Massage Therapists and Work-Related Pain: Where Sleep Fits

Last updated: October 2026

Work-related pain is common among massage therapists: in a survey of 1,103 Canadian massage therapists, 85 percent reported work-related pain in at least one body area, most often the hands and wrists, shoulders, low back, and neck (Barraclough et al., 2022). Pain and poor sleep tend to travel together in healthcare workers, and in one large cohort, poor sleep came before new low back pain (Vinstrup et al., 2020). Below is what the surveys found, how sleep fits in, and what pillow height changes for the neck and shoulders after a day of hands-on work.

Key takeaways

In a survey of 1,103 Canadian massage therapists, 85 percent reported work-related pain, with the neck affected in 49.2 percent (Barraclough et al., 2022).
Among 1,955 healthcare workers followed for a year, poor sleep at baseline was linked to higher odds of developing low back pain (Vinstrup et al., 2020).
A Pillowise fitting takes three measurements (shoulder width, neck circumference and neck length) and adds sleeping position and bed type to choose from seven sizes.

How common is work-related pain in massage therapists?

An online survey of 1,103 massage therapists in Ontario, aged 20 to 73, found that 85 percent reported work-related pain at one or more of five body sites (Barraclough et al., 2022).

The effects reached beyond the treatment room. Almost half said the pain affected daily living, 54.6 percent had worked while in pain, and 30.5 percent had considered or made a career change.

The survey was voluntary and self-reported, so therapists with pain may have been more likely to respond.

Where does it show up?

In the Canadian survey, the most commonly reported sites were the hands and wrists (65.5 percent), fingers and thumbs (60.3 percent), shoulders (55.0 percent), low back (50.1 percent), and neck (49.2 percent) (Barraclough et al., 2022).

A smaller study of 42 massage practitioners in Romania found the neck reported most often, at 69.0 percent, followed by the shoulder at 54.8 percent and the upper back at 52.4 percent (Sîrbu et al., 2022).

How does pain connect to sleep?

Among 3,593 Danish hospital workers, a high musculoskeletal pain score raised the risk ratio for poor sleep to 1.48 (Vinstrup et al., 2018).

The link runs the other way too. In a prospective cohort of 1,955 healthcare workers at 19 Danish hospitals, moderate and poor sleep at baseline were associated with higher odds of developing low back pain a year later (Vinstrup et al., 2020). These were hospital staff rather than massage therapists, and the studies show association rather than cause.

What does pillow height change for the neck and shoulders?

After a day of hands-on work, the neck and shoulders spend the night at the angle the pillow sets. In a radiographic study of 16 adults, raising the pillow from 0 to 10 to 20 cm increased T1 slope and C2-7 Cobb angle while neck tilt decreased (Kim et al., 2015).

In a pilot EMG study of 15 adults lying on their side, the height matched to shoulder width produced the lowest activity in the sternocleidomastoid and trapezius, two of the muscles that work hardest in the treatment room (Jiao et al., 2025).

Why do generic pillows miss?

A standard contoured pillow, not fitted to the individual, performed no better than ordinary shapes in a randomized study of 106 side sleepers (Gordon et al., 2009). No single optimal pillow height can be specified, because it depends on four variables that differ from person to person: cervical alignment, body dimension, contact pressure, and muscle activity (Lei et al., 2021).

What we measure

Pillowise is a fitted cervical pillow that licensed healthcare providers measure and dispense, made in seven sizes.

Our sleep specialists take three measurements: shoulder width, neck circumference, and neck length. Combined with sleeping position and bed type, an algorithm identifies the best-fitting pillow from seven sizes.

Shoulder width is the measurement the EMG study found mattered most. A height matched to it produced the lowest neck and shoulder muscle activity during side sleeping (Jiao et al., 2025), and body dimension is what drives the individual optimum (Tian et al., 2025).

A systematic review of 11 studies covering 309 participants identified a 7 to 11 cm unloaded central height among the parameters supporting spinal alignment and sleep comfort (Radwan et al., 2021). The size is chosen from those three measurements plus sleeping position and bed type, rather than from a single stock height.

Pillowise pillows are made from premium Dutch memory foam and certified to OEKO-TEX Standard 100, meaning every component has been tested against the standard's limits for harmful substances.

Scope

The massage therapist surveys were self-reported and measured pain, not sleep or pillows. No study has tested whether a pillow changes work-related pain in massage therapists, and we make no such claim. The pillow studies are small, and the most recent systematic review found no clear advantage for any pillow type in chronic neck pain (Ghosh et al., 2025).

For massage therapists and clinic owners

The same hands-on work that helps patients places steady demands on the therapist's own hands, shoulders, and neck. Recovery between sessions and between workdays is part of a sustainable practice.

Sleep is the longest recovery window in the day. Asking yourself how you sleep, in what position, and on what pillow is the same question you might ask a patient.

For your patients, a fitted pillow extends the work of the visit into the hours between visits, alongside the exercise, manual therapy, and other care the provider is already delivering.

Common questions

How common is pain among massage therapists?

Very common in surveys. Of 1,103 Canadian massage therapists, 85 percent reported work-related pain in at least one body area, and 30.5 percent had considered or made a career change (Barraclough et al., 2022).

Which body areas hurt most?

The hands and wrists led in the Canadian survey at 65.5 percent, followed by fingers and thumbs, shoulders, low back, and neck (Barraclough et al., 2022). In a smaller Romanian study of 42 practitioners, the neck led at 69.0 percent (Sîrbu et al., 2022).

Can poor sleep make work-related pain worse?

They are linked in both directions. In 1,955 healthcare workers, poor sleep at baseline was associated with higher odds of developing low back pain a year later (Vinstrup et al., 2020), and in 3,593 hospital workers, high pain raised the risk ratio for poor sleep to 1.48 (Vinstrup et al., 2018).

Is a contoured pillow from a store enough?

Not reliably. A standard contoured pillow, not fitted to the individual, performed no better than ordinary shapes in a randomized study of 106 side sleepers (Gordon et al., 2009), and no single optimal height can be specified because it depends on four variables that differ from person to person (Lei et al., 2021). A contour helps only if its height matches the person using it. That is what the fitting settles, in a provider's office.

Find a Pillowise provider or become one

Pillowise pillows are clinically measured and dispensed exclusively through licensed healthcare providers as part of broader sleep, posture, and recovery education.

To locate a Pillowise provider near you, visit: Find a Reseller

Licensed healthcare providers interested in offering Pillowise may register here: Become a Reseller

References

Barraclough, W., Baskwill, A., Higgs, C., Neilson, S., & Wilcox, D. (2022). A survey of Canadian massage therapists' experiences of work-related pain. International Journal of Therapeutic Massage & Bodywork, 15(3), 18-26. https://doi.org/10.3822/ijtmb.v15i3.717

Ghosh, S. K., Goyal, M., & Goyal, K. S. (2025). Effect of pillow on pain, disability and sleep quality in patients with chronic neck pain: A systematic review. Rehabilitación, 59(3), 100922. https://doi.org/10.1016/j.rh.2025.100922

Gordon, S. J., Grimmer-Somers, K., & Trott, P. (2009). Pillow use: The behaviour of cervical pain, sleep quality and pillow comfort in side sleepers. Manual Therapy, 14(6), 671-678. https://doi.org/10.1016/j.math.2009.02.006

Jiao, R., Xiao, W., Wang, M., Yu, S., & Li, H. (2025). The impact of pillow height on neck muscle activity: A pilot study. Sleep and Breathing, 29(1), 40. https://doi.org/10.1007/s11325-024-03219-6

Kim, H. C., Jun, H. S., Kim, J. H., Ahn, J. H., Chang, I. B., Song, J. H., & Oh, J. K. (2015). The effect of different pillow heights on the parameters of cervicothoracic spine segments. Korean Journal of Spine, 12(3), 135-138. https://doi.org/10.14245/kjs.2015.12.3.135

Lei, J.-X., Yang, P.-F., Yang, A.-L., Gong, Y.-F., Shang, P., & Yuan, X.-C. (2021). Ergonomic consideration in pillow height determinants and evaluation. Healthcare, 9(10), 1333. https://doi.org/10.3390/healthcare9101333

Radwan, A., Ashton, N., Gates, T., Kilmer, A., & VanFleet, M. (2021). Effect of different pillow designs on promoting sleep comfort, quality, & spinal alignment: A systematic review. European Journal of Integrative Medicine, 42, 101269. https://doi.org/10.1016/j.eujim.2020.101269

Sîrbu, E., Varga, M. G., Rață, A. L., Amăricăi, E., & Onofrei, R. R. (2022). Work-related musculoskeletal complaints in massage practitioners. Work, 72(3), 901-907. https://doi.org/10.3233/WOR-205306

Tian, S., Yao, C., Wang, Y., Cao, X., Sun, Y., Wang, L., & Fan, Y. (2025). The individualized optimal pillow height and neck support design for side sleepers. Medical and Biological Engineering and Computing, 63(2), 535-544. https://doi.org/10.1007/s11517-024-03204-x

Vinstrup, J., Jakobsen, M. D., & Andersen, L. L. (2020). Poor sleep is a risk factor for low-back pain among healthcare workers: Prospective cohort study. International Journal of Environmental Research and Public Health, 17(3), 996. https://doi.org/10.3390/ijerph17030996

Vinstrup, J., Jakobsen, M.D., Calatayud, J., Jay, K., & Andersen, LL (2018). Association of stress and musculoskeletal pain with poor sleep: Cross-sectional study among 3,600 hospital workers. Frontiers in Neurology, 9 , 968. https://doi.org/10.3389/fneur.2018.00968