When Acupuncture and Massage Work—and When They Don’t

This episode explores what massage and acupuncture can genuinely help with, where the benefits appear to be mostly short term, and where the evidence simply does not support the bigger claims.

Massage and acupuncture are widely used, and many people spend real time, money, and hope on them. I walk through an important distinction: feeling better is not the same as changing the underlying problem or speeding healing. A treatment may reduce pain, soreness, anxiety, or tension without actually fixing injured tissue or altering the course of recovery.

I also explain why the research can be so tricky to interpret. When massage or acupuncture is compared with no treatment, the results often look encouraging. But when they are compared with a sham treatment, the benefits usually shrink. That matters because even light touch, attention, expectation, and the ritual of care may create real symptom relief on their own. I discuss this challenge using a recent JAMA Network Open review.

For massage, the strongest case is short-term symptom relief. I review studies showing benefit after surgery, including improved pain, anxiety, and relaxation in cardiac surgery patients and better perceived comfort after colorectal surgery

But when massage is studied for neck pain, low back pain, or post-exercise recovery, the picture is much more mixed. It may help soreness or pain in the short term, but it does not clearly improve function, healing, or athletic performance, as seen in reviews on neck pain, low back pain and sports recovery

For acupuncture, I look at the areas where evidence is more promising and where it is less convincing. A recent review found possible benefit for delayed vomiting during cancer care and a Cochrane review found that acupuncture may help with migraine prevention

For chronic low back pain, acupuncture may help compared with no treatment, but it is not clearly better than sham acupuncture, according to a Cochrane review.  For tennis elbow, the evidence suggests possible short-term pain relief, but not strong proof of lasting benefit or faster recovery, based on this systematic review

Takeaways: Massage seems most helpful for relaxation, short-term relief, and reducing soreness, but not for clearly accelerating healing. Acupuncture appears to have narrower evidence-based uses, especially migraine prevention and possibly delayed vomiting in cancer care. When claims expand into fixing injuries, correcting structure, boosting immunity, or treating a wide range of unrelated conditions, the evidence becomes much weaker.

Transcript

Do These Therapies Really Work

SPEAKER_00 0:01

Acupuncture and massage seem to work, but are they actually changing the problem? Today we're looking at where these treatments truly help, where the benefits may be mostly a placebo, and where the evidence just isn't there. Hi, I'm Dr. Bobby Du Bois, and welcome to Live Long and Well, a podcast where we will talk about what you can do to live as long as possible and with as much energy and vigor that you wish. Together we will explore what practical and evidence-supported steps you can take. Come join me on this very important journey, and I hope that you feel empowered along the way. I'm a physician, Iron Man triathlete, and have published several hundred scientific studies. I'm honored to be your guide. Welcome, N of One Nation, my dear listeners, to episode number sixty eight. When acupuncture and massage work and when they don't. Today we're diving into the world of feeling better, or more specifically, massage and acupuncture. Massages typically cost around$100, and acupuncture, probably about the same. Both are common. According to the 2022 National Health Interview Survey, 11% of U.S. adults used massage in the prior year, and 2% used acupuncture. Since folks are spending time, money, and hope on these therapies, do they work? For what problems? For how long? That is our challenge for today. Massage and acupuncture have been around for a long time. Massage has been practiced in cultures around the world for almost all of human history, and it's one of the oldest ways to relieve pain and feel better. Acupuncture comes out of traditional Chinese medicine and has been used in some form for at least 2,500 years. As I often share, what's my story or what's my connection to all of this? Well, I like getting massages, and I have a wonderful massage therapist. For me, these massage sessions are one part painful, one part relaxing, and overall pretty enjoyable. But a couple of hours after these sessions, I kind of feel back to baseline or no lasting improvement that I can see. And if I've actually injured a muscle and she works on it, the massage doesn't seem to make it heal any faster. I've had a similar experience with acupuncture. I tried it for tennis elbow, and it seemed to help, but only for a day or two then the symptoms came back. So I started wondering maybe massage and acupuncture do help, but only for certain things. Maybe the real question isn't do they work? Maybe it's when do they work and when don't they? As an open-minded skeptic, I went down the rabbit hole to find out for myself and of course for you. As I'm fond of saying, I read the studies so you don't have to. The first, does massage or acupuncture help you feel better? And the second is, do these treatments actually change the course of the problem or help you heal sooner? A treatment can relax you or reduce pain or soreness, or make movement feel easier without actually speeding tissue healing or fixing the underlying cause. This distinction matters both as we look at the evidence and for us to choose treatments with our eyes wide open. What are we actually getting from a massage or acupuncture? And what aren't we? Feeling better temporarily is fine if we know up front that there might not be long-lasting changes. And as we'll see, these modalities are better in the short term than they are to change these problems in more fundamental ways. One thing that makes looking at the evidence tough is the comparison group used in these clinical trials. If you compare massage or acupuncture to no treatment, they often look pretty helpful. But if you compare them to a sham treatment, the benefits typically don't look as impressive. So what is this? What is a sham treatment and why does it matter here? A sham treatment is basically a fake or imitation version of the therapy that's designed to seem real to the patient, but without using the active ingredient in the same way. For drug studies, patients might get a pill, looks like the real one, but has no active ingredients in it. These placebo comparisons really tell us if the active treatments work. Now, how would you do this for massage or acupuncture? In acupuncture, that might mean needles placed in the wrong locations. In massage research, it might mean light touch or a simulated version of massage. The tricky part is figuring out what that sham treatment should be. If somebody touches you lightly and not like a typical massage, that could be enjoyable by itself. Should we ignore that benefit? A recent evidence review in a major journal made this point directly. Sham massage may not be inert because even light touch may have positive effects. And for acupuncture, as we'll see, the benefits look more impressive when acupuncture is compared with no treatment than when it's compared with sham acupuncture. On to some evidence. First, let's look at massage. Our evidence exploration is trickier than at first sounds. Because massage is not one thing. Swedish massage is usually gentle and relaxation focused. Deep tissue massage is more intense, more targeted. Sports massage is used in athletes and for quicker recovery. That matters because if the intervention itself varies a lot, it becomes harder to talk as if massage were one standardized treatment with either proven benefits or not. So how might massage help when it does help? Here are a few theories. One is mechanical. Pressure from the massage might temporarily change how tissues feel or how easily they move. Another is neurologic. The massage pressure may alter pain signaling and reduce sensitivity. And another is psychological. Since massage often feels relaxing, lying on a table, listening to music, it might reduce stress, create a sense of safety, and change how your brain interprets discomfort. For this theory, the sore muscle might not change at all, but our perception of that soreness changes. Probably the most realistic answer might be that massage works by a combination of those rather than one magic mechanism. I discovered there weren't a lot of studies just looking at normal folks without any problems. Most studied particular patient populations. Here's an example. There was a randomized trial in 113 cardiac surgery patients. Now, these folks lie on an operating room table for long periods of time and in post-op recovery, often ending up with sore shoulders or back. In this study, half got massage, and the other half had quiet relaxation time. The study found that massage significantly improved pain, anxiety, tension, and relaxation. And patients reported high satisfaction. So, positive results. In another study, the researchers compared massage to a social visit for 127 patients who had colorectal surgery. They found that the massage group had improvements in patients' perception of pain, tension, and anxiety. So the case that massage can make people feel better right away is pretty believable. The limitation is that these are mostly short-term studies in really specific settings. They're not proof of long-term benefit. And they're definitely not proof of faster tissue healing. Other areas have been studied for neck and shoulder pain massage may help, especially in the short term, but the evidence is not overwhelming. In a 2013 review of 12 studies with 757 participants, massage was compared to other active treatments like exercise or traction. What did they find? Massage beat non-active comparisons, but did not clearly show improvements versus other active therapies. And patient function didn't improve. So a mixed picture. Absolutely. For low back pain. The evidence is also mixed and not especially strong. A 2015 meta-analysis was based on 25 clinical trials and 3,100 patients. The investigators judged the quality of the studies. And they found the quality of those studies low, which means that any conclusions they found are not firmly grounded in strong evidence. Once again, massage seemed to help pain, but not function. But again, only when compared to inactive controls. The benefit was less clear when compared to active controls like traction. The author's own words and the conclusion were we have very little confidence that massage is an effective treatment for low back pain. So massage may help compared with doing little or nothing, but it's much harder to show that it's clearly better than other treatments. Another frequent use is post-exercise soreness. And that's something I certainly would like to find benefit. A 2020 systematic review and meta-analysis on sports massage and recovery pooled 29 studies. It found no evidence that sports massage improved strength, jump performance, sprint performance, endurance, or fatigue. It did find a small effect on flexibility and about a 13% improvement in delayed onset muscle soreness, like soreness the day or so after significant exercise. This review points out two claims people often blur together. Massage may help you feel less sore, but that's not the same as making you perform better or recover in a way that changes objective outcomes. Taking a step back, there have been lots of studies of massage. Unfortunately, most were not of high quality. And the conclusions of all the reviews is that we don't have much certainty. It's not that massage has no literature. It is that the literature is full of small trials, different techniques, different comparators, and limited methodologic rigor. Now, people say massage breaks up scar tissue, flushes out toxins, fixes tight muscles, improves circulation or helps injured tissue heal faster. But those are mechanistic or structural claims, and the clinical evidence for them is much thinner than the evidence for short-term relief. Oh well, the evidence is what it is. And now for acupuncture. Before getting into that evidence, I think there's an important distinction to make here. Acupuncture may help tissues locally. Put a needle near a painful area, and maybe that changes local sensitivity, local tissue signaling, or how pain is processed. Then there's the distant claim. Put a needle in the foot or hand and affect symptoms somewhere else in the body, through meridians or other non-local pathways. What's actually happening isn't known, unfortunately. Well, let's begin with one of the uses that was pretty rigorously tested some years ago. Acupuncture for nausea, typically related to cancer treatment. 2025 meta-analysis pooled 16 randomized trials with 1,247 patients. It found that acupuncture did not significantly improve acute nausea or acute vomiting, but it did significantly reduce delayed vomiting, especially when the treatment lasted at least five days. But the studies had methodologic problems. So we don't fully know. A second acupuncture use is for chronic low back pain. A 2020 Cochrane review included 33 trials and over 8,000 participants. Compared with no treatment, the evidence suggested some immediate pain relief. But compared with sham acupuncture, acupuncture wasn't clearly better for pain or for function. Now this distinction matters. It suggests that some of the apparent benefit may come from the acupuncture treatment ritual of a doctor placing her hands on you, or the expectation that you'll get better, and not just from the needles themselves and where they're actually placed. Okay, third use is migraine prevention. 2016 Cochrane Review included 22 trials with almost 5,000 participants. It found that acupuncture reduced headache frequency. Here they found that acupuncture performed even better than sham acupuncture, although the differences were pretty small. And in trials comparing acupuncture with preventive drugs, acupuncture performed at least similarly and did cause fewer adverse effects. So migraine prevention is one of the clearer examples where the evidence supports a real preventive benefit. Even if the benefit isn't huge. Now for areas with less evidence and less convincing benefit. Now that brings me back to my own experience with tennis elbow, where it wasn't clear if there were any long-lasting benefits for me. A 2020 systematic review on tennis elbow found some positive trials, but the evidence base was small and methodologically shaking. So the most you can really say is that acupuncture may help short-term pain in tennis elbow. Now that's very different from saying it has strong proof as a durable or clearly superior treatment, and no evidence that it shortens the duration of illness. And now we get into the many uses that practitioners of acupuncture may suggest to you. Acupuncture can treat fertility, allergies, asthma, and weight loss. It can boost your immune system and improve your general wellness. When you hear these uses, your alarm bells should go off, since evidence doesn't support them. Now, that doesn't mean every one of these uses has been disproven. It means the claims outrun the evidence. So where do I land as we bring this episode to a close? The evidence doesn't support broad statements that massage works in general or acupuncture is a powerful approach. But it also isn't accurate to say that these therapies don't work. The answer is narrower and more nuanced. Massage seems most useful for immediate relaxation, short-term symptom relief, and reducing some soreness. Acupuncture seems most useful for a few specific things like delayed vomiting and cancer care, migraine prevention, and some chronic pain conditions. And when the claims get bigger or broader, the evidence just isn't there, especially when people start talking about healing those injuries, correcting structural problems, or treating a long list of unrelated conditions. As is often the case, the story is less fat, flashy, but more useful. These therapies may help, but only for certain problems and usually in narrower ways than the hype suggests. Let me know what your experience has been. Until next time, I am Dr. Bobby, your open-minded skeptic. Thanks so much for listening to Live Long and Well with Dr. Bobby. If you like this episode, please provide a review on Apple or Spotify or wherever you listen. If you want to continue this journey or want to receive my newsletter on practical and scientific ways to improve your health and longevity, please visit me at Dr. Bobby Livelongandwell.com. That's Doctor as a Dr Bobby Livelongandwell.com.