Massage Therapy for Back Pain

massage therapy for back pain

Massage Therapy For Back Pain

Back pain is one of the leading cause of disability worldwide (Global Burden of Disease Study 2016).

The social and economical repercussions of this is enormousness. As a result the health care system is looking for options that cost-effective and easy to implement - In Steps Massage Therapy!

Massage Therapy Is A Non-Pharmacological Intervention Supported By Best Practice Guidelines

Recent recommendations from The American College of Physicians (Wenger et al. 2017) and the Canadian Medical Association (Traeger et al. 2017) represent a monumental shift in pain management. Physicians, now more than ever are recommending conservative treatment including massage, acupuncture and exercise as part of a multi-modal approach for patients suffering from low back pain, anxiety and stress.

Massage Therapy Should No Longer Be Considered A Luxury

Massage Therapy is a multi-modal approach that can involve a number of rehabilitation strategies based on patient-specific assessment findings including, but not limited to:
• Manual Therapy (nerve mobilizationsoft tissue massagetriggerpointIASTM)
• Education on Psychosocial Factors (eg. BPS framework of pain, fear avoidance)
• Mindfulness-Based Stress Reduction
• Remedial Loading Programs (eg. static stretching and strengthening exercises)

Why Does Massage Therapy Work?

Massage therapy is a clinically-oriented multi-modal approach (manual therapy, remedial exercise and patient education) based on the three pillars of evidence based practice (best available evidence, clinical expertise and patient values).

The responses to massage therapy are multifactorial - physiological and psychological factors interplay in a complex manner. A biopsychosocial framework is a practical approach for investigating the complex interplay between massage therapy and the determinants of health, and pain.

Structures To Be Aware Of When Treating Back Pain

Structures to keep in mind while assessing and treating patients suffering from low back pain may include neurovascular structures and investing fascia of:
• Gluteal Muscle Group (Gluteus Maximus, Gluteus Medius and Gluteus Minimus)
Thoracolumbar Fascia
• Piriformis
• Quadratus Lumborum
• External Obliques, Internal Obliques, Transverse Abdominis
• Hip Flexors (Psoas Major & Iliacus)
• Multifidus
• Erector Spinae (Iliocostalis, Longissimus, Spinalis)

More to Explore

Adelmanesh et al. (2016). The Diagnostic Accuracy of Gluteal Trigger Points to Differentiate Radicular From Nonradicular Low Back Pain. Clin J Pain.

Basson et al. (2017). The Effectiveness of Neural Mobilization for Neuro-Musculoskeletal Conditions: A Systematic Review and Meta-Analysis. J Orthop Sports Phys Ther.

Brinjikji et al. (2015). Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. American Journal of Neuroradiology.

Busse et al. (2017). Guideline for opioid therapy and chronic noncancer pain. CMAJ.

Cherkin et al. (2011). A Comparison of the Effects of 2 Types of Massage and Usual Care on Chronic Low Back Pain. Annals of Internal Medicine.

Chou et al. (2017). Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med. 

Chou et al. (2018). The Global Spine Care Initiative: applying evidence-based guidelines on the non-invasive management of back and neck pain to low- and middle-income communities. Eur Spine J.

Cook et al. (2017). Red flag screening for low back pain: nothing to see here, move along: a narrative review. Br J Sports Med.

Dewitte et al. (2018). Clinical classification criteria for nonspecific low back pain: A Delphi-survey of clinical experts. Musculoskelet Sci Pract.

Elder et al. (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.

Foster et al. (2018). Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet.

GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. (2017). Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet.

Gao et al. (2018). Spontaneous Disappearance of Large Lumbar Disk Herniation. JAMA Neurol.

Isu et al. (2018). Superior and Middle Cluneal Nerve Entrapment as a Cause of Low Back Pain. Neurospine.

Layne et al. (2018). Activities performed and treatments conducted before consultation with a spine surgeon: are patients and clinicians following evidence-based clinical practice guidelines? Spine J.

Maher et al. (2017). Non-specific low back pain. The Lancet.

Müller-Schwefe et al. (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 et al. (2016). Evidence-Based Evaluation of Complementary Health Approaches for Pain Management in the United States. Mayo Clinic Proceedings.

Neto et al. (2017). Effects of lower body quadrant neural mobilization in healthy and low back pain populations: A systematic review and meta-analysis. Musculoskelet Sci Pract.

Oliveira et al. (2018). Clinical practice guidelines for the management of non-specific low back pain in primary care. Eur Spine J.

O'sullivan et al. (2016). Unraveling the Complexity of Low Back Pain. Journal of Orthopaedic & Sports Physical Therapy.

O'Sullivan et al. (2017). Understanding Adolescent Low Back Pain From a Multidimensional Perspective: Implications for Management. J Orthop Sports Phys Ther.

Prather et al. (2017). Hip and Lumbar Spine Physical Examination Findings in People Presenting With Low Back Pain With or Without Lower Extremity Pain. J Orthop Sports Phys Ther.

Puentedura et al. (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 et al. (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.

Skelly et al. (2018). Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review. Agency for Healthcare Research and Quality.

Takamoto et al. (2015). Effects of compression at myofascial trigger points in patients with acute low back pain: A randomized controlled trial. Eur J Pain.

Tousignant-Laflamme et al. (2017). Rehabilitation management of low back pain - it's time to pull it all together! J Pain Res. (Open ACCESS)

Traeger et al. (2017). Diagnosis and management of low-back pain in primary care. CMAJ.

Wenger, H.C., & Cifu, A.S. (2017). Treatment of Low Back Pain. JAMA.