Massage Therapy: A Review Of The Evidence

What is Massage Therapy?

The Canadian Massage Therapy Alliance (CMTA) defines Massage Therapy as: "The practice of massage therapy is the assessment of the Musculoskeletal system of the body and the treatment and prevention of physical dysfunction, injury and pain by manipulation, mobilization and other manual methods to develop, maintain, rehabilitate or augment physical function, relieve pain or promote health. Massage therapy is a clinically-oriented healthcare option that helps alleviate the Musculoskeletal disorders associated with everyday stress, physical manifestation of mental distress, muscular overuse and many persistent pain syndromes."

Why Does Massage Therapy Make You Feel Better?

The responses to massage therapy are multifactorial - physiological and psychological factors interplay in a complex manner. The biopsychosocial model provides a practical framework for investigating the complex interplay between massage therapy and clinical outcomes.

Based off the biopsychosocial model, investigation into mechanisms of action should extend beyond local tissue changes and include peripheral and central endogenous pain modulation. An observed favorable outcome may be explained by a number of overlapping mechanism in the periphery, spinal cord, and brain represented in the image below.

Proposed Mechanisms of Massage Therapy

Massage Therapy: A Review Of The Evidence

Massage therapy has a growing body of evidence supporting its effectiveness in reducing pain and improving health-related quality of life in a variety of health conditions and rehabilitation, including but not limited to:
• Low Back Pain (Chou et al. 2017, Foster et al. 2018Traeger et al. 2017Qaseem et al. 2017)
• Neck Pain (Busse et al. 2017Chou et al. 2018Côté et al. 2016)
• Headaches and Migraines (Busse et al. 2017Millstine et al. 2017)
• Temporomandibular Disorder (Martins et al. 2016Randhawa et al. 2016)
• Shoulder Pain (Hawk et al. 2017Steuri, et al. 2017, Yeun 2017)
• Carpal Tunnel Syndrome (Huisstede et al. 2018)
• Hip Osteoarthritis (Cibulka et al. 2017)
• Knee Osteoarthritis (Busse et al. 2017, Nahin et al. 2016, Newberry et al. 2017)
• Plantar Fasciitis (Fraser et al. 2018)
• Chronic Ankle Instability (Powden et al. 2017)
• Post-Operative Pain (Boitor et al. 2017, Kukimoto et al. 2017)
• Cancer-Related Fatigue (Hilfiker et al. 2017, Kinkead et al. 2018)
• Fibromyalgia (Busse et al. 2017)
• Delayed Onset Muscle Soreness (Dupuy et al. 2018Guo et al. 2017)
• Postpartum Maternal Sleep (Owais et al. 2018)
• Pain Management in Labour (Smith et al. 2018)
• Hypertrophic Scarring (Ault et al. 2018)
• Palliative Care (Zeng et al. 2018)

More to Explore

Ault et al. (2018). Scar massage for hypertrophic burns scarring-A systematic review. Burns.

Boitor et al. (2017). The Effect of Massage on Acute Postoperative Pain in Critically and Acutely Ill Adults Post-thoracic Surgery: Systematic Review and Meta-analysis of Randomized Controlled Trials. Heart Lung.

Busse et al. (2017). Guideline for opioid therapy and chronic noncancer pain. CMAJ.

Chen et al. (2017). Management of chronic pain using complementary and integrative medicine. BMJ.

Chou et al. (2017). Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med. 

Chou et al. (2018). The Global Spine Care Initiative: applying evidence-based guidelines on the non-invasive management of back and neck pain to low- and middle-income communities. Eur Spine J.

Cibulka et al. (2017). Hip Pain and Mobility Deficits-Hip Osteoarthritis: Revision 2017. JOSPT.

Côté et al. (2016). Management of neck pain and associated disorders: A clinical practice guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur Spine J. 

Dupuy et al. (2018). An Evidence-Based Approach for Choosing Post-exercise Recovery Techniques to Reduce Markers of Muscle Damage, Soreness, Fatigue, and Inflammation: A Systematic Review With Meta-Analysis. Front Physiol.

Foster et al. (2018). Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet.

Fraser et al. (2018). Does manual therapy improve pain and function in patients with plantar fasciitis? A systematic review. J Man Manip Ther.

Guo et al. (2017). Massage Alleviates Delayed Onset Muscle Soreness after Strenuous Exercise: A Systematic Review and Meta-Analysis. Front Physiol.

Hawk et al. (2017). Systematic Review of Nondrug, Nonsurgical Treatment of Shoulder Conditions. J Manipulative Physiol Ther.

Hilfiker et al. (2017). Exercise and other non-pharmaceutical interventions for cancer-related fatigue in patients during or after cancer treatment: a systematic review incorporating an indirect-comparisons meta-analysis. Br J Sports Med.

Huisstede et al. (2018). The Effectiveness of Surgical and Post-Surgical Interventions for Carpal Tunnel Syndrome-A Systematic Review. Arch Phys Med Rehabil.

Kinkead et al. (2018). Massage therapy decreases cancer-related fatigue: Results from a randomized early phase trial. Cancer.

Kukimoto et al. (2017). The Effects of Massage Therapy on Pain and Anxiety after Surgery: A Systematic Review and Meta-Analysis. Pain Manag Nurs.

Martins et al. (2016). Efficacy of musculoskeletal manual approach in the treatment of temporomandibular joint disorder: A systematic review with meta-analysis. Manual Therapy.

Millstine et al.(2017). Complementary and integrative medicine in the management of headache. BMJ.

Nahin et al. (2016). Evidence-Based Evaluation of Complementary Health Approaches for Pain Management in the United States. Mayo Clinic Proceedings.

Newberry et al. (2017). Treatment of Osteoarthritis of the Knee: An Update Review. Agency for Healthcare Research and Quality (US)

Owais et al. (2018). Non-pharmacological interventions for improving postpartum maternal sleep: A systematic review and meta-analysis. Sleep Med Rev.

Powden et al. (2017). Rehabilitation and Improvement of Health-Related Quality-of-Life Detriments in Individuals With Chronic Ankle Instability: A Meta-Analysis. J Athl Train.

Qaseem et al. (2017). Clinical Guidelines Committee of the American College of Physicians.. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med.

Randhawa et al.(2016). The Effectiveness of Non-invasive Interventions for Temporomandibular Disorders. The Clinical Journal of Pain.

Skelly et al. (2018). Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review. Agency for Healthcare Research and Quality.

Smith et al. (2018). Massage, reflexology and other manual methods for pain management in labour. Cochrane Database Syst Rev.

Steuri et al. (2017). Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: a systematic review and meta-analysis of RCTs. Br J Sports Med.

Traeger et al. (2017). Diagnosis and management of low-back pain in primary care. CMAJ.

Yeun (2017) Effectiveness of massage therapy for shoulder pain: a systematic review and meta-analysis. J Phys Ther Sci. 

Zeng et al. (2018). Complementary and Alternative Medicine in Hospice and Palliative Care: A Systematic Review. J Pain Symptom Manage.