Neck pain can be divided into chronic, acute and subacute neck pain according to the duration of pain [1]. Chronic neck pain affects people's quality of life and physical and mental function, is the main cause of disability and is often difficult to treat [2]. It is understood that approximately 67% of people in the world will experience neck pain during their lifetime, and 20% of these people will develop chronic neck pain [3,4]. Chronic neck pain not only seriously affects personal health but also causes an unpredictable economic burden. Individuals, families and even society suffer substantial economic losses. The clinical symptoms of patients with chronic neck pain mainly include neck pain, difficulty performing neck exercises, shoulder or upper limb pain, migraine, muscle function imbalance, and abnormal breathing patterns [1,5,6]. At present, there is evidence that exercise therapy, muscle energy techniques, manual therapy and breathing training can effectively improve the discomfort of patients with chronic neck pain [[7], [8], [9], [10]].

Manual therapy for chronic neck pain includes manipulation, acupuncture, and soft tissue therapy. Among these approaches, there is evidence that acupuncture and manipulation can effectively improve the intensity of pain and the dysfunction of patients with chronic neck pain [11]. Soft tissue therapy includes massage, acupressure, and myofascial release. Compared with no treatment, the use of massage to treat musculoskeletal pain has a short-term effect, but compared with other therapies such as acupuncture, the short-term effect of massage is not obvious [12]. Additionally, there is insufficient evidence that myofascial release can effectively treat skeletal muscle pain and can only rely on a few studies [13].

Massage is a treatment method in which the therapist's body touches or manipulates the muscles and other soft tissues of the patient's body. The purpose of massage is to relieve pain, improve blood circulation, promote muscle relaxation, and relieve mental stress [14,15]. At the same time, it has a positive improvement effect on the peripheral and central nervous systems that may cause pain, such as reducing the activation of the spinal cord dorsal horn, affecting the mediation of the spinal cord, reducing the activation of the supraspinal regions responsible for processing central pain, and affecting the secretion of dopamine [16]. Studies have shown that treatment time usually takes at least 10–30 min [17,18]. Myofascial release includes two forms: directly or indirectly acting on the restricted fascia layer and applying slow and continuous pressure. Direct myofascial release technology directly acts on the restricted fascia; the practitioner uses the knuckles or elbows to slowly sink into the fascia and directly touches the restricted fascia by applying a force of several kilograms to release tension or stretch the fascia. Indirect myofascial release technology follows the path of least resistance to guide a gentle stretch until it achieves free movement. A few grams of force are applied, and the hand tends to follow the direction of the fascia limit, keep it stretched, and allow the fascia to relax itself [13,19].

Studies have shown a clear link between psychological factors and neck pain. Stress, pain, anxiety, tension and cognitive impairment have all been found to be important factors in the development of neck pain [20]. Massage and other manual soft tissue therapies can not only improve muscle function to relieve pain intensity, but also psychologically and effectively enhance the parasympathetic response, reducing anxiety and psychological stress, which is also an important factor that can relieve pain [21,22].

In addition, acupressure and myofascial trigger point treatments are also soft tissue therapies, but they only target specific acupoints or fascial nodules, rather than treating unspecified soft tissue areas, so these treatments were not included in this meta-analysis [23,24]. In summary, the purpose of this meta-analysis was to systematically review the effectiveness of manual treatment of soft tissues to relieve neck pain in patients with chronic neck pain.