Massage

Full-body massage: five strokes, one sequence

A classical full-body massage, the Swedish massage at the core of most training programmes, is built from 5 stroke families: effleurage, petrissage, friction, tapotement and vibration, applied in that order because each prepares the tissue for the next. A session takes 60 to 90 minutes, runs from the extremities towards the heart and ends with 10 to 15 minutes of rest. A therapist who uses a single movement for a whole hour is not giving you a classical massage.

Five strokes, and why the order is not optional

Effleurage opens and closes every treatment: long, gliding strokes with the flat of the hand, 3 to 5 passes over each region, always towards the heart. It spreads the oil, lets the skin get used to the touch and gives the therapist a first reading of where the tissue is tight. A muscle that is pressed before it is warm tenses against the hand.

Petrissage is the core of the hour. The therapist lifts, rolls and squeezes the muscle between fingers and thumb, working across the fibres of the shoulders, back, glutes and calves. It takes 40 to 50 percent of a 60-minute session and is where stuck layers of muscle are loosened and where you feel it the next day. Friction follows on single hard spots: small circles or short back-and-forth movements with the thumb or fingertips, 20 to 30 seconds per point, held until the tissue gives.

Tapotement, rhythmic tapping with cupped hands, the edge of the hand or loose fists, is stimulating, so it belongs to the morning or to a sports massage before an event and is often left out of an evening session; 30 to 60 seconds per region is enough. Vibration, a fine shaking of the tissue with the flat hand for 10 to 20 seconds, calms what tapotement has stirred and closes each region before the final effleurage. The 2 trials that put Swedish massage under laboratory conditions used exactly this set, which is what a therapist means by classical technique.

Sixty or ninety minutes, and what fits into each

A full-body massage takes 60 to 90 minutes. In 60 minutes the weight lies on the back, shoulders and the back of the legs: about 20 to 25 minutes for the back and neck and 10 to 15 for the legs, with a shorter pass over arms, hands, feet and the front of the legs. In 90 minutes those regions get their own full time and 5 to 10 minutes on the scalp and face are added. If you only want the back, book a 30-minute neck and back massage instead.

The sequence is the same everywhere: you lie face down under a sheet, the therapist works from the shoulders down to the feet, you turn, and the work runs from the feet back up to the shoulders. Within each limb the strokes run from the far end towards the trunk, calf before thigh, forearm before upper arm, because veins and lymph vessels drain that way. About 20 to 30 millilitres of a neutral oil is enough for a whole body; scented oils belong to aromatherapy massage and follow their own dilution rules. The room should be 24 to 26 °C, because a cold client cannot relax a muscle.

Pressure is agreed, not guessed. On a scale of 0 to 10, most people relax best between 5 and 7; say so if it drifts either way. Afterwards, stay lying down for 10 to 15 minutes and drink 2 to 3 glasses of water over the next hours. Soreness the following day is possible after intensive petrissage and settles within 24 to 48 hours; it is a reaction of the tissue, not a sign of a mistake. Expect 60 to 120 EUR for 60 minutes in western Europe and 80 to 150 USD in the United States.

What one session does, measured

The clearest data come from a randomised trial with 53 healthy adults aged 18 to 45 who received either 45 minutes of Swedish massage or 45 minutes of light touch with the back of the hand, from the same licensed therapists. After the massage, arginine vasopressin, a hormone tied to stress and blood pressure, fell significantly compared with light touch; cortisol fell too, but only slightly and not significantly. The number of circulating lymphocytes was higher 60 minutes after the massage, and several signalling proteins of the immune system were lower. One session changes the body's chemistry, modestly and for a while.

The same group then tested the dose: 45 minutes once a week or twice a week for 5 weeks. Once a week produced the larger rise in lymphocytes, with effect sizes between 0.77 and 1.27; twice a week raised oxytocin and lowered cortisol, with effect sizes of 0.50 to 0.67, but pushed some immune markers the other way. The authors' conclusion: more is not simply better, the frequency changes what the body does with the massage. For most healthy people a session every 2 to 4 weeks is a sensible rhythm, weekly for a few weeks if a specific problem is being worked on.

For pain the evidence is thinner than the brochures suggest. A 2015 review of 25 studies with 3,096 participants found short-term improvements in low back pain after massage, but the quality of the trials was low and the reviewers had very little confidence in a lasting effect. A 2013 review of 12 studies with 757 participants found massage better than doing nothing for neck and shoulder pain, and no better than other active treatments. That is why the British guideline on low back pain, published in 2016 and amended in 2026, allows massage only as part of a package that includes exercise. Regular movement, including a short stretch break at the desk, does what the massage cannot.

When the therapist should say no

Some conditions rule out massage on the day. Fever and acute infections, because the circulation is already working hard. A fresh injury, roughly the first 72 hours after a sprain, strain or heavy bruise, while bleeding into the tissue is still possible. A thrombosis or the suspicion of one: a single calf that is swollen, warm and painful is not massaged but examined, because a clot can be pushed loose. Acute inflammation with swelling and heat, open skin, a rash or an infection of the skin over the area. Reported harms are rare, but they include exactly these 3, clots, nerve injury and fractures, mostly after vigorous work or in older people.

Other conditions change the work rather than cancel it. With osteoporosis the pressure stays light and tapotement is left out entirely. On anticoagulants, deep petrissage bruises, so the therapist stays superficial. In pregnancy most practices work from week 13, in side-lying from about week 20 so that the weight of the uterus does not rest on the large vein along the spine, and leave the abdomen alone. Cancer, surgery in the last 6 weeks, diabetes with reduced sensation in the feet and heart disease need a word with the treating doctor first, and then usually a gentler protocol. A therapist who asks about all of this before you undress is doing the job properly; one who asks nothing is a reason to get dressed again.

Who may massage you, three examples

The word massage covers 2 professions that often share a building. Medical massage treats a diagnosis on a doctor's prescription; wellness massage in a spa or institute is a service you pay for yourself. Who may do which is decided nationally. In the United States, 45 states and the District of Columbia license massage therapists, typically after a programme of 500 to 1,000 hours and an examination; 10.9 percent of American adults had a massage in 2022, up from 4.8 percent in 2002. In the United Kingdom there is no statutory register for massage, only for osteopaths and chiropractors, so the health service advises choosing a therapist on a voluntary register accredited by the Professional Standards Authority. Germany trains medical masseurs for 2 years plus a 6-month placement under a federal law, and only they and physiotherapists deliver massage on prescription; the spa therapist next door works under no such law.

If you have a diagnosis, ask for the regulated profession and the prescription route, and expect a targeted treatment of 20 to 30 minutes rather than a 90-minute session. If you want the classical full-body massage for its own sake, look at the training, at the questions asked before the first session and at whether all 5 strokes appear in the hour. A consultation form and proof of insurance are the 2 documents a good practice has ready.

Before you lie down

Frequently asked

How long does a full-body massage take?

60 to 90 minutes. In 60 minutes most time goes to the back, shoulders and the back of the legs, with a shorter pass over arms, hands, feet and the front of the legs; in 90 minutes those regions get full time and 5 to 10 minutes on scalp and face are added. Plan 10 to 15 minutes of rest on the table afterwards.

Is it normal to feel sore the day after?

After intensive petrissage, yes. The soreness feels like the day after training and settles within 24 to 48 hours. Sharp pain, bruising or pain that is getting worse after 2 days are not normal and should be looked at.

When should I not have a massage?

With fever or an acute infection, in the first 72 hours after an injury, with a suspected thrombosis, with acute inflammation that is swollen and warm, and over open or infected skin. With osteoporosis, blood thinners or in pregnancy the massage is adapted rather than cancelled.

How often should I book one?

The laboratory trials used 45 minutes once or twice a week for 5 weeks and found that the frequency changes what the body does with the massage. For healthy people a session every 2 to 4 weeks is a sensible rhythm; weekly sessions for a few weeks make sense when a specific problem is being treated.

Can I have a full-body massage during pregnancy?

Usually yes from week 13, with a therapist trained in pregnancy massage. From about week 20 you lie on your side rather than on your back, the abdomen is left alone and the pressure stays light. Check with your midwife or doctor first if the pregnancy has complications.

What is the difference between a wellness massage and a medical massage?

Medical massage treats a diagnosis on a doctor's prescription and is delivered by a regulated profession, usually in 20 to 30 minute sessions. Wellness massage in a spa is a service you pay for yourself; who may offer it depends on the country, from state licences in 45 US states to voluntary registers in the UK.

Sources

• NCCIH (National Institutes of Health): Massage Therapy: What You Need To Know · Swedish massage as the core of training; 10.9 percent of US adults in 2022, 4.8 percent in 2002; 45 states plus the District of Columbia license therapists; 2015 review of 25 studies with 3,096 participants and 2013 review of 12 studies with 757 participants; rare harms: clots, nerve injury, fractures
• Rapaport MH et al.: A preliminary study of the effects of a single session of Swedish massage on hypothalamic-pituitary-adrenal and immune function in normal individuals (J Altern Complement Med 2010, via PubMed Central) · 53 healthy adults aged 18 to 45, 45 minutes of Swedish massage versus light touch; techniques effleurage, petrissage, kneading, tapotement and thumb friction; prone from shoulders to feet, then supine; vasopressin down, lymphocytes up 60 minutes later
• Rapaport MH et al.: A preliminary study of the effects of repeated massage on hypothalamic-pituitary-adrenal and immune function in healthy individuals: a study of mechanisms of action and dosage (J Altern Complement Med 2012, via PubMed Central) · 45 minutes once or twice weekly for 5 weeks; once weekly raised lymphocytes (effect sizes 0.77 to 1.27), twice weekly raised oxytocin and lowered cortisol (effect sizes 0.50 to 0.67)
• NICE guideline NG59: Low back pain and sciatica in over 16s, recommendations · recommendation 1.2.7: consider manual therapy including soft tissue techniques such as massage only as part of a treatment package that includes exercise; published 2016, amended 2026

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This guide is for general information. It does not replace medical or professional cosmetic advice or an examination.