Massage and the Autonomic Nervous System

BACKGROUND:

This essay was originally written for an Anatomy and Physiology (A&P) course supporting my Diploma of Remedial Massage. For that reason the paper has a strong A&P focus. My background is in psychology, not physiology, so, although I have read relatively widely in the preparation of this paper, I cannot guarantee the accuracy of every point covered.

Important note for NSWSTM A&P Students!

If you are currently studying anatomy and physiology at the New South Wales School of Therapeutic Massage, please be advised that the lecturer has requested that you don’t read this essay, because of past issues with plagiarism.

I was actually requested to remove the document from my website, however, I believe that it is each student’s responsibility to demonstrate integrity in researching and writing class assignments.

QUESTION:

“What general effects does massage have on the parasympathetic and sympathetic divisions of the autonomic nervous system and the endocrine system? Also discuss the general relationship between the hypothalamus and the pituitary gland and various target organs.”

INTRODUCTION:

This essay explores the effects of a variety of massage approaches on the autonomic nervous system and the endocrine system. Swedish massage, energy balancing methods, aromatherapy, lymphatic drainage, Bindegewebsmassage, serial connective tissue massage and general deep tissue massage methods are all considered in answering the question. The aim is (where possible) to identify scientifically validated claims of massage as well as to explore the probable or perceived benefits massage may have.

In the words of Tritton, (1993) “claims about massage are sometimes outcomes of rigorous research, but more often-than-not, they are wishful thinking or hypotheses based on the anatomical structures and physiology of the body. … unfortunately, there is very little to be found in the literature on the physiological effects of massage and very few scientific studies have been undertaken in this area.” Furthermore, the small amount of empirical research that does exist, more often than not, does not define the kind of touch or massage methodology employed, and massage is often rolled in with a range of other therapeutic methods (Westland 1993).

Nevertheless, interest in massage as a valid means of therapy is on the increase and in particular in the West, where stress is one of the most commonly experienced states, massage has a clear role to play in reducing stress and helping people learn to recognise early stressful symptoms as compared with a more relaxed and less stressed state. With pharmacology, medical technology and the ever-increasing depersonalisation of patients in conventional Western medicine, massage, and related healing approaches involving touching (body work) are rapidly on the increase.

INTERACTION OF BODY SYSTEMS:

The human body is a finely tuned interaction of organs and systems. “the close inter-relationship between the somatic, autonomic and endocrine systems makes it impossible for pathologic changes to take place in any one structure without causing adaptive changes in other structures.” Edner, quoted in Chaitow (1983). As early as 1928, Heartman described changes in the connective tissue within the dermatomes of the heart. His findings demonstrated that these changes were associated with heart symptoms which subsequently cleared up upon treatment of this connective tissue (Chaitow 1983). If this research is valid, then it stands to reason that massage (soft tissue manipulation) through improving circulation, nervous stimulation etc can have a marked effect on the body. Therefore assertions that massage can induce relaxation and stimulation of the parasympathetic nervous system seem quite plausible.

AUTONOMIC NERVOUS SYSTEM (ANS):

The autonomic nervous system (ANS) is a system of nerves and ganglia concerned with the distribution and reception of predominantly involuntary impulses to the heart (changing its rate and force of beating), smooth muscle (vasoconstriction or dilation of arterioles) and glands (increasing or decreasing their secretion).

The Autonomic Nervous System is made up of two sub-divisions – the sympathetic and the parasympathetic. While the sympathetic nervous system serves all parts of the body, the parasympathetic Nervous System is confined to the head and trunk. The former is generally associated with the fight/flight response while the latter is characterised by its role in sedating the body and restoring it to the resting state it was in prior to sympathetic stimulation. The ANS is a modifier of activity; either increasing or decreasing it. thus the heart can beat without innervation from the sympathetic fibres of the ANS, but its rate of beating does not change as a result of excitement or fear levels.

Anatomically, the autonomic nervous system differs from the somatic nervous system in that it has two effector neurones into the central nervous system. It also uses nor-epinephrine (nor-adrenalin) in addition to acetyl choline as a neurotransmitter.

EFFECTS OF MASSAGE ON AUTONOMIC NERVOUS SYSTEM (ANS):

To demonstrate the difficulty in getting an absolute answer on the actual rather than the deduced effect massage has on the ANS, quotes are provided from relatively up-to-date texts which attempt to objectively report the effects of massage. “it is obvious that massage stimulates the sensory and proprioceptive nerve fibres of the skin and underlying tissues, and that these messages pass along the afferent fibres to the spinal chord. From there it is conceivable that these stimuli may disperse through the central and autonomic nervous systems – producing various effects in any zones supplied from the same segment of the spinal chord. … Such reactions are called reflex effects” (Tappan, 1988). Massage bombards the skin and subcutaneous tissues with stimuli, and this not only produces a local effect but may exert either a stimulating or soothing effect on the body as a whole – depending on the type of massage technique used (Tritton, 1993).

Swedish massage, particularly effleurage and other slow stroking movements are thought to have a sedating effect leading to activation of the parasympathetic nervous system. Hard research about the actual role massage has here is not extensive, but it appears that massage may stimulate the parasympathetic nervous system – stimulating the Vagus nerve to slow down the heart rate and increasing peristalsis (Tritton, 1993). Slowed breathing, reduced heart rate and increased abdominal/digestive sounds all suggest that this could be the case.

However, in one study looking at the autonomic effects of a general back massage (Barr and Taslitz, 1970) (mainly effleurage movements) the result was that compared to baselines this routine caused an increase in sympathetic response – not what we would expect. The indices measured were heart rate, respiration, galvanic skin resistance, skin temperature, body temperature and pupil dilation.

Another study (Kisner and Taslitz, 1967) was primarily investigating connective tissue massage effects on autonomic activity, but used general effleurage stroking as one of its control situations. The second control situation was no stimulation. In this study, both the connective tissue and the effleurage measures resulted in increased sympathetic activity, but the sympathetic activity was less pronounced in the effleurage group. While clients and practitioners subjectively observe relaxation and presumably parasympathetic effects from slow relaxing massage strokes, it is understandable that (connected to wires and a variety of electronic monitoring equipment) subjects would be more stressed and have greater sympathetic NS indicators than a trusting and private massage session.

Faster, firmer and more percussive massage techniques are often used to revitalise and stimulate the client. Sports masseurs have to take care not to relax and slow a sports person prior to a race, and a careful balance of massage techniques are generally applied in pre-event situations. Of course, most pre-event massage is for the purpose of stretching muscles and increasing blood flow to the muscles being used in the event. A sportsperson who is tense and stressed may be calmed through a more soothing massage to a small extent.

Massage also may cause vasodilation in the skin and muscles by stimulating receptors of the sympathetic nervous system. Deep tissue massage often leads to a sense of relief and peace during or after the event – even if some of the deep tissue work is painful at the time of treatment. Research by Kisner and Taslitz, (1967) into the ANS effects of Elisabeth Dicke’s Bindegewebsmassage (a special form of connective tissue massage) found that this technique caused some sympathetic stimulation during and after treatment, although proponents of the method have traditionally claimed that it works through stimulation of the parasympathetic responses. A different study (Reed and Hald, 1988) of serial connective tissue massage to elderly and middle aged subjects found no significant sympathetic or parasympathetic response.

SELF-INDUCED RELAXATION RESPONSE:

Just lying in a quiet room, closing one’s eyes, and trying to stop thinking of those things that are troubling will have some effect on the ANS. Certainly, a restful few minutes can make one feel a bit better than before.

Many of the endocrine and ANS operations are not easily altered through conscious intent, but hypnosis, meditation and even massage-induced relaxation can often allow these unconscious systems to be modified by a person.

Biofeedback is an example of a common modern method by which people are able to monitor and then modify various body systems and processes such as heart rate, blood sugar level, blood pressure and brainwave frequency. Apparatus used to monitor the body’s various states and visual, auditory or combined audiovisual output systems are used to let the person know what states various systems of their body are in. While biofeedback is relatively new, profound results have been documented for practitioners of various systems of meditation. These disciplines have been practised for thousands of years, but great discipline and practise are required to elicit body changes compared to shorter training times in biofeedback situations.

“By learning to induce a relaxation response, subjects can modify the way in which stressful events affect the sympathetic nervous system”. Studies suggest that the relaxation response decreases the bodies response to norepinephrine. (Soliman, Schmidt and Adragna, 1990). Thus it is now recognised that it is possible to modify the responses of the ANS through operant conditioning techniques.

WHAT IS IT THAT MASSAGE ADDS TO THE ACT OF LYING DOWN IN A QUIET ROOM – HUMAN TOUCH

We know that light work on muscles and stroking of cutaneous tissue can be soothing. Light rhythmical stroking is often used to help a person (such as a child or someone who is unwell) to relax and fall asleep (Tappan, 1988).

But massage is more than systematic manipulation of soft tissues and soothing stroking; there is the human factor too. In addition to the stimulation of nerve endings and receptors in the skin, amongst other findings, Creiger found that human touch (caring or often termed “therapeutic touch”) increases haemoglobin levels in the blood of the person being touched (Tappan, 1988, Tritton, 1993).

Creiger believes that for touch to be truly beneficial and healing for the recipient (what she terms ‘therapeutic touch’) the practitioner needs “the intent to help” and “genuine concern” for the client. In the practise of energy balancing, proponents of this form of body work assert that the practitioner needs to be prepared to give a form of “love”to the client (of a non intimate/erotic nature of course) (cited in Tappan, 1988).

Body work practitioners who have been in their profession for a long time are often heard to say “it isn’t so much what the treatment is, but who gives it”. They have found that some practitioners are just intuitive and that their clients have better results from treatment. This act of concern is thought to be a factor in the therapy. Of course knowledge and understanding of massage and related techniques is important, still, some minimally trained practitioners have been reported to have gained very good results (Juhan, 1987).

If we speculate that stress, (arguably one of the most wide-spread illnesses in Western society) is often associated with feelings of rejection or because of a sense of lack of support at work or home, then it is understandable that massage (a form of therapeutic comforting and acceptance by the practitioner to the client) has the potential to have a very positive impact on reducing the levels of stress, thus allowing the parasympathetic NS to take hold during the massage and perhaps afterwards.

ENERGY BALANCING THERAPIES:

Energy Balancing is a general term for a group of hands-on body-work therapies the aim of which is to maximise the healing/warming/energetic touch between practitioner and client (Tappan, 1988). Irrespective of whether the client has been told ahead of time that the practitioner is going to do some energy balancing, much subjective and a smaller amount of objective observation/measurement has shown that there is often a very dramatic slowing of breathing, as well as a sense of peace reported by most clients. There is also a feeling of warmth, charge of connectedness between the client and the practitioner which is almost indefinable, but which usually leads to feelings of well-being in not only the recipient but the practitioner too.

If it is acknowledged that this sense of peace and relaxation is perceived by both parties, then it stands to reason that if such methods make the patient feel more at peace and ease, that this should in turn activate the hypothalamus, leading to action by the endocrine system and parasympathetic nervous system.

THE PITUITARY & HYPOTHALAMUS GLANDS AND MASSAGE:

Although historically the pituitary gland was considered to be the master gland and the master controller of the endocrine system (the system of glands and hormone-producing organs), in more recent times, it has become evident that the hypothalamus is the main organ which coordinates and controls this system. In fact, part of the hypothalamus itself is a gland, and cells in the hypothalamus synthesise at least nine different hormones. These hormones are passed to the anterior pituitary gland via portal blood vessels and stimulate or inhibit a variety of hormonal secretions by the anterior pituitary. The posterior pituitary produces other hormones (such as growth hormone) but usually not under hypothalmic control. The 9 hypothalmic hormones and the seven pituitary-produced hormones together play important roles in the regulation of virtually all aspects of growth, development, metabolism and homeostasis within the human body.

The mechanism for control of the release of hormones so far as the hypothalamus is involved is via negative feedback. Essentially, the hypothalamus monitors the levels of various hormones in its blood supply and then if these are low it sends releasing or stimulating chemical messengers to the pituitary gland which in turn releases other hormones which, through the blood stream, are conveyed to target organs. When the hypothalamus senses that such hormone levels are high, it stops sending releasing hormones to the pituitary. This negative feedback system is one reason why we have lasting effects of stress, because this chemical means of communication is slow and impacted by the relatively slow speed of blood-flow and diffusion of hormones into circulating fluids.

Thibodeau and Patton, (1996) describe the hypothalamus as the integrator of mind (psyche) and body (soma). It is also the main link between the nervous system and the endocrine system, In particular, it is the regulator and coordinator of autonomic activity. Though according to Soliman et al, (1990) “… Although the hypothalamus is considered the main sub-cortal centre for autonomic regulation, centres within the brain-stem (especially the medulla and spinal chord) are also very important. … in addition, areas of the cerebral cortex (particularly parts of the limbic system) can influence autonomic responses by sending messages to other parts of the CNS.”

Thibodeau et al, (1988) also describe the hypothalamus as the major relay station between the cerebral cortex and lower autonomic centres. thus, they propose that the hypothalamus is the main mechanism by which ‘mind over body’ changes can be effected, even of a psychosomatic nature. “Thus emotions can directly effect the activity and the state of the body.”

PAIN, STRESS AND MASSAGE:

It seems probable that deeper tissue massage may cause the release of endorphins (the bodies natural pain killing opiates) leading to the sense of well-being and the “good hurt” feelings (Tritton, 1993). This hypothesis is supported in other research sited in Tappan, (1988) confirming that acupuncture often leads to endorphin release, and since deep tissue massage works over many points in the acupuncture meridians, and finger pressure is often used over such points, it seems likely that such massage also elicits this release.

“Painful, stressful, and emotional experiences all cause changes in hypothalmic activity. In turn, the hypothalamus controls the autonomic nervous system and regulates body temperature, thirst, hunger, sexual behaviour, and defensive reactions such as fear and rage.” (Tortora and Grabowski, 1996).

There is a complex interrelationship between pain, stress and emotions. Massage sometimes causes pain during the treatment, but a large number of recipients come for a massage for short-term or medium-term pain relief. Thus if pain is diminished, the body is under less stress and presumably the parasympathetic NS is more likely to be activated. It has also been found that sympathetic arousal of the higher brain centres (such as that resulting from emotional stress) can exacerbate the nociceptive impulses originating from soft tissue injury (Cailliet, 1988). Thus if massage relaxes the client, and reduces sympathetic activity, pain is likely to be less intrusive and disruptive to the individual. “The endocrine involvement of the encephalin serotonin explains the benefits derived from stress management programs, and physical exercise” [and presumably massage] (Cailliet, 1988).

The hypothalamus is also implicated in the waking state. Thus we could speculate that massage could induce the hypothalamus to allow the body to be less awake through THE pleasurable emotions usually associated with a relaxing massage.

The hormones cortasol (natural cortisone) and adrenalin are produced when the body is under stress. These chemicals if present for long periods are said to have a poising effect on the body, as well as overstraining the adrenal glands (Juhan, 1987). One of the functions of the liver is to break-down hormones such as these and sex hormones, so we could conclude that massage which assisted the vascular and lymphatic return would expedite break-down of these undesirable hormones and may cause the body to become less stressed.

AROMATHERAPY MASSAGE:

Many claims are made about the effects of aromatherapy massage. This is the use of essential oils (plant essences) blended into the lubricating (carrier) oil used for the massage. The massage technique is generally slow, relatively light, rhythmical, and contains a lot of effleurage and sliding actions. Lymphatic drainage is also a major component of this massage technique. A reasonable and quite encyclopedic reference on this subject is “AromaTherapy an A to Z” (Davis, 1995).

The essences used in aromatherapy apparently can affect the body in three main ways, absorption through the skin, inhalation and absorption through the surface of the lungs, and the associations and responses caused by the stimulation of the olfactory nerves.

It is the third effect (the effect of the aromas of the oils used) which is the focus here. It is asserted that the mood and hence the physiological state (relaxed or stimulated) of the recipient can be powerfully influenced by the combination of essential oils employed. The brain centre for smell is closely related with the limbic centre of the brain. This centre in term is closely in communication with the hypothalamus which is of course in communication through nerve pathways with the ANS and via chemical messengers with the pituitary gland which itself is in communication with the adrenal glands and other glands of the body.

Memory and smell are highly associated and sensing a smell can evoke surprisingly strong memories associated with that smell FROM the past. Thus aromatherapy is likely to have the potential to evoke strong relaxation responses in recipients – as long as the essences employed have relaxing sensations for the recipient of the treatment. In addition, memories and physiological responses to smells can be conditioned, allowing a person to benefit some degree of relaxation just from smelling an essential oil regularly used in a soothing massage treatment.

CONCLUSION:

Although the research is not substantial, one of the main reasons people like to receive massages is for their perceived relaxing outcomes. The body of research beginning to support many other claimed benefits of massage suggests that hands-on therapies can be very effective and bring mental and physical relief to recipients. This paper has attempted to draw together a variety of different massage approaches and explore the impact these could or do have on the parasympathetic division of the autonomic nervous system and the endocrine system.

REFERENCES

ANDERSON, K.N., ANDERSON, L.E., GLANZ, W.D. (Eds) Mosby’s Medical, Nursing, and Allied Health Dictionary, 4th Ed., St. Louis, Mosby, 1994.

BARR,J.S., TASLITZ, N. The Influence of Back Massage on Autonomic Functions, Vol 50, Number 12, December 1970.

CAILLIET R., Soft Tissue Pain and Disability, Ed. 2: F.A. Davis Company, Philadelphia, 1988.

CHAITOW, L., Neuromuscular Technique: a practitioner’s guide to soft tissue manipulation: Thorsons, New York, 1983.

DAVIS, P., Aromatherapy an A-Z, Saffron Walden, Essex, UK, 1995.

JUHAN D., Job’s Body: A Handbook for Bodywork, Station Hill Press, Inc., New York, 1987.

KISNER, C.D. and TASLITZ, N: Connective Tissue Massage: Influence of the introductory treatment on autonomic functions.

REED, B.V., HELD, J.M., Effects of Sequential Connective Tissue Massage on Autonomic Nervous System of Middle-Aged and Elderly Adults: Vol. 68/ Number 8, August 1988.

SOLOMON, SCHMIDT & ADRAGNA: Human Anatomy and Physiology, 2nd ed. Fort Worth TX, Saunders College Publishing, 1990, pp 528 – 533.

TAPPAN, F.M., Healing Massage Techniques: Holistic, Classic and Emerging Methods, 2nd ed. Appleton and Lans, Connecticut, 1988.

THIBODEAU, G. & PATTON, K., Anatomy and Physiology, 3rd ed., St. Louis, Mosby, 1996 pp. 435-436.

TORTORA, G.J. and GRABOWSKI, S.R: Principles of Anatomy and Physiology, 8th Ed., Harper Collins, New York, 1996

TRITTON, B., Massage and Myotherapy, TAFE Publications, Abbotsford Vic. 1993.

WESTLAND G., Massage as a Therapeutic Tool, Part 1: British Journal of Occupational Therapy, April 1993, 56 (4) pp. 129 – 180.

WESTLAND G., Massage as a Therapeutic Tool, Part 2: British Journal of Occupational Therapy, May 1993, 56 (5) pp 177 -180.

ABOUT THE AUTHOR:

Tim Noonan (B.A.) tim@timnoonan.com.au 0419 779 669 is a massage therapist working from Surry Hills (Sydney Australia). Tim has a Diploma of Remedial Massage covering Swedish, Remedial, aromatherapy and Sports massage, as well as integrating energetic balancing principles into his massage technique. Tim has a degree in Psychology and Special Education which assists his human-focused approach to massage. In 1997, Tim studied for a month at the Beijing Massage Hospital in China, learning a little of their very different approach to massage and health. In particular, this Eastern approach to massage is well applied in the office environment or in situations where it is impractical to remove outer layers of clothing.

My Massage Philosophy

When I am conducting a massage, my entire focus is on the recipient. Each massage I give is unique and a direct response to the particular physical and emotional health needs of the recipient. I pride myself on my flexible, intuitive massage approach, supported by sound practical and theoretical training and backed by an Industry-endorsed code of ethical conduct.

For a massage to be good, it needs to leave the recipient in a better physical and mental state than before the treatment began. Sometimes this will happen immediately following the treatment, other times it may take one or two days for the effects to be fully realised. In many instances two or three treatments are recommended to gain long-term improvement.