Swedish Massage

Ling, Mezger and a disputed name

A physiotherapy history article credits Pehr Henrik Ling with founding the Swedish system of exercise and describes massage as a relatively minor part of his gymnastic regime. The same article says the style now called Swedish massage grew from the work of Johann Georg Mezger, who was born in 1838, trained as a physician in the Netherlands, graduated in 1868 and opened a private clinic in Amsterdam within two years. It states that his practice was mislabeled Swedish after it converged with Ling's ideas.

According to the same article, Mezger published little beyond his final dissertation, on friction treatment for ankle sprains, and his reputation spread largely through others. It reports that the Swedish physicians Berghmann and Helleday named four massage movements after time spent with him. The article cites a 2024 book on massage history, and this page relies on that single secondary account for the origin story, so the details should be read as one historian's reconstruction.

Place in modern massage training

The National Center for Complementary and Integrative Health (NCCIH) describes Swedish, or classical, massage as the most common form of massage in Western countries and the core of most massage training. It lists it alongside sports massage, clinical massage aimed at specific goals such as easing muscle spasms, and Eastern-derived styles such as shiatsu and tuina. The sources reviewed do not give dated figures for how the style spread between countries.

Names in use

NCCIH uses the pairing Swedish (classical) massage, and research reports usually say Swedish massage or Swedish massage therapy, often shortened to SMT. The word Swedish refers to the Ling tradition of gymnastics, while the history article cited here argues that the label attached to Mezger's Amsterdam practice by convergence of the two traditions. The name therefore describes a lineage of technique more than a place of origin.

The four named strokes

The history article lists the four movements named by Berghmann and Helleday as effleurage, friction, petrissage and tapotement. These French terms remain the standard vocabulary of the style: effleurage refers to long gliding strokes, petrissage to lifting and kneading of muscle, friction to small circular or transverse pressure, and tapotement to rhythmic tapping. The definitions of the individual strokes in this paragraph are general usage and are not drawn from a separate source.

Relation to other massage styles

NCCIH separates Swedish massage from sports massage, clinical massage, shiatsu and tuina. Trials that use the term Swedish massage generally apply a specified protocol, for example a fixed 45 minute session compared with a light-touch condition, so results apply to that protocol and should not be carried to other massage styles or to unstructured spa sessions.

What a session involves

In the research reviewed, Swedish massage is hands-on manual treatment of soft tissue delivered by trained therapists. A single-session study of 53 healthy adults aged 18 to 45 compared 45 minutes of Swedish massage with a light-touch control, using highly specified and matched protocols. Therapists were trained in both protocols and monitored through audiotapes and post-session interviews with participants.

Schedules differ by study. A 6 week trial in generalized anxiety disorder used twice-weekly sessions, and an 8 week trial in older adults with knee osteoarthritis used a home-based schedule of three 30 minute sessions per week. The sources reviewed do not describe a single standard session length or frequency.

Practitioners, certification and codes

In the United States the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) offers a Board Certification credential. Its About page says candidates pass its exam and a criminal background check and agree to uphold its Standards of Practice and Code of Ethics, and it reports a 50 percent exam pass rate for 2024. The page does not list training hours, and no statutory requirements are described here.

The American Massage Therapy Association (AMTA) publishes a Code of Ethics for members in two parts. The Principles are aspirational, and the Rules are enforceable conditions of membership. They include working within scope of practice and truthful advertising that does not misrepresent services, credentials or results.

Conditions and goals in the research literature

Swedish massage is promoted for relaxation, stress and muscle tension, and has been studied in specific groups. The trials reviewed here examined people with generalized anxiety disorder, older adults with knee osteoarthritis and healthy adults measured for hormone and immune markers. NCCIH more broadly reports studies of massage for low-back, neck and shoulder pain, knee osteoarthritis, headache, and anxiety in people with cancer, HIV or fibromyalgia, without confining those studies to the Swedish style.

Mechanisms proposed by researchers

Researchers have proposed that massage may act through oxytocin, vasopressin, cortisol and immune pathways. One exploratory team hypothesized that Swedish massage would raise oxytocin and so lower stress-axis activity. Their results did not support oxytocin as the mediator, and the authors describe the work as preliminary. These are hypotheses under test and not established explanations.

Generalized anxiety disorder trials

A proof-of-concept randomized trial at Emory University assigned 47 untreated adults with generalized anxiety disorder to twice-weekly Swedish massage or light touch for 6 weeks. Of 40 evaluable participants, the Hamilton Anxiety Rating Scale fell by a mean of 11.67 points with massage and 8.41 with light touch, a 3.26 point difference (P = .030, effect size -0.69, 95 percent CI -1.33 to -0.05). The authors cite small size and the impossibility of masking participants, and the comparator was light touch, not an established anxiety treatment.

A follow-up report found that scores kept falling with an additional 6 weeks, with most change in the first 12 sessions, and called its findings preliminary. A survey of the 19 participants who responded found that nine, or 47 percent, reported no return of symptoms up to 1 year after the study. That survey was uncontrolled and covered under half of those who qualified, so it cannot show lasting benefit.

Stress physiology in healthy adults

In the single-session study, Swedish massage was associated with a large effect size decrease in arginine-vasopressin and a small decrease in cortisol compared with light touch, along with changes in lymphocyte counts and cytokine levels. In the 5 week repeated-massage study, weekly and twice-weekly schedules produced different hormone and cytokine patterns, and the authors called confirmatory work in larger samples necessary. The authors note small samples, young healthy participants and that blood hormone levels may not reflect central effects, and these studies did not measure symptoms or clinical outcomes.

Knee osteoarthritis

A 2026 randomized trial in Iran assigned 75 adults over 60 with knee osteoarthritis to Swedish massage, hip strengthening exercises or a control for 8 weeks. Compared with control, massage lowered visual analog pain by an adjusted 0.81 cm (95 percent CI 0.38 to 1.24), and no serious adverse events occurred. A published comment on the trial noted that participants could not be blinded while outcomes were subjective, that the sample was modest and that the large screening-to-enrollment ratio limits generalization.

Overall strength of the evidence

NCCIH reviews massage in general and rates evidence for low-back pain as weak, saying reviewers had very little confidence in it as an effective treatment, with cancer-related anxiety evidence of very low quality. Searches of PubMed for systematic reviews specific to Swedish massage, run on 2026-10-11, did not locate one, so the trials above are individual studies with small samples, short follow-up and comparators that make attention effects hard to separate.

Harms reported in the literature

A systematic review of reports of adverse effects of massage found 16 case reports and four case series. Reported events included cerebrovascular accidents, hematoma, nerve damage, pulmonary embolism and pain syndromes, and in most cases a causal link seemed plausible. The review states that serious adverse effects were associated mostly with techniques other than Swedish massage, with massage delivered by laypeople, and that serious events are probably true rarities. Only the abstract could be read for this page.

NCCIH likewise says the risk of harm appears low and names rare serious events including blood clots, nerve injury and bone fracture, mostly linked to vigorous methods such as deep tissue massage or to people at higher injury risk, such as older adults. In the Swedish massage trials reviewed, no serious adverse events were reported, though acne in one trial was attributed to a lubricant.

Suitability and care boundaries

NCCIH notes that therapists may need lighter pressure for people with cancer, and that people with bleeding disorders, those taking anticoagulants and pregnant people should consult a health care provider, a point the page itself does not address. It warns against using massage to delay seeing a provider about a medical problem. This page describes published information and does not replace assessment or treatment by a clinician.