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Does massage work?

June 2020

Written By Graham H

© Trusted Touch Therapies

Massage has been defined as “a mechanical manipulation of body tissues with rhythmical pressure and stroking for the purpose of promoting health and well-being” (Cafarelli, et al 1992). This definition provides useful insight as to the problem with scientifically recording and thereby proving the benefits of soft tissue therapy including Sports Massage. Cafarelli (1992) states that massage promotes ‘health and wellbeing.’

The problem presented to clinicians and academics seeking to prove the efficacy of massage is that the benefits are qualitative, especially in terms of overall wellbeing, tissue and body function. This consideration, combined with the anecdotally experienced efficacy of massage, means that scientifically proving the effectiveness of massage is challenging. Most studies conclude that more research is needed with more stringent methodologies to ensure accuracy of results.

However, what appears to be a problem with using a scientific approach to prove the efficacy of massage is that there appear to be too many variable factors present.

For example, many massage therapists are aware that in order for treatment to be effective, a therapist will employ a multi-modal approach (i.e. a variety of techniques used over a course of treatments, to create the best result for the client). Even if 2 clients show the same injury caused in the same way, their injuries may respond differently to the same treatment. If the treatment modality is changed for the less responsive client, it may produce a positive result. This change in modality would create a variation, which would undermine the ‘scientific’ validity of the results. Using different modalities, both clients injuries improved. So anecdotally massage is effective, although we can not say that it has been ‘scientifically proven.’ However, it would also be inaccurate to conclude that massage is therefore ineffective.

There are many variables that can change within a scientific study, which as of yet, no study has been able to sufficiently control or eliminate enough of them to categorically conclude the efficacy of massage. These include, but are not limited to, the nature of each injury being treated, the health and fitness of the clients, clinical experience, competence of technique execution and the responsiveness of muscle tissue to different modes of treatment.

Traditionally, the effectiveness of massage treatment is measured using results obtained from the observable changes in localised muscle tissue, i.e. the area being treated. Results are taken from observable changes such as DOMS, injury recovery, tissue healing and in some cases ROM's.

Lebert (2018) suggests that there may be a way out of this quandary. Lebert presents a new and effective way to prove the effectiveness of massage to prove its effectiveness once and for all.

“In the past treatments may have been based on a bio-medical model. Looking forward, the bio-psycho-social model of health and disease provides a practical paradigm for investigating the complex interplay between massage therapy and clinical outcomes.” 

(Lebert 2018).

The responses to massage therapy are multifactorial (physiological and psychological factors interplay in a complex manner). Based on the bio-psycho-social model of health and disease, the investigation into mechanisms of action should extend beyond local tissue changes (Lebert 2018).

Lebert (2018) goes on to present a modern, inclusive framework to try to explain how massage works by looking beyond localised tissue response. If we consider factors such as the modulation of pain as recorded by the peripheral and central nervous systems, how the body responds to pain and therapeutic touch to relieve pain, the client’s experience of the therapeutic encounter, and so on; then perhaps the success of massage can be determined by a reduction in pain and the improved experience of the client.

Lebert (2018) draws attention to 4 overlapping mechanisms which make up the bio-psycho-social approach to the efficacy of massage. The aspects of this framework are:

1. Affective Touch - therapeutic touch stimulating somatosensory nerves resulting in the release of oxytocin and endogenous opioids. This results in a reduced physiological response to stress factors and improved mood/affect.

2. Contextual Factors - A positive therapeutic encounter contributing to positive clinical outcomes.

3. Endogenous Pain Modulation - Input from somatosensory nerves leads to descending inhibitory mechanisms, which in turn impact neuro-immune processes which reduce the experience of pain.

4. Mechanical Factors – Therapeutic touch helps diminish oedema by aiding the clearance of toxins and pro-inflammatory cells

Each aspect considers how an interplay of physiological processes, psychological responses and social conditioning come together to produce the widely experienced beneficial effects of massage.

In conclusion, a huge body of research exists including academic reviews and summaries of previous research, which aim to find trends within the existing body of work. Unfortunately, the underlying trend often concludes that more research is required using more stringent methodological practices to add scientific credibility to results.

It may be the case that we are unable to ‘scientifically prove’ the efficacy of sports massage and other soft tissue therapies by focusing on tissue response as a means of obtaining results. There are too many other factors at play, which need to be incorporated to define and determine a successful outcome for a specific treatment on a specific client.

Perhaps the scientific community needs to find a way to broaden the scope of what constitutes a meaningful result. In short, more research is needed, perhaps complemented by a new definition for what constitutes a positive result.


Cafarelli E, Flint F (1992) ‘The role of massage in preparation for and recovery from exercise.’ Sports Med 1992; 14 (1): P1-9

Richard Lebert (2018) 'How Does Massage Work'' Accessed January 2019)

Written By Graham H

© Trusted Touch Therapies

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