MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

Having been frantically searching for a decent quality study reporting a positive result, I am delighted to announce that I might have had some luck.

This study examined the effects of whole-body massage on knee osteoarthritis, compared to active control (light-touch) and usual care. Assessments were done at baseline and weeks 8, 16, 24, 36, and 52. Subjects in massage or light-touch groups received eight weekly treatments each lasting one hour, then were randomized to biweekly intervention or usual care to week 52. The original usual care group continued to week 24. Analysis was performed on an intention-to-treat basis. Five hundred fifty-one screened for eligibility, 222 adults with knee osteoarthritis enrolled, 200 completed 8-week assessments, and 175 completed 52-week assessments.

The primary endpoint was the ‘Western Ontario and McMaster Universities Arthritis Index’. Visual analog pain scale, PROMIS Pain Interference, knee range of motion, and timed 50-ft walk were secondary outcome measures.

At 8 weeks, massage significantly improved WOMAC Global scores compared to light-touch and usual care. Massage also improved pain, stiffness, and physical function WOMAC subscale scores compared to light-touch and usual care. At 52 weeks, the omnibus test of any group difference in the change in WOMAC Global from baseline to 52 weeks was not significant, indicating no significant difference in change across groups. Adverse events were minimal.

The authors concluded that the efficacy of symptom relief and safety of weekly massage make it an attractive short-term treatment option for knee osteoarthritis. Longer-term biweekly dose maintained improvement, but did not provide additional benefit beyond usual care post 8-week treatment.

Massage therapy is supported by encouraging evidence from several systematic reviews, for instance:

  • One overview identified 31 systematic reviews of massage for pain control, of which 21 were considered high-quality. The most common type of pain included in systematic reviews was neck pain (n=6). Findings from high-quality systematic reviews describe potential benefits of massage for pain indications including labour, shoulder, neck, back, cancer, fibromyalgia, and temporomandibular disorder. However, no findings were rated as moderate- or high-strength.
  • A systematic review showed that massage therapy has promise for caner palliation: massage can alleviate a wide range of symptoms: pain, nausea, anxiety, depression, anger, stress and fatigue. However, the methodological quality of the included studies was poor, a fact that prevents definitive conclusions. The evidence is, therefore, encouraging but not compelling. The subject seems to warrant further investigations which avoid the limitations of previous studies.

So, should massage be recommended for knee osteoarthritis?

Yes and NO.

Yes, because it does seem to alleviate pain with only few adverse effects.

No, because it is merely symptomatic and does not cure the problem. Patients who want to treat the ‘root cause’ of knee osteoarthritis (which is often possible) ought to see an orthopaedic surgeon.

Come to think of it, this is almost a general rule: Patients who want to treat the ‘root cause‘ of any disease (which is often possible) ought to see a real doctor and not an alternative practitioner.

27 Responses to Massage: one of the few alternative treatments that is supported by fairly sound evidence

  • I really don’t see massage as alternative at all.

    1. It is not based on fanciful notions of how the body works.
    2. There is a plausible mechanism of action.
    3. There is evidence of effectiveness.

    • I agree – but, in many countries (not in Germany or Austria, for instance), massage therapists are considered to be alternative practitioners.

    • Massage may not be alt.med, but I think you’ll quickly find a lot of overlap between alt.med fans and massage practitioners.

    • Actually Les, massage IS based on what many on this site would call fanciful notions of how the body works. If you read up on the history of massage, quacks like Hippocrates, Galen, Paracelsus, Ge Hong, Hua Tuo, etc, you’ll find it based in things like element theory, humoral theory, osteopathy, qi/xue…blah blah blah. Ideas that you can use your hands and/or tools to affect the physical structure of the body, and the physical structure plays a part in overall health. Totally implausible.

  • The ‘average’ person suffering from KOA is likely a senior, likely living on a tight-budget and may not be able to practically pay $65-85 per week for 8-weeks only to have the ‘temporary effect’ disappear when it’s discontinued.
    What Hugh Hefner said about sex holds true with massage: “when it’s good it’s great…and when it’s bad it’s still pretty good”. The problem for the massage-industry is that they need to claim to posses Supra-mundane treatment insights and applications, which of course is only their way of creating indispensablity. Best to show your spouse or significant other what you like and pay them half what the professional would charge.

  • I love a massage!
    It works by making me feel loved!

    Does it affect my arthritis?
    No.
    Does it help me put up with stiffness?
    Yes.

    So, I’m some respects massage is ‘regular’ – in other respects, alternative.

    • “Does it affect my arthritis?
      No.”

      Looks like the research says otherwise. You’re apparently conning yourself. Try being a bit more objective – or just have faith in the data.

    • Exactly my sentiments.

      For a number of years, I went for full body massages regularly. Now, I go just occasionally.

      They are like an ice-cold beer on a hot day. They do nothing to cure what ails me, but for the moment, they are fantastic.

      Do massages fix me? Not a chance. Do they feel great! Hell, yeah!

  • @ Edzard

    Paul Ingrham says “The profession is rife with pseudoscience like crank theories about the causes of pain, the myth that massage detoxifies, or that painfully “deep tissue” massage is needed to “release” tissues (which is stressful or even harmful for many patients).”

    Sounds like alt-med to me – is he wrong?

  • Prof. Ernst wrote:
    “Patients who want to treat the ‘root cause’ of knee osteoarthritis (which is often possible) ought to see an orthopaedic surgeon.”
    Tongue in cheek: If you ‘really’ wish to treat the root cause of arthritis, choose different parents. If you cannot do that, then try not too live too long•. 😀

    A wise scrub nurse (they are all wise, scrub nurses are a superior species ) taught me this during a colon cancer resection, back when I still thought life was good to me: “If you wake up one morning after the age of fifty”, she said, “and don’t feel pain somewhere, then you will know you are stone dead and already in heaven!”.

    •Mind you, this is of course a joke. If you wish to prevent knee OA then keep your weight (near) normal and avoid sports like football and floor-hockey (and many more) that put an untoward strain and trauma on your knees.

  • “The mechanical alignment of the knee influences the distribution of load across the articular surfaces. In a normally aligned knee, 60–70% of weight-bearing load is transmitted through the medial compartment. Any shift in either a valgus or varus direction affects load distribution. Abnormal increases in compartmental loading are thought to increase stress on the articular cartilage, and other joint structures, subsequently leading to degenerative change. A systematic review confirmed that knee malalignment is an independent risk factor for the progression of radiographic knee OA.40”

    British Medical Bulletin 2013;105
    Epidemiology and burden of osteoarthritis

  • I’m an LMT and my profession is RIPE with quackery and all sorts of nonsense. The studio I work at has just started offering cupping… I don’t have the heart to tell my colleagues it’s total b.s. or is it my ethical duty to? I’ve yet to meet another science-minded therapist. I’m honestly content just to provide people with a pleasant relaxing experience.

    • nothing wrong with just providing a relaxing experience – but then, don’t call it a therapy.

    • What diseases are they claiming cupping cures?

      • @”jm”
        Who claimed cupping cures diseases?
        Why don’t you tell us what cupping is good for, what do you tell your customers?

      • Good point, Bjorn. I suppose he could be referring to some other type of bs. I shouldn’t assume.

        • @”jm”
          For once, Just answer the question.

        • @00Bjorn

          As is often the case, it’s hard to tell when you’re kidding. It’s way to late for “just once” – I’ve told you many times that cupping is a massage technique. And like most massage techniques…it’s good for massage.

          Just because you don’t like the answer, doesn’t mean you didn’t get one. 😉

          • @jm

            You don’t have to say OO… to me, just call me Björn.

            I will repeat the question:

            “Why don’t you tell us what cupping is good for, what do you tell your customers?”

          • You repeat that question a lot, and my answer is always the same: cupping is a massage technique – it’s good for massage.

            Traditionally, this is the part where you ignore my answer and claim I never answered. Lather, rinse, repeat. Most recently, you used this technique to avoid answering my questions about your (and your expert friends) apparently secret methods for determining trauma. And a couple of ethics questions about claiming assault, child abuse & spousal abuse with zero evidence to back up your claims.

            Ready…set…go. 😉

          • @jm

            You have not answered the question. I will elaborate this time, not because I think you do not understand the question, which I know you do perfectly well.
            I simply wish to explain to the perplexed audience what is going on here. We have long since established that you are a charlatan that sells suckmarks and bruises pretending to thereby provide benefits to your gullible customers.
            Normal massage does not involve bruising or petechial skin bleeding like cupping and GuaSha scraping.

            The question you are asked to answer is perfectly simple:
            What do you tell your customers is the benefit they get from cupping or scraping, leaving marks on the body?

          • I think you’re the only “perplexed” one left, Bjorn. Maybe you should re-watch the video Edzard posted on one of the gua sha threads – the one where you speculate that Heidi’s husband “has a habit of beating her”. (Here’s the link in case you forgot: https://www.youtube.com/watch?v=1nnvqqIU5ts)

            Edzard (intentionally or not) and a bunch of others (including myself) have given you plenty of gentle “outs”, to gracefully climb out of the injury/assault/”threat to humanity” hole you dug yourself in to. The only really perplexing thing is why you keep digging…

            But you’re right – the question is quite simple. So is the answer. Cupping is a massage technique – it’s good for massage. But I can elaborate, if you like: it’s a pretty normal massage technique.

            My questions to you are pretty simple too. Let’s see if you dodge them for the eighth time*…

            _______________

            * To be fair, I understand why you dodge. Your “experts” never actually looked beyond pictures…which kind of takes them out of the “expert” realm, as far as injury assessment goes. And your assault/child abuse/spousal abuse claims are an ethical train wreck. I’d be tempted to dodge those too.

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