INTRODUCTION: Recent research has provided a rationale for the efficacy and use of massage therapy in the management of knee osteoarthritis (OA) symptoms. Additionally, research has also implicated the role of the quadriceps muscles in the genesis of knee OA. Although both areas of research have demonstrated strong evidence that the muscles and massage therapy may affect knee OA symptoms, self-massage applied on the quadriceps muscle has received no attention.
METHODS: Conducted at the Lourdes Wellness Center in Collingswood, NJ, the study investigated the outcomes of a self-massage intervention applied to the quadriceps muscle on reported pain, stiffness, physical function, and knee range of motion in adults with diagnosed knee OA. Forty adults with diagnosed knee OA were randomly assigned to either an intervention (n = 21) or a wait list control (n = 19) group. The participants applied a narrated 20-minute self-massage therapy twice weekly during ten supervised and three unsupervised intervention sessions. The control group had four supervised assessments with no intervention. Outcome measures were the Western Ontario and McMaster's Osteoarthritis Index (WOMAC) and assessment of knee range of motion.
RESULTS: Between-groups analyses of WOMAC pain, stiffness, function subscales, and total WOMAC scores indicated significant difference between groups (p < .05), n = 36). No significant differences were seen in range of motion.
CONCLUSIONS: The study demonstrated that participants who have OA of the knee benefit from the self-massage intervention therapy. Further studies are needed to clarify the long-term effects of self-massage on the progression and symptoms of knee OA.
BACKGROUND: In a previous trial of massage for osteoarthritis (OA) of the knee, we demonstrated feasibility, safety and possible efficacy, with benefits that persisted at least 8 weeks beyond treatment termination.
METHODS: We performed a RCT to identify the optimal dose of massage within an 8-week treatment regimen and to further examine durability of response. Participants were 125 adults with OA of the knee, randomized to one of four 8-week regimens of a standardized Swedish massage regimen (30 or 60 min weekly or biweekly) or to a Usual Care control. Outcomes included the Western Ontario and McMaster Universities Arthritis Index (WOMAC), visual analog pain scale, range of motion, and time to walk 50 feet, assessed at baseline, 8-, 16-, and 24-weeks.
RESULTS: WOMAC Global scores improved significantly (24.0 points, 95% CI ranged from 15.3-32.7) in the 60-minute massage groups compared to Usual Care (6.3 points, 95% CI 0.1-12.8) at the primary endpoint of 8-weeks. WOMAC subscales of pain and functionality, as well as the visual analog pain scale also demonstrated significant improvements in the 60-minute doses compared to usual care. No significant differences were seen in range of motion at 8-weeks, and no significant effects were seen in any outcome measure at 24-weeks compared to usual care. A dose-response curve based on WOMAC Global scores shows increasing effect with greater total time of massage, but with a plateau at the 60-minute/week dose.
CONCLUSION: Given the superior convenience of a once-weekly protocol, cost savings, and consistency with a typical real-world massage protocol, the 60-minute once weekly dose was determined to be optimal, establishing a standard for future trials.
TRIAL REGISTRATION: ClinicalTrials.gov NCT00970008.
<b>BACKGROUND: </b>The incidence of Achilles tendinopathy is high and underlying etiology as well as biochemical and morphological pathology associated with the disease is largely unknown. The aim of the present study was to describe biochemical and morphological differences in chronic Achilles tendinopathy. The expressions of growth factors, inflammatory mediators and tendon morphology were determined in both chronically diseased and healthy tendon parts.<b>METHODS: </b>Thirty Achilles tendinopathy patients were randomized to an expression-study (n = 16) or a structural-study (n = 14). Biopsies from two areas in the Achilles tendon were taken and structural parameters: fibril density, fibril size, volume fraction of cells and the nucleus/cytoplasm ratio of cells were determined. Further gene expressions of various genes were analyzed.<b>RESULTS: </b>Significantly smaller collagen fibrils and a higher volume fraction of cells were observed in the tendinopathic region of the tendon. Markers for collagen and its synthesis collagen 1, collagen 3, fibronectin, tenascin-c, transforming growth factor-β fibromodulin, and markers of collagen breakdown matrix metalloproteinase-2, matrix metalloproteinase-9 and metallopeptidase inhibitor-2 were significantly increased in the tendinopathic region. No altered expressions of markers for fibrillogenesis, inflammation or wound healing were observed.<b>CONCLUSION: </b>The present study indicates that an increased expression of factors stimulating the turnover of connective tissue is present in the diseased part of tendinopathic tendons, associated with an increased number of cells in the injured area as well as an increased number of smaller and thinner fibrils in the diseased tendon region. As no fibrillogenesis, inflammation or wound healing could be detected, the present data supports the notion that tendinopathy is an ongoing degenerative process.<b>Trial Registration: </b>Current Controlled Trials ISRCTN20896880.
The purpose of this study was to investigate the therapeutic effects of traditional Thai massage (TTM) on pain intensity, pressure pain threshold (PPT), muscle tension and anxiety associated with scapulocostal syndrome (SCS). Twenty patients were randomly allocated to receive a 30-min session of either TTM or physical therapy modalities (PT: ultrasound therapy and hot pack) for 9 sessions over a period of 3 weeks. Pain intensity, PPT, muscle tension and anxiety were measured before and immediately after the first treatment session, 1 day after the last treatment session and 2 weeks after the last treatment session. Results indicated that the TTM group showed a significant improvement in all parameters after the first treatment session and at 1 day and 2 weeks after the last treatment session (p < 0.05). For all outcomes, similar changes were observed in the PT group except for PPT (p < 0.05). The adjusted post-test mean values of each assessment time point for pain intensity and muscle tension were significantly lower in the TTM group than those of the PT group (p < 0.01). In addition, the values for PPT were significantly higher in the TTM group (p > 0.05). We therefore suggest that TTM could be an alternative treatment for the patient with SCS.
OBJECTIVE: To determine the effectiveness of lessons in the Alexander technique, massage therapy, and advice from a doctor to take exercise (exercise prescription) along with nurse delivered behavioural counselling for patients with chronic or recurrent back pain.
DESIGN: Factorial randomised trial.
SETTING: 64 general practices in England.
PARTICIPANTS: 579 patients with chronic or recurrent low back pain; 144 were randomised to normal care, 147 to massage, 144 to six Alexander technique lessons, and 144 to 24 Alexander technique lessons; half of each of these groups were randomised to exercise prescription.
INTERVENTIONS: Normal care (control), six sessions of massage, six or 24 lessons on the Alexander technique, and prescription for exercise from a doctor with nurse delivered behavioural counselling.
MAIN OUTCOME MEASURES: Roland Morris disability score (number of activities impaired by pain) and number of days in pain.
RESULTS: Exercise and lessons in the Alexander technique, but not massage, remained effective at one year (compared with control Roland disability score 8.1: massage -0.58, 95% confidence interval -1.94 to 0.77, six lessons -1.40, -2.77 to -0.03, 24 lessons -3.4, -4.76 to -2.03, and exercise -1.29, -2.25 to -0.34). Exercise after six lessons achieved 72% of the effect of 24 lessons alone (Roland disability score -2.98 and -4.14, respectively). Number of days with back pain in the past four weeks was lower after lessons (compared with control median 21 days: 24 lessons -18, six lessons -10, massage -7) and quality of life improved significantly. No significant harms were reported.
CONCLUSIONS: One to one lessons in the Alexander technique from registered teachers have long term benefits for patients with chronic back pain. Six lessons followed by exercise prescription were nearly as effective as 24 lessons.
TRIAL REGISTRATION: National Research Register N0028108728.
Recent research has provided a rationale for the efficacy and use of massage therapy in the management of knee osteoarthritis (OA) symptoms. Additionally, research has also implicated the role of the quadriceps muscles in the genesis of knee OA. Although both areas of research have demonstrated strong evidence that the muscles and massage therapy may affect knee OA symptoms, self-massage applied on the quadriceps muscle has received no attention.
METHODS:
Conducted at the Lourdes Wellness Center in Collingswood, NJ, the study investigated the outcomes of a self-massage intervention applied to the quadriceps muscle on reported pain, stiffness, physical function, and knee range of motion in adults with diagnosed knee OA. Forty adults with diagnosed knee OA were randomly assigned to either an intervention (n = 21) or a wait list control (n = 19) group. The participants applied a narrated 20-minute self-massage therapy twice weekly during ten supervised and three unsupervised intervention sessions. The control group had four supervised assessments with no intervention. Outcome measures were the Western Ontario and McMaster's Osteoarthritis Index (WOMAC) and assessment of knee range of motion.
RESULTS:
Between-groups analyses of WOMAC pain, stiffness, function subscales, and total WOMAC scores indicated significant difference between groups (p < .05), n = 36). No significant differences were seen in range of motion.
CONCLUSIONS:
The study demonstrated that participants who have OA of the knee benefit from the self-massage intervention therapy. Further studies are needed to clarify the long-term effects of self-massage on the progression and symptoms of knee OA.
