|Posted on 27 September, 2015 at 11:05|
Massage for mechanical neck pain
This version published: 2013; Review content assessed as up-to-date: February 07, 2012.
Link to full article: [Cochrane Library]
Plain language summary
Neck pain is common and can limit a person's ability to participate in normal daily activities. Massage is a widely used treatment for neck pain. In this review, it was defined as touching or manipulating the soft tissues surrounding the neck with the hand, foot, arm or elbow. There are a number of different types of massage. This review included studies that looked at Traditional Chinese massage, ischaemic compression, self‐administered ischaemic pressure using a J‐knob cane, conventional Western massage and occipital release, among other techniques. It did not include studies that examined techniques such as Reiki or Polarity.
We included 15 trials in this review that assessed whether massage could help reduce neck pain and improve function. Results showed that massage is safe, and any side effects were temporary and benign. However, massage did not show a significant advantage over other comparison groups. Massage was compared with no treatment, hot packs, active range‐of‐movement exercises, acupuncture, exercises, sham laser, manual traction, mobilization, and education.
There were a number of challenges with this review. Overall, the quality of the studies was poor and the number of participants in most trials was small. Most studies lacked a clear definition, description, or rationale for the massage technique used. Details on the credentials or experience of the person giving the massage were often missing. There was such a range of massage techniques and comparison treatments in the studies that we could not combine the results to get an overall picture of the effectiveness of massage. Therefore, no firm conclusions could be drawn and the effectiveness of massage for improving neck pain and function remains unclear.
Background: The prevalence of mechanical neck disorders (MND) is known to be both a hindrance to individuals and costly to society. As such, massage is widely used as a form of treatment for MND.
Objectives: To assess the effects of massage on pain, function, patient satisfaction, global perceived effect, adverse effects and cost of care in adults with neck pain versus any comparison at immediate post‐treatment to long‐term follow‐up.
Search methods: We searched The Cochrane Library (CENTRAL), MEDLINE, EMBASE, MANTIS, CINAHL, and ICL databases from date of inception to 4 Feburary 2012.
Selection criteria: Studies using random assignment were included.
Data collection and analysis: Two review authors independently conducted citation identification, study selection, data abstraction and methodological quality assessment. Using a random‐effects model, we calculated the risk ratio and standardised mean difference.
Main results: Fifteen trials met the inclusion criteria. The overall methodology of all the trials assessed was either low or very low GRADE level. None of the trials were of strong to moderate GRADE level. The results showed very low level evidence that certain massage techniques (traditional Chinese massage, classical and modified strain/counterstrain technique) may have been more effective than control or placebo treatment in improving function and tenderness. There was very low level evidence that massage may have been more beneficial than education in the short term for pain bothersomeness. Along with that, there was low level evidence that ischaemic compression and passive stretch may have been more effective in combination rather than individually for pain reduction. The clinical applicability assessment showed that only 4/15 trials adequately described the massage technique. The majority of the trials assessed outcomes at immediate post‐treatment, which is not an adequate time to assess clinical change. Due to the limitations in the quality of existing studies, we were unable to make any firm statement to guide clinical practice. We noted that only five of the 15 studies reported side effects. All five studies reported post‐treatment pain, discomfort and soreness as a side effect and one study (Irnich 2001) showed that 22% of the participants experienced low blood pressure following treatment.
Authors' conclusions: No recommendations for practice can be made at this time because the effectiveness of massage for neck pain remains uncertain.
As a stand‐alone treatment, massage for MND was found to provide an immediate or short‐term effectiveness or both in pain and tenderness. Additionally, future research is needed in order to assess the long‐term effects of treatment and treatments provided on more than one occasion.
Editorial Group: Cochrane Back Group.
Publication status: Edited (no change to conclusions).
Citation: Patel KC, Gross A, Graham N, Goldsmith CH, Ezzo J, Morien A, Peloso PMJ. Massage for mechanical neck disorders. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD004871. DOI: 10.1002/14651858.CD004871.pub4. Link to Cochrane Library. [PubMed