© Borgis - New Medicine 1/2010, s. 18-21
*Dariusz Boguszewski1, Aneta Dąbek2, Izabela Korabiewska1, Dariusz Białoszewski1
Relation between back massage and anxiety level
1Rehabilitation Unit Medical University of Warsaw
Head: dr n. med. Dariusz Białoszewski
2Academy of Physical Education Faculty of Rehabilitation in Warsaw
Head: dr hab. n. med. prof. AWF Janusz Domaniecki
Aim. The purpose of the research was to determine the relation between procedures of classic massage and the level of anxiety as a trait and as a state.
Material and Methods. The examined group consisted of 16 people aged from 20 to 49, from various professional environments. Research participants underwent ten 30-minute procedures of classic relaxation massage. The massage focused on the back, since, due to the large surface, it has the most general influence. The time of one series of procedures was three weeks. The Spielberger et al. self-evaluation questionnaire was the probe. The questionnaire measures the level of anxiety. The examined people completed the questionnaire three times: 1. before the first massage, 2. after the first massage, 3. after the last massage. The significance of differences was measured by Student's t-test.
Results. The results indicate that under the influence of massage, the level of anxiety as a trait and as a state (measurement 1 and 3) was diminished. A considerable difference was noted for the level of anxiety as a state between the 1st and the 2nd measurement and for the level of anxiety as a trait between the 2nd and the 3rd measurement. However, there was no significant statistical difference between the 1st and the 2nd measurement.
Conclusion. The classic typology of relaxation techniques does not include massage. The research indicated, however, that classic relaxation massage is beneficial for the level of anxiety as a state and as a trait.
Massage is one of the oldest medical arts – the first references concerning massage come from Egyptian papyruses dated to 5000 B.C. A detailed description of massage appears in the Chinese book of Kung-Fu (3000 B.C.) and the Hindu book of wisdom, the Vedas (1800 B.C.). Massage, as a method of therapy, was considered by Greek doctors and thinkers: Hippocrates, Celsus and Galen. In ancient Greece, sportsmen taking part in the Olympic Games were massaged (1-4).
In the middle ages, due to the lack of interest in the bodily sphere of man, all medical arts known by the ancients declined. It was not until the 16th century that a French medical doctor and surgeon, Ambrose Parč, became interested in massage as a method of relieving pain. The creator of Swedish gymnastics, Per Henrik Ling (19th cent.), contributed most to the development of contemporary massage (classic) (1-4).
Currently, massage is undergoing a revival. It is used both in rehabilitation, and in biological regeneration and cosmetology. It is also an integral element of the offer of "spa and wellness” salons.
Classic massage is a very broad term. It stands for a wide range of methods and schools, sometimes very different from one another. It is also the basis, a model for other forms, such as: isometric massage, lymphatic massage, and segment massage. Relaxation massage is a specific type of classic massage, since, apart from the direct effect on the physical sphere, it also has an effect on the mental sphere (5). Currently, relaxation massages also include aromatherapy, energizing, synchronic and rhythmical massages (6).
Since there are few reports in the literature concerning classic relaxation massage, which, by assumption, has beneficial effects for the mental state of man, an attempt to evaluate its effects was made.
The aim of the research was to determine the relation between procedures of classic back massage and the level of anxiety as a trait, and anxiety as a state.
MATERIAL AND METHODS
The examined group included 16 people, who willingly applied to the programme, underwent all planned procedures and filled in the self-evaluation questionnaire three times. The group included 12 women and 4 men aged between 20 and 49. Examination participants are residents of Warsaw from various professional environments (students, intellectual workers, physical workers). Initially, the group numbered 20 people; however, 4 people did not finish the programme for various reasons.
Examination participants underwent ten procedures of classic relaxation massage. It is considered that this is a sufficient amount, after which one can notice desired effects. The entire series of procedures took 15 to 25 days. Breaks between individual massage sessions were not shorter than 24 hours and not longer than 72 hours. The duration of one procedure was approximately 20-30 minutes, depending on the size of the massaged body surface (3, 4, 6, 7).
The instrument was a Spielberger et al. self-evaluation questionnaire measuring the level of anxiety. The instrument consists of two parts. The first concerns anxiety as a state – currently, at the moment of examination. The examined person, defining their mood, may choose one of the following answers: "definitely not”, "rather not”, "rather yes”, "definitely yes”. The second part defines the level of anxiety as a feature (trait), which is a continuous predisposition. The examined people choose among the following answers: "almost never”, "sometimes”, "often”, and "almost always”. Both parts contain 20 questions, and, in each part, the scale of results ranges from 20 to 80 points (8, 9). The examined people filled in the questionnaire three times:
– before the first massage (measurement 1),
– directly after the first massage (measurement 2),
– directly after the last massage (measurement 3).
To perform the statistical analysis, Student's t-test was used, adopting the significance level of p<0.05 (10).
The massage was applied to the back, since, due to the large skin surface, it has the most general effect, and the nape of the neck, since excessive tension of muscles in these areas usually has a stress origin (11).
All massages were performed by one person, in the same room.
The effect of massage on the peripheral and central nervous system has been proven. Acting on the central nervous system results in sending impulses to the muscles, glands of external secretion and particular organs of the body. This may be a stimulating effect or relaxing effect, depending on the techniques used and their performance (4). According to the methodology of classic massage, those techniques were used which are recommended for achieving a state of relaxation, calmness and reduced muscle tension. Hence the techniques applied included: stroking aiming at warming up and stretching the skin, increasing secretive functions of sweat and sebaceous glands, reducing irritation of skin nerve endings and calming the central nervous system. The next technique was rubbing, aimed at causing plethora in the massaged areas, increasing muscle, tendon, and muscle-ligament stretch and eliminating callosities of various origins. Circular pressing was applied in order to regulate muscle tension (by means of mechanical action on deep sense receptors), accelerate blood and lymph circulation, and facilitate tissue exchange in muscles (nutrition and disposal of metabolism products). Weak, slow shaking was also applied to distribute lymph better in intercellular spaces, reduce muscle tension and reduce irritability of the central nervous system. All techniques were performed slowly, smoothly, with the greatest hand surface possible, avoiding spot pressures and sudden changes in force or intensiveness (2-4).
The results (averaged for the entire group) indicate that massage caused a significant reduction in the level of anxiety as a state after the first procedure. Statistically significant differences (p<0.001) in the level of anxiety as a state before the first massage (measurement 1) and after the first massage (measurement 2) were observed. The level of anxiety was also considerably different (p=0.003) before the first massage (measurement 1) and after the series of procedures (measurement 3). There was no statistically significant difference in the level of anxiety (as a state) after the first massage (measurement 2) and after the series of procedures (measurement 3) (fig. 1).
Fig. 1. Average points for STAI state anxiety in three surveys (before the first, after the first and after the last massage).
A statistically significant difference (p<0.001) in the level of anxiety as a trait, that is a continual predisposition, was noted before the first massage (measurement 1) and after the series of procedures (measurement 3). The level of anxiety as a trait was significantly different (p<0.001) directly after the first massage (measurement 2) and after the series of procedures (measurement 3). There was no significant difference in the level of anxiety as a trait before the first massage (measurement 1) and after the first massage (measurement 2) (fig. 2).
Fig. 2. Average points for STAI trait anxiety in three surveys (before the first, after the first and after the last massage).
The greatest difference of level of anxiety as a state was among the men (21-40 years old): before the first and after the first massage (p=0.009) and before the first and after the last massage (p=0.039). There was no difference in trait anxiety.
A significant difference in the level of anxiety as a trait was noted before the first and after the last treatment in women in the age groups 21-40 (p=0.007) and 41-49 (p=0.008). Among younger women the greatest difference in level of anxiety as a state was between the 1st and 3rd measurement (p<0.001).
In world literature, little interest is devoted to the effect of massage on the human mental sphere. Currently, many research centres are conducting research concerning the positive influence of massage on the increase of immunity, pain relief, and improvement of mental condition in oncological patients (12-14). Imanishi et al. (13) proved that under the influence of aromatherapy massage, there was a statistically significant reduction of anxiety (as a state and as a trait) measured by the Spielberger questionnaire. The examined group contained 12 women with breast cancer. Deng and Cassileth (12) proved that massage, together with other procedures, such as acupuncture and hypnosis, not only has a positive effect on the level of anxiety, but also considerably reduces chronic pain in the terminal phase of cancer.
The influence of massage on chronic pain in various conditions (slipped disc, fibromyalgia, migraines, muscle pain, wrist tension complex) was the subject of research by Tsao (15). In all cases, a reduction of pain was noted.
In the United States, Beider and Moyer (16) applied massage in practice and therapy of children (older than 2). Using the modified Spielberger questionnaire (STAIC – version for children), they observed a reduction of anxiety level as a state and as a trait.
The quoted literature concerns ill people. Some authors attempted to evaluate the effectiveness of massage in healthy people. Examination of students with the use of massage and the Spielberger questionnaire (STAI) was conducted by Zeitlin et al. (17). It was found that after one procedure of classic massage, the level of anxiety as a state is considerably lower. The authors suggest practical use of massage as an effective tool for combating "exam stress”. Relaxing massage has also been applied as part of the sports training process. Athletes receive massage in the competitive season as mental training (18). Lipnicki and Pawelec (19) proved the relation between sports massage and personal features measured by the neuroticism and extraversion scale (Eysenck test).
The above research explicitly proves the wide spectrum of effects of various forms of massage, in both rehabilitation and prevention. There is, however, no agreement as to the methodology of performed massage: the choice of techniques, the methods of their performance, the choice of body part to be massaged, the duration of one procedure, the number of procedures in a series, or the duration of breaks. In many cases, the applied forms of massage are not reflected in the adopted methodology (2-4). It is known, however, that depending on the way of performing the techniques, one may influence the nervous system. Some techniques have a relaxing effect (stroking, shaking), and others have a stimulating effect (pressing, tapping). A massage which is to reduce the level of anxiety should be performed according to the canons of relaxing massage (1, 2, 4, 6). This was an inspiration for research with the use of classic relaxation massage.
1. The presented results indicate that the massage positively influenced the level of anxiety, both as a state and as a trait.
2. It seems justified to compare commonly applied relaxation techniques with the effects of massage in further research.
3. The research should also be conducted on a bigger group of people, e.g. sportsmen.
1. Benjamin PJ, Lamp SP: Understanding Sports Massage. Human Kinetics, Champaign, 2005. 2. Podgórski T: Masaż klasyczny (leczniczy, relaksacyjny, sportowy). Medikon, Warszawa, 2007. 3. Walaszek R (eds): Masaż z elementami rehabilitacji. Mehmed, Kraków, 2001. 4. Zborowski A: Masaż klasyczny. AZ, Kraków, 2004. 5. Vickers A, Zollman C: ABC of complementary medicine. Massage therapies. BMJ 1999; 319: 1254-1257. 6. Magiera L: Relaksacyjny masaż leczniczy. Bio-styl, Kraków, 2006. 7. Magiera L, Walaszek R: Masaż sportowy z elementami odnowy biologicznej. Biosport, Kraków, 2004. 8. Sosnowski T, Wrześniewski K: Polska adaptacja inwentarza STAI do badania stanu i cechy lęku. Przegląd Psychologiczny 1983; 26/2: 393-411. 9. Wrześniewski K, Sosnowski T, Matusik D: Inwentarz stanu i cechy lęku STAI. PTP, Warszawa, 2002. 10. Stupnicki R: Biometria. Margos, Warszawa, 2005. 11. Rakowska-Muskat M: Autoterapia i profilaktyka narządu ruchu w modelu holistycznym medycyny manualnej. Humanus, Zakopane, 2006. 12. Deng G, Cassileth BR: Integrative Oncology: Complementary Therapies for Pain, Anxiety and Mood Disturbance. CA Cancer Journal of Clinics 2005; 55: 109-116. 13. Imanishi J et al.: Anxiolytic Effect of Aromatherapy Massage in Patients with Breast Cancer. eCam 2007; 1-6. 10.1093/ecam/nem073. 14. Smith MC et al.: Outcomes of therapeutic massage for hospitalized cancer patients. Journal of Nursery Scholarship 2002; 34: 257-262. 15. Tsao JCI: Effectiveness of Massage Therapy for Chronic, Non-malignant Pain: A Review. eCam 2007; 4(2): 165-179. 10.1093/ecam/nel109. 16. Beider S, Moyer CA: Randomized Controlled Trials of Pediatric Massage: A Review. eCam 2007; 4(1): 23-34. 10.1093/ecam/nel1068. 17. Zeitlin D et al.: Immunological effect of massage therapy during academic stress. Psychosomatic Medicine 2000; 62: 83-84. 18. Boguszewski D, Adamczyk J, Dąbek A: Relaksacyjny masaż klasyczny jako element treningu psychologicznego. [In:] Kuder A., Perkowski K., Śledziewski D. (eds.): Proces doskonalenia treningu i walki sportowej - diagnostyka 2008; V: 405-409. 19. Lipnicki W, Pawelec R: Ocena wpływu masażu sportowego na wybrane cechy osobowości. Medycyna Sportowa 1994; 42: 16-17.