Massage, manipulation and other hands-on approaches can safely and effectively help with pain management.

The January issue of Mayo Clinic Women's HealthSource discusses the uses and benefits of massage, spinal manipulation, and Rolfing, as well as the Alexander technique and the Feldenkrais method.

Massage: Almost everyone feels better after the soothing strokes of a massage. This process involves applying pressure to the body's soft tissues by rubbing, kneading or rolling. There are a variety of techniques and styles, such as deep tissue massage, where deeper layers of muscle and connective tissue are manipulated. Another approach focuses on trigger points -- muscle "knots" that are painful when pressed.

Massage can help reduce pain, muscle soreness and swelling. It can improve circulation, joint flexibility and range of motion. Massage has been shown to help those with chronic back pain, migraines, knee osteoarthritis and cancer.

Spinal manipulation: Also called spinal adjustment, this therapy is used to treat restricted spinal mobility. The goal is to restore spinal movement, improving function and relieving pain. The practitioner uses his or her hands to apply a controlled force or thrust to a joint of the spine. Some techniques are more rhythmic and less abrupt than others.

Spinal manipulation can provide short- and long-term relief for pain, especially if the pain hasn't improved with self-care. Manipulation may also boost psychological well-being and everyday functioning. Some evidence shows that the therapy may improve headache symptoms and neck pain.

Rolfing: Rolfing manipulates the fascia -- the protective tissue that surrounds the muscles. It aims to improve posture and realign the body.

Patients lie on a massage table while the practitioner uses hands, knuckles, thumbs, elbows and knees to manipulate the patient's tissues. It can be painful.

There's little research on the effectiveness of Rolfing in relieving pain. Some patients report that Rolfing helps with flexibility and improves their posture. It may relieve stress and anxiety.

Alexander technique and Feldenkrais method: These therapies use different approaches, but both aim to help patients become more aware of their habitual or everyday movements. The theory is that changing movement can help with pain and other health problems.

Both therapies use touch and direction to help the patient become more aware of movement. An Alexander session might begin with the patient seated in a chair. The practitioner helps the patient adjust head, neck and spine positions.

With Feldenkrais, the patient may be lying down, sitting on a chair or standing. The practitioner guides the participant through a series of movements designed to improve flexibility and coordination. Research suggests that the Alexander technique can provide long-term relief for back pain.

These hands-on therapies probably won't replace pain relief medications but they could help manage chronic pain. A combination of approaches often works best in achieving long-term pain control.