Posts

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

 

lower back pain

Lower Back Pain Treatment Through Ayurvedic Massage

    Lower back pain may be a familiar discomfort for you. It is one of the most common conditions in the Western world. Martin et al. (2008) explained that over 300 billion dollars are spent annually in the United States for the treatment of lower back pain. Chronic sufferers may not only experience debilitating pain, but additional symptoms such as headaches and depression. Kumar et al. (2016) wanted to research the effects of Ayurvedic massage on chronic lower back pain.

    Ayurveda is a traditional, holistic Indian medicine. It includes treatments such as nutritional guidance, thermotherapy, herbal medicine, and much more. It is not uncommon to find doctors in Southern Asia regularly using this medicine, especially for the treatment of chronic pain. Ayurvedic medicine has seen an increase in popularity across Western countries, specifically external treatments such as massage. This is the reason why the researchers decided to test Ayurvedic massage on patients with chronic lower back pain.

    For the controlled clinical trial, a sample of 64 adults was used. Participants were randomly assigned to one of two groups: an Ayurvedic massage therapy group or a standard physical therapy group. However, over the course of the study, some participants dropped out. The most common reason was inability to return to the research center, or a perceived lack of benefit from the study. 3% of the Ayurvedic group dropped out, while 22% of the physical therapy group was lost.

    The intervention lasted for a total of four weeks, where the first two weeks were spent undergoing therapy and the next two used for rest and observation. During the first two weeks, participants received six sessions of therapy. Six sessions were used as this is the average prescription within the German healthcare system, where the study took place. Researchers primarily measured for pain intensity, although they also measured quality of life, level of physical functions (or level of disability stemming from back pain), and psychological effects such as depression, anger, and fatigue. Measurements were taken before the intervention and during weeks 2 and 4 of the intervention.

    The Ayurvedic massage sessions lasted for a total of 65 minutes. The massage therapist first applied a warm, medicated oil (Sahacharadi Taila) while using light manual pressure. Next, stuffed cotton bags (Kizhi) were applied with rhythmic movements across the lower back and gluteal region. Lastly, a gentle massage was provided on the lower back, gluteal region, and any specific pain areas. Patients then took a warm shower and relaxed for 30 minutes. For the physical therapy group, participants were given heated packs to apply to the lower back for 20 minutes. Afterwards, they received a light massage. Participants in this group then also relaxed for 30 minutes.

Kizhi Treatment. Photo by naturoayur.com.au

Kizhi Treatment.
Photo by naturoayur.com.au

    After the 4 weeks of intervention, the Ayurvedic massage group reported a higher decrease in lower back pain at both weeks 2 and 4. The Ayurvedic group’s decrease in pain was 18.7 points better than that of the physical therapy group. For psychological effects, the Ayurvedic group also reported less fatigue and anger. For other effects and quality of life, no significant changes were found. The Ayurvedic group also reported an increase in physical functions, but these results were not found to be significant.

    Future research is suggested to confirm the findings of the study, especially for longer periods of intervention. In addition, the researchers note that massage is only one part of Ayurvedic medicine, and that applying additional aspects of Ayurveda may shed more light on the traditional medicine’s effectiveness. Overall, though, it appears that Ayurvedic massage may provide some much-needed relief for patients of chronic lower back pain.

References
Kumar, S., Rampp, T., Kessler, C., Jeitler, M., Dobos, G. J., Lüdtke, R., Meier, L., & Michalsen, A. (2016). Effectiveness of Ayurvedic Massage (Sahacharadi Taila) in Patients with Chronic Low Back Pain: A Randomized Controlled Trial. The Journal of Alternative and Complementary Medicine. doi:10.1089/acm.2015.0272

Martin, B. I., Deyo, R. A., Mirza, S. K., Turner, J. A., Comstock, B. A., Hollingworth, W., & Sullivan, S. D. (2008, June). Expenditures and Health Status Among Adults With Back and Neck Problems. JAMA, 299(6). doi:10.1097/01.brs.0000320200.72604.9f