We don't know how effective advice to "act as usual", active mobilisation from the start, and immobilisation in a rigid collar are, compared with each other, at reducing neck pain, worsening of pain, or headache, in people within 10 days of a whiplash injury very low-quality evidence.
Advice to "act as usual" plus NSAIDs may be more effective at 6 months than immobilisation plus 14 days sick leave plus NSAIDs at improving neck stiffness, but not neck range not defined in people with acute whiplash. We don't know how effective advice to "act as usual", active mobilisation from the start, and immobilisation in a rigid collar are, compared with each other, in reducing neck disability in people within 10 days of a whiplash injury low-quality evidence. We found two systematic reviews search dates ,  and  which between them identified one RCT  of sufficient quality comparing early return to normal activity versus immobilisation plus rest, and we found one subsequent RCT.
It found no significant difference between treatments in neck range or length of sick leave reported as non-significant for both outcomes, P value not reported. The RCT also found that a similar proportion of people had severe symptoms of neck pain after 6 months proportion of people with severe symptoms defined as more than 3 on a scale from 0—5: The subsesequent RCT compared three interventions: The systematic reviews   and RCT  gave no information on adverse effects. The second systematic review 23 RCTs, people ,  found the overall quality of the RCTs poor, with heterogenous results and insufficient evidence to support any clearly effective treatment.
It found limited evidence that active and passive interventions seemed more effective than no treatment, but less convincing evidence about the effects of active interventions compared with passive ones. Early return to normal activity for acute whiplash injury One RCT added  which compared three interventions: One systematic review  revised its conclusions because of the poor quality of the RCTs, and heterogenous results, and found insufficient evidence to support any clearly effective treatment; benefits data enhanced; categorisation changed from Likely to be benefical to Unknown effectiveness.
Instruction on mobilisation exercises may be more effective than a soft collar at reducing pain at 6 weeks in people treated within 48 hours of a whiplash injury who all also took NSAIDs. We don't know whether active physiotherapy exercise or mobilisation plus advice on graded activity is more effective than usual care plus advice on graded activity in improving pain intensity or headache at 8, 12, 26, or 52 weeks in people with whiplash symptoms persisting for 4 weeks very low-quality evidence.
Different exercise regimens versus each other: We don't know whether a regular exercise regimen is more effective than a regular exercise regimen plus instructions to perform isometric exercise three times a day in improving pain at 3 or 6 months in people with acute whiplash low-quality evidence. Instruction on mobilisation exercises may be more effective than a soft collar at reducing self-assessed disability at 6 weeks in people treated within 48 hours of whiplash injury who also took NSAIDs.
We don't know whether active physiotherapy exercise or mobilisation plus advice on graded activity is more effective than general-practitioner care plus advice on graded activity in improving work activities at 8, 12, 26, or 52 weeks in people with whiplash symptoms of 4 weeks' duration very low-quality evidence. We don't know whether a regular exercise regimen is more effective than a regular exercise regimen plus instructions to perform isometric exercise three times a day in improving disability at 3 or 6 months in people with acute whiplash low-quality evidence.
We found three systematic reviews search dates ,  ,  and  , which identified two RCTs of sufficient quality. The second RCT 80 people with whiplash symptoms persisting for 4 weeks; see comment below compared active physiotherapy exercise or mobilisation plus advice on graded activity by physiotherapists versus usual care general-practitioner care which also included advice on graded activity.
There was substantial improvement in both groups over time. The RCT found no significant difference between physiotherapy and usual care in pain intensity, headache, or work activities measured at 8, 12, 26, or 52 weeks. One outcome for work activities was significantly better for usual care at 52 weeks compared with physiotherapy. However, this was no longer significant when adjusted for baseline differences between groups see comment below.
Of the secondary outcomes measured, physiotherapy was significantly more effective at improving neck rotation at 12 weeks compared with usual care mean difference — We found three systematic reviews search dates ,  ,  and  , which identified one RCT of sufficient quality. The systematic reviews    gave no information on adverse effects. The first RCT gave no information on adverse effects.
The study adjusted results for neck pain intensity, work activities, gender, pre-existing problems, and high number of complaints. The adjusted results were similar to non-adjusted results, with no significant differences between groups for all primary outcomes. PEMF treatment may be more effective at reducing pain at 4 weeks, but not at 3 months, in people with acute whiplash who also received analgesia and a neck collar very low-quality evidence.
We found four systematic reviews search dates ,  ,   and  , which identified the same single small RCT. The fourth systematic review 23 RCTs, people ,  found the overall quality of the RCTs poor, with heterogenous results and insufficient evidence to support any clearly effective treatment. Multimodal treatment postural training, psychological support, eye fixation exercises, and manual treatment may be more effective than physical treatment electrical treatment, sonic treatment, ultrasound, and TENS at improving pain at 1 and 6 months in people with whiplash due to a road traffic accident in the previous 2 months low-quality evidence.
Multimodal treatment postural training, psychological support, eye fixation exercises, and manual treatment may be more effective than physical treatment electrical treatment, sonic treatment, ultrasound, and TENS at reducing the time taken to return to work in people with whiplash due to a road traffic accident in the previous 2 months very low-quality evidence. NOTE We found no direct evidence about whether multimodal treatment is better than no active treatment.
We found two systematic reviews search dates ,  and  which identified the same RCT  of sufficient quality 60 people with whiplash due to a road traffic accident in the previous 2 months. The RCT compared multimodal treatment postural training, psychological support, eye fixation exercises, and manual treatment versus physical treatments electrical treatment, sonic treatment, ultrasound, and TENS.
The RCT  gave no information on adverse effects. We found no direct information about drug treatments analgesics, NSAIDs, antidepressants, muscle relaxants, epidural corticosteroids, epidural local anaesthetics in the treatment of people with acute whiplash injury. We found three systematic reviews search dates ,  ,  and  , which identified no RCTs. The subsequent RCT reported that, with ketorolac, eight people cited one or more of the following: Percutaneous radiofrequency neurotomy may be more effective than sham treatment with electrode insertion at increasing the proportion of people free from pain at 27 weeks, and at increasing the median time for half of the pain to return low-quality evidence.
We found four systematic reviews search dates ,  ,  ,  and  of percutaneous radiofrequency neurotomy for neck pain, which between them identified one small RCT 24 people. Few RCTs have considered treatment for chronic whiplash, and many people with whiplash are included in RCTs of chronic mechanical neck pain. The RCT identified by the reviews, although small 24 people , was well-designed and of high methodological quality.
Multimodal treatment may be more effective at increasing the proportion of people satsified with pain control and with their ability to perform activities at 3 months in people with chronic whiplash, but we don't know whether multimodal treatment is more effective at improving pain at the end of treatment or at 3 months low-quality evidence. We don't know whether multimodal treatment is more effective at improving disability or range of movement at the end of treatment or at 3 months in people with chronic whiplash low-quality evidence. NOTE We found no direct information about whether multimodal treatment is better than no active treatment.
We found two systematic reviews search dates  and  which identified the same RCT 33 people with chronic whiplash. It found no significant difference between treatments in disability, pain, or range of movement at the end of treatment or at 3 months. However, significantly more people treated with multimodal treatment were satisfied with pain control at the end of treatment and with their ability to perform activities at 3 months P less than 0.
Limitations of this RCT include its small size, and the difference in time spent with the therapist in the two groups. Physical treatments may be less effective at increasing the proportion of people satsified with pain control and with their ability to perform activities at 3 months in people with chronic whiplash, but we don't know whether physical treatments are more effective at improving pain at the end of treatment or at 3 months very low-quality evidence.
Exercise plus advice compared with advice alone: Exercise plus advice may be more effective at reducing pain at 6 weeks but not at 12 months in people with whiplash of 3—12 months' duration very low-quality evidence. We don't know whether physical treatments are more effective at improving disability or range of movement at the end of treatment or at 3 months in people with chronic whiplash very low-quality evidence. Exercise plus advice may be more effective at improving function measured by Patient-Specific Functional scale at 6 weeks but not at 12 months in people with whiplash of 3—12 months' duration very low-quality evidence.
One RCT people with whiplash of 3—12 months' duration compared exercise 12 sessions over 6 weeks plus advice versus 3 advice sessions. The RCT suggested that the effects of exercise in people with chronic whiplash injuries are small, short term, and only significant in people with greater baseline pain and disability. Physical treatments for chronic whiplash injury One RCT  added, comparing 12 sessions of exercise plus advice versus three advice sessions, which found that the effects of exercise were small and only seen in the short term 6 weeks ; benefits data enhanced; categorisation unchanged Unknown effectiveness.
We don't know how effective surgery, physical treatments, and immobilisation in a neck collar are, compared with each other, at reducing pain at 12 months in people with severe radicular symptoms of at least 3 months' duration very low-quality evidence. We found one systematic review search date ,  1 RCT . The RCT included in the review 81 people with severe radicular symptoms for at least 3 months; outcome assessors not blinded; see comment below compared three interventions: In the RCT, the number of people with prolapsed intervertebral disc was not reported.
We don't know whether epidural triamcinolone plus lidocaine plus morphine is more effective than epidural interlaminar triamcinolone plus lidocaine at reducing pain at 1 year in people with radiculopathy of more than 1 year's duration very low-quality evidence. NOTE We found no direct information about whether drug treatments analgesics, NSAIDs, antidepressants, muscle relaxants, epidural corticosteroids, epidural local anaesthetics are better than no active treatment.
We found two systematic reviews search dates  and  , which between them identified one RCT meeting our inclusion criteria. The first systematic review reported occasional complications, such as infection or abscess formation after cervical epidural injection. The FDA issued a drug safety alert on the risk of rare but serious skin reactions with paracetamol acetaminophen August The Food and Drug Administration FDA has issued a drug safety alert on the risk of rare but serious skin reactions with paracetamol acetaminophen.
Drug treatment s One new systematic review added  which identified no new RCTs; benefits and harms data enhanced; categorisation unchanged Unknown effectiveness. National Center for Biotechnology Information , U. Author information Copyright and License information Disclaimer. This article has been cited by other articles in PMC. Abstract Introduction Non-specific neck pain has a postural or mechanical basis and affects about two thirds of people at some stage, especially in middle age.
Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: Results We found 91 systematic reviews, RCTs, or observational studies that met our inclusion criteria. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: Key Points Non-specific neck pain has a postural or mechanical basis, and affects about two thirds of people at some stage, especially in middle age.
Manipulation and mobilisation may reduce chronic pain more than usual care or less-active exercise. They seem likely to be as effective as each other or as exercise, and more effective than pulsed electromagnetic field PEMF treatment, or than heat treatment. Acupuncture may be more effective than some types of sham or inactive treatment at improving pain relief and quality of life at the end of treatment or in the short term.
We don't know whether exercise, early return to normal activity, PEMF treatment, multimodal treatment, or drug treatment can reduce pain in people with acute whiplash injury. About this condition Definition In this review, we have differentiated non-specific uncomplicated neck pain from whiplash, although many studies, particularly in people with chronic pain duration longer than 3 months , do not specify which types of pain are included.
Prognosis Neck pain usually resolves within days or weeks, but can recur or become chronic. Aims of intervention To recover from an acute episode within 4 weeks; to maintain activities of daily living and reduce absence from work; to prevent development of long-term symptoms; to minimise adverse effects of treatment. Outcomes Pain; range of movement; function; return to work; level of disability Neck Disability Index ; adverse effects of treatment. Important outcomes Symptom improvement, functional improvement, quality of life Number of studies participants Outcome Comparison Type of evidence Quality Consistency Directness Effect size GRADE Comment What are the effects of treatments for people with non-specific neck pain without severe neurological deficit?
Directness point deducted for restricted population 1    Functional improvement Endurance or strengthening isometric exercise v no specific exercise programme 4 —2 0 —1 0 Very low Quality points deducted for sparse data and unclear randomisation. Directness point deducted for restricted population 1, 2 papers   Symptom improvement Exercise strength training, endurance training, or coordination exercises v stress management 4 —2 0 —1 0 Very low Quality points deducted for sparse data and incomplete reporting of results.
Directness point deducted for restricted population 1  Symptom improvement Exercise dynamic muscle training v relaxation training or advice to continue with ordinary activity 4 0 0 —2 0 Low Directness points deducted for low uptake of interventions and for restricted population 1  Functional improvement Exercise dynamic muscle training v relaxation training or advice to continue with ordinary activity 4 0 0 —2 0 Low Directness points deducted for low uptake of interventions and for restricted population 1  Symptom improvement Exercise plus infrared v TENS plus infrared v infrared alone 4 —1 —1 0 0 Low Quality point deducted for incomplete reporting of results.
Consistency point deducted for no consistent evidence of benefit across different symptoms 1  Functional improvement Exercise plus infrared v TENS plus infrared v infrared alone 4 —1 0 —1 0 Low Quality point deducted for incomplete reporting of results. Directness point deducted for unclear outcome assessment 1  Symptom improvement Exercise v sleeping neck support pillow v exercise plus pillow v placebo hot or cold packs plus massage 4 —3 0 —1 0 Very low Quality points deducted for sparse data, incomplete reporting of results, and uncertainty about validity of control group as it included two active treatments.
Directness point deducted for low overall baseline pain 1  Symptom improvement Traction v sham traction 4 —2 0 0 0 Low Quality points deducted for sparse data and incomplete reporting of results. Directness point deducted for unclear outcome assessment 1 81  Symptom improvement PEMF treatment v sham PEMF treatment 4 —3 0 —1 0 Very low Quality points deducted for sparse data, sub-group analysis, and baseline differences between groups.
Directness point deducted for unclear measurement of outcomes 9 at least        Symptom improvement Acupuncture v sham treatment, inactive treatment, or waiting list control 4 —2 0 —2 0 Very low Quality points deducted for weak methods of RCTs and incomplete reporting.
Evaluating and Managing Acute Low Back Pain in the Primary Care Setting
Directness points deducted for inclusion of people with whiplash or radicular pain, lack of clarity of diagnosis in 1 RCT, and use of a composite outcome measure 1  Quality of life Acupuncture v sham treatment, inactive treatment, or waiting list control 4 —2 0 —1 0 Very low Quality points deducted for lack of blinding and incomplete reporting of results. Directness point deducted for lack of clarity of diagnosis 1 74  Symptom improvement Spray and stretch v placebo 4 —2 0 —1 0 Very low Quality points deducted for sparse data and incomplete reporting of results.
Directness point deducted for unclear outcome assessment 1, 2 papers    Symptom improvement Mobilisation v exercise or v usual care 4 —2 0 0 0 Low Quality points deducted for sparse data and incomplete reporting of results 1 77  Symptom improvement McKenzie mobilisation v exercise or v control 4 - 3 0 0 0 Very low Quality points deducted for sparse data, poor methods, and incomplete reporting of results 1 people in total, only 96 of whom had neck pain  Symptom improvement McKenzie mobilisation v CBT 4 —2 0 —1 0 Very low Quality points deducted for incomplete reporting of results, and no seperate reporting of people with neck pain.
Directness points deducted for inclusion of co-intervention advice booklets 3  Symptom improvement Manipulation v muscle relaxants, NSAIDs, or usual care 4 —1 0 —2 0 Very low Quality points deducted for sparse data. Directness points deducted for inclusion of people with back pain and control including different active treatments including diazepam, anti-inflammatory drugs, and usual care 3    Symptom improvement Manipulation v mobilisation 4 —3 0 0 0 Very low Quality points deducted for incomplete reporting of results, lack of blinding, and short follow-up 3    Functional improvement Manipulation v mobilisation 4 —3 0 0 0 Very low Quality points deducted for incomplete reporting of results, lack of blinding, and short follow-up 1  Symptom improvement Manipulation or mobilisation v other physical treatments exercises plus massage with or without heat, PEMF treatment, ultrasound, or short-wave diathermy v usual care or placebo 4 —1 0 —2 0 Very low Quality points deducted for incomplete reporting of results.
Directness point deducted for inclusion of people with shoulder pain 1  Symptom improvement CBT plus physiotherapy v CBT v minimal treatment 4 —2 0 —2 0 Very low Quality points deducted for sparse data and incomplete reporting of results. Directness points deducted for inclusion of people with back pain and unclear clinical relevance of reported outcome 2   Symptom improvement Patient education or patient education plus exercise v no treatment, CBT or stress management 4 —2 0 —1 0 Very low Quality points deducted for incomplete reporting and inclusion of co-intervention exercise.
Directness point deducted for inclusion of people with back and shoulder pain 3    Symptom improvement Muscle relaxants v placebo 4 —2 0 —1 0 Very low Quality points deducted for incomplete reporting of results, and short follow-up. Directness point deducted for inclusion of people with range of musculoskeletal disorders Waht are the effects of treatments for acute whiplash injury?
Directness points deducted for no direct statistical comparison between groups, and inclusion of co-interventions other neck interventions 2   Functional improvement Early mobilisation including exercises v immobilisation or less active treatment 4 —1 0 —2 0 Very low Quality point deducted for incomplete reporting of results. Directness points deducted for no direct statistical comparison between groups and inclusion of co-interventions other neck interventions 2   Symptom improvement Early return to normal activity v immobilisation or v early mobilisation 4 —1 0 —2 0 Very low Quality point deducted for incomplete reporting of results.
Directness points deducted for no direct statistical comparison between groups, and inclusion of co-interventions other neck interventions 2   Functional improvement Early return to normal activity v immobilisation v early mobilisation 4 —1 0 —1 0 Low Quality point deducted for incomplete reporting of results. Directness point deducted for inclusion of co-interventions other neck interventions 2   Symptom improvement Exercise v soft collar or v usual care 4 —1 0 —2 0 Very low Quality point deducted for incomplete reporting of results.
Directness points deducted for high rate of withdrawals, baseline differences between groups, and use of co-intervention 2   Functional improvement Exercise v soft collar or v usual care 4 —1 0 —2 0 Very low Quality point deducted for incomplete reporting of results. Directness points deducted for high rate of dropouts baseline differences between groups, and use of co-intervention 1 59  Symptom improvement Different exercise regimens v each other 4 —2 0 0 0 Low Quality points deducted for sparse data and incomplete reporting of results.
Directness point deducted for inclusion of co-intervention 1 60  Symptom improvement Multimodal treatment v physical treatments 4 —2 0 —1 0 Very low Quality points deducted for sparse data and incomplete reporting of results. Directness point deducted for inclusion of different comparators in control group 1 60  Functional improvement Multimodal treatment v physical treatments 4 —1 0 —2 0 Low Quality point deducted for sparse data.
Directness points deducted for inclusion of different comparators in control group What are the effects of treatments for chronic whiplash injury? Directness point deducted for use of additional treatment 1  Functional improvement Exercise plus advice v advice alone 4 —1 0 —1 0 Low Quality points deducted for sparse data. Directness point deducted for use of additional treatment What are the effects of treatments for neck pain with radiculopathy? Open in a separate window. Glossary Cognitive behavioural therapy Brief 6—20 sessions over 12—16 weeks structured treatment, incorporating elements of cognitive therapy and behavioural therapy.
Behavioural therapy is based on learning theory and concentrates on changing behaviour. It requires a highly trained therapist. Low-quality evidence Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Manipulation A manual treatment involving the use of short- or long-lever high-velocity thrusts directed at one or more of the cervical spine joints which does not involve anaesthesia or instrumentation.
Manual treatment is usually performed by chiropractors or osteopaths. McKenzie treatment A type of mobilisation consisting of a comprehensive mechanical evaluation to assess the effect on the patient's symptoms of repetitive movements, static positioning, or both. This mechanical diagnosis is intended to enable the physiotherapist to prescribe a series of individualised exercises. The emphasis is on active patient involvement, with the aim of minimising the number of visits to the clinic. For people with more difficult mechanical problems, a certified McKenzie physiotherapist can provide advanced hands-on techniques until the person is able to perform the prescribed exercises alone.
Mobilisation Any manual treatment to improve joint function which does not involve high-velocity movement, anaesthesia, or instrumentation. Usually performed by physiotherapists. Moderate-quality evidence Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Multimodal treatment includes a physical or mechanical treatment plus psychotherapy such as cognitive behavioural therapy.
Usually performed by physiotherapists and psychologists working together. In this review, multimodal treatment does not include the use of combinations of physical and mechanical treatments, although some reviews and RCTs use this definition. Neck Disability Index A item self-report measure. Items include pain intensity, personal care, lifting, reading, headaches, concentration, work, driving, sleeping, and recreation. Each item is rated on a 6-point scale 0—5 , so the Neck Disability Index scores vary from 0— Northwick Park Neck Pain Questionnaire is a 9-item scale covering the following areas: Very low-quality evidence Any estimate of effect is very uncertain.
Notes Disclaimer The information contained in this publication is intended for medical professionals. Prevalence, determinants, and consequences of chronic neck pain in Finland. Am J Epidemiol ; The Saskatchewan health and back pain survey: The prevalence of neck pain in the world population: Eur Spine J ; Evaluation of the efficacy and acceptability to patients of a physiotherapist working in a health centre. Demographic and clinical characteristics of chiropractic patients: J Can Chiropr Assoc ; The traditional model in practice.
A review of the science of massage therapy … such as it is
Occurrence of musculoskeletal disorders in a manufacturing industry with special attention to occupational shoulder disorders. Scand J Rehabil Med Suppl ;8: The outcome of control groups in clinical trials of conservative treatments for chronic mechanical neck pain: BMC Musculoskel Disord ;7: Soft-tissue injuries of the cervical spine: J Bone Joint Surg Br ; Scientific monograph of the Quebec Task Force on whiplash-associated disorders: Spine ;20 suppl 8: Ferrari R, Russell AS. Ann Rheum Dis ; Vernon H, Mior S.
The neck disability index: J Manipulative Physiol Ther ; Spinal manipulation and mobilisation for back and neck pain: Search date ; primary source Medline. Conservative management of mechanical neck pain: Search date ; primary sources Medlars, Embase, Cinahl, and Chirolars. A critical analysis of randomised clinical trials on neck pain and treatment efficacy.
Does Massage Therapy Work?
A review of the literature. Scand J Rehabil Med ; Search date ; primary sources Medline, Cinahl, and hand searches of reference lists. Evidence-based clinical practice guidelines on selected rehabilitation interventions for neck pain. Evidence for exercise therapy in mechanical neck disorders. Chronic mechanical neck pain in adults treated by manual therapy: Manipulative Physiol Ther ; Changes in cervicocephalic kinesthesia after a proprioceptive rehabilitation program in patients with neck pain: Arch Phys Med Rehabil ; Perceived pain before and after three exercise programs — a controlled clinical trial of women with work-related trapezius myalgia.
Effects of training on female trapezius myalgia: Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain. A randomized, controlled trial. Ann Intern Med ; Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: A systematic review of efficacy of McKenzie therapy for spinal pain. Aust J Physiother ; Kjellman G, Oberg B. A randomised clinical trial comparing general exercise, McKenzie treatment and a control group in patients with neck pain. J Rehabil Med ; Multidisciplinary biopsychosocial rehabilitation for neck and shoulder pain among working age adults.
The role of the psychologist in multidisciplinary treatments for chronic neck and shoulder pain: Active neck muscle training in the treatment of chronic neck pain in women: Dose-response relationship of specific training to reduce chronic neck pain and disability. Med Sci Sports Exerc ; Effects of neck muscle training in women with chronic neck pain: J Strength Conditioning Res ; Effectiveness of dynamic muscle training, relaxation training, or ordinary activity for chronic neck pain: A randomized clinical trial of TENS and exercise for patients with chronic neck pain.
Effect of therapeutic exercise and sleeping neck support on patients with chronic neck pain: Effectiveness of manual therapy or pulsed shortwave diathermy in addition to advice and exercise for neck disorders: Arthritis Care Res ; Manual therapy, physical therapy, or continued care by the general practitioner for patients with neck pain: Clin J Pain ; Exercises for mechanical neck disorders.
The efficacy of traction for back and neck pain: Mechanical traction for mechanical neck disorders: An investigation of the effects of cervical traction. British Association of Physical Medicine. Pain in the neck and arm: Electrotherapy for neck disorders. The effect of pulsed electromagnetic fields in the treatment of osteoarthritis of the knee and cervical spine. Report of randomized double-blind placebo controlled trials. White AR, Ernst E. A systematic review of randomized controlled trials of acupuncture for neck pain.
Search date ; primary sources Medline, Embase, Cochrane Library, and Ciscom a database specialising in complementary medicine. Teasing apart quality and validity in systematic reviews: Search date ; primary sources: Cochrane Controlled Trials Register. Acupuncture for neck disorders. Efficacy and safety of acupuncture for chronic uncomplicated neck pain: Acupuncture for patients with chronic neck pain.
Manipulation and mobilization of the cervical spine: Search date ; primary sources Medline, Embase, Chirolars, Cinahl, and contact with experts. Chiropractic spinal manipulation for neck pain: Efficacy of spinal manipulation and mobilization for low back pain and neck pain: Spinal manipulation for chronic neck pain. In Bazian Ltd, ed. Succinct and timely evaluated reviews ;4. Manipulation and mobilisation for mechanical neck disorders: Intensive training, physiotherapy, or manipulation for patients with chronic neck pain.
A prospective, single-blinded, randomized clinical trial. Randomised clinical trial of manipulative therapy and physiotherapy for persistent back and neck complaints: The immediate effect of manipulation versus mobilization on pain and range of motion in the cervical spine: A randomized trial of chiropractic manipulation and mobilization for patients with neck pain: Am J Public Health ; Immediate effects on neck pain and active range of motion after a single cervical high-velocity low-amplitude manipulation in subjects presenting with mechanical neck pain: Randomized trial of two physiotherapy interventions for primary care neck and back pain patients: A randomized clinical trial of exercise and spinal manipulation for patients with chronic neck pain.
Chiropractic manipulation and acute neck pain: Chiropractic clinical practice guideline: Manipulation for chronic neck pain: Manipulation of the cervical spine: J R Coll Gen Pract ; Two-year follow-up of a randomized clinical trial of spinal manipulation and two types of exercise for patients with chronic neck pain. Adverse reactions to chiropractic treatment and their effects on satisfaction and clinical outcomes among patients enrolled in the UCLA Neck Pain Study.
Dabbs V, Lauretti WJ. Med J Aust ; Linton SJ, Boersma K, Jansson M, et al The effects of cognitive-behavioral and physical therapy preventive interventions on pain-related sick leave: Linton SJ, Andersson T. Can chronic disability be prevented? A randomized trial of a cognitive-behaviour intervention and two forms of information for patients with spinal pain. No significant differences between intervention programmes on neck, shoulder and low back pain: Neck pain and pillows: Medicinal and injection therapies for mechanical neck disorders.
The efficacy and safety of eperisone in patients with cervical spondylosis: Methods Find Exp Clin Pharmacol ; Cyclobenzaprine hydrochloride effect on skeletal muscle spasm in the lumbar region and neck: Cyclobenzaprine in the treatment of skeletal muscle spasm in osteoarthritis of the cervical and lumbar spine. Curr Ther Res ; A review of treatment interventions in whiplash-associated disorders.
Search date ; primary sources Medline, Cinahl, Embase, Psycinfo and reference list checks. Treatment of whiplash-associated disorders — part I: Pain Res Manag ; Conservative treatment for whiplash. Early mobilisation of acute whiplash injuries. Early mobilisation and outcome in acute sprains of the neck. Early intervention in whiplash-associated disorders: Prospective, randomized, controlled study of activity versus collar, and the natural history for whiplash injury, in Germany.
J Musculoskel Pain ;8: Neck collar, "act-as-usual" or active mobilization for whiplash injury? A randomized parallel-group trial. Active intervention in patients with whiplash-associated disorders improves long-term prognosis: Acute treatment of whiplash neck sprain injuries: Randomised, controlled outcome study of active mobilisation compared with collar therapy for whiplash injury.
Education by general practitioners or education and exercises by physiotherapists for patients with whiplash-associated disorders? A randomized clinical trial. Acute whiplash-associated disorders WAD: Low energy high frequency pulsed electromagnetic therapy for acute whiplash injuries. A double blind randomised controlled study. Multimodal treatment to prevent the late whiplash syndrome.
Intramuscular ketorolac versus osteopathic manipulative treatment in the management of acute neck pain in the emergency department: J Am Osteopath Assoc ; Radiofrequency denervation for neck and back pain. Therapeutic facet joint interventions in chronic spinal pain: Search date ; primary sources Medline, Embase, Cochrane, systematic reviews, narrative reviews, and manual search of bibliographies and abstracts from scientific meetings. Interventional techniques in the management of chronic spinal pain: Search date and primary sources not given.
Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain. N Engl J Med ; Cognitive behavioural components in physiotherapy management of chronic whiplash associated disorders WAD — a randomised group study. Physiother Theory Pract ; Randomized controlled trial of exercise for chronic whiplash-associated disorders. Cochrane review on the role of surgery in cervical spondylotic radiculomyelopathy. Long-lasting cervical radicular pain managed with surgery, physiotherapy, or a cervical collar: Persson LC, Lilja A.
Pain, coping, emotional state and physical function in patients with chronic radicular neck pain. A comparison between patients treated with surgery, physiotherapy or neck collar — a blinded, prospective randomized study. Epidural steroids in the management of chronic spinal pain and radiculopathy. Epidural steroids in the management of chronic spinal pain: Long-term results of cervical epidural steroid injection with and without morphine in chronic cervical radicular pain.
Br J Rheumatol ; Copyright and License information Disclaimer. Benefits We found five systematic reviews search dates ,  ,  ,  ,  ,   on exercise, which identified three RCTs 5 published papers of sufficient quality. Proprioceptive and strengthening exercise versus usual care: Endurance or strengthening isometric exercise versus no specific exercise programme: Exercise strength training, endurance training, or coordination exercises versus stress management: Exercise dynamic muscle training versus relaxation training or advice to continue with ordinary activity: Exercise plus infrared versus TENS plus infrared versus infrared alone: Exercise versus sleeping neck support pillow or versus exercise plus pillow or versus placebo hot or cold packs plus massage: Exercise strengthening isometric versus traction or no treatment: The reviews identified no RCTs of sufficient quality.
Exercise versus manipulation or mobilisation; exercise combined with other physical treatments versus manipulation or mobilisation: See benefits of manipulation. Exercise versus mobilisation or usual care: See benefits of mobilisation. Exercise versus manipulation or mobilisation: Exercise as part of multimodal treatment: See benefits of multimodal treatment.
Exercise versus McKenzie mobilisation versus control: Advice plus exercise alone versus manual therapy manipulation, mobilisation plus advice plus exercise versus pulsed short-wave diathermy plus advice and exercise: Strengthening exercises plus manipulation versus either treatment alone: Harms We found no good data on harms in included studies. Comment One high-quality systematic review search date of exercise therapy for mechanical neck disorders also included whiplash and myofascial disorders. Substantive changes Exercise for non-specific neck pain One systematic review added. Benefits We found four systematic reviews search dates ,  ,  ,  and  , which between them identified two RCTs   of sufficient quality comparing traction versus sham traction, placebo tablets, exercise, acupuncture, heat, collar, or analgesics.
Traction versus sham traction: Traction versus positioning, instruction in posture, neck collar, placebo tablets, or untuned short-wave diathermy: See benefits of acupucture. Harms We found no good data on harms in the included studies. Substantive changes Traction for non-specific neck pain One systematic review added which identified no new RCTs of sufficient quality;  categorisation unchanged Unknown effectiveness. PEMF treatment combined with other physical treatment versus manipulation or mobilisation: Harms We found no good data on harms. Substantive changes No new evidence.
Benefits We found five systematic reviews search dates ,  ,  ,   and  , and two subsequent RCTs. Acupuncture versus sham treatment, inactive treatment, or waiting list control: Substantive changes Acupuncture for non-specific neck pain One systematic review added which found moderate evidence that acupuncture is more effective at achieving pain relief immediately after treatment and at at short-term follow-up less than 3 months than some sham treatments, inactive treatment, or waiting list control; although only 4 of 10 RCTs were of high quality.
Benefits TENS versus mobilisation or neck collar: TENS plus infrared versus exercise plus infrared versus infrared alone: See benefits of exercise. Harms TENS versus mobilisation or neck collar: We found no RCTs. Benefits Heat combined with other physical treatment versus manipulation or mobilisation: Infrared alone versus TENS plus infrared versus exercise plus infrared: Pulsed short-wave diathermy plus advice plus exercise versus manual therapy manipulation, mobilisation plus advice plus exercise versus advice plus exercise alone: Summary We found no direct information about biofeedback in the treatment of people with non-specific neck pain without severe neurological deficit.
Benefits We found three systematic reviews search dates ,  ,   , which identified no RCTs of biofeedback in people with uncomplicated neck pain. Harms We found no RCTs. Benefits Spray and stretch versus placebo: Harms Spray and stretch versus placebo: Benefits We found 11 systematic reviews search dates ,  ,  ,   ,   ,   ,   and  , which between them identified five RCTs 6 publications       comparing mobilisation versus other treatments including manipulation , one of which had three arms and combined data comparing mobilisation and manipulation versus other treatments.
McKenzie mobilisation versus general exercise versus control: McKenzie mobilisation versus CBT: Mobilisation or manipulation versus other physical treatments exercises plus massage with or without heat, PEMF treatment, ultrasound, or short-wave diathermy versus usual care or placebo: Mobilisation or manipulation versus exercise: See benefits of acupuncture. Mobilisation versus TENS or neck collar: See benefits of TENS. Manual therapy manipulation, mobilisation plus advice plus exercise versus pulsed short-wave diathermy plus advice plus exercise versus advice plus exercise alone: Harms Mobilisation versus exercise or usual care: See harms of manipulation.
Comment The incidence of serious adverse effects seems to be low for all physical treatments considered. Substantive changes Mobilisation for non-specific neck pain One systematic review added;  one long-term follow-up publication  of an RCT added, which found that, although mobilisation speeded recovery at 7 and 26 weeks compared with exercise or usual care analgesics, education, and counselling , there was no significant difference in perceived recovery at 1 year.
Benefits We found 11 systematic reviews search dates ,  ,  ,   ,   ,    ,  and  which between them identified seven RCTs 8 published reports         comparing manipulation versus other treatments, and we found two subsequent RCTs. Manipulation or mobilisation versus other physical treatments exercises plus massage with or without heat, PEMF treatment, ultrasound, or short-wave diathermy versus usual care or placebo: Manipulation or mobilisation versus exercise: Manipulation plus strengthening exercises versus either treatment alone: Harms Manipulation versus diazepam, anti-inflammatory drugs, or usual care: Observational data assessing adverse effects of manipulation: Substantive changes Manipulation for non-specific neck pain One systematic review added;  One RCT added which found a greater improvement in neck pain at rest and in the range of movement with manipulation versus mobilisation;  benefits and harms data enhanced; categorisation unchanged Likely to be beneficial.
Benefits We found one systematic review  search date , 1 RCT  of multimodal treatment in people with chronic neck pain, and one subsequent RCT. Harms Exercise plus behavioural modification versus exercise plus CBT: Benefits Patient education or patient education plus exercise versus no treatment, CBT, or stress management: Harms The RCTs gave no information on adverse effects.
Benefits Sleeping neck support pillow versus exercise versus exercise plus pillow versus placebo control hot or cold packs plus massage: See benefits of exercise and postural treatments. Harms The RCT did not report any harms. Comment One cross-over study of 52 people with chronic neck pain 31 with associated sleep disturbance assessed 4 different pillows. Substantive changes Collars and pillows for non-specific neck pain One small RCT found that the exercise or pillow alone did not reduce pain compared with placebo control hot and cold packs and massage.
Cortisol levels after a massage do not give a meaningful picture of the organism, and there is no direct relationship between a temporary cortisol reduction and any health benefit. These myths barely scratch the surface: Dozens of bizarre and hilarious example are compiled here: A compilation of more than 50 examples of the bizarre nonsense spoken by massage therapists with delusions of medical knowledge.
Brittany goes to the Misogynist 0: And 48 seconds now. The title of the book he holds up — Massage Are Bollocks —cracks me up every time I watch it. Massage Are Bollocks 0: But the therapist is a riot, and she effectively lampoons several of the goofier ideas in massage. Proper Opossum Massage 8: This is not a hard thing to test — the principle is science-fair simple. Just compare metabolic waste products with and without massage involved. Then they measured those substances with and without the subjects receiving basic sports massage.
Massage actually slowed down recovery from exercise, as measured by lactic acid levels. In any case, the whole notion that you want or need to get rid of lactic acid in the first place is just bogus. Lactic acid is not the cause of muscle pain at any time except the immediate aftermath of intense exercise and probably not even then. So presenting lactic acid as some kind of metabolic bogeyman that massage can purge from the flesh is wrong on many levels. Years of sport massage practice have demonstrated that it does not improve recovery and generally leads to soreness.
In fact, this study confirms this position as results showed exactly that response. Well, so much for controversy! Massage probably has many interesting physiological effects … but getting rid of acid in your blood is certainly not one of them. Nor is drinking extra water going to help.
Other articles delving into detox myths:. Although much rarer than post-event massage, some athletes also want massage before an event, and some therapists provide that service. The idea is mainly to to stimulate and invigorate — a kind of warmup. When I was taught pre-event sports massage in school, I was actually warned to be quite cautious, because it really had the potential to throw an athlete off kilter. Proponents of sports massage are aware that things can go awry. There have been very few studies of pre-event sports massage. In , a rare example of it had a clear negative conclusion, 71 echoing the findings of a couple earlier ones.
But the bottom line is simple: The massage world is fragmented into dozens or even hundreds of these, depending on how you count. These techniques are proprietary and profit-motivated, and usually championed and promoted by a single entrepreneur who gets treated like a guru and has legions of dedicated followers who tolerate criticism rather poorly.
Both therapists and patients tend to get ripped off by modality empires branded treatment methods. The trouble with the toxic tradition of ego-driven, trademarked treatment methods in massage therapy, chiropractic, and physiotherapy. Is there any evidence that any of them actually work better than ordinary Swedish massage? They are all unproven and mostly based on shoddy, self-serving clinical reasoning. Such data is thin even for the most prominent massage modalities, and the rest have not been studied at all, or so poorly that it barely counts eg: For now, and maybe forever, we can only judge these methods on the basis of the the strength of their defining idea.
What can it do that supposedly other techniques cannot? Even if it is distinctive, is the big idea any better than a pet theory? The history of medicine is littered with pet theory corpses. Most treatment ideas do not work out null hypothesis , even really good ones. Structuralist techniques are all fixated to some degree on straightening or improving your meat, because they believe that you are crooked or unbalanced in some way. This notion is easy to sell, but the entire school of thought has little merit. It is debatable at best — and debunked nonsense at worst.
This is another topic I have covered in great detail in another article: Debunking the obsession with alignment, posture, and other biomechanical bogeymen as major causes of pain. There are dozens of lines of evidence showing that structural treatment concepts of all kinds have failed to deliver the goods over the decades see the structuralism article.
The results were the same, showing clearly that a typical selection of structuralist massage techniques was not one stitch more effective than simple relaxation massage. A course of relaxation massage, using techniques commonly taught in massage schools and widely used in practice, had effects similar to those of structural massage, a more specialized technique. All those assumptions and lovely-sounding structural theories. It all added up to … nothing. They could have done relaxation massage instead and their patients would have been just as well off.
These results make typical so-called advanced massage really look bad, and they make the popular modality empires and structuralism as a paradigm look ridiculous. The technique gurus push and sell the idea that their methods are dramatically more effective than humble Swedish techniques. The gap between the pretension and the carefully measured results is a nasty condemnation of a huge chunk of an industry, of at least half of all massage the way it is actually being practiced probably much more.
Thanks to reader SKY her actual initials for sharing this cringe-inducing tale of low palpatory intelligence:. A massage therapist was giving a massage to a middle-aged man, and started working deeply on his upper ribs below his clavicle. So the imperfect evidence shows that massage can maybe help low back pain, and yet the world has certainly not been saved from back pain.
Because there are many kinds of both massage and back pain. Results of therapy vary widely with the skills of therapists, and with the specific kinds of back pain brought to them. And so, on average:.
I have a theory about what massage has going for it. They certainly describe a real phenomenon — sore, stiff, aching spots in muscles — but their true identity is unclear, and the science of trigger points is incomplete at best. Trigger points may respond to massage, and that is certainly my impression from three decades of rubbing my own trigger points and trying to help other people with theirs.
Evaluating and Managing Acute Low Back Pain in the Primary Care Setting
It has rarely been directly tested and it has never been done well and never for back pain specifically, which is probably of the greatest interest. Dial up even a mild cynical impulse, and the evidence collectively looks more like a damning failure to produce any clearly good news. But, done with humility, informed consent, and some caution, it can be a safe, cheap experimental treatment that is at least pleasing. Nothing in massage is more satisfying than a good trigger point rub: The phenomenon is common and particularly tends to crop up as painful complications of many other kinds of painful problems.
And so many such problems seem to be at least partially helped simply by rubbing muscles in the area, creating some illusion that all problems are muscular problems. Back pain is the classic example. If this theory is correct, or even half-right, it would go a long way to explain the strong appeal of massage — maybe it actually can take the edge off a great variety of problems — but also its inability to work miracles.
If trigger points are the main reason massage seems at least a little bit helpful in so many cases, they are also the reason that the results are so unpredictable. The best ways to treat trigger points are simply unknown, and it may be next to impossible. All trigger point therapy is guesswork. Therapists have greatly variable education, skill, and luck in this process. Even when you have found them, we have no idea if they can actually be treated by any well-known method, none of which has ever been clearly shown to be effective.
There are many kinds of treatments for trigger points, and not one of them is much more than an educated guess. And every patient seems to respond differently for instance, some patients have clear cravings for brutal intensities of treatment that would cripple another patient. Countless known and unknown factors influence the outcome of any massage — far too many. The result is a weird mix of genuine potential with therapeutic unpredictability and mediocrity. Also offered as a free bonus 2-for-1 with the low back, neck, muscle strain, or iliotibial pain tutorials. Paying in your own non-USD currency is always cheaper!
My prices are set slightly lower than current exchange rates, but most cards charge extra for conversion. So I just offer my customers prices converted at slightly better than the current rate. Massage is a profoundly valuable service regardless of what specific effects it does or does not have on pain, tissues, or pathologies. A pleasant, relaxing experience may have any number of minor therapeutic benefits, such as bringing your blood pressure down.
However, the subtler benefits of massage extend well beyond that, into the territory of emotional and psychological benefits that are virtually impossible to define or measure — and surprisingly potent. Recently, after a long interval without massage, I got a brief chair treatment. Any massage therapist who has been working for more than a month has observed the curious way that touch provokes introspection, insight, and inspiration.
Intense and novel sensations can be a catalyst for personal growth. Above all, massage reminds us what it feels like to feel good … and we often badly need that reminder. Whether it is the actual goal of therapy, or just an intriguing side effect, the sensations of massage can change our sense of ourselves, how it feels to be in our own skin, and perhaps bump us out of some other sensory rut 82 — and that, in turn, may give us some leverage on our emotional ruts.
The sensory experience may have complex effects on emotions and cognition. And personal growth and emotional maturation probably have some clinical relevance to recovery and healing see Pain Relief from Personal Growth: Treating tough pain problems with the pursuit of emotional intelligence, life balance, and peacefulness.
Sloth Cuddles Cat 4: The road to intellectual dishonesty is paved with good intentions. When I worked as a therapist, there were times when — confession! Sometimes it seemed okay because the atmosphere of experimental treatment was thick already, with a desperate patient who had low expectations and was pretty much there to try anything. After all, if patients were my experimental research subjects, shouldn't I have been paying them? And many are unwary and have no idea that what they are doing is unethical. Such therapists are mostly ignorant of how science works, and actually hostile towards the idea of evidence-based care.
If scientifically unsupportable practices are surprisingly common medical massage therapists, they are close to universal among barely-trained and untrained bodyworkers. And that is why most people still go to a doctor or physiotherapist when they have an obvious injury. Does it work for what? What kind of massage therapy? How do we even define the benefits? Is modest, unreliable, temporary relief from muscle pain a significant enough benefit to base a profession on? Good massage therapists are the ones with more training and a bigger toolkit.
They do what they can with the tools they judge to be the most useful, and they candidly discuss risks, benefits, evidence, and controversies. Meanwhile, bad massage therapists oversell a narrow selection of less effective and mostly faith-based options, and generally lack the training or critical thinking skills to recognize their own limitations. This is no different in principle than any other health care profession. I am a science writer, former massage therapist, and I was the assistant editor at ScienceBasedMedicine.
I have had my share of injuries and pain challenges as a runner and ultimate player. My wife and I live in downtown Vancouver, Canada. See my full bio and qualifications , or my blog, Writerly. You might run into me on Facebook or Twitter. I wish I could agree. There are many reasons why massage therapists get this wrong. And note that she is describing the sort of things she used to buy into literally. Laura Allen is a self-described reformed flake.
We took turns lying down on the classroom tables, closing our eyes, and running our hands over the bodies of our supine partners and then experiencing them doing the same to us. We also went on to do Reiki II, which was optional. That was where we learned how to do distance healing. Yes, I actually believed that you could be in Alaska, and that I could be sitting in my North Carolina home sending you a healing.
The owner of the school collected and sold crystals, and used them for healing purposes. I ended up amassing quite a collection of my own, using them to do chakra balances on people, performing psychic surgery with them, and any number of woo procedures. I also purchased magnetic pads for my massage table. I attended homeopathy workshops. I stayed there as the administrator and an instructor for five years after I graduated, and during that period of time, I could not possibly even name all the things I went through. I had a lot of psychic readings. Mercola, [sic] 84 which basically consists of tapping on meridian points in order to relieve emotional negativity, food cravings, and pain.
I also used the chi machines, the detox foot baths and pads, biofeedback and all kinds of computer programs designed to balance your body, mind and spirit, and most New Agey-sounding things in existence at the time. If it was out there, I tried it. While we were on a road trip out west, I collected some buffalo dung—I actually witnessed the buffalo relieving himself, waited until he ambled off, and I jumped out of the car with a zip-lock bag to harvest it for future ceremonial purposes.
Since it had come from a buffalo on the reservation I figured it was more powerful than your average cow dung. In , the Facebook page Anatomy in Motion published this infographic , which quickly went a bit viral with hundreds of likes and shares, as infographics do. AiM is popular with massage therapists, and the comments on the post were overwhelmingly positive, reflecting the strong tendency in the massage therapy community to uncritically embrace anything sciencey that makes massage sound good.
Typical examples with typical grammar and spelling reflect rather poorly on the profession:. Unsurprisingly, there are almost no comments questioning or challenging anything about the image. Julie Onofrio chimed in with one of the only genuine criticisms: If there was stronger evidence to cherry-pick in service of promoting massage as medicine, it would have ended up on this infographic.
Exaggerated claims, or about right? Yes, certainly it is a bit exaggerated. But it could be a lot better. Citing single cherry-picked studies to support broad treatment claims is weak sauce, even if the picks are good and clearly not all of these are. The evidence and claims here that are stronger are also less important … and those that are more clinically important are also less sound. In ten years working as an RMT, I think I did that kind of abdominal massage maybe a half dozen times — demand for the service was rather low.
Flipping it the other way, the infographic features a particularly obvious example of an important-but-weakly-supported claim: I can increase my ROM with a few seconds of stretching, too … and stretching does not enhance performance look it up. What would all the athletes who win medals without massage make of that?
But it something like this will get applause from almost everyone who sees it, because people love to love massage, because massage is a lovely experience for all kinds of reasons. But whether or not it massage is good medicine is still an open question, and this infographic is really just a bit of mild-mannered propaganda. Amatereurish boosterism never does a profession any favours.
Paying lip service to science for promotional purposes cheapens it and impedes progress and understanding. Enthusiastically approving of such poor-quality information is a disturbing sign of how far the profession of massage therapy still has to go before it can be taken seriously as a full partner in health care. This article thoroughly discusses massage therapy in a way that is quite unusual in the profession: This is normal in modern medicine, where critical self-appraisal is a formal part of the professional culture.
Founder and moderator Brantley Moate:. Scientific skeptics are the kind of people who would go to an amazing meeting , or less-amazing nights with some other skeptics in the pub. We are used to being misunderstood. Almost no one really knows what scientific skepticism is all about.
Such skeptics are obviously a rarity in massage therapy, a profession notorious for attracting people with New Age and fringe science beliefs. The kind of people who would happily pay through the nose for tickets to see Deepak Chopra talk and think Mercola. Modern social media excels at bringing together special interest groups with low-density populations.
- Sechs Motetten, No. 4: Miserere Mei?
- Velvet Corner Blue?
- Authors and Writers Associated With Morristown With a Chapter on Historic Morristown;
This is one of the best examples I can think of. This is one of the oldest articles on PainScience. The update log is woefully incomplete, but that it will probably improve in and beyond. July — New Section: Sports massage before competition. I updated the evidence for massage for back pain at the same time, with similar results. I updated the evidence for trigger point massage at the same time, with similar results.
Massage for back pain: The scientific case for massage therapy. Added a footnote linking to an interesting article about the neurology of touch as a major mechanism of massage. Added an important point about the potential of novel sensory input to treat chronic pain. An expanded and improved introduction, and a new smartphone-only article summary.
New bad news evidence about manual lymphatic drainage. Just a new section. Added a table of contents finally. Added an appendix about the Skeptical Massage Therapists Facebook group. Skeptical massage therapists unite. Massage for fibromyalgia is not very promising. Trivial but fun addition of the sloth cuddling cat video.
Important good-science-news additions about the effects of stretching on heart rate regulation, and the effects of massage on anxiety and depression it reduces them. Also a few tweaks of related content. This is exactly the right idea and the right spirit. It is not expressed nearly often enough, or firmly enough:. If massage therapy is to be taken seriously, then massage therapists must take science, research and continuing academic education seriously. There is no room for amateurism in health care. Many possible questions arise! Could a combination of methods be effective where another combination fails?
How well trained is the therapist? Or maybe the basics are the basics because they really work? How much massage therapy? Could five sessions succeed where two would fail? Could nine sessions actually be better still? Can anything be done with short sessions, or are long ones needed? If massage works, how much of the benefit can be attributed to non-massage elements like bedside manner, relaxation, and reassurance? How much do those factors define massage? And worth the expense? Massage therapy research is stunted, and not showing signs that it is ready to progress.
Some might disagree, and would point to the increasing number of massage therapy studies. But I would counter by noting that there is no discussion in the field. The studies are conducted and published in isolation. They are not often being critiqued, and researchers with different theories and perspectives are not addressing each other in the literature or even at conferences.
Christopher Moyer, Facebook post. This geeky basic neurology experiment produced a rough estimate of the density of nerve endings in human glabrous hairless skin: They measured an average nerve diametre of about 3 thousandths of a millimetre. The discovery may explain why touching the skin can relieve pain.
It strongly implies that neurological responses to touch have considerable complexity. This seems like a fairly straightforward bit of good-news science about stretching. Two general effects [of massage, MT] are well-supported by scientific data and widely agreed-upon by MT researchers. Quantitative research reviews show that a series of MT treatments consistently produces sizable reductions of depression in adult recipients. The effects of MT on anxiety are even better understood. Single sessions of MT significantly reduce state anxiety , the momentary emotional experiences of apprehension, tension, and worry in both adults and in children, and multiple sessions of MT, performed over a period of days or weeks, significantly reduce trait anxiety, the normally stable individual tendency to experience anxiety states, to an impressive degree in adults.
Together, these effects on anxiety and depression are the most well-established effects in the MT research literature. They are especially important for us to understand not only for their own sake, but also because anxiety and depression exacerbate many other specific health problems. This study evaluated the effectiveness of a min. Analysis showed a significant reduction in participants' systolic and diastolic blood pressure after receiving the massage although there was no control group. This is both a scientific blow for massage therapy and a nice validation at the same time.
But it also reinforces the reassuring idea that any kind of touch is therapeutic, and that skill may not be a critical factor in the value of massage therapy to some patients. Incomplete blinding is a significant weakness in the study. The massage therapists knew what treatment they were giving: Prolonged wearing of a collar is associated with persistence of symptoms. This is a test of manual lymphatic drainage MLD , a gentle massage-like technique that allegedly reduces swelling by stimulating the natural mechanisms that drain excess fluids from between cells. Compared to 30 others who got a placebo.
It did reduce pain quite a bit right in the early stages, which is a nice demonstration of something we already know — gentle touch is quite soothing — but does little itself to justify MLD as a modality. A bit of good news: And the MLD treatments were done by therapists we have every reason to have confidence in: The same therapist performed all of the study treatments for a given patient. This review of six studies of manual lymphatic drainage for breast cancer-related lymphedema is about as on-point as we can hope for if we want to know if MLD works.
Note that swelling reduction is by far the most important outcome measure. But mostly the evidence is a classic example of damning with faint praise. This may be the first ever scientific test of friction massage for tendinitis. In when I was graduating from high school! This paper is an entertaining chapter in the history of the science of alternative medicine: Therapeutic touch practitioners could not demonstrate any ability to detect a person by feeling their aura, let alone manipulating it therapeutically.
The test made them look ridiculous. A short but clear, compelling, and strong critique of cranial osteopathy. As an osteopath himself, Dr. I think it is more that they are circumspect than pessimistic. Speaking as a scientist, we are very careful to guard against declaring a finding if there is even a small risk of it being a false positive. So, I think they are hewing to scientific norms in this regard, and I do not fault them for that; it is important to be careful in science. But was it because the results were less positive? Or just that the evidence is such junk? In fact, their data showed that the benefits of massage were minor to begin with, and barely detectable after six months.
They concede the flaw but fail to acknowledge its serious implicates: Never in a million years would I have summarized the way they did. Scientifically unsupportable ideas are common among massage therapists, according to Dr. And even worse, massage therapy schools, publications, and professional groups are an integral part of the deception. I agree with almost every detail of the article and wrote a letter of support to Dr. Barrett, which is published as an addendum to it. That said, the article does neglect some nice things that can be said about massage therapy, and it contains a few minor errors.
But I applaud the intent and embrace and welcome most of the criticism. Interestingly, that means that most of these patients experienced no noteworthy effect at all, good or bad! Researchers tested two physicians with training in manual medicine to see if they could detect the painful side of the neck or back by touch alone, feeling for tension in the spinal muscles. An odd anomaly occurred in the difference between the left and right side: The results are underwhelming.
As well, they were only attempting to detect the side of pain. Imagine how much worse their performance would have been if they had had to identify the location more precisely, or if the pain could have been anywhere or nowhere. So they barely passed the easiest possible test, and probably would have failed a harder one and done no better than guessing. An obvious weakness of the study is that only two examiners of uncertain skill were tested, and so the results are inconclusive.
One would still hope for a better detection, though, even from professionals with only average examination skills. Note that this study compares a more vigorous sports massage style with more common Swedish petrissage techniques. Vigorous massage did indeed show significantly increased circulation! However, this technique is rarely used — the vast majority of Registered Massage Therapists in British Columbia rarely treat their clients with vigorous sports massage techniques, yet they still have a habit of claiming that massage increases circulation. This study compared the effects of massage and minimal exercise therapy on poor circulation venous insufficiency in post-menopausal women.
Superficially it looks like a good news story for massage, and in some ways it is. Only the statistical significance of the results is touted in the abstract, not their size. This almost always means a real effect that was too small to emphasize. So I read the full paper and, sure enough, the effects of massage were positive but modest at best and in many cases trivial. There were a lot of measures of success, and none changed all that much.
Also, some of the measures also seemed barely useful. And it was really a lot of massage expensive in the real world. I wish the study had included a third group doing more exercise, perhaps a half hour of brisk walking per day. And walking is notably a lot cheaper than massage.
This review of 35 tests of treatments for delayed onset muscle soreness DOMS is strongly consistent with my own past interpretations of the research: This study is the source of a new massage myth that massage reduces inflammation. Unfortunately, the results of this study were actually negative: There are several major problems with the study: David Gorski at ScienceBasedMedicine. It is frequently asserted that massage therapy MT reduces cortisol levels, and that this mechanism is the cause of MT benefits including relief from anxiety, depression, and pain, but reviews of MT research are not in agreement on the existence or magnitude of such a cortisol reduction effect, or the likelihood that it plays such a causative role.
A definitive quantitative review of MT's effect on cortisol would be of value to MT research and practice. One of the great unanswered questions in physiology is why muscles get tired. The experience is universal, common to creatures that have muscles, but the answer has been elusive until now. Scientists at Columbia say they have not only come up with an answer, but have also devised, for mice, an experimental drug that can revive the animals and let them keep running long after they would normally flop down in exhaustion. For decades, muscle fatigue had been largely ignored or misunderstood.
Leading physiology textbooks did not even try to offer a mechanism, said Dr. Andrew Marks, principal investigator of the new study. A popular theory, that muscles become tired because they release lactic acid, was discredited not long ago. Perspective cuts both ways here. But when you take a pill, the side effect is usually unrelated to the problem i. In manual therapy, most adverse events are backfires — that is, you go for a neck adjustment at the chiropractor, and you come out with more neck pain instead of less.
And you pay through the nose for this! Manual therapy is much more expensive than most drug therapy. Manual therapists routinely claim that their services are much safer and more effective than drug therapies. Yet this data pretty clearly shows that the difference is really not great. Depending on how you look at it, drugs are only a little worse in some ways, or maybe a little better in other ways.
More investigations of this subject are urgently needed. Of the criteria used to determine the location of trigger points, the most reliable were localized tenderness. Therefore, my conclusion is that this review was mostly inconclusive, but actually found evidence that trigger point reliability is probably not all that bad — as compared to most comparable assessment procedures. P a i nScience. SUMMARY Therapeutic massage is expensive but popular and pleasant, with obvious subjective value, and proven benefit for anxiety and depression … but no other clear biological or medical effects.
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