Massage Therapy

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Massage Therapy

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Massage Therapy

Common Names

  • Swedish massage
  • Reflexology
  • Myofascial release
  • Neuromuscular therapy
  • Shiatsu
  • Manual lymphatic drainage
  • Reiki

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For Patients & Caregivers

Tell your healthcare providers about any dietary supplements you’re taking, such as herbs, vitamins, minerals, and natural or home remedies. This will help them manage your care and keep you safe.

What Is It

Massage is a modality used in many cultures to provide comfort and pain relief using therapeutic touch. There are many styles of massage including Swedish, reflexology, reiki, neuromuscular therapy, myofascial release, shiatsu, tui na, and manual lymphatic drainage, or MLD.

Swedish massage is the most common and consists of five basic strokes. Reflexology involves massaging specific areas on the hands or feet that correspond to other parts of the body. Reiki promotes the healing of physical and emotional ailments through gentle touch. Neuromuscular therapy uses pressure and friction to relieve areas of strain or trigger points. Myofascial release uses gentle sustained pressure to connective tissue to release muscular tightness and soreness. Shiatsu and tui na are techniques that started in Asia. They are used to stimulate energy and blood flow in acupuncture points and channels. MLD uses a light rhythmic technique that encourages the natural movement of lymph fluid throughout the body. 

Clinical trials have shown that massage therapy helps reduce pain, anxiety, fatigue, and shortness of breath in cancer patients. It can ease the mind, improve sleep, reduce depression, and provide comfort to patients. It may also help children and caregivers. In addition, studies suggest that massage can reduce pain and anxiety related to medical procedures, including surgery. 

Current oncology guidelines recommend using massage for depression and mood disorders. In addition, massage is increasingly used as a complementary therapy to provide relief from symptoms of cancer and other illnesses. However, patients should speak with their doctor and see a qualified massage therapist who understands their condition for treatment.

How It Works

Massage helps reduce muscle soreness, stiffness, and spasms. It also promotes relaxation and improves circulation, processes that can support recovery and healing. These effects can also reduce pain, anxiety, and depression. It may also help regulate breathing and improve sleep. Certain types of massage, such as reflexology, are better suited for hospital or clinic settings, or in weak and elderly patients. 

Purported Uses
  • Pain
    Several studies show massage can ease pain and can reduce use of pain medications.
  • Anxiety
    Studies show that massage can reduce anxiety, including anxiety related to medical procedures. This can also lead to improved mood and sleep.
  • Depression
    Studies show that massage can reduce depression and mood disturbances. Current oncology guidelines recommend using massage for depression and mood disorders.
  • Cancer-related symptoms
    Several clinical trials support use of massage in reducing pain, fatigue, anxiety, and other mood disturbances associated with cancer and its treatment. It can also improve shortness of breath and sleep quality.
  • Arthritis
    Studies have shown that massage helps relieve symptoms of arthritis.
  • Lower blood pressure
    Massage therapy may help to lower blood pressure and other measures such as heart rate.
  • Headache
    Massage can be helpful to relieve headaches.
Is It Safe

Massage is generally safe when provided by a qualified massage therapist. However, patients should speak with their doctor and see a qualified massage therapist who understands their condition for treatment. Abdominal massage should be avoided in:

  • Patients with tumor involvement in abdominal areas.
  • Patients who have received recent abdominal radiotherapy and surgery.
  • Patients who have had placement of underlying devices such as hepatic infusion pump or wound vacuum.
  • Those with suspected abdominal obstructions, intestinal inflammation, or irritable bowel syndrome.
  • Women who are pregnant.

In these cases, therapists should use alternate sites for massage. 

Who Can Provide this Service

In the United States, qualified therapists are licensed within each state by meeting specific education, exam, and experience requirements. There is also a voluntary national board certification, as well as specialty certifications for advanced training in various modalities. Certifications are also available for therapists who have had additional training and experience with certain populations, such as cancer patients.

Where Can I Get Treatment

A majority of NCI-designated cancer centers now offer massage, yoga, acupuncture, and meditation. This is usually through referrals from the healthcare team or by accessing their supportive care services. The Integrative Medicine Service at MSK offers many forms of massage therapy to support the recovery and wellbeing of cancer patients. In addition, the IMPACT trial at MSK is comparing the long-term effects of massage therapy versus acupuncture treatments for pain and related symptoms in patients with advanced cancers.

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For Healthcare Professionals

Clinical Summary

Massage is an ancient technique that involves manual manipulation of muscles and soft tissues of the body. It increases circulation and promotes relaxation. In addition, it has important emotional and psychological benefits. The various forms of massage that are commonly practiced include Swedish massage, reflexology, reiki, neuromuscular therapy, myofascial release, shiatsu, tui na, and manual lymphatic drainage, or MLD.

Swedish massage is the most common and consists of five basic strokes and their variations. Reflexology involves massaging reflex points on the hands, feet, or ears that correspond to particular regions in the body. It is utilized frequently and effectively for nausea, constipation, and peripheral neuropathy in the acute setting. Reiki promotes the healing of physical and emotional ailments through gentle touch. Shiatsu and tui na originated in Japan and China, and involve manual stimulation of acupuncture points and meridians to ensure proper flow of energy and blood to facilitate healing. Neuromuscular therapy uses pressure and friction to relieve areas of strain or trigger points. Myofascial release applies gentle sustained pressure to connective tissue to release muscular tightness and soreness. MLD uses a light rhythmic technique that encourages the natural movement of lymph fluid throughout the body.

In cancer patients, clinical studies show that massage can alleviate symptoms such as stress, anxiety, depression, nausea, pain, fatigue, and insomnia (1) (3) (7) (8) (9) (12) (41), and reduce neurological complications (2). In breast cancer patients, Swedish massage relieved persistent fatigue (40), and massage therapy alone or in combination with meditation appeared to help reduce postoperative stress (21). A preliminary study of Swedish massage prior to each paclitaxel infusion suggests it may help reduce or prevent chemotherapy-induced peripheral neuropathic pain, and improve nerve conduction and quality of life  (46). Other preliminary data indicate that postoperative arm massage can decrease pain and discomfort after lymph node dissection (5) and that MLD may reduce lymphedema (6), but studies on whether it can prevent lymphedema are mixed (10) (47). A small study evaluating a parotid gland massage technique taught to patients suggests it may help reduce radiation burden to salivary glands from I therapy (48), but additional studies are needed.

Studies indicate that reflexology can alleviate pain and nausea (4) and reduce anxiety (14) (15) (16), dyspnea, and fatigue in cancer patients (13). Some studies show that massage and reflexology sessions have benefit and clinical utility, particularly for pain or anxiety associated with surgery and procedural interventions (20) (25) (26) (27) (28) (29) (30) (31). Gentle abdominal massage was found to improve depression, anxiety, wellbeing, and perceived abdominal bloating in cancer patients with malignant ascites (22). In addition, clinical practice guidelines from the European Society for Medical Oncology (ESMO) determined there is some evidence abdominal massage may reduce GI symptoms and improve bowel efficiency, although the studies assessed were in noncancer populations (49).

Massage has also shown some benefits for pediatric cancer patients and caregivers. In a study of hospitalized adolescents with cancer, massage was well received with trends towards increased nighttime and overall sleep (23). In family caregivers of patients with cancer, it reduced anxiety, cortisol levels, blood pressure, and pulse rate, and improved sleep quality (24).

Massage therapy is also effective in treating chronic back pain (11), knee osteoarthritis (17) (50), neck pain (18) (42), headaches (32), and to reduce blood pressure (19). Both aromatherapy massage and inhalation aromatherapy reduced anxiety and pain in burn patients (33). In HIV patients, massage improved pain, anxiety, and hyperventilation (34). Reflexology reduced anxiety, labor pain, and duration among first-time mothers (35). Self-care massage improved mental health and blood pressure (36) and reduced stress (37) in some populations.

Clinical trials are evaluating massage therapy for conditions such as peripheral neuropathy, preoperatively for breast surgery patients, and combined with music therapy for hospice patients. A trial is also underway to determine whether massage can facilitate stroke recovery (38). And the IMPACT trial at MSK is comparing the long-term effects of massage therapy versus acupuncture treatments for pain and related symptoms in patients with advanced cancer.

Current oncology guidelines recommend using massage for depression and mood disorders (44) (45). Massage is generally safe and increasingly used as a complementary therapy to provide relief from certain symptoms of cancer and other illnesses. However, patients suffering from cancer, heart disease, or arthritis should consult a qualified massage therapist for treatment. The Integrative Medicine Service at MSK offers many of these therapies to support the recovery and wellbeing of cancer patients.

Contraindications

Avoid abdominal massage in:

  • Patients with tumor involvement in abdominal areas.
  • Patients who have received recent abdominal radiotherapy and surgery.
  • Patients who have had placement of underlying devices such as hepatic infusion pump or wound vacuum.
  • Those with suspected abdominal obstructions, intestinal inflammation, or irritable bowel syndrome (39).
  • Women who are pregnant.

In these cases, therapists should use alternate sites for massage.

Adverse Reactions

Massage is generally safe when provided by a qualified massage therapist.

Case report (rare)
Small bowel intramural hemorrhage secondary to anticoagulant therapy after abdominal massage: In a 68-year-old man on long-term warfarin therapy; presented to ER with persistent abdominal pain and vomiting, and no bowel movement since onset (39). Although the particular massage was not described, abdominal massage is more typically part of eastern massage modalities such as shiatsu and tui na and may vary in pressure and intensity.

Hematoma: In a 69-year-old woman admitted for pneumonia who had multiple comorbidities and complained of pain in the right thigh. She requested an inpatient massage, which appeared to worsen symptoms. The hematoma along with calcified vessels were identified on CT scan and the patient required transfusions and an external compression wrap. Range of motion and pain resolved gradually. The authors suggest vascular status screening when selecting therapeutic massage techniques for patients (51).

Practitioners and Treatments

In the United States, qualified therapists are licensed within each state by meeting specific education, exam, and experience requirements. There is also national board certification, which is voluntary, as well as specialty certification for advanced education and training in a particular modality. Certifications are also available for therapists who have had additional training and experience with certain populations, such as cancer patients.

A majority of NCI-designated cancer centers now offer massage, yoga, acupuncture, and meditation. This is usually through referrals from the healthcare team or by accessing their supportive care services. The Integrative Medicine Service at MSK offers many forms of massage therapy to support the recovery and wellbeing of cancer patients. In addition, the IMPACT trial at MSK is comparing the long-term effects of massage therapy versus acupuncture treatments for pain and related symptoms in patients with advanced cancer.

References
  1. Cassileth BR and Vickers AJ. Massage therapy for symptom control: outcome study at a major cancer center. J Pain Symptom Manage 2004; 28(3):244-249.
  2. Smith MC, et al. Outcomes of touch therapies during bone marrow transplant. Altern Ther Health Med 2003; 9(1):40-49.
  3. Soden K, et al. A randomized controlled trial of aromatherapy massage in a hospice setting. Palliat Med 2004; 18(2):87-92.
  4. Grealish L, Lomasney A, Whiteman B. Foot massage. A nursing intervention to modify the distressing symptoms of pain and nausea in patients hospitalized with cancer. Cancer Nurs. 2000 Jun;23(3):237-43.
  5. Forchuk C, et al. Postoperative arm massage: a support for women with lymph node dissection. Cancer Nurs 2004; 27(1):25-33.
  6. Williams AF, et al. A randomized controlled crossover study of manual lymphatic drainage therapy in women with breast cancer-related lymphoedema. Eur J Cancer Care (Engl) 2002; 11(4):254-261.
  7. Listing M, Reisshauer A, Krohn M, et al. Massage therapy reduces physical discomfort and improves mood disturbances in women with breast cancer. Psychooncology. 2009 Dec;18(12):1290-9.
  8. Noto Y, Kitajima M, Kudo M, Okudera K, Hirota K. Leg massage therapy promotes psychological relaxation and reinforces the first-line host defense in cancer patients. J Anesth. 2010 Dec;24(6):827-31.
  9. Krohn M, Listing M, Tjahjono G, et al. Depression, mood, stress, and Th1/Th2 immune balance in primary breast cancer patients undergoing classical massage therapy. Support Care Cancer. 2010 Jul 20.
  10. Torres Lacomba M, Yuste Sánchez MJ, Zapico Goñi A, et al. Effectiveness of early physiotherapy to prevent lymphoedema after surgery for breast cancer: randomised, single blinded, clinical trial. BMJ. 2010 Jan 12;340:b5396.
  11. 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. Ann Intern Med. 2011 Jul 5;155(1):1-9.
  12. Toth M, Marcantonio ER, Davis RB, et al. Massage Therapy for Patients with Metastatic Cancer: A Pilot Randomized Controlled Trial. J Altern Complement Med. 2013 Jul;19(7):650-6.
  13. Wyatt G, Sikorskii A, Rahbar MH, et al. Health-related quality-of-life outcomes: a reflexology trial with patients with advanced-stage breast cancer. Oncol Nurs Forum. 2012 Nov;39(6):568-77.
  14. Quattrin R, Zanini A, Buchini S, et al. Use of reflexology foot massage to reduce anxiety in hospitalized cancer patients in chemotherapy treatment: methodology and outcomes. J Nurs Manag. 2006 Mar;14(2):96-105.
  15. Sharp DM, Walker MB, Chaturvedi A, et al. A randomised, controlled trial of the psychological effects of reflexology in early breast cancer. Eur J Cancer. 2010 Jan;46(2):312-22. 
  16. Stephenson NL, Swanson M, Dalton J, et al. Partner-delivered reflexology: effects on cancer pain and anxiety. Oncol Nurs Forum. 2007 Jan;34(1):127-32.
  17. Perlman AI, Ali A, Njike VY, et al. Massage therapy for osteoarthritis of the knee: a randomized dose-finding trial. PLoS One. 2012;7(2):e30248. 
  18. Sherman KJ, Cook AJ, Wellman RD, et al. Five-week outcomes from a dosing trial of therapeutic massage for chronic neck pain. Ann Fam Med. 2014 Mar-Apr;12(2):112-20. 
  19. Givi M. Durability of effect of massage therapy on blood pressure. Int J Prev Med. 2013 May;4(5):511-6.
  20. Braun LA, Stanguts C, Casanelia L, et al. Massage therapy for cardiac surgery patients—a randomized trial. J Thorac Cardiovasc Surg. 2012 Dec;144(6):1453-9.
  21. Dion LJ, Engen DJ, Lemaine V, et al. Massage therapy alone and in combination with meditation for breast cancer patients undergoing autologous tissue reconstruction: A randomized pilot study. Complement Ther Clin Pract. May 2016;23:82-87.
  22. Wang TJ, Wang HM, Yang TS, et al. The effect of abdominal massage in reducing malignant ascites symptoms. Res Nurs Health. Feb 2015;38(1):51-59.
  23. Jacobs S, Mowbray C, Cates LM, et al. Pilot Study of Massage to Improve Sleep and Fatigue in Hospitalized Adolescents With Cancer. Pediatr Blood Cancer. May 2016;63(5):880-886.
  24. Pinar R, Afsar F. Back Massage to Decrease State Anxiety, Cortisol Level, Blood Prsessure, Heart Rate and Increase Sleep Quality in Family Caregivers of Patients with Cancer: A Randomised Controlled Trial. Asian Pac J Cancer Prev. 2015;16(18):8127-8133.
  25. Miller J, Dunion A, Dunn N, et al. Effect of a Brief Massage on Pain, Anxiety, and Satisfaction With Pain Management in Postoperative Orthopaedic Patients. Orthop Nurs. Jul-Aug 2015;34(4):227-234.
  26. Khorsand A, Tadayonfar MA, Badiee S, et al. Evaluation of the Effect of Reflexology on Pain Control and Analgesic Consumption After Appendectomy. J Altern Complement Med. Dec 2015;21(12):774-780.
  27. Dreyer NE, Cutshall SM, Huebner M, et al. Effect of massage therapy on pain, anxiety, relaxation, and tension after colorectal surgery: A randomized study. Complement Ther Clin Pract. Aug 2015;21(3):154-159.
  28. Peng S, Ying B, Chen Y, et al. Effects of massage on the anxiety of patients receiving percutaneous coronary intervention. Psychiatr Danub. Mar 2015;27(1):44-49.
  29. Mei L, Miao X, Chen H, et al. Effectiveness of Chinese Hand Massage on Anxiety Among Patients Awaiting Coronary Angiography: A Randomized Controlled Trial. J Cardiovasc Nurs. Mar/Apr 2017;32(2):196-203.
  30. Mobini-Bidgoli M, Taghadosi M, Gilasi H, et al. The effect of hand reflexology on anxiety in patients undergoing coronary angiography: A single-blind randomized controlled trial. Complement Ther Clin Pract. May 2017;27:31-36.
  31. Saatsaz S, Rezaei R, Alipour A, et al. Massage as adjuvant therapy in the management of post-cesarean pain and anxiety: A randomized clinical trial. Complement Ther Clin Pract. Aug 2016;24:92-98.
  32. Moraska AF, Schmiege SJ, Mann JD, et al. Responsiveness of Myofascial Trigger Points to Single and Multiple Trigger Point Release Massages: A Randomized, Placebo Controlled Trial. Am J Phys Med Rehabil. Sep 2017;96(9):639-645.
  33. Seyyed-Rasooli A, Salehi F, Mohammadpoorasl A, et al. Comparing the effects of aromatherapy massage and inhalation aromatherapy on anxiety and pain in burn patients: A single-blind randomized clinical trial. Burns. Dec 2016;42(8):1774-1780.
  34. Gregory R, Gilles C, Aude A, et al. Effects of massage therapy on anxiety, depression, hyperventilation and quality of life in HIV infected patients: A randomized controlled trial. Complement Ther Med. Jun 2017;32:109-114.
  35. Moghimi-Hanjani S, Mehdizadeh-Tourzani Z, Shoghi M. The Effect of Foot Reflexology on Anxiety, Pain, and Outcomes of the Labor in Primigravida Women. Acta Med Iran. Aug 2015;53(8):507-511.
  36. Eguchi E, Funakubo N, Tomooka K, et al. The Effects of Aroma Foot Massage on Blood Pressure and Anxiety in Japanese Community-Dwelling Men and Women: A Crossover Randomized Controlled Trial. PLoS One. 2016;11(3):e0151712.
  37. Lee YM, Yeun YR. Effects of Combined Foot Massage and Cognitive Behavioral Therapy on the Stress Response in Middle-Aged Women. J Altern Complement Med. Jun 2017;23(6):445-450.
  38. Lamas K, Hager C, Lindgren L, et al. Does touch massage facilitate recovery after stroke? A study protocol of a randomized controlled trial. BMC Complement Altern Med. Feb 04 2016;16:50.
  39. Chen HL, Wu CC, Lin AC. Small bowel intramural hematoma secondary to abdominal massage. Am J Emerg Med. Apr 2013;31(4):758.e753-754.
  40. Kinkead B, Schettler PJ, Larson ER, et al. Massage therapy decreases cancer-related fatigue: Results from a randomized early phase trial. Cancer. 2018 Feb 1;124(3):546-554.
  41. Donoyama N, Satoh T, Hamano T, et al. Effects of Anma therapy (Japanese massage) on health-related quality of life in gynecologic cancer survivors: A randomized controlled trial. PLoS One. 2018;13(5):e0196638.
  42. Pach D, Piper M, Lotz F, et al. Effectiveness and Cost-Effectiveness of Tuina for Chronic Neck Pain: A Randomized Controlled Trial Comparing Tuina with a No-Intervention Waiting List. J Altern Complement Med. Mar 2018;24(3):231-237.
  43. Xiong M, Li Y, Tang P, et al. Effectiveness of Aromatherapy Massage and Inhalation on Symptoms of Depression in Chinese Community-Dwelling Older Adults. J Altern Complement Med. Jul 2018;24(7):717-724.
  44. Lyman GH, Greenlee H, Bohlke K, et al. Integrative Therapies During and After Breast Cancer Treatment: ASCO Endorsement of the SIO Clinical Practice Guideline. J Clin Oncol. Sep 1 2018;36(25):2647-2655.
  45. Greenlee H, DuPont-Reyes MJ, Balneaves LG, et al. Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA Cancer J Clin. May 6 2017;67(3):194-232.
  46. Izgu N, Metin ZG, Karadas C, et al. Prevention of chemotherapy-induced peripheral neuropathy with classical massage in breast cancer patients receiving paclitaxel: An assessor-blinded randomized controlled trial. Eur J Oncol Nurs. Jun 2019;40:36-43.
  47. Devoogdt N, Geraerts I, Van Kampen M, et al. Manual lymph drainage may not have a preventive effect on the development of breast cancer-related lymphoedema in the long term: a randomised trial. J Physiother. Oct 2018;64(4):245-254.
  48. Son SH, Lee CH, Jung JH, et al. The Preventive Effect of Parotid Gland Massage on Salivary Gland Dysfunction During High-Dose Radioactive Iodine Therapy for Differentiated Thyroid Cancer: A Randomized Clinical Trial. Clin Nucl Med. Aug 2019;44(8):625-633.
  49. Larkin PJ, Cherny NI, La Carpia D, et al. Diagnosis, assessment and management of constipation in advanced cancer: ESMO Clinical Practice Guidelines. Ann Oncol. Oct 1 2018;29(Suppl 4):iv111-iv125.
  50. Perlman A, Fogerite SG, Glass O, et al. Efficacy and Safety of Massage for Osteoarthritis of the Knee: a Randomized Clinical Trial. J Gen Intern Med. Mar 2019;34(3):379-386.
  51. Sharma I, Joseph D, Kirton O. Traumatic complications of inpatient massage therapy: Case report and literature review. Trauma Case Rep. Dec 2018;18:1-4.
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