Sep
5
2023

Massage for lower back pain

Research confirms that some forms of massage help against low-back pain
But not all techniques live up to the promises made for them

Most people have experienced back pain – and many hope that massage will relieve it. But not all forms of massage have been scientifically proven to help against low back pain. That is what the German Institute for Quality and Efficiency in Health Care (IQWiG) pointed out in information published on informedhealthonline.org today.
Back pain often affects the lower back and can be a big physical and psychological burden. “The cause of back pain is not always immediately clear,” explains Professor Peter Sawicki, the Institute’s Director. “But low back pain usually gets better on its own within a few weeks.” Back pain is only rarely caused by a more serious health problem.

Classic massage, Thai massage and acupressure could help against low back pain
If low back pain does not get better on its own, massage therapy could be a worthwhile option. “Research suggests that classic massage, Thai massage and acupressure can relieve low back pain that has lasted longer than several weeks,” says the Institute’s Director. In classic (Swedish) massage the affected area of skin and muscles are massaged, in Thai massage the limbs are pulled and stretched, and acupressure involves applying pressure to certain points on the body. “But relying on massage alone does not appear to be the best approach when it comes to back pain”, adds Sawicki. Research indicates that people could benefit more if they combine massages with exercises and stretching. In some trials this combination of approaches led to better pain relief and mobility compared to massage alone.

Not all massages are the same
“Not all forms of massage have been scientifically proven to help against chronic back pain though,” concludes Sawicki. “So it is worth finding out about the different techniques before deciding to have a certain type of massage.” An overview of the most common forms of massage is now available on http://informedhealthonline.org/low-back-pain-can-massage-help.630.en.html

The researchers pointed out that the main goal of massage therapy can be very different. For example, some therapists are aiming to help the person (and their muscles) relax, while others are more focused on stretching or working on the body in other ways. Although the trials studied various massage techniques, there were not enough comparisons of treatments to show which forms of massage might be the most worthwhile for people with different problems.

Many of the treatments had mixtures of several elements – like massage oils, stretching, and more than one type of massage technique. The researchers concluded that acupressure (by hand or using an instrument to apply the pressure) may be particularly effective, but more research is needed to be sure. Based on the small amount of research so far, it seems that Thai massage achieves similar results to classic massage techniques. However, foot reflexology massage does not appear to relieve back pain or improve mobility. The people in the trials did not have any serious adverse effects. Some reported having pain during or shortly after treatment. And some had an allergic reaction to a massage oil and got a rash.

Sep
5
2023

Trigger Points & Acupuncture

Acupuncture and myofascial trigger points therapy each focus on hundreds of similar points on the body to treat pain, although they do it differently, says a physician at Mayo Clinic in Jacksonville who analyzed the two techniques.

Results of the study, published May 10 in the Journal of Complementary and Alternative Medicine, suggest that people who want relief from chronic musculoskeletal pain may benefit from either therapy, says chronic pain specialist Dr. Peter Dorsher of the Department of Physical Medicine and Rehabilitation at Mayo Clinic.

“This may come as a surprise to those who perform the two different techniques, because the notion has been that these are exclusive therapies separated by thousands of years,” he says. “But this study shows that in the treatment of pain disorders, acupuncture and myofascial techniques are fundamentally similar – and this is good news for anyone looking for relief.”

Classic Chinese acupuncture treats pain and a variety of health disorders using fine needles to “reset” nerve transmission, Dorsher says. Needles are inserted in one or several of 361 classical acupoints to target specific organs or pain problems. “This is a very safe and effective technique,” he says.

Myofascial trigger-point therapy, which has evolved since the mid-1800s, focuses on tender muscle or “trigger point” regions. There are about 255 such regions described by the Trigger Point Manual, the seminal textbook on myofascial pain. These are believed to be sensitive and painful areas of muscle and fascia, the web of soft tissue that surrounds muscle, bones, organs and other body structures. To relieve pain at these trigger points, practitioners use injections, deep pressure, massage, mechanical vibration, electrical stimulation and stretching, among other techniques.

In the study, Dorsher analyzed studies published on both techniques and demonstrated that acupuncture points and trigger points are anatomically and clinically similar in their uses for treatment of pain disorders.

In another recent study, he found that at least 92 percent of common trigger points anatomically corresponded with acupoints, and that their clinical correspondence in treating pain was more than 95 percent. “That means that the classical acupoint was in the same body region as the trigger point, was used for the same type of pain problem, and the trigger point referred pain pattern followed the meridian pathway of that acupoint described by the Chinese more than 2,000 years before,” Dorsher says. Myofascial pain therapy has lately incorporated the use of acupuncture needles in a treatment called “dry needling” to treat muscle trigger points.

“I think it is fair to say that the myofascial pain tradition represents an independent rediscovery of the healing principles of traditional Chinese medicine,” Dorsher says. “What likely unites these two disciplines is the nervous system, which transmits pain.”

Mayo Clinic (2008, May 14). Acupuncture And Myofascial Trigger Therapy Treat Same Pain

Sep
5
2023

Abstract from the Taks Force on neck pain paper

Here is the absctact from the article in Spine.

Clinical practice implications of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders: from concepts and findings to recommendations.

Based on best evidence syntheses of published studies on the risk, prognosis, assessment, and management of people with neck pain and its associated disorders, plus additional research projects and focused literature reviews reported in this supplement, the 12-member multidisciplinary Scientific Secretariat of the Neck Pain Task Force followed a 4-step approach to develop practical guidance for clinicians.

The Neck Pain Task Force recommends that people seeking care for neck pain should be triaged into 4 groups:
Grade I neck pain with no signs of major pathology and no or little interference with daily activities;
Grade II neck pain with no signs of major pathology, but interference with daily activities;
Grade III neck pain with neurologic signs of nerve compression;
Grade IV neck pain with signs of major pathology.

In the emergency room after blunt trauma to the neck, triage should be based on the NEXUS criteria or the Canadian C-spine rule. Those with a high risk of fracture should be further investigated with plain radiographs and/or CT-scan. In ambulatory primary care, triage should be based on history and physical examination alone, including screening for red flags and neurologic examination for signs of radiculopathy.

Exercises and mobilization have been shown to provide some degree of short-term relief of Grade I or Grade II neck pain after a motor vehicle collision. Exercises, mobilization, manipulation, analgesics, acupuncture, and low-level laser have been shown to provide some degree of short-term relief of Grade I or Grade II neck pain without trauma.

Those with confirmed Grade III and severe persistent radicular symptoms might benefit from corticosteroid injections or surgery. Those with confirmed Grade IV neck pain require management specific to the diagnosed pathology.

CONCLUSION: The best available evidence suggests initial assessment for neck pain should focus on triage into 4 grades, and those with common neck pain (Grade I and Grade II) might be offered the listed noninvasive treatments if short-term relief is desired.

http://www.ncbi.nlm.nih.gov/pubmed/18204393?dopt=Abstract