Swedish Massage Therapy Eases Knee Osteoarthritis

NEWARK, N.J., Dec. 12 -- Whole-body Swedish massage proved safe and effective in reducing pain and improving function in osteoarthritis of the knee, according to a pilot study.

In a randomized controlled crossover trial, 68 men and women, patients with radiographically confirmed osteoarthritis of the knee were assigned to twice-weekly hour-long sessions of standard Swedish massage in weeks one through four and once-weekly sessions in weeks five through eight.

This pilot study suggested that the popular Swedish technique seems to diminish symptoms and improve the course of osteoarthritis by increasing local circulation to the affected joint, said Adam I. Perlman, M.D., MPH, of the University of Medicine and Dentistry of New Jersey and colleagues at Yale.

Massage also improved the tone of supportive musculature, enhancing joint flexibility, and relieving pain, they reported in the Dec. 11 issue of the Archives of Internal Medicine.

Massage therapy has been found effective for various painful musculoskeletal conditions, "but to our knowledge, this is the first prospective, randomized trial assessing the efficacy of massage for osteoarthritis," said Dr. Perlman and colleagues.

Conventional treatment for knee osteoarthritis includes pain medication, exercises, hot and cold therapy, corticosteroid injections, and, eventually, surgery to repair the joint, they noted.

Patients were at least 35 years old, and were recruited from January to July 2003 at the St. Barnabas Ambulatory Care Center in Livingston, N.J. Those getting the massage were compared with a group of controls, who were all crossed over to massage after eight weeks -- called delayed intervention.

Massage therapists used a standard full-body massage technique and a standard protocol.

The control group continued to receive conventional care during the initial eight-week intervention period and then at the ninth week, the controls crossed over to receive massage.

Primary outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and functional scores, and the visual analog scale (VAS (0 mm to 100 mm) for pain assessment.

The group receiving massage therapy demonstrated significant improvements in the mean WOMAC global scores from baseline value (?21.15 mm; P

Possible study limitations included the use of a wait-list control design because there is no validated method of performing placebo massage. However, the researchers said, this resulted in increased contact between the groups during the eight-week intervention.

In addition, using intention-to-treat analysis and carrying forward baseline values may have biased the results toward the null. The treatment effects observed were stronger when limited to only those subjects returning for follow-up, suggesting that the findings are a conservative estimate.

Another limitation pointed out by the authors was demographic homogeneity. The study participants were all from northern New Jersey and most were white women.

The potential importance of massage as an adjunct to or even an alternative to pharmacotherapy is "self-evident," Dr. Perlman said.

Given the limitations and potential adverse effects of pharmacologic treatments -- cardiovascular, GI, renal, and hepatotoxic effects -- massage therapy seems to be a viable option as an adjunct to more conventional treatment modalities.

Discussing nonconventional treatments, such as glucosamine/chondroitin therapy, the results are inconclusive, the investigators said. A recent randomized controlled trial did suggest that the combination might be effective for patients with moderate to severe pain. Other treatments, such as devil's claw and ginger, have yet to be proven effective, they wrote.

Finally, they said, recent research has suggested benefits from acupuncture. Adding massage as therapy, would provide an additional benefit to the current approaches.

Further study of massage, even other types of massage, to determine optimal treatment protocols, absolute efficacy, cost-effectiveness, and generalization to other patients groups is clearly warranted, Dr. Perlman's team concluded.