In the last decade, hair loss treatment trials have expanded to involve stimulation-based therapies platelet-rich plasma therapy, microneedling and polysiloxane monofilament threading. Stimulation based therapies activate wound-healing responses by releasing platelet-derived growth factor and vascular endothelial growth factor, as well as activating anagen-initiating Wnt/β-catenin and dermal papilla stem cells.
Massaging has been shown to share therapeutic overlap with stimulation based therapies. When subject to mechanical force, cells respond by altering gene expression to initiate cellular damage or repair. Depending on the duration and technique of soft tissue manipulation, massage therapy may activate wound-healing and therapeutic mechanisms to elicit hair regrowth in a variety of hair loss disorders.
In animal models, massage therapy increases vascular endothelial growth factor A and neocollagenesis in the target area. Massage is hypothesised to enhance nutrient delivery to fibroblasts and help maintain tissue integrity, possibly by release of aromatase. Standard scalp massage increase hair thickness in non-balding men. Stretching the human scalp in vitro upregulates anagen-associated noggin, SMAD4, interleukin 6 signal transducer, and bone morphogenetic protein 4 while downregulating catagen-associated interleukin 6.