Should You Consider Massage for Chronic Back Pain?

Chronic back pain sufferers frequently consider massage therapy as an alternative to analgesic medications. There are some obvious advantages: no concerns about drug-drug interactions if you happen to be on other medications, and it is relatively non-invasive. Research regarding efficacy of massage for reducing pain intensity is mixed. In a systematic review published in the International Journal of General Medicine (Kumar et al., 2013), authors found consistent evidence for efficacy in the short term, but long-term results were more equivocal.

The authors proposed that heterogeneity in terms of study design was a major challenge to drawing conclusions from existing evidence. In addition, massage treatments cover a large spectrum of practices, ranging from traditional Swedish “relaxation” massage to lymphatic massage, and more focused “structural” techniques such as trigger point therapy, muscle energy techniques, positional release, strain-counter strain, cross frictions, and proprioceptive neuromuscular facilitation (Cherkin et al., 2009).

Given that massage performed by a licensed therapist has minimal side effects, it is worth considering, as primary or adjunct therapy to other modalities such as chiropractic adjustment and physical therapy. What is of utmost importance is finding a therapist with experience in treating chronic pain. In addition to verifying credentials, ask the therapist you are considering about ongoing education to keep up with current research.

Massage therapist Victoria VanDam, who has been practicing her arts for two decades, bases treatment recommendations on patient needs, their previous experience with massage, and the initial cues she picks up during her physical evaluation. The patient’s history is also important since massage therapists do not have access to electronic health records from other practices due to HIPAA restrictions.

VanDam emphasizes that fascia should be a primary focus of good massage, given its structural role within the body.

“You have to release the fascia, so it doesn’t hold onto the muscle,” she explains. This is particularly important when treating musculoskeletal chronic pain conditions which may involve fascial adhesions. However, releasing the fascia does not necessarily have to be painful to be effective.

“Massage doesn’t always have to be deep to be good,” she explains. Sometimes she finds that light movement to let the upper layer of fascia to “let go” is the most effective. “When someone has pain for a long time, the fascia puts a hold on the muscle,” she explained. If the patient is amenable, cupping is one way of pulling the fascia off the muscle to allow the muscle to relax and restore blood flow.

Massage can also be a form of relaxation, as part of a holistic approach to chronic pain. This may be particularly beneficial for persons whose busy schedules make it difficult to fit in self-care. Putting an appointment on the calendar is a good strategy for making sure you are taking care of your body and mitigating the effects of daily stress.

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