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An Introduction to the Evidence of Massage

Research evidence in Massage

Massage involves the manipulation of soft tissues of the body (1), especially muscles, tendons, ligaments and fascia (2). Massage can be adapted to treat athletes and non-athletes alike for many reasons. Massage can be used to treat various musculoskeletal injuries or conditions, ranging from acute to chronic.

Evidence of massage

Massage is thought to improve circulation, cell metabolism, venous and lymphatic flow, removal of chemical irritants, stretch superficial scar tissue, and alleviate adhesion. As a result, relaxation, pain relief, oedema reduction, increased range of movement, enhanced recovery, and injury prevention can be achieved (3). The growing use by elite athletes suggests there is belief that massage works (4-5), and has an important role to play in prevention, preparation, rehabilitation, and recovery of athletes (6).

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Characteristics of a good massage therapist 

Like all interventions, massage needs to be based on sound scientific ‘essential principles’. A good therapist, in addition to being competent in manual therapy should have an understanding of human anatomy, physiology, pathology; and the ability to apply this knowledge when practising massage (15). Frequently cited by many authors, therapists must acquire adequate knowledge of the pathophysiology of soft tissue injury and the healing process (15-18). Because, an understanding of tissue healing is fundamental to effective massage as the phases of healing guide clinical decision-making with respect to what, when, and how to apply appropriate massage (3,15). Otherwise, massage may result in poor performance and cause further tissue damage (19). Experience is an essential component in any profession and massage is no exception. For example, a pre-requisite for masseurs applying for major sporting events e.g. Olympics and Commonwealth games require a minimum of 500 hours practical sports massage.

In a recent study by Moraska (20), the level of therapist training was shown to impact effectiveness of massage as a post-race recovery tool following a 10-Km run. A greater reduction in muscle soreness was achieved by therapists with 950 hours of training as opposed to those with 450 hours. Interestingly, Bramah (5) believes the reason why chartered physiotherapists fail to understand ‘massage’ is because they only receive approx 6 hours of massage training throughout their entire university degree.


What the research literature says

Massage is not without its critics and the lack of robust research on the benefits or otherwise leaves the discipline open to criticism. Research evidence is scarce (6) and when it does exist produces equivocal findings (7). In many studies, authors cite the lack of positive findings is down to flawed methodology and poor design (6-8), in some studies, lack of therapist experience (9). Furthermore, within the literature, treatment styles and descriptions use conflicting or inconsistent terminology (10), which creates more confusion, further adding to the research dilemma.

In support of the continued use of massage

Although often frowned upon by some professions for its poor evidence-base, the lack of robust evidence is not just confined to massage. Watson (11) reports if one looks critically at the full range of physiotherapy treatments, there is simply insufficient evidence to support or reject many of them in all known circumstances. Furthermore, the absence of evidence does not always mean that there is evidence of absence (11). Although we should strive for evidence-based practice, the lack of sound evidence doesn’t mean a treatment doesn’t work in practice (12), or, shouldn’t be used. However, when sound evidence is lacking, treatment should be guided by experience and clinical reasoning (13). Crucially, treatment outcomes can be enhanced by taking opportunity to compliment massage using other suitable interventions, thereby adopting a multi-factorial and/or multi-disciplinary approach (4, 12, 14). Modern therapy encourages a wider approach.

Adapted from: Watson, (2006). Tissue repair: the current state of art The basic response to tissue injury

Repair and Rehabilitation

Therapeutic massage can be used to assist the natural healing and rehabilitation of various soft tissues (muscles, tendons, ligaments) at each successive phase of tissue healing following an induced injury. The phases of healing are universally known as; bleeding, inflammation, proliferation and remodelling. Clinically, the condition of the tissue should drive and dictate when and how to deliver massage. Therefore, it is understandable that a practicing Massage Therapist should possess a sound knowledge of human anatomy, physiology and pathology and the ability to apply it when dealing with injuries. The research literature unequivocally states that the phases of tissues healing should guide clinical reasoning and decision-making with respect to what, when and how to deliver safe and effective massage (21).

Tracey Chuwen

I was looking for an experienced massage therapist and was recommended to see Nick due to his professionalism and clinical knowledge by a Stockport college therapy lecturer.


Nick used aromatherapy oils as a medium and explained the benefits of each essential oil for my ailments involving me throughout the decision process.


Following the treatment I felt like I had just worked out in a gym! I also felt totally re-energised Nick you unblocked everything I needed to empty my bladder afterwards!


Well well well I can honestly say that was the best massage I have ever had! Nick is a natural healer spread the word...

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Kerrie West

His knowledge of anatomy was incredible. ...The pain I experienced disappeared almost instantly after I left the treatment room and has been a lot better since... Thanks Nick!

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Injury Prevention 

Regular, routine Massage Therapy can help injury prevention in various ways. Firstly, regular massage therapy facilitates ongoing dialogue between patient and therapist to discuss potential problems. It is claimed that regular massage improves the general condition of soft tissues, through enhancing tissue elasticity and pliability. Furthermore, regular massage may help prevent formation of adhesion and improve mobility of scar-tissue. This encourages contracted (shortened) muscles to return to their resting length which helps relieve muscle tension by preventing inhibiting antagonist muscles to achieve and restore joint motion.


 It has been shown that massage can have a positive effect on the immune system.  

When the skin is massaged, nerves send signals to particular glands where T cells are stored. This stimulation makes the glands produce more lymphocytes (types of white blood cells in the immune system) in the blood – the nett result is a larger number of healthy immune helping cells circulate around your body looking for invaders.

In one experiment performed for the BBC (Trust me I’m a Doctor) in 2020, they found a 70% increase in white blood cells after a one hour massage.

A larger study on children in 2006 performed a three month experiment on massage. Its findings also support the role for massage therapy in immune preservation. (22)

You can also read:

  • Scientific Reports No 5, 10913 (2015) for a study on ‘Massage-like stroking boosts the immune system in mice’

  • D'Acquisto F. (2017) Affective immunology: where emotions and the immune response converge.  Dialogues Clin Neurosci. 2017 Mar; 19(1): 9–19.


Your not being self-indulgent,
you’re simply trying to boost your immune system.

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In today’s society massage therapy is considered useful for every day aches and pains, stresses and strains as a beneficial addition to maintain and support health and well-being thereby promoting a balanced lifestyle.


Physiologically it has been suggested that caring touch helps the flow of blood and lymph around the body. Consequently studies have shown that touch can aid to decrease blood pressure and heart rate, soothe nerves and decrease tension, promoting relaxation and a state of well-being. Furthermore it has been suggested that massage may aid the production of the brain’s chemicals that function as natural painkillers reducing pain and producing a state of mind akin to euphoria.

Final thoughts

Although relatively few robust randomised controlled studies exist and much of the research is flawed, a strong belief remains that massage has significant therapeutic benefits. If massage failed to produce benefits, it is unlikely that experienced therapists would have continued its use throughout the decades.

Last updated January 2021

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  2. Brukner P, Khan K. (2001). Clinical sports medicine. 2nd edition. Sydney: The McGraw-Hill Companies.

  3. Anderson MK, Hall SJ, Martin M. (2004). Foundations of athletic training. Prevention, assessment, and management. 3rd edition. USA: Lippincott Williams & Wilkins.

  4. Cash M. (2003). Sports massage - hands on help. sportEX Health 18, 28-29.

  5. Bramah B. (2006). Massage training and the physiotherapy BSc degree. sportEX dynamics, 9, 9-10.

  6. Galloway S, Hunter A. (2005). Mind or Body? Research into sports massage. sportEX dynamics 4, 12-14.

  7. Robertson A, Watt JM, Galloway SD. (2004). Effects of massage on recovery from high intensity cycling exercise. British Journal of Sports Medicine, 38,173-176.

  8. Heymanson N, Hiskins B. (2006). Delayed onset muscle soreness and soft tissue therapy - what makes good research? sportEX dynamics, 10, 8-11.

  9. Hilbert J, Sforzo G, Swensen T. (2003). The effects of massage on delayed onset muscle soreness. British Journal of Sports Medicine. 37, 72-75.

  10. Dixon MW, Sherman KJ, Thompson D, Cherkin DC. (2007). Massage terminology - it’s all in the name. sportEX dynamics 11, 14-21.

  11. Watson T. (2000). The role of electrotherapy in contemporary physiotherapy practice. Manual Therapy, 5, 132-141.

  12. Patel K, Patel S. (2007). Low back pain - a multidisciplinary symposium and debate. sportEX dynamics 13, 19-22.

  13. Naylor CD. (1995). Grey zones of clinical practice: some limits to evidence-based medicine. Lancet, 345, 840-842.

  14. Bury T, Mead J. (1998). Evidence-based healthcare: a practical guide for therapists. Oxford: Butterworth Heinemann.

  15. Holey E, Cook E. (2003). Evidence-Based Therapeutic Massage. Edinburgh: Churchill Livingstone.

  16. Glasgow P. (2007). Sports rehabilitation: principles and practice. sportEX medicine. 32, 10-16.

  17. Kannus P, Parkkari TL, Jarvinen T., et al. (2003). Basic science and clinical studies coincide: active treatment approach is needed after a sports injury. Scandinavian Journal of Medicine and Science in Sports. 13, 150-154.

  18. Clark N. (2004). Principles of injury rehabilitation. sportEX medicine. 19, 6-10.

  19. Hunter G. (1998). Specific soft tissue mobilisation in the management of soft tissue dysfunction. Manual Therapy. 3(1), 2-11.

  20. Moraska A. (2007). Therapist education impacts the massage effect on postrace muscle recovery. Medicine & Science in Sports & Exercise, 39 (1), 34-37.

  21. Watson, T. (2006). Tissue repair: the current state of art. Journal of Sportex Health. 19, 8-12.

  22. Shor-Posner, G. et al (2006) Impact of a Massage Therapy Clinical Trial on Immune Status in Young Dominican Children Infected with HIV-1.  JACM 511-516 Vol 12 Issue 6.

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