Forms of Massage

HCA image for massage therapy Along with herbal treatment, touch-based therapy is easily 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 are many schools of massage. In most cases, massage therapists combine several techniques but there are 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 use deep pressure, but they do so according to the principles of acupuncture theory. This can differ markedly from those of Western-oriented massage therapies. Neuromuscular massage (such as the St. John Method of Neuromuscular Therapy) applies strong pressure to tender spots, technically known as trigger points.

How Strong 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. There are several reasons for this, but the main obstacle is that it is difficult to truly determine 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. In such a study, some participants receive a real treatment, others receive a placebo (dummy) treatment and neither the participants nor the researchers know which is which. It is difficult—some would argue even impossible—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 placebo massage?

Because of these problems, all studies of massage fall short. Many researchers have designed studies that compare massage to no treatment. However, studies of this type cannot provide reliable evidence about the effect 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 placebo treatment for the control group, referred to as “sham” massage. However, using a placebo treatment that is very different in form from the treatment under study is less than ideal.

Still other studies have simply involved giving people massages and seeing whether they improved. These trials are particularly meaningless. It is well-known that if a treatment of any kind is given, participants will think they have observed an improvement, regardless of whether or not the treatment does anything on its own. This is known as the placebo effect.

Given these cautions, below is a summary of what is known about the effects of massage. The best evidence regards low back pain.

Massage for Low Back Pain

Although the evidence is far from complete, it does appear that massage may offer benefits for low back pain. However, these benefits appear to be short term. One study compared massage to sham laser therapy in 107 people with low back pain. The results indicated that massage is more effective than laser therapy for relieving low back pain. The massage therapy combined with exercise and posture training is even more effective.

Another study compared acupuncture, massage, and self-care education in 262 people with persistent back pain. By the end of the 10-week treatment period, massage had shown itself more effective than self-care (or acupuncture). However, at a one-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.

Other Potential Uses of Massage

Other preliminary controlled trials of varying quality hint that massage may provide benefit in a number of other conditions, including the following:

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.

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, a technique that 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.

Safety Issues

Although massage is generally safe, 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.