Massage for shoulder pain

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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Soft-tissue massage improved range of motion, reduced pain and improved function in people with shoulder pain, according to one research study.

"A trial into the effectiveness of soft tissue massage in the treatment of shoulder pain" was conducted by staff at Auburn Hospital and Concord Repatriation General Hospital in Sydney, Australia.

Twenty-nine subjects who had been referred to the Concord hospital for management of shoulder pain participated in the study. Their medical diagnoses varied, but impingement, rotator-cuff tear and unspecified shoulder pain were the most common diagnoses.

Fourteen of the participants were randomly assigned to the control group, where they were placed on a waiting list for massage and received no treatment for two weeks.

Fifteen of the participants were randomly assigned to the massage group, where they received six sessions of soft-tissue massage around the shoulder for two weeks. The massage included the lateral border of the scapula, in full shoulder flexion; posterior deltoid, at end-of-range horizontal flexion; anterior deltoid, at end-of-range hand-behind-back; and pectoralis major, in the stretch position. Each session lasted 15-20 minutes.

Active range of motion was evaluated for flexion, abduction and hand-behind-back movements before and after the study. Pain was assessed on the Short Form McGill Pain Questionnaire, and functional ability was assessed with the Patient Specific Functional Disability Measure, both before and after the study period.

Subjects in the control group showed no significant improvements from the beginning to the end of the two-week period. Subjects in the massage group showed significant improvements in all measures, with a mean improvement of 22.6 degrees in flexion; 42.2 degrees in abduction; and the ability to reach a mean of 11 centimeters further up the back. Subjects in the massage group also reported decreased pain and improved function.

"This randomized, controlled trial has shown that soft tissue massage around the shoulder in subjects with shoulder pain of local mechanical origin produces significantly greater improvements in pain, function and range of motion than does no treatment over a two-week period," state the study’s authors.

"The fact that these patients improved with such a wide range of diagnoses points to the potential generalisability of the effects of this massage in patients with shoulder pain of local mechanical origin."

- Source: Auburn Hospital and Concord Repatriation General Hospital in Sydney, Australia. Authors: Paul A. van den Dolder and David L. Roberts. Originally published in the Australian Journal of Physiotherapy 2003, Vol. 49, pp. 183-188.

Another study was published in the Annals of Internal Medicine…

Manipulative Therapy for Patients with Shoulder Pain

21 September 2004 | Volume 141 Issue 6| Page I-27

The summary below is from the full report titled "Manipulative Therapy in Addition to Usual Medical Care for Patients with Shoulder Dysfunction and Pain. A Randomized, Controlled Trial." It is in the 21 September 2004 issue of Annals of Internal Medicine (volume 141, pages 432-439). The authors are G.J.D. Bergman, J.C. Winters, K.H. Groenier, J.J.M. Pool, B. Meyboom-de Jong, K. Postema, and G.J.M.G. van der Heijden.

Shoulder pain is a common reason for seeking medical care. The best treatment for shoulder pain is unclear unless the pain is due to a bone fracture or other specific injury that requires surgical therapy. Care for shoulder pain often includes medications to treat pain and inflammation, physical therapy to improve range of motion and strength, and therapies such as massage or heat to relieve symptoms. Manipulative therapy is an alternative therapy that some believe can be helpful in shoulder pain that is accompanied by neck symptoms. During manipulative therapy, a specially trained therapist or chiropractor applies movements to the spine with the aim of realigning or mobilizing specific segments. Manipulative therapy is different from physical therapy. Physical therapy involves range-of-motion and strengthening exercises that do not aim to realign or mobilize the spine.

To see whether the addition of manipulative therapy to usual care improves outcomes for patients with shoulder pain.

150 Dutch patients 18 years of age or older who presented to their primary care physicians with shoulder pain, defined as pain that occurs at rest or during movement of the upper arm in the area between the neck and the elbow and that is accompanied by neck symptoms. Patients who had signs of compression of the nerves in the neck or whose shoulder pain was due to severe trauma, fracture, rupture, dislocation, specific joint disease such as rheumatoid arthritis, or disease of the chest or abdomen were not eligible for the study.

The researchers assigned patients to receive usual care from their primary care physicians (usual care could include physical therapy) or usual care plus manipulative therapy. Manipulative therapy included up to 6 sessions over 12 weeks. One of 8 specially trained therapists provided the manipulative therapy. The researchers compared patients' reports of recovery, severity of pain, shoulder disability, and general health at 6, 12, 26, and 52 weeks after assignment to a treatment group.

At 6 weeks, there were no differences between the study groups. At 12 weeks, 43% of the patients who received manipulative therapy plus usual care reported recovery compared with only 21% in the usual care group. At 52 weeks, 52% of the patients who received manipulative therapy plus usual care reported recovery compared with 35% of the usual care group.

The patients knew which treatment they were receiving, and this knowledge alone may have influenced their reports of improvement. It is also uncertain whether different therapists would achieve similar results.

In patients with shoulder pain accompanied by neck symptoms, manipulative therapy added to usual care may increase patient-reported recovery from shoulder pain.

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