Massage affects more than muscles. In fact, touch, pressure, and movement provide sensory information that travels through the nervous system to the spinal cord and brain. As a result, research suggests that massage can influence autonomic regulation, brain activity, and physiological measures associated with stress and relaxation.[1][2]
However, an important distinction matters: research that finds changes in cortisol, serotonin, or dopamine after massage does not necessarily show that massage directly changes the concentration of those chemicals inside the brain. Instead, researchers have measured many of these biochemical changes in saliva or urine. Meanwhile, newer neuroimaging research gives scientists a more direct view of how massage may influence brain activity.
Watch: How Does Massage Affect Your Brain?
In this American Massage Council video, explore the relationship between massage therapy, the brain, and the body’s stress and relaxation responses.
How Does Massage Affect the Brain?
Massage creates a stream of sensory input. Specifically, pressure, movement, stretching, and touch activate receptors in the skin and deeper tissues. Those receptors then send signals through the peripheral and central nervous systems, and the brain processes that information.
However, that sensory input does not produce one predictable response. The type, intensity, duration, location, and context of massage can all influence the response. In addition, individual characteristics and treatment goals can affect the experience.
A 2026 scoping review examined 47 human studies that used electroencephalography (EEG), functional MRI (fMRI), or functional near-infrared spectroscopy (fNIRS). Overall, the researchers found that massage can produce measurable changes in brain activity. Across the studies, researchers reported patterns associated with relaxation, sensory processing, autonomic regulation, and pain processing.[2]
Massage and the Nervous System
Massage may feel calming partly because it interacts with the autonomic nervous system. This system, in turn, helps regulate functions such as heart rate, breathing, digestion, and the body’s response to stress.
For example, research has linked moderate-pressure massage with increased vagal activity, changes in heart rate, and EEG patterns associated with relaxation. In addition, earlier research found that massage can influence stress-related physiology. However, the size and consistency of these effects vary among studies.[2][3]
| What happens during massage | What researchers can measure |
|---|---|
| Touch and pressure stimulate sensory receptors | Changes in neural and autonomic activity |
| Sensory information travels through peripheral nerves and the spinal cord | Changes in EEG, fMRI, or fNIRS measures in some studies |
| The body may shift toward a more relaxed state | Changes in heart rate, heart rate variability, or stress-related measures |
| Massage may influence stress physiology | Researchers have reported changes in cortisol, although findings vary |
Does Massage Change Cortisol?
Cortisol is a hormone that helps regulate the body’s stress response. A frequently cited 2005 review reported an average 31% reduction in cortisol across studies that measured cortisol in saliva or urine after massage.[3]
Nevertheless, we should interpret that number cautiously. A later quantitative review found that massage produced generally small and statistically nonsignificant between-group effects on cortisol. Therefore, researchers should not interpret a percentage change before and after treatment as proof of a large treatment effect.[4]
For massage therapists, the practical takeaway does not involve promising a predictable cortisol reduction. Instead, massage may contribute to a broader relaxation response, with physiological effects that vary according to the client, treatment, comparison condition, and measurement method.
What About Serotonin and Dopamine?
The original AMC article describes massage as increasing serotonin and dopamine. However, the underlying evidence requires more precise language.
The frequently cited 2005 review found average increases of approximately 28% for serotonin and 31% for dopamine in studies that measured these substances in urine.[3] These findings provide interesting evidence; however, urinary measurements do not directly demonstrate increased serotonin or dopamine concentrations in the brain.
Therefore, massage therapists should describe the findings as associations between massage and changes in biochemical measures related to mood and stress. In contrast, they should not claim that massage directly “boosts brain chemicals.”
What Brain Imaging Research Tells Us
More recently, researchers have gained a more direct view of the brain’s response to massage. The 2026 scoping review identified studies that used EEG, fMRI, and fNIRS. Specifically, researchers found changes in brain activity across several sensory, emotional, autonomic, and pain-related networks.[2]
For example, EEG studies commonly reported increased alpha activity and reductions in faster-frequency activity during or after some massage protocols. Those patterns can accompany relaxed states. In addition, functional imaging studies reported activity involving regions such as the insula, anterior cingulate cortex, striatum, and periaqueductal gray.
These findings help explain why massage can produce a whole-body experience rather than simply a local muscular effect. However, researchers still need to determine exactly how specific techniques, pressures, treatment durations, and repeated sessions affect the brain.
Can Massage Rewire the Brain?
At present, current research does not support that broad claim.
For example, the 2026 review found signals that repeated massage may contribute to longer-term changes in neural activity and other physiological measures. However, the researchers examined heterogeneous studies, and they called for larger, more standardized longitudinal research before scientists can draw firm conclusions about durable neuroplastic changes.[2]
Therefore, for massage therapists, “massage may influence brain activity” provides a better-supported statement than “massage rewires the brain.”
What This Means for Massage Therapists
Understanding the nervous-system component of massage can improve clinical reasoning and client communication. More importantly, this understanding can help therapists explain the experience without making claims that go beyond the evidence.
- Think beyond the tissue. Massage provides sensory input that the nervous system processes along with the mechanical effects on soft tissues. Therefore, the client’s experience involves more than local tissue manipulation.
- Individualize pressure. More pressure does not automatically produce better results. Instead, consider client preference, tolerance, goals, health status, and treatment context.
- Use evidence-calibrated language. Describe massage as potentially supporting relaxation, comfort, and stress management. In contrast, avoid promising a specific hormonal or neurological outcome.
- Observe the client. For example, changes in breathing, muscle guarding, facial expression, and verbal feedback can help guide treatment decisions.
- Stay within scope. Massage therapists should not present changes in brain activity as a diagnosis or claim that massage treats neurological or psychiatric disorders unless the specific claim has appropriate evidence and falls within the therapist’s scope of practice.
Safety Still Matters
A calming response does not occur in every situation, and massage does not suit every circumstance. Therefore, massage therapists should modify pressure and technique when a client has relevant medical concerns, an acute injury, unexplained neurological symptoms, or another circumstance that requires additional assessment.
Massage can complement appropriate healthcare, but it should not replace medical evaluation or treatment when those services are necessary. For that reason, if a client reports new or concerning neurological symptoms, the therapist should prioritize appropriate healthcare referral.
Key Takeaways
- Massage provides sensory information that the spinal cord and brain process.
- Overall, research shows that some massage protocols can produce measurable changes in brain and autonomic activity.
- In addition, massage has links to changes in cortisol and other biochemical measures, but the size and consistency of these effects vary.
- However, changes that researchers measure in urine or saliva should not automatically become claims about changes in brain chemistry.
- Meanwhile, current neuroimaging research shows promise but does not establish that massage permanently “rewires” the brain.
- Ultimately, for massage therapists, the strongest practical message is that massage can influence the nervous system and may support relaxation and well-being when therapists apply it appropriately.
Protect Your Massage Practice
Good clinical practice involves more than understanding how massage affects the nervous system. In addition, professional risk management requires appropriate liability coverage and sound practices for documentation, communication, and informed consent.
American Massage Council provides professional liability coverage for massage therapists. Therefore, review the current policy information and coverage options before deciding what protection fits your practice.
Important: The actual policy terms, conditions, limitations, and exclusions determine insurance coverage.
References
- Field T, Hernandez-Reif M, Diego M, Schanberg S, Kuhn C. “Cortisol decreases and serotonin and dopamine increase following massage therapy.” International Journal of Neuroscience. 2005;115(10):1397-1413.
- “Through Massage to the Brain—Neuronal and Neuroplastic Mechanisms of Massage Based on Various Neuroimaging Techniques (EEG, fMRI, and fNIRS).” 2026 scoping review.
- Field T. “Massage therapy research review.” Complementary Therapies in Clinical Practice. 2014.
- Moyer CA, Rounds J, Hannum JW. “A meta-analysis of massage therapy research.” Quantitative review of massage therapy and cortisol effects.
Disclaimer: This article provides general educational information. It does not provide individualized medical, legal, or insurance advice. Therefore, massage therapists should follow applicable laws, regulations, professional standards, and their clients’ healthcare needs.
