How do you measure the amount of pressure or the massage technique that is done?  You can teach a 12 MT a specific technique and it will be done 12 different ways with each persons own unique touch and intention behind the technique. How do you regulate or measure the amount of pressure that is applied and how do you regulate or measure the exact spot in each muscle or muscle group so that you know exactly what it is that is making the difference?

There is also nothing really in massage that could replicate the idea of a placebo or sugar pill.  You can hand someone a pill that they don’t know what is in it, but how do you really do that with massage?

How do you control for all of the other factors in a persons life also – I guess that is a problem with all research – was it the intervention or the change in diet that they made or them getting more sleep or them living their life.

Yet one of the ways we will get the insurance companies and the general public’s attention is with having more research.  The insurance companies especially are moving toward using research to determine where they spend their money for their patients – what works best for the money spent.  It is also just as important to have research for the spa or relaxation division of the massage profession.  Spa massage, heat and special spa therapies are just as important in healing.

Getting massage therapists interested in research is another part of this challenge.  They are taught various techniques in school that are actually not proven scientifically and the research that is done to support various modalities is usually flawed in some way but massage therapists do not really know it because they are not trained in research literacy and more importantly – they see these same things work when they practice it.   When the ‘researchers’ show up and say something doesn’t work to the many massage therapists who are practicing that modality – it is like a slap in the face (even though the researchers that I have interacted with online don’t mean it that way- their approach is very well for lack of a better work -egotistical).   That is not going to get any points for research!  From what I understand so far in this process of learning about research is that it isn’t that it doesn’t work but more of the way that it is explained as to how it does work -(does that make any sense?)  For example – research does not support the practice of Reiki but there are many massage therapists, nurses and even people in hospitals and hospice units who practice it.  It does work but the reason it does work is a mystery really or so it is said to be by science.  Is it the therapeutic presence?  Most likely but we don’t really know.  Supposedly there is no such thing really (scientifically speaking) as Universal Energy according to this article- Reiki Can Not do Harm – or can it? by Christopher Moyer, a well known massage researcher and Assistant Professor of Psychology at University of Wisconsin-Stout

“universal energy” on which it is based cannot possibly exist, for if it did, it would have to do so in contradiction of the conservation of mass-energy principle, and that is as well supported by scientific evidence as practically any principle that we know

The problem with researching massage is how do we combine science with the art of massage and preserve the art of massage – of being present, of connecting, of being compassionate care givers, with science?  We (I) just want to do massage!

Related posts:

1. Evidence Based Massage
2. Massage Research Resources
3. Researching Massage Schools

Lower back pain is reduced and range of motion increased after massage therapy. Hernandez-Reif M, Field T, Krasnegor J, Theakston H.

A randomized controlled trial of aromatherapy massage in a hospice setting. Soden K, Vincent K, Craske S, Lucas C, Ashley S.

Effects of massage therapy on sleep quality after coronary artery bypass graft surgery.

Parkinson’s disease symptoms are differentially affected by massage therapy vs. progressive muscle relaxation: a pilot study

Randomised controlled trial of the effectiveness of using foot reflexology to improve quality of sleep amongst Taiwanese postpartum women.

See more on massage and sleep disorders

Related posts:

1. Benefits of Massage Therapy
2. MTCIM May 2010 Seattle

Research is an important part of the next steps for the massage profession.  The biggest reason is that it can help the massage profession and your massage business gain the respect that is needed by the general public and also the medical profession.  It will also help get massage covered by insurance.  One of the things that Debra Senn (a past insurance commissioner in WA State who made it possible for WA State MT to become contracted providers with insurance) said one of the most interesting things about the process.  She said when insurance companies first heard they were going to have to pay for massage, they complained thinking that it would cost them more money.  They thought they would have to pay $10,000 for the carpal tunnel surgery (or whatever type of surgery and that amount is just for example- how much does a carpal tunnel surgery really cost?)  and then pay a few extra thousand to cover the massage.  They did not understand that massage could eliminate the need for massage.  I still don’t think they really get it as what I see in the way of referrals from most doctors is generally for back and neck pain.  The doctors don’t really understand how massage can be used for various things like musculo-skeletal injuries such as plantar fasciaitis, tennis elbow, sprained ankles, and things like that.  Doctors will relate more to evidence and research that shows how massage can help.  They will also start getting it when more people provide start using massage for just those kind of issues and start giving feedback to the doctors.

One of the other things about research is that it is important to have research that shows what massage does.  Many of the things that are currently being taught in massage school are inaccurate and have just been handed down through classes because that is what they are taught.  There are still many schools saying that massage should not be used on people with cancer which was debunked many years ago. (See massage and cancer)   The other big myth is that of toxins being removed (See Massage and toxins) from the body through massage and also the myth that massage removes lactic acid. (See Lactating Mythers – Massage and the Lactic Acid Myth)   Right now there are many massage therapists that continue to say those things and don’t have the latest research that shows otherwise and having so much misinformation makes massage confusing to the general public.

But having more research is not really enough since most massage therapists are not research literate- that is the don’t understand how to evaluate a research study.  Just because a study was done and shows positive outcomes does not mean that it shows anything unless you can understand it.  Research literacy is needed and it begins with having to read and learn about things that most have no interest in.  Most massage therapists are just happy to be doing massage or are struggling to get clients or find a high paying job.  Who has time for research or learning any more when of course we already know that massage works?

Research Literacy according to Ravensara Traviallian from her article in Massage and Bodywork Magazine in the Research Perspectives column is :

the ability to read, understand, and
apply information from published
research—

Once you are research literate, then you have the opportunity to start influencing research and even creating research studies.

In your massage practice, you will be able to look up research to help you address the needs of your clients when they come in with more difficult diseases and conditions and when you want to know if massage can help them.  When clients ask you how massage works, you will be able to give a knowledgeable answer.  When clients understand more how their bodies work, they have the power to take care of it better.  They also may pass this information on to their doctors- and so it goes.

So please share your comments or insights as to why we do need research and need to also be able to understand research.

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1. Massage Therapy Research
2. Massage Research
3. Massage Research Resources

The real story is that most of what is written on my page on the history of massage was taken from bits and pieces from massage school textbooks.  I gathered it a small piece at a time.  Many of the books said similar things on each step in the time line.  Unfortunately for the massage profession – most of it is wrong and I was corrected a long time ago by the historian for the massage profession -Robert Calvert who now has passed away.  I was able to meet Robert in person a few times and talk about the history of massage.  What is intriguing to me is how massage has been handed down through time and how we have gotten to the point of having so many laws and regulations about massage when in fact is was done for so long without.  Also when I study the various types of massage and the history of each of those I often find that most come about out of need to heal the creator’s pain or someone in their family.  They study what is known and spin it around into their own design finding what works and what doesn’t.

Last weekend I spent a whole afternoon perusing the Google Books section on the history of massage and put together an interesting collection of historical massage books on massage and the movement cure as it was once talked about.  The books were written between 1850-1920 and most had a chapter on the history of massage.  Now we don’t actually know if they actually had accurate info or were they all copying each other like we currently have in many current books.   I would love to take the time to read all of those books and also look for other books to compare what they are saying and come up with more details on the history of massage.

The reason for doing such a project would be to learn more about ourselves and where we have come.  The current trends in the profession seem to be headed toward more hours of education and more legislation.  There is talk of degree programs in massage.   Historically from what I read in the old books was that massage was once a 2-3 year training program and it was mostly done by doctors.  It seems that more hours of training is needed to become more a part of the medical profession and to be accepted by the medical profession but we don’t really know if that is true.   Here in WA State we are able to be contracted providers with insurance companies and doctors refer to us all the time.   It came about mainly because of the work of a savvy insurance commissioner, Deborah Senn, who used to get massaged regularly by one of the massage professions political spokespeople, Lori Belenski who currently works for the Chiropractic association.  We didn’t need any more than our 500 hours of training that is required for licensing.  All we needed was a good insurance commissioner who loved massage and knew what it could do.

The old books also have quite a bit of case studies and research being done.  I would love to know more about that early research because there weren’t any big influences like who is paying for them to be done – or maybe there was at that time – I guess I don’t know for sure.

So back to the history of massage and what it can do for our future.  I believe that in studying our history we can get a clearer sense of ourselves and take a better look at just what we want it to become.   How can we help more people with touch and massage?  Could it be in getting back to having massage be a family activity being taught to sons to help their wives during child birth?  As we gain more research and evidence that massage can help people be more healthy, will it be able to become an everyday event covered by insurance for preventative means?  Could we see more programs like Massage for Peace and Touch to TEACH programs to support our communities?  Does that take more education or just more money to start them?  Could we as Robert Calvert spoke about in his book “The History of Massage” be less likely to repeat our past mistakes?

First up is to make sure that everyone knows that Per Ling was not the father of Swedish Massage! (See also Google Books excerpt from the History of Massage” and also this latest article from Judi Calvert on Massage Today)

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Personally I didn’t understand any of the talks in the am.  So if any one else did please share.

I went to the breakout session on massage and anxiety/depression and had some great experiences.  My favorite was between Dawn Donovan and Chris Moyer.  Dawn presented her research on Use of Massage Therapy to Reduce Anxiety and to Improve Sleep in Clients Participating in an Inpatient Withdrawal Management (Detox) Program: A Randomized Controlled Pilot Study

What I loved most was that it was real.  She started with saying how many billions of dollars are spent in the US and Canada on drug and alcohol rehab and issues each year.  Her study did show that massage was successful in reducing anxiety in people who were getting off of their substance.   I loved that she intuitively decided on the massage protocol which was totally different from her usual form of bodywork.  Taking into consideration the clients needs , combining intuition and science is what we need more.   I also think it was just the idea that it was on a topic that could actually be useful to massage therapists in getting and keeping clients or creating a job in massage.
Chris Moyer isn’t a massage therapist but is a researcher who loves massage.   He is another great example of being able to take massage and measure what it is doing.  He did a literature study on whether or not massage helps reduce cortisol.  Interestingly he found that it does not reduce cortisol which is very contradictory to most of the research already done in this area mainly by Tiffany Field at the Touch Research Institute.
Making research understandable is the main reason I am attending this conference.  I am also learning about why research is so important and what it can do for the massage profession.  I think one of the big challenges is taking research and turning it into something that massage therapists can use to apply to their practice which is really just about getting and keeping clients.

I was later told by Ruth Werner that I was also witness to a rare phenomenon in research with one presenter, Ross Turchinov being intensely challenged.  (I personally didn’t understand what he was trying to say or show.  The studies he did refer to were all done in the 50′s-70′s and the challenger didn’t think that there was any prior proof of what he was talking about.  His talk was “Impact of Massage Therapy on Electrophysiology of the Soft Tissue and Cellular Function”.   I might try to talk to him tomorrow to see if he could explain it more.

There are so many well known people there from all aspects of massage- Les Sweeney (ABMP), Sydney Duncan (Massage Today), someone from COMTA but I can’t remember her name right now, AMTA presidents/officers,  but hmm…. no sign of anyone from Massage Magazine.

It was such a great networking day too meeting many people who I have connected with on Facebook and www.massageprofessionals.com .   I can’t wait to show you a new project on massage research that will help you make sense of research that hopefully will be done in the fall!

Related posts:

1. MTCIM – day 1
2. MTCIM May 2010 Seattle
3. Massage Better than Psychotherapy?

There is too much to assimilate right now but the one thing I can say and already knew this – WA State is far ahead of all the other states in being accepted as a health care profession and perhaps others could be learning from what is going on here in WA.   Debra Senn was the insurance commissioner in the early 90′s who was instrumental in getting massage and other CAM providers to be a providers for health insurance companies.  She spoke at the conference today and I wish I had got a chance to meet her afterwards.   The current problem that  CAM providers (MT, Acupuncturists and others) in WA are now having is not being paid fair fees for services.  Her advice was to just hang on and bear with the system as they work things out.   It is taking time for insurance companies to really get the idea that massage can actually help save them money.  They still don’t see massage as being a replacement for things like surgery.   That is one of the main reasons I think that we need to have more research to show these companies just what it is that massage can do.   But then again WA State has accepted it without much research in place so I guess go figure…

I sat through some really interesting break out sessions of presentations of case studies and discussions that I am still trying to figure out what it all really means.   I think what case studies are used for is to help decide what research is needed next.

There were big posters in the lobby that I haven’t figured out what they are about – if they are case studies or actual research studies so hope to get to them tomorrow!

The other striking thing to me is that I think I heard the attendance count was about 350 people which is great and about 1/3 of them were from WA State.   Out of 15,000 MT state wide, that number is disappointing.  I am not sure if it because MT don’t care because we are already providers and accepted as health care professionals or what – but I do know that getting MT to rally is like herding cats.  It seems to be the same people in the leadership roles around the country.  I know most are just focused on getting and keeping clients and making a living but you could be in CA where  I here your careers are being really challenged with this Assembly Bill 1822 -For more info see Massage Today.

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1. MTCIM May 2010 Seattle
2. MTCIM – Day 2
3. Can a massage therapist bill insurance companies?

It unofficially started tonight with about 50-75 people meeting to watch  the “DVD viewing party featuring highlights from the 2009 Fascia Congress that took place this past October in Amsterdam (www.fasciacongress.org).  It was sponsored by Tom Myers (Anatomy Trains). I unfortunately got there an hour late as I was working all day and then only stayed for less than an hour.  I was going to say I was late because I was reading the 25 page paper Bodhi Haraldsson posted on his Facebook page in response to my question about what was the MT Foundations Best Practices Symposium.  He was meeting for the last two days with that committee.  I haven’t gotten a chance to read it.  When I do I’ll try to tell you what it is in a paragraph or two!  That is one of my issues/concerns with all this focus on research – They talk like researchers – not massage therapists but maybe it’s just me.  I haven been in massage school in over 21 years and don’t really keep up on the science of it all.  I am more of the feeling type and it seems to work well for me and my clients.

It was already over my head.  I haven’t heard the words collalogen, epimysium, proprioception or fascicle in about 21 years.  From what I was able to gather is that there is some new science regarding muscle contraction but not sure what it really is all about or how or why I even really need to know about it.  I encourage anyone else there to share their comments and perspective on the evenings talk – or are we not supposed to be sharing!

I’ll talk to Ruth tomorrow for sure.

I ran into an old friend from massage school so hopefully we can sit together and talk about what we don’t remember from massage school! (or maybe she has and can fill me in!)

I was able to leave some brochures from Heal-wa.org there for the local WA State Massage Therapists.  We have this great resource here in WA where we can access some of the research databases and other resources online as a part of our licensing fees.  I’ll be writing much more about that too on my other site www.wa-massage-therapy.com/ce as I learn more how to use it and what it can be used for.  I did meet with Valarie Lawrence last week who is the manager of it all.  It is such an amazing resource!

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1. Websites – Day 3 – Planning a foundation
2. World Massage Conference
3. World Massage Conference

I would like to see more doctors really get what massage does. I have had so many doctors refer people to surgery before massage and am always amazed that people even go and get surgery before trying anything else – and that is in WA State that is pretty open to alternative therapies. I just recently had a guy with carpal tunnel in both arms that the doctor recommended surgery. This guy did his research and couldn’t find any concrete research on the effectiveness of surgery so he looked for other options. Of course a few months later with massage and he’s fine. Another client had a herniated disc in his neck or so they thought. They went in and did surgery but when they got in there couldn’t find the disc with the problem but they fused his neck anyways! Of course he was still in pain and then he came for massage and of course the pain is gone!

Some of the things I don’t understand about research though are things like:

• How do they control the method of application?  10 people could learn the same technique from the same teacher at the same time and it will come out in 12 different ways.
• Just having one or two studies does not really prove anything.  How many do we need to say without a doubt that massage works for whatever they are studying?

Then as I said there is reading the research.  It can also be interpreted in different ways by different people.  I really don’t feel like I have the time to look into research since there isn’t any driving motivation to do that really.

I would love to see the Massage Therapy Foundation and other massage research groups do that for us!  Is it being lazy?  Yup probably.

I don’t use research though  – OK  I did refer people to a few studies on my clinic website but that is more for ‘looks’ than really believing in it all – that is just my personal opinion.

I also have been reading all I can and trying to learn about it but it just doesn’t seem to be going anywhere.  I am actually going to the Research Conference here in Seattle in May but it is mainly because it is only a block away from my office!  I didn’t really know what the whole title of the conference meant until Ruth Werner explained it to me.

Here is what the website says:

The Massage Therapy Foundation is pleased to present the second “Highlighting Massage Therapy in Complementary and Integrative Medicine (CIM) Research” conference. This three-day conference brings together massage and manual therapy practitioners, educators, CIM researchers, allied health professionals, and others interested in massage research. Current research related to massage and manual therapies will be presented, with a special focus on translational research and public health.

What the heck is translational research??

Here is Ruth’s answer from my Facebook Page:

Translational research: creating and strengthening the feedback loop between researchers and practitioners– so that practitioners can apply findings in real-world settings, and so that researchers can ask questions that really matter. In other branches of health care this is called “bench to bedside” communication: Bench refers to the laboratory, bedside to the caregiver and patient.

I would write:
A special focus on strengthening the bond between researchers and MT so that we can make more sense of research and researchers can make more sense of us!

I’ll be of course writing about what I learn at the conference…So see you there?!

Related posts:

1. Why do we need Massage Therapy Research?
2. Massage Research
3. MTCIM – day 1

There are still some places that won’t work on people with cancer or who have had cancer and rightly so without proper training and knowledge.

Today massage is far from becoming a standard part of cancer care but it is on it’s way into cancer patients lives, hospitals, hospices and keeping people healthy.

There isn’t much research on massage and cancer that shows that it can help the immune system.  What massage does for people with cancer is to help them deal with the stress, discomfort, symptom relief , help with anxiety, depression, fatigue, nausea and help increase spiritual aspects of dealing with a challenging disease like cancer.  The few studies that have been done show that massage looks promising for helping with anxiety and pain.

There are a few pioneers in the field of massage who studied massage and cancer and started making it OK for people with cancer to get massage.

Gayle McDonald is the author of  “Medicine Hands: Massage for People Living with Cancer.  She also teaches classes by the same name.  She also has a class called “Massage in the Oncology Setting: A five-day Hospital Intensive that she offers.  The 300 Hour Oncology Massage Certification Program is for people who are serious about doing massage with cancer patients.

Her expertise comes from more than 10 years of work with oncology patients at Oregon Health and Science University.  She has also supervised massage students and therapists on the oncology unit, in chemo infusion, radiation oncology, and the bone marrow transplant unit.  Her work has made it possible to take cancer off the list of contraindications for massage.

You can find more info on her classes and books on her website at www.medicinehands.com

Cheryl Chapman is another forerunner in the field of massage for cancer.  Cheryl is a pioneer in Cancer and Mastectomy Massage. She began teaching Cancer Massage in 1990.  She offers classes in breast massage to help keep breast tissue healthy and also deal with massectomies and other surgeries.

She is the author of  “The Happy Breast Book” .  You can find more information about her classes and work at her website www.cherychapman.com

Tracy Walton is a massage therapist and researcher.  Best known for an intensive continuing education course for massage therapists, Caring for Clients with Cancer, Tracy has taught it nationally since 1999. Her course offerings also include an Advanced Seminar and a basic one-day Cancer and Massage Training in safety essentials.   Her focus on research is an important step for the massage profession.  You can find a list of research papers on her website at  www.tracywalton.com along with details of her classes.

An ongoing project of mine has been to collect a list of articles on massage and cancer to have as a resource for massage therapists.  You can find it in the massage pathology section at the main website www.thebodyworker.com If you have any resources or information to add on massage and cancer – please share your information here!

See also:  Society for Oncology Massage

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There seems to be two schools and probably many in between but the two basic versions are:

• 100 hours of basic massage training focusing on giving massage
• 500+ hours of extensive training in anatomy, physiology, orthopedic massage or some advanced systems of massage

When I went to massage school back in 1987, the basic requirements in WA State were 250 hours of massage school which did include anatomy, physiology, pathology and treatment massage for working with various basic conditions such as sprains/strains, headaches and common conditions. I was in the last group that was let in under those requirements of 250 hours. The number of hours of training that was required was going up to 500 hour of massage school where it stands now. I was very glad to be in the last class at 250 hours because I didn’t want to spend the extra time and money. The reasons for the increase in the number of hours of training was just an arbitrary thing that the state board seemed to come up with at the time. The massage schools were actually requesting it for no other reason than that they could make more money by getting students to stay longer. Keith Grant in his white paper on “Issues in Massage Governance” which he wrote in 2002 described this situation exactly. I have spoken about it here and really recommend that anyone who is interested in the future of the massage profession read it. It is quite lengthy and I have summarized this before on the blog.

Basically what he says is the same thing – that 100 hours of massage school is enough training to do massage and become a massage therapist.

People who think differently seem to have such an extreme reaction to this statement but don’t seem to have any proof or references to back themselves up other than statements like:

• People can’t do medical massage with only 100 hours of training
• People can’t give a good massage with only 100 hours of training
• People need much more anatomy and physiology than could be fit into a 100 hour training class

There is a whole other controversy over the issue of medical massage. Does medical massage require extra training or is it just the ability to be able to bill an insurance company for massage services which only requires knowing what paperwork is needed and how to show improvement in a massage session. Anyone who can do basic massage and can create a change in a muscle can show improvement in a condition.

I guess I must have my own personal definition of medical massage because I have been doing it since 1989 when I started my practice with 250 hours of massage school. From the very beginning I was able to bill insurance companies and be paid and was also very successful in working with clients. That doesn’t mean I didn’t get more training through the 20 years of being a massage therapist.

I am not saying that having more training is not good and that all of those years and thousands of dollars that are spent are not worthwhile. I am not saying that more education can improve your chances of being successful.

What I am saying that anyone can be taught to do a basic massage in 100 hours of training. How successful they will be depends on them, just as it does with someone with 1000 hours of training. There are so many massage therapists that do have training and still are not successful. ABMP reports that about 50,000 massage therapists leave the field each year and though they don’t say why, I would guess that most are due to being unable to make a living whether that involves getting injured or sick or what.

The thing is that we really don’t know what is required as far as education in creating a massage therapist who can be effective and successful. As a profession we have not created any studies that show that 100 hours or that 1000 hours is the best.

I don’t really know what the answer is to the issue but am really open to hearing about solutions such as studies that could help create more successful massage therapists. Keith Grant’s solution is apprenticeship programs which seem to be put on the wayside to make room for the big massage school conglomerates such as Cortiva, Corinthian Colleges and the like. And with the increase in massage franchises that only pay massage therapists $15 an hour, I just have to wonder what exactly is going on.

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