Musculoskeletal pain has significant social and economic costs (Blyth et al., 2019, Shupler et al., 2019). What’s more is that conventional treatment options such opioid-based analgesics, corticosteroid injections, and surgical interventions are associated with small improvements versus placebo for pain and function and an increased risk of harm (Busse et al., 2017, Chou et al., 2020). This has prompted stakeholders to re-evaluate how treatment is provided for people living with musculoskeletal pain (Lewis et al., 2020; Lin et al., 2020).

Musculoskeletal pain is a complex and multifactorial phenomenon and treatment requires an individualized multidisciplinary approach that addresses biopsychosocial influences and empowers people with shared decision-making. Increasingly evidence-based non-pharmacological treatments options are being integrated with standard care as part of a person-centered approach (Lin et al., 2020; Manchikanti et al., 2020).

The paradigm shift to an evidence-based multidisciplinary approach presents an opportunity for massage therapists to collaborate with other healthcare professionals to improve a patient’s health and treatment outcome. With respect to the multidisciplinary treatment of pain, massage therapy has a desirable safety profile, and it is a health care option that has been shown to be effective for many persistent pain syndromes (Skelly et al., 2020). What is often not appreciated is that several clinical practice guidelines and systematic reviews support the use of massage therapy for patients suffering from a whole host of conditions including but not limited to back pain, tension-type headaches, temporomandibular joint disorder, carpal tunnel syndrome, and plantar heel pain.

Specific examples would be the endorsement from the American College of Physicians who recognize massage therapy as a treatment option for patients with acute and chronic low back pain (Chou et al., 2017; Qaseem et al., 2017). Another example is the Canadian Guideline for Opioid and Chronic Non-Cancer Pain who now recommends a trial of massage therapy rather than a trial of opioids for a number of conditions including back and neck pain, osteoarthritis of the knee and headaches (Busse et al., 2017). Internationally – The Global Spine Care Initiative also recognizes the value of non-pharmacological treatment options such as exercise, yoga, and massage therapy (Chou et al., 2018).

Key Takeaways

Based on updated clinical practice guidelines, as a profession Massage Therapists will see an increase in direct physician referrals as we are now recognized as front line treatments for acute and chronic pain. This is a change that did not happened over night, for years massage therapy has been shown to be a safe, effective non-pharmacological therapeutic intervention that is simple to carry out, economical, and has very few side effects.

References & Sources

Blyth, F. M., Briggs, A. M., Schneider, C. H., Hoy, D. G., & March, L. M. (2019). The Global Burden of Musculoskeletal Pain-Where to From Here?. American journal of public health, 109(1), 35–40.

Busse, J. W., Craigie, S., Juurlink, D. N., Buckley, D. N., Wang, L., Couban, R. J., … Guyatt, G. H. (2017). Guideline for opioid therapy and chronic noncancer pain. CMAJ: Canadian Medical Association journal, 189(18), E659–E666. doi:10.1503/cmaj.170363

Chou, R., Deyo, R., Friedly, J., Skelly, A., Hashimoto, R., Weimer, M., … Brodt, E. D. (2017). Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Annals of internal medicine, 166(7), 493–505. doi:10.7326/M16-2459

Chou, R., Côté, P., Randhawa, K., Torres, P., Yu, H., Nordin, M., … Cedraschi, C. (2018). The Global Spine Care Initiative: applying evidence-based guidelines on the non-invasive management of back and neck pain to low- and middle-income communities. European spine journal, 27(Suppl 6), 851–860. doi:10.1007/s00586-017-5433-8

Chou, R., Hartung, D., Turner, J., Blazina, I., Chan, B., Levander, X., … Pappas, M. (2020). Opioid Treatments for Chronic Pain. Agency for Healthcare Research and Quality (US). DOI:

Cieza, A., Causey, K., Kamenov, K., Hanson, S. W., Chatterji, S., & Vos, T. (2021). Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet (London, England), 396(10267), 2006–2017.

Côté, P., Yu, H., Shearer, H. M., Randhawa, K., Wong, J. J., Mior, S., … Lacerte, M. (2019). Non-pharmacological management of persistent headaches associated with neck pain: A clinical practice guideline from the Ontario protocol for traffic injury management (OPTIMa) collaboration. European journal of pain (London, England), 23(6), 1051–1070. doi:10.1002/ejp.1374

Foster, N. E., Anema, J. R., Cherkin, D., Chou, R., Cohen, S. P., Gross, D. P., … Lancet Low Back Pain Series Working Group (2018). Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet (London, England), 391(10137), 2368–2383. doi:10.1016/S0140-6736(18)30489-6

Fraser, J. J., Corbett, R., Donner, C., & Hertel, J. (2018). Does manual therapy improve pain and function in patients with plantar fasciitis? A systematic review. The Journal of manual & manipulative therapy, 26(2), 55–65. doi:10.1080/10669817.2017.1322736

Huisstede, B. M., van den Brink, J., Randsdorp, M. S., Geelen, S. J., & Koes, B. W. (2018). Effectiveness of Surgical and Postsurgical Interventions for Carpal Tunnel Syndrome-A Systematic Review. Archives of physical medicine and rehabilitation, 99(8), 1660–1680.e21. doi:10.1016/j.apmr.2017.04.024

Lewis, J. S., Cook, C. E., Hoffmann, T. C., & O’Sullivan, P. (2020). The Elephant in the Room: Too Much Medicine in Musculoskeletal Practice. The Journal of orthopaedic and sports physical therapy, 50(1), 1–4.

Lin, I., Wiles, L., Waller, R., Goucke, R., Nagree, Y., Gibberd, M., … O’Sullivan, P. (2020). What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. British journal of sports medicine, 54(2), 79–86. doi:10.1136/bjsports-2018-099878

Manchikanti, L., Singh, V., Kaye, A. D., & Hirsch, J. A. (2020). Lessons for Better Pain Management in the Future: Learning from the Past. Pain and therapy, 9(2), 373–391.

Qaseem, A., Wilt, T. J., McLean, R. M., Forciea, M. A., & Clinical Guidelines Committee of the American College of Physicians (2017). Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Annals of internal medicine, 166(7), 514–530. doi:10.7326/M16-2367

Randhawa, K., Bohay, R., Côté, P., van der Velde, G., Sutton, D., Wong, J. J., … Taylor-Vaisey, A. (2016). The Effectiveness of Noninvasive Interventions for Temporomandibular Disorders: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. The Clinical journal of pain, 32(3), 260–278. doi:10.1097/AJP.0000000000000247

Sebbag, E., Felten, R., Sagez, F., Sibilia, J., Devilliers, H., & Arnaud, L. (2019). The world-wide burden of musculoskeletal diseases: a systematic analysis of the World Health Organization Burden of Diseases Database. Annals of the rheumatic diseases, 78(6), 844–848.

Shupler, M. S., Kramer, J. K., Cragg, J. J., Jutzeler, C. R., & Whitehurst, D. (2019). Pan-Canadian Estimates of Chronic Pain Prevalence From 2000 to 2014: A Repeated Cross-Sectional Survey Analysis. The journal of pain: official journal of the American Pain Society, 20(5), 557–565.

Skelly, A.C., Chou, R., Dettori, J.R., Turner, J.A., Friedly, J.L., Rundell, S.D., … Ferguson, A.J.R. (2020). Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update. Rockville (MD): Agency for Healthcare Research and Quality (US). DOI:


Icon for the Creative Commons Attribution-NonCommercial 4.0 International License

Evidence-Based Massage Therapy by Richard Lebert is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.

Share This Book