Literature Review of Research on Massage for Low Back Pain

Massage in this review is defined as soft-tissue manipulation using hands or a mechanical device. Massage was applied to any part of the body, to the lumbar region only, or to the whole body.  In this review, the studies that were chosen researched massage as a stand-alone therapy, not as complementary to other therapies.  When massage therapy was used in conjunction with other therapies, if the effects of the massage therapy could be distinguished as separate, then the study was included.  A taxonomy of massage treatments for musculoskeletal pain was developed by Sherman in 2006.(13)  This taxonomy was used to include studies in this review and uses a three-level classification system as follows in Table 1:  

Table 1. Taxonomy of Massage Practice (Sherman et al 2006)


Goal of treatment

Relaxation massage

Clinical massage

Movement reeducation

Energy work


Intention

Relax muscles, move body fluids, promote wellness

Accomplish specific goals such as releasing muscle spasms

Induce sense of freedom, ease and lightness in body

Hypothesized to free energy blockages


Commonly used styles (examples)

Swedisch massage; Spa massage; Sports massage

Myofascial trigger points therapy; Myofascial release; Strain counterstrain;

Proprioceptive; Neuromuscular facilitation; Strain counterstrain; Trager

Acupressure; Reiki; Polarity; Therapeutic touch; Tuina;


Common Techniques (examples)

Gliding, kneading, friction, holding, percussion, vibration

Direct pressure, skin rolling, resistive stretching, stretching manual, cross-fiber friction,

Contract-relax, passive stretching, resistive stretching, rocking

Direction of energy, smoothing, direct pressure, holding, rocking, traction



The classification of outcomes that these clinical trials used:

  1. Pain
  2. Overall improvement
  3. Back-specific functional status
  4. Well-being (quality of life)
  5. Disability (Activity of Daily Living, work absenteeism)

Physical examination measures such as range of motion (ROM), spinal flexibility, degrees of straight leg raising (SLR) or muscle strength were considered as secondary outcomes and were only used if there were no primary outcomes, because these physical measures do not correlate with pain reduction or functional outcomes.  The outcome measurements were either short-term (assessed at the end of the intervention up to a period of three months) or long-term (assessed more than three months after the intervention).

Massage versus placebo or control in Low Back Pain
Preyde reported  that massage was significantly better than a sham laser treatment on measurements of pain intensity, measured on 0-5 Likert pain scale.(14) This study had a relatively low risk of bias with a sufficient sample size (n=51 people).  The mean improvement in the group that received massage therapy was 2.0 points on both short and long-term follow-up.  The mean improvement in pain intensity in the sham laser group was 0.35 and 0.25 points in the short and long-term follow-up, respectively. Massage therapy was also significantly better than the sham laser on measurements of function (both short and long-term).  This study also showed a statistically significant difference in the Roland-Morris Disability Questionnaire (RMDQ).  A score difference of 2.5 is considered the minimally important clinical difference when applying this questionnaire.(14)  The massage group scored 5.9 in the short-term and 6.8 in the long-term follow-up, while the sham laser treatment group scored 0.3 and 0.7. This resulted in a clinically significant difference between the two groups.  At one-month follow-up, 63% of subjects in the massage therapy group reported no pain as compared with 0% of the sham laser therapy group.(14)

Farasyn reported that one 30-minute session of deep cross-fiber friction massage with a copper myofascial T-bar (roptrotherapy) applied to the lumbar myofascia was significantly better than placebo and no treatment for the reduction of pain and improvement in function in patients (n=63) with sub-acute non-specific LBP.(15)  Pain was measured on a visual analogue scale and lumbar function was assessed by the standard Oswestry Disability Index (ODI) one week after the massage session.  Subjects in the massage group reported that their pain changed from 56 mm to 37 mm on the pain scale, while the placebo group reported that their pain changed from 57 mm to 59 mm.  The ODI changed from 34 to 16 in the massage group and from 36 to 38 in the placebo group.(15)  These studies showed statistically significant improvements in pain and function in the group of LBP patients that received massage therapy.

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