Massage: Popular Treatment for Neck Pain. Is It Effective?
Everyone loves a good massage -- especially if you have neck pain. But does it really help? Are the effects long lasting or effective enough to make it cost-effective? That's what these researchers from the University of Washington in Seattle set out to study. Given the fact that many adults suffer neck pain every year, these are important questions.
They compared two groups of adult patients (ages 20 to 64). Everyone had neck pain that lasted more than three months. Most of the participants actually had pain much longer than that. Eighty per cent had it for at least a year. The average length of time was 7.6 years. So this was truly a group of patients with chronic neck pain.
The cause of the neck pain was not serious such as a tumor, infection, or fracture. The type of neck pain was labeled mechanical, which means it is related to the human movement system (joints, ligaments, other soft tissues). Anyone with a more serious cause of neck pain (cancer, stenosis, fracture) was not included. Anyone who might not be a good candidate for a massage was also excluded from the study. People in this category had unstable physical or mental health issues.
One group received 10 massages (once a week for 10 weeks). There are different types of massage. This is the first study to look at massage as it is commonly practiced in the United States. The licensed massage therapists applied a wide variety of the possible massage techniques. These included friction massage, clinical gliding, Swedish gliding, traction, trigger point therapy, and kneading massage. Areas of the body massaged included the neck, upper back, chest muscles, and upper arms.
The second group got a self-care book for chronic neck pain. The book was written by a physician by the name of Jerome Schofferman. The title was What To Do for a Pain in the Neck. The book has chapters on causes of neck pain, headaches, and what to do after a whiplash injury. Other information in the book included postural and strengthening exercises and what to do for a flare-up of symptoms.
There was also a section on conventional versus complementary therapies for neck pain. Conventional care includes antiinflammatories or analgesics (pain relievers), physical therapy, rest, and activity modification. Massage is considered a complementary treatment. Other examples of complementary care include chiropractic, acupuncture, Reiki, Yoga, or Tai Chi.
Patients in both groups were allowed to seek other forms of treatment such as chiropractic care, their primary care physician, or in the case of the book group, a massage. Subjects in both groups received some type of nonstudy treatments during the 10-week period of time. People in the book group sought out care from others more often than the massage group (21 per cent for the book group versus 13 percent for the massage group).
Results for both groups were measured using self-reported questionnaires. The Neck Disability Index (NDI) was one. The numerical rating scale (NRS) was another. The Copenhagen Neck Functional Disability Scale, Short Form-36, and some additional questions designed by the authors of the study were also included.
Everyone completed all questions before starting the study. The information gathered at the beginning is called the baseline. The same questionnaires and questions were filled out and answered at four, 10, and 26 weeks after starting the study. The difference between the answers was compared after each of the time periods tested.
The authors report a significant decrease in pain and improved function for the massage group at the four-week time period. The treatment group held on to their improvements through the first 10 weeks. But by the end of 26 weeks, there was no difference between the two groups.
There was one major difference at the end of 26 weeks, and that was in the amount of medications used by the two groups. The massage group was still using the same amount of pain relievers as reported at baseline. But the book group's use of medications had increased significantly.
Given the fact that the massage group used less medication, fewer treatments outside of massage, and reported improved pain and function in the first 10 weeks, the authors conclude that at least in the short-term, massage for neck pain has merit.
Other studies using shorter massage treatments have not reported as good of results as this study. Studying dose and type of massage used in this study was helpful in showing that a longer period of time may be needed to get the desired results. Other studies comparing massage with acupuncture or sham laser treatments found better motion-related improvements with these treatments over massage.
The authors admit that their study did not figure out why massage worked better than self-study with a book on neck pain. It could have been any number of factors such as the physical touch, specific type of massage, interaction with the massage therapist, or patient expectations. In evaluating a single modality such as massage, it's important to keep the research pure and just study one part at a time. That's one of the strengths of this particular study.
Future studies are needed to examine patients with more severe neck pain, to follow-up for more than one year, and to study a larger number of patients. Eventually, it will be necessary to look at patients who are most likely to seek the services of a massage therapist. This would include patients who were left out of this study -- those who had a previous surgery, anyone who was in a car accident or involved in a lawsuit, and anyone receiving other kinds of treatment for their neck pain.
Karen J. Sherman, PhD, MPH, et al. Randomized Trial of Therapeutic Massage for Chronic Neck Pain. In The Clinical Journal of Pain. March-April, 2009. Vol. 25. No. 3. Pp. 233-238.
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