1. bookVolume 13 (2022): Edizione 1 (January 2022)
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1891-5469
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01 Jan 2010
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Open Access

Intravascular, interstitial and intracellular volume changes during short term deep tissue massage of the calf: A case study

Pubblicato online: 23 Nov 2022
Volume & Edizione: Volume 13 (2022) - Edizione 1 (January 2022)
Pagine: 73 - 77
Ricevuto: 28 Jul 2022
Dettagli della rivista
License
Formato
Rivista
eISSN
1891-5469
Prima pubblicazione
01 Jan 2010
Frequenza di pubblicazione
1 volta all'anno
Lingue
Inglese
Introduction
Massage

There are numerous types of physical massage modalities. Most massage therapies are done to relieve stress, reduce inflammation, ease sore muscles and/or restore the body's energy. Only Deep Tissue Massage (DTM) and Deep Lymphatic Massage (DLM) are done to reduce the fluid accumulation that may take place in different segments of the body.

DTM differs from DLM in its purpose, focus and mode of application [1]. DTM employs a greater pressure applied around the leg in slow strokes from the ankle toward the heart. DLM uses a gentler "kneading" type force applied to the skin surface to return accumulated fluids back into the lymphatic drainage system [2].

Little information is available regarding the depth or effectiveness of either DTM or DLM. The objective of this pilot level study was to assess how well this information can be obtained using the bioimpedance device described below. In particular, how DTM affects the three fluid compartments that may accumulate fluids in congestive heart failure patients. Congestive heart failure not only leads to fluid retention but also triggers a change in fluid distribution (intra- and extra-cellular and vascular fluid shifts).

Bioimpedance

An electrical impedance spectrograph (EIS) (Z-Scan-2, U.F.I. Inc, Morro Bay, CA) was used to monitor segmental intracellular and extracellular compartment volumes. A custom analytical program was then used to divide the extracellular compartment volume into its intravascular and interstitial components. Detailed descriptions of the EIS and analytical procedures used in this study can be found in Sasser and Gerth [3], Gerth and Watke [4] and Fricke [5,6]. The EIS was previously validated [7] and used [8,9] to monitor fluid shifts between the intracellular, interstitial, and intravascular compartments during dialysis.

Methods
Subject characteristics

The subject that took part in this pilot level study is a male who has congestive heart failure. He is 83 years old, weighs approximately 130 pounds and is 5 ft. 9 in. tall. He is on a limited fluid intake regime of 2 liters/day and closely monitors his food (sodium) intake to be under 600 – 800 mg/day. He is taking a diuretic in the form of 100 mg oral Torsemide (DEMADEX) administered orally once a day in the morning. This dosage is adjusted based upon his current weight, swelling and blood pressure. The goal for blood pressure is to maintain it at approximately 95/65 throughout the day.

To date, this program has been rather successful in preventing severe edema in the thigh, torso and chest. However, by the end of the day his calves exhibit mild pitting edema of approximately 1 mm in depth (Figure 1).

Figure 1

Extent of pitting edema in calf prior to DTM.

Massage technique used

The objective of DTM is for the pressure applied by the therapist to be more fully transmitted to the underlying muscles where it can mobilize and move the accumulated fluids back toward the heart [2].

The DTM in this study was administered as described by The Wellness Council [10] and Healthline [11] using the following steps:

The leg is placed in a horizontal position and allowed to rest prior initiation of the massage,

Aveeno (dimethicone skin protectant – Johnson & Johnson Co.) daily moisturizing lotion was then used to lubricate the calf before and during the deep tissue massage.

The therapist then applied circumferential force to the calf through long slow strokes from the ankle toward the knee using the hands and thumbs as shown in Figure 2.

DTM was continued for five minutes after which the leg remained horizontal for a recovery period.

After the recovery period the subject sat upright with the leg perpendicular to the floor

to allow the fluid in the calf to return to pretest levels.

Figure 2

Position of hands during DTM.

The timing sequence of the various phases of the DTM was:

Elapsed Time (minutes):

0 start treatment session - placed leg on chair
15 start massage and end of instrumentation period
20 stop massage - start recovery
60 placed leg on floor
120 end of treatment session
Bioimpedance instrumentation

The EIS was applied to the calf by using four ECG electrodes attached to the subject’s dominant lower leg as shown in Figure 3. An extraneous current is passed between the two (input) electrodes placed just above the knee, and just above the lateral malleolus. The resistance and reactance of the calf was measured between the two (detecting) electrodes placed just below the knee and above the ankle [12].

Figure 3

EIS electrode placement on the calf.

Informed consent

Informed consent has been obtained from all individuals included in this study.

Ethical approval

The research related to human use has been complied with all relevant national regulations, institutional policies and in accordance with the tenets of the Helsinki Declaration.

Results and discussion

To our knowledge, this is the first study to use bioimpedance to simultaneously quantify the intravascular, interstitial and intracellular fluid compartment volumes during DTM. DTM was found to affect each fluid compartment volume in two different ways: the amount of the fluid change during the five-minute application of DTM (Table 1) and the time period between initial DTM and its effect on the individual compartment volumes.

Vblood, Vcell, Vinstl Volumes and Changes in Volume (all mL) at Elapsed Times (min.) of changes in the DTM treatment.

ELAPSE TIME - Min. Vblood Change in Vblood Vcell Change in Vcell Vinstl Change in Vinstl
0 1035 0 926 0 1067 0
15 998 -37 907 -19 1054 -13
20 1013 15 816 -91 994 -60
60 1006 -7 556 -260 1001 7
120 957 -49 702 146 1033 31

The salient findings of the current study are as follows:

The EIS system and procedures, as used in this case study, can be used to quantify the intravascular, interstitial and intracellular fluid compartment volumes during DTM.

The Ri, Re and Cm values are used to calculate the separate intravascular, interstitial and intracellular fluid compartment volumes of the calf, as given in Table 1 and Figures 4 and 5, using a custom program [13]. Vblood is the intravascular fluid compartment of the calf. Vcell and Vinstl are the intracellular and interstitial compartments, respectively. All volumes and changes in volume are in mL.

Figure 4

Vblood, Vinst) and Vcell volumes (mL) of the calf during start of DTM vs. Elapsed Time (min).

Figure 5

Vblood, Vinst and Vcell compartment volumes (mL) of the calf during the total DTM treatment and recovery periods vs. Elapsed Time (min).

Table 1 provides the measured Vblood, Vcell and Vinstl (all in mL) at the start and end of each phase of the DTM therapy. Table 1 also shows the amount of fluid increase or decrease (mL) during each phase of DTM. All three fluid compartments lose fluid during the 15-minute control/ instrumentation period when the leg is placed on a chair. At the time when the DTM is terminated Vcell and Vinstl have both lost volume -91 and - 60 mL, respectively, while Vblood has increased by 15 mL.

During the time period Elapsed Time 60 to 120 minutes, when the subject sat upright, Vcell increased by 146 mL and Vinstl gained 31 mL. During this period Vblood decreased an additional 49 mL.

Figure 4 is a plot of one time period (Elapsed Time 0 - 40 min.) to better illustrate the dynamic response of the calf fluid compartments to DTM. DTM was found to be effective even though it was only applied for 5 min. This observation is consistent with other massage therapies that have been applied for short periods of time. Zhong et al. [14] tabulates several studies with ~5 min. application times that significantly improve the physiological, neurological and psychological feelings of the patients.

There is a time delay between the time of starting DTM and the time at which the external massage force affects a given compartment volume. Vblood loses fluid immediately upon the start of DTM. The effect of DTM is delayed approximately 1 min for Vinstl and 2 min for Vcell, respectively.

Figure 5 shows the three compartment volumes, illustrated in Figure 4, during the total duration of the DTM treatment period. This Figure 5 illustrates the volume changes after cessation of DTM, the placement of the leg in an upright position and during the extended recovery period.

The effect of DTM, removing fluid from a given compartment, continues for a prolonged period of time after termination of DTM

Between Elapsed Times 20 min. and 60 min., the leg remained horizontal. All three compartments lost fluid for 10 min. At Elapsed Time 30 min. both Vinstl and Vcell increased in volume. Vblood continued to lose volume until the leg was repositioned on the floor.

The prolonged recovery period found in this study is similar to that reported by Roffay et al. [15]. following changes in cell osmosis. They found that it may take up to 2 hours for the cell membrane tension to fully recover and return to its equilibrium state.

Mechanisms of DTM

Several authors [15,16,17] have set forth possible mechanisms of massage that may explain the above responses to DTM. A brief summary of these mechanisms is given below to provide additional insight regarding the application of DTM.

Equilibrium or "healthy" state of cells

Downey [15] describes "healthy" cells as being spherical in shape with a somewhat rough membrane when at their equilibrium state. The cell membrane is partially folded and partially unfolded at equilibrium. The cell membrane contains numerous transmembrane channels which become "active" or "inactive" in transporting electrolytes into or out of the cell to maintain an osmotic equilibrium across the cell membrane.

Effect of externally applied force upon cells

Hunt et.al. [16] suggests that when an external force is applied to the cell, it may force the cells to change shape and reduce or increase the extent of cell membrane folding. This causes the cells to increase or decrease the number of cell membrane channels that pump ions and electrolytes into or out of the cell in order to reestablish the cell's osmotic equilibrium state.

Prolonged recovery period after cessation of externally applied force

Roffay et. al. [17] reports that the effects of osmotic changes caused by an external force to the cells change the cell's volume which may take a prolonged period of time to dissipate. They found that cell volume slowly started recovery after about 15 min. but may take as much as 2 hours to be complete.

Conclusions

This pilot study has demonstrated that DTM does affect all three fluid compartments of the calf which can be quantified using bioimpedance spectroscopy.

It quantifies the amount of fluids present in and transferred between each compartment before, during and after DTM.

Possible mechanisms of how the cell structure is changed by DTM and how it may alter the intracellular, interstitial and intravascular compartment volumes are summarized from the literature.

This information may be useful in the study of massage and other fluid management techniques. Additional research should be done using the same EIS systems to confirm these results and their applications to other clinical and environmental conditions.

Figure 1

Extent of pitting edema in calf prior to DTM.
Extent of pitting edema in calf prior to DTM.

Figure 2

Position of hands during DTM.
Position of hands during DTM.

Figure 3

EIS electrode placement on the calf.
EIS electrode placement on the calf.

Figure 4

Vblood, Vinst) and Vcell volumes (mL) of the calf during start of DTM vs. Elapsed Time (min).
Vblood, Vinst) and Vcell volumes (mL) of the calf during start of DTM vs. Elapsed Time (min).

Figure 5

Vblood, Vinst and Vcell compartment volumes (mL) of the calf during the total DTM treatment and recovery periods vs. Elapsed Time (min).
Vblood, Vinst and Vcell compartment volumes (mL) of the calf during the total DTM treatment and recovery periods vs. Elapsed Time (min).

j.joeb-2022-0011.tab.001a

0 start treatment session - placed leg on chair
15 start massage and end of instrumentation period
20 stop massage - start recovery
60 placed leg on floor
120 end of treatment session

Vblood, Vcell, Vinstl Volumes and Changes in Volume (all mL) at Elapsed Times (min.) of changes in the DTM treatment.

ELAPSE TIME - Min. Vblood Change in Vblood Vcell Change in Vcell Vinstl Change in Vinstl
0 1035 0 926 0 1067 0
15 998 -37 907 -19 1054 -13
20 1013 15 816 -91 994 -60
60 1006 -7 556 -260 1001 7
120 957 -49 702 146 1033 31

Breathe Team (2020). Deep tissue massage vs. lympahatic drainage massage. https://breatheondemand.com/2020/02/17/deep-tissue-massage-vs-lymphatic-drainage. Breathe Team 2020 Deep tissue massage vs. lympahatic drainage massage https://breatheondemand.com/2020/02/17/deep-tissue-massage-vs-lymphatic-drainageSearch in Google Scholar

Eske J (2022). How to perform a lymphatic drainage massage. Medical News Today; https://www.edicalnewstoday.com/articles/324518. Eske J 2022 How to perform a lymphatic drainage massage. Medical News Today; https://www.edicalnewstoday.com/articles/324518Search in Google Scholar

Sasser DC, Gerth WA, Wu YC (1993) Monitoring of segmental intra-and extracellular volume changes using electrical impedance spectroscopy. J. Appl. Physiol. 74:2180-218. https://doi.org/10.1152/jappl.1993.74.5.2180 Sasser DC Gerth WA Wu YC 1993 Monitoring of segmental intra-and extracellular volume changes using electrical impedance spectroscopy J. Appl. Physiol 742180 218 https://doi.org/10.1152/jappl.1993.74.5.218010.1152/jappl.1993.74.5.21808335546Search in Google Scholar

Gerth WA, Watke CM (1993) Electrical impedance spectroscopic monitoring of body compartment volume changes. J. Clin. Eng. 18(3):253-260. https://doi.org/10.1097/00004669-199305000-00016 Gerth WA Watke CM 1993 Electrical impedance spectroscopic monitoring of body compartment volume changes J. Clin. Eng 183253 260 https://doi.org/10.1097/00004669-199305000-0001610.1097/00004669-199305000-00016Search in Google Scholar

Fricke H (1924) A mathematical treatment of electric conductivity and capacity of disperse systems. I. The electric conductivity of a suspension of homogeneous spheroids. Phys. Rev. 24:575-587. https://doi.org/10.1103/physrev.24.575 Fricke H 1924 A mathematical treatment of electric conductivity and capacity of disperse systems I. The electric conductivity of a suspension of homogeneous spheroids. Phys. Rev 24575 587 https://doi.org/10.1103/physrev.24.57510.1103/PhysRev.24.575Search in Google Scholar

Fricke H (1925) A mathematical treatment of electric conductivity and capacity of disperse systems. II. The capacity of a suspension of conducting spheroids surrounded by a nonconducting membrane for a current of low frequency. Phys. Rev. 26:678-681. https://doi.org /10.1103/physrev.26.678 Fricke H 1925 A mathematical treatment of electric conductivity and capacity of disperse systems II. The capacity of a suspension of conducting spheroids surrounded by a nonconducting membrane for a current of low frequency. Phys. Rev 26678 681 https://doi.org/10.1103/physrev.26.678Search in Google Scholar

Montgomery LD, Gerth WA, Montgomery RW, Lew SQ, Klein MD, Stewart JM, Velasquez MT (2013) Monitoring intracellular, interstitial, and intravascular volume changes during fluid management procedures. Med. Biol. Eng. Comput. 51:1167-1175. https://doi.org/10.1007/s11517-013-1064-3 Montgomery LD Gerth WA Montgomery RW Lew SQ Klein MD Stewart JM Velasquez MT 2013 Monitoring intracellular, interstitial, and intravascular volume changes during fluid management procedures Med. Biol. Eng. Comput 511167 1175 https://doi.org/10.1007/s11517-013-1064-310.1007/s11517-013-1064-3375713123549923Search in Google Scholar

Montgomery LD, Montgomery RW, Gerth WA, Lew SQ, Klein MD, Stewart JM, et al. (2017-1) Bioimpedance monitoring of cellular hydration during hemodialysis therapy. Hemo. Int. 21(4):575-584. https://doi.org/10.1111/hdi.12511 Montgomery LD Montgomery RW Gerth WA Lew SQ Klein MD Stewart JM et al 2017-1 Bioimpedance monitoring of cellular hydration during hemodialysis therapy Hemo. Int 214575 584 https://doi.org/10.1111/hdi.1251110.1111/hdi.12511927090927860119Search in Google Scholar

Montgomery LD, Montgomery RW, Gerth WA, Laughry M, Lew SQ, Velasquez MT. (2017-2) A system to monitor segmental intracellular, interstitial, and intravascular volume and circulatory changes during acute hemodialysis. J. Electr. Bioimp. 8:40-53. https://doi.org/10.5617/jeb.4443 Montgomery LD Montgomery RW Gerth WA Laughry M Lew SQ Velasquez MT 2017-2 A system to monitor segmental intracellular, interstitial, and intravascular volume and circulatory changes during acute hemodialysis J. Electr. Bioimp 840 53 https://doi.org/10.5617/jeb.444310.5617/jeb.4443Search in Google Scholar

Wellness Council, Deep Tissue Massage: The Definitive Guide (2020.) https://wellnesscouncil.org/articles/deep-tissue-massage. Wellness Council, Deep Tissue Massage: The Definitive Guide (2020.) https://wellnesscouncil.org/articles/deep-tissue-massageSearch in Google Scholar

Healthline, What's the Difference Between Swedish Massage and Deep Tissue Massage? (2014). https://www.healthline.com/health/swedish-massage-vs-deep-tissue#3 Healthline, What's the Difference Between Swedish Massage and Deep Tissue Massage? 2014 https://www.healthline.com/health/swedish-massage-vs-deep-tissue#3Search in Google Scholar

Montgomery LD, Hanish DM, Marker RA (1989) An impedance device for study of multisegment hemodynamic changes during orthostatic stress. Aviat. Space Environ. Med. 60:1116-1122. Montgomery LD Hanish DM Marker RA 1989 An impedance device for study of multisegment hemodynamic changes during orthostatic stress Aviat. Space Environ. Med 601116 1122Search in Google Scholar

Ridner SH, Montgomery LD, Hepworth JT, Stewart BR, Armer JM (2007) Comparison of upper limb volume measurement techniques and arm symptoms between healthy volunteers and individuals with known lymphedema. Lymphology 40(1):35-46 Ridner SH Montgomery LD Hepworth JT Stewart BR Armer JM 2007 Comparison of upper limb volume measurement techniques and arm symptoms between healthy volunteers and individuals with known lymphedema Lymphology 40135 46Search in Google Scholar

Zhong H, Wang C, Wan, Lei J (2019) The possible mechanisms of massage therapy. Biomedical Research 30:16. https://doi.org/10.1155/2019/8135985 Zhong H Wang C Wan Lei J 2019 The possible mechanisms of massage therapy Biomedical Research 3016 https://doi.org/10.1155/2019/813598510.1155/2019/8135985693076431915514Search in Google Scholar

Roffay C, Molinard G, Kim K, Urbanska M, Andrade V, Barbarasa V, et. al. (2021) Passive coupling of membrane tension and cell volume during active response of cells to osmosis. PNAS 118(47): 1-12. https://doi.org/10.1073/pnas.2103228118. Roffay C Molinard G Kim K Urbanska M Andrade V Barbarasa V et. al. 2021 Passive coupling of membrane tension and cell volume during active response of cells to osmosis PNAS 11847 1 12 https://doi.org/10.1073/pnas.210322811810.1073/pnas.2103228118861751534785592Search in Google Scholar

Downey BJ, Graham LJ, Breit JF, Glutting NK (2014) A novel approach for using dielectric spectroscopy to predict viable cell volume (VCV) in early process development. Biotechnol. Prog. 30 (2): 479-487. https://doi.org/10.1002/btpr.1845 Downey BJ Graham LJ Breit JF Glutting NK 2014 A novel approach for using dielectric spectroscopy to predict viable cell volume (VCV) in early process development Biotechnol. Prog 30 2 479 487 https://doi.org/10.1002/btpr.184510.1002/btpr.1845416299124851255Search in Google Scholar

Hunt ER, Confides AL, Abshire SM, Dupont-Versteeghen EE, Butterfield TA (2019) Massage increases satellite cell number independent of the age-associated alterations in sarcolemma permeability. Physiological Reports 7(17): e14200. https://doi.org/10.14814/phy2.14200 Hunt ER Confides AL Abshire SM Dupont-Versteeghen EE Butterfield TA 2019 Massage increases satellite cell number independent of the age-associated alterations in sarcolemma permeability Physiological Reports 717 e14200 https://doi.org/10.14814/phy2.1420010.14814/phy2.14200673249431496052Search in Google Scholar

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