Massage Beneficial for Select Patients with Chronic Lower Back Pain

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Massage Beneficial for Select Patients with Chronic Lower Back Pain

There are many treatments and therapies available to help manage chronic lower back pain (CLBP), with some working for some patients and not for others. One treatment that is gaining popularity is massage, likely one of the earliest and most primitive methods of treating pain.

The authors of this study reviewed the literature to find examples of trials done involving massage as a treatment for CLBP, compared with other treatment methods. The massage could be only on the lumbar area or the whole body. Some of the different techniques of massage performed are Cyriax, effleurage, petrissage, friction, kneading, or hacking. The common types of massage, either as a primary intervention or as an add-on treatment, are acupressure (Shiatsu), Rolfing, Swedish massage (SM), reflexology, myofascial release, and craniosacral therapy. The massages were performed by a licensed massage therapist, Physical Therapist, or chiropractor.

While it is not understood how massage may be beneficial, one theory is massaging the affected muscles may either induce biomechanical changes, thus influencing nerve activity or massaging could help release endorphins and serotonin, increasing the pain threshold.

Before massage therapy is initiated, a full patient history and physical examination should be performed to rule out any contraindications for massage. These contraindications include, but are not limited to, acute inflammation, skin infection, nonconsolidated fracture, burns, deep vein thrombosis, or active cancer tumors.

The authors reviewed the literature and found articles comparing massage with different treatment options. In a systematic review from 2002, it was concluded that massage therapy could be useful for patients with nonspecific subacute or chronic lower back pain, particularly if the massage was combined with exercise and education.

Among the randomized controlled trials reviewed, the study authors found the following:

- massage therapy was significantly better than sham therapy for pain and short-term function (1 high-quality study)
- acupressure massage was significantly better than standard Physical Therapy (1 high-quality study and 1 low-quality study)
- massage was significantly better than exercise for short-term function (1 high-quality study); massage and exercise were similar in outcome in both short- and long-term follow-up
- massage and relaxation therapy provided the same amount of pain relief on the first day of treatment; the massage group experienced less pain immediately after first and last treatments (1 low-quality study)
- massage was significantly better than acupuncture in function, but no difference was noted in pain, numbness or tingling (1 high-quality study)
- massage showed better symptom relief and function compared with self-education, after 10 weeks, but the differences were gone by 52 weeks (1 high-quality study)
- acupressure stimulation followed by acupressure with aromatic lavender oil was more effective for short-term pain relief than was usual care (1 low-quality study)

In two high-quality studies comparing acupressure with classic (SM) massage, combined with exercise, the results showed that acupressure was more effective, providing more pain relief and improved function.

When comparing the experience of the massage therapists, the researchers found that experience did provide significant benefits to the patients.

Although some patients did complain of post-massage soreness or irritation, no serious adverse events were reported.

The authors of this study conclude that there "is strong evidence that massage is effective for non-specific CLBP...There is moderate evidence that acupressure may be better than SM, especially if combined with exercise."

Marta Imamura, MD, PhD, et al. Evidence-informed management of chronic low back pain with massage. In The Spine Journal. January/February 2008. Vol. 8. Issue 1. Pp. 121-133.

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