What does the research show about massage therapy?

Massage therapy

Pooled trials found massage eased pain more than no treatment and, by a smaller margin, more than sham and other active treatments, mostly in the short term. Three meta-analyses found less muscle soreness after exercise, while strength and sprint recovery did not change. Anxiety and depression scores fell in pooled trials. Serious harms appear only in case reports.

Checked 2026-11-13

Status: In the 45 states and the District of Columbia that regulate massage therapy, therapists must hold a license or certification before practicing. State rules typically require an approved program and an examination [1].
Also called: massage, Swedish massage, deep tissue massage, sports massage, therapeutic massage, relaxation massage, structural massage, myofascial release, soft tissue therapy, tuina, Chinese massage, reflexology, foot reflexology, effleurage, petrissage
Used for: back pain, neck pain, knee osteoarthritis, chronic pain, muscle soreness, recovery after exercise, athletic performance, anxiety, stress, relaxation, depression, sleep, insomnia, cortisol, immunity, lactic acid removal, flushing toxins, blood flow

Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on

Shown to help7

StrongShown to reduce muscle soreness 24 to 72 hours after strenuous exercise compared with no massage, in three meta-analyses.
ModerateShown to ease pain more than no treatment, by a large margin, and more than sham or active treatments, by smaller margins, in a meta-analysis of 67 trials.
ModerateShown to ease subacute and chronic low back pain more than inactive controls in the short term, with no lasting difference. Against active treatments the pain difference was small.
ModerateShown to lower anxiety in pooled trials, including state anxiety after a single session and trait anxiety after a course of treatment.
ModerateShown to lower depressive symptoms against control groups in a meta-analysis of 17 trials, with a moderate pooled effect.
LimitedOne trial of 222 adults found weekly massage improved knee osteoarthritis scores more than light touch or usual care at 8 weeks, with no difference at 52 weeks.
LimitedLimited evidence: low-certainty trials in critically ill adults and cancer survivors found better self-reported sleep quality after massage.

Reported risks3

ModerateShown in trials as the most common side effect, with increased pain reported in 1.5% to 25% of participants across back pain trials.How often is not known
LimitedCase reports: 138 adverse events in 40 reports from 2003 to 2013, including disc herniation, nerve injury and vertebral artery dissection, often linked to spinal manipulation within massage.How often is not known
LimitedCase reports: 17 cases of volvulus in premature infants after abdominal massage, 4 of them fatal, in a review of 60 pediatric massage studies.How often is not known

What it is used for, and what was found

Shown to help7

Moderate

Pain across conditions

Shown to ease pain more than no treatment, by a large margin, and more than sham or active treatments, by smaller margins, in a meta-analysis of 67 trials.

Compared with sham treatments [2]; no treatment [2]; active treatments [2]

The numbers and sources

Effect: Massage lowered pain more than sham (SMD -0.44), no treatment (SMD -1.14) and active comparators (SMD -0.26) [2]. A map of 49 systematic reviews, 32 rated high quality, found their conclusions gave low strength of evidence for potential benefits in labor, shoulder, neck, low back, cancer, arthritis, postoperative and muscle soreness pain [3].
Population: 67 randomized trials of people with pain in the general population, 60 rated high quality [2]. 49 systematic reviews [3].
Sources: [2], [3]
Caveats: The evidence map notes few large, rigorous trials and poor description of the massage given, so reviews could not say which type helps which pain [3]. Participants cannot be blinded to massage.

Moderate

Low back pain

Shown to ease subacute and chronic low back pain more than inactive controls in the short term, with no lasting difference. Against active treatments the pain difference was small.

Compared with inactive controls [4]; active treatments [4]; usual care [5]

The numbers and sources

Effect: For subacute and chronic low back pain, massage lowered pain more than inactive controls in the short term (SMD -0.75, 95% CI -0.90 to -0.60, 7 trials, 761 participants) and improved function (SMD -0.72), with no difference in the long term. Against active controls, pain was lower in the short term (SMD -0.37, 12 trials, 964 participants) and long term (SMD -0.40), and function did not differ [4]. In 401 adults, Roland disability scores at 10 weeks were 2.9 points lower with relaxation massage and 2.5 points lower with structural massage than with usual care [5].
Population: 25 trials with 3,096 participants, almost all with subacute or chronic low back pain [4]. 401 adults aged 20 to 65 with chronic low back pain in Seattle [5].
Sources: [4], [5]
Caveats: The reviewers rated the evidence low to very low and wrote that they have very little confidence in massage for low back pain [4]. The trial did not blind participants to massage versus usual care [5].

Limited

Knee osteoarthritis

One trial of 222 adults found weekly massage improved knee osteoarthritis scores more than light touch or usual care at 8 weeks, with no difference at 52 weeks.

Compared with light touch [7]; usual care [7]

The numbers and sources

Effect: At 8 weeks, WOMAC global scores improved by 8.16 points more than light touch (95% CI -13.50 to -2.81) and 9.55 points more than usual care (95% CI -14.66 to -4.45), with gains in pain, stiffness and function. At 52 weeks, change did not differ across groups (P = 0.707) [7].
Population: 222 adults with knee osteoarthritis [7].
Sources: [7]
Caveats: One trial. Light touch was the closest thing to a sham, and participants knew which hands-on treatment they had.

Strong

Muscle soreness after exercise

Shown to reduce muscle soreness 24 to 72 hours after strenuous exercise compared with no massage, in three meta-analyses.

Compared with no intervention [8]; control conditions the source abstracts do not describe [9][10]

The numbers and sources

Effect: Against no intervention, soreness was lower at 24 hours (SMD -0.61, 95% CI -1.17 to -0.05), 48 hours (SMD -1.51, 95% CI -2.24 to -0.77) and 72 hours (SMD -1.46, 95% CI -2.59 to -0.33) after intense exercise [8]. Across 99 studies of recovery techniques, massage had the largest effect on soreness and perceived fatigue [9]. Across 29 studies with 1,012 participants, massage was linked to small improvements in soreness and flexibility [10].
Population: 504 participants in 11 trials [8]. 99 studies of recovery methods [9]. 1,012 participants in 29 randomized studies [10].
Sources: [8], [9], [10]
Caveats: Soreness is self-rated and participants know they had a massage. The three reviews share many of the same small trials.

Moderate

Anxiety

Shown to lower anxiety in pooled trials, including state anxiety after a single session and trait anxiety after a course of treatment.

Compared with control conditions in randomized studies the source abstract does not describe [12]; active treatments [2]

The numbers and sources

Effect: A meta-analysis of 37 randomized studies found single sessions reduced state anxiety, and a course of treatment reduced trait anxiety and depression, its largest effects, by amounts the authors likened to psychotherapy [12]. Against active comparators in pain populations, anxiety was lower with massage (SMD -0.57) [2].
Population: 37 randomized studies [12]. Trials in people with pain [2].
Sources: [12], [2]
Caveats: The older meta-analysis predates many current trials and its abstract gives no effect sizes [12]. Participants cannot be blinded to massage.

Moderate

Depression

Shown to lower depressive symptoms against control groups in a meta-analysis of 17 trials, with a moderate pooled effect.

Compared with control groups the source abstract does not describe [15]

The numbers and sources

Effect: Across 17 randomized trials, the pooled standardized mean difference was 0.73 (95% CI 0.52 to 0.93) in the random-effects model, favoring massage [15]. An earlier meta-analysis found reductions in depression among massage's largest effects [12].
Population: 786 people with depression in 17 trials, excluding infants and pregnant women [15]. 37 randomized studies [12].
Sources: [15], [12]
Caveats: Trials were of moderate quality, used different massage protocols and depression scales, and may be heterogeneous [15].

Limited

Sleep

Limited evidence: low-certainty trials in critically ill adults and cancer survivors found better self-reported sleep quality after massage.

Compared with control groups the source abstracts do not describe [16][17]

The numbers and sources

Effect: In critically ill adults, foot reflexology massage improved subjective sleep quality in subgroup analysis, and a two-night course helped in cardiac care patients [16]. In 4 trials in cancer survivors, massage improved self-reported sleep and accelerometer-recorded long sleep episodes [17].
Population: 569 participants in 10 trials in adult critical care [16]. Cancer survivors in 4 trials [17].
Sources: [16], [17]
Caveats: Overall certainty was rated low [16]. No trial in healthy adults or in people with insomnia alone was located.

Mixed results4

Limited

Neck pain

Limited evidence: very low-quality trials suggested some massage techniques improved function and tenderness more than control or placebo, and reviewers called the effect uncertain.

Compared with control or placebo treatment [6]; education [6]

The numbers and sources

Effect: Very low-quality evidence suggested traditional Chinese massage and strain-counterstrain techniques may improve function and tenderness more than control or placebo, and massage may ease pain bothersomeness more than education in the short term. Most trials measured outcomes immediately after treatment [6].
Population: 15 trials of adults with mechanical neck disorders [6].
Sources: [6]
Caveats: All trials were rated low or very low in quality, and only 4 of 15 described the massage adequately. The reviewers made no recommendation [6].

Moderate

Strength, sprint and performance recovery

Mixed results: one meta-analysis found no effect on strength, jump, sprint or endurance, while others found small gains in force or short-term performance recovery.

Compared with no intervention [8]; control conditions the source abstracts do not describe [10][11]

The numbers and sources

Effect: Across 29 studies, massage did not improve strength, jump, sprint, endurance or fatigue [10]. In another pooled analysis, maximal isometric force (SMD 0.56) and peak torque (SMD 0.38) were higher after massage [8]. Across 22 trials, performance recovery effects were small: +6.6% with 5 to 12 minutes of massage and +1.0% with more than 12 minutes, larger for recovery periods of up to 10 minutes (+7.9%) than more than 20 minutes (+2.4%) [11].
Population: 1,012 participants in 29 studies [10]. 504 participants in 11 trials [8]. 22 randomized trials [11].
Sources: [10], [8], [11]
Caveats: The authors of [11] called the effects rather small and partly unclear, larger in untrained people than in trained athletes.

Limited

Generalized anxiety disorder

Small trials disagree: one found Swedish massage lowered anxiety more than light touch, and another found massage did not differ from a relaxing room or heat therapy.

Compared with light touch [13]; thermotherapy [14]; a relaxing room [14]

The numbers and sources

Effect: In 47 untreated adults with generalized anxiety disorder, twice-weekly Swedish massage for 6 weeks lowered Hamilton Anxiety scores by 11.67 points against 8.41 with light touch (difference 3.26, P = .030) [13]. In 68 adults with the disorder, massage, thermotherapy and a relaxing room all lowered anxiety scores by 10 to 13 points, with no difference between groups (P = .39), and gains held at 26 weeks [14].
Population: 47 adults, 40 analyzed [13]. 68 adults [14].
Sources: [13], [14]
Caveats: Two small trials. The authors of [14] attributed the improvement in every group to a general relaxation response.

Moderate

Stress hormones, blood pressure and immune cells after one session

Mixed results: a single session lowered blood pressure and heart rate in pooled trials, and cortisol fell in one small trial but not in pooled trials.

Compared with control conditions in randomized studies the source abstract does not describe [12]; light touch [18]

The numbers and sources

Effect: Single sessions reduced state anxiety, blood pressure and heart rate, and did not reduce cortisol [12]. In healthy adults, 45 minutes of Swedish massage produced a large drop in arginine vasopressin and a small drop in blood cortisol against light touch. Circulating lymphocytes rose (effect sizes 0.14 to 0.43) and stimulated cytokine production fell [18].
Population: 37 randomized studies [12]. Healthy adults aged 18 to 45 [18].
Sources: [12], [18]
Caveats: The trial calls its data preliminary, and these were changes over one session [18]. Lymphocyte counts in blood do not show fewer infections.

Protocols studied

Massage in the trials was mostly given by hand, and 3 low back pain trials used a mechanical device [4]. The back pain trial compared structural and relaxation massage [5]. The knee osteoarthritis trial gave 60 minutes of full-body massage weekly for 8 weeks, then every other week to 52 weeks [7]. The generalized anxiety trials used Swedish massage twice a week for 6 weeks [13] and 10 sessions over 12 weeks [14]. The hormone and immune study used one 45-minute session [18].

After exercise, the soreness trials used massage after strenuous or high-intensity exercise [8][9]. In the performance analysis, sessions of 5 to 12 minutes showed larger effects than sessions longer than 12 minutes [11].

Risks

Reported risks3

ModerateHow often is not known

More pain or soreness after treatment

Shown in trials as the most common side effect, with increased pain reported in 1.5% to 25% of participants across back pain trials.

The numbers and sources

How common: How often is not known: the sources give no rate.
Effect: In low back pain trials, increased pain intensity was the most common adverse event, in 1.5% to 25% of participants [4]. In neck pain trials, the 4 that reported side effects all reported pain after treatment, and one found low blood pressure after treatment in 22% of participants [6].
Population: 25 low back pain trials [4]. 15 neck pain trials, 4 reporting side effects [6].
Sources: [4], [6]
Caveats: The range spans two frequency bands and no pooled rate was given. Most trials did not report side effects [6].

LimitedHow often is not known

Serious injuries in case reports

Case reports: 138 adverse events in 40 reports from 2003 to 2013, including disc herniation, nerve injury and vertebral artery dissection, often linked to spinal manipulation within massage.

The numbers and sources

How common: How often is not known: the sources give no rate.
Effect: From 2003 to 2013, 40 reports described 138 adverse events with massage, mainly disc herniation, soft tissue trauma, neurologic compromise, spinal cord injury and vertebral artery dissection. Spinal manipulation within massage was repeatedly tied to the serious events [19]. An earlier review of 16 case reports and 4 case series found most harms followed exotic techniques or massage by laypeople, rarely massage therapists. Reported events included stroke, nerve damage, pulmonary embolism and hematoma [20].
Population: 138 cases [19]. 16 case reports and 4 case series [20].
Sources: [19], [20]
Caveats: Case reports give no rate. Both reviews judged serious events rare [19][20].

LimitedStudied in childrenHow often is not known

Bowel twisting after abdominal massage in premature infants

Case reports: 17 cases of volvulus in premature infants after abdominal massage, 4 of them fatal, in a review of 60 pediatric massage studies.

The numbers and sources

How common: How often is not known: the sources give no rate.
Effect: Of 60 studies of massage in children, 16 reported at least one adverse event. There were 20 mild, 26 moderate and 18 severe events. Of the severe events, 17 were volvulus in premature infants given abdominal massage, and 4 were fatal [21].
Population: Children aged 0 to 18 in 60 studies [21].
Sources: [21]
Caveats: The reviewers say it is not yet defined whether the link is causal, and 31 of the 60 studies gave no adverse event information [21].

Checked, no increase found1

Moderate

Serious adverse events in trials

No serious adverse events were reported in 25 trials of massage for low back pain.

The numbers and sources

How common: How often is not known: the sources give no rate.
Effect: There were no reports of serious adverse events in any of the 25 trials [4]. In the knee osteoarthritis trial, adverse events were described as minimal [7].
Population: 3,096 participants in 25 trials [4]. 222 adults [7].
Sources: [4], [7]
Caveats: Trials are too small to detect rare events, and many did not report adverse events at all.

Claims tested and not found

That massage speeds removal of lactic acid from muscle after exercise. In 12 people, forearm blood flow and lactate removal after strenuous handgrip exercise were lower with massage than with passive rest [22].
That sports massage improves strength, sprint or jump performance. Pooled data from 29 studies found no improvement in strength, jump, sprint, endurance or fatigue [10].
That massage beats other relaxation treatments for generalized anxiety disorder. Anxiety fell by similar amounts with massage, heat therapy and a relaxing room [14].

Sources

National Center for Complementary and Integrative Health. Massage Therapy: What You Need To Know. 2019. https://www.nccih.nih.gov/health/massage-therapy-what-you-need-to-know
Crawford C, Boyd C, Paat CF, et al. The Impact of Massage Therapy on Function in Pain Populations: A Systematic Review and Meta-Analysis of Randomized Controlled Trials: Part I, Patients Experiencing Pain in the General Population. Pain Medicine. 2016. https://doi.org/10.1093/pm/pnw099
Miake-Lye IM, Mak S, Lee J, et al. Massage for Pain: An Evidence Map. The Journal of Alternative and Complementary Medicine. 2019. https://doi.org/10.1089/acm.2018.0282
Furlan AD, Giraldo M, Baskwill A, et al. Massage for low-back pain. Cochrane Database of Systematic Reviews. 2015. https://doi.org/10.1002/14651858.CD001929.pub3
Cherkin DC, Sherman KJ, Kahn J, et al. A comparison of the effects of 2 types of massage and usual care on chronic low back pain: a randomized, controlled trial. Annals of Internal Medicine. 2011. https://doi.org/10.7326/0003-4819-155-1-201107050-00002
Patel KC, Gross A, Graham N, et al. Massage for mechanical neck disorders. Cochrane Database of Systematic Reviews. 2012. https://doi.org/10.1002/14651858.CD004871.pub4
Perlman A, Fogerite SG, Glass O, et al. Efficacy and Safety of Massage for Osteoarthritis of the Knee: a Randomized Clinical Trial. Journal of General Internal Medicine. 2018. https://doi.org/10.1007/s11606-018-4763-5
Guo J, Li L, Gong Y, et al. Massage Alleviates Delayed Onset Muscle Soreness after Strenuous Exercise: A Systematic Review and Meta-Analysis. Frontiers in Physiology. 2017. https://doi.org/10.3389/fphys.2017.00747
Dupuy O, Douzi W, Theurot D, et al. An Evidence-Based Approach for Choosing Post-exercise Recovery Techniques to Reduce Markers of Muscle Damage, Soreness, Fatigue, and Inflammation: A Systematic Review With Meta-Analysis. Frontiers in Physiology. 2018. https://doi.org/10.3389/fphys.2018.00403
Davis HL, Alabed S, Chico TJA. Effect of sports massage on performance and recovery: a systematic review and meta-analysis. BMJ Open Sport & Exercise Medicine. 2020. https://doi.org/10.1136/bmjsem-2019-000614
Poppendieck W, Wegmann M, Ferrauti A, et al. Massage and Performance Recovery: A Meta-Analytical Review. Sports Medicine. 2016. https://doi.org/10.1007/s40279-015-0420-x
Moyer CA, Rounds J, Hannum JW. A meta-analysis of massage therapy research. Psychological Bulletin. 2004. https://doi.org/10.1037/0033-2909.130.1.3
Rapaport MH, Schettler P, Larson ER, et al. Acute Swedish Massage Monotherapy Successfully Remediates Symptoms of Generalized Anxiety Disorder: A Proof-of-Concept, Randomized Controlled Study. The Journal of Clinical Psychiatry. 2016. https://doi.org/10.4088/jcp.15m10151
Sherman KJ, Ludman EJ, Cook AJ, et al. Effectiveness of therapeutic massage for generalized anxiety disorder: a randomized controlled trial. Depression and Anxiety. 2010. https://doi.org/10.1002/da.20671
Hou WH, Chiang PT, Hsu TY, et al. Treatment effects of massage therapy in depressed people: a meta-analysis. The Journal of Clinical Psychiatry. 2010. https://doi.org/10.4088/jcp.09r05009blu
Fang C, Chang S, Fang C, et al. Effect of massage therapy on sleep quality in critically ill patients: A systematic review and meta-analysis. Journal of Clinical Nursing. 2023. https://doi.org/10.1111/jocn.16660
Samuel SR, Gururaj R, Kumar KV, et al. Randomized control trial evidence for the benefits of massage and relaxation therapy on sleep in cancer survivors: a systematic review. Journal of Cancer Survivorship. 2020. https://doi.org/10.1007/s11764-020-00972-x
Rapaport MH, Schettler P, Bresee C. A preliminary study of the effects of a single session of Swedish massage on hypothalamic-pituitary-adrenal and immune function in normal individuals. The Journal of Alternative and Complementary Medicine. 2010. https://doi.org/10.1089/acm.2009.0634
Yin P, Gao N, Wu J, et al. Adverse events of massage therapy in pain-related conditions: a systematic review. Evidence-Based Complementary and Alternative Medicine. 2014. https://doi.org/10.1155/2014/480956
Ernst E. The safety of massage therapy. Rheumatology. 2003. https://doi.org/10.1093/rheumatology/keg306
Karkhaneh M, Zorzela L, Jou H, et al. Adverse events associated with paediatric massage therapy: a systematic review. BMJ Paediatrics Open. 2020. https://doi.org/10.1136/bmjpo-2019-000584
Wiltshire EV, Poitras V, Pak M, et al. Massage impairs postexercise muscle blood flow and "lactic acid" removal. Medicine & Science in Sports & Exercise. 2010. https://doi.org/10.1249/mss.0b013e3181c9214f

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