Issue link: https://www.massageandbodyworkdigital.com/i/720675
nothing over the long term. "Doing nothing" is not always a viable option, however, especially for people who need relief in the short and medium term. (See "Some Relief" at left.) Back pain is also a difficult condition to study because its precipitators and perpetuating factors may vary greatly from one person to another. One person's back pain may be specifically tied to a structural anomaly in their lumbar vertebrae; another person's problem may be related to an initial injury that has subsided, but other pain-promoting factors have not. Each of these individuals may have similar symptoms, but they need different treatment approaches. Massage therapists who specialize in working with clients who have back pain need to be ready to approach it from multiple perspectives: the biomechanical approach that looks for structural problems that may be resolved, but also the biopsychosocial approach that addresses the behaviors and other factors that can contribute to pain. Since we see that establishing and maintaining pain-free movement is a high priority for almost all people with back pain, it makes sense to think about massage therapy as an adjunct to this goal. The massage itself may or may not have long-lasting impact on the experience of pain, but if massage can help a person be more physically active, then the long- term outcomes are much more likely to be positive. As with other chronic-pain issues, massage therapists in this situation will set up the best chances for success if they: 1. Work as part of an integrated team with the client's other health-care providers. This allows them to support what happens for the client in physical therapy, to make appropriate accommodations for medications, or to help prepare for, or recover from, surgery if that becomes necessary. 2. Acknowledge that pain is probably related to both a biomechanical trigger and biopsychosocial factors that prolong it. We can address this through massage by looking at whole-person strategies that offer pain relief, support, and empowerment to the client. PATHOLOGY PERSPECTIVES C h e c k o u t A B M P 's l a t e s t n e w s a n d b l o g p o s t s . Av a i l a b l e a t w w w. a b m p . c o m . 41 Resources Chou, R., et al. "Noninvasive Treatments for Low Back Pain." Comparative Effectiveness Review No. 169. Cochrane Database System Review 1, no. 9 (September 2015). Accessed July 2016. www.ncbi.nlm.nih.gov/pubmed/26329399. Furlan, K., and L. S. Wieland. "Massage for Low-back Pain." Explore (NY) 12, no. 3 (May–June 2016): 215–7. Accessed July 2016. www.ncbi.nlm.nih.gov/pubmed/27033320. Hedlund, R., et al. "The Long-Term Outcome of Lumbar Fusion in the Swedish Lumbar Spine Study." Spine Journal 16, no. 5 (May 2016): 579–87. Accessed July 2016. www.ncbi.nlm.nih.gov/pubmed/26363250. Menke, J. "Do Manual Therapies Help Low Back Pain?: A Comparative Effectiveness Meta-Analysis." Spine Journal 39, no. 7 (January 2014): 463–72. Accessed July 2016. www.researchgate.net/publication/259988037_Do_Manual_Therapies_ Help_Low_Back_Pain_A_Comparative_Effectiveness_Meta-Analysis. 3. Help clients identify specific goals. Maybe it's to reduce morning pain from a 5/10 to a 2/10. Maybe it's to be able to play nine holes of golf. Maybe it's to be able to attend dance classes, or hike five miles, or work in the garden for an hour or two. Client-led functional outcomes help to create a partnership so both clients and therapists are working toward the same objectives. 4. Track progress toward those goals so clients and therapists can determine whether the massage therapy is effective. Then, be prepared to change course if it's not working. And the final thing massage therapists can do to improve outcomes and serve both their clients and their profession: share their observations in case reports and let us know what works. I will look forward to reading them. Ruth Werner, BCTMB, is a former massage therapist, a writer, and an NCBTMB-approved provider of continuing education. She wrote A Massage Therapist's Guide to Pathology (Lippincott Williams & Wilkins, 2016), now in its sixth edition, which is used in massage schools worldwide. Werner is available at www.ruthwerner.com.