Massage for Complex Neck Pain

By Jerrilyn Cambron, DC, PhD
[Somatic Research]

Approximately two-thirds of the US population will experience neck pain at some point in their lives. The majority of pain is nonspecific and most likely involves a postural or mechanical cause. However, some neck pain becomes more complex, progressing to cervical radiculopathy or degenerative disc disease. Complex neck pain may be difficult to treat, but there is some evidence that massage therapy may be of benefit.  
Cervical Radiculopathy
Cervical radiculopathy is one neck disorder for which massage has been studied. In a recent review article, researchers scanned seven different electronic databases for manuscripts and conference proceedings on Chinese massage for cervical radiculopathy.1 Articles were included if they were clinical trials, included subjects with a clinical diagnosis of cervical radiculopathy in accordance with the criteria of the North American Spine Society, and included a specific form of Chinese massage called tui na. Tui na was defined as “the finger, hand, elbow, knee, or foot applied to muscle or soft tissue surrounding the neck.”  
A total of 6,935 articles were identified. After review for inclusion, only five clinical trials with 448 people were eligible. The majority of subjects were women over 45 years of age who had neck and arm symptoms including pain, paresthesias, numbness, and sensory changes. All studies included tui na compared to either cervical traction or a combination of both tui na and cervical traction for treatment of radiculopathy. Interestingly, traction was the only treatment that was compared to tui na. Groups in all studies were treated either every day or every other day for 14–28 days. Pain scores were collected in all studies (numeric rating scores or visual analog scales).  
The results comparing tui na to cervical traction included data from three clinical trials and demonstrated a statistically significant difference in pain reduction favoring tui na. For the two studies where a combination of tui na and cervical traction treatments were included, the results were even more strongly in favor compared to cervical traction alone. These data appear to demonstrate that tui na is more beneficial than traction for cervical radiculopathy, but that the combination of the two therapies further increases the benefit. No adverse events were reported within any of the studies, although most studies did not include any information, so the lack of adverse events was presumed.  
As with all studies, there are possible limitations to the interpretation and application of the study results. For example, poor methodological quality, small sample size of included studies, and few studies for analysis might have affected the outcomes of this review. More research studies that have stronger study designs would enable readers to better understand the benefit of tui na for cervical radiculopathy.  

A Client Case Study
Another recent article focused on massage therapy for neck pain that was even more complex.2 In this case report, the authors described a 66-year-old female with advanced degenerative disc disease at the C6–C7 level leading to left arm radiculopathy, chronic neck pain (5 to 7 out of 10), and decreased shoulder range of motion (ROM). Treatment included five 45-minute massage sessions over 2.5 weeks. Massage was provided for approximately 10 minutes to the upper back and shoulders, brief individual leg tractions, approximately 10 minutes on the upper extremities, and the final 20 minutes on the neck. Techniques included fascial techniques, lymphatic drainage, lower extremity traction, cervical traction with movement, neuromuscular techniques, and suboccipital lift.  
Even though many forms of massage were completed, the results of these treatments were beneficial, including an increase in pain-free cervical ROM and a decrease in the use of nonsteroidal anti-inflammatory drugs (NSAIDs). The patient’s neck pain, at its worst, went from 7 to 5 (out of 10); at its best, the pain went from 5 to 2 (out of 10). No adverse events due to care were described.  
The limitations of this case report are that the results only describe one individual. Other people may experience very different outcomes. Likewise, the outcome measures used in this study were subjective (patient-rated pain levels) and practitioner assessed (ROM approximation without the use of a goniometer). Because subjective measures can be biased, more objective measures may demonstrate a different outcome.  
Possible Benefits  
Even with the potential limitations, these two studies demonstrate the possible short-term benefits gained from massage for complex neck conditions. More research is needed to determine outcomes based on patient diagnosis, form of massage received, and duration of treatment. Prior to any massage treatment, it is strongly recommended that each patient first be assessed by their health-care team to determine if massage is appropriate.
1. X. Wei et al., “Clinical Evidence of Chinese Massage Therapy (Tui Na) for Cervical Radiculopathy: A Systematic Review and Meta-Analysis,” Evidence-Based Complementary and Alternative Medicine (February 2017): 9519285. doi: 10.1155/2017/9519285.  
2. R. M. Avery, “Massage Therapy for Cervical Degenerative Disc Disease: Alleviating a Pain in the Neck?,” International Journal of Therapeutic Massage & Bodywork 5, no. 3 (September 2012): 41–6.    

Jerrilyn Cambron, DC, PhD, MPH, LMT, is an educator at the National University of Health Sciences and president of the Massage Therapy Foundation. Contact her at