Massage

Nineteenth-century systems and the Swedish label

A review of massage in orthodox medicine notes that accounts of massage usually cite long use in ancient cultures and then stop with Per Henrik Ling, to whom modern massage in the early nineteenth century is attributed. Its author found a rich late nineteenth and early twentieth century literature in which massage was practiced as an orthodox therapy by doctors and nurses, in forms that differed from most current practice despite similar terminology. The therapy almost disappeared after the Second World War and re-emerged as a complementary therapy.

An essay on the Dutch physician Johann Georg Mezger, who lived from 1838 to 1909, says he qualified in medicine in 1868 and opened a clinic in Amsterdam within about two years. It credits Ling with a Swedish exercise system in which massage played a minor part, and says that Mezger's manual practice was labeled Swedish massage through a later convergence of the two approaches. It reports that Swedish physicians named four movements, effleurage, friction, petrissage and tapotement, after clinical time with Mezger. This is a single essay on a history site, so its dates and attributions need confirmation against primary scholarship.

Massage in nursing and medicine

A history of US nurse training found that massage instruction was delivered by physicians, nurses or masseurs for many conditions in the 1880s to 1900s. In the 1930s and 1940s influential nurse educators began recommending specialization in physiotherapy, and as pharmacological treatments became popular, basic comfort massage by nurses declined. A 2016 nursing article likewise describes massage as a skill once taught as core to nursing that lost ground in the second half of the twentieth century and has since seen renewed interest.

Regional and twentieth-century lineages

UNESCO inscribed Nuad Thai on its Representative List of the Intangible Cultural Heritage of Humanity in 2019. It describes the practice as beginning as self-care in rural Thai communities, where village massage healers were consulted for muscle pain from farm work, and notes a 1985 project to revitalize and expand knowledge of it. A Swiss practitioner association states that rhythmical massage began in 1921 at a clinic in Arlesheim, Switzerland, developed by the physician Ita Wegman on an anthroposophic basis.

Manual lymph drainage is attributed to Emil Vodder in the 1930s, using light touch in contrast to the heavy pressure of common Scandinavian massage of the period. One practitioner account says neuromuscular technique was developed in the 1930s by Stanley Lief and Boris Chaitow from the method of an Ayurvedic physician in Paris, and that trigger point work, shaped by Janet Travell, became a focus from the late 1950s. Japanese anma is described in a trial protocol as long used and widely popular in Japan; the sources reviewed give no dated history of it.

A family label with no single technique

The National Center for Complementary and Integrative Health (NCCIH) describes massage therapy as manipulation of the body's soft tissues, used to manage a health condition or to enhance wellness. A Cochrane review on back pain defined massage as soft-tissue manipulation using the hands or a mechanical device, and three of its 25 trials used a mechanical device. A review of neck pain trials found that descriptions of the massage and the credentials or experience of the massage professionals were frequently missing, so a trial label can stand for very different work. A historical review adds that lack of detailed specification of the massage limits much current research.

Overlapping style names

NCCIH lists Swedish (classical) massage as the most common style in Western countries, alongside sports massage, clinical massage aimed at goals such as releasing muscle spasms, and Eastern-derived styles such as shiatsu and tuina. Shiatsu is treated as a separate practice on this site rather than as a style of massage.

A 2017 narrative review found no commonly accepted definition of deep tissue massage; the definition used most often is the therapist's intention to reach deep tissue. Its authors propose reserving deep tissue massage for a specific method and using deep massage for any style applied with that intention. The CNHC core curriculum, a UK training standard, does not use the term remedial massage, so style names do not map neatly onto professional titles across countries.

Common elements

Sessions are delivered by a therapist's hands, and in some studies by devices, to muscle and connective tissue, with pressure adjusted to the person. NCCIH notes that therapists may need to use less pressure in sensitive areas for people with cancer. In a 2026 review of harms in cancer care, 16 of 29 intervention studies that reported adverse events used Swedish techniques, 17 described gentle or light pressure, and none described deep pressure.

Western styles

Swedish massage, according to a historical essay, uses four named movements: effleurage, friction, petrissage and tapotement. A review of deep tissue massage describes a method that works with layers of tissue to relax, lengthen and release holding patterns. Hot stone massage uses heated stones alongside Swedish massage or placed on the body, and a professional body article on safe use advises water-based heaters with temperature control. A 2023 review of 114 sports massage studies gave no single formal definition and grouped massage with related approaches such as rolling and acupressure.

Eastern and regional styles

UNESCO describes Nuad Thai as using the hands, elbows, knees and feet, often with herbal hot compresses, on the basis of energy lines called sen. A trial protocol describes anma as mainly kneading, with less stroking and pressing, applied over clothing at a comfortable pressure on a massage table. Manual lymph drainage is described as light-touch work. In the neuromuscular tradition, the European version uses delicate finger and thumb strokes to locate and deactivate trigger points, while the American version is a broader set of methods focused mainly on myofascial pain. Practitioners of rhythmical massage describe rhythm as central to the strokes. Ayurvedic massage appears in trials as one of several non-pharmacological Ayurvedic interventions, with steam therapy and enema.

Conditions and goals studied

NCCIH reports that massage has been studied for back pain, neck and shoulder pain, knee osteoarthritis, headaches, fibromyalgia, supportive care in cancer, HIV and AIDS, and weight gain in premature infants. A 2023 review of sports massage studies examined flexibility, soreness, performance and mood. Cochrane reviews exist for low back pain, neck pain, labor pain and breast cancer related lymphedema, and they are summarized under research and evidence.

Claims without support in the sources reviewed

Popular claims that massage flushes toxins or releases stored emotion were not supported by any source reviewed for this page, and they should not be repeated without a source for a specific claim in a specific population. The sources reviewed also do not document why most people seek massage, so this section lists research targets only.

Low back and neck pain

A 2015 Cochrane review of 25 trials (3,096 adults) with non-specific low back pain rated the evidence low to very low quality. Against inactive controls in sub-acute and chronic pain, massage lowered pain in the short term (standardized mean difference -0.75, 7 studies, 761 participants) and improved function (-0.72, 6 studies, 725 participants), but not in the long term. Against active comparators it also favored massage for pain in the short term (-0.37, 12 studies) and the long term (-0.40, 5 studies, confidence interval -0.80 to -0.01). The authors had very little confidence that massage is an effective treatment.

A Cochrane review of massage for neck disorders, with searches to September 2004, included 19 trials, 12 of them low quality. Six tested massage alone with inconsistent results, and the multimodal trials could not isolate massage. The authors made no practice recommendations.

Pain and cancer symptoms across trials

Two meta-analyses published in 2016, with searches to February 2014, pooled randomized trials of mixed massage styles. For pain populations in general (60 higher-quality and 7 lower-quality studies), massage was associated with less pain than sham (standardized mean difference -0.44), no treatment (-1.14) and active comparators (-0.26). In cancer populations (16 studies), pain was lower than with no treatment (-0.20) and active comparators (-0.55), with larger effects on fatigue (-1.06) and anxiety (-1.24) against active comparators; the recommendations were weak, and none were made against no treatment or sham. Pooling many styles does not show that any one style works.

Labor, lymphedema and single styles

A 2018 Cochrane review of 14 labor trials found that massage lowered first-stage pain more than usual care (-0.81, 6 trials, 362 women) on low-quality evidence, with no clear effect on labor length, assisted birth or cesarean on very low-quality evidence. For manual lymph drainage in breast cancer related lymphedema, a 2015 Cochrane review of six small trials found an additional 7.11% volume reduction when added to compression bandaging (two trials, 83 participants). A review of Thai massage for chronic pain found six studies with before-and-after pain reductions of 25% to 80%, which do not isolate the effect of the massage. A 2023 sports review found little direct effect on strength, speed or endurance. These results belong to their own style and condition and are not transferable.

Case reports and reviews of harm

A 2003 systematic review of massage harms found 16 case reports and four case series. Reported events included cerebrovascular accidents, hematoma, nerve damage, pulmonary embolism, displacement of a ureteral stent and ruptured uterus. Most were linked to unusual manual techniques or to non-professionals, with massage therapists rarely implicated, and serious events were mostly associated with techniques other than Swedish massage. The author concluded that serious events are probably rare.

A 2014 review of reports from 2003 to 2013 included 40 reports. Most involved spinal or cervical manipulation, often by chiropractors or unregistered practitioners, and eight involved massage therapists. Events included disc herniation, nerve injury, vertebral artery dissection, hematoma and one death after neck massage. Its authors note that case reports cannot establish causation or incidence.

Pressure and vigorous styles

NCCIH reports rare blood clots, nerve injury and bone fracture, in cases involving vigorous massage such as deep tissue or people at higher risk of injury such as older adults. A review of deep tissue massage likewise links rare serious events to forceful application. The low back pain trials in the Cochrane review reported no serious events, but increased pain in 1.5% to 25% of participants.

Cancer, pregnancy, heat and medications

A 2026 review of 66 studies in cancer care found no clear increase in adverse events (risk ratio 0.69, confidence interval 0.43 to 1.10 across 16 studies), on very low certainty, with mostly light massage; deep massage could not be assessed. The authors state that massage directly on a tumor is discouraged, though definitive evidence is lacking, and they list low platelet counts as a contraindication.

A professional body article on pregnancy says clients should be side-lying by the second trimester to reduce pressure on the vena cava and that certain pressure points are contraindicated, without listing them. An article on hot stone massage lists diabetes, neuropathy, heart disease, pregnancy and recent surgery as contraindications and states that burns are usually preventable. None of the sources reviewed for this page addresses massage for people taking anticoagulant medicine, and no professional body guidance on it was found, so it is not discussed here.

Training, professional standards and when to seek care

The CNHC core curriculum (November 2019) sets a minimum standard for safe and competent massage therapy and is the measure of eligibility for registration with the UK Complementary and Natural Healthcare Council; it expects trainees to recognize cautions and contraindications. In the US, the American Massage Therapy Association makes adherence to its code of ethics a condition of membership, with enforceable rules that include practicing within scope and a ban on sexual conduct with clients. According to NCCIH, massage should not be used to postpone seeing a health care provider about a medical problem.