Massage Therapy and Neuroendocrine Modulation: Clinical Promise - Research Gaps
Field T, Hernandez-Reif M, Diego M, Schanberg S, Kuhn C. Cortisol decreases and serotonin and dopamine increase following massage therapy. Int J Neurosci. 2005 Oct;115(10):1397-413. doi: 10.1080/00207450590956459. PMID: 16162447.
Massage therapy is frequently recommended as an adjunct intervention for stress, depression, and chronic pain. But how strong is the evidence that it modulates neurochemical markers like cortisol, serotonin, and dopamine?
A review by one of my favourite massage therapy researchers, Tiffany Field, titled “Cortisol Decreases and Serotonin and Dopamine Increase Following Massage Therapy” aggregates findings from multiple studies to assess whether massage produces measurable biochemical changes. The results are intriguing—but I think warrant cautious interpretation.
Clinical Benefits: What the Evidence Supports
1. Reduction in Cortisol
The most consistent finding across studies was a significant decrease in cortisol levels post-massage. Cortisol, a glucocorticoid released during stress, is implicated in mood disorders, immune suppression, and metabolic dysregulation.
Magnitude: Reductions in cortisol ranged from 31% to 38% in some studies—a substantial change for a non-pharmacologic intervention. (THESE ARE INSANE NUMBERS!)
Clinical Implication: Lower cortisol may reduce allostatic load (you all know I am massive fan of this), potentially enhancing immune function, decreasing inflammation, and improving mood regulation—particularly valuable for patients with chronic stress, anxiety, or depression.
2. Increase in Serotonin and Dopamine
Massage therapy (or so the authors would have us believe) also demonstrated increased levels of serotonin and dopamine, neurotransmitters critical for emotional regulation, pain perception, and motivation.
Serotonin: Increases ranged up to 28%, potentially contributing to improved mood and sleep.
Dopamine: Some studies reported dopamine increases up to 31%, which may improve executive function, focus, and pleasure response. (Some studies often means ignore the studies that do not fall within my bias.)
Clinical Application: For patients with depression, fibromyalgia, or Parkinson’s-related mood symptoms, this neurochemical boost may complement (not replace!) pharmacotherapy or behavioral therapy.
3. Utility Across Diverse Clinical Populations
The studies included subjects with depression, eating disorders, pain syndromes, and stress-related disorders, showing consistent hormone modulation across varied demographics.
Implication: Massage may have broad applicability as an adjunctive treatment, regardless of diagnosis. This is probably the most important finding in my opinion, it effects a multitude of patient populations.
4. Favorable Risk Profile
Massage is non-invasive, drug-free, and low-risk, with minimal side effects, making it suitable for populations where medications might be contraindicated or poorly tolerated.
Research Limitations: What Clinicians Should Consider
1. Inconsistent Methodologies
The review included studies with small sample sizes, non-randomized designs, and inadequate blinding. Many lacked active control groups or used inconsistent comparator conditions (e.g., rest, reading, sham treatments). These costly but controllable variables do not mean very much in our clinics as we often don’t need to think of them but in research they become incredibly important.
BIG BIG CAVEAT: Results may reflect placebo effects or non-specific benefits of touch and attention. Larger RCTs with standardized controls are needed. If you want to learn more about his you can listen here on my podcast (free) or wait a few weeks as I will be publishing my on-demand course called ‘I am Placebo Positive.’
2. Short-Term Outcomes
Most studies measured hormone levels immediately before and after massage sessions, with few tracking long-term persistence of effects.
Clinical Relevance: While short-term benefits are promising, it’s unclear whether regular massage is needed to sustain hormonal changes. Maintenance protocols have not been defined nor are they being looked at. Many manual therapy research articles look at the short-term positive effects but few delve into the long-term effects. Those that do leave us wanting more as we are seeing little long-term research that stands up to scrutiny justifying the long-term biochemical changes from massage therapy.
3. Heterogeneity of Massage Techniques
The interventions varied widely in duration, frequency, and modality (e.g., Swedish massage vs. trigger point therapy), making it difficult to determine optimal therapeutic parameters.
Implication: Without standardization, it's hard to provide evidence-based dosage recommendations for clinical practice. If you have listened to any of my podcasts attempting to define massage therapy we know how difficult standardization if within our profession.
4. Lack of Mechanistic Insight
While the outcomes are physiological, the mechanisms remain speculative. It’s unclear whether hormone shifts result from tactile stimulation, nervous system downregulation, therapeutic alliance, or vagal activation.
Clinical Question: Understanding the "why" is critical if we are to refine and optimize massage as a clinical tool.
I think this is often the point that many therapists choose to leave out when talking about massage therapy. Honestly a study needs to done of someone getting a relaxing massage and another person napping or meditating. I wonder how many of the effects are related to actual touch vs calm spaces, down time, self reflection etc.
So What’s The Bottom Line?
Massage therapy shows promising biochemical effects that may help reduce stress and enhance mood through measurable reductions in cortisol and increases in serotonin and dopamine. These findings support its use as an adjunctive treatment in mental health, chronic pain, and stress-related conditions.
However, methodological weaknesses in the existing literature limit generalizability and clinical prescription. Future research should focus on well-designed RCTs, standardized massage protocols, long-term follow-up, and mechanistic studies to clarify how massage works and for whom it is most effective.
Until then, clinicians can view massage therapy as a low-risk, potentially high-yield intervention—best used as part of a broader, individualized treatment plan.