Massage & Chiropractic Therapy

Body-based and manipulative therapies used by people with RA include chiropractic, massage, reflexology, and therapeutic touch.



Chiropractic medicine is one of the most popular CAM approaches. It is based on the idea that misalignments of vertebrae that exert abnormal pressure on nerves in the spinal cord can cause dysfunction in muscles and organs throughout the body. There is sufficient evidence from randomized, controlled studies to support the use of chiropractic treatment to decrease pain in the lower back and improve tension-type headache. There is less evidence to support the use of this approach in other types of pain (neck, shoulder, and thoracic spine), emotional difficulties, or other health conditions (such as infection, seizure, ulcer). Chiropractic care has been evaluated in one study for use in patients with osteoarthritis where it resulted in improvements in walking speed. However, there is no evidence to support its effectiveness in RA.1,2

Chiropractic medicine should be used with caution in people with arthritis, especially those with decreased bone mineral density. It should also be used with caution in patients with blood clotting disorders and migraine. Chiropractic care should be avoided in patients being treated with anticoagulant therapies, those with increased risk of bleeding, and those with vascular abnormalities (including aneurysms). It should also be avoided during pregnancy due to a lack of scientific data supporting its safe use.1


Types of Massage and Other Related Bodywork Commonly Used in US

  • Use of traditional techniques, including effleurage (stroke that is long and gliding), petrissage (compression or kneading), vibration (rapid, shaking motion), friction (circular and deep fingertip/thumb pad motions), tapotement (alternating hands in quick tapping or striking motion), or Reiki
  • Combines Swedish technique with therapeutic bath (this type may not be appropriate for MS patient who is heat sensitive)
  • Derives from traditional Chinese practice of acupuncture, using finger pressure instead of needles
  • Japanese technique using finger pressure to increase circulation and restore energy balance, focusing on health prevention rather than healing
Trager method
  • Gentle, rhythmic touch in combination with exercises to relieve tension and improve posture and movement
Rolfing or Aston
  • Deep pressure to fascia (tissue covering muscles and organs) to restore body alignment



Massage is an ancient medical treatment technique involving manipulation of soft tissue by means of pressure and traction. There are many different types of massage and the practice is often combined with other approaches for programs of integrative treatment for degenerative diseases, such as fibromyalgia. Massage is a popular therapeutic intervention for a range of health conditions, from pain syndromes to musculoskeletal problems, and is effective at promoting relaxation. Although massage is typically well tolerated and safe, it should be used with caution in patients with decreased bone mineral density due to increased risk of fracture. It should also be used with caution in patients with arthritis and fibromyalgia because of the potential for exacerbation of pain and discomfort.3

Although massage is widely used, studies evaluating the effectiveness of massage in specific patient groups are limited by problems in study design. Therefore, the strongest evidence of benefit is for quality of life improvements in patients with cancer. Convincing evidence is lacking in patients with different forms of arthritis. In one study conducted in patients with osteoarthritis of the knee, massage therapy (Swedish massage, twice weekly in weeks 1-4 and once weekly through week 8) resulted in significant improvements in pain, stiffness, physical functioning, range of motion, and walking speed. In terms of the effectiveness of massage in RA, there has only been one small study conducted in children with juvenile RA. In this study, massage therapy resulted in reductions in pain and decreases in anxiety.3



Reflexology is a healing art that has been practiced for thousands of years. Specific traditions can be found in China and throughout the Orient, in Egypt, as well as in other areas. The practice is based on the idea that areas on the feet (also the hands and ears) can be stimulated, resulting in effects in other parts of the body. Reflexology shares a similar approach to the practice of acupressure (one example of which is shiatsu), but the two practices are not the same.4

Although reflexology has been proposed for a range of health problems, there have been few carefully designed studies evaluating its effectiveness in specific health conditions. It may provide benefits including reduction of anxiety, decreased pain (lower back), reduction in side effects of chemotherapy, improvement in depression, and decreased fatigue associated with certain health conditions. There have been a limited number of studies evaluating reflexology as a treatment for lower back pain and these studies have produced conflicting results. There have been no studies of reflexology in RA.4


Therapeutic touch

Therapeutic touch is a modern approach developed in the 1970s, derived from several different traditions in folk medicine. In therapeutic touch, no physical contact is made with the patient. Rather, the practitioner holds arms and hands a short distance from the subject, with the goal of manipulating the energy field around the body to correct imbalances in that field. A number of different types of therapeutic touch have been developed. The claim that the approach works via manipulation of life force or life energy places the understanding of how and why it works beyond science and has made therapeutic touch very difficult to study. The strongest evidence for the effectiveness of therapeutic touch are reports by patients of relief of pain, anxiety, and stress. Therapeutic touch has been evaluated in a limited number of studies for use in patients with arthritis (osteoarthritis and degenerative arthritis) and fibromyalgia and has been shown to be effective in reducing musculoskeletal pain. However, these studies were limited in methodology and size and the specific intervention used varied widely from study to study.5

Written by: Jonathan Simmons | Last reviewed: September 2013.
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