Massage Research

What is research?

Research is a conversation that builds knowledge over time.  It is a way of taking all of our stories from our hands on work and putting it into a format that can help us to make sense of what massage does and what we are doing in our daily massage practice.   It is asking questions in a very particular way that is objective (free of bias, facts and opinions).   It also has to be reproducible by others and get the same results – that would be good!  It allows research to build on itself and go forward to the next steps.

Levels of Evidence

It is all about the levels of evidence and the strength/impact of the research.  Not all research is good research! Research that shows something works on a high number of people is better.  Research that also reduces bias is better.

The highest level of evidence is shown in systematic reviews such as a metaanalysis that collects info from many research studies and makes meaning of all the research on a topic.

A Randomized controlled Trial (RCT) is the next highest level – the Gold Standard as it is called.  There is a control group that separates the question from the study. It has to be random as in you put names in a hat and pick participants.  One group gets the massage and one group gets no treatment.   It’s random!

Pilot studies are usually done with 30 people and will usually tell us that we need more studies on a specific area.

Case Reports/Case Studies are the stories from our clinical work so others can begin to understand what it is that you do.  A case series can also be done on a few clients with the same issues like all of them have headaches or back pain or one issue.   You can’t prove anything with a case report but it is a very good place to start.  One of the most famous findings was in a case report – Five Young Men with Pneumocystis carinii pneumonia at 3 different hospitals in Los Angeles, California.

 Why is Research important for the massage profession?

One of the main reasons for doing research is so that we will have the best methods and techniques for clients to be able to help them more.   The more we know, the better our sessions can be or so it is said by many of the researchers.

The other main reason is that many insurance companies are requiring us to show them more research in order for massage to be covered by health insurance.

Health insurance companies do not really understand that allowing massage would help save them money.  They still  have the idea that they would be paying the massage therapist $1000  and also having to pay for surgery (an additional 20k rough guess). From what I have seen here in WA with being one of the only states where it is a mandate that insurance companies cover massage is that doctors still do not really understand the benefits of massage.  In general, they will prescribe massage for back/neck pain but don’t really send people with larger complaints like carpal tunnel or thoracic outlet syndrome.

 

“Reiki” (ray-key) is Japanese for ‘universal life energy’, a term used to describe a system of natural healing. This healing tradition was founded by Dr Mikao Usui in the early 20th century and evolved as a result of his research, experience and dedication.  Massage Therapists are often found taking classes in Reiki and it is also popular in the nursing profession with nurses using it often in the hospital with sick patients.

One of the hot topics of discussion on Facebook among massage therapists has been – Does Reiki Work? and the latest question asked was why does the NCBTMB approve Reiki classes as part of their continuing education requirements if there is no scientific evidence that there is even such a thing called Reiki.

There are many research studies that do try to show that Reiki works.  I just Goggled Reiki Research and there were many pages that showed many different studies on Reiki.

The problem though with all the research studies though is that they assume that there is something called ‘Universal Energy’.  I am told by Chris Moyer, PhD a well known researcher in the massage profession and Professor of Psychology at University of Wisconsin-Stout, that indeed there is no such thing as ‘Universal Energy’.

Most reiki research is also lacking in valid research methods that show what it really is that is happening because there are so many positive results that happen. Many Reiki practitioners will usually see some results in their clients.  It is my understanding that Reiki or so called laying on of hands or holding your hand over people does help them feel better- helps them feel calmer, more relaxed. It is not apparently because of the so called “universal energy field.”

The problem for me lies in how do we get this message to people who are doing Reiki and what really would need to be done?  Could people doing Reiki just change what they say about how it works to be more credible and just say we don’t know what is happening?  Does using Reiki and saying that Reiki works actually hurt the massage profession because it makes the profession look less reputable when they promote things that are not accurate methods of healing?

 

 

 

Personal note:  I don’t get Reiki.  I never have felt anything when someone said they were doing Reiki on me.  I took an energy class once (not specifically reiki) and they told me to imagine I felt the energy.  I was out of there!  The reason this topic interests me so what to do with all the Reiki practitioners out there spreading the word of Reiki.  I am sure that their reaction to this is going to be reactionary as I am guessing they may feel like they are being attacked both professionally and personally as I have seen in other cases of where research does not currently support a technique or process. My concern with this is how I see it separating the profession even more when there is already so much going on that separates us (Side bar: 2 major professional associations, 2 major testing organizations, the ELAP project, the Alliance for Massage Education – why can’t there be one org? that unites us all because it is needed if we want to be recognized as part of the health care profession and get massage to be covered by insurance.)  I also have been struggling for years to understand the meaning of research and what does it say or not say – does research ‘prove beyond a doubt’ that something works or doesn’t work and how much research do we need to prove something.

This effects of massage or what most massage therapists also refer to as the benefits of massage have been passed on by many massage schools as the way it is.  Unfortunately, most of the benefits of massage have not been widely researched and many of the things that are taught in basic massage school are not correct.

I know that after attending the Massage Therapy Foundations Research Conference a few years ago here in Seattle.  Even with all of that information, the stories continue on.  I recently attended the Alliance for Massage Therapy Education Conference (AFMTE) and took the class on Busting Myths and Teaching Truths about the Effects of Massage, with Tracy Walton (who by the way is one of Gods blessings for the massage profession!  If you ever get to take a class with her, she is absolutely fabulous! She is involved with doing research on massage and cancer.)

The rest of this post are based on my notes from the class!

There are three types of different outcomes that can be measured as a result of doing massage. (You can also read more in Chapter 6 in Tracy Waltons book – Medical Conditions and Massage

1. Clinical Outcomes are subjective reports about whether or not
   clients are doing better with their treatments.  Are they coping and managing better as a result of the massage?  Massage reduces stress is a clinical outcome.
2. Mechanistic outcomes are based on science.  They are measured in blood tests or other physiological mechanisms such as saliva tests.  Reducing Cortisol is a mechanistic outcome.
3. Financial Outcomes are is the treatment cost effective?  Can they save money on medications, reduce surgery and things like that.

In general, we use mechanistic outcomes more often even though there is not enough scientific evidence that they are true.  Mechanistic outcomes are weak and the clinical outcomes would be stronger without them. How many times have you heard or read a MT website and their claims:  increases endorphins, increases immunity, reduces cortisol, detoxifies, increases circulation or that they can’t do massage on someone who has cancer because it is spread through the body when.

There isn’t much research to support those effects of massage…sorry.

[Side Note:  Research Literacy.

In research, not all research is created equally and there are different levels of evidence and different classifications of research studies.  That means that there are research studies that are better than others because of the way that they are done.

The Highest Level of research – the one’s that are the best as far as what they show are Qualitative Reviews.  That is when a researcher researches research and make a review of the research that is done -aka Met-analysis. Narrative Reviews are reviews of literature (any type of literature on the topic) are the next top level of evidence, and then Randomized Control Studies -RCT, where there are groups of people who don’t get massage, Case Series which is a series of case studies on one topic, a case report (written by one therapist on one client and explores the massage sessions and results) and then the story or Anecdote that was told.

(This article from the AMTA has more info on research literacy (PDF).)

So back to the effects of massage one by one.

1. Massage increases endorphins.  T or F ? …………..sorry – F.  There are only two 2 RCT studies ever done.
2. Massage enhances immunity.   T of F? ……………sorry – F.  There are only a few studies done by the Touch Research Institute done on that which means that there could be research bias because of it being done at the same place.  We need more research on this.
3. Massage reduces cortisol.     T or F?………………sorry.  F.  Yes you were taught this over and over in massage school and there are many studies by the Touch Research Institute, but there was a big bomb that went off in the form of a Meta-analysis done by Chris Moyer, PhD that shows that massage does not lower cortisol. (see video below)
4. Massage detoxifies tissues.   T of F…….again. F   There are no studies what so ever on massage and toxins. Toxins are things like mercury or heavy metals or chemical compounds.  Some were taught that the waste products from normal cellular metabolism were called toxins and that massage moved them out of the tissues.  The body takes care of these products from what we know now.  Yes people feel better after massage, but it isn’t because the massage got rid of toxins.
5. Massage increases circulation.  T or F?  ………are you catching on?  F.  There are only a few RCT’s that were done a really long time ago and were not done with ultrasound so there isn’t any proof that massage increases circulation.  Because we just don’t know what massage does, there are many contraindications around circulatory effects such as blood pressure, blood clots and things like that.  It isn’t really a good idea to ignore the contraindications until more research is done.
6. Massage Spreads Cancer.    T or F?……… Yes.  F   There is plenty of research that now shows that it is OK to massage people with cancer.  If it was true that massage spreads cancer, patients would also be told to stop exercising and in fact they are usually told to exercise.

So there you have it….the truth about the effect of massage.  Be sure to share this on your Facebook walls, in your newsletters and start changing that long list of things on your website.

So what is the evidence for what massage can do?  The strongest evidence is also a meta-analysis by Chris Moyer that shows that massage reduces depression and anxiety as much as psychotherapy does.  Will massage one day be under psychology boards?