Massage

Injury type: Acute/ Chronic

Category: Complementary and Alternative Therapies

Rating: Not effective

What is it?

Therapeutic massage is the manipulation of the soft tissue of whole body areas to bring about generalised improvements in health. These include relaxation or improved sleep, or specific physical benefits, such as relief of muscular aches and pains. There are many different types of massage such as relaxation, therapeutic, remedial, soft tissue, deep connective tissue, effleurage, petrissage, kneading, myofascial to name a few.

How does it work?

Massage is thought to work through a mechanical action and a reflex action. A mechanical action is created by moving the muscles and soft tissues of the body using pressure and stretching movement. This mechanical action is purported to break up fibrous tissue and loosen stiff joints.

A reflex is created when treatment of one part of the body affects another part of the body, via the nervous system. It may help heal damaged muscle, stimulate circulation, clear waste products via the lymphatic system, boost the activity of the immune system, reduce pain and tension and induce a calming effect. Massage may also enhance a general sense of well-being by stimulating the release of endorphins (natural pain-killers and mood elevators) and reducing levels of certain stress hormones.

Is it effective?

There is conflicting evidence on the use of massage for whiplash. A systematic review of existing whiplash related clinical practice guidelines¹ revealed that three guidelines found no evidence for massage in the management of whiplash. Despite this, two guidelines suggested its consideration for acute or subacute whiplash, while one guideline did not recommend its current use.

A recent systematic review² which updated evidence on massage for chronic neck pain in identified three trials of fair methodological quality. Collectively, massage was found to be more effective in improving pain and function than self-management attention or waitlist control, but no difference in pain improvement when compared with exercise.

Are there any disadvantages?

Most massage techniques have a low risk of adverse effects. Cases reported in the literature are extremely rare and regularly involve techniques that are unusual, such as extremely vigorous massage. If you have other underlying health issues massage may not be suitable. Generally, massage should be avoided if you suffer from congestive heart failure, kidney failure, infection of the superficial veins (called phlebitis) or soft tissue (called cellulitis) in the legs or elsewhere, blood clots in the legs, bleeding disorders, or contagious skin conditions. If you have cancer, you must check with your doctor before considering massage because you should not receive such treatments under certain circumstances.

People with rheumatoid arthritis, a goiter (a thyroid disorder characterized by an enlarged thyroid), eczema and other skin lesions should not receive massage therapy during flare-ups. Experts also advise that people with osteoporosis, high fever, few platelets or white blood cells, and mental impairment, as well as those recovering from surgery may be better off avoiding massage. Massage obviously involves close physical contact. To minimise the risks of unprofessional behaviour in this situation, patients should ensure that practitioners are registered with an appropriate regulatory body.

Where do you get it?

Massage Therapists are listed in the Yellow Pages. Other professionals such as Physiotherapists and Chiropractors may use massage as a component of their treatment. Qualified Massage Therapists should belong to a relevant professional association.

Recommendations

The use of massage cannot be recommended following whiplash because of a lack of research evidence. More research is required to strengthen the evidence base.

References contributing to the treatment rating

Haraldsson, BG, Gross, AR, Myers, CD, Ezzo, JM, Morien, A, Goldsmith, C, Peloso, PM, Bronfort, G, Cervical Overview Group, ‘Massage for mechanical neck disorders’, Cochrane Database Systematic Reviews 2006, Issue 3. Art. No.: CD004871. DOI:10.1002/14651858.CD004871.pub3.

Hurwitz, E, Carragee, E, Van der Velde, G, Carroll, L, Nordin, M, Guzman, J, Peloso, P, Holm, L, Coˆte, P, Hogg-Johnson, S, Cassidy, D & Haldeman, S 2008, ‘Treatment of neck pain: noninvasive interventions; results of the bone and joint decade 2000–2010 task force on neck pain and its associated disorders’, European Spine Journal, vol. 17, no. 1, pp. 123-152.

Mercer, C, Jackson, A & Moore, A 2007, ‘Developing clinical guidelines for the physiotherapy management of whiplash associated disorder (WAD)’, International Journal of Osteopathic Medicine, vol. 10, no. 2-3, pp. 50-54.

Moore, A, Jackson, A, Jordon, J, Hammersley, S, Hill, J, Mercer, C, Smith, C, Thompson, J, Woby, S & Hudson, A 2005, Clinical guidelines for the physiotherapy management of Whiplash Associated Disorder, The Chartered Society of Physiotherapy, London.

Motor Accidents Authority 2007, Your guide to whiplash recovery in the first 12 weeks after the accident, MAA, Sydney, Australia.

National Institute of Health 2006, Massage Therapy as CAM, National Centre for Complementary and Alternative Medicine, viewed 23 October, 2007, http://nccam.nih.gov/health/massage/D327.pdf

Sherman, KJ, Cherkin, DC, Hawkes, RJ, Miglioretti, DL & Deyo RA 2009, ‘Randomized trial of therapeutic massage for chronic neck pain’, Clinical Journal of Pain, vol. 25, no. 3, pp. 233–238, doi:10.1097/AJP.0b013e31818b7912.

2. Skelly AC, Chou R, Dettori JR, Turner JA, Friedly JL, Rundell SD, Fu R, Brodt ED, Wasson N, Kantner S, Ferguson AJ. Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update.

1. Wong JJ, Côté P, Shearer HM, Carroll LJ, Yu H, Varatharajan S, Southerst D, van der Velde G, Jacobs C, Taylor-Vaisey A. Clinical practice guidelines for the management of conditions related to traffic collisions: a systematic review by the OPTIMa Collaboration. Disability and rehabilitation. 2015 Mar 13;37(6):471-89.

Verhagen, A, Scholten-Peeters, G, Van Wijngaarden, S, De Bie, R & Bierma-Zeinstra, S 2007, ‘Conservative treatments for whiplash’, Cochrane Database of Systematic Reviews, Issue 2, Art. No.: CD003338. DOI: 10.1002/14651858.CD003338.pub3.