In this article, we will take a look at some of the ongoing research around COVID-19 patients and massage therapy.
We’ll also share valuable resources to support your own professional learning and decision-making processes. And finally, we will present two ongoing research projects that explore how the pandemic has affected, on the one hand, massage therapists in their personal and professional lives and, on the other hand, massage therapy clients and their interest in seeking treatment during times of social distancing.
Massage for COVID-19 Patients?
As the COVID-19 pandemic holds the world in its grip, many questions are on the table that have not yet been answered. We are confronted with much uncertainty; and it is often difficult to know which data, claims and guidelines are based on trustworthy scientific resources and what is unfounded speculation or even misinformation.
The swirling mixture of facts and fiction spread by different sources requires us to be diligent in our discernment of the information we receive so we can make appropriate therapeutic and clinical decisions for our clients and for our own best practices as we navigate these extraordinary times.
We will start out by summarizing some of the symptoms of COVID-19 based on a report from the Harvard School of Medicine. Then, we will review three protocols for systematic review that have been proposed to analyze existing evidence-based data on the effectiveness of massage therapy for different client populations and how massage therapy may help alleviate specific COVID-related symptoms.
How COVID-19 Presents (So Far)
What we know with certainty is that COVID-19 presents itself in a variety of rather perplexing ways, affecting different people and populations via entirely different means. According to the Harvard Medical School,1 symptoms observed in people infected with the COVID-19 virus range from such common flu-like symptoms as fever, body aches, dry cough, fatigue, chills, headaches, sore throat, and loss of taste or smell, to more severe symptoms such as high fever, severe cough and shortness of breath, which often indicates pneumonia.
In addition, COVID-19 can cause a range of such neurological symptoms as muscle weakness, tingling or numbness in hands and feet, confusion, dizziness, brain fog, delirium, seizures and even strokes. Some COVID-19 patients can also experience such gastrointestinal (GI) symptoms as diarrhea, vomiting, nausea and loss of appetite, as well as abdominal pain and discomfort. Symptoms can appear to be mild for some time and then worsen rapidly; and these symptoms can also appear in any type of combination, such as, some people only experience neurological or GI symptoms without showing any type of respiratory symptoms.
There is some indication that the immune system of a person infected with COVID-19 can overreact and release too many immune messengers, called cytokines, into the bloodstream, which causes the body to attack its own tissues, potentially causing long-lasting harm. These “cytokine storms” trigger an exaggerated inflammatory response that could damage organs in the body and result in blood clot formations.
The topic of blood clots is especially important for us, as massage therapists; and it is advised to educate yourself on this matter as new research and updated information become available. Ruth Werner has written an excellent article on the topic of COVID-19-Related Coagulopathy.2
As the number of COVID-19 cases increases around the world, more patients are recovering from this disease, often dealing with many persistent symptoms and potentially long-lasting effects on their bodies that are not yet fully understood. Many convalescent patients are being treated within a traditional medical framework of care, and they are also seeking complementary therapies, including massage therapy.
What, however, do we know about the effects of massage therapy on recovering COVID-19 patients? To answer some of the questions, three research studies have been proposed to explore how massage therapy can support recovering COVID-19 patients from different populations presenting with a variety of specific symptoms.
The Effect of Massage on Quality of Life
The first article by Wu L. et al., “The effect of massage on the quality of life in patients recovering from COVID-19: A systematic review protocol,”3 presents a study conducted as a systematic research protocol.
For this project, all published randomized controlled trials (in English and Chinese languages) related to the topic of the effects of massage on COVID-19 patients available in a chosen number of databases will be analyzed according to primary and secondary outcome criteria.
The primary outcome is defined as the influence of massage on the quality of life of convalescent patients, and the secondary outcomes are defined as accompanying symptoms, average hospitalization time, clinical curative effect, and negative COVID-19 results rate on two consecutive occasions. The authors aim to provide a high-quality synthesis of current evidence for researchers in the field of alternative health care.
Tuina Massage to Address Diarrhea in COVID-19 Patients
The second research article by Zhou Ke-Lin et al., “Tuina (massage) therapy for diarrhea in COVID-19: A protocol for systematic review and meta-analysis,”4 proposes a systematic review of the existing evidence of the effectiveness and safety of massage therapy for diarrhea symptoms in coronavirus patients.
The chosen outcomes that this database research and analysis will focus on are defined as the improvement of diarrhea symptoms and adverse effects. The study aims to explore how Tuina—as one of the most widely used alternative medicine interventions worldwide—can affect the digestive system and help alleviate aversive diarrhea symptoms caused by COVID-19.
Pediatric Massage to Restore Lung Function from COVID-19
In the third research article, the authors, Zhou Ke-Lin et al., propose yet another protocol for systematic review and meta-analysis; in this case, focused on the pediatric population and pulmonary symptoms caused by COVID-19. The authors state that there is an urgent need for alternative medicine treatments to help relieve symptoms related to COVID-19 in children during self-quarantine, supporting their chances of survival and recovery from the virus.
In their article, “Pediatric massage therapy for restoring pediatric lung function from COVID-19: A protocol for systematic review and meta-analysis,”5 Zhou and his co-authors propose a systematic review of a number of electronic databases, including Pubmed, MEDLINE, EMBASE, CNKI and CINAHl to evaluate the role of pediatric massage therapy on the effectiveness and safety in pulmonary function of COVID-19 convalescent children based on the outcomes improvement of pulmonary function and adverse effects.
Health Care Practitioner-Related Research
As therapists navigating this pandemic, it is part of our responsibility to look at research data and discern what we need to know in order to practice safely. In addition to the scientific and medical side of COVID-19, there are also the human, emotional and personal sides.
How are you as a practitioner and health care provider doing personally? How are you dealing with the restrictions, limitations, uncertainties and heartbreak? Do you have a support network that helps you cope with the situation?
You may be interested to learn that there is a research study currently going on that strives to understand and document the experience of the COVID-19 pandemic for health care professionals. Ann Blair Kennedy, PhD, assistant professor at USC Greenville, South Carolina, and Smith Heavner-Sullivan, RN, from Prisma Health, Greenville, South Carolina, have created Project COPE: Share Your Story. Originally starting out as an observation study of COVID-19-induced burnout and the impact of the pandemic on nurses and doctors in the ER, the project has now been expanded to include such other groups of health care professionals as massage therapists.
In a Research Perch interview with Doug Nelson, president of the Massage Therapy Foundation (MTF),6 Kennedy and Heavner-Sullivan discuss the different experiences of health care workers whose services are deemed essential versus non-essential and how being allowed to work or not work during the shutdown affects their moral distress. Participants in this study are invited to fill out weekly surveys as well as upload video logs to document their personal experiences.
This combination of collecting both quantitative and qualitative data during an ongoing crisis is a unique opportunity since most studies exploring the effects of disasters on health care workers have been conducted after the events took place. Participation in this research study is still possible. If you would like to contribute your unique experience as a health care professional during the pandemic, please visit the website to learn more.
How Do Massage Clients Navigate Emotions During the Pandemic?
To bring our exploration of research related to COVID-19 and massage therapy full circle, it is important to also include the experiences of massage therapy clients. How are they feeling about massage during times where social distancing is recommended? Do they continue to seek treatments, perhaps look for complementary treatments for the first time, or are they staying away from massage therapy altogether? How do their decisions affect their health and well-being, emotional state and mood?
In another episode of Research Perch,7 Nelson interviews Niki Munk, PhD, LMT, associate professor at Indiana University School of Health and Human Sciences, Indianapolis, Indiana, and her student, Mica Rosenow, about their currently ongoing study, “Assessing Affective Measures in the 2020 Pandemic.” This research project focuses on exploring affective characteristics (mood) in massage therapy clients and how they navigate and manage their emotions during the time of the pandemic.
Munk and Rosenow encourage massage therapists to invite their clients to participate in this survey-based study to share their individual experiences. The more data that can be collected, the more valuable insights for our work as massage therapists can be gained so that we ultimately can better understand the people we are treating and help them reach their personal goals more efficiently. Please visit massagetherapyfoundation.org/iu-study-2020-pandemic-survey to learn more about this ongoing research study.
Let’s Learn and Grow Together
COVID-19, with its many expressions and often perplexing presentations, has certainly turned our world upside down. In addition to the hardships and heartbreaks we have experienced, this pandemic has also opened the doors to new insights and learning opportunities that are explored by the many research projects currently underway.
If you are interested in getting involved in research and helping our professional field grow during this time of crisis, we invite you to visit the website of the Massage Therapy Foundation, listen to the Research Perch podcasts, and participate in the two above-noted research studies.
Another great resource to receive information about COVID-19 is the International Journal of Therapeutic Massage & Bodywork, an open-access, peer-reviewed publication housed on massagetherapyfoundation.org that features articles presenting research on COVID-19 and related symptoms. The Massage Therapy Foundation offers many valuable resources to help practitioners support their clients and also guide educators on how to teach students about how to put that research into practice. Take advantage of the wealth of support and information available to you through these extraordinary resources.
We sincerely hope that there is a silver lining for you in these challenging times as we learn and grow together, discern facts from fiction, and collect valuable data through evidence-based research so we can make confident decisions for our best practices and the well-being of ourselves and our clients.
About the author
Andrea Winzer, M.Sc., LMT, BCTMB, holds a master’s degree in ecology and is a board certified massage and bodywork therapist. She practices CranioSacral Therapy and offers a variety of holistic treatment modalities with a focus on the integration of body-mind-spirit, release of physical and emotional trauma from the body, and supporting mental health therapies through trauma-sensitive bodywork. She wrote this article on behalf of the Massage Therapy Foundation.
1. Harvard Health Publishing, “COVID-19 basics: Symptoms, spread and other essential information about the new coronavirus and COVID-19.” Harvard Medical School; 2020. (health.harvard.edu/diseases-and-conditions/covid-19-basics). Accessed November 2020.
2. Werner, Ruth. “COVID-19-Related Coagulopathy.” Massage & Bodywork. July/August 2020.
3. Wu, L, Dong, Y, Li, J, Huang, J, Wen, D, Peng, T, Luo, J. The effect of massage on the quality of life in patients recovering from COVID-19. Medicine. June 5, 2020;99(23):e20529.
4. Zhou, K, Dong, S, Fu, G, Cui, S, Guo, S. Tuina (massage) therapy for diarrhea in COVID-19: A protocol for systematic review and meta-analysis. Medicine (Baltimore). 2020; Jul 10; 99(28):e21293.
5. Zhou, K, Dong, S, Wang, K, Fu, G, Niu, Y, Xie. Xoap, Guo, S. Pediatric massage therapy for restoring pediatric lung function from COVID-19: A protocol for systematic review and meta-analysis. Medicine (Baltimore). 2020; Aug 14; 99(33):e21581.
6. Massage Therapy Foundation. Update on Project Cope: Share Your Story. Research Perch; University of South Carolina School of Medicine Greenville, Prisma Health, Clemson University, and Indiana University; accessed November 2020; massagetherapyfoundation.org/update-on-project-cope-share-your-story-research-perch.
7. Massage Therapy Foundation. Assessing Affective Measures in the 2020 Pandemic. Research Perch; Indiana University Study;. accessed November 2020; massagetherapyfoundation.org/iu-study-2020-pandemic-survey.