Research on HIV/AIDS

More than 21 million people have died from AIDS and 40 million people are currently living with HIV, with 5 million new infections expected yearly.  HIV is a member of a group of viruses called retroviruses, viruses that change themselves very rapidly.  HIV is a particularly serious infection that attacks and destroys cells of the immune system (T-cells) that are designed to fight infections and diseases.  After HIV penetrates these cells, it reprograms the cell so that it begins to produce many copies of the virus.  Eventually, HIV destroys the immune cells.  Another reason why HIV is a very serious infection is that it has the ability to mutate rapidly, which makes it especially difficult for researchers to find an effective treatment or vaccine.  The virus slowly damages the immune system (11 years on average) until infectious diseases cannot be fought off.  AIDS is HIV in the late stages when the immune system has been weakened and the person is vulnerable to infectious diseases.  Common opportunistic infections are pneumonia, viral infections, and cancer.  HIV/AIDS can be transmitted by sexual contact, blood contact, and mother-to-child transmission.  It is not transmitted through ordinary social contact, touching, clothing, shared dishes or food, toilet seats, insect bites, or massaging.  Nor is it transmitted in tears, sweat, saliva, vomit, feces or urine. 

Research-Based Implications for Massage Therapists regarding HIV/AIDS

HIV/AIDS has been documented as only being spread through direct exchange of body fluids (semen, breast milk, blood, and vaginal secretions). There is no evidence supporting the transmission through massaging, touching, or casual contact.  The person most at risk for getting sick during a massage is the AIDS patient due to their compromised immune system.  It is important that the therapist does not introduce any active pathogens (bacteria or viruses) to the person with AIDS.  Clients that are HIV-positive and are asymptomatic can benefit from massage due to its stress reducing and immune enhancing properties.  It can also be an important source of comfort and support for these people who are rejected and isolated by society.   Recent research has shown that massage provides positive responses in people with HIV/AIDS by improving their overall health and helping them deal with stress.  Specific evidence reports improvements in their quality of life and immune function. (3)  Immune function has been shown to improve through massage by creating decreased levels of cortisol (stress hormone) and increased levels of serotonin (anti-stress neurotransmitter).(4)  Massage has been shown to increase CD4 cells, the bodies killer cells that attack invading cells.(3)  While massage alone provided an improvement in quality of life for these patients, it is more effective when combined with biofeedback stress reduction techniques and meditation. (5) The domains with significant effect sizes included a self-reported reduced use of health care resources, improvement in self-perceived spiritual quality of life and an overall improvement in total quality of life scores. (3) Another study was conducted on children with HIV/AIDS and the children in the massage therapy group improved in self-help abilities and communication, suggesting that massage therapy may enhance daily functioning for children with HIV/AIDS.  Moreover, the HIV infected children who were six or older also showed a decrease in internalizing behaviors; specifically depressive/anxious behaviors and negative thoughts were reduced. (10) 

The Lymphatic System

The lymphatic system is a “one-way” system to return interstitial fluid (fluid outside the cells) back to the systemic circulation. The capillaries are the smallest blood vessels and it is here that oxygen and nutrients are delivered to all the cells of the body.  The capillary is one cell thick and as oxygen and nutrients are delivered to the cells, a small amount of plasma seeps into the spaces between the cells.  This interstitial fluid must either be absorbed back into the capillary or it is destined to be picked up by the initial lymphatic, the beginning of the lymph vessel.  The initial lymphatic is also one-cell thick and it has large openings to allow fluid and some proteins into the lymph vessel.  The lymph vessel has special spiral muscles called lymphangions that assist is moving the lymph through the vessels.  Other things can assist the flow of lymph back to the systemic circulation.  Muscle contractions will squeeze the lymph vessels and push the lymph toward the heart.  Deep breathing draws lymph through the thoracic duct in the abdomen.  Massage can mechanically press lymph fluid through the lymphatic vessels.  Lymphatic drainage is a specialized systematic massage form specifically designed to move the lymph.  When the limbs are elevated above the heart, gravity assists with lymph flow.  If the lymph flow is slowed down or impeded, edema results.  Edema , the accumulation of fluid in the interstitial spaces, is caused by mechanical factors, such as an obstruction to lymph flow or a weakened heart pump, or proteins in the interstitial spaces that cause retention of water.  The lymphatic system is also an important part of the immune system.  Lymphocytes are specialized cells that search the lymph system for cellular debris, bacteria, viruses and cancer cells.  When lymphocytes find an invading cell they will engulf the cell and deactivate it so that it cannot harm your body. 

Research-Based Implications for Massage Therapists regarding the Lymphatic System

Often edema is a contraindication for massage therapy, so massage therapists should always use caution when their client or patient has edema.  Congestive heart failure can cause edema and in this case, massage is contraindicated.  Massage will not help edema under these circumstances and may make matters worse by putting an additional load on the cardiovascular system.  Kidney failure can cause chemical imbalances that allow fluid to build up in the tissues.  Again, massage will not help edema in this situation and may be harmful.  When tissues are infected they can swell and local infection contraindicates massage due to the risk of pushing pathogens into the lymphatic or circulatory system.  In the case of thrombosis (blood clot) or embolism (floating blood clot), massage is again contraindicated because it can make the problem worse.
Edema is considered a “red flag” for the massage therapist and caution should be used whenever you come across swelling.  Some localized edema from musculoskeletal injury may benefit from massage to gently clear the fluid out of an area.  In these cases, lymphatic drainage is the best form of massage to use because it is specifically designed to move the lymph in the correct direction.  Massage has been shown to stimulate the production of lymphocytes, which enhances the function of the immune system. (7)

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