Massage helps reduce low-back pain, increase function

In Brief

  • Massage helps reduce pain and improve functioning in patients who have had low-back pain for more than four weeks, especially when combined with exercise.
  • Although it can be costly, massage may save money by reducing the overall number of visits to health-care providers and the need for pain medications and other back-care services.

Why was this review done?

Massage is often used to ease low-back pain. It may release endorphins, improves oxygen flow to muscles, and promotes flexibility and relaxation. Despite these therapeutic properties, the effectiveness of massage as a treatment for chronic low-back pain has not been well researched. This systematic review examines the effects of massage for non-specific back pain, and compares the effects of different types of massage.

How was the review done?

Researchers searched for published studies up to May 2008 in six databases. They considered treatments for three types of back pain: acute (lasting less than four weeks), subacute (lasting four to 12 weeks) or chronic (lasting more than 12 weeks). Relevant studies were assessed for quality using the Cochrane Back Review Group criteria. The researchers then analyzed results from the 13 studies included in the review.

What did the reviewers find?

Massage improved pain and functioning in patients compared with fake, placebo or delayed treatment in both the short term and long term. Massage was more likely to work when combined with exercises – usually stretching – and education. For patients with chronic low-back pain, the beneficial effects lasted at least a year after treatment.

Compared with other approaches, massage reduced pain more than:

  • joint mobilization (a chiropractic technique)
  • relaxation
  • physiotherapy
  • self-care education
  • acupuncture.

There was one study of work-related effects that compared physiotherapy and acupressure (a technique in which pressure is applied on acupuncture points). Acupressure reduced the pain interfering with normal work, and reduced days off work or school more than physiotherapy.

In terms of specific massage treatments:

  • foot reflexology had no effect on pain and functioning
  • acupressure had more beneficial effects than classic (Swedish) massage
  • Thai massage had similar effects as Swedish massage.

What are some strengths and weaknesses of the review?

In this review, which updates a past review, researchers improved their approach by including a registered massage therapist to evaluate the massage therapy as described in the studies. Two independent reviewers assessed the quality of the studies.

Publication Information


Massage for low back pain: An updated systematic review within the framework of the Cochrane Back Review Group


Furlan A, Imamura M, Dryden T, Irvin E


Spine, 2009: vol. 34, no. 16, pp. 1669-1684