Massage therapy

Massage therapy uses the hands, and sometimes a device, to press, rub, knead and stretch the muscles and other soft tissues. People often use it for low back pain and neck pain.

It is most often given by a licensed massage therapist (LMT). Physical therapists and some other clinicians also use hands-on soft tissue techniques as part of treatment.

Styles fall into two broad groups. Relaxation massage, often called Swedish massage, uses long, gliding and kneading strokes to help the whole body relax. Structural or clinical massage, which includes deep tissue work, trigger point therapy and myofascial release, focuses on specific tight or tender areas in the muscles and the tissue around them.

Researchers are not sure exactly how massage eases pain. Pressure and stretching may help tight muscles loosen and move more easily.

Massage may also calm the body’s stress response. In studies, a single massage lowered anxiety, heart rate and blood pressure. Part of the benefit may come from the whole experience: time to relax, caring touch and advice on self-care.

Relief from massage tends to be short term.

Before

The therapist will ask about your pain, your health and your medicines, and what you hope to get from the session. Tell the therapist if you take a blood thinner, bruise easily, are pregnant, or have had a blood clot, a recent injury or surgery, or cancer.

During

A session often lasts 30 to 60 minutes, and a first visit may take longer. You usually undress to your comfort level and lie on a padded table under a sheet or towel, with only the area being worked on uncovered. Some massage, such as in many physical therapy clinics, is done with your clothes on.

Speak up about pressure. Firm pressure can feel intense, but it should not be sharply painful. You can ask the therapist to change the pressure or stop at any time.

After

Some people feel sore afterward, especially after deep pressure. It is usually temporary. Studies that found benefits usually gave a series of sessions, often weekly for several weeks, rather than a single massage.

Finding a massage therapist

Most states regulate massage therapists through licensing or certification, but the rules and titles vary. You can check a therapist’s credentials with your state’s licensing board. Only some massage therapists have extra training in treating back pain, so it is worth asking about their experience with back or neck problems. The National Institutes of Health has tips on choosing a practitioner (opens in a new tab).

The American College of Physicians lists massage among the non-drug treatments to try first for low back pain that is new or has lasted up to about 3 months. It rated the evidence as low quality. For low back pain that has lasted longer, the guideline did not include massage in its main list, although its evidence review found some benefit. [9] [10]

A Cochrane review of 25 trials found massage eased low back pain in the short term compared with no treatment or a sham treatment. Longer-term benefits were unclear, and the reviewers had very little confidence in the evidence. [1]

In a large US trial of people with long-lasting low back pain, gentle relaxation massage helped about as much as structural massage. Both did better than usual care on a measure of everyday function, and that difference lasted at least 6 months. That does not mean pain relief lasts that long for everyone. [3]

For neck pain, the latest Cochrane review found massage made little or no difference compared with a placebo treatment. Most of those studies tested only one session, so the question is not settled. A Canadian neck pain guideline lists clinical massage as an option for neck pain lasting more than 3 months, but advises against relaxation massage for neck pain. [2] [11]

Guidelines generally suggest using massage alongside exercise and staying active, not on its own. [11] [12]

Common and short lived

• Soreness or stiffness for a day or so, especially after deep pressure.

Less common

• Mild bruising after firm pressure.
• Feeling lightheaded for a short time afterward.

Rare but serious

• Serious problems are rare. Reported cases include a blood clot breaking loose, nerve injury and broken bones.
• Many of these cases involved very forceful techniques, such as sudden twisting or cracking of the neck during a massage, people without massage training, or people whose health conditions raised their risk.

Take extra care

If you take a blood thinner or have a bleeding problem, tell your clinician and the therapist. Forceful and deep tissue massage are best avoided in these cases.

Massage should not be done over a known or suspected blood clot, and a new swollen, painful leg needs a check by your clinician first. Check with your clinician before massage near a broken bone or fragile bones (such as from osteoporosis or cancer that has spread to bone). Massage should not be done on broken or infected skin.

If you are pregnant, check with your clinician first and look for a therapist trained in pregnancy massage.

Other downsides

• Massage is often not covered by health insurance, and the cost of many sessions adds up. Coverage is more likely when hands-on care is part of physical therapy.
• Relief is often short-lived, and pain may return between sessions.

Call your clinician if pain is severe or keeps getting worse after a massage, or if you notice new numbness, new weakness, or a swollen, painful leg. Get emergency care for sudden chest pain or shortness of breath.