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THE CENTER WITHIN · EVIDENCE LIBRARY

Hands-on soft-tissue work for tension, stress physiology and pain

Massage Therapy

B – Moderate (short-term pain, anxiety, stress) · C – Emerging (biomarkers)10 verified peer-reviewed articles

WHAT THE RESEARCH SHOWS

Massage is one of the most widely used complementary therapies. In US national survey data, massage and physical therapy were the most common ways adults managed chronic pain (see "Why This Matters"). For tension and stress, a network meta-analysis of healthcare workers found massage therapy significantly reduced occupational stress. A 2025 meta-analysis of 36 RCTs in cancer care found improvements in pain, quality of life and anxiety. The Cochrane review of low back pain found short-term pain relief. For the nervous and immune systems, small but carefully controlled studies at an academic medical center found that a 45-minute Swedish massage, compared with light touch, lowered arginine-vasopressin and cortisol and shifted immune markers. A single-blind RCT found rhythmical massage stimulated heart rate variability more than sham massage. These are promising mechanisms, not proof of long-term health effects.

the studies,

READ THE EVIDENCE

10 of 10 studies

C – EmergingSingle Swedish massage session shifts stress hormones and immune markersControlled comparison: Swedish massage vs light touch (single session) · Parasympathetic / stress physiology

IN PLAIN LANGUAGE

One 45-minute Swedish massage produced measurable changes in stress-related hormones and immune cells compared with light touch. The authors call these findings preliminary and in need of replication.

Study type
Controlled comparison: Swedish massage vs light touch (single session)
Who was studied
Medically and psychiatrically healthy adults, 18–45 years
Outcome area
Parasympathetic / stress physiology
Key finding
Compared with light touch, 45 minutes of Swedish massage produced a large decrease in arginine-vasopressin, a small decrease in cortisol, increased circulating lymphocytes and decreased several mitogen-stimulated cytokines.
Evidence grade
C – Emerging
Limitations
Preliminary; small sample of healthy young adults; oxytocin did not mediate the effects.
Citation
Rapaport MH, Schettler P, Breese C. A preliminary study of the effects of a single session of Swedish massage on hypothalamic-pituitary-adrenal and immune function in normal individuals. J Altern Complement Med. 2010;16(10):1079-88.
PubMed 20809811DOI 10.1089/acm.2009.0634
C – EmergingRepeated massage: effects depend on frequencyRandomized comparison (5 weeks) · Parasympathetic / stress physiology

IN PLAIN LANGUAGE

Over five weeks, the biological effects of massage depended on how often it was received. Twice-weekly sessions raised oxytocin and lowered cortisol. The authors note that larger studies are needed.

Study type
Randomized comparison (5 weeks)
Who was studied
Healthy young adults; weekly vs twice-weekly massage vs light touch
Outcome area
Parasympathetic / stress physiology
Key finding
Weekly massage sustained immune-marker changes. Twice-weekly massage increased oxytocin and decreased vasopressin and cortisol, but also slightly increased some pro- inflammatory cytokines.
Evidence grade
C – Emerging
Limitations
Preliminary; small sample; mixed immune findings.
Citation
Rapaport MH, Schettler P, Bresee C. A preliminary study of the effects of repeated massage on hypothalamic-pituitary-adrenal and immune function in healthy individuals: a study of mechanisms of action and dosage. J Altern Complement Med. 2012;18(8):789- 97.
PubMed 22775448DOI 10.1089/acm.2011.0071
C – EmergingRhythmical massage stimulates heart rate variability (single-blind RCT)Single-blind RCT with 24-hour Holter ECG · Parasympathetic

IN PLAIN LANGUAGE

After a stressful task, women who received rhythmical massage showed greater changes in heart rate variability, a marker of nervous system regulation, than those who received a sham massage.

Study type
Single-blind RCT with 24-hour Holter ECG
Who was studied
44 healthy women after a standardized stress task
Outcome area
Parasympathetic
Key finding
Rhythmical massage (with or without aromatic oil) stimulated HRV after a stress task; the sham massage group showed the least change.
Evidence grade
C – Emerging
Limitations
Small sample of healthy women; a specific anthroposophic technique.
Citation
Seifert G, Kanitz JL, Rihs C, Krause I, Witt K, Voss A. Rhythmical massage improves autonomic nervous system function: a single-blind randomised controlled trial. J Integr Med. 2018;16(3):172-177.
PubMed 29598986DOI 10.1016/j.joim.2018.03.002
B – ModerateMassage and yoga reduce occupational stress in healthcare workers (network meta-analysis)Systematic review & network meta-analysis of RCTs · Tension / stress

IN PLAIN LANGUAGE

In healthcare workers, one of the most burned-out groups, massage therapy was one of only two physical relaxation methods that significantly reduced work stress compared with no intervention.

Study type
Systematic review & network meta-analysis of RCTs
Who was studied
15 RCTs, 688 healthcare workers
Outcome area
Tension / stress
Key finding
Physical relaxation methods reduced occupational stress (SMD −0.53). Massage therapy alone (SMD −0.43) and yoga alone were significantly more effective than control.
Evidence grade
B – Moderate
Limitations
Modest number of trials; stress measured by self-report.
Citation
Zhang M, Murphy B, Cabanilla A, Yidi C. Physical relaxation for occupational stress in healthcare workers: A systematic review and network meta-analysis of randomized controlled trials. J Occup Health. 2021;63(1):e12243.
PubMed 34235817DOI 10.1002/1348-9585.12243
C – EmergingMassage for cancer pain, quality of life and anxiety (36 RCTs)Systematic review & meta-analysis (GRADE) · Tension / pain

IN PLAIN LANGUAGE

Across 36 trials, people with cancer pain who received massage reported less pain, less anxiety and better quality of life, although the overall certainty of the evidence was rated very low.

Study type
Systematic review & meta-analysis (GRADE)
Who was studied
36 RCTs, 3,671 participants with cancer pain
Outcome area
Tension / pain
Key finding
Massage improved pain (SMD −0.51), quality of life and anxiety (SMD −0.38) after intervention.
Evidence grade
C – Emerging
Limitations
Very low certainty of evidence; most studies at unclear or high risk of bias.
Citation
Win Myint O, Yoong SQ, Toh E, Lei F, Jiang Y. Effectiveness of Massage Therapy for Cancer Pain, Quality of Life and Anxiety Levels: A Systematic Review and Meta-Analysis. J Clin Nurs. 2025;34(1):49-87.
PubMed 39558520DOI 10.1111/jocn.17547
B – ModerateMassage matched acupuncture for advanced cancer pain (IMPACT RCT)Multicenter pragmatic RCT (26 weeks) · Tension / pain

IN PLAIN LANGUAGE

In a large trial at US cancer centers, massage reduced pain and improved sleep, fatigue and quality of life over six months, performing as well as acupuncture.

Study type
Multicenter pragmatic RCT (26 weeks)
Who was studied
298 adults with advanced cancer
Outcome area
Tension / pain
Key finding
Massage reduced worst pain by about 3 points (0–10 scale) and improved fatigue, insomnia and quality of life, comparable to acupuncture.
Evidence grade
B – Moderate
Limitations
No untreated control group.
Citation
Epstein AS, Liou KT, Romero SAD, et al. Acupuncture vs Massage for Pain in Patients Living With Advanced Cancer: The IMPACT Randomized Clinical Trial. JAMA Netw Open. 2023;6(11):e2342482.
PubMed 37962891DOI 10.1001/jamanetworkopen.2023.42482
C – EmergingCochrane review: massage for low back painCochrane systematic review · Tension / pain

IN PLAIN LANGUAGE

Massage relieved back pain in the short term, but the Cochrane authors had low confidence in the long-term benefit. It is a good example of why TCW frames massage as a supportive, not curative, therapy.

Study type
Cochrane systematic review
Who was studied
25 RCTs, 3,096 participants
Outcome area
Tension / pain
Key finding
Massage improved pain in the short term compared with inactive and active controls. Functional benefits were short-term only. There were no serious adverse events.
Evidence grade
C – Emerging
Limitations
The authors report "very little confidence" in effectiveness; benefits were short-term.
Citation
Furlan AD, Giraldo M, Baskwill A, Irvin E, Imamura M. Massage for low-back pain. Cochrane Database Syst Rev. 2015;2015(9):CD001929.
PubMed 26329399DOI 10.1002/14651858.CD001929.pub3
D – InsufficientCochrane review: massage for neck pain (balancing evidence)Cochrane systematic review · Tension / pain

IN PLAIN LANGUAGE

The most recent Cochrane review could not confirm that massage improves neck pain more than placebo. It is included for balance and transparency.

Study type
Cochrane systematic review
Who was studied
RCTs of massage for acute to chronic neck pain
Outcome area
Tension / pain
Key finding
For subacute and chronic neck pain, massage may make little or no difference compared with placebo. Most evidence was low certainty.
Evidence grade
D – Insufficient
Limitations
Predominantly low-certainty evidence; small trials.
Citation
Gross AR, Lee H, Ezzo J, et al. Massage for neck pain. Cochrane Database Syst Rev. 2024;2(2):CD004871.
PubMed 38415786DOI 10.1002/14651858.CD004871.pub5
B – ModerateMassage for generalized anxiety disorder (RCT with active controls)Randomized controlled trial (12 weeks, 6-month follow-up) · Tension / anxiety

IN PLAIN LANGUAGE

People with generalized anxiety improved with massage, but equally with heat therapy or quiet time in a relaxing room. This suggests the relaxation response itself may be the key ingredient.

Study type
Randomized controlled trial (12 weeks, 6-month follow-up)
Who was studied
68 adults with GAD
Outcome area
Tension / anxiety
Key finding
All groups (massage, thermotherapy, relaxing room) improved substantially and maintained gains at 26 weeks. Massage was not superior to the other relaxation conditions.
Evidence grade
B – Moderate
Limitations
Small sample; no no-treatment control.
Citation
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.
PubMed 20186971DOI 10.1002/da.20671
D – InsufficientSwedish massage raised IL-6, a muscle-derived signaling moleculeSingle-arm intervention study · Mechanisms

IN PLAIN LANGUAGE

A single Swedish massage raised blood levels of IL-6, a signaling molecule released by muscles that can have anti-inflammatory effects. This is early mechanistic research, not evidence of a health outcome.

Study type
Single-arm intervention study
Who was studied
46 healthy adults, 18–35 years
Outcome area
Mechanisms
Key finding
Circulating IL-6 increased significantly 1 hour after a 45-minute Swedish massage; IGF-1 did not change.
Evidence grade
D – Insufficient
Limitations
No control group; surrogate marker with uncertain clinical meaning.
Citation
Stenbäck V, Lehtonen I, Mäkelä KA, et al. Effect of Single Session of Swedish Massage on Circulating Levels of Interleukin-6 and Insulin-like Growth Factor 1. Int J Mol Sci. 2024;25(17):9135.
PubMed 39273084DOI 10.3390/ijms25179135

EDUCATIONAL DISCLAIMER

This library is for educational purposes and is not medical advice. Individual results vary. Consult a qualified provider before starting any new therapy. Citations were verified against PubMed on September 25, 2026.

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