by Steven Bratman, MD
Forms of Massage
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. One of the most common techniques is Swedish massage, which combines long strokes and gentle kneading movements that primarily affect surface muscle tissues. Deep-tissue massage uses greater pressure to reach deeper levels of muscles. 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 applies strong pressure to tender spots, technically known as trigger points.
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.
Because of this obstacle, 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 difficult to evaluate benefit. It is well-known that if a treatment of any kind is given, a lot of 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 more studies are needed, it does appear that massage may offer benefits for low back pain. For example, researchers in one study concluded that massage offered benefits, especially when paired with exercise and education, in people with low back pain that is not due to a specific injury or condition. And in some of those participants with chronic pain, the effects lasted up to a year. Another study involving people also with nonspecific back pain who were randomized to receive 2 different types of massage (structural or relaxation) or usual care. The people in the massage groups experienced an improvement in their ability to function and had fewer symptoms, which lasted at least 6 months.
Other Potential Uses of Massage ▲
There is some evidence to support the use of massage for a range of conditions, such as:
How to Choose a Massage Therapist ▲
As with all medical therapies, it is best to choose a practitioner who is licensed in your state. Most US states do require massage therapists to be licensed. Organizations like the http://www.amtamassage.org/index.html provide searchable databases to find a massage therapist in your area.
Massage, like other hands-on therapies, involves personal talents that go beyond specific training, certification, or license. 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 and technique for you.
Safety Issues ▲
Although massage is generally safe, it can sometimes temporarily make pain worse, 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.
American Massage Therapy Association
Massage Therapy Foundation
Cherkin DC, Sherman KJ, et al. A comparison of the effects of 2 types of massage and usual care on chronic low back pain: a randomized, controlled trial. Ann Intern Med. 2011 Jul 5;155(1):1-9.
Furlan AD, Giraldo M, Baskwill A, Irvin E, Imamura M. Massage for low-back pain. Cochrane Database Syst Rev. 2015;(9):CD001929.
Manual therapies for chronic low back pain. EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated June 30, 2015. Accessed October 19, 2017.
Massage therapy. EBSCO Natural and Alternative Treatments website. Available at:
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Updated September 2014. Accessed October 19, 2017.
Last reviewed October 2017 by EBSCO Medical Review Board Michael Woods, MD, FAAP
Last Updated: 1/17/2014
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