By Amanda MacMillan
April 6, 2017
TIME Health
For more, visit TIME Health.

Lower back pain is the leading cause of job disability in the world. About one in ten people have it, and for many who develop back pain, the condition becomes chronic.

Now, a new study finds that massage may provide lasting relief for chronic lower back pain, according to research published in the journal Pain Medicine.

To see how people in the real world respond to massage, researchers looked at 104 people with persistent back pain who were referred by their doctors to licensed massage therapists. They went to 10 sessions over 12 weeks, and the practitioners were free to design massage programs that were individual to the patients, rather than all using the same technique.

At the end of the study, most people completed a questionnaire, and more than 50% reported clinically meaningful improvement in their back pain. Several people improved so much that their scores on a standard screening test dropped below the threshold for disability, says lead author Niki Munk, an assistant professor of heath sciences at Indiana University-Purdue University Indianapolis. (Munk, who is also a licensed massage therapist, conducted the research while at the University of Kentucky.)

Many of those improvements lasted. Three months later, with no further massage sessions, 75% of the people who reported initial improvement said they still felt better. “They’d reverted back a little bit, but they were still significantly more improved than they were at the start of the study,” says Munk.

More research is needed to figure out exactly how massage works to reduce pain, but some research suggests that massage directly reduces inflammation in muscles.

Munk points out that the study included a diverse group of patients; some were obese, some had other health conditions that contributed to their back pain and others were taking opioid pain medications. “They reflect real-life,” Munk says. When a patient comes in with chronic lower back pain, it’s rare that they don’t have more, she says.

The researchers saw improvement across the board, but they did notice a few trends based on demographics. Adults ages 49 and older were more likely to meaningfully improve than younger patients. While people with obesity tended to improve, those gains didn’t last over time. And people taking opioids were two times less likely to experience meaningful changes, compared to those not taking them.

Studies like this have the potential to influence how doctors practice, says William Elder, the study’s other lead author and director of behavioral health at the University of Kentucky College of Medicine.

“Guidelines already say to use massage therapy for chronic pain, but it is not used much,” Elder told TIME in an email. Clinical trials have shown that treatments work in ideal, controlled situations, but doctors often want real-world evidence as well, he says. “They want to know if it ‘translates,’ meaning that the intervention will help their patients who may be receiving medications already or often have other conditions besides the back pain.”

This study provides more evidence that doctors may suggest massage to their patients as a potential treatment. “Providers may not even need to specify a certain type of massage,” says Elder. “That could be left up to an experienced therapist.” Techniques practiced in the study varied widely and included Swedish massage, active isolated stretching, myofascial techniques, lymphatic drainage, trigger point therapy, neuromuscular therapy, craniosacral therapy, reflexology, Reiki, acupressure and positional release.

However, the researchers note, massage is rarely covered by health insurance. While study participants received their sessions free of charge, people who can afford it will need to weigh the costs with potential benefits.

That’s why more studies are needed, says Munk: to help people decide whether massage is really worth the out-of-pocket cost. Future research should investigate whether massage can help people avoid back surgeries, she says, and how many sessions are really needed to provide lasting improvement.

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