Massage

The Massage recommendation has been downgraded one level because of inconsistent evidence and due to lack of internal consistency with recommendations of equal supporting evidence.

Two high quality study (Pehlivan 2018, Sansila 2019) and one moderate quality study (Perlman 2018) were reviewed that examined massage plus usual care to a usual care control group. Pehlivan et al. applied a leg massage focusing primarily on tissues around the knee for a total of 6 sessions over 3 weeks (Pehlivan 2018). Subjects receiving massage had greater improvements in knee pain at 4 weeks follow-up compared to the usual care control group but there was no difference between groups at 8 weeks. There were also no differences in function between groups at either time point. Perlman et al. applied a 60-minute total body massage one time per week for 8 weeks, followed by bi-weekly sessions for 52 weeks (Perlman 2018).  There was greater improvement in pain and function in the massage group at the 8-week follow-up, but these effects were not sustained for any of the longer-term follow-up timepoints.

Benefits/Harms of Implementation

Patients receiving massage may experience some short-term improvements in pain and function. Massage treatments are generally safe but common side effects may include skin redness or irritation, bruising, muscle soreness, fatigue, and nausea.

Feasibility

The interventions are considered feasible and relatively accessible to the general public. Patients who have transportation issues may have difficulty with obtaining access to treatment.

Future Research

Future research may be warranted to determine how massage could be combined with other interventions for knee osteoarthritis to sustain longer term effects on pain and function.