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Research With Massage Therapy Foundation

By Massage Therapy Foundation Contributor

About the Foundation
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Dosing for Neck Pain: How to Plan Your Sessions

Contributed by MK Brennan MS, RN, LMBT; Derek R. Austin, PT, DPT, MS, BCTMB, CSCS; Kelly Skellinger, LMT

How many massage sessions work best to relieve neck pain? Have you ever wondered about the optimum dosing of massage for the treatment of certain conditions or discomfort, such as neck pain? In a recent randomized trial, Cook, et al sought to address this question since it has been noted in numerous Cochrane reviews that previous studies have used many different types and doses of massage in an effort to relieve pain and discomfort.

As such, an optimum dose is unknown for treating neck pain. For massage therapy, dosing includes the duration, frequency, and number of treatments. In this month's Massage Therapy Foundation research review, researchers looked at an optimal combination of dosing factors starting with a four-week period of treatment and adding another six weeks of massage.

Clinical Trial

In this two-phase individually randomized clinical trial, there is a "primary" treatment period in which participants were randomly assigned to receive four weeks of one of five different doses of massage, or to a wait-list control group. The paper reporting the results of this initial study was reviewed and shared in February 2017. Once the initial four-week treatment period was completed, the individuals who had received massage were then randomized to the "booster" treatment to receive an additional six weekly, 60-minute massages or to stop receiving massage altogether.

During the "primary" treatment phase, the duration and frequency of the massage sessions were varied. Th-ere were five groups receiving four weeks of massage following a specific protocol: 30 minutes two times, or three times a week, or 60 minutes once a week, two times a week, or three times a week. Additionally, there was a wait-list control group.

Booster Treatment Phase

Those who received massage during this period of the trial were then randomized to receive massage in the "booster" treatment phase or to stop receiving massage. In the "booster" treatment, six weekly, 60-minute massages were scheduled for the participants.

Adherence was defined as completion of at least 75 percent of the visits in each of the above protocols. The massages were administered by eight massage therapists who each had at least five years of massage experience. The therapists were given time limits for each part of the massage protocol, but were allowed to use a wide range of massage techniques.

Following Institutional Review Board approval, participants with chronic non-specific neck pain were recruited though an integrated health care system and the general population of Seattle, Wash.  Individuals with pathologically identifiable causes for the pain or with low pain intensity were excluded.

Additionally, those with potential contraindications for massage, an inability to give informed consent or speak English, or with medico-legal issues related to neck or back pain, as well as those who received any massage within the last three months or massage for neck pain within the last year, were excluded.  The sample size achieved was 173 participants out of the 228 initial enrollees.

Dosing for Neck Pain: How to Plan Your Sessions - Copyright – Stock Photo / Register Mark Study Results

Outcomes were assessed at baseline, and at 5, 12, and 26 weeks after randomization by way of telephone interviewers who were blinded to the treatment assignment. Additionally, during each clinic visit and the 5 and 12 week telephone interviews, participants were asked about any adverse events such as an unfavorable or unintended sign, symptom, or disease temporally related to the massage.

Neck Pain Intensity (NPI) and Neck Disability Index (NDI) were the measurement tools used.  An 11-point scale was used for the NPI with higher scores indicating worse pain. The NDI ranges from 0 to 50 points with higher scores indicating worse dysfunction. For purposes of this study, clinically meaningful improvement was defined as a decrease in NPI of 30 percent or more from baseline and a decrease in NDI of more than five points from baseline.

The Booster & Reductions

Only the "booster" treatment resulted in short term reductions in NPI and NDI and these benefits diminished over time. It was determined, however, that the benefits of additional massages were found for those who initially received 60-minute sessions in the four-week period rather than those who received 30-minute sessions.

This was especially true for those who received 60-minute sessions, three times per week initially. The findings of this study suggest that the most effective dose of massage for neck pain may be continuing massage on a weekly basis. In total, the" booster" treatment group who received a total of ten 60-minute massages in 10 weeks showed the most improvement. The authors suggest future research can continue to explore "booster" treatment doses of massage for pain management.

Limitations of this study include the lack of a control group that did not receive massage. Additionally, there were relatively fewer individuals in the five primary treatment groups making it difficult to assess the exact combination of "primary" treatment and "booster" dose that was most effective. While this study recruited 228 participants, a larger study may simply be necessary to show any difference between the groups, if one exists.

Furthermore, since only 60-minute sessions (once a week) of the "booster" treatment were assessed at 2 - 3 times per week, sessions of the "booster" may potentially be more effective. The authors, nonetheless, conclude that future dosing studies for neck pain should use multiple 60-minute treatments per week for the first four weeks and a "booster" dose, at least once weekly for 60 minutes should be performed, and continued for six weeks.

The Learning Curve

This study's take-away message for massage therapists is that massage is clinically effective for neck pain, but clients may need to receive 60-minute massages at least once weekly for at least 10 weeks to achieve the greatest chance of feeling a real difference. The next time you encounter a client struggling with neck pain, sit down and talk with them about this current research. Let them know that research findings suggest that "there may be larger short term benefits to massage if those treatments are given for 10 weeks instead of four weeks," as this study found.

Support the Massage Therapy Foundation in our efforts to promote this type of dosing research which provides real information you can use in conversation with your clients. To read other studies regarding massage, please visit the Massage Therapy Foundation review article archives — browse accepted MTF Research Grant abstracts, or search PubMed for massage therapy research.


  • Cook AJ, Wellman RD, et al. "Randomized clinical trial assessing whether additional massage treatments for chronic neck pain improve 12- and 26-week outcomes." Spine J, Oct 1 2015;15(10):2206-15.

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

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