Massage techniques for rheumatoid arthritis

How Massage Helps Ease Rheumatoid Arthritis Pain

Massage isn’t just an occasional feel-good indulgence — it can be a great form of rheumatoid arthritis treatment. Need proof? According to research published in May 2013 in Complementary Therapy in Clinical Practice, study participants reported relief from pain and stiffness after four once-a-week moderate-pressure massages on arms affected by rheumatoid arthritis, supplemented with daily self-massage at home. They also reported having a stronger grip and a greater range of motion than those who were given only a light-touch massage.

Earlier research, published in the same journal, found that massage had similar benefits for RA pain in the hands and also reported that the combination of weekly massage therapy and daily self-massage led to improved mood and better sleep.

Massage therapy expert Tiffany Field, PhD, founder and director of the Touch Research Institute at the University of Miami Miller School of Medicine in Florida, led both studies. For the research that looked at massage for RA pain on the arms, she defined moderate pressure as “pressure that moves the skin.” Each person has his own comfort level. “Massage therapists will ask you where you feel pain and also whether the pressure they are applying is enough,” Dr. Field said. If you want to duplicate the results of her research, aim for pressure that is firm but not so deep as to be painful.

Though the bodywork treatment has benefits for people with rheumatoid arthritis, the question of how long those benefits might last remains unanswered. You might need ongoing treatments or tune-up visits when your pain and stiffness return.

“Massage has been shown to be useful in reducing pain temporarily,” explained A. Lynn Millar, PT, PhD, chair and professor of the department of physical therapy at Winston-Salem State University in North Carolina. And best of all, she added, there’s no reason not to include massage as part of your RA treatment.

Different Massage Treatment Options for Rheumatoid Arthritis

Although there are many types of massage, only two — moderate-pressure massage and myofascial release — have research support for pain relief for RA, but you can explore others as well.

Results are encouraging. For instance, in a study published in November 2015 in Complementary Therapies in Practice, researchers found participants who received a moderate-pressure massage targeted to the knees reported reduced pain and greater range of motion. Researchers speculate that the pain relief may be tied in part to an increase in the brain’s serotonin output, which the authors note is the body’s natural pain suppressant.

Consider these four massage choices:

Myofascial release. This is a style of hands-on therapy that involves longer pressure on select areas of the body to break up tight connective tissue. Research shows this style of therapy, applied three times a week for two weeks, can provide relief of pain and other RA symptoms. As part of the research, Carol Davis, PT, professor emerita of physical therapy at the University of Miami Miller School of Medicine, studied the use of myofascial release in the treatment of various conditions, including rheumatoid arthritis. She explained that the extended pressure (more than three minutes) applied in targeted locations on the body helps change the underlying structure of connective tissue, correcting structural changes that could be contributing to pain. Myofascial release could be effective by stimulating blood flow and triggering the body’s natural anti-inflammatory actions, she suggested. However, clinical trials have not shown this yet.

Swedish massage. The best-known massage technique, Swedish massage uses long strokes of varying pressure to ease and unknot muscles. You might ask for a moderate-pressure version of this style to achieve results similar to those in the research studies. Massage therapists who use this style might include lotions or oils during the session.

Hot stone massage. This style of massage combines hands-on therapy for knotted muscles with the application of hot stones that can relax muscles and ease pain. Hot stone massage is sometimes offered at spas. Millar advised caution with heat, however, as it might aggravate inflamed joints.

Deep-tissue massage. Deep-tissue massage uses intense pressure and tissue manipulation to address stiffness and soreness. However, if the pressure seems too great, don’t continue with this style of massage.

Finding the Right Massage Therapist

Try these strategies to get the best massage treatment fo you:

Ask for referrals. Talk to your medical team, physical therapist, or others with rheumatoid arthritis to get a recommendation for a massage therapist.

Look for experience. “You want a massage therapist who understands the rheumatoid arthritis disease process,” Millar noted.

Explain your pain. Be specific about the joints that hurt and how much they hurt. For example, even though moderate-pressure massage is helpful, Millar warned that deep pressure or high heat applied to joints that are actively inflamed could actually make pain and swelling worse.

Drink lots of water. Davis explained that massage with any degree of pressure will affect the water flow in your body and will be more effective if you are well-hydrated. “We recommend drinking half your weight in ounces of water,” she said. So if you weigh 150 pounds, aim for 75 ounces of water daily.

Ask for self-massage pointers. “You can reach most areas on your body,” said Field. Daily self-massage reinforces the pain relief.

A massage treatment, whether weekly or more frequently, could be a soothing addition to your RA treatment plan.

Rheumatoid arthritis (RA) is a chronic (long-term) disease. Rheumatoid arthritis symptoms can come and go, and each person with RA is affected differently. Some people have long periods of remission. Their rheumatoid arthritis is inactive, and they have few or no symptoms during this time. Other people might have near-constant rheumatoid arthritis symptoms for months at a stretch…

Various cultures have practiced massage for centuries, to promote relaxation, relieve tension, muscle aches, and pain. Massage therapy is highly beneficial for rheumatoid arthritis. It’s repetitive and methodical approach is effective in loosening muscles and restoring flexibility. Studies have proven increased blood and lymph circulation, pain reduction and enhanced mobility after undergoing massage therapy. A study conducted at the Harvard University substantial improvement in function and mobility in the treatment group. By measuring grip strength before and after treatment, the scientists were able to determine the level of improvement.

The gentle circular motion of massage enhances oxygen flow, aids transport of nutrients and removes toxins from surrounding tissues of affected joints. During the inflammatory stage of arthritis, massage therapy is not recommended. Although, during remission, therapeutic massage can effectively prevent inflammation and manage symptoms.

What is the best massage technique for rheumatoid arthritis?

The benefits of massage affect people differently. There is no one type or method of massage best for everyone. Rheumatoid arthritis sufferers can benefit from several different types of massage. The depth of the massage, amount of pressure, and style is unique to each massage.

Massage techniques are designed to correct or improve conditions and well-being. There are 100 or more different types of massage methods, and a few popular ones practiced in the U.S. are:

Swedish massage – A variety of strokes and pressure to improve blood flow to the heart. Enhances oxygen absorption in the body; removes toxins from tissues and muscles; stretches tendons and ligaments ensuring pliability. An enjoyable way to reduce stress.

Deep tissue massage –The goal of this technique is to reduce soreness deep within muscle tissue. Muscle stress can block nutrients and oxygen, causing toxic build up resulting in inflammation. Deep tissue massage loosens muscle, stimulating the release of toxins. This will promote blood and oxygen circulation. Deep tissue massage is recommended for people with constant pain and who suffers from musculoskeletal disorders. It involves the superficial and deep layers of muscle.

Shiatsu – A Japanese technique involving gentle finger, hand, and palm pressure to specific areas of the body to relieve pain. These areas are the energy pathways or meridians and once opened, blood and oxygen flow increases.

Reflexology – Reflexologists use finger and thumb massage techniques to particular areas of the hands and feet. They believe “reflex points” exist in these areas which directly correlate to organs, systems and glands of the body.

Myofascial release – A gentle and highly effective massage applied to the myofascial connective tissue to relieve pain and reestablish mobility. The fascia surrounds and connects to all structures of the body. In a relaxed state, it is pliable and able to move without restriction. Inflammatory responses, emotional or physical trauma and surgical procedures produce myofascial restrictions that do not show up on traditional tests ( myelograms, x-rays, CAT scans, etc.). The fascia then becomes restricted and tight, limiting mobility causing strain to other areas of the body. The use of myofascial release techniques enhances strength, movement, and flexibility. Myofascial restrictions are accurately detected by the therapist, who apply adequate pressure to ease release of the fascia, resulting in pain elimination.

Aromatherapy – A massage technique, which utilizes essential oils, originating from plants. The oils are rubbed into the skin during massage to promote healing, boost flexibility, and reduce pain.

Arthritic joints are extremely sensitive to touch. In the beginning a gentle massage technique should be used to apply reasonable amounts of pressure to joints and tissues without hurting the individual.

Massage for Rheumatoid Arthritis: A Beginner’s Guide

By

Jeff Trotti Was this helpful? (27)

Jeff Trotti is a Georgia-licensed massage therapist and owner of Comprehensive Bodyworks in Decatur, Georgia.

I’ve worked as a massage therapist for 30 years, and in that time I’ve massaged many clients with rheumatoid arthritis (RA).

For clients with RA, there’s evidence that receiving massage therapy once a week for four weeks, and then scaling back to once a month, is enough to reap the benefits of massage. These benefits include pain relief and maintenance of joint mobility. In the early stages of RA, massage may even help slow down the progression of the disease.

One of the first questions people with any condition often ask is: Can you fix me?

In the case of RA, the short answer is no. Massage therapy can’t completely heal RA. But it can relieve pain and help you stay active longer.

What You Should Expect from the Massage

I start my sessions by asking clients which areas they want me to work on. Most massage sessions will take about 50 minutes to an hour on the table. I suggest eating an hour or two before your session and visiting the restroom before getting started.

An hour-long massage can range in cost from $50 to $150, with $80 being fairly typical. Depending on your insurance company and your state of residence, there’s a chance the expense could be covered for you (especially if your doctor writes a prescription for you to receive massage therapy).

Most massage therapists will split an hour-long session in half, with the first half involving therapeutic massage and the second half involving relaxation massage.

During the therapeutic massage, the focus will be on the joints that are causing you problems. Most clients with RA need a fair amount of therapeutic massage, but the stage of your disease determines how thoroughly I can alleviate your pain. In the early stages, I can do a lot more to retain mobility in your joints, but if your joints are permanently deformed or calcified, the massage would be more limited.

RA affects every joint in the body, but people tend to notice it first in the smaller joints of the hands and the feet. Depending on your condition, the therapeutic massage will likely focus on your hands, forearms, elbows and shoulders, along with your feet, calves, knees and hips.

The relaxation portion of your massage isn’t geared toward your specific issues. It will involve slower strokes, moderate pressure and is typically full-body. But, as the client, you can decide whether you’d rather focus attention on the upper body or the lower body; it’s up to you.

During the massage, you can expect to feel comfortable and relaxed. Certain areas may feel tender under pressure, but you shouldn’t be in any pain. If anything feels painful, let your therapist know and he will reduce the pressure he is applying. Your massage therapist may also use aromatherapy, oils and other tools when appropriate, or may rely entirely on his hands.

After the massage, it’s pretty common for people to feel a bit light headed, especially if you’re taking a lot of medication. The feeling usually dissipates after 10 minutes. You’ll also want to make a conscious effort to drink plenty of water, as the massage will leave you dehydrated.

You should expect to feel looser and more relaxed for several hours following your appointment.

What You Should Expect from Your Massage Therapist

A good massage therapist will be able to tell a lot about where you’re having pain or stiffness just from your body language before you even get on the massage table. But that doesn’t mean communication is unnecessary. Throughout the massage, it’s very important your therapist ask repeatedly if the pressure he’s applying is okay, and whether certain massage strokes feel good or painful.

I tend to talk to my clients quite a bit during the massage itself, because I find my clients appreciate knowing why I’m doing what I’m doing. For example, I may explain why I’m focusing a lot of energy on a client’s upper forearm when it’s the client’s hand that’s really stiff or in pain. In this case, it’s because the muscles that control the hand actually run all the way up to the elbow, so massaging the upper forearm offers a lot of relief for your hand.

Another important topic your massage therapist should cover is self-massage. Clients with RA really benefit from practicing self-massage between scheduled massage sessions. I spend a lot of time during and after the session instructing clients on how to massage their joints at home. Practicing self-massage is an efficient and cost-effective way of receiving massage therapy every day instead of only once a week.

Ultimately, your massage therapist’s goal should be to help soothe pain, increase mobility and make you as comfortable as possible. If you’re uncomfortable disrobing completely, then a good therapist will work with you on that—even if it means massaging you through a sheet or fully-clothed.

You should take time to consider whether you’d be more comfortable with a male or female therapist. The majority of massage therapists are female, but you’ll likely be able to find a male massage therapist in your area.

I would urge you to find someone who matches these descriptions, but who also meets your specific needs. It may take talking to a couple different therapists—or even trying a few—before you find a perfect fit.

Jeff Trotti is a Georgia-licensed massage therapist and owner of Comprehensive Bodyworks in Decatur, Georgia. You can connect with him at [email protected]

Go Ahead, Try Massage Therapy for RA Joint Pain

Many arthritis patients wonder if massage therapy is right for them. The answer may lie in which type of arthritis they live with, how active their disease is at the time, and the skill level of their massage therapist. Massage is nonetheless becoming a more widely-recognized way to cope with the pain and stiffness of arthritis.

Every year, the Arthritis Foundation teams up with Massage Envy to host a “Healing Hands for Arthritis” event that raises funds and awareness for all types of arthritis. This year’s event will be held across the nation on Wednesday, September 17. Ten dollars from every one-hour massage or facial bought at Massage Envy that day will be donated to the Arthritis Foundation.

Massage therapy is traditionally used for improving flexibility and circulation, easing pain, and reducing stress and anxiety. But many rheumatoid arthritis (RA) patients still shy away from massages out of fear. Ellen Blair of Pittsburgh, Pennsylvania, who has lived with rheumatoid arthritis for 24 years, says she is afraid that “massage will be painful” and says she “doesn’t want to get hurt.”

Learn More About Rheumatoid Arthritis Doctors “

Is Massage Good or Bad for RA?

According to a study presented at the 2007 American Massage Therapy Association National Convention, “Therapeutic massage treatments, while able to achieve qualitative muscle release in an affected joint region, can also positively affect the physiological systems of a patient with RA and help to alleviate and prolong the deteriorating effects of the disease.” A 2013 study also showed that patients with RA in the upper limbs benefited from moderate pressure massage therapy.

“I feel that massage has helped alleviate some of my symptoms. I had a one-hour massage weekly to biweekly for about six months. I believe that by working my muscles it relaxed them, and had less pull on my joints. Plus, it relaxed me, and helped with general pain perception,” said Robin Spector Edds, an RA patient from Flat Rock, Michigan.

Many doctors agree. The National Institute of Arthritis and Musculoskeletal and Skin Diseases claims that, when done by a trained professional, methods like massage can help control pain, increase joint motion, and improve muscle and tendon flexibility. Events such as Healing Hands for Arthritis bring more awareness to the idea of using massage as a treatment for RA and other inflammatory types of arthritis.

“Massage can be beneficial for temporary relief for patients with RA. Swedish massage is the most common type that RA patients ask for,” said Kindle Fisher, an exercise physiologist and massage therapist at Greentree Chiropractic in Pittsburgh, Pennyslvania. “Each person has different pain levels and pain tolerances, so it is up to the massage therapist to communicate with the patient, and for the patient to provide proper feedback.

“A benefit to massage for arthritis patients is that it increases blood flow to certain areas of pain, which helps promote healing and gives a temporary relief,” she added. “However, I believe that deep tissue massage may be a negative treatment plan for some patients with RA. The pressure during the massage can be intense and may cause more pain and stiffness to some patients.”

Massage Therapy: Which Type Is Right for You? “

The Arthritis Foundation suggests researching different types of massages, as every RA patient is different. Robyn Alexander of Tuscaloosa, Alabama, said, “I love a deep tissue massage. I get a biweekly 30-minute massage and then every 4 to 6 weeks, a one-hour full body massage. It made a difference in my mobility, stress levels, and sleep. I can always tell a difference when I miss one and my therapist is sensitive to where I might be hurting or swollen.”

The Foundation of a Good Massage

A good massage starts with a good massage therapist. When looking for a knowledgeable masseuse, patients should ask whether the therapist is a member of the American Massage Therapy Association, whether they are licensed to practice in their state, and whether they are trained in any specific type of massage.

A massage therapist should get to know their patients and find out about their disease history.

“Massage is a great way for people with rheumatoid arthritis to feel better and improve their range of motion so they have more mobility. It’s crucial for a person with rheumatoid arthritis who decides to receive a massage to express any existing joint pain or flare-ups to their massage therapist prior to and during their session to prevent any discomfort and ensure a relaxing experience,” said Dr. Patience White, vice president of public policy and advocacy at the Arthritis Foundation.

Once you find a good massage therapist, you’ll want to decide on the type of massage you need. You should also consult your rheumatologist beforehand to find out what type they recommend.

Patients should keep in mind that a massage is a complementary treatment, and is not meant to replace medication. The National Institutes of Health goes a step further, saying, “In general, there is not enough scientific evidence to prove that any complementary health approaches are beneficial for RA, and there are safety concerns about some of them. Some mind and body practices and dietary supplements may help people with RA manage their symptoms and therefore may be beneficial additions to conventional RA treatments, but there is not enough evidence to draw conclusions.”

To Get a Massage or Not: Making the Choice

If you’re uncertain whether or not a professional massage is for you, you can start at home by practicing self-massage on affected joints, and go from there. A 2007 study published in the Journal of Bodywork and Movement Therapies showed that a group of adults with arthritis of the hand and wrist had lower anxiety and depression, less pain, and increased grip strength after four weeks of self-massage.

Some massage practices also offer “mini” massage sessions of 10 to 15 minutes to focus on one area. A short massage may give you an idea of whether you would like to take the plunge and try a longer or deeper massage therapy session in the future.

By Susan Bernstein and Mary Anne Dunkin
Massage, whether conducted in a softly lit day spa or a treatment room at a physical therapy clinic, is increasingly popular among people seeking to soothe sore joints and muscles, ease anxiety or improve sleep.
Nearly one in five U.S. adults had at least one massage in the previous year, according to the American Massage Therapy Association’s (AMTA) 2017 Consumer Survey. Of those, 42 percent received massage for health or medical reasons such as pain management, soreness, stiffness or injury rehabilitation.
Research suggests that massage can affect the body’s production of certain hormones linked to blood pressure, anxiety, heart rate and other key vital signs. But is massage safe and effective for people with arthritis?
What the Research Reveals
While most research on massage examines its effects on the general population, a number of recent studies have shown its effectiveness in people with arthritis and related conditions.
Knee osteoarthritis (OA). A handful of studies, including a 2018 study published in the Journal of General Internal Medicine, have found massage to be beneficial for people with knee osteoarthritis. The 2018 study, which assigned 200 patients with knee OA into one of three treatment groups, found those receiving a one-hour whole-body massage weekly experienced significant improvement in pain and mobility after eight weeks compared to those receiving light touch or standard care.
Hand arthritis. In an earlier study conducted at the University of Miami, a 15-minute, moderate pressure massage daily led to reduced pain and anxiety and improved grip strength in 22 adults diagnosed with hand or wrist arthritis. The participants were given four weekly massages from a therapist and taught to massage their sore joints daily at home. Results showed that the combination of massages could possibly reduce hand pain up to 57 percent.
Fibromyalgia. A 2014 review of nine randomized trials published in PLoS One found that massage therapy for five weeks or more significantly improved pain, anxiety and depression in patients with fibromyalgia.
Back pain. One of the most common reasons people pursue massage is for low back and neck pain, according to the National Center for Complementary and Integrative Health. A body of evidence confirms its effectiveness for that purpose, including a study of 401 people with chronic low back pain published in the Annals of Internal Medicine. The study found that people receiving 10 weekly sessions of either relaxation massage or structural massage had less pain and were better able to perform daily activities than those receiving usual care (such as analgesic and anti-inflammatory medications, physical therapy and education). However, the benefits of massage were less clear 12 months after message therapy ended. A separate 2014 study in Scientific World Journal found that deep tissues massage alone relieved back pain equally as well as the combination of massage and nonsteroidal anti-inflammatory drugs (NSAIDs).
How Does Massage Work?
How exactly does massage reduce pain and anxiety for people with arthritis? “We know that massage reduces anxiety quite well and can reduce certain painful conditions rather well. But we don’t know how those things are happening,” says Christopher Moyer, PhD, a psychologist at the University of Wisconsin in Stout.
Research has shown that massage can lower the body’s production of the stress hormone cortisol; decrease levels of the hormone arginine-vasopressin, which may lower blood pressure; reduce levels of some inflammatory cytokines including IL-4 and IL-10; and increase production of the mood-boosting hormone serotonin.
There are many variables involved in how massage may work to ease pain, stiffness and anxiety, says Rosemary Chunco, a licensed massage therapist in Plano, Texas, who treats many patients with arthritis and related diseases. “The actual mechanism that comes into play is still under investigation. For example, a more restful sleep that results from a massage may help with arthritis pain.”
What matters most is the level of pressure used in the massage, says Tiffany Field, PhD, a research psychologist at the University of Miami Medical School. Field published a 2010 study in the International Journal of Neuroscience that showed stimulating pressure receptors – or nerves under the skin that convey pain-reducing signals to the brain – with moderate pressure leads to reduced symptoms.
“The critical thing is using moderate pressure,” says Field. “Light pressure, just touching the surface of the skin or brushing it superficially, is not getting at those pressure receptors. Light pressure can be stimulating, not relaxing.”
Considerations Before You Try Massage
If you’re interested in trying one of the many types of massage as a way to ease your arthritis symptoms, it’s important to consult your rheumatologist or primary-care physician first to ensure that massage is safe for you. Some techniques may involve strong pressure to sensitive tissues and joints or moving limbs into various positions that may be difficult for someone with damaged joints from a disease like rheumatoid arthritis or ankylosing spondylitis.
Use caution when considering massage if you have:

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