Below, you will find common claims that persist in the profession, as well as how to talk to clients about the evidence-based benefits on which they should focus.
Claim: Massage elevates endorphins.
What this claim means: As neurotransmitters, endorphins function to transmit electrical signals within the nervous system. Today, we know humans have at least 20 different kinds of endorphins, found in the pituitary gland, brain and throughout the nervous system. These brain chemicals are most commonly released to help people manage stress, fear and pain. Interacting with the opiate receptors in the brain, endorphins help reduce our perception of pain, similar to how morphine and codeine work. They are also known to create feelings of euphoria and well-being, which is likely why they’re also associated with helping to mitigate stress.
Why this claim is problematic: Much of the problem, according to Tracy Walton, a massage therapist and educator, is that the claim that massage therapy elevates endorphins is often advanced on the findings of two small studies—one of which was a randomized-controlled trial where results were inconclusive and the other a study that found moderate elevation in beta-endorphins after massage therapy, but which had no control group for comparison and a very small sample size of 12 study participants. Additionally, there’s a difference between the claim “Massage therapy elevates endorphins” and how this claim is commonly talked about to clients—“Massage therapy increases feelings of well-being and reduces pain.” The first is a mechanistic outcome that focuses on explaining the how of massage therapy. The second describes a clinical outcome, or whether or not massage helps or works.
Clarifying the claim: You don’t have to completely dismiss the idea that massage can positively affect well-being and reduce pain, but if asked specifically about how massage therapy affects endorphins, Walton suggests being honest about what is known. You might say: “There is very little research on whether massage therapy has an effect on endorphins, and the research that exists does not settle this question.”
Claim: Massage increases blood circulation.
What this claim means: As a function of the cardiovascular system, blood circulation supplies blood to every tissue in the body. There are two main types of circulation: pulmonary, which moves blood between the heart and the lungs, and systemic, which moves blood between the heart and the rest of the body.
Why this claim is problematic: Simply put, the claim that massage increases blood circulation is ambiguous. Walton says that this is because there are too many unanswered questions to this statement, which adds multiple layers to the subject of massage and blood circulation: Where is blood circulation increasing? How deep is the circulation? Which system are we referring to? How long does the increased blood flow last? On top of this, the handful of existing randomized controlled trials on massage and circulation show a wide variation in results, which ties in with the subject of massage and circulation having multiple layers.
Clarifying the claim: If a client asks you about massage and its relation to blood circulation, you might offer something that conveys that we need to clarify what we are referring to when we talk about massage and circulation, like “Even though there are studies on massage and circulation, the results are inconclusive.”
Claim: Massage boosts immunity.
What this claim means: The immune system, which is made up of cells, tissues and organs, is commonly known as the body’s defense system. When functioning properly, our immune systems identify threats—such as viruses, bacteria and parasites— distinguishing them from the body’s own healthy tissue.
Why this claim is problematic: Much of the problem with claiming massage has a definitive effect on the immune system involves the complexity of the immune system. “The immune system is extremely complex, made up of many cell types, substances and functions,” Walton explains. “Research on immunity is hard work. With so many functions, the immune system could be affected by massage in a range of ways.”
On top of its complexity, the claim that massage therapy boosts immunity is currently supported by only two meta-analyses, according to Walton. The first meta-analysis reported that massage may boost immunity, while the second concluded that more research is needed. There are, however, a few smaller studies that showed massage therapy increased the number of white blood cells known as natural killer cells. These cells provide rapid responses to viral-infected cells. “A boost, if it actually happens, could occur in one or more functions, could be cancelled out by other factors or could actually be detrimental to the body,” Walton adds.
Clarifying the claim: It’s true that many massage clients report lowered stress and increased quality of life; however, Walton emphasizes that massage therapists need to be careful with their wording when talking to clients about how massage can benefit immunity. For instance, if clients ask specifically about how massage therapy may boost immunity, tell them more research is needed. Walton also cautions that massage therapists should be particularly careful when working with populations that may be hoping for an immune boost, like clients who have cancer, for example. These clients may be more vulnerable to casual claims about the benefits massage therapy may be able to provide.
Claim: Massage lowers cortisol.
What this claim means: Cortisol is a steroid hormone that is linked to the immune system and helps regulate body processes such as metabolism. Produced in the adrenal cortex in response to stress, cortisol levels that are consistently high impair functions in the body, such as the reproductive and immune systems. High cortisol levels can increase blood pressure as well as gastric acid production, which can be good in the short-term, but not so good in the long-term.
Why this claim is problematic: As with other claims, the idea that massage reduces cortisol is complicated by the fact that cortisol levels are but a single indicator of stress, making definitively linking massage with reducing stress to a reduction in cortisol, too, very difficult. Additionally, the existing studies on massage and cortisol had contradictory results—one meta-analysis found that massage does not reduce cortisol, while others conclude that massage could potentially affect cortisol levels.
Clarifying the claim: If asked about massage and cortisol, Walton says you might tell your clients that those who receive massage often report feeling less stress and an increased sense of well-being. Or be direct: “While we do have good research on massage reducing anxiety, the mechanisms behind these changes are unclear.”
Letting Go of Some Common Myths: Why Is It So Difficult?
Believe it's the truth. It can initially be difficult to let go of these common myths because we are invested in how they might appeal to our clients. “Many of the claims [we make] are benefits we want to believe,” Walton says. “They sound believable and appealing.”
Confusing massage-related outcomes. According to Walton, clinical outcomes are reported more than mechanistic outcomes, too, which can cause confusion. We focus too little on the how behind a massage, and by doing so, our claims become broad. Walton believes there is a reason why massage therapists leap toward clinical rather than mechanistic claims: “People want to feel better,” she admits. “They care less about how or why, and more about the result.”
Rely on one piece of evidence. A single research study, especially one with positive results, can make being critical of the findings more difficult. It might also be tempting to overstate the findings of the study. The difficulty with this, Walton says, is that one study will seldom, if ever, offer definitive proof. For stronger claims, you need a body of research that reaches the same conclusions. “A single study has inordinate power to guide our thinking, marketing and even the massage therapy brand,” she says. “Even a strong [study] does not prove anything conclusively. You need a body of research all pointing in the same direction.”
Setting the Myths Straight
Admit to the unknown. Sometimes it is better to admit to uncertainties to ensure that clients are not receiving any misleading information. According to Walton, while using the phrase “I don’t know” might seem counterintuitive, your clients will appreciate the truth. Massage therapists—as well as consumers—should be thinking critically about the claims made about massage therapy, and admitting to the unknown is often the first step in separating the facts from the myths. Remember, though, that even though we need to be honest about the research being inconclusive, we can still share what we know.
Conduct research. Another way that massage therapists can counter these myths is to both conduct research themselves and refer to more than one study when investigating some of the benefits massage therapy has to offer. Keep in mind, too, the level of evidence that’s examined by the research. Evidence can be weak or strong—or sometimes in between—so remember to think critically when assessing research results. Walton suggests starting with peer-reviewed journals.
Don't overstate the results. After delving into research, it is essential to report any results you find with clarity and accuracy. Your clients will take you more seriously the more honest you are. If you are unsure about how massage affects a certain symptom, convey that to your client. Walton emphasizes that responsibility plays a major role in eliminating myths in the massage therapy profession.