Is there scientific evidence for health benefits from massage?

by Ben Best

Massage has been regarded as therapeutic from the time of the ancient Greek physician Hippocrates (the "father" of medicine) who regarded rubbing as the primary medical therapy [MEDICAL CLINICS OF NORTH AMERICA; Field,T; 86(1):163-171 (2002)]. Yet scientific evidence for the health benefits of massage is still subject to dispute. As with exercise and meditation, double-blind clinical trials are not possible with massage. Moreover, the therapy is not uniform, and is greatly dependent upon the person delivering the massage. To encourage nursing staff to deliver massage, massage duration has been reduced from ten to five minutes, which may not be long enough to show benefit [JOURNAL OF CLINICAL NURSING; Harris,M; 19(7-8):917-926 (2010)]. In most of the scientific studies that have been conducted on massage, the sample sizes have not been large enough to confer much statistical power, and the control groups have been quite variable.

A study that used relaxation tapes as a control group, and used general health questionnaires to assess results, concluded that relaxation tapes are more cost-justified despite the greater preference for massage among repondents — and despite the marginally better results from massage [BRITISH JOURNAL OF GENERAL PRACTICE; 53(486):20-25 (2003)].

Psychological stress is associated with an increase in the stress hormone cortisol, which supresses the immune system. Breast cancer patients suffer from psychological stress and decreased number of natural killer (NK) cells. A study of breast cancer victims given massage therapy (three 30-minute sessions over 5 weeks) showed an increase in NK cell number and lymphocytes [JOURNAL OF PSYCHOSOMATIC RESEARCH; Hernandez-Reif,M; 57(1):45-52 (2004)]. But another study of massage for breast cancer victims (ten 20-minute sessions) showed no effect on NK cells, T cells, hormones, or psychological measures [AUTONOMIC NEUROSCIENCE; Billhult,A; 140(1-2):88-95 (2008)]. The stress of exercise increases cortisol, and a study of massage following exercise demonstrated a reduced decrease in salivary immunoglobulin A, but no change in salivary cortisol [JOURNAL OF STRENGTH AND CONDITIONING RESEARCH; Arroyo-Morales,M; 23(2):638-644 (2009)].

A review of scientific studies on possible benefits of massage found average cortisol decreases of 31% in saliva and urine, and average increases of serotonin (26%) and dopamine (31%) [regarded as "activating neurotransmitters"] in urine [INTERNATIONAL JOURNAL OF NEUROSCIENCE; Field,T; 115(10):1397-1413 (2005)]. A subsequent review of studies, which included critical comments about the 2005 review, found no statistical support for an effect of massage on cortisol, despite acknowledged benefits on anxiety, depression, and pain [JOURNAL OF BODY WORK AND MOVEMENT THERAPIES; Moyer,CA; 15(1):3-14 (2011)].

A 1996 study which used medical faculty and staff as subjects found that 15 minutes of massage 2 times per week for 5 weeks produced electroencephalography patterns associated with relaxation and alertness, as well as greater speed and accuracy on math computations than a control group [INTERNATIONAL JOURNAL OF NEUROSCIENCE; Field,T; 86(3-4):197-205 (1996)].

It is widely believed that massage benefits athletes by increasing blood flow while reducing muscular tension and anxiety. Such benefits are believed to enhance recovery after a competition, and improve performance on a following competition. A 2005 review of studies on this subject found them not to be conclusive, at least in part because of the small sample size of most of the studies [SPORTS MEDICINE; Weerapong,P; 35(3):235-256 (2005)]. A more recent study of elite athletes receiving weekly one-hour massage therapy found improvement in sleep and muscle tightness [BMJ OPEN SPORT & EXERCISE MEDICINE; Kennedy,AB; 4:e000319 (2018)].

In 2012 a well-controlled study of massage was performed on eleven young, healthy, recreationally-active males, who did aerobic exercise to the point of exhaustion. Leg muscle biopsies were taken before, shortly after, and 2.5 hours after exercise. Ten minutes after exercise the subjects received ten minutes of massage on one leg. The massaged legs showed lower levels of inflammatory cytokines, and increased mitochondrial biogenesis. Massage had no effect on muscle lactic acid levels [SCIENCE TRANSLATIONAL MEDICINE; Crane,JD; 4:119ra13 (2012)].

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