Massage May Be Best Approach for Back Pain

From the WebMD Archives

May 31, 2001 -- Georgia Richardson has been fighting back pain for a long time. Arthritis, fibromyalgia, and the effects from a fall down the stairs have created such a painful condition for her that she hasn't been able to continue to work as a teacher in the Philadelphia school system.

Fifteen years ago, her pain specialist suggested she try aquatic therapy because medical treatment couldn't bring her relief. The exercises got her moving, but the day after a session, the extra activity just added to her pain.

But as a patient of the Center for Integrative Medicine at Thomas Jefferson University Hospital, she now is receiving two hourly sessions of massage therapy each week, right along with her medications and herbal therapy. The strategy, she says, has allowed her to return to the pool three times a week to continue her aquatics in the longest sessions she's ever had.

"I feel great. I know, definitely, massage has been great for me," says the energized patient -- who first says she is "39 and holding," then later adds that she'll be 60 this August. All told, her routine has cut her pain in half, Richardson says.

For those who want to go the alternative route to treat their back pain, massage may be the best bet. A new study demonstrates that it is superior to both acupuncture and self-care for this frustrating and debilitating condition. Experts agree that often the best way to manage chronic back pain is to use several therapies at once, and therapeutic massage may be an important part of the package.

"This provides some scientific evidence that massage may be useful for people with chronic back pain," investigator Daniel C. Cherkin, PhD, tells WebMD. "Therefore, it's certainly something that one with chronic back pain should consider trying."

Back pain is one of the most common health problems facing Americans and is frequently the cause for visits to a physician, says Cherkin, acting director of the Group Health Center for Health Studies in Seattle. According to the National Institutes of Health, 70-85% of people experience back pain at some time in their lives, and it is the most frequent cause of limited activity in people under the age of 45.

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Back pain comes in all shapes and sizes and can affect anyone, but Anne Kanter, 56, of McLean, Va., is a fairly typical sufferer.

"I have an arthritic hip, and I compensate for it, then I pull muscles in my lower back," she tells WebMD. "I probably had my first real attack five or six years ago. I would get muscle spasms that involved spending a couple of days in bed and taking [medication]."

Kanter's back-pain triggers include standing for long periods of time (especially in high heels), gardening, and shoveling snow.

"Millions of people use massage therapeutically, and there's not a lot of hard evidence that it works," Michael Hirt, MD, tells WebMD. "This is one of the few well-conducted studies that shows there's some significant benefit, and the benefit might be higher than for some other alternative therapies that we consider to be effective for pain, like acupuncture. ... Three out of four people who had massage therapy in this study showed benefit, and that's legions above the kind of benefits we see with physical therapy or medications."

Hirt is medical director of the Center for Integrative Medicine at the Encino-Tarzana Regional Medical Center in Los Angeles.

In his study, Cherkin randomly divided 262 people with persistent back pain into one of three groups. All the people were between 20 and 70 years old.

The first group was given acupuncture, the second self-care materials, and the third therapeutic massage. None of the patients had the kind of back pain associated with a serious disease, like a tumor, infection, or disk problem, and many were also taking medication for their back pain but were not satisfied with the pain control it offered.

"There's a whole variety of massage techniques," says Cherkin. "We studied those techniques that are most commonly taught in massage schools. That includes techniques like Swedish, deep tissue, and trigger point techniques."

After 10 weeks, the participants rated their back pain symptoms and the disability it caused. Those given massage therapy reported more improvement in their pain and disability compared to those treated with acupuncture or self-care. After one year of therapy, those given massage reported better results than the acupuncture group and similar results to the self-care group. Overall, those given massage used the least medication and had the lowest costs for subsequent care.

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"There are treatments for back pain that extend beyond traditional Western medicine," says Hirt. "If you don't find help through traditional practices, there are now scientifically documented benefits for massage. You might even consider using massage therapy first-line because there aren't any side effects. ... Hopefully, by seeing these kinds of studies, insurance companies will step forward and pay for this kind of massage, seeing that it will actually reduce costs, reduce pain, and get people back to work sooner and with fewer side effects."

But massage isn't the only option for back pain.

Chiropractor Ralph Templeton, DC, agrees that massage therapy is important for fast relief of back pain but says that it does not get to the root of the problem. At his clinic, they use chiropractic manipulation and also offer other supportive care to alleviate discomfort while the back heals, including massage and medication. Templeton is chairman of the board of directors of the Georgia Chiropractic Association.

For those having trouble getting rid of back pain, Hirt recommends trying several things together for optimum benefit, like massage, medication, and acupuncture. By working with a healthcare practitioner experienced in treating back pain, you can find the best combination of available therapies based on your individual problem.

If you'd like to visit a massage therapist for back pain, heed the advice of Marlene Cohen, a nationally certified in therapeutic massage and bodywork. She is the owner of Health to the Third Power, located in Falls Church, Va., a suburb of Washington. She sees all kinds of back-pain sufferers, and Anne Kanter is one of her satisfied customers.

Kanter first started seeing Cohen for tight muscles in her upper back but soon learned that massage therapy could also help her recurring lower back problems. She sees Cohen about twice a month and also comes in for a visit if she feels the familiar twinges and muscles knot that are typical harbingers of more severe muscle pain.

Cohen treats Kanter mainly with deep tissue massage, although Kanter also does some muscle strengthening exercises at home. Since she began seeing Cohen about three years ago, Kanter has not had a recurrence of the severe muscle spasms that kept her bedridden.

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Cohen's advice on finding a good therapist for your back pain is the following:

  • Make sure the therapist is trained and experienced in dealing with your kind of problem. Ask about credentials and check them out. The National Certification Board for Therapeutic Massage and Bodywork offers a locator service for trained experts in your area. You can visit their web site at www.ncbtmb.com.
  • Your therapist should ask you detailed questions about your injury and the location of the pain before starting therapy, in order to determine which therapy is best. "Someone might come to me and say my back hurts, but the reality is they did something in their arms or neck," says Cohen, "and the lower back pain is the referred pain."
  • A good therapist usually has a host of things to offer a back-pain sufferer. In addition to massage, Cohen offers stretching, muscle rotation, joint rotation, cross-fiber friction, and ice.
  • A massage therapist should know never to work on a swollen or inflamed area, as this can make the injury worse. Such an injury requires ice and rest before massage can be given.

If you suffer from back pain, here are some things you can try at home:

  • For a new injury, remember the acronym RICE. This stands for rest, ice, compression, and elevation.
  • For ongoing back pain, back stretches are helpful. The key to these stretches is to move slowly, breath with each stretch, and keep your back fully supported. Often, the health care practitioner you are seeing for your back pain can teach you appropriate stretches. Yoga also offers good exercises.
  • Once you're moving again, keep moving. Walking and swimming are both good exercises for the back.
  • Always check out several other avenues before you consider surgery.

With reporting from David Flegel, MS

WebMD Health News Reviewed by Gary D. Vogin, MD
© 2001 WebMD, Inc. All rights reserved.

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