From the Guidelines
Massage relieves pain through several mechanisms, including increased blood flow, stimulation of endorphins, and activation of pressure receptors, as supported by moderate-quality evidence from recent studies 1. When muscles are massaged, blood flow increases to the area, delivering oxygen and nutrients while removing waste products that can contribute to pain. This improved circulation helps reduce inflammation and promotes healing. Massage also stimulates the release of endorphins, the body's natural pain-relieving chemicals, which create feelings of well-being and reduce pain perception. Additionally, massage activates pressure receptors under the skin that send signals to the brain, competing with pain signals and effectively "closing the gate" to pain transmission according to the gate control theory of pain. The mechanical pressure applied during massage helps break up adhesions or "knots" in muscle tissue, reducing tension and improving flexibility. Some key points to consider when using massage for pain relief include:
- The duration of massage sessions, which should last 30-60 minutes for optimal results
- The frequency of massage sessions, which may vary depending on the condition being treated, such as weekly sessions for chronic pain or more frequent sessions for acute conditions
- The type of massage technique used, such as Swedish, deep tissue, or trigger point therapy, which may be more effective for specific pain conditions
- The potential for cumulative benefits with regular treatment, as supported by moderate-quality evidence from recent studies 1. It is also worth noting that while some studies have shown mixed results, the most recent and highest-quality evidence suggests that massage can be a useful adjunct to standard treatment for improved pain outcomes, as stated in the aaos/metrc clinical practice guideline summary 1.
From the Research
Mechanism of Massage to Relieve Pain
- The mechanism of massage to relieve pain involves several factors, including:
- Biomechanical mechanisms: massage can produce mechanical pressure, which increases muscle compliance, resulting in increased range of joint motion, decreased passive stiffness, and decreased active stiffness 2
- Neurological mechanisms: mechanical pressure on the muscle can increase or decrease neural excitability, as measured by the Hoffman reflex 2
- Physiological mechanisms: changes in parasympathetic activity and hormonal levels following massage can result in a relaxation response 2
- Psychological mechanisms: a reduction in anxiety and an improvement in mood state can also cause relaxation after massage 2
- Massage has been shown to reduce the severity of muscle soreness, but has no effects on muscle functional loss 2
- The effects of different types of massage (e.g. petrissage, effleurage, friction) or the appropriate timing of massage (pre-exercise vs post-exercise) on performance, recovery from injury, or as an injury prevention method are not clear 2
- Massage or myofascial release yields a small improvement in low back pain, hip and knee osteoarthritis, and fibromyalgia 3
- Nonpharmacological interventions, including massage, have shown potential in reducing postoperative pain, opioid consumption, stress, and anxiety in patients with opioid tolerance or opioid abuse 4