Category ArchiveBack Pain

Back Pain 17 Jun 2009 04:26 pm

Massage Therapy and Back Pain Relief

I’ve had several readers write to me over the years and ask my opinion on massage therapy and whether or not I thought it was effective for back pain relief.

Unfortunately, at the time I was unable to answer their questions as completely as I would have liked.

You see the problem with giving an opinion — or being able to recommend a therapy — is that there is quite often a lack of reliable information on the subject. Up until now, we’ve only had anecdotal evidence to suggest that massage therapy helped to reduce pain. And as you know, anecdotal evidence leaves plenty of room for doubt.

However, I recently ran across a study published in the Annals of Internal Medicine that finally lends some credibility to this very popular treatment method.

The study involved 380 adults with advanced cancer who were experiencing moderate-to-severe pain. The participants were divided into two groups. One group received six 30-minute massage treatments over two weeks from certified massage therapists, while the control group received an equal number of treatments utilizing simple touch performed by untrained individuals.

The Results

The good news is that both groups experienced immediate pain relief according to the report:

“Primary outcomes were immediate … and sustained … change in pain. Secondary outcomes were immediate change in mood …


Both groups demonstrated immediate improvement in pain and mood …


Massage was superior for both immediate pain and mood … ” [1]

Now, while this is good news, it should be noted that patients did not experience total pain relief from the treatments. Their pain was only reduced between 1 to 2 points on a 0 – 10 scale. This represents a significant improvement, but not total relief.

Also, this was not a blind study as noted here…

“Limitations: The immediate outcome measures were obtained by unblinded study therapists, possibly leading to reporting bias and the overestimation of a beneficial effect. The generalizability to all patients with advanced cancer is uncertain. The differential beneficial effect of massage therapy over simple touch is not conclusive without a usual care control group.” [1]

The report went on to conclude…

“Massage may have immediately beneficial effects on pain and mood among patients with advanced cancer. Given the lack of sustained effects and the observed improvements in both study groups, the potential benefits of attention and simple touch should also be considered in this patient population.” [1]

Herein Lies the Rub

Now perhaps you noticed that this study did not directly involve treatment for back pain. This is something that I happen to consider a plus rather than a negative.

After all, what’s significant about this study is that it was conducted on advanced cancer patients. These were people with real pain. There was little or no chance that their pain was psychosomatic in nature.

The same cannot be said about back pain or migraine headaches or any other form of pain where emotions or stress can influence the results. After all, the brain can play tricks on us.

And while one study is not enough to establish proof, and it was not a double-blind situation, and the patients did not receive total pain relief, the fact remains that the results were immediate and sustained for the short term.

Overall, I feel the positive outcomes from this study are encouraging.

Until next time,


1. Kutner, JS. et all. Massage Therapy versus Simple Touch to Improve Pain and Mood in Patients with Advanced Cancer, A Randomized Trial. Annals of Internal Medicine. 16 September 2008 | Volume 149 Issue 6 | Pages 369-379


Back Pain 18 May 2009 02:43 pm

Back Pain and Anger


Yikes! Looks like somebody tried to swipe her Cheerios.

Which reminds me, here’s a portion of an email I received a while back that I decided to save — not because it was unusual — but because it was so typical of the type of thing I hear over and over again…

“I was 40 yrs old and I had never had any back problems prior to this incident. I had lower back discomfort beginning over 10 months ago now from what was over exerting myself while overhead lifting some sheetrock on a scaffold. Looking back I am so regretful, what a dummy that stuff was way heavy and I just got pissed off, we where trying to get this piece to fit and with all the stress in my life at the time and it being 95 plus degrees, I just lost my cool and at the moment was not thinking about my back…”

I can just see your head nodding and you’re thinking, “Yeah… been there, done that.”

And since this is something that seems to affect us all to one degree or another, I decided to look into this problem to see if there wasn’t something we could learn from it.

In a nutshell, what I found was:

  1. Anger definitely places you at risk for injury
  2. You can control how you respond
  3. Awareness of the risk seems to be the key to avoiding injury

Anger and Risk of Injury


Wouldn’t you know it? They actually did a study on this and proved what we already knew. Yes indeed, I kid you not. Researchers at the University of Missouri – Columbia (Go Mizzou) have demonstrated emphatically that blowing your top and kicking a fire hydrant is not a good idea.

God bless ’em. I don’t know about you, but I’m definitely going to sleep better now that that’s settled.

But seriously, (and you know I’m always serious) they really did a very interesting study on this and came up with some rather useful observations. Not about kicking cast iron objects, but about anger and the risk factors associated with it.

What they did was survey 2,400 patients from three hospital emergency departments to determine what emotions they were feeling just prior to their injury.

Here’s what they discovered…

In case-crossover analyses, higher levels of all anger variables were significantly associated with increased injury risk among men and women combined. [1]

They then go on to give us some numbers. (These guys love numbers.)

In this study, emotions reflecting externally directed anger were common. The prevalence of anger among injured patients was as follows: 31.7% reported some degree of “irritable” just before the injury, 18.1% reported feeling “angry,” and 13.2% reported feeling “hostile”. [1]

Hang on a minute.


According to my Hello Kitty calculator, that’s over 60% of the people surveyed were feeling somewhere between irritable and downright hostile just prior to the bonehead move that earned them a ride to the ER.

That’s a lot of avoidable accidents, if you ask me. (It is an accident when you punch a wall and break your hand, isn’t it? That’s what I thought. Just checking.)

In essence, what this study discovered was that people who were feeling angry just before getting hurt faced a substantial increase in the risk of injury.

You Can Control Your Anger


Okay, let’s face it. It’s normal to get angry from time to time. There’s nothing you can do to avoid emotions (unless you’re Leonard Nimoy), but that doesn’t mean that anger has to lead to injurious behavior.

One thing the author of this study noted was that anger seldom led to injury while driving.

Hmm… Isn’t that interesting. He noted that people experiencing road rage almost never put their anger into action.


He speculated that the reason people weren’t ramming each other on the freeway was that most of us are well aware of the possible consequences. No matter how enraged we might become at the other drivers on the road, we know that it’s not worth a trip to the hospital (or the morgue).

So we yell, we fume, we make socially unacceptable gestures, but we don’t turn into Kamikaze pilots just because some bozo cuts us off on the way to work.

(California doesn’t count. They’re nuttier than Texans out there.)

Awareness of the risk, key to avoiding injury

Here’s the deal:

If we can reign in our anger on the roadway, we can do the same during life’s other stressful moments. If that piece of sheetrock doesn’t fit, take it down and try it again later. If someone at work is pushing your buttons, just walk away.

Take a breather. Think bad thoughts. Plot your revenge. But don’t act on any of it.

Instead, when you’re tempted to take your anger out on someone or something, just remind yourself of the risk factors. You can do it. You do it all the time when you’re driving.

Yell, cuss, invent new forms of sign language, but don’t kick, hit, strain or otherwise express your anger and frustration physically. It’s not worth a sore toe, a busted hand or a trip to the emergency room with a sprained back.

Okay, maybe it’s easier said than done, but I think it’s worth a try.

By the way, I believe I just found the perfect solution for rush hour traffic.




1. Vinson DC, Arelli BS, State Anger and the Risk of Injury: A Case-Control and Case-Crossover Study. Annals of Family Medicine 4:63-68 (2006)


Back Pain 14 May 2009 05:34 pm

Back Pain and Ergonomics

The Evolution of Man…



It is a widely accepted among medical experts that back pain is closely related to sitting. And let’s face it; we spend a lot of time during the day doing just that.

  • We sit in the car on the way to work
  • We sit most of the time while we’re at work
  • Then we sit in the car on the way home
  • And when we finally get home at the end of the day, all we want to do is sit and relax

In fact, about the only time we’re not sitting is when we’re moving from one seat to the next. And, because of this, it should come as no surprise that back pain is a pretty common work related disorder.

Now I’m not crazy enough to suggest that we all stop sitting, because we both know that just isn’t going to happen. But what we can do is take a few simple steps to minimize the impact by making our workplace more back friendly.

Here are some suggestions you might want to consider.

General Back Saving Tips

laptop cat

  1. Take frequent breaks
  2. Get up and walk around every 30-60 minutes
  3. Lean back in your chair when you can
  4. Change position often
  5. Stretch your back frequently throughout the day
  6. Do warm-up stretches before lifting anything
  7. heavy

  8. Did I mention take frequent breaks?

Take Time to Arrange Your Workspace

Notice how I managed to incorporate ergonomics into the design of my office…


If you’re lucky enough to have your own office, desk or other individual work area, you can probably set it up to minimize back strain and fatigue.

  1. Give yourself plenty of room
  2. Arrange everything within easy reach
  3. Make sure your desk is a proper height
  4. Try a document holder to get work up to eye level
  5. Plan to do some tasks standing
  6. Take frequent breaks from sitting
  7. Make sure you have plenty of light
  8. Try to avoid slouching

Get a Good Chair


When you’re setting up your workspace, keep in mind that a good chair is worth its weight in gold. If you have to sit for extended periods of time, invest in a chair that’s ergonomically designed for back support. Even if you can’t adopt any of the other suggestions on this page, a good chair is a must.

  1. Get a chair with good lumbar support
  2. Get a chair that can lean back
  3. Get a chair with arm rests
  4. Try occasionally switching to a kneeling chair
  5. Try occasionally sitting on an exercise ball (20 min max)
  6. Plan to do some tasks standing (repeated on purpose)

What if You Use a Laptop?

Junior appears to be setting up his MySpace.

laptop on floor

  • Place laptop at proper typing height
  • Try using a normal keyboard and mouse
  • Occasionally place laptop in your lap and lean back
  • Try a larger monitor (See monitors below)
  • Try placing the laptop on the floor (See illustration above.)
  • Speaking of Computer Keyboards

    portable PC

    If you spend a lot of time working at a computer, having the ability to move around can greatly reduce the negative effects sitting has on the back.

    1. Place keyboard at proper typing height
    2. Occasionally place keyboard in your lap and lean back
    3. Try a keyboard tray or adjustable shelf
    4. Try a portable computer (See illustration above)

    What About the Mouse?

    laptop puppy2

    Many of the keyboard tips also apply to use and placement of your mouse. (Showing disdain for your Microsoft applications is optional.)

    1. Place the mouse within easy reach
    2. Arrange the mouse so you can occasionally lean back
    3. Try a cordless trackball or mouse
    4. Try a movable mouse stand next to your chair

    Select the Right Computer Monitor


    1. Place monitor close enough that you don’t have to lean forward
    2. Get a monitor large enough that you can lean back
    3. Place monitor at a comfortable height
    4. Center the monitor in front of you
    5. Try a movable monitor arm

    Wrapping Things Up

    If you’re like most of us, you spend way too much of your day sitting at a desk or working with a computer. This does not mean that you have to sacrifice your health for the sake of your job.

    Putting together an ergonomic work environment is not that difficult (although it may require spending a little of your own money). Most employers and co-workers will be willing to go along with your little idiosyncrasies if you take the time to explain the reasons why you’ve suddenly gone insane.

    With a little planning and ingenuity you can survive the work-a-day world with your back intact. People may think you’re a bit odd, but then they probably always have.

    Besides, you may even find that you get more work done.


    p.s. One last tip for that daily commute:

    Consider alternative transportation that allows for multitasking…