Services 1300 888 378

Massage for pain and movement

Last update: 11 Jul 2017

Massage involves rubbing or kneading of the soft muscles and connective tissues of the body and is thought to have multiple benefits for relaxation and rehabilitation
People with cerebral palsy often experience discomfort and movement difficulties and massage can reduce pain and increase mobility
Massage is most effective to treat a health problem when combined with other interventions.

Who is it for?

This page focuses on the benefits of massage for people with cerebral palsy who have the following characteristics and don’t have health problems that can be exacerbated by massage. Such health problems may include issues with circulation, heart, kidneys, skin and bones and interactions with certain medications.
Type of cerebral palsy : Bilateral cerebral palsy, Diplegia, Hemiplegia, Quadriplegia, Unilateral cerebral palsy

More information about cerebral palsy is contained in the What is CP? section.

Mobility : GMFCS I, GMFCS II, GMFCS III, GMFCS IV, GMFCS V

Gross Motor Function Classification System (GMFCS) – classifies severity of mobility difficulties of children and adolescents with CP.

GMFCS Level I
Walks without limitations in the home and community, climbs stairs and can run and jump, difficulties with speed and coordination.

GMFCS Level II
Walks with limitations, difficulties with long distances and uneven surfaces, uses a railing for climbing stairs, limited running and jumping.

GMFCS Level III
Walks using a hand-held mobility device such as crutches or walking frame, may use wheeled mobility for long distances.

GMFCS Level IV
Usually relies on wheeled mobility with assistance, may use powered mobility, usually needs special seating and assistance with transfers.

GMFCS Level V
Usually transported in a manual wheelchair, requires specialised seating and full assistance for transfers.

See full glossary

Arm ability : MACS I, MACS II, MACS III, MACS IV, MACS V

Manual Ability Classification System (MACS) – classifies severity of upper limb impairment: how children with cerebral palsy use their hands to handle objects in daily activities in the home, school, and community settings.

MACS Level I
Handles objects easily and successfully.

MACS Level II
Handles most objects but with somewhat reduced quality and/or speed of achievement.

MACS Level III
Handles objects with difficulty; needs help to prepare and/or modify activities.

MACS Level IV
Handles a limited selection of easily managed objects in adapted situations.

MACS Level V
Does not handle objects and has severely limited ability to perform even simple actions.

See full glossary

Communication ability : CFCS I, CFCS II, CFCS III, CFCS IV, CFCS V

Communication Function Classification System (CFCS) – classifies severity of everyday communication of people with cerebral palsy.

CFCS Level I
Effective Sender and Receiver with unfamiliar and familiar partners.

CFCS Level II
Effective but slower paced Sender and/or Receiver with unfamiliar and/or familiar partners.

CFCS Level III
Effective Sender and Receiver with familiar partners.

CFCS Level IV
Inconsistent Sender and/or Receiver with familiar partners.

CFCS Level V
Seldom effective Sender and Receiver even with familiar partners.

See full glossary

Movement disorder : Ataxia, Athetosis, Dystonia, Hypotonia, Spasticity

More information about movement disorders can be found on our websites.

Intellectual ability : Mild intellectual disability, Moderate intellectual disability, Severe intellectual disability

A person’s thinking skills – ability to understand ideas, learn and solve problems. People with intellectual disability have difficulty with intellectual functioning which may influence learning, communication, social and daily living skills. Intellectual disability may be mild to very severe.

See full glossary

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.

More about massage

There are different massage styles and techniques that can be used for both relaxation and rehabilitation. They can target the deeper muscles – or stimulate the layers of the skin and fascia.

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.

Assessments

A health professional, together with the child and their family will select outcome measures that can be used to determine if the intervention is meeting the client’s needs and goals. There are several assessments that can be used to guide the massage intervention and to measure the benefits. Your health professional can help you decide on the measures that are most relevant to the specific problems you would like to address. Examples include:

Outcome measures for pain:

  • Visual Analogue Scale – rates pain severity on a 0-10 scale
  • Non-communicating children’s pain checklist –measures observable signs of pain in children who cannot communicate about pain

Outcome measures focusing on muscle tone and range of motion:

  • Range of motion – assesses the amount of movement available at joints in the arms and legs
  • Modified Tardieu Scale – measures spasticity in different muscle groups

Outcome measures used for assessing gross motor skills:

  • Gross Motor Function Measure (GMFM)– measures change over time in children’s gross motor abilities (such as standing, walking, running and jumping)
  • Goal Attainment Scaling (GAS goals) – assesses the extent to which a person’s goals are being achieved and can be used to measure change in gross motor ability.
  • 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.

Best available research evidence

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 movement1,6. 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.

Date of literature searches: January 2017

  1. Nilsson, S., Johansson, G., Enskar, K., & Himmelmann, K. (2011). Massage therapy in post-operative rehabilitation of children and adolescents with cerebral palsy — a pilot study. Complementary Therapies in Clinical Practice, 17 (3), 127-131. See abstract
  2. Malila, P., Seeda, K., Machom, S., Salangsing, N., & Eungpinithpong, W. (2015). Effects of Thai massage on spasticity in young people with cerebral palsy. Journal of the Medical Association of Thailand, 98 Suppl 5:S92-6. See abstract
  3. Alizad, V., Sajedi, F., & Vameghi, R. (2009). Muscle tonicity of children with spastic cerebral palsy: how effective is Swedish massage? Iranian Journal of Child Neurology, 3(2), 25-29.
  4. Silva, L. M., Schalock, M., Garberg, J., & Smith, C. L. (2012). Qigong massage for motor skills in young children with cerebral palsy and Down syndrome. American Journal of Occupational Therapy, 66(3), 348-55.
  5. Rasool, F., Memon, A. R. Kiyani, M. M., Sajjad, A. G. (2017). The effect of deep cross friction massage on spasticity of children with cerebral palsy: A double-blind randomised controlled trial. Journal of the Pakistan Medical Association, 67(1), 87-91. See abstract
  6. Macgregor, R., Campbell, R., Gladden, M. H., Tennant, N., & Young, D. (2007). Effects of massage on the mechanical behaviour of muscles in adolescents with spastic diplegia: a pilot study. Developmental Medicine & Child Neurology, 49(3), 187-191.
Find out about CP Check-Up™

Cerebral Palsy Alliance offers a service called CP Check-Up™ which provides ongoing surveillance of the health and well-being of our clients aged 0-18 years.
The information on this page was developed using the best research evidence combined with the expertise of clinicians and people with cerebral palsy and their families. It is provided to help people with cerebral palsy, their families and caregivers, clinicians and service providers make decisions about suitable interventions. This information is intended to support, but not replace, information exchanged, and decisions made, between people with cerebral palsy, their families and health professionals.