A premature infant.

As massage therapists, we witness the healing power of touch every day. Massage research is providing a view into the why behind that power.

Across the many modalities we practice, our skilled therapeutic touch facilitates stress relief and relaxation, lowers anxiety and depression, reduces pain, supports skeletal and muscular realignment, and promotes overall improved well-being.

These beneficial outcomes create the foundation for the effectiveness of massage and bodywork — but have you ever wondered why it works the way it does, what the science is behind it?

Awareness of the mind-body connection is increasingly finding its way into the fields of medicine and integrative health care. Supported by modern neuroscience techniques, scientific research has increased efforts to demystify the benefits of touch and explore how the connection between the skin and the nervous system works and influences our bodies.

As we take a closer look at the results of massage research, we discover that the effects of massage on the body are truly more than skin deep. In fact, much deeper.

[Read “These are the 6 Types of Research that will Benefit Your Massage Practice.”]

Massage Research: Skin-Nervous System Connection

There is a close connection between the skin and the brain that begins at the earliest stages of embryonic development.1 After conception, the fertilized egg (the zygote) makes its way to the uterus, where it implants itself into the uterine lining, the endometrium. The fertilized egg then undergoes a series of cell differentiations, and in week three after conception, three distinct germ layers are formed: the ectoderm, the mesoderm and the endoderm.

The endoderm, the internal layer, develops into the epithelial lining of the digestive tract and forms organs such as the stomach, colon, liver, pancreas, bladder and lungs. The mesoderm, the middle layer, develops into bone, muscle, connective tissue, kidneys, gonads and the circulatory system.

The ectoderm, the outermost germ layer, develops into the skin, brain, spinal cord, and peripheral nervous system. Simplified, we can therefore say that the skin is the outermost part of the brain, and the brain is the innermost part of the skin.

As the largest organ, the skin covers approximately 22 square feet (2 m2) in an adult and accounts for about 16% of total body weight. Highly innervated, it contains millions of sensory receptors that gather information from the outside environment and transmit these impulses to the central nervous system (brain and spinal cord) for processing via the peripheral nervous system.

The role of the brain includes reception, processing and transmission of this environmental information from sensory organs inside the skin to the systems of the whole body.

This close developmental link between the skin and the brain explains why a significant relationship between skin-to-skin contact and activities in the nervous system can be observed throughout our lives, influencing neurological processes such as brain development and function, hormonal balance, mood and behavior.2

Skin-to-skin contact right after birth has been shown to increase physiologic stability, promote psycho-emotional well-being, and support structural and functional brain development in infants.3 Massage research studies conducted by Allan Schore, PhD, a neurobiologist from the University of California, Los Angeles, demonstrate that touch is an essential element in the maturation process of vital brain structures, such as the amygdala.4

This part of the limbic system is involved in emotional learning, memory modulation and the activation of the sympathetic nervous system, and is activated through postpartum skin-to-skin contact during its critical developmental period over the first two months after birth.

Massage Research: Psychological Health & Bonding

Numerous massage research studies conducted by Tiffany Field, PhD, at the Touch Research Institute at the University of Miami School of Medicine have also brought awareness to the positive effects of touch on infant development.

In one study on tactile/kinesthetic stimulation effects on preterm neonates, published in Pediatrics, Field, et al., observed premature infants who received 15-minute massages three times a day. In comparison to other infants who were left alone in their incubators, babies receiving touch therapy showed a 47% increased weight gain as well as a faster maturation of their nervous system (measured based on activity levels and responsiveness).

Altogether, premature infants treated with touch therapy were discharged from the hospital an average of six days earlier than infants who did not receive massage treatments.

James Prescott, PhD, a neuropsychologist and health science administrator at the National Institute of Child Health and Human Development in Washington, D.C., demonstrated in his studies that touch and motion are the most important senses affecting normal brain development and can be considered critical for the proper integration, connection and activation of those areas of the brain involved in psychological health and bonding.5

In addition to influencing the development of brain structures and metabolism, early life skin-to-skin contact has also been shown to create a foundation for peaceful behavioral expressions. After analyzing anthropological data from 49 primitive cultures, Prescott was able to conclude that societies in which babies were carried on their mothers’ bodies throughout the first year of their lives showed significantly less violence than groups that had not adopted this intimate level of care.6

In addition, the researcher was able to observe an association between longer duration of breastfeeding (more than two-and-a-half years) and very low or non-existing occurrences of suicide in these primitive cultures. Prescott concluded that during the sensitive time of brain formation in infants, skin-to-skin contact is a necessary factor for healthy neurological development and consequently protection against depression and violence.7

Massage Research: The Third Brain?

Through touch, we induce nerve and hormonal signals that are transmitted via the skin to the brain’s cognitive and emotional processing center. A massage research study by Field, et al., published in the International Journal of Neuroscience, demonstrates that following massage therapy, the parasympathetic nervous system is stimulated. Levels of stress hormones, including adrenaline, noradrenalin and cortisol are lowered, which leads to a decrease of stress, anxiety and feelings of overwhelm.8

In addition, neurotransmitters like serotonin and dopamine are boosted, promoting improved mood, increased vitality, and an overall feeling of well-being. Another hormone that is activated through skin-to-skin contact is oxytocin, the hormone responsible for bonding, creating trust and strengthening relationships.

The connection between skin-to-skin contact and activity of the brain and nervous system has a strong impact on our mental health and the development of a healthy relationship with ourselves and others.

In his article “Epidermis as the ‘Third Brain?’” Japanese researcher Mitsuhiro Denda, PhD, introduces the idea that the epidermis (the outermost layer of skin), which forms the interface between the body and the environment, could be considered the “third brain” (next to the digestive tract as the “second brain”), as it contains multiple environmental sensors and a sensory information-processing system, and generates a variety of hormones and neurotransmitters with the potential to influence whole-body states and emotions.9

The Role of Epidermal Keratinocytes

Denda points out the role of epidermal keratinocytes, the major cell type of the epidermis that originate in the deepest layer of the epidermis (the stratum basale) and move up to the final barrier layer of the skin (the stratum corneum) during their differentiation process. According to the author, keratinocytes have been shown to contain sensors of mechanical input, temperature and chemical stimuli, as well as a series of neurotransmitter receptors which play an important role in the central nervous system and the brain.

In addition, all components of the hypothalamic-pituitary-adrenal (HPA) axis, an interactive neuroendocrine unit that describes the functional connection between the hypothalamus, the pituitary gland (both located in the brain), and the adrenal glands (on top of the kidneys) can be found in epidermal keratinocytes.

The HPA axis is considered a key player in maintaining homeostasis and the body’s response to stress through the production and secretion of cortisol. Locating this system inside the epidermis supports Denda’s hypothesis that the skin plays a significant role in adapting whole-body physiology as well as emotional responses to changes in the environment.

A study on the effect of massage on the hypothalamic-pituitary-adrenal (HPA) axis and immune function in healthy individuals was conducted by Mark Rapaport et al. During a five-week survey with young adults who received either weekly or twice-weekly treatments of Swedish or light touch massage, the research team recorded and compared the respective increase or decrease of oxytocin (bonding hormone), cortisol (stress hormone) and adrenal corticotropin (stress hormone) levels, among other parameters.10

Individuals who received weekly massages didn’t show a significant response, but individuals who received massage twice a week showed response patterns with increased oxytocin levels and decreased levels of cortisol as well as adrenal corticotropin hormones. These findings show that frequent massage treatments have an effect on the hypothalamic-pituitary-adrenal (HPA) axis and can contribute to facilitating well-being and decreased stress levels.

New Approaches

Based on the growing body of scientific evidence for the physiological connection between the skin and the nervous system, and in further consequence emotional and mental health, new approaches are being explored by combining different treatment modalities that can create holistic therapy approaches.

One example within the field of medicine is the developing subspecies of psychodermatology, a novel approach that merges psychiatry and dermatology and their respective focuses on treating mental processes manifested internally and skin diseases manifested externally. Mohammed Jafferany, MD, et al., observed in a research study that in a typical dermatology practice, 30 to 40% of patients experience psychological problems in relation to their dermatological symptoms.11

Claudia Aguirre, PhD, a neuroscientist who specializes on the connection between psychology and the skin, suggests in her article “The Brain-Skin-Connection” that touch therapy provided by massage and bodywork therapists as well as estheticians could bridge the gap between these individual medical specialties by offering patients integrative mind-body therapies that restore the cellular balance between the skin, nervous system and immune system.12

More Massage Research is Needed

Over the last decades, scientific research and the application of newly developed neuroscience techniques has brought many exciting discoveries and a deeper understanding regarding the brain-skin connection, yet there is still much we do not know.

Further studies and research are required to acquire additional knowledge about the effects of touch on the body and potential integrative treatment modalities that could utilize the strong relation between the skin and the nervous system to effectively and safely support people in their healing.

About the Author:

Andrea Winzer, M.Sc., LMT, BCTMB, holds a master’s degree in ecology and is a board certified massage and bodywork therapist. She practices CranioSacral Therapy and offers a variety of holistic treatment modalities with a focus on the integration of body-mind-spirit, release of physical and emotional trauma from the body, and supporting mental health therapies through trauma-sensitive bodywork. She wrote this article on behalf of the Massage Therapy Foundation.

What the MTF Does for You: The Massage Therapy Foundation is a 501(c)3 providing support to the massage therapy profession. Since 1990, MTF has provided over $1 million in research grants studying the science behind therapeutic massage.MTF founded and publishes an open-access, peer-reviewed scientific journal and provides many educational resources for massage therapists, educators and students. MTF also provides community service grants to populations in need of therapeutic massage who would otherwise lack access.


1. Encyclopedia Britannica.

2. Harvard Medical School Newsletter: Recognizing the Mind-Skin Connection. October 2006.

3. Phillips R., MD, IBCLC, FAAP, Uninterrupted Skin-to-Skin Contact Immediately After Birth. NAINR, 2013; 13(2):67-72.

4. Schore A. Effects of a secure attachment relationship on right brain development, affect regulation, and infant mental health. Infant Mental Health J. 2001; 22:7-66.

5. Prescott J. Body pleasure and the origins of violence. Bull Atomic Sci. 1975: 10-20.

6. Prescott J. Cross-cultural studies of violence, in aggressive behavior: current progress in pre-clinical and clinical research. Los Angeles, CA: University of California, 1974.

7. Field T., Schanberg S., Scafidi F., Bauer C., Vega-Lahr N., Garcia R., Nystrom J., Kuhn C. Tactile/kinesthetic Stimulation Effects on Preterm Neonates. Pediatrics. 1986 May; 77(5):654-8.

8. Field T., Hernandez-Reif M., Diego M., Schanberg S., Kuhn C. Cortisol Decreases and Serotonin and Dopamine Increase Following Massage Therapy. Int J Neurosci. 2005 Oct;115(10):1397-413.

9. Denda M. Epidermis as the “Third Brain?”. Dermatologica Sinica 33 (2015) 70-73

10. Rapaport M., Schettler P., Bresee C. A Preliminary Study of the Effects of Repeated Massage on Hypothalamic-Pituitary-Adrenal and Immune Function in Healthy Individuals: A Study of Mechanisms of Action and Dosage. J Altern Complement Med. 2012. Aug; 18(8): 789-97.

11. Jafferany M, Vander Stoep A, Dumitrescu A, et al: The knowledge, awareness, and practice patterns of dermatologists toward psychocutaneous disorders: results of a survey study. Int J Dermatol. 2010; 49:784-789.

12. Aguirre C. The Brain Skin Connection.