What is massage therapy?
Along with herbal treatment, touch-based therapy is one of the most ancient forms of medical care. Humans stroke and rub areas of the body that hurt; massage therapy develops this human impulse into a professional treatment. There is no doubt that massage relieves pain and induces relaxation temporarily. Whether it offers any lasting benefits, however, remains unclear.
Forms of massage. There are many schools of massage. In most cases, massage therapists combine several techniques, although there are also purists who use one method only. The most common technique is Swedish massage, which combines long strokes and gentle kneading movements that primarily affect surface muscle tissues. Deep-tissue massage utilizes greater pressure to reach deeper levels of muscles. This may be called the “hurts-good-and-feels-great-after” approach. Shiatsu or acupressure massage also uses deep pressure but does so according to the principles of acupuncture theory. Neuromuscular massage (such as the St. John method of neuromuscular therapy) applies strong pressure to tender spots, technically known as trigger points.
Several other techniques are best described as relatives of massage. Rolfing structural integration aims to affect not muscles, but the connective tissue (fascia) surrounding muscles and everything else in the body. This highly organized technique aims to permanently improve the body’s structure. Reflexology is a form of foot massage based on the theory that the whole body is reflected in the foot.
There are many theories about how massage might work, but none have been proved true. Little doubt exists that massage temporarily increases blood circulation in the massaged area, but it is not clear that this makes any lasting difference. Some massage therapists and massage therapy schools promote the notion that massage breaks up calcium deposits in the muscle, but there is no objective substantiation for this claim. A completely different explanation is that massage promotes healing in a more general way, by reducing stress and inducing relaxation. Massage also satisfies the basic human need to be touched.
Some forms of massage (such as Rolfing, acupressure, and reflexology) have elaborate theories behind them. However, there is little to no scientific evidence for these theories; moreover, there is some evidence that the theory behind reflexology is incorrect.
Massage is most commonly used to relieve muscular tension and to promote relaxation. Massage is also said to be helpful as an aid to the treatment of various conditions, including attention deficit disorder (ADD), asthma, autism, bedsores, bulimia, cystic fibrosis, diabetes, eczema, fibromyalgia, human immunodeficiency virus infection, iliotibial band pain, juvenile rheumatoid arthritis, low back pain, lymphedema, neck pain, premenstrual syndrome (PMS), pregnancy, severe burns, and spinal cord injury.
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 one is most fundamental: even with the best of intentions, it is difficult to properly ascertain the effectiveness of a hands-on therapy like massage.
Only one form of study can truly prove that a treatment is effective: the double-blind, placebo-controlled trial. However, it is not possible to fit massage into a study design of this type. What could researchers use for placebo massage, and how could they make sure that both participants and practitioners did not know who was receiving real massage and who was receiving fake massage?
Because of these problems, all studies of massage fall short of optimum design. Many have compared massage to no treatment. However, studies of this type cannot provide reliable evidence about the efficacy of a treatment. If a benefit is seen, there is no way to determine whether it was caused by massage specifically, or just by attention generally. (Attention alone will almost always produce some reported benefit.)
More meaningful trials used some sort of fake treatment for the control group, such as phony laser acupuncture. However, using a placebo treatment that is very different in form from the treatment under study is less than ideal. One study compared real reflexology with fake reflexology. However, it is quite likely that the reflexologists unconsciously conveyed more enthusiasm and optimism when performing the real therapy than when performing the fake therapy; this, too, could affect the outcome. It has been suggested that the only way to avoid this last problem would be to compare the effectiveness of trained practitioners with actors trained only enough to provide a simulation of treatment; however, such studies have not been reported.
Still other studies have simply involved giving people massages and seeing whether they improved. These trials are particularly meaningless; it has been long since proven that both participants and examining physicians will, at minimum, think that they observe improvement in people given a treatment, whether or not the treatment does anything on its own.
Finally, other trials have compared massage to competing therapies, such as acupuncture or relaxation therapy. When one compares unproven therapies to each other, the results cannot possibly prove that any of the tested treatments are effective. Given these caveats, the following is a summary of what science knows about the effects of massage.
Low back pain. Although the evidence is far from complete, it does appear that massage may offer benefits for low back pain. However, these benefits may last for only a short time. One study compared massage with fake laser therapy in 107 people with low back pain. The results indicate that massage is more effective than fake laser therapy for relieving low back pain, and that massage therapy with exercise and posture training is even more effective.
Another study compared acupuncture, massage, and self-care education in 262 people with persistent back pain. By the end of the ten-week treatment period, massage had shown itself more effective than self-care (or acupuncture). However, at a one-year follow-up, no difference was seen in symptoms between the massage group and the self-care group. In another study, acupressure-style massage was more effective than Swedish massage for the treatment of low back pain.
In a review of thirteen randomized trials, researchers concluded that massage may be effective for nonspecific low back pain, and that the beneficial effects can last for up to one year in persons with chronic pain. Researchers also noted that exercise and education appear to enhance the effectiveness of massage.
Cancer. Massage therapy has been studied for its benefits in managing the symptoms associated with cancer and its treatment. In a randomized study investigating the effects of massage on 348 persons with advanced cancer who had moderate to severe pain, the researchers found that, compared with simple touch, massage was significantly more effective at reducing pain and improving mood immediately following treatment; the effect, however, was not sustained. The authors of a review of ten massage therapy studies could not draw firm conclusions about its benefits for a wide range of symptoms in persons undergoing treatment for cancer.
Massage without aromatherapy has shown promise for reducing nausea caused by chemotherapy. However, a small randomized trial found that effleurage massage, a common massage technique, had no significant effect on anxiety, depression, or quality of life among twenty-two women undergoing radiation therapy for breast cancer.
Other conditions. Preliminary controlled trials of varying quality suggest that massage may provide benefit in a number of conditions, including the following: ADD, anorexia nervosa, asthma in children, autism, bulimia, cystic fibrosis, anxiety, diabetes, eczema, fibromyalgia, iliotibial band pain (a form of tendonitis that can cause knee or hip pain), juvenile rheumatoid arthritis, migraine headaches, pregnancy and childbirth, quitting smoking, burn recovery, and spinal cord injury. One study found that massaging premature infants three times daily for ten days at acupressure locations resulted in greater weight compared with similar infants receiving routine care.
One study commonly cited as evidence that ordinary massage therapy is helpful for PMS was flawed by the absence of a control group. However, a better-designed trial compared reflexology with fake reflexology in thirty-eight women with PMS symptoms and found evidence that real reflexology was more effective.
Several studies indicate that massage with aromatherapy may be helpful for relieving anxiety. One study evaluated this combination therapy for treating anxiety or depression (or both) in people undergoing treatment for cancer. The treatment did appear to provide some short-term benefits. A 2008 review could find no convincing evidence for the effectiveness of massage therapy against depression in general.
Study results are mixed on whether massage can improve measures of immune function in people with human immunodeficiency virus infection. For chronic neck pain, one study found that massage is less effective than acupuncture. In fact, in this trial, massage was no more effective than fake acupuncture. Finally, a review of the literature published in 1997 suggests that massage is not helpful for preventing pressure sores (bedsores).
As with all medical therapies, it is best to choose a licensed practitioner. Where licensure is not available, persons should seek a referral from a qualified and knowledgeable medical practitioner. However, most states in the United States license massage therapists.
Note that massage, like other hands-on therapies, involves personal talents that go beyond specific training, certification, or licensure: Some people are simply gifted with their hands. Furthermore, what 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.
Massage is generally safe. However, it can sometimes exacerbate pain temporarily, even when properly performed. In addition, massage that is performed too forcefully on fragile people could cause bone fractures and other internal injuries. However, licensed massage therapists have been trained in ways to avoid causing these problems. Finally, machines designed to perform elements of massage may be less safe than standard massage.
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