Lower Back pain


lower back pain : Massage


What research has shown
It is important to know that most acute back problems are self-limiting. Around 90% of people
with an acute back problem will be better within 6 weeks, whatever treatment they receive
(unless it is a form of treatment that makes things worse!).
However, between 2 and 7% of people with an acute back pain problem will develop chronic back
pain, and it is this category that is most worrying because around 80% of work absenteeism is
the result of chronic back pain (Andersson 1997).
Back pain is often associated with a complicated dysfunction of the paraspinal and other back
muscles (Cooper 1993). It is possible that in many cases, massaging these could help improve or
normalize muscular function, and research (Cherkin et al 2001) suggests this is so. Professor
Edzard Ernst (1999)reports that, ‘On the European continent, massage has been a routine form
of therapy for acute and chronic LBP for many decades’ (Westhof & Ernst 1992). A recent survey
from Vienna shows that no less than 87% of back pain patients received massage as one form of
treatment (Ernst & Fialka 1994). Classical Swedish muscle massage has a long history (Westhof
& Ernst 1992) and is associated with various effects that are potentially beneficial in the
symptomatic treatment of neck and back pain:
Massage relaxes the mind as well as the musculature and we have seen (‘yellow flags’)
that in many instances of chronic back pain, emotion and stress are possible key features
Massage increases the pain threshold, possibly through endorphin release (Ernst & Fialka
It can also enhance local blood flow and this could increase the clearance of local
biochemical substances that increase pain (Ernst & Fialka 1994).
These known beneficial effects of massage do not however prove that massage is helpful in
treatment of back pain, but fortunately there are studies that do suggest this (Ernst 1994, Triano
et al 1995, Wiesinger et al 1997).
Unfortunately, many research reviews entirely ignore massage as a meaningful therapeutic option
(Deyo 1983, Frank 1993, Frymoyer 1988, Nachemson 1985) and some physiotherapy texts do
not mention it at all (Frost & Moffett 1992).
Proof of the value of massage in treatment of low back pain
Much research has proved the value of massage in the treatment of low back pain (see, e.g.
Bronfort et al 2004, Cherkin et al 2003, Ernst 1999). Cherkin et al (2003)pointed out that: ‘Few
treatments for back pain are supported by strong scientific evidence. Conventional treatments,
although widely used, have had limited success. Dissatisfied patients have, therefore, turned to
complementary and alternative medical therapies and providers for care for back pain’.
1. Cherkin et al (2003)conducted a summary of all good research on the subject since 1995,
in which different methods were compared in treatment of back and/or neck pain. They
found 20 research studies that were of a standard to include in their review, however only
three evaluated the benefits of massage. The finding of these studies was that ‘massage
therapy is both safe and effective for subacute and chronic back pain’. They also found
that there was evidence that spinal manipulation produced small clinical benefits that are
equivalent to those of other commonly used therapies, but that the effectiveness of
acupuncture remains unclear for these problems. Importantly, they found that there is
evidence that massage, but not acupuncture or spinal manipulation, may reduce the costs
of care after an initial course of therapy in treatment of back pain.
2. In a straight comparison of massage and acupuncture in treating back pain, Frey (1994)
found that those receiving massage used the least medications and that: ‘Therapeutic
massage was effective for persistent low back pain, apparently providing long-lasting
benefits. Traditional Chinese Medical acupuncture was relatively ineffective. Massage might
be an effective alternative to conventional medical care for persistent back pain’.
3. Güthlin and Walach (2000)conducted a study of patients with ‘non-inflammatory
rheumatic pain’ (not just back pain) who received either 10 sessions of classical massage
or usual medical care for 5 weeks. By the end of this period, both groups had improved
similarly, but at the 3-month follow-up, more pain relief had occurred in the massage
4. Another review (Furlan et al 2000) of research compared massage with de-tuned laser
therapy as the placebo, and with various other physical treatments such as acupuncture or
spinal manipulation. The results showed that massage is superior to placebo, relaxation
treatment, acupuncture, or self-care education, but that it is inferior to manipulation,
shiatsu, or transcutaneous electrical stimulation; and no different from treatment with
corsets or exercise in the care of back pain. The authors concluded that massage ‘might’
be beneficial for subacute and chronic non-specific low back pain.
5. Researchers at the Touch Research Institute, Miami School of Medicine, evaluated the
benefits of massage when treating low back pain (Hernandez-Reif et al 2001). They
summarized the research outcome as follows: ‘Adults with low back pain, with a duration of
at least 6 months received two 30-min massage, or relaxation therapy, sessions per week
for 5 weeks. Participants receiving massage therapy reported experiencing less pain,
depression and anxiety and their sleep improved. They also showed improved trunk flexion
Thus the evidence from these reviews and studies proves that when massage is compared with
other treatment methods such as acupuncture, manipulation, relaxation and ultrasound

Massage is at least as helpful in treating back pain as other modalities
Massage reduces use and therefore costs of medication when treating back pain
Massage as a treatment of back and neck pain is safe.