“We have enough data to say the evidence is there that this really does help with back pain in particular,” confirms physician Josephine Briggs, director of the National Center for Complementary and Alternative Medicine at the National Institutes of Health. She alsocites a study published this year in the online journal PLoS One that found that patients with osteoarthritis of the knee who got a weekly 60-minute Swedish massage — a popular, gentle type of bodywork that may include kneading, pressing or stroking the muscles — experienced significant pain reduction and improved function compared with those who received standard care with no bodywork; the gains persisted even after treatment ended.
One of the most popular complementary and alternative therapies in the United States, massage can be especially advantageous for avid exercisers, says licensed massage therapist Rebekah Owens, an instructor at the Center for Integrative Medicine at the University of Maryland School of Medicine. In addition to improving range of motion, “post-workout massage helps reduce spasms and cramping, helps relax and soften the injured, overused, tired muscles, and helps to stretch and exercise weak, tight and atrophied muscles, which is also great in hospital settings for patients who are bedridden,” she explains.
Just the beginning
Science is only beginning to clarify the complex mechanisms behind such benefits. A study published this year found that when a small group of men exercised to exhaustion and then had a massage, it led to decreased production of cytokines, compounds that play a role in inflammation and pain, and it stimulated cell recovery — a double dose of benefits.
“[This work] suggests that with vigorous exercise, there may be activation of muscle inflammatory pathways — we all know that if you really overdo it with a long run you will be aching next day — and massage may help that,” observes Briggs, who was not involved in the research. “It might be partly from the manipulation of the muscle fibers, and partly from stimulating circulation to the muscle.”
Experts stress that massage isn’t just a physical experience: “We talk about these as mind and body therapies because part of the way they work is through physical mechanisms, but the touch of another human also has a reassuring, relaxing effect on a person’s emotional state that may impact how the body processes or responds to pain,” says Briggs, who notes that it can be a challenge to disentangle the two in research.
“When a baby is crying,” Owens says, “the first thing a mother does is pick her up and pat her back — it’s intuitive and instinctual: you want to be touched and you need to be touched.” Owens believes that’s especially true in today’s society, where there’s so much impersonal communication via technology. “Instead of friends giving each other hugs, we’re liking and poking each other via Facebook, and so we’re all somewhat touch-deprived. A massage comforts, calms and fulfills that innate need; it shows that somebody cares and wants you to feel better, which can be really powerful.”
Not too hard, not too soft
The key to an optimally beneficial massage is the proper amount of pressure, says Field of the Touch Research Institute.
“When you get a massage, you stimulate pressure receptors under the skin, which leads to an increase in vagal activity,” she says, referring to the vagus, one of the 12 cranial nerves that emerge directly from the brain. This can produce a wide range of positive effects — including lowering heart rate and blood pressure, increasing immune function and reducing stress hormones.
“We know you need to have moderate pressure, to really move the skin, in order for all these effects to occur,” Field says. “On the other hand, light pressure is experienced like a tickle stimulus, which is an arousing, opposite effect.”
Just remember that it doesn’t have to hurt to help: “One recent study found that the combination of touching and the manipulation of soft tissues was equally effective [in terms of pain reduction for lower-back problems] whether it was through gentler Swedish massage or deeper structural massage,” Briggs says.
“A lot of people think they need deep-tissue work, but what they really want is heavy pressure, which is pressing harder as opposed to actually digging in between the muscle fibers and going down to deeper muscles,” Owens says. “Real deep-tissue massage can be a little bit painful, especially if you haven’t been warmed up properly.”
Today, massage is available everywhere from physical therapy centers and spas to strip mall chains. No matter what venue or type of bodywork you choose, it’s worthwhile to seek out a trained, licensed and experienced therapist. If you are dealing with a specific health issue, you might get a recommendation from your doctor. Overall, however, there is very little potential downside to massage, aside from minor side effects such as temporary pain or discomfort, bruising or an allergic reaction to massage oil (and, of course, the cost, which can be considerable).
“Massage has a very favorable risk-benefit ratio,” says Briggs. “Sure, occasionally somebody pushes a little too hard, but by and large we think of these as quite safe interventions.”
Sounds like an excellent excuse to indulge in a massage — or at least to persuade my husband to give better, lengthier and, above all, more frequent back rubs.