Does It Matter How Massage Works?
A Blog Article by Nick Ng, BA, CMT

A few months ago, I was in the ER at Pomerado Hospital for severe upper abdominal pain that kept me up all night. During my stay, my doctor explained to me that I most likely had biliary colic caused by a gallstone blocking the bile duct of my gallbladder. Since I knew little on the subject, the doctor took the time to sketch the digestive system and thoroughly explain how gallstones form and cause pain.

I wonder if we, massage therapists, could explain our clients' problems as well as my ER doctor explained to me how gallstones cause pain. If a client suffers from chronic back pain or migraines, can we explain how massage may work (or not work) for these conditions?

Neuroscience Evidence

We know that massage therapy can reduce pain and stress. Some scientific evidence supports this premise, yet few studies explain the underlying processes because most of the research focuses on the outcomes. Those few studies, however, give us a clue as to why massage often reduces pain and stress.


A 2009 Swedish study found that C-tactile (CT) nerve fibers are responsible for the pleasurable sensation that we often get when our skin is stroked gently. These unmyelinated nerve fibers are found near the surface of the skin and only on hairy skin. Stimulated CT fibers activate the left anterior insular cortex responsible for positive emotions. The test subjects, who were stroked on their forearm by a robotic arm, reported an increase in pleasure when the same area of the forearm was stimulated repeatedly. However, no association between the speed of the strokes and pleasantness was found when the palm of the hand – which has no CT fibers – was stroked.

In an interview with Bio-Medicine in 2009, Line Loken – a postgraduate student at Sahlgrenska Academy at Gothenburg – stated that the stroking impulses can “deaden the pain impulses” if the skin is stroked more often. “Basically the signals that tell the brain that we are being stroked on the skin have their own direct route to the brain, and are not blocked even if the brain is receiving pain impulses from the same area.”


Five years later, another Swedish study found that, in addition to light stroking, temperature likely plays a role in stimulating pleasure as it affects the CT firing frequency. For example, as the temperature transitioned from warm to cool, “the CT firing frequency decreased, as well as the pleasantness ratings.”

However, the perception of pleasure depends on both core and skin temperature. “Cool stimuli are preferred during body warming and warm stimuli during body cooling, although temperature discrimination is independent of the affective quality. In agreement with this, we found significantly lower pleasantness ratings for moving cool and warm stimuli compared with neutral stimuli,” the researchers stated. Thus, it is no big surprise that some clients feel more relaxed when a warm towel is placed over their neck and shoulders.

Why Should We Care How Massage Works?

“I think the reasons for understanding how massage works is to avoid nocebic effects, particularly poor explanations that generate fear and anxiety in people,” explained Dr. Bronwyn Thompson, PhD in an online interview. Dr. Thompson is Clinical Senior Lecturer at the Department of Orthopaedic Surgery & Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand.

“Understanding the mechanisms of massage also allows massage therapists to develop and refine the best parts of their work by improving the elements that work and dropping those that don't. This ensures treatments aren't just a response to a great personality or other nonspecific effects. And if they are, to know what it is about that personality or other nonspecific effects so [the work] can be done better.”

Whether your clients are in chronic pain or just curious about how massage affects pain, being able to explain how massage works creates a win-win situation. We get to maintain professionalism and transparency, while clients gain a deeper insight into the inner workings of massage – similarly to how I learned about my medical condition from the physician.

Nick Ng

About Nick Ng, BA, CMT:
A former rolled-taco junkie in college, Nick was a personal trainer of 13 years and is a freelance writer for more than five years. He earned his BA in Graphic Communication from San Diego State University in 2001 and worked for the Daily Aztec as a production designer in 2000. He attended IPSB College in San Diego from 2013-2014 for massage therapy.

Nick has written for various media, including, Miabella Magazine, and Tellus News Digest. He is currently the founder and editor of Massage & Fitness Magazine, an online publication that bridges science and research with clinical reasoning and hands-on work.

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