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:
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.
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.
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.
Brattberg G. Connective tissue massage in the treatment of fibromyalgia.
Eur J Pain. 1999;3:235–244.
Brosseau L, Casimiro L, Milne S, et al. Deep transverse friction massage for treating tendinitis.
Cochrane Database Syst Rev. 2002;(1):CD003528.
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.
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.
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.
Diego MA, Field T, Hernandez-Reif M, et al. Spinal cord patients benefit from massage therapy.
Int J Neurosci. 2002;112:133–142.
Eliott MA, Taylor LP. "Shiatsu sympathectomy": ICA dissection associated with a shiatsu massager.
Neurology. 2002;58:1302 1304.
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.
Field T, Hernandez-Reif M, Hart S, et al. Pregnant women benefit from massage therapy.
J Psychosom Obstet Gynaecol. 1999;20:31–38.
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.
Field T, Hernandez-Reif M, Seligman S, et al. Juvenile rheumatoid arthritis: benefits from massage therapy.
J Pediatr Psychol. 1997;22:607–617.
Field T, Hernandez-Reif M, Taylor S, et al. Labor pain is reduced by massage therapy.
J Psychosom Obstet Gynaecol. 1997;18:286–291.
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.
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.
Field T, Peck M, Krugman S, et al. Burn injuries benefit from massage therapy.
J Burn Care Rehabil. 1998;19:241–244.
Field T, Schanberg S, Kuhn C, et al. Bulimic adolescents benefit from massage therapy.
Field TM, Quintino O, Hernandez-Reif M, et al. Adolescents with attention deficit hyperactivity disorder benefit from massage therapy.
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.
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.
Hart S, Field T, Hernandez-Reif M, et al. Anorexia nervosa symptoms are reduced by massage therapy. Eating Disorders:
Journal of Treatment and Prevention. 2001;9:217–228.
Hernandez-Reif M, Deiter J, Field T, et al. Migraine headaches are reduced by massage therapy.
Int J Neurosci. 1998;96:1–11.
Hernandez-Reif M, Feld T, Hart S. Smoking cravings are reduced by self-massage.
Prev Med. 1999;28:28–32.
Hernandez-Reif M, Field T, Krasnegor J, et al. Children with cystic fibrosis benefit from massage therapy.
J Pediatr Psychol. 1999;24:175–181.
Hernandez-Reif M, Martinez A, Field T, et al. Premenstrual symptoms are relieved by massage therapy.
J Psychosom Obstet Gynaecol. 2000;21:9–15.
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.
Ironson G, Field T, Scafidi F, et al. Massage therapy is associated with enhancement of the immune system's cytotoxic capacity.
Int J Neurosci.
Offenbacher M, Stucki G. Physical therapy in the treatment of fibromyalgia.
Scand J Rheumatol Suppl.
Oleson T, Flocco W. Randomized controlled study of premenstrual symptoms treated with ear, hand, and foot reflexology.
Obstet Gynecol. 1993;82:906–911.
Preyde M. Effectiveness of massage therapy for subacute low-back pain: a randomized controlled trial.
Schachner L, Field T, Hernandez-Reif M, et al. Atopic dermatitis symptoms decreased in children following massage therapy.
Pediatr Dermatol. 1998;15:390–395.
Smith WA. Fibromyalgia syndrome.
Nurs Clin North Am. 1998;33:653–669.
Sunshine W, Field T, Quintino O, et al. Fibromyalgia benefits from massage therapy and transcutaneous electrical stimulation.
J Clin Rheumatol.
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.
Please be aware that this information is provided to supplement the care
provided by your physician. It is neither intended nor implied to be a
substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER
IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the
advice of your physician or other qualified health provider prior to
starting any new treatment or with any questions you may have regarding a