July 5, 2011

The Cherkin Study on Massage and Low Back Pain

The NPR piece on this summarizes it nicely:
Researchers headed by epidemiologist Daniel Cherkin, a senior investigator at Group Health Research Institute in Seattle, enrolled 401 people with chronic low back pain and no identifiable reason for the pain.

Study participants were randomly assigned to one of three treatments. One group received full-body relaxation massage. A second received targeted deep tissue massage. The third group got the usual care — medication and physical therapy. . . .

After 10 weeks, the results were dramatic: Nearly two-thirds of the patients who received either type of weekly massage said their back pain was significantly improved or gone altogether. Only about one-third of patients receiving the usual care experienced similar relief.
This is a large, well conducted, and convincing study. It's a resounding win for massage: two thirds of people who got massage felt they had gotten a lot better at the end of the ten weeks, compared to one third of the people who got standard treatment. What's more, the added benefit of massage was still impressive at six months (after the patients were no longer receiving massage.) At a year, it had mostly fallen away, which probably means that massage is mostly treating symptoms, not curing anything. (Nothing wrong with treating symptoms, but it's as well to be clear. Neither the traditional treatment nor the massage was “fixing people's backs.” Mostly, low back pain just gets better.)

The big loser here is “deep tissue” massage, and advanced massage training generally. The authors of the study were actually worried that they might be stacking the deck in favor of the deep tissue therapists:
We believed that the study therapists might have provided treatment in a way that favored structural massage because that form of therapy requires more specialized training, but the apparent absence of a difference between massage types makes this possibility unlikely.
In other words, they conclude they didn't stack the deck because the deep tissue therapists didn't win. Another possibility is that the deck was stacked, and by coming out even, the deep tissue therapists showed that training actually makes you worse. Either way, it doesn't make me eager to sign up for a pricey CE course in deep tissue. The benefit of massage for low back pain could be due to a huge number of things, but one thing it's not likely to be due to is your skill in finding adhesions and grinding them away.

Of course, we don't really know exactly what the “relaxation” massage therapists were doing. I'm aware of that. People talk as if “relaxation massage” were some particular thing, but really it's just what we call massage that doesn't make any very specific or extravagant claims, and that usually backs off if something hurts. But whatever they did, it seems to have been just as effective as what the people with specific training did. And that should really make us question whether higher educational standards and more advanced training for massage therapists will do anything other than a) drive therapists who have difficulty absorbing this kind of training out of the business, and b) drive up the cost of massage, so that fewer people who need it can afford it.


  1. Or maybe it was the human touch itself that made the difference.


  2. Yes, it could be that simple.

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