Massage Therapy for Lower Back Pain

Therapeutic massage therapy is a complementary and alternative medicine (CAM) that involves the manipulation of the body's soft tissues through specialized hands-on movements. The purpose of therapeutic massage is to influence cellular changes in the soft tissues that promote healing, reduce pain, and enhance overall wellness.

In the lower back, massage therapy affects the muscular and skeletal systems at the superficial and deep layers to foster healing and reduce pain.¹Salvo SG. Massage Therapy: Principles and Practice. Fifth edition. Elsevier; 2016. In a study that included 104 participants with lower back pain, over 40% of the patients experienced long-term, meaningful improvements in their back pain and disability after a series of therapeutic massage treatments.²Elder WG, Munk N, Love MM, Bruckner GG, Stewart KE, Pearce K. Real-world massage therapy produces meaningful effectiveness signal for primary care patients with chronic low back pain: results of a repeated measures cohort study. Pain Medicine. 2017;18(7):1394-1405. doi:10.1093/pm/pnw347

This article provides a guide to the objectives and potential benefits of massage therapy in treating lower back pain.

How Massage Therapy Works

Massage techniques involve a combination of hands-on movements, such as kneading, stretching, compressing, and/or gliding that may range from light stroking to deep pressure.¹Salvo SG. Massage Therapy: Principles and Practice. Fifth edition. Elsevier; 2016.^,3Ghavami H, Shamsi SA, Abdollahpoor B, Radfar M, Khalkhali HR. Impact of hot stone massage therapy on sleep quality in patients on maintenance hemodialysis: A randomized controlled trial. J Res Med Sci. 2019;24:71. Published 2019 Aug 28. doi:10.4103/jrms.JRMS_734_18 Massage is typically combined with first line treatments, such as physical therapy or manual manipulation, and aims to reduce pain, increase physical activity, and improve the quality of life.

Goals of massage therapy

The effects of massage therapy can be physical and psychological. In the lower back, massage stimulates the blood vessels, collagen fibers, muscle and tendon tissue, and nerve cells and may produce one or more of the following changes¹Salvo SG. Massage Therapy: Principles and Practice. Fifth edition. Elsevier; 2016.:

• Reduce stiffness in the muscles and tendons
• Improve tissue elasticity and increase the range of motion of joints
• Decrease inflammation and swelling in the soft tissues
• Reduce scar tissue formation
• Influence blood flow in the muscles, which in turn promotes nutrient exchange and removal of toxins, decreasing pain

Massage also increases the levels of endorphins, serotonin, and dopamine: hormones that help decrease pain, regulate sleep and mood, and promote relaxation.¹Salvo SG. Massage Therapy: Principles and Practice. Fifth edition. Elsevier; 2016.

While patients typically opt for massage therapy as a personal choice, some primary care providers may refer their patients to a massage therapist for back pain management.

Common Types of Massages for Treating Lower Back Pain

Depending on the treatment goals, different types of massage therapies may be considered. Each massage type works on a different principle to manipulate the tissue and produce the desired effects. While some techniques use light pressure and strokes, others use heat or knead deeper to stimulate the inner layers of tissue. Professional massage therapists are trained in different types of techniques and may sometimes use a combination of techniques to deliver massage treatment.

Neuromuscular massage or trigger point therapy

Neuromuscular massage is a type of hands-on therapy that targets myofascial trigger points under the skin, which are hypothesized to be responsible for musculoskeletal pain. These trigger points are taut bands of muscle tissue that are highly sensitive and induce pain when stimulated.⁴Takamoto K, Bito I, Urakawa S, et al. Effects of compression at myofascial trigger points in patients with acute low back pain: A randomized controlled trial. EJP. 2015;19(8):1186-1196. doi:10.1002/ejp.694

• In treating lower back pain, the therapist identifies trigger points in the back, buttocks, and thigh. These bands are pressed firmly with the thumb, one at a time, for 30 seconds to 2 minutes. The intensity of the applied pressure is controlled for a bearable and comfortable experience. The sequence of compression is repeated several times on all the trigger points.⁴Takamoto K, Bito I, Urakawa S, et al. Effects of compression at myofascial trigger points in patients with acute low back pain: A randomized controlled trial. EJP. 2015;19(8):1186-1196. doi:10.1002/ejp.694
• Trigger point massage relieves tightness in muscle tissue(s) and loosens the fibers through sequential compression and relaxation. The release of tension within the muscle fibers encourages new blood flow, promoting healing.

Trigger point therapy may be beneficial in treating acute low back pain originating from muscle tissue.⁴Takamoto K, Bito I, Urakawa S, et al. Effects of compression at myofascial trigger points in patients with acute low back pain: A randomized controlled trial. EJP. 2015;19(8):1186-1196. doi:10.1002/ejp.694

Read more about Myofascial Therapy for the Treatment of Acute and Chronic Pain

Swedish massage

Swedish massage promotes relaxation in the soft tissues through repeated long strokes, kneading, and elongating techniques that encourage blood circulation, loosen the tissues, and remove stiffness.⁵Stone VJ. The World’s Best Massage Techniques: The Complete Illustrated Guide ; Innovative Bodywork Practices from around the Globe for Pleasure, Relaxation, and Pain Relief. Fair Winds Press; 2010.

• For lower back pain, the patient lies face-down, and the therapist pays attention to the back muscles, hamstrings, and calf muscles. The health of the hamstrings and calf muscles play important roles in promoting back strength and lengthening these muscle groups can help improve lower back pain.
• Swedish massage may help reduce scar tissue formation, modify muscle tone, and increase muscle length and flexibility.⁵Stone VJ. The World’s Best Massage Techniques: The Complete Illustrated Guide ; Innovative Bodywork Practices from around the Globe for Pleasure, Relaxation, and Pain Relief. Fair Winds Press; 2010.
• This massage is also known to reduce inflammation and emotional stress, and enhance overall wellness.⁵Stone VJ. The World’s Best Massage Techniques: The Complete Illustrated Guide ; Innovative Bodywork Practices from around the Globe for Pleasure, Relaxation, and Pain Relief. Fair Winds Press; 2010.

Swedish massage may help treat chronic back pain originating in the lumbosacral area (L5-S1 spinal segment).⁶Netchanok S, Wendy M, Marie C, Siobhan O. The effectiveness of Swedish massage and traditional Thai massage in treating chronic low back pain: A review of the literature. Complementary Therapies in Clinical Practice. 2012;18(4):227-234. doi:10.1016/j.ctcp.2012.07.001^,7Boguszewski D, Krupiński M, Białoszewski D. Assessment of the effect of swedish massage and acupressure in rehabilitation of patients with low back pain. Preliminary report. Ortopedia Traumatologia Rehabilitacja. 2017;19(6):513-521. doi:10.5604/01.3001.0010.8042

Hot stone massage

A hot stone massage is a type of relaxation and healing therapy that involves placing heated basalt stones at specific locations on the body or moving them on the skin. The stones are heated by placing them in hot water.⁵Stone VJ. The World’s Best Massage Techniques: The Complete Illustrated Guide ; Innovative Bodywork Practices from around the Globe for Pleasure, Relaxation, and Pain Relief. Fair Winds Press; 2010.

• For back pain, the patient lies face down, and heated stones are placed in two rows on either side of the spine, followed by a large hot stone on the sacrum (above the buttock). The number of stones used is based on the therapist’s discretion. The back of each thigh, leg, and foot is then massaged with a heated stone lubricated with massage oil.⁵Stone VJ. The World’s Best Massage Techniques: The Complete Illustrated Guide ; Innovative Bodywork Practices from around the Globe for Pleasure, Relaxation, and Pain Relief. Fair Winds Press; 2010.
• The heat from the stones promotes muscle and soft tissue relaxation and reduces muscle cramps and spasms.⁵Stone VJ. The World’s Best Massage Techniques: The Complete Illustrated Guide ; Innovative Bodywork Practices from around the Globe for Pleasure, Relaxation, and Pain Relief. Fair Winds Press; 2010.
• Heat therapy from the stones also improves blood flow, increases oxygen in the cells, and helps release toxins.⁵Stone VJ. The World’s Best Massage Techniques: The Complete Illustrated Guide ; Innovative Bodywork Practices from around the Globe for Pleasure, Relaxation, and Pain Relief. Fair Winds Press; 2010.

Hot stone massage may help loosen tight connective tissues and treat back pain from muscle strains and ligament sprains.⁵Stone VJ. The World’s Best Massage Techniques: The Complete Illustrated Guide ; Innovative Bodywork Practices from around the Globe for Pleasure, Relaxation, and Pain Relief. Fair Winds Press; 2010.

Yoga massage

Also known as Thai yoga massage or Thai massage, this massage technique combines the benefits of gentle yoga stretching with massage strokes. The massage is delivered along specific energy or “sen” lines of the body.⁵Stone VJ. The World’s Best Massage Techniques: The Complete Illustrated Guide ; Innovative Bodywork Practices from around the Globe for Pleasure, Relaxation, and Pain Relief. Fair Winds Press; 2010.

• For treating back pain, yoga massage aims to lengthen the back muscles, open the hips, and loosen the hamstrings. The patient performs passive yoga stretches to lengthen the lower back, while the therapist massages specific areas in the lower back and/or thigh(s) to relieve stresses and relax the tissues.⁵Stone VJ. The World’s Best Massage Techniques: The Complete Illustrated Guide ; Innovative Bodywork Practices from around the Globe for Pleasure, Relaxation, and Pain Relief. Fair Winds Press; 2010.
• Yoga massage may help improve posture and alignment, and build strength in the connective tissues.⁵Stone VJ. The World’s Best Massage Techniques: The Complete Illustrated Guide ; Innovative Bodywork Practices from around the Globe for Pleasure, Relaxation, and Pain Relief. Fair Winds Press; 2010.
• Joint and muscle flexibility are improved through lower back stretches and massage strokes applied at the same time.⁵Stone VJ. The World’s Best Massage Techniques: The Complete Illustrated Guide ; Innovative Bodywork Practices from around the Globe for Pleasure, Relaxation, and Pain Relief. Fair Winds Press; 2010.

Yoga massage may help ease back muscle stiffness and pain due to a sedentary lifestyle.⁵Stone VJ. The World’s Best Massage Techniques: The Complete Illustrated Guide ; Innovative Bodywork Practices from around the Globe for Pleasure, Relaxation, and Pain Relief. Fair Winds Press; 2010.

Shiatsu

Shiatsu massage is a Japanese bodywork therapy that aims to promote healing by applying deep, firm pressure along specific energy lines or meridians in the body using the fingers, thumbs, elbows, and/or knees.⁵Stone VJ. The World’s Best Massage Techniques: The Complete Illustrated Guide ; Innovative Bodywork Practices from around the Globe for Pleasure, Relaxation, and Pain Relief. Fair Winds Press; 2010.^,8Kobayashi D, Shimbo T, Hayashi H, Takahashi O. Shiatsu for chronic lower back pain: Randomized controlled study. Complementary Therapies in Medicine. 2019;45:33-37. doi:10.1016/j.ctim.2019.05.019

• For back pain and sciatica, the patient lies face-down and the “bladder meridian” is massaged, which extends from the top of the head to the sole of each foot.⁵Stone VJ. The World’s Best Massage Techniques: The Complete Illustrated Guide ; Innovative Bodywork Practices from around the Globe for Pleasure, Relaxation, and Pain Relief. Fair Winds Press; 2010.
• Shiatsu provides deep tissue relaxation by improving circulation and releasing toxins.⁵Stone VJ. The World’s Best Massage Techniques: The Complete Illustrated Guide ; Innovative Bodywork Practices from around the Globe for Pleasure, Relaxation, and Pain Relief. Fair Winds Press; 2010.

This technique may help treat chronic back pain, back pain due to osteoarthritis, and back pain and leg pain from sciatica. The technique also provides a general feeling of wellness by improving energy (qi) balance and reducing fatigue.⁵Stone VJ. The World’s Best Massage Techniques: The Complete Illustrated Guide ; Innovative Bodywork Practices from around the Globe for Pleasure, Relaxation, and Pain Relief. Fair Winds Press; 2010.^,8Kobayashi D, Shimbo T, Hayashi H, Takahashi O. Shiatsu for chronic lower back pain: Randomized controlled study. Complementary Therapies in Medicine. 2019;45:33-37. doi:10.1016/j.ctim.2019.05.019

Side Effects of Massage Therapy

Rarely, some individuals may experience aggravated symptoms or new symptoms after their massage session. In a study that included 100 participants, approximately 10 participants experienced short-term side effects that included some combination of⁹Cambron, Jerrilyn A.; Dexheimer, Jennifer; Coe, Patricia; Swenson, Randy (2007). Side-Effects of Massage Therapy: A Cross-Sectional Study of 100 Clients. The Journal of Alternative and Complementary Medicine, 13(8), 793–796. doi:10.1089/acm.2006.6401 :

• Bruising
• Headache
• Tiredness or fatigue
• Increased soreness in the massaged areas

For most people, these side effects do not affect normal activities at home and/or work and typically resolve in a day or two after the massage.⁹Cambron, Jerrilyn A.; Dexheimer, Jennifer; Coe, Patricia; Swenson, Randy (2007). Side-Effects of Massage Therapy: A Cross-Sectional Study of 100 Clients. The Journal of Alternative and Complementary Medicine, 13(8), 793–796. doi:10.1089/acm.2006.6401

The probability of side effects after a massage typically depends on¹⁰Low Back Pain: Passive Treatments: Massages, Heat and Manual Therapy. Institute for Quality and Efficiency in Health Care (IQWiG); 2019. Accessed October 21, 2022. https://www.ncbi.nlm.nih.gov/books/NBK538546/:

• The ability of the patient to tolerate the pressure administered during the massage
• The intensity of force exerted by the therapist
• The patient’s tolerance to pain and bruising

Some individuals may also develop allergic rashes to the massage oil.¹⁰Low Back Pain: Passive Treatments: Massages, Heat and Manual Therapy. Institute for Quality and Efficiency in Health Care (IQWiG); 2019. Accessed October 21, 2022. https://www.ncbi.nlm.nih.gov/books/NBK538546/

Ongoing communication between the massage therapist and patient throughout the massage session can help reduce the risk of side effects or temporarily increased symptoms. Pain experienced during a massage should always be within tolerable limits.

When Massage Therapy Is Contraindicated

The presence of certain underlying conditions and/or the type of massage administered may cause serious adverse reactions or potential health risks to some individuals.

• Hot stone massages may not be suitable for people who have impaired sensitivity to heat and cold, or those with inflammatory conditions, such as diabetic neuropathy, rheumatoid arthritis, and multiple sclerosis, due to the potential risk of aggravation of the underlying condition or burn injuries.⁵Stone VJ. The World’s Best Massage Techniques: The Complete Illustrated Guide ; Innovative Bodywork Practices from around the Globe for Pleasure, Relaxation, and Pain Relief. Fair Winds Press; 2010.
• Massage may not be recommended while recovering from heart conditions.¹¹Vickers A, Zollman C, Reinish JT. Massage therapies. West J Med. 2001;175(3):202-204.
• Massage therapy is not recommended in people with metastatic cancer (cancer that can spread from the site of origin to other parts of the body), especially around the area of the tumor.¹¹Vickers A, Zollman C, Reinish JT. Massage therapies. West J Med. 2001;175(3):202-204.

While prenatal massage administered by a trained professional is considered safe for pregnant women, the stimulation of certain pressure points and the use of specific essential oils may rarely induce labor.

It is important to consult a licensed and experienced massage therapist to provide treatment. A licensed therapist has special training in massage therapy and can recommend the type of massage needed for the specific type of back problem. Physical therapists and chiropractors may also have special training in massage therapy.

Read more about Specialists Who Treat Back Pain