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Journal of Bodywork & Movement Therapies (2014) xx, 1e7

Available online at www.sciencedirect.com

ScienceDirect journal homepage: www.elsevier.com/jbmt

EXPLORATIVE STUDY

Thai traditional massage: Efficiencyassessment of three traditional massage methods on office workers: An explorative study Pongjan Yoopat, PhD. Ergonomics a,e,*, Christophe Maes, Lic. Kine, Drs. Ergonomics b,c, Stefaan Poriau, MD., Rheumatology Rehabilitation b,c, Kamiel Vanwonterghem, Dr. Ergonomics & Human Ecology a,b,d,e a

Research Institute of Rangsit University, Paholyotin Rd. Muang Ake, Pathumtani 12000, Thailand Mensana, Gentse steenweg, 132, B-8400 Sijsele, Damme, Belgium c Rehabilitation Centre EZ-HHK, Campus Sijsele, Gentse steenweg, 132, Sijsele, Belgium d Cergo International, Breestraat 28/8, B-3500 Hasselt, Belgium e Faculty of Science, Rangsit University, Pathumtani, Thailand b

Received 10 February 2014; received in revised form 27 March 2014; accepted 9 April 2014

KEYWORDS Thai massage; Massage efficiency; VAS; EMG; Muscle strength & endurance

Summary Thai Traditional Massage (TTM) is popular and widely spread in Thailand. This project is aimed at studying the physiological efficiency of three popular TTM methods based on acupressure Meridian basal lines: the Sen Sib(SS) ten lines, Ratchsamnak (RS), Royal style; and Chaloeysak (CS), Folk style. Thirty healthy female administrative employees participated as patients. All were treated for 30 min with the 3 types of massage with a two-week interval between each treatment. Muscle strain was objectified by measuring strength and endurance with surface electromyography of muscle put under stress during office work: the M. Trapezius (static postural load) and the wrist muscles (M. flexors & extensors Carpi-Radialis) (dynamic contractions) as well as measuring the subjective Visual Analogue Scale (VAS) before and after the sessions. An ANOVAstatistical analysis showed that strength in shoulders was not significantly different, but some forearm fatigue was decreased significantly among the three massage techniques. ª 2014 Elsevier Ltd. All rights reserved.

* Corresponding author. Research Institute of Rangsit University, Paholyotin Rd. Muang Ake, Pathumtani 12000, Thailand. Tel.: þ66 805922919; fax: þ66 2 7915692. E-mail address: [email protected] (P. Yoopat). http://dx.doi.org/10.1016/j.jbmt.2014.04.006 1360-8592/ª 2014 Elsevier Ltd. All rights reserved.

Please cite this article in press as: Yoopat, P., et al., Thai traditional massage: Efficiency-assessment of three traditional massage methods on office workers: An explorative study, Journal of Bodywork & Movement Therapies (2014), http://dx.doi.org/10.1016/ j.jbmt.2014.04.006

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Introduction Humanity is currently confronted with a fast evolution in living conditions of which the psycho-somatic impact on citizens affect the equilibrium between load-related factors and the individual’s adaptive capacity. Sustaining imbalances in the coping process may result in gradually increasing physical and psycho-mental strain, starting initially with discomfort and pain, but may evolve into a dysfunction or injury. In order to relieve the strain symptoms, people develop an individual strategy which is influenced by the importance of the complaints: if obvious and serious, they consult their ad-hoc expert for a classic treatment (physician, psychologist, psychiatrist). In less obvious cases however, many prefer to contact acquaintances, friends, or drugstores for several reasons (which may be financial, a lack of trust, and fear) and prefer alternative ways such as herbal medicine and/or ancient massage techniques. At present, the formal Thai Traditional Massage (TTM) has become very popular for residents of Thailand and for visitors (tourists and professional employees). In Thai Traditional massage (TTM) it is believed that health and well-being relies on the balance of life energy throughout the body via invisible pathways. The core treatment is built on releasing stress affecting the energy flows by pressing and stimulating correct pressure points (blockages) situated along the theorised energy Meridian basal lines. These energy lines are inscribed graphically in marble tablets which were brought to and kept in the ‘Wat Pho” temple in Bangkok during the reign of King Rama III (1824e1851, A.D.). In 2010, there were approximately 19,440 recognized therapists (male, female, some of whom were blind) but the information about a large amount of heritage-educated ‘massagers’ active in the informal sector is not available. Official Thai Traditional Massage (TTM) education is offered by many organizations such as schools, temples, universities, clinics, hospitals, and private enterprises. In 2014, 108 organizations were certified by the Ministry of Public Health to be the training center of professional therapists in Thailand. Conditions are 330 h training for an assistant massage therapist and 800 h for massage therapist. Thai Traditional Massage (TTM) gained in importance during the last decades and has spread world-wide. In the USA, approximately 6% of the population in 2002 used complementary and alternative medicine to treat back pain and sixty percent perceived it as a “great deal” of benefit (Anup et al., 2010). The three TTM-methods are described by Tyroler (2013). The Sen Sib method focuses the manual treatment on perceived blockages occurring along ten (10, ‘Sib’) basic life energy lines originating from the center point (underneath the abdominal surface (umbilicus), 2 fingers width deep). Each of the essential acupressure points on the assumed energy paths is stimulated for about 1e15 s, repeated three times. The total treatment time is about 15e30 min. The Ratchsamnak method, or ‘Royal style’, concerns deep muscle massage exerting slow, increasing pressure with fingers, thumbs, stretched arms, and elbows on taut palpable nodules, ‘trigger points’, along the Meridian lines. The concentration is put onto the back, inner legs, outer

P. Yoopat et al. legs arms, shoulders, abdomen, and the frontal and occipital parts of the head, and includes stretching exercises of the upper limbs. The normal therapy-time depends on the specific symptoms and lasts about 30e60 min. The Chaloeysak method: the ‘folk style’, includes a progressive series of movements to loosen and stretch muscles and joints, and includes deep muscle acupressure, stimulating the flow at more than 200 possible points along the main theorised energy lines with fingers, thumbs, palms, elbows, knees and feet. The treatment is robust and very thorough, enabling energetic and physical release at a very deep level. The therapist varies his/her posture frequently during treatment. Total massage time is about 30e60 min. All methods claim to revitalize mind, body, and spirit e and are aimed to impart a definite visceral feeling of wellbeing. The physiological and therapeutic effects e questionable due to a lack of scientific evidence e are often classified as ‘placebos’ (Evans, 2006), especially when fighting ‘pain’ and ‘discomfort-complaints’, and therefore TTM is often considered as quackery and the practitioners as frauds. In comparison to other Western methods, such as the somewhat comparable Swedish massage, TTM is a rather metaphysical treatment concentrating on invisible energy channels throughout the body, whereas the Swedish method starts from Western concepts of anatomy and physiology, also involving pressing and kneading but with additional effleurage, friction and tapping. In studying the effects of these traditional massage techniques, researchers concentrated their focus on the methods used in sports medicine: blood composition and flow, œdema, connective tissue, muscle, and the nervous system. However when evaluating, the ancient massage art the need for a scientific basis became obvious (Goats, 1994). Tasaki et al. (1967) studied the influence of massage on the skin and the intramuscular circulatory changes in using lumbar massage; Mori et al. (2004) found a significant difference between massage and rest in localized muscle fatigue and VAS with effects on skin temperature increase and improved blood flow in local regions. Donoyama et al. (2008) studied the physical and psychological effects of the Japanese ‘Anma’ massage in healthy female volunteers in their fifth decade who had problems of chronic muscle stiffness in the neck and shoulders. Two interventions of 40-min Anma therapy followed by a 40-min recovery lead to significantly reduced scores for VAS, lower anxiety and an increase of immunoglobulin (S-IgA) in mucous secretion. Moraska et al. (2008) reviewed the literature on physiological adjustments to stress. Despite some positive effects on diastolic blood pressure, on urinary cortisol and catecholamines, the research data were insufficient to make formal conclusions regarding efficiency. Additionally, Kenny and Marc (2011) made a randomized review of massage efficiency including modalities such as acupressure, lymphatic drainage, myofascial release, reflexology, Swedish massage, sports massage and trigger point therapies. Their key findings showed positive indications as to efficiency in managing sub-acute/chronic low back pain, delayed onset muscle soreness (DOMS), anxiety, nausea, stress, and relaxation and support for the

Please cite this article in press as: Yoopat, P., et al., Thai traditional massage: Efficiency-assessment of three traditional massage methods on office workers: An explorative study, Journal of Bodywork & Movement Therapies (2014), http://dx.doi.org/10.1016/ j.jbmt.2014.04.006

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Thai traditional massage: Efficiency-assessment of three traditional massage methods on office workers wellbeing of patients with chronic and/or terminal diseases such as cancer. It has been suggested that TTM manipulates not only the local involved tissues, but also distant points producing reflexogenic effects resulting in muscle relaxation, trigger point disruption and release of endorphin (Kumnerddee, 2009). Chatchawan et al. (2005) compared the effectiveness of TTM treatment with a Swedish massage method (SM) among patients with back pain associated with myofascial trigger points (MTrPs). The results showed that TTM and SM are both efficient in reducing back pain among MTrPs e patients, suggesting TTM as an alternative treatment to SM. Kumnerddee (2009) compared Ratchasamnak massage with Chinese acupuncture for myofascial back pain in Thai military personnel, and concluded TTM was an equivalent method to acupuncture, although with lower efficiency. Recently, Yothinarak et al. (2013) studied, the effects of 3 types of massage (Sen Silb, Ratchsamnak and Chaoeysak) via the biomarkers for inflammation and markers for muscle injuries (High Sensitivity-Creactive Protein, (hs-CRP); Creatine kinase, CK), and found significant benefits. Mackawan et al. (2005) studied the immediate effects of a 10-min TTM treatment on joint mobilization (substance P, a key mediator of inflammation) and found after the treatment a substantial decreased level of substance P and in the VAS of the perceived pain in patients with non-specific low back pain. From the subjective effects (VAS) and from the objective measured results (substance P), may it be concluded that TTM can be an alternative to the classic treatment methods? To answer this question, more objective results are needed regarding the efficiency of TTM on patients’ functional effects as well as on healthy people with less pronounced complaints, and these have not been studied yet. This is an important challenge, as TTM still lacks consistency regarding the qualification of therapists, a substantial code of practice and procedures, and reliability and ethical validity. This study compares the physiological effectiveness of 3 different popular TTM methods (the Sen Sib, the Ratchsamnak and the Chaloeysak) by focusing on the effects on muscle strength and endurance measured by electromyographic reactions (EMG) in combination with ‘VAS’ for office employees. The objective of the study was to compare Thai Traditional Massage (TTM) methods via a subjective assessment (VAS) and objective physiological criteria (effects on muscle potentials: power (MVC) and endurance (MPF) in order to estimate the efficiency of the methods.

Materials and methods Subjects Thirty female volunteer office employees (University and a Cement factory), aged between 30 and 40 years (average age 38  1 years), participated in the project. This comparable workload was selected to enhance the consistency of the participants’ sample. The administrative workload, characterized by fast but low intensity forearm muscle activity (keyboard typing) and long lasting postural load in

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shoulders, is combined with housekeeping duties. The healthy participants were screened for non-specific disorders by a professional physiotherapist. Their experience was of at least 15 years. An informed consent was obtained prior to the baseline examination.

Methods A randomized complete-block design experiment was realized under standardized procedures and airconditioned temperatures at 24  C in the Ergonomics Laboratory, Faculty of Science, Rangsit University. The RSU ethical committee approved the research protocol. The participants underwent three types of Thai traditional massage: the Sen Sib (SS), Ratchsamnak (RS) and Chaloeysak (CS) methods (Tyroler, 2013) successively. Each treatment took about 15e30 min. An interval of 2 weeks between the sessions allows an assumption that the influence on alternating the methods would not interfere the results.

Assessment factors These included: the Subjective Perceived Annoyance (VAS) and the muscular reactions characterized by changes in power (MVC e Maximal Voluntary Contraction) and endurance (MPF-Median Power Frequency) of the forearm muscles (M. Wrist flexor and extensor Carpi Radialis, left and right) and the upper part of M. Trapezius, (left and right). These muscles are representative for stress in administrative work and housekeeping activities by dynamic repetitive contractions of forearms and postural, static muscle load in the shoulders.

Visual Analogue Scale (VAS) The VAS objectifies self-reported problems which reflects the degree of individually perceived effects (discomfort, annoyance, pain, and vague disorders) and is registered on a simple 10-point scale, from 0 to 10 (0 Z no problem, 10 Z extremely problematic). The VAS (Huskisson, 1974) is widely used because for ease administration, and is in line with the Borg’s 10-points RPE-scale (rate of perceived exertion) (Borg, 2013).

Muscle load: maximal capacity test (MVC) The Maximal Voluntary Contraction (maximal power) concerns the average electromyographic electropotential (micro-volts, mV, at 1000 Hz) averaged during an at least 2 s maximal contraction. The MVC is rather sub-maximal (>95%) to avoid eventual muscle damage, when tested against a rigid and non-flexible resistance. For forearm muscles: Electrodes are placed on the body of the M. Wrist extensors and flexors (upper 1/3 of radius/ulna). These muscle-MVCs are confirmative for handgrip/fingers power. For shoulders (the MVC of the upper M. Trapezius): Electrodes are fixed at the muscular part of the superior border of the scapula, left and right sides. The test included a vertical shoulders lift against a resistance exerted by an experienced researcher.

Please cite this article in press as: Yoopat, P., et al., Thai traditional massage: Efficiency-assessment of three traditional massage methods on office workers: An explorative study, Journal of Bodywork & Movement Therapies (2014), http://dx.doi.org/10.1016/ j.jbmt.2014.04.006

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P. Yoopat et al.

Muscle load: endurance test (MPF)

complaints concerned the shoulder region, 26% the lower back, and about 10% the hands and fingers.

Muscle fatigue is assessed by Median Power Frequency (MPF) during a sustaining test for shoulders and forearms, expressed by differences in muscle conductive velocity and synchronization of Motor Units (MU) resulting in a shift to lower frequencies (Eberstein and Beattie, 1986; BiglandRitschie et al., 1981, 1986). The same muscles as for MVC are subjected to a sub-maximal effort. The endurance tests included: Forearm muscles: A dynamic muscle contraction of clenching Wrists from full flexion to full extension over 30 s; Shoulders (M. Trapezius): Holding a weight of 1.5 kg (3.3 lb) over 30 s with stretched arms in abduction (90 ). Both, MVC and MPF were recorded by the ME3000PElectromyography equipment, and analyzed by the MEGAWIN software (MEGA Electronics, Finland).

Statistical analysis The values of the parameters were analyzed by descriptive statistics in terms of the mean (M), standard error (SE), and minimum and maximum values. The differences in muscle strength and endurance, pre and post massage sessions, were analyzed for each method by using paired t tests. The ANOVA repeated measures, with a confidence interval of 95%, and a significance level of p < 0.05 was used to evaluate the effectiveness of the 3 types of massage.

Results The physical characteristics of the subjects (Table 1). The values can be estimated as a normal average for the Thai population.

Perceived Annoyances (VAS) The VAS results (Pre-Post) are summarized in Table 2 and are split into static and dynamic muscle work. All values show a lower score of annoyance ‘Post treatment’ for dynamic muscle contraction (p < 0.05) with an improvement of 14.94%, 16.88%, and 17.04% for SS, RS and CS respectively, indicating a positive effect of the massage for all muscles. For static postural load, only the CS method score was statistically significant. The ‘Pre-Post’ gain in the static contracted muscles was lower (only 3.40% for SS, 6.94% for RS and 8.36% for CS) compared to the profits in the dynamic contractions. Additional information from the subjective complaints revealed that about 53% of the

Table 1 Factors

Physical characteristics of participating subjects. Mean

SD

Min

Max

Age (years) 37.97 5.33 28.00 44.00 Weight (kg) 56.45 10.48 43.50 88.70 Height (cm) 154.05 5.74 142.00 167.00 Body Mass Index (BMI) 23.82 4.48 16.21 35.99 Systolic pressure mmg 116.33 13.03 98.00 155.00 Diastolic pressure (mmHg) 81.27 9.26 65.00 105.00 Resting heart rate (bpm) 79.83 10.66 60.00 102.00

Effects of massage on the muscular system Effects on the muscle capacity-strength (MVC) The average values of the observed MVC-changes in ‘Pre’ and ‘Post’ (in mV) of each the treatment method and each muscle group are summarized in Table 3 and Figure 1. The ‘Pre-Post’ MVC-difference (expressed in %) (Figure 1) of ‘zero’ refers to a ‘neutral’ efficiency: no loss, no gain. A positive outcome would indicate an improvement and a negative result a worsening or slight improvement, in the case of a lower or higher value, respectively. The best recuperation from the massage was found in the M. left Wrist extensor with the CS method (þ9.62%, p < 0.05), the right Wrist extensor RS (þ4.76%), and the M. left Wrist flexor (þ0.88% in SS). All other values remained as no full-power recovery and this was true for all massage methods. The worst result was found in the M. Trapezius, left and right sides: 15.91%, 2.61% and 14.12% for SS, RS and CS respectively. The highest loss was measured for the M. left Trapezius (SS method) (19.37%, p < 0.05). Effects on muscle fatigue (MPF-endurance test) The results of the Median Power Frequency (MPF) fatigue indicator are summarized in Table 4. The ‘Pre-Post’ MPF changes are expressed in Hz (Table 4). A negative () value reflects the degree of fatigue: the lower the value, the more fatigue. The relative values (in %) (Figure 2). All values remain negative in the postphase as it may be expected from maximal effort tests by which the cut-off happens at the exhaustion level. In case the ‘Post’ treatment value is smaller than ‘Pre’ treatment value, the value is marked as positive (þ) because it reflects an improvement in the fatigue level. If the negative value ‘after’ is greater than the ‘before’, then fatigue is persisting (). The differences expressed in percentages are summarized in Figure 2. Significance is found in RS for the M. Trapezius (respectively 34.57% left (p < 0.01) and 37.41% right, (p < 0.01), showing a worsening ‘Pre-Post’ condition in all types of massage. The ANOVA repeated measured showed that the effectiveness of Post Left Wrist Flexor was significant different at p < 0.01 among the three types of massage treatment. For SS, three out of four forearm muscles show recovered signs; only the M. Wrist flexor left remained negative. In the RS method, (also 3 out of 4 of the forearm muscles) only the M. right Wrist flexor made no progress. However, there seems to be a compensation lefteright for both muscles (e.g., left side of SS, 54.3% left to þ12.8% right; for RS, þ46.2% left to 24.5% right).

Discussion Three massage methods: the Sen Sib (SS) (a rather gentle massage), the Ratchsamnak (RS), and the Chaloeysak (CS) methods, (both more intensive), applied by experienced traditional massage therapists to 30 volunteering Thai

Please cite this article in press as: Yoopat, P., et al., Thai traditional massage: Efficiency-assessment of three traditional massage methods on office workers: An explorative study, Journal of Bodywork & Movement Therapies (2014), http://dx.doi.org/10.1016/ j.jbmt.2014.04.006

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Thai traditional massage: Efficiency-assessment of three traditional massage methods on office workers Table 2

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Perceived annoyance VAS between Pre treatment (Pre) and Post treatment (Post), (Mean  SE). SS a

Pre VAS static Post VAS statica Pre VAS dynamica Post VAS dynamica

RS

6.17 5.96 4.82 4.10

   

0.26 0.37 0.37 0.39*

CS

6.48 6.03 5.51 4.58

   

0.25 0.26 0.38 0.32*

6.22 5.70 5.81 4.82

   

0.31 0.28* 0.35 0.38*

F

P-value

95% CI

0.531 0.600 2.719 2.674

0.591 0.515 0.075 0.078

5.63, 5.12, 4.06, 3.29,

6.99 6.72 6.52 5.61

*, Significant difference between Pre and Post massage treatment at p < 0.05. a ANOVA repeated measure comparison of 3 types of massage therapies.

healthy female subjects, with a comparable administrative workload.

Perceived annoyances (VAS) In line with the Marras (2012) statement about introducing the exposed subjects’ vision as a prerequisite to assess the workload of a complex system, the experiences, here assessed by the VAS, (Mori et al. (2004), Mackawan et al. (2005)), this project show a clear advantage of all performed massage therapies with a 11.3% lower score for all results (Table 2), with a significant gain in the dynamic forearm muscles (16.29%, p < 0.05) and the lowest improvement is found in the static load components (6.24%). These results are difficult to compare with other literature findings, because they are obtained from chronic disorders patients such as lower back pain, e.g., Chatchawan et al. (2005), Anup et al. (2010), Kenny and Marc (2011), and Mackawan et al. (2005).

Effects on the muscle capacity-strength (MVC) The objective strain criteria (MVC) in the shoulders and arm-systems, represented in Figure 1 and (Table 3) show changes in the MVC before-after tests that are opposite to the VAS (lower subjective problems for more loss in power). The MVC for the Trapezius muscle calls upon almost all MU’s in a full isometric contraction, by which the muscle fibers are exhausted within 2 s. The sudden acidosis could not be fully dissolved before starting the therapy and the residue

Figure 1 Change of muscle capacity test EMG Pre and Post massage treatment (microvolts) in %.

(sustaining fatigue) will affect the evolution in the post MVC test. The MVC as an assessment factor can be questioned for the assessment of massage-efficiency because MVC could be affected by other factors than the ‘massagerelated’ method, such as some private inter- and intraindividual differences e.g., the left- or right-hand preferences.

Effects on muscle fatigue (MPF-endurance test) The MPF evolution (Figure 2, Table 4) shows a sustaining fatigue for the Trapezius muscles left and right (mainly

Table 3 Muscle capacity of M. Trapezius, M. Wrist flexor, M. Wrist extensor (MVC in microvolt), both left and right sides, of office workers Pre and Post massage treatment (Mean  SE). MVC (mv)

Sen Sib (SS) a

M. lt. TR Pre M. lt. TR Posta M. rt.TR Prea M. rt.TR Posta M. lt. WFL Prea M lt. WFL Posta M. rt. WFL Prea M. rt. WFL Posta M. lt. WEX Prea M. lt. WEX Posta M. rt. WEX Prea M. rt. WEX Posta

332.63 268.20 352.80 308.87 388.37 391.80 374.73 365.90 404.55 384.48 481.31 421.50

           

30.30 23.75* 35.34 33.88 24.09 26.59 24.21 25.95 27.79 20.35 37.33 27.11*

Ratchsamnak (RS) 283.07 274.41 365.41 357.24 364.10 357.93 363.14 332.93 362.33 358.72 447.48 468.79

           

27.10 21.21 41.50 38.85 28.82 23.46 27.58 19.52 29.53 25.50 33.48 32.66

Chaloeysak (CS) 294.10 243.52 374.03 332.72 367.83 366.17 370.21 351.62 318.19 348.81 445.41 443.83

           

36.65 25.22 39.68 36.78 25.19 23.97 24.92 23.61 20.95 26.17* 30.87 33.19

F

P-value

95% CI

1.197 1.123 0.117 1.380 0.347 0.578 0.115 0.927 10.952 1.937 1.372 2.194

0.310 0.333 0.890 0.260 0.708 0.564 0.892 0.402 0.000 0.154 0.262 0.121

219.03, 191.85, 280.41, 244.33, 305.06, 309.87, 309.64, 292.95, 275.12, 295.02, 378.90, 360.35,

397.01 318.50 455.32 436.83 435.45 443.35 428.18 423.07 361.25 431.27 564.02 535.70

*, Significant difference between Pre and Post massage treatment at p < 0.05. a ANOVA repeated measure comparison of 3 types of massage therapies.

Please cite this article in press as: Yoopat, P., et al., Thai traditional massage: Efficiency-assessment of three traditional massage methods on office workers: An explorative study, Journal of Bodywork & Movement Therapies (2014), http://dx.doi.org/10.1016/ j.jbmt.2014.04.006

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P. Yoopat et al. Table 4 Muscle fatigue test of M. Trapezius, M. Wrist flexor, M. Wrist extensor (Median Power Frequency, MPF in hertz) both left and right sides of office workers Pre and Post massage treatment (Mean  SE). MPF (Hz) a

M. lt. TR Pre M. lt. TR Posta M. rt.TR Prea M. rt.TR Posta M. lt. WFL Prea M lt. WFL Posta M. rt. WFL Prea M. rt. WFL Posta M. lt. WEX Prea M. lt. WEX Posta M. rt. WEX Prea M. rt. WEX Posta

Sen Sib (SS)

Ratchsamnak (RS)

Chaloeysak (CS)

F

P-value

95%CI

18.19 20.51 15.75 20.65 23.72 36.59 27.42 23.91 48.74 39.85 46.93 40.36

15.88 21.37 14.06 19.32 20.76 11.17 18.36 22.86 54.67 45.57 39.26 33.30

21.90 24.30 17.86 20.18 21.39 15.68 24.07 20.95 50.53 47.42 46.58 41.94

3.307 0.935 1.111 0.118 0.101 5.812 0.877 0.025 0.791 1.765 0.853 0.754

0.560 0.399 0.326 0.849 0.904 0.008 0.422 0.955 0.433 0.181 0.432 0.435

26.31, 28.72, 22.44, 28.80, 39.66, 50.17, 42.33, 40.58, 62.32, 54.55, 57.44, 50.02,

           

2.55 3.06 2.78 3.69 7.15 6.20 6.54 8.40 4.26 4.52 4.20 3.89

           

1.94 1.66** 2.06 2.37** 8.52 8.28 5.46 7.93 3.74 4.02* 7.37 7.45

           

2.15 2.16 2.23 2.01 6.66 7.49 6.99 8.81 4.12 3.48 5.30 3.94

13.03 14.18 9.48 13.24 3.31 þ5.80 7.19 2.91 40.05 30.77 24.15 18.04

*, ** Significant difference between Pre and Post massage treatment at p < 0.05 and p < 0.01. a ANOVA repeated measure comparison of three massage therapies.

RS) < 0.01), a moderate fatigue in SS and a low in CS and correspond with the MVC Trapezius muscles losses. There is an opposite fatigue in the Flexor muscles for SS and RS, left negative, right positive for SS and inversed for RS. The compensation effect could be attributed to an influence of the individuals’ right or left hand preferences .For CS both Flexors are improved. The extensor muscles left and right were improved in all three types of massage therapies. The differences between static load in the Trapezius muscles and dynamic contractions in the forearm muscles correspond with the higher VAS scores, which can be explained by the type of muscle contraction. In the forearm muscles, the dynamic muscle work (contraction/de-contraction) performed over 30 s, foster the lactate removal and fatigue will not create serious problems, and the e unconscious e switch in efforts between left-right arms has a balancing effect on the fatigue MPF. The positive effects can be linked to the advantageous dynamic pattern of ‘contraction and relaxation’ which creates micro recovery periods.

Figure 2 Change of muscle fatigue test, MPF Pre and Post massage treatment (Hertz) in %.

Conclusions The overall “Pre-Post” comparison of this study allows us to summarize that: The efficiency of three therapeutic traditional Thai massage methods Sen Sib, Ratchsamnak and Chaloeysak, was assessed through the psychosomatic reactions of the participating subjects VAS, subjectively experienced problems and muscle strain. All three methods put the focus on the theorised energy flow throughout the body by therapeutic methods with 3 intensities: from light/ soft in the Sen Sib method, to moderate in the Ratchsamnak and the intensive Chaloeysak therapy. The efficiency of selected methods was objectively evaluated by a measurement of changes in muscle capacities: the power (MVC, intrinsic potential) or endurance (MPF, muscle fatigue). The maximal pre and post tests were designed in function of the effort-types (static postural for shoulders and dynamic repetitive in the forearm muscles (fingers, hands, wrists). Conclusions of this study are as the following: The subjective assessment of the patient experiences (Visual Analogue Scale) revealed in the pre post analysis a clear lower score for problems in the shoulders and forearms, and for specific differences in muscle contractions: static for the shoulders (lower efficiency), dynamic for forearms (more beneficial). The effectiveness of three types of massage treatment according to MVC test are not significantly different. The results of the changes in power (MVC) revealed in general a loss in the shoulder muscles for the 3 massage systems, reflecting an adverse effect of the therapies. A possible cause can be found in the accumulated lactate during the isometric/isotonic contraction which supports shoulder stability in the maximal test. The negative values of MPF (Median Power Frequency) in pre and post tests confirmed muscle fatigue in the M. Trapezius which remained negative in all therapies. The same conclusions as for MVC are applicable here. The effectiveness of three types of massage treatment according to MPF-endurance test is significant different in the post test left Wrist Flexor muscle. The effects on the forearm muscles in dynamic contraction are more

Please cite this article in press as: Yoopat, P., et al., Thai traditional massage: Efficiency-assessment of three traditional massage methods on office workers: An explorative study, Journal of Bodywork & Movement Therapies (2014), http://dx.doi.org/10.1016/ j.jbmt.2014.04.006

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Thai traditional massage: Efficiency-assessment of three traditional massage methods on office workers promising as some fatigue signs reduced significantly, (Sen Sib and Chaloeysak for 3 muscles out of 4 with a positive improving effect, Chaloeysak for all four forearm muscles). This study, emphasizes the importance of using endurance (MPF) tests as a valuable scientific criterion.

Recommendation M. Trapezius: Static components are also essential in deep muscle massage, and gaining force (MVC) could be advantageous. As this is not possible during the therapies (requires changes in the morphology of strengthening muscle motor units, asking for training over longer periods) it might be advisable for therapists to consider a training program for healthy office employees. The study reveals also a need for more comprehensive experiments and studies (test design and re-design, development of assessment thresholds, modified methodological ‘body part, time, and effort’ procedures) to confirm these preliminary results. If the loss of power needs to be maintained as an evaluation criterion, the MVC test has to be redesigned to develop limits of acceptable loss before starting the therapy (for example a recovery of at least ‘x’% or an acceptable loss in micro-volts of e.g., 20%). Further analysis of the left-right side switches in upper limbs should be analyzed in function of the non-cognitive behavioral changes due to muscle fatigue in the different types of massage-related workload performed during the daily tasks.

Acknowledgements This study is supported by the Research Institute of Rangsit University. The author would like to sincerely thank the massage experts, participants, advisors, and therapists.

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Please cite this article in press as: Yoopat, P., et al., Thai traditional massage: Efficiency-assessment of three traditional massage methods on office workers: An explorative study, Journal of Bodywork & Movement Therapies (2014), http://dx.doi.org/10.1016/ j.jbmt.2014.04.006

Thai traditional massage: efficiency-assessment of three traditional massage methods on office workers: an explorative study.

Thai Traditional Massage (TTM) is popular and widely spread in Thailand. This project is aimed at studying the physiological efficiency of three popul...
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