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Massage for low back pain

Clinical bottom line: There is insufficient evidence to determine whether massage therapy works in the treatment of low back pain. The included trials were methodologically flawed.


Massage relaxes the mind and the muscles and is thought to increase pain threshold. In Europe, it is commonly used in the treatment of low back pain.

Systematic review:

Ernst E. Massage therapy for low back pain: A systematic review. Journal of Pain & Symptom Management 1999;17:56-69.

Date review completed: July 1997

Number of trials included: Four

Number of patients: (399 total; number per group unknown)

Control groups: chiropractic/spinal manipulation, electrical stimulation, corset, balneotherapy, traction, no treatment.

Main outcomes: improvement (unspecified); pain; straight leg raising to pain, fingertip floor distance.

Medline, Embase and the Cochrane Library were searched (all years to July 1997) for published reports of studies which assessed the effectveness of massage in the treatment of low back pain. Reference lists of retrieved reports were checked for additional citations and no language restrictions were made. Massage was defined as manual/apparative massage of muscular and soft tissue structure of the back. Trials which assessed massage in combination with other interventions were excluded. Data were extracted in a standardised, predefined manner. Duplicate data were excluded. A descriptive analysis was conducted.

Inclusion criteria were: controlled clinical trial, any form of low back pain, one treatment group which had massage therapy as sole form of treatment.

Findings:

Four trials were included. The patient population was: nonspecific, uncomplicated chronic or subacute LBP (63 patients), uncomplicated chronic or subacute LBP of the lumbosacral region (158), unspecified acute LBP (81), acute or chronic LBP of lumbosacral region (95). Three trials were randomised and single blind, the largest study was neither randomised nor blind. One trial found massage to be significantly inferior to chiropractic manipulation in uncomplicated chronic/subacute LBP. The other studies reported no significant difference between massage and the control treatments, except the nonrandomised study which reported massage to be significantly better than no treatment for uncomplicated chronic/subacute LBP at the end of the treatment period.

Adverse effects

There was no mention of adverse effects.

The studies were small and had major methodological flaws. The lack of randomisation and blinding in one study, and use of single-blinding in the others meant the studies were open to selection and observer bias. Inadequate definitions of massage and improvement were given in the trials and different outcomes and measurement tools were used. The studies were, therefore, of poor quality and validity and unlikely to be capable of providing a true result regarding the effectiveness of massage in low back pain.

Further reading

Related topics

Identifier AT042 - 4648 MASSAGE FOR LOW BACK PAIN: Jul-2000