DEAR DOCTOR K:
My back is always sore. A friend suggested that massage therapy might help. Massages are expensive, so I want to make sure there’s some evidence behind this. Is there?
Massage used to be considered an indulgence. But it’s now recognized as a legitimate therapy for some painful conditions — including back pain.
Therapeutic massage may relieve pain in several ways. It may relax painful muscles, tendons and joints, or relieve stress and anxiety. It may even change the way the brain processes pain signals.
Many types of massage are available in the United States, with Swedish massage being the most common. It involves long, gliding strokes and kneading of the major muscle groups, as well as friction, gentle rhythmic slapping and vibration. Other massage techniques include deep-tissue, pressure-point, Thai and neuromuscular massage. (I’ve put a table describing different types of massage, and what they involve, below.)
Types of massage
|There’s more to massage or “body work” than kneading and squeezing of tight muscles. Some approaches sprang from traditional medicine, while others were developed more recently. Here are some common options.|
|Type||How it works|
|Acupressure (shiatsu)||Deep finger pressure applied along “energy channels” in the body called meridians.|
|Cranial-sacral therapy||Claims to use light touch to adjust the balance and flow of cerebrospinal fluid.|
|Deep-tissue massage||Aggressive massage to relieve severe tension in the muscle and the connective tissues.|
|Neuromuscular therapy||Massage to relieve acute or chronic pain.|
|Myofascial release||Massage intended to release tension in the connective tissue surrounding the muscles.|
|Sports massage||Massage to help athletes prepare for and recover from sports activities.|
|Swedish massage||Long strokes with gentle or firm pressure as well as kneading.|
|Source: American Massage Therapy Association: health.harvard.edu/bmt|
Massage therapy can also involve varying degrees of pressure. Massage doesn’t have to be painful to be therapeutic, so be sure to tell your therapist what type of touch you prefer (light touch, firm pressure, hard pressure).
Massage should not be the only treatment you use for back pain. Instead, use massage in addition to standard care. That includes taking anti-inflammatory pain relievers, staying as active as possible, getting physical therapy and giving your body time to heal. When added to the mix, massage can reduce pain and speed your return to normal activities.
There hasn’t been enough research to say for certain what type of massage is best for back pain. We also don’t know the optimal “dose” and frequency of treatment.
Talk to people you know to get a recommendation. Good practitioners get good results and generate positive referrals. Find out if a medical center in your area has an alternative or integrative medicine program. Such programs typically offer massage by qualified practitioners: people licensed to practice in your state, and certified by a national organization such as the American Massage Therapy Association (www.amtamassage.org).
When I was just beginning medical practice, I learned a valuable lesson. A woman in her mid-80s told me that she had trouble sleeping. I told her about the various ways to improve her “sleep hygiene,” such as going to bed and getting up at the same time each day, not watching TV while in bed, etc.
When I saw her a few months later, she said a massage therapist had cured her sleep problem — and implied that my advice hadn’t done much good. What was keeping her up (as I would have known, had I asked her more questions about her sleep problem) was chronic back pain. That was resolved with massage — and she slept like a baby.