Non-specific low back pain is one of the most common muscular-skeletal issues reported by patients/clients seeking pain relief. Massage therapy is recognized in clinical practice as an effective treatment. However, the Massage Therapy Foundation is always looking for scientific evidence to support clinical recommendations. This month’s review illustrates study findings supporting the use of massage therapy to manage chronic low back pain. A controlled trial was recently published in the Annals of Internal Medicine. Dr. Daniel C.
Cherkin and his colleagues at the Group Health Research Institute in Seattle, compared massage plus usual care to usual care alone in their study of participants, ages 20 to 65 years old (n=401). Study findings, “suggest that both relaxation massage and structural massage are reasonable treatment options for persons with chronic low back pain. ” Participants in the study received 10 weekly treatments at no cost, which consisted of either relaxation massage or structural massage, randomly assigned. Twenty-seven licensed massage practitioners, all of whom had a minimum of five years experience, received 1.
5 days of protocol training and provided massage treatments. The LMPs knew which type of massage they were performing, which they did not disclose with participants. Additionally, participants were provided kinesthetic exercises to do in the home setting to help relieve their back pain between treatments. Study findings suggest, “massage therapy improved function and decreased pain more than usual care in patients with uncomplicated chronic lower back pain [LBP] after 10 weeks. ” The participants who received massage in addition to usual care reported significantly lower Roland Disability Quotient scores (p=<0.001) and symptom bothersomeness scores (p=<0. 001).
The beneficial effects of massage lasted at twenty-six weeks (p=0. 007) and fifty-two weeks (p=0. 049) when measured by the Roland Disability Quotient. Symptom bothersomeness was only significantly reduced at the end of the ten-week trial. The authors note that “massage recipients were more likely than participants in the usual care group to experience clinically meaningful reductions” in functional limitations and low back pain symptoms. Massage reduced self-reported medication use for LBP (p=0.006), including specifically NSAID use for LBP (p=0. 027) at the end of the ten-week trial.
However, the reduction in medication use did not persist by twenty-six weeks. Similarly, massage patients were able to decrease absenteeism to work or school caused by their LBP (p=0. 018) at the ten-week mark, although these effects did not last either. Patients in the massage group were significantly more likely to be “pleased or delighted if LBP remained at the current level for the rest of life” at the end of the ten-week trial (p=0. 007) than patients receiving usual care.
In addition, massage patients were significantly more likely (p<0. 001) to be “very satisfied with [their] LBP care” at ten weeks, twenty-six weeks and fifty-two weeks. While some massage therapists are more skilled than others, the authors “found no evidence of differential effectiveness among the massage therapists. ” For the consumer, this implies that local massage therapists are a great choice for managing lower back pain. Also, the authors examined both relaxation and structural massage, but they “could not detect a clinically meaningful difference between the two types” of massage.
This implies that structural massage – also known as neuromuscular and myofascial massage – may not be any more effective than relaxation massage at relieving nonspecific lower back pain. This is an exciting issue for future research to address. A limitation to this study was that participants receiving only usual care were told that they were enrolling in a trial of massage therapy and received no massage therapy. In other words, they were not blinded to being in the control group.
Also, these results may not be generalizable beyond the mostly-female group of mostly white individuals with nonspecific chronic low back pain. Persons with known causes of back pain, including disk herniation, were completely excluded from the study. Persons with these back issues represent a specific population and need, which may also be addressed in future research to expand on the findings of this study. The researchers report that at this point, there’s little evidence of which mechanisms explain the beneficial effects of massage.
Mechanisms may be explained by therapeutic touch, relaxing environment, therapist care, increased body awareness, self-care advice, a generalized central nervous system response, local stimulation of tissue or a combination of these influencing factors. What can be clearly stated is this research provides evidence to support the therapeutic benefits of massage for managing chronic low back pain. So what does this study contribute to the field of massage therapy? This study provides the evidence to support the clinical decision to use massage therapy to manage clients’/patients’ chronic low back pain.
Further, different types of massage therapy can be equally effective whether relaxation, neuromuscular and/or myofascial. Finally, because multiple therapists provided treatments, and no differences were found between therapists, findings indicate specialized skill is not necessary to provide clients/patients with effective treatments to manage symptoms of low back pain. Further, the authors of this study provide massage protocols for applying massage for low back pain, so these study results can be replicated in practice.
Want to incorporate these proven techniques into your massage practice? The exact study protocols are available free online at www. trialsjournal. com/content/10/1/96. Sources: * Cherkin DC, Sherman KJ, Kahn J, Wellman R, Cook AJ, Johnson E, Erro J, Delaney K, Deyo RA. A comparison of the effects of 2 types of massage and usual care on chronic low back pain: a randomized, controlled trial. Ann Intern Med. 2011;155:1:1-9, www. ncbi. nlm. nih. gov/pubmed/21727288. http://www. massagetoday. com/mpacms/mt/article. php? id=14543 Date view: 01/04/2013.