The Best Types of Massage for Chronic Pain Relief

Massage is gaining in popularity as an alternative therapy for chronic pain, but there are many types of massage and not all are equally effective. Choosing the right type can make the difference between achieving a temporary relaxation effect and getting long lasting pain relief.

Therapeutic massage and bodywork include a wide variety of techniques that involve manipulation of soft tissue or subtle energy to alleviate pain or resolve structural imbalances so that health and well-being are improved.

Physical therapists, chiropractors, and other types of health care providers may incorporate massage as one of the treatment modalities used during a session. Massage is also used as a stand-alone treatment; in which case the massage is usually of longer duration and more intensive.

In 2023 there were over 321,000 massage therapists in the United States. Forty-seven states and the District of Columbia regulate massage therapists or provide voluntary state certification. In states that regulate massage therapy, massage therapists need have a minimum number of hours of training and pass an exam to practice. Be sure to seek out a licensed or certified massage therapist when seeking care.

A recent survey found that in 2022 over 53% of those visiting massage therapists were seeking pain relief.

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There are many different types of massage and bodywork. These can be classified into four types of approaches:

Gentle bodywork includes light application of touch, as in Swedish massage, craniosacral therapy, and lomi lomi massage. These techniques help the body relax and return to its natural state of balance. For treatment of pain, gentle bodywork techniques are best suited to patients in significant pain, at least initially, as they are less likely to aggravate the condition than forms of massage that use more pressure.
Structural bodywork includes Rolfing, Hellerwork, and other schools of structural integration. The goal of this bodywork is to change structure by creating a direct change in muscles, tendons, ligaments, and other soft tissues to restore structural balance and reduce strain. The pressure applied with these techniques can create short-term pain.
Deep tissue bodywork, which focuses on the alleviation of pain and discomfort, includes, in addition to deep tissue massage, neuromuscular therapy, Trager psychophysical integration, and myofascial release.
Movement therapy, or reeducation, includes the Feldenkrais method, the Alexander technique, and Rolf movement work. Movement therapy aims to alter the person’s habitual body usage to reduce muscle strain. Movement therapy also helps maintain the results of structural bodywork.

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Numerous studies have shown that massage is a safe and effective treatment for chronic pain.

Studies that have demonstrated long term pain relief from massage or other types of bodywork have involved 8-10 sessions by experienced massage therapists over a period of up to 10 weeks. Studies used different follow up periods with some demonstrating improvement lasting up to 10 months in measures including pain intensity and function and reduced medication usage. Conditions that were studied that showed improvements included chronic low back pain, chronic neck pain, osteoarthritis and fibromyalgia. Some studies have also noted improvements in anxiety and depression.

A 2016 meta-analysis published in the journal Pain Medicine concluded that massage effectively treats pain and improves mood and health-related quality of life.

Other more recent studies have also concluded that massage that involves deeper work, such as deep tissue massage, are much more effective for chronic pain relief than massage techniques like Swedish massage that promote relaxation.

More on Recommended Massage Techniques

Rolfing: My favorite type of bodywork is structural integration, which was developed by Ida Rolf, a biochemist, in the mid-20th century. Structural integration (SI) is also known as Rolfing. Many years ago I developed foot pain following foot surgery for a bone spur. The pain got worse and worse until it was agony to walk more than a block or so, stand or even put my foot on the floor while I was sitting in a chair. I endured this pain for 14 years, searching for solutions. Finally, I learned about Rolfing. After two sessions of Rolfing I felt like I had a new foot. Over the more than 20 years since, I have frequently sought out Rolfing for help with other pain that I have developed, each time with good results.

Rolfing involves bringing the body as a whole into balance, rather than treating specific symptoms. For Rolfers, the essential question may be not what’s wrong but where is it coming from and what’s feeding it. Rolfing reduces biomechanical strain by promoting an optimal relationship of the body in gravity, through releasing and balancing the muscles and fascia of the body, and helping the body find more support. Rolf also believed that Structural Integration would improve psychological well-being because unprocessed emotions are stored in the body’s musculature.

During a Rolfing session, the practitioner applies manual force to the soft tissue in a more gradual and prolonged way than is typical of chiropractic manipulation, and with more pressure than is usual for massage. Sometimes the client is asked to perform slow movements as the pressure is applied to release stuckness in the myofascial tissues. Treatment also includes postural and movement awareness exercises. Transient pain can occur during the treatment. There can also be short-lived increases in anxiety or other negative emotions that spontaneously resolve within hours or days. The latter typically results in lasting improvements in levels of anxiety and depression.

Rolf developed a series of 10 treatments that constitute the initial course of therapy. Each session focuses on specific biomechanical changes that contribute to the overall goal of freeing the body to find support in gravity. More advanced work is then possible.

Neuromuscular Therapy: Neuromuscular therapy (NMT), developed in England in the 1930s by Dr. Stanley Lief, uses static pressure to manipulate muscles, tendons, and connective tissue to balance the central nervous system and relieve pain. NMT addresses these five causes of pain:

Ischemia, a lack of blood supply to the soft tissue that causes hypersensitivity to touch
Trigger points, which are irritated points in the muscles that refer pain to other parts of the body
Nerve compression, or entrapment, as a result of bone, cartilage, or soft tissue creating pressure on a nerve
Postural imbalance
Biomechanical dysfunction, which results when an imbalance of the musculoskeletal system causes dysfunctional movement patterns

Neuromuscular therapy also promotes release of endorphins, the body’s natural opioids.

The neuromuscular therapist uses thumbs, fingers, and elbows to release tissues in layers, from superficial to deep. The origins of the muscle pain as well as muscle insertions and the belly of the muscle are treated. The therapist identifies the constrictions and trigger points by touch and then applies an appropriate amount of pressure to resolve the problem. Patients are encouraged to drink adequate amounts of water; supplement with multivitamins, B-12, and B-6; and do stretching exercises to further enhance the therapy.

Conclusion

Massage is a safe and effective alternative therapy for chronic pain relief. Unfortunately, most health insurance plans won’t cover it. However, if the pain is caused by a work-related injury or auto accident, Workers’ Compensation or auto insurance may cover the cost of massage therapy.