A study of the effects of a conventional back mas­

sage on the autonomic activities of the body is

described. Ten normal somatotyped female col­
lege students underwent three massage and three
control periods. Measurements of arterial blood
pressure, heart rate, respiration rate, galvanic skin
response, skin temperature, body temperature, and
pupil diameter were made before, during, and after
each period. Subjective observations were also
collected. The changes in each of the parameters
between massage and control periods were hy­
pothesized to be the consequence of the massage's
effects on the autonomic nervous system. The data
were evaluated (and compared with changes ex­
pected from the known behavior of the autonomic
nervous system) to test the consistency and validity

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of this hypothesis. The results indicate an in­
crease in sympathetic activity in most of the in­
dexes.

The Influence
of Back Massage Manipulation of body tissues
with the hands, in the form of massage, has
on Autonomic Functions been employed by man for centuries as a means
of treating many of his ills. Massage has occu­
pied a place in his art, literature, history, and
medicine. Although the beneficial results of
massage have been attested to by many per­
sons including physical therapists, these reported
changes have seldom been subjected to quanti­
fication. A perusal of the literature on massage
emphasizes the dearth of recent studies in which
substantiated physiological effects of this pro­
cedure are presented.

JEAN SCOTT BARR, M.S.

and NORMAN TASLITZ, Ph.D.

Mrs. Barr is Associate in Physical Therapy, Duke Uni­

versity Medical Center, Durham, North Carolina 22706.
Dr. Taslitz is Assistant Professor of Physical Therapy
and Professor of Anatomy, Case Western Reserve Uni­
versity, Cleveland, Ohio 44106.
This paper was adapted from a thesis submitted to the
Graduate Physical Therapy Curriculum, Case Western
Reserve University in partial fulfillment of the require­
ments for the Degree of Master of Science, September
1967, and was presented at the Original Research Paper
session at the Forty-fourth Annual Conference of the
American Physical Therapy Association, Miami Beach,
Florida, July 1967.
The study was supported by funds from the U.S. Public
Health Service, Biomedical Sciences Support Grant, under
grant number FR 07076 S-02.

Volume 50 / Number 12, December 1970 1679

 The foundation for this research was formed
by the question: Does massage produce mea­
surable changes in the body's autonomic activi­
ties? A hypothesis that the conventional back
massage strokes would, in some manner, affect
the autonomic nervous system, and that the
change in activity could be monitored and
measured was formulated.
METHOD
Ten normal female college students ranging
in age from nineteen to twenty-one participated
in the study. Female subjects were selected to
avoid the effects which might result from a
female physical therapist administering massage
to male subjects. Selection of the subjects, who
had previously been somatotyped by the Clin­
ical Anthropology Department of Case Western
Reserve University, was made on the basis of a
narrow range of somatotype components, i.e.,
Fig. J. Position of the subject as seen from above: The galvanic skin response electrodes (A), sphyg­
momanometer cuff (B), and thermocouple attachments (C) are shown.
1680
the endomorphic component was limited to 5
and 5.5; ectomorphic to 2.5, 3, and 3.5; and
the mesomorphic to 2, 2.5, 3.5, and 4.
The subjects were undergraduate students
with no training in massage. At no time before
or during the sessions was the specific proce­
dure to be administered to their back identified
to them. Neither was the purpose of the study
made known to them.
A conventional back massage was admin­
istered by a qualified physical therapist. The
routine employed was kept constant for each
subject and each session.
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Just prior to administering the massage the
physical therapist immersed her hands for five
minutes (300 seconds) in a paraffin bath main­
tained at approximately 51.7 degrees Centi­
grade (324.8° K). The lubricant used was the
remaining oil on the physical therapist's hands
following the paraffin treatment. The temper­
ature of her hands ranged from 33.9 to 35.6
PHYSICAL THERAPY
degrees Centigrade (307.0 to 308.7° K) at the
beginning of the massage. During the admin­
istration of the massage, the physical therapist
stood at the subject's left. The subject was
prone on a plinth with her head facing to the
right (Fig. 1).
For purposes of this study the area of the
back was defined according to specific anatomic
boundaries. The superior boundary was fixed
at the first cervical segment. The inferior border
was delineated just proximal to the gluteal cleft.
Laterally, the area of the massage was limited
to the mid-axillary line and distal attachment
for each subject. A session consisted of three
periods.
An acclimatization period of fifteen minutes
(900 seconds) was utilized prior to each control
or massage period. The control or massage pe­
riod lasted twenty minutes (1200 seconds),
and a rest period of twenty minutes (1200 sec­
onds) followed.
During the first session the instructions were
read to the subject. Following this reading, the
subject was connected by means of thermo­
couples, an indirect blood pressure cuff, and
electrodes to the various monitoring devices.
No massage was administered during the con­

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of the deltoid on the humerus.
Measurements of the arterial blood pressure, trol period.
heart rate, galvanic skin response, peripheral
skin temperature, body temperature, pupil di­
ameter, respiration rate, and axillary sweating
were made during, as well as before and after,
each control or massage period. Subjective ob­ Posterior Anterior
servations regarding the occurrence of goose
flesh, thirst, sleep, urination, and defecation
were also collected.
Indirect blood pressure, heart rate, galvanic
skin resistance of the palm of the hand, and
respiratory activity were monitored by means
of sensing probes attached to the subject and
connected to preamplifier transducers (Fig. 1).
The peripheral skin temperature monitored at
specified body areas (Fig. 2), environmental
temperature, and relative humidity were re­
corded.* An oral body thermometer was used
to indicate the body temperature and a milli­
meter scale was used to measure the pupil
diameter. A computer processed the data.f
A series of three massage sessions were
postulated to be necessary in order to obtain
maximum relaxation. Each subject served as
her own control. The massage session was pre­
ceded by a control session on the prior evening.
Consequently, there were a total of six sessions

* Speedomax G. Leeds and Northrup Company. Phila­

delphia, Pennsylvania 19144.
Brown Recorder. Honeywell Regulator Company, Brown
Instrument Division. Philadelphia, Pennsylvania 19104.
f IBM 360/75. International Business Machines. White
Plains, New York 10601.
Fig. 2. Diagrammatic illustration of the attach­
ment of the thermocouples for recording periph­
eral skin temperature.

Volume 50 / Number 12, December 1970 1681

 In the first massage period, the same order
for connections to the equipment was followed
and the area of the sacrum to receive the fric­
tion massage was marked with a wax pencil.
A conventional back massage was administered.
Identical measurements were taken at the same
time intervals for both the control and massage
periods. The remaining sessions were con­
ducted in the same manner except that the
instructions were not read.
The arterial blood pressure, heart rate,
peripheral skin temperature, body temperature,
and environmental readings were recorded every
evening each subject recorded any noticeable
change in the occurrence of goose flesh, thirst,
sleep, urination, and defecation.
All sessions were conducted between 5:00
and 6:30 P.M. on a Monday through Thurs­
day schedule during the months of January,
February, and March in the constant-tempera­
ture room located in the Physical Medicine and
Rehabilitation Service of the Cleveland Vet­
erans Administration Hospital.
The environmental temperature ranged from
25.7 to 26.5 degrees Centigrade (298.8 to
299.6° K) during the entire session. A range

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five minutes (300 seconds) throughout the
control or massage and rest periods. The gal­
vanic skin response and respiration rate were
monitored continuously. Designated interval
readings of the pupil diameter were made at
fifteen minutes (900 seconds) before the con­
trol or massage period, upon completion of the
control or massage, and at the end of the rest
period. The axillary sweating pads were weighed
prior to and following the control or massage
period.
Observations concerning any change in the
way the subject felt during the control or mas­
sage were made by each immediately following
that period. Three to four hours later the same
of 36.2 to 37.5 percent occurred in the relative
humidity during the same period of time. How­
ever, the barometric pressure showed a very
small change from 30 to 31.1 millimeters of
mercury.
The mean of the measured autonomic re­
sponses was calculated for all ten subjects for
each of the sessions. Only those specific time
intervals were compared which were believed
to be significant in indicating trends in the
parameters measured. It was believed that such
trends should be useful in indicating parameters
which could be utilized more advantageously in
future research.

TABLE 1
MEAN ARTERIAL BLOOD PRESSURE
(mm HG.)

Control Massage
A B C A B C
Systolic 109.3 110.5 110.8 I 109.8 105.9 107.9
111.0 112.5 109.0 II 109.0 108.0 106.5
111.5 113.5 111.5 III 114.0 111.5 114.5

Diastolic 58.2 61.2 60.2 I 62.1 60.6 59.2

61.0 60.5 58.0 II 63.5 62.0 61.0
65.0 66.5 62.0 III 62.0 60.0 62.0
A: Five minutes (300 seconds) before control or massage period
B: Initial five minutes (300 seconds) of control or massage period
C: End of control or massage period
I, II, III: First, second, third session

1682 PHYSICAL THERAPY

RESULTS peared during the control period than during
the massage period (Tab. 4).
Arterial Blood Pressure Throughout the massage period, the response
varied with the area of the body to which the
An initial increase in both the systolic and
thermocouple was attached. Those thermo­
diastolic blood pressure appeared during all
couples attached to more distal segments from
three control periods when the blood pressure
the back, such as the left great toe (Tab. 4),
recordings which were taken five minutes (300
tended to fluctuate more in temperature range
seconds) before the control period began were
and from session to session than the more prox­
compared with those taken five minutes (300
imal area below the left clavicle (Tab. 5 ) .
seconds) after it began (Tab. 1). At the end
When temperatures of the anterior and pos­
of the control period the blood pressure tended
terior surfaces of the same segment of the body
to fall.
Initially, the systolic and diastolic blood

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pressure tended to decrease during the massage
period. The delayed effects measured at the
end of the massage, however, showed an in­
crease in systolic and a small decrease in di­
astolic pressure.

Heart Rate
The heart rate decreased during the control
period when the beats per minute (sixty sec­ TABLE 2
onds) recorded five minutes (300 seconds) MEAN HEART RATE
(BEATS PER MINUTE OR 60 SECONDS)
before the period were compared with those at
the end of the control period (Tab. 2). For Control Massage
the same time period during the massage pro­ B A B
A
cedure, however, the heart rate increased.
74.5 74.0 I 72.7 73.7
72.7 67.3 II 72.3 79.9
71.1 70.1 III 70.0 75.7
Galvanic Skin Response
A: Five minutes (300 seconds) before control or mas­
Decreased sweating, resulting in an increased sage period
skin resistance to electrical current, appeared B: End of control or massage period
I, II, III: First, second, third session
during control period I but was reversed in con­
trol periods II and III (Tab. 3). For the same
time, comparison of five minutes (300 seconds)
before and at the end of the massage, skin re­
sistance decreased as a result of increased
sweating. The mean change from five minutes
(300 seconds) before the control to the end TABLE 3
was 1.7 kiloohms while that for the massage
MEAN GALVANIC SKIN RESPONSE
period was 41.6 kiloohms. (KILOOHMS)

Control Massage
Peripheral Skin Temperature A B A B
Sixteen thermocouples were attached to the 158.4 163.6 I 128.3 67.7
body. In the majority of the cases similar re­ 145.9 139.9 II 116.7 84.3
154.4 150.0 III 115.2 83.4
sponses occurred during the control and mas­
sage periods making the effects of massage on A: Five minutes (300 seconds) before control or mas­
sage period
the peripheral skin vessels difficult to analyze. B: End of control or massage period
Often a wider range of mean temperatures ap­ I, II, HI: First, second, third session

Volume 50 / Number 12, December 1970 1683

ON
00
-P*

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TABLE 4
MEAN PERIPHERAL SKIN TEMPERATURE OF LEFT GREAT TOE

Control Massage
A B C A B C
33.3° C(306.5° K) 33.1° C(306.3° K) 32.7° C(305.9° K) I 32.6° C(305. 8° K) 32.7° C(305 .9° K) 32.7° C(305.9° K)
31.5° C(304.7° K) 32.6° C(305.8° K) 32.3° C(305.5° K) II 32.8° C(306.0° K) 32.6° C(305 .8° K) 31.7° C(304.9° K)
29.9° C(303.1° K) 30.4° C(303 .6° K) 30.5° C(303.7° K) III 32.4° C(305.6°K) 33.2° C(306.4°K) 31.9° C(305.1° K)
A: Five minutes (300 seconds) before control or massage period
B: Initial five minutes (300 seconds) of control or massage period
C : End of control or massage period
1, II, III: First, second, third session

TABLE 5

MEAN PERIPHERAL SKIN TEMPERATURE BELOW LEFT CLAVICLE

Control Massage
A B C A B C
36.7° C(309.9° K) 36.8° C(310.0° K) 36.9° C(310.1° K) T 36.8° C(310.0° K) 37. 1° C(310.3° K) 37.1° C(310. 3° K)
36.9° C(310.1° K) 37.0° C(310.2° K) 37.2° C(310.4° K) II 36.6° C(309.8° K) 37.0° C(310.2° K) 37.2° C(310.4° K)
36.3° C(309.5° K) 36.5° C(309.7° K) 36.6° C(309. 8° K) III 37.1° C(310.3° K) 37.1° C(310. 3° K) 37.2° C(310.4° K)

A : Five minutes (300 seconds) before control or massage period

B: Initial five minutes (300 seconds) of control or massage period
C : End of control or massage period
I, II, III: First, second, third session

m
>
-d
•<
 TABLE 6
o
MEAN PERIPHERAL SKIN TEMPERATURE OF LEFT ANTERIOR FOREARM

Control Massage

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©
A B C A B C
36.2° C(309.4° K) 36.2° C(309.4° K) 36.0° C(309.2° K) I 36.6° C(309.8° K) 36.4° C(309.6° K) 36.4° C(309.6° K)
35.7° C(308.9° K) 36.0° C(309.2° K) 35.9° C(309. 1° K) II 36.6° C(309.8° K) 36.5° C(309.7° K) 36.3° C(309.5° K)
36.1° C(309.3° K) 35.9° C(309. 1° K) 35.7° C(308.9° K) III 36.4° C(309.6° K) 36.3° C(309.5° K) 36.2° C(309.4° K)
A: Five minutes (300 seconds) before control or massage period
B: Initial five minutes (300 seconds) of control or massage period
C: End of control or massage period
I, II, HI: First, second, third session

TABLE 7

VC MEAN PERIPHERAL SKIN TEMPERATURE OF LEFT POSTERIOR FOREARM

©
Control Massage
A B C A B C
36.7° C(309.9° K) 36.8° C(310.0° K) 36.8° C(310.0° K) I 36.7° C(309.9° K) 36.8° C(310.0°K) 36.8° C(310.0° K)
36.6° C(309.8°K) 36.7° C(309.9° K) 36.8° C(310.0° K) II 36.8° C(310.0° K) 36.9° C(310. 1° K) 36.9° C(310. 1 ° K)
36.6° C(309.8° K) 36.6° C(309.8° K) 36.6° C(309.8° K) HI 36.8° C(310.0° K) 36.9° C(310. 1° K) 36.8° C(3 10.0° IK )
A: Five minutes (300 seconds) before control or massage period
B: Initial five minutes (300 seconds) of control or massage period
C: End of control or massage period
I, II, III: First, second, third session

TABLE 8
MEAN PERIPHERAL SKIN TEMPERATURE OF RIGHT CHEEK

Control Massage
A B C A B C
37.7° C(310.9° K) 37.7° C(310.9° K) 37.7° C(310.9° K) I 37.7° C(310.9° K) 37.8° C(311 .0° K) 37.9° C(311.1° K)
37.2° C(310.4° K) 37.2° C(310.4° K) 37.3° C(310.5° K) 11 37.3° C(310.5° K) 37.4° C(310.6° K) 37.4° C(310.6° K)
37.5° C(310.7° K) 37.6° C(310.8°K) 37.7° C(310.9° K) III 37.6° C(310. 8° K) 37.7° C(310.9° K) 37.7° C(310.9° K)
A: Five minutes (300 seconds) before control or massage period
B: Initial five minutes (300 seconds) of control or massage period
o\ C: End of control or massage period
oo I, II, III: First, second, third session
<-n
were compared, the temperature of the pos­ TABLE 10
terior aspect was slightly higher than that of MEAN RIGHT PUPIL DIAMETER
the anterior (Tabs. 6 and 7). This increased (mm)
temperature could have been the result of con­ Control Massage
striction of the peripheral skin vessels and sub­
A B A B
sequent decrease in blood flow to the distal
area. According to Guyton, this constriction 4.8 4.9 I 4.7 5.5
5.1 4.2 II 5.1 5.8
represents a sympathetic response. 1 4.3 4.3 III 4.6 4.9
Thermocouples monitoring the peripheral
A: Five minutes (300 seconds) before control or mas­
skin temperature of the face indicated an in­ sage period
itially higher skin temperature than at any B: End of control or massage period
I, II, III: First, second, third session
other location on the body (Tab. 8). During
both the control and massage periods, these

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temperatures varied little.
Body Temperature
The oral body temperature was compared at
five minutes (300 seconds) prior to and at
the end of the control period (Tab. 9). A
gradual decrease occurred in the core tempera­
ture during this period of twenty-five minutes
(1500 seconds). At the end of the massage,
the body temperature had increased.
Pupil Diameter
Variations in the right pupil diameter which
occurred during the control period did not
create a trend (Tab. 10). The massage pro­
cedure appears to have caused an increase in
the pupil diameter which was greatest in the
first session (4.7 to 5.5 mm) and decreased
only slightly with each succeeding massage (5.1
to 5.8 mm in II, and 4.6 to 4.9 mm in III).
Tearing
Tearing was not measured in this study be-
cause it was postulated that the placement of
litmus paper in the eye might create a sympa­
thetic response which could confuse the results.
Respiration Rate
Respiration rate data analyzed for the period
immediately prior to and at the end of the
control, showed a slight decrease in the respira­
tions per minute (Tab. 11). A similar decrease
in the respiration rate occurred during the
massage period.
Axillary Sweating
Difficulties with the analytical scale and in
securing the axillary pads in place made it
impossible to observe any trend in the effects
of massage on axillary sweating.

TABLE 9
MEAN BODY TEMPERATURE

Control Massage
A B A B
37.0° C(310.2° K) 37.0° C(310.2° K) I 36.9° C(310.1°K) 37.1° C(310.3° K)
36.8° C(310.0° K) 36.7° C(309.9° K) II 36.9° C(310.1°K) 36.9° C(310.1°K)
36.8° C(310.0° K) 36.8° C(310.0° K) III 36.8° C(310.0° K) 37.0° C(310.2° K)
A: Five minutes (300 seconds) before control or massage period
B: End of control or massage period
I, II, III : First, second, third session

1686 PHYSICAL THERAPY

Subjective Observations
The majority of the subjects did not indicate
any change in the normal occurrence of goose
flesh, thirst, sleep, urination, and defecation
following the control or massage sessions (Tabs.
12 and 13). A few noted that their thirst
increased and their sleep decreased following
the massage. These observations are both sym­
pathetic responses.
DISCUSSION

The effects of massage on the body have

TABLE 11 been reported by many persons and often have
RESPIRATION RATE varied with each report. This investigation
(RESPIRATIONS PER MINUTE OR 60 SECONDS)
was undertaken to observe and record the
Control Massage influence of conventional back massage on the
A B A B functions of the body controlled by the auto­

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17.2 17.2 I 17.3 17.0 nomic nervous system and to serve as a founda­
17.9 17.3 II 17.2 17.3 tion for future research in this area. Arterial
16.8 16.6 III 17.9 17.7 blood pressure, heart rate, galvanic skin re­
A: Five minutes (300 seconds) before control or mas­ sponse, peripheral skin temperature, body
sage period temperature, pupil diameter, respiration rate,
B: End of control or massage period
I, II, III: First, second, third session goose flesh, thirst, sleep, urination, and defeca-

TABLE 12
SUBJECTIVE RESPONSES OF SUBJECTS THREE TO FOUR HOURS
FOLLOWING THE CONTROL PERIOD

Observations Decreased Same Increased

Period I II III I II III I II III

Goose flesh 1 1 1 9 7 9 2

Thirst 7 8 9 3 2 1

Sleep 1 1 7 5 9 2 4 1

Urination 10 8 9 2 1

Defecation 10 9 10

TABLE 13
SUBJECTIVE RESPONSES OF SUBJECTS THREE TO FOUR HOURS
FOLLOWING THE MASSAGE PERIOD

Observations Decreased Same Increased

Period I II III I II III I II III

Goose flesh 1 1 1 6 7 6 3 2 3

Thirst 8 9 7 2 1 3

Sleep 2 3 4 6 6 5 2 1 1

Urination 10 9 10 1

Defecation ! 2 9 8 10

Volume 50 / Number 12, December 1970 1687

tion are indexes cited in the literature as
parameters which reflect the autonomic status
of the individual. 1-16 All of these indexes were
utilized as either measurable or subjective
parameters in the collection of data in the
present research to provide for wide coverage
of the autonomic functions of the body. The
data were not subjected to statistical analyses.
It was postulated that calculation of the mean
response of each index would provide sufficient
identification of the parameters in which trends
were observed. With the knowledge of such
trends, selection of the more significant indexes
could be made and used in a more detailed
study. In such a study statistical analysis of
the effects of back massage on the body could
be conducted.
Absence of statistical analyses and the small
sample size do not permit extrapolation of the
results of the present study to prove or dis­
prove the effects of massage on the autonomic
nervous system. A comparison of the results of
the current study with the literature on massage
indicates differing responses.
Arterial Blood Pressure
Earlier work by Edgecombe and Bain on
the effects of massage on blood pressure in­
dicated that with petrissage an immediate,
transient increase in blood pressure occurred
followed by a decrease. 17 Cuthbertson stated
that in normal subjects neither immediate nor
delayed effects of massage on the pulse rate or
blood pressure were evident. 18 In the current
study, the immediate response was a decrease
in systolic and diastolic pressure with varied
delayed responses.
The immediate parasympathetic response
seen in both the systolic and diastolic pressures
may have been the result of mechanical pres­
sure creating an increased distensibility of the
arterial bed 19 and vasodilatation of the periph­
eral blood vessels. 20 Such effects would bring
about the observed decrease in both systolic
and diastolic blood pressures.
Delayed sympathetic responses recorded in
the systolic pressure may be explained by the
accompanying increase in the heart rate which
could cause an increase in the stroke volume
if the cardiac output remained constant. Since
stroke volume is a determinant of the systolic
1688
pressure, such an explanation appears plausible.
The same increased heart rate could also af­
fect the diastolic pressure in like manner ex­
cept for the checks provided by the mechanical
and reflex effects of pressure on the peripheral
blood vessels. These mechanisms act to con­
trol the peripheral resistance and, by changing
it, also affect the diastolic pressure.
Heart Rate
The increased heart rate which occurred in
all three massage periods appears to be contra­
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dictory to Cuthbertson's statement that massage
has no delayed effect on the pulse rate. 18 An
increase in heart rate may have occurred as a
result of an increased blood flow. Possibly
the subjects may have responded to the massage
with fear, anxiety, or discomfort, any one of
which is a sympathetic response, causing the
heart to beat faster.
Galvanic Skin Response
Obvious increased sweating occurred
throughout the massage periods. This result
is in agreement with one report 21 but contra­
dicts another. 22 Since only the sympathetic
division of the autonomic nervous system is
distributed to the sweat glands, the effect must
be the result of sympathetic stimulation. Pos­
sibly repetitive mechanical stimulation of the
integument stimulated the sympathetic nervous
system to produce increased sweating. Psy­
chological stimuli also may trigger sympathetic
responses and thereby affect sebaceous secre­
tion. A third possible explanation may be
that an indirect vasomotor effect was triggered
through the central nervous system to bring
about a decrease in body temperature.
Peripheral Skin Temperature
Perhaps the indirect vasomotor mechanism
postulated above should be the explanation
of choice for the galvanic skin response results,
since the peripheral skin temperature recorded
at various locations over the body showed little
fluctuation. The massage may have caused
a sympathetic response as demonstrated by in­
creased sweating, and the sweating may have
cooled the body so that no changes in peripheral
skin temperature were evident.
PHYSICAL THERAPY
 Considering the extent of mechanical stimu­
lation through the physical therapist's hands on
the subject's back, one would expect an in­
crease in peripheral skin temperature. The
2 to 3 degree Celsius rise found by Cuthbert-
son 18 was not found in this study. This would
then mean, using the peripheral skin tempera­
ture as an index of peripheral blood flow, no
increase in blood flow occurred in the periphery.
When temperatures of anterior and posterior
aspects of the same segment were compared,
the temperature of the posterior aspect was
usually a little elevated. This could have been
the result of constriction of the peripheral blood
vessels. Such an effect would decrease the
blood flow to the periphery and consequently
prevent the escape of body heat. In accordance
with Takagi and Sakurai, the anterior aspect
of the extremity which registered a slightly
lower temperature may have attained the lower
temperature through sweating. 23 More sweat­
ing would be expected on the anterior aspect
since the subject was prone upon a plinth,
thereby applying pressure to the posterior sur­
face of her forearm causing a sweat reflex to
become operative (Fig. 1).
Body Temperature
During the massage periods, a slight increase
in body temperature occurred. The explana­
tion for this sympathetic response undoubtedly
involves the mechanical stimulation to the body
through the massage strokes. With manipula­
tion of the underlying musculature by massage,
some metabolic activities are increased. 20 In­
creased metabolic activities generate increased
body heat. The rise in blood temperature may
be transmitted via the blood to the temperature
regulating areas of the brain, i.e., hypothalamus,
which may then stimulate mechanisms designed
to decrease the temperature and return the
body to the homeostatic state. 1 Such a mecha­
nism may have operated in the subjects of
this study. Perhaps psychological factors alone,
or in combination with such a mechanism,
stimulated sympathetic activity which resulted
in a small elevation in body temperature above
that observed during the control period. Of
interest, however, is the lower than normal body
temperature present even during the massage
Volume 50 / Number 12, December 1970
periods. Sweating may have caused the lowered
temperature.
Pupil Diameter
Though there appears to be a trend toward
an increased pupil diameter, this response may
have been affected by many variables. The
massage may indeed have produced a sympa­
thetic response. A psychological response of
fear, however, may have been elicited in the
subject, particularly in the first session, since
the procedure had not been explained to her.
Fear will ordinarily trigger a response via the
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sympathetic nervous system which appears as
an increase in the pupil diameter. 1 Another
explanation is that, following the first session in
which the subject found the procedure was not
painful, little or no fear was experienced. This
may have caused the decrease in the pupil di­
ameter or, for an unknown reason, the para­
sympathetics could have been stimulated, bring­
ing about the smaller pupil.
Respiration Rate
In two of the massage periods, a slight de­
crease in the respiration rate occurred which
differs from Eccles' report that massage in­
creases the respiration rate. 24 In the third
session the respiration rate increased but, in
both the control and massage periods, the trend
was toward a decrease.
Since, of necessity, hand pressure on the back
increased and decreased while administering
the massage, the subject was forced into an
irregular respiratory pattern. Through analysis
of the respiratory tracings, hand pressure ap­
peared to bring about a decrease in the respira­
tion rate while the massage strokes persisted.
Perhaps this could be one explanation for the
observed results.
If the results are analyzed on the basis of
sympathetic or parasympathetic effects, the re­
sponse was sympathetic. In the bronchial tree,
sympathetic stimulation produces dilation which
allows for the passage of an increased volume
of air. 1 Thus, the individual does not need
to breathe rapidly or hard in order to obtain
air.
Psychological aspects of the effect of massage
on the individual were not evaluated in any
particular manner; therefore, the decrease in
1689
respiration could have been a result of one of
the mechanisms noted above or could be ex­
plained in terms of a reaction of anxiety to
the massage.
Subjective Observations
The majority of the subjects did not observe
marked changes in the parameters studied.
Those changes which were indicated tended
to be sympathetic responses.
CONCLUSIONS
The general results appear to indicate an
increase in sympathetic activity in most param­
eters measured with only isolated instances of
parasympathetic responses. The reasons for
such responses are not at all clear. It seems,
however, that massage does have an influence
on the autonomic functions of the body.
SUMMARY
The foundation of this study was the ques­
tion: Does massage produce measurable
changes in the autonomic activities of the
body? Since the body's viscera are under
autonomic nervous system control, indexes of
autonomic functions were used to establish
trends in responses to conventional back mas­
sage. A pressure transducer, transducer-pre­
amplifiers, thermocouples, an oral thermometer,
a millimeter scale, and subjective observations
were utilized to measure the autonomic re­
sponses.
Three massage and three control sessions
were designed for each of ten somatotyped
female subjects. Each session incorporated an
acclimatization period of fifteen minutes (900
seconds), a control or massage period of twenty
minutes (1200 seconds), and a rest period of
twenty minutes (1200 seconds).
A summary of the results indicates:
1. An increase of sympathetic activity oc­
curred during the massage period (which
was not observed in the control period)
as evidenced by a delayed increase in
systolic blood pressure, increased heart
rate, increased sweat gland activity, in­
creased peripheral skin temperature in
the posterior aspect of a segment, in­
1690
creased body temperature, increased
pupil diameter, and decreased respira­
tion rate.
2. Isolated instances of parasympathetic ac­
tivity during the massage period were
observed in an initial decrease in systolic
and diastolic blood pressure and a de­
layed decrease in diastolic blood pres­
sure.
3. Though the changes in most parameters
are small a trend is indicated which could
be subjected to further research to ascer­
tain the validity of the response.
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4. Obvious changes occurred in the heart
rate which differed from previous reports
in the literature.
5. Little noticeable change in the normal
occurrence of goose flesh, thirst, sleep,
urination, and defecation was reported
by the subjects.
6. Further research is needed on the emo­
tional and cognitive reactions of the sub­
jects to whom the massage was adminis­
tered to ascertain, where possible, if the
increased sympathetic effect was a result
of the massage or the mental state of the
individual.
Acknowledgment. The authors wish to ex­
press their gratitude to Dr. Roswell Lowry,
Miss Lucy Jones, Mrs. Geneva Johnson, Miss
Patricia Kelsey, and Dr. Roger Barr for their
individual contributions to this research project.
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4. Kahneman D, Beatty J: Pupil diameter and load on
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in man's temperature regulation. J Appl Physiol 20:
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SELECTED READING
Mangubat L, De Leon A, Aguino M: The use of litmus
paper in the determination of the degree of tearing.
Philipp J Surg 2:123-131, 1966

the authors
Jean Scott Barr, an associate in physical therapy, Duke University
Medical Center, received a B.S. degree in zoology from Baldwin-
Wallace College, Berea, Ohio, and a M.S. degree in physical therapy
from Case Western Reserve University, Cleveland, Ohio. She is an
active member of the APTA, Section on Education, and is Chairman
of the Education Committee for the North Carolina chapter.

Norman Taslitz is an assistant professor in the Graduate Physical Ther­

apy Curriculum, and in the Department of Anatomy at Case Western
Reserve University in Cleveland, Ohio. He received his B.S. degree
from New York University, a certificate in physical therapy from the
University of Pennsylvania and a Ph.D. in anatomy from Stanford
University. He was employed as a staff physical therapist at the Uni­
versity of Wisconsin Hospitals, and at the Wisconsin Neurological
Foundation in Madison, Wisconsin.

Volume 50 / Number 12, December 1970 1691