Massage Therapy in Naturopathic Practice: A Critical Narrative Review of Mechanistic Rationale, Clinical Evidence and Conceptual Coherence

Abstract

Massage is among the oldest and most widely recognised components of naturopathic physical medicine, yet its position within the discipline has become unsettled. Naturopathic philosophy justifies manual therapy through claims about circulation, elimination, nervous regulation and the stimulation of self-healing capacity, whereas the contemporary evidence base evaluates massage as an isolated modality tested against pain, anxiety and function in narrowly defined populations. This review examines that divergence. Its purpose is to assess how far the mechanistic rationale offered for massage within naturopathy survives critical scrutiny, what the clinical literature can and cannot support, and where the methodological architecture of the field constrains further progress. Literature was identified through scholarly indexes and citation registries accessible during the review, supplemented by backward and forward citation searching, with the final search conducted on 9 June 2026. Four findings dominate the synthesis. Mechanotransduction in skeletal muscle has emerged as the most biologically credible mechanism, supported by human biopsy work and animal models, although the translational distance between molecular signalling and patient-reported benefit remains large. The cortisol hypothesis, long central to naturopathic and popular accounts of massage, is not supported by rigorous between-group analysis and should be retired as a primary explanatory device. Affective touch mediated by C-tactile afferents offers a more coherent account of the affective and analgesic responses observed in practice, though it has rarely been tested using recognisable massage protocols. Clinical benefit is most defensible for short-term pain and anxiety reduction in palliative, perioperative and musculoskeletal contexts, but certainty of evidence is consistently low, effect durability is poorly characterised, and expectancy appears to contribute substantially to observed outcomes. Progress requires adequately dosed, longer trials with credible comparators, standardised intervention reporting, and mechanistic work that connects tissue-level responses to symptoms patients care about. The naturopathic claim for massage remains plausible but is presently underdetermined by evidence.