Massage Therapy Overview

Massage refers to the manipulation of bodily muscles, tendons, connective tissue, ligaments, and even organs to help promote health often primarily through relaxation.

It is documented that ancient civilizations have used massage for centuries and it is still used in modern day times the world over. Though there are hundreds of types of massage, some of the most common include Acupressure, Ayurvedic, deep tissue, Esalen, medical, reflexology, Shiatsu, stone, Swedish, Thai, Traditional Chinese Medicine, Trigger Point and Visceral.

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.

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 ¹ ; moreover, there is some evidence that the theory behind reflexology is incorrect. ²

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 refers to the manipulation of bodily muscles, tendons, connective tissue, ligaments, and even organs to help promote health often primarily through relaxation.

Along with herbal treatment , touch-based therapy is undoubtedly one of the most ancient forms of medical care. It is documented that ancient civilizations have used massage for centuries and it is still used in modern day times the world over. Though there are hundreds of types of massage, some of the most common include Acupressure, Ayurvedic, deep tissue, Esalen, medical, reflexology, Shiatsu, stone, Swedish, Thai, Traditional Chinese Medicine, Trigger Point and Visceral.

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.

Although there is some evidence that massage may be helpful for various medical purposes, in general the evidence is not strong. ³ 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

Although the evidence is far from complete, it does appear that massage may offer benefits for low back pain . ⁴ However, these benefits may last for only short term.

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. ⁵ Another study compared acupuncture, massage, and self-care education in 262 people with persistent back pain. ⁶ 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. ⁷ 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. ⁸ They also noted that exercise and education appear to enhance the effectiveness of massage.

Cancer

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. ⁹ 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. ¹⁰ Massage without aromatherapy has shown promise for reducing nausea caused by chemotherapy. ¹¹ 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. ¹²

Other Conditions

Preliminary controlled trials of varying quality suggest that massage may provide benefit in a number of conditions, including the following:

• ADD ¹³
• Anorexia nervosa ¹⁴
• Asthma in children ¹⁵
• Autism ¹⁶
• Bulimia ¹⁷
• Cystic fibrosis ¹⁸
• Anxiety ¹⁹
• Diabetes ²⁰
• Eczema ²¹
• Fibromyalgia ^{22 23 24}
• Iliotibial band pain (a form of tendonitis that can cause knee or hip pain) ²⁵
• Juvenile rheumatoid arthritis ²⁶
• Migraine headaches ²⁷
• Pregnancy and childbirth ^{28 29}
• Quitting smoking ³⁰
• Burn recovery ³¹
• Spinal cord injury ³²

One study found that massaging premature infants 3 times daily for 10 days at acupressure locations resulted in greater weight compared to similar infants receiving routine care. ³³ One study commonly cited as evidence that ordinary massage therapy is helpful for PMS was flawed by the absence of a control group. ³⁴ 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. ³⁵ Study results are mixed on whether massage can improve measures of immune function in people with HIV . ^{36 37} One study found that massage is less effective than acupuncture for chronic neck pain . ³⁸ In fact, in this trial massage was no more effective than fakeacupuncture.

A review of the literature published in 1997 suggests that massage is not helpful for preventing pressure sores (bedsores). ³⁹ Several studies indicate that massage combined with aromatherapy may be helpful for relieving anxiety . ⁴⁰ One study evaluated this combination therapy for treating anxiety and/or depression in people undergoing treatment for cancer . ⁴¹ The treatment did appear to provide some short-term benefits.

A 2008 review could find no convincing evidence for the effectiveness of massage therapy against depression in general. ⁴²

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