If you keep up with the world of therapeutic massage, you will eventually notice that there are some new ideas and terms going around. Evidence based massage. Evidence based practice. Evidence informed practice. Science based medicine. What does it all mean?
True to my commitment to being evidence-based, my thinking about trigger points has changed a bit since I first wrote this article. For now, I'll leave it as it was first written, but some time in the future I'll write about some new information about trigger points that challenges the ideas of Travell and Simons. As a result, my approach has altered a bit and has allowed me to work even more successfully with clients without making them sore like I did in the past! After 22 years in practice, I'm still learning and evolving. I wouldn't have it any other way.
Massage Based on Tradition
When I went to massage school, much of what we were taught was based 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 should drink a lot of water after a massage so it would "flush out toxins." It seemed 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 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 that 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 presence of lactic acid, right?
When someone finally did some research, it turned out that, in fact, massage did not reduce 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 is not 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 that this particular instructor was paying attention to science and research and was more interested in understanding the truth of what was happening rather than stubbornly defending traditional "wisdom" that might not be supportable.
Massage Based on Evidence
Shortly afterward I discovered 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 began 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 which I strive to follow to this day.
Evidenced based massage therapy is massage therapy founded on ideas and principles supported by evidence. There is 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.
Many of the claims made and practices used by massage therapists are founded on tradition rather than evidence. Since there is not yet a large body of knowledge documenting the physiology of and effects of massage therapy, if we were only able to make statements strictly on the basis of scientific studies, we would 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 one day when I found a large 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 always been done and are not necessarily supported by evidence that they are the best way or even effective.
In science, one always has to be open to new evidence and be willing to change your mind when confronted with new information that contradicts formerly held beliefs. Another one of massage therapists' dearly held beliefs was challenged last summer when researcher Christopher Moyer presented a paper that showed that massage therapy did not lower levels of the stress hormone cortisol nearly as much as had been previously thought and, in fact, its effect on cortisol may 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 evidence he presented. It took awhile for me to understand but in the end it seemed that 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 better, we just don't know exactly why or how.
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 truthful. I do not want to mislead them by making unsubstantiated claims. In addition, I believe that the more we are able to understand, the more effective we may 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.
During the last year, I have found some wonderful resources that have helped me to stay informed about research that may be of interest to massage therapists. I'm sure there are others and if you have favorites of your own, please feel free to post them in the comments section.
Paul Ingraham is a retired massage therapist who has become a science writer. His website, SaveYourself, is full of useful and fascinating articles of interest both to massage therapists and the lay person.
Christopher Moyer, Ph.D., does research in massage therapy. He rocked the world of massage therapy with his study on the stress hormone cortisol and most recently co-authored the book Massage Therapy: Integrating Research and Practice, a must-have for every evidence-based massage therapist. Links to his research papers can be found on his website PsychRadio.
Evidence Based Massage Therapy is a FaceBook page whose goal is to build a reference library of research articles and other related practice resources that assists the busy practitioner with their continued professional development.
Touch Research Institute at the University of Miami School of Medicine has been doing research on massage therapy and touch since 1992.
Additional resources can be found here.