Therapists be aware: Technology is quickly changing for massage and all other therapies. The Fitbits that everyone is now wearing on their wrists are really just rudimentary portable EKGs.
Currently, they are used to measure heart rate for zone training; however, there are a few programs that will take the heart rate readings and compile an HRV for the purpose of informing the subject when overtraining (sympathetic upregulation) has occurred.
This indicates the amount of rest that is needed for recovery, health and performance.
Measuring Anatomic Nervous System Function
Very few people, even therapists, know these portable devices can also crudely measure how successful your massage was.
How can this be possible?
Because as technology improves, so will its accuracy and scope, so that a simple wrist device will be able to measure autonomic nervous system function of the body and how it responds to its stimuli.
The implications are significant for anyone in medicine. Patients will have ever increasing access to sophisticated, wearable EKG sensing devices and clearly will pick up the relationship between quality and poor therapeutic services in the real time HRV values constantly measuring their health.
It is essential that every massage therapist understand how the nervous system controls disease if they are to carve out a legitimate slice of the therapeutic pie.
How massage therapy influences the autonomic nervous (ANS) and endocrine systems is what is going to elevate this profession out of the doldrums of poor perception in the marketplace.
To many physicians, massage is merely an adjunctive and not a standalone therapy. To many people, massage is used only by pleasure-seekers.
The only way to end this misperception is to prove massage’s medical legitimacy—and this can be done through evidence-based science on how massage can positively influence autonomic nervous system regulation.
Pain & Disease
According to the study, “Autonomic imbalance: prophet of doom or scope for hope?” published in Diabetic Medicine, imbalances of the parasympathetic (rest/healing/calming) and sympathetic (flight/fight/stress) branches of the ANS are directly linked to a wide variety of pain and diseases.
The sympathetic nervous system (SNS) is designed to facilitate short-term survival by creating a cascade of neurophysiological responses throughout the body. When the sympathetic system is remains stuck in high drive or persistent tone, this is clinically called up-regulation, or stress.
The study “Sympathetic regulation of vascular function in health and disease,” published in Frontiers in Physiology, suggests this persistent sympathetic nervous system stress is a key precipitator of ill health and disease, and may be accurately measured today in real time using sophisticated electro-cardiograms (ECG).
Science Today states the stress measurement that is most used research is called heart rate variability (HRV), or total power. HRV measures the relationship healthiness of the sympathetic and parasympathetic nervous systems and is comprised of over 30 scientific markers, such as stress, pulse, blood pressure and arterial blood flow.
HRV was originally developed for use in cardiology as a predictor of post surgical mortality.
According to a 2016 study, “Correlation between health-related quality of life in the physical domain and heart rate variability in asymptomatic adults,” published in Health Quality of Life Outcomes, low HRV values (<780ms) indicate sympathetic overactivity and are directly implicated in cardiac pathology, diabetes, cancer, morbidity, reduced quality of life and precipitous mortality.
In sports medicine research, “Heart Rate Variability in Athletes,” published in Sports Medicine, indicates high HRV values (>=780) are associated with improved exercise tolerance, cardiovascular health, improved autonomic nervous system control,and better emotional regulation.
Massage Therapy & HRV
Does massage therapy affect HRV? Very much indeed. Massage appears to provide significant influence on the nervous systems. Of the 30 scientific markers comprising HRV, three key markers are essential to understanding massage therapy’s potential benefits and the legitimization of your profession.
- Stress Index This sympathetic marker is the accelerator of your autonomic nervous system. Stress Index measures cardiac muscle oxygen demand related to heart work, and reflects the adaptability of the body to internal and external stressors that directly influence autonomic nervous system functioning.
Prolonged high stress values (>=180ms) are a known risk for general health, including high blood pressure, heart disease, obesity and diabetes.
- HF: High Frequency indicator of Parasympathetic Vagal Nerve Activity. This is the brakes of the ANS. Vagal tone refers to the activity of the vagus nerve (10th cranial nerve) which serves as 80 percent of the parasympathetic branch of the autonomic nervous system, and initiates the bodies healing phase.
High tones are seen in Olympic athletes and martial artists. Decreased vagal activity or tone (low value <=220ms) is associated with increased stress vulnerability, poor health and mental anxiety.
- HRV/ Power is the main indicator of overall ANS activity or balance between sympathetic/parasymapthetic systems, and is reflective of variations in time intervals between heart beats, known as Heart Rate Variability (HRV). HRV is the balance between stress and vagal tone. Lower than normal HRV values (<=780ms) are associated with disease and high vales (>=780) are associated with health and vigor.
Science of Massage
So we put massage to the stress test. We took a small sample of patients (n=5) who had pain, and provided an hour-long massage by an experienced massage therapist of 26 years.
We used a sophisticated EKG machine (ANS1) for a measurement of the ANS both before and after the massage. Patients reported the session very enjoyable, and one even quoted that it was “the best massage they ever had.”
No deep tissue techniques were used. Results? We found some good news; massage increased vagal tone an average 47 percent, which is very impressive documentation for the healing science behind massage therapy.
The bad news: massage increased stress index levels in pain patients. This increased stress cancelled out HF-vagal tone improvements, and in the end massage was left with a negative -3 percent HRV outcome.
The aim of research is to build accurate knowledge: Science = truth. We have searched for other modalities or techniques that can be applied as a complement or prior to massage to help reduce patient stress levels during therapy.
We found that acupressure and acupuncture, high-quality essential oils, and DC microcurrent were nervous system adjuncts to massage therapy, all reducing stress levels prior to manual therapy for improved HRV outcomes.
Looking forward, if the massage therapy industry can provide published evidence of nervous system regulation techniques, the profession will have the first real scientific proof that massage alone can play a viable and essential role in future of patient rehab and general health maintenance.
About the Author
Kelly Armstrong O.T.R/L., S.I.P.T., M.P.P., is a published researcher and international author and speaker who has lectured extensively around the world on the topics of scar therapy, pain management, sport performance, pediatric and women’s health for over 10 years. She is qualified continuing education provider both nationally and at the state level (Florida) for physical therapy, occupational therapy, acupuncture and massage, instructing over 100 CE seminars to date. She lives in St Augustine, Florida, with her four children.
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