The potential underlying mechanisms of the action of massage remain unclear, but the proposed mechanisms probably include improving local blood flow; promoting venous circulation; increasing lymphatic drainage to remove waste products and reduce edema; improving the mobility of ligaments, tendons and muscle; as well as relaxing muscle tension. Additionally, nerve transmission within large nerve fibers triggered by massage might also contribute to an analgesic effect via blocking the passage of painful stimuli entering through the spinal segment, which is known as the pain gate mechanism. Another plausible analgesic mechanism is believed to mediate via descending inhibitory pain pathways, involving release of endogenous opioids within the spinal segment . Besides the aforementioned possibilities, an analgesic effect of massage in animal models is also demonstrated to exert via an endogenous release of oxytocin into the plasma and in the periaqueductal grey in the midbrain.Oxytocin also causes an increase in beta-endorphin, L-encephalin, and dynorphin A1–13 contents in the rat spinal cord, suggesting the involvement of endogenous opiate peptide system in oxytocin-induced analgesia . Notably, integration of Chinese acupressure into TM might produce additive or synergistic effects in management of OA of the knee since it has been found that five minutes of acupressure stimulation on the Xiyangguan acupoint, located on the lateral side of the knee joint, causes a significant increase in regional oxygen saturation of the deeper tissues on the same side of the knee in healthy volunteers. This study revealed that TM coupled with acupressure is an attractive alternative option in treatment of OA of the knee. Additionally, TM was quite safe; it involved a low incidence of mild muscle ache which was self-limited within a few days.