Studying Massage for Low Back Pain

Researchers recruited adults, mostly women, ages 20 to 65 who had visited the doctor at least once for their low back pain.

People were not included in the study if their back pain could be attributed to a specific cause like fractures, cancer or spinal stenosis, if they'd had surgery for their back problems in the last three years, or if they had an underlying medical condition like fibromyalgia or rheumatoid arthritis that would complicate pain treatment.

Study participants were randomly assigned to receive either Swedish massages for relaxation or a more targeted kind of "structural" massage that focused on specific muscle and connective tissue problems that might affect the low back.

"The treatment will go into the gluteal muscles and up in to the neck, but it's not a fully body massage and it tends to be focused with the goal of treating the effected tissues," says Cherkin. "A full-body relaxation massage is more or less full-body and it doesn't focus on the back. It's intended to maximize relaxation."

A third group was told they were participating in a trial of massage therapy, but they were assigned to usual care.

Massage therapists all had at least five years of experience, and some had additional, specialized training to provide the focused, structural massage technique.

Study participants received their massages for free. People in the usual care group were paid $50 for their participation.

All study participants were followed for one year.

Before and after the 10 weekly massages, participants completed questionnaires that assessed pain and physical functioning. They were asked, for example, how easy or hard it was for them to get up from a chair or to tie their shoes.

Before getting the massage therapy, about half of study participants in each group reported taking daily medication to treat their low back pain. NSAIDs were most commonly used, followed by analgesics and sedatives. Across all groups, average scores of physical functioning were around 10 on a scale from 0 to 23. Average scores of pain were around 6 on a scale from 0 to 10.

After having 10 weeks of massage, participants in the structural massage group had average scores of 6.5 for physical functioning and 3.8 for pain. Those who got relaxation massages had average scores of 6 for physical functioning and 3.5 for pain. Those in the usual care group scored 9 for physical functioning and 5.2 for pain.

The massage groups improved in other important ways, too. After 10 weeks, they were less likely to report using medication for their low back pain than those in the usual care group. They also reported fewer days in bed and fewer days of lost work or school than those who got usual care.

After six months, many of the improvements experienced by the massage group had persisted, but they were negligible after one year, the study shows.

The study had limitations, the researchers say, particularly that people who got usual care knew they were missing out on massages received by other participants. That might have led them to exaggerate the symptoms they reported to researchers, making massage seem more effective than it really was.

And they said because low back pain often returns after the first episode, it would probably be wise for people who use massage in conjunction with exercise.

But often, Deyo points out, low back pain hurts so much that it's hard to move, and being inactive, studies show, can make back pain worse. Massage, he thinks, may help to break the pain-inactivity cycle.

"In some ways, this may be a way of helping patients to improve, giving them confidence that they can get some control over the problem and maybe help to ease the transition into a more active type of therapy," Deyo says.

"I don't see massage as the final solution," he says, "I see it as maybe a helpful step toward getting people more active."

Source WebMD.com

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