Do Physical Therapists Do Massage? (+ Benefits & Side-Effects)

Massage often provides immediate well-being, that’s clear. There’s no denying that. But many other things can also offer a similar sense of well-being: eating a pastry, receiving an affectionate letter or text, receiving sincere compliments, being caressed by someone you care about, and so on.

The question at hand is this: Is the primary role of physical therapists, funded by health insurance and supplementary health plans (in lot of countries), to improve people’s immediate well-being? If so, why should physical therapists use massage rather than other methods to enhance well-being?

My stance is as follows: Healthcare professionals, including physical therapists, have a mission to improve people’s health. Well-being is one of the determinants of health, among others.

We know that another major determinant of good health is the sense of autonomy. People need to feel autonomous, responsible for themselves and their happiness, to feel well in the long term.

Massage performed by healthcare professionals:

✅ Improves short-term well-being.

❌ Diminishes the sense of autonomy, and potentially long-term well-being, as it requires the presence of the professional. It can create dependency. The individuals receiving massages may feel that they need the massage to feel good, even though it objectively doesn’t alleviate their pain in the medium or long term.

👉 This is why, in my opinion, using massage to enhance long-term well-being is counterproductive, especially when delivered by a healthcare professional whose care is 60% funded by the community (like in France, my country).

Furthermore, when you spend time massaging someone, that’s time not spent on something else. When a person is being massaged, they are entirely passive. They do not move much or at all. This is less the case with other passive tools that do not require immobilization (e.g., TENS or CBD) or a third person (massage gun or other devices).

However, sedentary behavior, maintaining a fixed position, and lack of physical activity increase the risk of developing numerous chronic conditions. By practicing massage, we do little to encourage patients to be active.

This is my reasoned perspective. I am aware that some people may disagree with this argument or the conclusions it leads me to. Individuals with strong expectations regarding massage therapy from their physiotherapist may find more satisfaction working with another practitioner.

Indeed, it is important to start with patients’ expectations to maximize the chances of recovery. If there is a significant mismatch between a person’s expectations and what the professional they consult can offer, it is better to refrain from engaging in sessions.

In summary:

• Massage provides momentary relief and some aftereffects.
• It can make patients dependent on this treatment to feel good, even though it doesn’t alleviate their pain in the long term.
• It does not encourage people to be more active. However, sedentary behavior is one of the factors causing or exacerbating pain.

Clinical Studies on the Effectiveness of Massage by Physical Therapist

Until now, I have relied less on scientific literature to develop my argument on the usefulness of massage in physiotherapy. There are several hundred studies evaluating the effectiveness of massage on pain and other health parameters.

Let’s quickly review them. For this purpose, I searched for all publications that had ‘massage’ in their title and conducted a synthesis of studies assessing the effectiveness of massage. I used the largest medical study database, Medline (Pubmed).

Since there were too many studies (over 300) for me to review them all, I chose to focus on two health issues for which I am most frequently asked for massage:

1. Low back pain (lumbar back pain).
2. Leg pains and swellings.

Effectiveness of Massage for Back Pain

The Cochrane Collaboration is an international institution that writes summaries of scientific literature. These summaries are of very high quality and represent the best in the field: research teams of several people working for several years on each produced synthesis.

Good news: there is precisely a Cochrane review on the benefits of massage in cases of chronic back pain. Here is the conclusion of the review:

We have very little confidence that massage is an effective treatment for low back pain. Massage improves the outcome of acute, subacute, and chronic low back pain only in the short-term follow-up. Functional improvement was observed in participants with subacute and chronic low back pain when compared to inactive controls, but only in the short-term follow-up. There were only minor adverse effects with massage.

Cochrane Collaboration, 2015

What is meant by short term? In this review, it refers to the effects that occur during massage sessions and up to a maximum of 6 months after the sessions have ended. But most often, it refers to the effect over a few days or weeks.

Massage is also not suitable for lumbago (see Acute Low Back Pain: What to Do and Recovery Time of Back Sprain or Pain), where it does not even improve functional abilities in the short term.

Benefits of Massage and Manual Lymphatic Drainage for Leg Pain and Edema

Legs and feet are the second area of the body for which some people are very eager for massage. They often experience pain, numbness, and suffer from edema.

Massage could help relieve pain, while manual lymphatic drainage could reduce edema. But what is the reality?

👉 There are no studies evaluating the effectiveness of massage specifically for leg pain.

It is reasonable to assume that the effect of massage on the lower limbs is the same as the effect of massage on the back: leg pain decreases for a while but returns with the same intensity when sessions are discontinued for some time.

Furthermore, walking and daily activities are not facilitated by massage. The risk of falling is not reduced either.

And what about edema (= swelling)? No studies show any effect of massage in reducing edema.

Manual lymphatic drainage (MLD) does not even have proven therapeutic value for lymphatic edema, which is its primary indication. Most often, lymphedema occurs after breast cancer treatment. They have some short-term benefit only if:

• Administered for at least 30 minutes.
• Combined with the use of compression garments.
• Performed on people with mild to moderate edema, not severe edema.
• Administered regularly.

In the vast majority of cases, people with chronic leg pain do not have lymphedema. Therefore, there is no reason to believe that massage or lymphatic drainage would lead to a significant and lasting reduction over time.

It should be noted that even in people with real lymphedema, their quality of life does not seem to be improved by manual lymphatic drainage, although it does help reduce edema.

💡 The Revitive Medic, although often purchased with the aim of relieving leg edema and pain, is also not very effective in the medium or long term. However, I explain in this article what can be done for leg pain and swelling.

Manual lymphatic drainage is not effective in reducing swelling, not even for its primary indication, lymphedema, following breast cancer. Massage may temporarily relieve leg pain and swelling but does not enable people to be more active.

My doctor prescribed me physiotherapy sessions for massage

You most often consult your physiotherapist after obtaining a prescription for physiotherapy sessions from doctors or surgeons. Often, these medical professionals will specify physiotherapy techniques to be used.

However, please note that since February 2000 (more than 21 years ago at the time of writing), doctors no longer need to specify the techniques that can be used by physiotherapists in France.

In general, doctors will specify physiotherapy techniques systematically based on your condition. This prescription will not be personalized or individualized; all individuals with the same health issue will receive the same prescription. The real prescription examples below illustrate this situation.

When you consult a physiotherapist, an individualized assessment will be carried out. The goal is to define personalized treatment modalities based on this assessment, your expectations, and international physiotherapy recommendations.

Your doctor may not always have the time to stay informed about developments in physiotherapy treatment recommendations. Sometimes, they may automatically prescribe “massage” on the prescription without questioning whether massage is truly beneficial in your case.

This is what I explain to my patients who are surprised that I sometimes do not follow the package of techniques prescribed by the doctor on the prescription, especially the indication for massage:

1. Some of the techniques indicated on the prescription have never proven their effectiveness even though they have been tested on a large number of people.
2. Spending time delivering a technique that is not proven to be effective would detract from dedicating time to things that are known to be useful and effective.
3. Medical and surgical teams may not have the time to stay updated on new publications and recommendations in the field of physiotherapy.

Doctors may not be aware of the evolution of international studies and recommendations in physicl therapy. They may prescribe massage systematically even though it is now known to have little or no positive effect.

Regardless of the studies, massage by physical therapist works for me

Before any physiotherapy treatment, I of course discuss my patients’ expectations. I ask questions like:

• What can I do for you?
• How can I be of help?
• What do you have trouble doing today that you would like to be able to do again? When asking these questions, I expect people to answer with things like:
• I’d like to be able to drive again soon.
• I’d like to have less back pain in the morning when I wake up.
• I’d like to no longer be afraid of falling.
• I’d like to be able to walk down the stairs to go to a restaurant.
• I’d like to resume hiking.

Sometimes, people may not spontaneously think of specific goals to achieve. Instead, they might respond with:

• I’d like a good massage.
• I think massages would do me good.
• My previous physiotherapist used to massage my legs, and it helped me a lot.
• My mother needs 2 massage sessions a week.

I completely understand these people’s wishes, and they are right to express them to me. By understanding each other’s expectations, we are more likely to collaborate effectively. These wishes are understandable and even legitimate, as we are still called “masseur-physiotherapists” in France.

However, healthcare professionals are individuals in their own right. Morally and according to our code of ethics, we have the right to refuse or not initiate physiotherapy treatment at any time without having to justify ourselves. We simply need to refer the person to another physiotherapist who may potentially be able to help them.

For all the reasons stated in this article, I usually do not wish to perform massage, even for people for whom it is the only expectation and the only thing that could relieve them, according to them. Ultimately, it remains a personal and professional choice, even though it is based on factual elements.

Why do physiotherapists massage less?

First, we should verify if the phenomenon that many patients or physiotherapists describe is indeed a reality: did physiotherapists really massage more in the past?

I plan to look at empirical data on the subject in studies that evaluate which techniques are most commonly used by physiotherapists.

In the meantime, let’s consider this hypothesis: physiotherapists today massage less than before.

Here are the three most plausible explanations, in my opinion, for this change:

1. Today, we have a better understanding of the importance of movement and physical activity for physical and mental health, especially in managing chronic pain.
2. Physiotherapists today may earn less (in terms of inflation and the cost of living) than their counterparts from a few decades ago. This could lead them to prioritize treatments that empower patients to take more control of their own health.
3. Physiotherapists who perform massages may offer treatments outside of the standard healthcare reimbursement system to earn a higher income. A typical physiotherapy session in France is billed at around 16.13 euros gross for a theoretically 30-minute session with the patient. In contrast, a massage in a beauty salon is often billed at 50 euros for 30 minutes or even 150 euros per hour. Therefore, physiotherapists may prefer not to label their massage services as physiotherapy to receive better compensation.

To add a humorous touch to this delicate topic of massage, here’s how Playmobil represents the “physiotherapy office”! The patient is in motion!