Download Why does massage make you feel good

Why does massage
make you feel good?
Pleasure that is good for you
Jessica Bale
Therapeutic Massage Course 2004–5
Maitri Foundation, APNT
With thanks for inspiration and dedicated teaching to Sheila and Martin
and patience and humour from all my bodies
Why does massage make you feel good?
Contents
Introduction ......................................................................................................................................... 4
The ‘non-measurables’...................................................................................................................... 4
Contact – attention – care – love ............................................................................................. 4
Expectation – placebo effect .................................................................................................... 5
Meditation – relaxation .............................................................................................................. 6
Healing and immunity ................................................................................................................ 6
Sensation of touch ............................................................................................................................ 6
Sensory neurons ........................................................................................................................... 7
Stimulation of sensory neurons ............................................................................................... 9
Passing signals between neurons .........................................................................................11
Sensory perception ....................................................................................................................12
The measurables .............................................................................................................................12
Effects of touch – why does massage make you feel good? ..............................................13
It feels nice ...................................................................................................................................13
Immediate tissue changes ......................................................................................................13
Autonomic nervous system (ANS) .........................................................................................14
Pain relief ......................................................................................................................................16
Reduction of stress reaction ....................................................................................................19
Stress response .......................................................................................................................19
Post-stress response ..............................................................................................................21
Chronic stress .........................................................................................................................21
Massage and the stress response .....................................................................................21
Different massage strokes – different effects? ........................................................................22
Conclusion ........................................................................................................................................27
Bibliography .....................................................................................................................................27
Notes ..................................................................................................................................................29
All images © Jessica Bale 2005 unless otherwise noted
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Introduction
Why does massage make you feel good? I had learnt about many of the effects of
massage, such as the stimulation of the parasympathetic nervous system, but wanted
to know more about how these effects come about and maybe even to address the
question of why they happen. During the course of my research I have deepened my
understanding of how the nervous system works, the interaction between the
nervous, endocrine and immune systems, neurobiochemistry, how healing may come
about, the importance of touch in human physical, mental and emotional
development, relief of pain, reversal of the stress response and many other more or
less related topics. I have also discovered the difficulty of carrying out research in this
area, something I would like to be involved with at some time in the future. I have
been fascinated by it all (well, most of it!) and envisaged this project growing ever
wider and deeper. However, time being what it is I have had to focus on certain
aspects only and save the broader issues for my continuing interest as I learn more as
a massage therapist.
I have chosen to study as my primary subject the way the nervous system carries
information and the body’s use of chemical messengers in response to massage,
relegating other topics (though of equal interest) to an introductory section. I am also
focussing on the effects that you can actually feel at the time of or immediately
following a massage, although I touch on some of the longer term effects in passing.
This still leaves me a wide range of issues relating to the nervous, endocrine and
immune systems to discuss.
The ‘non-measurables’
The outcome of a treatment is frequently influenced by ‘nonmeasurable’ factors such as the mind–body–soul connection, subtle
healing energies, and the interaction between the patient and therapist.
Cassar 1999: 58
These factors also contribute to making massage feel good. If you feel uncomfortable
with your therapist, it will be difficult for your body to relax and you will be fighting
the physical and chemical processes towards relaxation the therapist is aiming to
produce. Similarly having worries or concerns you cannot let go of may effect the
outcome – massage can help you let go, but does not do it for you.
Contact – attention – care – love
The feeling that someone cares about you and is taking time to care for you (even if
you are paying them) is a powerful factor towards feeling good about yourself. For
many people with chronic illness this kind of regular contact may be essential in
helping them over feelings of isolation or being nothing but a ‘body’ in the health
system conveyor belt.
Paying attention to parts of the body with pain, injury or illness can help someone
focus consciously and unconsciously on that part to enable the body to focus its
healing ability there. The body can also experience a different state than the
painful/injured adapted state, and move towards that as ‘normal’.
James Oschmann refers to intention in this context.
Intentions are not trivial, because they give rise to specific patterns of
electrical and magnetic activity in the nervous system of the therapist
that can spread through their body and into the body of a patient.
Oschmann 2000: 48
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It is in this area that the positive flow of energy in the therapist can help the client’s
body adapt to a more positive position and a greater feeling of well-being. This can
be a whole mind-body feeling or can be in a specific area that was causing pain or
other problems. I find this subject very interesting but difficult to understand. My own
experience is of a feeling of ‘love’ pouring out of me and enveloping my client in a
protective bath where they are free to let go of some of the things that are
preventing healing in mind and body, and to let them find a healthier position for
themselves.
Since the whole body is interconnected, work on one part of the body may affect and
help another become more healthy.
The living matrix is a continuous and dynamic ‘supramolecular’
webwork, extending into every nook and cranny of the body … In
essence, when you touch a human body, you are touching a
continuously interconnected system, composed of virtually all of the
molecules in the body linked together in an intricate webwork. … Effects
on one part of the system can, and do, spread to others.
Oschmann 2000: 48
Ruth Werner talks about massage as being a ‘pleasure that is good for you’ (Werner
2003). There are many pleasures we indulge in that are not good for us and we often
have trouble allowing ourselves pleasure at all. We can regard massage as treatment
for a particular problem and thereby allow ourselves a wholesome pleasure too. So
we can experience the positive feelings of doing something pleasurable without
perhaps the guilt we may feel in other circumstances.
Emotions and sensations work together as I will discuss later with reference to
neuropeptides. Positive feelings that someone is caring for you can alter the chemical
state of your body to be more active in healing and restoring its balance.
… effective bodywork is an act of intimacy and deep sharing of
sensibilities, a communication, a communion, and ultimately the basis
for a new sense of community. It is in utter contrast to the grim social
bonds described by Malthus, the ruthless competitiveness presumed by
Darwin, and the self-serving Id and Ego of Freud. It is a personal
exchange untainted by obligations and power struggles, and as such is
an opportunity to see, and to feel, and to understand both ourselves
and another in an entirely new way.
Deane 2003: 406-7
Expectation – placebo effect
Belief that massage can be helpful has a powerful influence on the
recipient’s self-healing mechanisms.
Cassar 1999: 58
The thought that something is ‘just what we need’ can be sufficient to be ‘just what
we need’. This can apply to food or drink, going for a walk, a long talk or even a good
cry. It is not infallible but being in tune with our bodies can give us an insight into
what will help us feel better.
The placebo effect is a response to a treatment intervention that is unexpected and
not easily explained, although often it has been suggested by the practitioner. This
effect is inherent in all medical treatment and may simply reflect the body’s ability to
respond favourably if both the client and the practitioner believe a treatment or
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procedure is going to work. While the response mechanism is unknown, it is not
imaginary (NPF 2005).
Meditation – relaxation
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 [autonomic nervous system]
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.
Noonan 1999
Healing and immunity
This subject belongs both here and in the measurable section but as it is difficult to
feel during a massage I will only deal briefly with it.
The body’s healing and immune systems are stimulated by the stress response to
injury or disease to ensure that any tissue damage can be dealt with quickly.
However, after about half an hour of stress the body’s resources are diverted away
from healing towards immediate life-conserving activities (ie energy and oxygen use)
(Sapolsky 2004: 154). So if continuous stress is a problem for someone their ability to
heal themselves will be compromised. Massage reverses the stress response (see p21)
and can therefore start the healing process.
There appear to be many neuropeptides involved in healing and immunity that are
affected in various ways by our response to injury, pain and disease. These are vital
self-protection but may become out of balance. It has been shown that massage can
help this balance (eg increase in natural killer cells in Field 2000: 201-5). This may not
result in an effect that can be felt immediately, but can set our bodies on a path
towards better health.
Sensation of touch
The sensation of touch in its many forms is the brain’s interpretation of the many
messages it receives when a person is touched. A touch can be a feather light stroke
or the shortest pin prick, a thump, or a stab penetrating the skin, but a healthy brain
can distinguish between them, know where the contact is and react appropriately if
necessary.
The messages are sent from sensors throughout the body as electrical and chemical
impulses along nerves to the spinal cord; some go on to the brain via nerves called
interneurons. Since humans have more than a thousand billion nerve cells this system
is amazingly complex.
The sensors are neurons with special capabilities to detect variables such as pain,
pressure and temperature. There are two main types: mechanoreceptors monitor the
position of connective tissue responding to weak signals, gentle pressure and
movement and the normal range of motion at the joints. They are inhibited by
nociceptive input. They are found through nearly all connective tissue.
Nociceptors monitor abnormal input in connective tissue which results in changes in
the sympathetic nervous system and can cause dramatic changes in the body. They
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are inhibited by mechanoreceptor stimulation. They are found through nearly all
connective tissue (AMMA 2003b).
These sensory neurons do not receive information from other neurons, but generate
an electrical signal when triggered in their specialised endings, which is transmitted
along the nerve axon to other nerves.
If the stimulus is strong enough a charge is generated which is passed along the
nerve cell and sent across a gap to fire the next nerve cell and so to the brain. Each
neuron sends the signal to many different neurons which will pass it along if there is
a sufficient number of incoming signals. The message is acted upon in the spinal cord
(reflex action) and brain (perception and action), again if there are enough incoming
signals. The central nervous system discards more than 99% of all incoming signals as
irrelevant.
The action initiated by the brain could be muscle contraction or relaxation,
stimulation of the sympathetic or parasympathetic nervous system or release of
neuropeptides, transmitters and hormones among others. All these actions are
activated by sending signals through motor neurons as an electrochemical charge in
much the same way as other nerves.
Sensory neurons
There are sensory neurons all over the body which respond to different kinds of
stimuli from inside and outside the body. Massage can stimulate many of these such
as those listed in the table below. Sometimes the more specific senses such as hearing
and smell can also be stimulated by the setting of the massage (eg using essential oils
or playing music) but I am not going to deal with these here.
Table 1 Sensory neurons
Type of
sensor
Location
Stimuli
Free nerve
ending
Densely
throughout the
skin,
periosteum and
joint surfaces in
varying
branching
forms; deeper
in the body but
sparsely
Light continuous
touch; pressure;
mechanical,
thermal and
chemical pain
Wrapped
around all hairs
Movement of the
hair
Slow
adapting
so fires
while
stimulus
present
Hair
follicle
organ
Image
Fast
adapting
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Meissner’s
corpuscle
Fast
adapting
so fires
again
when
stimulus
ceases
Ruffini’s
end organ
Slow
adapting
Pacinian
corpuscle
Fast
adapting
Merkel’s
disc
Slow
adapting
Krause’s
corpuscle
Throughout
skin but
abundant on
lips, fingers,
genitals etc,
just below the
surface of the
epidermis;
ligaments,
tendons and
periosteum
Very light moving
pressure;
discriminative
touch; lowfrequency
vibration;
movement and
location of limbs
Deep in the
skin; joints;
muscle; tendon
Continuous
pressure on deep
tissues;
movement and
location of limbs
Deep in the
subcutaneous
layer of the
skin; joints;
tendons;
internal organs
High-frequency
vibration;
pressure changes
Lower
epidermis of
the skin
Light pressure;
discriminative
touch
Eyes, lips,
tongue,
genitals
Touch; possibly
cold
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Golgi
tendon
organ
Junction
between
muscle and
tendon
Stretch or
contraction of
tendon – muscle
force
Musclespindle
organ
Muscle
Speed of muscle
contraction (used
to control rate of
contraction)
Stimulation of sensory neurons
I am going to use a pacinian corpuscle as an example sensory neuron to show how a
signal is generated. At rest a pacinian corpuscle (in common with other cells) has a
difference in electrical potential of about 60 mV – the inside is negatively charged
and the outside is positive. This is caused by the concentration differences in various
ions between the inside and outside of the cell and means that if a channel is opened
in the membrane, ions will flow from high concentration to low. These channels are
twisted protein chains formed into tubes inserted in the membrane which can open
and close in response to many different stimuli and are ion-specific.
When a pacinian corpuscle is deformed by pressure on the skin, the membrane
surrounding the inner nerve ending is stretched and the sodium ion channels are
opened. Sodium ions (Na+) move from the positively charged outside of the neuron
into the negatively charged inside down the sodium concentration gradient. This
causes the internal electrical charge to change from negative to positive. This is a
generator potential and the beginning of the electrical signal. It then triggers the
adjacent sodium channels to open, changing the polarity in the next section of nerve
and moves the electrical charge along. At the same time the sodium ions are pumped
back ready for the next stimulus1.
When the first node of Ranvier (the gap between Schwann cells) is reached an action
potential is triggered. This works in a similar way to a generator potential. Action
potentials use both sodium and potassium channels to send a strong, quick signal
which does not reduce with distance. This signal carries on down the axon of the
neuron to the end where it is converted into a chemical signal and carried to the next
neuron. The charge jumps over the myelinated areas of the Schwann cells increasing
the speed the charge moves.
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There needs to be sufficient stimulus (in this case pressure) to reach the threshold for
that neuron to trigger a reaction. Greater pressure will increase the number of
generator potentials triggered. In the pacinian corpuscle the reaction is very rapid –
the neuron adapts very quickly to the stimulus and stops sending signals. It is also
triggered when the pressure is released – so sends the signal to the brain that the
stimulus has stopped. Other sensory neurons adapt more slowly and carry on
sending signals while the stimulus is in place.
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Action potential – when the charge inside the neuron reaches the firing threshold an action
potential is triggered
When a number of sensors in an area are stimulated by a touch they may all be
triggered and each send one or more signals. This information is distributed through
branching axons to many other nerves which integrate the information coming from
different nerves. If the signal is strong enough in any receptor nerve, an action
potential will be generated in that nerve and again be distributed through branching
axons to yet other nerves. In this way the signal is carried to the brain together with
an indication of its strength by the frequency of the signals.
Passing signals between neurons
When the signal reaches the end of the axon it is converted into a chemical signal
which generates another action potential in the next neuron. Again these are
cumulative and there needs to be a certain strength of incoming signal for the action
potential to be triggered in the next cell.
The gap between neurons is a synapse and chemical messengers are used to
communicate between cells across this gap. There are many effects of these
messengers, such as control of ion channels (eg opening, shape, voltage sensitivity),
how the neurons work and use energy and even changing the structure of the
cytoplasm in the neuron. These messengers can act slowly or fast. This leads to varied
and complex signalling to the brain, which interprets and responds.
When the action potential reaches the axon terminal it stimulates the release of
neurotransmitters stored in vesicles there. The vesicles move towards the membrane,
fuse with it and open up to release the contents into the synaptic cleft opposite the
receptors in the postsynaptic neuron. These small-molecule neurotransmitters attach
to the receptors in the post-synaptic membrane causing them to open and allow a
flow of ions through. This changes the polarity (as in the sensory neuron) and so
triggers an electrical charge called a synaptic potential in the next neuron.
The most common neurotransmitters are glutamate and acetylcholine (ACh) which
increase the charge (excitatory) and glycine and γ-aminobutyric acid (GABA) which
reduce the charge (inhibitory). There is also a system that releases mainly peptides
from large vesicles in the side of the presynaptic terminal and these work more slowly
and generally act indirectly via second messenger systems.
The frequency of the action potentials cause varying amounts of neurotransmitter to
be released which is reflected in the size of the synaptic potential produced.
Depending on the transmitter released it can also raise or lower the polarity of the
membrane making it more or less likely that the signal is passed on. Each neuron can
have many other neurons sending it signals. Therefore it has to integrate the synaptic
potentials into a coherent signal to pass on, often to many other neurons. It does this
by adding together the incoming excitatory signals and subtracting the inhibitory
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ones to produce a local potential sent to the initial segment at the base of the axon.
Here, if the threshold for firing is reached, an action potential is propagated and sent
along the axon.
There is an excellent animation of neurotransmission at the Lundbeck Institute’s Brain
Explorer website (Lundbeck Institute 2005b).
Sensory perception
The action potentials are carried by the afferent nerves which run through two
pathways to the brain: the dorsal column system is the white matter of the spinal
cord and transmits precise sensations at high speed; the spinothalamic system is the
grey matter of the cord and transmits cruder sensations such as pain, heat and cold
and pressure at a slower speed.
There are also sensory pathways coming down from the brain which regulate the
signals from the sensory receptors. This allows selection of sensory information to
occur based on previous experience and other incoming sensations at the time. This
is why pain is so relative and ‘felt’ so differently by different people.
Response to sensory information also occurs unconsciously in the spinal cord and
lower brain. It is only when the signals reach the cerebral cortex that it becomes
conscious. But all parts of the nervous system act in a highly synchronised way
responding to the multitude of information being fed to it and keeping the body
alive, healthy and active by directing the muscles, glands and organs.
The information that controls the body runs along nerves in the same way as the
sensory information through two pathways: the direct corticospinal pathway forms a
direct connection between the cortex and specific motor neurons in the spinal cord.
It is very fast and controls fine, conscious movements. The second is the
multineuronal pathway which is a series of neurons that interconnect through the
lower brain and organise the reflex actions of the spinal cord. This controls the many
movements that occur unconsciously and that are needed to carry out a conscious
movement (eg walking) as well as control of organs and glands. Both pathways work
closely together to enable our bodies to stay alive and be under our control.
If bodywork is to be more significant than just so many pokes and rubs,
if it is to effect lasting changes, then it must not merely address the
tissues. It must use tactile sensations to reach the mind, the whole mind,
from the surface of the skin to the spinal reflexes, to the subconscious
responses of the lower brain, to the fields of awareness in the cortex.
When this happens, touch is genuinely, profoundly therapeutic.
Juhan 2003: 182
The measurables
I have to say first of all that these issues are strictly speaking measurable, but in
practice many are difficult to measure accurately. There are many reasons for this.
The main one is the sheer size and complexity of the body and the incredible
interconnectedness of its systems: 10 billion neurons each with up to 10,000
connections and 10 times that number of supporting glial cells; at least 60
neuropeptides affect the nervous system each with their own receptors, often many
different kinds on each cell; the endocrine and immune systems as well as gene
expression all affect how the nervous system works. In addition there are the effects
of non-measurable factors such as an individual’s past experience and the physical
and emotional interaction of between client and therapist.
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In scientific research one of the aims is to distance the researcher from the subjects, to
have an objective result. Even when studying drug response the expectations of the
subjects, their personal circumstances and even the way they have been treated in
the past can all affect the outcome despite all efforts to remove these effects. With
massage therapy the effects are all brought about by human interaction and so if
these are diminished by controls you risk losing the very effects to be studied.
There are also many areas of interaction we are only beginning to be able to study,
such as the interaction of energy fields between people, how emotional states may
be transferred, and so on. I imagine these may become measurable as we develop
our knowledge and experience, but for the moment they are outside the scope of
this project.
There have also been issues with the methodology of some of the earlier research in
the field, which casts some doubt on the findings of that research. Tiffany Field
outlines the problems in the introduction to her review of the work at the Touch
Research Institutes (Field 2000): a lack of properly conducted clinical trials with poor
controls, small sample sizes and multiple treatments given to subjects with varying
levels of problems. Coupled with the variety of massage therapy techniques used, this
has made it very difficult to compare different pieces of research and build a broad
picture. The Touch Research Institutes have now conducted many experiments to
show what effects massage therapy does have in relation to a range of pathologies.
Effects of touch – why does massage make you feel good?
It feels nice
For many people being stroked feels nice – the brain interprets the sensation of most
massage strokes as pleasant. Exceptions to this obviously include uncaring massage
or a ‘no pain no gain’ attitude, as well as associations with previous unpleasant or
abusive experiences connected to touch. The sensory neurons register the pressure,
touch, stretch, movement, heat and vibration going on in the body and send these
messages as electrochemical impulses to the brain which perceives pleasure.
Immediate tissue changes
The ‘ahhh’ feeling when a stiff, tight muscle is released is caused by a number of
factors.
Under- or overused muscles, old injuries and scar tissue, adhesions and calcification in
muscle and connective tissue can be uncomfortable and painful. Massage over these
areas stretches the muscle to pump fresh blood through, reduces congestion and
disperses toxins through the lymph and venous circulation. It can break down areas
of calcification mechanically and by heat and break apart areas where adhesion has
occurred.
When over contracted muscles relax, they feel less painful and much more alive, with
an easier, wider range of movement. Massage has been shown to relax muscles by
studying the level of motor neuron excitability. This research measured how easily
the motor neurons in the spine sent reflex control messages to particular muscles.
Light and deep pressure, muscle tapping, as well passive stretching of tendons and
muscles stimulates a wide range of receptors in the skin, muscle, tendons and joints
which resulted in a reduction in excitability. It also showed that work on arm muscles
can relax the muscles in the same side leg (Cassar 2004). So if muscles contract less in
extent and frequency they also send messages to the brain to relax generally as no
other action is currently required. The brain then feeds back messages to reduce the
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excitability of motor neurons when it registers relaxation in the body: this process is a
positive feedback mechanism that deepens the relaxation of the muscles.
Releasing muscle contraction also gives more space to the adjacent nerves and blood
supply causing better transmission of nerve impulses and circulation. The nervous
system is particularly susceptible and becomes ineffective when not adequately
supplied with oxygen. This increases the system’s efficiency and amount of sensory
information available which contributes to the ‘more alive’ feeling the body can have
after massage.
Asthma, coughs and other respiratory problems can cause tightness in the muscles in
the area around the lungs and shoulder girdle. Breathing can become immediately
easier if these muscles are more relaxed with a resulting increase in relaxation and in
oxygen supply to the whole body.
Connective tissue (ground substance, blood, fascia, bone and organ covering,
tendons, ligaments, cartilage, bone) is thixotropic. When not used fully it gels too
much and becomes stiffer: this makes it difficult to transport essential items such as
oxygen and waste products and results in congestion. It becomes harder to use that
part of the body so it feels stiff and sore and can also mean other parts of the body
are over-used to compensate for this lack of movement. The pressure and stretching
of massage warms the connective tissues through friction and increases their
metabolic rate and therefore their fluidity. This normalises the tissues and makes the
affected area feel better – more alive and active (Juhan 2003: 68-9).
James Oschmann (Oschmann 2000: 168–73) also discusses the effects of pressure on
the connective tissues of the body. The gel (solid) state of cells and connective tissue
becomes more fluid under pressure and then returns to gel when the pressure is
released. This happens very quickly but enables trapped particles such as toxins to be
flushed out into the interstitial fluid and so out of the body via the lymphatic and
venous systems. These waste products get trapped in areas that become ‘densified’ as
a result of trauma or disuse – this can result in a hardened feeling in the tissues
accompanied by a feeling of stiffness or pain.
The abdominal area can cause pain and tension when the digestive system is not
working properly. Abdominal massage can ease this by moving the contents of the
gut, clearing the ileocaecal valve and relaxing abdominal muscles contracted from
pain. It also stimulates the vagus nerve, which controls the digestive system,
encouraging better action. The effects of the massage can often be felt immediately
when peristalsis is improved. Longer term improvement involves peptide release to
stimulate better digestion and a general improvement in the working of the gut.
Autonomic nervous system (ANS)
The ANS controls the unconscious functioning of the body although it is possible to
bring some aspects of it under conscious control. There are two systems within this:
parasympathetic and sympathetic. The sympathetic nervous system is a survival
mechanism which enables immediate action in the face of danger and keeps our
major organs functioning. The parasympathetic controls the energy production and
conservation systems of the body and stimulates the digestive, immune and
reproductive systems into normal action aiding rest and repair. Both these systems
work together to maintain an alive, healthy, reactive balance in the body’s major
organs and systems.
If the ANS is out of balance caused by too many stressors we risk a range of illnesses
leading in the extreme to death or a slide into inaction (and again death) if there are
too few. Our current western-style society leads more often towards an over active
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sympathetic system as we deal with a continuous barrage of stressors in day to day
life. Massage can work to rebalance the system and has a particular effect in
stimulating the parasympathetic system (see p21).
Receiving non sexual, nurturing, non threatening touch is one of the
most important ways humans and other mammals have to keep a
healthy stress response.
Werner 2003b
Relaxation is a state of deep rest in which the metabolism of the body slows: less
oxygen is needed, the heart and respiration rates drop, blood pressure drops, and
brain waves slow to an alpha state. It is induced by massage when the
parasympathetic nerves are stimulated by the brain interpreting incoming sensory
information as non-threatening, by the muscles relaxing and the release of certain
neurotransmitters. This also affects emotional state and behaviour, leading to feelings
of calmness and contentedness replacing anger or depression.
There are over 60 different neuropeptide transmitters (the most recent count I could
find) that have been shown to affect neurons and how they work producing a
system of great complexity.
 They may have an excitatory or inhibitory effect, or both, and there can be many
influencing how one cell works; this is mainly effected by the variety of receptors
available.
 They are made from a small number of different chemical precursors.
 Many are found in non-neuronal tissue (eg 95% of serotonin is found in the gut);
some are traditionally known as hormones (eg vasopressin or anti-diuretic
hormone) or hormone regulators (eg thyrotropin-releasing hormone); some
interact with the immune system.
 The parasympathetic nervous system activates some (eg serotonin) and the
sympathetic others (eg histamine).
 ‘Each neurotransmitter is made by a small number of neurons whose cell bodies
are clustered in specific areas of the brain. For example, noradrenaline is
synthesised mainly by neurons in the brainstem … the cell bodies of the dopamine
neurons are clustered in a few brain regions, most importantly those deep within
the midbrain, in the substantia nigra. However, the axons of these neurons extend
throughout the brain and influence almost the entire organ.’ (Lundbeck Institute
2005)
It has been shown that massage affects the levels of a number of these neurotransmitters (Field 2000) decreasing stress, anxiety and improving mood. Field also
notes a balancing of frontal EEG activation after massage, indicating a shift away
from depression. She hypothesises that these factors may be linked in the changes
that massage is causing in the chemical and electrophysiological systems of the body.
Particular neurotransmitters are known to cause certain effects but as they interact
with each other and other substances such as hormones there are probably many
more actions than those currently understood. I will look at some here – others will
be discussed under pain and stress relief.
Serotonin
Serotonin secretion is increased by massage (Field 2000). It is found mainly in the gut
where it plays an important role in digestion. It has been shown that it is secreted in
response to vagal stimulation, increased pressure in the gut and when the peristaltic
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Why does massage make you feel good?
reflex is initiated and that it is also involved in initiating that reflex2 (Gershon 2001).
It is also involved in cardiovascular regulation. The release of serotonin in the gut in
response to increased pressure from a large meal is responsible for that sleepy, afterdinner feeling.
Only about 2% of serotonin is found in the brain, but it is involved in a wide range of
brain functions. It is concerned with mood control, regulation of sleep (melatonin is
made from it), pain perception, body temperature, blood pressure and hormonal
activity.
Serotonin generally produces feelings of well-being and comfort. However, the
complexities of neurotransmitter interaction probably mean it is implicated in a wider
range of effects than this.
Dopamine
There is some indication that massage increases dopamine levels in the brain
(Field 2000). Dopamine controls the flow of information between the frontal lobes
and other areas of the brain which could be connected with the balancing effect of
massage on frontal lobe activity3 (Jones 1999). This increases happy affect and
dopamine is mainly associated with activating feelings of pleasure and enjoyment. It
also appears to increase desire and motivation. It has other effects and is critical to the
way the brain controls our movements.
Histamine
Histamine is released in response to antigens in the body to produce many of the
effects of inflammation and hypersensitivity and is generally considered an effect of
the sympathetic nervous system. It relaxes the vascular smooth muscle to dilate the
capillaries decreasing blood pressure, makes the capillaries more permeable which
allows fluid to escape into the tissues creating oedema and inflammation, and
contracts bronchial smooth muscle. These protect the body and allow the immune
system to deal with the antigens. It also stimulates gastric secretion and acts as a
neurotransmitter. It is thought that massage stimulates histamine relief which is
responsible for lowered blood pressure.
Pain relief
Pain is a language. To the body it is a language of expression. To the
therapist it is a language of science and physiology. … Pain may be
related to tissue damage and pain stimuli, or it may not be. Pain is an
unpleasant experience in the body that is ‘filtered’ through our mind
and emotions, and as such is experienced differently and expressed
differently from individual to individual.
AMMA 2003a
Pain is useful to the extent that it motivates us to modify our behaviors
in order to reduce whatever insult is causing the pain, because
invariably that insult is damaging our tissues. Pain is useless and
debilitating, however, when it is telling us that there is something
dreadfully wrong that we can do nothing about.
Sapolsky 2004: 187
We need pain. It protects us from ourselves and the environment. But disease that
has chronic pain as a symptom is debilitating on top of any other symptoms felt.
Chronic muscle pain due to contracted or damaged muscles drains energy and
distracts from enjoyment of life.
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Why does massage make you feel good?
Pain can be immediate, acute or chronic.
In the immediate phase following injury or trauma there may be little or
no pain perception, it is in this stage that other behaviors such as the
fight or flight response may take precedence as the body attempts to
avoid further pain.
In the acute phase the pain provokes coping mechanisms and
preparation for recovery, which may include seeking assistance with the
injury or trauma.
The chronic phase of healing and recuperation is characterized by
behavior related to recovery, rest and management of the injury for the
goal of complete restoration of function.
AMMA 2003a
Pain comes in various forms according to its underlying cause but is felt in many
different ways by different people.
Table 2 Different types of pain
Neuropathic Caused by
damage or
pain
dysfunction of
nervous system
Damage caused
by mechanical,
chemical,
heat/cold,
disease eg herpes
zoster
Follows
dermatomes ie
area of skin
innervated by
single nerve
root
Localised,
sharp pain or
pins and
needles or
numbness
Nociceptive
pain
Abnormal
temperature,
mechanical,
chemical
stimulation
Follows
sclerotome
pattern ie
along nerve
path
Deep, aching
diffuse pain
Caused by
stimulation of
nociceptor in
myofascial
tissue and
joints
Psychogenic Generated by
mind and
pain
emotions
Can affect
perception of
pain stimulation
Visceral
pain
Mechanical
eg ischemia,
chemical
irritation, acidity,
spasm, over
distension
In visceral
organs and
their coverings
Often referred
to surface of
body
eg gallbladder
to right
shoulder,
cardiac pain up
neck to jaw
Nociceptors are nerve endings that monitor abnormal input in connective tissue
which is generally interpreted by the brain as pain. They are found all over the body
and help the brain to deal with injury. Neurotransmitters such as bradykinin,
histamine, prostaglandins and substance P are released at the injury site, increase the
pain threshold and stimulate the nerve endings to send the pain signal to the brain
which can then take action.
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Why does massage make you feel good?
Opioid peptides
Endogenous opioid compounds – enkephalins, dynorphins endorphins – are made
and released in pain perception parts of brain. They reduce the firing threshold for
neurons that carry pain messages to the brain to cause analgesia and sedation.
The endogenous opioids are a large family of neuropeptides widely
distributed throughout the central and peripheral nervous systems.
These neurotransmitters are crucial to the normal functioning of
important processes such as motor coordination, learning and memory,
gastrointestinal function, the control of seizures, and the hormonal
regulation of the reproductive system, yet they are most often
recognized for their central role in the modulation of pain.
MNE 1998
Massage reduces pain effectively and over a wide range of conditions (Field 2000). It
works through a number of mechanisms some mechanical, some chemical.
 Physical changes mean the problem is no longer there eg an over contracted
muscle which relaxes will stop firing the nociceptors and they will stop sending
pain signals to the brain.
 Stimulation of mechanoreceptors (eg by pressure) can send messages which
reduce the firing threshold of nociceptors so they fire less often and less pain is felt.
Nociceptor inhibition can be accomplished through massage and
manual therapy technique that stimulates the pain sedating
mechanisms of the nervous system.
AMMA 2003a
 The ‘pain gate’ mechanism4 means that a short, sharp pain can remove the
sensation of a continuous, throbbing pain briefly by blocking the impulses in the
spinal cord. The continuous flow of sensory information during massage can keep
the ‘gates’ closed or only partially open, thus reducing pain impulses reaching the
brain.
 Transmission of continuous pain (rather than sudden, sharp pain) signals is slower
than that of other signals such as pressure because the nerve fibres are smaller and
not myelinated. When a painful area is stimulated by touch this signal blocks the
later, pain, signal from reaching the hypothalamus and cortex.
… pleasurable touch reaches the brain before pain and can cancel the
pain out.
(Juhan 2003)
 The endogenous opioids are released by massage and reduce the pain messages
at the nerve endings, in the spinal cord and brain.
 Massage often promotes deep, restorative sleep which stimulates the body to
produce somatostatin, which modulates pain experience. In contrast, if deep sleep
is missed substance P is released which increases the firing threshold of
nociceptors and therefore the amount of pain felt (Field 2000: 86).
 Substance P and other pain enhancing chemicals are removed from the circulation
by the increased venous blood flow resulting from massage (Cassar 2004). This will
reduce stimulation of the nociceptors.
All of these effects (except the first) change the brain’s perception of pain by reducing
the number of signals reaching it, rather than reducing the causes. In some cases the
effects of the massage will be reversed after a while and the increase in signals will
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Why does massage make you feel good?
result in the increased perception of pain. Sometimes the reduction in pain will be
sufficient for the body to relax enough to remove the cause of the pain (eg a
contracted muscle) and the massage will be effective. This effect can build up over a
number of sessions.
Reduction of the stress response
As a result of the relaxation provided by massage therapy, the
recipient’s sensitivity to anxiety and stress is likely to be reduced. This in
itself may be the only change needed for healing to take place.
Cassar 2004: 58
Tactile stimulation (or the lack of it) produces certain emotional and
conceptual responses in the higher brain; these feelings and concepts
then exert an effect upon central nervous system activities as a whole
and upon the production levels of the pituitary in particular. These
pituitary secretions in turn affect the health of the connective tissues
and their ability to respond to trauma. These effects are all very different
from mere ‘relaxation,’ the result most commonly associated with
bodywork.
Juhan 2003: 85
Stress response
The nervous system responds to perceived danger by putting the body into alert
mode. This involves two systems of the body which work closely together: endocrine
and autonomic nervous systems. The sympathetic nervous system is the part of the
autonomic nervous system activated when we think we are in danger. The
sympathetic nerves which run all over the body are stimulated to release
norepinephrine at their endings. This causes changes throughout the body to
prepare it for action (see Table 3 below).
The sympathetic nerves also stimulate the adrenal glands to release epinephrine and
small amounts of norepinephrine into the bloodstream which alerts the body for
action (see Table 3 below).
A number of releasing hormones are also secreted by the brain to help and sustain
the stress response. Corticotropin releasing hormone (CRH) is released from the
hypothalamus into a tiny network of capillaries connected to the pituitary gland. This
is stimulated to release adrenocorticotropic hormone (ACTH or corticotropin) which
is carried in the bloodstream to the adrenal glands. When sensed in the adrenal
cortex glucocorticoid hormones are released into the blood, which also cause
changes in the body to prepare for action. This is slower than the release of
epinephrine and norepinephrine and so helps sustain the stress response. Some of
the glucocorticoids aid recovery from the response and some prepare the body for
the next attack in situations where there are repeated stressors.
The pituitary secretes other hormones to stimulate organs throughout the body to
release hormones to control many processes. It also secretes hormones that directly
control processes (see Table 4 below).
Hormones that control processes that are not important in the short term are
inhibited by the stress response: reproductive hormones, growth hormones and
insulin (glucose storage) along with the corresponding processes they control.
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Why does massage make you feel good?
Body part Sympathetic
nervous system
effects
Adrenal gland
effects
Results
Skin
Less blood flow
Keep oxygen and
nutrients in main part
of body; less blood
flow in case of injury
Brain
function
Increase speed of
working
Increased alertness
Muscles
Increase blood flow
More energy, oxygen
and nutrients available
to work harder
Pupil dilation
Better sight
Less blood flow
Increase sweating
Contract arrector pili
muscles and raise
hairs on skin
Eyes
Increase sight
Nose
Increase sense of
smell
Lungs
Relax bronchial
muscles
Bronchioles enlarge
Increased respiration
so more oxygen
available
Heart
Increase heart rate
Increase heart rate
More blood can
circulate to supply
more oxygen and
nutrients to muscles
Blood
supply
Divert blood to
skeletal muscle
Increase blood
pressure
More blood to supply
energy, oxygen and
nutrients to muscles
Liver
Increase metabolic
rate and release of
glucose to raise blood
sugar level
Increase metabolic
rate and release of
glucose to raise
blood sugar level
More energy available
Digestive
system
Decrease in digestion
process
Decrease in
digestion process
Divert resources for
immediate survival
Kidneys
Water retention
Water retention
Divert resources for
immediate survival
Bladder
Enlarges to contain
more urine; sphincter
tightens to stop
emptying
Adrenal
glands
Stimulate production
of epinephrine and
norepinephrine
Sexual
organs
 2005 Jessica Bale
Better smell power
Divert resources for
immediate survival
Produce
glucocorticoids
Assist and sustain fight
or flight reaction
Reduce reproductive
function
Divert resources for
immediate survival
20
Why does massage make you feel good?
Table 3 (opposite) The body's reaction to stress through the sympathetic nervous system
Table 4 Effects of some other stress hormones
Trigger
Organ
CRH
Adrenal
(hypothalamus cortex
to pituitary);
ACTH (to
adrenal
glands)
Hormone
Effect
Glucocorticoids Promotes
breakdown of
eg cortisol
proteins to
produce glucose
Decreases white
blood cells at
injuries
Reduces allergic
reaction
Result
More energy
for muscles
Antiinflammatory
agent
Antiallergenic
agent
Pancreas
Glucagon
Raise levels of
glucose in blood
More energy
available
Pituitary
gland
ADH (antidiuretic
hormone)
Reduces water loss
from kidneys
Helpful in
case of blood
loss
Pituitary
gland
Prolactin
Suppresses
reproductive
system
Diverts
resources for
immediate
survival
Post-stress response
When the body perceives the danger is over the parasympathetic nervous system is
activated and the sympathetic inhibited. This produces the opposite effects to the
stress response and allows the body to recover and recuperate. So the processes that
were stopped (eg digestion, growth, reproduction, energy storage, immune system)
can start again.
Chronic stress
The stress response and recovery are normal and essential features of human life. It is
the malfunction of the system that causes problems not the actual stress: in fact if we
have too little stress our bodies cannot develop correctly (see Deane 2003: 313-16).
But reactions to constant stressors or expectation of stress will lead to a continuous
stress response, without the benefit of a restorative post-stress period. This in turn can
contribute to many different kinds of illness and other health problems
(eg depression, heart disease, emotional growth) as Robert Sapolsky demonstrates in
his book Why Zebras Don’t Get Ulcers (Sapolsky 2004).
Massage and the stress response
Massage reduces release of stress hormones (eg cortisol) and catecholamines
(epinephrine, norepinephrine) that prepare the body for fight or flight and stimulates
the parasympathetic nervous system to bring the body towards a resting state
(Field 2000: 219). One of the most important nerves for this is cranial nerve X – the
vagus nerve. This controls heart rate, respiration, emotional response and the action
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21
Why does massage make you feel good?
of the digestive system. When mechanoreceptors in the upper body are stimulated,
they send messages to the medulla and pons which increase vagal activity by
slowing heart rate, easing respiration and controlling the actions of the major organs
to promote energy conservation and recuperation (Cassar 2004: 71).
This means that massage is useful in situations where the body is stuck in a stress
response or has a sluggish return to normal after stress. The results of regular
massage to reduce the stress response can range from a renewed ability to relax and
not become irritable or outraged at every little thing, through having a good nights
sleep, reduction in symptoms of poor digestion, increase in sex drive and protection
from repeated infections.
Different massage strokes – different effects?
I think it is clear that massage makes you feel good and can have long term health
benefits. It can also make you feel unwell if used uncaringly or inappropriately or if
your body has an unusual reaction to it. My experience has been that most people
feel better generally and often in specific ways following a massage therapy session.
In the table below I have discussed how the different strokes can be used to elicit
different effects depending on the needs of the client. I have not discussed each
technique in detail.
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Why does massage make you feel good?
Table 5 Effects of massage strokes (based on Cassar 2004)
Stroke
Mechanical and reflex
effects
Effect on relaxation
Effect on pain
Other effects
Effleurage
Moves blood along blood
vessels
Nerve endings of sensory
receptors of superficial tissues
are stimulated so
 reflex pathways in the CNS
react – muscles in the area
relax
 the brain interprets touch as
beneficial not threatening –
muscles in this area relax
Stimulates parasympathetic
nervous system
Stimulates release of
neurotransmitters eg
endorphins, histamine,
serotonin
Moves contents of hollow
organs eg colon
Certain regions have reflex
effect eg enhances peristalsis
in gut
Relaxed muscles send
messages to brain which
stimulates the
parasympathetic nervous
system to relax body for rest
and recuperation, reversing
the stress response
Serotonin produces calm
and contented feelings
Can induce alpha rhythm
brain waves which are a
meditative state
Can induce deep sleep
Reduced by
 increased venous flow
removes inflammatory
agents reducing
nociceptor stimulation
 oedema reduced – built
up fluids moved away
mechanically and by
increased circulation –
reduces stimulation of
nociceptors by pressure
Blocks pain impulses
travelling to spinal cord by
pain gate mechanism
Stimulates release of
endogenous opioids
(painkillers)
Needs to be very slow and
continuous for some
minutes (within pain
threshold)
Reduces sensitivity and
other tissue
disturbances to improve
function of related
structures or organs
Histamine dilates blood
vessels to lower blood
pressure
Improves digestive
action
Improves breathing
capacity
Increases immune
function
Improves reproductive
system function
Improves vascular
system function
Stroking hands
and arms over
the body
Light stroking
 2005 Jessica Bale
Venous return flow increased
Toning effect on involuntary
muscles of arterial walls
23
Why does massage make you feel good?
Deep stroking
Venous return and lymphatic
drainage of deeper tissues
increased
Removal of lactic acid and
other by-products of muscle
activity relaxes muscle
Stretch superficial fascia and
reduce nodules and
congestion
Inhibitory effect on
 muscles and their sensory
neurons (eg muscle spindles
and Golgi tendon organs)
 motor impulses at
neuromuscular endplates
resulting in weaker
contractions so muscles
relax
Petrissage
Circulation increased in
dermis and subcutaneous
fascia
Compresses deeper blood
vessels against lower fascia
which improves circulation
here too (arterial and venous
flow are affected)
Muscular tissue and
surrounding fascia is
stretched which
 reverses shortening
Lifting tissues off
underlying
structures with a
twisting
movement
 2005 Jessica Bale
Reduced by
 stretching muscle fibres
 increasing circulation
 releasing adhesions
Fatigue reduced by
increased circulation
Improved vascular
system function
Imp[roved immune
function
24
Why does massage make you feel good?
 releases adhesion between
muscle bundles and layers
Improved lymphatic drainage
of muscle and superficial
tissue – pump action
Kneading
Pressing tissues
onto underlying
structures using a
kneading
movement
Friction
Muscular tissue and
surrounding fascia is
stretched which
 reverses shortening
 releases adhesion
Venous flow improved
Causes vasodilation of
superficial arterioles which
improves local circulation
Local circulation and
temperature are increased in
Working deeply
deep and superficial tissues
into muscles in
by release of histamine like
one place in small
substance which dilates
circles
 the capillaries
 the arterioles by an axon
reflex mechanism
Dispersion of calcifications
around joints
Releasing adhesions between
tissue layers eg skin, fascia,
muscle, tendon, aponeurosis,
bursae, periosteum and
ligaments
 2005 Jessica Bale
Muscles helped to relax
more by
 heat
 releasing adhesions
 improvement in local
circulation
so they send messages to
brain to relax body
Reduced by removal of
metabolites formed by
repeated muscle
contractions
Needs to be very slow and
continuous for some
minutes (within pain
threshold)
Increased arterial
circulation
Reduces congestion,
ischemia and fatigue by
clearing by-products of
muscle use
Improves vascular
system function
Stimulation in the skin and
fascia layers activates the
pain gate mechanism –
creating sufficient stimuli
along quick fibres to block
perception of pain
Reduction in oedema
reduces pressure on
surrounding tissues
Relaxed muscle is less
painful
Improved circulation
Lowers blood pressure
25
Why does massage make you feel good?
Heat is produced which helps
stretch collagen fibres in
fibrotic tissue
Reduction of chronic oedema
which tends to be more solid
Percussion
Cupped hand,
side of hand and
fisted hand
movements
rapidly and
rhythmically over
body
Passive
movements/
traction
Increase local circulation
Stimulate nerve endings –
tiny muscular contractions
increasing overall tone
Nerve pathways are
stimulated and restored
Muscles, ligaments and
Slowly and gently tendons are stretched
moving or pulling Makes more space in joints
a joint through its
range of
movement
 2005 Jessica Bale
Stimulates body
Brain relaxes control of
muscles
Blocks pain messages by the
pain gate mechanism
creating sufficient stimuli
along quick fibres to block
perception of pain
Can increase circulation
in joints aiding healing
and action
Range of movement
improved
26
Why does massage make you feel good?
Conclusion
The enormous complexity of the human body is just being discovered, yet we have
been healing each other through touch since before humans evolved. I think that the
current research into neurobiochemistry will explain a great deal about how this
works and that investigation into the interaction of low energy fields between living
beings will add another dimension to an already complicated subject. This important
understanding of how massage works is fascinating and will build up the
professional standing and practice of massage. But massage therapists will continue
to learn from each other, their own experience and that of their clients to increase
their practical understanding of what massage does and how to use it for the
greatest benefit of their clients.
Bibliography
AMMA 2003a, American Medical Massage Association, Basic Concepts in Pain
Physiology: For the medical massage and medical manual therapist, American Medical
Massage Association, http://www.americanmedicalmassage.com/education/a36z4.html
AMMA 2003b, American Medical Massage Association, A Comparison of the
Somatosensory Effects of Therapeutic Massage and Medical Massage, American Medical
Massage Association, http://www.americanmedicalmassage.com/education/a31z4.html
Cassar 2004, Mario-Paul Cassar, Handbook of Clinical Massage: A complete guide for
students and practitioners, Churchill Livingstone, 044307349X
CNS Forum 2003, CNS Forum, The Na+/K+ ATPase, Lundbeck Institute, http://
www.cnsforum.com/imagebank/section/Other_Neurotransmission_Basics/default.aspx
Field 2000, Tiffany Field, Touch Therapy, Churchill Livingstone, 0443057915
Gershon 2001, Michael D Gershon, The Enteric Nervous System: A second brain, Hospital
Practice, http://www.hosppract.com/issues/1999/07/gershon.htm
Hall 1992, Zach W. Hall (Ed), An Introduction to Molecular Neurobiology, Sinauer
Associates Inc, 0878933077
Jones 1999, Nancy Aaron Jones and Tiffany Field, Massage and Music Therapies
Attenuate Frontal EEG Asymmetry in Depressed Adolescents, Adolescence, Fall 1999,
http://www.findarticles.com/p/articles/mi_m2248/is_135_34/ai_60302519
Juhan 2003, Deane Juhan, Job’s Body: A handbook for bodywork, Barrytown/Station Hill
Press, Inc, NY, 1581770995
King 2005, Michael W. King, Common Vertebrate Hormones, Indiana University School
of Medicine, http://web.indstate.edu/thcme/mwking/hormone-table.html
Lundbeck Institute 2005a, Lundbeck Institute, Neurological Control, Lundbeck Institute,
http://www.brainexplorer.org/neurological_control/Neurological_index.shtml
Lundbeck Institute 2005b, Lundbeck Institute, Neurological Control, Lundbeck Institute,
http://www.brainexplorer.org/neurological_control/Neurological_Neurotransmission.
shtml#
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Why does massage make you feel good?
MNE 1998, Multimedia Neuroscience Education, Synaptic Transmission: A four step
process, Williams College Neuroscience, http://www.williams.edu/imput/synapse/pages/
IB1.html
Noonan 1999, Tim Noonan, The Effects of Massage on the Autonomic Nervous System,
Tim Noonan, http://www.softspeak.com.au/maspap98.htm
NPF 2005, National Pain Foundation, CRPS - Definitions, National Pain Foundation, CO,
http://www.nationalpainfoundation.org/MyTreatment/articles/CRPS_PainDefinitions.asp
Ornstein 1990, Robert Ornstein and Charles Swencionis (Eds), The Healing Brain:
A scientific reader, The Guilford Press, 0898624630
Oschmann 2000, James L Oschmann, Energy Medicine: The scientific basis, Churchill
Livingstone, 0443062617
Paulev 2000, Poul-Erik Paulev, Textbook in Medical Physiology and Pathophysiology:
Essentials and clinical problems, Copenhagen Medical Publishers,
http://www.mfi.ku.dk/ppaulev/content.htm
Sapolsky 2004, Robert M. Sapolsky, Why Zebras Don’t Get Ulcers: The acclaimed guide to
stress, stress-related diseases, and coping, Henry Holt & Co, 0805073698
Selye 1978, Hans Selye, The Stress of Life (revised edition), McGraw Hill Inc, 0070562121
SfN 1998, Society for Neuroscience, The Mind-Body Link, Society for Neuroscience,
http://web.sfn.org/content/Publications/BrainBriefings/mind.body.html
Thibodeau 2002, Gary Thibodeau and Kevin Patton, The Human Body in Health &
Disease, Mosby, 0323013384
Werner 2003a, Ruth Werner, Depression and the Stress Response System, Part I of III,
Massage Today Magazine, http://www.massagetoday.com/archives/2003/08/10.html
Werner 2003b, Ruth Werner, Depression and the Stress Response System, Part III,
Massage Today Magazine, http://www.massagetoday.com/archives/2003/12/12.html
All website pages were accessed between July and December 2005.
 2005 Jessica Bale
Why does massage make you feel good?
Notes
These notes are additional information I have found interesting but difficult to
incorporate into my main text because of their added level of complexity.
1
The Na+/K+ ATPase
‘Na+/K+ ATPase is a pump that uses the energy from the hydrolysis of ATP to actively
pump sodium and potassium ions against their concentration. The binding of three
sodium ions to internal binding sites on the cytoplasmic side of the pump and
phosphorylation of the pump induces a conformational change that releases the Na+
ions into the extracellular space. The subsequent binding of two potassium ions to
the pump within the synapse followed by dephosphorylation causes it to return to its
original confirmation and release the potassium ions into the cytoplasm. This pump is
found in almost all cells of the body and the ionic gradient that it creates is used to
carry out numerous important cellular processes, such as the transport of other
molecules across membrane eg the monoamines.’ (CNS Forum 2003)
2
Serotonin and the gut
‘The serotonin in enterochromaffin cells is stored in subcellular granules that
spontaneously release the amine into the adjacent lamina propria, which is endowed
with at least 15 distinct serotonin receptor subtypes … Additional serotonin is released
when the cells are stimulated either by increased intraluminal pressure, vagal
stimulation, anaphylaxis, acidification of the duodenal lumen, or exposure to
norepinephrine, acetylcholine, cholera toxin, or a variety of other chemical
substances.
‘We now have extensive data (from studies of the serotonin antagonist 5-HTP-DP and
anti-idiotypic antibodies that recognize 5-HT receptors) confirming that 1) serotonin
stimulates the peristaltic reflex when it is applied to the mucosal surface of the bowel,
2) serotonin is released whenever the peristaltic reflex is initiated, and 3) the reflex is
diminished when the mucosal source of serotonin is removed. Consequently, there is
wide support for the hypothesis, first proposed by Edith Bülbring in 1958, that entero 2005 Jessica Bale
Why does massage make you feel good?
chromaffin cells act as pressure transducers and that the serotonin they secrete acts
as a mediator to excite the mucosal afferent nerves, initiating the peristaltic reflex …
‘Provided that the vagus nerve is intact, a steady stream of messages flows back and
forth between the brain and the gut. We all experience situations in which our brains
cause our bowels to go into overdrive. But in fact, messages departing the gut
outnumber the opposing traffic on the order of about nine to one. Satiety, nausea,
the urge to vomit, abdominal pain--all are the gut's way of warning the brain of
danger from ingested food or infectious pathogens. And while the brain normally
responds with appropriate signals, the ENS can take over when necessary, as for
example when vagal input has been surgically severed.’ (Gershon 2001)
3
Massage affects EEG symmetry
‘EEG asymmetry, specifically greater relative right frontal activation, is associated with
negative affect. Depressed adults show stable patterns of this asymmetry. The present
study assessed the effects of massage therapy and music therapy on frontal EEG
asymmetry in depressed adolescents. Thirty adolescents with greater relative right
frontal EEG activation and symptoms of depression were given either massage
therapy (n = 14) or music therapy (n = 16). EEG was recorded for three-minute
periods before, during, and after therapy. Frontal EEG asymmetry was significantly
attenuated during and after the massage and music sessions.’ (Jones 1999)
4
Pain gate mechanism
‘In the case of sudden pain, the sudden pain fiber stimulates neuron X, causing a pain
signal to be relayed to the brain. The sudden pain fiber also stimulates an interneuron
(Y) that inhibits neuron X, after a brief delay. Thus, neuron X sends a pain signal to
the brain for only a short time. In contrast, the slow pain fiber stimulates neuron X
and inhibits interneuron Y. Thus, Y does not inhibit X, and X continues to send a pain
signal to the brain, producing a slow, diffuse pain.’ (Sapolsky 2004)
In contrast, if there is a dull, throbbing pain, stimulating the fast fibre quickly
stimulates the Y interneuron which shuts down the system for a while.
 2005 Jessica Bale