Massage Therapy

A colleague on a private forum asked the following questions in response to some thoughts I posted yesterday. In particular, he wondered about the description of an experience I had with a client. His question:
 

Having effect on the nervous system by stretching skin will relieve pain?  . . . [Is] Dianna [sic] relieving trigger points in this fashion? Seriously? Sixteen years ago, I never knew what was causing my pain. Doctors didn't know either. And then I ran into a PT who did know and mentored me. Trigger Point work, as I have benefitted, is painful. Paul Ingraham and Amber Davies agree, they hurt like hell when compressed. That "painful work" is the only thing that has ever given me tempory relief. I'm just not seeing where skin work is going to effect a mechanical release of myofascial contraction knots.....

The past year has seen a mental growth spurt for this therapist. After years of feeling isolated as an evidence-based massage therapist, I found an online community of MTs and related professionals with similar interests.

Most people find massage to be a very pleasant and relaxing experience. When scientists began to study massage and documented that levels of stress hormones were lower after massage, both clients and massage therapists alike were happy to have physiological evidence of their experience.

[A simpler article, written for clients, can be found here.]

For a number of years I've followed the research of Touch Research Institute at the University of Miami School of Medicine. They've been doing research on touch therapy since 1992 and have been pioneers in the field of massage therapy research in the United States. One of the markers they use in their studies is cortisol, a stress hormone that can be measured in blood, saliva, and urine.

The other day I wrote an article, directed at massage therapists, about massage and lactic acid.  However, for some clients it might be too much information, as they say, and may not answer the client's question, "What does this mean for me?"

Many, many people have heard that lactic acid is produced in the muscles during exercise, makes the muscles sore, and that massage helps get rid of lactic acid. This was once thought to be true. However, it has been discovered that lactic acid is not what makes muscles sore after exercise. What causes post-exercise soreness? We're not exactly sure but current thought is that it may be microscopic tears in the muscle fibers and inflammation.

What does this mean for the client? It may not change very much what we, as massage therapists, do. It changes what we think about what we do. Massage still makes people feel good and it makes muscles feel good. If you have aching muscles, there's a good chance that the right kind of massage can help.

[Please note: a simpler article on this topic, written for clients, can be found here.]

Lactic acid has been blamed for delayed onset muscle soreness (DOMS) for decades. Physiologists once believed this to be true. However, it has been known at least since the 1960s that lactic acid is not responsible for DOMS.

“Monkeys, and other animals, groom each other often with a marked reduction in stress. Touch is good, and one doesn’t need to wrap it up in pseudoscientific nonsense for it to be beneficial.” - Mark Crislip discussing reflexology on ScienceBased Medicine blog

These are the opening words to a paper on the interactor/operator model by Canadian physiotherapist Diane Jacobs, who describes herself as a "human primate social groomer and neuroelastician." When I first read this paper, I wasn't always completely clear about what Diane had to say, but what I understood resonated with me and articulated a dilemma I'd struggled with for a long time.

Yesterday I posted an article about my thoughts on energy work. I was surprised at the discussions it prompted among some manual therapists on forums off this site and was pleased with the thoughtful, respectful comments. I had actually been just a little nervous, afraid that my science-based friends might have thought that I'd gone daft and abandoned science, but they totally got it. I'm glad.

So now, I have a confession to make. I don't do it often but yes, I have engaged in energy work. In fact, some of the most profound experiences have occurred during sessions when my approach has come from this direction. Now, before you think I've gone over to the dark side, let me explain. Most of my work is done from a physiological approach, its purpose being to solve a particular physical problem. Some of my work, often with clients who have suffered trauma and have been referred from a psychotherapist, comes from an approach that is less focussed on physiology and more attentive to the emotional state of the client.

The world of therapeutic massage took a giant leap forward today as Ravensara Travillian presented the Project for Open Education in Massage (POEM) to the public. The world of massage therapy will never be the same.

What is POEM?

Impossible to describe in just a few words, POEM is a resource for massage therapists like nothing ever seen before. It is an online gathering place for massage therapists that is intelligent, articulate, and civilized, much like Ravensara herself. It is a resource for learning about the latest research, learning how to read and understand research, learning how to do case studies. Still incomplete and in a testing stage, it will include forums, quizzes, places to pose questions, articles, and educational material, including Raven's book on research literacy for massage therapists. Not only will research papers be presented but also analyzed and critiqued, allowing the massage therapist to learn to evaluate the quality of research. POEM's stated intention is to:

Recently, I wrote about the emergence of what has come to be called science based or evidence based massage therapy. At the end of the article, I listed a few online resources for massage therapists interested in keeping up with relevant research. However, there are many, many more resources available. Some are directly devoted to massage therapy. Some are related to massage therapy and other manual therapies. Still others are devoted to pain research, brain research, science, or medicine and may be of interest to massage therapists. In this article, I would like to start a list of what I think are good resources for massage therapists. This list is far from complete and will be updated periodically as I learn of other resources. Please feel free to submit your own favorite internet resources.