Massage Therapy: What You Need To Know
What is massage therapy used for?
Massage therapy is used to help manage a health condition or enhance wellness. It involves manipulating the soft tissues of the body. Massage has been practiced in most cultures, both Eastern and Western, throughout human history, and was one of the earliest tools that people used to try to relieve pain.
What are the different types of massage?
The term “massage therapy” includes many techniques. The most common form of massage therapy in Western countries is called Swedish or classical massage; it is the core of most massage training programs. Other styles include sports massage, clinical massage to accomplish specific goals such as releasing muscle spasms, and massage traditions derived from Eastern cultures, such as Shiatsu and Tuina.
Do massages help pain?
Massage therapy has been studied for several types of pain, including low-back pain, neck and shoulder pain, pain from osteoarthritis of the knee, and headaches. Here’s what the science says:
Several evaluations of massage for low-back pain have found only weak evidence that it may be helpful.
- The Agency for Healthcare Research and Quality, in a 2016 evaluation of nondrug therapies for low-back pain, examined 20 studies that compared massage to usual care or other interventions and found that there was evidence that massage was helpful for chronic low-back pain but the strength of the evidence was low. The agency also looked at six studies that compared different types of massage but found that the evidence was insufficient to show whether any types were more effective than others.
- A 2015 review of 25 studies with a total of 3,096 participants found that in both acute and chronic low-back pain, there were short-term improvements in pain after massage therapy. However, because the quality of the studies was low, the investigators who conducted the review concluded that they had “very little confidence” that massage is an effective treatment for low-back pain.
- Clinical practice guidelines (guidance for health care providers) issued by the American College of Physicians in 2017 included massage therapy as an option for treating acute/subacute low-back pain but did not include massage therapy among the options for treating chronic low-back pain.
Neck and Shoulder Pain
Massage therapy may be helpful for neck or shoulder pain, but the benefits may only last for a short time.
- A 2013 review of 12 studies (757 total participants) found that massage therapy was more helpful for both neck and shoulder pain than inactive therapies but was not more effective than other active therapies. For shoulder pain, massage therapy had short-term benefits only.
- A 2016 review of 4 studies conducted in the United States (519 participants) found that massage could provide short-term relief of neck pain if massage sessions were long enough and frequent enough.
Osteoarthritis of the Knee
The small amount of research that’s been done on massage therapy for osteoarthritis of the knee suggests that it may have short-term benefits in relieving knee pain.
- Of 6 studies that evaluated massage therapy for osteoarthritis of the knee (408 total participants), 5 found that it provided short-term pain relief. Two of the studies that showed pain relief (149 participants) involved the use of essential oils (aromatherapy massage).
For more information, see NCCIH’s fact sheet on osteoarthritis.
Only a small number of studies of massage for headache have been completed. These studies looked at different types of massage and different types of headache, and their results are not consistent.
- A 2016 study with 64 participants evaluated 2 types of massage (lymphatic drainage and traditional massage), once a week for 8 weeks, in patients with migraine. The frequency of migraines decreased in both groups, compared with people on a waiting list.
- In a 2015 study, 56 people with tension headaches were assigned to receive massage at myofascial trigger points or an inactive treatment (detuned ultrasound) twice a week for 6 weeks or to be on a waiting list. People who received either massage or the inactive treatment had a decrease in the frequency of headaches, but there was no difference between the two groups.
- A 2011 study evaluated the effect of adding hand massage to multimodal behavior treatment of migraine in 83 people. Hand massage had no effect on migraine frequency.
For more information, see NCCIH’s fact sheet on headaches.
Can massage help cancer patients?
With appropriate precautions, massage therapy can be part of supportive care for cancer patients who would like to try it; however, the evidence that it can relieve pain and anxiety is not strong.
- Massage therapy, with or without aromatherapy (the use of essential oils) has been used to attempt to relieve pain, anxiety, and other symptoms in people with cancer. A 2016 evaluation of 19 studies (more than 1,200 participants) of massage for cancer patients found some evidence that massage might help with pain and anxiety, but the quality of the evidence was very low (because most studies were small and some may have been biased), and findings were not consistent.
- Clinical practice guidelines (guidance for health care providers) for the care of breast cancer patients include massage as one of several approaches that may be helpful for stress reduction, anxiety, depression, fatigue, and quality of life. Clinical practice guidelines for the care of lung cancer patients suggest that massage therapy could be added as part of supportive care in patients whose anxiety or pain is not adequately controlled by usual care.
- Massage therapists may need to modify their usual techniques when working with cancer patients; for example, they may have to use less pressure than usual in areas that are sensitive because of cancer or cancer treatments.
For more information, see NCCIH’s fact sheet on cancer.
Can massage be helpful for fibromyalgia symptoms?
Massage therapy may be helpful for some fibromyalgia symptoms if it’s continued for long enough.
- A 2014 evaluation of 9 studies (404 total participants) concluded that massage therapy, if continued for at least 5 weeks, improved pain, anxiety, and depression in people with fibromyalgia but did not have an effect on sleep disturbance.
- A 2015 evaluation of 10 studies (478 total participants) compared the effects of different kinds of massage therapy and found that most styles of massage had beneficial effects on quality of life in people with fibromyalgia. Swedish massage may be an exception; 2 studies of this type of massage (56 total participants) did not show benefits.
For more information, see NCCIH’s fact sheet on fibromyalgia.
Can massage therapy be helpful for people with HIV/AIDS?
There’s some evidence that massage therapy may have benefits for anxiety, depression, and quality of life in people with HIV/AIDS, but the amount of research and number of people studied are small.
- Massage therapy may help improve the quality of life for people with HIV or AIDS, a 2010 review of 4 studies with a total of 178 participants concluded.
- More recently, a 2013 study of 54 people indicated that massage may be helpful for depression in people with HIV, and a 2017 study of 29 people with HIV suggested that massage may be helpful for anxiety.
Does massage help baby growth?
There’s evidence that premature babies who are massaged may have improved weight gain. No benefits of massage for normal full-term infants have been clearly demonstrated.
- A 2017 research review analyzed the results of 34 studies of massage therapy for premature infants. Twenty of the studies (1,250 total infants) evaluated the effect of massage on weight gain, with most showing an improvement. The mechanism by which massage therapy might increase weight gain is not well understood. Some studies suggested other possible benefits of massage but because the amount of evidence is small, no conclusions can be reached about effects other than weight gain.
- A 2013 review of 34 studies of healthy full-term infants didn’t find clear evidence of beneficial effects of massage in these low-risk infants.
What are the risks of massage therapy?
The risk of harmful effects from massage therapy appears to be low. However, there have been rare reports of serious side effects, such as a blood clot, nerve injury, or bone fracture. Some of the reported cases have involved vigorous types of massage, such as deep tissue massage, or patients who might be at increased risk of injury, such as elderly people.
What are the requirements to become a massage therapist?
In states that regulate massage therapy (45 states and the District of Columbia), therapists must get a license or certification before practicing massage. State regulations typically require graduation from an approved program and passing an examination.
Some massage therapists obtain certification from the National Certification Board for Therapeutic Massage & Bodywork. To do this, they must meet specific educational requirements, undergo a background check, and pass an examination.
NCCIH-sponsored studies have investigated various aspects of massage therapy, including
- Whether massage therapy can be helpful in preventing and treating repetitive motion disorders
- If massage can be helpful as a component of a nondrug approach to pain management in veterans
- If massage therapy can target sensory pathways that can help people with ankle sprains avoid chronic ankle instability (which can affect as many as 40 percent of people who experience this type of injury).
Tips To Consider
- Don’t use massage therapy to postpone seeing a health care provider about a medical problem.
- If you’re unsure whether massage therapy would be appropriate for you, discuss your concerns with your health care provider, who may also be able to help you select a massage therapist.
- Ask about the training, experience, and credentials of the massage therapist you are considering. Also ask about the number of treatments that might be needed, the cost, and insurance coverage.
- For more tips on finding a massage therapist or other complementary health practitioner, see NCCIH’s webpage How To Find a Complementary Health Practitioner.
For More Information
- Agency for Healthcare Research and Quality. Noninvasive Treatments for Low Back Pain. AHRQ Publication No. 16-EHC004-EF. February 2016.
- Bennett C, Underdown A, Barlow J. Massage for promoting mental and physical health in typically developing infants under the age of six months. Cochrane Database of Systematic Reviews. 2013;(4):CD005038. Accessed at http://www.cochranelibrary.com on January 21, 2017.
- Cortés Godoy V, Gallego Izquierdo T, Lázaro Navas I, et al. Effectiveness of massage therapy as co-adjuvant treatment to exercise in osteoarthritis of the knee: a randomized controlled trial. Journal of Back and Musculoskeletal Rehabilitation. 2014;27(4):521-529.
- Furlan AD, Giraldo M, Baskwill A, et al. Massage for low-back pain. Cochrane Database of Systematic Reviews. 2015;(9):CD001929. Accessed at www.cochranelibrary.com on January 26, 2017.
- Happe S, Peikert A, Siegert R, et al. The efficacy of lymphatic drainage and traditional massage in the prophylaxis of migraine: a randomized, controlled parallel group study. Neurological Sciences. 2016;37(10):1627-1632.
- Hillier SL, Louw Q, Morris L, et al. Massage therapy for people with HIV/AIDS. Cochrane Database of Systematic Reviews. 2010;(1):CD007502. Accessed at www.cochranelibrary.com on August 18, 2017.
- Niemi A-K. Review of randomized controlled trials of massage in preterm infants. Children. 2017;4(4):pii:E21
- Qaseem A, Wilt TJ, McLean RM, et al. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine. 2017;166(7):514-530.
- Shin ES, Seo KH, Lee SH, et al. Massage with or without aromatherapy for symptom relief in people with cancer. Cochrane Database of Systematic Reviews. 2016;(6):CD009873. Accessed at www.cochranelibrary.com on January 26, 2017.
- Yin P, Gao N, Wu J, et al. Adverse events of massage therapy in pain-related conditions: a systematic review. Evidence-Based Complementary and Alternative Medicine. 2014;2014;480956.
- Bao Y, Kong X, Yang L, et al. Complementary and alternative medicine for cancer pain: an overview of systematic reviews. Evidence-based Complementary and Alternative Medicine. 2014;2014;170396.
- Bureau of Labor Statistics. Occupational Outlook Handbook. Massage Therapists. Bureau of Labor Statistics Web site. Accessed at www.bls.gov/ooh/Healthcare/Massage-therapists.htm on July 28, 2017.
- Chang CY, Wu YT, Chen LC, et al. Massage-induced brachial plexus injury. Physical Therapy. 2015;95(1):109-116.
- Collinge W, MacDonald G, Walton T. Massage in supportive cancer care. Seminars in Oncology Nursing. 2012;28(1):45-54.
- Crump C, Paluska SA. Venous thromboembolism following vigorous deep tissue massage. The Physician and Sportsmedicine. 2010;38(4):136-139.
- Deng GE, Rausch SM, Jones LW, et al. Complementary therapies and integrative medicine in lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(5 Suppl):e420S-e436S.
- Field T, Diego M, Gonzalez G, et al. Knee arthritis pain is reduced and range of motion is increased following moderate pressure massage therapy. Complementary Therapies in Clinical Practice. 2015;21(4):233-237.
- Greenlee H, Balneaves LG, Carlson LE, et al. Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer. Journal of the National Cancer Institute Monographs. 2014;2014(50):346-358.
- Guo Z, Chen W, Su Y, et al. Isolated unilateral vertebral pedicle fracture caused by a back massage in an elderly patient: a case report and literature review. European Journal of Orthopaedic Surgery and Traumatology. 2013;23 Suppl 2:S149-S153.
- Hedborg K, Muhr C. Multimodal behavioral treatment of migraine: an Internet-administered, randomized, controlled trial. Upsala Journal of Medical Sciences. 2011;116(3):169-186.
- Kong LJ, Zhan HS, Cheng YW, et al. Massage therapy for neck and shoulder pain: a systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine. 2013;2013;613279.
- Li Y-h, Wang F-y, Feng C-q, et al. Massage therapy for fibromyalgia: a systematic review and meta-analysis of randomized controlled trials. PLoS One. 2014;9(2):e89304.
- Maste P, Paik SH, Oh JK, et al. Acute spinal subdural hematoma after vigorous back massage: a case report and review of literature. Spine. 2014;39(25):E1545-E1548.
- Moraska AF, Stenerson L, Butryn N, et al. Myofascial trigger point-focused head and neck massage for recurrent tension-type headache: a randomized, placebo-controlled clinical trial. Clinical Journal of Pain. 2015;31(2):159-168.
- Nahin RL, Boineau R, Khalsa PS, Stussman BJ, Weber WJ. Evidence-based evaluation of complementary health approaches for pain management in the United States. Mayo Clinic Proceedings. 2016;91(9):1292-1306.
- Nasiri A, Mahmodi MA, Nobakht Z. Effect of aromatherapy massage with lavender essential oil on pain in patients with osteoarthritis of the knee: a randomized controlled clinical trial. Complementary Therapies in Clinical Practice. 2016;25:75-80.
- Perlman AI, Ali A, Njike VY, et al. Massage therapy for osteoarthritis of the knee: a randomized dose-finding trial. PLoS One. 2012;7(2):e30248.
- Perlman AI, Sabina A, Williams AL, et al. Massage therapy for osteoarthritis of the knee. A randomized controlled trial. Archives of Internal Medicine. 2006;166(22):2533-2538.
- Poland RE, Gertsik L, Favreau JT, et al. Open-label, randomized, parallel-group controlled clinical trial of massage for treatment of depression in HIV-infected subjects. Journal of Alternative and Complementary Medicine. 2013;19(4):334-340.
- Reychler G, Caty G, Arcq A, et al. Effects of massage therapy on anxiety, depression, hyperventilation and quality of life in HIV infected patients: a randomized controlled trial. Complementary Therapies in Medicine. 2017;32:109-114.
- Schwartz J, Dawson, S, Whitridge P, eds. Massage therapy. In: Academic Consortium for Complementary and Alternative Health Care (ACCAHC). Clinicians’ & Educators’ Desk Reference on the Licensed Complementary & Alternative Healthcare Professions. 2nd ed. Seattle, WA: ACCAHC, 2013.
- Sun F, Yuan QL, Zhang YG. Large buttocks hematoma caused by deep tissue massage therapy. Pain Medicine. 2015;16(7):1445-1447.
- Yip YB, Tam AC. An experimental study on the effectiveness of massage with aromatic ginger and orange essential oil for moderate-to-severe knee pain among the elderly in Hong Kong. Complementary Therapies in Medicine. 2008;16(3):131-138.
- Yuan SLK, Matsutani LA, Marques AP. Effectiveness of different styles of massage therapy in fibromyalgia: a systematic review and meta-analysis. Manual Therapy. 2015;20(2):257-264.
NCCIH thanks Lanay Mudd, Ph.D., and David Shurtleff, Ph.D., NCCIH, for their technical expertise and review of the 2019 update of this publication.
This publication is not copyrighted and is in the public domain. Duplication is encouraged.
NCCIH has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your health care provider(s). We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy is not an endorsement by NCCIH.