Comparison of the Effects of Connective Tissue Massage and Classical Massage Methods on Pain, Flexibility, Disability and Autonomic Responses in Chronic Mechanical Back Pain, Randomized Study

Mechanical low back pain is defined as a condition that causes tension, pain, or stiffness in the lumbar region where it is not possible to define a specific cause (eg infection, tumor, osteoporosis, fracture, structural deformity, inflammatory disorder, radicular syndrome or cauda equina syndrome). Low back pain has become one of the biggest problems for public health systems in the Western world in the second half of the 20th century and continues to be a major health problem worldwide today. In a review based on studies on low back pain in 54 countries, the prevalence of low back pain was found to be 18.3%. As a result of researches made in Turkey in the 18-24 age range prevalence of women was 28.9%, in men was 18.1%, with advanced age over the age of 55 rate increasing further, it raise 48.1% in women and 31.5% in men. As shown in the researches, low back pain is seen more frequently in the age of late 20s and in women.

Disc degeneration, nociceptive factors, tumor necrosis factor α and smoking have been reported to be reason in mechanical low back pain. Although there are widely used clinical tests for pathologies arising from lumbar structures (discogenic low back pain, facet joint pain, sacroiliac joint pain), these tests cannot be used to diagnose non-specific mechanical low back pain.

The affect of chronic pain on individuals is quite different. Pain creates problems in the life of the individual starting from minimal to high level of disability and consequently severely restricts their participation in work and social life and their roles in the family. Medicines used to reduce pain are addictive after a while. Therefore, researchers emphasized the need for more emphasis on non-pharmacological treatment approaches in the management of persistent low back pain. Among these approaches, manual treatment, exercise, massage, and acupuncture methods are included in the treatment guidelines for mechanical low back pain.

No method of treatment of low back pain can produce a permanent improvement. However, there are several approaches that reduce pain and disability. Among these, massage is considered as a safe treatment method due to its low side effects and risk. Massage has been shown to be effective in some types of headaches, post-exercise muscle pain, and mechanical neck pain, but is also reported to cause relaxation and psychological relaxation. Classical massage (CM) is thought to improve the physiological and clinical outcomes by providing symptomatic reduction in pain through physical and mental relief and by increasing pain threshold by endorphin release. It is also suggested that CM has some effects on the nervous system. Massage applications cause repetitive sensory stimulations to occur and changes in neuronal circuits, such as blood pressure, cause altered activity in the autonomic nervous system.

Connective tissue remodeling has been reported in patients with chronic low back pain due to emotional, behavioral and motor dysfunction. Increased stress due to excessive use, repetitive motion and / or hypermobility, and reduced stress due to immobilization or hypomobility, cause changes in the connective tissue. Chronic, local increase in stress can lead to micro-injury and inflammation, while the absence of stress in the tissue leads to connective tissue atrophy, architectural disorder, fibroses, adhesions and contractures.