If you maintain with the world of massage therapy, you will eventually observe that there are a few new ideas and terms on offer. Evidence based massage. Evidence based practice. Evidence informed practice. Science based medicine. What does it all mean?
Massage Based on Tradition
When I went to massage school, much of what we were taught was predicated on tradition or that which was perceived to be good sense. We did certain things in certain ways because… well, because that has been the way we were taught to accomplish them. Massage “improved circulation.” We ought to drink lots of water after a massage so it would “flush out toxins.” It appeared to make sense, right?
My first introduction to the theory that science was beginning to contradict some of our dearly held beliefs came when an instructor told me that research had shown that massage did not, as was commonly claimed, reduce lactic acid in muscle tissue. We’d always been told a buildup of lactic acid in the muscles was what caused soreness and that massage reduced its presence. People repeatedly experience that massage reduces muscles soreness. Therefore, massage should be reducing the current presence of lactic acid, right?
When someone finally did some research, it turned out that, in fact, massage didn’t decrease the presence of lactic acid. How could this be? Did this mean what we’d been resulted in believe was wrong? Well, it’s true that massage does decrease soreness in muscles. Apparently, though, it is not because of lactic acid. How does massage decrease soreness? We don’t clearly know how it happens but we do know that it does happen.
Although one of massage therapy’s sacred cows had just been slain, I liked it that this particular instructor was watching science and research and was more interested in understanding the truth of that which was happening instead of defending a tradition that might not be supportable.
Shortly afterward I came across Neuromuscular Therapy, sometimes referred to as Trigger Point Therapy, and the work of Travell and Simons. Drs. Travell and Simons spent many years documenting the phenomena of trigger points and writing both volume set Myofascial Pain and Dysfunction: The Trigger Point Manual. Studying their work gave me the various tools to work effectively with some typically common pain conditions. It also began to give me the data and vocabulary to speak intelligently to physical therapists and physicians about my clients and their patients. It started me down the road of an evidence based practice, a path that i strive to follow to this day.
Massage Based on Evidence
Evidenced based massage therapy is therapeutic massage founded on ideas and principles supported by evidence. There is scientific, documented evidence to support the existence of and treatment of trigger points. There’s documented evidence that massage relieves muscle soreness and will alleviate anxiety and depression.
Most of the claims made and practices used by massage therapists are founded on tradition rather than evidence. Since there is not yet a big body of knowledge documenting the physiology of and ramifications of massage therapy, if we were only in a position to make statements strictly based on scientific studies, we’d be severely limited, indeed. Some people choose the term evidence informed practice as more accurate. deweyshouse.com An evidence informed practice takes into consideration scientific evidence, clinical experience, and careful observation.
I assumed this reliance on tradition was primarily confined to the field of massage therapy and was surprised 1 day when I found a big display about evidence based medicine in the halls of St. Louis University Medical School. Apparently, even in conventional medicine, many procedures are done because that’s the way they have been done and are definitely not supported by evidence they are the best way and even effective.
In science, one always must most probably to new evidence and become willing to change your brain when confronted with new information that contradicts formerly held beliefs. A different one of massage therapists’ dearly held beliefs was challenged last summer when researcher Christopher Moyer presented a paper that showed that therapeutic massage did not lower levels of the strain hormone cortisol nearly up to have been previously thought and, actually, its effect on cortisol could be negligible. I’m sure I was not the only massage therapist who was startled by this news. However, once I got over the initial shock, I examined the data he presented. It took awhile for me to understand but in the finish it seemed he had very good evidence to support his conclusions. Does this mean that massage does not “work?” Well, it’s obvious that massage makes us feel much better, we just don’t know exactly why or how.
Does it really matter if we understand? I believe so. For starters, as a therapist, I want to ensure that the claims I make to my clients are truthful. I do not need to mislead them by making unsubstantiated claims. In addition, I really believe that the more we are able to understand, the more effectively we might maintain our work. Finally, I really believe that the more we can document the ways in which massage therapy can be helpful, the more accepted it will become.