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Connective tissue reflex massage for type 2 diabetic patients with peripheral arterial disease: randomized controlled trial


Tags: massage, controversy, manual therapy, treatment, debunkery

PainSci summary of Castro-Sánchez 2011: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible.

The paper reports on a test of the effect of an exotic and specialized massage technique on leg circulation in diabetes patients. The authors are obviously fans of “connective tissue massage,” and are almost certainly motivated by the desire to prove that it works (high risk of bias). Their experimental design is decent, but also easily abused: lots of technical measures, ample opportunities for P-hacking. Even so, their technically “positive” results were only just barely so, but (of course) summarized as a simple win: “Connective tissue massage improves blood circulation in the lower limbs of type 2 diabetic patients.”

I do not trust this study any farther than I can throw a paper airplane into a high wind. Even if I did, it wouldn’t be relevant to the kind of massage therapy generally available to consumers.

So what’s so strange about the technique? “Connective tissue massage” is “massaging along reflex lines on areas of the skin connected (at a distance) with deep tissue and internal organs, known as Head zones.” This is a strange and unvalidated massage modality based on some extraordinary claims. It reeks of “pet theory.” More odd details, mostly to emphasize how far out in left field this method is:

The massage protocol consisted of reflex-massaging the skin with the third and fourth fingertips to stretch the subcutaneous connective tissue to the maximum. The massage must not cause pain or enter deep into structures under the connective tissue, avoiding overstimulation. The therapist flexes the elbow away from the body, rotates the shoulder internally and applies a light radial twist to the wrist. The patient should experience the massage as a ‘switching-off‘ feeling.

It goes on and gets stranger: an extremely detailed, specific, and kooky massage protocol that has exactly nothing to do with normal massage.

Conclusion: this is junk science.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

The objective of this study was to evaluate the efficacy of connective tissue massage to improve blood circulation and intermittent claudication symptoms in type 2 diabetic patients. A randomized, placebo-controlled trial was undertaken. Ninety-eight type 2 diabetes patients with stage I or II-a peripheral arterial disease (PAD) (Leriche-Fontaine classification) were randomly assigned to a massage group or to a placebo group treated using disconnected magnetotherapy equipment. Peripheral arterial circulation was determined by measuring differential segmental arterial pressure, heart rate, skin temperature, oxygen saturation and skin blood flow. Measurements were taken before and at 30 min, 6 months and 1 year after the 15-week treatment. After the 15-week program, the groups differed (P < .05) in differential segmental arterial pressure in right lower limb (lower one-third of thigh, upper and lower one-third of leg) and left lower limb (lower one-third of thigh and upper and lower one-third of leg). A significant difference (P < .05) was also observed in skin blood flow in digits 1 and 4 of right foot and digits 2, 4 and 5 of left foot. ANOVA results were significant (P < .05) for right and left foot oxygen saturation but not for heart rate and temperature. At 6 months and 1 year, the groups differed in differential segmental arterial pressure in upper third of left and right legs. Connective tissue massage improves blood circulation in the lower limbs of type 2 diabetic patients at stage I or II-a and may be useful to slow the progression of PAD.

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