The Whole Person: Massage Therapy Gets More Holistic

 by David Malone, August 1, 2025

The rise of holistic offerings in massage therapy is impossible to ignore. It has become nearly as common to see a massage therapist offering cupping, Reiki or aromatherapy as it is to see a therapist offering Swedish or deep tissue massage.

Related CE: Cupping Therapy and Your Massage Practice

Many holistic offerings are less about managing specific symptoms a client may be experiencing and more about integrating a client’s whole person into the massage session: physical, mental and spiritual.

“A holistic approach to massage therapy adds more depth to a session,” says Sarah Reuther, LMT and certified cupping therapist. “Manual therapies already accomplish so much in terms of reducing pain, increasing range of motion and relaxing tissue. Bringing in options like aromatherapy, hot packs and cupping therapy can further assist to calm the mind and double down on pain relief.”

Some common holistic techniques that are offered within massage therapy include:

• Aromatherapy
  
  
• Stretching
  
  
• Cupping
  
  
• Deep Breathing
  
  
• Hot towels, hot stones, hot packs

“I have always looked at the person’s body in a holistic manner,” says Michelle Agliano, LMT. “I work with my clients physically, mentally, emotionally and spiritually because it all matters.” (Though remember, massage therapists need to stay within their own scope of practice.)

Diversify Your Offerings, Diversify Your Clients

One of the things a more holistic approach to massage therapy can help with is reaching a larger client base. By offering things like cupping, aromatherapy or Reiki as either add-ons or standalone services, a massage therapist is opening themselves up to a wider audience.

“Using all these techniques is also a very efficient way to work because they are all supporting the massage,” Reuther says. “My clients love a session with variety, it gives my hands a break, and sessions feel more complete.”

The variety a holistic approach offers can make clients feel like they are getting more bang for their buck, too, as well as attracting new clients and reinforcing loyalty in your regular clients. Additional offerings can also help a client vary their massage therapy sessions so they never feel like they are plateauing.

As Reuther notes, many of these more holistic offerings give a massage therapist a chance to rest their hands—without sacrificing the benefits of massage. Many holistic offerings, such as aromatherapy and Reiki (and other types of energy therapies) are very low stress and low impact and provide massage therapists a way of incorporating their own self-care into massage sessions.

“One of the things I’ve noticed is there’s nothing new under the sun. I have seen things come and go in my 35 years,” Agliano says. “When I decide what to use, I am taking a look at what is needed for my client to bring them to optimal health. I use essential oils in the session. I use stretching and breathing techniques that I teach my clients. I use those things that are natural and helpful for the body.”

When you’re adding techniques or offering a different approach in your practice, however, you need to be thoughtful and deliberate. This is especially important when adding massage techniques, ensuring you have a good understanding and can practice safely. Many times, additional education will be necessary.

Reuther’s entry into cupping was an in-person, weekend-long continuing education class. Continuing education for many holistic practices can be found online, but it is important to make sure the company offering them is legitimate.

Holistic Therapy: What the Science Says

The benefits of extending what you offer your clients go beyond extra revenue streams and attracting new clients. There is also some science that supports the benefits of a more holistic approach.

A study¹ examined the effect of various holistic therapies (reminiscence, music and reality orientation therapy) on people with Alzheimer’s disease (AD). The study explored the effectiveness of these nonpharmacological treatments on depression levels, quality of life and cognitive status in individuals with AD.

The study placed 10 people with AD in a holistic therapy program for six weeks and an additional 10 in a control group. All 20 individuals took the mini-mental state examination (MMSE), geriatric depression scale short form (GDS-SF), Nottingham health profile (NHP), and World Health Organization quality of life instrument, elderly module, Turkish version (WHOQOL-OLD) before and after the therapy.

Initial and final assessment results were compared in the therapy group and showed a significant increase in the MMSE scores and a significant decrease in the GDS-SF scores. Additionally, there was a significant increase in the quality of life for the patients in the therapy group according to the NHP and WHOQOL-OLD.

“In this study, a significant improvement was observed in the therapy group in the following aspects: cognition, depression level and quality of life―especially in sleep, social isolation, emotional reaction, energy, autonomy, intimacy, fear of death and emotional ability areas,” researchers concluded.

It is important to note that the term “holistic” is wide-ranging and includes many therapies and interventions, which means that a holistic approach needs to be carefully tailored for an individual client so together you can find what works best and has the most benefit.

The Power of Placebo

One of the most common critiques of many holistic practices is how difficult measuring real benefit can be. But, does that mean there is no real benefit?

Many massage therapists have anecdotal evidence from clients, and so the question becomes: If clients report positive outcomes, is always understanding the mechanism of action—if there is one—of relief important?

Learning more about the placebo effect—and the nocebo effect—may be helpful.

Placebo effects have been widely studied across the medical profession. What’s been discovered is that placebo effects are not only psychological and involve specific brain circuits and activity, including the dopaminergic circuits, the system responsible for releasing dopamine when a person engages in rewarding activities, and the descending opioid system, which is a pathway in the brain that reduces pain signals by inhibiting pain transmission.²

A systematic review³ explored how choice (e.g., type and timing) can enhance the placebo effect. Fifteen independent studies comparing the placebo treatment with any form of choice over its administration were included in the review and assessed a range of conditions, such as pain, discomfort, sleep difficulty and anxiety.

Researchers found choice significantly enhances the placebo effect.

These outcomes suggest that much of what massage therapists already do—like making sure clients know they are in control of level of comfort around disrobing, pressure depth and body parts massaged—may enhance placebo effect benefits.

So, consider where you might give clients more control of the massage session, like lighting and music options, as well as any add-ons you might offer to customize the massage experience, like aromatherapy or stretching, for example.

The Nocebo Effect: A Self-Fulfilling Prophecy

The flip side of the placebo effect coin, however, is nocebo.

Nocebo effects, according to the National Cancer Institute (NCI), are side effects or symptoms that can occur with a drug or other therapy simply because the patient believes they may occur.

The NCI illustrates how the nocebo effect works by explaining how some patients in a trial who are informed of possible side effects will experience these symptoms even when given the placebo vs. the active treatment.

In other words, just being aware of the possible side effects can be enough to bring them about.

As with placebo effects, nocebo effects are not just psychological.

Recent research posits that nocebo responses in particular might be due to altered activation of the anterior cingulate cortex (ACC). The ACC has several functions, including pain perception and processing. With the nocebo effect, researchers suggest the ACC may be reinforcing negative anticipation, meaning side effects arise to alert a person to potential risk.

A review² explored both placebo and nocebo effects in the treatment of migraines to offer a summary of the current understanding on the topic. The review includes citations from 111 studies, reviews and articles on the topic, and suggests that integrating the understanding of contextual effects like placebo and nocebo into clinical practice has important implications for optimizing the effectiveness of treatments by limiting nocebo effects and enhancing placebo effects.

“[They] make up a significant part of the therapeutic experience … By addressing modifiable contextual factors such as patient expectations, lifestyle choices and the therapeutic relationship, health care providers can enhance the effectiveness of migraine treatment,” researchers noted. “A significant percentage of pain relief may be attributed to patients being informed about how their new drug treatment will likely impact their headache, thus channeling an effective placebo response.”

In other words, positive treatment expectation can potentially be associated with better treatment outcomes.

So what does all of this mean for massage therapists?

For one, making sure your clients have good, reliable information around the benefits of massage therapy alongside open communication are key.

Some benefits of massage therapy are well-established in research. What might be worth deeper consideration is the role placebo effect might have in the massage experience and where leaning into more robustly explaining evidence-based practice to clients may help extend existing benefits. Or, alternatively, introduce potential for side effects via the nocebo effect.

The possible implications for massage therapy center how clients are prepared before a massage session starts, mainly in how practitioners both talk to clients about their role in the massage session and the potential benefits.

Massage therapists who take the time to explain to clients how various massage techniques work or may work and what they should or should not expect—including those that might be harder to explain with solid research—might increase the overall benefits experienced by that client.

While there is still a lot to be understood about both placebo and nocebo effects, the more information a massage therapist has on the topic, the more likely they will be to provide clients with successful and beneficial massage sessions, holistic or otherwise.

Ice Ice Baby: Ice Massage Shows Promise in Relieving Pain

At one time or another, we have all been in a spot where we have twisted an ankle or bumped our head and grabbed an ice pack or a bag of frozen peas to apply to the area. Applying ice to the injured area helps reduce inflammation, as well as relieve pain.

Ice massage takes the benefits of cold therapy and adds the benefits of massage. Ice massage, also referred to as ice cupping, uses a tool called an ice cup to gently massage a specific area of the body, and is commonly used to reduce pain, increase blood circulation and promote lymph drainage.

One study⁴ looked at the effect of ice massage on labor pain, labor comfort, labor duration and anxiety. The study equally divided 100 pregnant women into an intervention group and a control group.

Rotational ice massage was applied to the SP6 point on both legs of the pregnant women in the intervention group at four to five centimeters, six to seven centimeters, and eight to nine centimeters dilation during three contractions. Standard midwifery care was provided to the control group.

The study found the Visual Analog Scale scores were significantly lower in the intervention group compared to the control group following the intervention at all dilation levels. Additionally, the total CCQ and comfort level scores of the pregnant women in the intervention group at 8- to 9-centimeters dilatation were significantly higher than the control group.

Another study⁵ looked beyond pain and explored the effect of abdominal ice massage on blood glucose level and cardiovascular function. Fifty volunteers were recruited for the study and underwent one session of ice massage to the abdomen for 20 minutes. Systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse rate (PR), pulse pressure, mean arterial pressure (MAP), rate pressure product (RPP), and double product (Do-P) were assessed before, immediately after and 20 minutes after the intervention.

The study showed a significant reduction in PR, RPP and Do-P in post-test assessments. The assessment at 20 minutes showed a significant reduction in random blood glucose, SBP, DBP, PR, MAP, RPP and Do-P compared to pre-test assessments.

Overall, ice massage has shown promise in helping people in a variety of ways by combining the benefits of cryotherapy with the benefits of massage.

References

1. Parlak MM, Bizbinar Ö, Köse A. “The Effect of Holistic Therapy in Alzheimer’s Disease.” Altern Ther Health Med. 2023 Apr;29(3):52-59.

2. Basedau H, Ornello R, Matteis ED, et al. “Placebo and nocebo in the treatment of migraine: How much does real world effectiveness depend on contextual effects?” Cephalalgia. 2023;43(12).

3. Tang B, Barnes K, Geers A, Livesey E, Colagiuri B. “Choice and the Placebo Effect: A Meta-analysis.” Ann Behav Med. 2022 Oct 3;56(10):977-988.

4. Türkmen H, Çetinkaya S, Kiliç H, Tuna SD, Şirvanci M, Mutlu H. “The Effect of Ice Massage Applied to the SP6 Point on Labor Pain, Labor Comfort, Labor Duration, and Anxiety: A Randomized Clinical Trial”. J Midwifery Womens Health. 2024 Jul-Aug;69(4):491-498.

5. Mooventhan A, Nivethitha L, Yogapriya C, Kahlilsubramanian K, Manavalan N. “Effect of Ice Massage to Abdomen on Blood Glucose Level and Cardiovascular Function in Healthy Individuals: A Single-group Pre-test and Post-test Experimental Study.” Int J Ther Massage Bodywork. 2024 Dec 12;17(4):43-48.