Breathe Easier: Asthma and Massage

By Donna Shryer, August 1, 2021

You likely have clients who routinely book sessions to address chronic muscle tightness, persistent stress, nagging-to-disabling pain or an incessant ache due to postural imbalances. Ironically, these symptoms are all too familiar for someone diagnosed with asthma, yet massage therapy sessions are rarely booked to specifically manage this chronic condition. 

So why hasn’t science fast-tracked this seemingly clear connection between asthma management and massage therapy? Perhaps because those with asthma, as well as anyone who cares for patients with asthma, tend to equate “treatment” with “instant relief,” such as pharmaceutical interventions like an emergency inhaler. 

That’s according to Miami-based Mark Freeman, LMT, who specializes in soft tissue therapy to help restore musculoskeletal function and pain relief from such conditions, including asthma. “An asthma flare requires immediate relief from a rescue inhaler or other pharmaceutical. In my experience—when I work with someone after things calm down and in between flares—I’ve seen massage help adjust breathing patterns and generate a state of relaxation, which can decrease the need for a rescue inhaler.”

Pinning Down the Diagnosis

If we could definitively say that massage therapy can augment conventional asthma treatment, that would be welcome news for the roughly 25 million Americans diagnosed with the chronic condition. Among this 15 percent of the population, 8 percent are adults (18+ years) and 7 percent are children (<18 years).¹

Asthma is a chronic condition that affects the tubes that carry air in and out of the lungs. Certain triggers exacerbate the condition, although not everyone shares identical triggers. Asthma can be set off by a viral infection, the weather, stress or anxiety, and allergens, such as dust, chemicals, smoke, pet dander and essential oils. As the American Lung Association explains, “When you breathe in a trigger, the insides of your airways swell even more. This narrows the space for the air to move in and out of the lungs. The muscles that wrap around your airways also can tighten, making breathing even harder. When that happens, it’s called an asthma flare-up, asthma episode or asthma ‘attack.’”²

While there is no cure for asthma, the American Lung Association adds, “It can be managed so you live a normal, healthy life.”²

All the Right Moves

To create an asthma action plan that includes massage therapy, you want to first focus on your gentlest, most relaxing techniques, says Nancy Rodgers, board-certified massage therapist at the Mayo Clinic. “When I work with a patient after they’ve suffered the trauma of an asthma attack, the last thing this person needs is a deep tissue massage. Their body will perceive that as another trauma,” Rodgers says. “With lighter pressure, I can guide their muscles into relaxation and help alleviate at least some of the physical and emotional stress their body just went through.” 

When working with a client diagnosed with asthma, Freeman agrees that it’s all about a calming, supportive touch. “An asthma flare-up is frightening, so I think a massage therapist’s initial goal with this person is to help them regain a positive relationship with their body and feel safe. My primary techniques are neuromuscular massage therapy, myofascial release applied slowly and gently, as well as anything that would be considered a gentle and supportive touch.” 

Practicing in Damariscotta, Maine, Lori Rizzuto, LMT, works with the Bowen technique, also called Bowenwork.³ Bowenwork is known for its gentle, non-invasive touch, Rizzuto says. “You don’t go deep into the muscle tissue. Instead, the principle here is that less is more,” she adds. “I use a rolling movement with my thumbs and forefingers, and I work directly with the autonomic nervous system and the superficial fascia. By stimulating the body’s own innate healing intelligence, Bowenwork can then help the body regulate and achieve homeostasis.” 

There are no clinical studies that cite Bowenwork’s effect on asthma, although Rizzuto supports the concept and a few smaller studies suggest that the therapeutic technique may have merit in other areas. For example, a 2020 study reports that Bowen Therapy delivered a short-term reduction in pain that was not evident in the study’s control group. “The mechanisms of action of Bowen Therapy remain uncertain but may involve sympathoexcitation,” the study concludes.⁴ Another clinical study, currently under way and set to close in December 2022, is investigating the effectiveness of Bowen Therapy in pain management for patients with fibromyalgia.⁵ 

Body Language

Studies that illustrate a data-driven link between massage therapy and asthma management usually have a small sample size and most often focus on pediatric asthma. But there are studies that include adult patients.

In one of the few known studies focused on adults with chronic obstructive lung disease, which includes asthma, researchers examined neuromuscular massage therapy (NRMT) to augment medical intervention and improve pulmonary function, respiratory muscle strength and quality of life.

The five study participants, ranging in age between 57 and 74, each received a weekly massage for 24 consecutive weeks. At the study’s close, all reported less dyspnea (difficulty breathing), improvements in physiological measurements (peak flows, pulmonary function tests and thoracic gas volume) and self-reported enhanced quality of life. Four out of five study participants chose to continue massage therapy—at their own expense—after the trial ended.⁶

Freeman has seen massage work in tandem with traditional asthma medication to reduce asthma-triggered dyspnea. “With time—and the amount of time is different for different people—massage therapy can help open the breathing mechanism muscles and ease the breathlessness someone with asthma feels when they’re gasping for oxygen,” he says.

Helping adults augment their asthma action plan with massage—and achieve an improved quality of life—may involve a little detective work, Rizzuto suggests. 

“Most people don’t see asthma as treatable with massage therapy, so they don’t book a massage therapy appointment for their asthma. But somebody might come to me with upper back and neck pain or maybe chest pain from coughing,” she says. “By looking at how the body tries to compensate because of the asthma, we can see secondary conditions that massage therapy is known to help manage. If we can get those unwanted side effects under control, there’s less stress on a person’s system and maybe they won’t need their inhaler as much.”

Studies investigating massage therapy’s impact on pediatric asthma patients are more robust. For example, a 2017 meta-analysis, which identified 14 research studies including 1,299 pediatric patients, concluded that conventional asthma treatment with massage therapy was more effective than conventional prescription asthma treatment alone.⁷

A second study randomly divided 44 children (ages 5 to 14) diagnosed with pediatric asthma into two groups. One group received traditional pediatric medication along with a 20-minute massage from a parent every night before bed for one month.

The second group received only traditional pharmaceutical treatment. Study findings report a “statistically significant” decrease in disease for the massage group. This prompted the study authors to conclude that massage “can improve airway tonicity, decrease airway sensitivity and provide better control of asthma.”⁸

A third study delivered significant results concerning the effect of massage therapy on the pulmonary functions of children with asthma. Sixty children with asthma were divided randomly into two groups. One group received standard asthma treatment and a 20-minute massage performed by a parent before bed for five weeks. The control group received standard asthma treatment only.

Children who received the massage showed notable improvement in the maximum amount of air they could forcefully exhale in one second (FEV1), which is a key measurement for those with asthma.⁹  

Stressing the Not-So-Obvious

While asthma is defined as a physiological disease marked by spasms in the bronchi of the lungs, those diagnosed with the chronic condition will likely tell you that it mental health affects it as well. Rodgers agrees wholeheartedly. “When I see someone in the hospital and they’re coming out of an acute asthma attack, they’re often stressed about having another attack that will bring them right back to the hospital.

Ironically, anxiety about having another attack increases the likelihood of another attack,” Rodgers says. “That’s where massage comes in. With massage, I can help break that cycle so the patient can relax, focus on their breathing and let their muscles do the job they’re supposed to do.”

Freeman describes this fear of having another episode as a “vicious loop,” and breaking the loop, he feels, does more than soothe anxiety. “When we’re in a relaxed state, I think we have a better presence of mind to say, ‘Here’s what I need to do right now.’ And for someone with asthma, that might mean reaching for an inhaler or moving away from an allergen before an attack even begins. And I think we can all agree that massage therapy absolutely helps achieve a relaxed state.”

The systemic flow continues, Freeman says. As massage therapy eases the body into a calmer state and breathing becomes more efficient, we exhale the right amount of carbon monoxide, inhale the right amount of oxygen and our blood’s pH level adjusts accordingly. “So it can be a much bigger picture than simply just the breathing mechanics,” Freeman says. 

While few studies definitively affirm massage therapy’s ability to healthfully complement traditional pharmaceutical asthma treatments, the existing research indicates there are some benefits. With time and more studies, there is a possibility that massage therapy will become a valuable and universally accepted tool in the asthma action plan. Further investigation might even suggest specific massage variations and timetables for adult and pediatric patients. 

In the meantime, Rodgers offers this piece of advice: “It’s not easy to manage asthma. There are still a lot of unknowns. But there is one thing I know for sure: As a massage therapist, I can help patients with relaxation—so they can focus on managing their asthma.”  

Keep It Simple

From full-out aromatherapy to gently scented lotions, fragrance often plays a part in massage therapy. If, however, you’re working with a client diagnosed with asthma, massage therapist beware. 

According to the Asthma and Allergy Foundation of America, “There is no evidence that essential oils can help asthma. In fact, breathing in the particles released by the oils may trigger an asthma attack.”¹⁰

The potential danger is because essential oils contain volatile organic compounds (VOCs), just like incense, air fresheners and scented candles. Every one of these fragrance carriers can affect indoor air quality and ignite an allergic reaction for someone with asthma. 

The best way to decide whether a scent is safe for a client is to ask them if they have any known allergies to any scents and/or essential oils. If the client is unsure, take a pass on aromatherapy. 

References

1. CDC.gov. (2019). CDC-Asthma.

2. American Lung Association. (2020). What Is Asthma?

3. American Bowen Academy.

4. Kiho Lee, Gwyn N. Lewis. (2020). "Short-term relief of multisite chronic pain with Bowen Therapy: A double-blind, randomized controlled trial." Journal of Bodywork and Movement Therapies. Volume 24, Issue 4, Pages 271-279.

5. ClinicalTrials.gov. Effectiveness of Bowen Therapy for Pain Management in Patients With Fibromyalgia.

6. Beeken JE, Parks D, Cory J, Montopoli G. (1998). "The effectiveness of neuromuscular release massage therapy in five individuals with chronic obstructive lung disease." Clinical Nursing Research 7(3): 309-325.

7. Wu J, Yang XW, Zhang M. (2017). "Massage Therapy in Children with Asthma: A Systematic Review and Meta-Analysis." Evid Based Complement Alternat Med. 5620568.

8. Afsaneh, Nekooee & Jamal, Faghihinia & Ghasemi, Ramin & Gheibizadeh, Mahin & Zohreh, Ghazavi. (2008). "Effect of Massage Therapy on Children with Asthma." Iranian Journal of Pediatrics. 18.

9. Fattah, M. A., Hamdy, B. (2011). "Pulmonary functions of children with asthma improve following massage therapy." Journal of Alternative and Complementary Medicine. 17(11), 1065–1068.

10. Asthma and Allergy Foundation of America. "AAFA Explains: Can Essential Oils Help Asthma?" https://community.aafa.org/blog/asthma-are-essential-oils-harmful-or-helpful.