massage therapy case study examples

How to Write a Massage Case Study: A Comprehensive Guide

Why do some massage treatments achieve remarkable results while others have minimal impact? It’s not just about technique, but also the understanding and application of that technique to the client’s individual needs. Case studies can help us to understand the results of treatments for different individuals and scenarios, and can offer valuable insights to enhance therapeutic outcomes.

What is a case study in massage therapy? A case study is a detailed account of a massage therapist’s work with a particular client over a period of time. It documents the client’s initial condition, the therapist’s assessment, the treatments provided, and the outcomes. These studies bridge the gap between anecdotal and empirical evidence, and offer insights into the efficacy of different techniques and approaches.

In this comprehensive guide, we’ll lay out a step-by-step formula to help you craft a massage case study. You’ll discover the importance of case studies in shedding light on varying massage outcomes in different situations, the components of a thorough case study, practical advice for documentation, and tips and resources for creating your own case study. We’ve also included a case study example and answers to common questions about case studies.

The Purpose of Massage Case Studies

Why exactly do we invest time in writing massage case studies? At its core, a massage case study is more than just a clinical narration; it’s a beacon of information, a testament to therapeutic transformation, and a tool for better practice.

A massage case study, also called a case report , is a deep dive into a specific client’s journey, serving both as a chronicle of treatment sessions and as a tangible piece of massage research. Its intricate details, right from the presenting problems to the massage therapy treatment outcomes, provide invaluable data for fellow massage therapists. This detailed exploration helps demystify complex cases, shedding light on specific massage techniques or modalities that yielded positive effects or highlighting the nuances that required a shift in approach.

Beyond its educational merit, a well-documented massage case study can be a potent marketing tool. Think about it: prospective clients reading these success stories might see themselves in the narrative, becoming more inclined to seek the same therapeutic relief. Moreover, these case studies affirm the credibility of a therapist’s approach, validating the benefits of massage therapy through real-life examples. These can be useful marketing tools when promoting your massage services to other health providers in your community.

In essence, when you write a case study, you’re not just documenting a series of events; you’re contributing to a growing body of evidence, sharing feedback, and offering a glimpse into the real-world impact of massage therapy. It’s about painting a vivid picture that resonates, informs, and inspires.

*It’s important to understand that not every case study shows a win. Sometimes, results are minimal or even point to the need for a referral to another provider (e.g., chiropractor, physical therapist, doctor, acupuncturist). Sometimes massage therapy isn’t the best treatment option. However, every case, whether a success or a lesson, is valuable. The key is to document each experience honestly and objectively.

Different Types of Research in Massage Therapy

Research is often ranked or ordered based on the strength of evidence it provides. At the top of this hierarchy are randomized controlled trials (RCTs), which are considered the gold standard due to their rigorous design and ability to ascertain cause-and-effect relationships. Systematic reviews and meta-analyses, which compile and analyze multiple RCTs, further strengthen the evidence base. 

Other types of research like observational studies, cohort studies, and case-control studies offer valuable insights but carry a higher potential for  bias . Case studies and expert opinions provide anecdotal evidence and individual perspectives, and are at the lower end of the hierarchy. While they are less robust in terms of how widely the results can be applied, they play a pivotal role in identifying novel hypotheses, offering in-depth insights on individual experiences, and providing preliminary data that can pave the way for more extensive research in the future. You may even see a questions or two about case studies of massage research on the MBLEx exam .

Components of a Well-Written Massage Case Study

So, you’re ready to write an engaging case study, but where do you start? Let’s dive into the anatomy of a massage case study to understand its core components.

• Title : Crafting the right title is essential. It should be more than just a label; it should be an inviting gateway. Consider incorporating the specific condition being addressed and a hint about the outcome or a unique aspect. This draws readers in and gives a snapshot of what to expect.
• Abstract : A concise snapshot! This section is your elevator pitch. Summarize the critical points, including the challenges, treatments, and key learnings. Mirroring the larger report in a compressed form can give your fellow therapists or potential clients an immediate understanding of the case’s essence.
• Introduction : Here’s where you set the stage. Start with a background that provides context and any notable or unique aspects of the case. Clarify the objective, emphasizing its relevance to massage therapy. What questions does this case study seek to address?
• Client Details : Anonymity is crucial! But while protecting identity, lay out the client’s demographics, such as age and occupation. Dive into the presenting problem, detailing the reasons they sought out massage therapy. Maybe it was chronic low back pain or persistent muscle tension that disrupted daily living. 
• Assessment : Every therapist has their method, but it’s essential to share how you gauged the client’s needs. Whether you relied on palpation, observed posture, or employed the visual analogue scale to measure discomfort, this section chronicles your initial investigative process. Objective measurements, like the Numeric Pain Rating Scale (NPRS), come handy here.
• Treatment Plan : Now, map out the journey ahead. Detail the proposed massage techniques, frequency of sessions, and any self-massage or exercises recommended. Clearly outline both short-term and long-term treatment goals, ensuring they’re tangible and realistic.
• Treatment Sessions : This section is the heart of your case study. It offers a chronological overview of each session, focusing on types of massage , techniques applied, the client’s feedback, any adjustments made, and post-treatment observations. If the client reported a dip in their pain level, this is where you note it. *A case study can cover a single treatment session, or it can range over a longer period and include multiple treatment sessions.
• Results and Observations : All your hard work culminates here. Highlight the number of sessions, side effects (adverse reactions), and any adjustments to the initial treatment plan. Contrast the client’s experience from their first appointment to their last, emphasizing tangible changes.
• Conclusion : Reflect and wrap up. Highlight the significance of the case, the lessons learned, and potential recommendations for similar future scenarios. For example, was neuromuscular therapy more effective than Swedish massage for this particular client? Was cold more effective than heat? Share those insights!
• References : The backbone of any case study. List down articles, books, or bodywork publications you referenced, ensuring readers can explore further if they choose.

In the world of massage therapy, every case study brings something special. By carefully understanding and using these parts, you’re not just sharing what you know, but you’re also making the whole field stronger and deeper in knowledge.

Best Practices in Writing a Case Study

Diving into the world of massage research and case studies can be intriguing, but to ensure your work resonates and informs effectively, you need a blueprint of best practices. So, how do you go about crafting a case study that’s both compelling, educational and accurate?

Genuine Client Stories : Your case study will resonate more if it’s rooted in a real client’s story. Draw from the client’s experience, noting their initial apprehensions, their journey through the treatment sessions, and their feedback. This offers a holistic view, turning data into a relatable narrative.

Consistency is Key : From the format you choose to the tone of your writing, ensure consistency. Whether you’re detailing massage techniques or documenting pain levels, a consistent format helps readers follow along effortlessly.

Use Objective Measurements : While personal experiences and client feedback are vital, integrating objective measurements like the Oswestry Disability Index or the Numeric Pain Rating Scale lends your study scientific credibility. It bridges the gap between anecdotal experiences and quantifiable data.

Include Visuals : A picture speaks a thousand words. Consider incorporating relevant images, whether it’s the client’s posture variations over weeks or graphical representations of their pain scale assessments. Visuals break up the text and offer readers a quick snapshot of progress. Remember to protect the client’s anonymity or get the client’s written consent.

Feedback Loop : Always encourage the client to share feedback after each session. Their perspectives on the therapeutic massage effectiveness, any discomfort they felt, or the positive effects they experienced, provide valuable insights. This gives your study a dynamic angle, showcasing real-time reactions and adjustments.

Protect Client Confidentiality:  An essential part of the selection process is ensuring you have the client’s permission to share their story, albeit anonymously. Respect their privacy by avoiding any details that might reveal their identity.

Stay Updated with Care Guidelines : The world of massage therapy is ever-evolving. To ensure your case study stands the test of time, make sure you’re adhering to the latest care guidelines. This not only ensures best practices but also demonstrates to your readers that you’re at the forefront of industry standards.

Proofread and Peer Review : Before hitting the publish button or sending off to bodywork publications, have a colleague review your work. A fresh pair of eyes can catch overlooked errors or offer insights on areas that might need more detail.

Cite Your Sources : Whether you’re referencing another case study example or pulling from international journals, proper citation is a non-negotiable. It lends credibility to your work and provides readers with a resource pool for further exploration.

Remember, a massage case study is more than just a clinical record; it’s a blend of science and personal journey, and your documentation should reflect that. With these best practices in hand, you’re well on your way to contributing valuable insights to the massage community.

Practical Tips for Consistent Documentation

Documentation. It’s the bridge between your client sessions and the written case study. But how do you keep things crisp, clear, and consistent? Here’s some hands-on advice.

Start with a Template : While every massage case differs, a standardized massage case study template keeps you on track. It ensures you capture every essential part, from the client’s story to their pain level progression.

Digital Tools are Your Friend : Modern apps and platforms offer smart features that massage therapists can utilize. Voice-recording apps can be handy when jotting down immediate post-session observations. But remember to always prioritize client confidentiality.

Consistency in Terms : When describing massage techniques or specific symptoms like muscle tension, keep your terminology consistent. It helps in painting a clear picture for your readers. Also use standard and consistent massage abbreviations .

Date Everything : Whether it’s a quick observation after a treatment session or a client’s feedback, always record the date. Over a week period, it aids in tracking progression and ensuring your case study remains chronological.

Keep Personal Notes : Often, it’s the little remarks a client makes or the subtle changes in their posture that provide a comprehensive guide to their improvement. Maintain a side-notes section for these valuable nuggets of insight.

Ensure Clarity : Aim for clarity over complexity. It might sound obvious, but if you’re ever in doubt about your documentation’s readability, share it with a colleague or even a friend outside the massage therapy world. If they get it, you’re golden.

Stay Updated on Guidelines : Case study guidelines evolve. Regularly brush up on the latest recommendations from bodywork publications and international journals. This ensures you’re not only consistent but also relevant.

In essence, consistent documentation is more than just a routine. It’s the backbone of a well-crafted massage case study. And when done right, it’s what turns your day-to-day sessions into valuable content that educates and inspires.

Massage Therapy Case Study Example: Relief from Upper Back and Neck Pain through Targeted Therapy

This case study examines the therapeutic journey of a client experiencing posterior neck and upper back pain attributed to muscle tension. Over a span of three weeks, the client underwent three massage therapy sessions at a massage school’s student clinic. Each session entailed a blend of Swedish massage, neuromuscular therapy, and during the third session, the incorporation of cupping therapy techniques. The emphasis of this study revolves around the efficacy of the combined modalities, with a focus on tracking pain reduction, muscle flexibility, and overall functional improvement. The study showcases the client’s positive outcomes, emphasizing the importance of consistent documentation, informed consent , and client education in the context of a student therapeutic environment.

Client Information and History

• Gender : Female
• Occupation : Desk job, frequent computer usage.
• Presenting Issue:  Chronic posterior neck and upper back pain attributed to muscle tension, exacerbated by prolonged periods of sitting and poor ergonomics.
• Previous Treatment : Over-the-counter pain relievers, topical analgesic.

Initial Assessment

Visual Assessment : The client presented with an elevated right shoulder and a forward head posture. The imbalances could be indicative of muscle overuse on one side, possibly due to repetitive strain or a habitual posture, especially given her occupation.

Pain Scale : The client reported a pain level of 6 out of 10 at the initial consultation, with 10 being the most painful. This pain was described as a constant dull ache with intermittent sharp sensations upon unspecified movements.

Range of Motion : Cervical rotation and lateral flexion were notably restricted. During a passive range of motion test, the client experienced pain and tightness, specifically when attempting to rotate her head to the left or tilt it to the side.

Palpation : Upon palpation, several tender points were identified in the right trapezius and levator scapulae muscles, indicating potential trigger points. These areas were hypertonic and hypersensitive to touch and appeared to be the primary sources of her discomfort.

Numerical Pain Rating Scale (NPRS) : The client rated her pain using the Numerical Pain Rating Scale, a tool that gauges pain intensity from 0 (no pain) to 10 (worst possible pain). She marked her initial pain at a level 6, indicating significant pain and aligning with her reported limitations in daily activities due to neck and upper back discomfort.

Contraindications : Screened client for massage contraindications at initial client assessment and before initiating each subsequent session. No contraindications were present.

Treatment Plan

To offer relief from muscle tension in the posterior neck and upper back, improve the client’s cervical range of motion, and provide self-care strategies to maintain benefits achieved during therapy.

Client Goals

• Alleviate pain in the posterior neck and upper back.
• Improve range of motion in the neck.
• Reduce muscle tension in the affected areas.

Treatment Strategy

• Deep tissue massage targeting the hypertonic muscles in the neck and upper back.
• Myofascial release to address fascial adhesions and restrictions.
• Trigger point therapy to alleviate specific points of tension in the trapezius and levator scapulae.
• Incorporation of cupping therapy techniques, with particular attention to the trapezius and upper back region, to enhance blood flow, relieve muscle tension, and address adhesions.
• Provide client education on self-care strategies .

Frequency & Duration

Three sessions over a span of three weeks, each treatment session lasting 60 minutes.

Treatment Sessions

Session 1 (day 1).

Duration : 60 minutes (excluding time for completing intake forms and initial client assessment)

Pain Level at Start : 6/10

Techniques Applied :

• Swedish Massage: Initiated with Swedish massage techniques to warm up the soft tissue and prepare the posterior neck and upper back for deeper work.
• Myofascial Release: Addressed the fascial restrictions around the trapezius and levator scapulae areas. This technique helped in elongating the fascia and reducing adhesions.
• Trigger Point Therapy: Targeted several trigger points identified in the trapezius and levator scapulae during the initial assessment. The client reported referral pain patterns typical of these trigger points, reinforcing their contribution to her discomfort.
• Deep Tissue Massage: Applied to address hypertonicity in the muscles . Sustained deep pressure was used on areas of tension, ensuring the client’s comfort was maintained throughout.
• Stretching: Introduced gentle stretching exercises for the cervical and upper thoracic regions to increase range of motion and alleviate muscle tightness.

Feedback During Session : The client reported a significant decrease in pain when the trigger points were addressed, especially in the levator scapulae area. However, she did express some discomfort when addressing adhesions deep within the trapezius muscle, indicating chronic muscle tension. This feedback was taken into consideration, and pressure was adjusted accordingly.

Pain Level at End : 3/10

Self-Care Recommendations :

• Cold Compress: Advised to apply a cold compress to the treated areas for 10 minutes if she experienced any soreness after the session.
• Gentle Neck Movements: Recommended slow, controlled neck rotations and side bending exercises to be done twice daily to promote flexibility and decrease muscle stiffness.

Notes for Next Session : Consider incorporating neuromuscular techniques in subsequent sessions and possibly introducing more extensive stretching exercises based on the client’s progress and comfort.

Session 2 (Day 8)

Duration : 60 minutes

Pain Level at Start : 5/10 (improved from the previous session)

• Hot Pack: Applied cervical hot pack for 15 minutes at upper back and posterior cervical region prior to beginning manual therapy treatment. Monitored client comfort and skin condition for safety.
• Swedish Massage: Began with Swedish massage strokes to relax the soft tissues, focusing on warming up the posterior neck and upper back.
• Trigger Point Therapy: A thorough assessment revealed persistent trigger points in the upper trapezius and rhomboids. Using ischemic compression, these areas were directly addressed, and the client was guided through deep breathing to assist in their release.
• Deep Tissue Massage: Diving deeper into the layers of the musculature, emphasis was placed on breaking up adhesions particularly present around the scapula and along the spine. This helped reduce the hypertonicity observed in certain muscle groups.
• Myofascial Release: Further focus was on the fascial network surrounding the neck and upper back muscles, aiming to ease restrictions and facilitate soft tissue mobility.
• Stretching: Building on the previous session, more advanced stretching techniques were introduced. Passive stretching of the levator scapulae and scalene muscles was initiated to address the muscle tightness contributing to the client’s pain.

Feedback During Session : The client expressed that while the trigger points in the trapezius were still palpable, their intensity and the referral pain had reduced from the previous week. She noted a slight discomfort during the deep tissue application but also commented on the relief it brought shortly after.

Pain Level at End : 2/10

• Heat Application: Suggested applying a warm towel or heating pad to the neck and upper back region for 15 minutes, once daily, to aid in relaxation and further reduce muscle tension.
• Postural Awareness: Advised the client to be mindful of her posture, especially during work hours. Emphasized the importance of taking regular breaks and performing gentle neck and upper back stretches. Also recommended using headset for work phone.
• Hydration: Reminded the client of the importance of drinking plenty of water post-session to keep hydrated.

Notes for Next Session : With the noted improvements, consider integrating more neuromuscular techniques and possibly some advanced stretching techniques to enhance range of motion. The response to the increased stretching regimen will also be evaluated.

Session 3 (Day 15)

Pain Level at Start : 3/10 (consistent improvement observed since the initial session)

• Swedish Massage: Initiated the session by gently warming the posterior neck and upper back with rhythmic Swedish massage strokes, preparing the tissues for deeper interventions.
• Trigger Point Therapy: Further attention was given to the lingering trigger points in the upper trapezius and rhomboids. The student therapist employed precise ischemic compressions, guiding the client through deep breathing techniques to facilitate trigger point release.
• Deep Tissue Massage: Continuing the work from the previous sessions, focused strokes aimed at the persistent adhesions, especially around the scapula and spinal erectors. The observed hypertonicity was addressed, paving the way for increased pliability in the tissue.
• Cupping Therapy: Under the watchful eyes of her clinical instructor, the massage therapy student introduced silicone-based cupping techniques. She applied static and gliding cups over the upper trapezius and rhomboids. The suction facilitated increased blood flow to the area and lifted the fascial layers, aiding in the release of deep-seated tension and promoting lymphatic drainage. Post cupping, the client’s skin displayed the typical erythema, indicating a positive therapeutic response.
• Myofascial Release: The session extended the focus on the fascia network. Gentle, sustained pressure was applied to release any remaining myofascial restrictions and promote optimal tissue health.

Feedback During Session : The client expressed intrigue and slight apprehension about cupping but reported feeling a unique yet pleasant pulling sensation during the technique. She was advised that the erythema from the cups might linger for a few days but would dissipate without intervention.

Pain Level at End : 1/10 (“Barely noticeable” according to the client)

• Cold Compress: Given the incorporation of cupping, advised the client to apply a cold compress if she experienced any discomfort in the cupped areas.
• Gentle Stretches: The client was encouraged to continue the stretching routine and was introduced to a couple more stretches to maintain flexibility in the neck and upper back.
• Hydration: The importance of ample water intake was reiterated, emphasizing its role in aiding tissue recovery and overall well-being.

Future Recommendations : The student therapist suggested that the client consider integrating regular massage sessions into her routine to manage her symptoms. Given the benefits observed from the cupping therapy, it was also recommended as an intermittent treatment option.

Outcomes and Client Reported Benefits

After three comprehensive sessions spanning three weeks, the outcomes of the treatments were as follows:

Pain Scale Progress : The client began her journey with a pain level of 6/10. With consistent therapy and adherence to home care advice, this was effectively reduced to 1/10 by the end of the third session. Such a marked reduction in pain levels signified not just the alleviation of discomfort but a restoration in the functional mobility of the affected area.

Range of Motion (ROM) : Objective assessments showed a notable improvement in cervical and thoracic mobility. Initial assessments showed a restricted ROM, particularly in cervical extension and lateral flexion. Post-treatment, the client demonstrated an approximate 20% increase in all planes of motion.

Trigger Point Resolution : Initial palpation had identified multiple active trigger points, especially within the upper trapezius and rhomboids. By the third session, most of these trigger points had been deactivated. This was indicative of reduced muscular hypertonicity and an overall decline in neuromuscular irritability.

Skin and Fascial Changes : The application of cupping during the third session, combined with consistent deep tissue manipulations and myofascial release, contributed to a more pliable and supple fascial network. The erythema post-cupping, which is often a mixture of petechiae and ecchymosis, was indicative of the drawing out of stagnation and the infusion of fresh blood to the treated areas.

Client Feedback : Beyond the objective measures, the client reported a series of qualitative benefits. She felt lighter, with the weight on her shoulders (both metaphorically and physically) noticeably reduced. The chronic tension that once felt like a “vice grip” around her neck and upper back had loosened substantially. The client also noted improved sleep patterns and an increased ability to manage stress.

Follow-up : Seven days after the third session, a follow-up with the client revealed that she maintained the benefits of the treatment, experiencing only occasional mild discomfort. At the 30-day mark post-treatment, she reported sustained relief, with her pain levels remaining consistently low and the gains in mobility and overall well-being persisting.

Daily Activities : The initial discomfort which had hampered daily activities, such as driving and computer work, had greatly diminished. The client reported being able to perform these tasks with minimal discomfort and increased endurance.

Client Education Impact : The strategies and routines imparted for self-treatment were acknowledged by the client as being instrumental. She expressed gratitude for the newfound knowledge, mentioning how the routines were seamlessly integrated into her daily life.

In summary, the therapeutic interventions, supplemented by diligent home care routines and client education, collectively contributed to a significant improvement in the client’s musculoskeletal health and overall well-being.

Additional Notes:

• Written informed consent was obtained prior to initiating the plan of treatment. Verbal client consent was obtained before each session, ensuring the client was aware of the techniques used and their potential effects.
• The client was encouraged to share feedback and any discomfort during sessions.
• All sessions were documented meticulously for future reference and to track progress.

In this case study, the client experienced significant relief from her symptoms over three sessions. The combination of massage therapy techniques, coupled with client education, showcased the efficacy and holistic approach of massage therapy in managing musculoskeletal issues.

Crafting an impactful massage case study isn’t just a nod to academic rigor; it’s a way to share success stories and lessons learned in the ever-evolving field of massage therapy. By thoroughly documenting each client’s journey, from their initial pain scale readings to their eventual return to daily living without chronic pain, we provide evidence that therapeutic massage has tangible benefits. 

These case studies don’t just resonate with our peers. They serve as authentic testimonials for prospective clients and referral partners, showing them the positive effects of massage on conditions like chronic low back pain or muscle tension. Moreover, they set a precedent for new therapists, illustrating the importance of consistency, adaptability, and continuous learning.

But remember, at the heart of every case study is the client’s experience. It’s their story of healing, enhanced by the skills and care of dedicated massage therapists. As we wrap up this comprehensive guide, let’s stay committed to sharing these narratives. Not only for the growth of our practice but for the advancement of massage as a respected therapeutic modality.

Additional Resources

While this guide has aimed to be a comprehensive starting point, the journey of mastering the art of writing a massage case study doesn’t end here. There are several other resources that can help deepen your understanding and hone your skills:

• Bodywork Publications : Several professional massage associations publish case studies. Magazines like ABMP’s Massage & Bodywork often feature exemplary massage case studies. These can serve as templates or inspiration for your own work. Analyzing real-world examples is a proven way to understand the nuances of crafting an engaging case study.
• Massage Research Journals : There’s an increasing number of research papers dedicated to therapeutic massage. Exploring articles in these journals can offer insights into the latest methodologies and data collection strategies, invaluable for those keen on producing case studies backed by solid evidence.
• Online Massage Forums : Provide a platform for massage therapists to share their experiences, ask questions, and offer feedback. If you’re ever stuck or need a second opinion on your massage case study template, these communities can be a goldmine of support.
• Case Study Examples : Websites like the NCBTMB or platforms like the International Journal of Therapeutic Massage & Bodywork ( IJTMB ) occasionally feature massage case study examples. These can offer a clearer understanding of the structure and content that makes a study effective and relatable.
• Online Tools : Online resources such as Google Scholar can help you find relevant articles, case studies, and research papers. Platforms like Grammarly can assist in ensuring your case study is written without errors, adding to its credibility.

Remember, the goal isn’t just to write a case study; it’s to communicate the transformative potential of massage therapy in a way that resonates with both peers and potential clients. So, immerse yourself in these resources, keep learning, and let every case study you write be a testament to your dedication and skill.

FAQs About Massage Case Studies

What is the purpose of a massage case study.

A massage case study is designed to provide a detailed account of a therapist’s clinical practice, showcasing the process, techniques, and outcomes, which can be useful for educational purposes and advancing the field.

How long does it take to write a case study?

The duration can vary based on the complexity of the case, the depth of information provided, and the writer’s experience. Typically, it takes several hours spread over days or weeks. A case study can cover a single treatment session, or it can span over multiple sessions delivered over several weeks or months.

Can anyone write a massage case study?

While anyone can document their observations and experiences, it’s essential that the individual has a deep understanding of massage therapy and follows established case study guidelines for the report to be credible. Student massage therapists and licensed practitioners can both document their experiences in the form of a case study. A student’s case study might occur under the supervision of an instructor or within a learning environment, potentially adding another layer of review and guidance.

What’s the difference between a massage case report and a case study?

They’re often used interchangeably. However, a case report typically focuses on a single client session, while a case study might delve deeper, exploring multiple sessions and offering a broader perspective on treatment.

How do peer reviews enhance the value of a case study?

Peer reviews ensure that the case study adheres to professional standards, verifies the accuracy of information, and offers feedback for improvement, bolstering the study’s credibility.

Are there standardized assessment tools for massage therapy case studies?

Yes, there are several standardized assessment tools specifically designed for objective measures in massage therapy case studies. The choice of tool often depends on the specific conditions being treated and the objectives of the study. It’s crucial to select the right tool based on the therapeutic goals and the type of data required to ensure accurate and meaningful results. Here is a list of some common tools:

• Numeric Pain Rating Scale (NPRS) : Asks patients to rate their pain on a scale from 0 (no pain) to 10 (worst possible pain).
• Visual Analogue Scale (VAS) : A tool often used to measure pain intensity. Clients mark their pain level on a 10 cm line ranging from “no pain” to “worst pain imaginable.”
• Oswestry Disability Index (ODI) : A questionnaire specific to measuring a patient’s disability due to low back pain.
• Neck Disability Index (NDI) : Measures disability in individuals with neck pain.
• Range of Motion (ROM) Measurements : Using a goniometer, inclinometer, tape measure or other measuring techniques, therapists can measure joint mobility and flexibility in specific areas.
• Brief Pain Inventory (BPI) : Provides information about pain severity and the impact of pain on daily functions.
• Patient-Specific Functional Scale (PSFS) : Allows patients to identify specific activities that have become difficult due to their condition and grade their ability to perform them.
• Fear-Avoidance Beliefs Questionnaire (FABQ) : Evaluates beliefs about how physical activity and work affect a patient’s back pain.
• Pressure Pain Threshold (PPT) : Using an algometer, this measures the minimum force applied which induces pain at a specific location, often used to identify trigger points or areas of hypersensitivity.
• Brief Pain Inventory (BPI) : Measures both the intensity of pain and the interference of pain in a patient’s daily life.
• McGill Pain Questionnaire (MPQ) : A comprehensive tool that evaluates the quality of pain (e.g., throbbing, shooting), its intensity, and its location. There’s also a Short Form McGill Pain Questionnaire (SF-MPQ) for quicker assessments.
• Pain Disability Index (PDI) : Evaluates the degree to which chronic pain interferes with daily activities.
• Functional Pain Scale (FPS) : Assesses pain in terms of its impact on function, from “pain with no interference” to “unable to move due to pain.”

What can readers typically learn from a massage case study?

Readers can gain insights into specific techniques and applications, treatment plans, client interactions, outcomes, and the overall therapeutic process, benefiting both practicing therapists and students.

What’s the difference between anecdotal and empirical evidence?

Anecdotal evidence comes from personal stories or experiences, while empirical evidence is based on systematic data collection and analysis, often through experiments or research studies. A case study provides detailed insights based on specific instances or individuals, landing somewhere between anecdotal and empirical: it’s more structured than mere personal accounts but not as generalized as broad studies. Overall, empirical evidence is considered more scientifically rigorous, but both anecdotal accounts and case studies offer valuable context and depth.

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Massage Therapy: Case Reports

Standard research practices often do not accurately reflect what massage therapists do in the treatment room. This is why it is important that massage therapists use case studies to report on what we do on a daily basis in the treatment room. By adding to the scholarly conversation researchers and other therapists are able to see on paper why massage is not just a massage. Instead massage therapy is a multi-modal individualized treatment approach that may consist of massage, joint mobilization, relaxation strategies, self care and patient education.

Case Report: Resources

International Journal of Therapeutic Massage and Bodywork- Author guidelines. The Massage Therapy Research Fund  (Canada) Massage Therapy Foundation - Grants  (United States)

CARE - Case Report Guidelines

Massage Therapy: Integrating Research and Practice (Dryden & Moyer)

Baskwill, A. (2013). Facilitating Case Studies in Massage Therapy Clinical Education.International Journal of Therapeutic Massage & Bodywork. (OPEN ACCESS) https://www.ncbi.nlm.nih.gov/pubmed/23730397 Munk, N. (2013). Case Reports: A Meaningful Way for Massage Practice to Inform Research and Education. International Journal of Therapeutic Massage & Bodywork. (OPEN ACCESS) https://www.ncbi.nlm.nih.gov/pubmed/24000303

Munk, N., Boulanger, K. (2014). Adaptation of the CARE Guidelines for Therapeutic Massage and Bodywork Publications: Efforts To Improve the Impact of Case Reports. Int J Ther Massage Bodywork. (OPEN ACCESS) https://www.ncbi.nlm.nih.gov/pubmed/25184013

Munk, N., Shue, S., Freeland, E., Ralston, R., Boulanger, K.T. (2016). Identifying Inconsistencies and Reporting Deficits in Therapeutic Massage and Bodywork (TMB)  Case Reports Authored by TMB Practitioners: a TMB-Adapted CAse REport (CARE) Guidelines Audit Through 2014. Int J Ther Massage Bodywork. (OPEN ACCESS) https://www.ncbi.nlm.nih.gov/pubmed/27648108

Porcino, A., & Moraska, A. (2015). Avoiding Common Writing Mistakes That Make Your Editors and Reviewers Cringe. International Journal of Therapeutic Massage & Bodywork: Research, Education, & Practice. (OPEN ACCESS) https://www.ncbi.nlm.nih.gov/pubmed/26668673 Porcino, A. (2016). Not Birds of a Feather: Case Reports, Case Studies, and Single-Subject Research. International Journal of Therapeutic Massage & Bodywork: Research, Education, & Practice. (OPEN ACCESS) https://www.ncbi.nlm.nih.gov/pubmed/27648107

Case Reports: Examples

Allen, L. (2016). Case Study: The Use of Massage Therapy to Relieve Chronic Low-Back Pain.International Journal of Therapeutic Massage & Bodywork: Research, Education, & Practice. (OPEN ACCESS) https://www.ncbi.nlm.nih.gov/pubmed/27648110 Burns, S. (2015). Concussion Treatment Using Massage Techniques: A Case Study. International Journal of Therapeutic Massage & Bodywork: Research, Education, & Practice. (OPEN ACCESS) https://www.ncbi.nlm.nih.gov/pubmed/26082825 Casciaro, Y. (2016). Massage Therapy Treatment and Outcomes for a Patient with Parkinson’s Disease: A Case Report. International Journal of Therapeutic Massage & Bodywork: Research, Education, & Practice. (OPEN ACCESS) https://www.ncbi.nlm.nih.gov/pubmed/26977216

Crane, P., Ladden, J., Monica, D. (2017). Treatment of axillary web syndrome using instrument assisted soft tissue mobilization and thoracic manipulation for associated thoracic rotation dysfunction: A case report. Physiother Theory Pract. https://www.ncbi.nlm.nih.gov/pubmed/28854081

Hill, R., Baskwill, A. (2013). Positive effects of massage therapy on a patient with narcolepsy. Int J Ther Massage Bodywork. https://www.ncbi.nlm.nih.gov/pubmed/22211155

Jayaseelan, D.J., Post, A.A., Mischke, J.J., Sault, J.D. (2017). Joint mobilization in the management of persistent insertional achilles tendinopathy. Int J Sports Phys Ther. (OPEN ACCESS) https://www.ncbi.nlm.nih.gov/pubmed/28217424

Lewis, P.A., & Cunningham, J.E. (2016). Dynamic Angular Petrissage as Treatment for Axillary Web Syndrome Occurring after Surgery for Breast Cancer: A Case Report. International Journal of Therapeutic Massage & Bodywork: Research, Education, & Practice. (OPEN ACCESS) https://www.ncbi.nlm.nih.gov/pubmed/27257446

Manella, C., Backus, D. (2011). Gait characteristics, range of motion, and spasticity changes in response to massage in a person with incomplete spinal cord injury: case report. Int J Ther Massage Bodywork. (OPEN ACCESS). https://www.ncbi.nlm.nih.gov/pubmed/21589693

Muir, B. (2009). Exercise related transient abdominal pain: a case report and review of the literature. J Can Chiropr Assoc. https://www.ncbi.nlm.nih.gov/pubmed/20037690

Porr, J., Chrobak, K., Muir, B. (2013). Entrapment of the saphenous nerve at the adductor canal affecting the infrapatellar branch - a report on two cases. J Can Chiropr Assoc. (OPEN ACCESS) https://www.ncbi.nlm.nih.gov/pubmed/24302782

Resnick, P.B. (2016). Comparing the Effects of Rest and Massage on Return to Homeostasis Following Submaximal Aerobic Exercise: a Case Study. International Journal of Therapeutic Massage & Bodywork: Research, Education, & Practice. (OPEN ACCESS) https://www.ncbi.nlm.nih.gov/pubmed/26977215 Wong, Y., Smith, R., & Koppenhaver, S. (2015). Soft Tissue Mobilization to Resolve Chronic Pain and Dysfunction Associated With Post-Operative Abdominal and Pelvic Adhesions: A Case Report. Journal of Orthopaedic & Sports Physical Therapy. https://www.ncbi.nlm.nih.gov/pubmed/26471853

“ Life is not a problem to be solved, but a reality to be experienced. ”

*This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

Richard Lebert Registered Massage Therapy

Richard is a Registered Massage Therapist in Petrolia Ontario who is experienced in the assessment and treatment of sport injuries. Richard uses a Adaptive Manual therapy  which means that myofascial release, acupuncture, cupping, sports massage and IASTM are used in an individualized one on one treatment .

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Richard Lebert, Registered Massage Therapist Ontario, Canada

Massage Research: How to Write a Case Report

• October 6, 2023
• Robin Miccio
• Business Tips
• Massage Practice Articles
• MBLEx Review

Have you had a significant clinical experience with a client? Writing and publishing your findings as a case report helps others expand their understanding of massage and improve practice. Here, we will explore how to write a case report.

The Massage Therapy Foundation defines a case report as a “description of a client seen in clinical practice which is written in a scientific manner.” Published case reports are most helpful when the case features a unique or unusual presentation, a rare diagnosis or an unexpected outcome. A case that challenges conventional theories or provides additional insights into the impact of massage for a particular condition is ideal.

Case reports have a structured format to ensure they are clear, concise and appropriately inform the reader . The scientific format consists of an abstract, introduction, methods (a description of the case and the massage techniques used), results and discussion.

Although case reports are written in the same manner as research reports, they are not research. Research studies test a hypothesis and systematically examine the relationship between topics of interest. A case report simply describes a therapist’s experiences of the treatment process for a single client. Its purpose is to inform an audience about an important issue and document the approach the therapist used to investigate that issue.

To write a case report, one must identify a suitable case. The client’s privacy must be protected and their medical information be accurate and complete. Once consent is obtained, the therapist should gather all relevant information, including the client’s history, medical findings and treatment, and conduct a literature review.

A literature review involves collecting and organizing all relevant published information about the case from peer-reviewed journals. (Notable databases are the National Library of Medicine’s PubMed and the International Journal of Therapeutic Massage & Bodywork .) It is important to research the relevant literature thoroughly to provide context for the case.

The Introduction

The introduction provides a brief background of the case and its relevance. A synthesis of the literature should be presented in the introduction to build the rationale for the case. There should be enough background information on the condition being studied for a reader to understand the topic.

A well-written case introduction is presented in a succinct and coherent manner, weaving in evidence to present the case for publication . Findings of previously published studies must be presented to help explain why the current case is of scientific interest. This is the literature review and it should be exhaustive, relating to the topic of interest. Extraneous information should be excluded.

If existing treatment-related research is limited, related articles (possibly some in other fields) can be used to support clinical decision-making and provide evidence-based rationale for massage treatment. The practitioner should synthesize the research well and integrate it into their explanation of why the case is of scientific interest.

The writing should flow seamlessly between published ideas and practitioner ideas. It should be evident the practitioner thoroughly understood the research and directly applied it to the case study. No results or data from the case should be in this section. The last sentence/s of the introduction should state the objective, outcomes and measurement tools.

The methods section provides all the details necessary for another practitioner to duplicate the work. It includes the client profile and the treatment plan. The medical story should be explained comprehensively enough so the reader can utilize their own clinical decision-making.

This section includes a presentation of the client’s demographics, such as age, gender and occupation, medical history and diagnosis, including what kind of professional arrived at the diagnosis and if applicable, include information or findings from other providers about the client’s condition. Prior treatments should be explained clearly, specifically the client’s experience with massage for the condition.

The practitioner should include massage contraindications, whether the client has consulted with or informed their doctor about receiving massage if under direct medical care, and a description of the client’s desired outcomes.

Outcomes & Assessments

The outcomes and assessments section should include any information from a health care practitioner who can perform diagnosis. How, when and where the assessments were taken should be clearly stated, as well as what measurement was chosen, why it was chosen and what was specifically measured.

The use of standardized assessment measures established in the literature is preferred. The assessments chosen should make sense for the presenting condition. The outcomes (at least one) should reflect the client’s goals and may be function-related, such as total hours sewing without pain.

The practitioner should describe relevant findings from the assessment, such as postural analysis, visual observations or range of motion. Assessments should be supported by literature, make sense for the presenting condition and be tied to the client’s goals. The practitioner should describe the training they received to be able to use the assessment approaches or tools. Clinical findings should be tied to the treatment plan rationale.

When describing the intervention, the author should also explain their background and the environment where massage was performed. The intervention needs to be clearly described, easy to understand and easily replicated.

Description should include intervention/s, number of treatments, duration, frequency and anatomical location/s of massage application. Applied techniques should be evidence-based, safe for the condition, involve clinical decision-making and be supported by the literature and clinical decision-making.

A crucial component of the treatment plan is the practitioner’s rationale for the particular massage or bodywork technique/s used:

• Treatment choices must be supported by the therapist’s scope, training and references to the available literature and safe practice guidelines.

• If there are no direct references to massage therapy for the condition, the author should indicate why the treatment approach was chosen based on an understanding of how the condition typically presents and how it presented in the client.

The results section presents the results of the intervention but should not attempt to interpret their meaning. Data should be presented in an organized and easily understandable manner; typically, raw data should not be presented. Practitioners are encouraged to succinctly present findings in either a table or graph format. The outcomes should be presented in the same order they’ve been introduced, and no new outcomes should be presented here.

Note that data should be presented only once. If a table or figure is presented it should be clear, organized and accurate. Graphs should have appropriate labels, including a chart title and axis titles; the graph’s range should match the assessment range. The written portion of the report must refer to any table or figure, if presented. Include how the client tolerated and followed the treatment plan and how this was monitored.

It is important to include the patient’s voice and thoughts on treatment/s and outcome/s, which can strengthen the report. Comments and quotes from the patient in the discussion section allow them to be heard about their experience. The practitioner should state whether there were any adverse or unexpected events.

The discussion section provides an opportunity to summarize and evaluate the outcomes of the treatment process. It is also important to integrate the findings from the case into the body of literature that currently exists on the topic.

Therefore, this section should start narrowly and end broadly; interpret overall findings clearly and concisely; not include raw data; restate the objective and relate findings back to the objective; and explain how findings add to the literature and relate to the client’s goal/s. Findings should not be overemphasized or described as “significant” or “proven.”

Only the outcomes presented in the results section should be discussed. The practitioner should speculate on why the treatment/s had an effect or not. The limitations of the process should be clearly discussed, including problems with methods and any abnormalities in the data. The author should explain future implications for practice and make suggestions for future research.

The Abstract

Although the abstract is the first section of the case report, it is usually written last. The information in the abstract should mirror the information in the body of the paper.

The abstract summarizes the key findings and conclusions of the report and is structured to include the following sections: background or introduction, objectives for the case report, case presentation (abbreviated client demographics, brief health history, diagnosis), assessment measures, treatment/s, practitioner’s background, results or findings and discussion.

You Can Write a Case Report

The Massage Therapy Foundation is reopening its annual Case Report Contest to practitioners. The deadline is June 1 each year. Review a free recording about case reports from an Information Session Webinar at massagetherapyfoundation.org/resources/webinars to learn more and earn one free CE.

Writing a case report is a valuable experience that can contribute to knowledge and improve client care. It is essential to follow ethical guidelines and reporting standards to ensure the report’s quality and accuracy. With hard work, patience and a growth mindset, anyone can write a case report.

About the Author

Robin Miccio, LMT, CEIM, is a massage therapist and program manager of the Integrative Health Program at Children’s Hospital of Philadelphia. Shortly after graduating from massage school, Robin wrote a case report that received an award through the Massage Therapy Foundation (MTF; massagetherapyfoundation.org) Case Report Contest. Miccio is a former MTF trustee, currently chairs the contest review committee and enjoys reading other therapists’ case reports. Miccio wrote this article on behalf of the Massage Therapy Foundation .

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Writing a Case Report: Where to Start

By Jerrilyn Cambron , LMT, DC, MPH, PhD February 16, 2011

Over the past few years, many massage therapists have asked me how to write a case report. There is such a great need for more research in this profession, I wish I could meet their expectations and rattle off a simple answer, as though I am giving directions to my Aunt Diane's house. Unfortunately, it is not that easy. However, there are certainly many therapists who have written and published case reports, showing all of us that it is possible - with the right directions.

Case reports can have a tremendous impact on our profession: recognition in the public sector, acceptance in the medical community, and advancement in our treatments and client outcomes, to name a few.

Published case reports have the potential to improve nearly every aspect in the massage profession. This is the first article in a series on writing case reports for the massage therapy profession. Generally, case reports describe the diagnosis, treatment and follow-up of an individual patient, which we will cover in proceeding articles. However, to get you started on your path to authorship, here are five important steps to follow before you ever begin writing.

Five Steps Before You Write

First and foremost, you need to choose a case to report. While this may seem obvious, it can be somewhat daunting to narrow down. Consider what interests you. Think about which clients you enjoy discussing with your colleagues, such as the client who was not expecting improvement but who now considers massage therapy the "miracle cure". Perhaps you want to discuss the client who had a negative reaction with one form of health care, but then greatly improved after bodywork sessions.

There are also plenty of unusual cases that would be of interest. Perhaps a gunshot victim for whom you increased the mobility of some of his scar tissue; or the person with an amputation who felt "whole" again after massage. Or, perhaps you want to discuss the typical clients you treat so that there is more evidence in the literature on massage therapy for back pain, headaches, stress disorders, and such. You will be spending time with this case, so it is a good idea to choose one you enjoy discussing.

Second, you need to consider why you want to write about a case. Is it because the case was so unique that you want to tell your fellow massage therapists about it? Do you want to write because you want to inform other health care professionals about the improvements that occurred due to massage therapy? Are you hoping to increase your credibility by publishing a case report in a peer-reviewed journal? Were you looking for evidence on massage for a particular condition and could not find anything, so you want to help add to the evidence base? Do you want to win the Massage Therapy Foundation's case report contest? Or do you want to accomplish all of these?

Understanding why you want to publish will help your motivation levels as you work towards your goal, and you can use that energy to keep yourself moving through the process. Understanding what is motivating you to write a case report will also help you better define your audience.

Knowing your audience is the third major hurdle you need to consider before you start writing. For example, let's say you had a pregnant client with low back pain, and you were able to help manage her back pain throughout her pregnancy. Would you want to tell your fellow massage therapists about your treatment protocol so that they might be able to utilize your methods? Or would you want to tell obstetricians about the benefits of our non-pharmaceutical approach to pain reduction, such as in this case of a pregnant women with back pain?

Both aspects might be important, but they would be written very differently and, most likely, they would be written for different journals. In a journal that is focused on the massage profession such as the International Journal of Therapeutic Massage and Bodywork or the Journal of Bodywork and Movement Therapy , we would expect the article to include a more specific description of the therapy so that fellow massage therapists would be able to replicate the treatment. However, if the case was written for submission to an obstetrics journal, you might need to include a bit more background information, describing massage therapy for the pregnant woman because obstetricians may not know what their patients should expect from a pregnancy massage. Try to imagine who might be reading the journal, and write as though you are speaking directly to them.

Choosing the journal to which you want to submit your case report is the fourth issue to consider before you start writing. There are many ways to find the best journal for your case report. One way is to go to a medical library and look at the different journals. Another way is to search online.

There is a great online resource from the University of Toledo, Mulford Health Science Library ( http://mulford.utoledo.edu/instr/ .) This resource allows you to type in a keyword and find journals that include that topic. For example, using our case report on a pregnant woman with back pain, we could go to this Web site and type in the word "obstetrics." According to the Web site of more than 6,000 journals, 18 have a focus on obstetrics and the list is provided. If we type in the word "pregnancy" we get only two journals. The word "massage" doesn't produce any journals, but the keywords "alternative medicine" produces three journals.

The real beauty of this site is that you can click on the name of any of these journals and you will be taken to that journal's "Instructions to Authors" section. Instructions to authors can be considered the "rules of writing" for that journal. Every journal has different instructions for authors, and it is your job to make sure you know what the expectations are before you start writing. For example, one journal might allow a case report to be 3,000 words but another only allows 1,000 words. You will increase your chances of acceptance if you know the rules before you start.

Finally, I strongly suggest you read several case reports from the journal to which you intend to submit your case report. I suggest this because it gives you a flavor of how the article should be written. Try to pay attention to the article's style and formatting: section headings, the length, the number of figures or tables, and the style of writing. Published case reports went through the peer-review process and were found to be good enough to be published. If you want your case to be published in the same journal, your report needs to be of the same quality.

These five steps to take before you start writing your case report (choose the case, determine why you are writing it, know your audience, choose the journal, and read previous examples) might make the difference between getting your case accepted for publication and having it rejected.

In the next article, we will begin our discussion on how to write a case report.

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Sample Case Studies

• Therapeutic Massage Provides Pain Relief to a Client with Morton’s Neuroma: A Case Report (Faith Davis, 2012)
• Massage Therapy Techniques as Pain Management for Erythromelalgia: A Case Report (Krista Dicks, 2010)
• CaseRe3: Case Report Research Repository

Reporting a Case Study: Tips & Resources

• Adaptation of the CARE Guidelines for Therapeutic Massage and Bodywork Publications (Munk & Boulanger, 2014) Suggestions for improving the impact of case reports.
• Anatomy of a Case Report A quick overview of the different parts making up a case report.
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Case Study: Massage Therapy for TMJ Dysfunction

A student case study explores how massage therapy can help relieve symptoms of TMJ dysfunction.

 February 1, 2021

Massage Therapy for TMJ Dysfunction

Veronica Seddon met her client during her clinical class at MacEwan University. “He has chronic conditions that make TMJ a real problem,” she says. “He wanted to feel more comfortable and improve his quality of life."

Seddon thought she could help, and so she did a thorough assessment, pinpointing areas where massage therapy would be beneficial. “We had a lot of discussion over the results of my assessment, as well as looking at questionnaire results,” she notes. "I did a lot of research on potential treatment paths and presented him with a couple of ideas, and together we decided on one that seemed like it would most improve his quality of life in the six weeks that we had together."

Seddon worked with the client for six weeks. The first session was dedicated to assessment, with the remaining five 60-minute sessions combining massage therapy and five minutes for measurements, discussion and client feedback. “I used Swedish techniques, myofascial release, muscle stripping, specific compressions and intraoral techniques,” Seddon explains.

The client was given self-care exercises to perform throughout the rest of the week to help reinforce the work he was doing with Seddon. “The client was given a self-care protocol that included active range-of-motion exercises for his jaw while his caregiver applied light pressure to moderate pressure on his temporalis or masseter muscles, and a jaw proprioception exercise he completed in front of the mirror,” she explains. “I gave him a calendar to mark each day that he completed the self-care protocol so I would know when he’d done them.”

The Results

“Maximum mouth opening was measured with a ruler before and after each treatment, and improved every treatment,” Seddon explains. “The Mandibular Functional Impairment Questionnaire was used at the first, third and fifth appointments to assess function, and those scores improved each time the questionnaire was completed.”

Seddon also used the Verbal Numeric Scale to assess levels of pain before and after each session. “His ‘worst’ pain score decreased from six at the first treatment to three at the final treatment,” she says.

Words of Encouragement

Sometimes, small changes can make big differences. “Even if you are only making what seem like small changes on paper, those small changes can truly change someone’s life,” Seddon says. “Don’t lose hope or feel discouraged if you’re not seeing monumental changes in the first couple of weeks. Keep at it and have confidence in your skills and knowledge base.”

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Massage Therapy Business Tips

Massage Therapy Treatment Plans That Really Work + Examples

October 5, 2023

Want to impress your massage clients with a treatment plan that renders BIG results? In this step-by-step guide, you’ll learn how to do just that with massage therapy treatment plan examples, from an experienced massage therapist. You’ll get how-to advice on gathering the information you need, documenting your plan, and getting your clients to follow through. 

If you can deliver results, your clients will do your marketing for you. Let’s do this!

Things Every Client Is Wondering About

Educating clients is an important part of your role as a massage therapist . Your clients aren’t just coming in for a massage, they are coming in for  therapy . They trust you to have answers. Regardless of whether your clients come in for relaxation or pain relief, they all want to know the same things. 

• How long of a session do I need?
• When should I come back?
• Can massage really help me?
• How long will it take?
• What should I be doing between sessions?

If your clients aren’t asking you these questions directly, they are thinking them. The easiest and most practical way to answer these questions is by creating a massage therapy treatment plan. 

When you tell clients what they need to do, the quality of care they receive increases and so does your  client retention . Creating a treatment plan isn’t a sales gimmick, it’s crafting a strategy for results.

What’s The Most Common Reason People Get A Massage?

According to the  latest AMTA statistics , 49% of consumers got a massage to improve their health and wellness, in 2022. Not only that, half of those massage clients said massage therapy was part of a treatment plan provided by their doctor.

Creating massage therapy treatment plans that help those clients reach their health & wellness goals is your job as a massage therapist. Do that job well, and referrals will start pouring in. 

How Do I Design A Treatment Plan My Clients Will Love?

Designing a successful  massage therapy treatment plan requires understanding what your client really wants. Engage them with open-ended questions, and listen to what they say - both with their words and their bodies. Conduct a thorough assessment, then craft a treatment plan that aligns with their desires and goals.

We’re all human, and we’re all different. That’s why the same plan doesn’t work for everyone. Recommend what you truly believe will be helpful. That may be a monthly massage regime, or it may be something else. Clients want your expert advice.

Speaking of goals, before you can come up with a strategy for treatment, you need to know what your client’s goals are. Don’t make assumptions. Ask. 

Start by asking your client what their goal for treatment is.  What’s bringing them in? This could be stress relief, pain relief, better mobility, ect. 

Once you know what their goal is,  the next question to ask is, “how will you know when we reach your goal?”  This is a crucial question that many therapists don’t ask. If you don’t have a benchmark to measure your progress against, how will you know if your therapy is working? Often clients don’t notice small improvements over time. Having a benchmark is a way to show your results.

Now that you know what you’re trying to achieve, you can start working on creating a massage therapy treatment plan. 

Create a template for documenting your treatment plan . If you don’t already have a  SOAP Note template , make one.  Writing effective SOAP Notes  is crucial to following through on your massage therapy treatment plans. It’s also a good idea to create something  that you can give to your client , so they don’t forget. You know how foggy the brain can be after a massage. 

Once you’ve created a system for creating and documenting massage therapy treatment, do it the same way with every client. Don’t forget to document this process in your  massage therapy business plan .

Here’s an example of a template you can use for sharing your massage therapy treatment plan with clients.

Treatment Goal: 

( Describe the client’s goal and benchmark indicating success )

Treatment Plan:

( Include things like duration of sessions, number of sessions, how far apart sessions will be scheduled, and what modality to use )

( Recommendations on what to do in between sessions. This could be things like stretching, exercise, heat, ice, rest, ect. )

*Stay within your scope of practice when making recommendations.

How To Get Clients To Follow Through On Their Massage Therapy Treatment Plan

After you create a treatment plan for your massage client, discuss it with them. Make sure they understand why you’re recommending this strategy and ensure it’s something that they are on board with. Write it down for them, and  get them to rebook  before they leave.

It’s also a good idea to follow-up with clients a few days after their initial session. Sending a brief text or email after the first visit shows that you care, and gives you a chance to gain valuable feedback.

Massage Therapy Treatment Plan Examples 

Let’s take a look at treatment plans for different kinds of massage clients. Keep in mind, these are just examples. When designing your own massage therapy treatment plans, customize it to fit the needs, desires, and goals of your clients. 

Here are 3 examples of things massage clients often seek treatment for, and treatment plans for helping them to reach their wellness goals.

Example 1: The Overworked & Stressed Out Client

Tina is a workaholic. She’s always in go mode, and her brain never shuts off. She’s been having trouble sleeping, and she was recently diagnosed with high blood pressure. Her blood pressure is being managed with medication, but her doctor says she needs to manage her stress levels and get more exercise.

Treatment Goal:

Stress relief and relaxation 

Benchmark: She’s able to easily fall asleep at night.

90 minute Swedish massage, bi-weekly over the next 2 months

Take a 30 minute walk when she gets home from the office each day to mark the end of the work day, get much needed exercise and relieve mental stress.

Example 2: Massage Client Recovering From An Injury

Tom injured his neck heading a soccer ball last weekend. Now, he has pain and limited ROM when he turns his head to the left. He had x-rays taken. They didn’t show anything concerning. His doctor said his pain is probably just muscular.

Relieve pain and increase ROM in his neck

Benchmark:  He can turn his head to check his blindspot while driving.

Three 30 minute neuromuscular therapy sessions spaced every 4 days

Use moist heat to relax muscles 1-2 times a day for up to 10 minutes. After the application, laterally flex the neck left and right to stretch tight muscles. DO NOT stretch to the point of pain.

Example 3:  Chronic Pain Sufferer

Sarah suffers from fibromyalgia. Her doctor has prescribed a few drugs that help, but she doesn’t like taking all that stuff. She can hardly function when she takes muscle relaxers, but they are the only thing that take the edge off. She wants to be more proactive in managing her pain levels, instead of solely relying on medication.

Manage chronic pain more naturally

Benchmark: No longer relies on muscle relaxers

60 minute deep tissue massage every 2 weeks 

Start a meditation practice, beginning with just 5 minutes a day and working up to more time.

What Do You Do After You Execute Your Plan?

You followed your plan, and it worked! (Or maybe it didn’t.) Now what?

If your plan doesn’t work, modify it or refer your client to someone who may be able to help. Changing course when something doesn’t work is part of every treatment plan.

If your plan does work, it’s time to create a maintenance plan. You won’t have to sell them on this because you already proved yourself to them. Create a new massage therapy treatment plan that helps them maintain their current state of wellness or to reach a new goal.

It’s also time to tell them about your  referral rewards program . Satisfied clients are one of the best ways to  promote your massage therapy business!  This is the time to  collect reviews and testimonials , or even turn your success story into a case study.

Can I Use Software To Create & Manage Massage Therapy Treatment Plans?

YES! The best way to manage the entire client journey is by using  massage therapy software , like ClinicSense. Software makes your life easier, and it ensures your clients get the best care every time. Here’s what using ClinicSense looks like in action:

A new client books online. An  intake form  is automatically sent to them to fill out online before their session. They also get an  appointment reminder , so they don’t forget to show up on time.

On the day of their appointment, you review their intake form before their appointment. Your new client shows up, and you start the session with no time wasted on paperwork. 

You chat about the reason for their visit and what their wellness goals are. Then, you do an assessment and make some initial notes in a SOAP Note on your tablet. Then, on to the good stuff - the massage.

After the session, you make a recommendation for follow-up treatment, schedule their next appointment, and process their payment. You finish up that  SOAP Note in just a few clicks , if you haven’t already.

A few days later, your client receives a personalized message from you asking about their experience. They say great things, and opt to publish those great things as a review on google. They’re feeling better already.

Want this experience in your practice? You can replicate it by signing up for a  free trial of ClinicSense.

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Case Study Issue 116: Deep Tissue Sports Massage

by Laurie Gee (more info)

listed in case studies , originally published in issue 116 - October 2005

Personal Details

CC has a curvature and tightness of the spine causing a lot of pain. The Osteopath referred her to me to keep her musculature in better condition, making it easier to manipulate and to maintain improvements after Osteopathic treatment. I see CC on a regular basis; weekly or fortnightly.

CC is of a slim build and 5' 8" tall. She is a medical secretary at a local hospital and complains that she sits in a draft causing her neck to become tight and immobile. Her hobby and great passion/interest is dancing. She attends many dance classes several times a week. She also attends weekend events, doing dances from Jazz to Hip Hop. She also travels all over the country to attend classes taught by skilled dancers from America to Spain.

First treatment

Her presenting problem was her lower back which had just been corrected by the osteopath. The facet joint had been re-aligned. The area that I found to be in need of treatment was mainly around the lower and upper back and neck.

Range of Movement

On testing, the range of movement was limited in the lower back, but was worse in the neck. The lateral movement – side to side – of the neck was limited, restricting the turning, left and right. Extension and flexion of the neck was tight, but not limited to any great extent. Visually her shoulders were raised towards the ears indicating tight Trapezius muscles.

Treatment Plan

The aim was to release the tension in the muscles of the lower and upper back and neck using palpation to find tight areas and points of Micro Trauma. I treated using neuromuscular techniques and the following machines: G5, Audio sonic – Nova sound and Interferential – endoscan, to avoid excessive pain if and when found. I avoided cross fibre friction because it tends to lead to further inflammation, pain and excessive soreness, interfering with on-going training and competition. Finally I used a Proprioceptive Neuromuscular Facilitation (PNF) muscle energy stretch to correct the tightness and to improve the muscle length. This stretch also ensures that the trauma eradication lasts longer and improves the range of movement (RoM) of the joint.

Details and Results

With the body in a prone position, I warmed the musculature of the back, using the classical massage movements of effleurage and then kneading the soft tissue as preparation for deep palpation.

I started with the lower back, checking/palpating the Erector Spinae group. When I found some micro trauma I used NMT (neuromuscular technique), that is holding the thumb (no longer than 30-60 seconds). on an area of discomfort until it fades. This is repeated several times until the trauma has faded. I also develop the NMT and use strain counter strain to lesson the discomfort if found too uncomfortable. Effleurage is followed to clear the area of waste and to soothe (warm down) the muscle. Lots of trauma was found, mainly in the lower back area. I then palpated the Quadratus Lumborum muscle group responsible for most of the lower back pain. Indeed I found a number of micro traumas and eradicated them using NMT. Several traumas were stubborn, which is normal when treating clients the first time. When the trauma was too painful or stubborn I used the audio sonic machine which is a sound wave vibration. This is excellent for most difficult areas of discomfort. When the trauma was still stubborn I used the endoscan (interferential-electrical stimulation giving a tingling sensation). This produced the required results alleviating the muscle tension. Having treated the Erector Spinae and the Quadratus Lumborum muscles, I then progressed to the upper back, palpating the Rhomboids and the Upper Trapezius after preparing the area with effleurage and kneading. The area of trauma was on the medial border of the scapula and around the insertion of the Levator Scapulae, which was fibrous. Trauma was also located on the upper Trapezius leading into the side of the neck on both sides.

I again found lots of micro trauma using NMT and eradicated many by using soft tissue release (stretching the muscle whilst using NMT) some of which was very painful, so I used soft tissue release, (rocked the limb whist holding the thumb on the trauma) until the trauma cleared. In a few cases, the trauma was difficult to remove, so I then used the audio sonic followed by the endoscan when needed. I softened the fibrous area using the audio sonic.

I then checked the neck and the body in a supine position for trauma.

After warming one side of the neck at a time, I palpated to find trauma. I found several points on both sides and treated using NMT. I used the audio sonic to release the trauma that I found to be stubborn or too painful. After the treatment, I used some manipulation to check the Range of Movement (RoM) of the neck. There the RoM was very limited laterally so I used a series of PNF stretches. This improved the flexibility of the neck. I then finished with some neck warming massage.

After-care Advice – Stretching

Several stretches were shown, to be done mornings and evenings. I suggested side stretches for the Quadratus Lumborum, a couple of stretches for the Rhomboids and the neck to help maintain the improvement and to keep the muscles flexible and the skeletal system stable.

CC is very happy with the treatment. She visits regularly so that she can continue with her dancing, avoid injury and prevent her vertebrae from misaligning and tightening. She also visits her Osteopath regularly. The Osteopath reported my client's musculature was in the best condition he had seen. We work in a multidisciplinary way for the benefit of CC.

Stretching Exercises

Quadratus lumborum.

For the left side, place the left leg over the right leg. Stretch the right arm down to the floor on the right. Stretch as far as is comfortable with out pain. Hold for up to 20 seconds or until the feeling of stretch eases. Stand up right then stretch again. Do this several times developing the stretch as far as possible without discomfort.

Do the same for the right side if the right Quadratus Lumborum is tight.

The Quadratus Lumborum is responsible for a lot of lower back pain.

Bend over and crouch down with feet apart. Clasp the side of the knees, with the right hand clasping the left knee and the left hand clasping the right knee. Head is bent down.

Push the knees outward and pull the hands inward. Hold for at least 7 seconds. Do this several times.

Neck Stretch

Bend the head to the right side and clasp head with the right hand. Push the head to the left and pull the head to the left hand holding the head still. Hold for 7 seconds. There should be no movement of the head. This is an isometric contraction.

Do the same with the head bent to the left holding the head with the left hand. Push gently and maintain an isometric contraction. Repeat this several times.

Christine said..

Hello just wondering have you any more treatments carried out on this client

Post Your Comments:

About  Laurie Gee

Laurie Gee is an ITEC trained Therapeutic Masseur and Sports Therapist and also holds a diploma from the London School of Sports Massage. Laurie organized sports massage at the Great South Run in the early 1990s and later at the South Coast Marathon. In 1992 Laurie's clients included athletes such as Tom Buckner, who represented Britain in the Olympics, Commonwealth Games and World Championships in steeple chase. Laurie later treated Dave Faulkner, Olympic gold medalist, and Amanda Larby (now Purser) World championship gold medalist, and many other top athletes. He can be contacted on [email protected] ; www.southsea-therapy.co.uk

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Writing Case Reports: Free Five-Part Webinar Series

This five-part case report webinar series breaks down the most important elements of a good case report and walks you through the writing process, making it easy for you to write your own case report. Join MTF for this complimentary webinar series collaboration between MTF and the Associated Bodywork & Massage Professionals (ABMP).

1. Writing a Case Report: Where do you start?

Presenter: Jerrilyn Cambron, PhD

Watch the recording of “Writing a Case Report: Where do you start?

A case report is a description of a client seen in clinical practice which is written in a scientific manner. Case reports may be the only evidence published on massage therapy for a given condition, and may be the “springboard” for researchers to develop larger studies. In this introductory webinar, you will learn how to decide which case might be worth documenting. You will also learn about the different sections of the case report and how to choose the journal to which you will submit your report.

Jerrilyn Cambron, LMT, DC, MPH, PhD, is a professor in the department of research at the National University Health Sciences, where her focus in on complementary and alternative medicine research (CAM) and evidence-based practice. She has been involved in CAM research since 1988, has published extensively in scientific literature, and teaches courses on research design, evidence-based practice, research literacy, and epidemiology. Jerrilyn is a Past President of the Massage Therapy Foundation. She has taught, “How to Write Case Reports” for many years, and has worked with numerous health-care professionals to get their case reports published.

2. Introduction and Discussion Sections – Making Your Case

Presenter: Ruth Werner

Watch the recording of “Introduction and Discussion Sections – Making Your Case” This webinar will delve into some strategies for writing the introduction and discussion sections of a good case report, with special emphasis on using other scientists’ work to help inform and advance your own project. While acknowledging that writing a case report is an ambitious project, this webinar helps break the “elephant” into bite-size pieces. Listeners interested in doing a case report will come out of this hour with step-by-step suggestions for how to go about the important task of writing outstanding introduction and discussion sections.

Ruth Werner is a retired massage therapist, writer, and educator with a passionate interest in massage research and the role of bodywork for people who struggle with health issues. She has been on the Case Report Contest Review Committee for the Massage Therapy Foundation since 2007, and is a Past President of the MTF.

3. Reporting the Case – What to Leave in and What to Take Out

Presenter: Karen Boulanger, PhD

Watch the recording of “What to Leave In and What to Take Out”

This webinar focuses on how to write the methods and results section of the case report. This includes describing the client, the specific intervention (massage technique), assessments used, and the results of the treatment. In addition, advice on how to determine the best measurements to use and how to appropriately present the results will be given.

Karen Boulanger has a PhD in community and behavioral health and has been a nationally certified massage therapist since 1999. Her career has included massage therapy, education, and research. In addition to her office in San Jose, California, Karen provides care to patients at Packard Children’s Hospital at Stanford.

4. Research Posters – An Option for Case Presentations

Presenter: Kim Goral Stevenson

Watch the recording of “Research Posters – An Option for Case Presentations”

Research posters are a visual snapshot of information contained in research articles and case reports. They are a great way to communicate the effects of massage therapy in a variety of settings such as your office, a health fair, or even a research conference.  In this webinar, participants will learn how to design and create a research poster, building on concepts discussed in the previous webinars from this series. Different uses of research posters will also be discussed.

Kim Goral Stevenson, MS, LMT, NCTMB, has been practicing massage since 2006. In addition to her passion for massage, Kim also has a love for science and research and works in the Clinical and Translational Science Institute at Boston University as an evaluation research analyst.  Kim has worked on a number of research and evaluation projects and her primary research interest related to massage therapy is its effect on psychological disorders such as anxiety and depression.

5. Case Report Contest Winner – Experience from the Field

Presenter: Rosemary Chunco

Watch the recording of “Case Report Contest Winner – Experience from the Field”

This webinar will be presented by Rosemary Chunco, a Massage Therapy Foundation Case Report Contest gold award winner. She will discuss the challenges encountered in writing a case report and will also give some tips and encouraging reasons why students and practitioners should consider writing a report. She will also provide personal insights on how going through the experience positively changed her outlook on her work.

Rosemary Chunco has been operating her own massage therapy practice in Plano, Texas, since 2003. She previously worked as a software engineer for more than a decade, but following some serious back issues, and being on the receiving end of massage, she changed careers and now enjoys debugging muscular issues! She was the gold award winner in the Practitioner Case Report Contest in 2010 and continues to use massage research to aid with informed, therapeutic decision making in her practice.

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Case Studies

Postural case study 1:.

Patient – Client is a 24 years old male student, currently working as a bar tender. Few months ago he decided to start looking after his overall health and posture more seriously which is why he started a course of Sports Massage treatments with us.

Initial Appointment – Client came to me the first time being concerned about his posture which has become increasingly rounded forward. At that time he did not have any considerable pain, although he has noticed increased tightness and discomfort in his upper back and neck with some tension headaches.

As a therapist, I understood that his main concern was that his posture will continue to decline especially as a kyphotic back is something that runs in his family and his future job would be sedentary. Observation: I carried out my first static assessment of the client’s posture and I noticed the typical upper crossed syndrome with a kyphotic thoracic spine, a lordotic upper cervical spine, protracted head, protracted scapula and internally rotated arms. The lower back seemed fine with no issues present. Palpation of the pectoral muscles found a lot of tension, as well as subscapularis, latissimus dorsi and teres major muscles too.

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Case Study 2:

Female, 37 year old, suffering with effects of ‘long covid’. 3 manual lymphatic drainage treatments in a three week period..

Client has been suffering the effects of ‘Long Covid’, she is not testing positive for Covid anymore. She has been experiencing extreme fatigue after contracting Covid 19 a few months ago. This has taken a huge strain on her body and throughout the day the fatigue is overwhelming. It’s affecting spending time with her family and she has been signed off work for a little while to give her time to combat the symptoms. Her doctor has suggested this style of treatment to give her system a boost.

1 st MLD session for 45 minutes

I positioned the bed into a ‘V’ shape to encourage lymph flow, and with client consent added grapefruit and lemon essential oils to the Grapeseed oil for an added boost to her system. I discussed how she would remain lying face up throughout and I would use a very light pressure to stimulate the lymph directly located under the skin. I used pulsing and pumping actions to stimulate stagnant lymph in the tissues, and then in areas such as the arms and legs, very long upwards strokes to increase the circulation of the lymph towards the lymph nodes. The idea being that this removes all the waste quicker from the body to detoxify and awaken.

Case Study 3:

53 year old female – presenting with constant Right sided shoulder pain following a Right sided Mastectomy and Lymphadenectomy 3 years prior (removal of Breast and Lymph Nodes).

During the surgery her Long Thoracic Nerve was damaged, which has lead to weakness and a lack of control around the shoulder and scapula, as the Long Thoracic Nerve innervates the Serratus Anterior which helps draw the scapula forward around the chest wall. The pain presents as a constant ache ranging 5-7/10 on the Visual Analogue Scale (VAS) scale which is aggravated by getting dressed, sleeping on it and pushing up through the arm. The client is semi-retired and still works as a Part-time Yoga instructor, taking 6 classes per week. An MRI of the shoulder showed nothing remarkable. She feels frustrated and is close to accepting that this is how her shoulder is going to be from now on.

Initial Assessment:

Observations – Patient has fair sitting posture, with moderately rounded shoulders on the right side more than the left, with a slight winging of the right scapula at rest.

Range of Movement – There is a 10-15% loss of Flexion, Abduction and Medial Rotation with significant compensatory movements in the Upper Traps through their ranges of movement.

Muscle Strength – Patient is weak through Flexion and both Internal and External Rotations (when arm raised to 90 degrees) as she is only able to push against light resistance without the Upper trapezius heavily assisting.

Neurological – Reflexes are intact with no noticeable loss of Dermatomal sensation.

Palpation – Upper traps, rotator cuff (Infraspinatus and Teres Minor) and Pectoralis Major are all tight and tender on palpation.

Impression: It appears that the patient’s scapular winging is caused by her weak Serratus Anterior (punching muscle), which is causing her Upper Trapezius to work a lot harder by assisting with most other movements. Her Rotator Cuff (RC) muscles are also working in an unorthodox fashion due to the winging.

Treatment: To help with the immediate pain the patient received various Soft Tissue Massage techniques to her RC, Lats, Pecs and Upper Traps, as well as some Medical Acupuncture to her Upper traps.

Home Exercise Programme (HEP): To stabilise the scapula and to strengthen the RC the following exercises were prescribed to be performed daily:

First Follow-Up: One week After Assessment

Patient reports feeling a ‘breakthrough’, she notices an increased range of movement and feels stronger as a result of doing her HEP. She’s incorporated the exercises into her elderly yoga classes. She still feels the ache in the evenings and if she carries a bag on that shoulder but it’s no longer constant pain. She’s doing her HEP twice daily.

Assessment – Still significant weakness into shoulder flexion and external rotation. Knots into the upper traps are reduced but still significant. Patient is still tight and tender into Pecs, RC, traps and lats. Slight correction needed for HEP exercises and advised to slow them down.

Treatment – Various Soft Tissue Massage techniques used to loosen RC, lats, pecs and traps. Medical acupuncture used again into the Upper Traps.

HEP: progressed to Single Arm Wall Push Up and the addition of two exercises:

Case Study 4:

Logan rees – scotland international, top ranked british under 23 in 2017 for 10km road (29m28s).

Logan came to see us regarding an ongoing foot issue he has had since 2014. He saw our Physiotherapist for a total of 4 sessions…

45mins Physiotherapy Initial 01/02/18

Physiotherapist’s Account: Patient attended the NHS in 2014 due to a sudden and constant pain underneath the first toe, beginning of the first phalange, on the right foot, with a mild swollen Metatarsophalangeal joint. He could not run because of the pain. After several tests there was still no diagnosis for his pain. He was then seen by a private Physiotherapist who did massage and exercises for the calf and recommended a steroid injection to ease the pain. He received this privately in December 2015. Logan found the injection lowered the pain allowing him to start running again in March 2016 but not without some discomfort. He has been unable to get this injury completely resolved.

Logan finds that self-massage on the area with a spiky ball helps as well as running will stiff shoes with good support. Soft shoes seem to make it worse (they allow more toe movement).

I could see that swelling was present and that the toe was externally deviated (Mild bunion). I found as well a great deal of tension on all lower leg muscles, especially on the 1st toe flexors on the right, making it slightly stiffer than on the other foot. Pain was noted when running and on direct touch on the insertion of the Flexor Hallicus Brevis.

Diagnosis: Tendinitis of the Plantar Flexors of the 1st toe on the right foot.

Treatment: Massage to the calve muscles

Home care Advice: Specific stretches for Gastrocnemius and Soleus to release tension on the specific tendon causing the pain.

Logan’s Account: During the first appointment, we discussed my injury history with particular focus on the long-term foot/toe injury that prevented me from running from May 2014 to around March 2016. The Physio had some ideas on how to treat this and he also took some photos to show the extent of the swelling on my right foot. He thought with treatment that the excess skin might become reabsorbed and my feet would end up similar sizes again. In the first session, he gave me a short massage on my upper calf. He also showed me some specific stretches to work on for next time to generally loosen my calf so that he could try to release the tension on the specific tendon that was causing pain.

Case Study 5:

Norma, 83 year old female.

45 Mins Physiotherapy initial

Client presented with first signs of Dupuytren’s contracture (a condition in which one or more fingers become permanently bent in a flexed position. It usually begins as small hard nodules just under the skin of the palm) on the 3rd finger on right hand, creating dry and pale skin with adhesion’s in the pathway of the 3rd finger flexors tendon limiting its movement. A year ago Norma stated it started affecting the carpal tunnel compressing the median nerve creating paresthesia on 3rd and 4 finger. Her grip in both hands is weak, but even weaker on her right hand. Things has been falling from her right hand lately as she has been unable to keep grip. She had a fall two years ago falling on her right arm and fractured T8 to T12.

I believe lack of strength is due to the muscle tension in both shoulders and arms. With her consent, massage to the right hand, forearm, biceps, pectoral and infraspinatus muscles is performed, to free the median nerve and reduce tension throughout the muscle chain. She feels much better after the massage, has a better grip and the paresthesia is now just on the tip of her 3rd finger. I showed her mobilisation of the median nerve, and a mild stretch of the pectoral-biceps-forearm-hand to do at home everyday. Norma agreed to gradually increase the physical activity as well as include a daily soft massage with moisturising cream on her palm.

Case Study 6:

47 year old female.

Reflexology

Client is a 47 years old, dedicated career woman running her own business whilst trying to manage her well being by doing regular exercise like cycling (indoor and outdoor) and long distance running.

Recently she has started to experience sleeping issues by having restless nights and struggling to unwind properly before bedtime.

The episodes were worse during times of stress, like the one she is going through just now. Most recently she has been suffering from pre- menstrual tension. She has hard skin in the ball of the foot and her feet were cold to touch which suggests signs of poor circulation but apart from that, her feet looked to have no other health issues.

My client wants to feel more relaxed and keep good energy levels to support her busy lifestyle. Her idea is to start implementing a monthly reflexology treatment as a preventative way for not feeling drained and fatigued but also to boost her immune system.

Treatment Plan/Advice:

First of all, I advised making some changes to her weekly exercise routine and try to join if she could a Yin Yoga class once per week, which is known to alleviate pain and tension, relieve stress and anxiety, and improve overall well-being.

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Massage therapy research review

Tiffany field.

a Touch Research institute, University of Miami/Miller School of Medicine, USA

b Fielding Graduate University, USA

In this review, massage therapy has been shown to have beneficial effects on varying conditions including prenatal depression, preterm infants, full-term infants, autism, skin conditions, pain syndromes including arthritis and fibromyalgia, hypertension, autoimmune conditions including asthma and multiple sclerosis, immune conditions including HIV and breast cancer and aging problems including Parkinson's and dementia. Although many of the studies have involved comparisons between massage therapy and standard treatment control groups, several have compared different forms of massage (e.g. Swedish versus Thai massage), and different active therapies such as massage versus exercise. Typically, the massage therapy groups have experienced more positive effects than the control or comparison groups. This may relate to the massage therapy providing more stimulation of pressure receptors, in turn enhancing vagal activity and reducing Cortisol levels. Some of the researchers have assessed physical, physiological and biochemical effects, although most have relied exclusively on self-report measures. Despite these methodological problems and the dearth of research from the U.S., the massage therapy profession has grown significantly and massage therapy is increasingly practiced in traditional medical settings, highlighting the need for more rigorous research.

Since a rather extensive massage therapy research review by Field was published in 2014, a significant literature has amassed on massage therapy effects on a variety of conditions that are reviewed here [ 1 ]. Empirical studies, systematic reviews and meta-analyses on massage therapy effects were found on a Pubmed search for the years 2013-2016. The studies were evaluated for treatment integrity, sample size and reliability of measures. Of the 159 studies that were initially selected for review, 79 were excluded because the entire article could not be located or the full paper was in a foreign language or the research failed to meet the criteria of being an empirical study (single-arm, randomized controlled waitlist or treatment comparison), a systematic review or a meta-analysis. Qualitative studies, case studies and small sample size studies were excluded. The final selection included 9 single-arm studies, 48 randomized controlled trials, 3 systematic reviews and 5 meta-analyses (see tables). These were focused on a variety of conditions including in vitro fertilization, prematurity, full-term newborns, autism, skin conditions including burn scars and surgical sores, pain syndromes including fibromyalgia and arthritis, blood pressure and hypertension, autoimmune conditions including asthma and multiple sclerosis, immune disorders including HIV and breast cancer and aging problems including menopause, Parkinson's and dementia. The empirical studies, systematic reviews and meta-analyses on massage therapy effects on these conditions are summarized here with respect to their primary findings, methodological flaws, potential underlying mechanisms, and suggested future research.

1. In vitro fertilization (see Table 1 for a listing of these studies and their primary results)

Prenatal and postnatal development conditions that are improved by massage therapy: reference numbers, trial types, comparison groups and primary results.

In vitro fertilization is probably the earliest developmental research involving massage therapy. In an in vitro fertilization study, oscillating vibrations were used prior to the transfer of the embryo [ 2 ]. The positive effects included greater pregnancy rates based on urine assays and ongoing pregnancies measured by fetal heartrate and birth rates as well as miscarriage rates. The problem with this study, however, was that only those who were willing to undergo the massage treatment were allocated to the massage therapy group, suggesting a potential self-selection problem. Nonetheless, it is a suggestive finding and one of the only studies on the use of massage therapy as an assisted reproduction technique. And the researchers did control for the participants' ages, hormonal substitution protocols and quality of the transfer of embryos, and no adverse effects were noted for the massage therapy. The authors speculated that the improved embryo implantation may have related to relaxation, reduced stress as well as decreased uterine contractions and possibly increased blood flow to that region.

2. Reducing prematurity by decreasing prenatal depression (see Table 1 )

We have conducted several studies showing that massage therapy by a therapist and by significant others reduces prenatal depression and in turn increases gestational age and birthweight (see Field 2014 for a review) [ 1 ]. In a recent study, massage therapy was compared to yoga, with yoga being considered a form of self-massage [ 3 ]. Both groups of prenatally depressed women became less depressed and their newborns were greater gestational age and birthweight. Despite the positive findings for both groups, the effects are confounded by yoga also being a source of social support from other prenatally depressed women in the group sessions. Despite these prenatal therapies, some depressed women unfortunately still experience preterm delivery.

3. Preterm infants (see Table 1 )

3.1. growth measures.

The most frequently reported effects for massage therapy with preterm infants are their greater weight gain and earlier hospital discharge. In a recent study, massage therapy was performed twice daily for two weeks for 15 min per session [ 4 ]. In this study, weight gain, height and head circumference were significantly increased. In addition, the frequency of pre-feed gastric residual was decreased and the number of bowel movements was increased in the group who received massage therapy. The authors concluded that NICU nurses needed to be trained in massage therapy techniques so that all preterm infants could receive massage therapy.

In another recent study, preterm infants were randomly assigned to 3 different groups including an oil massage group, a non-oil massage group and a control group [ 5 ]. Medium-chain triglyceride oil was used for the oil massage group as a nutritional supplement. The mean weight gain on the seventh day of the study was 105 g for the oil massage group, 52 g for the non-oil massage group and 54 g weight loss for the control group. The greater weight gain by the oil massage group could be related to the oil being absorbed by the skin which could contribute to the weight gain as has been reported in other studies and/or it could be related to increased vagal activity leading to greater gastric motility resulting in more efficient food absorption, as we have shown in an earlier study [ 1 ].

3.2. Vagal activity and gastric motility

The improved gastrointestinal function noted in the oil massage study just described [ 5 ] may relate to increased vagal activity leading to greater gastric motility, as has been shown in one of our studies on preterm infants [ 1 ]. In a related study on vagal activity, preterm infants were assessed for heart rate variability (vagal activity) after two weeks of twice daily massage therapy sessions [ 6 ]. The authors reported that the infants showed increased heart rate variability during caregiving, suggesting increased parasympathetic activity.

3.3. Natural killer cell activity

In one of the only studies on immune function of preterm infants following massage therapy, the researchers measured natural killer (NK) cell number and NK cell cytotoxicity (activity) [ 7 ]. Although the number of NK cells did not differ between the massage and the standard treatment control groups, the increase in NK cell activity was significantly greater for the massage group, particularly for those who received more than 5 days of therapy. The infants were also heavier and showed greater daily weight gain at the end of the study. The increased natural killer cell activity is consistent with data we have reported in other studies on massage therapy effects on individuals with immune disorders including women with breast cancer, and adolescents and adults with HIV ([ 1 ]). It is therefore not surprising that once again the immune measure most affected was NK cell activity. But given the greater NK cell activity, it is surprising that the number of infections did not differ between groups in the preterm infant study inasmuch as NK cells “kill” bacterial, viral and cancer cells. That the length of hospital stay was also not affected is inconsistent with data from many other studies on preterm infants. A meta-analysis, for example, suggested that massaged preemies on average have 5-6 fewer days of neonatal intensive care [ 8 ]. In the seventeen studies available for the meta-analysis, the massaged infants showed an average daily weight gain of 5.3 g and a mean of 5.4 days shorter hospital stay.

3.4. Developmental follow-up

Preterm infants have rarely been massaged by their mothers in these studies and they have rarely been followed for their long-term development. A recent study accomplished both having the mothers massage the preterm infants and following them to 12 months corrected age [ 9 ]. The researchers found that those infants who were massaged had higher cognitive scores at 12 months corrected age, consistent with earlier data we published showing similarly higher mental development scores at 6 months of age for those preemies who were massaged [ 1 ]. Unlike this recent follow-up study, we had also shown continuing greater weight gain.

3.5. Other touch therapies for preterm infants

Massage has been compared to a few other forms of neonatal stimulation including kangaroo care and exercise. In the kangaroo care versus massage therapy study, both were effective in increasing body weight and both resulted in shorter hospital stays [ 10 ]. The two forms of therapy may be equally effective inasmuch as they are both stimulating pressure receptors, with the kangaroo care providing the infant's skin pressure from the mother's or the father's skin and by the infant's skin being moved as the parent walks around, in essence stimulating pressure receptors. Although we did not find any studies on the effects of kangaroo care on the parents, just as massaging others can have positive effects on both the massager and massagee, kangaroo care is likely to have effects on both the parent and infant, given the stimulation of pressure receptors.

“Exercise” or the passive flexing and extending of the preterm infants' limbs (as in the middle portion of our preterm infant massage protocol) has been used to enhance bone formation [ 1 ]. The infants who received this “exercise” showed greater bone formation. The mechanism is not clear here, although it may relate to greater growth hormone (IGF-1) following massage therapy [ 1 ]. “Exercise” and massage therapy appear to have similar effects on preemie weight gain. However, our comparison between the moderate pressure massage and the exercise conditions suggested that vagal activity mediated the relationship between massage and weight gain and calorie intake mediated the relationship between “exercise” and weight gain [ 11 ]. A potential underlying mechanism for both the “exercise” and the massage effects may be the stimulation of pressure receptors.

3.6. Preterm infants with medical complications

Most of the preterm massage studies to date have been conducted with infants who are no longer experiencing medical complications and are off the respirator. However, in at least one recent study, infants with respiratory distress syndrome were given massage while still on the respirator [ 12 ]. In this study the mean oxygen saturation was improved in those who were massaged with sunflower oil. This suggests that massage therapy can also be used with infants who are being treated with continuous positive airway pressure.

3.7. Massage for NICU nurses

One of the main concerns about the neonatal intensive care unit is the stress experienced by the nursing staff. Their stress could be reduced by massaging the infants. As we have noted elsewhere, the massager can benefit as much as the massagee [ 1 ]. In that study, elderly volunteers massaged infants and were massaged themselves. Their stress hormones were lower, and they made fewer trips to their doctors after a month of massaging the infants. Although nurses may be too busy to provide massages for infants in the NICU, in at least one study, the nurses themselves were given massages to reduce their job stress [ 13 ]. In this study, the nurses were massaged for 20 min twice per week for 4 weeks. Two weeks after the intervention began, their overall job stress scores were significantly decreased as compared to the control group.

4. Full-term infants (see Table 1 )

Massage therapy has rarely been studied with full-term infants. This probably relates to weight gain not being a concern for full-term infants. However, increasing numbers of full-term newborns are receiving massage as it has been known to reduce irritability and sleep problems which are the most frequent complaints made by parents to pediatricians. In a recent study, healthy newborns were provided massage for 15 min a day and maternal attachment was assessed [ 14 ]. In this study the group who received massage had higher scores on the Maternal Attachment Inventory. In one of our studies, we taught mothers to massage their newborns from the day of birth to the end of the first month on a daily basis and compared a group who were massaged with lotion versus a group who were massaged without lotion versus a non-massage control group [ 15 ]. Both the mothers and the infants in the lotion massage group had better sleep patterns than those of the non-lotion massage and non-massage control groups. This could relate to the massage without lotion being less comfortable.

Bilirubin levels have also decreased in full-term healthy newborns following four days of twenty minute massages given twice daily [ 16 ]. In a very similar study but by a different group of researchers, bilirubin levels were also lower following four days of massage [ 17 ]. Thus, massage therapy may reduce the need for phototherapy or complement the phototherapy that is typically given to jaundiced newborns.

5. Infants with other conditions

5.1. infants with gastroesophageal reflux disease (gerd).

Infants with GERD have significant reflux problems. In one study a massage therapist taught mothers to massage their GERD infants [ 18 ].

The infants were randomly assigned to either a massage therapy or a non-massage control group and the massages were 30 min twice a week for six weeks. By the end of the study the Cortisol levels of the massage group had significantly decreased while the Cortisol levels in the non-massage control group had increased. These researchers also observed the mother-infant feeding interactions [ 19 ]. Both the massaging mothers and their infants had higher feeding interaction scores, with the mothers showing more sensitivity to the infants' cues.

5.2. Infants with asymmetry from congenital muscular torticollis

Infants with this condition were given massages and passive stretching for 30 min three times a week [ 20 ] At the end of the study the infants showed less asymmetry as measured by the thickness of the two sternocleidomastoid muscles, head tilt and the Torticollis Overall Assessment. Despite these suggestive data from a large sample of infants, methodological problems include the lack of a control group and the potential confound of the infants receiving passive stretching exercises along with their massages.

6. Autism (see Table 1 )

Children with autism spectrum disorder often have sleep problems. In a recent review of the literature eight studies were identified that explored non-behavioral and non-pharmacological approaches to managing sleep problems in these children [ 21 ]. Positive outcomes were reported for massage therapy. We noted in an earlier study that when parents massaged their children with autism before bedtime, the children's sleep improved (shorter latency to sleep, longer sleep time and fewer nightwakings) [ 1 ].

In another study using mothers as the massagers, the mothers massaged their children with autism for 20 min daily for 3 months followed by no massage for 4 months [ 22 ]. Saliva was collected to assay oxytocin (the “love hormone”) before and after a session during the treatment and during the control period. During the massage therapy period both the children and their mothers had higher oxytocin levels. Although this after treatment period control condition is unusual, the authors clearly anticipated the disappearance of the oxytocin effect when the massage therapy was withdrawn. Surprisingly, the mothers and children complied with the control condition after already experiencing the positive effects of massage. Lack of compliance is probably the rationale for having waitlist control groups as the typical control condition.

7. Skin conditions (see Table 2 )

Skin conditions that are improved by massage therapy: reference numbers, trial types, comparison groups and primary results.

7.1. Cleft-lip scars

Massage therapy has been used to reduce several skin problems including cleft-lip scars, burn scars, post-surgery scars and ulcers. In a study on cleft-lip scars, five weeks of massage including kneading and intra-oral massage was applied to individuals with cleft-lip [ 23 ]. Following the five-week treatment, the researcher reported increased range of motion and strength and increased symmetry. The problem with this study is that the sample was small and it lacked a control or treatment comparison condition.

7.2. Burn scars

In a study on burn scars, the participants received massage therapy and were observed on several measures including scar thickness, melanin and scar elasticity [ 24 ]. Following the massage therapy treatment period the massage group showed decreased pain, pruritis and scar tissue. These data are consistent with a study we conducted on children with burns, although our massage was focused on the non-burn areas [ 1 ]. The children's anxiety levels were reduced and their pain thresholds were increased so that they tolerated the debridement (skin brushing) better, as evidenced by less distress behavior. Similar effects were noted in our study on burns in adults including anxiety and Cortisol levels decreasing prior to debridement if the skin brushing was preceded by a massage [ 1 ]. Over the course of the study, pain and depression were also decreased.

7.3. Surgical scars

In a literature review on studies on scar management, the authors located 10 publications on scar massage [ 25 ]. The treatment protocols were highly variable, ranging from ten minutes twice daily to 30 min twice weekly. Of the 30 surgical scars treated with massage, 90% had improved appearance or their scores on the Scar Assessment Scale were significantly higher. The problems with the studies reviewed, however, are that the treatment protocols were highly varied and the measures were not standardized or objective.

7.4. Bed sores

Massage therapy was widely used until the 1950s to prevent and reduce bed sores or ulcers related to immobility in hospitalized patients. Pressure sores reputedly affect some 10% of patients in hospitals. Despite this problem a recent review of the literature failed to reveal any randomized controlled trials or even quasi-randomized controlled trials that met inclusion criteria for a meta-analysis [ 26 ]. Thus there were no studies eligible for this review and it remains uncertain whether massage therapy prevents bed sores.

8. Pain syndromes (see Table 3 )

Pain syndromes that are improved by massage therapy: reference numbers, trial types, comparison groups and primary results.

The lion's share of massage therapy research continues to relate to pain, probably because most massage therapy clients are receiving the therapy for pain syndromes. Therefore the massage therapist community is most interested in the research on pain. Since the last review approximately 20 randomized controlled trials have been conducted on pain syndromes including pain from muscle injury, labor pain, foot pain, knee pain, pelvic pain, low back pain, carpal tunnel syndrome pain, shoulder pain, neck pain, fibromyalgia, coronary bypass pain and pain in veterans [ 1 ].

8.1. Muscle pain

The muscle injury studies have typically involved exertion-induced muscle injury (weight lifting or leg pressing) including one in which participants were assigned to an exertion-induced muscle injury condition or a massage therapy group or an exertion-induced muscle injury plus massage therapy group [ 27 ]. The exertion involved a single round of bilateral eccentric exercise using the leg press. The results suggested that massage therapy attenuated the impairment of upper extremity function resulting from the exertion-induced muscle injury. That result might be expected given that the leg press also involves the upper extremity. In a similar study on eccentric exercise, the experimental groups received vibration or massage therapy [ 28 ]. Muscle soreness was significantly reduced for the two experimental groups versus the standard treatment control group. Range of motion also significantly increased for the massage versus the other groups.

8.2. Labor pain

In a study on labor pain, massage was provided for thirty minutes at each stage of labor, and pain and anxiety were measured [ 29 ]. The massage group had lower pain and anxiety levels and shorter duration of labor. These data are consistent with our earlier study in which we had partners provide massage for only the first 15 min each hour of labor and found similar effects including less pain and need for medication and an average of 5 h less labor [ 1 ].

8.3. Foot pain

In a study on foot pain massage therapy and exercise were compared to ultrasound therapy and exercise [ 30 ]. Six treatments were given over a period of 4—6 weeks in a single-blind randomized trial (single-blind basically being the only way a massage therapy study can be conducted with the researcher collecting the data being blinded). At the end of the treatment period the massage participants had lower pain than the ultrasound participants and they reported greater functional status as measured on the foot and ankle pain assessment.

8.4. Knee arthritis pain

Massage therapy has been used in individuals with knee arthritis pain in at least 3 recent randomized controlled studies. In one study, massage therapy and an exercise program were combined and compared to an exercise program alone [ 31 ]. Significant improvement was noted for both groups on the pain scale, get up and go test and on the WOMAC index, the variables typically used to test massage therapy effects on knee arthritis pain. In this study, the combined exercise/massage therapy led to greater improvement on these variables than the group that received exercise alone.

In another recent knee osteoarthritis study, Chinese massage (moderate pressure massage) was given three times per week for two weeks [ 32 ]. Gait was then evaluated using a motion analysis system by infrared cameras. The patients experienced less pain and stiffness and enhanced function. They also showed increased gait speed and greater step width. However, there was no increase in range of motion.

In contrast to other studies that were focused on the quadriceps muscles, the massage protocol of our study on knee osteoarthritis was focused on the hamstrings as well as the quadriceps [ 33 ]. We also used moderate pressure massage. We believe that using moderate pressure and massaging both the hamstrings and the quadriceps may have contributed to our unique finding of increased range of motion. Those two aspects may be necessary, i.e. the moderate pressure massage and the focus on both sets of muscles, although, unfortunately, they were confounded in this study, highlighting the need for a replication study.

8.5. Pelvic pain

In a study on pelvic pain a treatment comparison was made between massage and isometric exercises [ 34 ]. The treatment lasted eight weeks and the two groups were compared to a no-treatment control group. Pain intensity was significantly reduced in both treatment groups, although the reduction was greater in the massage group.

8.6. Carpal tunnel syndrome

A study on carpal tunnel syndrome involved the location of trigger points on the hand, and the massage was combined with trigger point therapy [ 35 ]. The results suggested a significant reduction in pain as well as an increase in functional activity after two weeks of 30-min massages twice per week. It is not clear that the trigger point therapy added anything given that massage therapy alone has been effective for carpal tunnel syndrome and on the same measures including the Phalen test and the Tinel test [ 1 ].

8.7. Hand pain and upper limb pain

Adults with hand pain have been taught massage so that they could massage their hands whenever they experienced pain, and, in addition, one group was given a topical analgesic to apply following the massage to be compared to a group that did the self-massages but without the topical analgesice [ 36 ]. The group that had both the massage and the analgesic had greater grip strength and a greater decrease in hand pain, depressed mood and sleep disturbance.

In a study we conducted on rheumatoid arthritis in the upper limbs, individuals were randomly assigned to one group who received moderate pressure massage or to another group who received light pressure massage [ 37 ]. After the first and last sessions, the moderate pressure versus the light pressure group showed greater grip strength and diminished pain. By the end of the study the moderate pressure massage group participants again had a greater decrease in pain and showed greater grip strength and greater range of motion in their wrists and upper joints (elbows and shoulders).

8.8. Neck pain

Much of the literature on massage therapy on neck pain is mixed depending on the dose level and the comparison groups, and many of the studies are based on self-report. In a randomized controlled study we conducted, massage therapists provided weekly moderate pressure neck massages and the participants were taught to massage themselves so that they could have daily massage [ 38 ]. The massage group showed significant immediate reductions in both self-reported pain and range of motion associated pain and an increase in range of motion on the first and last days of the study. The massage group versus the waitlist control group showed increased range of motion and decreased range of motion associated pain on the last versus the first day. These data suggest that moderate pressure massage may contribute to the effects that can be sustained by self-massage between therapist sessions.

In a review of randomized controlled trials that were identified by literature searches of 5 English and Chinese databases, a meta-analysis was conducted on massage therapies versus inactive therapies for neck and shoulder pain [ 39 ]. Their meta-analysis suggested that massage therapy yielded greater pain reduction. The authors recommended that massage therapy be compared with aqua therapies. However, when that comparison was made, massage therapy did not yield better effects for neck pain or shoulder pain. Although these results are consistent with our neck massage therapy versus waitlist control effects just described [ 38 ], their meta-analysis results suggest that treatment comparisons are more valid than comparing massage therapy with inactive controls, sham treatments or waitlist controls.

A meta-analysis on massage therapy for neck and shoulder pain by a different group further highlights that point [ 40 ]. These authors reported immediate effects of massage therapy versus inactive therapies for the reduction of both neck and shoulder pain. However, when massage therapy was compared to other active therapies, massage therapy did not yield better effects. The effects for active therapies may also derive from the stimulation of pressure receptors by the therapies.

8.9. Back pain

Several back pain studies have appeared in the literature comparing massage therapy to other forms of complementary treatment. The frequent study of back pain massage probably relates to the high incidence of low back pain as compared to other forms of pain, although carpal tunnel pain and smart thumb syndrome pain are becoming increasingly common. In one study, women with chronic low back pain were randomly assigned to massage therapy or physical therapy groups [ 41 ]. Stretching exercises were added to both the massage therapy and the physical therapy. The data analysis revealed that the massage therapy participants had a greater decrease in pain intensity and disability than the physical therapy group. These results may relate to physical therapy combined with stretching being more strenuous exercise. However, no group differences were noted for range of motion.

In another treatment comparison study, individuals with low back pain were randomly assigned to a Swedish massage with aromatic ginger oil versus a traditional Thai massage group (30 min sessions twice per week for 5 weeks) [ 42 ]. The Swedish massage was more effective than the Thai massage in reducing pain and disability. In this study, range of motion was not measured. These results were surprising given that Thai massage typically involves more pressure stimulation. The ginger oil could have had additive effects, although the use of an aromatic oil in one group and not the other confounds this comparison. Having direct stimulation of the skin versus being massaged fully clothed also confounds the comparison.

In a more matched comparison between structural massage (rocking and stretching) versus relaxation massage (stroking), the groups did not differ on self-reported back pain symptoms [ 43 ]. However, once again, range of motion was not measured. In our study comparing massage versus relaxation therapy, the massage group showed increased trunk flexion (touching toes to the point of pain and touching toes to the point of no pain) as well as less self-reported pain, depression, anxiety and sleep disturbance after 5 weeks of twice a week 30-min massages [ 1 ]. Our study, however, lacked a measure of compliance. The relaxation therapy participants should have had their sessions at the clinic to ensure compliance.

8.10. Pain in different joints

In a systematic review on pain in different joints, the 26 eligible randomized controlled trials included 2165 participants [ 44 ]. However, twenty of the trials were considered to be at high risk for bias. The results were somewhat mixed in that massage reduced pain in the short-term for shoulder pain and osteoarthritis of the knee but not for neck pain or low back pain. However, function was improved in the long-term for the individuals with shoulder pain and knee arthritis as well as low back pain. Several of the studies that were reviewed showed no greater benefits for massage than there were for joint manipulation or acupuncture. These results are perhaps not surprising in that each of those three treatment modalities involves stimulation of pressure receptors. The authors concluded, nonetheless, that the comparisons between massage and active treatments such as joint manipulation need to be replicated.

8.11. Fibromyalgia

In a series of fibromyalgia studies, positive effects have been noted for different types of massage therapies [ 1 ]. However, in a meta-analysis study on randomized and non-randomized trials, Shiatsu decreased pain, fatigue and sleep disturbances while Swedish massage did not improve outcomes [ 45 ]. This finding was not surprising inasmuch as Shiatsu versus Swedish massage typically involves moderate pressure. In another meta-analysis study on fibromyalgia, nine randomized controlled trials were included [ 46 ]. In this analysis, massage therapy with a duration greater than 5 weeks resulted in decreased pain, anxiety and depression, but no change occurred for sleep disturbances.

The results of the latter meta-analysis are inconsistent with the results of one of our fibromyalgia studies, possibly because we measured sleep activity with actometers rather than relying on self-report and we also measured substance P which causes pain [ 1 ]. We found an increase in deep/restorative sleep based on the activity recordings (minimal activity being associated with deep sleep) and a decrease in substance P across the course of the study. Substance P is released when there is insufficient deep/restorative sleep, and substance P causes pain.

Another example of sleep being improved following massage therapy comes from a Taiwanese study on insomnia in postpartum women [ 47 ]. The massage group received a 20-min back massage at the same time each evening for 5 consecutive days and the control group received standard treatment. As assessed by the self-report Pittsburgh Sleep Quality Index, the massage group experienced a greater decrease in sleep disturbances than the control group. The enhancement of sleep may be a mediating variable for pain reduction following massage therapy.

8.12. Veterans

In one of the very few studies on massage therapy with veterans, positive effects were reported [ 48 ]. The 153 veterans who received massage experienced reduced pain and anxiety following massage. These data, however, were pre-post treatment data without a comparison control or treatment group.

8.13. Coronary bypass and cardiac surgery

Massage has also been assessed for its effects on pain following coronary artery bypass and cardiac surgery. In the coronary artery bypass surgery study the patients received massage by a relative who was trained by a nurse [ 49 ]. The pain intensity measured by a visual analogue scale was decreased at all time points following massage. In a study on elective cardiac surgery patients, visual analogue scales were again used [ 50 ]. In this study, there was a 99% response rate which seems unusually high. Massage therapy led to a greater reduction in pain, muscle tension and anxiety and increased relaxation as compared to a control group who simply received rest for the same period of time as the massage group. This might not be an optimal control condition given that resting may lead to restlessness in a control group not receiving therapy. A control condition like rest can possibly be a negative experience.

In an even simpler post-surgery massage study, the therapy group received 15-min hand massages and the control group a simple hand-holding for 15 min [ 51 ]. These were given on 3 occasions within 24 h after surgery. Pain intensity and muscle tension were decreased for the hand massage but not the hand-holding control group. The authors concluded that this was a low-cost non-pharmacologic intervention. Although “hands-on” comparison groups may be better control groups, the hand-holding group may not have received the skin-moving, stimulation of pressure receptors that the massage group received. The pressure being applied needs to be measured, as can be done with a sound meter placed near the skin of the person being touched/massaged [ 1 ].

9. Blood pressure and hypertension (see Table 4 )

Blood pressure and hypertension conditions that are improved by massage therapy: reference numbers, trial types, comparison groups and primary results.

The effects of massage therapy on blood pressure have been studied in a number of different situations/conditions. These include recent studies on coronary care, hospitalization for trauma, prehypertension, essential hypertension and exploring potential underlying mechanisms for the reduction of blood pressure following massage therapy.

9.1. Coronary care

In a study on coronary care patients, a randomized controlled trial was conducted [ 52 ]. The patients were randomly assigned to a whole body massage group or a control group receiving standard treatment. Decreases occurred for both systolic and diastolic blood pressure and for heart rate and respiratory rate after massage therapy. These decreases may relate to the reduced anxiety following massage. In another study, patients in intensive care were randomly assigned to a massage therapy or a control group and vital signs were taken at hourly intervals [ 53 ]. Significant decreases were noted in systolic blood pressure at every time interval (1, 2,3 and 4 h).

In another massage by a family member study, trauma ICU patients received a full body 45 min massage by a family member and the control group received routine care [ 54 ]. One hour after the intervention significant differences were noted between the two groups, with the massage group having lower systolic and diastolic blood pressure, respiratory rate and heartrate. Significant group differences were also noted in the arterial blood gas measures including 02 saturation, PH and p02. The authors recommended massage by a family member as a routine clinical practice.

These were unusual studies in that the massage was conducted by family members and appeared to have yielded similar effects as other studies that involved massage therapists. However, when a direct comparison was made between nurse and family member massage for coronary patients, Cortisol levels were significantly decreased (by 90 nmol) in the massage by a nurse group but not in the other group [ 55 ].

9.2. Prehypertension

This condition has been studied primarily in women. In one study Swedish massage was applied to the face, neck, shoulders and chest for 10-15 min three times a week for ten sessions [ 56 ]. The data analysis suggested that both systolic and diastolic blood pressure decreased more in the massage than the standard treatment control group. In another study by the same group the sustainability of the massage therapy effects was assessed by taking vital signs at 72 h after completing the study [ 57 ]. At the 72 h follow-up there were still significant differences between the groups in both systolic and diastolic blood pressure favoring the massage therapy group. These surprising data need to be replicated as it is generally assumed that when stimulation is withdrawn, the effects are not sustained [ 1 ].

9.3. Hypertension

Although massage is often given to hypertensive patients who have a number of problems including anxiety, depression, elevated stress hormones, headache, vertigo, chronic pain in the back, shoulder and neck regions, typically the primary measures are systolic and diastolic blood pressure. In a study we conducted, high blood pressure symptoms were decreased including systolic and diastolic blood pressure as well as depression and urinary and salivary Cortisol [ 1 ].

In a meta-analysis, for another example, the outcome measures were systolic and diastolic blood pressure [ 58 ]. In this meta-analysis on 24 studies involving 1962 patients, the methodological quality of the trials was low. Nonetheless, the data tentatively suggested that massage was more effective than anti-hypertensive drugs in lowering systolic and diastolic blood pressure. These data need to be replicated in higher quality trials.

10. Auto-immune conditions (see Table 5 )

Auto-immune and immune conditions improved by massage therapy: reference numbers, trial types, comparison groups and primary results.

Several auto-immune conditions have been studied for massage therapy effects including asthma, diabetes, dermatitis, and multiple sclerosis [ 1 ]. The auto-immune research of the last few years has focused primarily on asthma and multiple sclerosis. These studies are summarized here.

10.1. Asthma

In a study on children with asthma, random assignments were made to massage and control groups [ 59 ]. Twenty-minute therapy sessions were given by the parents every night for five weeks. At the end of the study the mean forced expiratory flow in the first second (FEV1) was significantly higher in the massage group and although there was no difference in forced vital capacity (FVC) or peak expiratory flow, the FEV1/FVC ratio was significantly improved for the massage therapy group. These data are consistent with those we reported several years earlier except that we also found reductions in FVC and peak expiratory flow [ 1 ]. The inconsistencies are surprising inasmuch as the recent study was basically a replication of the Field et al. protocol [ 1 ]. Nonetheless, these are more objective, valid measures as opposed to self-report data, and except for clinician differences in administering the measures, the inconsistencies are difficult to interpret. Again, replications are needed especially of those studies that have used gold standard medical measures such as these pulmonary assessments. And, wherever possible the reliability of self-reports needs to be checked against the more objective laboratory measures.

10.2. Multiple sclerosis

In studies on multiple sclerosis, self-reports again were the most common measures, not unlike studies on the other conditions already discussed. In the first of these, the Multiple Sclerosis Efficacy Survey was used post massage therapy and at a 4-week and 8-week follow-up period [ 60 ]. The massage therapy group showed significantly more improvement on this survey than the waitlist control group at mid-treatment, end of treatment and at the 4-week follow-up period but not at the 8-week follow-up, surprisingly suggesting that the positive effects of the massage were sustained for as long as four weeks. In another study, exercise capacity and lung function were added to the self-report measures and the more objective 6-min walk test was administered [ 61 ]. Following a Swedish massage for 4 weeks there were no changes on these measures, although the participants reported improvement in quality of life in their written comments. Thus, these two studies have inconsistent findings, with the first study on therapeutic massage yielding positive change and the second study using Swedish massage reporting no change. This inconsistency may have related to the first study using therapeutic massage which typically involves more moderate pressure and/or it may have related to the more positive subjective self-report used in the first study versus the more objective walking measure used in the second study. Multiple subjective and objective, self-report and laboratory measures are needed to resolve these inconsistencies.

Another inconsistency is suggested by the positive changes reported for individuals with multiple sclerosis in another Swedish massage study [ 62 ]. In this study the patients were randomly assigned to four groups including massage therapy, exercise therapy, massage therapy combined with exercise therapy and a control group. The massage was provided for 15 sessions over 5 weeks and consisted of Swedish massage techniques. The exercise group was given a combination of strength, stretch and balance exercises. The results suggested that the massage therapy group experienced a greater reduction in pain and greater improvement in balance and the walking assessment than the other groups. The patients in the combined massage and exercise group showed greater improvement in balance than the exercise group. It is not clear why the massage group experienced greater improvement than the massage plus exercise group. The exercise may have exhausted the patients and thereby attenuated the positive effects of massage for these individuals with multiple sclerosis.

The inconsistent findings between the two Swedish massage therapy studies are difficult to interpret. It is not clear whether the Swedish massage techniques used in these two studies were different. However, it is striking that the same objective measures yielded different results for the two studies. The null finding study may have been using light pressure massage techniques and/or it may have sampled more severe multiple sclerosis patients. The greater dose of massage in the positive effects study (5 weeks versus 4 weeks) may have made the difference. Just as for the other conditions, the multiple sclerosis studies have the problem that different types of massage were used and different measures were assessed and most measures were by self-report.

11. Immune disorders (see Table 5 )

Immune conditions that have been studied since our last review on massage therapy research [ 1 ] have included HIV and cancer. The HIV studies summarized here include a study on HIV-exposed infants and another on HIV in adults. Breast cancer has been the most frequently researched cancer in the recent studies on massage therapy.

In the study on HIV-exposed infants, the mothers with HIV were taught to massage their infants which they did between 6 weeks when the study started and 9 months when the study ended [ 63 ]. Despite the massage group mothers having higher levels of maternal “mental pain”, their infants scored significantly higher on scales of mental development and hearing and speech at 9 months. Even though the CD4 cell count (the critical index of HIV severity) was measured in the mothers, there was no report on that measure or any measure of the effects of the infant massage on the mothers themselves. This is surprising given that the mothers presumably benefited from massaging their infants. As has been documented in at least a few studies, and as already discussed, massaging others has very similar stress-lowering (stress hormone-lowering) effects on the massager as well as the massagee [ 1 ]. In one of those studies elderly participants were noted to have lower norepinephrine levels and fewer trips to their physicians following a period of massaging infants [ 1 ].

In a study on HIV adults with a major depressive disorder, one group received Swedish massage and the second group received touch alone [ 64 ]. The massage was received for one hour twice per week. For the touch group, the massage therapist placed both hands on the patients' body with slight pressure but no movement. The massage significantly reduced the depression by the fourth week and continuing at the sixth and eighth weeks in contrast to there being no effects of the touch or the no-touch conditions. This is one of the rare studies that compared massage with simple touch. It is not surprising that the Swedish massage subjects experienced a greater decrease in depression than the touch alone group given that the touch group only involved hands-on and no movement of the skin which would be necessary to achieve positive effects. Once again, however, it is surprising that although these HIV studies measured immune function to ensure baseline equivalence of the groups, they have not reported the effects of the massage on immune function.

In massage studies by our group on adolescents with HIV and adults with HIV [ 1 ] significant decreases in Cortisol and increased natural killer cell number as well as natural killer cell activity were noted. In the study on HIV adolescents CD4 count also increased [ 1 ]. These data suggest a slowed progression of the disease both because natural killer cells “kill” viral cells, and CD4 cells are the cells killed by the HIV virus, so the increases in these immune measures are clinically significant.

11.2. Cancer

The cancer studies also used self-report measures in most cases. In one study on children with cancer, massage therapy was used to reduce anxiety and pain associated with bone marrow aspiration [ 65 ]. In this study, the children used visual analogue scales to report their pain and anxiety levels. Both these levels were significantly reduced in the massage therapy group. However, when the pretest and posttest scores were compared, no significant differences were noted between the massage and control groups.

Among the most negative side effects of chemotherapy are nausea and vomiting. In another pediatric cancer study, the effects of massage therapy on chemotherapy associated nausea and vomiting were measured [ 66 ]. The massage group children received 20 min massages 24 h before and 24 h after chemotherapy and they were given visual analogue scales for pain and intensity. Time and length of nausea and vomiting were also recorded. The results suggested that the pain severity was less for the massage group and the children in that group also had fewer bouts of vomiting. Massage therapy and ginger have also been identified as a therapeutic combination for adults' chemotherapy-induced nausea and vomiting [ 67 ].

In studies on women with breast cancer, the quality of sleep, the levels of depression, stress catecholamines, and immune cells including cytokines (Thl/Th2 immune balance) and natural killer cells have been measured following massage therapy. In a sleep study, the authors noted that insomnia was one of the most common problems following breast cancer [ 68 ]. In this study women with breast cancer were randomly assigned to a medical massage therapy group or a control group who received usual medical care. The results revealed pre-post intervention differences in immune scores and quality of sleep in the massage group based on the Pittsburgh Sleep Quality Index. Although medical massage usually involves moderate pressure so the effects reported here might be expected, it is unclear that the statistics they used involved an appropriate comparison between groups as a group by repeated measures analysis or simply pre-post comparisons for the separate groups.

In an immune study on breast cancer patients, the women were given two 30-min massages per week for five weeks [ 69 ]. The results suggested that depression and anxious depression were significantly reduced after the massage compared to the control condition. There was also an increase in Th1 over time for the massage group. That shift is significant in that the Thl/Th2 ratio is an important index of immune function with lower production of cytokines (pro-inflammatory cells associated with Th2) being a positive change. In another breast cancer study we reported reduced depression and increased dopamine and serotonin (both activating neurotransmitters) as well as increased natural killer cell number and lymphocytes [ 1 ]. The increased dopamine and serotonin may have mediated both the decrease in depression and the increased immune cells.

In a study on reconstruction after mastectomy for breast cancer, patients were randomly assigned to either a massage therapy group or a massage plus meditation group [ 70 ]. There were no additive effects of meditation on any of the self-report stress, insomnia, fatigue or pain measures. Although it is generally methodologically appropriate to assess the effects of two therapies combined versus one alone, the addition of meditation may have placed demands on the participants that were new to them, resulting in performance stress. Also, the comparisons can be confounded by the additional time demands on the participants when two therapies are combined.

Massage therapy effects have also been studied in patients with leukemia, but unfortunately only using self-report measures including stress and quality of life scales [ 71 ]. While the massage therapy group showed a significant decrease in stress and improvement in quality of life, the relatively small sample limits the generalizability of the data.

In a meta-analysis on the effects of massage therapy on cancer in general, cancer-associated pain was noted to be one of the most common complaints [ 72 ]. Nine high quality studies were included in this meta-analysis. Massage therapy was noted to significantly reduce cancer pain as compared to no massage control conditions. Massage was effective especially for surgery-related pain, and among the various types of massage, foot reflexology was the most effective. It may have been the most effective as it typically involves the application of moderate pressure and the movement of skin perhaps moreso than Swedish massage.

12. Aging (see Table 6 )

Aging conditions improved by massage therapy: references, trials, comparison groups and primary results.

Very few studies have focused on the effects of massage therapy on aging conditions. Recent studies on its effects on postmenopausal women, on Parkinson's and on dementia are summarized here.

12.1. Postmenopausal women

In a study on postmenopausal women 30-min sessions for four weeks of massage were provided with aromatherapy or with odorless oil [ 73 ]. These groups were compared to a non-massage group on measures of psychological symptoms on the postmenopausal scale. The aromatherapy-massage group showed the greatest decreases in psychological symptoms. This is not surprising since the literature has suggested that adding an aroma oil to the massage has additive effects and the aroma oils themselves have been noted to alter brainwaves in the direction of relaxation and reduced heartrate [ 1 ].

In another study on postmenopausal women, biochemical markers of bone formation were the primary measures [ 74 ]. In this study women were randomized to a two-hour session of Thai massage twice a week for four weeks and compared to a waitlist control group. The results suggested that serum P1NP (a primary biochemical bone formation marker) increased significantly after Thai massage while there was no change for the control group. The Thai massage was particularly effective for women who were older and had a smaller body build. The results of the study are interesting in that they suggest that even after a short period of four weeks, bone formation can occur following Thai massage. Inasmuch as Thai massage involves significant moving of the skin and moving the limbs, even more stimulation of pressure receptors may occur with this type of massage, although Thai massage is rarely studied.

12.2. Parkinson's

In a study on Parkinson's, Amma massage therapy was used to alleviate physical symptoms [ 75 ]. This study basically assessed the effects of one forty-minute Amma massage session involving upper and lower limb exercises as compared to a control group. After only one session, the analogue scale scores were lower for muscle stiffness, movement difficulties, pain and fatigue. On the more objective measures, gait speed was significantly faster, stride length was lengthened and shoulder flexion and abduction were improved. After several sessions the authors found improvements on the same measures. These effects are interesting in that Amma massage, like Thai massage, is given through clothing, making it more accessible to patients like those with Parkinson's. These data are consistent with our study on moderate pressure massage in terms of improved functioning in patients with Parkinson's [ 1 ]. We also noted a decrease in norepinephrine and epinephrine (stress neurotransmitters) which could mediate the physical symptoms associated with Parkinson's.

12.3. Dementia

In a study on elderly patients with dementia, the effects of massage therapy and ear acupuncture were compared with a control group [ 76 ]. Behavior alterations including sleep disturbance, eating and compliance were recorded during the three months of intervention. Positive effects were noted for massage and ear acupuncture when compared to the control group and they were persistent for two months after completing the treatment. The long-term effects are surprising given that continued stimulation of pressure receptors would be presumably needed for the effects to continue. This study also suggests that massage therapy and acupuncture might have similar underlying mechanisms, for example, that they involve the stimulation of pressure receptors, increased vagal activity and a reduction of Cortisol.

12.4. Potential underlying mechanisms

In a study that examined the underlying mechanisms for the effects of massage, for example, on blood pressure, a thematic analysis was conducted on 27 studies that considered the effects of massage therapy [ 77 ]. The author identified several potential underlying pathways for the relationship between massage therapy and the reduction of blood pressure. Just as we have previously noted [ 1 ], this author also suggested that massage therapy has effects via increased parasympathetic activity and decreased Cortisol or improved functioning of the hypothalamic-pituitary-adrenal-cortical (HPAC) system.

Examples have been seen in the literature on how parasympathetic activity can be increased by massage therapy, for example, in children [ 78 ]. In this study, parasympathetic activity increased significantly in children receiving foot and hand massage on a pediatric intensive care unit. Repeated sessions suggested that parasympathetic activity peaked after the second session and remained stable for the remaining sessions. Another study documented increased parasympathetic activity following a single short session (10 min) of head massage [ 79 ]. The head massage also reduced heartrate.

An example of the effects of massage on the HPAC system or the levels of Cortisol can be seen in a study that involved the patients' companions giving them full body massages [ 80 ]. In this randomized controlled trial on 60 patients admitted to intensive care those who received massage had significantly lower Cortisol levels. Again, this was an unusual study given that the massages were provided by the patients' companions. However, the reduction in Cortisol was not surprising given that Cortisol levels have significantly decreased by an average of 31% across our massage therapy studies [ 1 ].

13. Limitations of the therapy protocols

Massage therapy has typically been compared to a standard treatment control group. As massage therapy is increasingly noted to be therapeutic, an ethical question is whether a control group can be denied therapy. Increasing numbers of studies are therefore using waitlist control groups or comparison treatment groups. The waitlist control group would receive the same massage therapy at the end of the waitlist period. And treatment comparison groups would be given a similar therapy. The problem has been matching therapy protocols so they are not confounded by variables such as length of massage, duration of treatment period, and pressure applied. Some of the comparisons have been between different massage techniques, for example, Swedish versus Thai massage. The findings from those comparisons have often been mixed, with some studies suggesting that Swedish massage was more effective than Thai massage and other studies yielding the opposite effects. These are very different therapies with the Thai massage being fully clothed and the other not. In addition, Thai massage is typically a longer session than Swedish massage and Thai massage characteristically involves more movement of the joints and the skin. So these comparisons have been confounded by a number of basic differences between the protocols. Massage has also been compared to simple touch and is more effective probably because of the movement of the skin. And, massage has generally yielded better results than exercise, especially with individuals like those with multiple sclerosis who might find exercise too exhausting.

When a therapy is added to massage therapy it sometimes has additive effects. For example, adding aroma to massage oils has been effective. Other therapies have had no additive effect, for example, exercise, possibly because it was too exhausting. The added therapy needs to be assessed as a group on its own. So, comparisons, for example, would be made between a massage group, an exercise group and group that receives both massage and exercise. When exercise is added to massage, that combination may attenuate the positive effects of massage, again because an exhausting modality is being added to a relaxing modality. In contrast, other active therapies like yoga and tai chi and other forms of exercise may have positive effects as they are not exhausting and they involve stimulation of pressure receptors much like massage.

14. Limitations of the measures

The massage research reviewed here as compared to that reviewed in 2014 [ 1 ] has typically involved self-report measures even though measurement technology has become increasingly sophisticated. For example, in the earlier studies on breast cancer, immune measures were the primary measures, but in some of the recent studies on breast cancer, immune measures were not even reported. Gold standard medical measures have been used in some studies as, for example, blood pressure measures in hypertension studies, CD4 cells in HIV studies and range of motion measures in arthritis studies, but most of the studies reviewed in this paper relied on self-report measures. It is not clear why this focus on self-report measures has occurred as the reliability of self-report measures has been questionable. Their excessive use may in part relate to limited funding in recent years in this country and to limited funding in general in Asian countries where most of the massage therapy studies have been conducted. Ideally, research protocols would include psychological, physical, physiological and biochemical measures to document multivariable effects.

15. Limitations of the conditions studied

Pain syndromes continue to receive the lion's share of the research, probably because the most frequent massage therapy clients are those with pain syndromes, highlighting the importance of that research. Massage therapy research has also increasingly focused on hypertension and breast cancer. In contrast, some conditions that are also very prevalent in this country have not been assessed for massage therapy effects including obesity and diabetes (both conditions being NIH funding priorities) and drug use (a NIDA funding priority). Even though the growth of the massage therapy industry in the U.S. has been exponential, despite very limited insurance coverage for that therapy, relatively few researchers are studying massage therapy. Despite these problems with the literature, massage therapy is now considered more than just a complementary therapy and has been making inroads into more traditional medical settings.

16. Summary

In this review, massage therapy has been shown to have beneficial effects on many different groups and conditions including prenatal depression, preterm infants, full-term infants, autism, skin conditions, pain syndromes including arthritis and fibromyalgia, hypertension, autoimmune conditions including asthma and multiple sclerosis, immune conditions including HIV and breast cancer and aging problems including Parkinson's and dementia. Although many of the studies have involved comparisons between massage therapy and standard treatment control groups, several have compared different forms of massage (e.g. Swedish versus Thai massage), and different active therapies such as massage versus exercise. Typically, the massage therapy groups have experienced more positive effects than the control or comparison groups, potentially because massage involves the stimulation of pressure receptors leading to enhanced vagal activity and reduced Cortisol levels. Some of the researchers have employed physical, physiological and biochemical measures, although most of them have relied exclusively on self-report measures. Despite these methodological problems and the dearth of research from the U.S., the massage therapy profession has grown significantly and massage therapy is increasingly practiced in traditional medical settings, highlighting the need for more rigorous studies.

Acknowledgments

I would like to thank my collaborators, the individuals who participated in these studies and the research associates who assisted us. This research was supported by funding from Johnson and Johnson and Massage Envy to the Touch Research Institute. Correspondence and requests for reprints should be sent to Tiffany Field, Ph.D., Touch Research Institute, University of Miami Medical School, P.O Box 016820, Miami, Fl 33101. ude.imaim.dem@dleift .

Case Study: The Use of Massage Therapy to Relieve Chronic Low-Back Pain

• PMID: 27648110
• PMCID: PMC5017818
• DOI: 10.3822/ijtmb.v9i3.267

Objectives: To study the effects of massage on chronic low-back pain in a patient with four different diagnoses: osteoarthritis, scoliosis, spinal stenosis, and degenerative disc disease. The patient's goal was to cut down on the amount of pain medication he takes.

Methods: A 63-year-old man with chronic back pain received four massages across a twenty-day period. Progress was recorded using the Oswestry Low Back Pain Scale, as he self-reported on levels of pain and interference with his activities of daily living.

Results: Improvement was noted in 9 out of 10 measurements of self-reported pain and activities of daily living, with the only exception being his ability to lift heavy objects, which remained unchanged. The most dramatic differences were improvements in his ability to walk, and in the changing degrees of pain. The client also self-reported being able to decrease his pain medication and the ability to ride his bicycle for the first time in years.

Conclusions: Massage therapy is a promising treatment for chronic low-back pain for patients who may have multiple pathologies, any one of which could be responsible for the condition. Further study is encouraged to determine the efficacy of massage therapy as a readily accessible, lower-cost alternative to more invasive therapies and as an adjunct to regular medical care, when appropriate.

Keywords: back pain; degenerative disc disease; osteoarthritis; scoliosis; stenosis.