Chin. J. Integr. Med. 2013, 19, 68–72.
  39. Tong, X.; Liu, D.-D.; Wei, Y.; Kou, J.-Y.; Yang, T.-S.; Qiao, L.-D. Effect observation on point-through-point needling combined with tuina for post-stroke shoulder-hand syndrome. J. Acupunct. Tuina Sci. 2012, 10, 104–108.
  40. Ernst, E. The safety of massage therapy. Rheumatology 2003, 42, 1101–1106.
  41. Na, K.; He, J.E.; Hu, L.; Wu, L.; Li, Y.; Zhao, D.Y.; Li, R.Z.; Fan, W.J. Early treatment of acute ischemic stroke by integrated traditional and Western medicine. Int. J. Clin. Exp. Med. 2018, 11, 2901.
  42. Geri, T.; Viceconti, A.; Minacci, M.; Testa, M.; Rossettini, G. Manual therapy: Exploiting the role of human touch. Musculoskelet. Sci. Pract. 2019, 44, 102044.
More
© Text is available under the terms and conditions of the Creative Commons Attribution (CC BY) license; additional terms may apply. By using this site, you agree to the Terms and Conditions and Privacy Policy.
Upload a video for this entry
Information
Subjects: Health Care Sciences & Services
Contributor MDPI registered users' name will be linked to their SciProfiles pages. To register with us, please refer to https://encyclopedia.pub/register :
Rosa Cabanas-Valdés
View Times: 1.7K
Revisions: 2 times (View History)
Update Date: 30 Apr 2021
Table of Contents
    1000/1000
    Hot Most Recent
    Feedback