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Fall 2002

Massage and bodywork: Meeting the “knead” for relief?
By Mark Giuliucci

Beginning with this issue, The CFIDS Chronicle will feature quarterly articles about alternative and complementary therapies for people with CFIDS. These therapies are not always proven effective by medical research, and the Chronicle does not endorse any treatment or claims.

It’s an instinct as basic as breathing. When a part of our body hurts, we rub it with our hands to help ease the pain.

In a nutshell, that’s massage therapy. While there are dozens of variations and sub-variations, all involve touching the body in hopes of eventually relieving sore muscles, fatigue, headaches, aching or frozen joints, or tender trigger points.

“We re-educate the body about feeling,” says David W. Bouda, MD, FACP, director of the LIFEstyle Enhancement Center at the University of Nebraska Medical Center in Omaha. “Massage is part of this process, a way to stimulate the nervous system and to help reset it.”

No one claims that massage or other types of bodywork will cure CFIDS. But when done properly, there’s hope that they can induce at least temporary relaxation and pain relief. The key is to know what to look for, what to avoid and, most importantly, what to expect when you walk through the therapist’s door.

Below is a brief overview of several of the more popular massage and bodywork modalities:

Swedish massage is the most common and best-known massage therapy. It involves a combination of strokes, from long, sweeping effleurage to tapping or slapping tapotement.

“Swedish massage can be wonderfully relaxing,” says Dana Endsley-Denniston, a state-licensed massage and bodywork therapist in Charlotte, N.C. “It can calm the fight-or-flight reaction to stress, improve breathing and help stop the pain-spasm cycle that is typical in people with chronic fatigue syndrome and fibromyalgia.”

It’s also the most studied of all bodywork therapies. Swedish massage has shown some promise in relieving low-back pain and easing stress in general patient populations, although more and better research still needs to be performed.

Dr. Bouda says his center has conducted research showing that a regimen including Swedish massage can significantly improve blood pressure, pulse rates and stress, anxiety and fatigue levels in people with CFIDS. The results have not yet been published.

Dr. Bouda says that his patients follow a specific regimen and that they must be “experienced” patients who have received at least four one-hour massages prior to being included in his research. “This is our protocol, using our lighting and our candles and our music and our therapists. It’s clear that it doesn’t work when it’s done willy-nilly,” he says.

Deep tissue massage and neuromuscular therapy are specific modalities used to release muscles and connective tissue that have been held tense for long periods of time — months or even years. “Many of our clients suffer from chronically tense muscles,” says Robert Denniston, who co-owns Soma Life Support in Charlotte with Dana Endsley-Denniston. “When used in a relatively gentle way these specific massage techniques can, given time, halt and even reverse the negative effects of chronic muscle tension, such as muscle and connective tissue fibrosis.”

Unlike Swedish massage, deep tissue and neuromuscular massages may not always feel good right away. It doesn’t have to be painful, Denniston says, but it is by nature slow work. Several sessions may be necessary before clients feel tangible results.

“It takes time for people to re-learn, to let the mind listen to what the body is telling it,” Denniston says.

Myofascial release seeks to release muscles and ease localized muscle pain by working the fascia, tissue that covers muscle fibers and organs in the body. The method involves stretching the fascia with the hands in hopes of allowing more pain-free movement of the muscles.

“We use this a lot in patients with CFIDS or fibromyalgia, says Irene Metro, MD, medical director of the Plymouth Integrative Medicine Center in Plymouth, Mich. “These people have a lot of aches and pains, and we often find myofascia that’s stuck and needs to be addressed.”

Craniosacral therapy is based on the theory that some people have blockages of the flow of cerebrospinal fluid around the brain and back. According to practitioners, gentle manipulation of bones in the head and other parts of the body may help remove these blockages and increase energy levels and reduce pain.

“It can create a great feeling of movement and unwinding in people,” Endsley-Denniston says. “The reaction can be very immediate and energizing.”

“Movement” modalities such as Trager seek to improve flexibility, range of motion and relaxation in the body. They are not strictly massage. Trager, for example, involves rocking or cradling the subjects in specific ways to re-educate their bodies about proper movement.

The state of the science
Bodywork and massage therapies have become increasingly popular in America. This is due in large part to the frustration that patients feel over the inability of Western medicine to cure diseases such as CFIDS or fibromyalgia. Some people say they simply feel more comfortable seeking “natural” treatments that do not involve medicine.

Yet the research behind these therapies has lagged far behind their growing popularity. “Eighty percent of our patients get Swedish massage,” Dr. Bouda says. “We’re comfortable with its potential and research. We also do Trager and other things, too. But there’s simply no literature on them. You can’t say that they are likely to produce positive results.”

Some studies are underway, but not on the scale usually afforded to medicines or other traditional Western treatments. To a large extent, people seeking relief through most forms of massage and bodywork must accept the lack of evidence and proceed with caution.

Finding a therapist
Most states now license massage and bodywork practitioners. And most of the individual therapies offer training and certification programs. Do not hesitate to ask beforehand if the practitioner you want to visit is licensed and has specific training in individual modalities.

It’s also important that the therapist takes time to listen to you. “Everyone has different needs, and different desires about what they want to take away from the sessions,” Robert Denniston says. “If you encounter someone who wants to work on you right away, without asking anything about you first, it could signal a problem.”

Dana Endsley-Denniston stresses that you should always feel safe and comfortable. And if a treatment hurts, be sure to tell the therapist immediately. “You don’t have to bear pain to feel better,” she says. “That’s just not the way it works.”

Once you start a program, however, give it time to work. Don’t expect results in a single visit. On the other hand, never commit to a long series of sessions until you can sense that you’re gaining some benefit.

When to avoid bodywork
Massage and bodywork are not for everyone. People with a history of blood clots, cardiac problems, skin disorders and other problems could put themselves at risk. Always ask your doctor beforehand whether these therapies are safe for you.