Massage and Back Pain
Whilst massaging at Olympia, for a large exhibition, our team was asked if they could urgently attend to the event’s Manager whose back had “gone into spasm”. He was in pain and slightly fearful that he would not be able to keep the show on the road if his spasm persisted. His quick-witted PA thought that we might be able to help.
The Manager came hobbling down to the show floor and gingerly climbed onto one of our onsite couches. He was laid onto his side and the massage therapist, working rather quickly, identified muscle spasm and worked gently at first and then more deeply into his lower back muscles, concentrating on the side muscles that were causing his particular problem.
He was stressed, de-hydrated, hadn’t had a chance to relax, had been over working for several days and his back had gone into spasm. His fear of not being able to work and not knowing what was causing the pain had led to its intensification. However, after the soothing back massage his pain had allayed, his muscle function had improved, he got off the couch much less stressed and he was able to continue with his job.
What is back pain?
Well there is no one answer to this as there is no one type of back pain, it can manifest in a number of ways:
- Back pain can be experienced as lower back pain, it can be acute and gone in a few days1.
- Back pain can be non-specific (i.e. there are no red flags – see below) and last more than six weeks and cause extreme worry and discomfort.
- Back pain can be chronic and last more than a year.
- Back pain with red flags (conditions when a doctor should always be consulted) include abscesses, tumors, viral infections, fracture due to osteoporosis (mostly in the elderly) ankylosing spondylitis, inflammatory conditions and referred pain from internal organs2.
- Upper back pain residing in various muscles of the upper back.
- It can be simple uncomplicated back pain caused by a muscle spasm, or more complex and neurological caused by a prolapsed disc pressing onto a nerve.
Pain may be brought on suddenly such as when you sneeze or just bend down to pick something up. The back can go into spasm or there may be a slow build up to pain, sometimes caused by poor posture causing the muscles to strain3.
Most back pain is said to be of the soft tissues, muscles, ligaments and tendons, but some can be referred pain from an underlying cause. We know that back pain will affect almost everyone to some degree at some stage in their life, but only a very small proportion of back pain sufferers actually have a prolapsed disc. People under the age of 20 and over the age of 55 with back pain should see a doctor and anyone with back pain who also experiences a fever, has an underlying health condition, an infection or a persistent sharp pain, bowel and bladder problems, should immediately see their doctor.
How does Massage Help?
In general, massage is used to relieve simple uncomplicated back pain where a muscle has gone in to spasm or where there is a strain on the muscle itself. An accomplished massage therapist will not only be interested in the area of pain but:
- 1.When and how it started
- 2.The degree of pain
- 3.What aggravates the pain
- 4.What is happening to the surrounding muscles
- 5.They will want to know about your lifestyle – sports undertaken, nutrition, degree of stress or anxiety.
- 6.The posture you assume for most of the day, in case there are any other factors involved in your back
Satisfied that they can work on you safely, the massage works to warm the muscle, relax the muscle fibres and with certain techniques ease the muscle fibres apart and back to their normal mode of function. Nutrient and oxygen rich blood is brought to the area and this contains anti-inflammatory agents (see note 5 below) that aid in the recovery of the muscle. When the muscle goes into spasm to protect an underlying disc problem of the spine, a massage therapist may be able to help with the early onset muscle spasm, but will refer the client onto their doctor or osteopath for a diagnosis and subsequent management.
But what mechanism is at play in the beneficial nature of massage?
It has been postulated that touch simply turns off the gate in the nervous system that sends pain messages to the brain4. A recent Canadian Study looked at the effects of a ten-minute massage on skeletal muscle damaged by exercise, by taking a biopsy of the muscle before exercise, immediately after exercise and two and a half hours later. They found that massage stimulated the muscle cells to produce a range of anti-inflammatory and pain killing factors5. It is also postulated that pain can cause anxiety and if this can be alleviated it helps in the management of pain. Massage is known to relieve short-term anxiety6.
More recently massage therapists have been working with pain relief through the manipulation of trigger points, which are, “hyperirritable spots, usually lying within a taut band of skeletial muscle, or in the muscle’s fascia”7. These can become triggered through stress, postural problems and overuse and irritation. When triggered they cause pain, which can radiate to a localised area of the back particularly rising up the neck and causing neck strain too. We find them especially active in clients who sit at a computer for hours without movement. Massage therapists can work on these to relieve them through different techniques such as pressure, pressure and stretching and also a small myofascial roll of the skin.
The massage therapist’s role is to try to understand why you have the pain, what other factors in your life may be contributing to it, what postural factors could be changed and what lifestyle factors could also be changed to help you. After a massage they will want to suggest some gentle exercises for you to do to get you active, as movement is now recommended for people with back pain.
Medical research studies into the benefits of massage for back pain are ongoing but there is no doubt that the anecdotal evidence is overwhelming. In countless cases people who have received massage report an improvement in their condition or at the very least a positive referral to a medical practitioner. So if you have been experiencing back pain don’t just ‘live with it’, find a reputable massage therapist and get it sorted!
2 Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Pysicians and the American Pain Society, Chou R, Qaseem A, Owens, K, Ann Intern Med 2007; 147;478-491 pp 480
Low Back Pain: Early Management of persistent non-specific low back pain, Full Guideline May 2009, National Collaborating Centre for Primary Care, Royal College of General Practitioners, Savigny P, Kuntze S, Watson P, Underwood M, Ritchie g, Cotterell M, Hill D, Browne N, Buchanan D,Vogel S, Walsh D, P. 9 section 2.1 Non-specific low back pain.
4 Melzac R, and Wall P: text book of Pain, 2nd edition. Chruchill Livingstone, London. 1989 reported in A massage therapist’s guide to understanding, locating and treating myofascial trigger points, Leon Chaitow, Sandy Fritz
5 Massage Therapy Attenuates Inflammatory Signaling After Exercise-Induced Muscle Damage Justin, D Crane, Daniel L. Ogborn, Colleen Cupido, Simon Melov, Alan Hubbard, Jacquline M. Bourgeois, Mark A. Tamoposlsky, Science Translational Medicine, 1, Feb 2012, Crane et al, 4(119)ra13. taken online http://stm.sciencemag.org/content/4/119/119ra13.abstract
6 A Meta-Analysis of Massage Therapy Research, C.A. Moyer, James Rounds and James W. Hannum, University of ILLinois at Urbana-Champaign, Psychological Bulletin, 2004 Vol 130 No. 1, 3-18 pp 6 and p12 for anxiety reduction. And multiple dose massage for pain reduction.