Paul Manley Clinic London Massage Research

Pre-term neonates

Field, T., Diego, M., Hernandez-Reif, M., Dieter, J., Kumar, A., Schanberg, S. & Kuhn, C. (2008). Insulin and insulin-like growth factor-1 increased in preterm neonates following massage therapy. Journal of Developmental and Behavioral Pediatricts, 29, 463-466.

METHODS: Forty-two preterm neonates who averaged 34.6 weeks (M = 29.5 wk gestational age; M birth weight = 1237 g) and were in the "grower" (step-down) nursery were randomly assigned to a massage therapy group (body stroking and passive limb movements for three, 15-minute periods per day for 5 days) or a control group that received the standard nursery care without massage therapy. On Days 1 and 5, the serum collected by clinical heelsticks was also assayed for insulin and IGF-1, and weight gain and kilocalories consumed were recorded daily.

RESULTS: Despite similar formula intake, the massaged preterm neonates showed greater increases during the 5-day period in (1) weight gain; (2) serum levels of insulin; and (3) IGF-1. Increased weight gain was significantly correlated with insulin and IGF-1.Preterm infants who received massage therapy not only showed greater weight gain but also a greater increase in serum insulin and IGF-1 levels, suggesting that massage therapy might be prescribed for all growing neonates.

Prostatic Massage

Tarhan, F., Orcun, A., Kucukercan, I., Camursoy, N. & Kuyumcuoglu, U. (2005). Effect of prostatic massage on serum complexed prostate-specific antigen levels. Urology, 66, 1234-1238.

METHODS: Blood samples were obtained from each patient before and 30 minutes after prostatic massage.

RESULTS: After prostatic massage, the tPSA and fPSA levels and fPSA/tPSA ratio increased significantly, and the increase in cPSA was minimal but statistically significant.

Pulmonary Disease

Wu, H.S., Wu, S.C., Lin, J.G., & Lin, L.C. (2004). Effectiveness of acupressure in improving dyspnoea in chronic obstructive pulmonary disease. Journal of Advanced Nursing, 45, 252-259.

METHODS: Patients with chronic obstructive pulmonary disease (COPD) suffer from dyspnoea in their daily life and this may be increased by anxiety. 44 patients were randomly assigned either to a true acupoint acupressure or a sham group. The true acupoint acupressure group received a program to decrease dyspnoea. Those in the sham group received acupressure using sham pressure points. Both acupressure programs consisted of five sessions per week lasting 16 minutes per session, extending over 4 weeks for a total of 20 sessions. Before acupressure was initiated and at the conclusion of the 20th session, the Pulmonary Functional Status and Dyspnoea Questionnaire-modified scale and the Spielberger State Anxiety scale were administered, and a 6-minute walking distance test was performed. Physiological indicators of oxygen saturation and respiratory rate were measured before and after every session.

RESULTS: Pulmonary function and dyspnoea scores, 6-minute walking distance measurements, state anxiety scale scores, and physiological indicators of the true acupoint acupressure group improved significantly compared with those of the sham group.

Renal Disease

Tsay, S.L., Rong, J.R., & Lin, P.F. (2003). Acupoints massage in improving the quality of sleep and quality of life in patients with end-stage renal disease. Journal of Advanced Nursing, 42, 134-142.

METHODS: Sleep disturbance is common in patients with end-stage renal disease. The purpose of the present study was to test the effectiveness of acupoints massage for patients with end-stage renal disease and experiencing sleep disturbances and diminished quality of life. A total of 98 end-stage renal disease patients with sleep disturbances were randomly assigned to an acupressure group, a sham acupressure group, and a control group. Acupressure and sham acupressure group patients received acupoints or no acupoints massage three times a week during haemodialysis treatment for a total of 4 weeks. The measures included the Pittsburgh Sleep Quality Index, Sleep Log, and the Medical Outcome Study - Short Form 36.

RESULTS: There were significant differences between the acupressure group and the control group in Pittsburgh Sleep Quality Index subscale scores of subjective sleep quality, sleep duration, habitual sleep efficiency, sleep sufficiency, and global Pittsburgh Sleep Quality Index scores. Sleep log data revealed that the acupressure group significantly decreased wake time and experienced an improved quality of sleep at night over the control group. Medical Outcome Study - Short Form 36 data also documented that acupressure group patients experienced significantly improved quality of life.


Field, T. (1998). Massage therapy effects. American Psychological Association, 53, 1270-1281.

REVIEW: Massage therapy is older than recorded time, and rubbing was the primary form of medicine until the pharmaceutical revolution of the 1940's. Popularized again as part of the alternative medicine movement, massage therapy has recently received empirical support for facilitating growth, reducing pain, increasing alertness, diminishing depression, and enhancing immune function. In this article studies are reviewed that document these effects, and models are proposed for potential underlying mechanisms.

Field, T. (2002). Massage therapy. Medical Clinics of North America, 86, 163-171.

REVIEW: The author and other investigators have documented improvement in several medical and psychiatric conditions after massage therapy, including growth in preterm infants, depression and addictive problems, pain syndromes, and immune and autoimmune conditions. Although some potential underlying mechanisms have been explored for the massage therapy-improved clinical condition relationship, including decreased stress (and decreased cortisol), improved sleep patterns, and enhanced immune function, further research is needed in this area.

Field, T., Diego, M., & Hernandez-Reif, M. (2007). Massage Therapy Research. Developmental Review, 27, 75-89.
Massage therapy has been notably effective in preventing prematurity, enhancing growth of infants, increasing attentiveness, decreasing depression and aggression, alleviating motor problems, reducing pain, and enhancing immune function. This review covers massage therapy research from the last decade, as an update to the American Psychologist 1998 review paper. Models are presented for potential biochemical and physiological mechanisms underlying the massage therapy effects.

Field, T., Diego, M., & Hernandez-Reif, M. (2010).Preterm infant massage therapy research: a review. Infant Behavior and Development, 33, 115-124.

In this paper, preterm infant massage therapy studies are reviewed. Massage therapy has led to weight gain in preterm infants when moderate pressure massage was provided. In studies on passive movement of the limbs, preterm infants also gained significantly more weight, and their bone density also increased. Research on ways of delivering the massage is also explored including using mothers versus therapists and the added effects of using oils. The use of mothers as therapists was effective in at least one study. The use of oils including coconut oil and safflower oil enhanced the average weight gain, and the transcutaneous absorption of oil also increased triglycerides. In addition, the use of synthetic oil increased vagal activity, which may indirectly contribute to weight gain. The weight gain was associated with shorter hospital stays and, thereby, significant hospital cost savings. Despite these benefits, preterm infant massage is only practiced in 38% of neonatal intensive care units. This may relate to the underlying mechanisms not being well understood. The increases noted in vagal activity, gastric motility, insulin and IGF-1 levels following moderate pressure massage are potential underlying mechanisms. However, those variables combined do not explain all of the variance in weight gain, highlighting the need for additional mechanism studies.

Field, T., Diego, M., & Hernandez-Reif, M. (2010). Moderate pressure is essential for massage therapy effects. International Journal of Neuroscience, 120, 381-385. Moderate pressure appears to be necessary for massage therapy effects. Studies comparing moderate and light pressure massage are reviewed and they suggest that growth and development are enhanced in infants and stress is reduced in adults, but only by moderate pressure massage. The stimulation of pressure receptors leads to increased vagal activity which, in turn, seems to mediate the diverse benefits noted for massage therapy.


Shin, T.M., & Bordeaux, J.S. (2012). The role of massage in scar management: a literature review. Dermatologic Surgery, 38, 414-423.

METHODS: PubMed was searched using the following key words: “massage” in combination with “scar”. Information on study type, scar type, number of patients, scar location, time to onset of massage therapy, treatment protocol, treatment duration, outcomes measured, and response to treatment was tabulated.

RESULTS: Overall, 65 patients (45.7%) experienced clinical improvement based on Patient Observer Scar Assessment Scale score, Vancouver Scar Scale score, range of motion, prurities, pain, mood, depression, or anxiety. Of 30 surgical scars treated with massage, 27 (90%) had improved appearance or Patient Observer Scar Assessment Scale score. Efficacy appear to be greater in postsurgical scars than traumatic or postburn scars.

Sexual Abuse

Field, T., Hernandez-Reif, M., Hart, S., Quintino, O., Drose, L., Field, T., Kuhn, C., & Schanberg, S. (1997). Sexual abuse effects are lessened by massage therapy. Journal of Bodywork and Movement Therapies, 1, 65-69.

METHODS: Women (mean age = 35 years) who had experienced sexual abuse, were given a 30-minute massage twice a week for 1 month. RESULT: Immediately after the massage the women reported being less depressed and less anxious and their salivary cortisol levels decreased following the session. Over the 1-month treatment period the massage therapy group experienced a decrease in depression and in life event stress. Although the relaxation therapy control group also reported a decrease in anxiety and depression, their stress hormones did not change, and they reported an increasingly negative attitude toward touch.


Field, T., Kilmer, T., Hernandez-Reif, M. & Burman, I. (1996). Preschool Children's Sleep and Wake Behavior: Effects of Massage Therapy. Early Child Development and Care, 120, 39-44.

METHODS: Preschool children received 20-minute massages twice a week for five weeks.

RESULTS: The massaged children as compared to the children in the wait-list control group had better behavior ratings on state, vocalization, activity and cooperation after the massage sessions on the first and last days of the study. Their behavior was also rated more optimally by their teachers by the end of the study. Also, at the end of the 5 week period parents of the massaged children rated their children as having less touch aversion and being more extraverted. Finally, the massaged children had a shorter latency to naptime sleep by the end of the study.

Richards, K.C. (1998). Effect of a back massage and relaxation intervention on sleep in critically ill patients. American Journal of Critical Care, 7, 288-299.

METHODS: Critically ill patients are deprived of sleep and its potential healing qualities, although many receive medications to promote sleep. No one has adequately evaluated holistic nonpharmacological techniques designed to promote sleep in critical care practice. This study determined the effects of (1) a back massage and (2) combined muscle relaxation, mental imagery, and a music audiotape on the sleep of older men with a cardiovascular illness who were hospitalized in a critical care unit. Sixty-nine subjects were randomly assigned to a 6-minute back massage (n=24); a teaching session on relaxation and a 7.5 minute audiotape at bedtime consisting of muscle relaxation, mental imagery, and relaxing background music (n=28); or the usual nursing care (controls, n=17). Polysomnography was used to measure 1 night of sleep for each patient and the sleep efficiency index was the primary variable of interest.

RESULTS: The analyses showed improved quality of sleep in the back-massage group.


Hernandez-Reif, M., Field, T., & Hart, S. (1999). Smoking cravings are reduced by self-massage. Preventive Medicine, 28, 28-32.

METHODS: Attempts at smoking cessation have been correlated with severe withdrawal symptoms, including intense cigarette cravings, anxiety, and depressed mood. Massage therapy has been shown to reduce anxiety and stress hormones and improve mood. Twenty smokers were randomly assigned to a self-massage treatment or a control group. The treatment group was taught to conduct a hand or ear self-massage during three cravings a day for 1 month.

RESULTS: Self-reports revealed lower anxiety scores, improved mood, and fewer withdrawal symptoms. In addition, the self-massage group smoked fewer cigarettes per day by the last week of the study. These findings suggest that self-massage may be an effective adjunct treatment for attempting smoking cessation, to alleviate smoking-related anxiety, reduce cravings and withdrawal symptoms, improve mood, and reduce the number of cigarettes smoked.

Spinal Cord Injuries

Diego, M.A., Field, T., Hernandez-Reif, M., Hart, S., Brucker, B., Field, Tory, Burman, I. (2002). Spinal cord patients benefit from massage therapy. International Journal of Neuroscience, 112, 133-142.

METHODS: The study assessed the effects of massage therapy on depression, functionality and upper body muscle strength and range of motion on spinal cord injury patients. Twenty spinal cord injury individuals recruited from a medical school outpatient clinic were randomly assigned to a massage therapy or a control group. Patients in the massage therapy group received two-40-minute massage therapy sessions per week for five weeks. Patients in the control group practiced a range of motion exercise routine targeting the arms, neck, shoulders and back two times per week for five weeks.

RESULTS: Although both the massage and exercise group appeared to benefit from treatment, only the massage group showed lower anxiety and depression scores and significantly increased their muscle strength and wrist range of motion.


Field, T. & Diego, M. (2008). Cortisol: The Culprit Prenatal Stress Variable. International Journal of Neuroscience, 118, 1181-1205.

Elevated prenatal cortisol has been associated with several negative conditions including aborted fetuses, excessive fetal activity, delayed fetal growth and development, prematurity and low birthweight, attention and temperament problems in infancy, externalizing problems in childhood, and psychopathology and chronic illness in adulthood. Given that maternal prenatal cortisol crosses the placenta and influences other aspects of the prenatal environment, these effects on the fetus and later development are not surprising. Cortisol would appear to be a mediating variable, resulting from prenatal stress in several forms including depression, anxiety, anger, and daily hassles. Cortisol effects are further complicated by its interaction with neurotransmitters such as norepinephrine, which may itself cause premature birth via intrauterine growth deprivation related to uterine artery resistance. Recent research has suggested that cortisol-reducing therapies such as massage therapy can reduce the risk of perinatal complications including prematurity and low birthweight.

Harris, M. & Richards, K.C. (2010). The physiological and psychological effects of slow-stroke back massage and hand massage on relaxation in older people. Journal of Clinical Nursing, 19, 917-926.

REVIEW: Slow-stroke back massage and hand massage resulted in physiological or psychological relaxation. The most common protocols were three-minute slow-stroke back massage and 10-minute hand massage.

Osaka, I., Kurihara, Y., Tanaka, K., Nishizaki, H., Aoki, S., Adachi, I. (2009). Endocrinological evaluations of brief hand massages in palliative care. Journal of Alternative and Complementar Medicine, 15, 981-985.

METHODS: Inpatients received a 5-minute hand massage.

RESULTS: According to salivary chromogranin A levels, the massage reduced stress levels.


Mok, E., & Woo, C.P. (2004). The effects of slow-stroke back massage on anxiety and shoulder pain in elderly stroke patients. Complementary Therapies of Nursing Midwifery, 10, 209-216.

METHODS: This study explored the effect of slow-stroke back massages on anxiety and shoulder pain in hospitalized elderly patients with stroke. The scores were compared for self-reported pain, anxiety, blood pressure, heart rate and pain of two groups of patients before and immediately after, and three days after the intervention. The intervention consisted of ten minutes of slow-stroke back massage (SSBM) for seven consecutive evenings. One hundred and two patients participated in the entire study and were randomly assigned to a massage group or a control group.

RESULTS: The results revealed that the massage intervention significantly reduced the patients' levels of pain perception and anxiety. In addition to the subjective measures, all physiological measures (systolic and diastolic blood pressure and heart rate) changed positively, indicating relaxation. The prolonged effect of SSBM was also evident, as reflected by the maintenance of the psycho-physiological parameters three days after the massage. The patients' perceptions of SSBM, determined from a questionnaire, revealed positive support for SSBM for elderly stroke patients.

Substance P

Morhenn, V.B. (2000). Firm stroking of human skin leads to vasodilatation possibly due to the release of substance P. Journal of Dermatological Science, 22, 138-44.

METHODS: Eight individuals were given a face massage and skin temperature was measured.

RESULTS: In seven of eight humans tested, an elevation in the skin's temperature was documented after massaging of the cheeks of the face. The elevation of the skin's temperature reached a plateau after about 40 min of massaging and was correlated with visible erythema. This effect could be inhibited by repeated pretreatment of the skin with topical capsaicin, a chemical that results in the release of substance P from peripheral nerve endings. Thus, it appears that the temperature elevation induced by stroking of human skin is controlled, at least in part, by release of the neurotransmitter substance P.


Kim, M.S., Cho, K.S., Woo, H., & Kim, J.H. (2001). Effects of hand massage on anxiety in cataract surgery using local anesthesia. Journal of Cataract & Refractive Surgery, 27, 884-890.

METHODS: This study comprised 59 patients having cataract surgery. The patients were divided into those having a hand massage 5 minutes before surgery and those not receiving a hand massage. Patients' anxiety levels were measured using the Visual Analog Scale and by assessing systolic blood pressure, diastolic blood pressure, and pulse rate before and after the hand massage and 5 minutes before the end of surgery. Epinephrine, norepinephrine, cortisol, blood sugar levels, neutrophil, and lymphocyte percentages in white blood cells were also measured.

RESULTS: After the hand massage, the psychological anxiety levels, systolic and diastolic blood pressures, and pulse rate were significantly lower than before the massage. The hand massage significantly decreased epinephrine and norepinephrine levels in the experimental group while epinephrine, norepinephrine, and cortisol levels increased in the control group.

Antoniv, V.R. (2002). Effect of neck massage therapy on the soft tissues after thyroid surgery. Likarska Sprava, 93-96.

METHODS: The objectives of this study were to establish validated methods of massage of the neck, to determine its action on the neck structures, and to conduct a comparative evaluation of results of the control and study groups after performing massage.

RESULTS: In 85% of patients the skin became healthy pink and the cutaneous-and-muscle tone were improved, making the skin smooth and elastic following the massage. Over the first ten days of the massages 48% of subjects demonstrated resolution of the edema and swelling.


Smith, M.C., Reeder, F., Daniel, L., Baramee, J., & Hagman, J. (2003). Outcomes of touch therapies during bone marrow transplant. Alternative Therapies, 9, 40-49.

METHODS: This study investigated the effects of Therapeutic Touch and massage therapy on the outcomes of engraftment time, complications, and perceived benefits of therapy during bone marrow transplant. Subjects were adult patients on the bone marrow transplant unit of a large urban tertiary care center. Subjects were randomly assigned to 1 of 3 treatment groups: Therapeutic Touch, massage therapy, and a control group called the friendly visit. Subjects (N=88) were stratified by type of transplant (allogeneic or autologous). Twenty-seven subjects received massage therapy; 31 received therapeutic touch; and 30 received a friendly visit. Nurses with expertise in the 2 touch therapies administered them. The interventions of massage therapy, therapeutic touch, and friendly visit were administered according to standardized protocols every third day beginning the day chemotherapy began until discharge from the program. Time for engraftment, complications, and patient perceptions of benefits of therapy were the main outcome measures.

RESULTS: A signficantly lower score for central nervous system or neurological complications was noted for subjects who received massage therapy compared with the control group; however, no differences were found among the 3 groups with respect to the other 10 complication categories or in the total mean score for complications. Patients' perception of the benefits of therapy (total score) was significantly higher for those who received massage therapy compared with the friendly visit control group.

Vagus nerve Activity

Hatayama, T., Kitamura, S., Tamura, C., Nagano, M., & Ohnuki, K. (2008). Facial massage reduced anxiety and negative mood status, and increased sympathetic nervous activity. Biomedical Research, 29, 317-320.

METHODS: Healthy women received 45 minutes of facial massage.

RESULTS: Anxiety and negative mood decreased and the low- to high-frequency ratio in heartrate was higher after the massage.

Voice Disorders

Ternstrom, S., Andersson, M., & Bergman, U. (2000). An effect of body massage on voice loudness and phonation frequency in reading. Logopedics, Phoniatrics, Vocology, 25, 146-150.

METHODS: The effect of massage on voice fundamental frequency and sound pressure level was investigated. Subjects were recorded while reading a 3-min passage 4of prose text. Then, a 30-min session of massage was administered. Sixteen subjects were given the massage, while 15 controls rested, lying in silence for the same amount of time. The subjects were then recorded reading the same passage again.

RESULTS: In the post-massage recordings, subjects had lowered their fundamental frequency and sound pressure level.