The Effectiveness of Massage Therapy A Summary of Evidence-Based Research

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The Effectiveness of Massage Therapy 1 Contents
The Effectiveness of
Massage Therapy
A Summary of Evidence-Based Research
By Dr Kenny CW Ng, MBBS BMedSci DipRM CertIVFitness, Member
Australian Association of Massage Therapy.
In collaboration with Professor Marc Cohen, School of Health Sciences,
RMIT University.

The Effectiveness of Massage Therapy 2 Contents
Contents
Preface ........................................................................................................................... 3!
CEO message .................................................................................................................. 4!
Introduction .................................................................................................................... 5!
Methods ......................................................................................................................... 6!
Results ......................................................................................................................... 11!
Discussion .................................................................................................................... 20!
Conclusions .................................................................................................................. 24!
References ................................................................................................................... 25!
Appendix I: Search strategy ........................................................................................... 35!
Appendix II: Studies excluded due to time constraints in obtaining full-text article ............ 38!
Appendix III: Summary of systematic reviews ................................................................. 39!

The Effectiveness of Massage Therapy 3 Preface
Preface
The purpose of this report
Although massage therapy is recommended and administered to various extents by
healthcare practitioners and patients alike, research evidence is required to advocate
massage therapy effectively and safely.
This report reviews and collates existing evidence based research into the effectiveness of
massage therapy, identifies recommendations for clinical practice and highlights research
gaps. It is designed to be a reference tool for those interested in the available evidence
about the effectiveness of massage therapy.
Who should read this report?
! Massage therapists;
! Practitioners of complementary and alternative medicine;
! GPs and allied health professionals; and
! Researchers in the area of health, complementary and alternative medicine.

The Effectiveness of Massage Therapy 4 CEO message
Australian Association of Massage Therapy
CEO message
On behalf of the Australian Association of Massage Therapists,
I am pleased to present
‘The Effectiveness of Massage
Therapy’
report.
This report presents the body-of-knowledge of evidence-based
research into the effectiveness of massage therapy, comprising
a review of 740 existing Australian and international, academic
research papers, published between 1978 and 2008.
The research includes systematic reviews, randomised
controlled trials, comparative studies, case-series/studies and
cross-sectional studies covering acupressure, bowen therapy,
lymphatic drainage, myofascial release, reflexology, rolfing,
shiatsu, Swedish massage, sports massage, infant massage,
tuina and trigger point therapies/modalities.
Key findings of this literature review show:
! A growing body of research supports massage therapy as being an evidence-based
therapeutic modality
! There is strong evidence supporting acupressure management of nausea and
vomiting
! Massage therapy is effective in managing subacute/chronic low back pain, delayed-
onset muscle soreness (DOMS), anxiety, stress and relaxation, and helps support the
wellbeing of patients with chronic and/or terminal diseases such as cancer.
! There are opportunities for further research into the benefits of massage therapy for
infants, depression and post-natal depression, labour pain, fibromyalgia,
premenstrual syndrome, urinary symptoms in multiple sclerosis, myofascial pain and
knee osteoarthritis.
! There is consistent and conclusive evidence that massage therapy is safe. However,
the importance of qualified massage therapists adhering to appropriate scopes of
practice, safety guidelines and ethical procedures is stressed.
! Clinicians are encouraged to collaborate with professional massage practitioners for
best practice management of patients who may benefit from massage therapy.
We certainly hope that this groundwork provides remedial massage therapists,
complementary and alternative medicine practitioners and the broader allied health
community with a basis to pursue evidence-based practice, and that this report leads the
way for future research in the field of massage therapy.
I congratulate Dr Kenny Ng and thank Professor Marc Cohen, School of Health Sciences,
RMIT University for their efforts in developing this report.
Tricia Hughes

The Effectiveness of Massage Therapy 5 Introduction
Introduction
Massage can be defined as “manual soft tissue manipulation, and includes holding, causing
movement, and/or applying pressure to the body.”1 Massage therapy is the practice of
massage by accredited professionals to achieve positive health and well-being (physical,
functional, and psychological outcomes) in clients.1,2 As a distinct allied health and/or
complementary and alternative medicine (CAM) practice, massage therapy encompasses
different types of massage originating from Western and Eastern practice, alongside the use
of various supplementary therapeutic modalities e.g. cupping and dry needling.2
In Australia, a recent national survey showed that 70% of respondents used one of 17
forms of CAM, with 45% of respondents having visited a CAM practitioner in the preceding
year.3 CAM use in the United States of America appear to be similar to Australia.4 However
CAM use in the United Kingdom was more protracted, with ten per cent of survey
respondents receiving treatment from a CAM practitioner in a 12-month period.5 Amongst
the numerous forms of CAM surveyed, massage therapy ranked as one of the most
commonly used.3,4,5
Although massage therapy is
recommended and administered
to various extents by healthcare
practitioners and patients alike,
research is required to
determine its efficacy and
safety. Numerous systematic
reviews of massage therapy
have been performed and using variable search strategies and inclusion criteria to evaluate
single or multiple types of massage therapy.6-13 The broadest reviews were published by
Beider et al6 and Moyer et al,11 yet these reviews are still quite limited. The review by Beider
et al6 was limited to randomized controlled trials (RCTs) and case-studies within a paediatric
population, and the search terms used restricted the review to child/pediatric massage. The
review by Moyer et al on the other hand used an exhaustive search strategy with defined
massage therapies, yet limited the search to RCTs and excluded infant populations. Moyer et
al did however, collate data from the included studies and provided recommendations for
further research and best practice.11
Due to the nature of search strategies and inclusion/exclusion criteria, there were many
studies that assessed the effects and safety of massage therapy not found in published
reviews. The scattered nature of massage-related studies makes it challenging to confidently
identify research evidence that can inform best practice. An archive that indexes the
evidence of effectiveness for massage therapy would prove invaluable to assure access to
the breadth of existing evidence. Once established, enhanced evidence-based massage
practice would hopefully boost the growth of the massage profession and industry. The
Massage Therapy Research Database, administered by the Massage Therapy Foundation
since early 2000, appears to be the primary source of citations to massage therapy
articles.14 This established database indexes more than 4800 peer and non-peer reviewed
journal articles and books, including non-English literature, with a recent addition of real-
time access to PubMed.14
In 2007, a national survey of Australians
showed massage therapy ranked as one of
the most commonly used complementary
and alternative medicine practices.

The Effectiveness of Massage Therapy 6 Methods
With an evidence-based practice focus and explicit methodology to source studies for
inclusion, the Australian Massage Research Foundation15 commissioned a body-of-knowledge
(BOK), that would archive research evidence pertaining to effectiveness of massage therapy.
Using a broader search strategy and inclusion criteria than previous reviews, this study
systematically identified and compiled primary and secondary evidence that evaluated the
effectiveness of massage therapy and presents a summary of the current state of massage
therapy evidence.
Methods
Criteria for considering studies for this review
Type of studies
Studies published up to November 2008 that evaluated the effectiveness of massage
therapy for the management of health, medical conditions or clinical symptoms were
sourced for this review. This included studies that reported on the safety of massage
therapies. Studies that assessed physiological effects of massage therapy were also
considered for inclusion as these studies may lend support to further research or application
in clinical practice.
Primary and secondary studies such as systematic reviews, RCTs, comparative studies
(quasi-RCTs, cohort and case-controlled), case-studies/series, and cross-sectional studies
were included. These comprised of quantitative and qualitative studies. Studies published in
languages other than English were excluded unless an English abstract with sufficient
eligibility information was available.
Reviews were included when a systematic and explicit search strategy appropriate to
address the question of the review was conducted. These reviews may provide either
quantitative and/or qualitative summary, along with assessment of methodological quality of
included studies with or without a critical appraisal tool.
Study populations*
Included studies assessed measurable effects from massage treatment(s) relating to one of
the following: -
a) Diseased body systems and medical conditions (where available) consistent with
allopathic principles of medical diagnoses
b) Special groups
I. Paediatrics (includes neonates, infants and adolescents)
II. Obstetrics
c) Clinical symptom(s)
d) Sports and exercise
e) Physiological change(s)
Study participants were limited to human subjects. No age restrictions were applied.
Type of interventions*
The types of massage therapies that were included in the review are presented in Table 1.
These massage therapies were executed solely or in combination, and involved hands-on,
direct physical contact without utilization or supplementation of machines, devices,
equipment or tools including needles (acupuncture/dry-needling), bands and seeds
(acupressure). Manual therapy techniques commonly used by massage therapists including
trigger point therapy, myofascial release, deep transverse friction were also included.

The Effectiveness of Massage Therapy 7 Methods
Specific disciplines such as myotherapy, chiropractic, osteopathy and beauty therapy were
included if a massage component was specified within the treatment regime and if the
effects of massage therapy were measurable independently without confounding factors.
Anatomical and internal massages such as cardiac, ocular, perineal, prostate, rectal and
vaginal were excluded.
*Systematic reviews included in this study were exempted from assessment of these
criteria as these s t udies wi ll h o ld sp ec ific inclusion criteria of primary research. For
inclusion into this review, systematic reviews needed to include massage therapy as a
treatment mo dality.
Search strategy
Given the objective and breadth of this review, it was not possible to search through all
available databases. The search strategy applied was aimed at sensitivity more than
specificity in detecting studies. Several databases were used to increase the sensitivity of
the search as evidence on CAM can be found in different sources.16 The databases chosen
for this review were based on their sophistication to obtain a workable number of studies
(limited to <2500 hits/database and 8000 hits in total). Five (5) electronic databases
available through RMIT University library website were searched to acquire studies for
potential inclusion in this review (Table 2). These databases combined at least one (1) major
mainstream! and one (1) major non-mainstream" medical database. EMBASE, SCOPUS, Web
of Science and Proquest databases were not used because the workable number of hits was
unattainable even when search limits as listed in Table 3 were applied.
Table 2: Databases searched in this review
! Evidence Based Medicine (EBM) Reviews
! ! Pubmed (incorporating Medline)
! Cumulative Index to Nursing and Allied Health Literature (CINAHL)
! " Allied and Complementary Medicine (AMED)
! Meditext
Table 1: Massage therapies/techniques sourced for inclusion in this review
! Acupressure
! Aromatherapy
! Ayurvedic
! Bowen therapy
! Deep Tissue
! Deep Transverse Friction
! Hawaiian / Lomi-lomi
! Indian Head
! Infant
! Manual Lymphatic Drainage
! Myofascial Release
! Pregnancy
!
Reflexology
! Remedial
! Rolfing / Structural Integration
! Seated
! Shiatsu
! Sports
! Swedish (includes effleurage/petrissage)
! Thai
! Traditional Chinese Medicine (TCM) including Tuina/Qigong
! Trager
!
Trigger point therapy

The Effectiveness of Massage Therapy 8 Methods
Pilkington recommends that massage studies can mostly be identified through indexing
terms, otherwise known as medical subject headings (MeSH), and that sensitivity can be
increased if a textword search is also performed.16 MeSH headings were used for the search
term ‘massage,’ and where available the ‘explode’ function was applied (Table 3). Textword
searches were carried out for all search terms, otherwise a keyword search was performed
(Table 3 and 4). Citations and abstracts of studies identified through the electronic
databases were imported and stored in an electronic library using bibliographical software,
Endnote (Version X2). Specific searches through journals and unpublished literature i.e.
theses and dissertations, or contact with institutions and field experts were not undertaken
in this review.
Methods of the review
The search strategy (Appendix I) was implemented by the primary reviewer (KN), who
subsequently screened the titles and abstracts contained within an Endnote library to detect
irrelevant and duplicate studies. Given the scope of this review, studies were not matched
against the broad inclusion criteria individually. Instead, studies that met an exclusion
criterion were removed. For studies that had insufficient information in the title and
abstract to determine eligibility, a full-text version of the study was obtained via RMIT
University library. To prevent potential loss of valuable evidence, studies that did not state
exclusion criteria (e.g. utilization of massage devices) were included. The primary reviewer
(KN) independently determined the study designs of the included studies.
Table 3: Search methods and limits within databases used in this review
(Appendix I)
SEARCH METHOD AMED CINAHL EBM Reviews MEDITEXT PubMed
MeSH Heading # # # # #
Textword # # #
Keyword # #
Explode # # #
SEARCH LIMIT
English # # # #
Humans # #
Publication type* # # #
# denotes search function available within databases and utilized
* reviews/meta-analysis, clinical trials (including RCTs, comparative studies, multicentre study) and case reports
Table 4: Search terms applied to search strategy (Appendix I)
! acupressure
! bowen therapy / technique
! deep transverse friction
! manual lymphatic drainage / lymphatic massage
! massage
! myofascial release
!
reflexology
! rolfing
! shiatsu
! trager
! trigger point therapy
!
tui na / tuina / tui-na

The Effectiveness of Massage Therapy 9 Methods
Type of studies
The number of studies included in this review was divided and presented graphically to
indicate growth of published research evidence on the effectiveness of massage therapy.
Study designs such as systematic reviews, RCTs, comparative studies and case-
studies/series were ranked according to the National Medical and Research Council (NHMRC)
Hierarchy of Evidence (2000)$ (Table 5).17 This provides an overview of the study designs
used in massage-related research, and broadly informs the potential magnitude of bias
contained within the studies included in this review. Critical appraisal of included studies was
not within the scope of this review.
Study populations and topic areas of study
Studies included in this review included participants with particular medical conditions or
clinical symptoms that were categorised into different subgroups. Initially, these subgroups
were named according to allopathic medical specialties and special population groups.
Where these sub-groups were inappropriate, either ‘others’ or ‘physiological study’ was
designated. ‘Others’ encompassed participants:
a) with medical diagnoses that does not fit into allopathic medical specialties or special
population groups
b) with clinical symptoms without established diagnoses
c) who are well and healthy.
‘Physiological study’ refers to studies that primarily measured physiological changes induced
by massage therapy. Thirty-six different subgroups were used to document the types of
participants within included studies. The obstetrics sub-group included studies of massage in
the antenatal, perinatal and postnatal periods.
Type of interventions
Massage therapies were compiled as reported in the included studies. Not infrequently, the
type of massage was undefined, however treatment protocols were described. These
treatments were designated ‘non-specified massage (NSM)’ or ‘protocol.’ Massage
Table 5: NHMRC Hierarchy of evidence (2000)$, 17
Level
Study Design
Characteristics
I Systematic review% Collation of studies, with methods of search, appraisal and
synthesis specified
II Randomized controlled
trials (RCTs)
Subjects randomly allocated to groups
III Comparative studies
1 - Pseudo-RCTs Subjects allocated to groups but not at random
2 - Comparative study Comparison between groups: no allocation or matching of
subjects in groups
3 - Historical Comparison with a historical control
IV Case-studies/series No comparison group
$
NHMRC Hierarchy of Evidence does not rank cross-sectional studies
%
A systematic review will only be assigned a level of evidence as high as the studies it contains, excepting where those studies are
of level II evidence
18

The Effectiveness of Massage Therapy 10 Methods
treatments indicated to impact exercise recovery, sports performance and sports psychology
were designated ‘sports massage’ in this review.
Massage modalities and therapies that were not specifically searched for were considered
for inclusion in this review. Body awareness and multi-dimensional therapies where the
independent effect of massage was difficult to ascertain e.g. Alexander technique,
Feldenkrais and Trager psychophysical integration were excluded.
While the status of the massage therapist was not routinely reported, massage was variably
performed by professional healthcare practitioners including chiropractors, massage
therapists, nurses, osteopaths, physicians, physiotherapists, Traditional Chinese Medicine
(TCM) practitioners as well as research scientists and parents with varying degrees of
massage training.
Establishment of body-of-knowledge (BOK)
Studies that were included in this review were indexed within an Endnote library. Keywords
reflecting the types of studies (listed according to NHMRC Hierarchy of Evidence),
participants and interventions were entered for each included study. This formed a basic
searchable database that would constitute the foundation of a body-of-knowledge (BOK)
that archives research evidence in massage therapy.
Current massage therapy evidence
Citations of included Level I studies were entered into a Microsoft Excel 2007 spreadsheet
(Appendix III). Extraction of information was undertaken from these studies, which include:
! medical condition/symptoms
! number of included studies (where stated or reported)
! type of massage (if stated)
! findings and/or recommendations.
Based on the number of included studies, and the findings and/or recommendation as
reported by the reviews, a grading of clinical recommendation adapted and modified from
the NHMRC body-of-evidence matrix was applied (Table 6 and 7).
Table 6: Body of evidence matrix (NHMRC 2009)18
RECOMMENDATION
A
B C D E
Evidence Base 1-2 high quality
RCTs or
multiple (& 4)
poor to fair
quality
RCT/CCTs
and/or
recommended
for clinical
application by
author
3-4 poor to fair
quality
RCT/CCTs
and/or
recommended
for further
research of
high
methodological
quality
1-2 poor to fair
quality
RCT/CCTs which
may or may not
be statistically
significant
and
further research
recommended
Conclusions
were not
apparent
from
included
studies
' 1 RCT/CCT
of poor
quality
or
no studies
available
Rating of Evidence Strong Good Limited Poor Insufficient
Clinical Impact Substantial Moderate Restricted Minimal No

The Effectiveness of Massage Therapy 11 Results
A narration of the current evidence is provided for respective recommendations with
emphasis on those graded A, B and C due to greater clinical relevance. A narrative review
was also undertaken to outline the safety profile of massage therapy, with reference to
literature that highlighted safety/adverse effects in their titles and/or abstracts.
Results
Description of studies
Selection of studies
The search strategy (Appendix I) returned a total of 7671 hits (Figure 1). After eliminating
irrelevant and duplicate studies, 1194 studies remained. 138 studies were included following
review of titles and abstracts. 1056 full-text articles were required. Of these, 22 citations did
not contain sufficient information to enable location of the studies and 25 unattainable
through RMIT library due to inability to locate these articles within the time-frame of this
review (Appendix II). After reviewing the full-text articles obtained, 740 studies were
included within the body-of-knowledge±.
Type of studies
Research evidence that evaluated the effectiveness of massage therapy grew significantly
from 1978 to 2008 (Figure 2). With reference to the NHMRC Hierarchy of Evidence,17 Level
II evidence (RCTs) was most widespread while Level III evidence (comparative studies) was
most scarce (Table 8). Eight systematic reviews and 16 case-studies evaluated and/or
reported on the safety of massage therapy.
±
Due t o the large volume, the list of included studies will be published on the website
of Australian Association of Massage Therapists (www.aamt.com.au)
Table 7: Definition of grades of recommendations (NHMRC 2009)18
Grade of
Recommendation
Description
A
Body of evidence can be trusted to guide practice
B Body of evidence provides moderate support to guide practice in most situations
C Body of evidence provides limited support for recommendation(s) and care should be
taken in its application
D Body of evidence is weak and any recommendation must be applied with caution
E Body of evidence is insufficient to provide recommendation

The Effectiveness of Massage Therapy 12 Results
Study participants and topic areas of study
Musculoskeletal, oncology combined with palliative care, paediatrics, sports, neurology,
obstetrics, surgery, geriatrics, mental health and physiology represented the most common
populations studied (Table 9).
Musculoskeletal, oncology
combined with palliative care,
paediatrics, sports, neurology,
obstetrics, surgery, geriatrics,
mental health and physiology
represented the most common
populations studied.
Figure 1: Pathway for selection of studies in this review
Search strategy applied to five (5) databases
7671 hits
1194 studies
6477 irrelevant and/or
duplicate studies eliminated
1056 full-text
articles required
22 citations – insufficient
information to find studies
25 studies unattainable by
RMIT University
1009 full-text articles
acquired
740 studies met inclusion criteria
138 titles and
abstracts eligible
for inclusion
EBM reviews, Pubmed (Medline),
CINAHL, AMED and Meditext
Body-of-Knowledge
(BOK)
147 systematic
reviews
Literature review of current evidence-
based massage therapy research
407 studies met exclusion criteria

The Effectiveness of Massage Therapy 13 Results
Figure 2: Growth of published studies on the effectiveness of massage
therapy
Table 8: Study design and ranking according to National Health and
Medical Research Council (NHMRC) Hierarchy of evidence (2000)17
Study Design Hierarchy of Evidence Number of Included Studies
Systematic review I 147
RCT II 283
Comparative III 100
Case-studies/series IV 197
Cross-sectional N/A 13
Total 740
RCT, randomised controlled trial; N/A, not applicable
%
A systematic review will only be assigned a level of evidence as high as the studies it contains, excepting where those studies are of
level II evi
d
enc
e
18

The Effectiveness of Massage Therapy 14 Results
Type of interventions
Table 9: Subgroups of participants and topic areas of study
included in this review
Participant Subgroups Number of studies
Allopathic Medical
Specialties & Special
Population Groups
Anaesthetic
3
Cardiology
12
Dermatology
6
Endocrinology
6
Gastrointestinal
13
Genetics/Developmental
14
Geriatrics (include psychogeriatric)
!32
Gynaecology
13
Haematology
7
Immunology
2
Infectious diseases
14
Intensive care
9
Mental Health
!35
Musculoskeletal
!150
Neurology
!46
Neurosurgery
1
Obstetric
!39
Oncology
!76
Ophthalmology
1
Orthopaedic
3
Paediatrics
!88
Palliative Care
!24
Plastics
6
Rehabilitation
3
Respiratory
15
Rheumatology
15
Sexual & Reproductive Health
1
Spinal
8
Surgery
!38
Urology
4
Vascular
6
Sports
Exercise recovery
!27
Sports performance
!28
Sports psychology
2
Others
!81
Physiology
!33
!
Represent the most active domains of research

The Effectiveness of Massage Therapy 15 Results
Thirty-three different types of massage therapies and techniques used in the included
studies are listed below (Table 10). The most commonly researched massage therapies
included acupressure, Swedish massage, aromatherapy, reflexology, sports massage and
infant massage. While 144 studies did not specify the type of massage, sixty-seven of these
did describe a massage treatment protocol.
Table 10: Massage therapies/modalities included in this review
Sourced therapies/modalities Number of studies
1. Acupressure
!
86
2. Aromatherapy
!
53
3. Ayurvedic 1
4. Bowen 7
5. Deep tissue 18
6. Deep transverse friction 4
7. Hawaiian/Lomi-lomi Nil
8. Indian Head Nil
9. Infant
!
40
10. Manual Lymphatic Drainage 15
11. Myofascial release 19
12. Reflexology
!
49
13. Remedial Nil
14. Rolfing 5
15. Seated 10
16. Shiatsu 11
17. Sports
!
46
18. Swedish
!
82
19. Thai 3
20. Trager Nil
21. TCM including Tuina/Qigong 22
22. Trigger point therapy 21
Unsourced therapies/modalities
1. Anma (Japanese) 1
2. Back / Slow stroke back 19
3. Classical 1
!
Represent therapies/modalities most commonly researched; NSM, non-specified (type of) massage; TCM, Traditional
Chinese medicine

The Effectiveness of Massage Therapy 16 Results
Current evidence for massage therapy
Figure 3 provides a graphical representation for the summary of systematic reviews
(Appendix III).
Grade A
Six systematic reviews consistently
found acupressure effective for
the management of nausea and
vomiting.10,19-23 Several different
patient population groups were
investigated including oncology,10
palliative care,10 obstetrics10,19,20,22 and post-surgery.10,21-23 The effectiveness of acupressure
was deemed to be more effective over placebo across the different groups of patients,10,19
and equivalent to first-line anti-emetics and acupuncture in obstetrics and post-operative
patients.20-23
Grade B
Seven studies were in unison concluding that massage therapy for subacute and chronic low
back pain to be more effective than placebo,24-30 and comparable to spinal manipulative
therapy.25 Although further research with improved power and methodological quality
appears warranted,24,26,30 current evidence was reportedly moderate in strength and fairly
robust.25,27-29 The evidence suggested that massage therapy achieved significant patient
satisfaction and reduction in pain levels, both in the short and longer term, as well as
potential benefit in acute on chronic low back pain.26,28,30
Limited evidence from four reviews published between 1998 and 2004,31-34 supported the
use of massage for delayed onset muscle soreness (DOMS).
Table 10: Massage therapies/modalities included in this review
(continued)
Unsourced therapies/modalities Number of studies
4. Connective tissue 7
5. Malay 1
6. Medical 2
7. Neuromuscular 4
8. Orthopaedic 1
9. Rhythmical 2
10. Tactile 1
11. Therapeutic 12
12. Watsu 2
Others
1. Protocol
!
67
2. NSM
!
77
!
Represent therapies/modalities most commonly researched; NSM, non-specified (type of) massage
Six systematic reviews consistently found
acupressure effective for the management
of nausea and vomiting.

The Effectiveness of Massage Therapy 17 Results
Figure 3: Summary of systematic reviews
Grade of
Recommendation
Description
A Body of evidence can be trusted to guide practice
B Body of evidence provides moderate support to guide practice in most situations
C Body of evidence provides limited support for recommendation(s) and care should be
taken in its application
D Body of evidence is weak and any recommendation must be applied with caution
E Body of evidence is insufficient to provide recommendation

The Effectiveness of Massage Therapy 18 Results
However the latest review by Best
et al35 (2008) concluded moderate
evidence for massage therapy in
managing DOMS, although further
high quality research is
recommended. Huth et al36
reviewed the effects of massage
therapy on pulmonary function to assess the potential application in paediatric patients with
cystic fibrosis. These authors found moderate evidence for massage therapy in improving
pulmonary function.36 By extrapolating the data from relevant studies, the authors
recommended massage therapy for this patient group.36
Multiple studies provided good
evidence for massage therapy in
managing anxiety, stress and
promoting relaxation,11,37-50 which
was trialled in healthy adults,11,43,44
and oncology39,41,42,46,47,49,50 and
intensive/critical care patients.48
Massage was effective in modulating the physiological stress response as reflected in
reduction of heart rate and blood pressure.11,43,44,48
Massage therapy also provided moderate
clinical benefit for symptom management,
quality of life and promotion of positive well-
being in patients with chronic diseases and
terminal illnesses e.g. cancer, multiple sclerosis
and HIV/AIDS.37,41,42,45,48,50-56 Alongside anxiety
and stress, other positive outcomes from
massage therapy include pain reduction,
improved sleep, function, depressive
symptoms, and quality-of-life amongst
others.37,41,42,46,47,50-56
Grade C
Massage therapy in women’s health and for newborns dominated this grade of
recommendation. Collectively, nine reviews provided limited evidence for massage therapy
on obstetric patients; pre-partum (symptomatic management),58,59 intra-partum (labour
pain)57,59-63 and post-partum (post-natal depression).57,64,65 There were seven reviews that
were dedicated to evaluate the effects of infant massage on both the newborn including
pre-term and low birth weight babies, and the mother.6,66-71 Positive outcome measures that
were reported include reduction in infant distress, reduced length of newborn
hospitalisation, significant newborn growth and development, improved mother-infant
interaction, and symptoms of post-natal depression.6,67-69,71 One review reported limited
evidence for massage therapy in premenstrual syndrome.72
Limited evidence for massage therapy in musculoskeletal conditions were found in acute low
back pain,32,34,73 complaints of neck, arms and shoulder (CANS),29,74,75 fibromyalgia,29,76-79
juvenile rheumatoid arthritis,6 myofascial pain,80 knee osteoarthritis,81 and
temporomandibular dysfunction.82 Fibromyalgia had five reviews with consistent
conclusions,29,76-79 where massage therapy is commonly practised in conjunction with other
treatments. With acute low back pain32,34,73,83,84 and CANS,29,74,75,85 there were conflicting
Multiple studies provided good evidence
supporting the effectiveness of massage
therapy in managing anxiety, stress and
promoting relaxation.
Positive outcomes reported
following massage therapy
include pain reduction, better
quality of life, improved sleep
and function as well as
reduced depressive symptoms.
Seven studies were in unison concluding
that massage therapy for subacute and
chronic low back pain to be more
effective than placebo.

The Effectiveness of Massage Therapy 19 Results
findings in recommending massage therapy. The other conditions in this medical sub-group
had only one review each to support their recommendation.6,80-82
Massage therapy for
the management of
dementia (behavioural
and psychological
symptoms of
dementia)86-88 and
depression89-91 was
supported by limited
evidence through three
reviews each. Two reviews agreed that acupressure appears to be an effective treatment
modality for urinary symptoms in patients with multiple sclerosis.13,92 There were also two
reviews that support manual lymphatic drainage for treating lymphodema.93,94 However,
manual lymphatic drainage, commonly instituted in conjunction with compressive therapy
within the context of complex physical therapy (CPT)95 did not provide significant benefit
when applied independently.96,97 Similarly, the evidence for the effectiveness of massage
therapy was poor or limited for treating alopecia areata,38 attention deficit hyperactivity
disorder (ADHD),98 insomnia and sleep,99-101 pressure sores102,103 and procedural pain in
children.104
Grade D
Four medical conditions namely cervical spondylosis,105 chronic constipation,106 and ilio-tibial
band syndrome107 had inconclusive evidence.
Grade E
Table 11 lists medical conditions that were reported to have insufficient or no evidence.
Safety
Review of the literature found that adverse events with massage therapy were scarce and
treatments safe when guidelines are adhered to and instituted by appropriately trained
and/or qualified massage practitioners.8,9,39,49,50,51,90,125 Although it is non-invasive, massage
therapy is not entirely risk-free. A recent cross-sectional study146 with 91 out of 100
consecutive clients at a student massage clinic reported no significant adverse events with
ten percent experiencing some minor discomfort including headache, soreness, fatigue and
bruising. Ernst90 and Ezzo et al125 reviewed studies of patients with low back pain and
Studies into the benefits of massage therapy for
maternal and infant care reported a reduction in
infant distress, significant newborn growth and
development, improved mother-infant interaction
and reduced symptoms of post-natal depression.
Table 11: List of medical conditions with Grade E recommendation
Arthritis108 Knee pain121
Asthma and allergy13,109-111 Lateral epicondylagia122
Bell’s palsy112 Menopause123,124
Carpal tunnel syndrome113 Neck pain/disorders including whiplash125-130
Diabetes114 Occupational stress prevention131
Headache (acute/chronic/recurrent)115-119 Smoking cessation132
Induction/Augmentation of labour120 Tendinopathy133
Irritable bowel syndrome13 Weight loss134

The Effectiveness of Massage Therapy 20 Discussion
mechanical neck disorders and found that adverse events with massage were rare. In Ezzo
et al’s series,125 only three studies out of 19 RCTs/quasi-RCTs had transient and benign
post-treatment discomfort. In contrast to the results of these reviews, 16 case-studies147-162
noted significant adverse events in association with massage treatments. In these instances,
the massage practitioners were either traditional, had unknown qualifications or were not
reported.
Case incidents of bruising, swelling,147 internal haemorrhage148-149 and thrombus
embolization,150-154 highlight the need to consider the site, intensity and depth of massage as
well as coagulation states of patients, both hyper- or hypo-coagulable. Patients with
prosthetic devices e.g. stents155-156 and cardiac defibrillators, should be noted before
massage to avoid displacements of these devices or trauma to surrounding tissue.
Therapists should also be conscious about superficial neurovascular structures, as there
have been cases of vertebral artery dissections9 as well as neurovascular sequelae such as
pseudoaneurysm157 and posterior interosseous syndrome158 associated with massage,
although direct causation is difficult to ascertain. Grant9 had advised that symptoms of
vertebral artery compromise (dizziness, headache, loss of consciousness, vertigo) be
monitored during massage of the posterior neck and post-treatment advice provided if
appropriate. Isolated case reports of thyrotoxicosis in a patient with Hashimoto’s disease,159
bowel perforation160 and herpes zoster161 infection in an otherwise well patient are
interesting but unlikely to be related to massage therapy.
Corbin,39 Weiger et al49 and Wilkinson et al140 reviewed the safety of massage therapy in
cancer patients. There has been no known evidence that massage therapy contributes to
metastases from primary sites of cancer.39,49 However avoidance of direct manipulation of
the surrounds of tumour tissue that may or may not have been treated surgically or with
radiotherapy is recommended.39,49
The safety of infant massage was assessed by White-traut and Goldman163 with a
randomised controlled trial in pre-mature infants, who found that pre-mature infants were
susceptible to decrease body temperature and increased heart and respiratory rate when
receiving massage. The authors advised caution in the selection of pre-mature infants and
recommended monitoring of vital signs before, during and after massage to minimise risk.
No other studies described any adverse effects of infant massage.
Discussion
Description of studies
Selection of studies
A systematic search strategy aimed at sensitivity over specificity was executed across five
(5) databases. The high yield and repetition of studies suggest that the current search
strategy was comprehensive, however the inclusion of more databases may have yielded
more studies. More studies may have also be located through contact with professional
institutions, experts in the field and search of unpublished literature especially thesis and
dissertations.7,11,12
Type of studies
The criteria for selecting systematic reviews for inclusion in this review were broader than
the NHMRC definition (Table 5). This is consistent with the primary objective of establishing
a body-of-knowledge. Included reviews were either reviews of management

The Effectiveness of Massage Therapy 21 Discussion
(medical/sports-related condition or clinical symptom) or effectiveness of massage as a
therapeutic modality including safety. Non-systematic reviews that discussed the effects of
massage therapy were frequently encountered. Within these reviews, case-studies were
often used to provide specific examples, while authors of case-studies often provided a
background literature review. Together, non-systematic reviews and case-studies
occasionally posed difficulty in determining inclusion. These studies were generally included
to prevent loss of potentially valuable evidence.
RCTs were the most frequently found study design in this review. However, many of these
appear to be pilot studies with small sample sizes. After RCTs, case-studies/series were
most common. In attempting to organise/analyse case-studies, difficulties were met due to
poor structure, ill-defined objectives and/or lack-of-focus of some studies. In parallel, this
may translate to difficulty for readers to decipher the message(s) authors were
endeavouring to convey. In addition, case-studies were more common in massage-related
or other complementary medicine journals.
It was not the aim of this review to conduct methodological quality assessment, data
collation or meta-analysis. Although the NHMRC Hierarchy of Evidence17 was used to rank
the study designs of included studies, study designs do not reflect the breadth of
methodological quality. Therefore critical appraisal of the studies included in this review will
be required to properly assess the strength of current evidence.
Adverse reactions and side effects are usually secondary outcome measures in clinical trials
(RCTs, comparative studies, case-studies/series). Case-studies were frequently found to
highlight single episodes of adverse reactions in association with massage therapy.
However, caution must be exercised in attributing causation in these instances.
Articles that represent knowledge of the art and science of massage were abundant and
widespread in the literature. While this wealth of knowledge may not embody research
evidence of effectiveness, archiving these massage-related articles will enable preservation
of knowledge and benefit healthcare practitioners, students and patients alike. With a
broader scope than the body-of-knowledge (BOK), the established Massage Therapy
Foundation Database would presently be the best reference for this purpose.14
Type of participants
The breadth of participant subgroups included in this review demonstrated the versatility of
massage therapy. Due to the direct soft-tissue manipulation of massage, it was not
surprising that the most active research domains included musculoskeletal, neurological and
sports-related conditions.
The other active domains
such as oncology/palliative
care, obstetrics, surgery,
geriatrics and mental health
utilised the indirect effects
of massage for symptomatic
relief e.g. pain, nausea,
anxiety and depression. In
paediatrics, growth and
developmental effects of
infant massage may be
largely attributed for driving
research in this domain. The broad scope of this review made it impossible to present the
The breadth of participant subgroups included
in this review demonstrated the versatility of
massage therapy. Due to the direct soft-tissue
manipulation of massage, it was not
surprising that the most active research
domains included musculoskeletal,
neurological and sports-related conditions.

The Effectiveness of Massage Therapy 22 Discussion
outcome measures that were assessed in the included studies because there was too much
variability. Frequently, more than one objective and/or subjective outcome measures were
used in single studies to measure the effectiveness of massage therapy. Depending on the
patient population group, recurrent outcome measures in the literature include pain, nausea,
anxiety, mood, behaviour, stress, function, wellbeing and quality-of-life.
One of the most common effects of massage therapy includes benefits as an adjunctive
treatment of anxiety and depression. However, while the diagnostic criteria for anxiety
disorders and clinical depression are defined in the Diagnostic and Statistical Manual (DSM)
of Mental Disorders163 and International Classification of Diseases (ICD) -10 Classification of
Mental and Behavioural Disorders,164 the delineation between normal and disordered states
of anxiety and depression were rarely defined in the included studies.
Type of interventions
Although the majority of studies specified the type of massage therapy applied, several
massage therapies e.g. remedial massage and
sports massage that were specifically searched for
were rarely or never encountered in the literature.
Coupled with the high numbers of massage
treatments that were either non-specified or
described with a protocol, the names of different
massage therapies merely infer a characteristic
combination of strokes and techniques. This is
largely reflected in clinical massage practice,
whereby massage practitioners commonly combine techniques and modalities from two or
more massage therapies/techniques within a single treatment. With the exclusion of
effleurage and petrissage that is characteristic of Swedish massage, there was no attempt to
classify non-specified massage treatment protocols, despite knowledge of described strokes
and techniques exemplifying a particular massage therapy.
Current evidence for massage therapy
This review provides an overview of existing massage therapy evidence, and should be
utilised as a resource to access and review areas of interest within the scope of massage
practice. Although clinical recommendations of evidence-based massage therapy were
extrapolated from existing systematic reviews, critical appraisal of these reviews was not
undertaken. Consequently, biased inclusion/exclusion criteria, and a flawed search strategy
or review methodology could
impact on the interpretation of
the conclusions and/or
recommendations of these
reviews. Clinicians are
cautioned in directly applying
the recommendations of this
review without reviewing the
original article. Critical
appraisals of respective
systematic reviews are
encouraged with conclusions and/or recommendations interpreted in light of methodological
quality of the review and included studies.
The numbers of cases with known adverse
events associated with massage therapy
compared with its widespread practice were
very few. In fact the numbers were deemed
too small to be statistically meaningful in
estimating risk.
Massage practitioners commonly
combine techniques and
modalities from two or more
massage therapies/techniques
within a sin
g
le treatment.

The Effectiveness of Massage Therapy 23 Discussion
Massage therapy, although non-invasive is not truly risk free. Serious complications were
rare in the literature, and despite its widespread practice, the numbers of cases with known
adverse events associated with massage therapy were very few and too small to be
statistically meaningful in estimating risk.9

The Effectiveness of Massage Therapy 24 Conclusions
Conclusions
The evidence presented in this review is a summary of existing research on the use of
massage. A summary of systematic reviews included in this review found moderate to
strong (Grade A and B) evidence to support massage therapy for nausea and vomiting,
anxiety, stress, chronic disease management, delayed onset muscle soreness (DOMS) and
pulmonary function. There was limited evidence (Grade C) for recommending massage
therapy in over 20 other conditions while there were many other conditions with
inconclusive or no evidence. There is consistent and conclusive evidence that massage
therapy is generally safe.
Implications for research
Throughout the literature, the need for higher quality research studies especially RCTs that
are sufficiently powered with strong methodological quality was highlighted. Further
research on the longer term
effects, cost-effectiveness and
feasibility of massage therapy
is required to better define the
scope for massage therapy.
Publication of clear and
focussed case studies may
enable future researchers elicit potentially promising areas for further research.
Implications for practice
This review highlights the volume and significant growth of massage-related evidence over
which in turn reflects growing interest in the effectiveness of massage as a therapeutic
modality. This growing evidence base
should aid clinicians in recommending
massage as a therapeutic modality. While
numerous indications for massage therapy
are yet to be supported by research,
massage may still be recommended based
on its excellent safety profile as well as
anecdotal evidence. In the context of
integrative medicine, clinicians are encouraged to collaborate with professional massage
practitioners in the interest of the best management of their patients.
There is a need for more, higher quality research
studies and controlled trials backed by strong
methodology in the field of massage therapy.
This growing evidence base should
aid clinicians in recommending
massage as an evidence-based
therapeutic modality.

The Effectiveness of Massage Therapy 25 References
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The Effectiveness of Massage Therapy 35 Appendix I: Search strategy
Appendix I: Search strategy
AMED
No. Search term(s) and applied functions Hits
1 Acupressure/ or acupressure.mp. 298
2 bowen technique.mp. 6
3 bowen therapy.mp. 0
4 deep transverse friction.mp. 4
5 dry needling.mp. 21
6 lymphatic massage.mp. 0
7 manual lymphatic drainage.mp. 8
8 massage.mp. or exp Massage/ 1790
9 myofascial release.mp. 38
10 reflexology.mp. or exp Reflexology/ 203
11 rolfing.mp. 21
12 shiatsu.mp. or exp Shiatsu/ 226
13 trager massage.mp. 0
14 trager therapy.mp. 1
15 trigger point therapy.mp. 23
16 tui na.mp. 15
17 tuina.mp. 20
18 tui-na.mp. 15
19 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12
or 13 or 14 or 15 or 16 or 17 or 18
2502
20 limit 19 to English 2286
CINAHL
No. Search term(s) and applied functions Hits
1
exp SWEDISH MASSAGE/ or exp DEEP TISSUE MASSAGE/
or exp MASSAGE/ or exp SPORTS MASSAGE/ or exp
NEUROMUSCULAR MASSAGE/ 4282
2 massage.tw. 2637
3 acupressure.tw. 244
4 bowen technique.tw. 24
5 bowen therapy.tw. 5
6 deep transverse friction.tw. 5
7 dry needling.tw. 48
8 lymphatic massage.tw. 3
9 manual lymphatic drainage.tw. 24
10 myofascial release.tw. 60

The Effectiveness of Massage Therapy 36 Appendix I: Search strategy
No. Search term(s) and applied functions Hits
11 reflexology.tw. 222
12 rolfing.tw. 22
13 shiatsu.tw. 70
14 trager massage.tw. 0
15 trager therapy.tw. 1
16 trigger point therapy.tw. 40
17 tui na.tw. 12
18 tui-na.tw. 12
19 tuina.tw. 11
20 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or
13 or 14 or 15 or 16 or 17 or 18 or 19
5325
21 limit 20 to English 5162
22 limit 21 to (case study or clinical trial or "systematic
review")
651
23 limit 21 to research 1191
24 22 or 23 1478
EBM Reviews
No. Search term(s) and applied functions Hits
1 acupressure.tw. 238
2 bowen technique.tw. 0
3 bowen therapy.tw. 0
4 deep transverse friction.tw. 2
5 dry needling.tw. 35
6 lymphatic massage.tw. 2
7 manual lymphatic drainage.tw. 16
8 myofascial release.tw. 12
9 reflexology.tw. 72
10 rolfing.tw. 5
11 shiatsu.tw. 9
12 trager massage.tw. 0
13 trager therapy.tw. 0
14 trigger point therapy.tw. 11
15 tui na.tw. 3
16 tuina.tw. 16
17 tui-na.tw. 3
18 massage.tw,sh,xs. 1073
19 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or
13 or 14 or 15 or 16 or 17 or 18
1380
20 limit 19 to english language [Limit not valid in CDSR,ACP
Journal Club,DARE,CCTR,CLCMR; records were retained]
1375
21 limit 20 to humans [Limit not valid in CDSR,ACP Journal
Club,DARE,CCTR,CLCMR; records were retained]
1366

The Effectiveness of Massage Therapy 37 Appendix I: Search strategy
No. Search term(s) and applied functions Hits
22 limit 21 to (case report or clinical trial or comparative study
or multicenter study or "review") [Limit not valid in
CDSR,ACP Journal Club,DARE,CLCMR,CLHTA,CLEED;
records were retained]
746
Meditext
No. Search term(s) and applied functions Hits
1 MHJ=massage 83
2 Reflexology 8
3 Shiatsu 1
4 Rolfing 0
5 (bowen technique) 2
6 (bowen therapy) 3
7 Acupressure 8
8 (dry needling) 2
9 (myofascial release) 2
10 deep transverse friction) 0
11 Tuina 0
12 (tui na) 2
13 tui-na 0
14 (trigger point therapy) 6
15 (lymphatic massage) 1
16 (manual lymphatic drainage) 0
17 1 OR 2 OR 3 OR 4 OR 5 OR 6 OR 7 OR 8 OR 9 OR 10 OR
11 OR 12 OR 13 OR 14 OR 15 OR 16
108
Pubmed*
No. Search term(s) and applied functions Hits
1 ((massage[MeSH Terms]) OR ("massage"[Text Word])) 2182
2 (("acupressure"[Text Word]) OR ("shiatsu"[Text Word])) 276
3 ("reflexology"[Text Word]) 64
4
((("tuina"[Text Word]) OR ("tui-na"[Text Word])) OR ("tui
na"[Text Word])) 4
5 ("rolfing"[Text Word]) 8
6 ((trager therapy) OR (trager massage)) 35
7 ((lymphatic massage) OR (manual lymphatic)) 93
8
(("bowen therapy"[Text Word]) OR ("bowen
technique"[Text Word])) 2
9
(("trigger point therapy"[Text Word]) OR ("dry
needling"[Text Word])) 51
10
(("myofascial release"[Text Word]) OR ("deep transverse
friction"[Text Word])) 27
*Each entry was searched independently. Limits: Humans, Clinical Trial, Meta-Analysis, Randomized Controlled Trial, Review,
Case Reports, Comparative Study, Multicenter Study, English

The Effectiveness of Massage Therapy 38Appendix II: Studies excluded due to time constraints in obtaining full-text article
Appendix II: Studies excluded due to time constraints in
obtaining full-text article
No. Author Year Citation
1 Bailey 2003 The use of Shiatsu in a patient with depression and anxiety.
Shiatsu Society News
; 85:7.
2 Chung et al 2003 Effects of LI4 and BL 67 acupressure on labor pain and uterine
contractions in the first stage of labor.
J Nurs Res
; 11:251-60.
3 Dundee 1988 Acupuncture/acupressure as an antiemetic: studies of its use in
postoperative vomiting, cancer chemotherapy and sickness of
early pregnancy.
Complement Med Res
; 3:2-14.
4 Harris and Lewis 1995 Acupressure and traditional Chinese massage.
Int J Alternat
Complement Med
; 13:8.
5 Jackson 1995 Acupressure for post-operative nausea.
Nurs Times
; 91(26):58.
6 Kalauokalani et al 2003 Lessons from a trial of acupuncture and massage for low back
pain.
Massage Ther J
; 42:112-23.
7 Lee 2005 The effect of infant massage on weight gain, physiological and
behavioral responses in premature infants.
Taehan Kanho
Hakhoe Chi
; 35:1451-60.
8 Littmann et al 1988 Treatment of 11 cases of chronic enuresis by acupuncture and
massage.
Chest
; 94:650-2.
9 Martin 1993 Acupressure technique: menstrual pain in athletes.
Int J Alternat
Complement
; 11:23-4.
10 Moriarty 2007 Psychophysiologic responses to acupressure used as a pre-birth
treatment at full term gestation
(Dissertation)
; 232 pages.
11 O'Mathuna 2003 Bone marrow transplant patients perceive benefits from
massage therapy, but the value of therapeutic touch is more
questionable.
Focus Altern Complement Ther
; 8:342-3.
12 Philips and Gill 1993 Acupressure. A point of pressure.
Nurs Times
; 89:44-5.
13 Pouresmail and
Ibrahimzadeh
2002 Effects of acupressure and ibuprofen on the severity of primary
dysmenorrhea.
J Tradit Chin Med
; 22:205-10.
14 Rappenecker and
Gordon
2000 Shiatsu for chronic pain in the lower back.
Shiatsu Society News
;
76:2-5.
15 Sadler 1989 Can acupressure relieve nausea?
Nurs Times
; 85:32-4.
16 Symons and McNeil 1987 Analgesic effects of acupressure on experimental pain.
NZ J
Physiother
; 15:26.
17 Zeidenstein 1998 Alternative therapies for nausea and vomiting of pregnancy.
J
Nurse Midwifery
; 43:392-3.
18 2004 Sports massage case study: 2: restricted trunk rotation in a
golfer.
Sportex Dyn
1:20.
19 2004 Sports massage case study: 1: decathlon athlete with tight
hamstring.
Sportex Dyn
1:19.

The Effectiveness of Massage Therapy 39 Appendix III: Summary of systematic reviews
Appendix III: Summary of systematic reviews
SR = systematic review; RCT = randomized controlled trial; CCT = controlled clinical trial; NOS = not otherwise specified
No. Medical condition Year Author Type of
massage
Type (number) of
included studies
Conclusion and/or recommendations
Grade A Recommendations
1 Nausea & vomiting 2006 Helmreich et al20 Acupressure RCT (8); CCT (6) Significant reduction in nausea and vomitting, and greater effect than
acupunture
2 Nausea & vomiting 2006 Shiao and Dune23 Acupressure RCT (33) Korean hand acupressure most effective, as effective as 1st line
antiemetics and acupuncture
3 Nausea & vomiting 2006 Shiao and Dibble22 Acupressure SR (3) Multiple acupoints shown as effective (adults > children) as
medications/acupuncture and more feasible/convenient
4 Nausea & Vomiting 2000 Freels and Coggins19 Acupressure Unspecified (8) Proven effectiveness for nausea/vomitting over placebo in early
pregnancy
5 Nausea & Vomiting 1999 Lee and Done21 Acupressure RCT (24; 19 used
for meta-analysis)
Deemed equivalent to 1st-line anti-emetics post-surgery
6 Nausea & Vomiting 1997 Harris10 Acupressure Unspecified Effective anti-emetic as compared to placebo
Grade B Recommendations
7 Anxiety, nausea, pain
and lymphoedema
2002 Weiger et al49 Massage (NOS);
manual lymphatic
drainage
Unspecified Moderate evidence effectiveness/safety - recommended for anxiety
and lymphoedema in conjunction with complex physical therapy.
Positive findings for nausea; inconclusive (mixed) for pain - precaution
described and recommended
8 Back pain
(subacute/chronic)
2003 Cherkin et al24 Massage (NOS) RCT (3) Deem to be effective treatment; further data will assist
recommendation. Safe (few adverse effects) and relatively cost-
effective
9 Cancer 2008 Myers et al47 Swedish,
aromatherapy,
acupressure,
reflexology
Unspecified (24) Benefits in managing anxiety and pain in cancer patients observed

The Effectiveness of Massage Therapy 40 Appendix III: Summary of systematic reviews
No. Medical condition Year Author Type of
massage
Type (number) of
included studies
Conclusion and/or recommendations
10 Cancer 2008 Hughes et al41 Massage (NOS) -
paediatric
massage /
reflexology
RCT, CCT,
observational
studies
Recommended as supportive therapy for management pain, anxiety,
depression, constipation and hypertension
11 Cancer 2008 Myers et al46 Swedish,
aromatherapy,
reflexology,
acupressure
Unspecified (22) Recommended for anxiety management for some cancer pts with less
robust evidence for other symptoms i.e. pain, fatigue, depression -
further research warranted
12 Cancer 2006 Joske et al12 Massage (NOS),
aromatherapy,
reflexology
SR, RCT Moderate evidence in symptom management i.e. anxiety, pain, quality
of life and potential for improved immunity
13 Cystic Fibrosis 2005 Huth et al36 Massage (NOS) RCT/CCT (4) (inc
chronic lung dx,
asthma, CF)
Moderate evidence of fair to good quality trials - improved pulmonary
function tests, anxiety and depression - recommended massage
therapy for youths with cystic fibrosis
14 Low back pain
(chronic)
2008 Imamura et al28 Massage /
acupressure
RCT (5) Moderate to strong evidence of effectiveness in symptoms and
function both short and long term
15 Low back pain 2007 Chou and Huffman25 Massage (NOS) 2 SR containing 8
RCT
No evidence for acute low back pain; fair evidence for
subacute/chronic low back pain reportedly as effective as spinal
manipulative therapy
16 Low back pain 2005 van Tulder et al30 Massage (NOS) Cochrane SR (1) More effective (moderate) than placebo/sham for chronic low back
pain and appears effective in acute on chronic low back pain - more
research required
17 Low back pain
(chronic/sub-acute)
2002 Furlan et al27 Massage (NOS),
Swedish,
acupressure
RCT(8); quasi-RCT
(1)
Moderate evidence with potential for long-term benefits supports
massage therapy in chronic/sub-acute low back pain
18 Lung cancer 2007 Cassileth at al37 Massage (NOS);
reflexology;
aromatherapy
Not specified - RCT
included (9)
Clinical/statistical significant difference for anxiety, pain and other
cancer symptoms i.e. fatigue/distress - recommended as part of
multimodality treatment approach - avoid anatomical cancer lesions,
post-operative and bleeding risks
19 Mood and anxiety 2000 Cooke and Ernst19 Aromatherapy RCT (6) Mild, transient alleviation of anxiety (not anxiety disorders) - caution
due to poor quality studies
20 Non-specific low back
pain
2004 Dryden et al26 Massage (NOS) SR (2); RCT (4) Positive findings but insufficient data - recommended for low back
pain wt sig patient satisfaction and pain reduction
21 Pain (chronic, non-
malignant)
2007 Tsao29 Massage (NOS) SR/clinical trials
unspecified
Fairly robust evidence for analgesia for non-specific low back pain,
moderate support for shoulder pain and headache and modest
preliminary support for fibromyalgia and mixed chronic pain, neck pain

The Effectiveness of Massage Therapy 41 Appendix III: Summary of systematic reviews
No. Medical condition Year Author Type of
massage
Type (number) of
included studies
Conclusion and/or recommendations
22 Physiology 1997 Labyak and
Metzger44
Swedish (back) CCT (9) Recommended as effective therapy to reduce heart rate and
respiratory rate, and blood pressure (more drastic drop in male vs
female) include patients wt cardiovascular disease - sustained effects
unclear
23 Physiology, anxiety,
depression
2004 Moyer et al11 Massage (NOS) RCT (37) Single application showed decrease state anxiety, heart rate and blood
pressure whilst multiple applications also moderated pain. Largest
effect in managing anxiety and depression.
24 Recovery / Delayed
Onset Muscle
Soreness (DOMS)
2008 Best et al35 Sports massage RCT (10), Case-
series (17)
Moderate beneficial evidence, further studies required
25 Relaxation 2000 Kerr43 Massage (NOS) Various (13) Effective in reducing physiological/ psychological stress response
26 Relaxation, comfort
and sleep
2000 Richards et al48 Massage (NOS) RCT, CCT,
observational
studies
Evidence exist for significant effects to reduced anxiety, physiologic
markers of relaxation and pain reduction. Inconclusive for improving
sleep due to methods of effect measure
27 Stress / anxiety 2005 Corbin39 Massage (NOS)
excluding
reflexology
Unspecified -
Original research
inc letters and case
studies
Reportedly strong evidence for benefit in managing stress and
reducing anxiety
28 Symptom
management / quality
of life
2006 Lafferty et al45 Massage (NOS) RCT/CCT (11) Significant benefits demonstrated in multiple trials with
methodological flaws - anxiety, depression, pain, nausea, fatigue,
insomnia, quality of life
29 Symptoms (anxiety,
nausea and pain)
2008 Wilkinson et al140 Massage (NOS);
Aromatherapy
CCT (10) Short-term anxiolytic effect and potentially beneficial for management
of pain and nausea - further research warranted due to lack of
methodological rigour
30 Unspecified 1999 Gauthier40 Swedish massage
(back)
Unspecified (22) Deem effective to promote sleep and enhance sleep quality and
reducing anxiety without haemodynamic compromise
Grade C Recommendations
31 Alopecia areata 2000 Cooke and Ernst38 Aromatherapy RCT (1) Positive but insufficient data and poor methods for recommendation
32 Anxiety 2008 Parslow et al141 Massage (NOS) RCT (1) Promising findings that massage therapy may reduce anxiety in
children/adolescent but further research to validate findings with
larger trials required
33 Anxiety, depression,
insomnia
2007 Meeks et al86 Massage (NOS) RCT Positive findings but insufficient data / poor quality studies - further
research required

The Effectiveness of Massage Therapy 42 Appendix III: Summary of systematic reviews
No. Medical condition Year Author Type of
massage
Type (number) of
included studies
Conclusion and/or recommendations
34 Anxiety, mood, other
symptoms (mood,
skin conditions,
respiratory
conditions)
2007 Beider et al6 Paediatric
massage
Unspecified Reduced state anxiety as single dose effect; reduced pain for juvenile
rheumatoid arthritis - limited evidence-based recommendations
35 Anxiety, nausea, pain
and lymphoedema
2002 Weiger et al49 Massage (NOS);
manual lymphatic
drainage
Unspecified Moderate evidence effectiveness/safety - recommended for mx of
anxiety and lymphoedema in conjunction with complex physical
therapy. Positive findings for nausea; inconclusive (mixed) for pain -
precaution described and recommended.
36 Arm, neck and
shoulder complaints
2007 Verhagen et al75 Massage (NOS) CCT (3) Limited/positive outcome of massage therapy as add on in manual
therapy treatment in single study of low quality - further research
warranted
37 Arm, neck and
shoulder complaints
2006 Verhagen et al74 Massage (NOS) CCT (3) Limited/positive outcome of massage therapy as add on in manual
therapy treatment in single study of low quality - further research
warranted
38 Attention deficit
hyperactive disorder
(ADHD)
2001 Arnold98 Massage (NOS) Comparative (1) Positive but insufficient data
39 Breast cancer -
lymphoedema
2007 Moseley et al93 Manual lymphatic
drainage
CCT (8) Level B (moderate evidence) - Positive findings but more convincing
when used in combination with compression therapy vs monotherapy
- long term benefits unclear
40 Breast cancer -
lymphoedema
2004 Kligman et al94 Manual lymphatic
drainage
Clinical trial (2) Positive but no significant difference - insufficient evidence as
monotherapy - recommended in combination with compression
therapy for management established lymphoedema
41 Cancer 2008 Myers et al46 Swedish,
aromatherapy,
reflexology,
acupressure
Unspecified (22) Recommended for anxiety management for some cancer patients with
less robust evidence for other symptoms i.e. pain, fatigue, depression
- further research warranted
42 Cancer pain 2008 Liu and Fawcett51 Massage (NOS) Unspecified Promising short term results - poor quality studies warrant more
research
43 Cancer-related fatigue 2007 Sood et al55 Massage (NOS) RCT (1) Positive for fatigue, nausea, vomitting and anxiety but sustained
effects unclear - further studies required
44 Delayed onset muscle
soreness (DOMS)
2003 O'Connor and
Hurley33
Sports massage RCT (4) Limited (mixed) evidence of fair quality showing benefit in reducing
pain intensity
45 Dementia 2006 Viggo Hansen et al88 Massage (NOS) RCT (2) Limited evidence for hand massage for immediate short term
reduction in agitation - single study - more research required

The Effectiveness of Massage Therapy 43 Appendix III: Summary of systematic reviews
No. Medical condition Year Author Type of
massage
Type (number) of
included studies
Conclusion and/or recommendations
46 Dementia (behaviour
disturbances)
1999 Opie et al87 Massage,
aromatherapy
Unspecified (3) Evidence of moderate quality with positive findings in heart rate
reduction and objective ratings of relaxation but not of agitated
behavior
47 Depression, anxiety,
leg/back pain,
prematurity, labor
pain
2008 Field58 Pregnancy
massage
Unspecified (2) Positive findings, but insuffient data - no clinical recommendation
provided
48 Depression 2006 Jorm et al91 Paediatric
Massage
RCT (3) Positive evidence but limited quality - immediate effect on mood but
sustained effect to be investigated- further research warranted
49 Depression 1998 Ernst et al165 Massage (NOS) RCT (1) Positive but insufficient data and small sample size
50 Fibromyalgia 2007 Mannerkorpi and
Henriksson79
Massage (NOS) RCT (3) May improve symptoms; positive but insufficient evidence to provide
recommendations - further research warranted
51 Fibromyalgia 2007 Hardy-Pickering et
al76
Massage (NOS) Unspecified Some evidence to support massage therapy, with recommendation for
use as part of multimodality treatment
52 Fibromyalgia 2003 Holdcraft et al77 Swedish/Massage
(NOS)
RCT(2) Positive outcomes observed with pain, quality of life, perceived
helplessness - better quality studies required
53 Fibromyalgia /
musculoskeletal pain
1999 Karjalainen et al78 Massage (NOS) -
multidisciplinary
rehab
RCT/CCT Limited evidence due to poor quality studies and lack of quantifiable
benefits - further research required
54 General Wellbeing 2005 Anderson and
Johnson57
Reflexology RCT (1) Positive but insufficient data
55 Growth and
development
2007 Beider et al6 Infant massage Unspecified Improved weight gain and shorter hospital stays, improved mother-
infant interaction, sleep and relaxation, reduced crying but based on
single study and mixed evidence - safe by physiologic status and
agitation/pain scores - also improved satisfaction and decreased post
natal depression symptoms
56 Growth and
development
2006 Underdown et al69 Infant Massage RCT (23) Some evidence of benefits on mother-infant interaction, sleeping and
crying, and on hormones influencing stress levels without evidence
for harm - recommended for community application. Single highly
biased positive outcome of massage therapy for growth - further
research
57 Growth and
development
2004 Vickers et al70 Infant Massage RCT (15) Insufficient evidence due to poor methodological quality but
suggestive of positive outcome

The Effectiveness of Massage Therapy 44 Appendix III: Summary of systematic reviews
No. Medical condition Year Author Type of
massage
Type (number) of
included studies
Conclusion and/or recommendations
58 HIV / AIDS 2007 Uwimana and
Louw56
Massage (NOS) Peer reviewed
scientific
publications - RCT
(2)
Improve health perception and decreased utilization of health
resources and improved measures of quality of life i.e. anxiety,
depression and improved immune function - may be effective and
incorporated in palliative care - insufficient evidence however
59 HIV 2005 Mills et al52 Massage (NOS) RCT (3) Positive findings in anxiety, depression, quality of life and immonology
but insufficient data - small studies
60 HIV / AIDS 1999 Ozsoy and Ernst68 Infant Massage Unspecified
?CCT/RCT (1)
Benefits include reduced excitability, and improved weight gain as
compared to placebo
61 Insomnia 2003 Richards et al101 Swedish RCT (1),
unspecified (1)
Limited evidence support use of relaxation massage to promote sleep
62 Knee osteoarthritis 2007 Zhang et al81 Massage (NOS) RCT (1) Significant benefit for pain in knee osteoarthritis - recommended as
part of multimodality management
63 Labor pain 2007 Smith et al62 Acupressure RCT (2) Positive - decreased anxiety and reduced pain in treatment group of
separate study but evidence is limited - further research warranted
64 Labor pain 2006 Smith et al63 Acupressure,
massage (NOS)
RCT (3) - 2
acupressure, 1
massage
No recommendations for acupressure - positive in reducing anxiety
and decreasing length of labour - massage appears to improve both
anxiety and pain
65 Labor pain 2005 Anderson and
Johnson57
Acupressure RCT (1) Time/pain reduction of 1st stage of labour but insufficient data
66 Labor pain 2004 Huntley et al59 Pregnancy
massage
RCT (2) Positive but poor quality trials - not presently recommended - further
research
67 Labor pain 2004 Simkin and Bolding60 Massage (NOS),
acupressure
RCT (3) Compared to usual care in 2 RCTs, women who received massage
therapy perceived reduced labor pain - promising results but small
studies - further research required - no included trials of acupressure
68 Labor pain 2002 Simkin and O'hara61 Pregnancy
massage
RCT/CCT (2) Limited evidence and small studies for actually reducing pain but
recommended as useful at any time in labor, these should be used to
convey reassurance, empathy, and to enhance comfort, relaxation,
and relief of back pain
69 Low back pain (acute) 2007 Louw et al73 Massage (NOS) SR (21), RCT (4)
and clinical
guidelines (11)
May be beneficial - recommended in combination with exercise and
education but not as monotherapy
70 Lung cancer (well-
being and quality of
life)
2004 Sola et al54 Reflexology RCT/quasi-RCT (1) Positive (potentially beneficial for anxiety) but small study - further
research required

The Effectiveness of Massage Therapy 45 Appendix III: Summary of systematic reviews
No. Medical condition Year Author Type of
massage
Type (number) of
included studies
Conclusion and/or recommendations
71 Mood disorders 2008 Andreescu et al89 Aromatherapy
Reflexology
Massage (NOS)
Case-series (2)
Unspecified (6)
Positive but insufficient data
72 Mood enhancement 2005 Anderson and
Johnson57
Massage (NOS) RCT (1) Positive but insufficient data
73 Mother-infant
relationship
2005 Beal66 Infant massage Qualitative studies
(2)
Positive but insufficient data
74 Multiple 2000 Ireland and Olson67 Paediatric / Infant
Massage
Unspecified Recommends massage therapy for preterm neonates reduced length
of hospitalization, benefit growth and development - symptom
management in older children that is condition specific but further
research warranted. Benefits include pain, anxiety, depresssion and
respiratory function; other studies available - atopic dermatitis, autism
75 Multiple sclerosis 2008 Wang et al13 Reflexology CCTs (5) Single-blind RCT study demonstrating large effect in multiple sclerosis
patients wt urinary symptoms, small effect on paraesthesia and
spasticity
76 Multiple sclerosis 2000 Huntley and Ernst92 Massage (NOS);
Reflexology
RCT (2) Positive effect on anxiety, depression and self-esteem but significant
methodological quality flaws - further research required
77 Muscular pain (low
back pain/DOMS
2004 Ernst32 Massage (NOS) 2 SR containing 13
(6; 7) RCT/CCT
Promising but poor quality of primary studies - warrants more
research
78 Myofascial pain 2006 Rickards80 Deep transverse
friction, digital
ischaemic
pressure, Swedish,
Thai
RCT/quasiRCT (2) All techniques showed reduced pain and disability measured - but no
control group and difference between groups - appears benefit but
limited evidence akin to case-studies
79 Nausea and vomitting
- post-/intra-
operative
2008 Allen and Habib166 Acupressure RCT (6) Some benefit but inconsistent findings
80 Nausea and vomitting
- post-/intra-
operative
2005 Anderson and
Johnson57
Acupressure RCT (2) Positive but insufficient data
81 Nausea and vomitting
- prenatal
2005 Anderson and
Johnson57
Acupressure RCT (7) Mixed evidence
82 Nausea/ Vomitting 2004 Klein and Griffiths135 Acupressure RCT (2) Positive but mixed evidence - potential value and recommended as
adjunct treatment

The Effectiveness of Massage Therapy 46 Appendix III: Summary of systematic reviews
No. Medical condition Year Author Type of
massage
Type (number) of
included studies
Conclusion and/or recommendations
83 Pain (Chronic, non-
malignant)
2007 Tsao29 Massage (NOS) SR/clinical trials
unspecified
Fairly robust evidence for analgesia for non-specific low back pain,
moderate support for shoulder pain and headache and modest
preliminary support for fibromyalgia and mixed chronic pain, neck pain
84 Pain (low back
pain/DOMS)
2001 Wright and Sluka34 Massage (NOS) SR (2) 2 reviews (low back pain/DOMS) Insufficient evidence - may be of
limited benefit due to methodological flaws
85 Pain / other
symptoms
2000 Cooke and Ernst38 Aromatherapy RCT (1) Positive but insufficient data and poor methods for recommendation
86 Physical distress 2005 Beal66 Infant massage SR (1), Unspecified
(1)
Positive but insufficient data
87 Physiology, anxiety,
depression
2004 Moyer et al11 Massage (NOS) RCT (37) Single application showed decrease state anxiety, heart rate and blood
pressure whilst multiple applications also moderated pain; largest
effect in managing anxiety and depression
88 Postnatal depression,
infant growth and
development
2005 Zealey71 Infant massage SR (2), RCT (2) Rapid weight gain, reduced length of hospitalizations (based on
systematic reviews), positive outcomes in post natal depression and
mother-infant interaction (based on 1 RCT)
89 Post-natal depression 2004 Dennis65 Massage (NOS) RCT (2) Positive findings, but insuffient data and long term effects
undetermined
90 Postpartum
depression and
mother-infant
relationship
2008 Bamigboye and
Smyth64
Reflexology RCT (1) Positive but insufficient data
91 Postpartum
depression and
mother-infant
relationship
2005 Anderson and
Johnson57
Infant massage RCT (1) Positive but insufficient data
92 Premenstrual
syndrome
2001 Stevinson and
Ernst72
Massage,
reflexology
RCT (1 massage, 1
reflexology)
Positive outcomes but limited evidence - massage study had no
comparison, whilst reflexology had small sample size - further
research warranted
93 Pressure sores
(prevention)
1997 Buss et al102 Massage (NOS) Unspecified (10) Positive but lacks statistical significance; lack evidence to recommend
for high risk patients
94 Procedural pain 2008 Evans et al105 Massage (NOS) Comparative study
(1; unspecified)
Positive single study in burns patients otherwise limited evidence
95 Recovery / delayed
onset muscle
soreness (DOMS)
1998 Ernst31 Sports massage RCT (1) Positive but insufficient data and small sample size

The Effectiveness of Massage Therapy 47 Appendix III: Summary of systematic reviews
No. Medical condition Year Author Type of
massage
Type (number) of
included studies
Conclusion and/or recommendations
96 Relaxation 2003 Smith and
O'Driscoll137
Massage (NOS) Unspecified Inadequate reporting and apparent methodological flaws, but benefits
appear positive towards cancer/mental health patients but conflicting
in medical/intensive care patients
97 Symptoms inc
anxiety, dypsnea,
fatigue, pain
2008 Wilkinson et al50 Reflexology; foot
massage
CCT (3) Positive reduction of dypsnea, fatigue, anxiety and pain but
heterogeneous studies - further studies with methodological
rigour/sample size/long term effects/safety - lacks evidence for
recommendation
98 Symptoms (anxiety,
nausea and pain)
2008 Wilkinson et al140 Massage (NOS);
aromatherapy
CCT (10) Short-term anxiolytic effect and potentially beneficial for management
of pain and nausea - further research warranted due to lack of
methodological rigour
99 Symptom
management and
quality of life
2006 Lafferty et al45 Massage (NOS) RCT/CCT (11) Significant benefits demonstrated in multiple trials with
methodological flaws - anxiety, depression, pain, nausea, fatigue,
insomnia, quality of life
100 Symptom
management (pain,
dypsnea, nausea and
vomitting)
2000 Pan et al53 Massage (NOS),
aromatherapy
RCT (1), case-series
(2)
Promising/positive results with significant benefit to reduce pain of
short-term value but further research required - maybe beneficial for
pain
101 Temporomandibular
joint disoders
2007 Kalamir et al82 Massage (NOS) Unspecified Positive evidence as part of manual therapy / combined treatment
approach - but lack of evidence as standalone treatment
102 Unspecific 1994 Ernst and Fialka7 Massage (NOS) NOS Promising but insufficient evidence for pain, anxiety, lymphoedema
and depression requiring better quality CCTs
Grade D Recommendations
103 Cancer pain 1998 Sellick and Zaza139 Massage (NOS) RCT (1) Mixed/Inconclusive findings with methodological limitations
104 Dementia /
depression
2003 Snowden Met al167 Massage (NOS) Case series (4) Limited mixed evidence - 1 study showed reduced agitation during
hand massage but not sustained
105 Cervical spondylosis 2008 Wang et al105 Tuina Comparative studies
(7)
Negligible pooled effects and mixed evidence - lacks evidence for
clinical recommendation
106 Constipation 1999 Ernst106 Massage (NOS) CCT (3)/RCT (1) Inconclusive due to mixed evidence and poor quality studies
107 Ilio-tibial band (ITB)
syndrome
2007 Ellis et al107 Deep transverse
friction
RCT (4) No significant benefit; insufficient data
108 Insomnia 2007 Cheuk et al99 Acupressure RCT (7) May improve sleep quality; however inconsistent and lack of evidence
of good quality
109 Low back pain 1999 Ernst83 Massage (NOS) CCT (4) Inconclusive due to mixed evidence and poor quality studies

The Effectiveness of Massage Therapy 48 Appendix III: Summary of systematic reviews
No. Medical condition Year Author Type of
massage
Type (number) of
included studies
Conclusion and/or recommendations
110 Lymphoedema 2007 Warren et al97 Manual lymphatic
drainage
Unspecified Manual lymphatic drainage may not contribute substantial reduction in
edema volume over effects of compression. Commonly practised as
complex physical therapy incorporating compression and exercise -
generally positive up to 40-60% vol reduction reported but mixed
evidence.
111 Nausea and vomitting
- prenatal
2005 Anderson and
Johnson57
Acupressure RCT (7) Mixed evidence
112 Neck pain (chronic) 2007 Vernon et a168 Massage (NOS) RCT (2) Lack of evidence (mixed) - further research
113 Pain 2006 Bardia et al138 Massage (NOS) RCT (3) Mixed evidence - 1 study short-term / immediate benefit, 2 studies
showed no benefit
114 Pain 2006 Lewis and
Johnson169
Massage (NOS) -
therapeutic
Unspecified (20) Mixed evidence - poor quality studies
115 Pain 2003 Stephenson and
Dalton170
Reflexology Unspecified (14) Mixed evidence - inconclusive - further research required
116 Pressure sores
(prevention)
2005 Duimel-Peeters et
al103
Swedish Unspecified (12) Mixed evidence, insufficient data
117 Sports physiology,
psychology and
performance (DOMS
included)
2001 Hemmings171 Sports massage Unspecified Equivocal results - inconclusive - further research warranted
Grade E Recommendations
118 Anxiety 2007 Robinson et al172 Massage (NOS) RCT/quasi-RCT No studies were included in this review
119 Arthritis 1994 Nicholas108 No included massage therapy studies
120 Asthma 2005 Hondras et al111 Massage (NOS) RCT (1) Insufficient evidence for recommendation - further research required
121 Asthma allergy 2004 Balon and Mior109 Massage (NOS) RCT (2) No significant difference compared with control
122 Atopic eczema 2001 Hoare et al110 Massage (NOS) Insufficient evidence
123 Bell's Palsy 2008 Teixeira et al112 Massage (NOS) RCT /quasi-RCT (3) Lack of evidence (mainly assessed in combination ie physical therapy)
124 Breast cancer -
lymphoedema (arm)
2001 Erickson et al95 Manual lymphatic
drainage
Unspecified (6) Manual lymphatic drainage, often prescribed as part of a multi-
modality approach - recommended as effective therapy
125 Bronchial asthma 2008 Wang et al13 Reflexology CCT (5) No evidence

The Effectiveness of Massage Therapy 49 Appendix III: Summary of systematic reviews
No. Medical condition Year Author Type of
massage
Type (number) of
included studies
Conclusion and/or recommendations
126 Carpal tunnel
syndrome
2003 O'Connor et al113 No included
massage therapy
studies
RCT/quasi-RCT No included massage therapy studies
127 Cervicogenic
headache
2004 Bronfort et al117 Deep transverse
friction; trigger
point therapy
RCT (1) Inferior to spinal manipulative therapy
128 Dementia 2003 Thorgrimsen et al173 Aromatherapy RCT (1) Lack of evidence - single study used topical application - not massage
although results were positive to management agitation and
neuropsychiatric symptoms
129 Diabetes mellitus 2001 Ezzo et al114 Swedish;
acupressure
Unspecified No data on increasing insulin sensitivity, insufficient/flawed evidence
for improving blood sugar control, no evidence for symptom control of
peripheral neuropathy; no adverse effects/contraindications observed
130 Headache 1999 Vernon et al119 Deep tissue
massage
RCT (0); nil as
stand-alone
treatment
Lack of evidence - no included studies
131 Headache - tension
type
2006 Fernandez-de-Las-
Penas et al118
Massage (NOS /
connective tissue
massage
RCT/CCT (3) Limited evidence and of mixed quality
132 Headache (chronic /
recurrent - tension,
migraine,
cervicogenic)
2004 Bronfort et al174 Massage (NOS) Not applicable Lack of evidence as stand-alone treatment
133 Insomnia / sleep 2004 Haesler100 Massage (NOS) Quantitative /
qualitative studies
No evidence of massage therapy reviewed
134 Intrapartum
lymphoedema
2008 Wang et al13 Reflexology CCT (5) No evidence
135 Irritable bowel
syndrome
2008 Wang et al13 Reflexology CCT (5) No evidence
136 Knee pain -
tendinopathy
2001 Philadelphia panel121 Deep Transverse
Friction
RCT (1) Insufficient data
137 Labour - induction /
augmentation and
analgesia
2001 Allaire120 Acupressure Nil No data
138 Lateral epicondylagia
(tennis elbow)
2005 Bisset et al122 Deep transverse
friction; ,assage
(NOS)
RCT (0); nil as
stand-alone
treatment
Lack of evidence

The Effectiveness of Massage Therapy 50 Appendix III: Summary of systematic reviews
No. Medical condition Year Author Type of
massage
Type (number) of
included studies
Conclusion and/or recommendations
139 Low back pain
(subacute)
2002 Pengel et al136 Massage (NOS) RCT (2) No recommendations of effectiveness of massage therapy due to lack
of evidence/insufficient data
140 Low back pain -
acute, subacute and
chronic
2001 Philadelphia panel84 Therapeutic
Massage
RCT (1)
Comparative (1)
Insufficient data
141 Low back pain 1998 Ernst90 Massage (NOS) Unspecified (7) Overall negative/neutral - poor/lack of evidence
142 Lymphoedema 2004 Preston et al96 Manual lymphatic
drainage
RCT (1) Manual lymphatic drainage not shown to add benefit to compresive
therapy - but has design limitation
143 Menopause 2005 Carpenter and
Neal123
Reflexology RCT (1) No significant benefit; insufficient data
144 Menopause 2002 Kronenberg and
Fugh-Berman124
Massage (NOS) RCT No reported evidence
145 Mood disorders /
depression
2008 Coelho et al142 Swedish RCT (4) Lack of evidence in RCTs to support previous findings that suggest
that massage therapy may be beneficial for mood disorders.
146 Multiple sclerosis 2008 Wang et al13 Reflexology CCT (5) Single-blind RCT study demonstrating large effect in multiple sclerosis
patients wt urinary symptoms, small effect on paraesthesia and
spasticity
147 Neck pain (chronic) 2008 Graham et al126 Traction RCT (7) Insufficient evidence due to poor quality studies
148 Neck pain 2007 Ezzo et al127 Massage (NOS) RCT inc quasi-
RCT(19)
Inconclusive evidence
149 Neck disorders 2006 Trinh et al175 Acupressure RCT (1) Lack of evidence - reportedly inferior to acupuncture in a single study
for neck pain
150 Neck pain -
acute/chronic
2005 Committee
Guidelines
Development128
Massage (NOS) Not found Insufficient/Lack of evidence to support recommendations (expert
extrapolation) for management within scope of practice of practitioner
151 Neck and shoulder
pain
2003 Karjalainen et al85 Massage (NOS) -
multidisciplinary
rehab
RCT/CCT Poor evidence for multidisciplinary rehab
152 Neck disorders 2002 Gross et al127 Massage (NOS) RCT/quasi-RCT Equal effects to placebo, when combined with exercise may have
positive effects on pain reduction/patient satisfaction
153 Neck pain - acute and
chronic
2001 Philadelphia panel129 Therapeutic
massage
Nil No data
154 Oedema / varicose
veins
2006 Bamigboye and
Hofmeyr64
Reflexology RCT (2) Negative but insufficient data
155 Pelvic / back pain 2007 Pennick and
Young143
No included massage therapy studies

The Effectiveness of Massage Therapy 51 Appendix III: Summary of systematic reviews
No. Medical condition Year Author Type of
massage
Type (number) of
included studies
Conclusion and/or recommendations
156 Peri-natal depression
/ anxiety
2008 Coelho et al142 Swedish
RCT(7) Lack of evidence for perinatal anxiety or depression
157 Primary headaches
(tension, migraine,
cervicogenic)
2005 Biondi116 Massage (NOS) Not applicable Lack of evidence; generally less effective compared with physical
therapy (unspecified) or chiropractic (spinal manipulative therapy)
159 Quality of life (pain /
function)
2008 Reid et al176 Massage (NOS) RCT (7) No evidence for older adults. Available (limited) finds benefit of
massage for chronic pain in short term (?long term) - appears safe
and studies are in young-mid age adults
160 Shoulder pain (non-
specific)
2001 Philadelphia Panel145 Massage (NOS) RCT (1) Insufficient data to provide recommendations
161 Smoking cessation 2006 White et al132 Acupressure RCTs (24 inc other
acupressure /
apuncture type
modalities)
No evidence
162 Stress (occupational)
prevention
2006 Marine et al131 Massage (NOS) RCT Lack of evidence
163 Tendinopathy 2002 Brosseau133 Deep transverse
friction
RCT (2) Inconsistent findings; insufficient data
164 Weight loss/ appetite 1997 Ernst134 Acupressure CCT (4) Overall negative - poor/lack of evidence
165 Whiplash 2007 Verhagen et al130 Massage (NOS) SR/RCT Lack of evidence - combination treatments used but generally
conflicting evidence for recommendations - no independent studies of
massage therapy available to provide indication