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44 m a s s a g e & b o d y w o r k m a y / j u n e 2 0 1 5 SOMATIC RESEARCH education Studies Show Effectiveness of Massage for Addressing Nonspecific Low-Back Pain By Jerrilyn Cambron In the United States, 80 percent of adults will experience back pain at some point in their lives. Most back pain episodes occur between the ages of 25 and 45, and interfere with home, work, and personal life. The cost to employers for back pain in workers aged 40–65 is estimated to be $7.4 billion per year. 1 Even with such a heavy social and financial burden, we still do not understand the etiology of back pain and, therefore, diagnose most back pain cases as "nonspecific low-back pain." Without knowing the reason for the pain, health-care providers struggle to determine the best form of care. SWEDISH MASSAGE VS. PHYSICAL THERAPY In a recent comparative effectiveness study, Fahimeh Kamali and a team of researchers at Shiraz University of Medical Sciences compared two of the most common treatments for back pain: Swedish massage therapy and routine physical therapy. 2 Women with subacute or chronic nonspecific low-back pain who were referred to a physical therapy center were assessed for eligibility. Subjects were excluded if they had acute disc herniation, fracture, malignancy, pain due to surgery, pain lasting for more than one year, pain medication use for more than one month, pregnancy, radicular pain, spondylolysis, spondylolisthesis, or trauma. Thirty women agreed to participate in the study and signed an informed consent document. Of these, 15 subjects were randomized to a Swedish massage group where they received 15 minutes of low-back massage including "deep stroking, pulling, friction, rolling, and wringing." After the massage, the hamstring and paravertebral muscles were stretched and stabilizing exercises were prescribed. The remaining 15 subjects were randomized to routine physical therapy where they received several electrical modalities, including ultrasound for three minutes, TENS for 20 minutes, and vibration for three minutes. The subjects then did the same stabilizing exercises as the massage group. Subjects in both groups received 10 treatment sessions. Three measures were used to determine the outcome of the study protocols. Pain was assessed using the Numerical Rating Scale (NRS), functional disability was measured by the Oswestry Disability Index, and trunk flexion was measured by the modified Schober range of motion (ROM) test. Both massage therapy and physical therapy groups demonstrated improvements in all three outcome measures after the 10 visits. However, when the groups were compared with one another, the massage therapy group demonstrated a significantly greater decrease in pain and increase in function, with no difference in trunk flexion. To demonstrate the change in pain, average NRS measures (out of 10) dropped from 6.0 to 1.8 in the massage group, and from 7.3 to 4.1 in the physical therapy group. Overall, both low-back pain groups improved, but the massage group had significantly less pain and dysfunction compared to the physical therapy group. There were several limitations of this study, including the small sample size (n=30) and the lack of male subjects. Also, there was no long-term follow-up to determine continued improvement beyond the last treatment session. Following the subjects for a longer time period may have given a better view of how long the treatment benefits lasted. Finally, this study was performed in Iran, so the participants might have other factors associated with low-back pain and disability when compared to back pain patients in the United States, leading to possible questions about generalizability of results.