Massage Therapy for People with Osteoarthritis

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"Musculoskeletal conditions" is an umbrella term for issues affecting muscles, bones, joints, tendons, ligaments, and nerves. Rather than isolated injuries, these conditions should be conceptualized as complex networks of interacting symptoms—such as pain, stiffness, poor sleep, and decreased activity. The wide variance in clinical presentations underscores a multifaceted etiology involving genetic, metabolic, biomechanical, and environmental factors.

Massage Therapy for People with Osteoarthritis

Osteoarthritis affects over 500 million people globally, with women being more likely to suffer from the condition. It's characterized by joint pain and stiffness and commonly impacts the hands, knees, hips, and spine (Kolasinski et al., 2020; Long et al., 2022). Often we seek a quick fix for musculoskeletal conditions, but these conditions particularly in the case of osteoarthritis are influenced by a complex interplay of biological, psychological, social, and environmental factors (Döding et al., 2026). For this reason, an individualized approach is necessary. Clinical guidelines for musculoskeletal conditions consistently recommend several key strategies:

  • Person-Centered: Treatment plans should be customized for the individual and include education about their condition.

  • Psychosocial Factors: A person's mental and social well-being should be considered.

  • Physical Activity: Exercise and movement are important parts of the recovery process.

  • Manual Therapy: This can be a helpful addition to other treatments.

  • Medication: Short-term pain relief is an option, but potential risks should be weighed.

  • Non-Surgical Care: High-quality, non-surgical options should be explored before considering surgery.

Since there's no single cure, the most effective approach is a combination of these individualized management options, including physical activity, manual therapy, and lifestyle interventions. Essentially, the most effective approach is a combination of treatments tailored to the individual, rather than relying on a single method alone.

A Whole Person Approach to Massage Therapy: The Whole is More Than The Sum of its Parts

Within a whole person framework for massage therapy there are six components that make up a treatment plan (informed consent and shared decision making, assessment, outcome measurements, education and reassurance, multimodal treatment, ongoing re-evaluation).

Six Pillars of a Massage Treatment Plan - Within an evidence-based framework for massage therapy there are six components that make up a treatment plan (informed consent and shared decision making, assessment, outcome measurements, education and reassurance, multimodal treatment, ongoing reevaluation).

Informed Consent and Shared Decision Making

Informed consent will include a discussion about natural history and the effects of no treatment, as well as the possible risks and benefits of receiving treatment. The therapist and patient will then work together to develop a plan of care based on the individualized goals and needs of the patient. This approach gives people the opportunity to be engaged in their own health through the process of shared decision making.

Assessment

A comprehensive assessment assists the clinician come up with a treatment plan that is best suited to each individual. It may involve a physical assessment and detailed health history intake to gather information about patients' limitations, course of pain and can help identify those with a higher likelihood of red flags (serious underlying pathologies) or yellow flags (prognosis factors for delayed recovery). This may also help establish therapeutic alliance and identify the biological, psychological, social and contextual factors contributing to pain and disability.

  • Red Flags (serious underlying pathologies) - Red flags are signs and symptoms that raise suspicion of serious underlying pathology, if a serious pathology is suspected a clinical decision should be made to refer the patient to an appropriate healthcare practitioner. For the general population there are several red flags to be mindful of such as, substantial motor/sensory loss or progressive neurological deficits, fractures or osteoporosis risk/fragility fracture, acute infection (fever/chills/malaise), joint dislocation, peripheral arterial disease and venous thromboembolism.

  • Yellow Flags (risk factors for delayed recovery) - This assessment process could also include screening questionnaires, such as the Orebro musculoskeletal pain questionnaire or Optimal Screening for Prediction of Referral and Outcome Yellow Flag (OSPRO-YF) to help identify yellow flags or identify patients at risk of poor prognosis. If the patient develops worsening physical or psychological symptoms consider a referral to counseling or an appropriate healthcare professional for further evaluation.

  • Physical Assessment - A physical assessment could include palpation, observing gait, neurological screening tests, assessing mobility and/or muscle strength. Interpret assessment results in the context of all assessment findings and implement an individualized treatment plan that is based on the assessment findings and goals of the individual.

  • Orthopedic Tests - Clinicians could also incorporate one or more of the following physical assessment tools and interpret assessment results in the context of all other assessment findings.

    • Neural Screening

    • Manual screening of joint movements

    • Palpation of musculoskeletal system

Outcome Measurement

Outcome measurements can be used to monitor and evaluate the effectiveness of the treatment plan and adapt care accordingly. This could include incorporating one or more of the following outcome measurements when assessing and monitoring patient progress:

  • Patient Global Impression Change

  • Pain Self Efficacy Scale

  • Self-Rated Recovery Question

  • Patient Specific Functional Scale

  • Brief Pain Inventory (BPI)

  • Numeric Pain Rating Scale (NPRS)

  • Visual Analogue Scale (VAS)

  • McGill Pain Questionnaire (MPQ) or The Revised Short McGill Pain Questionnaire Version-2

  • Multidimensional Pain Inventory

  • Short Musculoskeletal Function Assessment (SMFA)

  • Knee Injury and Osteoarthritis Outcome Score (KOOS)

  • Hip Disability and Osteoarthritis Outcome Score (HOOS)

  • Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)

  • Six Minute Walk Test

Education & Reassurance

Focus on the whole person concept of health that addresses biological, psychological, and social factors and empowers people with shared decision making. This can be used to provide reassurance and facilitate an evidence based understanding of treatment options and encourage the use of healthy coping strategies to help manage symptoms and mental well-being.

Example: Osteoarthritis can cause pain, stiffness, and decreased joint mobility. Medication might improve sleep (one node) and manage pain (another node). Massage therapy might improve mobility (one node) and reduce pain (another node). physical activity and exercise (another treatment) then helps strengthen the muscles (another node), further reducing pain and stiffness, creating a positive feedback loop. Once symptoms stabilize people may feel comfortable managing symptoms with various self-management strategies. All three treatments together contribute to an overall improvement in the symptom network.

Multimodal Treatment

To effectively address musculoskeletal health a personalized, multifaceted approach is key (e.g. self-management, education, exercise, and manual therapy). By integrating these various strategies, the overall effect is often greater than the sum of its individual parts. Rather than relying on a single treatment, the most successful strategies combine several components, including:

  • Manual Therapy - Massage can enhance health and well-being for individuals with a number of health-related conditions through the complex interplay of immunological, neurological, and psychological components (Keter et al., 2025; Packheiser et al., 2024). For people impacted by osteoarthritis massage therapy when used within a whole-person framework can be used to help manage.

    • Osteoarthritis of the Hand (Mi et al., 2023)

    • Osteoarthritis of the Knee (Zhu et al., 2024) - Randomized clinical trials have highlighted the effect of conservative treatment options for patients suffering from osteoarthritis related knee pain. In one randomized clinical trial published in the Journal of General Internal Medicine massage therapy was shown to improve function in patients who suffer from osteoarthritis related knee pain (Perlman et al., 2019). In addition, a randomized trial published in The New England journal of medicine demonstrated the benefits of a conservative multimodal approach (manual therapy + exercise) for patients with symptomatic osteoarthritis of the knee (Deyle et al., 2020).

    • Osteoarthritis of the Hip (Koc et al., 2025)

    • Osteoarthritis of the Spine (Bussières et al., 2021; Cashin et al., 2025)

  • Self-Management Strategies - Supported self-management empowers individuals to actively manage their health through ongoing support, guidance, encouragement and problem-solving skills (Kang et al., 2024). Massage therapists play a dual role: providing hands-on treatment and designing personalized self-management programs which may include.

    • Mindfulness-Based Interventions - There are a variety of mindfulness-based interventions that can help relieve pain and stress (e.g., walking, meditation, cognitive behavioral theory, yoga, tai chi, and qigong).

    • Passive Heating Exposure - Heat therapy (e.g., deep moist heat, heating pad, hot baths, sauna, or heated garments) can increase local blood flow, improve range of motion, and provide pain relief.

    • Healthy Sleep Habits - People with chronic pain can benefit from restorative sleep.

  • Exercise and Physical Activity - Exercise programs that are enjoyable and meaningful (e.g. muscle strengthening, joint mobility, proprioception and aerobic exercises) are a core treatment for people with osteoarthritis (Daste et al., 2021). There is good evidence that even modest volumes of exercise can benefit people with arthritis-related pain (Kraus et al., 2019). Meaning people with osteoarthritis should be encouraged to engage in physical activity, irrespective of duration.

  • Interdisciplinary Collaboration and Referrals - A multidisciplinary approach that supports healthy lifestyle factors, such as sleep, stress management, physical activity, and nutrition, can significantly benefit both physical and mental well-being. Massage therapists play a valuable role within this collaborative framework, working alongside medical and allied health professionals.

Regardless of age, exercise and physical activity (aerobic, resistance, flexibility, balance) can improve health and quality of life. People often prefer to participate in exercise programs that are designed with consideration of their preferences and past exercise experiences. With this in mind there are a range of exercise types that have shown to be effective for reducing pain and disability such as aerobic training, aquatic exercise, motor control exercises, Tai Chi, resistance training, walking, and yoga.

Ongoing Reevaluation

Clinical practice guidelines for osteoarthritis recommend an interdisciplinary approach with an emphasis on self-management, physical and psychological therapies, and less emphasis on pharmacological, intra-articular interventions and surgical treatments (Bowden et al., 2020; Kolasinski et al., 2020). It is not suggested that massage therapy alone can control symptoms but can be utilized to help relieve pain & reduce anxiety when integrated with standard care. Clinicians should work in partnership with patients to develop a person-centered care plan that considers best available evidence and the patient's goals, values, and preferences. If appropriate, start with multi-modal conservative care (education and reassurance, exercise, manual therapy, hydrotherapy, acupuncture, etc.) and reassess the person’s status at each visit for new or worsening symptoms, or satisfactory recovery. Then the patient is discharged, treatment is continued, or treatment is escalated based on response to the initial treatment plan, risk/benefit assessment and shared decision making.

Key Takeaways

In whole-person health, the human body is understood as a dynamic, living ecosystem rather than a collection of isolated parts. This paradigm shifts the clinical focus from simply treating isolated symptoms to evaluating how interconnected systems—biological, psychological, behavioral, and environmental—shape an individual’s health trajectory over time. Within this framework, massage therapy serves as a valuable component of an integrated, multidisciplinary care model. By complementing key lifestyle factors such as sleep quality, stress regulation, and physical activity, evidence-informed massage therapy supports both physical resilience and mental well-being.

Tailoring care to individual needs, goals, and assessment findings, massage therapists apply a range of evidence-informed clinical strategies:

  • Comprehensive Screening & Risk Stratification: Identifying red flags (underlying pathology requiring referral) and yellow flags (psychosocial factors influencing recovery).

  • Person-Centered Education & Reassurance: Utilizing empathetic communication, shared decision-making, and healthy coping strategies to build self-efficacy.

  • Targeted Manual Therapy: Employing soft-tissue techniques, neural mobilization, and joint mobilization to modulate pain and restore movement capacity.

  • Collaborative Self-Management: Empowering patients through remedial exercise (stretching, strengthening, and physical activity), sleep hygiene recommendations, hydrotherapy, and mindfulness-based interventions.

The available evidence suggests that the effects of massage Therapy cannot be explained by a single mechanism. Instead, it acts through a complex interplay of interconnected responses. This aligns with the concept of a "whole-person approach," which emphasizes the interconnectedness of biological, psychological, and social factors that contribute to our overall health and well-being.

References and Sources

With over 15 years of clinical experience and extensive study of massage therapy research, I'm committed to creating resources that foster the professional development of massage therapists globally. Whether you're a seasoned massage therapist or a curious newcomer, this massage therapy glossary is here to be your one-stop shop for understanding terms as it relates to massage therapy. Additionally this post highlights a substantial body of evidence supporting the use of massage therapy in alleviating pain and enhancing quality of life across a range of health issues.

This is a selection of sources I used to help formulate my ideas based on over-lapping concepts from massage therapy, physiotherapy, chiropractic, osteopathy, lifestyle medicine and traditional healing approaches.

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