Massage Therapy Foundation backs back pain massage

One very common issue reported by patients seeking pain relief is back pain, specifically of the lower back. For this muscular-skeletal issue, an effective treatment is massage therapy, recognised by clinical practises and the layperson.

The Massage Therapy Foundation has been looking for evidence to support the recommendations of clinicians, and in this month’s review they have another trial that supports massage therapy as a help for managing chronic back pain.

Dr Daniel Cherkin and colleagues from the Group Health Research Institute published a trial in the Annals of Internal Medicine. This trial compared the effect of massage on top of usual care and found that massage is a reasonable treatment for anyone with chronic lower back pain.

Just over 400 patients were involved, and their ages ranged from 20 years old to 65. Either they would receive standard care, or standard care plus a weekly massage for 10 weeks. These massages could be either a relaxation massage or a structural massage. The distinction is that structural massage involves myofascial and neuromuscular manipulation, but the authors couldn’t find any significant difference between the two.

The massage practitioners all had experience of at least five years, and received a day and a half of specific training. The practitioners knew whether they were performing structural or relaxation massage to their patients, but did not disclose this information. The patients were also given kinaesthetic exercises which they were encouraged to do at home in their own time to help lower back pain in between treatments.

Those patients who received massage were much more likely to experience clinically reductions in their functional limitations as well as a reduction in lower back pain. This remained true after both 26 weeks and 52 weeks, despite just 10 weeks of massage. This was measured by use of the Roland Disability Quotient, as well as ‘symptom bothersomeness scores’.

In addition, the patients that got massage reported a reduction in non-steroidal medication over the 10 weeks, but this did not remain the case at the 26 week point. Similarly there was a decrease in absenteeism from school or work caused by lower back pain, but this effect did not remain beyond the duration of the massages.

There did not seem to be any significant differences between the varying massage therapists. A limitation on this study’s results is that it was not blind. It was obvious to the control group that they were the controls, because they were not receiving massage despite being in a massage study. Further, the study used a group that was predominantly white females, and it may not be possible to extrapolate from this to other groups.

It is not obvious how massage helps to relieve pain. There are many possible factors, such as therapeutic touch, a relaxing environment, increased body awareness, stimulation of tissue, or any combination of these factors or others not listed. What is for certain is that for this group, there is evidence that massage is more effective than usual care for reducing lower back pain.