Massage as Medicine: How it Can Ease Pain and Improve Lives

Musculoskeletal (MSK) pain—pain that affects the muscles, joints, ligaments, tendons, and bones—is very common, with about half of all Americans estimated to suffer from it.
Untreated MSK pain can contribute to a host of adverse conditions like hypertension, obesity, and heart disease, and can worsen others, like diabetes. It has also been connected to opioid abuse and addiction and can lead to other serious health conditions like depression and insomnia.

Massage has been proven through numerous studies to be an effective and safe treatment for MSK pain, improving mobility and reducing pain, and unlike medication and surgery, achieving this improvement without adverse health effects.

Massage reduces the body’s production of cortisol, the stress hormone, thus lowering blood pressure and muscle tension. This reduction of stress can improve mental health, promoting better sleep and reducing anxiety. In addition, some studies show that massage can help reduce inflammation after extensive muscle use, and inflammation can cause acute MSK pain.

Most studies on the efficacy of massage show that weekly massage is exponentially more effective than occasional massages.

CLINICAL RECOMMENDATIONS

The ideal type of massage for treating MSK pain may depend on the location of the pain. A study of low back pain sufferers found that, both relaxation-focused Swedish massage and the more intense deep tissue massage were equally effective at reducing chronic back pain. A study published in the Journal of Physical Therapy Science, found that for shoulder pain, deep tissue or sports massage was more effective than gentler modalities.

Arthritis is not just one condition but an umbrella term used to describe the swelling and inflammation of joints. Two of the most common types of arthritis are osteoarthritis and rheumatoid arthritis, though other kinds exist. While arthritic conditions may have different origins, arthritis, if untreated, can lead to joint damage, impaired mobility, weight gain, increased incidence of falls, and depression or anxiety.

Fortunately, many arthritic symptoms can be alleviated by massage. A 2018 study of patients with osteoarthritis found a significant increase in mobility and decrease in pain in subjects who received regular whole-body massage as opposed to the control group.

Autoimmune conditions, including rheumatoid arthritis, are often triggered by stress. Massage has been proven to reduce stress hormones like cortisol and induce relaxation and well-being, thus reducing stress conditions that can trigger RA flares.

Other studies have found that deep tissue massage can effectively treat stiffness and pain in the neck and back, often as well as NSAIDs, and more so than acupuncture and health education.

CLINICAL RECOMMENDATIONS

For osteoarthritis, gentle heat therapy may decrease joint stiffness, making hot stones or a simple heating pad a beneficial addition to a massage. Gentle movement therapy, such as stretching, can also be effective.

For rheumatoid arthritis, firmer pressure, such as that of a deep tissue massage, may be more beneficial than lighter pressure, as found in a University of Miami study.

Hypertension—or, a blood pressure reading higher than 120/80—can have a variety of causes, including age, obesity, medications, high salt consumption, smoking, lack of exercise, and even pregnancy. Hypertension often has no symptoms until it causes a serious health issue—which is why it’s sometimes called the “silent killer.” These conditions include heart attack, heart failure, stroke, and kidney disease. So how can massage help?

Massage is a safe and non-invasive treatment for hypertension, with multiple studies indicating it is most effective when performed regularly. A study published in the Journal of Human Hypertension found that massage combined with blood pressure-lowering medication was more effective than medication alone. Another study found a weekly regimen of 2-3 massages effective in lowering blood pressure, both systolic and diastolic pressure.

Stress has been shown to cause short-term spikes in blood pressure, and massage has been consistently proven to reduce stress—both acute and long-term. Additionally, stress can lead to behaviors that further increase hypertension, like smoking, drug use, and overeating, so the stress reduction of massage will have a compound effect for those with hypertension. And what better way to abstain from unhealthy behaviors than with something as enjoyable as a massage?

CLINICAL RECOMMENDATION

Sudden or intense discomfort or pain can cause a spike in blood pressure, so hypertension patients should opt for gentler modalities that induce a relaxation response, such as Swedish massage, instead of more active and deep pressure styles, such as sports massage.

Depression is a common psychological diagnosis, characterized by sadness or hopelessness, irritability, loss of interest and pleasure in activities and relationships, lethargy, abnormal sleep and dietary habits, and difficulty concentrating.

With wide-ranging adverse secondary effects, depression is not just a disease of the mind. Depression can increase severity of other conditions like hypertension and arthritis; it’s tied to blood vessel damage and resulting cardiac vulnerabilities; it can reduce immune function and even amplify the experience of pain. So how can massage take this all on?

Massage has been proven effective at treating depression in multiple ways. For one, massage increases relaxation-promoting parasympathetic activity in the autonomic nervous system while decreasing stress-related sympathetic activity. A single massage can measurably lower cortisol levels and promote increased production of serotonin and dopamine—an average of 28% and 31%, respectively, in one study. These essential hormones for maintaining a positive emotional state are broadly linked to depression when under-produced.

Massage also improves circulation (impacted by depression) and alleviates physical stress on the body. This, along with improved mood, makes patients more likely to be able to exercise, which is known to alleviate depression. Massage helps foster a positive cycle of mental and physical health.

CLINICAL RECOMMENDATIONS

A study of depressed patients found that moderate pressure, as opposed to light pressure, during massage treatments were more effective in releasing mood-lifting endorphins and inducing deeper sleep.

Anxiety disorders, which affect up to 40 million Americans, are marked by excessive worry and fear about common situations like work, personal interactions, and public activities. This can cause severe stress and negatively affect physical health and overall quality of life.

Massage is a powerful tool for treating an array of anxiety disorders. Massage increases parasympathetic activity in the autonomic nervous system, promoting relaxation and calm, while decreasing sympathetic activity, also known as the “fight or flight” response. A single massage can significantly lower levels of the “stress hormone” cortisol, with regular massage shown to exponentially compound this effect. This also promotes increased production of stress-modulating serotonin and dopamine—an average of 28% and 31%, respectively, in one study.

A study published in Depress Anxiety of patients with general anxiety disorder treated with therapeutic massage showed that ALL participants who received massage experienced a reduction in anxiety symptoms. Other studies have shown massage helpful for relieving social anxiety in obese patients.
Massage also relieves muscle tension and pain while improving focus and mood, all of which are affected negatively by anxiety. These benefits of massage also make patients more likely to exercise, another activity that has been shown to moderate anxiety.

CLINICAL RECOMMENDATIONS

GAD patients treated with massage also responded well to thermotherapy, indicating that warmer rooms, hot stones, or a simple heating pad may be complementary when treating such patients. 

If a patient is anxious about receiving massage therapy, breathing exercises before or during massage treatment can help alleviate potential anxiety.