Massage Outperforms Meds For Low Back Pain

Is it conceivable that massage can provide more effective relief from low back pain than medication? A new study published in the Annals of Internal Medicine suggests this therapy might indeed alleviate back pain better in the short term than traditional interventions of medicine, bed rest or exercise: Healthday reports.

The investigation conducted by the Group Health Research Institute in Seattle involved 400 patients who had low back pain, the majority of which were middle aged, Caucasian and female. Researchers found those who were given a series of relaxation massage or structural massage were better able to work and be active than those who were given traditional medical care, such as pain pills, muscle relaxants or physical therapy.

According to The New York Times, the study’s participants were randomly divided into three groups: structural massage, relaxation massage and traditional care. Patients in the massage groups received one hour of therapy weekly for 10 weeks.

At the conclusion of the 10 week period, over one-third of the patients who were given massage therapy reported their pain was much improved or eliminated completely, as opposed to only one in 25 patients who were given traditional care. Furthermore, patients in the massage groups were twice as likely to have spent fewer days in bed rest, used less pain pills and participated in more activity than the traditional care group.

Lead author Daniel Cherkin was surprised by the fact that structural massage did not prove superior to relaxation massage in relieving pain. Structural massage involves manipulating specific back pain related muscles and ligaments, while relaxation massage, otherwise known as Swedish massage, involves inducing body-wide relaxation.

The beneficial effects of the massage seemed not only to be experienced during the 10-week therapy period, but also to linger for a time following the cessation of therapy. Evidence of this lingering effect was manifested by the fact that the massage groups continued to display improved function six months after the study’s onset. At the one year mark, however, no significant differences were found in the three groups.

Although the researchers were uncertain of massage therapy’s exact mechanism of action for easing back pain, they voiced several theories. One suggestion was that it either stimulated tissue locally or produced a general central nervous system response. Another speculation was that merely spending time in a relaxing environment and feeling cared for might have been responsible for the improvement. An additional factor to consider is the subjectivity that is impossible to eliminate in such studies. Patients in the control group were aware that the other groups were receiving massage and this knowledge may have caused them to discount their own progress.

It should be reiterated that the study suggests rather than proves the benefit of massage for back pain. Also, some members of the American medical community not associated with the research have expressed reluctance to accept the suggested benefits as being valid.

Conversely, the study’s authors offered their assessments of its import. Cherkin characterizes the results as being “pretty strong.” He states the massage was tested on patients who did not improve using the standard medical approach to back pain treatment. He feels that massage therapy is a reasonable thing to try for anyone getting insufficient relief from this malady. The coauthor, Dr. Richard Deyo, feels that massage appears to provide clinicians with another choice for managing the challenging medical problem of chronic low back pain.

A Golfer’s Worst Nightmare Rehabilitated Through Massage

For many golfers, the only meaningful way to spend a sunny day is out on the links. With 18 holes to look forward to — the sun’s rays caressing the greens, blue skies inviting deep breathes, and the warm leather grip of a favored club in hand — nothing much can break their joy of being alive.

Until, that is, pain strikes. Pain in the physical sense such as a muscle tear or unstable joint, or the pain they feel from a continually declining game performance. For a die-hard golfer, the two pains are equally worrisome. And, left unresolved, grow to become their worst nightmare: the end of their golfing and no more need for sunny days.

Massage therapists are all well aware that, as the human body ages: muscles atrophy, tissues lose elasticity and overall flexibility declines. What many therapists have yet to fully understand, however, is that static stretching of muscles is rarely enough to correct these affects (Siff and Verkhosansky 1993, Siff 1994, and 1998). And even dynamic stretching is an incomplete course of treatment for many of our clients — especially those who golf.

Kinematic Sequencing and Therapeutic Improvements

To effectively assess and treat the unique needs of a golf client requires that the therapist first acquire an advanced knowledge of body dynamics, namely, the kinematic sequencing of the golfer’s body.

Kinematic sequencing refers to the specific order that the body engages its muscles, bones, joints and balance to perform a movement. In our golfing clients, the movement is striking the ball.

For an efficient golf swing to take place, the process of kinematic sequencing looks like this:

  • First, the pelvis is engaged and rotates towards the ball.
  • Second, the trunk engages and follows the pelvis.
  • Third, the arms engage and follow the trunk.
  • Fourth, the hands and club follow the arms until the ball is struck.

Once the ball is struck, the body again engages in a kinematic sequence, this time of deceleration, with the pelvis engaging first, followed by the trunk, followed by the arms, followed by the hands and club. That is good sequencing.

As massage therapists, the better we understand kinematic sequencing — especially in our rotational athletes who play golf, tennis, baseball, bowling and soccer — the the better we become at assessing our clients’ pains, restrictions, limitations and frustrations.

And the first step to better assessing our clients is to perform better evaluations. Specifically, how they present when they take a static posture and when they take a dynamic posture as they describe their pains, restrictions and issues.

Static posture is, of course, the position of the body at rest, sitting, standing or lying down. This is typically what we see most often as massage therapists. Our clients sitting or standing before us or perhaps already laying on the table as they describe their pains and wait for us to treat them.

Dynamic posture, on the other hand, has the patient: move, twist, lift, pull, push and balance in order to reveal the likely causes of the client’s pain or imbalance. The difference in evaluating your client’s condition using dynamic posture as well as a static posture is often the critical and missing step in properly assessing and treating our patients (Doctor Vladimir Janda “Upper and Lower Cross Syndrome” 1979, cited in Lewitt 1999).

To only evaluate your client in a static posture would be missing the holistic nature of human dynamic motion and posture. Sure, you can look at a left hip internal rotation when your client is on the table and find a deficiency of say 15-20 degrees, but that won’t give you an accurate picture of what’s really affecting the golf swing until you ask your client to stand up and perform the very movement that causes the trouble. So to replicate the golf swing, you must ask your client to do an internal rotation so as to move the trunk over the hip.

Frankenstein on the Golf Course

Here’s an example from my own clinic. I recently had the opportunity to work with a golfer who had bilateral hip replacements, a right knee replacement, and a left shoulder injury that was never repaired. I hate to say it, but he walked like Frankenstein and, as you can predict, his traumas lead to a continuing decline in his game performance.

When golfers ready themselves to strike the ball they bend their knees into a semi-squat formation. So to properly assess my client’s condition, I asked him to squat, slowly, all the way into a chair. And as he did so, I observed his ankles, knees, hips, trunk and motor control. I then asked him to stand on one leg. His ability to maintain a one-legged posture lasted less than three seconds. I also noted that he could not even begin to touch his toes; and he had limited trunk control, pelvic and spinal rotation. He had a forward head posture, kyphosis, and evaluation of his left shoulder joint presented the arm well in front of his ear instead of the proper placement which is beside or behind the ear. As you might infer, he clearly needed better flexibility. But, because of his hip prosthetics, it would be inadvisable to stretch his hips into internal rotation.

For this client, I began by making a basic golf movement better. Namely, the squat. Simply by teaching him to use his hips better, it allowed him to stay in a golf posture longer which helped with his swing path, tempo and striking distance — and his enjoyment of the game. We always combined our sessions with manual therapy, focusing around the hip rotators, to help him improve his hip hinge.

If you are ever presented with a client suffering with similar impairments, begin by writing down your assessment of how each muscle is affecting the joints in the lower extremities. Look at the flexibility of the feet as they relate to overall stability during weight shifts. Create more ankle mobility by addressing the dorsiflexors and removing myofascial restrictions. Check the client for the ability to do inversion and eversion of the ankles. Attempt to lengthen the quads, hamstrings, adductors, IT band, gluteals and psoas. Your goal is to increase the length of the flexor chain and increase strength to the extensor chain.

Once you’ve completed all of the above, recheck the client’s movement by asking your client to perform another squat or the movement pattern that is causing the concern. If your client has yet to improve, it may indicate that just stretching the lower extremity is not enough. Adding mobility without adding stability may not change the movement pattern. You may need to become a teacher of the squat. Put a chair behind the client, have them do an isometric press into their hands to activate the core, and teach them to hip-hinge back into the chair. Then repeat your manual therapy and re-check your client’s range-of-motion. Continue to do this as many times as necessary throughout the session to reveal how much your client’s motor control is improving. You will often see minor improvements during the first session and noticeably bigger improvements during subsequent appointments.

This is the protocol I implemented with my own client and he improved dramatically. In just three months, I had him transform his gate from that of a B-movie monster to that of a young man walking with a kick in his step. He also lowered his golf handicap, feels younger, stands taller and more importantly . . . he is now free of his worst fear — that of believing that he’d never again enjoy playing 18 rounds of the great game of golf.

References

  1. Supertraining: Yuri Verkhoshansky and Mel Siff.
  2. Manipulative Therapy in the Rehabilitation of the Locomotor System: Karel Lewit, Third Edition 1999.
  3. Superstretch : Mel Siff 1994.
  4. Facts and Fallacies of Fitness : Mel Siff 1998.

Tools For Touch Webinar

 

On Tuesday, October 25th, At Peace Media, in association with Massage Magazine Insurance Plus, will co-host its second LIVE online webinar, “Techniques, Tips & Success Methods of Top Massage Instructors” with Val Guin, creator of Forearm Dance Massage. Val will be joined by nine internationally known massage educators in the second production of the Tools for Touch Webinar series.
Sessions and prior plans prevent you from attending the full day webinar?  No worries…each presentation will be archived for later viewing, whenever you wish.  All presentations archived for minimum of 30 days. 
More reasons to sign up…
  • 9 CE hours available, NCBTMB approved
  • LIVE hands-on video demonstrations
  • Spend NO money on airfare, hotel, rental car, food or gas
  • Learn techniques from home or office
  • Up-close, insider success secrets
  • Participate in live Q&A sessions with presenters
  • 10am – 8pm Eastern time

Your Cost: $99.00

All-Star Webinar – Sign up Now

Oct. 25th Presenter Topics and Schedule

ALL Times are EST *
10am – Val Guin, Co-Host
Creator, Forearm Dance Massage
Topic: Side Lying-Shoulders; Applying Principles of Forearm Dance
11am – Tom Myers
Author, Anatomy Trains and Lecturer
Topic: Anatomy Trains and Fascial Response
12pm – Ryan Hoyme “MassageNerd”
Creator of MassageNerd website
Topic: How to Add Video to Your Own Massage Website
1pm – Chuck Duff
Founder, Thai Bodywork School of Thai Massage
Topic: Treating Muscle Shortening Dysfunction with Clinical Thai Bodywork
2pm – Tiffany Blackden
Social Media Expert and Massage Practice Owner
Topic: Use Facebook, LinkedIn & Twitter to Grow Your Practice
3pm – Ben Benjamin
Founder, Muscular Therapy Institute
Topic: TP7 ligament sprains, assessment and treatment
4pm – Whitney Lowe
Founder, OMERI
Topic: Orthopedic massage for lumbosacral pain
5pm – James Waslaski
International Lecturer, Author Advanced Clinical Massage Therapy – A Structural Approach to Pain Management
Topic: James will present clinical studies and research that will change the way manual therapists approach tendon pain and adhesive capsulitis of the hip and shoulders.  Added bonus:  James will discuss highlights from his new book.
6pm – Bruce Baltz
VP Education, Bon Vital’
Topic: Use of Lubricants in Stone Massage

*Schedule subject to change

More Info – Register Here