Massage therapy is an important component of health and wellness services for millions of Americans each year.
One reason for this is the hope of pain relief. According to national surveys, more than 40 percent of clients receive massage therapy for medical reasons such as pain relief and injury recovery.
Critical Thinking is Needed
However, more critical thinking about massage therapy and education regarding how to assess findings is needed. Evidence-informed massage therapists may encounter unproven, exaggerated or unrealistic beliefs about the benefits of massage therapy. This misinformation can make it difficult for massage therapists to explain the proven benefits of massage.
Massage therapists are in a great position to help people manage their pain. Therefore, a key question for all critically thinking massage therapists or clients should be, is there evidence that supports the belief that massage provides pain relief? (Read “An Exploration of Clinical Research: Three Researchers Share How Their Work Helps Move the Massage Profession Forward.”)
Fortunately, in recent years a body of research has been building on the effects of massage on pain. In this article we review some of the evidence supporting massage therapy for pain relief.
The Heart of the Question
Let’s start here: Pain is a complex multifactorial biopsychosocial experience. Because of this, pain relief is more of a subjective clinical outcome rather than an objective mechanistic outcome that can be measured by an observer. This makes it a bit trickier to determine the effect of massage on pain. Still, researchers have developed tools and methods to get to the heart of the question.
PubMed is a large, free search engine accessing references and abstracts on life sciences and biomedical topics. It is constantly updated and used to find research evidence published in journals and books.
In the last five years, there have been more than 900 studies regarding massage and pain published in research literature found on PubMed. Research includes massage for back pain and other musculoskeletal pains; pain related to exercise and work; pain from fibromyalgia, multiple sclerosis, cancer and other medical conditions; pain during pregnancy and labor; pain experienced from surgery; and pain suffered by patients who are opioid-dependent. This is a growing body of research.
Let’s take a look at three areas in the literature and see what the research shows — and keep in mind the hierarchy of research evidence: case report, case series, randomized controlled trial, systematic review and meta-analysis.
One pain type that has been studied quite a lot in recent years is cancer pain. Having cancer does not always mean having pain; but when pain occurs there are many different kinds of medicines and non-drug methods that can be used to help relieve it. Let’s look at what has been discovered about massage and cancer pain.
The highest level of evidence currently available is a 2015 meta-analysis by Lee, et al., in Integrated Cancer Therapies, which used advanced statistics to combine the results of 12 studies, including nine studies described as being of high quality, to reach this conclusion:
“Our results indicate that massage is effective for the relief of cancer pain, especially for surgery-related pain. Among the various types of massage, foot reflexology appeared to be more effective than body or aroma massage. Our meta-analysis indicated a beneficial effect of massage for relief of cancer pain.”
This conclusion reflects the overall good result of massage in the studies selected. Among the other results discussed in the paper, there are other specific conclusions worth mentioning: In five studies based on measurements one week following massage, there was still a significant effect of massage in reducing pain; at two weeks two of the studies still showed significant effect of massage in reducing pain; and there was a significant effect of massage for breast cancer patients in four studies.
Massage of the body was significantly effective in seven of the studies, while foot reflexology was significantly effective in four.
While most authors will conclude that more research is needed and replication of studies is an important priority in science, we can say with confidence that, based on the best available evidence, massage therapy is effective for relieving many types of cancer pain.
Pregnancy massage is practiced by many massage therapists. There are special considerations for providing pregnancy massage such as positioning, precautions and concentration areas. Pregnancy-related back pain is known to occur in all trimesters, with pain reported most often in the area of the twelfth rib to gluteal folds and at the sacroiliac joints.
Only one article on the effects of massage therapy in pregnancy was identified in PubMed. This 1999 article entitled “Pregnant women benefit from massage therapy,” published in the Journal of Psychosomatic Obstetrics and Gynecology, reported the following conclusion: “Overall, the present findings suggest that massage therapy is effective for reducing pregnant women’s anxiety levels, stress hormones, sleep disturbance and back pain and for lessening obstetric and postnatal complications.
Further research is needed to explore the underlying mechanisms for these changes.”
This 20-year-old study with a small sample size of 24 women reports a good outcome from massage for not only pain but other factors that affect pregnant women. More studies on this topic are needed.
The effects of massage on labor pain have more recently been studied. The journal Complementary Therapies in Clinical Practice published a study in 2017 that included 62 pregnant woman who received back massage or standard care during labor. Massage was provided at the start of labor contractions and followed a prescribed protocol.
The results of the study concluded: “This study has found that lower back massage has a significant effect on reducing labor pain and increasing the satisfaction with birth. Positive feedback from women about massage and the request for massage shows that non-pharmacologic pain relief is important and useful for easing the pain, feeling self-confidence and developing positive interactions with surrounding people.”
Although both study sizes were small, the best available evidence supports massage as effective in reducing pain related to pregnancy and labor.
Treatment of muscle and other soft tissue is the primary target of massage therapy. It clearly shows that research into this topic provides some of the high level of evidence. In 2015 the Australian publication The Journal of Physiotherapy released a systematic review by Bervoets, et al.
The review selected 26 studies from past years that met the requirements for inclusion. Bervoets examined studies that included low back pain, knee arthritis and shoulder pain.
The conclusion stated: “Massage therapy, as a stand-alone treatment, reduces pain and improves function compared to no treatment in some musculoskeletal conditions.
When massage is compared to another active treatment, no clear benefit was evident.” Let’s look deeper into the study’s discussion of the results and consider possibly reframing our understanding based on what is found so we can analyze the results. What is found in the discussion of the results is that there is low to moderate evidence that massage has a short-term effect on improving pain and function.
A short-term effect is not insignificant. It is measured in hours to weeks in most of the studies, with long-term effects considered to be beyond 12 weeks.
Much of the downgrading of the quality of evidence in the studies is due to flaws in the research methodology, something that can be improved in future efforts.
When the authors state what this study has added to the existing knowledge base about massage, they write: “Massage reduces pain, in the short term, in shoulder pain and osteoarthritis of the knee. Massage improves function, in the short term, in shoulder pain, low back pain and osteoarthritis of the knee. Massage is not clearly more or less beneficial that other commonly used treatments for musculoskeletal disorders.”
So again, while more can be done to improve research on massage therapy so that greater certainty can be developed, it is reasonable to conclude that massage for musculoskeletal pain can provide relief from hours to weeks for a number of body areas and is on a par with other treatments for pain. It can also improve function.
Visit academic.oup.com, the website of Oxford Journals, and search for massage pain to access three studies that investigated the impact of massage therapy on function in three types of pain populations:
1) Populations who would typically visit their general health care practitioner with complaints of pain (“The Impact of Massage Therapy on Function in Pain Populations — A Systematic Review and Meta-Analysis of Randomized Controlled Trials: Part I, Patients Experiencing Pain in the General Population”);
2) Patients undergoing or recovering from surgical or operative procedures (“The Impact of Massage Therapy on Function in Pain Populations — A Systematic Review and Meta-Analysis of Randomized Controlled Trials: Part III, Surgical Pain Populations”); and
3) Cancer patients (“The Impact of Massage Therapy on Function in Pain Populations — A Systematic Review and Meta-Analysis of Randomized Controlled Trials: Part II, Cancer Pain Populations”).
Additional articles about massage and pain management can be found on the Massage Therapy Foundation’s website, massagetherapyfoundation.org/massage-research.
About the Authors: Arthur Veilleux, PT, DPT, OCS, was
certified as a massage therapist in 1987. He continued a private massage
practice and teaching through physical therapy program graduation in 1993. He
received a doctor of physical therapy degree in 2006 and served as an adjunct
instructor at the Rutgers University Doctor of Physical Therapy program from
2012–2017. Kelly Skellinger, LMT, NJ, LNT, founded Maitrisage – Massage +
Reflexology, a private practice, in June 2013. She is also a writer and editor
for the Massage Therapy Foundation’s writing group. They wrote this article on behalf of the Massage
- Lee SH, Kim JY, Yeo S, Kim SH, Lim S. Meta-Analysis of Massage Therapy on Cancer Pain Integrative Cancer Therapies. 2015 July.
- Field T, Hernandez-Reif M, Hart S, Theakston H, Schanberg S, Kuhn C. Pregnant women benefit from massage therapy. Journal of Psychosomatic Obstetrics and Gynecology. March 1999.
- Seda Unalmis Erdogan, Emre Yanikkerem, Asli Goker. Effects of low back massage on perceived birth pain and satisfaction. Complementary Therapies in Clinical Practice. May 2017.
- Bervoets DC, Luijsterburg PA, Alessie JJ, Buijs MJ, Verhagen AP. Massage therapy has short-term benefits for people with common musculoskeletal. Journal of Physiotherapy. July 2015.