Massage eases pain of knee arthritis
January 07, 2011
A regular massage may do more than just relax your body: It also appears to reduce pain and improve function in people suffering from osteoarthritis of the knee, a new study suggests.
The authors of the study, the first of its kind, are now embarking on larger studies to confirm the findings and see if massage is a viable alternative or adjunct to drugs and other existing treatments.
"This is a very happy outcome, but it's a pilot study in that the duration is short and the population is small," said senior author Dr. David Katz, associate adjunct professor of public health and director of the Prevention Research Center at Yale University School of Medicine. "We think that the primary role for massage therapy will be to reduce dependence on pharmacotherapy, rather than replace it outright, and to delay any functional decline rather than reverse the disease. So, the question then becomes, what is the bang for the buck?"
Katz and his colleagues are now researching the cost of massage, in the hopes of convincing insurance companies that it can take its place as a legitimate therapy for this disease.
Osteoarthritis is caused by a progressive degeneration of bone cartilage and is the most common type of arthritis in the United States. The condition affects some 21 million people and is associated with aging.
Conventional treatments include pain medication, exercise, hot and cold therapy, corticosteroid injections and, possibly, surgery.
The medications used for osteoarthritis, however, are problematic. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, can cause serious gastrointestinal side effects. The cox-2 inhibitors such as Vioxx that were developed to bypass those side effects are now known to cause cardiovascular problems, and some, including Vioxx, have been taken off the market.
"Primarily therapy is NSAIDs, but the target population is the very group that is least tolerant of those drugs," Katz said. "The cox-2s were developed as alternatives to NSAIDs to offer less toxicity, and look at how that turned out. We've kind of left folks high and dry."
While massage has been shown to relieve chronic lower back pain and musculoskeletal disorders, there has been no research on massage to help osteoarthritis sufferers. At least until now.
For this study, appearing in the Dec. 11 issue of the Archives of Internal Medicine, 68 adults with osteoarthritis of the knee were randomly assigned to receive either standard Swedish massage therapy or to a wait-list control group that started massage eight weeks after the first group. All participants were encouraged to continue with their previous treatments and medications.
Individuals in the massage group received a one-hour Swedish massage twice a week for four weeks, then once a week for the following four weeks.
After the first eight weeks, participants receiving massage had improved flexibility and range of motion and reduced pain.
Those in the control group showed no changes in symptoms until they, too, started receiving massage. Then, during weeks nine through 16, they experienced benefits similar to the first group.
Interestingly, the benefits did not go away even when the massages were stopped.
"The very significant therapeutic response over eight weeks of therapy persisted eight weeks later," Katz said. "Two months after the last massage, they were still significantly better than baseline and significantly better than the control group. That exceeded our expectations."
There are two possible explanations for the improvements.
In the immediate time frame, Katz explained, "sensory input [the massage] competes with pain input in the spinal cord, travels faster and blocks pain symptoms."
Massage may also enhance blood flow to the region affected by osteoarthritis. "Since the acute pain of osteoarthritis is related to inflammation, increased perfusion brings an influx of cells to clean out the debris and facilitates, to whatever extent possible, bone and cartilage remodeling," Katz explained.
More studies are needed before doctors, patients and insurance companies can be persuaded to accept this as common practice, he said.
"The end game would be that this would be something people with osteoarthritis would be able to access routinely," Katz said. "We ultimately want to change the standard of practice, but we don't do that with one study."