Swedish Massage Matches Hip Exercises for Knee OA Pain Relief in Older Adults

Knee osteoarthritis (KOA) affects roughly 18% of women and 10% of men over age 60, causing pain, stiffness, reduced mobility, and increased fall risk. Pharmacological options like NSAIDs carry significant risks in older adults, making non-pharmacological alternatives increasingly important. Despite evidence supporting both Swedish massage and hip-strengthening exercises individually, no prior study had directly compared them in an older adult population.

Researchers at Rafsanjan University of Medical Sciences conducted an 8-week, three-arm randomized controlled trial enrolling 75 adults over 60 with symptomatic KOA (VAS pain 40–70 mm). Participants were randomized to self-administered Swedish massage (SM), hip strengthening exercises (HSE), or a control group receiving only routine care. Both active groups trained in 45-minute face-to-face sessions before performing their protocols at home three times per week for 30 minutes. SM involved effleurage, petrissage, and tapotement around the knee. HSE used resistance bands for side-lying leg lifts, single-leg stabilization, and step abductions with progressive Thera-Band resistance. Adherence was tracked via daily logs, weekly phone calls, and bi-weekly clinic visits.

Seventy participants completed the study (93.3% retention). Intention-to-treat ANCOVA adjusted for baseline values showed both interventions significantly outperformed control. SM reduced VAS pain by an adjusted 0.81 cm (d = 0.69, p < 0.001) and HSE by 0.77 cm (d = 0.65, p < 0.001). KOOS-ADL function scores improved by 3.59 points with SM (d = 0.71) and 3.40 points with HSE (d = 0.67). Active knee flexion ROM increased by 3.42° for SM and 3.69° for HSE versus control. Effect sizes were in the moderate range for all outcomes. No serious adverse events were recorded in either intervention group.

Notably, SM and HSE did not differ significantly from each other across any outcome, though SM showed a marginally larger improvement in daily function (KOOS-ADL). The authors suggest this ADL benefit may reflect SM's unique mechanisms: improved local circulation, reduced muscle tension, and possibly neurological pain modulation — benefits that operate independently of muscular strengthening.

Key caveats temper these findings. Participant blinding was not feasible, introducing potential placebo and detection bias despite blinded outcome assessors. The control group received less contact time, raising the possibility that attention effects contributed to the active group advantages. The trial was conducted in a single Iranian outpatient center with a homogeneous sample, limiting generalizability. The 8-week follow-up cannot confirm whether benefits persist long-term. Additionally, the study was not powered to detect between-intervention differences, so the apparent equivalence of SM and HSE should be interpreted cautiously.