Efficacy of Manual Massage Therapy on Spasticity in Patients with Stroke and Cerebral Palsy: A Systematic Review and Meta-Analysis

Abstract

Background

Spasticity commonly complicates upper motor neuron syndromes, reducing quality of life. While manual massage is widely used to manage muscle tone, its overall efficacy remains unquantified.

Objective

To evaluate the effectiveness of pure manual massage interventions (without instruments) for reducing spasticity in patients with stroke and cerebral palsy and clarify its clinical neurorehabilitation role.

Methods

A systematic search of multiple databases identified randomized controlled trials (RCTs) investigating manual massage for spasticity in patients with stroke or cerebral palsy. The primary outcome was spasticity measured by the Modified Ashworth Scale. Bias was assessed using RoB 2.0. We conducted a random-effects meta-analysis calculating pooled standardized mean differences (SMDs).

Results

Four RCTs (n = 253) were included. Manual massage was associated with reduced spasticity compared with controls (SMD=0.59, 95% CI 0.31–0.87), with low-to-moderate heterogeneity (I²=35.7%). Subgroup analysis demonstrated consistent, significant improvements in children with cerebral palsy (SMD=0.56, I²=0%). Conversely, results in adult stroke populations were non-significant with substantial heterogeneity (SMD=0.78, I²=73%). Despite spasticity reductions, downstream functional outcomes were not consistently improved.

Conclusions

Manual massage may be considered as a preparatory adjunct for reducing spasticity, particularly in children with cerebral palsy. However, the evidence base remains limited, most included interventions were delivered alongside conventional rehabilitation, and functional benefits were not consistently demonstrated.