Does massage help back pain? What the studies show

Two large evidence reviews both found a benefit and both rated it weak. The Agency for Healthcare Research and Quality (AHRQ), in a 2016 evaluation of nondrug therapies for low-back pain, examined 20 studies comparing massage to usual care or other treatments. It found evidence that massage helped chronic low-back pain, but rated the strength of that evidence as low. The same review looked at 6 studies pitting different massage styles against each other and could not say whether any one type beats another.

The 2015 Cochrane review, covering both acute and chronic low-back pain, found the same short-term improvement. NCCIH's plain-language read is that evaluations of massage for low-back pain have found "only weak evidence that it may be helpful."

A 2011 randomized controlled trial of 401 adults with nonspecific chronic low-back pain compared two kinds of massage, structural and relaxation, against usual care. At 10 weeks, both massage groups were doing meaningfully better on function and symptoms than the usual-care group. The relaxation-massage group scored 2.9 points lower on the Roland Disability Questionnaire, a standard measure where lower means less disability. Benefits on function still showed up at 52 weeks, though by then they were small.

Structural massage, with its targeted approach, was no better than plain relaxation massage in that trial, which suggests the benefit does not depend on a specialized technique.

Mostly short-term. Relief shows up soon after treatment, and the 2015 Cochrane review could not establish a long-term effect. The 2011 trial above is a partial exception: small gains in function were still there a year later.

A trial cited in the American Massage Therapy Association's position statement shows the same pattern in a hospital setting. Researchers randomized 605 veterans recovering from major surgery to one of three tracks: routine care, brief individual attention, or evening back massages for up to 5 days. The massage group had faster short-term drops in pain intensity, pain unpleasantness and anxiety. What massage did not change was opioid use, length of stay or complications.

It depends on the guideline and on how long you have had the pain. The American College of Physicians (ACP) issued clinical practice guidelines in 2017 covering acute, subacute and chronic low-back pain. Massage made the list for acute and subacute pain, based on low-quality evidence. For chronic low-back pain, the ACP left massage off its recommended options entirely. Know which side of that acute-chronic line your pain sits on before you book.

The CDC's 2022 opioid-prescribing guideline found that several noninvasive, nondrug treatments improve chronic pain and function, with "small to moderate effects in specific pain conditions" and no association with serious harms. Massage therapy is named in that guideline as appropriate for some types of chronic pain, alongside acupuncture, tai chi, yoga and mindfulness. That supports trying massage as one part of a pain plan.

The neck evidence is no stronger, and the relief is just as brief. A 2013 review of 12 studies (757 participants) found massage more helpful for neck and shoulder pain than inactive comparisons, but no better than other active treatments, and for shoulder pain specifically the benefit was short-term only. A 2016 review of 4 U.S. trials found massage could give short-term relief of neck pain, with a condition attached: the sessions had to be long enough and frequent enough.

A 2014 trial randomized 228 people with chronic nonspecific neck pain to different doses of massage over four weeks, and the result was unusually specific. Sessions of 30 minutes, however often they happened, were no better than sitting on a wait list. What worked was 60 minute massages two or three times a week. Those longer, more frequent sessions made a clinically meaningful improvement in neck function roughly 3 to 5 times as likely, and in pain about 2 to 3 times as likely.

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

Something measurable, and not yet explained. The American Massage Therapy Association's position statement gathers the effects researchers have recorded: less anxiety and depression, lower blood pressure and heart rate, less pain. It also points to physiological changes measured after a single Swedish massage, including shifts in stress hormones and immune markers. A 2012 study found that massage of muscle damaged by exercise dialed down inflammatory signaling inside the tissue.

A meta-analysis cited in the American Massage Therapy Association (AMTA) position statement describes massage's largest effects as reductions in trait anxiety and depression, of a magnitude similar to psychotherapy. The most consistent thing massage does may be to calm you down.

The risk is low and the role is supporting. NCCIH's read is that the risk of harmful effects from massage "appears to be low," which for a healthy adult is most of the story. Its broader chronic-pain guidance adds that people with medical conditions and people who are pregnant may need to modify or skip some approaches. That safety record is part of why massage keeps appearing in guidelines even though the effectiveness evidence is weak to modest.

NCCIH's other instruction is blunt: don't use massage to postpone seeing a clinician about a medical problem. With that said, here are the steps the research supports, in order.

At W Spa, 441 Waverley Street in downtown Palo Alto, a 60 minute Swedish massage is $80 and a 60 minute deep tissue massage is $90. Both run 30 to 120 minutes, and deep tissue costs more at every length the two share. Since relaxation massage matched the structural kind in the 2011 trial, Swedish is a fair place to start. Book deep tissue if you want slower, firmer work on one area.

The 30 minute deep tissue session ($65) covers one tight spot; for the whole back, book 60 minutes. Say where it hurts and how firm you want the work before you lie down. Book on Fresha or call (650) 272-6881; W Spa is open every day from 9:30 AM to 10 PM. None of this is medical care, and a back that has been hurting for months deserves a clinician's opinion before it gets an hour on a table.