Benefits of Massage

By Susan Bernstein and Mary Anne Dunkin

Massage, whether conducted in a softly lit day spa or a treatment room at a physical therapy clinic, is increasingly popular among people seeking to soothe sore joints and muscles, ease anxiety or improve sleep.

Nearly one in five U.S. adults had at least one massage in the previous year, according to the American Massage Therapy Association’s (AMTA) 2017 Consumer Survey . Of those, 42 percent received massage for health or medical reasons such as pain management, soreness, stiffness or injury rehabilitation.

Research suggests that massage can affect the body’s production of certain hormones linked to blood pressure, anxiety, heart rate and other key vital signs. But is massage safe and effective for people with arthritis?

What the Research Reveals
While most research on massage examines its effects on the general population, a number of recent studies have shown its effectiveness in people with arthritis and related conditions.

Knee osteoarthritis (OA). A handful of studies, including a 2018 study published in the Journal of General Internal Medicine , have found massage to be beneficial for people with knee osteoarthritis. The 2018 study, which assigned 200 patients with knee OA into one of three treatment groups, found those receiving a one-hour whole-body massage weekly experienced significant improvement in pain and mobility after eight weeks compared to those receiving light touch or standard care.

Hand arthritis. In an earlier study conducted at the University of Miami, a 15-minute, moderate pressure massage daily led to reduced pain and anxiety and improved grip strength in 22 adults diagnosed with hand or wrist arthritis. The participants were given four weekly massages from a therapist and taught to massage their sore joints daily at home. Results showed that the combination of massages could possibly reduce hand pain up to 57 percent.

Fibromyalgia. A 2014 review of nine randomized trials published in PLoS One found that massage therapy for five weeks or more significantly improved pain, anxiety and depression in patients with fibromyalgia.

Back pain. One of the most common reasons people pursue massage is for low back and neck pain, according to the National Center for Complementary and Integrative Health. A body of evidence confirms its effectiveness for that purpose, including a study of 401 people with chronic low back pain published in the Annals of Internal Medicine . The study found that people receiving 10 weekly sessions of either relaxation massage or structural massage had less pain and were better able to perform daily activities than those receiving usual care (such as analgesic and anti-inflammatory medications, physical therapy and education). However, the benefits of massage were less clear 12 months after message therapy ended. A separate 2014 study in Scientific World Journal found that deep tissues massage alone relieved back pain equally as well as the combination of massage and nonsteroidal anti-inflammatory drugs (NSAIDs).

How Does Massage Work?
How exactly does massage reduce pain and anxiety for people with arthritis? “We know that massage reduces anxiety quite well and can reduce certain painful conditions rather well. But we don’t know how those things are happening,” says Christopher Moyer, PhD, a psychologist at the University of Wisconsin in Stout.

Research has shown that massage can lower the body’s production of the stress hormone cortisol; decrease levels of the hormone arginine-vasopressin, which may lower blood pressure; reduce levels of some inflammatory cytokines including IL-4 and IL-10; and increase production of the mood-boosting hormone serotonin.

There are many variables involved in how massage may work to ease pain, stiffness and anxiety, says Rosemary Chunco, a licensed massage therapist in Plano, Texas, who treats many patients with arthritis and related diseases. “The actual mechanism that comes into play is still under investigation. For example, a more restful sleep that results from a massage may help with arthritis pain.”

What matters most is the level of pressure used in the massage, says Tiffany Field, PhD, a research psychologist at the University of Miami Medical School.  Field published a 2010 study in the International Journal of Neuroscience that showed stimulating pressure receptors – or nerves under the skin that convey pain-reducing signals to the brain – with moderate pressure leads to reduced symptoms.

“The critical thing is using moderate pressure,” says Field. “Light pressure, just touching the surface of the skin or brushing it superficially, is not getting at those pressure receptors. Light pressure can be stimulating, not relaxing.”

Considerations Before You Try Massage
If you’re interested in trying one of the many types of massage as a way to ease your arthritis symptoms, it’s important to consult your rheumatologist or primary-care physician first to ensure that massage is safe for you. Some techniques may involve strong pressure to sensitive tissues and joints or moving limbs into various positions that may be difficult for someone with damaged joints from a disease like rheumatoid arthritis or ankylosing spondylitis.

Use caution when considering massage if you have:

• Damaged or eroded joints from arthritis
• Flare of inflammation, fever or a skin rash
• Severe osteoporosis (brittle bones)
• High blood pressure
• Varicose veins

“It’s also very important to tell the therapist if you are experiencing pain or if you are uncomfortable with the work that she is doing. A good therapist will want feedback on what you are feeling during the session,” says Chunco.

Massage should make your arthritis pain and stiffness feel better, not worse, says Veena Ranganath, MD, a rheumatologist at the University of California, Los Angeles Department of Medicine. “I do tell my patients that if it hurts, don’t do it,” says Dr. Ranganath.

Your doctor also can refer you to a massage therapist, which may not only lead you to a qualified professional, but also help you qualify for reimbursement if your insurance policy covers massage treatments.

Massage is not medicine. It’s a complement to your doctor-prescribed arthritis treatment. Communication with your doctor and massage therapist beforehand can ensure that massage is right for you and help you achieve beneficial results.