Massage therapy: sessions, safety and evidence

Massage therapy is hands-on work on the muscles and other soft tissues, and people most often try it for aches, muscle tension and stress. The evidence is not strong. Some studies suggest short-term relief for specific kinds of pain, but most of that research is low in quality.

What it is

Massage is one of the oldest ways people have tried to relieve pain. It has been practiced in most cultures, Eastern and Western, throughout human history. Today it has many forms. Swedish, or classical, massage is the most common Western style and the core of most training programs.

Other styles include sports massage, clinical massage aimed at a specific goal, and Eastern traditions such as Shiatsu and Tuina. Practitioners say that working the soft tissues eases pain and tension, helps people relax, supports recovery from injury and aids general wellness. Some also say it improves circulation, which the research reviewed here does not show.

Most people who seek therapeutic massage want relief from back, neck or shoulder pain, or simply a way to unwind. Its use is growing. In 2022 about one in ten US adults had used massage, roughly double the share two decades earlier.

What a session is like

A session usually lasts about 50 minutes, in a quiet room with low lighting and soft music. You lie under a sheet and blanket, and you remove only as much clothing as you are comfortable with. Loose clothes help if stretches are part of the plan.

There are more than 80 types of massage. Some use less pressure than the weight of a hand, and others press deeply into specific points. Talk with your therapist beforehand about which techniques they will use and how each should feel. Speak up during the session if the pressure is too much. Most people leave feeling more relaxed.

Before booking, it is worth asking:

• What training and experience they have, and whether they are licensed
• How many sessions they suggest for your goal
• What it costs and whether insurance covers it

What research says

The US National Center for Complementary and Integrative Health (NCCIH) describes the evidence on massage for back pain as weak. A 2015 Cochrane review of 25 randomized trials in people with low-back pain found that massage gave better short-term pain relief than inactive comparisons. However, the evidence was low or very low quality and the benefits were mostly short term. The authors had very little confidence that massage reliably helps. A 2017 American College of Physicians guideline still lists it as one option for acute or subacute low-back pain.

NCCIH reports that massage may help neck and shoulder pain, though the relief may not last. A handful of studies on knee osteoarthritis mostly found short-term pain relief. In one evaluation, at least five weeks of massage improved pain, anxiety and depression in fibromyalgia, but not sleep. Evidence for people with cancer is very low in quality, and headache studies are few and mixed.

The bottom line is that the support is for short-term relief of specific kinds of pain. It is not for lasting change, and not for broad claims such as better immunity or circulation.

Who should be careful

For most people the risk is low, but rare serious problems have been reported, including blood clots, nerve injury and bone fractures. Some of these followed vigorous styles such as deep tissue massage, and some occurred in higher-risk people such as older adults.

Check with your clinician first in any of these situations:

• You take blood thinners or have blood clots in your legs.
• You have tumors, osteoporosis or a spine disorder.
• You have a high-risk pregnancy or use an implanted medical device.
• You have an acute injury or had surgery in the past 48 hours.

People with cancer may need lighter pressure on sensitive areas. Massage should never be a reason to delay seeing a health care provider. If you have symptoms that are new, severe or not improving, see a doctor or other licensed clinician rather than relying on massage alone.

How it fits with the pillars

For the body, massage is hands-on work on muscles and soft tissue. It is best supported for short-term relief of some kinds of pain, not as a fix for broader health problems.

For the mind, most people feel calmer after a session. If you want a way to release muscle tension on your own between sessions, progressive muscle relaxation is a self-guided practice you can try at home.