Massage might be beneficial for patients with subacute and chronic non-specific low-back pain, especially when combined with exercises and education. The evidence suggests that acupuncture massage is more effective than classic massage, but this need confirmation. More studies are needed to confirm these conclusions, to assess the impact of massage on return-to-work, and to determine cost-effectiveness of massage as an intervention for low-back pain.
[Acupuncture massage vs Swedish massage and individual exercise vs group exercise in low back pain sufferers--a randomized controlled clinical trial in a 2 x 2 factorial design].
Rehabilitation programs for low back pain (LBP) almost always contain massage and exercise therapy in one form or another.
                This study aimed to quantify the effectiveness of therapeutic 'Acupuncture' massage (APM; i.e. tonic stimulation of entire meridians) according to Penzel versus Swedish massage (SM) and individual medical exercises (IE) versus group exercises (GE) in LBP sufferers.
                109 patients participating in a complex in-patient rehabilitation program were randomised to four groups in a 2 x 2 factorial design. Main outcome measures were functional ability/disability (Functional Questionnaire Hanover, FFbH) and pain intensity (10 cm visual analogue scale, VAS). Pre/post changes were evaluated by means of 2-way analysis of variance (ANOVA). Additionally, lumbar motility was measured by a 2-inclinometer technique.
                Baseline mean FFbH score was 66 (SD = 18)%, mean pain intensity on VAS was 4.5 (SD = 2.4) cm. Lumbar flexion and extension were 49 (13) and 13 (7). Because of some differences between groups at baseline, group-standardized outcomes were used for analysis. APM showed beneficial effects for both disability and pain compared with SM (group differences: delta FFbH 7.0% [95% confidence interval (CI) 2.5-11.6], p = 0.003; delta VAS 0.8 cm [95% CI: 2-15], p = 0.024). Standardized response means were SRMFFbH = 0.5 and SRMVAS = 0.8 for APM, as opposed to SRMFFbH = -0.01 and SRMVAS = 0.4 for SM. Neither significant group differences between both exercise groups [delta FFbH -0.5% (95% CI -5.2 to 4.2); delta Vas 0.4 cm (95% CI 0.3 to 1.1)] nor significant interactions between medical exercise and massage were found.
                Given the fact that even the treatments considered to be the best available achieve at best moderate effects, the observed effect sizes with APM are promising and warrant further investigation in replication studies. In contrast to common view, no superiority of individual versus group exercises could be found in the present study.