Chiropractic modality added to massage reduced headaches and improves range of motion

In this study, they concluded that the addition of spinal manipulation to massage therapy reduced headaches and improved neck range of motion.

The effect of manipulation plus massage therapy versus massage therapy alone in people with tension-type headache. A randomized controlled clinical trial

Espi–Lopez GV, et al. – A randomized, single–blinded, controlled clinical trial was conducted to compare the impact of spinal manipulation combined with massage versus massage alone on range of motion of the cervical spine, headache frequency, intensity and disability in patients with tension–type headache (TTH). The results obtained from the study support the advantage of treating TTH with either massage or massage combined with a manipulative technique. However, the addition of manipulative technique was more effective for increasing range of motion of the upper cervical spine and for decreasing the effect of headache.


  • In the present study, 105 subjects with TTH were enrolled.
  • Participants were divided into 2 groups:
    • Manipulation and massage;
    • Massage only (control).
  • 4 treatment sessions were applied over 4 weeks.
  •  The Headache Disability Inventory (HDI) and range of upper cervical and cervical motion were assessed at baseline, immediately after the intervention and at a follow-up, 8 weeks after completing the intervention.


  • The results of this study showed that both groups exhibited a large (ƒ=1.22) improvement on their HDI scores.
  • In addition, those that received manipulation reported a medium-sized reduction (ƒ=0.33) in headache frequency across all data points (P<0.05) compared to the control group.
  • Researchers observed that both groups demonstrated a large within-subject effect for upper cervical extension (ƒ=0.62), a medium-sized effect for cervical extension (ƒ=0.39), and large effects for upper cervical (ƒ=1.00) and cervical (ƒ=0.27) flexion.
  • According to the findings obtained, the addition of manipulation resulted in larger gains of upper cervical flexion range of motion, and this difference remained stable at the follow-up.

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