Traditional Thai Massage Improves Bone Formation in Postmenopausal Women
When you were young, your parents may have told you drinking milk would give you healthy bones. As adults, we learn that activities such as exercise are also necessary in helping our body maintain bone density and decrease the risk of osteoporosis. This month, we will discuss a recent study showing how promoting healthy bones can be as easy as receiving Thai massage while lying relaxed on a floor mat.A study performed at the Endocrine and Metabolism Unit of Ramathibodi Hospital in Bangkok, Thailand, and subsequently published in BMC: Complementary and Alternative Medicine (2013), examined the effects of traditional Thai massage on bone formation in postmenopausal women. The researchers speculated that the pressure exerted by the massage therapist on the patient may, "induce strain in the skeleton and affect bone, similar to other means of applying mechanical load."
Forty-eight postmenopausal women participated; subjects diagnosed with any disorders affecting bone metabolism such as diabetes, cancer or rheumatoid arthritis, among others, were excluded. A randomized crossover design was used, meaning each participant was in the control and the treatment group. In describing the design, the authors wrote, "Subjects in the treatment group underwent a two-hour session of Thai traditional massage twice a week for four weeks, while no intervention was given to subjects in the control group. After a two-week washout period, subjects were switched to the other arm of intervention for four weeks." Additionally, the subjects were asked to avoid exercise for 24 hours and to fast for a minimum of 10 hours prior to the morning blood test. In order to track changes in biochemical markers of bone turnover, each subject had measurements taken of their body and bone composition, as well as the bone mineral density of their first four lumbar vertebrae, neck of the femur and hip as a whole.
The methods of the study described the traditional Thai massage in moderate detail. A single massage practitioner performed Thai massage for two-hour sessions that involved direct pressure by the heel of outstretched hands on the subject's body for about a one to two second duration. The researchers outlined the subject's position (lying on back, lying on side, lying on chest) and various positions of the practitioner with photos. However, inadequate detail was given describing the amount of pressure being applied by the massage therapist. And, while the researchers indicated that the massage therapists applied pressure using the heel of the hand, the photos clearly indicated that fingers and broad hand positions were also used.
In a previous study, the researchers measured that a single two-hour treatment of traditional Thai massage increased the markers for bone formation by 4.8%. This current study indicated that two treatments per week resulted in higher markers, with the biggest improvement noted in the older women with smaller body frames (14.8% ± 3.3%). This is exciting news for older women who are concerned about osteoporosis and are not actively involved in a strength training routine, as well as for massage therapists who frequently use compressive techniques during treatments. The researchers discussed several other studies related to this project. Previous research has indicated that massage will decrease bone pain, improve bone growth and promote lean mass and bone growth in the early postnatal period. Additionally, people who participate in physical activity in addition to massage during the peri-neonatal period have improved bone formation. However, there is little research on the effects of massage on bone metabolism in adults.
As many people already know, performing mechanical load exercises (i.e. weightlifting and load bearing exercises such as walking and running) put strain on our skeletal muscles that then induces bone growth. Active and passive exercises will improve bone mass and decrease bone loss. What research has not yet shown is whether a light load must be accompanied by a high frequency in order to be as effective as a heavy weight with low frequency. It may be possible that low-impact activities such as walking or receiving massage must be repeated more often to receive the same benefits in terms of bone formation of someone lifting heavy weights less often. When speaking with our patients, we should note that this study indicates that Thai massage should be performed two times per week to have an impact on bone markers.
Though these findings are intriguing, the researchers discussed several limitations to the study. Most notably, this study does not specifically indicate that increased bone markers will result in increased bone mass and reduced fractures. Additionally, this study had a fairly small subject pool (n=48). It is also unclear if the effects of this study could be generalized to all massage therapists since only a single massage therapist was used to provide the Thai massage. The researchers also failed to mention the qualifications or education training of the massage practitioner. Future studies with this team should provide more details about the massage itself, such as qualification standards and a massage protocol for consistency and replication. One additional limitation was noted, in that the researchers indicated that while they excluded subjects taking medications for osteoporosis, they did include seven subjects who had osteoporosis at the spine, femoral neck or hip. Including women with an existing history of osteoporosis would certainly impact the results.
Despite the limitations of this research, the findings still have important implications for research and practice. First, we often think of outcomes associated with massage related to stress and pain reduction, however this study demonstrated healing effects of Thai massage that might not have otherwise been considered by most. This research extends the body of knowledge in massage research outcomes and can be used to help practitioners explain the impact of their work in promoting healthy bones. As practitioners and researchers work together to explore the impacts of Thai massage and other touch modalities on diverse outcomes, we continue to expand the knowledge of this work and its application to the larger field of health and wellness.
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