Does massage therapy help with osteoarthritis related knee pain?

Ross Hauser, MD., Danielle R. Steilen-Matias, MMS, PA-C

Many people will benefit from massage therapy, many will not. The idea behind massage therapy is that the kneading and stroking of massage therapy will bring blood into the knee and blood initiates the healing immune response to repair soft tissue. It also feels good.

Like many non-surgical applications, massage therapy is considered somewhat controversial. Controversial meaning researchers are not sure if it works and if it does help people, is it really addressing the problem in the knee or the muscles in the thigh?

While we see many patients who are trying to avoid a knee replacement, we do see patients who are having pain challenges after their knee replacement. These people are generally represented by someone who will tell us a story that goes like this:

I had a knee replacement a few months ago. I still cannot fully extend my knee and it is still pretty swollen. My therapists are telling me that I am “very tight.” That is an understatement, my tightness extends from my hip to my knee. During my massage therapy, the therapist tells me something I already know, I have huge knots throughout my muscles that are not working out. I am trying to work these knots out on my own as well. I bought everything online that I thought could help.

Does massage therapy help with osteoarthritis-related knee pain?

If you have not had a knee replacement, you are likely here reading this article because you are trying to avoid one. So will massage therapy help you?

An October 2020 paper in the medical journal Medicine (1), announced a new study into the effectiveness of massage therapy in people with knee osteoarthritis. The researchers of this study have noted “previous studies that have also confirmed that massage therapy is useful in improving pain, stiffness, and functional status for patients with knee osteoarthritis”, however, they also note that at present, “the evidence of massage for knee osteoarthritis lacks a comprehensive system evaluation.” In other words, researchers are not sure if it works and if it does help people is it really addressing the problem in the knee. As mentioned above.

So the goal of this study is to offer “comprehensive evidence for evaluating whether massage therapy is useful in treating patients with knee osteoarthritis.” For many people, a massage feels good. Whether it helps people or not in research does not usually matter to someone whose knee hurts and their initial response is to rub it.

Aromatherapy massage for the knee

For those of you exploring or who have had it, you know that aromatherapy massage adds a topical element to the massage. This is usually an essential oil or oil that is found in many over-the-counter products such as chamomile, eucalyptus, ginger, lavender, frankincense, lemon, peppermint, the list is large.

We do see many patients who have found aromatherapy massage to be beneficial and soothing. But these people are in our office because the benefit is short-term and their knee problems continue to get worse.

A March 2018 study in the journal Pain Management Nursing, the official journal of the American Society of Pain Management Nurses, (2) evaluated the effect of aromatherapy massage on knee pain and functional status in subjects with osteoarthritis.

They found: “Aromatherapy massage performed in patients with osteoarthritis reduced knee pain scores, decreased morning stiffness, and improved physical functioning status. Thus, as long as specific training is provided for aromatherapy massage, aromatherapy can be recommended for routine use in physical therapy units, hospitals, and homes.”

Aromatherapy and massage therapy need longer times to work – at least 6 months

A January 2021 study (5) compared the effects of aromatherapy and massage therapy on knee pain, morning stiffness, daily life function, and quality of life in patients with knee osteoarthritis. In all 93 patients were randomly divided into three groups including massage therapy (31 patients), aromatherapy (31 patients), and the control 31 patients). The data gathering tools were a demographic characteristics questionnaire and the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire. The questionnaire was completed before intervention and at the 5th and 10th sessions after intervention in all three groups.

Results: The study shows that average score subscale of symptoms, discomfort and function in the 5th session and 10th session of intervention in the aromatherapy group is significantly higher than in the control group (the aromatherapy was not providing as much symptomatic relief).
The massage therapy group had the highest pain score at the beginning of the intervention, but at the end of the 10th session of intervention had the least pain score.
Average performance of daily life scores in the 5th session and 10th session of intervention in the aromatherapy group is significantly higher than in the control group.
Average performance of exercise, and recreational activities significantly differs between the aroma therapy and massage therapy groups compared with the control group in all times of interventions.
In the average score in the subscale Quality of life, there is no significant difference between the groups in all times of interventions.

Conclusion: The researchers suggested use of both massage therapy and aromatherapy is recommended for patients with knee osteoarthritis. Interventions should be prolonged for at least 6 months in patients so their effects appear on the patient.

physical therapy units, hospitals, and homes.”

Aromatherapy and massage therapy not a long-term solution

A February 2022 study in the journal Complementary therapies in clinical practice (6) wrote: While massage therapy is being used for knee osteoarthritis, the researchers of this study note that the evidence is lacking. In their study the research team looked to seek out the evidence on the effect of massage therapy on knee osteoarthritis. To do this, the reviewed previously published material. Twelve studies with 737 participants were included.

After one to four weeks of therapy, there was a significant reduction in pain and stiffness scores in the massage group and after six to eight weeks of therapy, there was a significant reduction in stiffness and functionality scores. There was no significant difference in outcomes with long-term therapy. A statistically significant reduction in stiffness scores was seen with aromatherapy massage.
Aromatherapy massage was not superior to standard massage.

The conclusions reached: “Massage therapy may lead to some improvement in pain, stiffness, and functionality scores in the short term but not in long term. Aromatherapy massage was not found to be any better than standard massage therapy.”

Not addressing the knee but the thigh

A May 2018 study in the Journal of Manipulative and Physiological Therapeutics (3) offered another assessment of the benefits of massage therapy for knee pain. In this study, doctors assessed the effect of continuous compression stimulation (5-minute massage therapy) on pressure-pain thresholds and muscle spasms in older adults with knee osteoarthritis.

What the researchers found was that in a group of patients (16 patients) who had the continuous compression stimulation (5-minute massage therapy), “the pressure-pain threshold improved significantly for pain both at rest and while walking, but the improvement in muscle spasm was not significant.”

What they then concluded was: “Massage therapy resulted in minimal clinically important changes for pain relief. There was an increase in the pressure pain threshold in older adults with knee osteoarthritis. We propose that the improvements in pain may be related to the medial thigh muscle rather than knee osteoarthritis.”

It is about quality of life and it may be about the placebo effect

Here is research from a June 2017 study in the journal Pain Medicine. (4) The study makes some curious points on whether or not the massage is helping physically or mentally.

Let’s look at the learning points:

In this qualitative study (basically a study that asks people how do they feel?) the people in the study reported:
- “Relaxation effects, improved quality of life, and symptomatic relief, possibly beyond increased functional status and pain scores as found in our clinical trial.” In other words, the people felt better than they should have.
- The researchers noted when they interviewed patients about the benefits massage was offering them, the patients noted:
  - Empowerment, with an improved ability to perform activities of daily living.
  - One patient reported significant pain relief even though her knee physically got worse. The researchers suggested that her massage therapy may have provided relief through relaxation.
  - Another participant noted positive changes and a general improvement in daily life with massage despite showing a substantial decline in knee function scores after eight weeks; that is, this participant was demonstrably worse but noted a subjective improvement in her quality of life. This paradoxical finding may be the placebo effect

Does massage therapy prevent further knee damage?

It is clear from the research that massage therapy can offer benefits. What is also clear is that massage therapy is paradoxical. It may provide pain relief even as the knee continues to decline its way toward knee replacement.

In our office, we specialize in non-surgical regenerative medicine injections. Here are some links and descriptions to articles on our website to help you with your research in learning more about these options.

Platelet Rich Plasma for Knee Osteoarthritis: When it works, when it does not
- In this article, we are updating research and clinical observations in the use of Platelet Rich Plasma Therapy (PRP) for the treatment of knee osteoarthritis. We will also explain why PRP may not work and how getting a single PRP injection will usually lead to unsatisfying long-term results.
Prolotherapy knee osteoarthritis research: An option to knee surgery
- In this article, we update new research and discuss Prolotherapy knee osteoarthritis injections. The knee is the most common joint treated with Prolotherapy at Caring Medical. We use a comprehensive Prolotherapy approach that stimulates the natural repair of connective tissue. Prolotherapy research shows significant improvement in selected patients with knee osteoarthritis. Treating the whole knee joint as opposed to selective parts of the knee is more effective in alleviating knee pain and healing the damage.
Research on Hyaluronic injections for Knee Osteoarthritis
- It should be noted that we see many patients who have tried hyaluronic acid injections. These injections have worked for these people in the short term. These patients are now in our office because the short-term has not transpired to the long-term and now a different treatment approach needs to be undertaken.
When stem cell therapy works and does not work for your knee pain
- When opting for regenerative medicine injections, providers and the patients have to have a realistic idea of just how effective or non-effective these treatments can be. For some patients stem cell injections can be of great benefit in helping prevent or delay the need, long-term, for knee replacement surgery. For others, stem cell therapy results will be disappointing and non-effective. So how do you know?

Research citations

1 Qin S, Chi Z, Xiao Y, Zhu D, Zhong G, Xu W, Ouyang X, Li J, Cheng P, Yu T, Li H. Effectiveness and safety of massage for knee osteoarthritis: A protocol for systematic review and meta-analysis. Medicine. 2020 Oct 30;99(44). [Google Scholar]
2 Efe AD, Kutlutürkan S, Korkmaz M. The Effect of Aromatherapy Massage on Knee Pain and Functional Status in Participants with Osteoarthritis. Pain management nursing: official journal of the American Society of Pain Management Nurses. 2019 Feb;20(1):62. [Google Scholar]
3 Tanaka R, Umehara T, Kawabata Y, Sakuda T. Effect of Continuous Compression Stimulation on Pressure-Pain Threshold and Muscle Spasms in Older Adults With Knee Osteoarthritis: A Randomized Trial. Journal of manipulative and physiological therapeutics. 2018 May;41(4):315. [Google Scholar]
4 Ali A, Rosenberger L, Weiss TR, Milak C, Perlman AI. Massage therapy and quality of life in osteoarthritis of the knee: A qualitative study. Pain Medicine. 2017 Jun 1;18(6):1168-75. [Google Scholar]
5 Hasanpour-Dehkordi A, Kabiri F, Dris F. Comparing the effects of massage therapy and aromatherapy on knee pain, morning stiffness, daily life function, and quality of life in patients with knee osteoarthritis. Complementary Medicine Research. 2021;28(4):292-9. [Google Scholar]
6 Wu Q, Zhao J, Guo W. Efficacy of massage therapy in improving outcomes in knee osteoarthritis: A systematic review and meta-analysis. Complementary Therapies in Clinical Practice. 2022 Feb 1;46:101522. [Google Scholar]

This article was updated October 10, 2022