Americans spend at least $50 billion each year to treat lower back pain, the second most common neurological problem in the U.S. after headaches, according to the National Institutes of Health.

A new study in the Annals of Internal Medicine finds that massage may be an effective therapy for treating lower back pain, when compared with conventional medical treatment.

When patients visit the doctor with lower back pain, the usual treatments include medications for pain, inflammation, and muscle spasms, as well as prescribing physical therapy, back exercises and educating patients about possible causes of back pain and methods for preventing future injuries.

But many people seek out alternative therapies for lower back pain relief, and massage is one of the most popular, accounting for over one-third of the more than 100 million annual massage therapy visits, according to the study. The authors note that while recent studies have found limited evidence that massage helps chronic back pain, none compared different massage methods for lower back pain relief against usual medical therapy, which is what the researchers did in this study.

The study included 401 participants 20 to 65 years old who had chronic low back pain whose cause was not known. They were randomly divided into three groups: 133 participants received usual medical care without massage, 132 participants received structural massage, which identifies and massages muscular and skeletal causes of lower back pain, and 136 participants received relaxation massage, which is also called Swedish massage, and is intended to produce a general relaxed state.

Participants in the two massage groups received about one hour of massage per week for 10 weeks. All participants answered questionnaires at baseline, 10 weeks, 26 weeks, and 52 weeks to rate how bothersome their back pain was.

The study revealed that both types of massage therapy resulted in less pain and better mobility than usual care patients after 10 weeks. Both types of massage showed improved function at 26 weeks, but their benefits were of questionable significance at the one-year mark. The authors are careful to note that the reasons for the benefits are unclear, but they speculate that massage may trigger beneficial tissue and nervous system responses. Another possibility is that being touched in a relaxing environment produces the positive effects that the massage groups experienced.