Therapeutic oil massage (TOM) is an external Snehana (oleation) therapy described in Ayurveda, when performed daily becomes a component of the Dinacharya (daily regimen), involving systematic massage of the entire body from head to toe using medicated oils.¹ The procedure is performed with controlled pressure and specific directional strokes and is recommended across age groups, including children. Classical texts advocate daily application of herbal oils processed with Bala (Sida cordifolia Linn) during infancy.² Selection of oil is individualized based on Dosha (bodily humors) predominance, disease condition, Bala (physical strength), seasonal variation, and climatic factors, with oil temperature adjusted accordingly, typically warm in colder seasons and cooler in warmer climates.³ Following TOM, Swedana (sudation therapy) and Snana (bath) are commonly advised as part of comprehensive care.

The therapeutic effects of TOM include pacification of aggravated Vata Dosha (one of the body humors), reduction of fatigue, delay in aging, enhancement of physical strength, nourishment of body tissues, improvement in vision, induction of sound sleep, and improvement in skin tone and complexion.⁴ Clinically, these outcomes can be assessed through parameters such as reduction in tiredness, improvement in sleep quality, and enhancement of skin texture and tone, particularly in pediatric populations. Oils such as Ksheerabala Taila, Dhanvantaram Taila, and Balashvagandhadi Taila are commonly employed in Vata-dominant conditions, while sesame or coconut oil is widely used for daily practice.

The duration of TOM is explained in Ayurvedic literature based on the time required for oil penetration into different body tissues, ranging approximately from 1.5 to 4.5 minutes per body region.⁵ In adults TOM is performed for about 35 minutes for whole body⁶, whereas in clinical practice TOM is performed for about 15 minutes to 30 minutes in children. However, modifications in posture and duration are required in children due to smaller body surface area. The therapy is generally administered for seven consecutive days, and the applied oil may be retained on the body for up to four hours, beyond which adverse effects may occur.⁷ TOM is contraindicated in conditions such as fever, Ajirna (indigestion), immediately after purification therapies, and in states of aggravated Kapha Dosha (one of the body humors).⁸

As a time-tested intervention, TOM has demonstrated favorable effects on physical growth and well-being in infants with minimal risk of adverse cutaneous reactions, and emerging evidence from related traditional massage therapies suggests potential physiological and psychological benefits in children.^9,10 This study focusses on observing the tolerable oil temperature for performing TOM, changes in body temperature before and after TOM and observing the comfortable position of TOM in children. This study will help in developing similar assessment protocols and the standardization of TOM in children.

MATERIALS AND METHODS:

Objectives:

The primary objective of this study was to develop the preliminary guidelines for TOM with respect to the tolerable oil temperature, changes in the body temperature before and after TOM and the comfortable position of TOM among the study participants.

Eligibility criteria:

Children aged between 3 and 15 years were selected for the study irrespective of religion, gender or socioeconomic status. Participation was contingent upon the willingness of parents or legal guardians to provide written informed assent, along with consent from the child wherever appropriate.

Exclusion criteria:

Children who were clinically unfit for TOM based on the indication of TOM and Ayurveda health parameters and who were non-cooperative or unable to tolerate the procedure were excluded from the study. 

Withdrawal criteria:

Participants will be withdrawn from the study if they/their parents are unwilling to continue the study for any reason and if there are any serious adverse events during the study period or any other health ailments necessitating immediate/emergency medical care.

Intervention:

There was no direct intervention involved in this study, but observations during the whole-body TOM. The TOM was performed using the herbal oil which was processed with Sida cordifolia Linn. indicated in Pediatric age group.

Trial design:

This study was designed as a prospective, single arm, observational pilot study conducted to evaluate the selected indicators in pediatric participants.

Study setting and participants:

The study was carried out at the inpatient department (IPD) of Ayurveda Pediatrics in a teaching hospital of Mysuru. Subjects included were indicated for TOM and who met the predefined inclusion criteria. Before enrollment, the parents/guardians received a detailed explanation of the study, including details of procedures, benefits, and risks.

Study procedure:

Axillary temperature was noted for assessment of the body temperature before and after TOM. The oil was heated to the comfortable temperature then checked by applying it over the dorsal aspect of the hand of the subjects followed by the assessment of the temperature of the oil using the lab thermometer. The assessment of comfortable position was noted on the feeling of comfort by study participants. 

Assessment timeline:

Participant timeline was divided for objective and subjective parameters. Timelines for outcome assessment of objective parameters along with the instruments used and other details are depicted in table no.1.

Table no. 1: Table showing assessment timeline of objective parameters

Subjective parameter was on the position of TOM performed and the comfortable position of TOM among the subjects.

Data analysis: 

The mean of body temperature was calculated using the data recorded before and after TOM. The difference between the means was calculated to assess the change in body temperature following TOM. The significance of change is analyzed using the paired t test. value less than 0.05 was considered as significant. The mean value of oil temperature was noted only before the treatment. The details of statistical analysis are depicted in table no. 2. to note the significance of data before and after TOM.

Table no. 2: Table showing statistical analysis.

RESULTS:  

This observational preliminary study was carried out in a sample size of 10 subjects; the TOM was performed for a minimum of 3 days to maximum of 7 days.  In this present study it was noted that the minimal and maximum body temperature noted before TOM was 97.5°F and 98.6°F respectively.  The difference in body temperature before and after TOM ranged from 0.3°F (minimum) to 0.6°F (maximum) and the mean difference was found to be 0.4°F. The mean of the observations of the body temperature was 98.33°F and 98.75°F, before and after treatment respectively.  At the 0.05 significance level, the data provides sufficient evidence to conclude that there is a real difference between the means of the observations noted in the body temperature before and after TOM.        

The comfortable oil temperature reported by the subjects ranged from 100°F to 120°F and the mean comfortable temperature was 110.3°F. None of the subjects reported discomfort, burning sensation, or irritation, suggesting that the oil temperature used was safe and appropriate.

It was observed that the most of the subjects were comfortable in supine and sitting positions and uncomfortable in prone position. It was also observed that the TOM was not conducted in lateral position due to the lesser surface area on the lateral part of the body. The lateral aspects of the body were adequately covered by performing massage in both supine and prone positions. The preliminary tool is developed based on these changes observed during the study. The assessment tool is depicted in table no.3.

Table no. 3: Table showing preliminary assessment tool for Abhyanga in children.

Preliminary assessment tool for Abhyanga in children

DISCUSSION:

TOM is an Ayurveda therapeutic procedure mentioned in classical Ayurveda texts performed by applying manual pressure all over the body surface using various techniques and by usage of medicated oils which helps in inducing physical relaxation also helps in pacification of several disease conditions. Through TOM, the nervous system is stimulated, which in turn activates the muscular system, blood vessels, and glands supplied by the respective nerves, thereby contributing to overall health maintenance.¹¹ The mechanism of action of TOM can be explained through subcutaneous absorption, relaxation of muscle groups, and stimulation of tactile receptors.¹² These mechanisms help modulate pathological changes within the body and gradually facilitate their reversal.

In this present observational study, the changes observed in body temperature of children before and after TOM were physiological in nature, with no evidence of pathological rise or fall in temperature. The post-procedure temperature values were recorded within physiological limits, without causing any constant rise in body temperature or making the subjects to feel lethargy, indicates that TOM does not induce fever or hypothermia when performed appropriately.  

In this present observational study, the mild increase in body temperature observed after TOM can be attributed to increased peripheral circulation, cutaneous vasodilatation, and heat generated due to friction during TOM. These mechanisms promote improved blood flow to the skin and superficial tissues, leading to a transient rise in surface temperature without disturbing core thermoregulation. Thus, TOM can be considered as the thermally safe procedure when it is conducted with standard precautions.

The tolerability of oil temperature is a crucial safety parameter in pediatric TOM. The temperature of the oil used for TOM was assessed based on the comfort level of the subjects.  In this study, oil heated to a lukewarm temperature was well accepted by children and did not result in discomfort, skin irritation, or burns. Excessively heated oil poses a potential risk of thermal injuries including burns or erythema, particularly in children due to their thinner skin and increased sensitivity. Conversely, oil applied at a lower temperature might lead to discomfort and shivering.

In this present study the assessment was also done on the comfortable position of the child during TOM. Comfortable positioning helped in better cooperation of the child and smooth conduct of the procedure. It was observed that the subjects were more comfortable in the sitting and supine position, the subjects felt discomfort in prone position. It was also observed that the TOM of the lateral aspects of the body was covered by the procedure, while performing over the supine and prone position due to lesser body surface of subjects on the lateral aspect. Comfortable positioning minimizes anxiety and excessive movement especially in the child suffering with ASD, ADHD etc. This supports the concept that TOM should always be performed in a comfortable position, especially in children, to avoid unnecessary physiological stress.

Limitation of the study:

Most of the parameters were assessed manually, so there are possible chances of errors. Wide variations in the study age group of the participants might have influenced the results. No biochemical investigations were performed in this study.

Future research:

This study will serve as an initiation in standardization of TOM and other therapeutic procedures of Ayurveda in children.

CONCLUSION:

The findings of this observational study indicate that TOM produces only physiological alterations in body temperature, without causing any pathological thermal changes. The mean of temperature difference before and after TOM was within the range of 0.4°F, emphasizing the safety of TOM in children. The comfortable oil temperature reported by the subjects ranged from 100°F to 120°F. Proper monitoring of oil temperature, contribute in minimizing risks such as burns or undue thermal stress. These observations reinforce the role of TOM as a safe external therapeutic and preventive measure in pediatric Ayurveda.

It was also observed that the subjects were comfortable in sitting and supine position and uncomfortable in prone position during the procedure of TOM. Proper positioning helps in the smooth performance of TOM especially in children by giving equal importance to all body parts. The preliminary assessment tool developed contains 3 domains i.e. assessment on body temperature, tolerance of oil temperature and comfortable positioning during the procedure. The tool also contains the respective reference ranges of the domain.

TOM did not cause and adverse effects on the subjects. The absence of any pathological temperature change confirms the safety of TOM in children, especially considering the sensitive thermoregulatory mechanisms in pediatric age groups. This was pilot study conducted in 10 subjects, the author recommended large sample study for better evidence.

CRediT author statement:  JKB: conceptualization, supervision, study design, editing. JNJ: clinical study, assessment, writing original draft, writing review and editing, data analysis. NJ: assessment, writing review and editing. CMR: Assessment, writing review and editing.

Acknowledgement: We thank co-PG scholars and interns for helping in performing assessment and in manuscript preparation.

Financial support and sponsorship: There was no any financial support and sponsorship for this study.

Conflicts of interest: Authors declare no conflicts of interest

Usage of AI: AI- assistance was used to check and correct the grammatical mistakes.

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