Besides its direct effect on bone through mechanical
loading, it is conceivable that Thai traditional massage
may affect bone indirectly through the central nervous
system. The adipokine leptin inhibits bone formation
through a central nervous system delay [19]. Mechanical
tactile stimulation reduces stress hormones and improves
bone mineralization in rats [20]. Moreover, a study using
functional MRI has shown that types of massage can influence
brain cortical areas differently [21]. To what extent
the effect of Thai traditional massage is due to its effect
on stress hormones and the central nervous system is
unknown. One of the other possible mechanisms involves
ghrelin. It has been shown that ghrelin enhances bone