Massage for low‐back pain
Abstract
Background
Low‐back pain is one of the most common and costly musculoskeletal problems in modern society. Proponents of massage therapy claim it can minimize pain and disability, and speed return to normal function.
Objectives
To assess the effects of massage therapy for non‐specific low‐back pain.
Search methods
We searched Medline, Embase, Cochrane Controlled Trials Register, HealthSTAR, CINAHL and Dissertation abstracts from their beginning to May 2001 with no language restrictions. References in the included studies and in reviews of the literature were screened. Contact with content experts and massage associations was also made.
Selection criteria
The studies had to be randomized or quasi‐randomized trials investigating the use of any type of massage (using the hands or a mechanical device) as a treatment for non‐specific low‐back pain.
Data collection and analysis
Two authors blinded to authors, journal and institutions selected the studies, assessed the methodological quality using the criteria recommended by the Cochrane Back Review Group, and extracted the data using standardized forms. The studies were analysed in a qualitative way due to heterogeneity of population, massage technique, comparison groups, timing and type of outcome measured.
Main results
Nine publications reporting on eight randomized trials were included. Three had low and five had high methodological quality scores. One study was published in German and the rest in English. Massage was compared to an inert treatment (sham laser) in one study that showed that massage was superior, especially if given in combination with exercises and education. In the other seven studies, massage was compared to different active treatments. They showed that massage was inferior to manipulation and TENS; massage was equal to corsets and exercises; and massage was superior to relaxation therapy, acupuncture and self‐care education. The beneficial effects of massage in patients with chronic low‐back pain lasted at least one year after the end of the treatment. One study comparing two different techniques of massage concluded in favour of acupuncture massage over classic (Swedish) massage.
Authors' conclusions
Massage might be beneficial for patients with subacute and chronic non‐specific low‐back pain, especially when combined with exercises and education. The evidence suggest that acupuncture massage is more effective than classic massage, but this need confirmation. More studies are needed to confirm these conclusions and to assess the impact of massage on return‐to‐work, and to measure longer term effects to determine cost‐effectiveness of massage as an intervention for low‐back pain.
PICOs
Plain language summary
One of the oldest forms of health care now has Cochrane evidence of benefit. In the newly updated Cochrane review of massage for low back pain, there is now some evidence to show overall benefit. New, high quality trials show that massage gives some relief from back pain that has continued for many weeks or months ‐ and the benefit may continue at least a year after the course of massage is over. There is still not enough evidence about massage for acute back pain (back pain that started recently).
Massage was more likely to work when combined with exercises (usually stretching) and education. The amount of benefit was more than that achieved by relaxation, self‐care or acupuncture (although it may be less than the relief possible from manipulation or TENS machines). However, more evidence is still needed on specific forms of massage.
There is a trend showing that the greatest benefit came with massage from trained massage therapists who had many years of experience, or licensed massage therapists. It seems that acupressure or pressure point massage techniques provide more relief than classic (Swedish) massage, although more research is needed to confirm this.
