How Stress Affects the Body and How Massage May Help

Stress is not simply a feeling in the mind, nor is it caused by one troublesome hormone. It is a coordinated response involving the brain, nervous system, hormones, immune signalling, attention and behaviour. In the short term, that response is useful. It helps you meet a deadline, react to danger or manage an unfamiliar challenge. Difficulties are more likely to develop when demands remain high and opportunities to recover become too brief or infrequent.

Massage cannot remove a demanding workload, resolve a difficult relationship or make the causes of stress disappear. What it may offer is something different but still valuable: a protected period of rest, skilled and consensual touch, relief from physical discomfort and an opportunity to feel less hurried or vigilant.

What Happens in Your Body When You Feel Stressed?

When your brain interprets a situation as demanding or threatening, the sympathetic branch of your nervous system responds rapidly. Your heart may beat faster, your breathing can become quicker or shallower, your attention narrows and your muscles prepare for action. A slower hormonal pathway, known as the hypothalamic–pituitary–adrenal axis, also contributes by releasing cortisol.

Cortisol is often described as a harmful “stress hormone”, but it is essential to health. It helps regulate energy, blood pressure, inflammation and the sleep–wake cycle. In their detailed examination of the stress response, Herman and colleagues (2016) explain that healthy regulation depends upon the timing, scale and duration of cortisol activity, as well as the body’s ability to settle afterwards. The aim is not to keep cortisol permanently low, but to have a stress response that can rise when needed and subside when the immediate demand has passed.

When stress continues for a long time, this regulation may become less adaptable. That does not necessarily mean that cortisol remains continuously elevated. Some people develop exaggerated responses, while others show flatter or otherwise altered daily patterns. It is therefore more helpful to think of ongoing stress as affecting the regulation of several interconnected systems than as leaving a single hormonal tap permanently open.

How Ongoing Stress Can Feel

Stress does not feel the same for everyone. You might notice it as tension through your jaw, neck or shoulders, while someone else becomes more aware of headaches, digestive discomfort or a racing heartbeat. Sleep may become disrupted, leaving you tired and less able to concentrate during the day. Irritability, worry, indecision and a sense of being overwhelmed can accompany these physical changes.

Stress can also affect everyday behaviour. When your physical and emotional resources are already stretched, regular movement, social contact and nourishing routines may gradually give way to inactivity, withdrawal or greater reliance on alcohol, smoking or comfort eating. These responses are not necessarily personal failures. They can be attempts to find immediate relief when more restorative forms of recovery feel difficult to access.

Stress and pain can also reinforce one another. Feeling threatened or under pressure may increase protective muscular activity and make physical sensations feel more prominent or concerning. Pain can then disturb sleep, movement and concentration, creating an additional source of stress. This does not mean that pain is imaginary or “all in the mind”. It means that tissue sensitivity, sleep, attention, emotion, previous experience and your present circumstances continually influence how pain is experienced.

The World Health Organization (2026) similarly recognises that prolonged stress can aggravate existing health problems and contribute to anxiety or depression when its effects persist and begin to interfere with daily life. How stress affects you depends not only on how much pressure you face, but also on how long it lasts, what it means to you and whether you have sufficient opportunities for recovery.

What Might Massage Add to Rest?

A massage treatment brings together several influences that are difficult to separate. Touch and pressure are important, but so are warmth, comfortable positioning, focused attention, reduced movement, communication, the therapeutic relationship and time away from ordinary demands. These are not irrelevant additions to the treatment. Together, they help shape whether an experience feels comfortable, reassuring and safe.

In 2024, Packheiser and colleagues brought together 137 controlled studies involving 12,966 participants. Across different types of touch intervention, their analysis found moderate improvements in adult pain, immediate anxiety, more persistent anxiety symptoms and depressive symptoms. Repeated sessions were also associated with greater improvements in some longer-term outcomes.

These findings support the therapeutic value of touch, but they do not identify one universal mechanism or ideal massage technique. The studies involved different populations, treatment styles and session schedules. Many were relatively small, and it is impossible to conceal fully from someone whether or not they are receiving touch. Massage can provide meaningful benefits, but the research does not suggest that everyone will respond in precisely the same way.

Giving Your Body an Opportunity to Settle

During massage, you may notice your breathing slowing, your thoughts becoming less busy or your body beginning to feel heavier, warmer or more at ease. These experiences are consistent with a temporary reduction in arousal, although the physiology is more complex than simply switching the body from “fight or flight” into “rest and digest”.

Meier and colleagues (2020) explored this response in 60 healthy young women. Ten minutes of massage produced a greater increase in high-frequency heart-rate variability than quiet rest. Heart-rate variability describes the small variations in time between successive heartbeats; under suitable conditions, an increase in its high-frequency component can indicate greater parasympathetic influence.

Importantly, quiet rest also improved heart-rate variability and the participants’ reported sense of relaxation. This suggests that some of the benefit experienced during massage may also come from stopping, resting and receiving focused care. Touch may add to this experience, but breathing, posture, attention, interpersonal contact and temporary relief from everyday demands are likely to contribute as well.

Massage may therefore help you experience a calmer state without permanently “resetting” or “rebalancing” your nervous system. Roura and colleagues (2021) examined 12 systematic reviews investigating the autonomic effects of manual therapies. Although changes were sometimes recorded, their direction and size were inconsistent, and their clinical importance remained uncertain. It is reasonable to describe massage as an opportunity for relaxation and reduced arousal, but not as a guaranteed method of permanently retraining the nervous system.

Easing Tension and Physical Discomfort

Stress is commonly accompanied by muscular guarding, stiffness and increased sensitivity, particularly around the jaw, neck, shoulders and lower back. Massage may temporarily reduce discomfort, change how pressure or movement is perceived and make comfortable movement feel more accessible. When an uncomfortable area feels less demanding, you may also spend less time monitoring or worrying about it.

Mak and colleagues (2024) examined 129 systematic reviews of massage for painful conditions in adults. Among the reviews that formally evaluated the quality of the evidence, most conclusions were supported by low- or very-low-certainty evidence. A smaller number of pain outcomes reached moderate certainty, but convincing evidence that massage consistently performed better than other active treatments was rare.

This does not mean that relief is unimportant. Massage can be a reasonable part of pain and tension management when you find it helpful and the treatment is appropriate for your circumstances. A period of reduced discomfort may make it easier to sleep, walk, exercise, work or participate in rehabilitation. The value of relief depends partly upon what it enables you to do.

Massage should not, however, be expected to physically break down “knots”, flush toxins from the body, correct posture or permanently reshape tissues. Its most supportable benefits concern comfort, temporary symptom modulation and the possibility of movement feeling easier or less guarded.

Feeling Calmer and Less Preoccupied

Some of the clearest benefits of massage are those reported by the person receiving it: feeling calmer, less anxious, more comfortable or temporarily less preoccupied with physical discomfort. These experiences matter because stress is not defined solely by what can be measured in blood, saliva or heart-rate recordings. It is also shaped by how manageable your circumstances feel.

Zhang and colleagues (2021) examined physical relaxation methods in 688 healthcare workers. Their systematic review and network meta-analysis found that massage produced a modest reduction in occupational stress when compared with no intervention. The results were encouraging, although they came from a relatively small collection of studies involving a particular working population.

Massage is not a treatment for an anxiety disorder, depression or occupational burnout. It may nevertheless provide supportive relief while you address sleep, workload, movement, relationships, psychological health and the circumstances contributing to your stress. A restorative experience does not need to resolve every underlying problem before it can have value.

What Can Hormone Measurements Tell Us?

You may have encountered claims that massage reduces cortisol by approximately 31 per cent. This figure has been widely repeated, but it does not provide a reliable account of the research.

Moyer and colleagues (2011) found that the familiar percentage had largely been derived from changes measured within groups receiving massage, without adequately comparing those changes with control groups. When the researchers used the more appropriate comparison between massage and control conditions, the effects on cortisol were generally small and statistically indistinguishable from zero.

Cao and colleagues (2026) subsequently mapped the findings of 72 studies investigating cortisol and oxytocin responses to massage and other manual therapies. Approximately half of the cortisol studies reported a significant change, while the remainder found no effect or changes resembling those seen in comparison groups. Research into oxytocin was more limited and similarly inconsistent. Treatment methods, sample sizes, biological samples and measurement times varied considerably, making firm conclusions difficult.

You can feel deeply calm after a massage without showing a large or readily measurable hormonal change. This does not make the experience less real. It shows that relaxation cannot be reduced to one chemical measurement. Comfort, attention, expectation, bodily sensation, human interaction and the opportunity to pause may all contribute to how you feel.

Massage, Blood Pressure and Immunity

Your heart rate and blood pressure may fall temporarily as you become more comfortable, but this is not the same as treating hypertension or preventing cardiovascular disease. Vijayakumar and colleagues (2024) combined studies involving 290 people with hypertension and found only minimal and statistically uncertain reductions in blood pressure, with considerable inconsistency between the results.

If you are receiving treatment for high blood pressure, massage may be used for comfort and relaxation where appropriate, but it should not replace clinical assessment, prescribed medication, physical activity or other established approaches to cardiovascular health.

Claims that massage “boosts” the immune system also go beyond what the evidence can presently support. Small studies have reported changes in circulating immune cells or inflammatory markers, but a change in a laboratory measurement does not necessarily mean that the body has become better protected against disease. Research has not established that massage prevents infection, strengthens immunity or accelerates recovery from illness. Its role is better understood as supportive care.

How Massage May Support You

Massage does not need to produce dramatic hormonal or immune changes to be worthwhile. Its value may lie in the combined experience of uninterrupted time, responsive touch, reduced physical discomfort and temporary freedom from the expectation that you must continue doing or achieving something.

For some people, massage makes slower breathing and bodily awareness easier. You may recognise how much tension you have been carrying, discover that an area can move more comfortably than expected or simply experience a period in which your body demands less attention. If discomfort decreases, sleep, activity and concentration may improve indirectly. Immediate anxiety and perceived stress may also lessen, even though the external source of the stress remains.

Rather than forcing your body into a prescribed nervous-system state, massage may create conditions in which vigilance feels less necessary for a while. Your response remains individual, which is why pressure, pace, positioning and communication should be adapted to you rather than imposed as a fixed treatment formula.

Touch itself is personal. What one person experiences as reassuring may feel unfamiliar or uncomfortable to another. A constructive massage experience therefore depends not only on technique, but also on trust, clear communication, informed consent and your continuing freedom to alter or stop the treatment.

Making Massage Part of a Wider Approach

Massage is likely to be most helpful when it forms one part of a broader approach to managing stress. Longer-term recovery may also depend upon regular movement, adequate sleep, supportive relationships, manageable working conditions, time outdoors, psychological support or medical care. The right combination will depend upon your circumstances and the sources of pressure in your life.

If stress persists, interferes with your work or relationships, or is accompanied by severe anxiety, sustained low mood, panic, chest pain or other concerning symptoms, an appropriate healthcare professional should be consulted. Seeking further support does not mean that massage has failed. It recognises that some difficulties need a wider form of assessment and care.

Massage is generally considered low risk when it is delivered appropriately, but it is not suitable in every circumstance. Your practitioner should be told about relevant health concerns, including recent surgery or injury, pregnancy, osteoporosis, cancer treatment, anticoagulant medication, unexplained swelling, acute illness or skin conditions. Treatment can then be adapted, postponed or referred for medical advice where necessary.

What You Can Reasonably Expect from Massage

Massage is not a biochemical switch that reliably lowers cortisol, releases a guaranteed mixture of “feel-good chemicals” or strengthens the immune system. What it can offer is more grounded and more personal: reduced anxiety, perceived stress and physical discomfort for some people, particularly in the short term, together with a structured opportunity for rest and recovery.

You do not need to experience a dramatic physical or emotional transformation for a massage to have been worthwhile. Its value may be found in feeling more comfortable, moving with less apprehension, sleeping more easily or simply having a period in which you feel listened to, unhurried and able to rest.

The effects will not be identical for everyone, and massage cannot remove every source of stress. However, when it is delivered thoughtfully, adapted to your needs and supported by clear communication and consent, it can provide a meaningful space in which comfort and recovery become more possible.

References

Cao, A.T., Alanazi, M.S., Billings, R. and Reed, W.R. (2026). ‘Physiological changes of cortisol and oxytocin following manual therapy: a scoping review’. Frontiers in Rehabilitation Sciences, 7, 1719735. https://doi.org/10.3389/fresc.2026.1719735

Herman, J.P., McKlveen, J.M., Ghosal, S., et al. (2016). ‘Regulation of the hypothalamic–pituitary–adrenocortical stress response’. Comprehensive Physiology, 6(2), pp. 603–621. https://doi.org/10.1002/cphy.c150015

Mak, S., Allen, J., Begashaw, M., et al. (2024). ‘Use of massage therapy for pain, 2018–2023: a systematic review’. JAMA Network Open, 7(7), e2422259. https://doi.org/10.1001/jamanetworkopen.2024.22259

Meier, M., Unternaehrer, E., Dimitroff, S.J., et al. (2020). ‘Standardized massage interventions as protocols for the induction of psychophysiological relaxation in the laboratory: a block randomized, controlled trial’. Scientific Reports, 10, 14774. https://doi.org/10.1038/s41598-020-71173-w

Moyer, C.A., Seefeldt, L., Mann, E.S. and Jackley, L.M. (2011). ‘Does massage therapy reduce cortisol? A comprehensive quantitative review’. Journal of Bodywork and Movement Therapies, 15(1), pp. 3–14. https://doi.org/10.1016/j.jbmt.2010.06.001

Packheiser, J., Hartmann, H., Fredriksen, K., Gazzola, V., Keysers, C. and Michon, F. (2024). ‘A systematic review and multivariate meta-analysis of the physical and mental health benefits of touch interventions’. Nature Human Behaviour, 8, pp. 1088–1107. https://doi.org/10.1038/s41562-024-01841-8

Roura, S., Álvarez, G., Solà, I. and Cerritelli, F. (2021). ‘Do manual therapies have a specific autonomic effect? An overview of systematic reviews’. PLOS ONE, 16(12), e0260642. https://doi.org/10.1371/journal.pone.0260642

Vijayakumar, V., Boopalan, D., Ravi, P., et al. (2024). ‘Effect of massage on blood pressure in patients with hypertension: a meta-analysis’. Journal of Bodywork and Movement Therapies, 37, pp. 109–114. https://doi.org/10.1016/j.jbmt.2023.11.028

World Health Organization (2026). ‘Stress’. Available at: https://www.who.int/news-room/questions-and-answers/item/stress

Zhang, M., Murphy, B., Cabanilla, A. and Yidi, C. (2021). ‘Physical relaxation for occupational stress in healthcare workers: a systematic review and network meta-analysis of randomised controlled trials’. Journal of Occupational Health, 63(1), e12243. https://doi.org/10.1002/1348-9585.12243