Abstract
This article examines the positive effects that
massage therapy has on individuals
suffering from a single chronic illness and suggests
that massage therapy would have
beneficial effects on individuals suffering from
multiple chronic illnesses. Specifically, protocols
were developed to address the lack of a therapeutic
framework for individuals dealing with multiple
chronic illnesses. Eighteen studies that met the
following three criteria were selected: First, they
dealt with massage therapy being
applied to individuals suffering from chronic
illnesses; second, they were published in
peer-reviewed nursing, allied health, and alternative
health journals; and third, they were quantitative in
scope. While a framework for the administration of
massage therapy for chronic illnesses
has been proposed, the benefits still need to be
empirically examined for individuals dealing with
multiple chronic conditions.
Key Words: massage,
massage therapy, therapeutic touch,
chronic illness
Introduction
In the late 1990s, the authors of this article, who
were specializing in the fields of psychotherapy and
traditional and alternative medicine, developed an
integrated health program and commenced an interactive
journey to develop a more effective and aggressive
intervention aiding individuals dealing with multiple
chronic illnesses. Chronic illness has been described
as "long term or permanent and interferes with the
person's ordinary physical, psychological, or social
functioning" (Hymovich & Hagopian, 1992). We have
found that chronic illnesses affect numerous areas in
an individual's life, including the physical,
psychological, spiritual, financial, and social
functioning of the individual.
Our purpose in creating the Integrated Health
Advocacy Program was to treat more than the physical
needs of these individuals; we sought to deal with
their unique and numerous needs. Appropriate goals
were established for each participant through a
program of education, training, decision, and support
received from a multidisciplinary team of health
advocates (comprised of a physician, case manager,
nurse, and clinical counselor). Furthermore, our
multidisciplinary team assisted participants in
gradually assuming control and responsibility for
their own health care, resulting in the desired goals
being met. This approach has been described in our
clinical intervention as a "whole person" approach
(Joyce, Kuhn, Curtin, & Murphy, 1999). Toward the goal
of improving the overall health of these individuals,
we wanted to include treatment modalities that address
the various mind and body issues that contribute to
illnesses. Specifically, a massage
component was integrated into the participants' care
plans to improve their physical, psychological, and
social functioning. Our multidisciplinary team was
interested in utilizing massage
therapy because of its value in facilitating healing
powers within the body.
The purpose of this article is two-fold. The
primary goal is to promote the utilization of
therapeutic massage in treating
various medical and psychological illnesses. In
accordance with this first objective, we will present
the insights that can be taken from recent research
studies that incorporate the appropriate research
techniques. The secondary goal of this article is to
suggest methods for incorporating the use of
massage therapy into a variety of
health-related settings as a treatment for specific
health concerns. In accordance with the second
objective, we will explore the benefits of
massage therapy and the types of
massage appropriate for various functional
issues. Furthermore, we will address the issue of the
appropriate frequency and duration of treatment.
Brief Historical Perspective of Massage
Therapy
References to massage are found in
"the Vedas of India and Chinese medical texts dated
more than 4,000 years old" (Greene, 2000).
Massage has been recognized in the Western
world as a therapeutic modality since 400 B.C., and in
the 19th century American physicians were using
massage as a therapeutic treatment in
their medical practices (Greene, 2000). This
time-intensive practice of massage
was delegated to nurses and assistants, and by the
1940s massage therapy disappeared
with the pharmaceutical revolution (Field, 1998;
National Institute of Health, 1994). Recently,
massage therapy has experienced a rebirth as
a health treatment modality in the complementary
health care community. Additionally, with the
publication of the National Institute of Health's
(1994) review of alternative medical systems and
practices, massage was generally
acknowledged as an important and beneficial
therapeutic modality. The re-emergence and recognition
of the value of massage by the
National Institute of Health (NIH) was the impetus in
planning the objectives of this article.
Criteria for Review
The National Institute of Health (NIH) and the
National Institute of Mental Health (NIMH) consider
Dr. Tiffany Field to be an expert in research and
critical analysis pertaining to massage
therapy. Field (1998) concluded that past studies
examining the effects of massage
contained serious methodological issues. For example,
the literature on this topic focused on clinical
maladies, and few studies were based on clinical
application. in addition, Field previously recognized
that typical sampling problems consisted of a failure
to include control groups and a lack of random
assignment of subjects to treatment conditions.
Furthermore, sample sizes were small in most studies,
and treatment groups often received more than one type
of massage therapy. Another issue is
the lack of the use of statistical analyses to examine
the effects of massage. However,
researchers have recently examined the effects of
massage using control groups, random
assignment of subjects, appropriate sample sizes, the
use of a single type of treatment in the experimental
group, and an examination of the data using
statistical analyses (Field, 1998). Additionally, a
wide variety of populations have been examined, from
individuals diagnosed with multiple sclerosis, to
those dealing with diabetes, to individuals dealing
with chronic pain (Lundberg, 1984; Yates, 1990; Field
et al., 1997a). However, it is important to note that
the effects of therapeutic massage on
the population of individuals dealing with multiple
chronic illnesses have not been examined; this is a
population that has become more pervasive and could
greatly benefit from such treatment.
Physical and psychological problems are just a few
of the issues that people suffering from chronic
illnesses must combat. Hernandez-Reif, Field,
Krasnegor, and Theakston (2001) confirmed that
massage therapy has a positive effect on the
physical discomfort experienced by people suffering
from chronic lower back pain. Participants in the
massage therapy group, as compared to
the relaxation group (control group), indicated that
they experienced less pain and an improvement in sleep
quality and quantity following treatment. They
demonstrated improved trunk and pain flexion
performance, as well as increased serotonin and
dopamine levels. In another study, children suffering
from rheumatoid arthritis reported a decrease in pain
(both the incidence and severity) and fewer of their
activities were limited by pain (Field et al., 1997b).
Associated with these findings is a study
investigating the effects of massage
on individuals afflicted with chronic musculoskeletal
pain. Participants in this study reported pain relief
(a 50% reduction), resulting in a decrease of their
consumption of analgesic drugs (Lundberg, 1984).
Building on these findings, Ironson et al. (1996)
found that massage therapy enhanced
the production of the immune system's cytotoxic cells
(e.g., natural killer cells) for men with HIV. These
men also reported a significant decrease in anxiety
and an increase in self-reported relaxation.
Collectively these and other studies (e.g., Farr,
Nottle, Nosaka, & Sacco, 2002; Hilbert, Sforzo, &
Swenson, 2003) indicate that massage
therapy is a viable and effective treatment for
chronic pain, which enables the individual to decrease
the use of pain medication while strengthening the
immune system.
In addition to the physical consequences of chronic
illnesses, there are psychological consequences that
often develop. One of the serious effects of dealing
with chronic illnesses is depression. Field et al.
(1992) found evidence that massage
therapy is effective in lessening symptoms of
depression when they examined the benefits of
massage therapy using 52 hospitalized
children and adolescents who were depressed and/or
dealing with an adjustment disorder. The subjects were
either randomly assigned to a massage
therapy group (experimental condition) or spent the
same amount of time watching a relaxing videotape
(control condition). Participants who received
massage treatment were less depressed and
reported lower levels of stress (as compared to before
the treatment, and as compared to the control group).
In another study, children suffering from diabetes who
received massage therapy over a
course of 30 consecutive days reported a decrease in
stress and anxiety. In addition, their compliance to
taking their prescribed insulin and to eating
regularly improved (Field et al., 1997a). Similarly,
in a study involving adults suffering from multiple
sclerosis, individuals in the massage
group, in comparison to the control group
(medical-care-only group), reported less anxiety and
less depressed mood immediately following the
massage sessions. At the conclusion of the
study, the massage group had improved
their self-esteem, indicated a better body image, and
reported a healthier image of their disease
progression. In addition, the massage
group, as compared to the controls, was functioning at
a higher social level (Hernandez-Reif, Field, Field, &
Theakston, 1998). In tandem with the above studies,
other researchers (Field et al., 1996; Ironson et al.,
1996) demonstrated that massage
therapy can be beneficial in alleviating the
psychological difficulties that people diagnosed with
chronic illnesses are at risk to develop.
However, questions remain in regard to the
application of massage therapy,
specifically regarding the appropriate time per
session, the frequency of sessions, and the duration
of treatment that is most effective to achieve
positive health-related outcomes. Researchers have
found sustained physical and psychological changes
when using biweekly 30-minute massages
for a period of 4 to 5 weeks, as compared to
individuals who did not receive massage
therapy (e.g., Field et al., 1999; Ironson et al.,
1996; Field et al., 1997a; Hernandez-Reif, Field,
Field, & Theakston, 1998). Some of these researchers
studied acute health issues, implying a single
condition, such as pregnancy (Field et al., 1999) or
muscular soreness (Farr, Nottle, Nosaka, & Sacco,
2002; Hilbert, Storzo, & Swensen, 2003), while other
researchers examined the effects of massage
therapy on chronic health issues, implying an ongoing,
reoccurring condition such as depression (Field et
al., 1992), multiple sclerosis (Hernandez-Reif, Field,
Field, & Theakston, 1998), and autism (Field et al.,
1997c). The focus of the aforementioned studies was to
examine the effects on individuals with a single
health issue, as opposed to chronic, multiple
illnesses. Furthermore, the results indicate that the
amount of time and the duration of treatment are
powerful predictors of successful rehabilitation.
However, researchers have not specifically tested the
effects of varying times, frequencies, or durations of
massage therapy; testing these
factors, either independently or interactively, impact
the therapeutic outcomes of massage
therapy. To summarize, the research shows that
massage therapy is a practical alternative
treatment for people suffering from a single chronic
illness. Specifically, it has been demonstrated that
individuals who receive massage
therapy report lower levels of pain, depression, and
anxiety. Moreover, massage therapy
positively impacts their self-perceptions and social
functioning.
Extrapolating from these research findings, it
would be reasonable to hypothesize that
massage therapy would result in similar
benefits for individuals suffering from multiple
chronic illnesses. In accordance with experiencing an
increase in physical and psychological wellness, there
should be a decrease in their use of pharmaceuticals
(e.g., less pain and anxiety medications).
Massage Therapy Training
It is estimated that 20 million Americans have
received massage therapy. Currently,
there are approximately 50,000 qualified
massage therapists who provide 45-million
one-hour massages per year. It is
apparent that massage therapy is a
technique that is becoming more commonly utilized in
the United States for both medical and psychological
reasons. This type of treatment has provoked important
licensing issues, especially when massage
is utilized in a medical setting. Most states require
that massage therapists complete 500
or more hours of education from a recognized school.
Therapists must also pass a state and a national
certification exam that is accredited by the National
Commission of Certifying Agencies. This agency began
its certification program in 1993, and currently the
Psychological Corporation administers the program. The
Commission on Massage Training (a
national accreditation agency) presently recognizes 60
massage therapy programs. These
programs must include training in anatomy, physiology,
massage theory, practice, and ethical
standards regarding licensure and certification
(National Institute of Health, 1994).
Massage Therapy Modalities
There are approximately 80 methods that are
currently classified as massage
therapy, and approximately 60 of these methods have
been in existence for less than 20 years. Researchers
believe that various types of massage
therapy will eventually be reduced to approximately 5
to 10 techniques (National Institute of Health, 1994).
There are five basic types of massage
modalities that are consistently part of certification
and training programs for massage
therapists in the Western medical community. These
therapies have been utilized for more than two
decades. The majority of professionals who have been
trained and certified by regional or state boards
employ these five types of massage
techniques:
Swedish Massage: This system
consists of long gliding strokes, kneading, and
friction techniques on superficial layers of the
muscles. Generally, the strokes are made in the
direction of blood flow toward the heart, sometimes
combined with active and passive movements of the
joints. Generally, this system is used to promote
relaxation, improve circulation, increase range of
motion, and relieve muscle tension.
Deep Tissue Massage: This type of
massage is used to release chronic
patterns of muscular tension using slow strokes,
direct pressure, and friction directed across the
grain of the muscles with fingers, thumbs, and elbows.
The movements are applied with greater pressure and to
deeper layers of muscle.
Manual Lymphatic Drainage Massage:
This type of massage is utilized to
improve the flow within the lymphatic system using
light and rhythmic strokes. This process is used for
conditions related to poor lymph flow, such as edema,
inflammation, and neuropathy.
Neuromuscular: This method uses light rocking,
rhythmatic rocking, and shaking movements to loosen
joints, ease movement, and release chronic patterns of
tension. Compressions, elongations, and light
bouncing, as well as rocking motions distinguish this
method of movement redirection. The goal is to work on
general functional movement, partially by creating a
feeling of pleasure in being able to move body parts
more freely.
Deep Connective Tissue Massage:
This technique consists of applying strokes that
produce a tangential pull on the skin to the series of
reflex zones, or connective tissue zones, distributed
over the body surface. This technique is considered to
be especially use fill for loosening and relaxing
tissues as preparatory to therapeutic exercises
following surgery or trauma. This type of
massage is claimed to have profound effects
on the functioning of the autonomic nervous system.
Existing research has not considered which
technique is the most effective in treatment for
illnesses, and more precisely, which technique works
best with a specific illness. Questions remain when
applying these findings to help people suffering from
multiple chronic illnesses: What kind of
massage therapy is suitable for which
illness? What would be the specific goals of
treatment? These questions require a diagnostic
process to determine which type of massage
therapy is optimal for a person with a specific
illness and what treatment goals should be initiated.
Charts were constructed to address the above
questions. Systems and conditions that could benefit
from massage therapy have been
recognized (Yates, 1990), but information has not been
placed into an applicable format.
Goals, rationales, and objectives are the
measurable techniques used in our current managed-care
environment. Table 1, Functional Systems, Conditions,
and Treatment Goals, was developed to enable the
health care professional to identify the functional
system impacted and to provide suggestions or
direction regarding the appropriate goals for a health
condition. Table 2, Functional Systems and
Massage Techniques, is designed to give the
health care professional further suggestions or
direction in recommending a specific type of
massage based on the system that is impacted
in the condition.
When dealing with individuals with multiple chronic
illnesses, it would not be unusual to have more than
one condition in a functional system, or to have
multiple functional systems impacted. Table 3,
Recommendations for Time, Frequency of Sessions, and
Duration of Treatment Across Number of
Illnesses/Conditions, offers suggestions for length,
frequency, and duration of treatment sessions for
individuals with a single chronic illness and for
individuals with multiple chronic illnesses. These
recommendations are based on clinical interventions
and reports from participants and their health
advocates.
Although Table 3 was designed to assist the
clinician in making recommendations for the use of
massage, there is still a need for
future research. Further studies need to include the
population that suffers with multiple chronic
illnesses. This population is dependent on the health
care system for medical support and also needs the
positive benefits that massage
therapy can provide. In lieu of empirical evidence to
support the use of massage with this
population, clinical observations indicate that
60-minute massage therapy sessions
for individuals with three or more chronic illnesses
should result in a decrease in chronic pain and an
increase in physical mobility in these individuals.
Additional Questions Need to Be Addressed
One of the goals of this article is to provide both
clinical and medical health care professionals with a
framework to guide and support the use of
massage therapy for individuals dealing with
multiple chronic illnesses. In connection with this
purpose, a framework has been introduced that directs
clinicians to the type, duration, and goal of
massage therapy for certain functional
systems. Although this framework is based on
experimental research findings and clinical
observations, there is still a need to have additional
empirical evidence to address the following questions:
1.) Does the use of massage therapy
result in the same positive physical and psychological
outcomes for individuals with multiple chronic
illnesses as it does for individuals with a single
chronic illness? 2.) Does massage
therapy result in the reduction or elimination of
medications and/or hospitalizations in individuals
dealing with multiple chronic illnesses? 3.) Are there
illnesses/conditions that by their nature, or in
combination with their illnesses/conditions, require a
certain regiment of massage treatment
(frequency and duration) to sustain a specific goal
(i.e., pain relief to increase mobility)? And if so,
what type of massage therapy would be
most beneficial and how often should it be offered?
Conclusion
To review, researchers (e.g., Field et al., 1996;
Field et al., 1997; Hernandez-Reif, Field, Field, &
Theakson, 1998; National Institute of Health, 1994)
have documented the physical and psychological
benefits of massage. Massage
therapy is also acknowledged for its promotion of
wellness and as a technique that supports a lifestyle
change in the journey from illness to a healthier
"whole person." As a result of the current training
and certification processes required for therapists,
massage therapy has improved in
quality and recognition as an alternative treatment
modality.
Empirical studies have demonstrated that
massage therapy results in both physical and
psychological benefits for individuals dealing with a
single chronic illness. In order to best utilize this
treatment modality, the clinician must first identify
the functional system that is impacted by the illness
and then determine which specific type of
massage is most appropriate. In addition, the
clinician needs to determine the frequency and
duration of therapy to optimize clinical outcomes.
This process becomes more complicated when initiating
treatment for individuals who are dealing with
multiple chronic illnesses. Currently, there is a lack
of studies examining the effects and the parameters of
applying this therapeutic treatment to individuals
with multiple chronic illnesses.
We propose that massage therapies
that have been found to be beneficial to individuals
with one chronic condition would also be beneficial
for those suffering from multiple chronic illnesses.
In addition, a framework is suggested to facilitate
the process of using massage therapy.
Within this framework certain protocols are
recommended. Those recommendations include determining
the appropriate goals and determining the type of
massage therapy that would be most
effective. Recommendations are also made regarding the
length, frequency, and duration of therapeutic
sessions to optimize clinical outcomes. For this
framework to be effective, ongoing study and dialogue
between researchers and clinicians is warranted. It is
at this juncture that both the practitioner and his or
her client will benefit from a systematic, empirical
study of the sustained benefits of massage
therapy as a function of length and frequency of
sessions and duration of treatment.
Table 1: Functional System Rational, Conditions, and Treatment Goals
Functional System (s)
I. Circulatory and Lymphatic
A. Circulatory system aides in home-
ostasis and transports respiratory
gases (oxygen), nutrients, metabolic
wastes, hormones, and antibodies to
tissues throughout the body via contin-
uous blood flow
B. Lymphatic system supports the
body's Immune system by producing
white blood cells
II. Muscular/Skeletal
A. Provides structure
B. Protects internal organs
C. Facilitates movement
D. Stores minerals
E. Contains the tissue for most blood
cell production
III. Respiratory
A. Facilitates gas exchange & ventila-
tion
B. Filters inhaled air
C. Delivers oxygen from the atmos-
phere
D. Rids the body of carbon dioxide
IV. Neurobiological and Psychological
A. Highly somatic or psychoemotional
arousal
B. Physiological response
C. Impact on seratonin,norepinephrine,
epinephrine, and cortisol levels
Conditions
I. Circulatory and Lymphatic
A Blood disorders
B. Immune system conditions
1. Inflammatory conditions in post-
acute stage
2. Various low-grade inflammatory
conditions
C. Lymph systems conditions
D. Vascular conditions
E. Other circulatory conditions
II. Muscular/Skeletal
A. Injury
B. Immobilized, paralyzed, and dener-
vated muscle(s)
C. Joint disorder
D. Bone disorder
E. Neuromuscular disorder
III. Respiratory
A. Chronic obstructive pulmonary dis-
ease (COPD)
B. Asthma/allergy
C. Bronchitis
D. Emphysema
E. Tuberculosis
IV. Neurobiological and Psychological
A. Stress
B. Depression
C. Anxiety
D. Neuron system injuries
E. Chronic pain syndrome
F. Chronic degenerative disorder
G. Infectious disorders
H. Seizure disorders
Treatment Goals
I. Circulatory and Lymphatic
A. Increase lymph flow in non-edema-
tous tissues
B. Removal of edema fluid from tissues
C. Increase blood flow in some
conditions of impaired
circulation or venous stasis
D. Induce some vascular changes
resulting in a reduction of heart rate
and blood pressure
II. Muscular/Skeletal
A. Reduce muscle strain
B. Massive increase in sensory stimula-
tion
C. Interrupting the' pain-tension cycle'
that involves ischemic pain
D. Relaxation of both the intrafascial
and extrafascial fibers
E. Increase movement and strength
F. Improve stability
III. Respiratory
A. Improve neck stiffness
B. Increase rib cage mobility
C. Reduce stress and anxiety levels
D. Improve postural drainage
F. Improve respiratory and oxygenation
IV. Neurobiological and Psychological
A. Increase attention
B. Improve symptoms of distress
and/or mood
C. Improve degrees of tranquility and
vitality
D. Alleviate effects of trauma
E. Facilitate expression of loss or grief
Table 2: Functional Systems and Massage Technique
Manual
Deep Lymphonic
Systems Swedish Tissue Drainage
I. Lymphatic & Circulatory X X X
II. Muscular and Skeletal X X X
III. Respiratory X X X
IV. Neurobiological and X X
Psychological
Deep
Connective
Systems Neuromuscular Tissue
I. Lymphatic & Circulatory X
II. Muscular and Skeletal X X
III. Respiratory X
IV. Neurobiological and X X
Psychological
Table 3: Recommendations for Length, Frequency, and Duration of
Treatment Sessions Across Number of Illnesses/Conditions
Frequency of Duration of
Number of Illnesses Time Per Session Sessions Treatment
1 60 minutes Once per week 2-3 months
60 minutes Twice per month
2-3 60 minutes Once per week 6 months
60 minutes Twice per month 6-12 months
4 or more 60 minutes Twice per week 3-6 months
(3 optional approaches 60 minutes Once per week 6 months
in treatment course) 60 minutes Twice per month 6 months
This article is approved by the following for one
continuing education credit:
ACFEI (APA) is approved by the American
Psychological Association to offer continuing
professional education for psychologists. ACFEI
maintains responsibility for the program.
ACFEI/APA provides this continuing education credit
for Diplomates after October 2001 who are required to
obtain 15 credits per year to maintain their status.
ACFEI is California Board of Registered Nursing
Provider 13133.
Table 1: Functional System Rational, Conditions, and Treatment Goals
Functional System (s)
I. Circulatory and Lymphatic
A. Circulatory system aides in home-
ostasis and transports respiratory
gases (oxygen), nutrients, metabolic
wastes, hormones, and antibodies to
tissues throughout the body via contin-
uous blood flow
B. Lymphatic system supports the
body's Immune system by producing
white blood cells
II. Muscular/Skeletal
A. Provides structure
B. Protects internal organs
C. Facilitates movement
D. Stores minerals
E. Contains the tissue for most blood
cell production
III. Respiratory
A. Facilitates gas exchange & ventila-
tion
B. Filters inhaled air
C. Delivers oxygen from the atmos-
phere
D. Rids the body of carbon dioxide
IV. Neurobiological and Psychological
A. Highly somatic or psychoemotional
arousal
B. Physiological response
C. Impact on seratonin,norepinephrine,
epinephrine, and cortisol levels
Conditions
I. Circulatory and Lymphatic
A Blood disorders
B. Immune system conditions
1. Inflammatory conditions in post-
acute stage
2. Various low-grade inflammatory
conditions
C. Lymph systems conditions
D. Vascular conditions
E. Other circulatory conditions
II. Muscular/Skeletal
A. Injury
B. Immobilized, paralyzed, and dener-
vated muscle(s)
C. Joint disorder
D. Bone disorder
E. Neuromuscular disorder
III. Respiratory
A. Chronic obstructive pulmonary dis-
ease (COPD)
B. Asthma/allergy
C. Bronchitis
D. Emphysema
E. Tuberculosis
IV. Neurobiological and Psychological
A. Stress
B. Depression
C. Anxiety
D. Neuron system injuries
E. Chronic pain syndrome
F. Chronic degenerative disorder
G. Infectious disorders
H. Seizure disorders
Treatment Goals
I. Circulatory and Lymphatic
A. Increase lymph flow in non-edema-
tous tissues
B. Removal of edema fluid from tissues
C. Increase blood flow in some
conditions of impaired
circulation or venous stasis
D. Induce some vascular changes
resulting in a reduction of heart rate
and blood pressure
II. Muscular/Skeletal
A. Reduce muscle strain
B. Massive increase in sensory stimula-
tion
C. Interrupting the' pain-tension cycle'
that involves ischemic pain
D. Relaxation of both the intrafascial
and extrafascial fibers
E. Increase movement and strength
F. Improve stability
III. Respiratory
A. Improve neck stiffness
B. Increase rib cage mobility
C. Reduce stress and anxiety levels
D. Improve postural drainage
F. Improve respiratory and oxygenation
IV. Neurobiological and Psychological
A. Increase attention
B. Improve symptoms of distress
and/or mood
C. Improve degrees of tranquility and
vitality
D. Alleviate effects of trauma
E. Facilitate expression of loss or grief
Table 2: Functional Systems and Massage Technique
Manual
Deep Lymphonic
Systems Swedish Tissue Drainage
I. Lymphatic & Circulatory X X X
II. Muscular and Skeletal X X X
III. Respiratory X X X
IV. Neurobiological and X X
Psychological
Deep
Connective
Systems Neuromuscular Tissue
I. Lymphatic & Circulatory X
II. Muscular and Skeletal X X
III. Respiratory X
IV. Neurobiological and X X
Psychological
Table 3: Recommendations for Length, Frequency, and Duration of
Treatment Sessions Across Number of Illnesses/Conditions
Frequency of Duration of
Number of Illnesses Time Per Session Sessions Treatment
1 60 minutes Once per week 2-3 months
60 minutes Twice per month
2-3 60 minutes Once per week 6 months
60 minutes Twice per month 6-12 months
4 or more 60 minutes Twice per week 3-6 months
(3 optional approaches 60 minutes Once per week 6 months
in treatment course) 60 minutes Twice per month 6 months
References
Farr, T., Nottle, C., Nosaka, K., & Sacco, P.
(2002). The effects of therapeutic massage
on delayed onset muscle soreness and muscle function
following downhill walking. Journal of Science and
Medicine in Sport, 5(4), 297-306.
Field, T., Morrow, C., Valdeon, C., Larson, S.,
Kuhn, C., & Schanberg, S. (1992). Massage
reduces anxiety in child and adolescent psychiatric
patients. Journal of the American Academy of Child and
Adolescent Psychiatry, 31(1), 124-131.
Field, T., Ironson, G., Scafidi, F., Nawrocki, T.,
Goncalves, A., Burman, I., et al. (1996).
Massage therapy reduces anxiety and enhances
EEG pattern of alertness and math computations.
International Journal of Neuroscience, 86, 197-205.
Field, T., Hernandez-Reif, M., LaGreca, A., Shaw,
K., Schanberg, S., & Kuhn, C. (1997a). Massage
therapy lowers blood glucose levels in children with
diabetes. Diabetes Spectrum, 10(3), 237-259.
Field, T., Hernandez-Reif, M., Seligman, S.,
Krasnegor, J., Sunshine, W., Rivas-Chacon, R., et al.
(1997b). Juvenile rheumatoid arthritis: Benefits from
massage therapy. Journal of Pediatric
Psychology, 22(5), 607-617.
Field, T., Lasko, D., Mundy, 12, Henteleff, T.,
Kubat, S., & Talpins, S., et al. (1997c). Autistic
children's attentiveness and responsibility improved
after touch therapy. Journal of Autism and
Developmental Disorders, 27(3), 333-339.
Field, T. (1998). Massage therapy
effects. American Psychologist, 33, 1270-1281.
Field, T., Hernandez-Reif, M., Hart, S., Theakston,
H., Schanberg, S., & Kuhn, C. (1999). Pregnant women
benefit from massage therapy. Journal
of Psychosomatic Obstetrics and Gynecology, 20, 31-38.
Greene, E. (2000). Massage
therapy. In D.W. Dovey (Ed.), The clinician's complete
reference to complementary/alternative medicine (pp.
338-348). St. Louis, MO: Mosby.
Hernandez-Reif, M., Field, T., Field, T., &
Theakston, H. (1998). Multiple sclerosis patients
benefit from massage therapy. Journal
of Bodywork and Movement Therapies, 2(3), 168-174.
Hernandez-Reif, M., Field, T., Krasnegor, J., &
Theakston, H. (2001). Lower back pain is reduced and
range of motion increased after massage
therapy. International Journal of Neuroscience, 106,
131-145.
Hilbert, J.E., Sforzo, G.A., & Swensen, T. (2003).
The effects of massage on delayed
onset muscle soreness. British Journal of Sports
Medicine, 37(1), 72-109.
Hymovich, D.P., & Hagopian, G.A. (1992). Chronic
illness in children and adults: A psychosocial
approach. Philadelphia: W.B. Saunders.
Ironson, G., Field, T., Scafidi, F., Hashimoto, M.,
Kumar, M., & Kumar, A., et al. (1996). Massage
therapy is associated with enhancement of the immune
system's cytotoxic capacity. International Journal of
Neuroscience, 84, 205-217.
Joyce, S., Kuhn, M., Curtin, K., & Murphy, L.
(1999). The integrated health advocacy handbook
Unpublished document.
Lundberg, T. (1984). Long-term results of vibratory
stimulation as a pain relieving measure for chronic
pain. Pain, 20, 13-23.
National Institute of Health. (1994). Alternative
medicine: Expanding medical horizons. (NIH Publication
No. 94-066). Chantilla, VA: National Institute of
Health.
Yates, J. (1990). A physician's guide to
therapeutic massage: Its
physiological effects and their application to
treatment. Vancouver, B.C: Massage
Therapists' Association of British Columbia.
Maria Kuhn, MA, LPC, DAPA, is a partner in Benefit
Performance Associates. She functions as a health and
psychosocial counselor and educational advisor. She
uses her knowledge of massage therapy
in her current counseling practice. Kuhn has
established two multi-faceted counseling centers and
is a co-author of the Integrated Health Advocacy
Handbook. This advocacy program works with individuals
dealing with multiple chronic illnesses. She endorses
the use of massage therapy as an
effective means of helping clients deal with
psychological and physical conditions. Kuhn is a
Diplomate of the American Psychotherapy Association
and has been a member since 1999.
Dr. Christopher Jones received his PhD from
Northern Illinois University in the areas of
experimental and social psychology. He is an assistant
professor at Calumet College of St. Joseph and the
assistant director of research of the Integrated
Health Advocacy Program.
Dr. Christina Krause received her PhD from Northern
Illinois University in experimental and developmental
psychology. Her academic research focused on adults'
perceptions of personal control in various areas of
their lives. Her research interests include
empowerment techniques, psychological and physical
experiences of the aging process, and health-related
issues. She is an assistant professor at Aurora
University and serves as the research director of the
Integrated Health Advocacy Program.
Karen Curtin is a registered nurse and has a BS in
Allied Science. She is also a certified case manager
and certified disability management specialist. She
has 25 years of nursing experience with a background
in orthopedics and neurology. Her primary focus is in
rehabilitation and disability management. She is a
coauthor of the Integrated Health Advocacy Handbook
and is the Primary Advocate for Sherman Health
Systems.
COPYRIGHT 2004 American Psychotherapy Association
