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massage low back pain

“Real-World” Massage for Chronic Low Back Pain

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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

 

Postpartum Anxiety and Massage

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Many mothers can attest that motherhood is no easy feat. Perhaps more daunting are the first few days after the birth of your first child. While most may imagine these days as filled with joy and excitement, the reality is that many first-time mothers experience anxiety, from mild to severe, as well as exhaustion and fatigue. Researchers Jahdi, Mehrabadi, Mortazavi, and Haghani (2016) warn that postpartum anxiety may be a stepping stone to postpartum depression (which may lead to long-term consequences for mother and child), and decided to test whether massage was an effective treatment for anxiety in primiparous women.
 
The researchers found 100 mothers who had given birth a day before the study to include in their single-blind clinical trial. The mothers were randomly separated into two groups: a massage group and a control group. The massage group received a 20-minute seated massage. The procedure was as follows:
 

“The mother was seated on the edge of the bed. Then, the researcher grasped the top of the mother’s shoulders with both hands and placed the thumbs of each hand just below the base of the skull, making tiny circular movements on the upper neck. In the next stage, the researcher placed the palm of one hand at the base of the skull and made a long and smooth stroke all the way down the patient’s spine to her waist. The second hand followed the first at the base of the skull and stroked down the spine as the first hand returned to the base of the skull. Next, the researcher placed her hands on either side of the mother’s neck under the mother’s ears and stroked down and over the mother’s collarbones with her thumbs just over the shoulder blades and repeated the motion several times. Then, she placed the thumb of each of her hands beside the spine, beginning with the shoulders, and moved the thumbs down the spine to the waist and repeated this movement several times. Finally, she completed the procedure by placing her palms on each side of the mother’s neck and making continuous, long, sweeping strokes down the neck, across each shoulder, and down the back near the spine and repeated the entire process several times.”

 
The researchers then tested the mothers on their anxiety, using a STAI test. The mothers who had received a massage had significant decreases in their anxiety scores immediately after the massage, as well as into the next morning.  Since massage regulates the autonomic nervous system, can adjust neural activity (amygdale, frontal brain, control network), and stimulates afferent c fibers in the skin, it is not all too surprising that massage is effective in alleviating anxiety symptoms. An interesting topic of study may be stress levels for new fathers, and whether massage can help new fathers too.
 
As new mothers are acclimating to the new physical and emotional demands of motherhood, massage can help bring them moments of peace and calm.
 
 

Reference

Jahdi, F., Mehrabadi, M., Mortazavi, F., & Haghani, H. (2016). The Effect of Slow-Stroke Back Message on the Anxiety Levels of Iranian Women on the First Postpartum Day. Iranian Red Crescent Medical Journal, 18(8). doi:10.5812/ircmj.34270

 

Traditional Thai Massage for Short-Term Back Pain Management

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    Traditional Thai massage, or TTM, is part of traditional Thai medicine. This massage includes deep pressure massage with sustained compression on a muscle. Passive stretching is included at the completion of the massage. Previous research on TTM has found a variety of benefits, ranging from increased flexibility and decreased muscle tension, to reduced pain. The traditional massage is guided by lines on the body, called the Sen Sib. These imaginary lines serve as directions for the massage therapist, who applies pressure to points across these lines. The Sen Sib, however, falls on most of the trigger points on the body, which may explain its effectiveness.

 
    Researchers Buttagat, Narktro, Onsrira, and Pobsamai (2016) wanted to look into the effectiveness of TTM, specifically concerning myofascial pain syndrome. Myofascial pain syndrome (MPS) is not an uncommon condition. It is characterized by localized pain and may include a decrease in range of motion, problems with sleep, and the presence of myofascial trigger points. Skootsky, Jaeger, & Oye (1989) found that MPS occurs most often in the upper body, and Rachlin and Rachlin (2002) elaborated further, explaining that the most common areas affected are in this order: the trapezius, levator scapulae, and axial postural muscles.

 
    While previous research has looked into the effectiveness of TTM on myofascial pain syndrome, the researchers felt like there needed to be more concrete evidence on its efficiency. For their 2016 study, they used electromyography (measurement of muscle energy) to measure the effect of TTM on muscles.

 
    The researchers conducted a single-blind, randomized clinical trial consisting of 50 participants. These participants had to have suffered from upper back pain for at least three months prior to the study, with the presence of at least one myofascial trigger point in the upper trapezius muscles. The researchers noted that, “the criteria used to diagnose MTrP described previously by Buttagat et al. (2016) was as follows; the presence of a tender nodule that causes a referred pain within taut bands of muscle in areas which the patient identified as painful.”

 
    The 50 participants were randomly assigned to one of two groups, TTM or control. For the TTM group, participants lay down on their side while fully clothed. For 30 minutes, the massage therapist used the thumb or another digit to apply body weight onto different points of the upper back, slowly increasing pressure for a duration of 5 to 10 seconds per point. At the end of the massage, the massage therapist would passively stretch the participants’ muscles. The control group did not receive any actual treatment. The researchers set up a micro-wave therapy machine next to the participant. The machine was turned on, but was kept in standby mode as a form of placebo therapy. This intervention also lasted for 30 minutes.

 
    The researchers measured EMG activity as well as participants’ ratings of perceived muscle tension and pain intensity. These variables were measured both before and after intervention.

 
    Participants in the TTM group showed a significant decrease in all three variables – EMG activity decreased, as did reported muscle tension and pain intensity. The control group had almost no change to EMG activity or reported pain, but the control group participants did surprisingly report a decrease in muscle tension.

 
    Traditional Thai massage seems to provide beneficial results for patients with upper back myofascial pain syndrome. These results support the findings of existing research on the benefits of TTM. The researchers indicate that long-term studies on the effect of TTM would be ideal, but that based upon the results of the study, TTM is “a useful intervention for promoting physical relaxation and decreasing muscle tension and pain in MPS patients.”

 
References
Buttagat, V., Narktro, T., Onsrira, K., & Pobsamai, C. (2016). Short-term effects of traditional Thai massage on electromyogram, muscle tension and pain among patients with upper back pain associated with myofascial trigger points. Complementary Therapies in Medicine, 28, 8-12. doi:10.1016/j.ctim.2016.07.004

Buttagat, V., Taepa, N., Suwannived, N., & Rattanachan, N. (2016). Effects of scapular stabilization exercise on pain related parameters in patients with scapulocostal syndrome: A randomized controlled trial. Journal of Bodywork and Movement Therapies, 20(1), 115-122. doi:10.1016/j.jbmt.2015.07.036

Rachlin, E., & Rachlin, I. (2002). Chapter 11 – Trigger Point Management. In Myofascial Pain and Fibromyalgia (2nd ed., pp. 231-258). St. Louis, MO: Mosby.

Skootsky, S., Jaeger, B., & Oye, R. (1989). Prevalence of myofascial pain in general internal medicine practice. Western Journal Of Medicine, 151(2), 157-160.

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Aromatherapy Massage and Inhalation on Pain and Anxiety in Burn Patients

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    Burn patients make up 5% of hospital intakes, with over one million burn patients in the U.S. alone. In many developing countries, burn injuries are an increasing risk. Treatment for burns can be very painful, such as dressing and re-dressing wounds. In addition, scars left after treatment can affect the patient’s physical, social, and emotional health. Researchers Seyyed-Rasooli et al. (2016) wanted to investigate alternative therapy for burn patients in Iran, specifically through the use of aromatherapy. The researchers explain that many burn patients are treated with tranquilizers, which reduce pain and anxiety, but are expensive, slow, and addictive. Instead, the researchers set after relieving pain and anxiety through aromatherapy, with lavender and rose essential oils.

 
    The researchers describe lavender as both calming and antiseptic, an aroma that is widely known and used. While lavender has many benefits, it is not best for everyone. Women who are pregnant or anyone suffering from certain allergies should avoid lavender. The researchers also chose rose because it has chemicals that can alleviate anxiety, depression, tension, and headaches.

 
    Seyyed-Rasooli et al. conducted a single-blind clinical trial with a randomized sample. The sample consisted of 90 women who had burns covering less than 20% of their bodies. From these 90 women, 3 groups were established: a control group who received standard treatment in the hospital, an inhalation aromatherapy group who inhaled essential oils, and an aromatherapy massage group. The 90 women were randomly assigned to a group with each group consisting of 30 women.

 
    The intervention occurred only once for a 30-minute duration. Women in the massage group were brought to an isolated room, away from any noise and interruptions. The massage group received treatment with a blend of lavender and almond oil. Researchers massaged the women’s backs, which included: back surface stroking, back deep stroking, effleurage, re-effleurage, back deep stroking, then back surface stroking. Each segment lasted for five minutes.

 
    Women in the inhalation group were also brought to an isolated room. The researchers applied lavender and rose oils to cotton, which was placed near the patient’s nose for a total of 30 minutes. For both massage and inhalation group, scores for pain and anxiety were re-tested 10 minutes after the intervention.

 
    Women in the inhalation group had the largest decrease in anxiety, although the massage group was only shortly behind. For pain, the massage group reported the highest decrease, nearly double the decrease of the inhalation group. Nevertheless, both aromatherapy massage and inhalation had positive effects on pain and anxiety for the burn patients.

 
    With these results, the researchers argue that aromatherapy inhalation is best for the treatment of anxiety, especially because the patient can perform the treatment alone. The researchers continue to explain that aromatherapy massage would be best in the treatment of pain, as the treatment can reduce pain signals from sensory nerves and increase the release of endorphins.

 
    The researchers do acknowledge that the study was only conducted on female patients, and that further research should include men. However, it is important to note that the study is not without flaws. Perhaps most glaring of them all is that the researchers used a different blend of essential oils when treating the two different groups, which may have had an effect on the outcome of the results. That is, the essential oils used may have had more of a significant effect on pain and anxiety than the researchers anticipated. Considering the researchers did not investigate the effects of almond oil, it seems strange that this was substituted for the rose oil in the massage group.

 
    Regardless of this inconsistency, this study provides light on the impact that alternative therapies can provide patients. While standard care certainly does aid patients in many different areas of medical treatment, alternative therapies such as massage and essential oil inhalation can surely assist such treatments further.

 
References
Seyyed-Rasooli, A., Salehi, F., Mohammadpoorasl, A., Goljaryan, S., Seyyedi, Z., & Thomson, B. (2016, June). Comparing the effects of aromatherapy massage and inhalation aromatherapy on anxiety and pain in burn patients: A single-blind randomized clinical trial. Burns. doi:10.1016/j.burns.2016.06.014

osteoarthritis, massage therapy, oa, knee oa, massage

Osteoarthritis and Massage Therapy

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Researchers published results of their study (Ali, Rosenberger, Weiss, Milak, & Perlman, 2016), investigating the effects of Swedish massage techniques on patients with osteoarthritis (OA) of the knee. The study’s aim was to investigate how massage therapy could help patients’ quality of life while living with OA.

 

Murphy & Helmick (2012) wrote that 10% of Americans suffer from OA. OA can cause severe pain, and may limit the physical abilities of the affected person. This can have an effect on the person’s daily life, as daily activities may become more challenging and/or painful. Other researchers (Perlman, Sabina, Williams, Njike, & Katz, 2006) previously held a study in which they tested whether massage therapy for OA of the knee was feasible, safe, and effective, and found that it was successful, including increasing functionality and decreasing pain.

 

For this new study, the researchers instead wanted to see how massage affected the emotional aspects of OA. A previous study by Hsu, Bluespruce, Sherman, & Cherkin (2010) investigated complementary and alternative treatments for people suffering from chronic back pain. The study found that these treatments increased positive emotional states for patients, as well as feelings of hope, improved their ability to relax, and also improved their ability to cope with the back pain.

 

For this study, the researchers used purposive sampling to find 18 adults as research participants. The qualitative study measured results through in-person and telephone interviews, both before and after treatment. Questions from these interviews asked about attitudes towards massage therapy and OA, as well as changes in these attitudes or lifestyle post-treatment. Participants were randomly assigned to receive 8 weeks of Swedish massage weekly or biweekly, for a session of 30 or 60 minutes. Researchers noted that this massage style was used due to its popularity in the United States, as it includes effleurage, petrissage, tapotement, vibration, friction, and skin rolling.

 

After 8 weeks, the participants discussed feelings of greater relaxation and a better quality of life. 44% of participants said the massages made it easier for them to relax, and half of said that the massage affected their “thoughts, feelings, reactions, and activities” (p. 5). However, some patients said the 30 minute sessions were too short, as it would end just as they were beginning to relax.

 

44% of participants also told researchers that the massage therapy improved their quality of life. These include functional abilities, emotional moods, mental state (including outlook on life), and overall well-being. Some participants explained that the massage had improved their physical abilities, so that they were able to carry out daily activities that OA had prevented before. One participant even told researchers that she needed her anti-inflammatory medication less, as the massage provided pain relief from her OA.

 

Almost a quarter of the participants reported short-term pain relief from massage therapy. In addition, 13 participants informed researchers that they believed massage therapy was an effective treatment for OA. Many of the participants explained their satisfaction with massage therapy, but were unhappy that massage therapy was not more available as a method of medical treatment.

 

These participants explained their unhappiness that insurance would not cover massage therapy as a method of treatment for their OA. Many believed its effectiveness warranted coverage through insurance. Researchers asked 10 participants if they would pursue massage therapy as treatment for their OA, if covered by insurance, and all 10 participants answered that they would.

 

This new research shows how massage therapy does more beyond physical healing and comfort, but stretches into improving the emotional aspects of chronic pain. Massage therapy continues to provide vast benefits to recipients, both physical and emotional.

 

 

References

Ali, A., Rosenberger, L., Weiss, T. R., Milak, C., & Perlman, A. I. (2016). Massage Therapy and Quality of Life in Osteoarthritis of the Knee: A Qualitative Study. Pain Med Pain Medicine. doi:10.1093/pm/pnw217

Hsu, C., Bluespruce, J., Sherman, K., & Cherkin, D. (2010). Unanticipated Benefits of CAM Therapies for Back Pain: An Exploration of Patient Experiences. The Journal of Alternative and Complementary Medicine, 16(2), 157-163. doi:10.1089/acm.2009.0188

Murphy, L., & Helmick, C. G. (2012). The Impact of Osteoarthritis in the United States. Orthopaedic Nursing, 31(2), 85-91. doi:10.1097/nor.0b013e31824fcd42

Perlman AI, Sabina A, Williams A, Njike VY, Katz DL. (2006). Massage Therapy for Osteoarthritis of the Knee: A Randomized Controlled Trial. Arch Intern Med. 166(22), 2533-2538. doi:10.1001/archinte.166.22.2533

Newborn massage, infant massage, massage therapy, baby massage, real bodywork

Massaging a newborn can lead to a better night’s sleep for child and mother

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Previous studies have shown that both parents and infants benefit from massage therapy with oil, especially concerning night-time sleep interruptions. A recent study (Field, Gonzalez, Diego, & Mindell, 2016) noticed that almost all of these studies focused on older infants rather than newborn infants. These researchers wanted to not only study newborn children, but their mothers as well.

The study included 59 mothers and their newborns, who were gathered for the study within 24 hours after giving birth. The participants were then assigned to one of three groups: lotion massage, no lotion massage, or no massage. The mothers in the massage groups were trained to give their infants a 15-minute massage, 15 minutes before bedtime, consisting of: five minutes of moderate-pressure stroking of the infant in a prone position, five minutes of moderate-pressure extensions/flexions of the arms and legs while in a supine position, and a repeat of the five-minute stroking. The massage was done slowly and rhythmically, and the lotion group used a lavender scented massage lotion on the infants.

After one month, the study found that mothers who gave massage with lotion spent the most time sleeping and the highest decrease in problems sleeping. In addition, the mothers had less difficulty falling asleep. Infants from the lotion group got the most sleep out of all three groups, had les difficulty falling asleep, and had decreased night wakings. Interestingly, the no lotion group infants had more frequent night wakings and more difficulty falling asleep than the other two groups.

Parenthood is never an easy task, but it appears that massaging a baby with massage oil/lotion close to bed time has significant effects for both mother and child.

 

References:

Field, T., Gonzalez, G., Diego, M., & Mindell, J. (2016). Mothers massaging their newborns with lotion versus no lotion enhances mothers’ and newborns’ sleep. Infant Behavior and Development, 45, 31-37. doi:10.1016/j.infbeh.2016.08.004