Aromatherapy in massage: what works, what is myth and precautions

The smell of lavender in a massage room, a few drops of eucalyptus in the bath, a diffuser on the bedside table. Aromatherapy has become part of the everyday life of many people, and essential oils are sold with promises ranging from relaxation to boosting immunity.

Aromas can indeed influence how we feel. But there is a big gap between what science shows and what is promised. And essential oils, being “natural”, are not harmless.

What aromatherapy is

Essential oils are concentrated extracts of aromatic substances from plants, generally obtained by distillation or, in the case of citrus fruits, by expression of the peel. They are very concentrated: large volumes of plant are needed to obtain small amounts of oil.

In aromatherapy, they are used in two main ways:

• Inhalation: diffusers, a few drops on a tissue, inhalation in the bath.
• Applied to the skin, diluted in a vegetable oil (for example, sweet almond, jojoba, sunflower), especially in massage.

How it may act

• Smell and emotion: smell connects directly to areas of the brain involved in emotion and memory. A smell associated with pleasant moments can trigger relaxation.
• Substances with biological activity: some components of oils, such as the linalool in lavender, have effects studied in the laboratory and in animals. Translation into relevant effects in people is less clear.
• Expectation and context: the calm room, the ritual, liking the aroma and the expectation of relaxing carry a lot of weight.

The weight of expectation

An interesting study showed precisely this: in participants exposed to the aroma of lavender or to no aroma, changes in relaxation depended mainly on what people expected to feel, more than on the actual presence of the aroma (Howard and Hughes, 2008).

This does not make aromatherapy useless: if an aroma helps a person to relax, the relaxation is real. But it helps to adjust expectations and to be wary of specific promises for each oil.

What the studies say

Anxiety

A systematic review of aromatherapy in people with anxiety symptoms found generally favourable results, but stressed that the studies were small, heterogeneous and at risk of bias, which prevents firm conclusions (Lee and colleagues, 2011). The most consistent effects appear in situations of momentary anxiety, such as before medical or dental procedures.

Sleep

In a trial with university students, inhaling lavender combined with sleep hygiene rules improved the sleep quality reported by participants, more than sleep hygiene alone (Lillehei and colleagues, 2015). It is an interesting result, but preliminary.

Lavender taken orally

There are standardised oral lavender oil preparations studied in anxiety, with some positive results. But they are specific medicines or supplements, with controlled doses, and not the same as essential oil for aromatic use. Never swallow essential oils on your own: they can be toxic.

Massage with or without essential oils

A Cochrane review in people with cancer concluded that massage may reduce anxiety in the short term, and that adding essential oils showed no clear additional benefit (Fellowes and colleagues, 2004). A later update maintained the conclusion that the evidence on aromatherapy massage is limited (Shin and colleagues, 2016).

In practice: the main benefit comes from touch. Aromas make the experience more pleasant for those who like them, and that has value, but they do not transform the effect of massage.

Unsupported claims

There is no evidence that essential oils, used in aromatherapy:

• Treat infections, cancer, autoimmune diseases or other diseases.
• “Detoxify” the body.
• Boost immunity.
• Replace medication.

Be wary of anyone who makes these promises.

The most commonly used oils

Safety: what you need to know

“Natural” does not mean harmless. A review of published cases documented adverse effects of aromatherapy ranging from mild irritation to, rarely, serious situations (Posadzki and colleagues, 2012).

On the skin

• Always dilute. For massage in adults, a dilution of 1 to 3% (roughly 1 to 3 drops of essential oil for every 5 ml of vegetable oil) is the usual reference. On the face and in sensitive skin, less.
• Do a patch test on a small area (for example, the inner forearm) and wait 24 hours.
• Contact allergies are relatively common, especially with oxidised oils (old or badly stored). Keep them closed, away from light and heat.
• Citrus and sun: some citrus oils, especially cold-pressed bergamot and lemon, can cause burns and marks on skin exposed to the sun. Avoid the sun for 12 hours after application.
• Do not apply to broken, irritated skin or skin with active eczema, or near the eyes.

By inhalation

• Use diffusers in moderation, in ventilated spaces and for limited periods.
• People with asthma, rhinitis or sensitivity to smells can have attacks triggered by strong aromas.

Children

• Keep essential oils out of reach of children. Swallowing small amounts of some oils (such as eucalyptus, camphor or wintergreen) can cause serious poisoning, with seizures.
• Eucalyptus and peppermint should not be used on babies and small children, nor applied near the face.
• Cases have been described of breast development in prepubertal boys associated with repeated use of products containing lavender and tea tree oils, which regressed after stopping (Henley and colleagues, 2007). The causal relationship is still debated, but it justifies caution.

Pregnancy and breastfeeding

Many oils have not been studied in pregnancy. Use only at low dilution, avoid the first trimester and speak to your doctor or obstetric nurse. In prenatal massage, it is common to opt for vegetable oils without essential oils.

Pets

Cats are especially sensitive to several essential oils. Avoid diffusers in spaces the animals cannot leave and never apply oils to animals without veterinary advice.

Ingestion

Do not swallow essential oils. For other questions, call SNS 24 (808 24 24 24).

At Luxmed Clinic

At Luxmed Clinic, in Algés, you can choose to have your massage, carried out by a massage therapist, with or without aromas. We always use diluted oils and ask beforehand about allergies, asthma, pregnancy and skin sensitivity. If you prefer a massage without scent, that is also possible: the main benefit comes from touch.

Aromatherapy and massage are wellbeing complements and do not replace medical assessment or treatment. Results vary from person to person.

Frequently asked questions