Is Massage Therapy the Solution to Your Chronic Back Pain?
A doctors' group recently changed its guidelines to recommend massage
If you still see massage as a mere indulgence, it’s time to update your image of rubdowns. A growing number of scientific studies suggest that massage therapy can provide meaningful relief for chronic lower back pain, which afflicts more than 26 million Americans, according to the American Academy of Pain Medicine.
And adults over 50 are the most likely to benefit from regular back massage, according to groundbreaking research at the University of Kentucky, published in the journal Pain Medicine.
Maturity Pays Off For Massage Therapy
Researchers followed 104 patients who had consulted their primary care providers about back pain lasting three months or more, defined as chronic. More than half reported significantly less pain after 10 one-hour massage therapy sessions — rising to 70 percent among those 50 or older. Most still showed improvement six months later.
Why the age difference? Older participants were more likely to stick with the 12-week program, says co-author Niki Munk, a gerontologist and licensed massage therapist (LMT) who teaches and conducts research at the Indiana University School of Health and Rehabilitation Sciences.
While the results don’t pinpoint other reasons, mature patients may be more self-aware, says Munk. “Older patients have better perceptions of their pain and relief,” she notes.
Many doctors have traditionally prescribed opioids, which can be highly addictive, for persistent back pain. But rising concerns about the current epidemic of opioid addiction have encouraged a search for safe, effective alternatives, including massage.
The American College of Physicians, which represents primary-care doctors, recently revised its clinical guidelines to recommend non-drug treatments such as massage, spinal manipulation and acupuncture as the first response to persistent lower back pain.
Orthopedic surgeons are also “very focused” on properly controlling pain prescriptions, says Dr. Alan Hilibrand, a spokesperson for the American Academy of Orthopaedic Surgeons and professor of orthopedic surgery at Jefferson Medical College in Philadelphia. He sees “significant short-term benefit” in massage for chronic back pain.
The new emphasis on hands-on treatments has made therapeutic massage more widely available. “Doctors are seeking us out now,” says Dolly Wallace, president of the American Massage Therapy Association (AMTA). She notes that hospitals and HMOs have been adding licensed massage therapists to their clinical staffs. And while neither Medicare nor Medicaid, in most cases, will cover medical massage, some Veteran's Administration pilot programs, and a small-but-growing contingent of insurers, do.
The national average cost for a massage is about $70 per hour, according to the American Massage Therapy Association.
How Massage Works
As anyone who has ever enjoyed a soothing spa massage might testify, bodywork can relax the muscles and undo tense knots. Beyond that, researchers are still identifying the precise ways that massage can alleviate long-term pain.
One possibility: Regular massage can reduce the body’s production of the stress hormone cortisol and a neurotransmitter linked to pain, and it boosts the level of mood-enhancing serotonin, according to the Arthritis Foundation. This can mute pain caused by both skeletal issues, such as the typical disc degeneration of aging, or spasms in the muscles caused by overuse and poor posture, says Munk.
“Massage isn’t going to put a spine back in place, but it can release muscle holdings around that site,” she says.
The Arthritis Foundation website quotes Tiffany Field, director of the Touch Research Institute at the University of Miami School of Medicine, as saying that regular massage can lead to a significant reduction in pain for those with arthritis.
Hitting the Right Spot
Would-be massage patients may confront a confusing roster of massage styles, ranging from Ayurvedic to shiatsu. But most massage styles fall into one of two broad categories: Swedish, involving long strokes of varying intensity levels, and deep tissue, which concentrates on kneading knots and “trigger points” in muscles and connective tissue (myofascia).
Some therapists consider deep-tissue massage especially effective in chronic cases, but any style may counteract pain if it suits you, experts agree. Check with your regular health care practitioner before starting massage therapy, however, if you’re taking blood thinners or suffer from severe osteoporosis, varicose veins or a flare-up of rheumatoid arthritis that may be exacerbated by pressure.
How do you find the right healing hands for your back?
- Ask for referrals from your doctor, chiropractor, physical therapist and experienced friends. Use AMTA’s locator service at FindaMassageTherapist.org.
- Call your insurer to see whether massage is covered and whether you need a prescription.
- Contact the therapists you’re considering. Check credentials; therapists are licensed as LMTs or CMTs (Certified Massage Therapist) in 46 states and Washington, D.C. Ask about their preferred approaches and expertise — are they experienced with low back pain? Do they accept insurance?
- Visit their workplace. “Look for quiet, clean, comfortable surroundings,” advises Linda Wheatland Smith, a chiropractor and acupuncturist in St. Louis and a spokesperson for the Arthritis Foundation. Whether the therapist works in a clinic or makes home visits, request an adjustable head- and neck rest.
- “Find someone you can communicate and collaborate with,” Smith says. You want to feel free to tell the therapist if a technique bothers you, hurts or makes you anxious. (To make sure she targets the right spot, Smith asks patients to color it in on a chart of the body.)
- Look for someone willing to create a treatment plan, adapt to any changes in your condition and to follow up, telling you when the therapist wants to see you next. But seek a therapist who values silence during the actual massage, says Smith, so you both can concentrate on healing.
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