Massage Reduces Non-Specific Shoulder Pain and Improves Function

By Massage Therapy Foundation Contributor

Contributed by Derek R. Austin, PT DPT MS BCTMB CSCS; Jolie Haun, PhD EdS LMT; Pualani Gillespie, LMT MS RN BCTMB

While seemingly universal, pain and stiffness in the shoulders can be a significant cause of disability.

Often a pain that does not go away on its own, shoulder complaints tend to linger, sometimes for 12 months or longer. A recently published research analysis examined the question of whether massage and exercise are effective in treating shoulder pain and stiffness. This month's research review by the Massage Therapy Foundation explores the findings of a meta-analysis of 20 individual trials examining the effects of massage and exercise in people with non-specific shoulder pain.

"Non-specific shoulder pain" refers to shoulder pain without a clear pathology or physical signs. This broad category of potential non-specific causes of shoulder pain includes myofascial trigger points, bursitis, impingement syndrome, rotator cuff injuries and adhesive capsulitis. Paul ven den Dolder and his team from the Discipline of Physiotherapy at the University of Sydney in Australia published their research in the British Journal of Sports Medicine in August 2014. Physical therapists also use soft tissue massage, as well as exercise therapy to treat shoulder pain. The authors report that surveys have shown that physical therapists use massage and/or exercise to treat almost all of their patients with shoulder complaints.

While tight and painful shoulders are a common complaint in many massage therapy settings, this research article is the first systematic review of the effectiveness of massage for shoulder pain. Previous systematic reviews of the effectiveness of exercise for shoulder disorders have had differing conclusions. The authors aimed to review all of the research regarding the effectiveness of soft tissue massage and of exercise for non-specific shoulder pain compared to placebo, no treatment or other interventions.

Studies were included in the review if they were randomized controlled trials (RCTs) with participants who were adults with shoulder symptoms with the any of the diagnoses of "rotator cuff tendonitis, rotator cuff tendinopathy, rotator cuff tear, impingement syndrome, bursitis, adhesive capsulitis, periarthritis, 'frozen shoulder' [or] non-specific shoulder pain." Studies with participants with diagnoses of "infection, neoplasm, fracture, instability, dislocation, hemiplegia, postoperative or perioperative shoulder pain or inflammatory disease" were excluded. All studies had to include massage or exercise in isolation or with other therapies, as well as report patient outcomes such as disability, pain, and return to work. Two separate reviewers independently found studies by searching major databases including MEDLINE, EMBASE and PEDro. Then, they each assessed research quality and risk of bias for each of the identified studies. In total, the authors analyzed 20 discrete trials.

Based on data from these 20 trials, the authors conclude that soft tissue massage is effective for improving range of motion function and pain; exercise approaches improve pain immediately following treatment although the change may not be clinically worthwhile; and exercise does not improve reported range of motion function. The most important take-away for massage therapists treating clients with non-specific shoulder pain may be found in one study that showed the greatest treatment effect for massage. The authors wrote, "The greatest improvements with soft tissue massage [were found with] targeted treatment towards the lateral border of the scapula in end-range flexion, the posterior deltoid region in end-of-range horizontal flexion, anterior deltoid in end-of-range external rotation (measured as hand behind back) and pectoralis major in the stretch position. This demonstrated moderate improvements in active flexion and abduction ranges of motion, pain levels and functional scores." The researchers also conclude that there is evidence that soft tissue massage is effective for improving external rotation range of motion in patients with adhesive capsulitis. The authors emphasize that soft tissue massage techniques should be considered an important form of therapy, and they encourage future researchers to describe the massage techniques used in their studies in more detail.

While this meta-analysis was well-conducted and thorough, it is also limited by the generally low quality of the included studies. All of the studies that showed any effect for massage or exercise were low-quality RCTs. This research review is also limited by the fact that non-specific shoulder pain is an incredibly broad category. Thus, many possible massage and exercise treatment approaches may be indicated. Matching up the correct treatment to the correction presentation is difficult for practitioners and researchers alike. In the future, higher-quality research is needed to determine which techniques work best for which subgroups of patients.

This publication makes several contributions to research, practice, and the field of massage therapy. First, this systematic review of RCTs makes a significant contribution to the body of massage research providing supportive evidence that soft tissue massage is effective for improving range of motion, function and pain in people with shoulder pain. Second, these findings provide practitioners with the evidence needed to justify using massage techniques as an effective means of treatment for shoulder pain and stiffness. Finally, as research accumulates and supports evidence-based practice for treating common conditions such as shoulder pain, the field of massage will increase its presence in the practice of personal health and wellness.

Are you a massage therapy student who has an interesting case of your own? The deadline to submit to the MTF Student Case Report Contest is June 1, 2015. The Massage Therapy Foundation has sponsored Case Report Contests since 2006 to provide massage and bodywork practitioners and students a way to develop research skills and enhance their practice of evidence-based massage. Cash prizes are available to the winners of each contest, contingent on publication of the case report. If you or your students are interested in learning how to write and submit a case report of your own, check out the MTF's five-part case report webinar series to learn the how to write a winning case report.

To learn more about the effects of massage therapy, you can review the Massage Therapy Foundation review article archives, read accepted MTF Research Grant abstracts, or search PubMed for massage therapy studies. Visit www.massagetherapyfoundation.org.

Reference:

• van den Dolder PA, Ferreira PH, Refshauge KM. Effectiveness of soft tissue massage and exercise for the treatment of non-specific shoulder pain: a systematic review with meta-analysis. Br J Sports Med. 2014 Aug;48(16):1216-26. doi: 10.1136/bjsports-2011-090553. Epub 2012 Jul 26. PubMed PMID: 22844035.