The Role of Massage Therapy in Rehabilitation

 November 1, 2023

When thinking about the general benefits of massage therapy—such as reduced muscle tension, improved circulation and relaxation—understanding how massage can be an integral component of a client’s rehabilitation process isn’t difficult.

“When you incorporate massage in recovery or rehabilitation, we are retraining and reengaging muscle memory, as well as the neurological pathways, to help the body heal properly from injury, surgery or trauma,” says Ashia Walker, owner and massage therapist at Reformation Massage & Bodywork.

More recently, massage therapy that is focused on rehabilitative outcomes has expanded from largely athletes and surgical patients—although these clients are still the majority—to include stroke patients, preterm infants and clients who have been paralyzed due to traumatic injury.

Many recent studies provide some evidence that suggests adding massage therapy to an individual’s rehabilitation plan can help improve outcomes. “The body is one machine with many different parts,” Walker says. “When a machine breaks down you need different tools to repair it. The approach for rehabilitation should be thought of in the same way. If everyone collaborates together, each specialist plays a part in the client’s total recovery.”

Massage for Athletics and Recovery

One of the most common ways massage therapy is used to help with rehabilitation is sports massage. Typically, sports massage targets specific muscles or groups of muscles and is meant to help athletes recover from exertion, prevent injury and increase flexibility.

A 2022 study¹ explored the effects of massage and cold-water immersion after an exhaustive run on running economy and biomechanics. During the study, participants randomly received either massage, cold-water immersion, or passive rest (control) after performing an exhaustive interval running protocol and incremental treadmill test at 12-, 14- and 16-km per hour. The runners repeated the treadmill test 48 hours later.

The study found the massage group had significantly better recovery than the control group at 14-km per hour, as well as greater stride height and angle changes at 16-km per hour than the cold-water immersion group. These results suggest massage therapy may provide for faster recovery of running economics and running biometrics than either cold-water immersion or passive rest.

“I have worked with countless clients who have sought me out as a last resort when dealing with aches and pains, chronic issues resulting from injuries and postoperative limitations,” says Cindy Bradsfield, LMT, owner of Mamassage Medical & Spa Massage Therapy. “Although I strongly feel every health care professional has a place in this world when dealing with client care, oftentimes I have witnessed clients being directed to professions that do very little for them because they are treating the symptoms as opposed to the catalyst of many of their issues and concerns.”

Dealing with the root cause versus just relieving symptoms is a cornerstone of the potential benefits of massage therapy.

After a thorough intake to discuss problem areas, Bradsfield begins the massage sessions through the sheet with compressions to help warm the tissues and achieve hands-on feedback through palpation. Range of motion, as well as functional and strength issues, are then assessed.

“Next, I undrape the area to be addressed and, if warranted, begin with myofascial work. Otherwise I use Swedish techniques to warm up the tissues,” she explains. “I utilize forearm and elbow work, pin and stretch techniques, trigger point therapy, range of motion exercises, contract/relax exercises, and assisted and passive stretching.” She then finishes the session with light tapotement and lymphatic techniques.

Related: Sports Massage 1: Starting Your Career

Throughout her 25-year career, Bradsfield notes the most common injuries and conditions she has seen are meniscus tears in the knees and rotator cuff tears and injuries in the shoulders. Other common injuries include ruptured biceps, hamstrings and Achilles tendons at the muscle attachment site. “With a combination of my work in collaboration with doctors, physical therapists and trainers, I have been successful in helping clients avoid surgeries,” Bradsfield says.

Even with clients who have needed surgery, Bradsfield can help further recovery. In 2022, for example, she worked with a client after their ruptured Achilles tendon had been surgically repaired but they felt like their recovery had plateaued. “They wanted to be healthy enough to run a marathon in November,” she recalls.

“Our sessions consisted of two-a-week visits for the first two weeks. They immediately felt the results after our first visit, however, they had a ways to go,” Bradsfield remembers. “I incorporated myofascial work early on as it was very clear that there were adhesions that needed more than just trigger point work. We incorporated assisted stretching as well as contract/relax exercises to increase flexibility. Range of motion exercises were performed assisted and unassisted. We also incorporated deep transverse friction at the external scar sites, which aided in some slight visible reduction of scaring but greatly reduced the presence and texture of internal scarring. I was able to take a client who could barely walk and was unable to apply much pressure on their foot while walking to a successful completion of a marathon in about eight months.”

Massage for Stroke Patient Rehabilitation

Massage therapy is also being more rigorously investigated as a beneficial addition to rehabilitation protocols for patients recovering from stroke. One study² evaluating the effectiveness and safety of acupuncture and massage combined with rehabilitation in the treatment of hemiplegia after a stroke suggests that acupuncture and massage in combination with modern rehabilitation techniques may greatly shorten the clinical treatment cycle and improve therapeutic effect, though researchers noted more evidence was needed.

Another study³ looked at the effectiveness of massage therapy for improving secondary affects in post-stroke survivors. Researchers found evidence to suggest that therapeutic Chinese massage (Tuina), in addition to conventional physiotherapy, is an effective noninvasive treatment for improving upper/lower limbs motor function and for reducing spasticity.

“A stroke affected individual is not cookie-cutter,” says Heather Dalton LMT, CLT, CPT, RM, which for her means the importance of the initial intake cannot be overstated. Dalton makes sure to ask questions that help her understand past and current medical conditions, as well as what the client is hoping massage therapy will help achieve.

A few of the questions she asks include:

• How long has it been since your last stroke?
• Do you have a single stroke or multiple stroke history?
• Are comorbidities present?
• What are you motivated to accomplish through massage therapy?
• What are you willing to do for yourself to help between sessions?

“For stroke patients, massage is helpful in keeping the body ‘interested’ with pleasant stimulation (such as Swedish massage),” says Dalton. “Massage can also aid the circulatory and muscle system by stretching and pulsing.” Dalton notes stretching should not be athletic stretching, but something more akin to simulating the ankle motion of walking.

“Something I cannot stress enough is a stroke client must feel empowered during the session,” Dalton adds.

Massage for Preterm Infants

Massage therapy continues to show promise with preterm (< 32 weeks gestation) infants, though always needs to be performed with parental consent. A study⁴ investigating the effect of tactile/kinesthetic massage therapy on the growth and body composition of preterm infants suggests massage has benefits for weight gain.

In the study, preterm infants were randomly assigned at corrected gestational age of 35 weeks to receive three consecutive 15-minute massage sessions over five days. Massage therapy was associated with significant increase in daily weight gain (19.3 vs 6.2 g/day) and growth velocity (12.5 versus 3.6 g/kg/d) compared with routine care.

Additionally, infants receiving massage therapy showed significant increase in total body mass, fat mass, lean mass and bone mineral density values compared with the routine care group.

“Neonatal massage can have many benefits,” says Marie-Josee Berard, LMT and owner of Baby Wellness Massage. “It can help maximize sleep, increase weight gain, reduce bilirubin levels, provide comfort and improve neurodevelopmental outcomes.”

Berard notes that, in her experience, premature babies can experience a form of post-traumatic stress after being in the neonatal intensive care unit, and massage may also help to reduce that stress, improve the autonomic nervous system, and support the positive long-term development of preterm infants.

Additionally, massage can help to enhance caregivers’ observation skills of neonates, increase their knowledge of infant development, and increase their understanding of the evidence-based effects of touch, according to Berard.

Related: Slow-stroke back massage for new mothers

For Berard, the first meeting with a new infant is crucial because it is the first chance to start gathering information so she can customize her approach. “First, I perform a visual assessment to see if the baby is fussy, crying, has any bruises or is moving their head from side to side,” she explains. “Then, I conduct a physical assessment, checking muscle tone and range of motion, including neck, shoulder and hip movements. I take all of this information into consideration when creating a massage plan.”

Berard also does a skin test using grapeseed oil on the infant’s wrist to make sure there are no signs of an allergic reaction. A heating blanket is placed on the massage table to make sure the baby stays warm, and the massage room temperature is maintained around 78 to 80 degrees F.

“I start newborn massage with eye contact. I put a small amount of oil on my hands and rub them together, making a swishing sound, and then always ask baby for permission,” Berard explains. “One  of the easiest ways from there to start the massage is to work on foot reflexology.”

For instance, if a baby is fussy and has a lot of gas, I would work on large intestine reflex points on the feet, she adds. Depending on what issues the baby is having, I would use other proper modalities. At the end of the massage, I always tell the baby I’m working with that massage time is over.

Berard began working with one premature infant when he was 12 days old. The infant’s mother wanted to help the baby alleviate his nose congestion and constipation.

She used myofascial release to alleviate the baby’s digestive and elimination issues and manual lymphatic drainage on the upper body for the nose congestion. “After the massage, his mother was so excited because it was the first time she had seen the child so relaxed,” Berard says. “His nose congestion was gone, he passed stool at the end of the session, and he slept longer than usual.”

As research continues to shine a light on all the ways massage therapy can be beneficial, especially when incorporated into an integrative approach to health and well-being, more people are discovering its benefits. Massage has been used for years to help athletes recover faster, and now those benefits are reaching others, too.

References

1. Duñabeitia I, Arrieta H, Rodriguez-Larrad A, Gil J, Esain I, Gil SM, Irazusta J, Bidaurrazaga-Letona I. “Effects of massage and cold water immersion after an exhaustive run on running economy and biomechanics: A randomized controlled trial.” J Strength Cond Res. 2022 Jan 1;36(1):149-155.

2. Liu C, Pang T, Yao J, Li J, Lei S, Zhang J, Wang Y, Bian J. “Acupuncture and massage combined with rehabilitation therapy for hemiplegia after stroke: A protocol for systematic review and meta-analysis.” Medicine (Baltimore). 2022 Feb 11;101(6).

3. Cabanas-Valdés R, Calvo-Sanz J, Serra-Llobet P, Alcoba-Kait J, González-Rueda V, Rodríguez-Rubio PR. “The effectiveness of massage therapy for improving sequelae in post-stroke survivors: A systematic review and meta-analysis.” Int J Environ Res Public Health. 2021 Apr 21;18(9):4424.

4. Elmoneim MA, Mohamed HA, Awad A, El-Hawary A, Salem N, El Helaly R, Nasef N, Abdel-Hady H. “Effect of tactile/kinesthetic massage therapy on growth and body composition of preterm infants.” Eur J Pediatr. 2021 Jan;180(1):207-215.