Blog the third - Evidence Based Therapy

Finally a massage themed post!

Much of massage literature uses the term "evidence based" and I find it a bit frustrating. We use the term to validate ourselves and to counter criticism that massage is untested and unscientific, but it's too soon. There just isn't that much evidence yet!

Strides are being made, research is beginning to happen. We will eventually have data that will allow us to weed through the myths and truths of the various massage therapy traditions.

It's important that we acknowledge that in it's current state, clinical massage therapy is still based primarily on experience and observation of individual cases. The phrase I like to use to describe my practice is "results driven" massage therapy. I encourage my patients to ask the question: "How much has my treatment helped you?". I had a cranial sacral instructor who recommended a target of 50% change per treatment as a reasonable goal. With most orthopaedic problems I have to agree. Chronic problems sometimes seem to require less optimistic goals. This applies to both the objective measure of joint function (ROM), and the subjective measure of their discomfort. Observable change is the best measure of our efficacy as therapists.

There are studies that do show massage is an effective therapy for chronic pain, stress reduction, and improvement of qualify of life. This give us a legitimate basis to say that we can help manage pain and reduce stress. It does not allow us to say much about most pathologies and cases. There's certainly very little we can say for certain about the techniques we use. How well do they work? Are some techniques better than others for particular conditions? What physiological processes are we engaging?

We need more data!

In schools and in courses we take post graduation we're often taught answers to those questions as we just naturally consider them to be proven and effective. And certainly they often are... But what they aren't is scientifically evaluated.

Probably the best example in recent months is the often made claim that massage is good for athletes post-workout because it reduces lactic acid buildup and increases blood flow. I can remember reading this back in school as part of our "evidence based" education. Yet, a recent study seems to disprove this claim. (http://tinyurl.com/yayhw5a)

Ok, ok... This study hasn't been replicated and wasn't done by massage therapists so I have to be a little bit suspect of it's accuracy. But it does make a point: A lot of what we claim as fact is largely untested and more study is necessary to find out what we actually do when we treat someone.

It's food for thought.