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H. Lee1, A. Gross2, J. Ezzo3, N. Chacko2, C.H. Goldsmith4, G. Gelley5, M. Forget6, A. Morien7, N. Graham2, P.L. Santaguida8, M. Rice9, C. Dixon9
1Silla University, Physical Therapy, Busan, Korea (Republic of), 2McMaster University, School of Rehabilitation Science, Hamilton, Canada, 3JME Enterprises, Baltimore, United States, 4Simon Fraser University, Faculty of Health Sciences, Burnaby, Canada, 5University of Manitoba, Faculty of Health Sciences, Winnipeg, Canada, 6Government of Canada, Canadian Forces Health Services Group, Kingston, Canada, 7Florida School of Massage, Research Department, Gainesville, United States, 8McMaster University, Department of Clinical Epidemiology and Biostatistics, Hamilton, Canada, 9McMaster Univesity, Hamilton, Canada
Background: Neck pain are prevalent, disabling and costly. Massage is widely used, yet its effectiveness remains unclear.
Purpose: To assess the effects of massage for neck pain in adults with (NPR) or without radiculopathy (NP w/o R), and cervicogenic headache (CGH) including whiplash associated disorders.
Methods: CENTRAL, MEDLINE, Embase, CINAHL, ICL and two trial registries (March 2020) were used. Selection criteria: RCTs comparing any type of massage with any type of control (sham or placebo, no treatment, massage as adjunct treatment to standard non-surgical treatment or compared to another treatment) in adults with neck pain of any duration (acute to chronic) at short (ST) to long-term follow-up. Data collection and analysis: Cochrane’s standard methodological procedures were employed. GRADE was used to rate the quality of evidence.
Results: 44 studies (18 new trials in this update) were included to assess the influence of massage on neck pain, function, global perceived effect and quality of life. Temporary minimal adverse events such as treatment soreness were reported. The contribution of massage to managing neck pain remains uncertain given the following low quality evidence.
For persisting neck pain w/o R, there were diverse findings, with subgroup analysis indicating there may be evidence of a difference between dose of massage. High-dose multi-session massage indicated a moderate-level pain reduction (RRp 0.36, 95% CI 0.23 to 0.57, MD -16.20, 95% CI -26.42 to -5.98), while medium-dose (MDp -10.54, 95% CI -17.25 to -3.82) and low-dose showed either a minimal difference or no evidence of a difference. Similar findings emerged for function, global perceived effect and patient satisfaction. For persisting NP w/o R or CGH, medium-dose massage compared to another standard treatment like exercise or passive approaches (i.e. acupuncture or another type of manual therapy) may improve pain and function a very small amount but does not alter quality of life.
Quality of the Evidence: There were a number of challenges with this review. Overall, the quality of the studies was low and the number of participants in most trials was small. Most studies did not clearly describe the massage technique used. Replication of trials is needed. The heterogeneity within the current massage literature made it difficult to draw firm conclusions of the effectiveness of massage.
For persisting neck pain w/o R, there were diverse findings, with subgroup analysis indicating there may be evidence of a difference between dose of massage. High-dose multi-session massage indicated a moderate-level pain reduction (RRp 0.36, 95% CI 0.23 to 0.57, MD -16.20, 95% CI -26.42 to -5.98), while medium-dose (MDp -10.54, 95% CI -17.25 to -3.82) and low-dose showed either a minimal difference or no evidence of a difference. Similar findings emerged for function, global perceived effect and patient satisfaction. For persisting NP w/o R or CGH, medium-dose massage compared to another standard treatment like exercise or passive approaches (i.e. acupuncture or another type of manual therapy) may improve pain and function a very small amount but does not alter quality of life.
Quality of the Evidence: There were a number of challenges with this review. Overall, the quality of the studies was low and the number of participants in most trials was small. Most studies did not clearly describe the massage technique used. Replication of trials is needed. The heterogeneity within the current massage literature made it difficult to draw firm conclusions of the effectiveness of massage.
Conclusion(s): The contribution of massage to managing neck pain remains uncertain given the low quality evidence; we are not confident in the estimate of effect for practice. For NP w/o R, massage as a stand-alone treatment showed mixed results when compared to sham or no treatment. Outcomes were not clinically relevant unless high-dose massage was applied. This produced a small to medium effect size for pain, function, global perceived effect, and quality of life variables. Adding massage to exercise or passive care had a very small added benefit. Further research should focus on large adequately dosed, high-quality and long-term trials.
Implications: We are not confident in the evidence for or against massage. Due to the limitations of existing studies, we cannot make any firm statement to guide clinical practice.
Funding, acknowledgements: No fund supported
Keywords: massage, neck pain, Cochrane review
Topic: Musculoskeletal: spine
Did this work require ethics approval? No
Institution: McMaster University
Committee: McMaster University
Reason: It is not required due to study design, systematic review.
All authors, affiliations and abstracts have been published as submitted.
