Lower Back Pain Treatment : Addressing Gaps in Non-Specific Diagnosis Care
Back Pain Affects Millions and Costs Billions
"Low back pain is the second most common cause of disability in US adults and a common reason for lost work days. An estimated 149 million days of work per year are lost due to LBP. The condition is also costly with total costs estimated to be between 100–200 billion dollars annually, two-thirds of which are due to decreased wages and productivity."
Non-specific back pain is defined as low back pain not attributable to a recognizable, known specific pathology. This mysterious, although real and present pain, has led 85% of people who report back pain to their doctors on a wild goose chase of various unsuccessful treatments, surgeries, and medications. Patients are faced with many options, some of which carry some hefty risks, up to and including surgery complications or opioid addictions, but very little direction. These known risks lead those suffering to seek out non-invasive, non-addictive treatments that have been anecdotally successful for others but have yet to be scientifically validated for the medical community.
One of these treatments, massage therapy, has been undergoing recent study, in an attempt to quantify pain relief outcomes. Two studies, which indicated positive results, have revealed the potential of massage therapy in mitigating lower back pain:
2011 NCCAM Study on Massage
National Center for Complementary and Alternative Medicine funded a study of 400 participants, some received no massage but were instructed to treat their pain as they usually would, some received full body Swedish massage once a week for ten weeks, and some received what was called "structural massage" with the intent of focusing only on the implicated tissues causing pain once a week for 10 weeks. Therapists received training on the specific protocols to be utilized along the posterior chain for the tissues implicated.
Key Findings Reported
"Daily functioning, for example, improved, on average, between 2 to 4 points on a 23-point scale. Average pain improved about 2 points on a 10-point scale."
"At the end of the 10-week intervention, 36% and 39% of patients in the massage groups said their pain was nearly or completely gone, compared to 4% in the usual care group."
Although, overall after 10 weeks, 62% to 65% of massage recipients and 38% of usual care recipients had clinically meaningful improvement, the benefits of massage decreased over time and were not statistically significant at 52 weeks".
Expert Analysis and Review
Fredrick P. Wilson, DO, director of the Cleveland Clinic Solon Center for Spine Health, in Ohio, reviewed the study for WebMD, "Certainly, it's not going to hurt," he says of massage therapy, "But it's a short-term improvement, and it's certainly not a fix." Wilson also said that it may be worth a try but should also be coupled with exercise, "When we see patients, we push them toward active exercise rather than passive natural therapy kind of a thing. If they can have stronger core strength to support their spine, they're going to be better off in the long run. So we're trying to fix, rather than ease, their pain."
Another reviewer of the study, Roger Chou, MD, an associate professor of medicine at Oregon Health and Science University, helped to write the 2009 American Pain Society guidelines for treating low back pain, as well as the study's researchers also agreed that exercise is likely to offer far greater benefits than massage for people who've been struggling with back pain for a long time. They stress that people shouldn't assume that massage alone will banish low back pain for good.
2017 SHRS Purdue University Study
In the second study, released in 2017, researchers at the School of Health and Rehabilitation Sciences at Indiana University-Purdue University Indianapolis performed a smaller study on 104 participants with lower back pain.
These participants were given what was a considered a "real world massage experience" that involved a referral from their primary care physician and received 10 massage sessions in 12 weeks. The massage therapists were instructed to tailor the therapy to each of the individual patient's needs.
Key Findings Reported
After the initial 12 weeks, of the 85 that completed the therapy protocols, 54.1% showed clinically meaningful improvement in their lower back pain.
At 24 weeks, of the 76 still participating in the full program, 75% retained clinically meaningful change. (The study did not follow the participants further than 24 weeks.)
Research and Analysis Challenges
Although this shows huge amounts of promise for massage therapy, it also highlights some of the challenges of validating massage, as a whole:
Replication of results will prove to be a challenge because efficacy of massage is largely based on the individual practitioner and their knowledge and ability to choose and perform correct techniques.
Different practitioners will have varying backgrounds in their education from state to state and even school to school. This makes it difficult to assess the real qualifications a therapist has to provide what would qualify as appropriate massage techniques for relieving lower back pain.
Massage therapists rely on SOAP notes, which, even in their best execution, do not give the full perspective of therapy performed. This presents a challenging task to expect perfect interpretation from one therapist to the next, assuming the next therapist is even trained in the techniques used initially.
Overcoming Challenges with Integrated Biomechanic Therapy
The adaptive therapy management system utilized by Integrated Biomechanic Therapy seeks to fill these gaps in massage in numerous ways:
IBT integrates scientifically justifiable orthopedic massage techniques, corrective exercises, and instructed self care.
Hypertonic tissues are relieved by way of specific, trackable orthopedic massage.
Specific, trackable corrective exercise and pre-established movement patterns are then introduced in order to strengthen hypotonic muscles.
The client is also instructed on specific, trackable self-care on both self-massage and exercises to maintain long term pain relief and improved mobility.
Non-specific back pain has an exorbitantly high cost both monetarily and from quality of life. We are seeing more and more that massage has a definite right to a place as an intervention for pain but is lacking in long term results.
Whether massage is paid for out of pocket or covered by insurance, it can be expensive for an option viewed only serving as a temporary relief and not a long term solution.
By integrating the corrective exercise and instructed self care components with orthopedic massage, IBT is able to relieve pain, provide strengthening and empower clients for long term maintenance with education and self care. Integrated Biomechanic Therapy will serve as a long term investment and stop the cause of non-specific pain, prior to escalation to diagnosable pathologies.
