Lower back pain affects people young and old. It can disrupt quality of life but seeking quality care will improve the road to recovery. The most common type of low back pain is non-specific back pain. This is a term when no pathology can be linked to the pain.

As part of the massage blog series, this blog will discuss how massage paired with an evidence-based approach will help eliminate non-specific low back pain and regain healthy movement.

Symptom vs Cause

Low back pain is a symptom rather than a disease. Similar to other symptoms such as headaches, it can have many causes. Traditional treatments like hands on massage directly applied to the lower back can be like rubbing where it hurts. The pain response may change but it is unlikely to create long term effects.

To truly eliminate low back pain, the cause of the symptoms needs to be addressed. In other words, pain triggers (mechanisms) have to be identified and corrected with specific therapeutic techniques – they can be massage, exercise or modified movements. Pain triggers are related to postures, motions and loads (force applied to the body). There are many concepts here but to keep it simple; accumulated forces such as compression, and shearing are imposed on the non-optimal spine, triggering pain.

Moving Without Pain

In addition to identifying pain triggers, there is also awareness of specific postures and certain movements that relieve pain. Together, they create a road map for recovery that allows the introduction of pain-free movement patterns into daily life. For example, finding low stress postures in lying, sitting, standing, tying shoes or picking up items on the floor. The purpose of introducing these alternative movement patterns is to allow injured tissues to heal and reduce their pain sensitivity (from not being re-injured).

Building Back Fitness

Now that pain has eased, the next step is to enhance back fitness and work to broaden the range of pain-free activities. Foundational movement exercises are learnt to spare the back while building muscular fitness, stability, control and endurance. Generally, it is stability at the lower back that needs to be developed in order to prevent painful spinal joint micro-movements. This spine stability is created through muscle stiffness like a “guy wire system” – in much the same way a ship mast is held stable with tensioned cables.

So Where Does Massage Fit Into This Approach?

When it comes to massage for non-specific low back pain, there is no “one-size-fits- all” protocol. It must be modified and adjusted to fit each individual’s limitations while minimising their pain triggers.

As a general guideline, massage should aim to release areas that are too stiff (hypomobile), while limiting release to areas that are moving too much (hypermobile). As an example, stiff hips can result in more motion transferred to the spine, and so massage directed to the hips rather than spine will be effective in maintaining optimal spinal motion.

So the best way to eliminate back pain requires a new approach, one that identifies the cause of the symptoms and addresses them directly. Massage paired with an evidence-based approach is key to taking control of back pain. For it to be truly effective it requires a team approach – both therapist and client working together to reach a full resolution.

Ray Gesta is a Sports Lab Massage Therapist. He also looks after the team providing pre and post-race care at all the Running Events and Total Sport events around Auckland.