Massage Therapy For Neck And Shoulder Pain

  • Natasha Larkin Master of Public Health - MSc, London School of Hygiene and Tropical Medicine
  • Regina Lopes Senior Nursing Assistant, Health and Social Care, The Open University

Musculoskeletal disorders, defined as injuries of the muscles, nerves, tendons, joints, cartilage and spinal discs are the fourth greatest burden on health globally and are responsible for 21% of years lived with disability.1 The neck and shoulder are two of the most common areas affected by pain. Approximately 20-50% of the population at any one time suffer from neck and/or shoulder pain.1

Massage therapy is thought to be one of the earliest known tools used for pain relief. The use of massage as a pain reliever was first documented in China in 2700 BC.2 Many different types of massage therapy exist and it is a popular method of pain relief around the world. Here we will discuss massage therapy as a form of pain relief in the context of neck and shoulder musculoskeletal pain.

Understanding neck and shoulder pain

Musculoskeletal pain can affect all areas of the body however it most commonly affects the lower back, neck and shoulder. There are many different disorders that result in shoulder and neck pain ranging from stress induced or chronic pain conditions to repetitive strain injuries or joint disorders. 

It is important to understand first the underlying cause of your pain so that the most appropriate methods of treatment can be started. Here are some of the most common injuries and disorders causing neck and shoulder pain.3

Soft tissue injury: Injury to the muscles, tendons or ligaments in the neck or shoulder. This can be due to an accident such as ‘whiplash’ caused by a motor collision, a sporting injury, fall or due to a repetitive strain injury. Rotator cuff injury is a specific soft tissue injury where there is damage to the tendons which connect your humerus (upper arm bone) to your scapular (shoulder blade). 

Tendonitis: Inflammation of the tendons in the shoulder are a common cause of shoulder pain and stiffness and can result from repetitive movements which strain the tendons or from a traumatic blow to the shoulder.

Poor Posture: Poor posture, either when awake or asleep, can lead to chronic neck pain, as holding your neck in an awkward position for a prolonged period of time leads to strain and tension on your muscles and joints. This form of neck pain is often found in those who spend a lot of time hunched over a computer or phone.

Stress and anxiety: Chronic stress and anxiety can lead to increased tension and strain on the muscles in the shoulder and neck causing pain and stiffness. 

Pinched nerve: Cervical radiculopathy, also called a ‘pinched nerve’ found in the neck, can occur due to changes in your spine resulting from age or injury. A nerve becomes pinched between the spinal discs causing pain and muscle weakness in the shoulder and arm.

Joint disorders: Cervical spondylosis is a common ‘wear and tear’ injury affecting the spinal discs in your neck. This occurs as you age and your discs become stiffer and smaller, moving your vertebrae (bony parts of your spine) closer together causing the lining between them to rub and become inflamed and painful. Adhesive capsulitis (frozen shoulder) is another common disorder of the shoulder found predominantly in those aged 40-60. The cause is unknown but it can be a painful and debilitating condition resulting in the inability to lift your arm above shoulder height.

Other: Referred pain to the neck and/or shoulder can also be a rare but significant symptom of a serious medical condition such as cancer, heart attack or stroke. It is extremely important that any sudden onset of pain in the neck or jaw be investigated by a healthcare professional urgently.

Burden of shoulder and neck pain

Neck and shoulder pain is a common medical complaint in populations around the world. It is more common in females and rises to a peak in middle age before plateauing in older age.4 Factors associated with the development of neck or shoulder pain overlap significantly with other musculoskeletal disorders and include, lifestyle, genetics, mental ill-health, obesity, smoking and sleep disorders. 5

The burden of suffering from shoulder and neck pain is significant and has been found to affect all aspects of one's life. It can affect sleep causing fatigue, affect work and home life leading to stress and poor mental health, have financial implications as well as an effect on your social life and hobbies.6 

With so many people suffering from neck and shoulder pain and with such a high potential burden on daily life, it is imperative that we have effective methods of managing these conditions, which are not solely limited to the use of pain medications.

Massage therapy for shoulder and neck pain

A number of different treatments are available to manage shoulder and neck pain. The treatment offered to you will depend on the underlying cause of your pain however various options available include:7

  • Pain medications (opioids and nonopioids)
  • Surgery 
  • Massage therapy
  • Acupuncture
  • Other complementary pain treatments such as mind-body methods

What is massage therapy

Massage therapy is a complementary and alternative treatment that has long been accepted as an effective method of treating musculoskeletal pain.2 It is defined as therapeutic manipulation using the hands or a mechanical device, which includes numerous specific and general techniques that are often used in sequence, such as effleurage (stroking), petrissage (kneading), and percussion.2

Massage therapy, an ‘alternative therapy’, is usually used in conjunction with other treatment methods such as exercise therapy and pain medication.1 One study found that 87% of patients undergoing treatment for neck and shoulder pain were using massage therapy as part of their pain management plan.1  

Benefits of massage therapy

The benefits of massage therapy are multifaceted. Overall, multiple studies have found that it has a positive effect on the immediate and short-term reduction of neck and shoulder pain.1,2 Currently the specific mechanism of action by which massage therapy reduces pain is unknown however it is likely a combination of various physiological responses.1 Massage therapy induces a number of physiological responses such as, increasing lymph flow, shifting nerve response from a sympathetic to a parasympathetic response which causes your muscles to relax and rest, prevents muscle fibrosis (formation of scar tissue), and increases the clearance of blood lactate around the muscles and tendons.1

Current scientific thinking is that it also produces localised biochemical changes which lead to an increase in nerve activity in the spinal cord and brain causing an increase in serotonin and endorphins and subsequently a reduction in pain as well as a positive effect on mood and a reduction in stress, both of which are associated factors in neck and shoulder pain.1

Whilst the benefits that massage therapy has on neck and shoulder pain are well documented, it is less clear if it has any effect on improving other aspects of neck and shoulder injuries that are often present alongside pain such as a reduction in range of movement of the neck and shoulder joints. One study found that when compared to no treatment, massage therapy showed a significant improvement in the range of movement of the shoulder with sports massage therapy being the most effective technique.8 

Types of massage techniques 

Massage therapy has existed in many cultures for thousands of years, over time certain techniques have gained in popularity and are now commonly used worldwide.

Swedish massage

Swedish massage is a gentler technique often used on the whole body. It uses a combination of kneading, long flowing strokes and deep circular motions to apply gentle pressure to the muscles. It is very good at inducing relaxation                                                        

Sports massage

This is a form of deep tissue massage which targets deeper tissue layers than a Swedish massage and helps to release chronic muscle tension. It mobilises and stretches soft tissue and in the context of shoulder and neck pain it has been found to improve both pain and joint mobility.8 

Trigger point therapy

This is where specific muscles are targeted and pressure is applied by finger or instrument in order to encourage healing in the muscle and reduce pain and stiffness.                      

Myofascial release

This form of massage therapy targets specific connective tissue layers and gently stretches them, resulting in reduced pain and increased mobility.

Considerations and precautions

Most massage techniques are very low risk and adverse effects are rarely reported. However, you should still discuss the use of massage therapy with your healthcare provider before starting a course of treatment.9 

There are a few health conditions where massage therapy is contraindicated and this includes those in early pregnancy, those who have recently suffered from a heart attack and it is contraindicated in limbs where there is deep vein thrombosis.9 

Lastly, it is important to note that you should always use an appropriately registered massage therapist.

Other self-care techniques 

Massage therapy is just one line of treatment that can be used to reduce shoulder and neck pain but there are many other techniques that can and should be used alongside it if you want to have the best chance at resolving your pain. Many of these can be done at home by yourself after speaking with a healthcare professional or using alternative medicine healthcare providers. Certain stretching exercises, as well as acupuncture, have been found to reduce neck and shoulder pain, as well as some mind-body therapies.

Conclusion

Shoulder and neck pain are an extremely common finding amongst the general population. Trauma and repetitive strain injuries are common causes of shoulder and neck pain; however, age, poor sleep, genetics, and lifestyle all play a significant role in its development.

Massage therapy for shoulder and neck pain has been found to be beneficial in relieving pain in the short term. The exact mechanism by which this happens is unknown but it is likely due to a number of physiological effects that massage induces on the soft tissues, joints and nervous system.

On the whole, massage therapy is considered a very safe pain relief technique; however, it should still be discussed with your healthcare provider before embarking on a treatment course.

References

  1. Bervoets DC, Luijsterburg PA, Alessie JJ, Buijs MJ, Verhagen AP. Massage therapy has short-term benefits for people with common musculoskeletal disorders compared to no treatment: a systematic review. Journal of Physiotherapy [Internet]. 2015 Jul 1 [cited 2024 Jan 23];61(3):106–16. Available from: https://www.sciencedirect.com/science/article/pii/S1836955315000582
  2. Kong LJ, Zhan HS, Cheng YW, Yuan WA, Chen B, Fang M. Massage therapy for neck and shoulder pain: a systematic review and meta-analysis. Evid Based Complement Alternat Med [Internet]. 2013 [cited 2024 Jan 23];2013:613279. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3600270/
  3. Kazeminasab S, Nejadghaderi SA, Amiri P, Pourfathi H, Araj-Khodaei M, Sullman MJM, et al. Neck pain: global epidemiology, trends and risk factors. BMC Musculoskelet Disord [Internet]. 2022 Jan 3 [cited 2024 Jan 25];23:26. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8725362/
  4. Cohen S. Epidemiology, Diagnosis, and Treatment of Neck Pain . Symposium on pain medicine. 2015 Feb;90(2):284–99.
  5. Peterson G, Pihlström N. Factors associated with neck and shoulder pain: a cross-sectional study among 16,000 adults in five county councils in Sweden. BMC Musculoskelet Disord [Internet]. 2021 Oct 12 [cited 2024 Jan 25];22:872. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8513299/
  6. van Randeraad-van der Zee CH, Beurskens AJHM, Swinkels RAHM, Pool JJM, Batterham RW, Osborne RH, et al. The burden of neck pain: its meaning for persons with neck pain and healthcare providers, explored by concept mapping. Qual Life Res [Internet]. 2016 May 1 [cited 2024 Jan 25];25(5):1219–25. Available from: https://doi.org/10.1007/s11136-015-1149-6
  7. Miake-Lye IM, Mak S, Lee J, Luger T, Taylor SL, Shanman R, et al. Massage for pain: an evidence map. The Journal of Alternative and Complementary Medicine [Internet]. 2019 May [cited 2024 Jan 24];25(5):475–502. Available from: https://www.liebertpub.com/doi/full/10.1089/acm.2018.0282
  8. Young-Ran Y. Effectiveness of massage therapy on the range of motion of the shoulder: a systematic review and meta-analysis. The Journal of Physical Therapy Science. 2017;29:365–9.
  9. Vickers A, Zollman C, Reinish JT. Massage therapies. West J Med [Internet]. 2001 Sep [cited 2024 Jan 25];175(3):202–4. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071543/
This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Natasha Larkin

Doctor of medicine - BM BS, Peninsula Medical School UK
Master of Public Health - MSc, London School of Hygiene and Tropical Medicine

Natasha worked for a number of years as a junior doctor in the NHS before undertaking a MSc in Public Health and the world-renowned London School of Hygiene and Tropical Medicine. Realizing her passion and strengths lie within medical writing she is utilizing her strong medical knowledge and experience in medical research to produce high quality medical content that is aimed at and accessible to the general public.

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