Can Remedial Massage or Myotherapy Help with Lower Back Pain?
If you are experiencing Lower Back Pain and are not sure what to do about it, you are not alone. There is a lot of information out there and it is difficult to know what to listen to.
Throughout the rest of this blog we want to give you some evidence-based information and steps to help resolve your lower back pain.
According to the World Health Organisation, Lower Back Pain is the leading cause of years lived with disability across the world. They are recommending a shift away from surgical intervention, unless absolutely necessary as well to limit the use of pain medication and/or steroid injections. (1)
Instead there is a shift towards physical and psychological therapies to manage lower back pain. In fact soft tissue therapies like remedial massage and myotherapy are recommended by 6 International Guidelines for the treatment and management of Lower Back Pain. (2)
What does the evidence say?
The Lancet Journal is one of the world's leading authorities of health related topics. In 2018 an article was published describing significant mismanagement of Lower Back Pain. It outlined the shift away from surgical intervention to physical and psychological therapies.
The body of evidence showed limited to no evidence of the benefit of procedures like spinal fusion compared to more conservative, non-surgical treatment. (2) Instead, countries across the world have outlined clinical guidelines for a conservative, non-surgical approach to treatment of Lower Back Pain.
Here is what has been recommended across 6 International Clinical Guidelines from countries including - Australia, the United States, the United Kingdom, Denmark and Germany.
What Can Be Done?
1. Remain Active
The first recommendation of all six International Guidelines is to, where possible remain active. Your body relies on the strength of its musculoskeletal system to get by, especially for the movement and stability of your spine. It is common for people experiencing lower back pain to stop moving and lie down or limit movement to 'try and protect it', even after the area has healed.
When you stop moving muscles like the ones supporting your spine, begin to decondition. Interestingly, a research study done at the AIS showed that this happened in as short a period as a long-haul plane flight. Which is why trying to remain active is important. It does not take long for these changes to occur and they can create their own set of problems and prolong your pain.
Obviously this recommendation needs to be under the guidance of your health professional team and you should follow their instructions, as each individual case is different.
2. Complementary and Physical Therapies
Physical therapies, included massage were recommended across the six International Guidelines for both acute and chronic lower back pain management.
Interestingly mindfulness-based stress reduction, yoga, acupuncture and tai chi were recommended by four out of the six guidelines for chronic lower back pain.
3. A Team Approach
Lower Back Pain, both acute and chronic usually require a team approach to treatment. This is because there are a multitude of factors that contribute to it. A multimodality approach is recommended by five out of the six International Guidelines. (2, 3)
Here is an idea of why:
- Strength & Stability - Posture, muscle weakness and poor quality of movement are shown to cause lower back pain. Having someone on your health team be it a myotherapist, exercise physiologist , physiotherapist and/or other allied health professional, to assess and provide recommendations on your movement patterns and muscle strength is essential.
- Joint Range of Motion & Muscle Tightness - Additionally, joint range of motion and muscle tightness can cause or be a symptom of lower back pain. Having someone on your team, like a remedial massage therapist or myotherapist to decrease muscle tightness and improve your joint range of motion can help to decrease lower back pain and improve recovery time.
- Education & the Brain - Education on what you can be doing at home, common misnomers and how to decease the time periods spent in pain is critical.
Additionally, with chronic lower back pain there can be a psychological element that needs to be factored into treatment. It is common for practitioner to recommend a good psychologist or counsellor as part of the treatment or at least discuss mindset and the brain's role in chronic lower back pain.
The brain is very good at 'keeping itself safe.' If the brain perceives that it is in 'danger' either real or perceived, it will do everything in its power to protect you from harm. Sometimes even after the initial injury has healed, the brain can believe it is still in 'perceived danger.' This is particularly true when you have had a condition for a really long time - for example chronic lower back pain. Helping the brain to recognise that the danger is no longer there is sometimes just as important as physical therapy. (4)
Things to think about:
- Quads and Hip Flexor Tightness - Can contribute to Lower Back Pain because of where they attach to the pelvis and spine. Massage, Dry Needling, Triggering & Foam Rolling these areas can help to decrease Lower Back Pain.
- Pelvis and Lower Limb Strength - Gluts, Hamstrings, Hip Flexor Abdominal Strength can play a part in Lower Back Pain because of their role in lower back stability and pelvic and lower limb movement. It is why strength is generally recommended as part of a lower back treatment.
- Thoracic (Middle Back) Stiffness - Can contribute to Lower Back Pain. If the middle of your back is too stiff other parts of your spine have to compensate, such as your lower back. Using massage, joint mobilisation and/or a foam roller to improve your thoracic mobility can help to prevent or decrease your lower back pain.
- Underlying Conditions - According to research if we were to perform spinal imaging of 100 clients, WITHOUT SYMPTOMS OF LOWER BACK PAIN it is likely that as many as 37 of them would have some level of disc bulge and 30 would have some level of spinal degeneration.(5)
It is important to keep this in mind when spinal imaging is required. Having some level of degeneration is REALLY common and not always directly related to the pain being experienced. A lot can be done to relieve pain and symptoms of lower back pain, even when degeneration is present.
*Please note with the factors above, we recommend seeking the help of a health professional to get treatment specific to you and your condition.
Where to from here?
If you are experiencing Lower Back Pain it is worth getting it assessed by a health professional. Our remedial massage therapist or myotherapist team carry out a quick but thorough health history as well as physical assessment to determine how they can do to help as well as if they need to involve other practitioners like the ones discussed above.
Our aim is to:
- Get you on the road to recovery in the most effective and efficient way possible,
- Help educate and inform you about the latest treatment protocols
- Advise you on what you can be doing at home to decrease your pain.
To book in with one of our friendly and experienced team, click here the button below or give us a call using the information at the very bottom of the screen.
References:
- Harris IA, Traeger A, Stanford R, Maher CG, Buchbinder R. Lumbar spine fusion: what is the evidence? Intern Med J. 2018 Dec;48(12):1430–4. doi: http://dx.doi.org/10.1111/imj.14120 PMID: 30517997
- Traeger, A. (2018) Care for low back pain: can health systems deliver?
[Viewed Online] https://www.who.int/bulletin/volumes/97/6/18-226050.pdf?ua=1 - Stochkendahl MJ, Kjaer P, Hartvigsen J, Kongsted A, Aaboe J, Andersen
M, et al. National clinical guidelines for non-surgical treatment of patients 31. with recent onset low back pain or lumbar radiculopathy. Eur Spine J. 2018 01;27(1):60–75. doi: http://dx.doi.org/10.1007/s00586-017-5099-2 PMID:28429142 - Mosely, L and Butler, D.(2013) Explain Pain Handbook: Protectometer 2nd Edn Noigroup Publications (2013), ISBN: 978-0-9873426-6-9
- Brinjiji, W Et Al. (2014) Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations, AJNR Am J Neuroradiol. 2015 Apr; 36(4): 811–816.
Published online 2014 Nov 27. doi: 10.3174/ajnr.A4173
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