Preyde, M. (2000). Effectiveness of massage therapy for subacute low-back pain: a randomized controlled trial. Can Med Assn J, 162(13), 1815-1820.

BACKGROUND

The effectiveness of massage therapy in treating low back pain has not been clinically documented. In the studies that have used massage to investigate the treatment of low back pain there have been many methodological flaws that have prevented the studies from being accurate. Flaws such as improper placebo control or not using a qualified massage practitioner have plagued most of the studies that have been published to date. This is one of the first studies to look at this process with an accurately constructed study design.

In this study there was a group of 98 subjects who were recruited with a complaint of subacute back pain (duration 1 week to 8 weeks). All of the subjects were examined to rule out other possible causes of pain such as bone fracture, nerve damage, pregnancy, or psychiatric condition. They were randomly assigned to one of four groups. The first group received comprehensive massage therapy (soft tissue manipulation, remedial exercise, and posture education). The second group received soft tissue manipulation only. The third group received remedial exercise and posture education only. The fourth group received a sham laser treatment. All subjects received 6 treatments within a 1-month period. Subjects were evaluated at the end of 1 month after the beginning of treatment and again at 1 month after the time when treatment ended.

The soft tissue manipulation that was given to the first two groups consisted of a variety of different techniques including, but not limited to trigger point therapy neuromuscular approaches, and friction. The duration of treatment was for about 30-35 minutes and all treatments were provided by qualified massage practitioners with many years of experience.

Those in the comprehensive massage therapy group and the remedial exercise and posture education group received the same instructions in stretching and basic postural awareness. They were also encouraged to engage in general strengthening or mobility activities such as walking, swimming or aerobics to build overall fitness. Those in the sham laser treatment group got a “session” that was also about 20 minutes long to make sure they had enough time to account for any effects that were the result of time spent with the practitioner.

RESULTS AND DISCUSSION

Several pain and disability questionnaires were used to evaluate the effectiveness of the treatments. The questionnaires focused on measures of function, intensity of pain, and quality of pain. In addition, improvements in range of motion were calculated with all the treatments.

After evaluating the results from the questionnaires, the comprehensive massage therapy group had significantly better scores than the remedial exercise and sham laser treatment group on the measures of function, intensity of pain, and quality of pain and better scores than the soft tissue manipulation group on intensity of pain. The soft tissue manipulation group had better scores than the remedial exercise group and the sham laser group, but not better than the comprehensive massage therapy group. All of the subjects in the comprehensive massage therapy group reported a decrease in the intensity of their pain from the beginning of the study to the end. This did not happen in any other group.

Based on the results in this study it appears that the most beneficial of these treatments for subacute low back pain is the comprehensive massage therapy approach. However, before these results should be considered definitive, this study must be replicated and many similar ones should be conducted. It is important to note that this study was performed in Ontario where the educational training of massage therapists is much more comprehensive and aimed toward work that is medical in nature. It will be important to repeat this study in the United States and in other areas where the training of massage therapists is quite different to see if there is an effect of training standards on the effectiveness of the massage approach.

It will be important for other forms of treatment to be compared with those done in this study. Massage therapy approaches, like the ones used in this study, must be evaluated against other forms of treatment that are commonly used to treat back pain. In addition, further work needs to be done within the massage community to evaluate if there are other forms of massage therapy that might even be more effective than the methods used here in this study. We won’t really understand the best way to use massage as a treatment until we have a better understanding of those factors.

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