The lower body contains the largest muscle (gluteus maximus), bone (femur) and joint (knee), and with so many large, complex areas, come sometimes large, complex and painful problems. When these problems arise, massage therapy is increasingly showing itself as an effective, non-pharmacological intervention to help people manage lower body pain.
“In my years of experience and research, most pain related to the legs, knees and feet is related to the muscles that move the joints,” says Dorothea Atkins, ThD, MA, DSN, LMT. “Therefore, I use variations of the four basic massage techniques, including tapotement, effleurage, muscle energy technique and myofascial release.”
Tapotement is used to stimulate circulation and relax muscles and effleurage helps release muscle tension. Muscle energy technique is used with joint resistance to release muscle tension, and myofascial release is used to reduce the tension in connective tissues, Atkins explains.
Massage for the Knee: Updates in Research
Clients dealing with knee injuries or chronic conditions that affect the knee joint may experience symptoms such as pain, swelling and stiffness, redness and warmth, weakness or instability, popping or crunching noises, and the inability to fully straighten the knee.
“Knee pain usually stems from above or below the knee itself,” says Jennifer Hanna, LMT. “Normally, decreased range of motion in the hips or locked talus, calcaneus, and/or navicular will be the cause of knee pain.”
Osteoarthritis is one of the most common forms of arthritis, and often affects the knee joint. According to the National Institutes of Health (NIH), age, weight and trauma to the joint caused by repetitive movements (such as squatting and kneeling) are some of the most common risk factors for knee osteoarthritis.
A 2021 study1 compared the effects of aromatherapy and massage therapy on knee pain, morning stiffness, daily life function and quality of life in patients with knee osteoarthritis. The clinical trial divided 93 patients evenly into three groups: massage therapy, aromatherapy and the control.
A demographic characteristics questionnaire and the Knee Injury and Osteoarthritis Outcome Score questionnaire were used to measure outcomes and completed before the intervention, at the fifth intervention and at the 10th intervention.
Results showed the massage therapy group had the highest pain score at the beginning of the intervention but the lowest pain score at the end of the 10th session, and both massage therapy and aromatherapy showed significant results in performance, exercise and recreational activities when compared to the control group.
“The use of both massage therapy and aromatherapy is recommended for patients with knee osteoarthritis,” researches noted. “Interventions should be prolonged for at least six months.”
A systematic review2 and meta-analysis aimed to synthesize available evidence on the effects of massage therapy for knee osteoarthritis and included 12 studies with a total of 737 participants. Massage was compared to controls.
“After 1‒4 weeks of therapy, there was a significant reduction in pain and stiffness scores in the massage group, and after 6‒8 weeks of therapy, there was a significant reduction in stiffness and functionality scores,” researchers noted, adding that outcomes were short-term.
Massage for Restless Leg Syndrome: What We Know
According to the NIH, restless leg syndrome (RLS) is a neurological disorder that causes unpleasant or uncomfortable sensations in a person’s legs and an irresistible urge to move them. Common symptoms include aches, pulling, itching, tingling, tightness, and electrical or jolting sensations. These symptoms can lead to poor sleep quality and a decreased quality of life.
Some kidney failure patients who need hemodialysis also experience RLS. One study3 explored the effects of foot massage with lavender and orange essential oil on a patients’ sleep quality and RLS. Patients were divided into three groups, massage with lavender oil, massage with orange oil and a control.
Patients in the massage group received 30-minutes of foot massage with either lavender or orange essential oil three times a week for three weeks. Results were measured via the Pittsburgh Sleep Quality Index and RLS questionnaire, and researchers noted both massage groups significantly increased the mean score of sleep quality and reduced RLS symptoms.
A separate study4 also looked at the effect of massage therapy with lavender oil on the severity of RLS and quality of life in hemodialysis patients. This study found that massage with lavender oil lessened the severity of RLS and improved quality of life.
Related: Is Massage Nature's Sleep Aid?
Finally, a meta-analysis of 14 studies5 evaluated the effect of non-pharmacologic interventions on muscle-related symptoms (including cramping and RLS) in hemodialysis patients. The analysis concluded non-pharmacological therapies like massage may help manage muscle-related symptoms and should be considered for both their beneficial effects and because they’re practical, well tolerated and easily integrated into a treatment plan.
Foot Massage: More Than Meets the Eye
For most people (and some massage therapists), it’s easy to forget how important our feet are—until they begin to hurt. But, research is showing that foot massage can be effective in helping reduce anxiety, lower blood pressure and reduce generalized pain.
For example, one study6 evaluated the effects of foot massage on relieving pain and anxiety for patients receiving anterior cervical discectomy and fusion (ACDF). The study enrolled patients who had undergone ACDF and had been diagnosed with anxiety disorder at least six months before the surgery.
Related: Post-operative Massage Therapy
Participants received a daily 10-minute foot massage for four weeks, and outcomes measured included the neck pain visual analog pain scale, neck disability index and self-rating anxiety scale. Researchers noted foot massage was effective in alleviating pain and anxiety while also improving the quality of life in patients who had undergone ACDF.
Another study7 investigated the influence of foot and back massage on blood pressure and sleep quality in women with essential hypertension. Six sessions (30 minutes, twice a week for three weeks) of foot massage and back massage were provided to the 60-person intervention group, and results indicated the intervention group reduced systolic blood pressure and diastolic blood pressure values.
Foot massage has also been shown to help women with pain during labor. A 2023 study8 explored the effect of foot massage in pregnant women during labor for outcomes around labor pain, the duration of the delivery, postpartum bleeding and the emotional state of the mother. The study separated 80 women into two groups of 40 (foot massage and control). The intervention group received a 20-minute foot massage on each foot at three separate times during the first phase of birth.
Results showed that pain severity for women who received the foot massage decreased after the intervention, and they also experienced less pain in the postpartum period. Additionally, women in the intervention group had shorter second and third stages of labor.
Massage for the lower body is proving beneficial for more than just achy joints and muscle pain. While research has long suggested massage is a good intervention for these types of pain, especially when included as part of a larger integrative health care treatment plan, we’re starting to understand more about the value massage brings to other conditions, such as restless leg syndrome, ACDF, and labor pain and duration.
Between Massage Sessions: Self-Massage to Maintain Massage Benefits
Self-massage can be very helpful for clients who want or need to extend the benefits of massage between sessions. Foam rollers are some of the most common and inexpensive self-massage tools on the market today, and some of the purported benefits include improved flexibility and balance, and relief from sore muscles and muscle tension. But are they actually effective? A few recent studies have examined that exact question.
One study9 explored the effects of self-massage with a foam roller on ankle joint range of motion and tendon-muscle morphology. The main goal of the study was to investigate extensibility changes in the gastrocnemius muscle (GM), muscle-tendon unit and the Achilles tendon.
The foam rolling intervention was performed on the right leg plantar flexor muscles for three minutes on each of the 10 study participants. Results showed ankle joint dorsiflexion range of motion (ROM) increased significantly following the foam rolling intervention.
“Foam rolling was effective in increasing ankle joint dorsiflexion ROM,” researchers noted. “Moreover, it was suggested that the GM morphology might be affected by the intervention.”
A separate study10 looked at the effectiveness of foam rolling versus manual therapy in post-exercise recovery interventions for athletes. The results of the study showed that in the foam roller group, dynamic balance scores increased for both limbs at post-intervention and at follow-up, which suggests self-massage with a foam roller may be more effective than manual therapy for the recovery of dynamic balance in athletes after intense exercise.
Atkins stresses the importance of self-massage to her clients, and sets clients up with the resources they need to be able to stretch the benefits of the work they do together during a session. “I demonstrate the techniques on my own leg and ask the client to repeat it. This can help empower them to use the techniques at home,” Atkins explains. “I then use the client’s phone to video while they perform the techniques and ask them to explain if they sense any changes in their joint pain.”
Atkins also takes pictures of any pillow placement so the client will be able to remember the location and purpose for any bolstering when performing self-massage at home.
Hanna also provides clients with ways to manage self-care after massage sessions. “I will suggest rolling, stretching, and sometimes strength training as part of a client’s self-care routine,” she says.
Massage Therapy Journal
Self-Massage for Knee Pain
1. Hasanpour-Dehkordi A, Kabiri F, Dris F. “Comparing the Effects of Massage Therapy and Aromatherapy on Knee Pain, Morning Stiffness, Daily Life Function, and Quality of Life in Patients with Knee Osteoarthritis.” Complement Med Res. 2021;28(4):292–299.
2. Wu Q, Zhao J, Guo W. “Efficacy of massage therapy in improving outcomes in knee osteoarthritis: A systematic review and meta-analysis.” Complement Ther Clin Pract. 2022 Feb;46:101522.
3. Oshvandi K, Mirzajani Letomi F, Soltanian AR, Shamsizadeh M. “The effects of foot massage on hemodialysis patients’ sleep quality and restless leg syndrome: a comparison of lavender and sweet orange essential oil topical application.” J Complement Integr Med. 2021 Apr 12;18(4):843–850.
4. Döner A, Taşcı S. "Effect of massage therapy with lavender oil on severity of restless legs syndrome and quality of life in hemodialysis patients." J Nurs Scholarsh. 2022 May;54(3):304–314.
5. Kesik G, Altinok Ersoy N. “The effect of nonpharmacologic interventions for muscle cramps and restless-leg syndrome in hemodialysis patients: A meta-analysis of randomized controlled trials.” Ther Apher Dial. 2023 Aug;27(4):636–654.
6. Ren N, Yang G, Ren X, Li L. “Effects of foot massage on relieving pain, anxiety and improving quality of life of patients undergone a cervical spine surgery.” Health Qual Life Outcomes. 2021 Jan 19;19(1):22.
7. Arslan G, Ceyhan Ö, Mollaoğlu M. “The influence of foot and back massage on blood pressure and sleep quality in females with essential hypertension: a randomized controlled study.” J Hum Hypertens. 2021 Jul;35(7):627-637.
8. Şanli Y, Güngör Satilmiş İ. “Effect of foot massage on labor pain in parturient women.” Altern Ther Health Med. 2023 Mar;29(2):82–88.
9. Yoshimura A, Sekine Y, Furusho A, Yamazaki K, Hirose N. “The effects of calf muscle self-massage on ankle joint range of motion and tendon-muscle morphology.” J Bodyw Mov Ther. 2022 Oct;32:196–200.
10. Espí-López GV, Ruescas-Nicolau MA, Castellet-García M, Suso-Martí L, Cuenca-Martínez F, Marques-Sule E. “Effectiveness of Foam Rolling vs. Manual Therapy in Postexercise Recovery Interventions for Athletes: A Randomized Controlled Trial.” J Strength Cond Res. 2023 Jun 1;37(6).