What is massage therapy used for?

Massage therapy is used to help manage a health condition or enhance wellness. It involves manipulating the soft tissues of the body. Massage has been practiced in most cultures, both Eastern and Western, throughout human history, and was one of the earliest tools that people used to try to relieve pain.

What are the different types of massage?

The term “massage therapy” includes many techniques. The most common form of massage therapy in Western countries is called Swedish or classical massage; it is the core of most massage training programs. Other styles include sports massage, clinical massage to accomplish specific goals such as releasing muscle spasms, and massage traditions derived from Eastern cultures, such as Shiatsu and Tuina.

Do massages help pain?

Massage therapy has been studied for several types of pain, including low-back pain, neck and shoulder pain, pain from osteoarthritis of the knee, and headaches. Here’s what the science says:

Low-Back Pain

Several evaluations of massage for low-back pain have found only weak evidence that it may be helpful.

• The Agency for Healthcare Research and Quality, in a 2016 evaluation of nondrug therapies for low-back pain, examined 20 studies that compared massage to usual care or other interventions and found that there was evidence that massage was helpful for chronic low-back pain but the strength of the evidence was low. The agency also looked at six studies that compared different types of massage but found that the evidence was insufficient to show whether any types were more effective than others.
• A 2015 review of 25 studies with a total of 3,096 participants found that in both acute and chronic low-back pain, there were short-term improvements in pain after massage therapy. However, because the quality of the studies was low, the investigators who conducted the review concluded that they had “very little confidence” that massage is an effective treatment for low-back pain.
• Clinical practice guidelines (guidance for health care providers) issued by the American College of Physicians in 2017 included massage therapy as an option for treating acute/subacute low-back pain but did not include massage therapy among the options for treating chronic low-back pain.

Neck and Shoulder Pain

Massage therapy may be helpful for neck or shoulder pain, but the benefits may only last for a short time.

• A 2013 review of 12 studies (757 total participants) found that massage therapy was more helpful for both neck and shoulder pain than inactive therapies but was not more effective than other active therapies. For shoulder pain, massage therapy had short-term benefits only.
• A 2016 review of 4 studies conducted in the United States (519 participants) found that massage could provide short-term relief of neck pain if massage sessions were long enough and frequent enough.

Osteoarthritis of the Knee

The small amount of research that’s been done on massage therapy for osteoarthritis of the knee suggests that it may have short-term benefits in relieving knee pain.

• Of 6 studies that evaluated massage therapy for osteoarthritis of the knee (408 total participants), 5 found that it provided short-term pain relief. Two of the studies that showed pain relief (149 participants) involved the use of essential oils (aromatherapy massage).

Headaches

Only a small number of studies of massage for headache have been completed. These studies looked at different types of massage and different types of headache, and their results are not consistent.

• A 2016 study with 64 participants evaluated 2 types of massage (lymphatic drainage and traditional massage), once a week for 8 weeks, in patients with migraine. The frequency of migraines decreased in both groups, compared with people on a waiting list.
• In a 2015 study, 56 people with tension headaches were assigned to receive massage at myofascial trigger points or an inactive treatment (detuned ultrasound) twice a week for 6 weeks or to be on a waiting list. People who received either massage or the inactive treatment had a decrease in the frequency of headaches, but there was no difference between the two groups.
• A 2011 study evaluated the effect of adding hand massage to multimodal behavior treatment of migraine in 83 people. Hand massage had no effect on migraine frequency.

Can massage help cancer patients?

With appropriate precautions, massage therapy can be part of supportive care for cancer patients who would like to try it; however, the evidence that it can relieve pain and anxiety is not strong.

• Massage therapy, with or without aromatherapy (the use of essential oils) has been used to attempt to relieve pain, anxiety, and other symptoms in people with cancer. A 2016 evaluation of 19 studies (more than 1,200 participants) of massage for cancer patients found some evidence that massage might help with pain and anxiety, but the quality of the evidence was very low (because most studies were small and some may have been biased), and findings were not consistent.
• Clinical practice guidelines (guidance for health care providers) for the care of breast cancer patients include massage as one of several approaches that may be helpful for stress reduction, anxiety, depression, fatigue, and quality of life. Clinical practice guidelines for the care of lung cancer patients suggest that massage therapy could be added as part of supportive care in patients whose anxiety or pain is not adequately controlled by usual care.
• Massage therapists may need to modify their usual techniques when working with cancer patients; for example, they may have to use less pressure than usual in areas that are sensitive because of cancer or cancer treatments.

Can massage be helpful for fibromyalgia symptoms?

Massage therapy may be helpful for some fibromyalgia symptoms if it’s continued for long enough.

• A 2014 evaluation of 9 studies (404 total participants) concluded that massage therapy, if continued for at least 5 weeks, improved pain, anxiety, and depression in people with fibromyalgia but did not have an effect on sleep disturbance.
• A 2015 evaluation of 10 studies (478 total participants) compared the effects of different kinds of massage therapy and found that most styles of massage had beneficial effects on quality of life in people with fibromyalgia. Swedish massage may be an exception; 2 studies of this type of massage (56 total participants) did not show benefits.

Can massage therapy be helpful for people with HIV/AIDS?

There’s some evidence that massage therapy may have benefits for anxiety, depression, and quality of life in people with HIV/AIDS, but the amount of research and number of people studied are small.

• Massage therapy may help improve the quality of life for people with HIV or AIDS, a 2010 review of 4 studies with a total of 178 participants concluded.
• More recently, a 2013 study of 54 people indicated that massage may be helpful for depression in people with HIV, and a 2017 study of 29 people with HIV suggested that massage may be helpful for anxiety.

Does massage help baby growth?

There’s evidence that premature babies who are massaged may have improved weight gain. No benefits of massage for normal full-term infants have been clearly demonstrated.

• A 2017 research review analyzed the results of 34 studies of massage therapy for premature infants. Twenty of the studies (1,250 total infants) evaluated the effect of massage on weight gain, with most showing an improvement. The mechanism by which massage therapy might increase weight gain is not well understood. Some studies suggested other possible benefits of massage but because the amount of evidence is small, no conclusions can be reached about effects other than weight gain.
• A 2013 review of 34 studies of healthy full-term infants didn’t find clear evidence of beneficial effects of massage in these low-risk infants.

What are the risks of massage therapy?

The risk of harmful effects from massage therapy appears to be low. However, there have been rare reports of serious side effects, such as a blood clot, nerve injury, or bone fracture. Some of the reported cases have involved vigorous types of massage, such as deep tissue massage, or patients who might be at increased risk of injury, such as elderly people.

What are the requirements to become a massage therapist?

In states that regulate massage therapy (45 states and the District of Columbia), therapists must get a license or certification before practicing massage. State regulations typically require graduation from an approved program and passing an examination.

Some massage therapists obtain certification from the National Certification Board for Therapeutic Massage & Bodywork. To do this, they must meet specific educational requirements, undergo a background check, and pass an examination.

NCCIH-Funded Research

NCCIH-sponsored studies have investigated various aspects of massage therapy, including

• Whether massage therapy can be helpful in preventing and treating repetitive motion disorders
• If massage can be helpful as a component of a nondrug approach to pain management in veterans
• If massage therapy can target sensory pathways that can help people with ankle sprains avoid chronic ankle instability (which can affect as many as 40 percent of people who experience this type of injury).

Tips To Consider

• Don’t use massage therapy to postpone seeing a health care provider about a medical problem.
• If you’re unsure whether massage therapy would be appropriate for you, discuss your concerns with your health care provider, who may also be able to help you select a massage therapist.
• Ask about the training, experience, and credentials of the massage therapist you are considering. Also ask about the number of treatments that might be needed, the cost, and insurance coverage.

Reflexology is a practice in which different amounts of pressure are applied to specific points on the feet or hands. These points are believed to match up with certain other parts of the body. Reflexology is claimed to cause relaxation and healing in those parts of the body, but this has not been proven.

• In a study funded by the National Cancer Institute, women with advanced breast cancer who received reflexology treatments showed improvement in a few symptoms, such as shortness of breath, but not others, such as nausea or pain. In this study, reflexology was safe even for the most fragile patients.
• A small amount of research suggests that reflexology might be helpful for reducing a burning or prickling sensation sometimes associated with multiple sclerosis, but there’s insufficient evidence to support the use of reflexology for most multiple sclerosis symptoms.
• There’s too little evidence on reflexology for irritable bowel syndrome to allow any conclusions to be reached about whether it’s helpful.

Several reviews of research have found weak evidence that massage may be helpful for low-back pain. Clinical guidelines issued by the American College of Physicians in 2017 included massage as an option for treating acute/subacute low-back pain but did not include massage therapy among the options for treating chronic low-back pain.

What Does the Research Show?

• The Agency for Healthcare Research and Quality, in a 2016 evaluation of nondrug therapies for low-back pain, examined 20 studies that compared massage to usual care or other interventions and found that there was evidence that massage was helpful for chronic low-back pain but that the strength of evidence was low. The agency also looked at 6 studies that compared different types of massage but found that the evidence was insufficient to show whether any types were more effective than others.
• A 2015 Cochrane review found evidence that massage may provide short-term relief from low-back pain, but the evidence is not of high quality. The long-term effects of massage for low-back pain have not been established.
• Clinical practice guidelines issued by the American College of Physicians in 2017 included massage therapy as an option for treating acute/subacute low-back pain but did not include massage therapy among the options for treating chronic low-back pain.

Massage therapy may provide short-term benefits for neck or shoulder pain.

What Does the Research Show?

• A 2016 review of four randomized controlled trials found that massage therapy may provide short-term benefits from neck pain. However, a 2012 Cochrane review of 15 trials on massage therapy for neck pain concluded that no recommendations for practice can be made at this time because the effectiveness of massage for neck pain remains uncertain.
• A 2013 review of 12 studies of massage for neck pain (757 total participants) found that massage therapy was more helpful for both neck and shoulder pain than inactive therapies but was not more effective than other active therapies. For shoulder pain, massage therapy had short-term benefits only.
• A 2014 randomized controlled trial involving 228 participants with chronic nonspecific neck pain found that 60-minute massages given multiple times per week was more effective than fewer or shorter sessions. The participants were randomized to 5 groups receiving various doses of massage (a 4-week course consisting of 30-minute visits 2 or 3 times weekly or 60-minute visits 1, 2, or 3 times weekly) or to a single control group (a 4-week period on a wait list).

Only a few studies have examined massage therapy for osteoarthritis, but results of some of these studies suggest that massage may have short-term benefits in relieving knee pain.

What Does the Research Show?

• A 2017 systematic review of seven randomized controlled trials involving 352 participants with arthritis found low- to moderate-quality evidence that massage therapy is superior to nonactive therapies in reducing pain and improving functional outcomes. A 2013 review of two randomized controlled trials found positive short-term (less than 6 months) effects in the form of reduced pain and improved self-reported physical functioning. Results of a 2006 randomized controlled trial of 68 adults with OA of the knee who received standard Swedish massage over 8 weeks demonstrated statistically significant improvements in pain and physical function.

Only a small number of studies have looked at massage for headache, and results have not been consistent.

What Does the Research Show?

• Limited evidence from two small studies suggests massage therapy is possibly helpful for migraines, but clear conclusions cannot be drawn. A 2011 systematic review of these two studies concluded that massage therapy might be equally effective as propranolol and topiramate in the prophylactic management of migraine.
• A 2016 randomized controlled trial with 64 participants evaluated 2 types of massage (lymphatic drainage and traditional massage), once a week for 8 weeks, in patients with migraine. The frequency of migraines decreased in both groups, compared with people on a waiting list.
• In a 2015 randomized controlled trial, 56 people with tension headaches were assigned to receive massage at myofascial trigger points or an inactive treatment (detuned ultrasound) twice a week for 6 weeks or to be on a waiting list. People who received either massage or the inactive treatment had a decrease in the frequency of headaches, but there was no difference between the two groups.

With appropriate precautions, massage therapy can be part of supportive care for cancer patients who would like to try it; however, the evidence that it can relieve pain and anxiety is not strong. 2014 clinical practice guidelines for the care of breast cancer patients include massage as one of several approaches that may be helpful for stress reduction, anxiety, depression, fatigue, and quality of life.

What Does the Research Show?

• Clinical practice guidelines issued in 2009 by the Society for Integrative Oncology recommends considering massage therapy delivered by an oncology-trained massage therapist as part of a multimodality treatment approach in patients experiencing anxiety or pain.
• In 2017 the Society for Integrative Oncology issued guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment, recommending the use of massage therapy to improve mood disturbance in breast cancer survivors after active treatment (grade B). This recommendation is based on results from six trials.
• In clinical practice guidelines issued by the American College of Chest Physicians in 2013, massage therapy is suggested as part of a multi-modality cancer supportive care program for lung cancer patients whose anxiety or pain is not adequately controlled by usual care.
• A 2016 Cochrane review of 19 small studies involving 1,274 participants found some studies suggesting that massage with or without aromatherapy may help relieve pain and anxiety in people with cancer; however, the quality of the evidence was very low and results were not consistent.
• Another 2016 systematic review and meta-analysis of 16 studies concluded that based on the available evidence, weak recommendations are suggested for massage therapy, compared to an active comparator, for the treatment of pain, fatigue, and anxiety.

Results of research suggest that massage therapy may be helpful for some fibromyalgia symptoms.

What Does the Research Show?

• A 2014 systematic review and meta-analysis of 9 studies (404 total participants) concluded that massage therapy, if continued for at least 5 weeks, improved pain, anxiety, and depression in people with fibromyalgia but did not have an effect on sleep disturbance.
• A 2015 systematic review and meta-analysis of 10 studies (478 total participants) compared the effects of different kinds of massage therapy and found that most styles of massage had beneficial effects on the quality of life in fibromyalgia. Swedish massage may be an exception; 2 studies of this type of massage (56 total participants) did not show benefits.

There is some evidence that massage therapy may have benefits for anxiety, depression, and quality of life in people with HIV/AIDS, but the amount of research and number of people studied are small.

What Does the Research Show?

• A 2010 review of four studies involving a total of 178 participants concluded that massage therapy may help improve the quality of life for people with HIV or AIDS.
  A 2013 randomized controlled trial of 54 people suggested that massage may be helpful for depression in people with HIV; and a 2017 study of 29 people with HIV found that massage may be helpful for anxiety.

There is some evidence that premature infants who are massaged may have improved weight gain. No benefits of massage for healthy full-term infants have been clearly demonstrated.

What Does the Research Show?

• In a 2017 review of 34 randomized controlled trials of massage therapy for premature infants, 20 of the studies (1,250 total infants) evaluated the effect of massage on weight gain, with most showing an improvement. The mechanism by which massage therapy might increase weight gain is not well understood. Some studies suggested other possible benefits of massage but because the amount of evidence is small, no conclusions can be reached about effects other than weight gain.
• A 2013 Cochrane review of 34 studies of healthy full-term infants didn’t find clear evidence of beneficial effects of massage in these low-risk infants.

Safety

The risk of harmful effects from massage therapy appears to be low. However, there have been rare reports of serious side effects, such as blood clot, nerve injury, or bone fracture. Some of the reported cases have involved vigorous types of massage, such as deep tissue massage, or patients who might be at increased risk of injury.

Only a few studies have been conducted on massage therapy for symptoms of Parkinson’s disease, so there is insufficient data to support or refute its use.

What Does the Research Show?

• The American Academy of Neurology’s practice parameter on neuroprotective strategies and alternative therapies for Parkinson’s disease concluded that there is insufficient evidence to support or refute manual therapy, including massage therapy, biofeedback, or Alexander technique in the treatment of Parkinson’s disease.
• A 2013 randomized controlled pilot study of 45 participants with Parkinson’s disease found that salivary cortisol (a natural biomarker for stress) concentrations were significantly reduced immediately following the tactile massage intervention, but there were no significant differences in reduction compared to the control group and no long-term effect.

Safety

• Massage therapy is generally safe and well-tolerated in most people when it is performed by a licensed practitioner.

The term “massage therapy” includes many techniques, and the type of massage given usually depends on your needs and physical condition. In general, massage therapists work on muscle and other soft tissue to help you feel better.

A lot of the scientific research on massage therapy is preliminary or conflicting, but much of the evidence points toward beneficial effect on pain and other symptoms associated with a number of different conditions. Here are six things you should know about massage therapy for health purposes.

1. Evidence suggests that massage therapy may be useful for some pain conditions such as low-back pain and chronic neck pain. However, research on massage for headaches is preliminary and only somewhat promising.

2. Research has suggested that at least for the short-term, massage therapy for cancer patients may reduce pain. Evidence has suggested that massage therapy may also promote relaxation and boost mood in people with cancer.

3. A recent review of scientific literature concluded that massage therapy may help to reduce depression. However, a 2013 review found there is not enough evidence to determine if massage helps pregnant mothers with depression.

4. A 2010 review concluded that massage therapy may help temporarily reduce pain, fatigue, and other symptoms associated with fibromyalgia, but the evidence is not definitive. The authors of the review noted that it is important that the massage therapist not cause pain.

5. Several studies on massage therapy in preterm infants have been conducted to determine if therapeutic massage provides any benefits. A 2010 review of the scientific literature suggested that massaging preterm infants using moderate pressure may improve weight gain. However, a 2013 review determined that there is not enough evidence to know if massage benefits healthy infants who are developing normally.

6. Massage therapy appears to have few risks when performed by a trained practitioner. However, massage therapists should take some precautions with certain health conditions. You should talk with your health care providers to determine if massage therapy is safe for you.

Many people associate massage with vacations or spas and consider them something of a luxury. But research is beginning to suggest this ancient form of hands-on healing may be more than an indulgence—may help improve your health.

Massage therapists use their fingers, hands, forearms and elbows to manipulate the muscles and other soft tissues of the body. Variations in focus and technique lead to different types of massage, including Swedish, deep tissue and sports massage.

In Swedish massage, the focus is general and the therapist may use long strokes, kneading, deep circular movements, vibration and tapping. With a deep tissue massage, the focus is more targeted, as therapists work on specific areas of concern or pain. These areas may have muscle “knots” or places of tissue restriction.

Some common reasons for getting a massage are to relieve pain, heal sports injuries, reduce stress, relax, ease anxiety or depression, and aid general wellness. Unfortunately, scientific evidence on massage therapy is limited. Researchers are actively trying to understand exactly how massage works, how much is best, and how it might help with specific health conditions. Some positive benefits have been reported.

“Massage therapy has been noted to relax the nervous system by slowing heart rate and blood pressure. Stress and pain hormones are also decreased by massage, reducing pain and enhancing immune function,” says Dr. Tiffany Field, who heads a touch research institute at the University of Miami Medical School. Much of her NIH-funded research focuses on the importance of massage for pregnant women and infants. Some of her studies suggest that massage may improve weight gain and immune system function in preterm infants.

A study published earlier this year looked at how massage affects muscles at the molecular level. The findings suggest that kneading eases sore muscles after exercise by turning off genes associated with inflammation and turning on genes that help muscles heal.

A recent NIH-supported study found that an hour-long “dose” of Swedish massage therapy once a week was optimal for knee pain from osteoarthritis, especially when practical matters like time, labor and convenience were considered. Other research suggests that massage therapy is effective in reducing and managing chronic low-back pain, which affects millions of Americans.

If you’re considering massage therapy for a specific medical condition, talk with your health care provider. Never use massage to replace your regular medical care or as a reason to postpone seeing a health care professional.

Every therapist and every massage is unique. If you decide to try massage therapy, work with different therapists until you find one that meets your needs. One of the best ways to get a great massage is to communicate with your therapist. Most will check in with you during your session for feedback, but—if not—speak up!

Getting a Safe Massage

• If you have a medical condition, ask your health care provider if massage therapy is right for you.
• Before beginning massage therapy, ask about the therapist’s training, experience and credentials. Also ask about the number of treatments that might be needed, the cost and insurance coverage.
• Massage should not hurt. If you feel pain, tell your therapist.
• Tell your health care providers about all complementary and alternative practices you use, including massage.