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As canine rehabilitation professionals, we routinely incorporate soft tissue mobilization—massage techniques (effleurage, petrissage, kneading, friction, etc.) and therapeutic stretching—into treatment plans for orthopedic patients, post-surgical cases, geriatric dogs, and performance athletes. These interventions feel intuitive: they seem to reduce muscle guarding, improve range of motion (ROM), promote relaxation, and support tissue remodeling. But how strong is the evidence base specifically for dogs?

A 2022 systematic review by Bergh and colleagues provides a much-needed, high-level synthesis of the literature on soft tissue mobilization in sport and companion animals (cats, dogs, and horses). The authors followed Cochrane and SBU methodology, searching Web of Science, CABI, and PubMed (1980–2020) and ultimately screening 1,189 unique publications. Only 11 studies met strict inclusion criteria (original peer-reviewed research, English/Finnish/Swedish/etc., focused on a single soft-tissue intervention, therapeutic or experimental mimicking clinical use). Nine examined massage; two examined stretching. Only three studies involved dogs—and just two were canine-specific. The rest were equine.

Key Findings Relevant to Canine Practice

Massage (9 studies total, mostly horses)  

• Canine evidence is extremely limited. One moderate-risk-of-bias randomized cross-over study in minimally conditioned Alaskan husky sled dogs (n=8) evaluated 14 minutes of petrissage, effleurage, and compression before exercise. No significant change was found in creatine kinase (CK) release, a marker of exercise-induced muscle damage.  

• Several equine studies (some moderate risk of bias) reported reductions in heart rate and increases in relaxation-related behaviors after massage, consistent with human and animal-model data on autonomic shifts. However, most studies had high risk of bias due to lack of blinding, inadequate randomization reporting, small samples, no power calculations, and confounding factors (e.g., concurrent exercise or unblinded outcome assessors).  

• No canine studies in the review examined pain, lameness, or functional outcomes in clinical patients.

Stretching (2 studies total)  

• The only canine study was a moderate-risk-of-bias cohort of 10 Labrador retrievers (>1.5 years old) with confirmed osteoarthritis and limited ROM in elbow, stifle, or carpus. Passive stretching (10 repetitions of 10-second holds, twice daily for 21 days) produced a statistically significant increase in ROM of the affected joints.  

• The single equine stretching study (high risk of bias) found no improvement in stride length or trot ROM and noted possible adverse reactions with daily stretching.

Overall quality assessment

Eight of the 11 studies were rated high risk of bias; three were moderate. No study achieved low risk of bias. Common limitations included small sample sizes, lack of blinding, heterogeneous outcome measures (heart rate, behavior, CK, ROM, racing performance), and minimal description of animal health status or concurrent treatments. The review authors explicitly state that “the scientific evidence is not strong enough to define the clinical efficacy and effectiveness of massage and stretching in sport and companion animals.”

Human studies and where the strongest evidence lies

The benefits of massage therapy with the greatest and strongest supporting evidence from human literature center on pain relief, anxiety reduction, and improvements in depressive symptoms. While massage has been studied for many outcomes (e.g., circulation, sleep, immune function), high-quality evidence syntheses—systematic reviews, meta-analyses, and evidence maps—consistently show the most robust support for these three areas. Evidence quality is typically moderate at best (rarely high), due to heterogeneity in techniques, small samples, lack of blinding, and variable comparators, but effects are generally positive compared to no treatment or sham/inactive controls. Benefits are often short-term and may be enhanced when massage is combined with exercise or education.

1.   Pain Relief (Strongest and Most Consistent Evidence Base)  

Massage has the largest body of research and moderate-certainty support for reducing pain in several conditions, outperforming no treatment or sham therapies. Pain relief is the area with the most reviews, largest number of trials, and highest (moderate) certainty ratings. It is not consistently superior to all active therapies (e.g., exercise alone), but it is safe and effective as a non-pharmacologic option.

2.   Anxiety Reduction (Strong Physiological and Psychological Effects)

Single sessions reliably produce immediate reductions in state (situational) anxiety, while multiple sessions yield larger, more sustained effects on trait (general) anxiety.  Anxiety reduction is one of the most reliably replicated benefits and aligns with autonomic nervous system calming (e.g., lowered heart rate).

3.   Reduction in Depressive Symptoms 

Multiple sessions of massage show consistent benefits for mood, with effect sizes often similar to psychotherapy.  These mood benefits often overlap with anxiety and pain relief but stand as a distinct, well-supported outcome.

Practical Implications for Canine Rehabilitation Professionals

1.   Our clinical experience is ahead of the published evidence. The scarcity of high-quality canine data does not mean these techniques are ineffective—it means we lack rigorous RCTs with blinded assessors, validated functional outcomes, and adequate power focused on dogs with clinical conditions (e.g., hip dysplasia, chronic OA, or neurological cases).

2.   Stretching shows promise for ROM deficits in OA. The Crook et al. (2007) findings support short, frequent passive stretching sessions in dogs with osteoarthritis-related stiffness. This aligns with our hands-on experience and can be a low-risk adjunct when performed within the dog’s comfort zone and owner compliance is high.

3.   Massage appears safe and may support relaxation. Heart-rate reductions and behavioral calming seen in equine studies (and paralleled in human literature) suggest a role for massage in stress-prone or anxious rehabilitation patients. However, we should not overstate physiologic claims (e.g., improved perfusion or scar remodeling) without stronger data.

4.   Document, measure, and contribute to the evidence. Use goniometry, validated pain scales (e.g., CBPI, LOAD), force-plate analysis, stance analysis or owner-reported outcomes before and after interventions. Consider publishing case series or collaborating on future trials—our field desperately needs them.

Bottom Line for Evidence-Informed Practice

Soft tissue mobilization remains a pillar of canine rehabilitation—safe, non-invasive, and frequently appreciated by patients and owners. The 2022 systematic review confirms what many of us have suspected: while promising signals exist (ROM gains in OA dogs; relaxation effects), the body of evidence is thin, heterogeneous, and dominated by high-bias studies. We should continue using these techniques thoughtfully, prioritize measurable outcomes, and advocate for (and participate in) better canine-specific research.

Inspiration for Blog:

Bergh, A., Asplund, K., Lund, I., Boström, A., & Hyytiäinen, H. (2022). A systematic review of complementary and alternative veterinary medicine in sport and companion animals: Soft tissue mobilization. Animals, 12(11), Article 1440. https://doi.org/10.3390/ani12111440