Massage Therapy
Massage therapy includes a range of modalities that may be beneficial for those experiencing concussion or post-concussion syndrome symptoms. It may be recommended by doctors for a variety of reasons: to help alleviate tension patterns in the neck and shoulders, to regulate mood disorders, and to improve lymphatic fluid circulation.
Massage for muscle tension and alignment
Neck injuries and whiplash commonly co-occur with concussions. Also, significant muscle tension in the neck and shoulders can develop from bracing against concussion-related headaches. By reducing muscle tension in the head and neck, massage may promote healing from concussions and post-concussion syndrome as well as reduce pain.
In addition to easing muscle tension, massage therapy can affect head, neck, and spine alignment, potentially reducing concussion symptoms. A case study for using massage techniques for post-concussion syndrome can be found here.
Craniosacral therapy
Another form of massage therapy that may be used to treat concussions is craniosacral therapy, which uses light touch on the head and back to gently manipulate the body’s connective tissue and movement of fluids to improve well-being. Craniosacral therapists view the skill as being made of mobile plates that can be manually manipulated to improve skull suture mobility and cerebrospinal fluid flow. More information on this technique can be found here.
Cupping therapy
Cupping therapy, offered by some massage therapists, can be helpful for concussion and post-concussion syndrome symptoms. Cupping therapy is an ancient form of medicine practiced worldwide. A 2015 article in the Journal of Traditional and Complementary Medicine referenced studies showing cupping helped with chronic neck pain, pain management in general, headaches, anxiety, and insomnia. Although there is limited research examining cupping as a treatment for concussion, it appears to alleviate symptoms that are common with concussions and post-concussion syndrome.
In cupping therapy, the cups are made of glass, bamboo, earthenware, or silicone. The therapist lights a small amount of flammable substance in the cup, and as the flame goes out, puts the cup upside down onto the skin. It takes about five minutes to apply multiple cups to the area, which are then left on for between five and twenty minutes. A vacuum is created as the cup cools, causing the skin to rise and blood vessels to expand, which therapists believe improves blood flow to the area, improving recovery.
Cupping leaves temporary purple marks on the skin. Michael Phelps had visible cupping marks on his shoulders and back when he won multiple gold medals at the 2016 Summer Olympics. A WebMD article references Michael Phelps' use of cupping therapy; in the article, Dr. Iman Majd at the University of Washington talks about cupping therapy decreasing pain, improving mobility, and improving the healing process.
Manual lymphatic drainage
Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436. - Own work
Damage to the brain, including a concussion, can trigger an inflammatory response. Although inflammatory responses can be temporarily beneficial for the brain, they can be counterproductive. Inflammatory responses can lead to the accumulation of waste products in the brain if continued long-term, affecting the brain’s recovery and function. The brain has a lymphatic system, called the meningeal lymphatic system, which is responsible for clearing waste products and can be injured by impacts to the brain. An impaired meningeal lymphatic system would have a reduced ability to remove waste products, resulting in accumulation of waste and poorer recovery from concussion.
Some massage therapies affect the lymphatic system by encouraging the movement of lymphatic fluid. This has the possibility of being a valuable treatment for concussion and TBI. One specific massage modality, Manual Lymphatic Drainage (MLD), uses light massage to stimulate the flow of lymphatic fluid. By stimulating movement of the lymphatic fluid, the lymphatic system may have an increased ability to clear waste products from the brain. Although MLD may not directly massage the lymphatic sites in the brain, MLD in other areas may affect the entire body’s lymphatic system.
In general, there is not a large quantity of research assessing the efficacy of MLD as a concussion treatment. However, one study included patients experiencing concussion symptoms after a head injury and assigned them to two categories: experimental, which received MLD (from an osteopathic physician) including “glymphatic and lymphatic drainage of the head and neck,” and control, which received concussion education. They found that the experimental MLD group saw a greater decrease in concussion-like symptoms than the control concussion education group.
In addition to the benefits from MLD, a variety of massage therapies can be used in conjunction to achieve a positive recovery outcome. For example, a case study of a 24-year-old with a sports-related concussion suggests that more than one massage modality could be effective. The patient in the study had been experiencing post-concussion syndrome for 18 months, and as part of the study’s treatment, received 11 massage therapy sessions over three months. The modalities used in the study were MLD (applied to the body) and craniosacral therapy and glymphatic system techniques (which include working on the head). After the three-month treatment schedule, the patient experienced a significant 87% reduction of concussion symptoms. It was hypothesized that the symptoms were caused in part by stagnation of lymphatic fluid and the massage therapy helped to ameliorate this problem.
Finding a massage therapist with experience working with concussion patients
Massage therapists with training in craniosacral therapy
One way to find a massage therapist who has experience with concussions is to look for a practitioner with some training in craniosacral therapy, which focuses specifically on the head, brain, and spinal cord. You may want the practitioner to focus on symptoms in your neck or shoulders; most of the practitioners listed in these search tools are massage therapists in addition to having training in craniosacral therapy. We suggest you use all three of the search tools below because they have different databases.
For a list of suggested questions to ask a prospective massage therapist in terms of their experience with concussions, see our page on craniosacral therapy.
What kind of provider can I see?
Certified lymphedema specialists: these can include PTs, OTs, SLPs, PAs, and more. Most commonly, you will see a PT with this certification.
Craniosacral therapists
Osteopathic physicians
Massage therapists with specific training
Information about credentials for craniosacral therapy
The text below in this section is from our professional contributor Lauren M. Christman, LMT, CBSI/KMI, CCST, who is a practitioner, author, and teacher.
Currently, there is not a unified national credential for CST. Instead, individual schools provide certification programs to prepare students. Most require over 200 hours of training beyond an initial license to touch (such as massage therapist.) Many practitioners also have a background in massage therapy, physical therapy, occupational therapy or a form of psychological or spiritual counseling.
Please note: it is possible for someone to have little or no training and still advertise as a CST — if you have an acute or complex condition, it is important and appropriate to inquire about a practitioner's training and practice experience.