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Massage for Mechanical Neck Disorders: A Systematic Review

Ezzo, Jeanette, PhD, CMT*; Haraldsson, Bodhi G., RMT; Gross, Anita R., MSc; Myers, Cynthia D., PhD, LMT§; Morien, Annie, PhD, PA-C, LMT; Goldsmith, Charlie H., PhD; Bronfort, Gert, PhD, DC#; Peloso, Paul M., MD, MSc** the Cervical Overview Group

doi: 10.1097/01.brs.0000254099.07294.21
Cochrane Collaboration

Study Design. Systematic review.

Objective. To assess the effects of massage on pain, function, patient satisfaction, cost of care, and adverse events in adults with neck pain.

Summary of Background Data. Neck pain is common, disabling, and costly. Massage is a commonly used modality for the treatment of neck pain.

Methods. We searched several databases without language restriction from their inception to September 2004. We included randomized and quasirandomized trials. Two reviewers independently identified studies, abstracted data, and assessed quality. We calculated the relative risks and standardized mean differences on primary outcomes. Trials could not be statistically pooled because of heterogeneity in treatment and control groups. Therefore, a levels-of-evidence approach was used to synthesize results.

Results. Overall, 19 trials were included, with 12/19 receiving low-quality scores. Descriptions of the massage intervention, massage professional’s credentials, or experience were frequently missing. Six trials examined massage as a stand-alone treatment. The results were inconclusive. Results were also inconclusive in 14 trials that used massage as part of a multimodal intervention because none were designed such that the relative contribution of massage could be ascertained.

Conclusions. No recommendations for practice can be made at this time because the effectiveness of massage for neck pain remains uncertain. Pilot studies are needed to characterize massage treatment (frequency, duration, number of sessions, and massage technique) and establish the optimal treatment to be used in subsequent larger trials that examine the effect of massage as either a stand-alone treatment or part of a multimodal intervention. For multimodal interventions, factorial designs are needed to determine the relative contribution of massage. Future reports of trials should improve reporting of the concealment of allocation, blinding of outcome assessor, adverse events, and massage characteristics. Standards of reporting for massage interventions, similar to Consolidated Standards of Reporting Trials, are needed. Both short and long-term follow-up are needed.

This systematic review assesses whether massage can reduce neck pain and disability. Results of 19 trials show few side effects with massage, but results for pain and disability are inconclusive due to the methodological limitations of existing studies. We cannot recommend any current therapy based on the current weak evidence.

From *JPS Enterprises, Baltimore, MD; †West Coast College of Massage Therapy, Massage Therapy Association of British Columbia, Vancouver, British Columbia, Canada; ‡McMaster University, Hamilton, Ontario, Canada; §Integrative Medicine Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; ∥Dermatology and Skin Cancer Clinic, Gainesville, FL; ¶Department of Clinical Epidemiology & Biostatistics, McMaster University, and Father Sean O’Sullivan Research Centre, St. Joseph’s Healthcare, Hamilton, Ontario, Canada; #Northwestern Health Sciences University, Bloomington, MN; and **Product Benefit Risk Assessment and Management, Amgen Inc., Thousand Oaks, CA.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Institutional and Professional Organizational funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Jeanette Ezzo, PhD, CMT, 1905 West Rogers Avenue, Baltimore, MD 21209; E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.