Ask the Massage Therapist

I had a couple of interesting conversations today that made me think about confirmation bias. Someone raised the question: 

How can you be certain you are not operating out of confirmation bias?

This is an excellent question and one that we should never stop asking ourselves. 

Confirmation bias is the tendency for us to see what we want to see and ignore what we don't want to see. As professional massage therapists who want to serve our clients well, it's important for us to be aware of confirmation bias and take steps to minimize it. The very first step is to recognize that it exists. 

 A reader asked the following question:

How do you describe Craniosacral Therapy to a client who has never experienced it before and how do you promote it?

The simple, most straightforward answer is that I do not practice Craniosacral Therapy (CST) so I do not promote it. I've never had a client ask about it that I can recall. However, if a client were to ask about it, I'd probably answer something like this:

I had classes in Craniosacral Therapy many years ago from two different nationally known instructors. However, I never used it in my practice. I probably practiced some of the things learned in class shortly after I learned them, but abandoned it pretty quickly. 

When people say, “I have TMJ,” they usually mean that they have temporomandibular joint dysfunction, a condition that can cause jaw pain that can be difficult to treat. Chewing may be painful and it can lead to headaches and neck, shoulder, and upper back pain. They may experience popping, clicking, and shifting when they open and close their jaw and their mouth may even get stuck in an open position if they yawn or open their mouth too far.

These are notes from a presentation given at the Skeptical Society of St. Louis Skepticamp on Saturday, September 14, 2013. Links to some of the resources and studies mentioned during the presentation, as well as additional links that may be of interest, are provided for those who would like to look at them.

A Skeptical Look at Back Pain: Notes from Skepticamp 2013

In 1995 I was working at St. Mary’s hospital when I heard about this study which examined 98 people who had no low back pain (LBP) and found that a large percentage had herniated discs. ("asymptomatic" means without symptoms i.e. no pain)

 http://www.nejm.org/doi/full/10.1056/NEJM199407143310201

            98 asymptomatic individuals ages 20 – 80

            36% normal discs at all levels

            52% bulging disc at at least 1 level

            38% abnormal at more than one level

            Findings similar in men & women

            Abnormalities increased with age

"Did you hear about the study of the MRIs and herniated discs?" It was 1995, I was working at St. Mary's Hospital, and one of my fellow massage therapists had news about a surprising piece of research. In those days before the internet it was difficult for us to get information about studies of interest to us massage therapists. A juicy tidbit like this was cause for excitement.

 If all you have is a hammer, everything looks like a nail.

There are many modalities in the field of manual therapy. All of them sometimes work yet many of their explanations contradict each other. 

A massage therapist is trained to treat trigger points. When a client comes to them seeking relief for a pain problem, the therapist will look for trigger points, will inevitably find them, and attempt to resolve them. The client often feels some relief after the treatment. Both client and therapist conclude that the pain was a result of trigger points and that the trigger points have been resolved, at least temporarily.

Another therapist is trained in myofascial release. A client comes seeking relief from pain. The therapist will look for and inevitably find fascial restrictions. The client may feel better at the end of the session, may even find long-lasting relief. Both assume that the pain was the result of fascial restrictions that have now been properly treated and resolved.

Anxiety and depression are common yet serious disorders.  Massage therapy may help.

A massage therapist recently asked the question, "Who was your mentor and what did you learn from them?" Immediately, a particular individual came to mind and I began to think of how I would answer that question. Then I thought of the first massage therapist I considered to be a mentor. And then the second one. Shortly after, I thought of two individuals who came into my life a couple of years ago. They challenged me in ways that changed and improved my thinking. I thought back to my science-minded father who did little experiments with me and bought an encyclopedia for me when I was five years old. The list kept growing longer. It seemed to have no end.

The SomaSimple forums are one of the best resources available for any manual therapist working with clients with chronic pain. However, massage therapists who find their way to the SomaSimple site are often overwhelmed at first by the enormity of the material, intimidated by the level of discussion, and confused about where to start. Having been through that and survived, I'd like to help make it easier for those curious massage therapists who come behind me. Why? Because I think that what SomaSimple has to offer is of enormous value and can't be found anywhere else. It is one of the best resources I've found for learning about current pain science and how to apply it in your practice.

What is SomaSimple?

SomaSimple is a website of forums and archived material for science-minded manual therapists. The majority of members are physical therapists (called physiotherapists outside of the U.S.). Other professions are also represented: osteopaths, chiropractors, massage therapists, yoga instructors, personal trainers, coaches. What they have in common is an interest in pain science and science relevant to manual therapists.