Massage as Therapy: A Look at the Evidence

Massage feels great. People go get massage treatments all the time for a whole variety of reasons and often it is because of underlying back pain or discomfort. There are many different types of massage; Swedish massage, deep tissue massage, and reflexology are just a few examples. For those patients with chronic low back pain, does massage help? Until recently the literature was scant at best. In the July 5th Annals of Internal Medicine, a randomized controlled trial was published describing the role of 2 types of massage and usual care on chronic low back pain.

Swedish massage is the most common form of massage in the United States. Its focus is on relaxation and includes, "effleurage, petrissage, circular friction, vibration, rocking, and jostling. Structural massage is less common and focuses on myofascial, neuromuscular and soft tissue techniques and on specific areas to alleviate pain and tension. In this study the patients were randomized to receive Swedish massage, structural massage or no massage at all. All of the patients had a diagnosis of nonspecific chronic low back pain (pain for at least 3 months). A total of 401 patients participated in the study for a period of 10 weeks, receiving 10 weekly treatments lasting 75 to 90 minutes.

The authors found that massage improved function and decreased pain when compared to "usual care." There was no difference between the two types of massage therapy. The benefits lasted at least 26 weeks, but the benefit at the 1 year mark was questionable.

If both techniques work equally well, what is it about the massage that helps treat chronic low back pain? Both may trigger the same physiologic effects but the mechanism is unclear. The benefit may also be due to other aspects of massage including "time spent in a relaxing environment, being touched, receiving care from a caring therapist or increased body awareness."

It would be interesting to have a fourth arm of this study that involved meditation techniques, but that study will have to wait. For now it is nice to know that we can prescribe massage therapy for chronic low back pain and know that our recommendation is evidence based.