Combining acupuncture and massage in one session is common, but does the order matter? A new study from Japan tried to answer that with a simple experiment. The answer is interesting, though it comes from nine people and one forearm muscle, so it deserves a careful reading.
The study, published in Cureus on 31 October 2026 by Yoshitaka Arima and Miho Oba of Tokoha University, recruited nine healthy men aged 19 to 23. Each volunteer had both forearms treated at the same time, with a different order on each side, chosen at random. On one arm the sequence was acupuncture first and massage second (AM). On the other it was massage first and acupuncture second (MA).
The acupuncture was electroacupuncture, a mild electrical current through two needles for five minutes at a low frequency, strong enough to cause gentle muscle twitching. The massage was five minutes of thumb pressing and kneading. The target was the extensor digitorum communis, the forearm muscle that straightens the fingers. The researchers measured muscle hardness before and after the ten-minute treatment, both at rest and while the muscle was contracting.
Resting hardness fell overall. After acupuncture then massage it dropped from about 65.3 to 62.8, a statistically significant change. After massage then acupuncture it dropped from about 65.9 to 64.0, which did not reach significance. The two orders were not significantly different from each other.
With the muscle contracting, acupuncture then massage lowered hardness (about 69.4 to 67.2). Massage then acupuncture left it unchanged at about 68.4. That difference between the sequences was statistically significant.
To relieve stiffness, acupuncture then massage looked better. To keep the muscle responsive, massage then acupuncture looked better. They say the order could be chosen to match the goal.
A handheld muscle hardness tester pressed on ten marked points along the forearm. Because force is hard to measure reliably in this muscle, the team used hardness during contraction as a stand-in for how forcefully the muscle can contract. They did not measure force itself.
The authors suggest one possible explanation: acupuncture may recruit muscle fibres and offset the relaxing effect of the massage. They are clear that this is a hypothesis they did not test.
One small study is a starting point for better research, not a rule about how to order your treatment.
If you have a combined session, such as acupuncture with massage, the order is a clinical decision. This study hints that acupuncture first may help more with general tightness at rest, and that massage first may be preferable if you need your muscles to stay responsive, for example before sport. The second idea is a suggestion for future research, not an established guideline.
At AcuRodos, we decide on the order based on what you need on the day, and we check how you respond. Our combined Acupuncture + Heat + Massage sessions are described on our fees page.
Book a consultation at AcuRodos in Clonee Village, Co. Meath, and we will work out the right approach for you.
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