Massage for Knee Arthritis: What a 222-Person Trial Found

Knee arthritis brings stiff mornings, sore stairs and a knee that complains after a long walk. Massage is one of the treatments people try. A large trial gives a clear picture of what it can do, how long the benefit lasts, and where it fits in a wider plan.

What knee osteoarthritis does to the muscles around the knee

Osteoarthritis changes the joint surfaces of the knee. It also changes how you move. When a knee hurts, people tend to walk with a stiffer leg, avoid bending it fully, and shift weight to the other side. Over time, the thigh muscles can weaken, and the muscles around the knee, hip and calf can feel tight and sore from working in a new way.

Massage does not change the joint surfaces. What it can change is how the muscles and soft tissue around the knee feel, and that can make moving easier for a while. For many people with knee arthritis, the hardest part is getting started with exercise on a sore day, and that is where a period of easier movement helps.

What the largest trial found

The clearest evidence comes from a 2019 trial in the Journal of General Internal Medicine. It enrolled 222 adults with knee osteoarthritis across several sites and compared three groups:

• A 60-minute full-body massage, once a week for eight weeks.
• A 60-minute light-touch session on the same schedule, as an active comparison.
• Usual care, with no added treatment.

At 8 weeks, the massage group had better scores on a standard arthritis questionnaire for pain, stiffness and physical function than both other groups. After the first eight weeks, people in the massage and light-touch groups were assigned at random to continue every two weeks or to stop. At 52 weeks, there was no meaningful difference in change between the groups.

That gives two plain lessons. Massage helped more than light touch, so the effect was more than just attention and a calm hour. And the benefit did not hold for a year, even with sessions every two weeks for some people.

A 2015 review in the Journal of Physiotherapy of 26 trials agrees. It found low-to-moderate evidence that massage reduces pain and improves function in the short term compared with no treatment in people with knee arthritis.

How to use massage well

Given what the trial found, massage works best as a short-term tool inside a longer plan:

• Use a course of weekly sessions to ease a flare of pain and stiffness.
• Use the easier weeks to start or build strength and walking.
• Space massage out once the flare settles, and keep the strength work going.

In our view, the goal of massage for knee arthritis is to make movement easier, so you can keep doing the exercise that supports the knee over time. Our osteoarthritis page and the post on why exercise comes first for knee arthritis explain how a physiotherapist builds that exercise plan.

What a session covers

The trial used a full-body massage, so it is reasonable to look beyond the knee. A session for knee arthritis often covers:

• The front of the thigh, which controls the knee on stairs and slopes.
• The back of the thigh and the calf.
• The outside of the thigh and the hip muscles.
• The soft tissue around the kneecap, with gentle pressure.
• The hips and low back, which often ache when a sore knee changes how you walk.

Pressure stays moderate around the joint, and firm work is kept for the larger muscles of the thigh and hip. Your registered massage therapist will ask about pain during the session and adjust. Our page on your first massage visit explains what to expect.

How to tell if it is working

The trial measured pain, stiffness and day-to-day function with a standard questionnaire, plus knee range of motion and a timed 50-foot walk. You can track the same kinds of things at home without any special tools:

• How stiff the knee feels for the first few minutes after you get up.
• How many stairs you can climb before the knee complains.
• How far you can walk on your usual route before you want to stop.
• How often knee pain wakes you at night.

Write these down before your first massage and again after three or four weekly visits. If they are moving in the right direction, keep going and add strength work. If nothing has changed, the plan needs to change, and a physiotherapy assessment is a good next step.

Self-massage between visits

You can ease tight thigh and calf muscles at home between sessions. Sit with the leg supported and use your hands or a foam roller on the front and outside of the thigh and on the calf, with moderate pressure, for a few minutes each. Keep firm pressure away from the joint itself, the kneecap, and any area that is swollen or warm. Our post on foam rolling explains what the research says about it.

A warm towel or a warm shower before your home exercises can make a stiff knee feel easier to move. Gentle bending and straightening of the knee while sitting, a few times a day, keeps it moving between visits.

Safety around an arthritic knee

Massage is safe for most people with knee arthritis. A few points change the plan:

• A knee that is swollen and warm gets gentle work around it and none directly on it.
• Blood thinners mean lighter pressure, because bruising is more likely.
• After a knee replacement, massage near the scar waits until the wound has closed and the surgeon agrees.

Some signs need a doctor first. A knee that becomes suddenly hot, red and swollen, especially with a fever, needs medical care the same day. If one calf becomes swollen, hot, red and painful, or you become short of breath, call 911 or go to Lions Gate Hospital emergency. A swollen, painful calf can be a blood clot, and massage must never be done over one.

What to tell your massage therapist

A short conversation at the start of the first visit helps the session fit your knee. Bring:

• Which knee hurts, how long it has hurt, and what makes it better or worse.
• Any scans or reports, and whether a doctor has said the arthritis is mild or advanced.
• Any injections, surgery or knee replacement, with dates.
• Your medicines, especially blood thinners and pain medicines.
• What you want to get back to, such as walking the Spirit Trail, gardening, or climbing the stairs at home without stopping.

With that information, the therapist can plan pressure and position, and can tell you whether a physiotherapy assessment should come first.

Other treatments that fit with massage

Massage sits alongside other parts of a knee arthritis plan:

• Strength work for the thigh and hip muscles, set by a physiotherapist.
• Staying active with walking, cycling or swimming at a level the knee tolerates.
• Treatments in the clinic that some people use to ease pain enough to exercise, such as laser therapy for knee osteoarthritis and TECAR for knee osteoarthritis.

None of these replaces exercise. They make it easier to start and keep going.

What the wider research says about massage and pain

A 2024 review in JAMA Network Open mapped 129 systematic reviews of massage for pain in adults. None of their conclusions were rated high certainty, and only 7 were rated moderate certainty, all finding that massage helped pain. Findings that massage beats other active treatments were rare.

That fits the knee trial. Massage can ease pain for a while. It is one part of the plan, and the part that keeps you moving is the exercise you do between visits.

Paying for massage for arthritis

Many work health plans pay for visits with a registered massage therapist up to a yearly limit, and Medstar bills most major plans directly. For people who qualify by income or receive the Guaranteed Income Supplement, the Government of BC's MSP supplementary benefits give partial payment for up to 10 visits each calendar year, shared across massage, physiotherapy and other services. Our coverage page has more detail.

A sensible plan for a sore knee

If knee arthritis is flaring, a practical plan is a course of weekly massage for up to eight weeks, matching the schedule in the trial, while a physiotherapist sets strength work you can do at home. Once the flare settles, space the massage out and keep the exercise going. If pain keeps getting worse, the knee locks or gives way, or night pain stops you sleeping, see your doctor or a physiotherapist for a fresh assessment. The massage therapy guide explains booking and session lengths.

This article is general information, not personal medical advice. A regulated practitioner can confirm whether the patterns described apply to you.

Sources

• Perlman A, et al. Efficacy and safety of massage for osteoarthritis of the knee: a randomized clinical trial. Journal of General Internal Medicine, 2019
• Bervoets DC, et al. Massage therapy has short-term benefits for people with common musculoskeletal disorders. Journal of Physiotherapy, 2015
• Mak S, et al. Use of massage therapy for pain, 2018 to 2023: a systematic review. JAMA Network Open, 2024
• Government of BC: MSP supplementary benefits

This article is for general information only and does not constitute medical advice, diagnosis, or treatment. Individual presentations vary, and assessment findings and treatment plans differ from person to person. If you are experiencing severe symptoms, neurological changes (numbness, weakness, bowel or bladder changes), or a significant trauma, contact your physician or emergency services. Care at Medstar Sport Physio & Health is provided by practitioners registered with their respective British Columbia regulatory colleges.