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Massage Therapy for Dogs and Cats Lisa Corti DVM, DACVS, CCRP

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Topics in Companion Animal Medicine

Cite this article as: Lisa Corti DVM, DACVS, CCRP, Massage Therapy for Dogs and Cats, Topics in Companion Animal Medicine, http://dx.doi.org/10.1053/j. tcam.2014.02.001 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Massage Therapy for Dogs and Cats Lisa Corti, DVM, DACVS, CCRP Physical Therapy and Rehabilitation Center Massachusetts Veterinary Referral Hospital Intown Veterinary Group Woburn, MA Introduction Traditionally, the word “massage” would cause an individual to envision lowly lit rooms and relaxing music at a day spa. Attitudes towards massage, however, are changing. According to the American Massage Therapy Association (AMTA) 17th annual consumer survey, 75% of individuals claimed their primary reason for receiving a massage was medical and stress-related. Only 34% of respondents believed massage therapy is only a form of pampering.1 This is because recent scientific research in humans has documented great benefits from therapeutic massage for a variety of health conditions. While the scientific evidence for the benefits of massage in companion animals is mostly lacking, we can still gain insight into its potential effects on dogs and cats.

Physiology of Massage Massage is defined as the therapeutic manipulation of the soft tissues of the body,2,3 and has mechanical, physiological, and psychological effects.4 When massaged, muscle is mechanically stretched, reducing its tone and increasing its pliability. Over time, this can lead to a reduction in muscle soreness and an increase in connective tissue strength.4 Scar tissue is also mobilized and softened, helping to maintain movement between tissues and restore function after injury or surgery.3,4 Physiologically, massage increases interstitial pressure, which in turn increases venous and lymphatic flow. Massaging in a distal to proximal direction is recommended to move fluid from the extremities back to the central circulatory system.4 In addition, as the hands move, squeeze, and stretch the tissues, pressure differences are created between one tissue and another. High pressure pushes old fluid and irritating metabolites into the vasculature and areas of low pressure draw in new fluid. This flushing effect may be responsible for decreasing inflammation, pain, and muscle fatigue.3,4 Massage also influences the sensory and autonomic nervous systems, inducing reflexes that decrease blood pressure, slow breathing, and improve digestion.2,3,4 Levels of cortisol and epinephrine decrease as serotonin increases.3,4 Patients that receive massage also consistently report feeling less pain and request less pharmacologic analgesic intervention.1,2,3,4 The body and mind are both linked to the skin via the nervous system. Different types of touch will elicit different types of mental responses. Psychologically, massage decreases stress and anxiety, produces relaxation, and improves emotional wellbeing.1,3,4 Dogs and cats lick and rub themselves and their young in response to injury

and pain3, so it is not far-fetched to assume that they, too, feel the same psychological effects of massage that humans do.

Massage Techniques Understanding the biomechanics of soft tissues is important when performing massage. Briefly, tissues of the body exhibit both viscosity, a property of fluids, and elasticity, a property of solids.4,5 Viscoelastic materials absorb energy depending upon the applied rate of loading. When such materials are loaded too rapidly or with a great amount of force, their stiffness increases. This is relevant when performing massage as it is important not to load tissues too rapidly or with too much force as stiffness will increase.4,5 Knowledge of canine and feline muscular and vascular anatomy is mandatory before performing massage. In addition, knowing canine and feline behavior is a prerequisite for performing a successful massage session. While each massage technique utilizes a certain level of pressure, the amount of pressure applied should always be individualized to the patient, ensuring patient comfort at all times. The therapist should also be comfortable and attend to his body mechanics, choosing to either perform massage with the dog or cat on a padded floor or elevated on a padded table (Figure 1). Some of the various techniques employed during a massage session are listed in the following table. Table: Massage Techniques2,3,4 Technique Application Stroking Hands are run smoothly over the patient from head to tail to digits with medium pressure. Effleurage Hands are molded to the limb, stroking from distal to proximal with medium pressure. Hands should maintain contact and pressure throughout the strokes. Compression, Large muscles are compressed and kneading, and released in a rhythmical manner. wringing The right and left hands or back of fists alternate with each other and in opposite directions; one moves clockwise, the other counterclockwise, with medium or deep pressure. Friction Thumbs or fingers make small rotary movements with increasing pressure to the depth of the tissue being treated (Figure 2).

Effects Allows assessment of tissues. Reduces anxiety. Encourages relaxation. Decreases swelling and edema, pain, and muscle tone. Stretches muscle and improves mobility between tissues. Flushing effect removing byproducts of inflammation. Increases mobility, extensibility, and strength of tissues. Decreases muscle tension and pain. Aids in venous and lymphatic return. Breaks down adhesions. Stimulates local circulation. Restores mobility to tissues being treated.

Percussion (clapping, hacking)

Hands are cupped with wrists held loosely. The cupped side strikes the area rapidly and briskly, alternating between hands. With the hands held vertically, the pinky finger strikes the tissues lightly and rapidly, with movement coming from the wrists.

Stimulates local circulation. Stimulates muscle and tendon reflexes and enhances muscle tone. Loosens airway secretions (coupage).

Common Indications for Massage Swelling and Edema A variety of conditions can cause swelling and edema. From soft tissue trauma to fracture repair, to immune-mediated and infectious vasculitides, to hypoproteinemia, swelling and edema can be very debilitating. Pain, immobility, poor perfusion, cutaneous wounds and infections, scarring between tissues, and a delay in recovery are often consequences of untreated edema. Many studies have shown massage to be very effective in reducing limb edema in humans and small mammals.4,6,7 Depending upon the size of the patient and the area to be massaged, morning and afternoon 5minute massage sessions can be performed until the patient’s edema improves. Patients in the ICU Serious illnesses often lead to prolonged recumbency. Prolonged recumbency in turn often leads to a range of physical ailments. Accumulation of pulmonary secretions, reduced joint range of motion, stiffness, pain, and dependent edema can occur with prolonged immobility. These can all be ameliorated or prevented with daily massage therapy (Figure 3).2,4,6,7 Massage has also been shown to significantly lower heart rate, blood pressure, and respiratory rate in critically ill human patients, increasing relaxation.8 Studies in preterm infants receiving massage therapy have demonstrated a decrease in pain responses, improved daily weight gain, and an increase in natural killer cell cytotoxicity.9,10 ICU patients are also often sleep-deprived, due to frequent bed-side visits from nurses, noise from surrounding monitoring equipment, and anxiety. Sleep deprivation can have many detrimental physiologic consequences. Massage has been shown to improve the quality of sleep and to prolong time slept in critically ill human patients.11 Massage seems to be a very beneficial non-pharmacological technique that can improve the health and well-being of ICU patients. Osteoarthritis and Chronic Pain Degenerative joint disease, or osteoarthritis, is very debilitating for both humans and companion animals. Chronic joint dysfunction and pain lead to a decrease in range of motion, lameness, a decrease in muscle mass and strength, and an inability to perform activities of daily living. A multimodal approach to treating osteoarthritis,

including weight and dietary management, anti-inflammatory medications, analgesics, and physiotherapy, has been shown to be very effective for relieving pain associated with this condition. Physiotherapies have gained more attention as the need for longterm use of medications and their side effects prevent many patients from using them. When humans with osteoarthritis of the knee received a weekly Swedish massage during an eight-week period, their pain scores decreased significantly when compared to those patients who received a standard protocol.12 Even when self-massage was employed in patients with various forms of arthritis, pain scores and joint range of motion improved significantly.13,14 Massage could also benefit dogs and cats that suffer from osteoarthritis and can easily be incorporated into the multimodal treatment plan. Massage also is a proven therapy for chronic low back pain and muscle spasms in people.1,15 Many canine cranial cruciate ligament patients exhibit lumbar and pelvic muscle pain as a result of chronically shifting their weight from the affected limb to the unaffected limb (personal experience), and it would seem that massage might benefit these patients as well (Figure 4). Chronic pain also occurs among cancer patients. Massage has been shown to be effective in decreasing pain in people with various forms of cancer,1,16 and one can assume that canine and feline cancer patients would experience the same effects.

Palliative and Hospice Care Palliative and hospice care for the purposes of this discussion refers to caring for patients at the end of their lives. Aging leads to degenerative joint disease, a steady decline in organ function, loss of muscle mass and strength, and loss of cognition. Pain, immobility, gastrointestinal problems, inability to perform daily activities of living, and cognitive dysfunction become commonplace. In human medicine, the hospice movement has gained steady support over the past few decades, with therapeutic massage being used more frequently for people at the end of life. A systematic review of the use of massage in people in improving quality of life at the end of life showed significant improvements in emotional distress, nausea, anxiety, and pain.17 Quality of life scores also increased when massage was applied regularly with other modalities.18 Massage and “therapeutic touch” can maximize function, comfort, and connection during the most difficult time of people’s lives.1,4 Anatomy, physiology, and neurology are similar between humans and companion animals, so extrapolating the evidence for the use of massage in humans to the use of massage in dogs and cats at the end of their lives seems reasonable.4 More importantly, massage and therapeutic touch, when applied by owners, can enhance the human-companion animal bond during a time when this relationship is most needed. Summary Massage has many beneficial mechanical, physiological, and psychological effects for numerous health conditions that research in humans has shown are valid. While massage techniques can be taught to the lay person, a professional massage therapist is the expert sought after in human medicine, and the need for their expertise

is growing. The AMTA’s 17th annual survey revealed that 48% of respondents were encouraged by their doctor to receive a massage.1 Veterinarians should follow their lead and seek out certified canine rehabilitation practitioners, certified rehabilitation therapists, or certified animal massage therapists for the care of companion animals. Figures Figure 1: Massage being performed on a patient on a padded table elevated off the floor. Both the patient and therapist are in a comfortable position. Figure 2: Friction massage being performed on the extensor muscles and tendons of the right hind limb of a dog. Figure 3: A cat in the Intensive Care Unit at Massachusetts Veterinary Referral Hospital receiving a massage. Figure 4: A dog receiving a back massage. Note the patient is on a padded floor. (Photos courtesy of Amie Hesbach, DPT, CCRP, Physical Therapy and Rehabilitation Center, Massachusetts Veterinary Referral Hospital, IVG.)

References 1. American Massage Therapy Association. Consumer Survey Fact Sheet. Massage Therapy Has a Role in Pain Management. Massage Therapy Research Roundup, Volume 2. www.amtamassage.org, 2013. 2. Sharp, B. Feline Physiotherapy and Rehabilitation: 1. Principles and potential. Journal of Feline Medicine and Surgery (2012):14;622-632. 3. Downing, R. The Role of Physical Medicine and Rehabilitation for Patients in Palliative and Hospice Care. Vet Clin Small Anim (2011):41;591-608. 4. Sutton, A. and Whitlock, D. Massage. In: Millis, D.L. and Levine, D. Canine Rehabilitation and Physical Therapy. 2nd edition. Elsevier; 2014. pp.464-483. 5. Hulse, D. and Hyman, B. Fracture Biology ad Biomechanics. In: Slatter, D. Textbook of Small Animal Surgery. 3rd edition. Saunders; 2003. pp.1785-1792. 6. Kriederman, B. et.al. Limb volume reduction after physical treatment by compression and/or massage in a rodent model of peripheral lymphedema. Lymphology. March 2002;35(1):23-27. 7. Coban, A. and Sirin, A. Effect of foot massage to decrease physiological lower leg oedema in late pregnancy: a randomized controlled trial in Turkey. Int J Nurs Pract. 2010 Oct;16(5):454-460. 8. Hayes, J. and Cox, C. Immediate effects of a five-minute foot massage on patients in critical care. Intensive Crit Care Nurs. 1999 Apr;15(2):77-82. 9. Abdallah, B. et.al. The efficacy of massage on short and long term outcomes in preterm infants. Infant Behav Dev. 2013 Aug 6;36(4):662-669.

10. Ang, JY. et.al. A randomized placebo-controlled trial of massage therapy on the immune system of preterm infants. Pediatrics. 2012 Dec;130(6):e1549-1558. 11. Richards, KC. Effect of back massage and relaxation intervention on sleep in critically ill patients. Am J Crit Care. 1998 Jul;7(4):288-299. 12. Perlman, Al. Massage therapy for osteoarthritis of the knee: a randomized dosefinding trial. PLoS One. 2012;7(2):e30248. 13. Atkins, DV and Eichler, DA. The effects of self-massage on osteoarthritis of the knee: a randomized, controlled trial. Int J Ther Massage Bodywork. 2013;6(1):414. 14. Field, T. et.al. Rheumatoid arthritis in upper limbs benefits from moderate pressure massage therapy. Complement Ther Clin Pract. 2013 May;19(2):101103. 15. Cherkin, DC. et.al. Randomized trial comparing traditional chinese medical acupuncture, therapeutic massage, and self-care education for chronic low back pain. Arch Intern Med. 161(8):1081-1088; Apr 23, 2001. 16. Batalha, LM and Mota, AA. Massage in children with cancer: effectiveness of a protocol. J Pediatr (Rio J). 2013 Nov-Dec;89(6):595-600. 17. Lafferty, WE. et.al. Evaluating CAM treatment at the end of life: a review of clinical trials for massage and meditation. Complement Ther Med. 2006 Jun;14(2):100-112. 18. Williams, A. et.al. A randomized controlled trial of meditation and massage effects on quality of life in people with late-stage disease: a pilot study. J Palliat Med. 2005 Oct;8(5):939-952.

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Massage therapy for dogs and cats.

Massage is gaining recognition as a beneficial modality for the treatment of many ailments due to recent scientific research in humans. We can infer t...
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