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The Somatic Connection  |   July 2012
Massage Shown to Benefit Patients With Chronic Low Back Pain
Article Information
The Somatic Connection   |   July 2012
Massage Shown to Benefit Patients With Chronic Low Back Pain
The Journal of the American Osteopathic Association, July 2012, Vol. 112, 411-412. doi:10.7556/jaoa.2012.112.7.411
The Journal of the American Osteopathic Association, July 2012, Vol. 112, 411-412. doi:10.7556/jaoa.2012.112.7.411
Cherkin DC, Sherman KJ, Kahn J, et al. A comparison of the effects of 2 types of massage and usual care on chronic low back pain: a randomized, controlled trial. Ann Intern Med. 2011;155(1):1-9.  
Researchers in Seattle, Washington, with access to a large patient population in the Group Health Cooperative screened 1161 respondents (recruited through advertisements in the cooperative's magazine) who had chronic low back pain documented in their medical records. Chronic low back pain was defined as low back pain lasting at least 3 months without 2 or more pain-free weeks, as well as a pain bothersomeness rating of at least 3 on a scale of 0 to 10. Exclusion criteria were the following: (1) specific causes of back pain, such as cancer or fractures; (2) complicated back conditions, such as sciatica, or medicolegal issues; (3) conditions making treatment difficult, such as paralysis or psychosis; (4) conditions that might confound interpretation, such as fibromyalgia; (5) inability to speak English; (6) massage within the past year; or (7) plans to visit a provider for back pain. A total of 401 patients were included in the study. 
Patients were randomly assigned to receive 1 of 2 types of massage (ie, relaxation or structural massage) or usual care. Relaxation massage was intended to induce a state of relaxation and comprised effleurage, pétrissage, circular friction, vibration, rocking and jostling, and holding. Patients receiving relaxation massage could also receive a take-home compact disc about a relaxation exercise to be performed at home. Structural massage was intended to identify and alleviate musculoskeletal contributors to back pain and comprised myofascial, neuromuscular, and other soft-tissue techniques. Patients receiving structural massage could also be recommended a home exercise consisting of psoas stretch. Patients in the usual care group received no special care, but they were paid $50 for participation. Medical records of patients in the usual care group were reviewed to determine the actual care that they received during the study period. Patients in the relaxation and structural massage groups received 10 weekly sessions of massage at no financial cost. The same 27 licensed massage therapists delivered both the relaxation and structural massages in a randomly determined manner. 
Primary outcome measures were results of the modified Roland Disability Questionnaire and scores on the symptom bothersomeness scale at baseline and at 10 weeks. Secondary outcomes were these measures at 26 and 52 weeks. The relaxation massage group started with 136 patients and had 130 patients at 10 weeks. The structured massage group started with 132 patients and had 127 patients at 10 weeks. The usual care group started with 133 patients and had 123 patients at 10 weeks. Demographically, the 3 groups were similar. More than 60% of participants were women, and the mean age of participants, in years, was the mid-40s. 
Results showed that patients in all groups had improved function and decreased symptoms at 10 weeks. However, the improvements were greater for patients who received either type of massage, compared with patients who received usual care. There was no statistically significant difference between results achieved with either massage. Beneficial effects decreased after 10 weeks, and by 26 to 52 weeks, benefits from massage were not statistically significant. 
This study was selected for review to inform readers of JAOA—The Journal of the American Osteopathic Association about progress made in other areas of manual medicine and manual therapy. Furthermore, the study was published in a relatively high-impact journal (Annals of Internal Medicine). The editors of the journal commented that massage appeared to produce benefits for patients with chronic low back pain in the short term and somewhat longer term (ie, 26 weeks, but not 52 weeks). 
Of note is the previously mentioned description of structural massage provided in the article by Cherkin et al. That description makes the structural massage technique appear to be similar to certain manipulative techniques, such as myofascial release and progressive neuromuscular inhibition, that are taught in osteopathic medical school—yet this structural massage technique was no more effective than the relaxation massage technique. It should also be noted that non-DO professionals who use their hands in the delivery of health care—especially massage therapists—are adopting terminology similar to that used in training for osteopathic manual medicine. The question of whether massage therapy is as effective as, or more effective than, osteopathic manipulative treatment is yet to be determined. Nevertheless, there is no doubt that the quality of massage therapy research is often very good, and this research needs to be taken into account by researchers in osteopathic medicine.—H.H.K.