Post-exercise massage can relieve the DOMS. Many clinical findings confirm that MT is a promising treatment for DOMS (Field, 2002). Hippocrates (the father of modern medicine; 400 BC) described MT as the "medicine rubbing technique"; ancient medicine was essentially contact therapy. "Takeover" has been a major form of healing throughout history in places such as ancient Greece, where Hippocrates wrote that "a physician must be experienced in many things, especially friction." Tuina (Chinese traditional medicine) and Abhyanga (Indian Ayurveda) are tactile therapies of the East, which have for long implemented touch therapy. MT, reached West relatively late; western massage dates back to the 19th century Swedish physical educator, Per Henrik Ling. Well-researched effects of massage on flexibility and DOMS can inform coaches and athletes about its benefits and guide decisions about incorporating massage into training and competition (Ooi et al., 2018). The efficacy of Thai massage in pain reduction is confirmed; compared to passive physical therapy, Thai massage reduces the average pain intensity more significantly. Thai massage effects on pain can last for several weeks (Keeratitanont et al., 2015). Both Thai and Swedish massage relieve chronic back pain by strengthening bodily functions, providing pain relief, improving disability and range of motion, improving psychological function, anxiety reduction, and mood improvement. Although based on different theoretical frameworks, they appear to be equally effective in relieving chronic back pain (Netchanok et al., 2012).

Few countries (China, Japan, Russia and West Germany) recognize MT as a medical treatment. United States recognizes it as an alternative therapy. Although, methodologically flawed, clinical trials seem to suggest that abdominal massage is effective in treating chronic constipation (Ernst, 1998). In constipated patients, it can stimulate peristalsis, shorten colon transit time, increase the frequency of bowel movements, and reduce the discomfort and pain associated with it. Massage can stimulate peristalsis in patients with fecal impaction after surgery. Individual case reports indicate that abdominal massage is effective in relieving long-term functional constipation in patients diagnosed with various physiological abnormalities (Sinclair, 2011). Massage and cold-water immersion improved perceptions of recovery and reduced DOMS, especially in women. Mancinelli et al also reported a significant reduction in muscle soreness in female college basketball and volleyball players who received massage; around 80% of those who received massage reported a reduction in pain. Post-exercise massage may help relieve DOMS (Davis et al., 2020), (Table 2).

MT is very popular among Australians as a complementary and alternative therapy. As Australian health authorities increase their emphasis on evidence-based health care decision-making, massage therapists are required to move toward evidence-based practices (EIPs). Because MT research has received considerable attention over the past 30 years, clinical evidences-that support the effectiveness of MT in many health conditions, including chronic back pain-exist. Compared to inactive treatment, massage was significantly better in pain intensity and disability management in patients with acute/subacute non-specific low back pain (Furlan et al., 2015). Thus, growing research supports MT as an evidence-based treatment modality (Field et al., 2005).

To investigate whether MT positively reduces cortisol levels, we reviewed literature on depression (including those on sexual abuse and eating disorders), pain syndromes, autoimmune conditions (including asthma and chronic fatigue), immunity (including HIV and breast cancer), work stress reduction, aging stress, and pregnancy stress. MT reduced cortisol levels in saliva and urine significantly (average reduction of 31%) (Field et al., 2005).

MT increased urine serotonin and dopamine levels by an average of 28% and 31%, respectively. Taken together, MT has anti-stress (reducing cortisol) and mood elevating (increasing serotonin and dopamine) effects in a variety of medical conditions and stressful experiences (Calenda, 2006). MTs could exert their sympathetic effects through physiological and psychological mechanisms. MT may enhance hypothalamic-pituitary-adrenal cortical axis function and improve endothelial function by increasing blood flow (Edinoff et al., 2020). Pressure applied during MT can stimulate visceral activity, reduce anxiety and pain and increase serotonin levels (Stecco et al., 2016).

MT appear to be safe and effective in treating cancer pain. Cancer patients who received the massage reported reduced pain, nausea, and anxiety during the procedure and an improved quality of life. Massage is increasingly used in cancer treatment centers and hospitals. Massage positively affects biochemistry: it increases dopamine levels, lymphocytes and natural killer cells numbers (Nelson, 2015). When treating fascia-related ailments, anatomy and characteristics of fascial tissue must be considered to identify appropriate massage type (Goats, 1994). Ailments involving superficial fascia-which includes changes in mechanical coordination, proprioception, balance, myofascial pain-are characterized by lymphatic, facial vascular, and thermoregulatory dysfunctions. Superficial fascia contains more surface and elastic tissue than other types. Therefore, expectedly, light massage or massage using a large surface to apply diffuse friction in the parasympathetic first layer, are more effective in treating ailments involving superficial fascia. Spasticity involves deep fascia and posterior membrane and therefore requires deep massage (that reaches the muscle surface). Therefore, use of small surface tool and manual deep rub with the knuckle or elbow is recommended for treating deep fascia and/or posterior membrane ailments. Benefit of using appropriate massage type is supported by the results of previous local anesthesia experiments that showed that arterial dilatation was primarily controlled by local axonal reflexes. Excessive massage in healthy adults increases both local blood flow and heart rate. Further, this excessive massage effect lasts longer than that of gentle pressure massage; thus, it is a powerful tool to accelerate healing. While local vascular reactions are primarily due to histamine release, increased stroke volume reflects improved venous return. MT promotes psychosocial relaxation, can reduce stress, and improves immune function. MT is currently used in palliative care to relieve anxiety and pain. Psychosocial status is generally evaluated through subjective psychological tests, conducted using questionnaires such as STAI (State-Trait Anxiety Inventory); these assessments are limited by lack of reliability in self-reporting. Salivary gland biomarkers are useful objective indicators to evaluate psychosocial status. MT modulates biomarkers in saliva which indicate psychosocial relaxation, reduced stress, and improved immune function status. As such, MT is currently used in palliative care for anxiety and pain relief (Noto et al., 2010) (Table 3).

MT shows beneficial results in various ailments. It improves nasal breathing in children, reduces back pain in nurses, and improves adrenal cortical function in infants. Swedish massage has beneficial effects in several populations and can be used therapeutically. It is recommended for use in disease prevention (Angelopoulou et al., 2020). MT induces relaxation. Various therapeutic massage types (such as classic full-body therapeutic massage and reflexology), improve quality of life. MT-such as classic deep therapy massage, traditional Japanese massage, Thai massage, neuromuscular therapy, and intuit-improves non-motor symptoms such as sleep disorders, pain, fatigue, anxiety, and depressive symptoms. They also improve motor symptoms (Michalsen & Bühring, 1993). Connective tissue massage involves the skin and subcutaneous tissue. It focuses on specific body areas that are classified into segments comprising of closely-associated internal organ and locomotor systems (such as spinal cord, joints, muscles). Connective tissue massage is derives name from the concept that the physiology of a given connective tissue and the organ it is partially connected to, are mutually associated. Sympathetic reflex dystrophy may explain such localized pathophysiology. Connective tissue massage is considered an important component of physical therapy (Moraska et al., 2010). The use of MT by common people has increased significantly in recent years. Given the popularity of MT for stress reduction, a comprehensive review of established literature is important to summarize the effects of MT on physiological indicators of stress-response. Although MT significantly alleviates stress symptoms, due to lack of scientific rigor a definitive understanding of the effects of MT-on various physiological variables associated with stress-is missing (Posadzki & Parekh-Bhurke, 2011). Among existing literature, most data, on the effect of massage on physiological stress indicators, were collected twice weekly for five weeks, and trained therapists assessed the physiological indicators of stress, after single- or multiple-session MT. Although, effect of single MT session on stress indicators were repeatable within a study, a sustained effect was not seen across studies. To date, experimental results on multi-session MT effect on urine cortisol and catecholamines levels are inconclusive. However, it is definitively known that multi-session MT positively affects diastolic blood pressure.

MT increases blood circulation and lymphatic fluid, lowers stress on muscles, helps to remove waste products, and releases endorphins to release tension. Among the different types of massage, abdominal massage can stimulate the gastrointestinal response by stimulating parasympathetic nerve activity. Through mechanical and reflexive methods, it increases peristalsis and changes the pressure in the abdomen, which in turn accelerates the passage of food through the gastrointestinal tract. In patients with nasogastric tubes, abdominal massage reduces muscle tension, improves local circulation, alleviates malnutrition, stimulates gastric acid secretion, increases appetite and intestinal motility, reduces gastric residual volume, reduces abdominal distension, fecal incontinence, intra-abdominal pressure, and constipation. Abdominal massage effectively reduces residual volume and swelling in patients receiving mechanical ventilation in a surgical intensive care unit. Abdominal massage also reduces distension, urinary incontinence, bowel movement frequency, and laxative consumption in spinal cord injury patients. Moreover, in chronically constipated disabled children and elderly people in nursing homes, it increases appetite, bowel movement frequency, stool weight and consistency, and complete defaecation (Dehghan et al., 2020). MT comprising moderate pressure massage, led to weight gain in premature infants. Passive limb movement in preterm infants caused them to gain significantly more weight and increased their bone densities. Several putative mechanisms (such as increases in vagal activity, gastric motility, or IGF-1 and insulin levels) underlying the MT effects on weight gain in preterm infants were analyzed. It was found that increased caloric intake and physical activity were not involved in weight gain. However, greater weight gain was associated with increased gastric motility which was caused by increased vagal activity. Additionally, greater weight gain was associated with increased IGF-1 levels. However, IGF-1 level was not associated with increased vagal activity, suggesting that increased IGF-1 represents an independent pathway for MT mediated weight gain in preterm infants (Field et al., 2011). MT is increasingly being used to relieve symptoms in cancer patients. MT significantly reduces cancer pain compared to treatments not involving massage. Massage is effective in relieving cancer pain, especially surgery-related pain (Lee et al., 2015). MT reduces chemotherapy-induced nausea and vomiting (Mazlum et al., 2013).

This article tries to highlight literature that could help integrate the fields of psychotherapy and massage, given the nature of their individual beneficial effects. In this multifaceted review, we seek to help patients by combining principles of anatomy, physiology, and neuroscience with psychotherapy and MT. Psychotherapists with interdisciplinary knowledge are more likely to provide holistic treatment to depressed patients. A descriptive review and a qualitative and conceptual synthesis of the literature were conducted to create a novel theoretical-pragmatic framework, to introduce accepting MT as part of psychotherapy practice; potentially integrating psychotherapeutic knowledge on managing depressive symptoms with clinical decision-making (Viggo Hansen et al., 2006). Massage and touch are the basis of other therapies offered to reduce or manage various conditions associated with dementia, such as anxiety, agitation, and depression. As a non-pharmacological alternative, massage and touch can offset cognitive decline (Heidari et al., 2022). Various approaches involving massage are effective on patients; and symptoms such as fatigue, pain, anxiety, depression, and convulsions are improved through MT. The results of this review indicate that massage may have beneficial effects on motor and non-motor symptoms, and massage can be considered as a complementary and alternative treatment combined with conventional medicine for patients with multiple sclerosis. Pain and fatigue are best improved by Swedish massage, while anxiety and depression are effectively improved by reflexology. MT can improve behavioral conduct disorders (aggression, anxiety, agitation, resistance to care) in the elderly, and therapeutic massage can be a complementary treatment in rehabilitation programs to improve behavior disorders (Pang et al., 2021). Obesity affects health, and effective preventive measures are needed to reduce the occurrence of obesity-related diseases in childhood. The etiology of simple obesity is spleen deficiency, which can be alleviated with a specific massage. Oriental acupuncture and massage are based on meridian theory; and MT aims to obtain similar therapeutic effects to acupuncture by stimulating specific meridians. Massage is widely applied clinically because it is economical, convenient, and safe. During massage treatment, the therapist touches the skin with their hands, presses, rubs, kneads, grabs, pinches, etc. to penetrate the body with pressure to achieve the therapeutic purpose. Appropriate pressure is required for MT to be effective, and a review of studies comparing medium and light pressure massage suggests that improved growth and development in infants and reduced stress in adults, in response to MT, is observed only with medium pressure massage. Various benefits associated with MT are mediated through increased vagal activity caused by baroreceptors stimulation. MT is becoming increasingly popular in the field of physical therapy and rehabilitation of humans and animals. The widespread application of MT has led to research efforts aimed at providing scientific evidence for its anecdotal beneficial effects, particularly pain relief. MT alters dopamine and serotonin levels, reduces noradrenaline levels, and modulates the immune system. Psychological effects such as reduction of stress and anxiety, along with improvement in depressed patients, are reported in humans (Formenton et al., 2017). Connective tissue massage improves depression and quality of life. Acupressure improves pain, pain pressure threshold, fatigue, sleep, and quality of life. Overall, most MT types have consistently improved quality of life for patients with fibromyalgia (Yuan et al., 2015).

MT is the scientific manipulation of the body's soft tissues to normalize the tissue, and consists of manual techniques that apply fixed or movable pressure and hold and/or move the body. There are over 1500 massage training centers or schools in the United States. Several studies have evaluated the effectiveness of massage for improving children's health and treating various disorders. Pupillary massage increases blood circulation in the body, improves breathing, stimulates growth, and increase concentration and IQ. MT improves the immune system, reduces stress, pain, anger, aggression, and the ability to sleep well (Emtiazy & Abrishamkar, 2016). MT reduces subjectively perceived symptoms of pain in cancer patients receiving palliative care. MT provides relief to palliative care patients in hospices. Thus, MT should be considered as a cost effective and non-invasive intervention that has a positive impact and contributes to the reduction of pain, anxiety and depression in patients with severe cancer (Falkensteiner et al., 2011). Among effects of massage on relaxation, comfort, and sleep, the most consistent effect of massage was anxiety reduction. Massage significantly reduced perceptions of anxiety or tension. We also found that massage induced physiological relaxation manifests as significant changes (in the expected direction) of one or more physiological stress indicators. Moreover, when examining the effect of massage on discomfort, it was found to be effective in reducing pain (Richards et al., 2000). Massage is an effective method of treatment. The main goal of treatment is to reduce pain. Significant improvements in health may be seen with MT. It is easy to administer in daily medical practice (Miernik et al., 2012) (Table 4).