Massage Therapy and Back Pain: Part I

Mark asks, "Can you explain how massage helps each of the different types of back injuries: spinal (disc), nerve, and muscle (or tendon)?

Are there injuries where rest or exercise is the better treatment?"

That's an excellent question and a complex one. I'll try to answer as concisely yet thoroughly as I can, but the short answer is this: back pain can be a complicated problem and there is no short and easy answer to the question. However, in most cases I've encountered, massage therapy can be a helpful addition to other treatments, such as rest or exercise, and promote faster and more thorough recovery.

First, let me emphasize that a massage therapist is not qualified to diagnose any condition. Only a qualified physician can diagnose whether your back pain is due to a herniated disc, muscle strain, nerve irritation, or a combination of factors. When in doubt, always consult your primary health care practitioner. Especially when there is numbness, loss of function such as foot drop, or pain when there has been no history of pain and no obvious cause, medical attention should be sought promptly to determine the cause of pain. Sometimes back pain can be caused by very serious conditions that need immediate attention.

Back pain can take many forms and have many causes. It can range from mild discomfort from overexertion to serious, debilitating pain that interferes with any movement at all. The causes may be sore and tight muscles, trigger points, nerve irritation or entrapment, disc degeneration or herniation, or other factors. There can be a combination of factors.

Each situation is unique and treatment needs to address the particular problems involved. Often treatment will involve more than one modality. Rest, ice, heat, traction, chiropractic adjustments, acupuncture, and massage may all be utilized, either alone or in appropriate combinations. Medications for relief of pain and/or anti-inflammatories may be recommended, either prescription or non-prescription drugs. Again, recommendations for medications should always come from the physician.

In most of the cases of back pain that I've encountered, massage can be a helpful addition to other therapies provided the therapist has the skills to handle the situation appropriately. If the therapist is unsure of their skills or what the nature of the condition is, it would be best to do nothing. The first rule is always to do no harm. For the massage therapist, it is always better to err on the side of caution. Too little may be ineffective but it will not hurt the client. Too much might make the client worse. When in doubt, don't.

I would not massage a person whose pain was strong, of sudden onset, with no history of pain or no obvious reason for it until they had been evaluated by a physician. I would not touch a person who was experiencing loss of sensation or control, such as foot drop, until they had been evaluated by a physician. I would not treat any person whose physician or physical therapist had recommended they not receive massage therapy.

Outside of those circumstances, skilled massage can often be a helpful addition to other treatment recommended by the primary health care practitioner. The choice doesn't need to be massage or rest or exercise. Massage, in addition to the rest or exercise, can help speed the healing process and can help recovery to be more complete.

Many chronic pain problems began as an acute injury that was not properly or thoroughly treated. Tightness from the initial trauma can remain in the muscles for years. The client may be aware of its presence through a persistent tightness or ache. Or it may be so low grade that the client is not aware of this continuing tension in the muscles, but it is still there waiting for the next opportunity to flare up. "All I did was bend over to pick up the trash and wham! - my back went out!" How often have you heard that? It isn't the trash. It's usually low-grade tension that keeps building until finally one movement becomes the straw that breaks the camel's back and sends the muscle into an acute spasm.

In the next few entries, I'll talk about some of the specific conditions that can cause back pain and exactly how massage therapy can help.