Massage Research

From chronic conditions to quality of life 

massage research is proving a point

• For some, massage therapy is a short-term intervention to help with injury and rehabilitation. For others, massage is their salve to reduce the stresses of a hurried and chaotic life. Wherever you are on the spectrum of health care, massage offers many valuable benefits to those who receive it. This resource will provide a bit of background about massage therapy in general, and then we’ll look at what scientific research says about benefits of massage for specific populations. 

Touch Hunger

• From the earliest days of humankind, when one person reached out to soothe another, we have known that welcomed physical contact is good for us. The loving touch that occurs between infants and their caregivers helps to create a sense of safety in the world that follows us for a lifetime. Touch that occurs between humans helps us to build our foundational relationships, supports social interaction, enables emotional sharing, and provides many other benefits (Gentsch, Brendtro).

• By contrast, prolonged touch deprivation is connected with failure to thrive and the inability to create social attachments when it happens in infants and young children (Jakubiak), and with shorter lifespans and more illness in isolated elders (Butts).

• The need for healthy touch is so important, and the consequences of touch deprivation are so dire, that groundbreaking anthropologist Ashley Montagu gave our drive for this form of human-to-human interaction a name: “touch hunger” (Montagu). We know that touch is a basic human need, but we live in a society with few appropriate venues for physical contact. Massage therapy is an intervention that meets that need.

What is Massage?

• Defining massage turns out to be a tricky proposition. Many cultures across the globe have traditional touch-related protocols designed to promote health, but not all practitioners of these arts would consider their work to be massage. For our purposes, we will consider massage to include any skilled hands-on interventions that work toward improving a person’s well-being and/or function through manipulating skin, fascia, and muscles.

Research Has Revealed a Lot About Massage 

• For this resource we have pulled together findings from small-scale projects that might have just a few participants, substantial clinical trials, and large-scale systematic reviews and meta-analyses—these are compilations of multiple studies that combine results. Each study comes from a peer-reviewed academic publication. We arranged information by population groups, but diseases and conditions don’t occur by themselves; there’s always crossover, so any single study might address multiple issues.

For healthy people: wellness, relaxation, revitalization, improved immune system function 

• While most research is conducted in the context of illnesses or conditions, some studies have looked at bodywork for healthy people, and concluded that massage therapy for wellness or for stress relief is consistently effective in a variety of ways. Even a simple hand massage appears to move healthy people into a relaxed state (Kunikata). A comparison of traditional Swedish massage and Thai massage found that Swedish massage produced stronger relaxation responses and improved sleep, while Thai massage led to a sense of energy and revitalization (MacSween). Improvements in immune system function, along with reductions in stress-related hormones have been found as well (Barreto, Lovas, Rapaport). More specific effects of massage for stress are covered in the context of some of the conditions listed below.

Massage in the workplace: reduced injuries, improved job satisfaction

• Several studies have looked at what benefits occur when massage therapy is offered in the workplace. Through these we see that onsite massage can help to prevent overuse injuries (Cabak), decrease pain and increase range of motion (Siško), reduce blood pressure (Day), and improve job satisfaction (Back) among office workers. Other studies found it is both feasible and beneficial to offer massage to reduce stress-related symptoms among health-care providers (Engen, Keller, Mahdizadeh).

For athletes: improved strength, speedy recovery

• The research about massage for athletes is not always consistent; it seems to depend a lot on the sport in question, and the type of athlete being studied. In general, massage appears to be a better choice after an event instead of before it (Mine). One study found massage may improve strength in muscles damaged by overuse (Shin); another suggests that people who receive massage feel they recover from overexertion more quickly, so they can return to training sooner (Poppendiek). A systematic review of several studies found that immune system recovery is supported by post exercise massage (Tejero-Fernández). 

For people with musculoskeletal injuries: noninvasive options, long-lasting results 

• Muscular aches and pains drive many clients to seek massage. Here is a synopsis of what the most current research says about this intervention:

Muscle and tendon injuries

• Muscle and tendon injuries are usually related to overuse. Research has revealed that when these injuries persist, traditional anti-inflammatories are not effective, and physicians are encouraged to explore noninvasive options before recommending surgical repair. Fortunately, these injuries often respond well to manual therapies. Studies of tendon injuries in a violinist (Wilk), at the elbow (Yi), at the Achilles tendon (Li, H. Y.), and the knee (Cook) show that skilled massage therapy can be a helpful contributor to successful muscle and tendon recovery.

Sprains

• Sprains (torn ligaments) often respond well to massage therapy along with some movement therapy. Research has shown that stimulating nerves in the area of sprains can improve balance and stability, especially around the ankle (Stecco, Wikstrom).

Plantar fasciitis 

• Many physicians recommend massage therapy, especially to the muscles of the lower leg, as part of treatment for plantar fasciitis (Goff, Schwartz). However, relatively little research has been done on this topic. One study compared massage and exercise to ultrasound and exercise, and found that massage led to longer-lasting relief for the participants (Saban), and a small systematic review found support for soft tissue mobilization to help patients with plantar fasciitis (Pollack).

Carpal tunnel syndrome (CTS)

• A systematic review combining findings from dozens of studies found that massage therapy was helpful for CTS symptoms (Huisstede). This supports similar conclusions of studies that found patients with CTS who received massage had significant decreases in symptom severity and improvements in strength and function of their hands and wrists—especially in comparison with other interventions (Elliott, Wolny, Moraska).

For people with insomnia: improved sleep quality for many

• Much of the research about massage therapy as a way to manage sleep quality and insomnia has been done in the context of other conditions. For instance, one study found that massage helped reduce insomnia symptoms for women who are postmenopausal (Hachul). A systematic review concluded that massage could improve sleep quality for women who are pregnant (Hollenbach). Several studies find that massage helps people to sleep better while they deal with complex medical conditions such as breast cancer (Kashani, Tarrasch); congestive heart failure (Sable); or chronic health conditions in children (Brown). 

For people with acute and chronic pain: a safe and effective option 

• Massage therapy for pain in general has a strong evidence base, led by a massive systematic review comprising nearly 70 studies that found it compares well with several other interventions for pain and restored function, and that it has the added benefit of having a low risk of adverse events (Crawford). Another systematic review found evidence in favor of massage, along with several other nonpharmacologic interventions, for chronic noncancer pain (Lin).

For back and neck pain 

• The American College of Physicians recommends massage as an early option for acute and subacute low-back pain (Qaseem). This is supported by evidence in favor of massage alone or massage plus exercise for back pain (Joseph, Skelly). Craniosacral therapy has also been seen to be helpful for chronic, uncomplicated low-back pain (Castro-Sánchez). And a systematic review of nonpharmacologic therapies for low-back pain recommends massage among other interventions (Chou). 

• Similarly, manual therapy has robust evidence for clients with neck pain in a variety of settings, so it is often included in clinical practice guidelines managing neck pain (Puntumetakal, Chou, Kjaer, Bussières, Haller). 

For pain related to fibromyalgia

• Research supports massage therapy for fibromyalgia, specifically for pain, anxiety, quality of life, and sleep (Castro-Sánchez, Oliveira). The best results were seen with long-term treatments, so this suggests that people with fibromyalgia commit to several weeks of regular massage to derive the most benefit (Kalichman, Li, Yuan). 

For headaches

• Headaches, especially tension-type headaches and those related to neck pain and trigger points, appear to respond well to massage therapy. Researchers found that patients experienced lower levels of pain and reduced frequency (Moraska, Quinn, Hopper). All these findings support a systematic review that found massage can be as effective as pharmacological interventions for tension-type headaches (Chaibi). Massage therapy is so consistently helpful that it is recommended in clinical guidelines for headache care (Côté).

In the context of opioids

• Because massage therapy is demonstrably effective for many kinds of pain, and because it is a comparatively low-risk treatment option, it is generating a lot of interest in the context of reducing the need for opioid drugs. Several policy-making organizations, including The Joint Commission, The US Department of Health and Human Services, and the American Society of Interventional Pain Physicians have published strategies that could include massage therapy as a part of pain management to reduce reliance on opioid drugs (Massage & Bodywork).

For people living with chronic conditions: long-term management

• While it was once considered an indulgence for healthy people, or a short-term intervention to help with a musculoskeletal injury, massage therapy is now often integrated into conventional health care for people who live with chronic conditions, including arthritis, autoimmune diseases, hypertension, diabetes, and kidney failure.

Arthritis

• Massage by itself or in combination with aromatherapy, can be an effective strategy to help manage symptoms and improve function in people who have arthritis. Some studies looked at whole-body relaxation treatments, while others examined bodywork, including self-massage, targeted to the affected area. (Perlman, Nasiri, Tosun, Atkins, Peungsuwan, Zwolińska).

Autoimmune diseases

• Autoimmune diseases, including lupus, multiple sclerosis, rheumatoid arthritis, and scleroderma, present challenges that massage therapy can address. Pain, fatigue, quality of life, mood, and self-efficacy (the belief that one can succeed and thrive in spite of obstacles) are all positively affected by massage for people who live with autoimmune diseases (Schroeder, Finch, Poole). In addition, these specific benefits have been found:

Lupus

• Massage therapy is a popular intervention among people with lupus (Morgan), but it hasn’t been extensively studied yet. Massage therapy along with acupuncture helped improve sleep and quality of life for a person with lupus in one case report (Mooventhan). 

Multiple sclerosis (MS)

• A specific type of massage at the injection site for MS medication may help patients tolerate side effects (Márquez-Rebollo), and abdominal massage has been seen to help with constipation among people with MS (Coggrave).

Rheumatoid arthritis (RA)

• Moderate-pressure massage (compared to light-pressure massage) helped to decrease pain and increase grip strength in one study (Field), and foot reflexology was seen to improve pain and fatigue for people with RA as well (Metin).

Scleroderma

• Many people with scleroderma have trouble with mobility in their hands and arms. Lymphatic massage and other types of bodywork have been demonstrated to be helpful with hand function, joint motion, and skin compliance (Bongi, Horváth, Poole).

Hypertension 

• Multiple systematic reviews have found that massage along with antihypertensive drugs is more effective for managing hypertension than drugs alone (Xiong, Liao). A clinical trial found that blood pressure readings dropped after massage, and remained below baseline for 72 hours or more (Givi). These findings are confirmed by several other studies and systematic reviews, which conclude that massage therapy can be a helpful part of hypertension treatment, but doesn’t replace medication (Walaszek, Liao, Niu, Mohebbi). The type of massage appears to matter in this situation: in one important study Swedish massage reliably lowered blood pressure, but trigger-point work and sports massage raised blood pressure readings, at least temporarily (Cambron).

Diabetes

• Skilled massage therapy has a number of documented benefits to offer people with diabetes. It has been seen to temporarily lower blood glucose, although how long this lasts is unpredictable (Sajedi). Massage alone or along with exercise has been seen to improve some biomarkers for this disease (Wändell) and to improve circulation in the legs (Castro-Sánchez). Foot reflexology and Thai massage have also been shown to improve tissue health (Silva), accurate sensation in the feet (Hasneli), and balance (Chatchawan, Tütün). 

Kidney failure, dialysis 

• Only gentle bodywork is appropriate for people living with renal failure, but among these patients, massage may help with fatigue and depression (Raina, Cho). Dialysis patients often seek massage (Ceyhan), and find it helpful for itching, leg cramps, and general quality of life (Shahgholian, Mastnardo, Bullen).

For mental and emotional well-being: improved symptoms for anxiety and depression

• Massage therapy has a surprisingly robust body of evidence showing benefits for people with depression, anxiety, posttraumatic stress disorder (PTSD), and other mood-related challenges. Much of this research has been done in settings where depression, anxiety, and stress are part of a larger health picture (such as among hospital patients, or in the context of chronic pain), although one study looked at the effects of massage therapy on 70 women diagnosed with anxiety and depression who underwent a month of spa treatments; not surprisingly, their stress-related hormones and other biochemical changes suggested that massage can be helpful in this circumstance (Bicikova). 

Depression

• Several studies found massage therapy benefits for people living with depression, both as a freestanding disorder and as a part of a complicated health situation. A systematic review found that aromatherapy massage was substantially more effective than aromatherapy alone for this population (Sánchez-Vidaña). One study found clearly better results for people with major depressive disorder receiving Swedish massage compared to a sham treatment (Hohl). This is important because it helps to delineate between the effect of the bodywork, and the positive effect of spending time with an attentive caregiver. Both are useful, but in this situation the massage was more powerful.

Anxiety

• Anxiety can be a freestanding disorder that radically impairs a person’s quality of life. It can also develop as a part of a complicated health challenge. In either case, welcomed touch in the form of massage therapy has been seen to be an effective treatment component. Results show it can be effective for patients with generalized anxiety disorder (Rapaport). It was also seen to decrease anxiety scores in hospital settings (Cutshall), and among caregivers of patients with cancer (Pinar). Massage with and without aromatherapy improved anxiety among patients in palliative care (Hsu) and in those receiving dialysis (Bullen). 

Posttraumatic stress disorder (PTSD) 

• Massage therapy is often recommended for survivors of torture, refugees, and veterans, if people are comfortable with touching and being touched (Collinge, Kahn, Davis, Longacre). Participants in these studies reported reductions in pain, tension, anxiety, irritability, depression, and other negative aspects of living with this complicated and challenging disorder.

For women: for cramps, labor, symptoms of menopause

Painful menstruation 

• Painful menstruation, also called dysmenorrhea, is a leading reason for missed school and work. It has been the subject of substantial research, because massage therapy is a noninvasive, nonpharmaceutical, and low-risk option for women who struggle with painful cramps. One study found that connective tissue manipulation (a specialized type of bodywork on the back) was effective for menstrual pain (Özgül). Another study compared this technique to foot reflexology; both interventions were equally helpful for symptoms, and benefits lasted at least through the following menstrual cycle (Demirtürk). A meta-analysis that combined data from several studies concluded that abdominal aromatherapy massage was helpful for pain relief among women with menstrual cramps (Sut).

Pregnancy and postpartum

• A review of interventions for pregnant women found that massage can be helpful for prenatal depression, and that training new mothers in infant massage was beneficial for both mothers and babies (Sangsawang, Letourneau), including premature babies in the neonatal intensive care unit (Zhang). Another study found that aromatherapy massage may enhance immune system function and decrease stress among pregnant women (Chen).

Labor and delivery 

• Special training to offer massage during labor is available, and it appears to have significant benefits. A large-scale systematic review and meta-analysis found that massage may help to shorten labor, reduce pain, and improve women’s sense of control during childbirth (Smith). It compares well to other pain-relieving interventions (such as changing positions) during labor (Abdul-Sattar). Massage therapy is so effective in this setting that it is often included in prenatal education and recommendations for new parents (Levett).

Menopause, perimenopause 

• Women who experience mood swings, hot flashes, insomnia, and other symptoms associated with perimenopause (the time leading up to the complete cessation of the menstrual cycle) are often enthusiastic consumers of massage therapy, and research supports this choice. Two studies found that massage may improve climacteric symptoms (that is, hot flashes and night sweats), and offered benefits related to insomnia for this population group (Oliveira, Hachul). Another study concluded that massage with and without aromatherapy could be helpful for menopausal women (Darsareh). A large study compared foot reflexology to nonspecific foot massage for women with hot flashes, night sweats, and other symptoms related to perimenopause; the women receiving reflexology had better improvement of symptoms compared to those receiving nonspecific foot massage (Gozuyesil).

• One study concluded that traditional Thai massage may increase biomarkers that signal bone formation in postmenopausal women—this is a surprising finding that may lead to more exploration of manual therapies to promote bone density (Saetung). 

For elders: better balance, connection with others

• Many older people view massage therapy as a helpful and welcome relaxing treat. One study compared 15 minutes of hand massage to 15 minutes of foot massage. Both interventions led to pleasant, relaxed, refreshed feelings (Nakano). This is reinforced by a systematic review of 14 clinical trials that concluded that massage offers benefits for health and well-being of older people in residential care facilities, and may promote increased engagement with others (McFeeters).

Improved balance

• Older people often worry about balance, mobility, and the risk of falls. Some evidence suggests that massage therapy may have a role to play in this concern. This is not to say that massage therapy always prevents or lowers the risk of falling, but it seems to be a viable strategy that elders can use to manage this challenge. One study found long-term benefits in postural stability and other measures with weekly 60-minute therapeutic massage sessions (Sefton). Thai foot massage improved balance and mobility for patients with diabetic neuropathy (Chatchawan). Massage along with other interventions has also been used to improve balance, postural stability, and mobility for patients in general (Wikstrom), and for those with multiple sclerosis (Bisht), Parkinson’s disease (Donoyama), and other conditions.

Parkinson’s disease (PD)

• Parkinson’s disease often involves tremors, progressive muscle tightness, and other symptoms, and PD patients often seek out massage for relief (Donley, Shin). Two studies found that abdominal massage was effective and well received by patients with PD and constipation (Coggrave, McClurg). Anma massage has been seen to help with stiffness, gait, and other functional outcomes (Donoyama). And an early study of Trager massage (a technique that uses rhythmic gentle shaking of the limbs and trunk) found it helped with some of the muscle rigidity that limits many patients with PD (Duval).

Alzheimer’s disease and dementia 

• A substantial amount of evidence favors massage therapy and bodywork for people with Alzheimer’s disease or other forms of dementia. A large-scale report found that massage therapy, along with other sensory enrichment experiences, may help to improve familiarity, reassurance, engagement, and connection for people with dementia (Bunn). Two systematic reviews found that massage therapy, as a nonpharmacological sensory practice, could be an important part of successful care for patients with various forms of dementia (Scales, Margenfeld). Another study found that massage therapy may be helpful for reducing agitation and aggressive behavior among this population (Dimitriou).

For children: help and support for chronic illness

• A systematic review combined findings from 50 studies of manual therapies for children. They found that massage was consistently helpful for low-back pain, elbow pain, and premature babies, although positive findings were found for many other childhood complaints as well, including asthma, reflux, and cystic fibrosis. One important conclusion of this project was that massage therapy is usually a safe intervention, with a low risk of adverse events (Prevost). A treatment guideline for managing pain in pediatric pain patients recommends massage therapy among other options (Wren).

• An overview of research done on massage therapy for children with cancer finds that qualitative reports (in which patients describe their experience with massage) are consistently positive; that massage appears to help with pain and anxiety; and that more research needs to be done to understand how best to help this population (Jacobs).

For people with cancer: pain relief, less anxiety, better sleep, and much more 

• We used to think that because many types of massage claim to boost circulation (this is not strongly supported by research, by the way), and because cancer uses the blood and lymphatic systems to spread (it does, but it is an extremely complicated and multifactorial process), then massage therapy must be dangerous for any and all cancer patients. Research has revealed that carefully applied highly skilled massage therapy for people with cancer may offer many benefits, including these:

Improved sleep, reduced fatigue (Jacobs, Fernández-Lao, Miladinia)

Reduced stress, anxiety, and depression (Krohn, Greenlee, Darabpour)

Less nausea and constipation (Lyman, Zorba)

Improved immune system function (Fernandez-Lao, Khiewkhern, Armstrong) 

Improved quality of life (Donoyama, Rhee, Vergo) 

• The benefits of massage therapy are so well demonstrated in the research that massage and manual lymphatic drainage are recommended in clinical practice guidelines, specifically for women in treatment for breast cancer (Greenlee). In addition, we have evidence in favor of massage for cancer-related pain, chemotherapy- induced peripheral neuropathy, and lymphedema. Massage therapy also appears to have many benefits for caregivers for patients with cancer.

Cancer-related pain 

• Two systematic reviews and meta-analyses have found various types of massage therapy helpful for cancer-related pain (Lee, Boyd). A large study of almost 600 patients compared a protocol called Healing Touch to oncology massage therapy, and found that both elicited pain relief immediately after the treatment (Gentile). A similar study compared reiki therapy to massage, with a similar finding: both interventions helped with pain, fatigue, nausea, anxiety, depression, and overall well-being (Vergo). The Academic Consortium for Integrative Medicine and Health Care recognizes that massage therapy is a safe and effective pain-relieving intervention for patients with cancer (Tick). 

Lymphedema

• Lymphedema is a common complication of cancer and cancer treatment. A variety of manual therapies have been developed to work with this condition, and they are frequently used in hospital and outpatient settings. Manual lymphatic drainage (MLD) is a type of bodywork that is considered an important component in complex decongestive therapy for people with lymphedema (Schaverien, Ozcan, Todd). A systematic review of several studies found that MLD led to a significant difference in fluid volume in the affected limb, compared to routine treatment (Shao). One study showed that combining MLD with another technique called proprioceptive neuromuscular facilitation led to significant improvements in fluid volume, shoulder range of motion, pain, and depression in patients with lymphedema (Ha).

Peripheral neuropathy

• Chemotherapy-induced peripheral neuropathy (CIPN) is a complication of cancer treatment that can lead to numbness and pain. It can be severe enough to make it necessary to alter patients’ treatment schedules, so that cancer treatment may be less effective. A systematic review of nonpharmacologic interventions for CIPN suggested that massage therapy may be helpful in reducing CIPN symptoms (Oh). Massage therapy is often included in integrative medicine approaches to reduce CIPN and other complications of cancer treatment (Armstrong). And a case report found that manual therapy was associated with almost complete resolution of many symptoms of CIPN in one patient (Cunningham). 

For caregivers of patients with cancer

• One clinical trial found that a simple back massage helped to improve anxiety, blood pressure, heart rate, and sleep quality for people who were caring for a loved one with cancer (Pinar). Another study found that even a single massage treatment resulted in immediate reduction of self-reported symptoms of pain, fatigue, and anxiety for both patients and their caregivers (Lopez). 

In hospital settings—surgery patients, hospice: speedier recovery, support for healing 

• Massage therapy in hospital settings is a relatively new field, but from dialysis facilities to outpatient clinics to surgical suites, massage is being used to promote wellness, lessen the risk of complications, and possibly to reduce reliance on pain medications.

• A large systematic review and meta-analysis consolidated findings from 12 clinical trials to examine the role of massage for critically and acutely ill adults following thoracic surgery. The conclusion was that massage, in addition to pharmacological anesthesia, can reduce post-cardiac surgery pain intensity (Boitor).

• One clinical trial showed that specialized massage to the abdomen can speed up recovery of gastrointestinal function after laparoscopy (Ruan). Another study found that massage to the face, neck, and shoulders improved recovery from nerve damage after a facial surgery; this is an important finding for plastic surgeons (Tsai).

• In the context of joint replacement surgeries, massage therapy may have an important role in helping to reduce the incidence of pulmonary embolism—a common and dangerous complication (Imai). Another study found that massage may help minimize swelling after knee replacements, although this project used a massage tool rather than hands-on therapy (Kim). However, an earlier project also found that manual lymph drainage in the early days after knee replacement had a significant positive impact on knee flexion that lasted for several weeks (Ebert).

• Hospice and palliative care patients are enthusiastic users of massage therapy (Harte), and an important study found that massage reduced the need for medication to treat pain and anxiety in a hospice ward (Pedersen). This supports a systematic review of 17 clinical trials that found that complementary and alternative medicine (including massage with and without aromatherapy) in hospice settings is associated with short-term benefits in symptom relief (Zeng).   

"This review of research is by no means comprehensive; it is just a brief overview of the work that has been done in the relevant contexts. A vast amount of research about massage therapy is not touched upon in this collection, simply because the studies didn’t fit in the categories we decided to include. The field of massage therapy research is growing quickly, and each new publication helps us to understand more about how we can use massage therapy to promote health and to integrate with massage therapy with conventional health care".

The structure of this review was inspired by A Massage Therapist’s Guide to Pathology, 7th ed. published by Books of Discovery.

This content is offered as an evidence-informed summary of what we generally understand are some of the benefits of massage therapy.

 It is not an exhaustive literature review, which requires a different level of analysis of the cited studies.

För mig är det viktigt att mina massagebehandlingar vilar på en trygg och vetenskaplig grund. Därför ser jag det som en självklar del av mitt arbete att följa och sammanställa aktuell forskning inom manuell terapi.

Daniel Näsman
Medicinsk Massageterapeut @ Massageterapeuten Göteborg