Last month I was fortunate to work with a group of excellent clinicians providing sports medicine services at the 1^st European Olympic Games in Baku.

Although we had different background skills as a physiotherapist, sports massage therapist, osteopath, chiropractor or podiatrist, we all agreed on the importance and value of soft tissue work in the management of musculoskeletal (MSK) conditions.

The role and effectiveness of manual techniques, particularly massage, has been the topic of discussion in recent years. This review examined whether massage as a stand alone treatment has benefits for people with common MSK disorders.

Here’s what they did

PubMed, PEDro and CINAHL were searched from inception until October 2014 with no language restrictions. The reviewers included randomised controlled trials studying the effect of massage as a stand-alone intervention (compared to no treatment or to another active intervention) in people aged over 18 years with common musculoskeletal disorders.

Studies were excluded if participants had severe pathology such as fracture, nerve damage, psychological disorders (eg, depression) or sport injuries; if the intervention involved joint manipulation, energy manipulation, or mechanical devices, or if massage was combined with or additional to other active interventions.

The quality of the included studies was assessed using the Cochrane Back Review Group risk of bias tool. The quality of the evidence was assessed using the GRADE approach. The outcomes of interest were pain and function. Data were categorised as short term (post treatment up to 12 weeks) or long term (12 weeks or over).

Here’s what they found

From 1313 titles, only 26 studies were eligible for inclusion. The mean sample size among the studies was 95 participants (ranging from 16 to 579). Fourteen studies recruited fewer than 25 participants per arm and the smallest study arm recruited eight. Participants had a range of MSK disorders including spinal and peripheral conditions, fibromyalgia and chronic pain.

A broad variety of massage techniques, durations and frequencies were used including Swedish massage (n = 5), Thai massage (n = 4), self-massage (n = 1) or a combination of techniques (e.g., therapeutic and structural massage) (n = 12). Where pain was measured  using VAS,  the authors presented the results as mean differences on a 0 to 100 mm scale. Effect estimates of 16 to 19 mm were considered to be clinically relevant.

Massage versus no treatment control

• There was moderate-level evidence that massage reduces pain compared to no treatment in people with shoulder pain in the short term (pooled mean difference of –16 mm, 95% CI –25 to –7, I2 = 15%) but not in those with low back pain (MD = –12, 95% CI –32 to 8, I2= 81%).
• Low-level evidence that massage reduces pain compared to no treatment in people with osteoarthritis of the knee (pooled estimate of MD –19 (95% CI –28 to –10, I2= 0%) in the short term, but is ineffective compared to no treatment in those with neck pain (single study).
• Moderate-level evidence that massage improves function compared to no treatment in people with low back pain in the short term.
• Low-level evidence that massage improves function compared to no treatment in people with shoulder pain and those with osteoarthritis of the knee in the short term.

Massage versus active treatments

• There was low-level evidence (single study) that acupuncture reduces pain more than massage in people with neck pain.
• Very-low-level evidence (single study) that massage reduces pain more than joint mobilisation in people with low back pain, but that there is no benefit of massage over manipulation or relaxation therapy in those with fibromyalgia, low back pain and musculoskeletal pain.
• Low-level evidence (two single studies) that massage does not improve function more than acupuncture or relaxation in people with low back in the short term; in the long term, relaxation seems superior to massage.

The authors concluded

Massage reduces pain, in the short term, in shoulder pain and osteoarthritis of the knee. Massage improves function, in the short term, in shoulder pain, low back pain and osteoarthritis of the knee.

The Musculoskeletal Elf’s view

Low quality studies downgraded due to imprecision, inconsistency or design, and lack of consistent terminology made this review challenging for the authors. Missing information included the type of massage, duration of massage session, and the intensity or grade/depth of pressure, making comparisons difficult.

Although this review has shown that massage as a stand alone treatment can improve pain and function, further well designed studies are required. The exact mechanism of how massage works – biomechanical changes, therapeutic touch, etc. is still unclear and merits further investigation. Unfortunately, this review excluded studies looking at the effectiveness of massage in sports injury, an area I am particularly interested in.

What do you think?

• Do you use massage regularly – are you surprised by these findings?
• Are you involved in any studies looking at the effectiveness of massage?
• What about the role of massage in sports therapy?

Send us your views on this blog and become part of the ever expanding Musculoskeletal Elf community. Post your comment below, or get in touch via social media (Facebook, Twitter, LinkedIn, Google+).

Links

Bervoets, D.C., Pim A.J., Luijsterburg, P.A.J., Alessie, J.J.N., Buijs, M.J.& Verhagen, A.P. 2015 ‘Massage therapy has short-term benefits for people with commonmusculoskeletal disorders compared to no treatment: a systematic review’ Physiotherapy, Vol 61. pp. 106-116 [PDF]