WHAT’S BETTER FOR LOW BACK PAIN — PHYSICAL THERAPY OR THAI MASSAGE?
WHAT IS LOWER BACK PAIN?
Low back pain (LBP) is the leading cause of disability and the most common musculoskeletal condition globally. It’s described as pain between the lower edge of the ribs and the buttock and can last for a short time (acute), a little longer (sub-acute) or a long time (chronic). It also can affect anyone at any age with over 80% of the population will experience LBP at some point in their lives. LBP makes it difficult to move and deeply affects mental well-being and quality of living. It’s also one of the most common reasons for work loss causing a tremendous economic burden.
There are two types of LBP — Specific and Non-Specific. Specific LBP pain is caused by an indentifiable musculoskeletal problem or even disease. This type may require medical intervention such as orthopedic surgery. The more common Non-specific LBP is not directly associated with a specfici structural reason to explain the pain. This is a more common condition, occuring in about 90% of cases. It can be highly complex due to a wide range of risk factors and patient behaviors. Non-specific is usually categorized as acute, sub-acute and chronic low back pain — based on the duration. Acute LBP is an episode lasting less than 6 weeks, sub-acute is identified as occuring between 6 and 12 weeks, while a chronic condition is identifed as lasting 12 weeks or more.
This artlcle reviews the findings of a study that was conducted at Lerdsin General Hospital in Bangkok, Thailand, to evaluate and compare the efficacy of Physical Therapy versus Ttraditional Thai massage for treating non-specific LBP.
USING PHYSICAL THERAPY
Physical Therapy is a common healthcare industry approach for treating non-specific LBP. The typical treatment is called Joint Mobilization, which involves various manual techniques aimed at restoring motion and relieving pain in the lumbar spine. The intervention typically includes physical assessments, active and passive physiologic back mobilization, stretching, strengthening, and thermotherapy using hot packs. The underlying principle of joint mobilization is based on the gate control theory, which posits that increased proprioceptive input can block central pain transmission.
Participants in the joint mobilization group received therapy from certified physical therapists with over 10 years of experience. Each session lasted approximately 30 minutes and was conducted twice weekly over a four-week period, with a maximum of eight sessions. Patients are also engaging in at-home self care exercises such as back and leg stretching and strengthening exercises at home.
The specific PT techniques applied in this study included:
Posterior-to-Anterior Directed Manual Pressures: Applied to the spinous process of the lumbar vertebrae, as described by Maitland and Beattie et al.
Prone Press-Up Exercise: Based on McKenzie’s approach, designed to alleviate pain through controlled spinal movements.
USING THAI MASSAGE
Traditional Thai massage is an ancient therapeutic practice rooted in Thai traditional medicine, emphasizing the balance of the body’s primary elements (earth, water, fire, and air) and energy lines (sen). This form of massage involves deep tissue manipulation with prolonged pressure and passive stretching along the body’s main energy channels.
Key elements of the traditional Thai massage technique include:
Prolonged Pressure: Applied along the body’s 10 major energy channels to release blocked energy and enhance vitality.
Gentle Stretching: To promote relaxation and flexibility.
Herbal Hot Packs: Used to enhance the therapeutic effects.
One of the significant advantages of traditional Thai massage is its accessibility. Unlike PT, which often requires a doctor’s referral and can involve long waiting times for a physical therapist’s schedule to open up, Thai massage is readily available. Certified Thai massage therapists are widely accessible, allowing patients to receive timely and effective treatment without the need for medical intermediaries.
The traditional Thai massage was administered by certified massage therapists with over 10 years of experience. Each session also lasted approximately 30 minutes, conducted twice weekly over a four-week period, with a maximum of eight sessions. The massage focused on points along the spinous processes from L2 to L5.
STUDY RESULTS
The study was conducted at Lerdsin General Hospital in Bangkok, Thailand. It was a randomized study and included 120 hospital outpatients who were randomly assigned to receive either traditional Thai massage or PT joint mobilization therapy. Each group underwent approximately 30-minute treatment sessions twice a week for four weeks, not exceeding eight sessions in total.
The study population comprised 120 patients, with 20 males (16.7%) and 100 females (83.3%). The average age of participants in the Thai massage group was 50.7 years, while the joint mobilization group had an average age of 48.3 years.
Data analysis was performed using the SPSS statistical program. The primary outcome measures were the Visual Analog Scale (VAS) for pain and the Oswestry Disability Index (ODI) for functionality. Secondary outcome measures included patient satisfaction and adverse effects. Statistical significance was assessed using paired t-tests and intention-to-treat (ITT) and per protocol approaches.
Out of 345 potential subjects, 120 met the inclusion criteria. Both treatment groups demonstrated significant reductions in pain and disability with no major differences between them.
Traditional Thai Massage Group:
Pre-treatment VAS: 5.3
Pre-treatment ODI: 24.9
Post-treatment VAS: 0.51
Post-treatment ODI: 8.1
Joint Mobilization Group:
Pre-treatment VAS: 5.0
Pre-treatment ODI: 24.6
Post-treatment VAS: 0.86
Post-treatment ODI: 8.26
WHAT’S BETTER?
There is no clear winner, both approaches are very effective short-term treatments for reducing pain and disability in patients with chronic non-specific LBP. However, traditional Thai massage has advantages including superior accessibility and convenience, making it a practical and effective option for immediate relief without the need for a doctor’s referral or long waiting times for an appointment. For patients seeking timely and efficient treatment for LBP, Thai massage provides an excellent alternative to physical therapy.
The results demonstrated significant reductions in both pain and disability for participants in both treatment groups (see references to the study in the footnote). Prior to treatment, the mean Visual Analog Scale (VAS) for pain was 5.3 in the Thai massage group and 5.0 in the joint mobilization group. The Oswestry Disability Index (ODI) scores were 24.9 and 24.6, respectively. Post-treatment scores indicated significant improvements:
Traditional Thai Massage Group:
Mean VAS: 0.51
Mean ODI: 8.1
Joint Mobilization Group:
Mean VAS: 0.86
Mean ODI: 8.26
THE THAI SPORT DIFFERENCE
Our proprietary Thai massage, called the Thai Sport Massage, stands out even further because it focuses on anatomical markers versus the “energy line” approach of typical Thai massage. When it comes to musculoskeletal problems, the mystical energy line work often misses the mark, whereas the Thai Sport Massage addresses specific muscle and fascia that is determined to be the problem. In addition, our Therapists can also use advanced protocols not available with a typically trained Thai massage therapist, such as IASTM, myofascial release, and trigger point therapy. Thus we always recommend starting with Thai Sport Massage for non-specific LBP; and upgrading to our advanced therapies such as Prehab Pilates, Deepwave Therapy, or Neuromuscular Therapy, if results are not lasting.
Another huge advantage of Thai Sport Bodyworks versus the typical Thai massage business is that we are llicensed and credentialed to use Thai Sport massage and all of our other services to be reimbused for PPO insurance holders as well as Workman’s Compensation. We also can process HSA and FSA for all of our services as well.
REFERENCEShttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5495387/