Massage and the Cardiovascular System
Massage has a significant effect on the cardiovascular system. Locally, massage produces vasodilatation in the tissue and speeds the removal of toxins that cause aches and pains. The produced vasodilata-tion improves circulation and, thereby, the availability of oxygen and nutrients to the area. This has been shown to enhance recovery after intense exercise or injury. In one study, in contrast to those previously cited, the massage of 10 healthy subjects failed to show any alteration in limb blood flow, indicating a need for additional research.
The increase in superficial blood flow has been ex-plained as a result of direct mechanical stimulation of superficial capillaries and arterioles, release of histamine, and axon reflex—the same physiologic effects of triple response.11 The increased blood flow in deeper tissues, such as muscles, is a result of alternating squeezing and relaxing of muscles caused by strokes such as effleurage and petrissage.8 These centripetal strokes squeeze veins and lymphatic vessels and force blood and lymph toward the heart, decreasing the chance for accumulation of waste and stagnation of blood.7 Other than the strokes, the use of heat before and during massage also produces dilatation of blood vessels as a result of temperature changes.12
It has been shown that blood flow not only in-creases in the local area during massage but also re-flexively in other areas.13 For example, an increased blood flow has been measured in the limb opposite the one being massaged,13 and massage in the neck and shoulder area has changed blood flow in the finger.3
It is interesting to note that, as early as 1945, mas-sage was shown to increase blood flow in the limbs of individuals with flaccid paralysis.14,15 This finding il-lustrates the potential benefit massage may have in improving the healing of ulcers, a common problem in these individuals.
It has been observed that there is a decrease in blood viscosity and a drop in hematocrit during mas-sage as a result of hemodilution.4,15 This may be of benefit to those individuals prone to thrombus forma-tion. Interestingly, a study of surgery patients showed that intermittent compression and massage of the arms reduced the incidence of deep vein thrombosis, possibly by increasing the fibrinolytic activity in blood.4 However, additional research is needed to pro-vide evidence that massage is of benefit.
The blood levels of myoglobin and other muscle enzymes have also been shown to increase after deep massage.16This may confound the results in patients whose blood is being tested for these enzymes for other purposes.
The inhibitory effect of massage on the sympathetic nerves slows the heart rate and force of con-traction and, thereby, the work of the heart.7 This effect, coupled with vasodilation, produces a drop in blood pressure3,17 and can also be of benefit to those diagnosed with hypertension.18 In one study, massage produced a decrease in diastolic blood pressure, anx-iety, and levels of cortisol (a hormone that is in-creased during stress).19 However, more research is needed to document the long-term effects of massage in lowering blood pressure.
All therapists should obtain a thorough history to identify any cardiovascular condition the client may have that requires special precautions or may be con-traindicated. For example, history of hypertension and antihypertensive medication should alert the therapist to possibilities of postural hypotension. History of varicose veins, if severe, has to be associ-ated with possibilities of thrombus, emboli, and ul-cers. In individuals taking anticoagulants, there may be a tendency to bleed and bruise easily.
Other than taking a good history, the therapist must observe the surface of the skin for changes in color or pigmentation. Presence of unusually dilated veins, jaundice, edema, cyanosis, pallor, bruises, and bleeding under the skin are just a few that can give the therapist an indication of cardiovascular system activity. It is vital for the therapist to gather sufficient information about any cardiovascular disease that a client has and plan a strategy for management before treatment sessions.
The therapist should be aware of the signs, symptoms, and complications of common cardiovascular diseases in the elderly. Many elderly individuals may be on drugs to treat or prevent progress of the disease, and the adverse effect of these drugs may have a bearing on therapy.