Introduction

Therapeutic massage can be used to relieve some types of back pain. Back pain is a common problem affecting around half of adults in a given year with a large range of causes producing different types of pain.¹ Lower back pain is particularly common, affecting up to 80% of people throughout their lifetime.²

What is massage therapy?

Massage involves the application of pressure, rubbing, stroking or kneading into the soft tissues of the body from the head, through to the neck, back, limbs to the feet, and is most commonly applied via hands, fingers, forearms and elbows although sometimes feet and massage tools are used.

The purpose and benefits of massage 

Massage has several functional effects that are part of aiding recovery and pain relief in conditions associated with back pain.¹⁵

These include: 

• Massage improves circulation, which supports healing and muscle repair as it stimulates blood flow to the muscles and tissues of the back¹⁰
• Massage helps with relaxation and stress reduction, releasing tension in the back, shoulders and neck. It promotes the release of endorphins, dopamine and serotonin which contribute to a feeling of wellbeing and calm^3,8
• Massage has also been found to increase oxytocin, a hormone linked to social bonding, whilst reducing stress hormones such as ACTH^4,9
• Regular back massages can help loosen tight muscles and improve flexibility, which can be beneficial for those who suffer from stiffness or a limited range of motion¹¹
• Massage also assists with maintaining appropriate posture, because releasing tension in muscles helps to correct postural imbalances

The origins of massage

There are many forms of massage practised throughout the globe. The origins of massage can be traced back to 3000 BC in India - when massage therapy started being used to treat injury and prevent illness as part of Ayurveda or ‘life health’ medicine in Hindu culture. 

Many other cultures have a long history of using massage, such as ancient traditional Chinese medicine (TCM) with Tui Na massage, and Native American tribal cultures who use massage along with heat, oils and herbs to treat pain, indigestion, and pregnancy-related discomfort.¹³

Massage techniques

Effleurage (French for skimming), is a light friction massage technique involving long, stroking motions using the fingers or a flattened hand. This may be used at the beginning of a massage session, helping to increase blood flow as well as lymph flow, thus promoting healing.

Another key technique is petrissage (French for kneading), which involves pushing into the soft tissues and releasing like when kneading dough to make bread. Muscle tissue is lifted, compressed, and released. There are variations:

• Knuckling is a variation of petrissage/kneading but with use of the knuckles in circular movements
• Scissoring is another subtype of petrissage, involving just the index and middle fingers with lower pressure into the soft tissues of the back

Cupping is a massage technique using suction cups to create a vacuum, reducing tension in the muscles and skin, and promoting healing through enhancing circulation.

Vibration therapy utilises a vibration device to relieve tight muscles and reduce back pain. The muscles will be loosened and warmed, increasing circulation and gradually inducing relaxation.

Types of massage and their impact on back pain

Swedish massage

Swedish massage is a common rehabilitative massage, which is superficial (rather than deep) and primarily involves stroking movements. Massage can be traced back to a 19th-century Swedish fencer who developed ‘medical gymnastics’, but it was actually a Dutch doctor, Johann Georg Mezger, who practised massage stroking techniques on injured patients in the 1860s and developed the system of five Swedish massage techniques.⁵

A number of studies have shown Swedish massage to be an effective complementary therapy for chronic lower back pain, particularly for producing pain relief, and some degree of functional improvement.^6,14

Deep tissue massage

Deep tissue massage uses deep pressure to relax, extend and realign the soft tissues of the back. A combination of strokes and high pressure from fingers are used to release muscle tension and it can therefore improve back postural muscle functioning and thus posture. 

In randomised single-blind controlled trials, deep tissue massage was found to be as effective at treating chronic lower back pain on its own, as deep massage plus non-steroidal anti-inflammatory drugs (NSAIDS) together. Patients receiving both deep tissue massage and NSAIDS had only a similar reduction in pain as deep tissue massage alone.⁷ 

Sports massage

Sports massage combines techniques such as stretching, deep tissue massage, and joint mobilisation, to help with soreness or injury arising from sports. As well as treating pain, including back pain, sports massage may also be used to help prevent injury. 

Issues such as tight muscles, inflammation or soft tissue damage will be specifically targeted, promoting relaxation, healing, flexibility and correct movement.¹⁶

Thai massage

Thai massage focuses on health and the prevention of illness with an emphasis on promoting longevity. Muscles are passively stretched and elongated, to increase mobility in the spine, surrounding muscles in the torso, and limbs. 

Various techniques aim to reduce stiffness, increase flexibility and stimulate blood flow to reduce back pain and aid natural healing. Thai massage also targets specific acupressure points, similar to traditional Chinese practices.

It is a holistic approach aiming to address stress as well as physical causes of pain and has been shown to be effective for short-term reduction of pain and disability in patients with chronic non-specific lower back pain.¹⁷

Trigger point therapy

Trigger point therapy (TPT) targets muscle knots and tightness, to soften and elongate tissues in the back and reduce pain. It incorporates a range of specific techniques such as manual pressure release, strain counter strain, and integrated neuromuscular inhibition to manage back pain. Fingers, foam rollers or balls may be used to provide manual pressure release to a specific painful point in the soft tissue. 

Strain counter strain is also known as positional release technique, which has the aim of alleviating chronic muscle spasms by manually pushing muscles into comfortable, less painful positions. Integrated neuromuscular inhibition realigns muscles with the use of compression to relieve pain and tension.¹⁸

Hot stone massage

Hot stone massage is a therapeutic technique that involves integrating the use of heated stones placed on the back into a massage session, with the key function of relieving muscle tension and allowing relaxation of the tissues of the back.²⁰

Aromatherapy massage

This technique combines aromatherapy with massage, using essential oils such as lavender which promote relaxation. Essential oils – diluted in a carrier oil such as almond oil – may be applied topically to the skin, used on their own in a diffuser for inhalation, or both. Studies have indicated that aromatherapy helps reduce pain and muscle tension as well as being helpful for conditions such as depression and anxiety.¹⁹

Causes of back pain 

Muscular

Often back pain is related to tight or strained (injured) muscles around the spine, which may often occur following exercise, after participation in sports activities or after repetitive overuse actions. Muscular back pain usually causes soreness and aches rather than tingles or electric shocks. Massage is effective at giving pain relief if the cause is muscular.^2,7,21

Slipped disc (herniated disc)

A slipped disc is a poor descriptive term because there is no slippage of anything. It occurs when the disc - a soft, gel-filled ‘cushion’ of tissue in between the vertebrae of the spine which acts like a ‘shock absorber’ - herniates (bulges out) between the vertebral bones. This is a common issue which can cause sharp pains in the back.

If the disc protrusion (bulge) irritates nerve roots which exit from the spinal cord between the vertebrae it can cause pain, tingling or numb sensations in the buttocks, legs and feet, problems with certain movements, and potentially subsequent muscle weakness. There is some evidence that certain massage therapies can assist recovery from a disc protrusion alongside physiotherapy and pain medication.^22,23

Sciatica 

Sciatica refers to nerve pain in the lower back, buttocks and gluteal area, which may radiate down the legs. This presents as a shooting or electric pain, often on just one side. It is a symptom which can arise from various causes that involve irritation of the spinal nerve roots. As these causes can include serious problems –such as spinal tumours, infections or inflammatory diseases – the benefits of massage will be limited by the cause. Alongside exercise, physiotherapy, pain medication, and the use of heat or ice, massage can be used to relieve sciatica-related pain.

Scoliosis

Scoliosis is a sideways curvature of the spine, which can be present from birth, or develop later due to a variety of causes, and results in very painful symptoms. Massage therapy may be used to release tension and improve muscle relaxation to ease scoliosis symptoms.²⁴

Degenerative disc disease 

Degenerative disc disease can produce age-related back pain, numbness and tingling. This back pain can sometimes be relieved through massage techniques.²⁵

When to seek medical attention

Urgent evaluation by a physician or emergency department and imaging is advised if there are symptoms of significant leg or arm weakness; numbness, tingling or loss of feeling in the rectal/genital area (including the perineum); loss of control of urine or stool (including the inability to urinate or defaecate); a history of metastatic cancer; a significant recent infection or fever combined with nerve root irritation ( including sciatica); or an injury that caused the pain. If there are signs of progressive neurologic deficit (such as progressive weakness) during assessment, imaging is also recommended in this instance.

Other treatments for back pain

• Pain medication: such as oral non-steroidal anti-inflammatory drugs (e.g. ibuprofen), or corticosteroid injections may be required to help patients live with back pain conditions
• Transcutaneous electrical nerve stimulation (TENS): uses electric current to relax muscles, reducing spasms and pain
• Chiropractic and Osteopathy: according to the UK National Institute for Clinical Health and Care Excellence (NICE) there is moderate evidence that in low back pain (with or without sciatica) spinal manipulation results in improvements in pain and function in the short term in comparison to either NSAIDs alone or self-management. It recommends use as part of a package which includes exercise
• Physiotherapy: is commonly prescribed to patients with back pain, to strengthen affected muscles, release tension, and support recovery. A recent meta-analysis ( a review of previous research) concluded that physiotherapy in a multidisciplinary approach is a most effective strategy to reduce pain and disability²⁶
• Surgery: such as spinal fusion, is sometimes recommended to correct causes of back pain such as vertebral collapse in osteoporosis, spinal cord compression (resulting from severe disc prolapse, tumour etc.), spondylolisthesis, and extreme scoliosis

FAQs

Is massage therapy good for back pain?

Research studies have shown that massage therapies are effective for treating back pain, typically alongside other treatments such as medication and physiotherapy. Pain is reduced with reduced muscle tension and healing is promoted by the increased circulation.^{2,6,7,14,16,17,18,19,21}

How do I know if my back pain is a disc or muscle?

Muscular back pain is more likely to feel ‘dull’ and aching, whilst skeletal issues and herniated discs may feel sharp, electric, or shooting, especially with spreading sensations into the limbs of tingling or pain. Both muscular and disc-related back pain can be eased with massage therapy.^2,7,21,22,23

Will massage therapy heal a ‘slipped’ (herniated) disc?

Massaging the soft tissues surrounding ‘slipped’ or herniated discs will not directly cure the problem but may relieve pain and muscle tension. As well as relieving the painful symptoms, massage therapy increases blood flow promoting tissue healing.^22,23

Summary

Back pain is an extremely common problem affecting adults, with numerous causes including muscular issues, nerve irritation, and herniated (‘slipped’) discs. Massage therapy has a long history as well as substantial clinical evidence to support its role as a complementary therapy to improve back pain in a number of clinical contexts. Common types are Swedish massage, which is light in pressure and superficial, deep tissue massage, which involves much heavier pressure, and sports massage which incorporates passive stretching carried out by the masseuse.