Hello, International Arthrofibrosis Association! As a representative of the massage therapy profession, it is my pleasure to offer you this short piece about how massage therapy might be helpful for AF.
To begin: I am not a doctor or physiotherapist or any other kind of medical professional, but I am deeply knowledgeable about two things: massage therapy, and where it intersects with diseases or conditions that might impact our clients’ health.
It was in the context of my podcast that I first heard about arthrofibrosis
It was in the context of my podcast that I first heard about arthrofibrosis; that episode is available here. In the process of preparing that 15-minute talk, I encountered the IAA and the work of Dr. Usher—who very generously let me interview her, with about 2 hours’ notice. I then took on the topic for a full column in Massage & Bodywork magazine, which allowed me to do a deeper dive, all with the purpose of discerning what is important for massage therapists whose clients may live with AF. This column will be published in the April/May 2023 edition of the magazine.
And Dr. Usher invited me to write a blog for the IAA about how or if massage therapy might be useful for people with AF.
My first strategy with a project like this is to consult PubMed.gov, the world’s largest database of academic, peer-reviewed articles about the life sciences. But the search terms “massage” and “arthrofibrosis” yield only one study: a case report that found success with an aggressive protocol using stainless steel scrapers on the skin (called the Graston technique) and although this yielded good results in the short term, no long-term follow up was reported to see if this inflammation-promoting intervention might eventually have made things worse instead of better.
Everything that follows is based on massage therapy research, but how it applies specifically to AF is essentially a highly educated guess.
And so here we are: I know a lot about massage therapy, and now I know a bit about arthrofibrosis, but there is almost no data about how these two things might intersect. Consequently, everything that follows is based on massage therapy research, but how it applies specifically to AF is essentially a highly educated guess. However, this information may help people with AF to seek out massage therapists with the skills they need to lead to the best possible outcomes.
Massage therapy can influence blood circulation - The research on how much massage therapy influences blood circulation is surprisingly thin—it depends on how locally or distant from the site of massage one is measuring blood flow. However, simply based on the observation of local skin color, and temperature changes, and tissue pliability, it is safe to state that manual manipulation of tissues causes local capillary dilation and blood flow to that area. This can promote healing and circulatory turnover, especially in areas where blood flow may be limited.
Massage therapy can influence lymphatic circulation and reduce edema. The research on massage therapy in the form of manual lymphatic drainage or lymph drainage technique is robust and positive. These approaches are typically used for people with problems with lymphatic flow—those with lymphedema as a complication of cancer or cancer treatment, for instance. But they have also found use as a post-surgical intervention to reduce edema, and for people healing from orthopedic injuries to manage swelling and pain. These techniques are extremely gentle and can be done safely, even soon after surgery.
Massage therapy might attenuate inflammation. The research on massage and inflammation is scattered, and it looks at a huge variety of modalities and approaches. Overall findings trend toward the possibility that skilled massage therapy may reduce inflammatory markers under certain circumstances. The mechanisms behind this finding are not clear; this is a phenomenon that demands more investigation, because it could be so useful for so many people.
Massage therapy can influence muscle tightness. One type of manual therapy that particularly interests me in the context of AF is work that addresses muscular patterns that might make the situation worse. The threat of pain makes muscles tight: we tighten up to guard against potentially painful movement. These tight muscles can irritate internal structures by compressing the joint, interfering with local circulation, and limiting range of motion. The sensory neurons that tell us how tight we need to be (our proprioceptors) may become accustomed to a high level of muscle tension—which makes it hard to undo this pattern. Massage techniques that address proprioceptive messaging (proprioceptive neuromuscular facilitation and muscle energy technique are two examples) use pain-free contract/release exercises to reduce tightness and improve range of motion.
Welcomed touch can reduce stress and pain. Research confirms this, but we know instinctively that welcomed touch helps people who are in distress to feel better. We automatically soothe a troubled child with an adapted sort of massage, and of course adults can benefit too. Although this work doesn’t address joint damage directly, the effects of stress reduction and a calming affect can support healthy attitudes, choices, and a sense of optimism, all of which can contribute toward a positive outcome.
Massage therapists cannot reach inside a damaged or inflamed joint to put things right. But our skills can help to make the challenges of living with AF a bit easier. I hope this short overview of the possible benefits massage therapy has to offer will prompt readers to seek out our work as part of a coping strategy for living with AF as fully and happily as possible.
About the author:
Ruth Werner is a massage therapy educator who focuses on topics about pathology and research literacy. Her textbook, A Massage Therapist’s Guide to Pathology, was first published in 1998. It is now in its 7th edition, and is used all over the world. Ruth served as the president of the Massage Therapy Foundation (our profession’s nonprofit organization dedicated to advancing the science and practice of massage therapy through supporting research, education, and community service). She also writes columns and feature articles for the award-winning Massage & Bodywork magazine, and her podcast, “I Have a Client Who… pathology conversations with Ruth Werner” publishes weekly at ABMP.com/podcasts.