How many times have you heard that massage flushes toxins? Breaks up fascia? Emotions stored in the tissue? Resets your stress hormones?
Probably more times than you can count. Maybe you've said some of them yourself. Most of us have. We were taught them, they sound good, and clients love hearing them.
As National Massage Therapy Awareness Week in the US comes to an end I’d like to address some of these claims I’ve seen on social media over the past week. I want to make the case for something different.
The amazing thing with massage is that we don’t need the magical, mystical or mythical explanations. When you look at what actually happens to people who get massage, the real story is by far enough. The experience is by far magical enough.
What is actually happening?
Massage has been studied both mechanistically and clinically for decades now, and the areas with the most evidence aren’t tissue based. It isn’t about what is happening in muscles or fascia. It's stress, anxiety and mood.
Back in 2004, a team of psychologists pulled together 37 studies and looked at them as a whole [1]. One massage lowered how anxious people felt in the moment, along with their heart rate and blood pressure. It is worth noting that the biggest changes came after a series of sessions, not after a single session being measured. Subject’s everyday anxiety and their depression both dropped by about as much as you see in studies of talk therapy.
I think I’ll say that again as it should already affect how frequently your stressed/anxious clients come see you. Not one massage. A series.
A few years later, another team gathered 17 studies on massage and depression [2]. Every one of them leaned in massage's favour (which is a bit of a red flag to be honest).
Then in 2016, psychiatrists at Emory University tried something bold [3]. They took people diagnosed with generalized anxiety disorder who weren't on any other treatment, and gave them Swedish massage twice a week for six weeks. Their anxiety dropped substantially, and massage beat the comparison group. Other research has found similar benefits for anxiety in people living with pain [5]. The major downside to this finding is the frequency of treatment, both in terms of finances and time. Twice a week can get quite expensive as well time consuming for busy lifestyles.
Those are pretty good findings that help justify massage, but I said I’d offer you a more modern understanding. Let's look at the other side.
The Part Massage Therapists Don’t Like to Talk About
In that Emory study, the comparison group didn't get nothing. They got gentle light touch. And they improved too. A lot. Massage came out ahead, but most of the improvement happened in both groups. This brings us to our first complication. Is gentle light touch massage therapy (think cranio-sacral, trauma informed, lymphatic - these are all light touch intervention models)? Again bringing us back to an issue of definition within our profession.
Another study, from Seattle, compared massage with a heat treatment and with simply resting in a calm room with relaxing music [4]. All three groups got better and stayed better six months later. Massage didn't beat the quiet room. (This is something I discuss in several of my classes and I know many educators address, it is the entirety of the intervention that brings the positive outcomes. not simply the touch.)
When researchers stepped back in 2024 and looked at over a hundred reviews of massage for pain, they found a lot of research but very little of it rock-solid [6].
You could read all of that as bad news. I don't. I think it's telling us something important. More on that later in the article.
What This Means When Your Client Walks In
As therapists we need to build trust in the series of sessions, not in the single session. The deepest changes came with regular care. Build your treatment plans around that.
Regular massage can help many people feel less anxious and lift their mood is honest and backed by research. Massage can treat depression isn't, and it's outside our scope (you might be surprised to see that this exact statement came across my social media feed this past week. THIS EXACT PHRASE!). I think it is important to remember that we work alongside doctors and therapists, not instead of them.
If a client shares persistent low mood, hopelessness or thoughts of hurting themselves, listen without judgment and help them reach a doctor or mental health professional. Have those local numbers ready before you need them. (If in the US https://findtreatment.gov if in Canada https://health-infobase.canada.ca/mental-health/indicators/explore.html?indicator=SIJH)
You've probably heard that massage "lowers cortisol." That idea took off in the early 2000s, mostly from one research group reporting that cortisol dropped by roughly a third after massage [12]. But when Christopher Moyer's team gathered all the studies they could find, 18 studies and about 700 people, and analysed them with standard methods, the effect on cortisol was tiny and couldn't be told apart from zero [11] so not statistically significant. The only exception was a moderate effect in children, based on just a few studies. His 2004 review had already pointed the same way [1].
Those same researchers stressed that massage's benefits for anxiety, depression and pain are real and much larger than any cortisol effect. (I love that.) So something else is driving them, and we don't fully know what yet (I love that as well.). That's okay. "You'll probably feel calmer, especially with regular sessions" is a promise the research backs. "I'm lowering your cortisol" isn't, and it's exactly the kind of claim any client can check in thirty seconds with such easy access to research and findings today.
A simple "On a scale of 0 to 10, how stressed have you felt this week?" at each visit shows you, and your client, what's changing and how much over time.
A Modern Massage Practice Means an Honest One
Our profession seems to be pulled in two directions: massage as a luxury, and massage as a health benefit. The truth is, it can be both. Massage feels wonderful, and the research shows it does real good for stress, anxiety and mood.
The trouble starts when we try to prove the health side with stories that aren't true. Toxins, stored emotions, cortisol. Those claims fall apart the moment anyone asks a follow-up question, and when they do, massage gets pushed right back into the "nice, but just a luxury" box.
Honesty is how we earn our place on the health side.
If we want clients and the healthcare world to take us seriously, here's where I'd start:
Talk about what changes for people, not about unverified mechanisms.
When you share research, share the big picture, not one cherry-picked study.
Share the results that didn't go our way, too. It makes you more believable, not less.
Support research. Volunteer for studies, support groups like the Massage Therapy Foundation, APROS, Canadian Massage Therapy Association, and connect with local universities.
Track your own clients' progress. That's where real-world evidence starts.
Learn the basics of reading a study. You don't need a PhD. You just need to know which questions to ask.
Our Greatest Tools Are Our Ears and Words
Remember that quiet room that did as well as massage? And the light-touch group that improved so much?
Here's what I think they're telling us. A big part of what helps people is feeling safe, heard and cared for. Calm. Attention. Someone who takes them seriously.
That isn't a threat to what we do. It's a huge part of what we do. It means the conversation before your client ever gets on the table isn't paperwork. It's intervention.
Most of us spend about five minutes on intake and fifty on the table. What if, with your anxious and stressed clients, you gave a little more of that time to the intake conversation?
When a client responds to your intake questions, wait. Wait longer. Wait 15 more seconds to see if they continue the story with more detail. Maybe they will give you more information that is relevant.
Ask what they think is going on based on their experiences, and what concerns they have about it.
Ask what they've been told. "Your spine is degenerating" can stay with someone for years. You might be the first person with enough time to put it in perspective.
Say back what you heard. Feeling understood is calming all on its own.
Ask what a good week would look like for them, and build the session around it.
Explain what you're going to do in plain, reassuring words.
A very important warning: more time talking only helps if the words are good. Careless words can do real harm, and more time gives them more room to do it.
So this week, I'll leave you with a few questions:
How much of my session is spent listening?
When did a client last tell me something that changed my whole plan, and what question led to it?
What do I say out of habit that might make a client more worried?
What would change if I treated my intake as part of the treatment?
Our hands open the door. Our ears and our words are often what help people walk through it.
Sources
Moyer CA, Rounds J, Hannum JW. A meta-analysis of massage therapy research. Psychol Bull. 2004;130(1):3-18. https://doi.org/10.1037/0033-2909.130.1.3
Hou WH, Chiang PT, Hsu TY, Chiu SY, Yen YC. Treatment effects of massage therapy in depressed people: a meta-analysis. J Clin Psychiatry. 2010;71(7):894-901. https://doi.org/10.4088/JCP.09r05009blu
Rapaport MH, Schettler P, Larson ER, et al. Acute Swedish massage monotherapy successfully remediates symptoms of generalized anxiety disorder: a proof-of-concept, randomized controlled study. J Clin Psychiatry.2016;77(7):e883-91. https://doi.org/10.4088/JCP.15m10151
Sherman KJ, Ludman EJ, Cook AJ, et al. Effectiveness of therapeutic massage for generalized anxiety disorder: a randomized controlled trial. Depress Anxiety. 2010;27(5):441-50. https://doi.org/10.1002/da.20671
Crawford C, Boyd C, Paat CF, et al. The impact of massage therapy on function in pain populations — a systematic review and meta-analysis of randomized controlled trials: Part I, patients experiencing pain in the general population. Pain Med. 2016;17(7):1353-1375. https://doi.org/10.1093/pm/pnw099
Mak S, Allen J, Begashaw M, et al. Use of massage therapy for pain, 2018–2023: a systematic review. JAMA Netw Open. 2024;7(7):e2422259. https://doi.org/10.1001/jamanetworkopen.2024.22259
Busse JW, Wang L, Kamaleldin M, et al. Opioids for chronic noncancer pain: a systematic review and meta-analysis. JAMA. 2018;320(23):2448-2460. https://doi.org/10.1001/jama.2018.18472
Fernández-de-las-Peñas C, Cleland J, Palacios-Ceña M, et al. Effectiveness of manual therapy versus surgery in pain processing due to carpal tunnel syndrome: a randomized clinical trial. Eur J Pain. 2017;21(7):1266-1276. https://doi.org/10.1002/ejp.1026
Fernández-de-las-Peñas C, Ortega-Santiago R, Díaz HF, et al. Cost-effectiveness evaluation of manual physical therapy versus surgery for carpal tunnel syndrome: evidence from a randomized clinical trial. J Orthop Sports Phys Ther. 2019;49(2):55-63. https://doi.org/10.2519/jospt.2019.8483
Yin P, Gao N, Wu J, Litscher G, Xu S. Adverse events of massage therapy in pain-related conditions: a systematic review. Evid Based Complement Alternat Med. 2014;2014:480956. https://doi.org/10.1155/2014/480956
Moyer CA, Seefeldt L, Mann ES, Jackley LM. Does massage therapy reduce cortisol? A comprehensive quantitative review. J Bodyw Mov Ther. 2011;15(1):3-14. https://doi.org/10.1016/j.jbmt.2010.06.001
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;115(10):1397-1413. https://doi.org/10.1080/00207450590956459