Massage for pain and movement

Massage can be performed by a variety of health professionals including massage therapists, physiotherapists and occupational therapists. It can also be given in the home by appropriately trained family members or carers.

Cerebral Palsy Alliance offers a service where our health professionals can advise whether massage is an appropriate intervention for you and your family.

There may be fees for a person to receive an assessment for massage and have sessions with a physiotherapist or occupational therapist. This fee would cover developing a tailored massage program, and training for a parent or carer to implement the program. There may also be costs to purchase or hire equipment such as a massage table. The cost will depend on the provider and the number of sessions needed. You should check if there will be extra costs for the specialist to travel to home sessions, prepare a home program, write reports for you or your child and liaise with other health professionals. If a paid support person is implementing the program, this will also carry a fee.

You should ask your health care provider if you are eligible for funding to assist with fees and any equipment required. People with a disability living in Australia may also be eligible for a health care rebate through Medicare or funding from the National Disability Insurance Scheme.

Massage needs to be performed regularly to benefit a person with cerebral palsy. Each session should be at least 15 to 30 minutes long. In most current research studies, the subjects receive their massage more than five times per week from parents or carers who have been trained by a health professional.

Positive effects include:

• Increasing blood flow to specific body areas
• Reducing muscle tension by applying physical pressure
• Lowering heart rate, blood pressure and stress-hormones
• Increasing muscle temperature in certain places
• Decreasing nerve sensitivity.

Benefits may include:

• Pain reduction
• Improved range of movement
• Decreased hypertonic (overactive) muscle tone
• Improved gross motor skills.

Other potential benefits that are not covered in this review may include decreased swelling in the body, reduced stress, improved relaxation, rehabilitation after injury, bond between baby and parent and reduction in anxiety and depression.

While there are many perceived benefits of massage, limited research has been conducted to confirm them.

• Other interventions that can be effective when combined with a massage program include goal directed training, serial casting, orthoses (e.g. AFOs) and medical interventions such as botulinum toxin-A
• There are a number of risks associated with massage, which means it may not be a suitable therapy for everyone. We recommend you discuss and identify these with a medical practitioner, physiotherapist or occupational therapist before starting the intervention
• Early research suggests some children and adolescents with cerebral palsy have altered sensation which could make it hard for them to tolerate massage¹.

We searched the medical and allied health literature to find research evaluating the effectiveness of manual massage for people with cerebral palsy.

We were looking for the best available research of whether different types of manual massage can help reduce muscle tightness and pain caused by cerebral palsy. We included outcomes like reduced range of motion, pain, contracture and mobility. We excluded massage used as a sensory-based intervention, cranio-sacral therapy, acupressure and electronic massage.

We found six papers on the effects of manual massage including four level 2 studies and two level 4 studies. The papers focused on different types of massage including Thai², Swedish³, Qigong⁴, deep cross-friction massage⁵ and massage using varying degrees of pressure and movement^1,6. These studies evaluated outcomes for muscle tone, motor skills, pain and range of motion for people with cerebral palsy.

Muscle tone

Four studies looked at the effectiveness of massage for reducing muscle tone in people with cerebral palsy. All studies showed slight reductions in muscle tone following the massage. Three of these studies, however, used the Modified Ashworth Scale (MAS) which has been shown to have poor psychometric properties for people with cerebral palsy.

Also, worth noting is that although the study by McGregor and colleagues found a reduction in the incidence of abnormal stretch reflex, it also found resistance to stretch in calf muscles actually increased. This indicates certain massage styles can increase muscle tone. Overall, there is low quality evidence that different types of massage can have mixed effects on decreasing muscle tone in children with spastic cerebral palsy.

Pain

There was only one study investigating the effect of massage on pain. Nilsson and colleagues measured participants’ heart rates and self-reported pain following massage and reported no statistically significant improvement. The results from this single, level 2 study suggest massage does not reduce pain for children and adolescents with cerebral palsy.

Range of Motion

A single level 4 study was found looking at the effect of massage on range of motion. The study by McGregor and colleagues, assessed whether massaging the calf muscles affects passive range of motion of the ankle joint. They found that following massage, greater force was needed to achieve the same range of motion. This indicates that massage reduced the range of motion of the calf muscles. This means there is very low-quality evidence to suggest that massage has a small, negative effect on range of motion in adolescents with cerebral palsy.

Motor Skills

Three studies at levels 2 and 4 evaluated the effects of massage on motor skills for people with cerebral palsy. The results showed small improvements which were largely non-significant except for a study by Silva and colleagues which showed a small but statistically significant within and between-group difference. However, this improvement is not deemed to be clinically significant. The improvements seen in the study were on the object manipulation and locomotion domains of the Peabody Developmental Motor Scales. Overall, this indicates there is low quality evidence that varying types of massage may improve motor skills in children and adolescents with cerebral palsy. However, effect sizes are very small and further research is needed to confirm if improvements are statistically significant and clinically important.

Overall, there is low quality evidence to guide decision-making about the effectiveness of massage for pain, mobility and muscle tone in people with cerebral palsy. The research is designated as low quality because of the variability in types of massage, study designs, outcome measures and the strength of the findings. Generally, the results have shown small and clinically insignificant improvements for the outcomes being reviewed. However, research is just one piece of information used to make decisions about an intervention. People with cerebral palsy and their families and carers, who are interested in pursuing massage, are advised to speak with a health professional to discuss how massage can help them.