This effects of massage or what most massage therapists also refer to as the benefits of massage have been passed on by many massage schools as the way it is. Unfortunately, most of the benefits of massage have not been widely researched and many of the things that are taught in basic massage school are not correct.
I know that after attending the Massage Therapy Foundations Research Conference a few years ago here in Seattle. Even with all of that information, the stories continue on. I recently attended the Alliance for Massage Therapy Education Conference (AFMTE) and took the class on Busting Myths and Teaching Truths about the Effects of Massage, with Tracy Walton (who by the way is one of Gods blessings for the massage profession! If you ever get to take a class with her, she is absolutely fabulous! She is involved with doing research on massage and cancer.)
The rest of this post are based on my notes from the class!
There are three types of different outcomes that can be measured as a result of doing massage. (You can also read more in Chapter 6 in Tracy Waltons book – Medical Conditions and Massage
- Clinical Outcomes are subjective reports about whether or not
clients are doing better with their treatments. Are they coping and managing better as a result of the massage? Massage reduces stress is a clinical outcome. - Mechanistic outcomes are based on science. They are measured in blood tests or other physiological mechanisms such as saliva tests. Reducing Cortisol is a mechanistic outcome.
- Financial Outcomes are is the treatment cost effective? Can they save money on medications, reduce surgery and things like that.
In general, we use mechanistic outcomes more often even though there is not enough scientific evidence that they are true. Mechanistic outcomes are weak and the clinical outcomes would be stronger without them. How many times have you heard or read a MT website and their claims: increases endorphins, increases immunity, reduces cortisol, detoxifies, increases circulation or that they can’t do massage on someone who has cancer because it is spread through the body when.
There isn’t much research to support those effects of massage…sorry.
[Side Note: Research Literacy.
In research, not all research is created equally and there are different levels of evidence and different classifications of research studies. That means that there are research studies that are better than others because of the way that they are done.
The Highest Level of research – the one’s that are the best as far as what they show are Qualitative Reviews. That is when a researcher researches research and make a review of the research that is done -aka Met-analysis. Narrative Reviews are reviews of literature (any type of literature on the topic) are the next top level of evidence, and then Randomized Control Studies -RCT, where there are groups of people who don’t get massage, Case Series which is a series of case studies on one topic, a case report (written by one therapist on one client and explores the massage sessions and results) and then the story or Anecdote that was told.
(This article from the AMTA has more info on research literacy (PDF).)
So back to the effects of massage one by one.
- Massage increases endorphins. T or F ? …………..sorry – F. There are only two 2 RCT studies ever done.
- Massage enhances immunity. T of F? ……………sorry – F. There are only a few studies done by the Touch Research Institute done on that which means that there could be research bias because of it being done at the same place. We need more research on this.
- Massage reduces cortisol. T or F?………………sorry. F. Yes you were taught this over and over in massage school and there are many studies by the Touch Research Institute, but there was a big bomb that went off in the form of a Meta-analysis done by Chris Moyer, PhD that shows that massage does not lower cortisol. (see video below)
- Massage detoxifies tissues. T of F…….again. F There are no studies what so ever on massage and toxins. Toxins are things like mercury or heavy metals or chemical compounds. Some were taught that the waste products from normal cellular metabolism were called toxins and that massage moved them out of the tissues. The body takes care of these products from what we know now. Yes people feel better after massage, but it isn’t because the massage got rid of toxins.
- Massage increases circulation. T or F? ………are you catching on? F. There are only a few RCT’s that were done a really long time ago and were not done with ultrasound so there isn’t any proof that massage increases circulation. Because we just don’t know what massage does, there are many contraindications around circulatory effects such as blood pressure, blood clots and things like that. It isn’t really a good idea to ignore the contraindications until more research is done.
- Massage Spreads Cancer. T or F?……… Yes. F There is plenty of research that now shows that it is OK to massage people with cancer. If it was true that massage spreads cancer, patients would also be told to stop exercising and in fact they are usually told to exercise.
So there you have it….the truth about the effect of massage. Be sure to share this on your Facebook walls, in your newsletters and start changing that long list of things on your website.
So what is the evidence for what massage can do? The strongest evidence is also a meta-analysis by Chris Moyer that shows that massage reduces depression and anxiety as much as psychotherapy does. Will massage one day be under psychology boards?
So out of curiousity, what would you say that massage does do? Many therapists have used those for marketing purposes and if they’re not correct, what do you think should be used in place?
Go more with the clinical outcomes – massage reduces pain, helps people feel happier, help them feel better but don’t say why because we just don’t know much other than the study I did site at the end that massage reduces trait anxiety and depression.
Um..so you are saying that all the massage text books that have ever been printed, including worldwide over, in the past 6,000 years of mankind’s massage history ..are lying. Sounds like you’re with the AMA. You were hired by some hospital or medical org to discredit massage therapy. That’s apostacy, unethical and slanderous libel to the profession. You need to be banned and to have your credentials removed. Go work for a hospital! You sound just like the doctors I used to work for!
They aren’t lying, the just didn’t have the information that we have now. They did the best they could with what they knew at the time. This is not to discredit massage therapy at all but to start telling the truth about what it does. If you want to keep spreading myths about massage, you are hurting the profession more than you know. People coming in and asking for massage that detoxifies or increases their circulation and having MT tell them that they are doing it are mis-informed. I am just reporting on a class that I took from a very well known researcher and I already have known these things for years, having gone to the research conference that presented the paper on cortisol levels. It is just about keeping up to date on what is going on in the profession.
Direct or Indirect
I was at the Alliance for Massage Therapy Education (AFMTE) meeting last week in Tucson. Like those reporting back it was a great meeting. I do have an observation to share. A wonderful presentation by Tracy Walton on the myths of massage I think might be taken out of context. My concern is about how her excellent information may have been interpreted. My understanding of her points is that we do not have enough quality research in some areas to state that massage does certain things- ie increase endorphins, reduce cortisol, affect circulation and remove toxins. I agree that the evidence for a direct influence in these areas is scant or does not exist at this time. I am glad to again note the debunking of the removes toxins myth and point out that the evidence is good for modulation of pain, mood and mobility. Changes in pain, mood, and mobility can be considered outcomes that clients ask for from the massage. Here is the issue. If pain is influenced then somehow pain modulating mechanisms both physiological and psychological need to be affected. The same for the other two mentioned outcomes. I would suggest that indirectly somehow massage is affecting the complex human mind /body function which would include the chemicals above ( endorphins/ cortisol) plus many more in a general sort of way as well as influences of the therapeutic relationship described by Christopher Moyer in his meta analysis . Let’s not get reactionary here by stating that this or that is false and massage does this or that. More accurately we can state that we aren’t truly sure why people feel better and can often do better in response to a massage. Maybe we have a “ what comes first – the chicken or the egg – question here. Is massage pleasurable therefor the chemicals shift or do the chemicals shift and pleasure occurs? For me as I write textbooks and justify my personal massage work, I focus on outcomes- and then wonder about our amazing anatomy, physiology and psychology that make “ feel better” and “do better” happen.
So you think I am taking it too literally? With the endorphins, Yes I guess I could be a little less dramatic and not just have T or F and say that we just don’t know. But as far as the cortisol, it seems we have enough research to say it is not reduced. We have enough don’t we? In the form of a meta-analysis which is the highest level of evidence.
Massage enhances immunity. T of F? ……………sorry – F. There are only a few studies done by the Touch Research Institute done on that which means that there could be research bias because of it being done at the same place. We need more research on this.
Sorry not false, true that there could be research bias, true we need more research done, but of the small amount of research done by TRI those results say massage enhances immunity.
Yes but the small amount done by the TRI is not top level research. For now, we just don’t know.
Wow, this is really depressing! I think that I need a massage!! 😉 Well, hopefully this will just encourage more real, valid research. I need to really watch what I tell people, I guess.
I think it most accurate right now to say that we are not sure of the mechanisms however the stress perception appears to be influenced. There has be additional research since the meta analysis and the results are mixed.
When was this article written?
The Truth about the Effects of Massage
June 11, 2012 Julie Onofrio Massage Research
In this reply to Danielle when you say “helps people feel happier” isn’t that endorphin’s being released? And you say that massage reduces pain? How does it reduce pain with out circulation being involved? Circulation carries 02 and nutrients to the damaged area to help repair the tissue; When I am breaking up knots or trigger points is that not increasing circulation to repair the damaged or blood deprived muscular tissue? When a client is lying on the table shivering and “feeling cold” is that not circulation being moved while their bodies are still or Am I being mislead in my physiology on this as well? Lymph-edema therapy is moving fluid out of extremities is that not part of the circulation to remove waste?
Julie, thanks for sharing your article. It is difficult to change our minds not only about what we were taught in massage school but also what we think we observe in our practice. It’s a good idea to point out that a study is flawed or incomplete and therefore we shouldn’t be using the topic to promote our practices until there is better research. There’s nothing wrong with saying “I don’t know”.
It would be doing a service for our clientele if we just stick with what we do know; that massage decreases anxiety, depression, improves body awareness, etc. Isn’t that good stuff right there, isn’t that good enough without promoting info that we are unsure about?
Lately, I’ve been studying neuroscience and learning how the role of the brain and nervous system have more to do with the things we attribute to other systems of the body. Pain is considered an output of the brain, the tissues have nothing to do with it. Therefore, massaging the tissues don’t help pain. What does help pain? Reducing the perception of threat and relieving anxiety is what lowers the input of pain. There is a good deal of research that shows when a person is relaxed, they feel less pain than when they are under stress.
Just because massage has been around for a while and the effects are noted in books or texts that are hundreds of years old, does not make the information correct. Human brains tend to look for patterns and therefore if I did “this” and then “that” happened, then “this” is what caused “that”. Our brains seem to constantly generate false observations, memories and beliefs. We can’t trust everything that we see or perceive, for example – optical illusions and 3-D images. There was an experiment where researchers put red food coloring in a cheap white wine and served it to wine experts. The wine experts described the wine as though the wine was a red. We can’t always believe what we are seeing. Furthermore, memory itself is not a passive recording of events, memory is constructed and filtered through our beliefs and subjected to contamination and morphing over time. This is exactly why we must read ancient texts with a “grain of salt”. If we are to go that route of believing ancient texts or books, then we would still believe the Earth is flat, the sun revolves around the Earth and mercury is cure all for any ailment.
With this in mind, think about the idea we have about “breaking up knot” or “adhesions”, are we really? How do we know? Because it FEELS like it, but that doesn’t mean that is what is going on and it is unlikely given the above information about our perceptions not being trustworthy that we are actually doing any such thing. Do you think instead that if the brain is relaxed, the neural system may be releasing its hold on the tissues and that is what is happening? According to modern neuroscience, this explanation is definitely more plausible.
Understanding and promoting what we know to be true of massage, what has been studied through research is what credits our industry. It doesn’t credit our industry to propagate myths or promote ideas that sound good to us or make us look better. It also doesn’t credit our industry to become emotionally attached to ideas that we believe to be true but are questionable or haven’t been proven. As a massage community we should support each other in the quest for truth and knowledge and not tear one another down or accuse other massage therapists of slander when they point out the truth, as a previous poster mentioned (which by the way, is not only a mean post but very unprofessional). I know many massage therapists aren’t interested in science or the scientific process, but that shouldn’t cause a rift in our field. We should support those in our profession who want to know the truth, so they may share it with the rest of us who are either uninterested, too lazy or not educated in the critical thinking process.
For further reading, I highly recommend these books for massage therapists:
Explain Pain by David Butler & Lorimer Moseley
The Sensitive Nervous System by David Butler
Your Deceptive Mind: A Scientific Guide to Critical Thinking Skills by Dr. Steven Novella
The Patient’s Brain by Fabrizio Benedetti (this one is a bit complicated read, but there’s some fantastic info about the placebo response- which massage can play a large role).
Here’s an article discussing some of Dr. Benedetti’s work- http://www.sciencebasedmedicine.org/index.php/benedetti-on-placebos/
The Brain That Changes Itself by Norman Doidge
The Body Has A Mind of It’s Own by Sandra Blakaslee
It appears that massage has a much larger following in the U.S.A than in the U.K and therefore more time and money is dedicated to proving or disproving it’s uses and benefits.
I understand that proving certain benefits will be very beneficial for the practice of massage therapy but regardless of proving things scientifically people need to take on board how it makes people feel and why so many people have regular massages and use massage in their daily lives to help them in numerous different ways.
This is a very simplistic outlook I know but if we always focus on the scientific will we not become overly clinical in our treatments and less holistic.
First, I’d like to say that I very much appreciate research based practitioners in any healthcare field. The only thing I’d like to point out is that there is a difference between an “evidence of absence” and an “absence of evidence”. This is not just semantics.
In the evidence of absence, a sufficient amount of studies have been conducted, and a sufficient body of research exists, showing that X claim cannot be supported.
However, in the absence of evidence, no studies (or insufficient studies) have been performed to show whether or not X claim may be supported.
The reason I bring this distinction up is that the entire massage therapy profession is plagued by the absence of evidence. A handful of studies have been done on the benefits of massage as compared to the immense body of research available for other health fields.
But we cannot run around saying that, because of this lack of evidence, that every claim regarding the benefits of massage is outright false. The only thing we can responsibly say is that there is not enough evidence to show that massage provides these benefits.
That is, admitting that we don’t know whether or not a claim is true is a True statement, but claiming that, because we don’t know whether a claim is true then the claim must be false, is a False statement.
The reason I think this is such an importance distinction to make is because A) we really don’t have much evidence at all to work with regarding any benefits derived from massage and B) future research may show that some of those claims may be true. Yes, future research may also prove those claims false … which is why all we can say for now is that we really just don’t know.
But this should not be taken as a death blow for the profession. At the very least, your clients provide you with subjective feedback. In the absence of scientific research, the best we can do for now is to really listen to our clients and establish professional, caring relationships with them. Make notes. What do you notice to be effective treatment for X condition, and for how many clients does this hold true? Learn to think like a researcher.
The responsibility to centralize our profession and to come up with ideas for research falls on us. What do WE need to know in order to treat our clients? Scientists are scientists. They love to figure things out, but where is the interest from ourselves and the public that would warrant the kinds of studies we would need to have conducted? Telling a researcher that we need to know if massage increases circulation means very little. What parameters do we need to focus on? What type of massage/touch/bodywork? Which population … age, gender, physical conditioning, socioeconomic status, mental health status, pre-existing medical conditions, etc.? What theories are we starting out with; what hypotheses can we make based on our observations? And, from a funding perspective particularly, what benefit does gaining this knowledge hold for the general public?
For myself, I stick to the research we have available when making claims regarding the benefits of massage. But I also tell people to see for themselves. No, I don’t have a diagnostic exam showing you specifically where TP 1 on your Trapezius is located. But I can tell you what I feel. More importantly, what do you feel? Is this the pain or sensation you’ve noted? Does what I’m doing bring you relief? How do you feel after 1 session? After 3 sessions?
Research begins in your practice. Don’t forget that the medical field of today has a history shadowed by charlatans selling magical elixirs, that today’s surgeons and dentists trace their origins to humble barbers who learned and taught from anecdotal evidence, theories, and experience, and that the scientific study of medicine is not only young in relation to the history of humanity but is itself still growing and evolving. There is a place for us. But we have to create it.
Rebekah, I’m responding to a 3 year old question so you may already know the answer at this point. But anyway, pain is an output of the brain and nervous system, it doesn’t exist in the soft tissues of the body. So when massage reduces pain, it is effectively calming the nervous system down, so the NS is not producing as much discomfort. Other than the fact that the nervous system needs blood supply, circulation is not a driving factor of pain or the decrease of pain.