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Research With Massage Therapy Foundation

By Massage Therapy Foundation Contributor

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A Study on Massage Dosing in the Treatment of Chronic Neck Pain

Contributed by Beth Barberree, BA MA RMT; MK Brennan, MS, RN, LMBT; Jolie Haun, PhD EdS

People with chronic neck pain commonly seek massage therapy for relief. If you asked a dozen massage therapists what they would recommend as a treatment plan for this condition, you would likely get a variety of answers. This month's Massage Therapy Foundation (MTF) review is based on an article published in the Annals of Family Medicine by Sherman and colleagues, which tackled the topic of massage dosage for chronic neck pain. The authors reviewed literature on massage care for chronic neck pain and noted that previous studies offered a variety of conclusions and often contained clinically irrelevant information. This inspired the current work that explored optimum dose, or treatment frequency and duration, of massage therapy for people with chronic neck pain.

Two hundred and twenty-eight participants between the ages of 20 and 64 years, who had been experiencing chronic nonspecific neck pain for at least three months, were recruited for random assignment to one of six study groups. Individuals whose neck pain was a result of an identifiable pathology, or who scored less than four on a pain intensity scale (0 to 10) or less than five on the Neck Disability Index (NDI) (0 to 50) were excluded. Ultimately, 37 to 39 persons were allocated to each of the five dosing groups or the single wait list control group. Based on a previous study, specific massage treatment protocols were utilized for both the 30 and 60-minute sessions. All protocols included range of motion assessment, hands-on check-in, and massage applied directly to the neck. Compensatory patterns and reestablishment of being in a unified body after the participants received intensive isolated work were also addressed in the protocols.

A Study on Massage Dosing in the Treatment of Chronic Neck Pain - Copyright – Stock Photo / Register Mark Eight licensed massage therapists, each with over five years of experience, provided the treatments. The therapists had time limits for each part of the massage, but were permitted to use a broad range of massage techniques. In an effort to attribute results to the massage intervention, no self-care recommendations were allowed. A research assistant, who is also a massage therapist, monitored adherence to the treatment protocol guidelines.

Outcomes were measured prior to commencing treatment and one week after the four-week protocol was completed. Although the study found that all massage groups showed clinically important improvement in participants' NDI over the control group, the most significant outcomes were seen in the 60-minute massage groups. When compared with individuals in the control group, massage participants were three times more likely to have a clinically meaningful improvement in neck function if they received 60 minutes of massage twice a week, and five times more likely if they received 60 minutes of massage three times a week. Further, the authors noted that medication usage or visits to other clinicians did not account for improvements in the participants' conditions.

The authors concluded that massage appears to be relatively safe when provided by appropriately trained therapists, but can be associated with temporary increases in pain. They also suggested that published studies of massage therapy for neck pain may not have delivered adequate massage doses in the treatment protocols. The massage protocols in this study maximized standardization of the treatment yet allowed therapists sufficient freedom to provide the care that they believed would best benefit their patients.

The authors identified that their study had limitations, such as modest sample sizes in each sub-group and challenges with the use of a wait-list control design. Based on the inclusion criteria for this study, only inferences to patients with mild to moderate neck pain should be made. The authors suggested future trials exploring massage for chronic neck pain, which evaluate specifically the effect of multiple 60-minute treatments each week for the first four weeks, self-care recommendations, and inclusion of longer term follow-up.

This study has significant implications for practice and research. Study data suggests that massage can be an effective intervention for patients with chronic neck pain. Moreover, these patients are more likely to show improvement with multiple 60-minute treatments per week, rather than only one session. However, the feasibility of an individual's ability to schedule multiple 60-minute sessions every week may need to be taken into consideration. From a research perspective this study advances the science of massage dosing, which is much needed in the literature. Attempt to replicate these study findings in diverse patient populations could provide evidence for informing massage therapy treatment guidelines.

Does this study make you curious about something you commonly see in your massage practice? Do you have a research idea you would like to explore? The Massage Therapy Foundation provides research grants to help you explore these questions and is currently accepting applications.


Editor's Note: This synopsis is authored by volunteers from the MTF's Writing Workgroup. To learn more please visit their columnist page.

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