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Research-Based Massage for Stress and Immune Function (2 CE Hours)

This course is approved by the Texas Department of State Health Services DSHS for Continuing Education for Massage Therapists CE0009 and by the NCBTMB for Nationally Certified Massage Therapists for 2 CE Hours.

Learning Objectives: After reading this course, you will...

  1. be able to identify and describe the different types of specific immunity our body uses to fight diseases based on the research.
  2. be able to list and describe the physiological events and the clinical signs of inflammatory response.
  3. be able to describe and explain the research-based implications of massage for inflammatory conditions.
  4. be able to explain the disease states of Lupus and describe the clinical implications for massage therapy supported by the research.
  5. be able to describe how massage therapy can have a number of positive effects on stress based on the research.
  6. be able to explain the implications, according to the research, for massage therapy on people with HIV/AIDS and cancer.
  7. be able to list the contraindications of massage for people with inflammatory conditions or immune system compromise.

Introduction to Research-Based Massage for Stress and Immune Function

The immune system functions in distinguishing your cells from “other” cells invading your body and eradicates those “other” cells as quickly as possible.  It is composed of specialized cells located throughout your body that are on the constant look-out for “non-self” cells.  T-cells, B-cells and CD4 cells are specialized immune system antibodies that are activated once a macrophage signals or “displays” an invader has entered your system.  Once your immune system identifies these cells, an inflammatory response ensues where your body attacks and destroys the invading cells.  Table 1 below outlines different types of immunity. (1)
Table 1. Types of Specific Immunity



Inborn Immunity

Immunity to certain diseases is inherited (eg. canine distemper)

Acquired Immunity

Immunity acquired from an outside source (eg. your mother)

  Natural immunity

Exposure to “non-self” cells is accidental

         Active exposure

Immunity forms after being exposed to causative agent (eg. chicken pox)

         Passive exposure

Immunity forms from receiving protection from Mother (eg. breast milk)

  Artificial immunity

Exposure to “non-self” cells is deliberate

         Active exposure

Immunity forms due to injection of causative agent (eg. vaccination)

         Passive exposure

Immunity forms due to introduction of antibodies into the system (eg. antibiotics)

An “Inflammatory Response” happens whenever your body is alerted to invasion or injured.
The major physiological events which occur during an inflammatory response include:

  • Immediate vasoconstriction of the blood vessels leading away from the site.
  • Increased volume of blood flow to the site (vasodilation).
  • Decreased velocity of blood flow to the site (leucocytes are able to slow down and adhere to vascular endothelium).
  • Increased expression of vascular endothelial adhesion molecules (leucocytes are able to attach to vascular endothelium)
  • Increased vascular permeability (fluid enters tissues more easily)
  • Influx of phagocytic cells into tissues (macrophages engulf bacteria and cellular debris)

The classic clinical signs of an inflammatory response are:

  • rubor (redness)
  • tumor (swelling)
  • calor (heat)
  • dolor (pain)

The inflammatory response is a natural response.  A quick and appropriate inflammatory response indicates a strong immune system.  Over-reaction of the immune system occurs in hypersensitivity reactions like allergies and autoimmune disorders.   There 4 types of hypersensitivity reactions:
Type 1 – an immediate reaction to an antigen or allergen.  Immunoglobulin E, a specific antibody sensitizes nearby mast cells, which release chemicals (especially histamine) that create the physiological events listed above.  Examples of Type 1 hypersensitivity reactions are hay fever, eczema, hives and asthma.
Type 2 – involve cytotoxic, or cell killing, reactions to specific antigens. They are less common than Type 1 reactions.
Type 3 – reaction of antibodies with antigens where small particles form that are too small to be phagocytized.  These small particles get lodged in the delicate fibers of the kidneys, eyes and brain or serous membranes around the heart and lungs.  This results in an inflammatory response in these tissues.  Systemic lupus erythematosus is an example of this type of reaction.
Type 4 – is a delayed reaction to an irritant. Contact dermatitis is an example of this type of reaction.  When an irritating substance comes in contact with the skin, a delayed reaction can take 24-48 hours to manifest. (2)

Research-Based Implications for Massage Therapists Inflammatory Conditions
Type 1 and Type 4 reactions are the most applicable to massage therapists.  Type 1 hypersensitivity will typically occur within in a few seconds after a particular allergen contacts the skin.  However, a late-phase Type 1 reaction can continue to cause allergic signs and symptoms after the irritant has been removed.  Arachidonic acid, an omega-6 fatty acid, is a substance associated with late-phaseType 1 hypersensitivity reactions.  Some types of massage oils break down into arachidonic acid on the skin.  A client who is hypersensitive to arachidonic acid may not have an immediate reaction, but may suffer from coughing, wheezing and shortness of breath several hours after contact.  Oils that are particularly prone to breakdown into arachidonic acid are safflower, soy, almond, sunflower and corn oil.  These are the most likely to cause skin irritation and allergic reactions and should not be used as massage oils. 

Research on Systemic Lupus Erythematosus
Lupus is an autoimmune disease in which the body develops antibodies that react against the persons own tissue.  Its cause is unknown and it can manifest in mild cases with little danger or can cause fatal damage to the heart, lungs, kidneys and brain.  It affects different people in different ways and its progression is extremely variable.  Lupus is not contagious, infectious or malignant.  It is more prominent in women (90%) and is more common in African-American and Latin-American women.  The general manifestations of Lupus are fatigue, weight loss, episodic fever, depression, confusion, skin painful itching, “butterfly” rash on face, scaly rash on skin, easy bruising, arthritis pain, joint swelling, anemia, blood clotting, sensitivity to cold, swelling of hands and feet, shortness of breath,  nephropathy (kidney disease), frequent urinary tract infections, and gastrointestinal dysfunction.  A person with lupus may develop only a few mild symptoms or many symptoms of varying severity.  Stress, sunlight, viruses, chemicals and hormones are all factors that can exacerbate Lupus symptoms.  People with lupus require a lot of physical and emotional rest, protection from UV rays and avoidance of infectious agents due to their suppressed immune system. 

Research-Based Implications for Massage Therapists Systemic Lupus Erythematosus
During acute flare-ups, massage can exacerbate the symptoms of lupus and put unhealthy stress on the cardiovascular system.  During times of remission, massage can be a benefit by reducing stress and that can lead to decreased flare-ups.

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