Massage therapists have historically lamented the lack of respect paid our profession by the medical community, insurance companies and even the public. We roll our eyes and throw up our hands, mystified and defeated by our perennial subjugation. Woe are we!
I have good news, friends. The mystery is over. We can stop demonizing doctors, “big medicine” and territorial physical therapists. We can draw a straight line to a prime factor within our control that has perpetuated our situation. You and me.
As massage therapists, we are taught to extol the circulatory, toxin-flushing, muscle tone-improving, cortisol-reducing, immune system-boosting benefits of massage therapy. These claims have been the holy grail of massage marketing. The problem is that there is little or no evidence to support these claims. In fact, in some cases (namely, “increased circulation”), the small number of studies conflict (see Chapter 6 of Tracy Walton’s new book Medical Conditions and Massage Therapy). In the case of cortisol, the body of evidence clearly states massage does not lower ithttp://www.uwstout.edu/faculty/moyerc/upload/MT-meta-analysis-PB2004.pdf. Period. Although these claims are still taught in massage schools, propagated in the literature, and carried across legions of massage promotional materials, they reflect only theories, opinions, lore, and wishful thinking. In oncology massage, at the forefront of the medicine-massage interface, we must be scrupulously honest, and well-supported in our claims.
No matter what we are taught in school, or read in the massage literature, it’s our professional responsibility to question what is claimed about massage, think them through, and look for consensus on each point. It’s our responsibility to continue to learn and grow, and become as research literate (or at least “conversant”) as possible. When we do this, we find that many of the “massage benefits” we have learned along the way are unproven, disproven, or are still theories with no research effort at all behind them.
In this regard, the reform of the massage therapy profession is certainly a monumental undertaking and not one that this wee newsletter and we can tackle alone, but we can each do our own small part to create momentum. We can start by bringing greater mindfulness and accountability to the way we promote massage therapy. We must commit to stricter standards and to model legitimacy before we can put our hands out to be pulled up to what we think is our rightful place at the mainstream healthcare table.
First and foremost, bear in mind: one single research study does not establish a truth. No matter what the title of the article says (“Massage improves X and Y in cancer patients!”), even a well-designed study only suggests a relationship and invites more research. By themselves, a handful of studies do not tell us anything conclusive. Instead, there needs to be a body of work, enough strong studies from enough different places to say for sure what massage does and doesn’t do. And the body of work needs to be formally evaluated statistically to determine what it tells us about massage, then published as a meta-analysis or quantitative review.
When we really look at the body of work, rather than a single study, the science tells us that, for people with cancer, massage therapy decreases perception of pain and anxiety. That’s about it, at this point. This is what we can truthfully claim that massage “does”, according to replicated, well-designed, credible studies. As far as other claims, we can say that it “may” increase energy, may boost mood and some of the other things we are currently claiming. BUT we need to stop just tossing these benefits around willy nilly as though they are proven facts.
It’s a simple matter of answerability in our choice of words. Be clear about what’s possible…and what’s not. Take it upon yourself to learn (or review and refresh) your massage claims and physiology, then familiarize yourself with the research that is out there.
There are so many resources in the massage research realm. Follow the free open-source international journal http://www.ijtmb.org/index.php/ijtmb at the Massage Therapy Foundation website. Read the summary in Gayle MacDonald’s book, Medicine Hands. View Tracy Walton’s webinarhttp://s4om.org/div0/walton_webinar.htm on massage and cancer research for a summary of what the evidence says (and doesn’t say), and how we evaluate the evidence. Check in at the National Library of Medicine (www.pubmed.gov) regularly and use the search terms, “massage” and “cancer” or “massage” and the factor about which you are interested in knowing more. And remember that any one study you pull up will probably not tell the whole story.
I know, I know. Maybe you’re saying, “But science isn’t everything. Have you no soul?!” As with most things, it’s all about balance. While you’re being all professional and responsible don’t throw the lotion out with the holster. There is probably a lot that massage does that we can’t quite put our fingers on. Personally, I “know” that my clients feel loved and heard and more hopeful and a host of other positive things that science will likely never get around to measuring. How do I know this? Because they tell me. These “benefits”, in my humble opinion, are why clients really come back week after week and year after year. Sure, I make their shoulders feel better and I ease their headaches, but the expansive beauty of what we’re each offering in our treatment spaces defies explanation…and that’s just as well if you ask me. That daily sip of the mystery is how we can do this work for years and years without burning out.
So then how do we do this dance of professional due diligence and not lose the heart of it? I think of myself as a sort of double agent. In my treatment suite I am making a living simply by loving my clients through clinically safe, physiologically sound massage therapy, curious and caring listening and good old fashioned presence. Meanwhile, outside my treatment suite my job (and yours!) is to be a responsible, committed, well-educated healthcare professional.
Each doctor, each nurse, each physical therapist and insurance company who is convinced of the value of massage therapy by my professionalism, demeanor and adherence to the standards of respectable, legitimate, safe, effective healthcare opens the door for me to use massage therapy as a means to love, to hear and to foster hope in one more person who may never have considered massage therapy before.
You and me?…we are that powerful. Let’s use that power to its most beautiful, empowering and legitimate potential.
(orginially published at www.lighthold.org)