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Massage as a CAM


Massage Therapy as CAM

Massage therapy is a practice that dates back thousands of years. There are

many types of massage therapy; all involve manipulating the muscles and other

soft tissues of the body. In the United States, massage therapy is sometimes

part of conventional medicine.In other instances, it is part of complementary

and alternative medicine (CAM).This Backgrounder provides a general

overview of massage therapy used as CAM and suggests some resources you

can use to learn more.

Key Points

People use massage therapy as CAM for a variety of health-related purposes,

from treating specific diseases and conditions to general wellness.

Scientists do not fully know what changes occur in the body during

massage, whether they influence health, and, if so, how. The National

Center for Complementary and Alternative Medicine (NCCAM) is sponsoring

studies to answer these questions and identify the purposes for which

massage may be most helpful.

There appear to be few risks to massage therapy if it is used appropriately

and provided by a trained massage professional.

Tell your health care providers about any CAM therapy you are considering

or using, including massage therapy. This helps to ensure safe and

coordinated care.

Conventional medicine is medicine as practiced by holders of M.D. (medical doctor) and D.O. (doctor of

osteopathy) degrees and by their allied health professionals, such as physical therapists, psychologists, and

registered nurses. An example of massage therapy as conventional medicine is using it to reduce a type of

swelling called lymphedema.

CAM is a group of diverse medical and health care systems, practices, and products that are not presently

considered to be part of conventional medicine. While some scientific evidence exists regarding some CAM

therapies, for most there are key questions that are yet to be answered through well-designed scientific

studies. An example of massage therapy as CAM is using it with the intent to enhance immune system


What Massage Therapy Is

The term massage therapy (also called massage, for short; massage also refers to an individual

treatment session) covers a group of practices and techniques. There are over 80 types of

massage therapy. In all of them, therapists press, rub, and otherwise manipulate the muscles

and other soft tissues of the body, often varying pressure and movement. They most often use

their hands and fingers, but may use their forearms, elbows, or feet. Typically, the intent is to

relax the soft tissues, increase delivery of blood and oxygen to the massaged areas, warm

them, and decrease pain.

A few popular examples of this therapy are as follows:

In Swedish massage, the therapist uses long strokes, kneading, and friction on the

muscles and moves the joints to aid flexibility.

A therapist giving a deep tissue massage uses patterns of strokes and deep finger pressure

on parts of the body where muscles are tight or knotted, focusing on layers of muscle deep

under the skin.

In trigger point massage (also called pressure point massage), the therapist uses a variety

of strokes but applies deeper, more focused pressure on myofascial trigger points—"knots"

that can form in the muscles, are painful when pressed, and cause symptoms elsewhere in

the body as well.

In shiatsu massage, the therapist applies varying, rhythmic pressure from the fingers on

parts of the body that are believed to be important for the flow of a vital energy called qi.

Massage therapy (and, in general, the laying on of hands for health purposes) dates back

thousands of years. References to massage have been found in ancient writings from many

cultures, including those of Ancient Greece, Ancient Rome, Japan, China, Egypt, and the

Indian subcontinent.

In the United States, massage therapy first became popular and was promoted for a variety of

health purposes starting in the mid-1800s. In the 1930s and 1940s, however, massage fell out of

favor, mostly because of scientific and technological advances in medical treatments. Interest

in massage revived in the 1970s, especially among athletes.

More recently, a 2002 national survey on Americans' use of CAM (published in 2004) found that

5 percent of the 31,000 participants had used massage therapy in the preceding 12 months,

and 9.3 percent had ever used it. According to recent reviews, people use massage for a wide

variety of health-related intents: for example, to relieve pain (often from musculoskeletal

conditions, but from other conditions as well); rehabilitate sports injuries; reduce stress;

increase relaxation; address feelings of anxiety and depression; and aid general wellness.

Who Provides Massage Therapy

A person who professionally provides massage therapy is most often called a massage

therapist, although there are some other health care providers (such as chiropractors) who also

have massage training. This Backgrounder mainly uses the term massage therapist. Most

massage therapists learn and practice more than one type of massage.

To learn massage, most therapists attend a school or training program, with a much smaller

number training instead with an experienced practitioner. Many students are already licensed

as another type of health care provider, such as a nurse.

There are about 1,300 massage therapy schools, college programs, and training programs in

the United States. The course of study typically covers subjects such as anatomy and

physiology (structure and function of the body); kinesiology (motion and body mechanics);

therapeutic evaluation; massage techniques; first aid; business, ethical, and legal issues; and

hands-on practice of techniques. These educational programs vary in many respects, such as

length, quality, and whether they are accredited. Many require 500 hours of training, which is

the same number of hours that many states require for certification. Some therapists also

pursue specialty or advanced training.

At the end of 2004, 33 states and the District of Columbia had passed laws regulating massage

therapy—for example, requiring that massage therapists graduate from an approved school or

training program and pass the national certification exam in their field in order to practice.

Cities and counties may have laws that apply as well. Professional organizations of massage

therapists have not agreed upon the standards for recognizing that a massage therapist is

properly and adequately trained.

Licenses and Certifications

Some common licenses or certifications for massage therapists include:

LMT Licensed Massage Therapist

LMP Licensed Massage Practitioner

CMT Certified Massage Therapist

NCTMB Has met the credentialing requirements (including passing an exam) of the

National Certification Board for Therapeutic Massage and Bodywork, for

practicing therapeutic massage and bodywork

NCTM Has met the credentialing requirements (including passing an exam) of the

National Certification Board for Therapeutic Massage and Bodywork, for

practicing therapeutic massage

What Massage Therapists Do in Treating Patients

Massage therapists work in a variety of settings, including private offices, hospitals, other

clinical settings, nursing homes, studios, and sport and fitness facilities. Some also travel to

patients' homes or workplaces to provide a massage.

Massage therapy treatments usually last for 30 to 60 minutes; less often, they are as short as 15

minutes or as long as 1.5 to 2 hours. For some conditions (especially chronic ones), therapists

often advise a series of appointments. Therapists usually try to provide an environment that is

as calm and soothing as possible (for example, by using dim lighting, soft music, and


At the first appointment, a massage therapist will discuss your symptoms, medical history, the

results you (and your health care provider, if applicable) desire, and possibly other factors such

as your work and levels of stress. She will likely perform some evaluations through touch. If

she finds nothing that would make a massage inadvisable, she will proceed with the massage.

At any time, you can bring up questions or concerns.

During treatment, you will lie on a special padded table or sit on a stool or chair. You might be

fully clothed (for example, for a "chair massage") or partially or fully undressed (in which case

you will be covered by a sheet or towel; only the parts of your body that the therapist is

currently massaging are exposed). Oil or powder helps reduce friction on the skin. The

therapist may use other aids, such as ice, heat, fragrances, or machines. He may also provide

recommendations for self-care, such as drinking fluids, learning better movement, and

developing an awareness of your body.

Why People Use Massage Therapy

In the 2002 national survey on Americans' use of CAM, respondents who used a CAM

therapy could choose from five reasons for using the therapy. The results for massage

were as follows:

They believed that massage combined with conventional medicine would

help: 60 percent

They thought massage would be interesting to try: 44 percent

They believed that conventional medical treatments would not help: 34 percent

Massage was suggested by a conventional medical professional: 33 percent

They thought that conventional medicine was too expensive: 13 percent

Side Effects and Risks

Massage therapy appears to have few serious risks if appropriate cautions are followed. A very

small number of serious injuries have been reported, and they appear to have occurred mostly

because cautions were not followed or a massage was given by a person who was not properly


Health care providers recommend that patients not have massage therapy if they have one or

more of the following conditions:

Deep vein thrombosis (a blood clot in a deep vein, usually in the legs)

A bleeding disorder or taking blood-thinning drugs such as warfarin

Damaged blood vessels

Weakened bones from osteoporosis, a recent fracture, or cancer

A fever

Any of the following in an area that would be massaged:

An open or healing wound

A tumor

Damaged nerves

An infection or acute inflammation

Inflammation from radiation treatment.

If you have one or more of the following conditions, be sure to consult your health care

provider before having massage:



Fragile skin, as from diabetes or a healing scar

Heart problems

Dermatomyositis, a disease of the connective tissue

A history of physical abuse.

Side effects of massage therapy may include:

Temporary pain or discomfort



A sensitivity or allergy to massage oils.

Some Other Points To Consider About Massage Therapy as CAM

Massage therapy should not be used to replace your regular medical care or to delay seeing

a doctor about a medical problem.

Before you decide about having massage therapy, ask the therapist about:

Her training, experience, and any licenses or credentials

Any medical conditions you have and whether she has had any specialized training or

experience with them

The number of treatments that might be needed


Insurance coverage, if any.

If a massage therapist suggests using other CAM practices (herbs or other supplements, a

special diet, etc.), discuss it first with your regular health care provider.

For findings from research studies on massage therapy for various health conditions,

see "For More Information." However, the available literature is limited, and more research

is needed to make firm conclusions.

How Massage Therapy Might Work

Scientists are studying massage to understand what effects massage therapy has on patients,

how it has those effects, and why. Some aspects of this are better understood than others. For

example, it is known that:

When certain forces are applied to the muscles, changes occur in the muscles (although

those changes are not clearly understood or agreed upon).

Massage therapy typically enhances relaxation and reduces stress. Stress makes some

diseases and conditions worse.

There are many more aspects that are not yet known or well understood scientifically,

however. Some of the proposed theoriesare that massage:

Might provide stimulation that may help block pain signals sent to the brain (the "gate

control theory" of pain reduction).

Might shift the patient's nervous system away from the sympathetic and toward the

parasympathetic. The sympathetic nervous system helps mobilize the body for action.

When a person is under stress, it produces the fight-or-flight response (the heart rate and

breathing rate go up, for example; the blood vessels narrow; and muscles tighten). The

parasympathetic nervous system creates what some call the "rest and digest" response

(the heart rate and breathing rate slow down, for example; the blood vessels dilate; and

activity increases in many parts of the digestive tract).

Might stimulate the release of certain chemicals in the body, such as serotonin or


Might cause beneficial mechanical changes in the body—for example, by preventing

fibrosis (the formation of scar-like tissue) or increasing the flow of lymph (a fluid that

travels through the body's lymphatic system and carries cells that help fight disease).

Might improve sleep, which has a role in pain and healing.

Might provide some health benefit from the interaction between therapist and patient.

More well-designed studies are needed to understand and confirm these theories and other

scientific aspects of massage.

NCCAM-Sponsored Research on Massage

Some recent examples of NCCAM-sponsored research on massage include:

How massage affects healthy people, and whether these effects are different depending on

how many massages are given and how often

On this topic, see especially the reference by C.A. Moyer et al.

The effects of massage on chronic neck pain, and comparing the benefits of conventional

therapeutic massage with usual medical treatment

Massage for cancer patients at the end of life, to see if massage helps relieve depression,

improves emotional well-being and quality of life, and eases the process of dying

Whether massage given at home by a trained family member helps reduce pain from sickle

cell anemia.


Sources are primarily recent reviews on the general topic of massage therapy in the peerreviewed

medical and scientific literature in English in the PubMed database, selected

evidence-based databases, and Federal Government sources.

Alvarez DJ, Rockwell PG. Trigger points: diagnosis and management. American Family Physician. 2002;65(4):653-660.

Barnes PM, Powell-Griner E, McFann K, Nahin RL. Complementary and alternative medicine use among adults: United

States, 2002.CDC Advance Report #343. 2004.

Cherkin DC, Sherman KJ, Deyo RA, et al. A review of the evidence for the effectiveness, safety, and cost of

acupuncture, massage therapy, and spinal manipulation for back pain. Annals of Internal Medicine. 2003;138(11):898-907.

Corbin L. Safety and efficacy of massage therapy for patients with cancer. Cancer Control: Journal of the Moffitt Cancer

Center. 2005;12(3):158-164.

Dillard MH, Knapp S. Complementary and alternative pain therapy in the emergency department. Emergency Medicine

Clinics of North America. 2005;23(2):529-549.

Eisenberg DM, Cohen MH, Hrbek A, et al. Credentialing complementary and alternative medical providers. Annals of

Internal Medicine. 2002;137(12):965-973.

Ernst E. The safety of massage therapy. Rheumatology. 2003;42(9):1101-1106.

Field T. Massage therapy effects.American Psychologist. 1998;53(12):1270-1281.

Goldstone LA. Massage as an orthodox medical treatment past and future. Complementary Therapies in Nursing and

Midwifery. 2000;6(4):169-175.

Massage: Bottom Line Monograph. Natural Standard Web site. Accessed at www.naturalstandard.com on

August 22, 2006.

Massage Therapists: Occupational Outlook Handbook, 2006-2007 Edition. U.S. Bureau of Labor Statistics Web site. Accessed

at http://www.bls.gov/oco/ocos295.htm on August 22, 2006.

Moyer CA, Rounds J, Hannum JW. A meta-analysis of massage therapy research. Psychological Bulletin. 2004;130(1):3-18.

National Center for Complementary and Alternative Medicine.Manipulative and Body-Based Practices: An Overview.

Bethesda, MD: National Center for Complementary and Alternative Medicine; 2004. NCCAM publication no. D238.

National Institute of Arthritis and Musculoskeletal and Skin Diseases.Osteoarthritis. Bethesda, MD: National Institute of

Arthritis and Musculoskeletal and Skin Diseases; 2006. NIH publication no. 06-4617.

National Institute of Arthritis and Musculoskeletal and Skin Diseases.Osteoporosis: Coping With Chronic Pain. National

Institute of Arthritis and Musculoskeletal and Skin Diseases Web site. Accessed at

http://www.niams.nih.gov/bone/hi/osteoporosis_pain.htm on August 31, 2006.

Sherman KJ, Cherkin DC, Kahn J, et al. A survey of training and practice patterns of massage therapists in two U.S.

states. BioMed Central Complementary and Alternative Medicine. 2005;5:13.

Weerapong P, Hume PA, Kolt GS. The mechanisms of massage and effects on performance, muscle recovery and injury

prevention. Sports Medicine. 2005;35(3):235-256.

Created September 2006 D327

For More Information

NCCAM Clearinghouse

The NCCAM Clearinghouse provides information on CAM and NCCAM, including publications

and searches of Federal databases of scientific and medical literature. Examples of relevant

publications include Manipulative and Body-Based Practices: An Overview, Selecting a CAM

Practitioner, and Conference on the Biology of Manual Therapies, June 9-10, 2005: Conference

Recommendations. The Clearinghouse does not provide medical advice, treatment

recommendations, or referrals to practitioners.

Toll-free in the U.S.: 1-888-644-6226

TTY (for deaf and hard-of-hearing callers): 1-866-464-3615

Web site: nccam.nih.gov

E-mail: info@nccam.nih.gov


A service of the National Library of Medicine (NLM), PubMed contains publication information

and (in most cases) brief summaries of articles from scientific and medical journals. CAM on

PubMed, developed jointly by NCCAM and NLM, is a subset of the PubMed system and focuses

on the topic of CAM.

Web site: www.ncbi.nlm.nih.gov/entrez

CAM on PubMed: nccam.nih.gov/camonpubmed/


NCCAM thanks the following people for their technical expertise and review of this

publication: Karen Sherman, Ph.D., M.P.H., Center for Health Studies, Group Health

Cooperative; Jeanette Ezzo, Ms.T., M.P.H., Ph.D., National Advisory Council for Complementary

and Alternative Medicine; and Partap Khalsa, D.C., Ph.D.; Richard Nahin, Ph.D., M.P.H.; and

Linda Rich, M.P.S., C.M.T., NCCAM.

This publication is not copyrighted and is in the public domain.

Duplication is encouraged.

NCCAM has provided this material for your information. It is not intended to substitute

for the medical expertise and advice of your primary health care provider. We

encourage you to discuss any decisions about treatment or care with your health care

provider. The mention of any product, service, or therapy is not an endorsement by


National Institutes of Health


U.S. Department of Health and Human Services