As you keep up with the world of massage therapy, you will eventually find some new ideas and terms circulating. Evidence based massage. Evidence-based way of working. 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 based on tradition or what was considered common sense. We did certain things a certain way because… well, because that’s the way we were taught to do them. Massage “improved circulation.” We need to drink a lot of water after a massage so that it “washes out toxins”. It seemed logical, right?
My first introduction to the idea that science was beginning to contradict some of our cherished beliefs came when an instructor told me that research had shown that massage did not reduce lactic acid in muscle tissue, as commonly claimed. We had always been told that a buildup of lactic acid in the muscles was the cause of pain and that massage reduced its presence. People repeatedly experience that massage reduces muscle pain. Therefore, massage should reduce the presence of lactic acid, right?
When someone finally did some research, it turned out that massage did not reduce the presence of lactic acid . How can this be? Did this mean what we were told was wrong? Well, it is true that massage reduces muscle soreness. Apparently, though, it’s not because of lactic acid. How does massage reduce pain? We don’t understand exactly how it happens, but we do know it happens.
Although one of the sacred cows of massage therapy had just been slaughtered, I was pleased that this particular instructor paid attention to science and research and was more interested in understanding the truth of what happened rather than defending a tradition that may not be supported.
Shortly afterwards I discovered Neuromuscular Therapy, also called Trigger Point Therapy, and the work of Travell and Simons. drs. Travell and Simons spent years documenting the phenomena of trigger points and writing the two-part set Myofascial Pain and Dysfunction: The Trigger Point Manual. Studying their work gave me the tools to work effectively with some common pain conditions. It also started to give me the knowledge and vocabulary to talk intelligently with physical therapists and doctors about my clients and their patients. It set me on the path of an evidence-based practice, a path I try to follow to this day.
Massage based on evidence
Evidence-based massage therapy is massage therapy based on ideas and principles supported by evidence. There is scientific, documented evidence to support the existence and treatment of trigger points. There is documented evidence that massage relieves muscle pain and can relieve anxiety and depression.
Many of the claims and practices used by massage therapists are based on tradition rather than evidence. Since there is not yet a great body of knowledge documenting the physiology and effects of massage therapy, if we could make statements strictly on the basis of scientific studies, we would be very limited indeed. Some people prefer the term evidence-informed practice as more accurate. An evidence-informed practice takes into account scientific evidence, clinical experience and careful observation.
I assumed that this reliance on tradition was primarily limited to the field of massage therapy, and was surprised to find one day a major exhibit on evidence-based medicine in the halls of the St. Louis University Medical School. Apparently even in conventional medicine many procedures are done because that is the way they have always been done and not necessarily supported by evidence that they are the best way or even effective.
In science, you should always be open to new evidence and willing to change your mind when confronted with new information that contradicts previous beliefs. Another cherished belief of massage therapists was put to the test last summer when researcher Christopher Moyer presented a paper showing that massage therapy did not lower levels of the stress hormone cortisol as much as previously thought and, in fact, its effect on cortisol may be negligible. to be. I’m sure I wasn’t the only massage therapist shocked by this news. However, once I got over the initial shock, I examined the evidence he presented. It took me a while to understand, but in the end it seemed that he had very good evidence to support his conclusions. Does this mean that massage doesn’t “work?” well, it’
Does it really matter if we understand? I think so. First of all, as a therapist, I want to make sure that the claims I make to my clients are true. I don’t want to mislead them by making unsubstantiated claims. In addition, I believe that the more we can understand, the more effective we can be in our work. Finally, I believe that the more we can document the ways in which massage therapy can be helpful, the more accepted it will become.
There are some great resources that can help massage therapists stay on top of the current research in massage therapy. Online forums, Facebook pages and professional associations can be a start. In addition to forums and articles specifically focused on massage therapy, areas such as pain science, neuroscience, and related fields can help the science-based therapist stay informed about how the body works and how we, as therapists, can influence it. Networking with physical therapists and researchers can also increase one’s understanding.
When we truly understand how the body works, we are much better able to achieve the client’s goals, be it for pain relief or relaxation. And when our knowledge is based on what is actually known about how the body works, customers can trust us and know that they are in good hands.
Alice Sanvito is a licensed massage therapist in St. Louis, MO. In practice since 1991, her focus is on evidence-based modalities and the problem-solving aspects of massage.