If you keep up with the world of therapeutic massage, 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, a lot of what we were taught was predicated on tradition or what was perceived to be common sense. We did certain things in certain ways because… well, because that was the way we were taught to do them. Massage “improved circulation.” We have to drink many water after a massage so that it would “flush out toxins.” 부달 It appeared to make sense, right?
My first introduction to the idea that science was beginning to contradict some of our dearly held beliefs came when an instructor explained 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 must be reducing the current presence of lactic acid, right?
When someone finally did some research, it turned out that, in fact, massage did not decrease the presence of lactic acid. How could this be? Did this mean what we’d been led to believe was wrong? Well, it’s true that massage does decrease soreness in muscles. Apparently, though, it isn’t because of lactic acid. How does massage decrease soreness? We don’t clearly understand 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 paying attention to science and research and was interested in understanding the truth of what was happening instead of defending a tradition that may 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 the two volume 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 begun to give me the knowledge and vocabulary to speak intelligently to physical therapists and medical doctors about my clients and their patients. It started me down the path of an evidence based practice, a path that i strive to follow to this day.
Massage Based on Evidence
Evidenced based therapeutic massage is massage therapy founded on ideas and principles supported by evidence. There’s scientific, documented evidence to support the existence of and treatment of trigger points. There is documented evidence that massage relieves muscle soreness and can alleviate anxiety and depression.
A lot of the claims made and practices utilized by massage therapists are founded on tradition rather than evidence. While there is not yet a large body of knowledge documenting the physiology of and ramifications of massage therapy, if we were only able to make statements strictly on the basis of scientific studies, we’d be severely limited, indeed. Some people prefer the term evidence informed practice as more accurate. 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 yet in conventional medicine, many procedures are done because that’s the way they have always been done and are not necessarily supported by evidence they are the best way or even effective.
In science, one always has to most probably to new evidence and be willing to change your mind when met 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 degrees of the stress hormone cortisol nearly as much as 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 on the initial shock, I examined the data he presented. It took awhile for me personally to understand but in the end it seemed that he had very good evidence to aid his conclusions. Does this mean that massage will not “work?” Well, it’s obvious that massage makes us feel better, we just don’t know why or how.
Does it really matter if we understand? I think so. First of all, as a therapist, I would like to be sure that the claims I make to my clients are truthful. I really do not need to mislead them by making unsubstantiated claims. In addition, I really believe that the more we’re able to understand, the more effectively we may be in our work. Finally, I believe that the more we can document the ways that massage therapy can be helpful, the more accepted it’ll become.