Massage for low‐back pain

Background Low‐back pain (LBP) is one of the most common and costly musculoskeletal problems in modern society. It is experienced by 70% to 80% of adults at some time in their lives. Massage therapy has the potential to minimize pain and speed return to normal function. Objectives To assess the effects of massage therapy for people with non‐specific LBP. Search methods We searched PubMed to August 2014, and the following databases to July 2014: MEDLINE, EMBASE, CENTRAL, CINAHL, LILACS, Index to Chiropractic Literature, and Proquest Dissertation s. We also checked reference lists. There were no language restrictions used. Selection criteria We included only randomized controlled trials of adults with non‐specific LBP classified as acute, sub‐acute or chronic. Massage was defined as soft‐tissue manipulation using the hands or a mechanical device. We grouped the comparison groups into two types: inactive controls (sham therapy, waiting list, or no treatment), and active controls (manipulation, mobilization, TENS, acupuncture, traction, relaxation, physical therapy, exercises or self‐care education). Data collection and analysis We used standard Cochrane methodological procedures and followed CBN guidelines. Two independent authors performed article selection, data extraction and critical appraisal. Main results In total we included 25 trials (3096 participants) in this review update. The majority was funded by not‐for‐profit organizations. One trial included participants with acute LBP, and the remaining trials included people with sub‐acute or chronic LBP (CLBP). In three trials massage was done with a mechanical device, and the remaining trials used only the hands. The most common type of bias in these studies was performance and measurement bias because it is difficult to blind participants, massage therapists and the measuring outcomes. We judged the quality of the evidence to be "low" to "very low", and the main reasons for downgrading the evidence were risk of bias and imprecision. There was no suggestion of publication bias. For acute LBP, massage was found to be better than inactive controls for pain ((SMD ‐1.24, 95% CI ‐1.85 to ‐0.64; participants = 51; studies = 1)) in the short‐term, but not for function ((SMD ‐0.50, 95% CI ‐1.06 to 0.06; participants = 51; studies = 1)). For sub‐acute and chronic LBP, massage was better than inactive controls for pain ((SMD ‐0.75, 95% CI ‐0.90 to ‐0.60; participants = 761; studies = 7)) and function (SMD ‐0.72, 95