“How, Exactly, Does Massage Therapy Work?”

The Anatomy of Happiness

By Douglas Nelson

As I greeted Craig in the waiting room, the radiant smile on his face told me we were making good progress on his shoulder pain. 


“My shoulder is so much better,” he remarked as he entered my treatment room. “I hardly think about it anymore—not when I am exercising, not during sleep, not at work, nothing. I am thrilled.” As a massage therapist who specializes in dealing with specific muscular issues, this is exactly what I hope to hear from the people I serve. 

“The muscle in the back of my shoulder you treated last session seemed to completely eliminate the remnants of my shoulder pain. Each of our previous sessions has focused on slightly different aspects of my shoulder discomfort, with different muscles playing a role each time. 

I must say that the educational process has been just as valuable as the hands-on work. It has given me a greater understanding of my own body, what to do, and maybe more importantly, what not to do. I discovered that there were motions at work—and also at the gym—that were irritating my shoulder, and I have a better sense of what was happening to my shoulder and why. This whole process is so interesting and educational.”

As someone who prides himself in both precise hands-on treatment and client education, I found that Craig’s statement was music to my ears. “So, I’m a little perplexed,” he announced. 

“About what?” I asked. 

“About how massage works,” he said with a smile.

As a massage therapist who was feeling pretty good about himself, I was thrown for a bit of a loop. 

“I came to see you for help with my shoulder,” he continued, “but one of the most striking benefits of my massage treatment is the effect on my mood. When I leave your office and go back to work, I seem to function much more efficiently; I get way more stuff done than usual. Mostly, I am in a much better mood, much happier, and more positive about the world. I have really enjoyed understanding how massage helped my shoulder, but now I’d like to understand how massage affects my mood.” 

Ready to accept the challenge, I jumped in. 

“Here is one reasonable explanation based on emerging neuroscience. For many decades, the prevailing wisdom was that emotions are experienced in the mind and, as a result, those powerful emotions then affect our body. For example, when someone offends us, we have the emotional experience of anger. Shortly thereafter, we experience physical symptoms of anger, such as increased muscle tension, constricted breathing, and an increased heart rate. On the other hand, powerful positive emotions like joy and happiness also have corresponding physical effects. Our emotions and thoughts have physical consequences. As it turns out, however, the new scientific understanding reveals that these mind-body experiences are at least bi-directional, if not completely the other way around.”

“I’m a little lost,” he said. “What do you mean by the other way around?”

“The emerging science is providing some really good evidence that the physical sensation can lead to the emotion, instead of the emotion manifesting as a physical experience.”

“Wow, that seems completely backward!” he exclaimed. “Give me an example.” 

“Sure. Your mind is always trying to make sense of what the body experiences. The brain needs a reason for what it experiences; we interpret meaning so we know how to respond appropriately. As an example, let’s imagine you have an increased respiration and pulse rate. Are you excited or are you fearful? When you think about it, the physical experiences of excitement and fear are almost identical. The mind must decide which emotion it is based on the context of the experience. If you are seated in a theater waiting for a much anticipated concert to begin, it is excitement. If you are seated in a dental chair, your mind is going to interpret your physical sensations as signs of fear. 

“The same process can occur with regard to a bad mood. I am sure you can remember being really tense some morning, feeling completely out of sorts. If someone asked you why, you probably couldn’t point to any specific offense as the reason. Throughout the morning, however, little things that would normally go unnoticed now really bothered you. You looked for things that were wrong to confirm that the tension you were feeling was perfectly appropriate for the terrible mood you were in. In essence, you created a viable emotional reason to explain your tense physical state.”

“I assume that the reverse is also true, correct?” Craig interjected. “A better physical state should have a positive effect on emotions.”

“Exactly. This might indeed explain what you experience after a massage. You leave my office with a very different physiology than when you arrived. The optimization of muscle function after massage will be experienced as efficient and effortless movement. The muscle tension in your shoulders is drastically reduced. Your breathing is slower and there is a heightened sense of awareness. Think about the emotional correlate your brain must then assign to this new stream of physical information. When do you normally feel such lack of tension, such lightness and freedom?” 

“When I am extremely relaxed, happy, and contented; when the world seems like a wonderful place,” he responded. 

“The experience of physical ease is then interpreted by the brain as being a sign of emotional ease. Relaxation of the body is also relaxation of the mind, as evidenced by the fact that the same class of drugs (benzodiazepines) given as muscle relaxants is also used in the treatment of anxiety disorders. Furthermore, when you return to work with that emotional framework, it changes what you notice around you as well. Little annoyances don’t seem as disturbing. Since attention is selective, your peaceful and positive emotional state predisposes you to notice lots of little blessings that you previously might have overlooked. This process becomes very self-reinforcing.”

“That is fascinating!” Craig said. “I love the idea that not only do emotions affect the body, but that our physical experiences also influence our emotions. It makes so much sense that one can influence the other. This really deepens my understanding of how the body and mind are integrated. Plus, now I see the value of massage at a whole new level. Far more than just relaxing my body, massage is also having a very positive effect on my emotional well-being.”

“That’s great, Craig. I have to tell you, I really enjoy your challenging and thoughtful questions.” 

“I am glad you do, because I find this subject fascinating. In fact, after each of our previous sessions, that evening I’d share with my wife some cool anatomy fact or principle I learned from you. I even gave each lesson a name.”

“You’re kidding,” I said, bemused and curious. “If I might ask, what might you call this one?”

“The Anatomy of Happiness,” he replied with a smile.  


Douglas Nelson is the founder and principal instructor for Precision Neuromuscular Therapy Seminars and president of the 16-therapist clinic BodyWork Associates in Champaign, Illinois. His clinic, seminars, and research endeavors explore the science behind this work. For more information, visit www.nmtmidwest.com, or email doug@nmtmidwest.com