Last Updated on February 11, 2026 by MASSAGE Magazine
Back massage performed in the prone position was found to increase cerebral blood flow in a brain region associated with the autonomic nervous system and relaxation.
Many massage therapists work with clients lying prone. We know this position often supports relaxation, and previous research has shown that massage can activate the body’s relaxation response. Researchers in Japan wanted to take that one step further. Could a back massage in the prone position actually change brain activity in areas linked to stress regulation?
The study, “Changes in cerebral blood flow under the prone condition with and without massage,” was conducted at the Hamamatsu Medical Center in Japan and published in Neuroscience Letters (Vol. 407, Issue 2, Oct. 27, 2006, pp. 131–135).
Why Study Brain Blood Flow During Massage?
The researchers hypothesized that back massage in the prone position could alter regional cerebral blood flow (rCBF) in a brain region connected to the autonomic nervous system.
Regional cerebral blood flow refers to the amount of blood flowing through specific regions of the brain. Changes in rCBF can reflect shifts in brain activity.
Because massage is known to influence the autonomic nervous system, the researchers wanted to see whether those effects could be observed directly in the brain.
Who Participated in the Study?
Eight healthy adult volunteers participated in the study.
The group included four women and four men. While small, the sample allowed researchers to closely monitor changes using imaging technology.
To measure rCBF, the researchers used PET scans (positron emission tomography). PET scans produce three-dimensional images that show functional activity in the body, including changes in blood flow in the brain.
What Conditions Were Compared?
Each participant underwent four to six PET scans under different conditions:
- Supine at rest
- Prone at rest
- Prone with back massage four minutes into the session
- Prone with back massage 20 minutes into the session
This design allowed researchers to compare posture alone versus posture combined with massage.
What Did the Back Massage Involve?
Two professional therapists from Balance Therapy University performed the massage.
The treatment consisted of palm-pressure massage applied to the back muscles, including:
- Trapezius
- Rhomboideus
- Latissimus dorsi
Each massage session lasted approximately 24 minutes and was delivered consecutively while the participant remained in the prone position.
What Changes Were Observed?
Cerebral blood flow significantly increased during back massage in the prone position compared with the supine condition.
This increase in rCBF corresponded with two key observations:
- Participants reported a comfortable sensation
- Heart rate slowed during the massage
The researchers also found that rCBF correlated with parasympathetic function, as indicated by heart rate reduction. This suggests involvement of the autonomic nervous system when participants experienced comfort.
In simple terms, as participants relaxed and their heart rate slowed, measurable changes were observed in brain blood flow.
What Did the Researchers Find?
The authors stated that their findings “verified the efficacy of the present back stimulation to reduce mental stress or anxiety.”
They also noted that the prone posture itself appeared to activate the precuneus, a brain region associated with awareness. Light back massage in this position may help the brain accommodate comfortable stimulation.
What Does This Mean for Massage Therapists?
For therapists who routinely work with clients in the prone position, this study offers interesting confirmation of what you may observe every day.
The combination of posture and back massage was associated with increased cerebral blood flow and parasympathetic activation, both of which are linked to relaxation.
Although the sample size was small and further research is needed, the study provides imaging-based evidence that back massage may influence brain activity in regions associated with stress and autonomic regulation.
For practitioners, that reinforces an important point. The relaxation response observed in your clients is not merely subjective. It may be reflected in measurable changes within the brain itself.