Stimulating Knee Massage: Does One Session Improve Joint Position Sense in Elders?
An individual’s ability to perceive a specific joint angle and then repeat that same joint angle after moving the associated limb is what’s known as joint position sense. This sense of awareness, also known as proprioception, is crucial to a person’s balance and reduces the risk of falling.
With joint wear being an inevitable part of aging, older adults are susceptible to poor joint position sense and therefore at increased risk for injury. Are there measures older adults can take to improve knee proprioception following the onset of limitation?
Over the years there have been studies conducted on the effects stimulating knee massage has on knee joint functioning. Research on younger adults finds that massage improves athletic performance and sensorimotor function. In older adults, with a recent study focusing on healthy men over age 65, massage is shown to potentially be more or as beneficial than rest. How was this study undertaken and how reliable are the findings?
The Participants
As previously stated, the individuals recruited were healthy older men. All were capable of walking at least a third of a mile without assistance. None reported the presence of a specific disease or other significant health issue. They all had the capability of understanding and performing the test procedures.
Excluded from the study were individuals who had received sedative drugs or physical therapy in the last month; had a bone fracture or surgery in the lower extremities in the last three months; or the presence of open wounds on the lower extremities.
In total, 20 men participated in the study. Half of the participants first received a massage, followed by a one-week long *washout period, and then a rest session.
The other half rested first and then received a massage following the washout period.
*A “washout period” is a predetermined span of time before or during a clinical trial when study participants receive no form of treatment.
Assessment
Prior to the test, the participants from both groups were assessed for a knee extension angle of -65 degrees. While each participant sat on a bed with the knee flexed at a 90 degree angle, they were asked to extend the knee until a -65 degree angle was reached.
After the results were measured, the participants were each asked to replicate that same angle with their eyes closed. This determined their initial sense of knee joint proprioception.
Testing
Participants each received ten minutes of massage targeting superficial muscles associated with stabilization, flexion, extension, and/or rotation of the knee.
More specifically, they received a five-minute long supine-positioned session focused on the anterior muscles such as the quadriceps, sartorius, gracilis, and tensor fasciae latae. Five more minutes of prone massage followed, focusing on the hamstrings.
Anterior Upper Leg Muscles
Hamstrings
The massages were carried out by a physical therapist specializing in manual therapy. Techniques applied included effleurage (gliding), petrissage (kneading), tapotement (rhythmic percussion), and cupping.
During the rest sessions, the participants were to lie comfortably for ten minutes. The therapist didn’t interact with the participants unless they had questions or wanted conversation.
Results
The study showed significant improvement in joint position sense following massage, regardless of the order in which it was received. Rest alone didn’t have much effect.
Conclusion
A single session of massage was shown to improve joint position sense in older males.
Limitations
The study leaves out an important factor – a one-time treatment is unlikely to be helpful for the long term. In order for the participants to experience long term relief, multiple corrective massage sessions over an extended period of time will be necessary. Once significant improvement has been retained over the course of at least a couple weeks, maintenance massage should be applied on a basis determined by the therapist.
Katrina Jenkins
Author, Licensed Massage Therapist
Katrina Jenkins graduated from Towson University in 2013 with a Bachelor’s Degree in Health Science and worked as a nurse’s aide briefly before pursuing her true passion. She graduated from the Massage Therapy Institute of Colorado in April 2016 with honors and completed the Touch of Healers Scholarship Program the following summer. She has been a part of the Moyer Total Wellness Team since the summer of 2017.
Resources
Mahmood Akramzadeh, Seyed Majid Hosseini, Minoo Khalkhali Zavieh, Khosro Khademi-Kalantari and Alireza Akbarzadeh Baghban (2024b). The Effect of Single-Session Stimulating Massage on the Knee Joint Position Sense in Healthy Older Adult Men: A Randomized Crossover Trial. International Journal of Therapeutic Massage & Bodywork Research Education & Practice, 17(2), pp.4–11. doi:https://doi.org/10.3822/ijtmb.v17i2.961.
Physiopedia (2024). Proprioception. [online] Physiopedia. Available at: https://www.physio-pedia.com/Proprioception.
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