Ever wonder how massage relieves pain, stress, and anxiety? Not only do many traditional cultures practice massage as a medicine, but there’s also a lot of science behind the powerful effects of massage. Read this post to learn more about how massage really works and its proven health benefits.
What is Massage Therapy?
Massage therapy is a simple and effective way to improve physical and mental health. Sessions typically last from 15 to 90 minutes. There are many different types of therapeutic massage, some of which include [1, 2]:
- Swedish massage – a classic form of massage that relaxes tense muscles and improves blood circulation. The skin and muscles in affected areas are gently stroked, kneaded, rubbed, tapped, and vibrated.
- Manipulation – ligaments, tendons, and muscles are massaged, stretched, and moved to improve mobility and to relieve pain. It is often done in combination with physical therapy techniques.
- Mobilization – focuses on moving the spine, joints, and muscles in the body to improve mobility, relax muscles, and improve posture. Like manipulation, it is done with physical therapy techniques.
- Connective tissue massage – treats illnesses by relieving tension in connective tissue, which connects organs, muscles, and nerves together.
- Deep tissue massage – treats the deeper layers of muscle by applying strong pressure to muscles and tendons.
- Myofascial (trigger point) massage – pressure is specifically applied to pain-triggering points that are oversensitive, tense muscle tissue and adhesions of connective tissue. The idea of trigger points is controversial and myofascial massage may not be consistently effective [3].
- Chinese traditional massage – moderate pressure is applied to certain acupoints of the body using rotating movements with fingertips; often done in combination with acupuncture.
- Shiatsu massage – a Japanese form of trigger point massage therapy that uses thumbs to massage acupuncture points.
- Manual lymphatic drainage – encourages the natural drainage of waste products from the lymph nodes.
- Thai massage – involves stretching and pulling the limbs and applying strong, rhythmical pressure to the body with hands, elbows, knees, or feet. Focuses on manipulating “energy lines” (similar to acupuncture meridians) that run throughout the body to treat illnesses.
- Ayurvedic massage – a traditional form of Indian medicine that involves gently massaging the body using rhythmical stroking movements and herbal oils.
- Tantric massage – a type of massage that uses sexual energy to achieve a higher state of consciousness by using specific sensual touches. Produces feelings of well-being and deep relaxation.
Why Massage Feels so Good
Researchers have a pretty good idea about why massage makes us feel good. In various trials, massage has:
- Stimulated the release of hormones (endorphins and enkephalins) that reduce anxiety, stress, and pain [4, 5].
- Lowered levels of stress hormones (norepinephrine, epinephrine, and cortisol), which reduce heart rate, lower blood pressure, slow breathing, and relax muscles [6].
- Increased levels of oxytocin, which is a hormone that increases social bonding and behaviors like trustworthiness, generosity, and empathy [7].
- Reduced activation of pain receptors in the spinal cord and muscles [8, 4].
- Blocked the production of inflammatory cytokines (TNF-alpha, interleukin-6, and HSP-27), which stops swelling and inflammation of muscle tissue [9].
- Increased blood flow to muscles, connective tissue, and the lymph nodes [10].
Potential Health Benefits of Massage
While massage has been found to be beneficial in many studies, it should never be used in place of something your doctor recommends or prescribes.
Likely Effective
1) Back Pain
A meta-analysis concluded that massage can help people with chronic back pain, especially when combined with exercises and education [11].
Massage effectively treated chronic back pain in 401 patients by improving back function. Massage increases blood flow, blocks pain receptors in muscle tissue, and signals the brain to relax the body [12, 13, 14].
2) Quality of Life in Cancer Patients
In a meta-analysis of 12 studies, massage reduced pain in cancer patients, especially those suffering from postoperative pain [15].
Therapeutic massage reduced pain, fatigue, nausea, and anxiety in 58 participants undergoing chemotherapy. In another study, massage therapy reduced stress, anxiety, pain, and provided comfort to 343 cancer patients. Massage increases dopamine, serotonin, endorphins, and enkephalins, which increase relaxation and reduce pain [16, 17, 5, 18].
In 31 women with breast cancer, manual lymphatic drainage decreased swollen lymph nodes, which relieved pain and discomfort. Manual lymphatic drainage increases circulation and redirects waste away from the lymph nodes [19].
Possibly Effective
1) Migraines and Chronic Headaches
Massage reduced migraine frequency and improved sleep quality in 47 patients suffering from migraines in a clinical trial. The massage included myofascial release and deep ischaemic compression of the back, shoulders, neck, and head [20].
In a clinical trial, massage reduced headache intensity in 105 individuals suffering from tension headaches (pain in the head, neck, and behind the eyes) [21].
Massage improved headaches in 65 patients by reducing pain at the trigger points on the neck and shoulder. Trigger points are sensitive, painful areas of the body that are associated with tension headaches. Massage reduced pain receptor stimulation at these trigger points [22, 23].
Migraine triggers commonly involve physical and emotional stress. Massage reduced stress by decreasing heart rate, anxiety, and cortisol levels during the massage sessions. It induced longer periods of deep sleep by reducing levels of substance P and inflammatory agents that trigger migraine pain [20].
2) Fibromyalgia
Fibromyalgia is a chronic condition with symptoms of pain, rigid joints, and intense fatigue. In one study (DB-RCT), massage reduced pain and anxiety in 74 patients with fibromyalgia [24].
In another study, manual lymphatic drainage therapy and connective tissue massage lowered pain intensity and pressure in 50 women with fibromyalgia. Both types of massage relaxed the body, reduced muscle spasms, relieved pain, and increased blood flow [25, 1].
Massage reduced pain and anxiety by lowering the heart rate, blood pressure, and breathing rate. It also increased pain-killing and relaxation hormones (enkephalins and endorphins) [5].
3) Arthritis
Arthritis is a chronic inflammation of joints that damages cartilage. Massage therapy relieved pain and stiffness in 40 adults with knee arthritis (DB-RCT). In another study, weekly massage sessions benefited 125 patients with arthritis [26, 27].
Massage reduced stress hormones and increases pain-killing hormones. The pressure from massage reduced joint tension by stimulating muscle and connective tissue receptors [4].
4) Stroke Rehabilitation
Electric acupuncture and massage improved movement of the shoulder and hand in 120 hemiplegia patients who had suffered a stroke. Acupuncture and massage relaxed muscles and improved circulation around blocked arteries and blood vessels [28].
Touch massage helped rehabilitate 50 stroke patients by decreasing anxiety and pain, improving the quality of life and sensorimotor functions. It increased activity in brain regions associated with feelings of pleasure and emotional regulation [29].
Facial rehabilitation, which included muscle training, massage, and meditation-relaxation, helped manage facial paralysis in 160 patients. Electrical stimulation and massage stimulated cut off nerves in muscle targets and leads in full recovery of muscle movement [30, 31].
5) Burn Scars
Massage reduced pain, stopped itchiness, and improved scar appearance in 146 burn patients. Massage stopped scar tissue growth by breaking down scar tissue and repairing the skin. Massage also stimulated nerve fibers to relieve pain, relax muscles, and produce a sense of well-being [32, 33, 34].
6) Labor and Birth
In a systematic review, vaginal massage in the final month of pregnancy prepared 2497 women for birth, reducing the likelihood of trauma and pain, increasing flexibility, and decreasing muscle and soft tissue resistance. However, massage was only effective for women who had previously given vaginal birth [35, 36].
7) Anxiety and Stress
In a meta-analysis of 1,157 patients, massage reduced anxiety associated with postoperative recovery [37].
Swedish massage reduced anxiety in 48 ICU patients. Massage relaxed muscles, increased circulation, slowed breathing, and relieved pain [38].
Massage reduces anxiety and stress by reducing hormones that increase heart rate, breathing, and sweating (norepinephrine and ACTH) [7].
Much of the research on massage for anxiety and stress has been done on hospitalized or physically ill patients. In a study of 68 people with generalized anxiety disorder, massage was no more effective than thermotherapy or relaxing room therapy in alleviating anxiety [39].
8) Blood Pressure
In a clinical trial, Swedish massage lowered blood pressure in 50 women with high blood pressure [40].
Change in blood pressure varies depending on the type of massage, for example [41, 42]:
- Trigger point therapy caused a pain response, which increased heart rate and blood pressure.
- Swedish massage decreased blood pressure by inhibiting the stress response (by stimulating the vagus nerve).
Deep-tissue massage decreased blood pressure and heart rate in 263 participants. Massage lowers blood pressure and heart rate by increasing oxygen intake, which may decrease the activation of a pathway related to blood pressure (renin-angiotensin pathway) [43].
Insufficient Evidence For
The following purported benefits are only supported by limited, low-quality clinical studies. There is insufficient evidence to support the use of massage for any of the below-listed uses. Massage should never be used as a replacement for something your doctor recommends or prescribes.
9) Recovery After Exercise
29 patients with shoulder pain were treated with soft tissue massage. Soft tissue massage improved muscle repair after shoulder injuries and strains. Massage stopped muscle soreness by reducing swelling and by stopping the release of bradykinins and prostaglandins from inflammatory white blood cells [44, 45, 46].
However, a meta-analysis showed that the effects of massage on recovery in athletes were not significant but relevant under appropriate circumstances (short-term recovery after intensive mixed training) [47].
Massage increased muscle repair by promoting cell growth and reduced inflammation from exercise-induced muscle damage by blocking the production of inflammatory cytokines (TNF-alpha, IL-6, and HSP27) [9, 48].
10) Spinal Cord Injury Pain
20 patients with spinal cord injuries benefited from bi-weekly massage sessions, with lower pain, anxiety, and depression. The group that received massage also had improved muscle strength and range of motion. In another study, acupuncture and massage reduced pain in 30 individuals with spinal cord injuries [49, 50].
Massage reduced pain by activating pain inhibiting systems in the spinal cord and by releasing natural pain-killing hormones (endorphins and enkephalins) [5].
11) Myofascial Pain Syndrome
Myofascial pain syndrome is caused by pain at trigger points in the neck and shoulder muscles. Massage treated myofascial pain syndrome in 67 patients by reducing pin receptor stimulation at trigger points. Massage also activated a brain region (prefrontal cortex) to reduce pain perception [8, 51, 52].
12) Carpal Tunnel Syndrome
In a pilot study, carpal tunnel syndrome targeted massage reduced pain and improved grip strength in 27 patients with carpal tunnel syndrome. In another study, massage improved pain severity and function of hands and wrists in 21 patients with carpal tunnel syndrome [53, 54].
Massage improved blood flow, increased drainage of waste from lymph nodes, and reduced muscular tension. It also softened excessive connective tissue, reduced myofascial trigger point activity in the soft tissue, and reduced compression along the nerve pathway from the cervical spine to the wrist [54].
13) Insomnia
Chinese therapeutic massage helped relieve insomnia in 44 postmenopausal women. Massage increased stage 3 and 4 sleep, which are important for repairing the body and stimulating the immune system. It induced longer periods of deep sleep by reducing levels of substance P and inflammatory agents [55, 20].
Massage produced a calming and relaxing effect. It released endorphins that reduce heart rate, breathing, muscle tension, and increase circulation [10].
14) Immunity
Weekly massage treatments boosted the immune system by increasing white blood cell and immune cell levels in 45 participants [56].
A single session of Swedish massage increased white blood cell count and decreased cortisol levels in 53 participants [57].
15) Quality of Life in HIV/AIDS
Massage improved quality of life, preserved immune function, and reduced stress in 42 patients infected with HIV [58].
In another study on 24 children with HIV, massage increased the number of immune cells (CD4 and CD8 lymphocytes and natural killer cells) [59].
16) Chronic Constipation
Stomach massage treated chronic constipation in 60 patients. Massage increased bowel movements and relieved discomfort and pain [60].
Massage activated stretch receptors that cause the intestines and rectum to contract. Massage also decreased stomach muscle tension, which increases bowel movements [61].
17) Infant Growth & Development
Infant massage improved motor skills, personal and social behavior, sleep, and relaxation. Infant massage also lowered stress hormones and reduced crying [6, 62].
52 infants benefited from massage by improving infant behavior and mother-infant interactions. Massage increased oxytocin, a hormone that increases social bonding and behaviors like trust, generosity, and empathy [63, 7].
18) Hair Growth
In 9 healthy men, scalp massage improved hair growth by increasing blood flow to the scalp and directly stimulating hair follicle cells. Hair loss initially occurred after 12 weeks, but hair growth and thickness increased significantly after 24 weeks [64].
Combination of Massage with other Therapies
Traditional Chinese massage is often done in combination with acupuncture to help treat muscle injuries and to relieve pain. Cupping therapy, a traditional Chinese medical treatment, is also done with massage to reduce chronic neck and shoulder pain [65, 66, 67].
Although aromatherapy is often used purely for its fragrance, essential oils have a wide range of medicinal properties, including effects on wound healing, infection, blood circulation, and digestion. Essential oils enhance the effect of massage by reducing anxiety and improving quality of life [68, 69].
Sauna and mud therapies in combination with massage relieve pain and reduce inflammation [70].
Side Effects and Limitations
Side effects of massage are limited and relatively minor. Common effects include bruising, headaches, fatigue, increased discomfort, nausea, and soreness [71, 72].
More serious, but rare side effects include bone fractures, liver ruptures, and rhabdomyolysis, which results from the death of muscle fibers. Rhabdomyolysis causes weakness, fever, and can lead to kidney failure [43, 73].
Most doctors recommend avoiding massages if you are dealing with a skin rash, infection, wound, or fever. People that are prone to bleeding should likewise be cautious. Deep stomach massage is associated with internal bleeding and should be avoided in people with high risk for blood clots. Massage should also be avoided by blood clots, stents, and prosthetic devices [43, 74, 75].
To avoid adverse effects, if you have concerns, ask your doctor if massage is safe and appropriate for you.
User Reviews
Users report that massage improves overall health, decision-making skills, enhances performance at work, and boosts energy and focus. It also improves memory and blood circulation in the body.
Some users report pain and soreness during the massage and don’t find them enjoyable. Others believe that massage is a relaxing, soothing experience with many added health benefits, including muscle recovery after fitness and weightlifting.
One user believes that the touch of healing is instinctive and the natural human reaction to pain and stress. Massage helps convey compassion and support and provides a nice escape from the stress of the world.
