Low back pain: Can massage help?

Coburg Remedial Massage Centre: Studies that show the benefits of massage for healing, to reduce pain and acute back pain.

Low back pain: Can massage help?

 Some forms of massage, for example Remedial massage, acupressure, can relieve low back pain that has lasted longer than several weeks. As well as relieving pain, massage could possibly improve mobility too, especially if accompanied by exercising or stretching.

Pain in the lower (lumbar) back is the most common form of back pain. It is sometimes called lumbago. Most of the time, low back pain improves so much on its own within a few weeks that people can return to everyday activities. But back pain can also be very disabling, and become a chronic physical and psychological burden.

Pain in any part of the back can be caused by problems affecting the bones, muscles or nerves of the spine. For example, tense muscles can irritate nerves and lead to pain which may be felt in other parts of the body, like the legs (sciatic pain). Bad posture or damage to a spinal disc can cause back pain too.

But very often the cause is not clear. This is called “non-specific back pain”. Back pain is a very individual matter and can have many causes. People can have no sign of anything wrong and still be in pain – while others can show signs of wear and tear in their back on an x-ray, and have no pain whatsoever.

Back pain is classified according to how long it lasts:

    Acute back pain – less than 6 weeks
    Sub-acute back pain – between 6 and 12 weeks
    Chronic back pain –  longer than 12 weeks

In rare cases, back pain could be a sign of more serious health problems. These may then be accompanied by other symptoms, such as numbness, paralysis, weakness, tingling sensations or bladder and bowel movement problems. If you have one of these symptoms, it is important to see a doctor soon.
Treatment options

People often use pain-relieving tablets or are given an injection for the pain. Surgery is rarely used to treat non-specific back pain. Other options include exercises, relaxation techniques, learning about taking care of the back, physiotherapy, chiropractic treatment, applying heat or cold, acupuncture, liniments or medicated ointments, and movement therapies like the Alexander Technique. Some people also use cognitive behavioural therapy (CBT). That is a type of psychological treatment that can be used to teach people ways to cope with pain and stress.

Massage is a traditional back pain treatment. Massage therapy aims to relieve pain, relax muscles and achieve a sense of wellbeing. It is meant to reduce muscle stiffness that might be responsible for the pain, and make the muscles more flexible. There are several theories about how massage might work. One theory is that it triggers the release of pain-relieving substances, so-called endorphins, in the brain. Other theories suggest that massage therapy stimulates the nervous system in ways that relieve pain.

There are many forms of massage. Widely used forms include classic (Swedish) massage, Thai massage and acupressure. They differ in terms of the hand movements used, the parts of the body that are massaged, the amount of pressure applied, and the instruments and parts of the body that the massage therapist might use. The different massage types are also based on different theories about what causes back pain. You can read more about different forms of massage here. 
Research results: massage therapy could help relieve longer-lasting pain

Researchers from the Cochrane Collaboration – an international network of researchers – analysed trials which tested the effect of massage therapy for non-specific low back pain. They looked for trials that compared massage therapy with a dummy treatment, no treatment or a different treatment. You can read about why it is important to do trials in this way to find out whether a health care intervention works here. The researchers wanted to know how massage therapy affected pain, general wellbeing, back-specific function, quality of life and overall mobility.

The researchers found 13 trials, but they were mostly very small trials. They concluded that 5 of the trials, involving just under 670 people, could provide sound scientific results. These trials covered very different types of massage, and people had had their back pain for different lengths of time. So the trials could not provide a single strong answer to most questions.

The researchers report that the trials suggest a combination of massage and exercises is probably more effective than doing one of these things alone. The people who had massages as well as exercises and stretching, for example, were more mobile and had less pain in the short and long term.
Not yet clear which types of massage might be best

The researchers pointed out that the main goal of massage therapy can be very different. For example, some therapists are aiming to help the person (and their muscles) relax, while others are more focused on stretching or working on the body in other ways. Although the trials studied various massage techniques, there were not enough comparisons of treatments to show which forms of massage might be the most worthwhile for people with different problems.

Many of the treatments had mixtures of several elements – like massage oils, stretching, and more than one type of massage technique. The researchers concluded that acupressure (by hand or using an instrument to apply the pressure) may be particularly effective, but more research is needed to be sure.

Based on the small amount of research so far, it seems that Thai massage achieves similar results to classic massage techniques. However, foot reflexology massage does not appear to relieve back pain or improve mobility.

The people in the trials did not have any serious adverse effects. Some reported having pain during or shortly after treatment. And some had an allergic reaction to a massage oil and got a rash.

It is not known in what way the massage therapists’ training and experience affects the success of treatment or how long (or how often) the massage sessions should ideally be. The most suitable form of massage for an individual will depend on many factors, including their symptoms, general physical condition and personal preferences. Author: German Institute for Quality and Efficiency in Health Care (IQWiG)
References

    IQWiG health information is based on research in the international literature. We identify the most scientifically reliable knowledge currently available, particularly so-called “systematic reviews”. These summarise and analyse the results of scientific research on the benefits and harms of treatments and other health care interventions. This helps medical professionals and people who are affected by the medical condition to weigh up the pros and cons. You can read more about systematic reviews and why these can provide the most trustworthy evidence about the state of knowledge here. The authors of the major systematic reviews on which our information is based are always approached to help us ensure the medical and scientific accuracy of our products.
    Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. [Cochrane summary] [PubMed]

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0005109/

The Psoas muscle is the leading cause of back pain.

The Psoas muscle is the leading cause of back pain.

Some basic psoas information:
The psoas causes low back pain, sacroiliac pain, sciatica, disc problems, scoliosis, hip degeneration and knee pain
Unresolved trauma can keep the psoas short and reactive
The psoas (pronounced "so - az") primarily flexes the hip and the spinal column
The psoas functions as a hip and thigh flexor, which makes it the major walking muscle
The psoas can torque your spine to the right or left, pull it forward and twist the pelvis into various distortions
When the psoas is stuck in contraction stretches or strengthening can tighten the muscle even more
The psoas is part of a group of muscles effecting the back and hips that include: iliacus, iliopsoas, psoas minor and quadratus

lumborum
The psoas is a major part of your body's defensive physiology which responds to danger with flight, fight or freeze.

 #1. What is the Psoas Muscle?
The number of problems caused by the psoas is quite astonishing.
The psoas (pronounced "so - az") primarily flexes the hip and the spinal column. At about 16 inches long on the average, it is one of the largest and thickest muscles of the body (in animals it's known as the tenderloin). This powerful muscle runs down the lower mid spine beginning at the 12th thoracic vertebrae connecting to all the vertebral bodies, discs and transverse processes of all the lumbar vertebrae down across the pelvis to attach on the inside of the top of the leg at the lesser trochanter. The lower portion combines with fibers from the iliacus muscle, which sits inside the surface of the pelvis and sacrum, to become the Iliopsoas muscle as it curves over the pubic bone and inserts on the lesser trochanter.

#2. What is the function of the psoas?
The psoas has a number of diverse functions, making it a key factor in health. The psoas functions as a hip and thigh flexor, which makes it the major walking muscle. If the legs are stationary the action of it is a bend the spine forward; if sitting, it stabilizes and balances the trunk. The lower psoas brings the lumbar vertebrae forward and downward to create pelvic tilt.
When we think of smooth, elegant and graceful movement in dancers and athletes we are looking at the psoas functioning at its optimum. It requires that the psoas maintains the pelvis in a dynamically neutral orientation that can move easily and retain structural integrity. This creates positions of the spine that require the least muscular effort.

#3. What are the common pain symptoms of the psoas?
When the muscle becomes contracted due to injuries, poor posture, prolonged sitting, or stress, it can alter the biomechanics of the pelvis and the lumbar, thoracic and even cervical vertebrae. Typically a dysfunctional psoas is responsible for referred pain down the front of the thigh and vertically along the lower to mid spinal column. Trigger points are found above the path of the psoas on the abdomen. Frequently the quadratus lumborum muscles develop trigger points, as well as the piriformis, gluteals, hamstrings, and erector spinae.
The psoas can torque your spine to the right or left, pull it forward and twist the pelvis into various distortions. Frequently one psoas will shorten and pull the spine and/or pelvis to our dominant side. The distortions of the spine and pelvis can also show up as a short or long leg. This all results in scoliosis, kyphosis, lordosis, trigger points, and spasms in back muscles trying to resist the pulling of the psoas.It can also pull the spine downward, compressing the facet joints and the intervertebral discs of the lumbar spine. The pressure can cause the discs to degenerate, becoming thinner and less flexible. This degeneration makes the discs more susceptible to bulging or tearing, especially with twisting and bending movements.
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Full of easy directions and photos of each exercise, you will quickly find the relief you have been searching for.Each of the 7 methods contains an introduction to the activity, clear directions and photos that illustrate the experience.
This pdf is designed to help you to gently release your psoas. The methods, if done on a regular basis, should help to keep your back (and hips) flexible and resilient.


#4. What keeps the psoas in contraction?
The psoas will stay contracted because of postural habits and trauma. The way we stand, walk and sit can distort the psoas. If we walk or stand with our chin in an overly forward position the muscle will tighten. Sitting through much of the day at the office, car or elsewhere causes the muscle to shorten to keep us bio-mechanically balanced in our chairs. Over time we develop a "normal" way of holding the psoas that is dysfunctional.
Unresolved trauma can keep the psoas short and reactive. This is a primary muscle in flight, fight, freeze or fear responses to danger. When survival is at stake, it propels the body to hit the ground running. When startled, it ignites preparation of the extensor muscles to reach out (grab hold) or run. Until the psoas is released the muscle may stay contracted and go into further shortening and spasm very easily.

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