Can Massage Therapy Help With Concussion Recovery?

Concussions are complex injuries with wide-ranging effects, and their recovery process can be equally multifaceted. Among clinicians and healthcare professionals seeking supportive therapies for concussion recovery, massage therapy is often mentioned. 

But can it really play a meaningful role in concussion recovery?

Let’s examine the potential benefits of massage therapy within the scope of post-concussion care, backed by clinical reasoning, research literature, and practical application. While massage is not a primary intervention for concussion itself, it may offer valuable support when applied thoughtfully as part of a multidisciplinary treatment plan.

Understanding Concussions and Recovery Challenges

Concussions are mild traumatic brain injuries (mTBIs) caused by biomechanical forces, often occurring in sports, accidents, or falls. Symptoms may include headache, dizziness, nausea, light and sound sensitivity, cognitive changes, and emotional dysregulation. Most individuals recover within a few weeks, but for others, symptoms may persist—referred to as persistent concussion symptoms (PCS).

The 2022 Consensus Statement on Concussion in Sport outlines a graduated return-to-learn and return-to-play process, emphasizing rest followed by guided, individualized progression based on symptoms. However, symptom overlap with cervical and vestibular dysfunction, as well as autonomic and emotional disturbances, can complicate recovery.

While vestibular therapy and cognitive rest are well-established interventions, massage therapy has attracted interest for its potential to address co-occurring musculoskeletal and autonomic factors that can exacerbate or prolong symptoms.

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Massage Therapy’s Mechanisms of Action

Massage therapy involves the manipulation of soft tissues to improve circulation, reduce muscle tension, alleviate pain, and promote relaxation. Its physiological and neurological effects may intersect with several systems implicated in concussion symptoms:

  1. Autonomic Nervous System Regulation: Concussions often disrupt autonomic balance, resulting in symptoms like elevated heart rate, poor sleep, and anxiety. Massage therapy may help shift the autonomic response from sympathetic dominance (fight-or-flight) to parasympathetic activity (rest-and-digest), fostering systemic relaxation.

  2. Myofascial and Cervicogenic Contributions: Neck trauma is common in concussive injuries, particularly in contact sports or falls. Cervical dysfunction—especially involving the upper cervical spine—can mimic or exacerbate headache, dizziness, and visual disturbances. Massage targeting these regions may reduce trigger point activity and improve soft tissue mobility, potentially alleviating symptoms.

  3. Pain Reduction and Neuromodulation: Massage can modulate nociceptive input through gate control theory and descending inhibitory pathways, offering temporary relief from persistent headache or muscle pain associated with concussion.

  4. Psychological Relief and Sleep Support: Anxiety and disrupted sleep are common post-concussion. Studies show massage can reduce cortisol levels and increase serotonin and dopamine, potentially improving mood and supporting circadian rhythm normalization.

What the Research Says

While the evidence base for massage therapy specifically in concussion recovery remains limited, related studies and clinical observations suggest potential value when appropriately applied.

1. Cervical Involvement and Headache:

A systematic review titled "The effectiveness of manual and exercise therapy on headache intensity, frequency and duration in people with cervicogenic headache: a systematic review and meta-analysis" was published in Cephalalgia in 2016. This review evaluated the impact of manual therapies, including soft tissue mobilization, on cervicogenic headaches, finding that such interventions may reduce headache intensity and frequency. ​PMC

2. Autonomic Regulation:

Research by Tiffany Field, published in The Journal of Alternative and Complementary Medicine in 2014, reviewed the effects of moderate pressure massage. The study indicated that such massage can lead to increased vagal activity and decreased cortisol levels, suggesting a role in balancing autonomic function. ​Source

3. Psychological Impact:

A meta-analysis conducted by Christopher A. Moyer and colleagues, published in BMC Complementary and Alternative Medicine in 2011, examined the effects of massage therapy. The analysis demonstrated significant reductions in anxiety and improvements in mood among participants receiving regular massage therapy. ​ResearchGate

4. Clinical Integration:

A pilot study" explored the feasibility and preliminary efficacy of an interdisciplinary intervention for persistent post-concussion symptoms. While the sample size was small, results indicated improvements in neck pain and functional status, warranting further study. ​ScienceDirect

Importantly, current consensus guidelines do not include massage therapy as a core treatment modality, but this reflects the state of the research more than clinical rejection. In the presence of muscular tension, cervical dysfunction, or stress-related symptom perpetuation, massage therapy may offer meaningful secondary benefits.

Clinical Considerations: When and How Massage May Help

Massage therapy should not be applied indiscriminately after concussion. Its role is adjunctive and best suited for specific clinical presentations, such as:

  • Cervical musculoskeletal involvement: Tension in suboccipital muscles, levator scapulae, or upper trapezius can drive headache and dizziness. Soft tissue work combined with manual cervical assessment and therapeutic exercise may facilitate symptom resolution.

  • Stress-related exacerbation: Athletes or patients experiencing heightened anxiety, irritability, or sleep difficulty may benefit from relaxation-based massage integrated within a broader behavioral or medical management strategy.

  • Recovery plateaus: For individuals who have passed the acute recovery stage but experience persistent symptoms like neck stiffness, mild headache, or tension, massage may help remove secondary barriers to full recovery.

It’s essential that massage therapy be coordinated with medical providers, athletic trainers, or physical therapists, particularly in athletic settings. Untrained application—especially involving cervical manipulation—can risk symptom aggravation if underlying pathology (e.g., cervical instability) is missed.

Limitations and Cautions

Despite its potential, massage therapy is not appropriate for all concussion cases. Key precautions include:

  • Acute Phase (first 24–72 hours): Massage is not advised during acute rest periods or in the presence of worsening neurological signs.

  • Vascular or Cervical Red Flags: Vertebral artery dissection, upper cervical instability, or cranial nerve involvement warrant thorough screening prior to any manual intervention.

  • Isolated Use: Massage should not be viewed as a standalone concussion treatment. It must be integrated into a coordinated plan involving cognitive, vestibular, and exertional assessment.

Moreover, evidence remains limited, and standardized protocols for massage in concussion care are lacking. This emphasizes the need for case-by-case assessment and clinical judgment, grounded in interdisciplinary collaboration.

A Thoughtful Addition to the Recovery Toolbox

Massage therapy is not a cure for concussion, nor is it a first-line treatment. But when applied with clinical insight, it may ease symptoms related to cervical strain, stress, and autonomic imbalance—factors that often complicate recovery.

Physical therapists and sports medicine providers working with post-concussive patients should consider massage as one tool among many, appropriate for specific symptom profiles and always implemented in consultation with the broader care team.

Ultimately, the goal in concussion care is to guide safe, efficient recovery while addressing the diverse systems affected. Massage therapy, when thoughtfully applied, can contribute meaningfully to that mission.