Deep Tissue Massage and It's Many Benefits

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

Deep tissue massage therapies provide proven health benefits beyond tissue repair, benefiting the whole health of the patient

Research into the benefits of deep tissue massage therapy, or soft tissue mobilization, called Tui Na in Traditional Chinese Medicine (TCM), is proving that these therapies can be very beneficial to overall health beyond the obvious benefits of improved healing of deep tissue musculoskeletal pathology. An article in the New York Times on September 20, 2010, reported on a clinical trial by the Cedars-Sinai Medical Center in Los Angeles, California, sponsored by the National Institutes of Health (NIH) (see the article link below), where randomly assigned patients were tested for physiological changes during either light massage or deep tissue therapies. To the surprise of the researchers, the beneficial physiological changes measured in the deep tissue physiotherapy group were dramatic. The researchers noted significant decreases in the circulating cortisol, vasopressin, increased immune response, increases in oxytocin, and decreases in adrenal corticotropin hormone. Similar beneficial effects were noted in studies of the active metabolites measured in saliva samples. These findings imply that myofascial syndromes and deep tissue inflammatory disorders are linked to hormonal homeostasis strongly, as well as healthy immune function, and that this type of deep tissue therapy can significantly reduce physiological stress and improve one's overall health.

While standard scientific studies with randomized controlled human clinical trials are difficult to apply to all manual therapies, including acupuncture needle stimulation, more and more accepted proof of the success of these physiotherapies is emerging. It is obvious that professional physiotherapy applied to deep soft tissue to improve circulation, restore function and help promote tissue healing by breaking up problematic scar tissue and inflammatory adhesions is important to fix musculoskeletal pathologies. What studies in the last decade have found is that the benefits go way beyond this obvious set of benefits. As we overcome a system of medical study design bias, a consensus is finally emerging that these treatments provide not only proven benefits to directly promote soft tissue healing and restoration, but that this realm of therapy actually provides a host of systemic benefits that could improve health, contribute to healing from difficult chronic diseases, and prevent many serious disease states. Integration of deep soft tissue physiotherapy, such as Tui Na, into the overall treatment protocol can improve outcomes in medical care dramatically.

To explain these findings, let's look at what they mean to our health. Cortisol, also known as hydrocortisone, is a steroid hormone produced continuously by the adrenal gland, which is part of the kidneys. Cortisol is called the stress hormone because it functions to counter the ill effects of acute physiological stress in the body, not because it reduces nervous tension or emotional stress. Cortisol is continuously released in a feedback system that responds to a variety of factors related to physiological stress, including decreased blood sugars (hypoglycemia), excess immune, or inflammatory responses, blood loss, fever or tissue burns, and hormonal changes associated with emotional alarm. Cortisol is not only a hormone that reacts to sudden changes in physiological stress, but also to chronic physiological stress. Cortisol is continuously excreted in a tightly contolled manner that has a diurnal pattern, or changes according to the cycle of wake and sleep. Chronic cortisol excesses and deficiencies are seen within this diurnal pattern when a number of chronic physiological stressors are present. It has been demonstrated that abnormal cortisol levels occur with thyroid disorder, anxiety and depressive disorders, insulin disorder, gastric hypofunction, electrolyte imbalances, chronic inflammatory syndromes and diseases, sleep disorders, and even with chronic use of some medications, such as oral contraceptives. Because cortisol is diurnally fluctuating normally, the question is not always of a simple excess or deficiency, but rather of inappropriate cortisol levels within the diurnal phasing. For instance, adrenal insufficiency may result in a sluggish cortisol response, leaving the patient with excess cortisol at night and deficient cortisol during the day. This results in insomnia and non-restful sleep, as well as daytime sluggishness and poor tissue repair. When we look at the subject of cortisol, we must look at how to normalize the cortisol homeostasis.

Patients with excess stimulation of cortisol may develop a variety of chronic health problems. Deep tissue therapies were shown to reduce the triggers for this chronic cortisol excess release, and thus the body needed less cortisol, as measured in the study. The deep tissue physiotherapy thus targeted the cause of the problem, not the effect. Now, synthetic corticosteroids are also widely prescribed today, as well, and in fact, can be purchased in many drugstore medications without prescription. These synthetic cortisols are called cortisone, which is closely related to corticosterone, a steroid hormone very similar to cortisol, but that has limited effects, and is mainly important as an intermediate in the transformation of pregnenelone to aldosterone, which regulates blood pressure and mineral, or electrolyte, excretion in the kidneys. Synthetic corticosteroid, or cortisone, is very similar to cortisol and is used to suppress immune responses, reduce acute inflammation and pain, mediate allergic reactions, and control asthma. Cortisone has been shown to have an effect on adrenal natural cortisol production, though, and potentially has a variety of adverse side-effects, especially with chronic use, such as high blood sugars, insulin resistance, diabetes, osteoporosis, anxiety, depression, gastritis, colitis, high blood pressure, erectile dysfunction, hypothyroidism, retinopathy, menstrual cessation, and other health problems. Many of these side effects may be attributed to the negative effects of synthetic cortisones on the adrenal production of cortisol. Cortisol production varies according to need, in a feedback system, and the use of synthetic corticosteroid may inhibit natural cortisol production in this feedback system. Healthy cortisol responses in the body, or adrenal homeostasis, would protect the patient from many of these health problems. Deep tissue physiotherapy has been shown to benefit the cortisol homeostasis and reduce the need for excess cortisol response. Acupuncture stimulation has also been proven to benefit cortisone homeostasis and the combination of Tui na and acupuncture has obvious benefits.

Vasopressin, or antidiuretic hormone (ADH), is a peptide hormone that regulates blood pressure and plays a key role in homeostasis, contributing to the regulation of levels of water, glucose and salt in the blood circulation. Vasopressin is released by the hypothalamus and pituitary complex. Abnormal levels of vasopressin may create excess water retention or dehydration of tissues and cells. Vasopressin has also been shown to have a variety of neurological effects, influencing relationship bonding and feelings of reward. Decreasing excess vasopressin may help lower the blood pressure and normalize homeostasis. Oxytocin is another hormone of the brain, only oxytocin acts primarily as a neurotransmitter. It was originally found to be associated with female reproduction, labor, and breastfeeding, but research in the last few decades has revealed an extensive role in the body. Oxytocin has been shown to significantly influence orgasm, pair bonding, anxiety, maternal behaviors, and social recognition, influencing many of our daily social interactions, both in males and females. Sufficient oxytocin has been shown to evoke feelings of calmness, contentment and security. Deep tissue physiotherapy has been shown to increase oxytocin. Oxytocin action in the brain is mediated by G-protein coupled receptors that require sufficient magnesium and cholesterol. This is one reason why many patients find that they feel better, and function better, when they take magnesium supplement. Inhibition of cholesterol production may also have a negative effect on oxytocin action. Stimulating proper levels of oxytocin may not only result in better homeostasis and emotional well being, but may help with fertility and conception as well. Synthetic oxytocin is used to induce labor in the hospital, and deep tissue physiotherapy may help reduce the need for a high dosage of this drug when proceeding to labor.

Immune responses were found to be significantly aided by deep tissue physiotherapy as well. The patients in the clinical trial mentioned above were found to have higher levels of circulating lymphocytes (CD25+, CD4, CD56+, and CD8), and decreased levels of cytokines (IL-1beta, IL-2, IL-4, IL-5, IL-6, IL-10, IL-13, and IFNgamma) that are associated with many chronic inflammatory and autoimmune diseases, as well as neurodegenerative disease. The deep tissue physiotherapies were found to decrease the key pathogenic cytokines to baseline levels, thus exerting a normalizing, or modulating effect. The lead author of this study, Dr. Mark Rapaport, chairman of the department of psychiatry and behavioral neurosciences at Cedars-Sinai, which is associated with the David Geffen School of Medicine at the University of California, Los Angeles (UCLA), stated that he was a skeptic before this study was conducted, and is now very impressed by these findings.

While numerous studies in the past 20 years have shown that the massage, or physiotherapy, utilized in Traditional Chinese Medicine (CIM/TCM), is proven to be beneficial for soft tissue healing and pain relief, applying randomized and placebo-controlled trials to actual physiotherapy is, of course, difficult in design. Like acupuncture, designing a placebo and blinding the patient and therapist to the real and sham technique is impossible. For this reason, medical journals in the United States, dominated by the pharmaceutical industry, for which placebos and blinding the patient and administrator to which is real and which is a sham pill, is not a problem, continue to state that physiotherapy is not proven to be beneficial by these standards. Of course, with this criteria, surgery in not proven to be effective either. We do know, though, that physiotherapies, as well as surgery, can be effective, if performed properly. These studies in recent years take a more realistic look at scientific validation of physiotherapy, and we see that TCM physicians were correct in their observation that deep tissue therapies, such as Tui Na and Shiatsu, provide benefits even beyond the local improvement in soft tissue healing.

When these deep tissue therapies are combined with acupuncture, other physiotherapies of Traditional Chinese Medicine, topical herbal medicines, and herbal and nutrient medicines taken internally, the overall benefits to one's whole health are considerable. In a complete practice, the TCM physician is also able to instruct the patient in self-administered therapeutic routines and correct postural mechanics and habits. We see that our immune, neurological and hormonal health is highly variable and affected daily by healthy routines and therapies. Adopting TCM therapeutics into your life does much to insure that you will lead a healthy, productive and happy life, and prevent many common diseases.

A high incidence of vertebral fractures in the aging population and the need for mobilization of the spine and surrounding soft tissues

Tui na, or soft tissue mobilization, encompasses a wide array of physiotherapy techniques in Traditional Chinese Medicine. Mobilization of the spine and surrounding soft tissue is central to the practice of Tui na, and modern studies of the incidence of vertebral fractures in the aging population show how important this therapy is. A large study of the incidence of vertebral fracture, which often goes undiagnosed, but produces back pain, was conducted in Europe in 2002, and published in the Journal of Bone Mineral Research (Apr 17(4);716-724). Over 14,000 men and women were recruited in 29 European centers and their spines were analyzed with X-ray. The incidence of vertebral fracture in women was almost twice that of men, with almost 11 women per 1000 experiencing vertebral fractures each year. An article in the June 18, 2011 New York Times Science section, stated that by age 80, 2 of every 5 women have had one or more vertebral fractures. Multiple vertebral fractures were found in 20 to 30% of these cases studied. In most cases of vertebral fracture, the pain is either minimal or attributed to a muscle spasm. Most of these cases go undiagnosed, and even when seen on X-ray studies, most of these vertebral fractures are ignored by the physician and patient.

While osteoporosis and osteopenia present increased risk of vertebral fractures, immobility of the spine, chronic inflammation, poor circulation to the bone, calcified ligaments and joint capsules, and loss of vertebral disc height all play an important role in the incidence of vertebral fracture. When there is poor spinal mobility, there is inhibition of circulation and poor bone maintenance. With calcified soft tissues and chronically contracted muscles, aging bones may face acute stress more easily, and a simple movement or fall may result in excess force applied to the bone. While active excercise and postural correction is important, passive mobilization of the spine and surrounding soft tissue, and myofascial release, is very important to maintaining a healthy spine that can react with sufficient movement to avoid a fracture. Soft tissue and spinal mobilization gently breaks up inflammatory adhesions, improves circulation, and stimulates improved cell growth. Osteopenia and osteoporosis itself is largely due to the poor turnover of cartilage and the vertebral plates adjacent to the discs. Hardening of these tissues prevents circulation and bone remodeling, a constant process in the body. Weight bearing exercise is often insufficient to restore vertebral endplate circulation, especially if the spine is not mobile. Passive mobilization by a professional, performed lying down, allows the tissues to be mobilized that weight bearing exercise prevents.

Of course, the high incidence of vertebral fractures in aging postmenopausal women reflect the high incidence of hormonal deficiency and imbalance in this population. These hormonal challenges inhibit normal bone maintenance as well as soft tissue repair and maintenance. Deep tissue massage, such as Tui na, not only helps to mobilize the spine and surrounding soft tissues to keep them healthy, but also acts to improve the hormonal balance to aid tissue repair and maintenance. The Licensed Acupuncturist is able to provide Tui na, instruction in postural mechanics and targeted stretch and exercise, acupuncture, and herbal and nutrient medicines in the therapeutic procotol. All of these protocols are important and act synergistically to help the body maintain soft tissue and bone health to avoid vertebral fractures with aging. Herbal and nutrient medicines can help with hormonal balance and bone density, correcting or preventing osteoporosis and osteopenia. Periodic supplementation with bone strengthening supplements, such as strontium, will also help to prevent vertebral fractures. This complete package of care provides assurance that you are doing all that you can to avoid this painful aspect of aging.

Information Resources / Additional Information and Links to Scientific Studies

  1. The New York Times reported in September of 2010 on an NIH sponsored clinical trial of physiological effects of deep tissue massage therapy, commonly called Tui Na in Traditional Chinese Medicine: http://www.nytimes.com/2010/09/21/health/research/21regimens.html?src=me&ref=general
  2. The above mentioned clinical trial of deep tissue massage therapy was reported in the Journal of Alternative and Complementary Medicine on September 1, 2010: http://www.liebertonline.com/doi/abs/10.1089/acm.2009.0634
  3. Clinical trials and studies with randomly assigned patients in recent years have also proven that acupressure, or Tui Na / Shiatsu, is more effective in relieving low back pain than standard physical therapy, as reported in articles in the British Medical Journal: http://www.sciencedaily.com/releases/2006/02/060217092325.htm
  4. Studies of the physiological benefits of deep tissue myofascial techniques at the University of Granada in Spain, showed that a significant modulation of anxiety, heart rate and systolic blood pressure was observed following treatment: http://www.ncbi.nlm.nih.gov/pubmed/18724827
  5. A 2016 large meta-review of high quality randomized human clinical trials for opioid narcotic pain medication to treat low back pain, from experts at the University of Sydney School of Medicine, in Australia, found that these pain medications did not meet the criteria for clinically relevant pain medication, and did not outperform NSAIDs and aspirin. Clearly, we have been sold a bill of goods concerning treatment of back pain, and we need to actually use a more holistic protocol of targeted stretch and exercise, heat, acupuncture and physiotherapy to both achieve pain relief and restore function. The damage to health and the problem of narcotic addiction from pain medication protocol has harmed the public immensely: http://archinte.jamanetwork.com/article.aspx?articleid=2522397
  6. A 2014 study of deep tissue massage for the treatment of chronic low back pain, at the Poznan University of Medical Sciences, in Poznan, Poland, found that a short course of deep tissue massage reduced pain significantly, and that adding NSAIDS to the protocol had no significant improvement in pain measurements: http://www.ncbi.nlm.nih.gov/pubmed/24707200
  7. A 2015 randomized controlled study of soft tissue mobilization, called Tui na in Traditional Chinese Medicine, at the Biomechanics Laboratory of the Mayo Clinic, in Rochester, Minneapolis, Minnesota, U.S.A. found that tendon health was significantly improved over controls in laboratory animals with induced achilles tendinopathy. The treated tendons had better tissue quality, with more predominance of Collagen Type 2, stronger fiber alignment and less loss modulus, showing how soft tissue mobilization can significantly improve tendon healing in just 6 treatments, performed every 3-4 days: http://www.ncbi.nlm.nih.gov/pubmed/25620609
  8. A 1997 study of soft tissue mobilization by Ball Memorial Hospital, in Muncie, Indiana, U.S.A. also found that this therapy improved tendon healing significantly in laboratory animals with induced tendon injury. Biopsy study of the treated tendons compared to controls showed that the tendons treated with soft tissue mobilization had significantly increased fibroblast formation with healthy collagen: http://www.ncbi.nlm.nih.gov/pubmed/9139169
  9. A large 2010 meta-review of all published randomized controlled human clinical trials (RCTs) of Complementary and Integrative Medicine (CIM), formerly referred to a "alternative", found 265 RCTs in 2010 that showed significant proof of benefit of soft tissue mobilization, joint manipulation and deep tissue massage, and effectiveness of acupuncture over standard treatment for back and neck pain, as well as cost effectiveness for acupuncture over standard therapy:http://www.ncbi.nlm.nih.gov/pubmed/23126534
  10. A large high quality randomized controlled human clinical trial was begun for assessing Tui na soft tissue mobilization therapy for chronic low back pain at the Chengdu University of Traditional Chinese Medicine in China, and is expected to provide sound evidence for inclusion of this therapeutic specialty in standard treatment and prevention: http://www.ncbi.nlm.nih.gov/pubmed/25352050
  11. A 2012 large meta-review of all published randomized controlled human clinical trials of treatments for frozen shoulder syndrome (adhesive capsulitis) by the University of York, York, United Kingdom, found that physiotherapy, high-grade soft tissue mobilization, and acupuncture were effective, and that these therapies could be integrated with a single (not multiple) corticosteroid injection to increase effectiveness. The studies were too small to fully conclude that the cost-effectiveness is proven, but considering the low cost of a short course of soft tissue mobilization combined with acupuncture, the answer to this seems obvious: http://www.ncbi.nlm.nih.gov/pubmed/22405512
  12. A 2015 meta-review of all published studies of the use of manual physiotherapies for whiplash and neck pain, by experts at the University of Ontario, the University of Montreal, and the University of Toronto, in Canada, Queen's University in the UK, and the NYU School of Medicine in the U.S.A. found that scientific evidence supports soft tissue mobilization, manipulation, and clinical massage interventions for these injuries and pain. This is called Tui Na in TCM, and may be combined with other treatment protocols to achieve a more holistic set of therapeutic goals: http://www.ncbi.nlm.nih.gov/pubmed/26707074
  13. A 2016 study of soft tissue mobilization by experts at the University of Illinois at Chicago, U.S.A., the University Rey Juan Carlos, in Madrid, Spain, and Aalborg University in Denmark, all agreed that mobilization is proven to enhance mechanisms of conditioned pain modulation for patients with Osteoarthritis of the knee to increase the pain threshold perception. Of course, direct soft tissue mobilization, called Tui na in TCM therapy, can be very helpful to promote tissue repair as well: http://www.ncbi.nlm.nih.gov/pubmed/26721229
  14. A 2010 study at the Medical University of Varna, Bulgaria, found that the incidence of dural tears and leak of spinal fluid with lumbar decompressive surgery is estimated to occur in 1-17 percent of cases, a considerable risk, and should be approached with better preventive measures before surgery. The dura matter is a watertight sac of tissue that covers and protects the spinal cord and spinal nerves: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3198662/
  15. A 2008 study at the Nanjing University of Traditional Chinese Medicine, in Nanjing, China, found that integrating Tui na soft tissue mobilization at the low spine with standard acupuncture treatment resulted in an effective treatment for chronic primary Dysmenorrhea, or menstrual cramps in more than 93 percent of cases: http://www.ncbi.nlm.nih.gov/pubmed/18416074
  16. A 2014 meta-review of studies at the China Academy of Chinese Medical Sciences, in Beijing, China showed that there is strong evidence that Tui na is an effective adjuvant treatment for essential hypertension, or high blood pressure: http://www.ncbi.nlm.nih.gov/pubmed/24906593
  17. In Chinese hospitals, pediatric Tui na is a common treatment modality, and this meta-review of scientific studies showed that it was effective for treating anorexia in infants and children, showing the broad systemic benefits. Tui na is used instead of acupuncture for infants and children due to the fear of needle stimulation, and has been found effective in children for many centuries: http://www.ncbi.nlm.nih.gov/pubmed/25141371
  18. A 2015 study at the University of Oslo, in Norway, and the Institute of Health and Society, found that the practice of acupuncture, or needle stimulation, was not widely practiced in Chinese hospitals on infants and small children, but that the traditional practice of pediatric Tui na was widely used. The use of needle stimulation in Western hospitals for infants and children is not based in TCM practice in Asia: http://www.ncbi.nlm.nih.gov/pubmed/26553838