Massage Therapy & Neck Pain
For those who suffer from neck pain, massage therapy has been shown to be a safe, effective non-pharmacological therapeutic intervention that is simple to carry out, economical, and has very few side effects (Brosseau et al. 2012, Bussières et al. 2016, Côté et al. 2016, Nahin et al. 2016, Sutton et al. 2016, Wong et al. 2016, van der Velde et al. 2016).
Why Does Massage Therapy Work?
Massage therapy is a clinically-oriented multi-modal approach (manual therapy, remedial exercise and patient education) based on a biopsychosocial model and on the three pillars of evidence based practice (best available evidence, clinical expertise and patient values).
The mechanism by which massage therapy alleviates localized pain is not clear, biological factors (physiology), psychological (i.e. thoughts, emotions, and behaviors) and social (i.e. culture, and religion) factors play a significant role in the experience and reduction of pain.
In terms of clinical responses to massage therapy there are a couple of proposed mechanisms of action:
- Contextual responses: This is likely to play a role in any therapeutic intervention, the way we present ourselves and present our techniques has influence on the treatment. The magnitude of a response may be influenced by mood, expectation, and conditioning (Bialosky et al. 2017).
- Endogenous pain modulation: Massage has a modulatory affect on peripheral and central processes via input from large sensory neurons that prevents the spinal cord from amplifying the nociceptive signal. This anti-nociceptive effect of massage therapy can help ease aches and pain. (Bishop et al. 2015, Vigotsky et al. 2015).
- Improved blood flow: Researchers demonstrated that compression and its release improves localized blood flow. It is proposed that improved perfusion and oxygen delivery to the muscle, encourages the removal of cellular exudates and drainage of metabolic waste (Moraska et al. 2013).
- An increase in parasympathetic activity: Studies have demonstrated an increase in parasympathetic activity following local compression of myofascial triggerpoints. This alteration within the autonomic nervous system result in changes to regional perfusion (Takamoto et al. 2009).
- Myofascial trigger points: Randomised controlled trials have demonstrated that compression at myofascial triggerpoints (MTrPs) significantly improved subjective pain scores compared with compression at Non-MTrPs and the control treatments for patients suffering form neck pain (Morikawa et al. 2017).
- Immunomodulation: One interesting paper suggests that the application of massage induces a phenotype change, prompting the transition of M1 macrophages into the M2 macrophages (Waters-Banker et al. 2014).
Physicians, now more than ever are recommending conservative treatment including massage, acupuncture and exercise as part of a multi-modal approach for patients suffering from neck pain, anxiety and stress. Below you will finds links and clinical research related to neck pain.
More to Explore
Brosseau, L., Wells, G.A., Tugwell, P., Casimiro, L., Novikov, M., ... Cohoon C. (2012). Ottawa Panel evidence-based clinical practice guidelineon therapeutic massage for neck pain. J Bodyw Mov Ther.
Bussières, A. E., Stewart, G., Al-Zoubi, F., Decina, P., Descarreaux, M., Hayden, J., . . . Ornelas, J. (2016). The Treatment of Neck Pain–Associated Disorders and Whiplash-Associated Disorders: A Clinical Practice Guideline. Journal of Manipulative and Physiological Therapeutics.
Cook, A. J., Wellman, R. D., Cherkin, D. C., Kahn, J. R., & Sherman, K. J. (2015). Randomized clinical trial assessing whether additional massage treatments for chronic neck pain improve 12- and 26-week outcomes. The Spine Journal.
Costello, M., Puentedura, E. ‘, Cleland, J., & Ciccone, C. D. (2016). The immediate effects of soft tissue mobilization versus therapeutic ultrasound for patients with neck and arm pain with evidence of neural mechanosensitivity: A randomized clinical trial. Journal of Manual & Manipulative Therapy.
De Meulemeester, K.E., Castelein, B., Coppieters, I., Barbe, T., Cools, A., Cagnie, B. (2017). Comparing Trigger Point Dry Needling and Manual Pressure Technique for the Management of Myofascial Neck/Shoulder Pain: A Randomized Clinical Trial. J Manipulative Physiol Ther.
Frieden, T. R., & Houry, D. (2016). Reducing the Risks of Relief — The CDC Opioid-Prescribing Guideline. New England Journal of Medicine.
Furlan, A. D., Yazdi, F., Tsertsvadze, A., Gross, A., Tulder, M. V., Santaguida, L., . . . Tsouros, S. (2012). A Systematic Review and Meta-Analysis of Efficacy, Cost-Effectiveness, and Safety of Selected Complementary and Alternative Medicine for Neck and Low-Back Pain. Evidence-Based Complementary and Alternative Medicine.
Gerber, L.H., Sikdar, S., Aredo, J.V., Armstrong, K., Rosenberger, W.F., Shao, H., Shah, J.P. (2017). Beneficial Effects of Dry Needling for Treatment of Chronic Myofascial Pain Persist for 6 Weeks After Treatment Completion. PM R.
Gross, A., Langevin, P., Burnie, S. J., Bédard-Brochu, M., Empey, B., Dugas, E., . . . Leblanc, F. (2015). Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment. Cochrane Database of Systematic Reviews.
Haller, H., Lauche, R., Cramer, H., Rampp, T., Saha, F. J., Ostermann, T., & Dobos, G. (2016). Craniosacral Therapy for the Treatment of Chronic Neck Pain. The Clinical Journal of Pain.
https://www.ncbi.nlm.nih.gov/pubmed/26340656 (OPEN ACCESS)
Kjaer, P., Kongsted, A., Hartvigsen, J., ... Povlsen, T.M. (2017). National clinical guidelines for non-surgical treatment of patients with recent onset neck pain or cervical radiculopathy. Eur Spine J.
Morikawa, Y., Takamoto, K., Nishimaru, H., Taguchi, T., Urakawa, S., Sakai, S., Ono, T., Nishijo, H. (2017). Compression at Myofascial Trigger Point on Chronic Neck Pain Provides Pain Relief through the Prefrontal Cortex and Autonomic Nervous System: A Pilot Study. Front Neurosci.
https://www.ncbi.nlm.nih.gov/pubmed/28442987 (OPEN ACCESS)
Nahin, R. L., Boineau, R., Khalsa, P. S., Stussman, B. J., & Weber, W. J. (2016). Evidence-Based Evaluation of Complementary Health Approaches for Pain Management in the United States. Mayo Clinic Proceedings.
Nee, R.J., Vicenzino, B., Jull, G.A., Cleland, J.A., & Coppieters, M.W. (2012). Neural tissue management provides immediate clinically relevant benefits without harmful effects for patients with nerve-related neck and arm pain: a randomised trial. Journal of Physiotherapy.
Sherman, K. J., Cook, A. J., Wellman, R. D., Hawkes, R. J., Kahn, J. R., Deyo, R. A., & Cherkin, D. C. (2014). Five-Week Outcomes From a Dosing Trial of Therapeutic Massage for Chronic Neck Pain. The Annals of Family Medicine.
Sherman, K. J., Cherkin, D. C., Hawkes, R. J., Miglioretti, D. L., & Deyo, R. A. (2009). Randomized Trial of Therapeutic Massage for Chronic Neck Pain. The Clinical Journal of Pain.
Sutton, D. A., Côté, P., Wong, J. J., Varatharajan, S., Randhawa, K. A., Yu, H., . . . Stupar, M. (2016). Is multimodal care effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. The Spine Journal.
van der Velde, G., Yu, H., Paulden, M., Côté, P., Varatharajan, S., Shearer, H.M., Wong, J.J.,...,Taylor-Vaisey, A. (2016). Which interventions are cost-effective for the management of whiplash-associated and neck pain-associated disorders? A systematic review of the health economic literature by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. The Spine Journal.
Wong, J. J., Shearer, H. M., Mior, S., Jacobs, C., Côté, P., Randhawa, K., . . . Taylor-Vaisey, A. (2016). Are manual therapies, passive physical modalities, or acupuncture effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? an update of the bone and joint decade task force on neck pain and its associated disorders by the optima collaboration. The Spine Journal.