Is Massage Useful in the Management of Diabetes? A Systematic Review
- Jeanette Ezzo, MsT, MPH, PhD,
- Thomas Donner, MD,
- Diane Nickols, BA, PA-C and
- Mary Cox, MsT, BS
Massage is among the fastest growing complementary therapies used in the United States. This article systematically reviews the available evidence on potential benefits and adverse effects of massage for people with diabetes. Massage at injection sites may increase insulin absorption. In addition, uncontrolled studies suggest that massage may have a positive effect on blood glucose levels and symptoms of diabetic neuropathy. However, randomized, placebo-controlled studies are needed to confirm any short- and long-term benefits of massage as a complementary treatment for diabetes and to further define an optimal massage treatment.
Massage has been recommended for diabetes for nearly 100 years. However, the usefulness of massage for people with diabetes remains unclear as evidenced by a recent exchange on an Internet diabetes message board. One writer posts the message, “Does anyone know if massage can help diabetes?” The only reply is another inquiry: “Hi! If you find out any information on massage therapy, please let me know. I just want to help my 16-year-old daughter, who has been diagnosed with diabetes. How do you think massage can help? Even type 2 diabetics, do you think?”
If these writers were to surf the World Wide Web in search of answers to their questions, they would likely be left confused and frustrated. Internet information on this topic is fraught with unsubstantiated claims. One site actually suggests that diabetes can be prevented through self-massage. Another reports on an individual who allegedly had the bottoms of his feet massaged, eliminated large amounts of sugar in his urine during the second week of treatment, and then recovered from his disease. How, then, do consumers decide, or clinicians advise, about the usefulness of massage to people with diabetes?
This article aims to clarify what is and is not known about the usefulness of massage for people with diabetes by summarizing a systematic review of the scientific literature using Cochrane review methodology, a method specifically designed to maximize comprehensiveness and minimize bias. Through this method, all relevant studies that meet prespecified inclusion criteria are included in the review regardless of their results.
Using this method, we will address four frequently asked questions:
- Can massage improve insulin absorption, for example, by increasing serum insulin in type 1 diabetes or increasing tissue insulin sensitivity in type 2 diabetes?
- Can massage help normalize blood glucose levels?
- Can massage provide relief of symptoms associated with diabetic neuropathy?
- What are the known adverse effects, contraindications, or precautions related to massage for people with diabetes?
Trends in Use and Attitudes Toward Massage in the United States
Utilization of massage is rising, making the examination of this issue quite timely. From 1990 to 1997, the proportion of U.S. consumers using massage jumped from 7 to 11% of the population, the most statistically significant increase of any complementary medicine (CM) modality.
Despite stereotypical images of people receiving massage as a way of pampering themselves, nearly three-fourths of those who seek massage do so for a specific health complaint for which they have already consulted a physician. Among rehabilitation outpatients, massage ranks as one of the most common CM therapies sought. Among general practice patients, 32% report using massage, and this proportion exceeds that of individuals reporting the use of herbs, megavitamins, or meditation.
Not only is massage use increasing, but survey evidence indicates that utilization will continue to rise as health plans provide reimbursement. A recent health insurance survey found that respondents were not only willing to pay more for their insurance if CM therapies were covered but also ranked massage as the number one CM therapy they would be most likely to use if it were covered by their health plan. Third-party payers, however, cite lack of efficacy data as the primary reason for their reluctance to reimburse CM.
Massage is among the CM therapies with the highest physician referral rate, and family practice physicians rate bodywork as the CM therapy most likely to be beneficial and least likely to be harmful. Given the growing popularity of massage, it is not surprising that magazines for people with diabetes have begun to offer information about the therapeutic effects of massage.
Types of Massage/Bodywork
Swedish massage is the most widely practiced type of massage in the United States. Developed in 1914 by Per Henrik Ling, this method is considered one of the first scientific approaches to massage, aiming specifically to affect the circulatory, lymphatic, and nervous systems. Long, gliding strokes (referred to as friction) are used to enhance blood and lymph flow; kneading (called petrissage) is used to relax muscle tension; and tapping, cupping, and hacking movements (called tapotement) are used to stimulate nerves.
There are other popular forms of bodywork in the United States. Trager uses a gentle, rhythmic, rocking motion to help the body relax. Rolfing uses intense deep-tissue manipulation to restructure fascia. Craniosacral therapy aims at gently influencing the rhythm and flow of the cerebrospinal fluid. Neuromuscular therapy manipulates the deep soft tissues to improve circulation, release nerve entrapment, and deactivate trigger points. Manual lymphatic drainage lightly redirects subcutaneous lymphatic stasis or blockages into functional lymphatic channels.
Swedish Massage Procedure
Swedish massage is the manipulation of the soft tissues of the whole body to bring about generalized improvements in health. Generally, sessions range from 30 to 90 min. The procedure usually begins with a medical history. Then, the massage therapist leaves the room while the person receiving the massage disrobes and lies under a sheet or flannel blanket on a massage table.
The massage usually begins with the patient lying supine. The therapist administers massage first to the arms, neck, and head and then progresses to the torso, feet, and legs. The patient then lies prone, and the legs, hips, and back are massaged. Massage lotion or oil may be applied to minimize friction on the skin.
Trained massage therapists work in spas, health clubs, private practices, chiropractic offices, physical therapy practices, and hospitals.
Physiological Effects of Massage
Several studies have documented the relaxing effects of massage. Massage has been demonstrated to reduce muscle tension in both subjective self-reports and objective electromyographic testing.
Relaxation from massage has been demonstrated to be greater than that brought about from rest alone. Massage can reduce heart rate and blood pressure, two features of the relaxation response.
Additionally, massage has been shown to decrease anxiety in a variety of patient populations, including people with diabetes. These stress-reducing benefits of massage have raised the possibility that massage may be of benefit to people with diabetes by inducing the relaxation response, thereby controlling the counter-regulatory stress hormones and permitting the body to use insulin more effectively.