How does massage help a client feel less anxious?
Updated: Oct 15
“I feel like I can finally switch off.”
When a client says this after massage, it raises an interesting clinical question: what might have changed? Stress hormones are one possible part of the explanation, although the relationship is more complicated than “massage lowers cortisol”.
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Where cortisol fits
The stress response involves communication between the brain and the body. One pathway, the hypothalamic–pituitary–adrenal (HPA) axis, carries hormonal signals from the brain through the pituitary gland to the adrenal glands, which release cortisol.
Cortisol helps us respond to demands. It also supports normal daily functions, so reducing it is not automatically a treatment goal.
Does massage change stress hormones?
Researchers have measured hormones before and after massage, rather than relying only on reports of relaxation.
A small 2010 study comparing Swedish massage with light touch found a small difference in cortisol reduction favouring massage. However, a 2011 review found that cortisol effects were generally small and not statistically significant compared with control groups.
More recent findings are encouraging. A large 2024 review reported reductions in cortisol and anxiety following touch interventions in adults. Most adult interventions involved massage, but the review also included other forms of touch. It supports a possible influence on stress physiology without proving that reduced cortisol explains anxiety relief.
Feeling calmer and having lower cortisol are different outcomes. One does not automatically demonstrate the other.
More than one possible pathway
Touch, physical comfort, a supportive therapeutic relationship and time away from everyday demands may all contribute to the experience. Their individual contributions remain difficult to separate.
This matters when explaining treatment. A client’s report that they feel less anxious is valuable, even when we cannot identify the precise biological mechanism.
Instead of promising to “lower your stress hormones”, a more useful explanation is:
“Massage may help you feel more settled. We can adjust the session to what feels comfortable and see how you respond.”
About the publisher
TheTherapyWeb.com provides online professional development for manual therapy practitioners in Australia and New Zealand.
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