Effects of Manual Lymph Drainage of the Neck on EEG in Subjects with Psychological Stress
Identifieur interne : 004115 ( Pmc/Corpus ); précédent : 004114; suivant : 004116Effects of Manual Lymph Drainage of the Neck on EEG in Subjects with Psychological Stress
Auteurs : Jung-Myo Shim ; Sung-Joong KimSource :
- Journal of Physical Therapy Science [ 0915-5287 ] ; 2014.
Abstract
[Purpose] The present study investigated the effect of manual lymph drainage (MLD) of the neck on electroencephalography (EEG) in subjects with psychological stress. [Methods] Twenty-six subjects were randomly allocated to receive one 15-min session of either MLD or resting on a bed (control). [Results] Analysis of EEG in the MLD group showed a significant increase in relaxation, manifested as an increase in average absolute and relative delta and alpha activity. [Conclusion] It is suggested that MLD provides acute neural effects that increase relaxation in subjects with psychological stress.
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DOI: 10.1589/jpts.26.127
PubMed: 24567691
PubMed Central: 3927024
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Effects of Manual Lymph Drainage of the Neck on EEG in Subjects with
Psychological Stress</title><author><name sortKey="Shim, Jung Myo" sort="Shim, Jung Myo" uniqKey="Shim J" first="Jung-Myo" last="Shim">Jung-Myo Shim</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Kim, Sung Joong" sort="Kim, Sung Joong" uniqKey="Kim S" first="Sung-Joong" last="Kim">Sung-Joong Kim</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">24567691</idno><idno type="pmc">3927024</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3927024</idno><idno type="RBID">PMC:3927024</idno><idno type="doi">10.1589/jpts.26.127</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">004115</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">004115</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Effects of Manual Lymph Drainage of the Neck on EEG in Subjects with
Psychological Stress</title><author><name sortKey="Shim, Jung Myo" sort="Shim, Jung Myo" uniqKey="Shim J" first="Jung-Myo" last="Shim">Jung-Myo Shim</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Kim, Sung Joong" sort="Kim, Sung Joong" uniqKey="Kim S" first="Sung-Joong" last="Kim">Sung-Joong Kim</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Physical Therapy Science</title><idno type="ISSN">0915-5287</idno><idno type="eISSN">2187-5626</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p> [Purpose] The present study investigated the effect of manual lymph drainage (MLD) of
the neck on electroencephalography (EEG) in subjects with psychological stress. [Methods]
Twenty-six subjects were randomly allocated to receive one 15-min session of either MLD or
resting on a bed (control). [Results] Analysis of EEG in the MLD group showed a
significant increase in relaxation, manifested as an increase in average absolute and
relative delta and alpha activity. [Conclusion] It is suggested that MLD provides acute
neural effects that increase relaxation in subjects with psychological stress.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Kelly, Dg" uniqKey="Kelly D">DG Kelly</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kim, Sj" uniqKey="Kim S">SJ Kim</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wittlinger, H" uniqKey="Wittlinger H">H Wittlinger</name></author><author><name sortKey="Wittlinger, D" uniqKey="Wittlinger D">D Wittlinger</name></author><author><name sortKey="Wittlinger, A" uniqKey="Wittlinger A">A Wittlinger</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chikly, B" uniqKey="Chikly B">B Chikly</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kasseroller, Rg" uniqKey="Kasseroller R">RG Kasseroller</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Weissleder, H" uniqKey="Weissleder H">H Weissleder</name></author><author><name sortKey="Schuchhardt, C" uniqKey="Schuchhardt C">C Schuchhardt</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kim, Sj" uniqKey="Kim S">SJ Kim</name></author><author><name sortKey="Kwon, Oy" uniqKey="Kwon O">OY Kwon</name></author><author><name sortKey="Yi, Ch" uniqKey="Yi C">CH Yi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Field, Tm" uniqKey="Field T">TM Field</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ellis, V" uniqKey="Ellis V">V Ellis</name></author><author><name sortKey="Hill, J" uniqKey="Hill J">J Hill</name></author><author><name sortKey="Campbell, H" uniqKey="Campbell H">H Campbell</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kresse, Mc" uniqKey="Kresse M">MC Kresse</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tsao, Jc" uniqKey="Tsao J">JC Tsao</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Koh, Kb" uniqKey="Koh K">KB Koh</name></author><author><name sortKey="Park, Jk" uniqKey="Park J">JK Park</name></author><author><name sortKey="Kim, Ch" uniqKey="Kim C">CH Kim</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Madeleine, P" uniqKey="Madeleine P">P Madeleine</name></author><author><name sortKey="Farina, D" uniqKey="Farina D">D Farina</name></author><author><name sortKey="Merletti, R" uniqKey="Merletti R">R Merletti</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Buttagat, V" uniqKey="Buttagat V">V Buttagat</name></author><author><name sortKey="Eungpinichpong, W" uniqKey="Eungpinichpong W">W Eungpinichpong</name></author><author><name sortKey="Kaber, D" uniqKey="Kaber D">D Kaber</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Field, T" uniqKey="Field T">T Field</name></author><author><name sortKey="Ironson, G" uniqKey="Ironson G">G Ironson</name></author><author><name sortKey="Scafidi, F" uniqKey="Scafidi F">F Scafidi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Diego, Ma" uniqKey="Diego M">MA Diego</name></author><author><name sortKey="Field, T" uniqKey="Field T">T Field</name></author><author><name sortKey="Sanders, C" uniqKey="Sanders C">C Sanders</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Maeda, K" uniqKey="Maeda K">K Maeda</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Haken, H" uniqKey="Haken H">H Haken</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Phys Ther Sci</journal-id><journal-id journal-id-type="iso-abbrev">J Phys Ther Sci</journal-id><journal-id journal-id-type="publisher-id">JPTS</journal-id><journal-title-group><journal-title>Journal of Physical Therapy Science</journal-title></journal-title-group><issn pub-type="ppub">0915-5287</issn><issn pub-type="epub">2187-5626</issn><publisher><publisher-name>The Society of Physical Therapy Science</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">24567691</article-id><article-id pub-id-type="pmc">3927024</article-id><article-id pub-id-type="publisher-id">jpts-2013-335</article-id><article-id pub-id-type="doi">10.1589/jpts.26.127</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original</subject></subj-group></article-categories><title-group><article-title>Effects of Manual Lymph Drainage of the Neck on EEG in Subjects with
Psychological Stress</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Shim</surname><given-names>Jung-Myo</given-names></name><degrees>MSc</degrees><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Kim</surname><given-names>Sung-Joong</given-names></name><degrees>PT, PhD</degrees><xref ref-type="aff" rid="aff2"><sup>2</sup></xref><xref rid="cor1" ref-type="corresp"><sup>*</sup></xref></contrib><aff id="aff1"><label>1)</label> Department of Beauty and Health Therapy, Susung College, Republic of Korea</aff><aff id="aff2"><label>2)</label> Department of Physical Therapy, Kangwon National University: 3 Hwangjo-ri, Dogye-eup, Samcheok-si, Gangwon-do 245-907, Republic of Korea</aff></contrib-group><author-notes><corresp id="cor1"><label>*</label>Corresponding author. Sung-Joong Kim, Department of Physical Therapy, Kangwon National
University, Republic of Korea. (e-mail: <email xlink:href="lymphkim@kangwon.ac.kr">lymphkim@kangwon.ac.kr</email>)</corresp></author-notes><pub-date pub-type="epub"><day>06</day><month>2</month><year>2014</year></pub-date><pub-date pub-type="ppub"><month>1</month><year>2014</year></pub-date><volume>26</volume><issue>1</issue><fpage>127</fpage><lpage>129</lpage><history><date date-type="received"><day>10</day><month>7</month><year>2013</year></date><date date-type="accepted"><day>17</day><month>8</month><year>2013</year></date></history><permissions><copyright-statement>2014©by the Society of Physical Therapy Science</copyright-statement><copyright-year>2014</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-nd/3.0/"><license-p>This is an open-access article distributed under the terms of the Creative
Commons Attribution Non-Commercial No Derivatives (by-nc-nd) License. </license-p></license></permissions><abstract><p> [Purpose] The present study investigated the effect of manual lymph drainage (MLD) of
the neck on electroencephalography (EEG) in subjects with psychological stress. [Methods]
Twenty-six subjects were randomly allocated to receive one 15-min session of either MLD or
resting on a bed (control). [Results] Analysis of EEG in the MLD group showed a
significant increase in relaxation, manifested as an increase in average absolute and
relative delta and alpha activity. [Conclusion] It is suggested that MLD provides acute
neural effects that increase relaxation in subjects with psychological stress.</p></abstract><kwd-group><title>Key words</title><kwd>Manual lymph drainage</kwd><kwd>Electroencephalogram</kwd><kwd>Psychological stress</kwd></kwd-group></article-meta></front><body><sec id="s1"><title>INTRODUCTION</title><p>The term manual lymph drainage (MLD) was coined by the Vodders during their years of
developing many of the techniques in use today. The Vodder technique of MLD is the most
widely practiced method in Asia, Europe, North America, and countries in other areas of the
world<xref rid="r1" ref-type="bibr">1</xref>, <xref rid="r2" ref-type="bibr">2</xref><sup>)</sup>. MLD is widely employed for medical disorders, such as lymphedema,
phlebedema, lipedema, postsurgical edema, arthropathy, and rheumatic disease; cosmetic
disorders; gynecological disorders; neurological disorders; and autonomic retuning and as a
health spa treatment<xref rid="r3" ref-type="bibr">3</xref>, <xref rid="r4" ref-type="bibr">4</xref><sup>)</sup>.</p><p>MLD affects the treatment of edema and acts on the body in various ways<xref rid="r3" ref-type="bibr">3</xref>, <xref rid="r4" ref-type="bibr">4</xref><sup>)</sup>,
especially on the psychological and physical changes that result from stress, the
environment, and other factors<xref rid="r3" ref-type="bibr">3</xref><sup>)</sup>. This
means that the appropriate application of MLD to subjects who are in a state of disharmony
with regard to their psychological and physical status restores them to a normal state, with
MLD having a tonic effect on the smooth muscle of lymph vessels that possess numerous
sensory nerve endings with connections to the autonomic nervous system (ANS) and other human
systems<xref rid="r4" ref-type="bibr">4</xref>,<xref rid="r5" ref-type="bibr">5</xref>,<xref rid="r6" ref-type="bibr">6</xref><sup>)</sup>.</p><p>There are many articles have investigated the effects of massage on stress, pain, systems,
fatigue, anger, fear, the autonomic nervous system, and brain state<xref rid="r7" ref-type="bibr">7</xref>,<xref rid="r8" ref-type="bibr">8</xref>,<xref rid="r9" ref-type="bibr">9</xref>,<xref rid="r10" ref-type="bibr">10</xref>,<xref rid="r11" ref-type="bibr">11</xref><sup>)</sup>. However, study of the effect of MLD on electroencephalography
(EEG) has not been reported. Therefore, the aim of this study was to objectively investigate
the EEG performance of subjects with psychological stress under MLD of the neck.</p></sec><sec sec-type="methods" id="s2"><title>SUBJECTS AND METHODS</title><p>The subjects included 115 university students. They were chosen according to the following
criteria: 1) no history of mental illness, 2) not currently taking any medication known to
affect EEG signal, and 3) no known heart- or muscle-related disease. All responded to the
stress responses inventory (SRI)<xref rid="r12" ref-type="bibr">12</xref><sup>)</sup> and
returned it to the authors. They were asked how they respond to stressful situations (e.g.,
emotionally, cognitively, somatically, or behaviorally) and to write 39 responses to
stressful situations. According to the results of the questionnaire, 26 subjects with an SRI
score >80 were enrolled in the study. They were randomly allocated to receive a 15-min
session of either MLD or rest (control).</p><p>Participants were asked whether they suffered from any cardiovascular diseases or endocrine
disorders. If so, they were excluded from the study. All test protocols were approved by the
ethics committee of the Physical Therapy Faculty of Kangwon National University. All
subjects participated voluntarily and provided written informed consent.</p><p>All interventions were completed in a supine position on a massage table with a pillow
placed under the knees to relax the low back muscles. Data acquisition and MLD took place in
a quiet temperature-controlled environment (22−24°C). Talking, phone calls, and noise that
could increase the activity of the sympathetic nervous system were minimized<xref rid="r13" ref-type="bibr">13</xref>), and the subject’s body was covered with a soft, thin
sheet so as to avoid discomfort from body exposure.</p><p>Subjects were allowed to rest comfortably for at least 5 min prior to the baseline
recording procedure. EEG was performed for 5 min prior to performing MLD. Subjects in the
experimental group received MLD of the neck for 15 min, while the subjects in the control
group relaxed by lying quietly for the same time period. The technique was applied in the
areas of the neck twice. The MLD procedure can be found in detail in Dr. Vodder’s Manual
Lymph Drainage: A Practical Guide<xref rid="r3" ref-type="bibr">3</xref><sup>)</sup>. The
protocol was standardized in that the stroke category (type) and time of each stroke was the
same between all participants.</p><p>A total 18 channels of EEG were recorded, including FP1, FPZ, FP2, F7, F3, FZ, F4, F8, T3,
C3, CZ, C4, T4, T5, P3, PZ, P4, and T6. There were two other electrodes, which were placed
on both zygomatic bones as a ground electrode and reference electrode. EEG was recorded
before and immediately after the treatment. Participants were asked to close their eyes and
refrain from talking, falling asleep, or making exaggerated body movements during EEG
measurement. Analysis was based on a 5-min period of EEG signal acquisition, followed by
computerized Fourier analysis of the EEG waves using the TeleScan software package (LAXTHA,
Daejeon, South Korea). The signal was sampled at a rate of 256 Hz and was digitally filtered
using a 1–50 Hz band-pass filter. Absolute and relative power values were obtained for delta
(1–4 Hz), theta (4–8 Hz), alpha (8–13 Hz), and beta (13–30 Hz). The spectral power data
(μV<xref rid="r2" ref-type="bibr">2</xref>) were subjected to a log<sub>10</sub>transformation. All outcome measures were determined and analyzed by an investigator who was
blinded and was not obligated to provide any intervention for subjects.</p><p>Data are given as mean ± SD values. All variables were tested for normality using the
one-sample Kolmogorov-Smirnov test and did have a normal distribution. The paired t-test was
used to test for homogeneity and to compare the pre-MLD and post-MLD results for differences
in EEG. The collected data were analyzed using a statistical package program (SPSS ver.
19.0). A two-tailed probability of p<0.05 was considered statistically significant.</p></sec><sec sec-type="results" id="s3"><title>RESULTS</title><p>The general characteristics did not differ statistically between the two groups at baseline
(p>0.05, <xref rid="tbl_001" ref-type="table">Table 1</xref><table-wrap id="tbl_001" orientation="portrait" position="float"><label>Table 1.</label><caption><title> Homogeneity test for general characteristics the subjects at baseline</title></caption><table frame="hsides" rules="groups"><thead><tr><td align="center" rowspan="2" valign="middle" colspan="1">Variable</td><td align="center" colspan="2" rowspan="1">Group</td></tr><tr><td align="center" rowspan="1" colspan="1">MLD (n=14)</td><td align="center" rowspan="1" colspan="1">Control (n=12)</td></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Age (yrs)</td><td align="center" rowspan="1" colspan="1">21.2±1.2</td><td align="center" rowspan="1" colspan="1">20.9±1.4</td></tr><tr><td align="left" rowspan="1" colspan="1">Sex (Male/Female)</td><td align="center" rowspan="1" colspan="1">3/11</td><td align="center" rowspan="1" colspan="1">2/10</td></tr><tr><td align="left" rowspan="1" colspan="1">Height (cm)</td><td align="center" rowspan="1" colspan="1">163.7±4.5</td><td align="center" rowspan="1" colspan="1">165.3±5.4</td></tr><tr><td align="left" rowspan="1" colspan="1">Weight (kg)</td><td align="center" rowspan="1" colspan="1">58.3±8.5</td><td align="center" rowspan="1" colspan="1">60.1±6.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Body Mass Index (kg/m<sup>2</sup>)</td><td align="center" rowspan="1" colspan="1">21.8±3.0</td><td align="center" rowspan="1" colspan="1">21.9±1.8</td></tr></tbody></table></table-wrap>).</p><p>The average absolute and relative EEG subband power distribution did not differ
statistically between the two groups at baseline (p>0.05, <xref rid="tbl_002" ref-type="table">Tables 2</xref> and<xref rid="tbl_003" ref-type="table">3</xref><table-wrap id="tbl_002" orientation="portrait" position="float"><label>Table 2</label><caption><title><bold>.</bold> Average absolute EEG subband power distribution of all
channels</title></caption><table frame="hsides" rules="groups"><thead><tr><td align="left" rowspan="1" colspan="1">Type</td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">Pre</td><td align="center" rowspan="1" colspan="1">Post</td></tr></thead><tbody><tr><td align="left" rowspan="2" colspan="1">δ (μV<sup>2</sup>)</td><td align="left" rowspan="1" colspan="1">MLD</td><td align="center" rowspan="1" colspan="1">1.44±0.80</td><td align="center" rowspan="1" colspan="1">1.61±0.89</td></tr><tr><td align="left" rowspan="1" colspan="1">Control</td><td align="center" rowspan="1" colspan="1">1.61±0.42</td><td align="center" rowspan="1" colspan="1">1.79±0.59</td></tr><tr><td align="left" rowspan="2" colspan="1">θ (μV<sup>2</sup>)</td><td align="left" rowspan="1" colspan="1">MLD</td><td align="center" rowspan="1" colspan="1">3.52±0.56</td><td align="center" rowspan="1" colspan="1">3.56±0.52</td></tr><tr><td align="left" rowspan="1" colspan="1">Control</td><td align="center" rowspan="1" colspan="1">3.53±0.58</td><td align="center" rowspan="1" colspan="1">3.61±0.54</td></tr><tr><td align="left" rowspan="2" colspan="1">α (μV<sup>2</sup>)</td><td align="left" rowspan="1" colspan="1">MLD</td><td align="center" rowspan="1" colspan="1">2.52±0.47</td><td align="center" rowspan="1" colspan="1">2.72±0.43*</td></tr><tr><td align="left" rowspan="1" colspan="1">Control</td><td align="center" rowspan="1" colspan="1">2.49±0.56</td><td align="center" rowspan="1" colspan="1">2.52±0.45</td></tr><tr><td align="left" rowspan="2" colspan="1">β (μV<sup>2</sup>)</td><td align="left" rowspan="1" colspan="1">MLD</td><td align="center" rowspan="1" colspan="1">2.62±0.51</td><td align="center" rowspan="1" colspan="1">2.31±0.64</td></tr><tr><td align="left" rowspan="1" colspan="1">Control</td><td align="center" rowspan="1" colspan="1">2.47±0.32</td><td align="center" rowspan="1" colspan="1">2.51±0.43</td></tr></tbody></table><table-wrap-foot><p>All variables are means ± SD. MLD: Manual lymph drainage. *p<0.05</p></table-wrap-foot></table-wrap>). The post-MLD average absolute alpha rhythm was significantly higher in the
experimental group (p<0.05, <xref rid="tbl_002" ref-type="table">Table 2</xref>). There
were also significant difference between the pre-MLD and post-MLD average relative alpha and
delta rhythms in the experimental group (p<0.05, <xref rid="tbl_003" ref-type="table">Table 3</xref><table-wrap id="tbl_003" orientation="portrait" position="float"><label>Table 3.</label><caption><title> Average relative EEG subband power distribution of all channels</title></caption><table frame="hsides" rules="groups"><thead><tr><td align="left" rowspan="1" colspan="1">Type</td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">Pre</td><td align="center" rowspan="1" colspan="1">Post</td></tr></thead><tbody><tr><td align="left" rowspan="2" colspan="1">δ</td><td align="left" rowspan="1" colspan="1">MLD</td><td align="center" rowspan="1" colspan="1">0.17±0.059</td><td align="center" rowspan="1" colspan="1">0.19±0.059*</td></tr><tr><td align="left" rowspan="1" colspan="1">Control</td><td align="center" rowspan="1" colspan="1">0.18±0.058</td><td align="center" rowspan="1" colspan="1">0.19±0.042</td></tr><tr><td align="left" rowspan="2" colspan="1">θ</td><td align="left" rowspan="1" colspan="1">MLD</td><td align="center" rowspan="1" colspan="1">0.51±0.08</td><td align="center" rowspan="1" colspan="1">0.54±0.07</td></tr><tr><td align="left" rowspan="1" colspan="1">Control</td><td align="center" rowspan="1" colspan="1">0.53±0.11</td><td align="center" rowspan="1" colspan="1">0.52±0.11</td></tr><tr><td align="left" rowspan="2" colspan="1">α</td><td align="left" rowspan="1" colspan="1">MLD</td><td align="center" rowspan="1" colspan="1">0.18±0.04</td><td align="center" rowspan="1" colspan="1">0.22±0.05*</td></tr><tr><td align="left" rowspan="1" colspan="1">Control</td><td align="center" rowspan="1" colspan="1">0.18±0.094</td><td align="center" rowspan="1" colspan="1">0.19±0.04</td></tr><tr><td align="left" rowspan="2" colspan="1">β</td><td align="left" rowspan="1" colspan="1">MLD</td><td align="center" rowspan="1" colspan="1">0.07±0.033</td><td align="center" rowspan="1" colspan="1">0.08±0.054</td></tr><tr><td align="left" rowspan="1" colspan="1">Control</td><td align="center" rowspan="1" colspan="1">0.08±0.049</td><td align="center" rowspan="1" colspan="1">0.09±0.048</td></tr></tbody></table><table-wrap-foot><p>All variables are means ± SD. MLD: Manual lymph drainage. *p<0.05</p></table-wrap-foot></table-wrap>).</p></sec><sec sec-type="discussion" id="s4"><title>DISCUSSION</title><p>The main purpose of the present study was to investigate the effect on acute brain activity
of MLD in subjects with psychological stress by using EEG. Although the effect of various
massages on brain activity has been previously observed<xref rid="r15" ref-type="bibr">15</xref>,<xref rid="r16" ref-type="bibr">16</xref>,<xref rid="r17" ref-type="bibr">17</xref><sup>)</sup>, we are not aware of any reports on the effects of MLD on brain
activity using EEG power. So, to the best of our knowledge, this is the first study to
investigate the differences in brain activity resulting from MLD. This study demonstrates
that MLD of the neck area is effective for promoting relaxation, manifested as an increase
in post-MLD average absolute alpha rhythm, relative delta rhythm and alpha rhythm
(p<0.05). Comparison between the two groups in the present study revealed that subjects
receiving MLD had significantly higher alpha and delta activities than those in the control
group. This finding indicates psychological benefits of MLD over resting for stress
reduction in subjects with stress.</p><p>The mechanism by which MLD promotes relaxation and changes in brain activity may be
explained by the findings of Kim et al<xref rid="r7" ref-type="bibr">7</xref><sup>)</sup>.
They reported that MLD contributed to increased cardiac parasympathetic activity, which led
to decreased sympathetic activity in the neuromuscular system; thus, it can cause
relaxation. Alpha waves are dominant under relaxed conditions, whereas beta wave becomes
dominant under excited conditions. Delta waves are found during some parts of sleep<xref rid="r18" ref-type="bibr">18</xref><sup>)</sup>. Our finding of reduced cortical arousal
through MLD may also be explained by the findings of other studies<xref rid="r14" ref-type="bibr">14</xref>, <xref rid="r15" ref-type="bibr">15</xref><sup>)</sup>. They reported
the state induced by massage techniques represent a hypoactive central nervous system state
that may by similar to stageIsleep. Since MLD is a kind of light pressure massage, it is
possible that the same mechanism was partly responsible for the decrease in psychological
stress observed in this study.</p><p>The clinical implication of the present study is that MLD was found to be an effective
intervention for stress reduction in subjects with psychological stress. Moreover,
interpretation of brain activity of subjects in this study demonstrated greater relaxation
after MLD compared with control group. The beneficial effects found could be used as a guide
for good treatment for stress reduction in subjects with stress.</p><p>Regarding limitations of this study, we did not use other secondary outcome measures in
order to subjectively quantify subject anxiety and pain intensity and only evaluated the
acute effects of MLD. Further studies should include other outcome measures and specific
treatment groups, and longitudinal study of MLD effects on brain activity using EEG would be
an interesting direction.</p><p>In conclusion, the present study is the first report of the effect of MLD on acute brain
responses using EEG. The study provides insight into physiological changes of relaxation
associated with MLD. The findings reveal that a single 15-min session of MLD at the neck
region produces an immediate decrease in brain activity. It is recommended that MLD be
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