Posted by: Edzard Ernst25 August 2012
It might be best to start this article with a declaration of conflict of interest: I am quite fond of massage therapy and, many years ago, learnt the techniques of Swedish massage myself.
There is good evidence that it is helpful for a wide range of conditions from back pain to anxiety and from cancer palliation to constipation1. There is also evidence to show that most patients adore massages.
As a young doctor in Germany, I used to prescribe massage therapy mainly for musculoskeletal problems, and one of my problems was to persuade my patients to come off that prescription. The level of patients’ satisfaction was so high that they wanted more and more of it.
Being fond of an intervention is, however, not the same as being uncritical – at least not for me. The effects of massage are positive but usually not large and they are almost invariably short-lasting. Thus one might question the cost-effectiveness of this approach. Also, as always, we need to ask, is this therapy safe?
'What on earth might be the risks of a massage,' I hear my readers ask. 'Surely nobody can be harmed by such a natural, agreeable and gentle treatment?'
Yes, we might assume it is safe, but safety is far too important to be left to assumptions. We need data, not least, because in the UK massage is amongst the most popular of all alternative therapies.
And, if we look for data, we soon realise that there is no reporting schemes for adverse events. This striking absence is a phenomenon we observe in many areas of alternative medicine. I find this worrying: if we do not look, we will not see.
In such a situation, we have to rely on published case-reports for information. Having had a long-standing interest in massage therapy, I decided a decade ago to systematically review this type of evidence.
What I found was surprising and a little unsettling: there were reports of cerebrovascular accidents, stent displacements, embolisations of kidneys, haematomas, leg ulcers, nerve damage, pseudo-aneurisms, pulmonary embolisms, ruptured uterus, strangulation of the neck and pain syndromes all of which had occurred after massage therapy2. In most cases, there seemed to be little doubt about causality. Since then, many more adverse effects have come to light, and there is good reason to suspect that under-reporting is huge.
Surely, the risks of mainstream drugs and other conventional treatments are dimensions greater?
Yes, probably, and I still think that massage therapy is a relatively safe intervention – and so are many other forms of alternative medicine.
However, in order to reliably judge the value of any therapy, we cannot just look at the risk but need to balance the potential for harm with the documented benefits of that treatment. In alternative medicine, this is rarely possible: the benefits are often not well enough researched, and the risks are not systematically monitored.
What follows is, I think, fairly obvious; a healthy level of scepticism towards under-researched interventions of any kind is not a bad thing.
Professor Edzard Ernst is professor of complementary medicine at the Peninsula Medical School, University of Exeter
(1) Ernst E, Pittler MH, Wider B, Boddy K. The Desktop Guide to Complementary and Alternative Medicine. 2nd edition. Edinburgh: Elsevier Mosby. 2006.
(2) Ernst E. The safety of massage therapy. Rheumatology. Oxford 2003;42:1101-1106.