massage therapy better than acupuncture for back pain?

April 5, 2007

Massage Therapy by Steven Bratman, MD

Along with herbal treatment, touch-based therapy is undoubtedly one of the

most ancient forms of medical care. We instinctively stroke and rub areas of our

body that hurt; massage therapy develops this instinct into a professional

treatment.

Forms of Massage There are many schools of massage. In most cases, massage

therapists combine several techniques, although there are also purists who stick

to one method. The most common technique is Swedish massage, which combines long

strokes and gentle kneading movements that primarily affect surface muscle

tissues. Deep-tissue massage utilizes greater pressure to reach deeper levels of

muscles. This may be called the “hurts-good-and-feels-great-after” approach.

Shiatsu or acupressure massage also use deep pressure, but they do so according

to the principles of acupuncture theory, which differ markedly from those of

Western-oriented massage therapies. Neuromuscular massage (such as the St. John

Method of Neuromuscular Therapy) applies strong pressure to tender spots,

technically known as trigger points.

How Strong is the Scientific Evidence for Massage Therapy? Although there

is some evidence that massage may be helpful for various medical purposes, in

general the evidence is not strong. There are several reasons for this

(including funding limitations), but the most fundamental is that even with the

best of intentions, it is difficult to properly ascertain the effectiveness of a

hands-on therapy like massage.

Only one form of study can truly prove that a treatment is effective: the

double-blind, placebo-controlled trial. In such a study, some participants

receive a real treatment, others receive a placebo treatment and neither the

participants nor the researchers know which is which.

However, it is difficult—some would argue even impossible—to fit massage into

a study design of this type. What could researchers use for placebo massage? And

how could they make sure that both participants and practitioners would be kept

in the dark regarding who was receiving real massage and who was receiving

placebo massage?

Because of these problems, all studies of massage fall short of optimum

design. Many researchers have designed studies that compare massage to no

treatment. However, studies of this type cannot provide reliable evidence about

the efficacy of a treatment. If a benefit is seen, there is no way to determine

whether it was caused by massage specifically, or just attention generally.

(Attention alone will almost always produce some reported benefit.)

More meaningful trials used some sort of placebo treatment for the control

group, referred to as “sham” massage. However, using a placebo treatment that is

very different in form from the treatment under study is less than ideal.

Still other studies have simply involved giving people massages and seeing

whether they improved. These trials are particularly meaningless; it is well

known that if a treatment of any kind is given, both the participants and the

examining physicians will think they have observed an improvement, regardless of

whether or not the treatment does anything on its own.

Given these caveats, below is a summary of what is known about the effects of

massage. The best evidence regards low back pain.

Massage for Low Back Pain Although the evidence is far from complete, it

does appear that massage may offer benefits for low back pain. However, these

benefits appear to be short term.

One of the more recent studies compared massage to sham laser therapy in 107

people with low-back pain. The results indicated that massage is more effective

than laser therapy for relieving low back pain, and that massage therapy

combined with exercise and posture training is even more effective.

Another study compared acupuncture, massage, and self-care education in 262

people with persistent back pain. By the end of the 10-week treatment period,

massage had shown itself more effective than self-care (or acupuncture).

However, at a one-year follow-up, there was no difference in symptoms between

the massage group and the self-care group.

In another study, acupressure-style massage was more effective than Swedish

massage for the treatment of low back pain.

Other Potential Uses of Massage Other preliminary controlled trials of

varying quality hint that massage may provide benefit in a number of other

conditions, including the following:

Attention deficit disorder (ADD)

Anorexia nervosa

Asthma in children

Autism

Bulimia

Cystic fibrosis

Depression and anxiety in children

Diabetes

Eczema

Fibromyalgia

HIV

Iliotibial band pain (a form of tendonitis that can cause knee or hip pain)

Juvenile rheumatoid arthritis

Migraine headaches

Pregnancy and childbirth

Quitting smoking

Spinal cord injury

How to Choose a Massage Therapist As with all medical therapies, it is

best to choose a licensed practitioner. Where licensure is not available, your

best bet is to seek a referral from a qualified and knowledgeable medical

practitioner. However, most U.S. states license massage therapists.

Note that massage, like other hands-on therapies, involves personal talents

that go beyond specific training, certification, or licensure: Some people are

simply gifted with their hands. Furthermore, a technique that works for one

person may not work for another. For these reasons, some trial and error is

often necessary to find the best massage therapist for you.

Safety Issues Although massage is generally safe, it can sometimes

exacerbate pain temporarily, even when properly performed. In addition, if

massage is performed too forcefully on fragile people, bone fractures and other

internal injuries are possible. However, licensed massage therapists have been

trained in ways to avoid causing these problems. Machines designed to perform

elements of massage may be less safe.

RESOURCES:

American Massage Therapy Association

http://www.amtamassage.org

Sources:

Birk TJ, McGrady A, MacArthur RD, et al. The effects of massage therapy alone

and in combination with other complementary therapies on immune system measures

and quality of life in human immunodeficiency virus. J Altern Complement Med.

2000;6:405–414.

Brattberg G. Connective tissue massage in the treatment of fibromyalgia. Eur J

Pain. 1999;3:235–244.

Brosseau L, Casimiro L, Milne S, et al. Deep transverse friction massage for

treating tendinitis. Cochrane Database Syst Rev. 2002;(1):CD003528.

Chang MY, Wang SY, Chen CH. Effects of massage on pain and anxiety during

labour: a randomized controlled trial in Taiwan. J Adv Nurs. 2002;38:68–73.

Cherkin DC, Eisenberg D, Sherman KJ, et al. Randomized trial comparing

traditional Chinese medical acupuncture, therapeutic massage, and self-care

education for chronic low back pain. Arch Intern Med. 2001;161:1081–1088.

Diego MA, Field T, Hernandez-Reif M, et al. HIV adolescents show improved

immune function following massage therapy. Int J Neurosci. 2001;106:35–45.

Diego MA, Field T, Hernandez-Reif M, et al. Spinal cord patients benefit from

massage therapy. Int J Neurosci. 2002;112:133–142.

Eliott MA, Taylor LP. " Shiatsu sympathectomy " : ICA dissection associated with

a shiatsu massager. Neurology. 2002;58:1302 1304.

Field T, Henteleff T, Hernandez-Reif M, et al. Children with asthma have

improved pulmonary functions after massage therapy. J Pediatr. 1998;132:854–858.

Field T, Hernandez-Reif M, Hart S, et al. Pregnant women benefit from massage

therapy. J Psychosom Obstet Gynaecol. 1999;20:31–38.

Field T, Hernandez-Reif M, LaGreca A, et al. Massage therapy lowers blood

glucose levels in children with Diabetes Mellitus. Diabetes Spectrum.

1997;10:237–239.

Field T, Hernandez-Reif M, Seligman S, et al. Juvenile rheumatoid arthritis:

benefits from massage therapy. J Pediatr Psychol. 1997;22:607–617.

Field T, Hernandez-Reif M, Taylor S, et al. Labor pain is reduced by massage

therapy. J Psychosom Obstet Gynaecol. 1997;18:286–291.

Field T, Lasko D, Mundy P, et al. Brief report: autistic children's

attentiveness and responsivity improve after touch therapy. J Autism Dev Disord.

1997;27:333–338.

Field T, Morrow C, Valdeon C, et al. Massage reduces anxiety in child and

adolescent psychiatric patients. Am Acad Child Adolesc Psychiatry.

1992;31:125–131.

Field T, Peck M, Krugman S, et al. Burn injuries benefit from massage therapy.

J Burn Care Rehabil. 1998;19:241–244.

Field T, Schanberg S, Kuhn C, et al. Bulimic adolescents benefit from massage

therapy. Adolescence. 1998;33:555–563.

Field TM, Quintino O, Hernandez-Reif M, et al. Adolescents with attention

deficit hyperactivity disorder benefit from massage therapy. Adolescence.

1998;33:103–108.

Franke A, Gebauer S, Franke K, et al. Acupuncture massage vs Swedish massage

and individual exercise vs group exercise in low back pain sufferers—a

randomized controlled clinical trial in a 2 x 2 factorial design [in German;

English abstract]. Forsch Komplementarmed Klass Naturheilkd. 2000;7:286–293.

Furlan AD, Brosseau L, Imamura M, et al. Massage for Low-back Pain: A

Systematic Review within the Framework of the Cochrane Collaboration Back Review

Group. Spine. 2002;27:1896–1910.

Hart S, Field T, Hernandez-Reif M, et al. Anorexia nervosa symptoms are

reduced by massage therapy. Eating Disorders: Journal of Treatment and

Prevention. 2001;9:217–228.

Hernandez-Reif M, Deiter J, Field T, et al. Migraine headaches are reduced by

massage therapy. Int J Neurosci. 1998;96:1–11.

Hernandez-Reif M, Feld T, Hart S. Smoking cravings are reduced by

self-massage. Prev Med. 1999;28:28–32.

Hernandez-Reif M, Field T, Krasnegor J, et al. Children with cystic fibrosis

benefit from massage therapy. J Pediatr Psychol. 1999;24:175–181.

Hernandez-Reif M, Martinez A, Field T, et al. Premenstrual symptoms are

relieved by massage therapy. J Psychosom Obstet Gynaecol. 2000;21:9–15.

Irnich D, Behrens N, Molzen H, et al. Randomised trial of acupuncture compared

with conventional massage and sham laser acupuncture for treatment of chronic

neck pain. BMJ. 2001;322:1–6.

Ironson G, Field T, Scafidi F, et al. Massage therapy is associated with

enhancement of the immune system's cytotoxic capacity. Int J Neurosci.

1996;84:205–217.

Offenbacher M, Stucki G. Physical therapy in the treatment of fibromyalgia.

Scand J Rheumatol Suppl. 2000;113:78–85.

Oleson T, Flocco W. Randomized controlled study of premenstrual symptoms

treated with ear, hand, and foot reflexology. Obstet Gynecol. 1993;82:906–911.

Preyde M. Effectiveness of massage therapy for subacute low-back pain: a

randomized controlled trial. CMAJ. 2000;162:1815–1820.

Schachner L, Field T, Hernandez-Reif M, et al. Atopic dermatitis symptoms

decreased in children following massage therapy. Pediatr Dermatol.

1998;15:390–395.

Smith WA. Fibromyalgia syndrome. Nurs Clin North Am. 1998;33:653–669.

Sunshine W, Field T, Quintino O, et al. Fibromyalgia benefits from massage

therapy and transcutaneous electrical stimulation. J Clin Rheumatol.

1996;2:18–22.

Vickers A. Yes, but how do we know it's true? Knowledge claims in massage and

aromatherapy. Complement Ther Nurs Midwifery. 1997;3:63–65.

Food fight? Enjoy some healthy debate

in the Answers Food & Drink Q & A.

April 5, 2007

Hi Twylahooda,

You or Steven Bratman, MD, may have seen some different results in

therapies between massage therapists and acupuncturists in low back

back pain. But I had been working with several massage therapists and

also with deep tissue massage therapists for more than 5 years.

Everything has its own benefits. I have worked on several low back

pains and neck pains with difficult and chronic cases. They came out

with unbelievable " magic " instant effects. However, I do not know

how much effective for low back pains result comparing between deep

tissue therapy and acupuncture therapy.

I have given some respects to massage therapists if they work on

people with physical stress and tenses, but I have not seen a long

term effects ( it may be depended on the experts ). I have seen some

cases of chiropractic therapy are much better than massage therapy.

But there are cases of low back pain caused by hormones deficiency,

muscle weakness or tense, sciatica, immune disorders such as

arthritis, osteoarthritis, lupus, MS, inflammation of tissues, pinched

nerves, slipped discs or protruded discs, I think acupuncture therapy

are much more in advance. Acupuncture therapy is not only using

needles, but with moxa, cupping, rubbing, and also with herbal therapy.

I do not care who or which is better. I think the best result is

within the therapists themselves if they know what they are doing and

know when to refer their patients to a proper healthcare professional.

Chinese Medicine , Twyla

<twylahoodah wrote:

>

> Massage Therapy by Steven Bratman, MD

>

> Along with herbal treatment, touch-based therapy is undoubtedly

one of the most ancient forms of medical care. We instinctively stroke

and rub areas of our body that hurt; massage therapy develops this

instinct into a professional treatment.

> Forms of Massage There are many schools of massage. In most

cases, massage therapists combine several techniques, although there

are also purists who stick to one method. The most common technique is

Swedish massage, which combines long strokes and gentle kneading

movements that primarily affect surface muscle tissues. Deep-tissue

massage utilizes greater pressure to reach deeper levels of muscles.

This may be called the " hurts-good-and-feels-great-after " approach.

Shiatsu or acupressure massage also use deep pressure, but they do so

according to the principles of acupuncture theory, which differ

markedly from those of Western-oriented massage therapies.

Neuromuscular massage (such as the St. John Method of Neuromuscular

Therapy) applies strong pressure to tender spots, technically known as

trigger points.

>

> How Strong is the Scientific Evidence for Massage Therapy?

Although there is some evidence that massage may be helpful for

various medical purposes, in general the evidence is not strong. There

are several reasons for this (including funding limitations), but the

most fundamental is that even with the best of intentions, it is

difficult to properly ascertain the effectiveness of a hands-on

therapy like massage.

> Only one form of study can truly prove that a treatment is

effective: the double-blind, placebo-controlled trial. In such a

study, some participants receive a real treatment, others receive a

placebo treatment and neither the participants nor the researchers

know which is which.

> However, it is difficult—some would argue even impossible—to fit

massage into a study design of this type. What could researchers use

for placebo massage? And how could they make sure that both

participants and practitioners would be kept in the dark regarding who

was receiving real massage and who was receiving placebo massage?

> Because of these problems, all studies of massage fall short of

optimum design. Many researchers have designed studies that compare

massage to no treatment. However, studies of this type cannot provide

reliable evidence about the efficacy of a treatment. If a benefit is

seen, there is no way to determine whether it was caused by massage

specifically, or just attention generally. (Attention alone will

almost always produce some reported benefit.)

> More meaningful trials used some sort of placebo treatment for the

control group, referred to as " sham " massage. However, using a placebo

treatment that is very different in form from the treatment under

study is less than ideal.

> Still other studies have simply involved giving people massages

and seeing whether they improved. These trials are particularly

meaningless; it is well known that if a treatment of any kind is

given, both the participants and the examining physicians will think

they have observed an improvement, regardless of whether or not the

treatment does anything on its own.

> Given these caveats, below is a summary of what is known about the

effects of massage. The best evidence regards low back pain.

>

> Massage for Low Back Pain Although the evidence is far from

complete, it does appear that massage may offer benefits for low back

pain. However, these benefits appear to be short term.

> One of the more recent studies compared massage to sham laser

therapy in 107 people with low-back pain. The results indicated that

massage is more effective than laser therapy for relieving low back

pain, and that massage therapy combined with exercise and posture

training is even more effective.

> Another study compared acupuncture, massage, and self-care

education in 262 people with persistent back pain. By the end of the

10-week treatment period, massage had shown itself more effective than

self-care (or acupuncture). However, at a one-year follow-up, there

was no difference in symptoms between the massage group and the

self-care group.

> In another study, acupressure-style massage was more effective

than Swedish massage for the treatment of low back pain.

>

> Other Potential Uses of Massage Other preliminary controlled

trials of varying quality hint that massage may provide benefit in a

number of other conditions, including the following:

> Attention deficit disorder (ADD)

> Anorexia nervosa

> Asthma in children

> Autism

> Bulimia

> Cystic fibrosis

> Depression and anxiety in children

> Diabetes

> Eczema

> Fibromyalgia

> HIV

> Iliotibial band pain (a form of tendonitis that can cause knee or

hip pain)

> Juvenile rheumatoid arthritis

> Migraine headaches

> Pregnancy and childbirth

> Quitting smoking

> Spinal cord injury

>

> How to Choose a Massage Therapist As with all medical

therapies, it is best to choose a licensed practitioner. Where

licensure is not available, your best bet is to seek a referral from a

qualified and knowledgeable medical practitioner. However, most U.S.

states license massage therapists.

> Note that massage, like other hands-on therapies, involves

personal talents that go beyond specific training, certification, or

licensure: Some people are simply gifted with their hands.

Furthermore, a technique that works for one person may not work for

another. For these reasons, some trial and error is often necessary to

find the best massage therapist for you.

>

> Safety Issues Although massage is generally safe, it can

sometimes exacerbate pain temporarily, even when properly performed.

In addition, if massage is performed too forcefully on fragile people,

bone fractures and other internal injuries are possible. However,

licensed massage therapists have been trained in ways to avoid causing

these problems. Machines designed to perform elements of massage may

be less safe.

>

> RESOURCES:

> American Massage Therapy Association

> http://www.amtamassage.org

>

> Sources:

> Birk TJ, McGrady A, MacArthur RD, et al. The effects of massage

therapy alone and in combination with other complementary therapies on

immune system measures and quality of life in human immunodeficiency

virus. J Altern Complement Med. 2000;6:405–414.

> Brattberg G. Connective tissue massage in the treatment of

fibromyalgia. Eur J Pain. 1999;3:235–244.

> Brosseau L, Casimiro L, Milne S, et al. Deep transverse friction

massage for treating tendinitis. Cochrane Database Syst Rev.

2002;(1):CD003528.

> Chang MY, Wang SY, Chen CH. Effects of massage on pain and anxiety

during labour: a randomized controlled trial in Taiwan. J Adv Nurs.

2002;38:68–73.

> Cherkin DC, Eisenberg D, Sherman KJ, et al. Randomized trial

comparing traditional Chinese medical acupuncture, therapeutic

massage, and self-care education for chronic low back pain. Arch

Intern Med. 2001;161:1081–1088.

> Diego MA, Field T, Hernandez-Reif M, et al. HIV adolescents show

improved immune function following massage therapy. Int J Neurosci.

2001;106:35–45.

> Diego MA, Field T, Hernandez-Reif M, et al. Spinal cord patients

benefit from massage therapy. Int J Neurosci. 2002;112:133–142.

> Eliott MA, Taylor LP. " Shiatsu sympathectomy " : ICA dissection

associated with a shiatsu massager. Neurology. 2002;58:1302 1304.

> Field T, Henteleff T, Hernandez-Reif M, et al. Children with

asthma have improved pulmonary functions after massage therapy. J

Pediatr. 1998;132:854–858.

> Field T, Hernandez-Reif M, Hart S, et al. Pregnant women benefit

from massage therapy. J Psychosom Obstet Gynaecol. 1999;20:31–38.

> Field T, Hernandez-Reif M, LaGreca A, et al. Massage therapy

lowers blood glucose levels in children with Diabetes Mellitus.

Diabetes Spectrum. 1997;10:237–239.

> Field T, Hernandez-Reif M, Seligman S, et al. Juvenile rheumatoid

arthritis: benefits from massage therapy. J Pediatr Psychol.

1997;22:607–617.

> Field T, Hernandez-Reif M, Taylor S, et al. Labor pain is reduced

by massage therapy. J Psychosom Obstet Gynaecol. 1997;18:286–291.

> Field T, Lasko D, Mundy P, et al. Brief report: autistic

children's attentiveness and responsivity improve after touch therapy.

J Autism Dev Disord. 1997;27:333–338.

> Field T, Morrow C, Valdeon C, et al. Massage reduces anxiety in

child and adolescent psychiatric patients. Am Acad Child Adolesc

Psychiatry. 1992;31:125–131.

> Field T, Peck M, Krugman S, et al. Burn injuries benefit from

massage therapy. J Burn Care Rehabil. 1998;19:241–244.

> Field T, Schanberg S, Kuhn C, et al. Bulimic adolescents benefit

from massage therapy. Adolescence. 1998;33:555–563.

> Field TM, Quintino O, Hernandez-Reif M, et al. Adolescents with

attention deficit hyperactivity disorder benefit from massage therapy.

Adolescence. 1998;33:103–108.

> Franke A, Gebauer S, Franke K, et al. Acupuncture massage vs

Swedish massage and individual exercise vs group exercise in low back

pain sufferers—a randomized controlled clinical trial in a 2 x 2

factorial design [in German; English abstract]. Forsch Komplementarmed

Klass Naturheilkd. 2000;7:286–293.

> Furlan AD, Brosseau L, Imamura M, et al. Massage for Low-back

Pain: A Systematic Review within the Framework of the Cochrane

Collaboration Back Review Group. Spine. 2002;27:1896–1910.

> Hart S, Field T, Hernandez-Reif M, et al. Anorexia nervosa

symptoms are reduced by massage therapy. Eating Disorders: Journal of

Treatment and Prevention. 2001;9:217–228.

> Hernandez-Reif M, Deiter J, Field T, et al. Migraine headaches are

reduced by massage therapy. Int J Neurosci. 1998;96:1–11.

> Hernandez-Reif M, Feld T, Hart S. Smoking cravings are reduced by

self-massage. Prev Med. 1999;28:28–32.

> Hernandez-Reif M, Field T, Krasnegor J, et al. Children with

cystic fibrosis benefit from massage therapy. J Pediatr Psychol.

1999;24:175–181.

> Hernandez-Reif M, Martinez A, Field T, et al. Premenstrual

symptoms are relieved by massage therapy. J Psychosom Obstet Gynaecol.

2000;21:9–15.

> Irnich D, Behrens N, Molzen H, et al. Randomised trial of

acupuncture compared with conventional massage and sham laser

acupuncture for treatment of chronic neck pain. BMJ. 2001;322:1–6.

> Ironson G, Field T, Scafidi F, et al. Massage therapy is

associated with enhancement of the immune system's cytotoxic capacity.

Int J Neurosci. 1996;84:205–217.

> Offenbacher M, Stucki G. Physical therapy in the treatment of

fibromyalgia. Scand J Rheumatol Suppl. 2000;113:78–85.

> Oleson T, Flocco W. Randomized controlled study of premenstrual

symptoms treated with ear, hand, and foot reflexology. Obstet Gynecol.

1993;82:906–911.

> Preyde M. Effectiveness of massage therapy for subacute low-back

pain: a randomized controlled trial. CMAJ. 2000;162:1815–1820.

> Schachner L, Field T, Hernandez-Reif M, et al. Atopic dermatitis

symptoms decreased in children following massage therapy. Pediatr

Dermatol. 1998;15:390–395.

> Smith WA. Fibromyalgia syndrome. Nurs Clin North Am. 1998;33:653–669.

> Sunshine W, Field T, Quintino O, et al. Fibromyalgia benefits from

massage therapy and transcutaneous electrical stimulation. J Clin

Rheumatol. 1996;2:18–22.

> Vickers A. Yes, but how do we know it's true? Knowledge claims in

massage and aromatherapy. Complement Ther Nurs Midwifery. 1997;3:63–65.

>

> Food fight? Enjoy some healthy debate

> in the Answers Food & Drink Q & A.

>

April 5, 2007

Why is it an either/or? They all have their benefits. The massage therapists

loosens it all up and relaxes the muscles, the chiropractor puts it all

where it goes and the acupuncture stabilizes and strengthens the body, etc

to make everything work better. If you put all three together for nearly any

condition, the results are amazing. Throw a good exercise and nutrition

program in mix and it gets even better.

Lee Tritt, AP, OMD, Dipl. Ac.(NCCAOM)

321-961-6432

A LITTLE " NEEDLING " NEVER HURT ANYONE

Chinese Medicine