People with chronic low back pain have improved symptoms, better function and few side effects with massage therapy, researchers from Group Health Research Institute reported in Annals of Internal Medicine. The investigators say theirs is the first study to compare relaxation (Swedish) and structural massage – both types were found to work well.

Trial leader, Daniel C. Cherkin, PhD, said:

“We found that massage helps people with back pain to function even after six months. This is important because chronic back pain is among the most common reasons people see doctors and alternative practitioners, including massage therapists. It’s also a common cause of disability, absenteeism, and ‘presenteeism,’ when people are at work but can’t perform well.”

400 Group Health Cooperative patients with chronic low back pain took part in the trial. Chronic in this case was defined as pain that persisted for over three months. There was no identified cause for their pain (nonspecific). They were selected at random into one of three groups:

  • Structural massage group – weekly one hour sessions for 10 weeks
  • Relaxation (Swedish) massage group – weekly one hour sessions for 10 weeks
  • Usual care group – this group would carry on with their ongoing treatment, which usually involved drugs.

Ten weeks later, 1 in every 3 patients in the massage groups said their back pain had either gone or got much better, compared to just 1 in every 25 in the usual care group.

Questionnaire feedback also showed that just over two-thirds of those in the massage groups had significantly better back function at 10 weeks compared to just over one-third in the usual care group.

Those in the massage groups also spent less time laid up bed than those in the usual group, they were more active and used smaller quantities of anti-inflammatory drugs.

Dr. Cherkin said:

“As expected with most treatments, the benefits of massage declined over time. But at six months after the trial started, both types of massage were still associated with improved function.”

No significant benefits from the massage were detectable after 12 months.

Dr. Cherkin added:

“We found the benefits of massage are about as strong as those reported for other effective treatments: medications, acupuncture, exercise, and yoga,” Dr. Cherkin said. “And massage is at least as safe as other treatment options. So people who have persistent back pain may want to consider massage as an option.”

Previous studies had only looked at structural massage in relation to back pain. Relaxation massage, also known as Swedish massage, which is supposed to promote a feeling of relaxation throughout the whole body, is much more widely available and is taught in schools that specialize in massage. The structural massage therapist has to identify specific pain-related soft tissues, such as ligaments and muscles. Structural massage requires considerably more training and tends to cost a great deal more. However, insurance plans are more likely to cover structural massage rather than the Swedish type.

Dr. Cherkin’s colleague Karen J. Sherman, PhD, MPH, said:

“The massage therapists assumed structural massage would prove more effective than relaxation massage. They were surprised when patients in the relaxation group got so much relief from their back pain.”

Further researcher should find out why structural and relaxation massages are effective:

  • Do both have specific effects, such as calming the CNS (central nervous system) or tissue – or does just one do that?
  • They may have non-specific effects that may help the patient become involved in his/her own healing. Examples include spending time in a relaxing environment, being touched, receiving care from a caring therapist, being advised on self care, better awareness of one’s own body, etc.
  • Possibly a combination of non-specific and specific effects may be involved in reducing the back pain symptoms.

“A Comparison of the Effects of 2 Types of Massage and Usual Care on Chronic Low Back Pain – A Randomized, Controlled Trial”
Daniel C. Cherkin, PhD; Karen J. Sherman, PhD, MPH; Janet Kahn, PhD; Robert Wellman, MS; Andrea J. Cook, PhD; Eric Johnson, MS; Janet Erro, RN, MN; Kristin Delaney, MPH; and Richard A. Deyo, MD, MPH
Annals of Internal Medicine July 5, 2011 vol. 155 no. 1 1-9

Written by Christian Nordqvist