Massage therapy techniques for low back and hip pain

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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A number of treatments called "passive modalities" are used for musculoskeletal problems.

These are treatments in which the patient isn't required to actively participate. Passive modalities include heat, cold, massage, ultrasound, electrical stimulation, traction and acupuncture. All of these measures can help some people with back pain.

Another form of passive treatment is spinal manipulation.

There are many schools of massage. In most cases, massage therapists combine several techniques, although there are also purists who stick to one method. The most common technique is Swedish massage, which combines long strokes and gentle kneading movements. Deep-tissue massage utilizes greater pressure to reach deeper levels of muscles. Shiatsu or acupressure massage also use deep pressure, but are done according to principles of acupuncture theory. Neuromuscular massage (such as the St. John Method of Neuromuscular Therapy) applies strong pressure to tender spots.

One problem with all these massage techniques is that it is difficult to properly ascertain the effectiveness of a hands-on therapy like massage.

Only one form of study can truly prove that a treatment is effective: the double-blind, placebo-controlled trial.

However, it is difficult to look at massage into a study design of this type. What could researchers use for placebo massage? And how could they make sure that both participants and practitioners would be kept in the dark regarding who was receiving real massage and who was receiving placebo massage?

Given these caveats, below is a summary of what is known about the effects of massage. The best evidence has evaluated low back pain.

It appears that massage may offer benefits for low back pain. The same is true for hip pain. However, these benefits appear to be short term.

One of the more in-depth studies compared massage to sham laser therapy in 107 people with low-back pain. The results indicated that massage is more effective than sham laser therapy for relieving low back pain, and that massage therapy combined with exercise and posture training is even more effective.

Another study compared acupuncture, massage, and self-care education in 262 people with persistent back pain. By the end of the 10-week treatment period, massage had shown itself more effective than self-care (or acupuncture). However, at a one-year follow-up, there was no difference in symptoms between the massage group and the self-care group.

In another study, acupressure-style massage was more effective than Swedish massage for the treatment of low back pain.

Adults with chronic low-back pain found relief from massage therapy, according to a research study. Massage eased pain, reduced depression and anxiety, and improved sleep and range of motion.

The study, "Lower Back Pain is Reduced and Range of Motion Increased After Massage Therapy," was completed in January 2000 by the Touch Research Institute in conjunction with the University of Miami School of Medicine and Iris Burman of Educating Hands, and was first published in the International Journal of Neuroscience.

Twenty-four adults who had experienced low-back pain for at least six months were randomly assigned to either a massage therapy group or a relaxation therapy group.

The massage therapy group received twice-weekly, 30-minute massages for five weeks. Starting in the prone position, the following techniques were used: kneading and pressing the back muscles, stroking both sides of the spine and hips, gliding strokes to the legs, and kneading and pressing the thighs. Continuing in the supine position, participants received: gliding strokes to the neck and abdomen, kneading of the rectus and oblique muscles that help bend the trunk of the body forward, stroking of the legs, kneading of the anterior thighs, flexing of the thighs and knees, and gentle pulling on both legs.

Those in the relaxation group were instructed in progressive muscle relaxation techniques to tense and relax muscles in the feet, calves, thighs, hands, arms, back and face. Participants performed these exercises at home twice weekly for 30 minutes.

Assessments taken before and after the first and last sessions included: the Profile of Mood States Depression Scale to rate depression; the State Anxiety Inventory to rate feelings at the present moment; the McGill Pain Questionnaire to measure pain; the Visual Analogue Scale to measure present level of pain; the Range of Motion Measures test to rate the level of ability to bend; a Symptom Checklist-90 Revised to measure moods; a sleep scale to measure quality of sleep; and urine samples to measure levels of the stress hormone cortisol, serotonin and catecholamines (amino acid derivatives that affect the nervous system, cardiovascular system, metabolic rate, temperature and muscles).

Results showed that both groups experienced a decrease in stress and long-term pain, but only the massage group experienced less pain directly after the session, fewer depressive symptoms, better sleep, improved range of motion and an increase in serotonin and the catecholamine dopamine biochemical levels.

"The findings from the present study are compelling and if the effects can be replicated and persist, these data suggest that massage therapy effectively reduces pain, positively impacts on the biochemical system, and attenuates psychological symptoms associated with lower back pain," the study authors wrote.

The authors also wrote that future studies might "examine the impact of massage therapy on job productivity and absenteeism for individuals with chronic low back problems."

- Source: Touch Research Institute. Originally reported in International Journal of Neuroscience, 2001, Vol. 106, pp. 131-145.

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