Effects of 12-week massage on pain, muscle co-contraction, and knee loading in medial knee osteoarthritis: a randomized clinical trial

Background Evidence regarding the effects of massage therapy for improving pain, muscle co-contraction, and knee loading in individuals with medial knee osteoarthritis (OA) remains limited. Aims To investigate the effects of 12 weeks of massage therapy on pain, muscle co-contraction, and knee loading in individuals with medial knee OA. Methods In this prospective, single-center, assessor-blinded randomized controlled trial, 56 participants with medial knee OA were randomly assigned to a massage therapy group or a healthcare education group (28 participants per group). Participants received their assigned intervention twice weekly for 12 weeks. The primary outcome was change in Western Ontario and McMaster Universities OA Index (WOMAC) pain score. Secondary outcomes included WOMAC stiffness and physical function, muscle co-contraction, external knee adduction moment, knee adduction angular impulse, knee flexion angle, and walking speed. Results Compared with healthcare education, massage therapy resulted in greater reductions in WOMAC pain and stiffness and greater improvement in physical function. Massage therapy also significantly reduced medial muscle co-contraction during early stance. No significant between-group differences were observed in external knee adduction moment, knee adduction angular impulse, or walking speed. Conclusion Twelve weeks of massage therapy resulted in greater improvements in pain, stiffness, physical function, and medial muscle co-contraction than healthcare education in individuals with medial knee OA. These findings suggest that massage therapy may improve symptoms and neuromuscular function in individuals with knee OA. Trial registration International Traditional Medicine Clinical Trial Registry: ITMCTR2025001524.