The Skeletal System, Joints, and Massage
In general, massage therapy is not used extensively to correct bony deformities. However, problems related to tendons, bursae, and muscles around joints can be addressed. Also, the psychological benefits of touch should not be forgotten.
When joints are immobilized, the connective tis-sue elements, such as capsules, ligaments, and sur-rounding tendons, tend to loose their elasticity be-cause of the release of water from the ground substance that allows connective tissue fibers to come in closer contact and form abnormal cross-linkages between them. By manipulation of joints (including joint replacements), a massage therapist can facilitate breakage of cross-linkages and increase range of motion. Range of motion can also be im-proved by regular passive and active exercises, use of special techniques to prevent adhesions, and by re-ducing spasm of surrounding muscles. Chiroprac-tors and physiotherapists specialize in the use of techniques that help mobilize joints.
Massage has been shown to be of benefit to those suffering from joint-related disorders such as arthri-tis.1 It reduces stiffness and swelling, increases blood flow, relieves pain and muscle spasm, and mobilizes fibrous tissue.2 By improving muscle action, it in-duces a state of general relaxation. Ice massage or immersion, applied using specific techniques, are es-pecially helpful in pain relief and, thereby, introduc-tion of early mobilization exercises.3 Massage prior to mobilization is also very useful.
Massage has been shown to benefit those with some types of low back pain by decreasing pain and associated depression and anxiety and by increasing range of motion.4-9 However, a 1999 review6 of stud-ies in which massage was used for low back pain con-cluded that there is inadequate evidence; that mas-sage has some potential as a therapy, but more reliable studies are needed. Some studies published after this review have shown improvements in range of motion.7-10
Massage has also been shown to improve the range of motion and performance of university dancers11 and the elderly.12A study of patients with spinal cord injuries13 showed improvement in range of motion and muscle function in these patients.
Massage may lessen the fibrosis that usually devel-ops after injury. Friction massage has been used on muscles, ligaments, tendons, and tendon sheaths for prevention and treatment of scar tissue formation.14Deep transverse friction massage has been found to be particularly beneficial in conditions such as chronic tendinitis and bursitis. This technique breaks down scar tissue, increases extensibility and mobility of the structure, promotes normal orientation of col-lagen fibers, increases blood flow (thereby, speeding healing), reduces stress levels, and allows healing to take place.14 Although friction massage is beneficial to the underlying structures as stated above, it should be avoided if the nutritional status of the skin is com-promised in the area.
Before massaging a client with musculoskeletal disorders, a therapist should obtain a thorough his-tory. Massage is contraindicated locally and generally in many musculoskeletal conditions. Acute arthritis of any type, fractures, dislocation, ruptured liga-ments, recent trauma (e.g., whiplash), severe osteo-porosis, and prolapse of intervertebral disk with nerve dysfunction are just a few of the conditions.