Comparison between massage and spinal manipulation or joint mobilization
Makawan showed that patients receiving traditional Thai massage reported significantly less pain (as measured by Visual Analog Scale) than patients in a joint mobilization group.(16)  This study had a relatively low bias potential and adequate sample size (n=67).  Both Thai massage and joint mobilization provided significant improvement in pain scores after treatment as compared to the subjects’ baseline values.  The Thai massage group improved from 4.22 to 2.45, and the joint mobilization group improved from 4.35 to 3.39 on measures taken immediately after the treatment sessions.(16)

Comparison between massage and acupuncture
Cherkin reported a significant improvement in function in patients that received massage versus acupuncture.(17)  This study had a relatively low risk of bias and a good sample size (n=172).  At 52 weeks, massage was statistically superior to acupuncture in its effect on pain (ANCOVA, P = 0.002) and function (ANCOVA, P = 0.05).(17)

Comparison between massage and self-care education
The Cherkin study also reported a significant improvement in pain and function compared to a self-care education group after 10 weeks.(17)  These differences were not maintained at 52 weeks because the self-care education group also demonstrated substantial improvements during this period.  This study had a low risk of bias and a very good sample size (n=172)

Comparison between acupressure massage and physical therapy
Two studies conducted by the same group (Hseih, et al) reported that acupressure massage was significantly better than physical therapy for pain both in the short-term and long-term follow-ups.(18,19)  The 2006 Hsieh study also showed that subjects who received acupressure massage reported better improvements in function than the subjects who received physical therapy on both short and long-term follow-ups.(19)  Based on these two studies, evidence showed that acupressure massage is more efficacious than physical therapy in alleviating low-back pain and improving function as measured by a visual analogue scale for pain, the Roland and Morris Disability Questionnaire and the Oswestry Disability Index.(18,19)

Massage as a component of a combined therapy
In studies where the effects of massage could be distinguished as separate, the following evidence was reported.  In the Preyde study, patients who received massage combined with exercises and education reported significantly better outcomes in pain and function than the group that received exercises only on both short and long-term measurements.(14)   Massage combined with exercise and education was significantly better than sham laser in the three outcome measures on both short and long-term follow-up.   Massage combined with exercise and education was better than massage alone only on measurements of pain intensity, in the short-term.  Based on this study, massage therapy appears to be the intervention that provided the most benefit.

Franke,et al. reported a significant improvement in patients with LBP when acupressure massage was added to exercise in a study with a low risk of bias and 190 subjects.(20)  Acupressure massage (combined with group or individualized exercise) reduced pain and increased function, while classic Swedish massage did not.  The most decrease in LBP occurred in the intervention group who received acupressure massage plus individualized exercises.(20)

Yip and Tse reported that acupressure massage added to a course of “usual care” (which was not described in detail) provided decreased pain compared to “usual care” alone in the short-term follow-up, but not for measures of function.(21)  The acupressure massage group had a 39% greater reduction in pain intensity than the “usual care” group at one week after the end of treatment.  There was no significant difference in outcome measures of function in activities of daily living between the two groups.(21)

Different styles of massage for Low Back Pain
Franke, et al. compared acupressure massage to classical Swedish massage.(20)  Each massage therapy group also received one of two types of exercise programs (individualized or in group). Based on this study, acupressure massage provided more decreased pain and a greater improved function to subjects compared to Swedish massage (regardless of the type of exercise received).(20)

Chatchawan, et al. compared traditional Thai massage with Swedish massage in 180 subjects with LBP.  This study with a low risk of bias, showed that both massage techniques provided an equal effectiveness in the treatment of LBP.(21)  There was no significant difference in the degree of pain reduction between the two groups at the end of three weeks or at the one-month follow-up.  Based on this study, both traditional Thai massage and Swedish massage provided significant improvement in pain scores after treatment compared to baseline values.(21)

Ling Jun Kong and colleagues compared chinese massage with herbal ointment to simple Swedish massage on athletes with non-specific low back pain. One-hundred ten athletes with non-specific low back pain were randomly assigned to chinese massage group or simple massage group. The athletes received a thirty-minute massage twice a week for four weeks. The primary outcome reported was pain and the secondary outcome was muscle stiffness. At the end of four weeks, the chinese massage group reported significant improvements in low back pain and muscle stiffness.(27) Please, CLICK HERE to read this research study as part of this course information.

In a National Institutes of Health study, authors used a randomized controlled trial to compare ten weekly sessions of Structural massage versus Relaxation massage on subjects with low back pain.(28) Researchers used the Roland Disability Questionnaire and the Symptom Bothersomeness Scale to track treatment outcomes. At ten weeks, both massage groups had significant decreases in low back pain and disability compared to the control group. The authors concluded that massage is effective in the treatment of low back pain. Although the Structural massage group reported better results than the Relaxation massage group, the authors deemed these differences clinically insignificant. Please, CLICK HERE to read this research study as part of this course information.

Experience of the therapist
Based on the studies reviewed, the most significant benefits in the reduction of pain and improvement of function in patients with LBP were observed in the studies that used a trained massage therapist with many years of experience, a Certified Massage Therapist or a Licensed Massage Therapist. (14,17,23)

Work-related outcomes
Two trials, Hsieh et al. and Yip and Tse evaluated work-related outcome measures.(19,21)  Hsieh et al looked at that the mean scores for: 1)pain interfering with normal work, 2)days cut down on doing things and 3)days off from work or school.  Patients who received acupressure massage reported significantly lower work-related interference due to pain compared to patients who received physical therapy.(19)  Yip and Tse reported that subjects who received electrical stimulation on acupuncture points followed by acupressure massage with aromatic lavender oil had no significant functional benefits related to housework, occupational work or leisure time.(21)

A recent study evaluated the efficiency of massage in reducing occupational low back pain, and its influence on the work and life activities of an 18 member nursing team. After receiving 7 to 8 massage sessions, there was a significant decrease in LBP and a significant decrease in functional disability. The study concluded that massage was effective in reducing occupational LBP and improving work and life activities. (25) Please, CLICK HERE to read this research article as part of this course information.

Harms and Contraindications
There were no serious adverse effects reported by any of the subjects in any of the studies reviewed. Although there were some reports of discomfort during the deep cross-fiber friction massage and ischemic compression and some reports of significant post-massage soreness, the benefits of decreased LBP and improved function outweighed the risk of experiencing mild discomfort or soreness. Contraindications include:

  1. Constant pain for more than one month. 
  2. Night pain (especially with a history of cancer).
  3. Referred pain or other radicular symptoms below the knee indicative of nerve root impingement.  These could include tingling, numbness, sensation of hot/cold, or weakness.
  4. Bowel or bladder dysfunction, indicative of cauda equina or serious nerve root impingement.
  5. Acute back trauma, like a fall or Motor Vehicle Accident.
  6. Acute diagnosis of disc damage, like a herniated or ruptured disc.

Systematic Review of Research: Massage for Low Back Pain

In this systematic review, the authors reviewed the latest research on the efficacy of massage in the treatment of low back pain. (11) Thirteen randomized trials were incluced in this review with a total of 1596 patients, which assessed various types of massage therapy for low-back pain. Results showed that massage was more likely to work when combined with exercises (usually stretching) and education. The amount of benefit was more than that achieved by joint mobilization, relaxation, physical therapy, selfcare education or acupuncture. It seems that acupressure or pressure point massage techniques provide more relief than classic (Swedish) massage, although more research is needed to confirm this. No serious adverse events were reported by any of the patients, however, some patients reported soreness during or shortly after the treatment. In summary, massage might be beneficial for patients with subacute (lasting four to 12 weeks) and chronic (lasting longer than 12 weeks) non-specific low-back pain, especially when combined with exercises and education. Please, CLICK HERE to read this research study as part of this course information.

Systematic Review of Research: Effectiveness of Massage for Non-Specific Low Back Pain

In this systematic review, the authors conducted a step-by-step review of 14 databases to study the effectiveness of massage in the treatment of non-specific low back pain.(26) The authors cited 9 systematic reviews and drew the conclusion that there is an emerging body of evidence that supports the effectiveness of massage in the treatment of non-specific low back pain in the short term. Please, CLICK HERE to read this research study as part of this course information.

Individual Patient Education in Low Back Pain

In this systematic review, the authors reviewed the latest research on the efficacy of patient education in the treatment of Low Back Pain. (24) While many different types of education are used to help patients understand their low back pain and assist in the healing process, the effect of this education on healing low back pain is in question. A number of studies have put this to the test and this review summarizes these studies in a systematic way. The intention of the review is to see if individual patient education is effective in the treatment of low back pain and what types of patient education are the most effective. Please, CLICK HERE to read this research study as part of the course information.

Implications for massage therapy practice
Massage is beneficial for patients with subacute and chronic non-specific LBP in terms of decreasing the symptoms of pain and improving function.  The beneficial effects of massage are increased if it is combined with exercise (either group or individualized) and patient education.  The beneficial effects of massage in patients with chronic LBP may be long lasting, with some patients reporting benefit after one-year post intervention.   Based on the studies reviewed, it appears that acupressure massage provided more benefit than Swedish massage.

REFERENCES

TAKE THE TEST

1... 2 (previous page) Page 3

©2013 Healing Arts Continuing Education. All Rights Reserved.