Real Bodywork Massage Blog

massage low back pain

“Real-World” Massage for Chronic Low Back Pain

Lower back pain is no unknown culprit – many have found themselves battling this common condition. Yet, while most recover from this pain quickly, some are left with lower back pain for extended periods of time. Chronic lower back pain is experienced as pain in the sacral or lumbar regions with symptoms lasting over three months.

Massage is a common treatment option for chronic lower back pain relief. Massage’s effectiveness at treating this condition is well-known and well-documented; this explains why massage is commonly recommended. However, almost no empirical evidence exists supporting massage as a treatment option in “real world” primary health care. That is, those interested in chronic lower back pain treatment wanted to see more evidence of massage’s effectiveness in “real-world” scenarios.

Researchers Elder et al. (2017) recruited 104 participants with chronic lower back pain from their primary care physicians. 85 participants remained at the 12-week measurement, and 76 completed the full study after 24 weeks. Participants would receive 10 massages within 12 weeks then take measurements; they would then return 12 weeks later for a follow-up measurement.

Participants were assigned to licensed massage therapists in their respective communities. Massage therapists had to have at least five years of professional experience and had to schedule and develop treatment plans. Massage therapists were allowed to apply any massage technique they preferred; because of this, techniques varied widely, from the more common techniques like Swedish massage to the less common like lymphatic drainage or Reiki. By recruiting from participants’ actual primary care physicians, and assigning participants to local massage therapists, researchers were hoping to recreate an authentic experience, as would be experienced by an actual primary care patient.

The researchers measured for variables like pain, quality of life, and physical functionality/disability. At the end of 12 weeks (and 10 massages), participants reported clinically significant improvements across all measures. After 24 weeks, however, these improvements had begun diminishing. Although measurements did not return to baseline scores, they did begin to weaken. It is important to note, though, that improvements of disability/functionality and pain were still considered clinically significant at the 24-week measurement in comparison to the original, baseline scores.

The researchers also noticed that older participants were more likely to achieve better results than their younger counterparts. Participants age 50 and older were 3.75x more likely to achieve clinically significant improvements than their younger counterparts. Another interesting discovery was the effect of prescribed pain medications on score improvements. Researchers found that participants who were continuously prescribed at least one pain medication (including opioids) were 2.46x less likely to achieve clinically significant results.

It is important to understand that this study is only a pilot study – larger, more controlled studies will need to be conducted in order to determine that massage as a primary care treatment is beneficial, accessible, and feasible. Regardless, Elder et al. have established a foundation for future investigations into massage therapy’s effectiveness as a “real-world” treatment option for primary care physicians.

References

Elder, W. G., Munk, N., Love, M. M., Bruckner, G. G., Stewart, K. E., & Pearce, K. (2017). Real-World Massage Therapy Produces Meaningful Effectiveness Signal for Primary Care Patients with Chronic Low Back Pain: Results of a Repeated Measures Cohort Study. Pain Medicine. doi:10.1093/pm/pnw347

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Slow-Stroke Back Massage to Treat Leukemia

     Leukemia, sometimes referred to as blood cancer, affects the blood forming tissues in the body. This can make an individual prone to excessive bleeding and infection. Leukemia itself and its treatment can cause a cluster of symptoms, most commonly pain, fatigue, and sleep disorders. These symptoms are related in that: pain can interfere with sleep quality, lack of sleep can increase fatigue, and fatigue can increase sensitivity to pain. In addition, cancer-related fatigue is more severe than standard fatigue, and cannot be alleviated by more sleep.

     These symptoms can have a drastic effect on a patient’s quality of life. He or she may have difficulties socializing, may suffer from mood disorders, may be unable to carry out common, daily tasks, and more. Unfortunately, many treatments do not effectively treat this symptom cluster and many leukemia patients suffer daily.

     The rates of leukemia are increasing worldwide. Therefore, researchers Miladinia, Baraz, Shariati, and Malehi (2017) conducted research about massage’s efficacy of treating this symptom cluster. Currently, only one research study addressed the use of massage as an additional form of treatment in leukemia patients (Taylor, Snyder, & Bourguignon, 2009). Massage, and many other forms of alternative treatment, can pose risks to leukemia patients that might not exist for other cancer patients – the heightened risk of infection and bleeding means treatments like acupuncture and deep massage are incredibly dangerous and must be avoided.

     The researchers recruited 60 adults with leukemia for their study. 30 of these participants were randomly assigned to a massage group, and the other 30 participants were randomly assigned to a control group. The massage group would receive a slow-stroke back massage (SSBM) immediately after undergoing chemotherapy for a total time of 10 minutes. These 10-minute massages would happen three times a week over the course of four weeks. The control group received routine care after chemotherapy. The SSBM was as follows:

  • Vaseline was applied to the skin with the participant in a seated position.
  • Small circular strokes with thumbs on the neck (20 strokes in 30 seconds)
  • Surface strokes from the base of the skull to the sacral region using the palm of one hand and repeating the action on the other side of the spine using the palm of the other hand, while the first hand would move toward the base of the skull (60 strokes in 120 seconds)
  • Hand strokes along the shoulder blades using the thumb (20 strokes in 30 seconds)
  • Hand strokes using the thumb on either side of the spine from shoulder to waist (10 strokes in 30 seconds)
  • Sweeping strokes from the neck to the sacrum area using the palms of both hands (40 strokes in 90 seconds)
  • This routine was repeated, then the massage concluded.

     The researchers measured the intensity of the symptom cluster (pain, fatigue, and sleep disorder), as well as quality of sleep.

     At the conclusion of the study, the researchers discovered that SSBM significantly decreased the intensity of the symptom cluster and significantly increased the quality of sleep. This discovery seems to align with results from the only other study of massage and leukemia, in that massage provides significant relief for leukemia patients. The other study found significant relief after a 7-week intervention, whereas this study found significant results after a 4-week intervention. While both studies did discover that massage is a suitable, complementary therapy, it should be noted that the effects are short-term. Miladinia, Baraz, Shariati, and Malehi found that the effects of the massage had faded a week after the study had ended, with participants reporting that their symptoms began worsening.

     Regardless of its short-term effects, SSBM seems to provide a safe, noninvasive, and nondrug treatment that can improve the quality of life and level of comfort for patients with leukemia.

References:

Miladinia, M., Baraz, S., Shariati, A., & Malehi, A. S. (2017). Effects of Slow-Stroke Back Massage on Symptom Cluster in Adult Patients With Acute Leukemia. Cancer Nursing, 40(1), 31-38. doi:10.1097/ncc.0000000000000353

Taylor, A. G., Snyder, A. E., & Bourguignon, C. M. (2009). 123. Effects of massage on AML treatment-related symptoms and health-related QoL. Brain, Behavior, and Immunity, 23. doi:10.1016/j.bbi.2009.06.128

positional release for achilles tendon

Plantar Foot Massage to Treat Type 2 Diabetes Mobility and Balance Symptoms

An unfortunate reality for many people affected by type 2 diabetes is foot and leg circulatory problems. Decreased circulation means weakened sensitivity and poor healing. While symptoms vary widely between each individual, some of those affected have severe diabetic neuropathy that impacts mobility and balance. This can culminate into constant tripping/falling and decreased quality of life.

Researchers Yümin, Şimşek, Sertel, Ankarali, and Yumin (2017) investigated the effects of foot plantar massage as treatment for these balance, mobility, and reach issues.

The study consisted of 38 adults who were diagnosed with type 2 diabetes. The participants would partake in three assessments, receive a ten-minute massage, then retake assessments. The assessments went in this order:

Timed-Up and Go Test: This test is used to measure mobility. In this test, a participant is timed as he or she starts from a seated position, walks 3 meters, and returns to the seated position. The higher the score, the better the mobility and the lower the score, the poorer the mobility.

One-Leg Standing Test: This test is used to measure a person’s balance. The participant is timed while standing on one foot with no assistance. The longer a person is able to stand on one foot means the better his or her balance. For this study, the researchers had the participants run the test on each leg three times, then the mean value was recorded.

Functional Reach Test: This test is used to measure reach. The participant would stretch an arm as far as possible with measurements taken from base recordings. The reach value is then deducted from the base value.

For the massage, the researchers used a combination of Swedish and deep-friction massage, including kneading and stroking. The participants were in supine positions as the massage was applied to the left and right foot dorsum; medial, lateral regions of the foot; the toes; and the plantar region.

Researchers discovered that after receiving a ten-minute foot plantar massage, participants’ balance, reach, and mobility were significantly increased. Researchers argue that this is most likely because the soles of the feet are thought to be important to attain postural control and balance.

There are limitations to this study, however. The study only used one group for a single treatment – it is unknown if the effects last over time. The use of a control group would also provide better accuracy with the results of this study.

Regardless, significant gains were made with participants with type 2 diabetes in terms of balance, mobility, and reach. It appears that foot massage may provide a positive treatment that can be incorporated into rehabilitation programs.

References

Yümin, E. T., Şimşek, T. T., Sertel, M., Ankaralı, H., & Yumin, M. (2017). The effect of foot plantar massage on balance and functional reach in patients with type II diabetes. Physiotherapy Theory and Practice, 33(2), 115-123. doi:10.1080/09593985.2016.1271849