Although massage is both an art and a science, the early nurse massage specialists recognized massage as a science. Rawlins (1933) stated, “Massage is a science, not a fad of the times” (p. 19). Jensen (1932) defined massage as “the scientific manipulation of body tissue as a therapeutic measure” (p. 2).

Florence Nightingale based the use of nonpharmacological interventions such as massage on the Environmental Adaptation Theory. Nightingale believed that nurses should promote the best possible environment that would allow natural laws to improve the healing process (Dossey, Selanders, Beck, & Attewell, 2005).

Today, perhaps due to the relative lack of its study by rigorous research methods, massage is often thought of as more of an art than a science. Nurse researcher Dr. Tiffany Fields established the first center in the world devoted to the science of touch and massage. The Touch Research Institute was established in 1992 at the University of Miami School of
Medicine (Touch Research Institute, n.d.). Dr. Field was one of the first to study the effects of massage on weight gain in preterm infants (Field, 2002) and build the capacity for nursing science on massage.

Massage is used by nurses to promote health and wellness. It is used to increase circulation, relieve pain, induce sleep, reduce anxiety or depression, and improve quality of life (Rose, 2010). Massage produces therapeutic effects on multiple body systems: integumentary, musculoskeletal, cardiovascular, lymph, and nervous. Manipulating the skin and underlying muscle makes the skin supple. Massage increases or enhances movement in the musculoskeletal system by reducing swelling, loosening and stretching contracted tendons, and aiding in the reduction of soft-tissue adhesions. Friction to the cutaneous and subcutaneous tissues releases histamines that in turn produce vasodilation of vessels and enhance venous return (Snyder & Taniguki, 2010).

Massage is a proposed mechanism for relaxation to reduce psychological and physiological stress (Harris & Richards, 2010). Stress is also an individual subjective experience. When the body interprets a physiological or psychological response as stressful, the sympathetic nervous system stimulates the hypothalamic-pituitary-adrenal (HPA) axis in the brain. There is a release of stress hormones such as cortisol and epinephrine. Tactile stimulation in the body tissues causes neurohormonal responses throughout the nervous system. Mechanoreceptors cause impulses to travel from the peripheral nervous system, up the ascending spinal cord to the neuro cortex. The stimulus is then interpreted in the higher brain resulting in a neurological or biochemical response (Lawton, 2003). Massage activates the parasympathetic nervous system to decrease heart rate, blood pressure, and respirations that result in relaxation (Moraska, Pollini, Boulanger, Brooks, & Teitlebaum, 2010).

Studies show that massage produces physiological and psychological indicators for the relaxation response (Harris & Richards, 2010). Using foot massage with cardiac patients, Hattan, King, and Griffiths (2002) found that subjects receiving this therapy reported feeling much calmer. In a quasi-experimental study (n = 24), Holland and Pokorny (2001) showed a statistically significant difference (p = 0.05) in vital signs before and after the slow-stroke massage intervention. The decrease in vital signs indicates that massage may mediate the stress response (Harris & Richards, 2010).

Reduction of pain, a frequent desired outcome of massage, is closely related to the relaxation response. Through the relaxation response, massage relieves pain by stimulating the large-diameter nerve fibers that have an inhibitory input on T-cells (Furlan, Imamura, Dryden & Irvin, 2008). According to Wang and Keck, “massaging the hands and feet stimulates the mechanoreceptors that activate the nonpainful nerve fibers, preventing pain transmission from reaching consciousness” (2004, p. 59). Studies have validated that patients were more comfortable after the administration of massage (Frey Law et al., 2008; Wang & Keck, 2004).

In addition, research is emerging on how massage impacts the psychoneuroimmunological functions of the body and mind. There was higher natural killer (NK) cytotoxicity and higher daily weight in preterm infants who received massage in a randomized placebo-controlled trial (Ang et al., 2012). Billhult, Lindholm, Gunnarsson, and Stener-Victoria (2008) explored the effect of massage on CD4 + and CD8 + T-cells in women with cancer. Findings revealed that massage had no effect on these indices.

Massage is a holistic therapy that promotes overall health, including emotional well-being (Currin & Meister, 2008); decreases pain and anxiety during labor (Chang, Wang, & Chen, 2002); and increases quality of life (Williams et al., 2005).