Massage for Treatment of Psychological Disorders

Learn about different massage techniques and whether massage is helpful for treating depression, anxiety, stress, ADHD in children and other mental health and health conditions.

Before engaging in any complementary medical technique, you should be aware that many of these techniques have not been evaluated in scientific studies. Often, only limited information is available about their safety and effectiveness. Each state and each discipline has its own rules about whether practitioners are required to be professionally licensed. If you plan to visit a practitioner, it is recommended that you choose one who is licensed by a recognized national organization and who abides by the organization's standards. It is always best to speak with your primary health care provider before starting any new therapeutic technique.

• Background
• Theory
• Evidence
• Unproven Uses
• Potential Dangers
• Summary
• Resources

Background

Massage techniques have been practiced for thousands of years in many cultures. There are references to massage in ancient records of Chinese, Japanese, Arabic, Egyptian, Indian, Greek and Roman nations.

Massage spread throughout Europe during the Renaissance. The basis of Swedish massage was developed in the 1800s by Per Henrik Ling (1776-1839) as a combination of massage and gymnastic exercises. George and Charles Taylor, two physicians who had studied in Sweden, introduced massage therapy to the United States in the 1850s. By the early 1930s, massage became a less prominent part of American medicine because of increased focus on the biological sciences. Interest increased in the 1970s, when massage became popular among athletes as a therapy to promote musculoskeletal injury healing and pain reduction, as well as well-being, relaxation, stress relief, sleep enhancement and quality-of-life.

Many approaches can be classified as massage therapy. Most involve the use of fixed or moving pressure or manipulation of the muscles and connective tissues. Practitioners may use their hands, forearms, elbows or feet with or without lubricants to aid the smoothness of massage strokes. Touch is central to massage and is used by therapists to locate painful or tense areas, to determine how much pressure to apply and to establish a therapeutic relationship with clients.

Swedish massage involves several techniques:

• Effleurage — Superficial stroking in a direction away from the heart or deep stroking toward the heart
• Friction — Deep muscle stimulation using the palm, elbow and forearm
• Petrissage — Kneading in a circular pattern using fingers and thumbs, with the goals of enhancing circulation and stimulating muscle tissue
• Tapotement — Rhythmic movements such as slapping or tapping to stimulate muscles, often used for athletes before competitions
• Vibration — Delivered by the therapist's hands or by an electric vibrator

There are many other massage approaches used throughout the world. Examples include:

• Aromatherapy massage uses essential oils with the goal of enhancing healing and relaxation.
• Bindegewebsmassage focuses on connective tissues between the skin and muscles and is based on the theory that some ailments are caused by imbalances in these tissues.
• Classical massage aims to provide calmness and relaxation and to encourage self-healing and revitalization.
• Craniosacral therapists strive to locate and realign imbalances or blockages that are thought to exist in the soft tissues or fluids of the sacrum, head and spine.
• Deep tissue massage uses slow strokes, friction and direct pressure across the muscles with fingers, thumbs or elbows, often with the goal of improving chronic muscular tension.
• Esalen massage focuses on generating a deep state of relaxation and is often combined with other forms of massage.
• Ice massage has been studied for knee osteoarthritis, exercise-induced muscle damage and labor pain, with inconclusive results.
• Jin Shin Do involves finger pressure to acupoints of the body to release muscular tension or stress.
• Manual lymph drainage uses light, rhythmic strokes with the goals of improving lymphatic flow and reducing edema, inflammation or neuropathy.

• Myofascial release may be used by physical therapists, chiropractors or massage therapists. This approach involves gentle traction, pressure and body positioning to relax and stretch soft tissues.
• Neuromuscular massage, triggerpoint massage and myotherapy are forms of deep massage administered to specific muscles or nerve points, used to release trigger points or entrapped nerves and to relieve pain.
• On-site or chair massage is administered to the upper body of fully clothed clients.
• Physiotherapy aims at stabilization of the lumbar spine in a flexed posture rather than in lumbar lordosis and at increased overall physical fitness.
• Polarity treatment is based on the concept that rebalancing the body's energy fields with gentle massage can improve health and well-being.
• Reflexology aims to return the body to its natural balance by targeting certain areas on the feet (or ears) believed to correspond with specific body parts or organs.
• Rolfing® structural integration involves deep tissue massage aimed at relieving stress as well as improving mobility, posture, balance, muscle function and efficiency, energy and overall well-being.
• Shiatsu emphasizes finger pressure not only at acupoints but also along the body's meridians. This type of massage can incorporate palm pressure, stretching and other manual techniques.
• Sports massage is similar to Swedish massage but is adapted specifically for athletes.
• St. John's neuromuscular technique may be used for chronic pain conditions that involve the musculoskeletal system.
• The Trager approach involves relearning patterns of movement to improve efficiency and well-being.
• Tibetan massage may be performed on any of several areas of the body, based on the practitioner's judgment of the patient's energy flow (for example, head, neck, vertebra, abdomen, legs).

Many other variations and styles of massage or touch exist, often developed in specific regions of the world.

Most massage approaches involve the client lying face down on a platform or table with a sheet covering the lower body. Depending on the technique, sessions may last from 15 to 90 minutes. Many clients fall asleep during therapy. Environment is considered integral to massage therapy and often consists of a comfortable, warm, quiet location. Soothing repetitive low-volume music or sounds may be played in the background.

Massage therapy practices may be based in a therapist's home, a private practice office, a hospital, spa, athletic club, hair salon, hotel or airport or outdoors. Some practitioners will travel to a client's home or office. Sports massage may be administered in a gym or locker-room setting.

In the United States, licensure requirements for administering massage therapies vary from state to state. Some practitioners are licensed as nurses, physical therapists, massage therapists or other types of health care professionals. Some have attended extensive programs that grant professional degrees. However, many massage practitioners are not licensed, and national or international organizations have not agreed on standards. The International Therapy Examinations Council offers testing in this area.

It is recommended that patients seeking a massage therapist for medical reasons discuss the choice of massage practitioner with their primary health care provider. References and training history should be checked before starting a therapeutic program.

Theory

There are many theories about how massage may work, although none has been scientifically proven. There is limited research in this area. It is suggested that massage may have local effects on muscles and soft tissues, reduce inflammation, soften or stretch scar tissue, reduce the buildup of lactic acid in muscles, stimulate oxygenation of tissues, break up adhesions, induce muscle fiber relaxation and stimulate healing of connective tissues or damaged muscles. Other proposed effects include immune system enhancement, reduction of blood pressure, central nervous system relaxation and sedation, parasympathetic stimulation, blockage of sensations from nerves that sense pain (the "gate theory"), stimulation of blood and lymphatic circulation, decreases in heart rate, increases in skin temperature, endorphin release, alteration of hormones such as cortisol, stimulation of substance P release, stimulation of somatostatin release, sleep enhancement or removal of blood toxins. Practitioners suggest that Swedish massage may assist the body in delivering nutrients and removing waste products from various tissues.

There is little high-quality research of massage. Scientifically based conclusions about the effectiveness of massage cannot be drawn at this time for any health condition.

Evidence

Scientists have studied massage for the following health problems:

Anxiety
There are several trials of massage in individuals with anxiety. Studies have focused on patients with cancer, chronic illnesses, headache, dementia, multiple sclerosis, fibromyalgia, anxiety, stress, depression or premenstrual syndrome; before or during medical procedures; and agitation in elderly institutionalized patients. However, most research is not well designed. Better studies are necessary to make a scientifically based recommendation.

Asthma
There is promising initial evidence that massage may improve lung function in children with asthma. Better research is necessary to make a firm conclusion.

Back pain
Several studies in humans report temporary improvements in low back pain with various massage techniques. However, most studies are not well designed. Better-quality research is necessary to make a scientifically based recommendation.

Constipation
A small number of studies report that abdominal massage may be helpful in patients with constipation. Overall, these studies are not well designed or reported. Better-quality research is necessary to make a scientifically based recommendation.

Musculoskeletal conditions/chronic pain
Preliminary research reports that massage may help relieve chronic pain. Soft tissue massage may also improve range of motion and function. Further well-designed study is needed to confirm these results.

Dementia
Several studies have used massage (with or without essential oils) in patients with dementia living in chronic care facilities in order to assess effects on behavior. Early evidence suggests that aromatherapy with essential oils may reduce agitation in patients with dementia, although the effects of massage itself are not clear.

Depression
There is not enough scientific information to conclude if massage is helpful in patients with major depressive disorder, situational mood disorder, critical illness, pregnancy, or postpartum depression (including infant massage).

Fibromyalgia
A small number of studies report that massage may improve pain, depression and quality of life in patients with fibromyalgia. Additional research is necessary to form a scientifically based recommendation.

Iliotibial band friction syndrome
There is not enough scientific information to conclude if massage is helpful in patients with iliotibial band friction syndrome, a painful tendonitis of the lower leg that occurs in joggers and other athletes.

Multiple sclerosis
Initial research reports that massage may improve anxiety, depression, self-esteem, body image and social functioning in patients with multiple sclerosis. Benefits on the disease process itself have not been well evaluated. Additional research is necessary to make a firm conclusion.

Infant development, neonatal care
Therapists or mothers sometimes use massage in pre-term infants with the goal of improving infant development and weight gain. Although several studies are reported, it remains unclear if this is a beneficial therapy.

Postoperative recovery
Several massage approaches have been used after surgery with the aim of improving recovery and decreasing pain. Better research is necessary to make a firm conclusion.

Pregnancy and labor
Massage approaches are sometimes used during pregnancy and labor, more commonly in Europe than in the United States. Reduction of pain or anxiety is often the goal. There is not enough research to determine if this is effective or safe. Pregnant women should speak with their health care provider before beginning massage therapy, particularly if massage to the abdominal area is involved.

Premenstrual syndrome
There is not enough scientific information to conclude if massage is helpful in women with premenstrual syndrome or with premenstrual dysphoric disorder.

Well-being in cancer patients
Massage techniques are frequently used in patients with cancer, with the goals of improving well-being and reducing anxiety. Although there are many anecdotal reports of benefits, there is not enough reliable scientific evidence to draw a firm conclusion.

Immune function
Preliminary evidence suggests massage therapy may preserve immune function. One randomized study reported that massage treatment maintained immunocompetence in HIV-1-infected children without antiretroviral medication. Another study stated an increase in lymphocytes in women with breast cancer. Further research is needed before a firm conclusion can be made.

Attention-deficit hyperactivity disorder (ADHD)
Preliminary research suggests massage therapy improves mood and behavior in children with ADHD. Additional evidence is needed before a recommendation can be made.

Unproven Uses

Massage has been suggested for many other uses, based on tradition or on scientific theories. However, these uses have not been thoroughly studied in humans, and there is limited scientific evidence about safety or effectiveness. Some of these suggested uses are for conditions that are potentially life-threatening. Consult with a health care provider before using massage for any use.

Potential Dangers

Reports of adverse effects of massage are rare, although this area is not well studied. Bone fractures, discomfort, skin bruising, swelling of massaged tissues, a case of liver hematoma (internal bruising), cerebrovascular accidents, displacement of a ureteral stent, embolization of a kidney, leg ulcers, nerve damage, posterior interosseous syndrome, pseudoaneurism, pulmonary embolism, ruptured uterus, strangulation of neck, thyrotoxicosis and various pain syndromes have been reported.

Areas of the body where there are fractures, weakened bones from osteoporosis or cancer, open or healing skin wounds, skin infections, recent surgery or blood clots should not be massaged. Individuals with bleeding disorders or low platelet counts or those taking blood-thinning medications (such as heparin or warfarin) should avoid vigorous massage. Allergies or skin irritation can occur with some essential oils used in massage.

Pregnant women should speak with their health care provider before beginning massage therapy, particularly if massage to the abdominal area is involved. In general, touch-based therapies should be used cautiously in people with a history of physical abuse. Massage should not cause pain to the client.

Massage should not be used as a substitute for more proven therapies. Massage has not been evaluated as a method to diagnose medical conditions.

Summary

Various types of massage are used throughout the world for many health conditions. Relief of pain, anxiety, muscle spasm or tension or depression and athletic event preparation are common uses. There is limited reliable scientific evidence in these areas, and it remains unclear if massage is effective for any specific health condition. Massage should not be used as a substitute for more proven therapies, and it is not a diagnostic technique. Massage should be used cautiously in pregnant women and in those at risk of fracture or bleeding.

The information in this monograph was prepared by the professional staff at Natural Standard, based on thorough systematic review of scientific evidence. The material was reviewed by the Faculty of the Harvard Medical School with final editing approved by Natural Standard.

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Resources

1. Natural Standard: An organization that produces scientifically based reviews of complementary and alternative medicine (CAM) topics
2. National Center for Complementary and Alternative Medicine (NCCAM): A division of the U.S. Department of Health & Human Services dedicated to research

Selected Scientific Studies: Massage

Natural Standard reviewed more than 1,070 articles to prepare the professional monograph from which this version was created.

Some of the more recent studies are listed below:

1. Aly H, Moustafa MF, Hassanein SM, et al. Physical activity combined with massage improves bone mineralization in premature infants: a randomized trial. J Perinatol 2004;24(5):305-309.
2. Blanc-Louvry I, Costaglioli B, Boulon C, et al. Does mechanical massage of the abdominal wall after colectomy reduce postoperative pain and shorten the duration of ileus? Results of a randomized study. J Gastrointest Surg 2002;6(1):43-49.
3. Bowles EJ, Griffiths DM, Quirk L, et al. Effects of essential oils and touch on resistance to nursing care procedures and other dementia-related behaviours in a resident care facility. Internat J Aromather 2002;12(1):22-29.
4. Brosseau L, Casimiro L, Milne S, et al. Deep transverse friction massage for treating tendonitis. Cochrane Database Syst Rev 2002;(2):CD003528.
5. Callaghan MJ. The role of massage in the management of the athlete: a review. Br J Sports Med 1993;27(1):28-33.
6. Diego MA, Field T, Sanders C, et al. Massage therapy of moderate and light pressure and vibrator effects on EEG and heart rate. Int J Neurosci 2003;114(1):31-44.
7. Ernst E. The safety of massage therapy. Rheumatology (Oxford) 2003;Sep, 42(9):1101-1106.
8. Epub 2003;May 30. Review. Ernst E. Does post-exercise massage treatment reduce delayed onset muscle soreness? A systematic review. Br J Sports Med 1998;32(3):212-214.

1. Ernst E. Massage therapy for low back pain: a systematic review. J Pain Symptom Manage 1999;17(1):65-69.
2. Field T, Diego MA, Hernandez-Reif M, et al. Massage therapy effects on depressed pregnant women. J Psychosom Ostet Gynaecol 2004;25(2):115-122.
3. Field T, Henteleff T, Hernandez-Reif M, et al. Children with asthma have improved pulmonary functions after massage therapy. J Pediatr 1998;132(5):854-858.
4. Field T. Massage better than relaxation therapy for fibromyalgia. J Clin Rheumatol 2002;8(2):72-76.
5. Fogel GR, Cunningham PY 3rd, Esses SI. Coccygodynia: evaluation and management. J Am Acad Orthop Surg 2004;Jan-Feb, 12(1):49-54.
6. Forchuk C, Baruth P, Prendergast M, et al. Postoperative arm massage: a support for women with lymph node dissection. Cancer Nurs 2004;27(1):25-33.
7. Furlan AD, Brosseau L, Imamura M, et al. Massage for low-back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine 2002;27(17):1896-1910.
8. Gauthier DM. The healing potential of back massage. Online J Knowl Synth Nurs 1999;Jun 17, 6:5.
9. Goffaux-Dogniez C, Vanfraechem-Raway R, Verbanck P. Appraisal of treatment of the trigger points associated with relaxation to treat chronic headache in the adult: relationship with anxiety and stress adaptation strategies. Encephale 2003;Sep-Oct, 29(5):377-390.
10. French. Hasson D, Arnetz B, Jelveus L, Edelstam B. A randomized clinical trial of the treatment effects of massage compared to relaxation tape recordings on diffuse long-term pain. Psychother Psychosom 2004;Jan-Feb, 73(1):17-24.
11. Hernandez-Reif M, Ironson G, Field T, et al. Breast cancer patients have improved immune and neuroendocrine functions following massage therapy. J Psychosom Res 2004;57(1):45-52.
12. Hernandez-Reif M, Martinez A, Field T, et al. Premenstrual symptoms are relieved by massage therapy. J Psychosom Obstet Gynaecol 2000;21(1):9-15.
13. Howatson G, Van Someren KA. Ice massage: effects on exercise-induced muscle damage. J Sports Med Phys Fitness 2003;Dec, 43(4):500-505.
14. Khilnani S, Field T, Hernandez-Reif M, et al. Massage therapy improves mood and behavior of students with attention-deficit/hyperactivity disorder. Adolescence 2003;38(152):623-638.
15. Muller-Oelinghausen B, Berg C, Scherer P, et al. [Effects of slow-stroke massage as complementary treatment of depressed hospitalized patients]. Dtsch Med Wochenschr 2004;129(24):1363-1368.
16. Moyer CA, Rounds J, Hannum JW. A meta-analysis of massage therapy research. Psychol Bull 2004;130(1):3-18.
17. Piotrowski MM, Paterson C, Mitchinson A, et al. Massage as adjuvant therapy in the management of acute postoperative pain: a preliminary study in men. J Am Coll Surg 2003;197(6):1037-1046.
18. Remington R. Calming music and hand massage with agitated elderly. Nurs Res 2002;Sep-Oct, 51(5):317-323.
19. Shor-Posner G, Miguez MJ, Hernandez-Reif M, et al. Massage therapy in HIV-1 infected Dominican children: a preliminary report on the efficacy of massage therapy to preserve the immune system in children without antiretroviral medication. J Altern Complement Med 2004;10(6):1093-1095.
20. Trotter JF. Hepatic hematoma after deep tissue massage. N Engl J Med 1999;341(26):2019-2020.
21. van den Dolder PA, Roberts DL. A trial into the effectiveness of soft tissue massage in the treatment of shoulder pain. Aust J Physiother 2003;49(3):183-188.
22. Vickers A, Ohlsson A, Lacy JB, et al. Massage for promoting growth and development of preterm and/or low birth-weight infants (Cochrane Review). The Cochrane Library 2002;(2).
23. Walach H, Guthlin C, Konig M. Efficacy of massage therapy in chronic pain: a pragmatic randomized trial. J Altern Complement Med 2003;Dec, 9(6):837-846.
24. Waters BL, Raisler J. Ice massage for the reduction of labor pain. J Midwifery Womens Health 2003;Sep-Oct, 48(5):317-321.
25. Westcombe AM, Gambles MA, Wilkinson SM, et al. Learning the hard way! Setting up an RCT of aromatherapy massage for patients with advanced cancer. Palliat Med 2003;Jun, 17(4):300-307.
26. Wunschmann BW, Sigl T, Ewert T, et al. Physical therapy to treat spinal stenosis. Orthopade 2003;Oct, 32(10):865-868. Review. German.

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