***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Clinical approaches like mobilization , stretching , and /or massage may decrease shoulder tightness and improve symptoms in subjects with stiff shoulders . We investigated the effect and predictors of effectiveness of massage in the treatment of patients with posterior shoulder tightness . Methods A r and omized controlled trial was conducted in a hospital-based outpatient practice ( orthopedic and rehabilitation ) . Forty-three women and 17 men ( mean age = 54 years , range 43 - 73 years ) with posterior shoulder tightness participated and were r and omized into massage and control groups ( n = 30 per group ) . A physical therapist provided the massage on the posterior deltoid , infraspinatus , and teres minor of the involved shoulder for 18 minutes [ about 6 minutes for each muscle ] two times a week for 4 weeks . For the control group , one therapist applied light h and touch on the muscles 10 minutes two times a week for 4 weeks . Glenohumeral internal rotation ROM , functional status , and muscle tightness were the main outcomes . Additionally , the potential factors on the effectiveness of massage were analyzed by multivariate logistic regression . For this analysis , patients with functional score improvement at least 20 % after massage were considered responsive , and the others were considered nonresponsive . Results Fifty-two patients completed the study ( 29 for the massage and 23 for the control ) . The overall mean internal rotation ROM increased significantly in the massage group compared to the control ( 54.9 ° v.s. 34.9 ° ; P ≤ 0.001 ) . There were 21 patients in the responsive group and 8 in the nonresponsive group . Among the factors , duration of symptoms , functional score , and posterior deltoid tightness were significant predictors of effectiveness of massage . Conclusions Massage was an effective treatment for patients with posterior shoulder tightness , but was less effective in patients with longer duration of symptoms , higher functional limitation , and less posterior deltoid tightness . Trial registration This clinical trial is registered at Trial Registration " Trial registration : Clinical trials.gov NCT01022827 " BACKGROUND Massage therapy is an attractive treatment option for osteoarthritis ( OA ) , but its efficacy is uncertain . We conducted a r and omized , controlled trial of massage therapy for OA of the knee . METHODS Sixty-eight adults with radiographically confirmed OA of the knee were assigned either to treatment ( twice-weekly sessions of st and ard Swedish massage in weeks 1 - 4 and once-weekly sessions in weeks 5 - 8 ) or to control ( delayed intervention ) . Primary outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) pain and functional scores and the visual analog scale of pain assessment . The sample provided 80 % statistical power to detect a 20-point difference between groups in the change from baseline on the WOMAC and visual analog scale , with a 2-tailed alpha of .05 . RESULTS The group receiving massage therapy demonstrated significant improvements in the mean ( SD ) WOMAC global scores ( -17.44 [ 23.61 ] mm ; P < .001 ) , pain ( -18.36 [ 23.28 ] ; P < .001 ) , stiffness ( -16.63 [ 28.82 ] mm ; P < .001 ) , and physical function domains ( -17.27 [ 24.36 ] mm ; P < .001 ) and in the visual analog scale of pain assessment ( -19.38 [ 28.16 ] mm ; P < .001 ) , range of motion in degrees ( 3.57 [ 13.61 ] ; P = .03 ) , and time to walk 50 ft ( 15 m ) in seconds ( -1.77 [ 2.73 ] ; P < .01 ) . Findings were unchanged in multivariable models controlling for demographic factors . CONCLUSIONS Massage therapy seems to be efficacious in the treatment of OA of the knee . Further study of cost effectiveness and duration of treatment effect is clearly warranted . Objectives : To present the prevalence of  self reported musculoskeletal diseases  , the coexistence of these diseases , the test-retest reliability with six months in between , and the association with musculoskeletal pain symptoms . Methods : Twelve layman descriptions of common musculoskeletal diseases were part of the question naires of a prospect i ve cohort study of a r and om sample in the general Dutch population aged 25 years or more ( baseline : n=3664 , follow up after six months : n=2338 ) . Data collection also included information about pain relating to five different anatomical areas . Results : Osteoarthritis of the knee ( men 10.1 % , women 13.6 % ) was amongst the most reported musculoskeletal diseases , whereas the figures for self reported rheumatoid arthritis ( RA ) were 1.6 % and 4.6 % for men and women , respectively . The coexistence of these diseases is high : 47 of the 66 combinations were reported more often than would be expected if they were independent of each other ( p<0.05 ) . For most diseases the test-retest reliability was good ( κ between 0.6 and 0.8 ) , but for repetitive strain injury ( κ=0.37 ) and chronic arthritis other than RA ( κ=0.44 ) the agreement was fair to moderate . All complaints of pain were more often reported by those with musculoskeletal diseases than those without those diseases , and the pain pattern was disease-specific . Conclusions : Self reported musculoskeletal diseases are highly prevalent , with a fair to good reliability and a disease-specific pain pattern . Health surveys are a limited but valuable source of information for this group of health problems , which is not available from most other sources of information Objective To determine the effectiveness of lessons in the Alex and er technique , massage therapy , and advice from a doctor to take exercise ( exercise prescription ) along with nurse delivered behavioural counselling for patients with chronic or recurrent back pain . Design Factorial r and omised trial . Setting 64 general practice s in Engl and . Participants 579 patients with chronic or recurrent low back pain ; 144 were r and omised to normal care , 147 to massage , 144 to six Alex and er technique lessons , and 144 to 24 Alex and er technique lessons ;  half of each of these groups were r and omised to exercise prescription . Interventions Normal care ( control ) , six sessions of massage , six or 24 lessons on the Alex and er technique , and prescription for exercise from a doctor with nurse delivered behavioural counselling . Main outcome measures Rol and Morris disability score ( number of activities impaired by pain ) and number of days in pain . Results Exercise and lessons in the Alex and er technique , but not massage , remained effective at one year ( compared with control Rol and disability score 8.1 : massage −0.58 , 95 % confidence interval −1.94 to 0.77 , six lessons −1.40 , −2.77 to −0.03 , 24 lessons −3.4 , −4.76 to −2.03 , and exercise −1.29 , −2.25 to −0.34 ) . Exercise after six lessons achieved 72 % of the effect of 24 lessons alone ( Rol and disability score −2.98 and −4.14 , respectively ) . Number of days with back pain in the past four weeks was lower after lessons ( compared with control median 21 days : 24 lessons −18 , six lessons −10 , massage −7 ) and quality of life improved significantly . No significant harms were reported . Conclusions One to one lessons in the Alex and er technique from registered teachers have long term benefits for patients with chronic back pain . Six lessons followed by exercise prescription were nearly as effective as 24 lessons . Trial registration National Research Register N0028108728 . How does the Alex and er Technique work ? What are the authors findings about the clinical and cost effectiveness of the treatment ? Watch this video to find out ( 12 mins ) . Abstract Objectives : To compare the efficacy of acupuncture and conventional massage for the treatment of chronic neck pain . Design : Prospect i ve , r and omised , placebo controlled trial . Setting : Three outpatient departments in Germany . Participants : 177 patients aged 18–85 years with chronic neck pain . Interventions : Patients were r and omly allocated to five treatments over three weeks with acupuncture ( 56 ) , massage ( 60 ) , or “ sham ” laser acupuncture ( 61 ) . Main outcome measures : Primary outcome measure : maximum pain related to motion ( visual analogue scale ) irrespective of direction of movement one week after treatment . Secondary outcome measures : range of motion ( 3D ultrasound real time motion analyser ) , pain related to movement in six directions ( visual analogue scale ) , pressure pain threshold ( pressure algometer ) , changes of spontaneous pain , motion related pain , global complaints ( seven point scale ) , and quality of life ( SF-36 ) . Assessment s were performed before , during , and one week and three months after treatment . Patients ' beliefs in treatment were assessed . Results : One week after five treatments the acupuncture group showed a significantly greater improvement in motion related pain compared with massage ( difference 24.22 ( 95 % confidence interval 16.5 to 31.9 ) , P=0.0052 ) but not compared with sham laser ( 17.28 ( 10.0 to 24.6 ) , P=0.327 ) . Differences between acupuncture and massage or sham laser were greater in the subgroup who had had pain for longer than five years ( n=75 ) and in patients with myofascial pain syndrome ( n=129 ) . The acupuncture group had the best results in most secondary outcome measures . There were no differences in patients ' beliefs in treatment . Conclusions : Acupuncture is an effective short term treatment for patients with chronic neck pain , but there is only limited evidence for long term effects after five treatments . What is already known on this topic Acupuncture is a widespread complementary treatment Evidence from trials have given conflicting results on its use in the treatment of neck pain because of method ological shortcomings and because effects were compared either with alternative treatments or with different sham procedures imitating acupuncture , but not both What this study adds Compared with sham laser acupuncture and massage , needle acupuncture has beneficial effects on mobility and pain related to motion in patients with chronic neck pain Acupuncture was clearly more effective than massage , but differences were not always significant compared with sham laser acupuncture Acupuncture was the best treatment for patients with the myofascial syndrome and those who had had pain for longer than five Some cancer patients use therapeutic massage  to reduce symptoms , improve coping , and enhance quality of life . Although a meta- analysis concludes that massage can confer short-term benefits in terms of psychological wellbeing and reduction of some symptoms , additional vali date d r and omized controlled studies are necessary to determine specific indications for various types of therapeutic massage . In addition , mechanistic studies need to be conducted to discriminate the relative contributions of the therapist and of the reciprocal relationship between body and mind in the subject . Nuclear magnetic resonance techniques can be used to capture dynamic in vivo responses to biomechanical signals induced by massage of myofascial tissue . The relationship of myofascial communication systems ( called “ meridians ” ) to activity in the subcortical central nervous system can be evaluated . Underst and ing this relationship has important implication s for symptom control in cancer patients , because it opens up new research avenues that link self-reported pain with the subjective quality of suffering . The reciprocal body – mind relationship is an important target for manipulation therapies that can reduce suffering The purpose of this study was to investigate the immediate effects of traditional Thai massage ( TTM ) on stress-related parameters including heart rate variability ( HRV ) , anxiety , muscle tension , pain intensity , pressure pain threshold , and body flexibility in patients with back pain associated with myofascial trigger points . Thirty-six patients were r and omly allocated to receive a 30-min session of either TTM or control ( rest on bed ) for one session . Results indicated that TTM was associated with significant increases in HRV ( increased total power frequency ( TPF ) and high frequency ( HF ) ) , pressure pain threshold ( PPT ) and body flexibility ( p<0.05 ) and significant decreases in self-reported pain intensity , anxiety and muscle tension ( p<0.001 ) . For all outcomes , similar changes were not observed in the control group . The adjusted post-test mean values for TPF , HF , PPT and body flexibility were significantly higher in the TTM group when compared with the control group ( p<0.01 ) and the values for pain intensity , anxiety and muscle tension were significantly lower . We conclude that TTM can increase HRV and improve stress-related parameters in this patient population Introduction Recent research has provided a rationale for the efficacy and use of massage therapy in the management of knee osteoarthritis ( OA ) symptoms . Additionally , research has also implicated the role of the quadriceps muscles in the genesis of knee OA . Although both areas of research have demonstrated strong evidence that the muscles and massage therapy may affect knee OA symptoms , self-massage applied on the quadriceps muscle has received no attention . Methods Conducted at the Lourdes Wellness Center in Collingswood , NJ , the study investigated the outcomes of a self-massage intervention applied to the quadriceps muscle on reported pain , stiffness , physical function , and knee range of motion in adults with diagnosed knee OA . Forty adults with diagnosed knee OA were r and omly assigned to either an intervention ( n = 21 ) or a wait list control ( n = 19 ) group . The participants applied a narrated 20-minute self-massage therapy twice weekly during 
    Output:
    
Overall , low-to-moderate-level evidence indicated that massage  reduces pain in the short term compared to no treatment in people with shoulder pain and osteoarthritis of the knee , but not in those with low back pain or neck pain .
Furthermore , low-to-moderate-level evidence indicated that  massage improves function in the short term compared to no treatment in people with low back pain , knee arthritis or shoulder pain .
Low-to-very-low-level evidence from single studies indicated no clear benefits of  massage  over acupuncture , joint mobilisation , manipulation or relaxation therapy in people with fibromyalgia , low back pain and general musculoskeletal pain .
Massage therapy , as a st and -alone treatment , reduces pain and improves function compared to no treatment in some musculoskeletal conditions .
When massage is compared to another active treatment , no clear benefit was evident