While many people seek massage therapy as a way to alleviate low back pain, researchers from the Institute for Work & Health in Toronto, Canada, concluded in a 2015 meta-analysis that they have “very little confidence that massage is an effective treatment for [low back pain].”
Based on 25 randomized-controlled trials with a total of 3,096 people, the researchers, led by Dr. Andrea Furlan, rated the quality of the evidence was “low” or “very low” because the samples were small and the methods were “flawed.” They identified several problems, such as the majority of the trials failed to blind the participants and/or the healthcare providers, blind the outcome assessors, perform an allocation concealment, and/or disclose study protoccols.
“Small trials with inadequate allocation concealment may exaggerate the effect of the interventions when they were compared to larger studies,” they wrote.
The review excluded trials that included people with low back pain caused by LBP caused by infection, neoplasm, metastasis, osteoporosis, rheumatoid arthritis, fracture, and inflammatory processes.
Furlan and her colleagues compared the massage intervention with inactive controls and active controls, whereas:
- Inactive controls are treatments that aren’t expected to change the results. These include fake therapies, no treatment, being put on a waiting list, or getting the same basic care as everyone else in the study. In these cases, the control group didn’t get anything more than what the massage group already received.
- Active controls are treatments that are expected to have some effect. These include things like physical therapy, exercises, acupuncture, relaxation techniques, or self-care education. People in these groups knew they were getting a type of treatment and participated.
“The results are conflicting for the long‐term follow‐up (massage versus inactive controls) and for the outcome of function (massage versus active controls), with some comparisons showing that massage is better than the control groups, and others showing no significant differences,” the researchers concluded. “We did not find any large effect size. The magnitude of the effect was small to medium in all meta‐analyses of continuous outcomes.”
This review contrasts a previous Cochrane Review that Furlan and another team conducted in 2008. They had concluded “Massage might be beneficial for patients with subacute and chronic non-specific low-back pain, especially when combined with exercises and education.” That review was based on 13 trials.
Furland and her colleagues reported that quality of evidence changed because they “grouped more studies in the same comparisons, therefore increasing the types of biases that were introduced in each comparison.” Also, they placed a “stricter” definition to imprecision and inconsistency than the previous review.
“The benefits of massage for patients with acute, sub‐acute and chronic non‐specific [low back pain] were found mostly in the short‐term follow‐up period (up to six months after randomization) for pain outcomes,” Furlan and her colleagues wrote. “The inclusion of new studies in this Cochrane Review update allowed for a larger population and amount of studies. It objectively revealed heterogeneity [mixed methodologies] and low quality of the evidence, suggesting the need for meta‐analysis of larger and better studies with more specific populations, interventions, co‐interventions and outcome measures.”
Massage therapist Beret Kirkeby, owner of Body Mechanics Orthopedic Massage in New York City, said in an interview with Massage & Fitness that massage therapy is a “managment tool,” not a cure for low back pain.
“As far as what massage therapists should get out of reading the paper, they should be relieved,” Kirkeby said. “Short-term effects are still effects. I think a lot of therapists out there are secretly frustrated at why they can’t ‘fix’ people—permanently. People get ‘better’ for a lot of reasons, and it’s highly unlikely that a passive activity, like getting a massage, is the magic bullet for back pain.”
Besides the hands-on work, she said that communication with clients and patients is also another factor that could influence their pain outcome.
“[Communication] also opens the door to talking about sound reasons to return rather than you won’t get better if you do not come in,” Kirkeby said. “If massage therapists step up to the plate and change their verbiage or website to massage positive messages reflecting the truth, such as ‘we can help you manage’ rather than we ‘correct’ or ‘treat,’ they are far more likely to have returning clients based on the idea that the clients understand it’s not a one-time show and have less disappointment when their $90 commitment did not ‘fix’ them.”
“Obviously we would want to see some studies on management as well,” Kirkeby continued. “As a management tool, massage has far more likelihood to gain respect within medicine. It pairs well with many other treatments that cause anxiety and pain, such as [physical] rehab and could easily be incorporated into pre- and post-surgical plans if the therapist had the right training.”
Further reading: Making sense of the 2015 Cochrane Review on massage and lower back pain with Dr. Christopher Moyer.
Originally published on Sept. 21, 2015. Updated May 9, 2025.
Nick Ng is the editor of Massage & Fitness Magazine and the managing editor for My Neighborhood News Network.
An alumni from San Diego State University with a bachelor’s in graphic communications, Nick also completed his massage therapy training at International Professional School of Bodywork in San Diego in 2014. In 2021, he earned an associate degree in journalism at Palomar College.
When he gets a chance, he enjoys weightlifting at the gym, salsa dancing, and exploring new areas in the Puget Sound area in Washington state.
