In my experience as a physiotherapist working with diverse client populations—including those with neurological conditions, chronic injuries, and athletic injuries—collaborating with Registered Massage Therapists (RMTs) has enhanced my clients’ outcomes across multiple domains.
While physiotherapy addresses movement, function, and rehabilitation through structured exercise, modalities, guidelines, equipment, and manual therapy, the massage therapy profession offers complementary mechanisms that can support pain relief, muscle recovery, and overall wellness.
At Propel Physiotherapy, I’m fortunate to work in a multidisciplinary setting. There is no better feeling than being able to ask a fellow clinician to team up with me to help a client achieve their goals. I’ve seen firsthand how my clients benefit from the skillset of a registered massage therapist on their rehabilitation team.
In this article, I outline six evidence-based reasons to consider referral to a massage therapist.
Table of Contents:
- Pain reduction
- Improve circulation
- Enhance muscle recovery and reduce muscle soreness
- Addressing muscle spasticity and stiffness in neurological conditions
- Decrease hypersensitivity to touch and persistent pain
- Address psychological and emotional stress
- Professional opinion
Six Reasons Physiotherapists Recommend to Massage Therapy
1. Pain Reduction
Massage therapy can help relieve pain by calming the nervous system and changing how the body processes pain signals. Research shows that massage may lower stress hormones, promote relaxation, and reduce long-term muscle and joint pain.
Clients who receive massage therapy after suffering an injury, often report pain reduction during the session itself, with some having longer lasting effects as well. Some clients prefer different techniques to address their pain (e.g., Deep Tissue, Swedish Massage, Instrument Assisted Soft Tissue Mobilization), and their preferences can be communicated to the therapist providing treatment. Involving a client in their course of treatment can help to establish a positive rapport.
A 2020 Cochrane review found moderate evidence that massage reduces pain and improves function in people with low back pain compared to no treatment or placebo.[i]
2. Improve Circulation
Clients with deconditioning or neurological injury may suffer from poor vascular or lymphatic circulation. Massage therapy techniques—particularly effleurage and manual lymph drainage—can improve blood flow and reduce swelling. We often see this issue with our clients who have limited mobility, are wheelchair users, or use orthoses like AFOs.
When some of our clients have been bed or wheelchair limited for a long time (sitting or laying limited), and they are beginning to become more physically active through their rehabilitation program, massage therapy will be important in improving their circulation and limit the swelling that can accumulate throughout the day.
A study published in the Archives of Physical Medicine and Rehabilitation demonstrated that massage increases local blood flow and reduces edema in patients with lymphedema.[ii]
3. Enhance Muscle Recovery and Reduce Muscle Soreness
Massage therapy helps reduce muscle soreness and improve subjective recovery for clients engaged in new exercise programs— including athletes and individuals with chronic pain reconditioning,
Zainuddin et al. showed that massage applied after eccentric exercise significantly reduced Delayed-Onset Muscle Soreness (DOMS) and improved muscle performance in the days following exertion.[iii] A meta-analysis by Poppendieck et al. confirmed that post-exercise massage improves strength and power recovery in athletes.[iv]
Implemented by many therapists, this strategy can help a client’s adherence to movement-based strategies as well. Additionally, we cannot forget that some clients might be engaging in a formal exercise plan for the first time. As a result, their soreness level might be greater than originally anticipated during the recovery process. Having an RMT to assist in their recovery will assist our clients in progressing to the next step in the plan with greater comfort.
When a person’s quadricep muscles are feeling particularly sore after a leg-day gym session, a massage therapy appointment can help to offset that soreness and bring that person back to the gym faster. We see similar things happen at physiotherapy, where a person is often sore after doing their rehab exercises or pushing themselves hard (e.g., relearning to walk) for the first time in a while. Massage therapy in this setting offers the same benefits to our clients and keeps them on track for their goals!
4. Addressing Muscle Spasticity and Stiffness in Neurological Conditions
Massage therapy— using techniques like sustained pressure and rhythmic compressions—can help reduce resting muscle tension with neurological disorders such as stroke or multiple sclerosis. By calming the nervous system and reducing stress, massage may lessen muscle tightness and improve comfort.
Research supports these benefits across conditions:
- A randomized controlled trial by Field et al. found that massage significantly reduced muscle spasticity in children with cerebral palsy.[v]
- Similarly, massage has been shown to reduce limb rigidity and improve sleep in people with Parkinson’s disease.[vi]
While physiotherapy targets retraining movement in people with neurological conditions, massage therapy complements these efforts by relaxing muscles and enhancing overall comfort.
5. Decrease Hypersensitivity to Touch and Persistent Pain
People with chronic pain, post-traumatic stress disorder, or neurological disorders often experience heightened sensitivity to touch or persistent pain signals, known as central sensitization. Massage can help calm this overactive response by gradually reintroducing touch and soothing the body’s stress response system when applied appropriately and with the correct clients.
- Research by Nijs and colleagues suggests that hands-on therapies like massage may help reduce oversensitivity to pain by activating the body’s natural pain-relief systems.[vii]
Gentle exposure to touch and tactile stimuli can help a variety of disorders. In some circumstances, our physiotherapists will team up with massage therapists to gradually expose a person to different forms of sensation—light touch, deep pressure, vibration, and more—to help desensitize that specific area.
6. Address Psychological and Emotional Stress
Psychological stress and pain are deeply intertwined. Massage therapy has been shown to reduce anxiety, depression, and stress levels through the release of serotonin and dopamine, and decreased cortisol production.
- A meta-analysis by Moyer et al. found that massage therapy significantly reduces trait anxiety and depression.[viii]
For clients with chronic pain, psychological stress may exacerbate symptoms; thus, massage may serve as a valuable adjunct in managing biopsychosocial aspects of pain.
Although we are not able to provide direction in psychological wellness, assessment, or treatment, it is clear that a person who is feeling well, also moves well. Some of our clients may find themselves in the middle of a dispute while they are in their rehabilitation process, whether its work or other governing systems. These additional stressors increase the barriers to achieving their physical goals. When the emotional and psychological stressors are addressed, physiotherapists are able to work more effectively with their respective patient populations.
Professional Opinion
In my clinical practice, we frequently see clients recovering from serious injuries pertaining to motor vehicle collisions, work place accidents, and chronic diseases and disorders. Our clients often require more focus on movement, functional exercises, and restoring strength, balance, range of motion, and physical abilities.
At the start of a treatment plan, it can be a really challenging for some of our clients to actively participate in physiotherapy. Having RMTs to refer to can help to ensure our clients are able to recover physically and mentally from a difficult physiotherapy session.
It is also extremely important to appreciate the different techniques, instruments, levels of skill, goals, and context, that massage therapy can be provided. Those factors, when calibrated to the client, make massage therapy an effective intervention in improving one’s journey through rehabilitation and recovery.
References
[i] Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database Syst Rev. 2015;(9):CD001929.
[ii] Catarino Jde S, et al. Manual lymphatic drainage versus active exercises in the treatment of lymphedema after breast cancer: a randomized controlled trial. Arch Phys Med Rehabil. 2011;92(4):626–634.
[iii] Zainuddin Z, Newton M, Sacco P, Nosaka K. Effects of massage on delayed-onset muscle soreness, swelling, and recovery of muscle function. J Athl Train. 2005;40(3):174–180.
[iv] Poppendieck W, Wegmann M, Ferrauti A, Kellmann M, Pfeiffer M, Meyer T. Massage and performance recovery: a meta-analytical review. Sports Med. 2016;46(2):183–204.
[v] Field T, Diego M, Hernandez-Reif M. Massage therapy research. Developmental Review. 2007;27(1):75–89.
[vi] Hernandez-Reif M, Field T, Largie S, Diego M, Cullen C, Taylor S, Ironson G, Schanberg S, Kuhn C. Parkinson’s disease symptoms are reduced by massage therapy. Massage Therapy Journal. 2002;41(2):1–8.
[vii] Nijs J, et al. Pain neuroscience education: contrasting a modern understanding of pain with traditional beliefs. Phys Ther. 2012;92(5):707–717.
[viii] Moyer CA, Rounds J, Hannum JW. A meta-analysis of massage therapy research. Psychol Bull. 2004;130(1):3–18.
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