Does massage help back pain? What the studies show

Two large reviews found some benefit for low-back pain, and both rated the evidence low. The Agency for Healthcare Research and Quality (AHRQ), in a 2016 evaluation of nondrug therapies, examined 20 studies comparing massage with usual care or other treatments and found evidence that massage helped chronic low-back pain, with a low strength of evidence. It also looked at 6 studies comparing massage styles and found too little evidence to say whether any one style works better. The 2015 Cochrane review found short-term improvement in both acute and chronic low-back pain, again from low-quality studies. NCCIH's summary is that evaluations have found "only weak evidence that it may be helpful."

One better-designed trial adds detail. A 2011 randomized trial assigned 401 adults with nonspecific chronic low-back pain to structural massage, relaxation massage or usual care. At 10 weeks both massage groups had better function and fewer symptoms than the usual-care group. The relaxation group scored 2.9 points lower on the Roland Disability Questionnaire, where lower means less disability and the researchers counted a 2 point difference as clinically meaningful. The benefit to function was still there at 52 weeks, though small by then.

Structural massage, the more targeted and technical of the two, did no better than relaxation massage. The benefit did not depend on a specialized technique, which matters when you choose a session.

Usually days or weeks. Massage tends to help in the period right after a course of treatment, and the relief fades; the 2015 Cochrane review states that the long-term effects of massage for low-back pain have not been established.

A trial cited in the American Massage Therapy Association's position statement shows the same pattern after surgery. Researchers assigned 605 veterans recovering from major operations to routine care, 20 minutes of individual attention from a massage therapist, or a back massage each evening for up to 5 days. In the massage group, pain intensity and unpleasantness fell faster over the first 4 days, and anxiety eased after each massage. Length of stay, opioid use and complications did not differ between the groups.

Short-term relief still counts during a flare-up that keeps you off your feet. Plan for it as a reset that may need repeating, and keep the treatments with longer-lasting evidence in place.

The American College of Physicians (ACP) supports massage for recent back pain only. Its 2017 guideline on acute, subacute and chronic low-back pain included massage as an option for acute and subacute pain, based on low-quality evidence, and left it off the options for chronic low-back pain. Before booking, it helps to know which side of that line your pain sits on.

The Centers for Disease Control and Prevention (CDC) takes a wider view. Its 2022 guideline on prescribing opioids concluded that several nondrug treatments improve chronic pain and function "with small to moderate effects in specific pain conditions" and "are not associated with serious harms." It names massage, with acupuncture, mindfulness-based interventions, tai chi and yoga, among the approaches appropriate for some types of chronic pain. That supports trying massage as one part of a plan, with modest expectations.

Somewhat, for a short time, and only when sessions are long and frequent enough. A 2013 review of 12 studies (757 participants) found massage more helpful for neck and shoulder pain than inactive comparisons but no better than other active treatments, and the shoulder benefit was short-term only. A 2016 review of 4 U.S. studies (519 participants) found massage could bring short-term relief of neck pain if the sessions were long enough and frequent enough.

The dose question got a direct test. A 2014 trial randomized 228 people with chronic nonspecific neck pain to different amounts of massage over 4 weeks, or to a wait list. Sessions of 30 minutes did no better than the wait list, however often they were given. Sessions of 60 minutes given two or three times a week made a clinically meaningful improvement in neck function roughly 3 to 5 times as likely, and in pain about 2 to 3 times as likely.

A 2012 Cochrane review of 15 neck-pain trials reached a more cautious verdict. It concluded that no recommendations for practice could be made, because the effectiveness of massage for neck pain remained uncertain.

No one knows for certain, and the best clue points to general relaxation rather than a mechanical fix. In the 2011 back-pain trial, structural massage did no better than relaxation massage; if a specific manipulation were correcting a specific problem, the technical version should have won. NCCIH notes that even where massage has a measurable effect, such as weight gain in premature infants, the mechanism "is not well understood."

Researchers have measured physical changes. The AMTA position statement collects studies reporting lower anxiety, blood pressure and heart rate after massage. A 2010 study of a single 45 minute massage found shifts in stress-related hormones and immune markers compared with light touch, and a 2012 study of 11 young men found that 10 minutes of massage on exercise-damaged thigh muscle reduced inflammatory signaling in the tissue.

The largest effects may be on mood. A meta-analysis of 37 studies, cited in the same statement, found massage's biggest effects were reductions in trait anxiety and depression, similar in size to the benefit of a course of psychotherapy. If massage works mainly by easing anxiety and muscle tension, that would fit the back-pain trial results, though none of these studies proves it.

For most healthy adults, yes: NCCIH says the risk of harmful effects from massage "appears to be low." Its chronic-pain guidance adds that people with medical conditions and people who are pregnant may need to modify or skip some approaches.

Most of these studies tested massage as an addition to usual care. In the 2013 neck and shoulder review it beat inactive comparisons and tied with other active treatments, and the ACP lists it as one of several options for acute back pain. For chronic low-back pain the ACP points to other options, including acupuncture, tai chi, yoga and mindfulness-based stress reduction, covered in our guide to massage for chronic pain.

NCCIH's advice is direct: don't use massage to postpone seeing a clinician about a medical problem. With that in place, the research supports these steps.