Short-term Efficacy of massage and related treatments for Ankylosing Spondylitis: A Systematic Review and Meta Analysis.

BACKGROUND

Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease causing significant pain, stiffness, and functional impairment. Conventional treatments are limited by adverse events and poor efficacy for axial manifestations, leading AS patients to seek complementary therapies such as massage. However, no systematic reviews or meta-analyses have synthesized evidence on massage for AS, leaving its efficacy unconfirmed.

METHODS

From inception to July 5, 2025, a comprehensive literature search was conducted using eight electronic databases to identify randomized controlled trials of massage and related treatments for AS. Risk of bias was assessed via Cochrane RoB 2, and data was synthesized using Review Manager 5.4. Subgroup analysis was performed according to the different intervention methods. The I2 statistic was used to assess the heterogeneity.

RESULTS

Seventeen RCTs involving 1,687 patients were included. Meta-analysis demonstrated that massage significantly improved disease activity (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]: SMD = -1.09, 95% CI: -1.38 to -0.80, P < 0.001), physical function (Bath Ankylosing Spondylitis Functional Index [BASFI]: SMD = -1.00, 95% CI: -1.33 to -0.67, P < 0.001), spinal pain (Visual Analog Scale [VAS-pain]: MD = -1.43, 95% CI: -1.80 to -1.05, P < 0.001), and inflammatory markers (erythrocyte sedimentation rate [ESR]: MD = -3.58, 95% CI: -4.71 to -2.99, P < 0.001; C-reactive protein [CRP]: SMD = -0.73, 95% CI: -1.03 to -0.43, P < 0.001) compared to control groups. Subgroup analysis suggested that massage alone might be more effective than massage combined with other therapies like acupuncture. Significant heterogeneity was observed, attributable to variations in massage techniques and protocols. Of note, the long-term efficacy of massage was not evaluated in this review, as no included studies provided follow‑up beyond the treatment period.

CONCLUSION

Massage and related treatments are effective in alleviating disease activity, improving physical function, reducing pain, and lowering inflammation in patients with ankylosing spondylitis. It can be considered as a beneficial non-pharmacological adjunct for AS. However, these findings must be interpreted with caution due to several limitations inherent in the included studies, including methodological flaws, small sample sizes, inconsistent treatment protocols, and insufficient statistical precision. Moreover, blinding was not feasible in massage therapy, which precludes exclusion of potential placebo or observer effects. Therefore, future high‑quality, standardized, and longitudinal RCTs are warranted to confirm the role of massage in evidence‑based AS management.