What Does the Research Say?
Like many complementary therapies, high quality research on massage has
been limited due to the lack of funding. However several relatively recent
developments have increased the amount of good research in this area.

To begin, massage has become an important research priority for the
National Center for Complementary and Alternative Medicine (NCCAM ). In
addition, the American Massage Therapy Association, recognizing the
importance of high quality research, convened a working group of
established research scientists and leaders in massage therapy in 1999.
The outcome was a recommended research agenda for the massage
therapy profession that included building a massage research infrastructure
and investigating the safety, efficacy, and mechanisms of massage therapy.

So while there is still relatively little massage therapy research compared to
other treatment approaches, high quality research is emerging. This is
particularly true in the area of low back pain, but also for other healthcare
concerns, such as cancer symptom management, premature infancy, and
other areas.

What are some of the issues in researching massage?
Like any treatment, massage therapy can and should be studied using
rigorous scientific methods. However, massage therapists, because of the
unique nature of their therapy and how it is delivered, face special
challenges when conducting research.

In medicine, the gold standard for clinical research has traditionally been the
double-blind, placebo-controlled clinical trial. Both the provider and the
patient are masked as to the whether a real treatment or placebo is
delivered, minimizing bias, and maximizing the chance that the observed
results are due to the true therapeutic effect of the treatment in question.

While this approach works well for drug trials (the placebo pill can be made
to look identical to the real pill), it isn’t effective for treatments like massage.
Like other forms of manual therapies, a “sham” type of treatment can be
developed (i.e. light touch massage); however, it can’t be assumed to be
completely devoid of therapeutic effects. In fact, several massage therapy
techniques utilize a light touch approach as a legitimate form of treatment.

Further, while attempts can be made to make the sham treatment appear
legitimate to the patient, it becomes difficult as patients learn more about
massage therapy from friends, media, and their own experience. Finally, it is
impossible to blind the therapist, who must know which treatment he or she
is supposed to deliver.

However, just because a randomized clinical trial can’t be placebo-
controlled or double-blinded, doesn’t mean it can’t be of high quality and
contribute to the greater scientific knowledge.

Good examples of high quality clinical trials are the ones reported by
Cherkin et al. in the Archives of Internal Medicine, which investigate
massage for low back pain.

What areas are being researched?
As massage therapy has many purported benefits, research has or is being
conducted on a wide range of patients with a variety of conditions. Most of
the research to date has included small, preliminary studies that lack the
methodological quality to draw firm conclusions regarding massage therapy’
s effectiveness.

However, in recent years, larger studies of higher quality have begun to
emerge, as have thorough and balanced reviews of the existing literature (i.
e. systematic reviews), which evaluate the effectiveness of massage
therapy. There are also several ongoing, federally funded, randomized
clinical trials studying the effect of massage on chronic back pain, cancer
pain, depression during pregnancy, and pre-term infants.

While the evidence to date is most compelling for low back pain, there are
also promising results regarding massage’s effectiveness for pre-term
infants, and symptom management in cancer and dementia sufferers.

One example is the study summarized below:

Cherkin et al. (2003) conducted a systematic review of existing reviews and
randomized controlled trials evaluating massage therapy, acupuncture, or
spinal manipulation. The purpose was to provide a rigorous and balanced
summary regarding the effectiveness, safety, and costs of the three
treatments for low back pain. They found evidence that massage was safe
and effective for persistent low back pain and may reduce the costs of care
after the course of treatment.

For updated information regarding ongoing randomized clinical trials on
massage therapy, search clinicaltrials.gov, a service of the U.S. National
Institutes of Health, and search “massage”.

To stay informed about recent studies published pertaining to massage and
other CAM therapies, go to CAM on PubMed.

References
Barnes P, Powell-Griner E, McFann K, Nahin R. (2002). Complementary and
alternative medicine use among adults: United States. CDC Advance Data
Report #343. 2004.

Cherkin DC, Eisenberg D, Sherman KJ, Barlow W, Kaptchuk TJ, Street J,
Deyo RA. (2001). Randomized trial comparing traditional Chinese medical
acupuncture, therapeutic massage, and self-care education for chronic low
back pain. Arch Intern Med, 161(8):1081-8.

Cherkin DC, Sherman KJ, Deyo RA, Shekelle PG. (2003). A review of the
evidence for the effectiveness, safety, and cost of acupuncture, massage
therapy, and spinal manipulation for back pain. Ann Intern Med, 138(11):898-
906.

Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL.
(1993). Unconventional medicine in the United States. Prevalence, costs,
and patterns of use. N Engl J Med, 328(4):246-52.

Eisenberg DM, Davis RB, Ettner SL, et al. Trends in alternative medicine use
in the United States, 1990-1997: results of a follow-up national survey.
(1998). Journal of the American Medical Association, 280(18):1569-1575.

Fellowes D, Barnes K, Wilkinson S. (2004). Aromatherapy and massage for
symptom relief in patients with cancer. Cochrane Database of Systematic
Reviews, Issue 3. Art. No.: CD002287. DOI: 10.1002/14651858.CD002287.
pub2.

Haraldsson BG, Gross AR, Myers CD, Ezzo JM, Morien A, Goldsmith C,
Peloso PM, Bronfort G, Cervical Overview Group. (2006). Massage for
mechanical neck disorders. Cochrane Database of Systematic Reviews,
Issue 3. Art. No.: CD004871. DOI: 10.1002/14651858.CD004871.pub3.

Underdown A, Barlow J, Chung V, Stewart-Brown S. (2006). Massage
intervention for promoting mental and physical health in infants aged under
six months. Cochrane Database of Systematic Reviews, Issue 4. Art. No.:
CD005038. DOI: 10.1002/14651858.CD005038.pub2.

Viggo Hansen N, Jorgensen T, Ortenblad L. (2006). Massage and touch for
dementia. Cochrane Database Syst Rev. 18;(4):CD004989.

Vickers A. Methodological issues in complementary and alternative
medicine research: a personal reflection on 10 years of debate in the United
Kingdom. (1996). J Altern Complement Med, 2(4):515-24.

Expert Contributors: Roni Evans, DC, MS

Reviewed by: Dale Healey, DC

Date: October 2008
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