Massage Therapy and Back Pain
Low back pain is a difficult to treat global health burden, one of the reasons for this is that there is often no clear identifiable cause. There is much debate about the best way to manage low back pain, some of the strongest reviews support the need for a multidisciplinary therapeutic approach. A multidisciplinary approach can involve a number of management strategies that include but is not limited to education, reassurance, analgesic medicine and a number of non-pharmacological therapies.
Recent recommendations from The American College of Physicians (Chou et al. 2017, Qaseem et al. 2017), Center for Disease Control (Frieden et al. 2016), Ontario Protocol for Traffic Injury Management (OPTIMa) (Wong et al. 2017) and The Mayo Clinic (Nahin et al. 2016) represent a monumental shift in pain management. Physicians, now more than ever are recommending conservative treatment including massage, spinal manipulation, acupuncture and exercise as part of a multi-modal approach for patients suffering from low back pain.
Why Does Massage Therapy Work?
Massage therapy is a clinically-oriented multi-modal approach (manual therapy, remedial exercise and patient education) based on a biopsychosocial model and on the three pillars of evidence based practice (best available evidence, clinical expertise and patient values).
The mechanism by which massage therapy alleviates localized pain is not clear, biological factors (physiology), psychological (i.e. thoughts, emotions, and behaviours) and social (i.e. culture, and religion) factors play a significant role in the experience and reduction of pain.
In terms of clinical responses to massage therapy there are a couple of proposed mechanisms of action:
Endogenous pain modulation: Massage has an affect on peripheral and central processes via input from large sensory neurons that prevents the spinal cord from amplifying the nociceptive signal. This anti-nociceptive effect of massage therapy can help ease aches and pain. (Bishop et al. 2015, Vigotsky et al. 2015).
Improved blood flow: Researchers demonstrated that compression and its release improves localized blood flow. It is proposed that improved perfusion and oxygen delivery to the muscle, encourages the removal of cellular exudates and drainage of metabolic waste (Moraska et al. 2013).
An increase in parasympathetic activity: Studies have demonstrated an increase in parasympathetic activity following local compression of myofascial triggerpoints. This alteration within the autonomic nervous system result in changes to regional perfusion (Takamoto et al. 2009).
Myofascial trigger points: Randomized controlled trials have demonstrated that compression at myofascial triggerpoints (MTrPs) significantly improved subjective pain scores compared with compression at Non-MTrPs and the control treatments for patients suffering for back pain (Takamoto et al. 2015).
Contextual responses: This is likely to play a role in any therapeutic intervention, the way we present ourselves and present our techniques has influence on the treatment. The magnitude of a response may be influenced by mood, expectation, and conditioning (Bialosky et al. 2017).
Immunomodulation: One interesting paper suggests that the application of massage induces a phenotype change, prompting the transition of M1 macrophages into the M2 macrophages (Waters-Banker et al. 2014).
For those who suffer from low back pain, massage therapy has been shown to be a safe, effective non-pharmacological therapeutic intervention that is simple to carry out, economical, and has very few side effects. Below you will finds links and clinical research related to back pain.
More to Explore
Massage Therapy: Theories and Treatment Strategies
As the body of knowledge to support the use of massage therapy continues to grow, understanding the basic science behind what we do and the guiding principles of adaptability enable us to apply this work to a number of conditions including, but not limited to:
• Sports Related Aches and Pain
• Carpal Tunnel Syndrome
• Post-Operative Patients
• Compartment Syndrome
• Dupuytren's Disease
• Low Back Pain
• Post-Concussion Syndrome
• Temporomandibular Dysfunction (TMD)
• Scar Management
Research Links: Basic science and clinical research related to back pain.
Al-Shareef, A. T., Omar, M. T., & Ibrahim, A. H. (2016). Effect of Kinesio Taping on Pain and Functional Disability in Chronic Nonspecific Low Back Pain. Spine.
Andronis L, Kinghorn P, Qiao S, Whitehurst DG, Durrell S, McLeod H. (2017). Cost-Effectiveness of Non-Invasive and Non-Pharmacological Interventions for Low Back Pain: a Systematic Literature Review. Appl Health Econ Health Policy.
Arguisuelas, M.D., Lisón, J.F., Sánchez-Zuriaga, D., Martínez-Hurtado, I., Doménech-Fernández, J. (2017). Effects of Myofascial Release in Nonspecific Chronic Low Back Pain: A Randomized Clinical Trial. Spine.
Bialosky, J.E., Bishop, M.D., Penza, C.W. (2017). Placebo Mechanisms of Manual Therapy: A Sheep in Wolf's Clothing? J Orthop Sports Phys Ther.
Bishop, M. D., Torres-Cueco, R., Gay, C. W., Lluch-Girbés, E., Beneciuk, J. M., & Bialosky, J. E. (2015). What effect can manual therapy have on a patient's pain experience? Pain Management.
https://www.ncbi.nlm.nih.gov/pubmed/26401979 (OPEN ACCESS)
Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., . . . Jarvik, J. G. (2015). Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. American Journal of Neuroradiology.
Chen, L., Michalsen, A. (2017). Management of chronic pain using complementary and integrative medicine. BMJ.
Cherkin, D. C., Sherman, K. J., Kahn, J., Wellman, R., Cook, A. J., Johnson, E., . . . Deyo, R. A. (2011). A Comparison of the Effects of 2 Types of Massage and Usual Care on Chronic Low Back Pain. Annals of Internal Medicine.
Chou, R., Deyo, R., Friedly, J., Skelly, A., Hashimoto, R., ... Brodt, E.D. (2017). Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med.
Cooper, N.A., Scavo, K.M., ... Sluka, K.A. (2016). Prevalence of gluteus medius weakness in people with chronic low back pain compared to healthy controls. Eur Spine J.
Elder, W.G., Munk, N., Love, M.M., Bruckner, G.G., Stewart, K.E., Pearce, K. (2017). Real-World Massage Therapy Produces Meaningful Effectiveness Signal for Primary Care Patients with Chronic Low Back Pain: Results of a Repeated Measures Cohort Study. Pain Med.
Frieden, T. R., & Houry, D. (2016). Reducing the Risks of Relief — The CDC Opioid-Prescribing Guideline. New England Journal of Medicine.
Kamper, S.J., Apeldoorn, A.T., ... van Tulder, M.W. (2014). Multidisciplinary biopsychosocial rehabilitation for chronic low back pain. Cochrane Database Syst Rev.
Kumar, S., Beaton, K., & Hughes, T. (2013). The effectiveness of massage therapy for the treatment of nonspecific low back pain: A systematic review of systematic reviews. International Journal of General Medicine.
Maher, C., Underwood, M., & Buchbinder, R. (2016). Non-specific low back pain. The Lancet.
Mense, S., & Hoheisel, U. (2016). Evidence for the existence of nociceptors in rat thoracolumbar fascia. Journal of Bodywork and Movement Therapies.
Müller-Schwefe, G., Morlion, B., ... Sichère, P. (2017). Treatment for chronic low back pain: the focus should change to multimodal management that reflects the underlying pain mechanisms. Curr Med Res Opin.
Nahin, R. L., Boineau, R., Khalsa, P. S., Stussman, B. J., & Weber, W. J. (2016). Evidence-Based Evaluation of Complementary Health Approaches for Pain Management in the United States. Mayo Clinic Proceedings.
O'sullivan, P., Caneiro, J. P., O'keeffe, M., & O'sullivan, K. (2016). Unraveling the Complexity of Low Back Pain. Journal of Orthopaedic & Sports Physical Therapy.
Puentedura, E.J., Flynn, T. (2016). Combining manual therapy with pain neuroscience education in the treatment of chronic low back pain: A narrative review of the literature. Physiother Theory Pract.
Qaseem, A., Wilt, T.J., McLean, R.M., Forciea, M.A. (2017). Clinical Guidelines Committee of the American College of Physicians.. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med.
Steffens, D., Maher, C. G., Pereira, L. S., Stevens, M. L., Oliveira, V. C., Chapple, M., . . . Hancock, M. J. (2016). Prevention of Low Back Pain. JAMA Internal Medicine.
Takamoto, K., Bito, I., Urakawa, S., Sakai, S., Kigawa, M., Ono, T., Nishijo, H. (2015). Effects of compression at myofascial trigger points in patients with acute low back pain: A randomized controlled trial. Eur J Pain.
Thompson, W. R., Scott, A., Loghmani, M. T., Ward, S. R., & Warden, S. J. (2016). Understanding Mechanobiology: Physical Therapists as a Force in Mechanotherapy and Musculoskeletal Regenerative Rehabilitation. Physical Therapy.
https://www.ncbi.nlm.nih.gov/pubmed/26637643 (OPEN ACCESS)
Vigotsky, A. D., & Bruhns, R. P. (2015). The Role of Descending Modulation in Manual Therapy and Its Analgesic Implications: A Narrative Review. Pain Research and Treatment.
https://www.ncbi.nlm.nih.gov/pubmed/26788367 (OPEN ACCESS)
Wong, J., Côté, P., Sutton, D., Randhawa, K., Yu, H., Varatharajan, S., . . . Taylor-Vaisey, A. (2017). Clinical practice guidelines for the noninvasive management of low back pain: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. European Journal of Pain.
Wong, K., Chai, H., Chen, Y., Wang, C., Shau, Y., & Wang, S. (2017). Mechanical deformation of posterior thoracolumbar fascia after myofascial release in healthy men: A study of dynamic ultrasound. Manual Therapy.