After having conducted MEDLINE, AMED, and Science Citation Index search, it was demonstrated that the functional questionnaires were most commonly used to measure the effect of back pain on daily activity of the patient [14
]. Due to their methodological value and easiness in use, these tests are currently used in many countries as a basic research tool in people with low back pain. The questionnaires are used for patients with pain in the lumbar spine, but also with patients who experience pain radiating to the lower extremities [16
The study showed a significant improvement with regard to the experienced pain and the self-reported disability, both in the TG (deep tissue massage) and in the CG (deep tissue massage together with nonsteroidal anti-inflammatory drugs), which may suggest the effectiveness of deep tissue massage in back pain.
The Quebec Task Force test confirmed the validity of choosing the patients with chronic pain, and it excluded patients who underwent spine surgery up to 6 months before the study. The test also showed that most patients experienced pain without radiation and with no neurological symptoms. Those patients were susceptible to deep tissue massage therapy.
DTM is a form of massage used with “the understanding of the layers of the body and the ability to work with tissues in layers to relax, extend, and unlock the persisting, incorrect tensions, in the most effective and energy-efficient manner” [16
]. Therapists working with this type of massage aim to change the soft tissues structure and limit the motion of the muscles. The knowledge of anatomy of locomotor system and the understanding of layer structure of tissues including fascia and muscles are needed. The therapist affects the tissues gradually until they respond with relaxation. Patient's body is put in proper positions, that is, muscles in the extended position. The therapist affects the muscle belly as well as the tendon-to-bone attachment, trying to soften the tendon and to influence receptors of muscle extension (Golgi organs of tendons) [16
Medical literature contains very few studies showing that massage reduces lumbosacral pain in the acute stage. It was suggested, on the other hand, that massage in the subacute stage and in the early chronic stage of lumbosacral pain reduces the intensity and the quality of pain as effectively as a placebo therapy. Comparing the therapeutic effect of massage with other forms of therapy in lumbosacral pain, the results were similar to the effect of exercises and manipulation [18
]. Research on patients with chronic lumbosacral pain suggested that massage was effective in reducing the intensity of pain and in improving patient's functionality. However, massage was not as effective in pain reduction as transcutaneous electrical nerve stimulation. On the other hand, authors showed that massage was more effective than relaxation, acupuncture, and mere health education [19
]. Studies along with the research on patients with the visual analogue scale suggest that massage is effective in subacute stages and in chronic stages of unknown etiology (nonspecific pain). It is particularly effective when used along with exercises and when it is performed by an experienced therapist. The effectiveness of massage depends on the duration and the number of sessions, the surface area that undergoes massage, the strength of compression, and the patient's stress level [20
]. Massage was reported to be more effective than placebo, patient education, acupuncture, muscle relaxation, and exercises increasing ability [21
]. However, the assessment of massage effectiveness performed with functional questionnaires, the Roland-Morris Questionnaire and the Oswestry Disability Index, showed a small improvement in the functionality of patients with low back pain, and these results were not statistically significant. A small number of papers on deep tissue massage shows effectiveness of this form of massage in the treatment of myalgia symptoms [22
], lowered systolic and diastolic blood pressure [23
], and stronger effectiveness of deep tissue massage in comparison to therapeutic massage with regard to patient's pain sensation [24
It is suggested that there are no individual and objective forms of therapy in chronic low back pain and that the spine care community needs to develop or update high-quality treatment guidelines [25
]. Sole assessment of pain intensity is a difficult task and it is most often based on a subjective self-evaluation of the patient. The simultaneous use of different assessment scales helped to achieve more objective results.
The effectiveness of using NSAID in the treatment of chronic low back pain is questionable [26
]. Some papers suggest a small improvement in wellbeing and a reduced subjective pain sensation in patients using certain NSAIDs when compared with the control group (placebo) [29
]. At the same time, there are no reports which would show that these drugs cause a long-lasting improvement in wellbeing or reduced subjective pain sensation [31
]. Limited effectiveness of percutaneously absorbed nonsteroidal anti-inflammatory was reported [32
]. Additionally, some studies suggest that patients have a dismissive attitude towards the drugs and do not believe in its effectiveness [26
This study is one of the first studies assessing the effect of deep tissue massage on chronic lumbar pain. An attempt was made to check the effect of deep tissue massage on the possible reduction of nonsteroidal anti-inflammatory drugs. In our study we propose that the use of deep tissue massage causes fast therapeutic results and that, in practice, it could help to reduce the use of NSAID in the treatment of chronic low back pain.
4.1. Study Limitations
The eligibility of patients for the study was based on subjective criteria. Methods were based on patient's subjective experience of pain. In the future, the study protocol could be supplemented with objective functional tests, daily activity tests, and assessment of tissue tension.
This study did not distinguish between different nonsteroidal anti-inflammatory drugs. In the future similar studies could be conducted to evaluate the effectiveness of the therapy depending on the type of administered drug.