Back and shoulder pain are two of the most common types of pain a massage therapist is likely to see on a daily basis.
Back pain is especially common, with some estimates suggesting as many as 80 percent of the population will experience a back problem at some point in their lives, according to the American Chiropractic Association.
Additionally, the Georgetown University Health Policy Institute suggests roughly 83 million days of work are lost each year due to back pain, making this condition one of the leading causes of work-loss days.
Shoulder pain, although less common than back pain, is still one of the most common regional pain syndromes. According to one study1, population surveys show that shoulder pain affects between 18 to 26 percent of adults at any point in time.
With so many people experiencing upper body pain, massage therapists have a real opportunity to help clients find some real relief.
Common Types and Causes of Back and Shoulder Pain
The causes of back and shoulder pain are as numerous as the people experiencing it. “I see a lot of back pain from sports injuries, degenerative joint disease, car accidents, bulging and herniated discs, falls, pregnancy, and from sitting too much for work,” says Alicia Durrence, owner and massage therapist at Southern Charm Massage.
Understanding the lower, middle and upper back regions can help massage therapists better pinpoint where pain is occurring:
- The low back includes the lumbar spine (composed of five vertebrae).
- The middle back, also called the thoracic spine, is made up of 12 vertebrae and provides support for the majority of your body’s weight.
- The upper back is part of the cervical spine, which includes the neck, and is composed of seven vertbrae.
Each area of the back also includes and is surrounded by various structures, including intervertebral discs, the spinal cord, nerves, muscles, tendons and ligaments, according to the Cleveland Clinic.
Because each part of the back serves a different function and supports a different part of the body, the cause and source of pain can be vastly different for each area. For example, pain in the upper back and neck may intersect. “There are layers of muscles throughout our neck and back, many of which are involved in the same activities, like bending, lifting and turning,” says Brandilyn Jobe, LMT. “When tense, over-contracted muscles pull on their attachment sites and the surrounding muscles often over-contract as well.”
The shoulder is the most flexible joint in the human body, as well as one of the most complex, which means deciphering the source or cause of pain can be tricky. “Shoulder pain is usually a complex puzzle caused by held tension, repetitive motion, or strain/injury due to some form of over-extension or imbalance in the muscles that provide rotation, adduction and abduction, flexion, and extension of the humerus,” says Dede Dancing, LMT, BCTMB. “Sometimes the biceps tendon is part of the puzzle. Sometimes nerves of the brachial plexus are trapped or compressed by tight scalenes, pectoralis minor or by bones being pulled too tightly together with imbalances in one or more of the muscle groups already mentioned.”
Overuse is one of the most common sources of shoulder pain. Other sources include post-surgery pain, frozen shoulder, and fascial/scar adhesions around the shoulder capsule and collarbone.
Massage for Back Pain: Updates in Research
The benefits of massage therapy for back pain are well-studied, and results have long shown the promise of massage, especially as alternatives to pharmacological interventions become an important part of combatting the opioid epidemic.
In recent years, numerous studies investigating the effects of massage therapy on back pain have continued to build on the existing knowledge base. One such study2 explored the effect of lumbar myofascial release with electrotherapy on the elastic modulus of lumbar fascia and pain in patients with non-specific low-back pain.
The purpose of the study was to compare the effect of lumbar myofascial release and electrotherapy on clinical outcomes of non-specific low-back pain and elastic modulus of lumbar myofascial tissue. Low-back pain severity and elastic modulus of the lumbar myofascial tissue were assessed before and after treatment.
The study found improvements in the outcome measures, which suggests that lumbar myofascial release may be effective in reducing non-specific low-back pain. “Data suggest that the elastic modulus of lumbar fascia and the severity of low-back pain are directly linked,” researchers noted. “Decreasing the elastic modulus after myofascial release can directly affect reducing low-back pain.”
Another study3 focused on the effect of massage force on relieving non-specific low-back pain. The study enrolled 56 female patients with non-specific low-back pain at a single medical center.
For each patient, a massage therapist performed a 30-minute (20-minute general session and 10-minute focal session) massage session using a special instrument with a force sensor inserted. During the 10-minute focal session, the patients were split into two groups, a high force group (≥2 kg) and a low force group (≤1 kg). Pain intensity using the visual analog scale was the primary outcome measured.
The study concluded high force massage exerted superior effects on pain relief in female patients with non-specific low-back pain when compared to low force massage.
These results align with how some massage therapists we talked with describe the work they do with clients with low-back pain. “The techniques I use—effleurage, petrissage, friction and compression—don’t vary much from client to client, but the pressure, speed and direction of movement do,” Jobe explains.
For Jobe, a typical massage session with a client experiencing back pain starts with warming the tissue using Swedish massage, myofascial release or a warm compress and identifying any tension or trigger points. Once areas that may benefit from attention are identified, she moves to massage techniques like petrissage, friction and compression.
“I gradually increase the pressure, change the direction of my strokes, and add movement until I feel a difference in the muscle tissue,” Jobe adds.
After identifying tight spots and trigger points, Durrence will also use deeper pressure and active and passive stretching to release tension.
Massage for Shoulder Pain: Updates in Research
A January 2022 study4 sought to determine the effectiveness of proprioceptive neuromuscular facilitation and myofascial release techniques in patients with subacromial impingement syndrome. The study measured the effectiveness of the interventions in terms of pain, range of motion, muscle strength, quality of life, functionality and disability. The study divided 30 patients into two groups, a proprioceptive neuromuscular facilitation group and a proprioceptive neuromuscular facilitation combined with myofascial release group.
Both treatment methods were performed three times a week for four weeks. Pain severity was assessed by visual analog scale, range of motion using a goniometer, muscle strength by digital hand dynamometer, quality of life by Nottingham health profile, functionality by arm, shoulder and hand problems questionnaire, and disability by shoulder pain and disability index.
The study concluded that the combined application of proprioceptive neuromuscular facilitation and myofascial release had a more acute and cumulative positive effect on all of the measured outcomes. Additionally, myofascial release was found to be more effective in increasing flexion, external and internal rotation range of motion, and flexion and abduction muscle strength after the first session.
Another study5 compared the effects of massage therapy in tandem with pharmacological treatment versus pharmacological treatment alone for shoulder pain after laparoscopic surgery. The intensity of shoulder pain was evaluated using a visual analog scale before and after each 20-minute treatment.
The study’s findings showed a significant reduction in pain, suggesting that massage therapy could help reduce post-laparoscopic shoulder pain.
Real Results: Success Stories of Massage Therapy for Pain Relief
Back in January of 2018, Durrence had a 38-year-old pediatric occupational therapist client come in with an L1 compression fracture after a fall. The client had a kyphoplasty―a procedure for treating vertebral compression fractures that uses an inflated balloon to restore bone height followed by an injection of bone cement into the vertebral body―performed two months after the fall. Her back was now in complete spasm after being bedridden for weeks and from the strain of the surgery.
“I knew that I didn’t want to put direct hard pressure on the area, so in collaboration with the client I came up with some techniques that would release the muscles from one side while having her move the opposite side,” Durrence says. “Five and a half years later, she works full-time with minimal pain while maintaining the results with monthly massage, yoga and some Pilates.”
Jobe works with a lot of clients who need help managing back pain during pregnancy. “Many seek my help to alleviate lower back pain during pregnancy. The hormonal changes, fluid retention and shifts in their center of gravity often make pregnancy an exceptionally uncomfortable experience,” she says. “Numerous clients have shared that their weekly massages are the only time they find any physical comfort during their pregnancy. Many have also expressed that they only sleep well after their massage sessions.”
A Common Shoulder Condition: Osteoarthritis
According to the Arthritis Foundation, shoulder osteoarthritis is a degenerative joint disease where cartilage and joint tissue gradually break down. Friction in the joint leads to pain, which slowly reduces mobility and function. Although less common than hip or knee osteoarthritis, it’s estimated that one in three people over the age of 60 are dealing with some degree of shoulder osteoarthritis.
There are two types of shoulder osteoarthritis: primary and secondary. Primary shoulder osteoarthritis has no known cause, but is thought to be related to age, genes and sex, as it’s generally seen in people over 50 and women are affected more often than men. Alternatively, secondary shoulder osteoarthritis has a cause, such as previous injury, infection or rotator cuff tears.
Common symptoms clients with shoulder osteoarthritis may be trying to manage include pain, reduced range of motion and crepitus.
Massage Therapy Journal
Don't Shoulder the Pain
1. Linaker CH, Walker. “Bone K. Shoulder disorders and occupation.” Best Pract Res Clin Rheumatol. 2015 Jun;29(3):405-23
2. Tamartash H, Bahrpeyma F, Mokhtari Dizaji M. “Comparative effect of lumbar myofascial release with electrotherapy on the elastic modulus of lumbar fascia and pain in patients with non-specific low back pain.” J Bodyw Mov Ther. 2022 Jan;29:174-179.
3. Chen PC, Wei L, Huang CY, Chang FH, Lin YN. “The Effect of Massage Force on Relieving Nonspecific Low Back Pain: A Randomized Controlled Trial.” Int J Environ Res Public Health.
4. Çelik MS, Sönmezer E, Acar M. “Effectiveness of proprioceptive neuromuscular facilitation and myofascial release techniques in patients with subacromial impingement syndrome.” Somatosens Mot Res. 2022 Jun-Dec;39(2-4):97-105.
5. Mottahedi M, Shamsi M, Babani SF, Goli S, Rizevandi P. “Comparing the effect of transcutaneous electrical nerve stimulation and massage therapy on post laparoscopic shoulder pain: a randomized clinical trial.” BMC Musculoskelet Disord. 2023 Sep 28;24(1):764.