Does Massage Therapy Work for Chronic Back Pain Relief?

As science reveals more about pain, the answer is leaning towards more shades of gray than a clear ‘yes’ or ‘no’.

At first, I would say “yes,” but only temporarily. I cannot say with total certainty that massage will get rid of your back pain—or any kind of musculoskeletal or neuropathic pain—because pain is much more than just a biological phenomenon. Most of the time, clients get some relief that lasts from two days to two weeks. A few do not get better after one or two sessions within a month, and a lucky few get lasting relief for more than a year after a few sessions over three to six months.

Because pain itself stems from so many factors, it is almost impossible to pinpoint a single cause of persistent pain. A single type of treatment is even less possible. Even the most recent systematic review from Cochrane in 2015 “have little confidence” in massage therapy for low back pain. (1)

This is quite different than the 2009 systematic review that concluded, “Massage might be beneficial for patients with subacute and chronic nonspecific low back pain, especially when combined with exercises and education. ” (2)

Does this mean massage is useless or less likely to help you with low back pain? Not quite. In fact, some massage therapists actually think the recent review allows greater opportunities for them to improve their practice. Beret Loncar, who is a massage therapist and owner of Body Mechanics Orthopedics Massage in New York City, suggests that we should reframe how we communicate with our clients or patients.

“Communication also opens the door to talking about sound reasons to return, rather than you won’t get better if you do not come in,” Loncar emphasized. “If massage therapists step up to the plate and change their verbiage or website to massage positive messages reflecting the truth, such as ‘we can help you manage’ rather than we ‘correct’ or ‘treat,’ they are far more likely to have returning clients based on the idea that the clients understand it’s not a one-time show and have less disappointment when their $90 commitment did not ‘fix’ them.”

So, massage therapy is not the “magic pill,” but it can be a huge contributor to short-term pain relief for many people. Before we ask whether does massage help with back pain (or most kinds of common aches and pains), we should take a look at the nature of pain itself.

So What Do We Know About Chronic Back Pain?

Like chronic neck pain, shoulder pain, hip pain, and knee pain, chronic back pain rarely stems from a single cause. Given our modern understanding of pain based on the more up-to-date biopsychosocial (BPS) model, we now know that pain is always multi-factorial, with varying degrees of contribution from our biology (e.g. nerves, hormones, immune system), psychology (e.g. knowledge about pain, prior experience, expectations, stress, fear), and social environment (e.g. family upbringing, culture, career, language, socioeconomics).

All of these factors vary among individuals. They intertwine among each other in a constant interaction rather than having a linear, cause-and-effect relationship (e.g. A –> B –> C). For chronic back pain, there may be a feedback loop within the nervous system and endocrine system that constantly interact with each other to create and maintain the chronicity of pain.

“In a complex system, control is not located in any particular area, but emerges from the complex interactions of all the different parts. For example, a termite colony is an incredibly sophisticated architectural project, but there is not a single termite that knows how to build it. Instead, each termite is just following its own simple algorithm for behavior,” Todd Hargrove wrote.

The same can be said about how neurons in the brain and synapses and signals between hormones and neurons that contribute to the emergence of chronic pain.

Physical therapist Mark Kargela, who practices in Phoenix, Arizona, described pain as being “emergent,” similar in concept to the emergent theory used in sociology to describe collective behavior in organisms, from termites and bees to humans. It is not the individual parts that make up the end product, but it is the relationship of the three ingredients of the biopsychosocial model of pain.

“My question has always been, ‘Do we have any interventions that uniquely achieve this better than others?’

“My opinion is that with pain being emergent, we will never have an intervention that elicits the same effect in every patient. You can’t control for the unique lived experience that each human comes into a study with that will never have an equal meaning ascribed to the intervention under study, ” Kargela described.

Looking Beyond Massage as Stand-Alone Treatment

The bottom line is that chronic pain is complex. Sometimes it goes away seemingly on its own. And sometimes pain returns to stay for a few days or weeks “out of nowhere.” No one can really reliably predict whether an intervention—like massage—can truly help alleviate pain. What we do know, at least in my own experience, is that massage therapy works better when it is combined with exercise and good stress management (like sleep!), as well as being educated about the nature of pain.

Science writer and former registered massage therapist Paul Ingraham mused about pain: “Tissue damage is real & pain arising from it is real. But they have an ‘it’s complicated’ relationship.”

Yes, pain is complicated, but it can be less so when both the massage therapist and the patient or client have a mutual, foundational understanding of pain, what it means to the client, and what massage therapy can and cannot do for it. Based on both the scientific literature about pain and manual therapy and my own experience in working with clients in pain and disability, building trust and promoting self-efficacy for clients are just as important as massage therapy itself.

And the better the relationship between the therapist and the client or patient, the more likely they will get better back pain relief with the help of massage therapy.

References

1. Furlan AD, Giraldo M, Baskwill A, Irvin E, Imamura M. Massage for low-back pain. Cochrane Database Syst Rev. 2015 Sep 1;(9):CD001929. doi: 10.1002/14651858.CD001929.pub3.

2. Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low back pain: an updated systematic review within the framework of the Cochrane Back Review Group. Spine (Phila Pa 1976). 2009 Jul 15;34(16):1669-84. doi: 10.1097/BRS.0b013e3181ad7bd6.

Further Reading

1. Making Better Sense About Massage and Low Back Pain With Dr. Christopher Moyer

2. Does Massage Therapy Work?

3. What Is Pain?

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