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Massage for Low Back Pain: An Updated Systematic Review Within the Framework of the Cochrane Back Review Group

Furlan, Andrea D. MD, PhD*†‡; Imamura, Marta MD, PhD§; Dryden, Trish RMT, MEd; Irvin, Emma BA*

doi: 10.1097/BRS.0b013e3181ad7bd6
Cochrane Collaboration

Study Design. Systematic Review.

Objectives. To assess the effects of massage therapy for nonspecific low back pain.

Summary of Background Data. Low back pain is one of the most common and costly musculoskeletal problems in modern society. Proponents of massage therapy claim it can minimize pain and disability, and speed return to normal function.

Methods. We searched MEDLINE, EMBASE, CINAHL from their beginning to May 2008. We also searched the Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, issue 3), HealthSTAR and Dissertation abstracts up to 2006. There were no language restrictions. References in the included studies and in reviews of the literature were screened. The studies had to be randomized or quasi-randomized trials investigating the use of any type of massage (using the hands or a mechanical device) as a treatment for nonspecific low back pain. Two review authors selected the studies, assessed the risk of bias using the criteria recommended by the Cochrane Back Review Group, and extracted the data using standardized forms. Both qualitative and meta-analyses were performed.

Results. Thirteen randomized trials were included. Eight had a high risk and 5 had a low risk of bias. One study was published in German and the rest in English. Massage was compared to an inert therapy (sham treatment) in 2 studies that showed that massage was superior for pain and function on both short- and long-term follow-ups. In 8 studies, massage was compared to other active treatments. They showed that massage was similar to exercises, and massage was superior to joint mobilization, relaxation therapy, physical therapy, acupuncture, and self-care education. One study showed that reflexology on the feet had no effect on pain and functioning. The beneficial effects of massage in patients with chronic low back pain lasted at least 1 year after the end of the treatment. Two studies compared 2 different techniques of massage. One concluded that acupuncture massage produces better results than classic (Swedish) massage and another concluded that Thai massage produces similar results to classic (Swedish) massage.

Conclusion. Massage might be beneficial for patients with subacute and chronic nonspecific low back pain, especially when combined with exercises and education. The evidence suggests that acupuncture massage is more effective than classic massage, but this need confirmation. More studies are needed to confirm these conclusions, to assess the impact of massage on return-to-work, and to determine cost-effectiveness of massage as an intervention for low back pain.

The objective of this systematic review is to assess the effects of massage therapy for nonspecific low back pain. Thirteen randomized trials were included. Massage might be beneficial for patients with subacute and chronic nonspecific low back pain, especially when combined with exercises and education. SUPPLEMENTAL DIGITAL CONTENT IS AVAILABLE IN THE TEXT.

From the *Institute for Work & Health, Toronto, ON; †Department of Medicine, University of Toronto, Toronto, ON; ‡Toronto Rehabilitation Institute, Toronto, ON; §Division of Physical Medicine and Rehabilitation, Department of Orthopaedics and Traumatology, University of São Paulo School of Medicine, São Paulo, Brazil; and ¶Centennial College, Applied Research Centre, Toronto, ON.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

This review is adapted from the Cochrane Review “Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No: CD001929. DOI: 10.1002/14651858.CD001929.” Copyright Cochrane Library, reproduced with permission.

Address correspondence and reprint requests to Andrea D. Furlan, MD, PhD, Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, ON, Canada M5G 2E9; E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.