Massage Therapy Should Be Avoided in Patients with Cervical Stenosis and Muscle Spasm
A patient with cervical stenosis should not receive massage therapy due to the risk of catastrophic spinal cord injury, even when presenting with muscle spasm. The potential for precipitating acute cervical myelopathy or worsening existing cord compression outweighs any symptomatic benefit from massage.
Critical Safety Concern: Risk of Spinal Cord Injury
Massage to the cervical spine in patients with pre-existing stenosis can cause acute cervical cord injury requiring surgical intervention, as documented in a case report where a 47-year-old man developed compressive myelopathy after neck massage, resulting in permanent hand dysfunction and ambulation problems despite 6 months of rehabilitation 1.
The mechanism of injury involves mechanical compression or herniation of disc material during manipulation of an already compromised spinal canal, which can precipitate acute myelopathy in patients with underlying stenosis 1.
Evidence Against Massage for Musculoskeletal Conditions
The American College of Rheumatology conditionally recommends against massage therapy for knee and hip osteoarthritis due to high risk of bias in studies, small patient numbers, and lack of demonstrated benefit for disease-specific outcomes 2.
Studies addressing massage have suffered from methodological limitations and have not demonstrated benefit for musculoskeletal outcomes, despite some patients reporting subjective improvement 2.
Natural History of Cervical Stenosis: Why Conservative Treatment Is Risky
Long periods of severe stenosis are associated with demyelination of white matter and may result in necrosis of both gray and white matter, leading to potentially irreversible neurological deficits 3.
The natural history of untreated severe cervicomedullary compression carries a mortality rate of 16% 4.
Cervical stenosis significantly affects cervical proprioception and range of motion, making the cervical spine more vulnerable to injury from external manipulation 5.
Safer Alternative Treatments for Muscle Spasm
For cervical radiculopathy with muscle spasm, appropriate nonoperative management includes physical therapy with strengthening and stretching exercises, nonsteroidal anti-inflammatory drugs, and muscle relaxants 6.
Cervical collar immobilization for limited periods (8 hours daily for 3 months) has been studied in patients with mild cervical spondylotic myelopathy, though outcomes are variable 2.
Manual therapy combined with exercise is conditionally recommended against over exercise alone for musculoskeletal conditions, as it provides little additional benefit 2.
Critical Pitfall to Avoid
Do not assume that "muscle spasm" is a benign musculoskeletal problem requiring only symptomatic treatment when cervical stenosis is present. Muscle spasm in the setting of cervical stenosis may represent early myelopathy or radiculopathy, and aggressive manual therapy could precipitate neurological deterioration 1.
When to Refer for Surgical Evaluation
Patients with cervical stenosis who develop gait disturbances, balance problems, or progressive neurological symptoms require urgent neurosurgical evaluation rather than conservative management 3, 4.
The presence of cord signal changes on T2-weighted MRI indicates established cord injury and represents a contraindication to any form of cervical manipulation 3.