BACKGROUND: The study aimed to compare the effects of connective tissue massage (CTM) and classical massage (CM) in patients with chronic mechanical low back pain on pain and autonomic responses and to determine the most effective manual therapy method. METHODS: Seventy individuals with chronic mechanical low back pain were randomly divided into CTM (n = 35) and CM (n = 35) groups. The participants were given a 4-week treatment protocol consisting of a hot pack, exercise, and CTM or CM for 20 sessions. A visual analog scale was used to measure pain intensity. Heart rate, blood pressure, and skin temperature were measured for the evaluation of autonomic responses. In addition, disability (Oswestry disability index), quality of life (short form 36), and sleep quality (Pittsburgh sleep quality index) were evaluated. Participants were assessed before and after the 4-week treatment period as well as at the end of the 6-week follow-up period. In addition, visual analog index measurements were repeated at the end of each treatment week. RESULTS: Pain intensity was decreased in both groups (p < 0.05). However, CM was more effective than CTM at the end of the 2nd week (p < 0.05). In autonomic responses results, there were increases in peripheral skin temperatures in both groups (p < 0.05). Disability, quality of life, and sleep quality improved in both groups (p < 0.05). There were no differences between the groups relating to autonomic responses, disability, quality of life, and sleep quality (p > 0.05). CONCLUSION: The results of this study showed that massages were similar effect. The fact that CM is a frequently used technique in pain management and is as effective as CTM in autonomic responses will make it more preferred in the clinic.

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