Back Massage

Will back massage help your back pain?

Back Massage is another very old therapy, Ayurvedic massage can be traced back 5000 years in India. It involves applying movement and pressure to soft tissues such as muscles and skin. This pressure is usually applied with the hands but can be applied with the feet or elbows and also with mechanical devices such as massage rollers or massage machines like electronic massage chairs.

image of massage
Image Courtesy Lubyanka
via Wikimedia Commons

There are many different approaches to back massage and a dozen different schools of thought. Which type you choose depends very much on personal preference, some people prefer a firm massage whilst another will respond better to a lighter, less direct approach. You will need to shop around to find the one that suits you.

How does massage work?

It is thought to work in a number of ways:

  • By increasing the blood supply to the area which reduces muscle spasm and therefore pain.
  • A combination of the relaxing effects of touch and the stimulation of the soft tissues causes the body to release its own natural pain relievers called endorphins ( a bit like a TENS machine or acupuncture would)
  • Releasing tension generally helps improve well being and mood.

Does back massage help lower back pain?

-RESEARCH UPDATE 2016 -

A further update of the Cochrane review in 2015 (5) found very little evidence that massage is helpful for low back pain. Many of the research studies out there are of low or very low quality which means that even when positive results were reported its not possible to trust them as they may be biased.

The authors conclude from the best evidence they could find that massage was helpful for pain - but only on the short term. Long term improvements were not found.Some reports of increased pain post massage were also found but no serious harm was reported for any of the participants in the research they studied. So again, if you find it helpful in the short term that's fine but don't expect longer term improvements.

 

UPDATED RESEARCH 2011

I have just come across a new study looking at the effects of massage on chronic lower back pain. (Cherkin et al. 2011). This is a decent study, pretty well designed and using quite a large sample group (401 people between the ages of 20 and 65 with chronic non-specific lower back pain).The study is a randomised controlled trial. This means they randomly split the group up into three different sections and compared normal massage with deep tissue massage and compared both those interventions against a group that didn't receive any massage at all.

The results from the trial are quite interesting. Firstly the massage helped, however, it didn't really matter what type of massage it was and the amount of improvement was quite small. (Although if you have back pain you may feel that any improvement may well be worth pursuing.)

The finding that the type of massage doesn't really change the outcome is not new to those of us who have been practicing manual therapy for many years. For a long time there has been a growing suspicion that the particular type of treatment is less important than many people think. For example recent studies looking at acupuncture have identified that dry needle acupuncture is helpful for pain relief but it doesn't really matter where you put the needles (Haake et al. 2007).


It's much the same the manual therapy - when different types of manual therapy mobilisation techniques are compared there often isn't the greatest difference between them.


The bottom line from this new study is that massage may help chronic low back pain sufferers a little. It doesn't really matter what type of massage you have, relaxing massage may be just as helpful as other more complex and expensive types. Which leaves us with the question - we still don't really know why massage works - it just seems to.

OLDER RESEARCH

One of the most recent high standard examinations of this question was as long ago as 2002 and was updated in 2009 with similar findings (Furlan et al ). This study was what is called a meta-analysis. (This basically means a review and examination of all the collected research regarding back pain and massage, so its pretty reliable). The authors found weak evidence that massage may be helpful.

More recently a published guideline (Chou, R et al 2007 ) has looked again at the evidence for back massage and has decided that there is fair evidence that massage may be helpful for lower back pain but no evidence that it is helpful for acute low back pain.

So the decision lies with you, there is no suggestion that massage can harm and for some it’s very helpful. Perhaps try it and see how you get on. Massage may help with pain relief but remember that active treatments such as exercise have been shown to be better at managing back pain in the long run (Chou, R et al 2007).

References

  1. Cherkin, D.C. et al., 2011. A comparison of the effects of 2 types of massage and usual care on chronic low back pain: a randomized, controlled trial. Annals of Internal Medicine, 155(1), pp.1-9.
  2. Haake, M. et al., 2007. German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups. Archives of Internal Medicine, 167(17), pp.1892-1898.
  3. Furlan, A.D. et al., 2009. Massage for low back pain: an updated systematic review within the framework of the Cochrane Back Review Group. Spine, 34(16), pp.1669-1684.
  4. Chou, R. & Huffman, L. H. 2007, "Nonpharmacologic Therapies for Acute and Chronic Low Back Pain: A Review of the Evidence for an American Pain Society/American College of Physicians Clinical Practice Guideline", Annals of Internal Medicine, vol. 147, no. 7, pp. 492-504.
  5. Furlan AD, Giraldo M, Baskwill A, Irvin E, Imamura M. Massage for low-back pain. Cochrane Database of Systematic Reviews 2015, Issue 9

29-Apr-2016