Massage Therapy - The Evidence

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The therapeutic nature of massage has been utilised by various societies and in many ways for millennia.

From therapeutic references by Hippocrates [1] to the current day, there are countless advocates praising therapeutic massage; but how much scientific evidence is there, and in what areas does therapeutic massage appear to have the most benefit?

Because anecdotal reports do not lend themselves well to scientific evaluation, many of the apparent benefits of massage have not translated as quickly to main stream use as perhaps they could.  In recent years, however, more systematic studies for various types of massage therapy have produced some quite positive results.

1. Shiatsu Massage in Full Term Pregnancy [2]
A study in the UK on 66 post-term women (those who attended hospital after 40 weeks gestation) showed that women who used shiatsu were significantly more likely to have spontaneous labour than the non shiatsu group who more frequently required induced labour.

2. Aromatherapy Massage [3]
A small trial measuring the effect of aromatherapy massage using a lavender based product showed a significant increase in lymphocytes, a type of protective blood cell, in the treatment group.  Treated patients also had decreased stress and depression scores.  Although small, the study reveals the potential for aromatherapy massage to improve immune function in a measurable way.

3. Lower Back Pain [4]
A research group studying alternative therapies for non-specific low back pain concluded that massage therapy gave better results than no therapy.  More studies are required to further clarify the role of massage in lower back pain.

4. Headaches [5]
Researchers reviewed many recent articles and studies on the use of complementary medicine in treating headache.  Their conclusion was that Physical Therapy was more effective than massage in tension type headache.  More specific studies would greatly clarify the role of massage in treating headache.  Anecdotal evidence would appear strong.

5. Stress Reduction and Relaxation
Many studies demonstrated effective stress reduction with massage.  For example, a clinical trial [6] involving 80 women using a stress reduction program which comprised massage therapy plus stress management provided in group sessions recorded significantly decreased stress scores not only during the trial but 8 weeks after it had ceased.

6. Improved Immune Function
A clinical trial [7] of massage therapy in breast cancer patients not only demonstrated improved mood and anxiety scores for the participants but increased levels of protective immune cells (lymphocytes and NK cells).  The improved immunity that follows stress reduction from massage therapy is an often overlooked important benefit.

7. Lymphedema
This term relates to decreased clearance of lymph fluid and the resultant swelling in limbs.  The role of manual lymph drainage massage is currently being debated in medical circles, and a new larger study [8] is being undertaken to clarify the issue.
A recent study on manual lymph drainage in the lymphedema of breast cancer patients [9] showed a benefit in massage for mild lymphedema patients.

8. Massage During Pregnancy
Massage therapy is viewed generally as a very safe form of treatment.  This is especially the case during pregnancy.  A study at Yale University [10] looked at treatment preferences for pregnant women with lower back pain, as well as treatment recommendations from pre natal care givers (nurse educators, nurse midwives and obstetricians).  Both groups reported a preference for using massage therapy (about 61% in both cases).

A study of massage therapy effect on depressed pregnant women [11] demonstrated not only improved mood in the treatment group but improved blood levels of the neurotransmitters dopamine and serotonin, plus less infant prematurity and higher birth weight than the non-massage group.

9. Constipation
Abdominal massage therapy was once an accepted treatment for constipation and there is now renewed interest in massage as non-drug options are being sought.  A systematic review [12] of studies on the massage treatment of constipation concluded that massage therapy is a promising treatment, and that further studies were warranted.

A study [13] on abdominal massage with an aromatherapy product which included rosemary, peppermint and lemon oils found that the aromatherapy massage was significantly more effective than massage alone for the treatment of constipation.

10. Asthma
Chest physiotherapy has long been used in the treatment of respiratory conditions.  The use of massage in asthma has not been very well studied in a controlled way.  A recent review [14], however, found some clinical evidence to support massage therapy in terms of improved lung function measurements.  So, although promising, more research is required.

11. Frozen Shoulder
A recent clinical trial [15] compared a treatment programme of massage, exercise and electrical therapy with a control group.  After the 4 week programme the treatment group had significantly improved shoulder strength and range of motion compared to the control group.  The treatment group also had less shoulder pain.

12. Massage and Sports Medicine
Although lacking extensive scientific trials, sports massage is believed to have such benefits as increased blood flow, reduced muscle tension, increased range of motion, decreased passive stiffness and active stiffness, reduced recovery times, reduced stress and anxiety (with potential immune system improvements) and improved mood.

Post-exercise massage has been shown to reduce the severity of muscle soreness [16], probably by clearing the muscles of excess lactic acid.

Certainly, more standardised sports massage research would clarify the issue.  Massage therapy, however, remains a key aspect of sports medicine and sporting preparation.

Conclusion
There are many and varied applications for therapeutic massage, together with a recent surge of interest of patients, therapists and researchers to find out exactly what therapeutic massage can achieve.  With a focus more than ever on safety, continued interest will naturally seek the healing hands of massage therapy.  Armed with more therapeutic evidence, massage therapy will further enhance its crucial position in mainstream medical care.
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