The Journal of Korean Physical Therapy

The Korean Society of Physical Therapy (대한물리치료학회)
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Effects of Massage Combined with Peanut Ball Self-Myofascial Release on Disability, Forward Head Posture, and Cervical Range of Motion

  • Mi-Ran Lee (Baron Therapy) ;
  • Dong-Kyun Koo (Department of Physical Therapy, College of Health Sciences, Wonkwang University)
  • Received : 2026.03.17
  • Accepted : 2026.04.20
  • Published : 2026.04.30
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Abstract

Purpose: To compare the effects of a four-week massage program with and without peanut ball self-myofascial release on neck disability, forward head posture, cervical range of motion, and quality of life in adults with neck pain. Methods: Thirty adults aged 20-65 years with neck pain were randomly assigned to a massage plus peanut ball self-myofascial release group (n=15) or a massage-only group (n=15). Of 37 screened volunteers, 30 were enrolled after four were ineligible and three declined. Both groups received a standardized 60-minute massage program once weekly for four weeks. The experimental group also performed 15 minutes of self-myofascial release once weekly using a peanut ball device. Between-group comparisons were analyzed using ANCOVA with baseline values as covariates. Results: In within-group analyses, both groups showed significant pre-post improvements in the neck disability index, craniovertebral angle, cervical range of motion, and WHOQOL-BREF total score (p<0.05). In the exploratory between-group analyses, the massage plus self-myofascial release group showed greater post-intervention craniovertebral angle, flexion, extension, and left lateral flexion than the massage-only group (all p<0.05). No significant between-group differences were observed for neck disability, right lateral flexion, rotation, or WHOQOL-BREF total score. Conclusion: Both interventions were associated with short-term improvement. Adding peanut ball self-myofascial release was associated with greater improvement in postural alignment and the selected cervical range-of-motion variables after baseline adjustment, but not in neck disability or the quality of life. These findings should be interpreted cautiously because the experimental group received additional treatment time, and multiple outcomes were analyzed without multiplicity adjustment.

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References

  1. Hoy D, Protani M, De R et al. The epidemiology of neck pain. Best Pract Res Clin Rheumatol. 2010;24(6):783-92.
  2. Fejer R, Kyvik KO, Hartvigsen J. The prevalence of neck pain in the world population: a systematic critical review of the literature. Eur Spine J. 2006;15(6):834-48.
  3. Genebra CVDS, Maciel NM, Bento TPF et al. Prevalence and factors associated with neck pain: a population-based study. Braz J Phys Ther. 2017;21(4):274-80.
  4. Cagnie B, Danneels L, Van Tiggelen D et al. Individual and work related risk factors for neck pain among office workers: a cross sectional study. Eur Spine J. 2007;16(5):679-86.
  5. Gustafsson E, Thomee S, Grimby-Ekman A et al. Texting on mobile phones and musculoskeletal disorders in young adults: a five-year cohort study. Appl Ergon. 2017;58:208-14.
  6. Pietrobon R, Coeytaux RR, Carey TS et al. Standard scales for measurement of functional outcome for cervical pain or dysfunction: a systematic review. Spine. 2002;27(5):515-22.
  7. Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther. 1991;14(7):409-15.
  8. Vernon H. The Neck Disability Index: state-of-the-art, 1991-2008. J Manipulative Physiol Ther. 2008;31(7):491-502.
  9. Song KJ, Choi BW, Choi BR et al. Cross-cultural adaptation and validation of the Korean version of the Neck Disability Index. Spine. 2010;35(20):E1045-E1049.
  10. Mahmoud NF, Hassan KA, Abdelmajeed SF et al. The relationship between forward head posture and neck pain: a systematic review and meta-analysis. Curr Rev Musculoskelet Med. 2019;12(4):562-77.
  11. Quek J, Pua YH, Clark RA et al. Effects of thoracic kyphosis and forward head posture on cervical range of motion in older adults. Man Ther. 2013;18(1):65-71.
  12. Rani B, Paul A, Chauhan A et al. Is neck pain related to sagittal head and neck posture? A systematic review and meta-analysis. Indian J Orthop. 2023;57(3):371-403.
  13. Daffner SD, Hilibrand AS, Hanscom BS et al. Impact of neck and arm pain on overall health status. Spine. 2003;28(17):2030-5.
  14. Luo X, Edwards CL, Richardson W et al. Relationships of clinical, psychologic, and individual factors with the functional status of neck pain patients. Value Health. 2004;7(1):61-9.
  15. Pedisic Z, Pranic S, Jurakic D. Relationship of back and neck pain with quality of life in the Croatian general population. J Manipulative Physiol Ther. 2013;36(5):267-75.
  16. The WHOQOL Group. Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychol Med. 1998;28(3):551-8.
  17. Min SK, Lee CI, Kim KI et al. Development of the Korean version of WHOQOL-BREF. J Korean Neuropsychiatr Assoc. 2000;39(3):571-9.
  18. Cheng YH, Huang GC. Efficacy of massage therapy on pain and dysfunction in patients with neck pain: a systematic review and meta-analysis. Evid Based Complement Alternat Med. 2014;2014:204360.
  19. Sherman KJ, Cherkin DC, Hawkes RJ et al. Randomized trial of therapeutic massage for chronic neck pain. Clin J Pain. 2009;25(3):233-8.
  20. Büyükturan B, Şaş S, Kararti C et al. The effects of combined sternocleidomastoid muscle stretching and massage on pain, disability, endurance, kinesiophobia, and range of motion in individuals with chronic neck pain: a randomized, single-blind study. Musculoskelet Sci Pract. 2021;55:102417.
  21. Bingölbali Ö, Taşkaya C, Alkan H et al. The effectiveness of deep tissue massage on pain, trigger point, disability, range of motion and quality of life in individuals with myofascial pain syndrome. Somatosens Mot Res. 2024;41(1):11-7.
  22. Behm DG, Wilke J. Do self-myofascial release devices release myofascia? Rolling mechanisms: a narrative review. Sports Med. 2019;49(8):1173-81.
  23. Kalichman L, David CB. Effect of self-myofascial release on myofascial pain, muscle flexibility, and strength: a narrative review. J Bodyw Mov Ther. 2017;21(2):446-51.
  24. Kim Y, Hong Y, Park HS. A soft massage tool is advantageous for compressing deep soft tissue with low muscle tension: therapeutic evidence for self-myofascial release. Complement Ther Med. 2019;43:312-8.
  25. Behnampour M, Barati AH, Jafari B et al. The effect of remote self-myofascial release and stretch on range of motion and chronic neck pain: a randomized control trial. J Bodyw Mov Ther. 2025;44:808-14.
  26. Mylonas K, Angelopoulos P, Billis E et al. Combining targeted instrument-assisted soft tissue mobilization applications and neuromuscular exercises can correct forward head posture and improve the functionality of patients with mechanical neck pain: a randomized control study. BMC Musculoskelet Disord. 2021;22(1):212.
  27. Kang ST, Jung JH, Kwon OY. Immediate effects of roller massage for posterior neck muscles on the muscle strength and range of motion for cranio-cervical flexion in subjects with forward head posture. J Kor Phys Ther. 2021;28(2):138-45.
  28. Joshi R, Poojary N. The effect of muscle energy technique and posture correction exercises on pain and function in patients with non-specific chronic neck pain having forward head posture-a randomized controlled trail. Int J Ther Massage Bodywork. 2022;15(2):14-21.
  29. Kang NY, Kim K. Effects of a combination of scapular stabilization and thoracic extension exercises on respiration, pain, craniovertebral angle and cervical range of motion in elementary school teachers with a forward head posture: a randomized controlled trial. J Korean Soc Phys Med. 2022;17(2):29-40.
  30. Al Suwaidi AS, Moustafa IM, Kim M et al. A comparison of two forward head posture corrective approaches in elderly with chronic non-specific neck pain: a randomized controlled study. J Clin Med. 2023;12(2):542.
  31. Anwar S, Zahid J, Alexe CI et al. Effects of myofascial release technique along with cognitive behavior therapy in university students with chronic neck pain and forward head posture: a randomized clinical trial. Behav Sci (Basel). 2024;14(3):205.
  32. Ali RR, Elsayed SNM, Kamel RM et al. Effect of integrated neuromuscular inhibition technique on subjects with neck pain and forward head posture: a randomized controlled trial. J Man Manip Ther. 2025;33(5):401-11.
  33. Lau HMC, Chiu TTW, Lam TH. Clinical measurement of craniovertebral angle by electronic head posture instrument: a test of reliability and validity. Man Ther. 2009;14(4):363-8.
  34. Mylonas K, Tsekoura M, Billis E et al. Reliability and validity of non-radiographic methods of forward head posture measurement: a systematic review. Cureus. 2022;14(8):e27696.
  35. Aafreen, Khan A, Ahmad A et al. Clinimetric properties of a smartphone application to measure the craniovertebral angle in different age groups and positions. Heliyon. 2023;9(9):e19336.
  36. Gallego-Izquierdo T, Arroba-Díaz E, García-Ascoz G et al. Psychometric proprieties of a mobile application to measure the craniovertebral angle: a validation and reliability study. Int J Environ Res Public Health. 2020;17(18):6521.
  37. Sherman KJ, Cook AJ, Wellman RD et al. Five-week outcomes from a dosing trial of therapeutic massage for chronic neck pain. Ann Fam Med. 2014;12(2):112-20.
  38. Sefton JM, Yarar C, Carpenter DM et al. Physiological and clinical changes after therapeutic massage of the neck and shoulders. Man Ther. 2011;16(5):487-94.