• Acupressure; Deep-tissue Massage; Neuromuscular Massage; Reflexology; Rolfing; St. John’s Neuromuscular; Shiatsu; Structural Integration; Swedish Massage
Principal Proposed Uses
• General Stress Reduction; Low Back Pain; Other Forms of Muscular Pain
Other Proposed Uses
• Anorexia; Anxiety; Asthma; Attention Deficit Disorder (ADD) ; Autism; Bulimia; Cancer Treatment Support; Cystic Fibrosis; Depression; Diabetes; Eczema; Fibromyalgia; HIV Support; Iliotibial Band Pain; Juvenile Rheumatoid Arthritis; Migraine Headaches; Neck Pain; Neonatal Sepsis (Life-threatening Infection in Premature Infants); Osteoarthritis; Premenstrual Syndrome (PMS) ; Pregnancy Support; Quitting Smoking; Recovery from Severe Burns; Spinal Cord Injury
Along with herbal treatment , touch-based therapy is undoubtedly one of the most ancient forms of medical care. We instinctively stroke and rub areas of our body that hurt; massage therapy develops this instinct into a professional treatment. There is no doubt that massage relieves pain and induces relaxation at least temporarily; besides that, it feels good! Whether it offers any lasting benefits, however, remains unclear.
Forms of Massage
There are many schools of massage. In most cases, massage therapists combine several techniques, although there are also purists who stick to one method. The most common technique is Swedish massage, which combines long strokes and gentle kneading movements that primarily affect surface muscle tissues. Deep-tissue massage utilizes greater pressure to reach deeper levels of muscles. This may be called the “hurts-good-and-feels-great-after” approach. Shiatsu or acupressure massage also uses deep pressure, but according to the principles of acupuncture theory. (Acupuncture is so similar to acupressure that we have elected to discuss studies of acupressure in the acupuncture article rather than here.) Neuromuscular massage (such as the St. John Method of Neuromuscular Therapy) applies strong pressure to tender spots, technically known as trigger points.
Several other techniques are best described as relatives of massage. Rolfing® Structural Integration aims to affect not muscles, but the connective tissue (fascia) surrounding muscles and everything else in the body. This highly organized technique aims to permanently improve the body’s structure. Reflexology is a form of foot massage based on the theory that the whole body is reflected in the foot.
How Does Massage Work?
There are many theories about how massage might work, but none have been proved true. Little doubt exists that massage temporarily increases blood circulation in the massaged area, but it is not clear that this makes any lasting difference. Some massage therapists and massage therapy schools promote the notion that massage breaks up calcium deposits in the muscle, but there is no objective substantiation for this claim.
A completely different explanation is that massage promotes healing in a more general way, by reducing stress and inducing relaxation. Massage also satisfies the basic human need to be touched.
Some forms of massage (such as Rolfing Structural Integration, acupressure, and reflexology) have elaborate theories behind them. However, there is little to no scientific evidence for these theories 44 ; moreover, there is some evidence that the theory behind reflexology is incorrect. 1
What Is Massage Therapy Used For?
Massage is most commonly used to relieve muscular tension and promote relaxation. It is also said to be helpful as an aid to the treatment of various conditions, including attention deficit disorder (ADD) , asthma , autism , bedsores, bulimia , cystic fibrosis, diabetes , eczema , fibromyalgia , HIV , iliotibial band pain , juvenile rheumatoid arthritis, low back pain , lymphedema , neck pain , premenstrual syndrome (PMS) , pregnancy , severe burns, and spinal cord injury .
What Is the Scientific Evidence for Massage Therapy?
Although there is some evidence that massage may be helpful for various medical purposes, in general the evidence is not strong. 2 There are several reasons for this, but one is most fundamental: Even with the best of intentions, it is difficult to properly ascertain the effectiveness of a hands-on therapy like massage.
Only one form of study can truly prove that a treatment is effective: the double-blind, placebo-controlled trial . (For more information on why such studies are so crucial, see Why Does This Database Rely on Double-blind Studies? ) However, it isn’t possible to fit massage into a study design of this type. What could researchers use for placebo massage? And how could they make sure that both participants and practitioners would be kept in the dark regarding who was receiving real massage and who was receiving fake massage? The fact is, they can’t.
Because of these problems, all studies of massage fall short of optimum design. Many have compared massage to no treatment. However, studies of this type cannot provide reliable evidence about the efficacy of a treatment. If a benefit is seen, there is no way to determine whether it was caused by massage specifically, or just attention generally. (Attention alone will almost always produce some reported benefit.)
More meaningful trials used some sort of fake treatment for the control group, such as phony laser acupuncture. However, using a placebo treatment that is very different in form from the treatment under study is less than ideal. One study (discussed below) compared real reflexology against fake reflexology. However, it is quite likely that the reflexologists at least unconsciously conveyed more enthusiasm and optimism when performing the real therapy than the fake therapy; this, too, could affect the outcome. It has been suggested that the only way to get around this last problem would be to compare the effectiveness of trained practitioners against actors trained only enough to provide a simulation of treatment; however, such studies have not been reported.
Still other studies have simply involved giving people massages and seeing whether they improved. These trials are particularly meaningless; it has been long since proven that both participants and examining physicians will at least think that they observe improvement in people given a treatment, whether or not the treatment does anything on its own.
Finally, other trials have compared massage to competing therapies, such as acupuncture or relaxation therapy . Unfortunately, when you compare unproven therapies to each other, the results cannot possibly prove that any of the tested treatments are effective.
Given these caveats, the following is a summary of what science knows about the effects of massage.
Low Back Pain
One study compared massage to fake laser therapy in 107 people with low-back pain. The results indicate that massage is more effective than fake laser therapy for relieving low back pain, and that massage therapy combined with exercise and posture training is even more effective. 4
Another study compared acupuncture, massage, and self-care education in 262 people with persistent back pain. 5 By the end of the 10-week treatment period, massage had shown itself more effective than self-care (or acupuncture). However, at a 1-year follow-up, there was no difference in symptoms between the massage group and the self-care group.
In another study, acupressure-style massage was more effective than Swedish massage for the treatment of low back pain. 6
In a review of 13 randomized trials, researchers concluded that massage may be effective for nonspecific low back pain, and the beneficial effects can last for up to 1 year in patients suffering from chronic pain. 48 They also noted that exercise and education appear to enhance the effectiveness of massage. A subsequent large study involving 401 adults (aged 20-65 years old) with nonspecific back pain were randomized to one of three groups: structural massage, relaxation massage, or usual care. 51 At 10 weeks, the patients in the massage groups had improved function and fewer symptoms compared to the usual care group. But unlike the previous review, there were no differences, though, at weeks 26 and 52.
Massage therapy has been studied for its benefits in managing the symptoms associated with cancer and its treatment. In a randomized study investigating the effects of massage on 348 advanced cancer patients suffering from moderate to severe pain, the researchers found that, compared to simple touch, massage was significantly more effective at reducing pain and improving mood immediately following treatment, but the effect was not sustained. 47 The authors of a review of 10 massage therapy studies were unable to draw firm conclusions about its benefits for a wide range of symptoms in patient undergoing treatment for cancer. 46 A subsequent trial, however, offers tentative evidence that massage therapy may be helpful for people who have bone pain from cancer that has spread. Seventy-two people were randomized to receive massage therapy or simply attention from a therapist for about 40-45 minutes for 3 days in a row. 53 Those in the massage group reported less pain.
Massage without aromatherapy has shown promise for reducing nausea caused by chemotherapy. 41 However, a small randomized trial found that effleurage massage, a common massage technique, had no significant effect on anxiety, depression, or quality of life among 22 women undergoing radiation therapy for breast cancer. 43
Preliminary controlled trials of varying quality suggest that massage may provide benefit in a number of conditions, including the following:
One study commonly cited as evidence that ordinary massage therapy is helpful for PMS was flawed by the absence of a control group. 29 However, a better-designed trial compared reflexology against fake reflexology in 38 women with PMS symptoms and found evidence that real reflexology was more effective. 30
A review of the literature published in 1997 suggests that massage is not helpful for preventing pressure sores (bedsores). 35
Several studies indicate that massage combined with aromatherapy may be helpful for relieving anxiety . 36 One study evaluated this combination therapy for treating anxiety and/or depression in people undergoing treatment for cancer . 40 The treatment did appear to provide some short-term benefits.
Researchers analyzed 4 studies investigating the benefits of manual therapy (including massage therapy, joint mobilization, and manipulation ) for osteoarthritis of the hip or knee. 52 The results were inconclusive. Although one of the studies (involving 68 people) did find that massage therapy helped to improve pain and function, it was compared to no intervention rather than another treatment or a placebo.
How to Choose a Massage Therapist
As with all medical therapies, it is best to choose a licensed practitioner. Where licensure is not available, your best bet is to seek a referral from a qualified and knowledgeable medical practitioner. However, most US states license massage therapists.
Note that massage, like other hands-on therapies, involves personal talents that go beyond specific training, certification, or licensure: Some people are simply gifted with their hands. Furthermore, what works for one person may not work for another. For these reasons, some trial and error is often necessary to find the best massage therapist for you.
Massage is generally safe. 38 However, it can sometimes exacerbate pain temporarily, even when properly performed. In addition, if massage is performed too forcefully on fragile people, bone fractures and other internal injuries are possible. However, licensed massage therapists have been trained in ways to avoid causing these problems. Machines designed to perform elements of massage may be less safe. 37
1. White AR, Williamson J, Hart A, et al. A blinded investigation into the accuracy of reflexology charts. Complement Ther Med. 2000;8:166-172.
2. Vickers A. Yes, but how do we know it's true? Knowledge claims in massage and aromatherapy. Complement Ther Nurs Midwifery. 1997;3:63-65.
3. Furlan AD, Brosseau L, Imamura M, et al. Massage for low-back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine. 2002;27:1896-1910.
4. Preyde M. Effectiveness of massage therapy for subacute low-back pain: a randomized controlled trial. CMAJ. 2000;162:1815-1820.
5. Cherkin DC, Eisenberg D, Sherman KJ, et al. Randomized trial comparing traditional Chinese medical acupuncture, therapeutic massage, and self-care education for chronic low back pain. Arch Intern Med. 2001;161:1081-1088.
6. Franke A, Gebauer S, Franke K, et al. Acupuncture massage vs Swedish massage and individual exercise vs group exercise in low back pain sufferers—a randomized controlled clinical trial in a 2 x 2 factorial design [in German; English abstract]. Forsch Komplementarmed Klass Naturheilkd. 2000;7:286-293.
7. Field TM, Quintino O, Hernandez-Reif M, et al. Adolescents with attention deficit hyperactivity disorder benefit from massage therapy. Adolescence. 1998;33:103-108.
8. Hart S, Field T, Hernandez-Reif M, et al. Anorexia nervosa symptoms are reduced by massage therapy. Eating Disorders: The Journal of Treatment and Prevention. 2001;9:217-228.
9. Field T, Henteleff T, Hernandez-Reif M, et al. Children with asthma have improved pulmonary functions after massage therapy. J Pediatr. 1998;132:854-858.
10. Field T, Lasko D, Mundy P, et al. Brief report: autistic children's attentiveness and responsivity improve after touch therapy. J Autism Dev Disord. 1997;27:333-338.
11. Field T, Schanberg S, Kuhn C, et al. Bulimic adolescents benefit from massage therapy. Adolescence. 1998;33:555-563.
12. Hernandez-Reif M, Field T, Krasnegor J, et al. Children with cystic fibrosis benefit from massage therapy. J Pediatr Psychol. 1999;24:175-181.
13. Field T, Morrow C, Valdeon C, et al. Massage reduces anxiety in child and adolescent psychiatric patients. Am Acad Child Adolesc Psychiatry. 1992;31:125-131.
14. Field T, Hernandez-Reif M, LaGreca A, et al. Massage therapy lowers blood glucose levels in children with Diabetes Mellitus. Diabetes Spectrum. 1997;10:237-239.
15. Schachner L, Field T, Hernandez-Reif M, et al. Atopic dermatitis symptoms decreased in children following massage therapy. Pediatr Dermatol. 1998;15:390-395.
16. Sunshine W, Field T, Quintino O, et al. Fibromyalgia benefits from massage therapy and transcutaneous electrical stimulation. J Clin Rheumatol. 1996;2:18-22.
17. Offenbacher M, Stucki G. Physical therapy in the treatment of fibromyalgia. Scand J Rheumatol Suppl. 2000;113:78-85.
18. Brattberg G. Connective tissue massage in the treatment of fibromyalgia. Eur J Pain. 1999;3:235-244.
19. Smith WA. Fibromyalgia syndrome. Nurs Clin North Am. 1998;33:653-669.
20. Brosseau L, Casimiro L, Milne S, et al. Deep transverse friction massage for treating tendinitis. Cochrane Database Syst Rev. 2002;(1):CD003528.
21. Field T, Hernandez-Reif M, Seligman S, et al. Juvenile rheumatoid arthritis: benefits from massage therapy. J Pediatr Psychol. 1997;22:607-617.
22. Hernandez-Reif M, Deiter J, Field T, et al. Migraine headaches are reduced by massage therapy. Int J Neurosci. 1998;96:1-11.
23. Chang MY, Wang SY, Chen CH. Effects of massage on pain and anxiety during labour: a randomized controlled trial in Taiwan. J Adv Nurs. 2002;38:68-73.
24. Field T, Hernandez-Reif M, Taylor S, et al. Labor pain is reduced by massage therapy. J Psychosom Obstet Gynaecol. 1997;18:286-291.
25. Field T, Hernandez-Reif M, Hart S, et al. Pregnant women benefit from massage therapy. J Psychosom Obstet Gynaecol. 1999;20:31-38.
26. Hernandez-Reif M, Feld T, Hart S. Smoking cravings are reduced by self-massage. Prev Med. 1999;28:28-32.
27. Field T, Peck M, Krugman S, et al. Burn injuries benefit from massage therapy. J Burn Care Rehabil. 1998;19:241-244.
28. Diego MA, Field T, Hernandez-Reif M, et al. Spinal cord patients benefit from massage therapy. Int J Neurosci. 2002;112:133-142.
29. Hernandez-Reif M, Martinez A, Field T, et al. Premenstrual symptoms are relieved by massage therapy. J Psychosom Obstet Gynaecol. 2000;21:9-15.
30. Oleson T, Flocco W. Randomized controlled study of premenstrual symptoms treated with ear, hand, and foot reflexology. Obstet Gynecol. 1993;82:906-911.
31. Birk TJ, McGrady A, MacArthur RD, et al. The effects of massage therapy alone and in combination with other complementary therapies on immune system measures and quality of life in human immunodeficiency virus. J Altern Complement Med. 2000;6:405-414.
32. Diego MA, Field T, Hernandez-Reif M, et al. HIV adolescents show improved immune function following massage therapy. Int J Neurosci. 2001;106:35-45.
33. Ironson G, Field T, Scafidi F, et al. Massage therapy is associated with enhancement of the immune system's cytotoxic capacity. Int J Neurosci. 1996;84:205-217.
34. Irnich D, Behrens N, Molzen H, et al. Randomised trial of acupuncture compared with conventional massage and sham laser acupuncture for treatment of chronic neck pain. BMJ. 2001;322:1-6.
35. Buss IC, Halfens RJ, Abu-Saad HH. The effectiveness of massage in preventing pressure sores: a literature review. Rehabil Nurs. 1997;22:229-234,242.
36. Cooke B, Ernst E. Aromatherapy: a systematic review. Br J Gen Pract. 2000;50:493-496.
37. Eliott MA, Taylor LP. Shiatsu sympathectomy: ICA dissection associated with a shiatsu massager. Neurology . 2002;58:1302-1304.
38. Ernst E. The safety of massage therapy. Rheumatology (Oxford). 2003;42:1101-1106. Epub 2003 May 30.
39. Lawler SP, Cameron LD. A randomized, controlled trial of massage therapy as a treatment for migraine. Ann Behav Med. 2006;32:50-59.
40. Wilkinson SM, Love SB, Westcombe AM, et al. Effectiveness of aromatherapy massage in the management of anxiety and depression in patients with cancer: a multicenter randomized controlled trial. J Clin Oncol . 2007;25:532-539.
41. Billhult A, Bergbom I, Stener-Victorin E. Massage relieves nausea in women with breast cancer who are undergoing chemotherapy. J Altern Complement Med . 2007;13:53-58.
42. Coelho HF, Boddy K, Ernst E. Massage therapy for the treatment of depression: a systematic review. Int J Clin Pract. 2008;62:325-333.
43. Billhult A, Lindholm C, Gunnarsson R, et al. The effect of massage on cellular immunity, endocrine and psychological factors in women with breast cancer—a randomized controlled clinical trial. Auton Neurosci. 2008 May 10.
44. Wang MY, Tsai PS, Lee PH, et al. The efficacy of reflexology: systematic review. J Adv Nurs. 2008;62:512-520.
45. Mendes EW, Procianoy RS. Massage therapy reduces hospital stay and occurrence of late-onset sepsis in very preterm neonates. J Perinatol. 2008 Jul 17.
46. Wilkinson S, Barnes K, Storey L. Massage for symptom relief in patients with cancer: systematic review. J Adv Nurs. 2008;63:430-439.
47. Kutner JS, Smith MC, Corbin L, et al. Massage therapy versus simple touch to improve pain and mood in patients with advanced cancer: a randomized trial. Ann Intern Med. 2008;149:369-379.
48. Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database Syst Rev. 2008;CD001929.
49. Chen LL, Su YC, Su CH, Lin HC, Kuo HW. Acupressure and meridian massage: combined effects on increasing body weight in premature infants. J Clin Nurs. 2008;17:1174-1181. Erratum in: J Clin Nurs. 2008;17:2089.
50. Sherman KJ, Ludman EJ, Cook AJ, et al. Effectiveness of therapeutic massage for generalized anxiety disorder: a randomized controlled trial. Depress Anxiety. 2010 May;27(5):441.
51. Cherkin DC, Sherman KJ, Kahn J, et al. A comparison of the effects of 2 types of massage and usual care on chronic low back pain: a randomized, controlled trial. Ann Intern Med. 2011;155(1):1-9.
52. French HP, Brennan A, White B, Cusack T. Manual therapy for osteoarthritis of the hip or knee - a systematic review. Man Ther. 2011;16(2):109-17.
53. Jane SW, Chen SL, Wilkie DJ, et al. Effects of massage on pain, mood status, relaxation, and sleep in Taiwanese patients with metastatic bone pain: a randomized clinical trial. Pain. 2011;152(10):2432-2442.
54. Smith CA, Levett KM, Collins CT, Jones L. Massage, reflexology and other manual methods for pain management in labour. Cochrane Database Syst Rev. 2012;2:CD009290.
Last reviewed July 2012 by EBSCO CAM Review Board
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