Deep Tissue Massage in Office Workers With Chronic Low Back Pain
Condition: Chronic Low-back Pain
MeSH terms: Back Pain; Low Back Pain
Study type: Interventional

Summary: 
      The main objective of the study was to assess the impact of deep tissue massage on subjective
      and objective parameters in a group of office workers with chronic low back pain.

      Specific objectives:

        -  Assessment of the impact of deep tissue massage on the level of pain

        -  Assessment of the impact of deep tissue massage on the level of disability

        -  Assessment of the impact of deep tissue massage on the mobility of the lumbar spine

        -  Assessment of the effect of deep tissue massage on the discomfort threshold of tissue
           compression in the area of the erector spinae muscle

        -  Assessment of the impact of deep tissue massage on the biophysical parameters of the
           soft tissues of the erector spinae muscle

        -  Evaluation of the impact of deep tissue massage on the bioelectric potentials of the
           erector spinae muscle during everyday activities and the flexion-relaxation test

      Hypotheses:

        -  Deep tissue massage will reduce the level of pain in the lumbar spine

        -  Deep tissue massage will reduce the level of disability

        -  Deep tissue massage will increase the range of motion of the lumbar spine in all
           directions

        -  Deep tissue massage will reduce the threshold of discomfort when compressing the soft
           tissues of the erector spinae muscle

        -  Deep tissue massage will reduce muscle tone and stiffness and increase the elasticity of
           the back extensor muscle

        -  Deep tissue massage will increase the bioelectrical potentials of the erector spinae
           muscle while performing tests of activities of daily living

        -  Deep tissue massage will reduce the value of the flexion-relaxation test
    

Detailed description: 
      Deep tissue massage is a manual action of the therapist in the superficial and deep layers of
      muscles and fascia in order to relax, change abnormal patterns, eliminate tension and pain in
      a maximally ergonomic way. Deep tissue massage should be described as an independent method
      of therapy using a specific set of techniques and principles. It is a safe method with a wide
      range of applications, while the techniques themselves can be modified to the needs of the
      patient. It is believed that deep tissue massage causes: improvement of tissue blood supply,
      reduction of muscle tension, stretching of muscles and fascia, improvement of muscle and
      joint function.

      Participants A total of 40 patients (30 to 60 years of age) participated in the study. All
      participants were characterized by the presence of chronic low back pain syndrome, performed
      office work for 8 hours a day and were characterized by moderate physical activity. Using
      randomization, participants were divided into two groups (experimental and control). The
      experimental group included participants who received deep tissue massage (N=20, 18 women and
      2 men, average age: 40). The control group included participants who did not receive therapy
      (N=20, 13 women and 7 men, average age: 43).

      Intervention The deep tissue massage lasted 45 minutes. The entire therapy included 4
      treatments over a period of 2 weeks. The interval between treatments was 3 days. The
      conducted therapy included techniques for: quadratus lumborum muscle, erector spinae muscle,
      thoracolumbar fascia, iliopsoas muscle. All techniques were performed on both sides of the
      patient's body.

      Research methods

      The following measurement equipment was used to collect the data:

        1. Electrogoniometer. Penny & Giles strain gauge electrogoniometer with two sensors (SG150
           - two-axis, Q110 - single-axis). Measurements were taken in a standing position, in
           accordance with the measurement methodology according to Lewandowsky. All movements of
           the lumbar spine (forward bending, backward bending, right bending, left bending, right
           rotation, left rotation) were examined. The average of the three measurements was the
           result of movability for a given direction. The sensors were attached to the skin using
           Biometrics double-sided tape. The upper sensor was placed on the Th12 spinous process
           (lower edge of the sensor), while the lower sensor was mounted on the base of the sacrum
           (upper edge).

        2. Algometer. The Wagner Instruments algometer was used to assess the subjective parameter,
           i.e. the first discomfort threshold. In the study, the measurement site was the point
           located on the longissimus muscle, which is a component of the erector spinae muscle.
           The subjects lay in front. The pressure, detected by the algometer sensor, was applied
           from above and perpendicularly to the examined muscle (two fingers laterally from the L1
           spinous process). Three measurements were made alternately for both sides of the
           examined muscle. From these measurements, mean values were calculated, which were the
           results for the right and left sides of the examined muscle.

        3. MyotonPRO. In order to study the biophysical parameters of soft tissues, i.e. muscle
           tone (F) [Hz], stiffness (S) [N/m] and elasticity (D) [no units], the MyotonPRO
           apparatus was used. During the measurements, the tested person lay on his front.
           Measurements were made on the longissimus muscle (2 fingers lateral to the L1 spinous
           process). The pattern composer was programmed as follows: tapping time: 15 ms, interval:
           0.8 s, mode: multiscan (5 repetitions). Measurements were made on the right and left
           muscles.

        4. Kinesiologic electromyography (EMG). Kinesiologic electromyography was carried out with
           an 8-channel electromyographic system with plate electrodes (model W4X8, Biometrics
           Ltd). The results were recorded using DataLog Bluetooth V7.5 software (Biometrics Ltd).
           During the examination, six multiple-use surface electrodes (type SX230 1000) were
           attached with an adhesive tape, after removal of body hair froma 2 cm x 1 cm area of
           intact skin, disinfection of electrode surface, and wiping the skin a few times with
           salicylic alcohol to reduce its resistance. The reference electrode (type R230,
           Biometrics Ltd) was fixed at the distal end of the radius (Lister's tubercle region)
           with an elastic band. The examination involved lumbar segment of the longissimus muscle,
           iliocostalis and multifidus (both right- and left-sided bundles). The electrodes were
           placed according to the international guidelines published by SENIAM. The examination
           was painless and noninvasive and did not require subject's exposure to any additional
           electric stimulation. The measurement was preceded by a 10-min warm-up of the keymuscle
           groups. The list of determined electromyographic parameters included the amplitude of
           bioelectrical signal from the longissimus, iliocostalis and multifidus muscles,
           expressed in microvolt. Avoiding a confounding effect associated with measurement
           conditions, the results were normalized to a reference Maximum Voluntary Contraction
           (MVC) and expressed in percent. After fixation of the electrodes and preparation of the
           system, MVC of the longissimus, iliocostalis and multifidus were determined according to
           the international SENIAM guidelines. The examination started with the subject lying down
           in a prone position, with arms crossed under the chin, and extended legs. The EMG
           recordings were obtained during three active extensions of the spine, each lasting 3
           seconds, with 30-second intervals in between. MVCs , corresponding to 100% neuromuscular
           activation of the muscles, was calculated as the mean amplitude for the three
           repetitions (for each muscle). At the beginning, the Flexion-Relaxation (FR) test was
           performed. The participant performed forward flexion of the spine and hung freely in
           this position for 10 seconds. During this test, the participant was asked to be as
           relaxed as possible. Then the participant was tested during successive tests of
           activities of daily living: getting up from a chair, sitting on it, lifting and lowering
           a 1 kg and 2 kg weight. Each test was run at an individually adjusted pace and consisted
           of three repetitions with 30-second rests between them. The test started at the
           investigator's request. While lifting and lowering the weights, the subjects kept a
           straight back, and each hold of the weight lasted 3 seconds and was performed on
           straight elbows. The result of each test is presented as the mean amplitude for three
           repetitions for each muscle. The results were normalized to the MVC to assess the degree
           of muscle involvement during various activities (standing up, sitting down, raising and
           lowering the roller) in relation to maximal neuromuscular activation. To ensure accurate
           results, the correct attachment of each electrode was rechecked before each repetition.

        5. Revised Oswestry Pain Questionnaire (ODI). The degree of LBP imposed limitations in
           activity of daily ling (ADLs) was determined with Revised Oswestry Pain Questionnaire,
           also referred to as Oswestry Disability Index (ODI). The survey consisted of 10
           questions, each with 6 possible responses scored from 0 to 5 points. If the respondent
           chose more than one answer to a given question, the one with higher score was recorded
           and subjected to the analysis. Maximum overall score amounted to 50 points, which
           corresponded to 100% disability due to lumbar pain.

        6. Roland-Morris Disability Questionnaire (RMDQ). The instrument consists of 24 statements
           about pain and its influence on ADLs. The respondent chooses only the statements that
           refer to his/her ailments. Maximum overall score may vary between 0 and 24 points.

        7. Visual-Analog Scale (VAS). This subjective tool is used to assess the level of pain. The
           participant marks the level of pain on a 10 cm scale, where 0 is no pain and 10 is the
           maximum pain he has ever felt.

      In order to assess the impact of deep tissue massage therapy on the study population, two
      measurements were made over time: before and after therapy.

      Ethics All measurement methods used were non-invasive and safe for health. The study was
      approved by the local Bioethics Committee. Each participant had the right to withdraw from
      the study at any stage. All collected data is anonymous and will be used only to conduct
      statistical analyzes for scientific purposes.
    

Intervention name(s): Deep Tissue Massage
Intervention type(s): Other
Intervention description(s): The Deep Tissue Massage lasted 45 minutes. The entire therapy included 4 treatments over a period of 2 weeks. The interval between treatments was 3 days. The conducted therapy included techniques for: quadratus lumborum muscle, erector spinae muscle, thoracolumbar fascia, iliopsoas muscle. All techniques were performed on both sides of the patient's body.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The first step was recruitment. Based on the qualifying and disqualifying criteria, 40 people were selected. Each participant was randomly assigned to a specific group (Deep Tissue Massage (DTM) experimental group or control group). Initial measurements were collected from all participants. Participants in the DTM group had therapy, while those in the control group had no therapy. The therapist was responsible for performing the DTM therapy. Each participant in the experimental group received 4 treatments (45 minutes each, 3 days between them) over a period of 2 weeks. After the end of the whole therapy, final measurements were made. The researcher was responsible for taking measurements for each participant. The person acting as the coordinator supervised the proper course of the research. The collected data was analyzed by a person evaluating the results.
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Chronic Low-back Pain; Range of motion; Pressure pain threshold; Myoton; Muscle properties; Surface electromyography; Oswestry Disability Index; Rolland Morris Disability Questionnaire; Disability; Visual Analogue Scale; Deep Tissue Massage; Manual Therapy