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Evidence based massage therapy
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Permalink Reply by Christopher A. Moyer on
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Hi Noel.
You are correct that we scientists often like to focus on a single factor of a phenomenon while we attempt to hold other factors constant, and that is because this is often a fruitful way to pursue scientific research. But it certainly isn't the only way, and plenty of good researchers are doing multifactorial research that allows for the study of numerous factors and their interactions. The interactions are sometimes the most important and interesting things to try to understand. The world is, as you note, definitely multifactorial! That's my very short answer to your good question.
Keep in mind that MT research is really in its infancy, as Dryden, Shipwright, and I have noted in a recent article:
http://www.ijtmb.org/index.php/ijtmb/article/view/51/64
If it seems that MT research has been kind of simplistic and limited its focus to one factor at a time, that's probably because it has. This is to be expected in the earliest stages of research. Once we pin some of those things down, then we can go on to more complicated research designs that examine multifactorial phenomena.
As for quant vs. qual - each have their place. I myself have done both types of research, sometimes within the same project. If it appears that there is a preference for quantitative research, that may be because the findings of quant research are easier to summarize briefly in news reports, announcements, and literature reviews.
MT needs both kinds of research, just as any clinical research field does. But I will add this opinion, which some might not share - when something is able to be reliably and meaningfully quantified, it should be, because that has a lot of scientific benefits. To conduct qual research in lieu of quant research, without a good rationale, is a practice that some lazy or poorly trained scientists sometimes engage in. Again, that's my opinion.
I hope I addressed your questions as they were written. Please let me know if I need to clarify any of what I've tried to say.
-CM
Noel Norwick said:Christopher: Delighted that you have joined the discussion as I wonder what your perspective is regarding what I perceive to be:
1. A "single factor" bias in current scientific research (that doesn't exist in what for the most part is a multifactorial reality) 2. A quantitative research vs. a qualitative research bias (as discussed in Working Minds, A Practitioner's Guide to Cognitive Task Analysis by Beth Crandall, Gary Klien & Robert Hoffman, The MIT Press, 2006).
Additionally, I would welcome your suggestions regarding what I (and possibly others) might do to overcome both of my above noted concerns.
Christopher A. Moyer said:Greetings everyone.
As someone who does massage therapy research, I've read this thread with interest. I'd like to comment on a few of the themes I have noticed here. I hope it will be O.K. to address several points in one message, as opposed to replying to many single posts individually. Money and Research: Yes, it takes money to do research. But it is not true that research is entirely guided by money, or that research will only be funded when it is in some person's or company's best interest to get a particular finding. I am glad to see that many of you are skeptical of scientific research such as drug research, and can recognize that drug-company funded research may be biased and suspect. But, I would encourage you to try and think of counterexamples to your concerns, too - are there not plenty of cases of research that was conducted merely to find something out, or to benefit humanity, without any profit motive? (Yes, there has been - there are thousands of examples.) When research is skewed by a profit motive, doesn't the self-corrective nature of science usually discover that and reveal it? (This usually happens - that's why you know about it! Also, scientists love nothing more than proving someone else wrong, so skewed results are vulnerable to being overturned.) I myself have done, and am doing, massage therapy research which I do not profit from, except indirectly as it bolsters my standing within a university.
MT isn't standardized: Some folks are often quick to conclude that MT cannot be studied scientifically because no two therapists will practice in the same way, no two patients are the same, no two massages are the same, etc. Yes, this makes our job as researchers more difficult. But it does not at all mean that we cannot do meaningful research. Many things that scientists study in nature have this quality. No two animals are exactly the same, but biology has been chugging along and making plenty of progress for hundreds of years! No human circulatory systems are exactly alike, but research into heart surgery advances every day. In fact, explaining some of the variability in MT is exactly what we need to do. WHY is this massage therapist especially good at X, and this one is better at Y? Why did John Doe give great massages yesterday, but can't seem to do so today? These questions can be difficult to answer, but they are not impossible, at least not in principle. Obtaining answers to them will be good for the profession and for the recipients.
"Holism" and "left-brain" thinking: Yes, I put scare quotes around those terms; please forgive me. I did so because I think these terms can be misleading and simplistic. Yes, it is true that certain important things can be more than the sum of their parts - "taking apart" a session of MT to understand it may not always work or may miss something critical. But again, this is not unique to massage - this is a problem that can be encountered in all the sciences. The solution is to do various forms of research that focus at different levels of the phenomenon. In MT research, sometimes it makes sense to focus on a single part of the anatomy, but at other times our unit of analysis may be the recipient-therapist dyad. In the first case we are focused on only a part of a single person, in the second we are focused on more than two entire organisms. Regarding "left-brain" phenomena, it seems to me that people use this to refer to that which is intuitive. Intuitive phenomena can be difficult to understand and to study, but that does not mean we just throw our hands in the air and declare them to be magic. Intuitive phenomena and other difficult to explain phenomena are what attract some of us scientists to massage therapy as a subject.
Alright, I'm not sure how articulate I've been, especially in that last part, but I think that's the best I can right now. I enjoy reading this discussion that combines many different viewpoints and hope I can make a meaningful contribution.
-CM
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Permalink Reply by Jan Schwartz on
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Jennifer, I don't think this is an appropriate tone to further the discussion. Regardless of your personal opinion about Diana she has worked tirelessly for the Massage Therapy Foundation and deserves respect.
Jennifer L. Hensley said:Christopher, I'm curious if you've read up on the findings presented at the first International Fascia Conference.
One of the things that made me weep for the future of massage therapy after that was Diana Thompson whining they didn't give any direct applications for massage therapy. I'm sorry, but if you can't read or hear an article such as the one done with mouse tissue and finding it heals better and faster with stretching and be able to apply it to your modality, you shouldn't be "in charge" of research.
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Hi Jennifer.
I think I know what you mean. The contribution of any single case study, especially one that reaches a less-than-earth shattering conclusion, is usually pretty small.
But, you never know to whom that particular study might prove to be particularly important. Also, case studies serve a secondary function in getting practitioners in the field connected with the research enterprise.
The fact is, what you say about case studies is true of most scientific studies - most are just small bricks in an enormous and constantly growing wall, and the wall would still stand if you took anyone one of them out. But the wall is still made of bricks - no bricks, no wall.
-CM
Jennifer L. Hensley said:The problem with a lot of the massage therapy case studies I've seen have been very tried and generic, like "Swedish Helps Rotator Cuff Syndrome"--things that add nothing new to the profession, like medical case studies do: they're usually used for abnormal, rare, or new conditions and treatment.
Christopher A. Moyer said:Something else I'd like to add - someone mentioned that the profession cannot simply leave the research up to PhDs in their labs. To some degree, I agree with this. (Full disclosure moment - I'm a PhD with a lab.) While many types of research do require special training or facilities to conduct them, dedicated practitioners CAN make a contribution to research by means of case studies. Be informed that the Massage Therapy Foundation has TWO different case study competitions (one for students, and one for practitioners). Also, the recently established online journal, International Journal of Therapeutic Massage and Bodywork (see www.ijtmb.org), is a possible publication outlet for well-conducted case studies.
I'm the Research Section editor for the journal, and would be happy to answer questions or provide guidance to practitioners who are thinking of conducting a case study. The journal website should have all my contact information.
-CM
P.S. At the risk of building up cynicism for academics, you do all know what PhD stands for, right? Your BS degree is Bull***, your MS is More ****, but the PhD is Piled Higher, and Deeper. :)
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I know some of the fascia research, but not a lot.
Now, in response to this message and the two that following concerning Diana Thompson, I must take issue with your position. Diana is a friend and colleague and I have worked with her on several projects. Personally, I have never heard her whine, but even if she did lament what came out of that conference - I do not know if she did, I'm just saying if she did - I tend to doubt that she whined about it. I could believe that maybe she was disappointed that it was not more practice-focused, or that it didn't have a particular emphasis, but again, I have never discussed it with her.
As for respect, I can assure you that her efforts AND the quality of her work are worthy of respect. She works very hard for the profession and has completed or contributed to MANY high quality projects. You could count on one hand the number of people who are advancing the profession as much as she does, and I am confident that I would say that even if I did not count her among my friends. In fact, a colleague and I sought her out just recently in the hope that she would contribute a chapter to our upcoming book which is tentatively titled "Massage Therapy: Integrating Research & Practice," which is testimony to my own professional opinion of her.
If you'll allow me to speculate, I get the impression that you are generally disappointed with the state of massage therapy research. Good! More people should be, because there isn't very much, and much of what there is isn't all that good. However - and I say this from personal experience - I would caution you not to be too critical too quickly. It is a very small community of people who are involved in this enterprise, and everyone who has contributed to it or attempted to contribute to it is deserving of some respect. Further, it is my own observation that the people involved in this enterprise are, almost universally, really nice and really dedicated folks. My advice is to wait until you really know their work well, and possibly even until you have met them or worked with them, before you are openly critical.
-CM
Jennifer L. Hensley said:Christopher, I'm curious if you've read up on the findings presented at the first International Fascia Conference.
One of the things that made me weep for the future of massage therapy after that was Diana Thompson whining they didn't give any direct applications for massage therapy. I'm sorry, but if you can't read or hear an article such as the one done with mouse tissue and finding it heals better and faster with stretching and be able to apply it to your modality, you shouldn't be "in charge" of research.
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Jennifer -
I thought I made a pretty strong case for why Diana and my other colleagues in the Massage Therapy Foundation deserve respect. I don't think Diana sees herself as a "leader in science." She's not a scientist, but she certainly is well acquainted with the science surrounding her profession. I'm not sure who is the "leader in science" for massage therapy or if there even needs to be one.
And I'll say again, Diana has done MANY significant things. She's written books and magazine articles and spoken at conferences, helped initiate and complete MTF projects such as the case report competitions, and lots of other things. She is excellent in her administrative and executive roles. You are entitled to your opinion, but I don't think the evidence supports your opinion in this case. It seems to be based mostly or entirely on a remark that the person made. I would hate for my reputation to come down to a single remark, as I am sure I've made thousands of throwaway comments that I wish I could revise.
So no, nothing about Diana or her accomplishments makes me upset. She's a terrific professional colleague and the profession is lucky to have her.
Finally, I certainly won't tell you not to criticize her or anyone else - that's your right - but I do ask you not to be personal about it if what we are attempting to discuss is professional (e.g., your remark about two-syllable words).
-CM
Jennifer L. Hensley said:I completely understand what you're saying, still, the results are missing: we don't have a respectable leader in science, we have someone who's done nothing significant on her own, just someone who's been around other people that have contributed: I notice you didn't have any specific achievements to tell of her.
And of course I don't know what her tone was, but it really reminded me of "Math is _hard._" Instead of figuring out what to do with the information or collaborating those who did, I interpreted the "They didn't give us anything to apply that to massage" [I'm paraphrasing, and I'm sorry I can't remember if they had that in AMTA's Hands On or the local Washington chapter's newsletter], that the conference should have figured it out and spelled it out in two-syllable words for her.
And I think part of the problem is that you and others have worked with her, and I'm sure she's a nice and bright and social lady, but she doesn't _do_ anything. She has no impressive credentials. And that's who's heading our research.
Doesn't that make you a bit upset?
Christopher A. Moyer said:I know some of the fascia research, but not a lot.
Now, in response to this message and the two that following concerning Diana Thompson, I must take issue with your position. Diana is a friend and colleague and I have worked with her on several projects. Personally, I have never heard her whine, but even if she did lament what came out of that conference - I do not know if she did, I'm just saying if she did - I tend to doubt that she whined about it. I could believe that maybe she was disappointed that it was not more practice-focused, or that it didn't have a particular emphasis, but again, I have never discussed it with her.
As for respect, I can assure you that her efforts AND the quality of her work are worthy of respect. She works very hard for the profession and has completed or contributed to MANY high quality projects. You could count on one hand the number of people who are advancing the profession as much as she does, and I am confident that I would say that even if I did not count her among my friends. In fact, a colleague and I sought her out just recently in the hope that she would contribute a chapter to our upcoming book which is tentatively titled "Massage Therapy: Integrating Research & Practice," which is testimony to my own professional opinion of her.
If you'll allow me to speculate, I get the impression that you are generally disappointed with the state of massage therapy research. Good! More people should be, because there isn't very much, and much of what there is isn't all that good. However - and I say this from personal experience - I would caution you not to be too critical too quickly. It is a very small community of people who are involved in this enterprise, and everyone who has contributed to it or attempted to contribute to it is deserving of some respect. Further, it is my own observation that the people involved in this enterprise are, almost universally, really nice and really dedicated folks. My advice is to wait until you really know their work well, and possibly even until you have met them or worked with them, before you are openly critical.
-CM
Jennifer L. Hensley said:Christopher, I'm curious if you've read up on the findings presented at the first International Fascia Conference.
One of the things that made me weep for the future of massage therapy after that was Diana Thompson whining they didn't give any direct applications for massage therapy. I'm sorry, but if you can't read or hear an article such as the one done with mouse tissue and finding it heals better and faster with stretching and be able to apply it to your modality, you shouldn't be "in charge" of research.
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Your training does not qualify you to work for the MTF, but it does qualify you to conclude that it isn't respected by scientists? How does that work, exactly?
In any case, on this you are flat-out wrong. I'm a scientist - I respect what they do, and that's why I have applied for their grants and volunteered my time to their projects. As someone who has worked on the research grant committee, I can tell you that it attracts applications from many good scientists. The most recent grant competition I worked on awarded a grant to Seth Pollak at University of Wisconsin's Waisman Center. If the MTF is on the radar of a scientist as good as Pollak, then their work is definitely succeeding. And they haven't even been at it that long!
Your final point it also entirely wrong. The profession does not have a surplus of massage therapists who are involved in the activities and initiatives of the Foundation. There is only a small core of therapists who devote their time, energy, and money to it.
-CM
Jennifer L. Hensley said:In it's current state? With my level of education and training?
It's not respected by scientists. I'm not qualified to do anything that would make a difference. To suggest that more average massage therapists get involved is not the answer--we have a surplus of that as it is.
Bodhi Haraldsson said:I to echo Christopher's sentiment. The Diana I know is not a whiner. I gather from many of your posts, Jennifer, that you are frustrated by the state of MT research. Rather than attacking those that volunteer many hours of their own time to advance the profession, I suggest you become a volunteer with the Massage Therapy Foundation.
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Permalink Reply by Noel Norwick on
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Hi Christopher: I appreciate and totally agree with your response/stated opinions. Thank you. Noel
Christopher A. Moyer said:Hi Noel.
You are correct that we scientists often like to focus on a single factor of a phenomenon while we attempt to hold other factors constant, and that is because this is often a fruitful way to pursue scientific research. But it certainly isn't the only way, and plenty of good researchers are doing multifactorial research that allows for the study of numerous factors and their interactions. The interactions are sometimes the most important and interesting things to try to understand. The world is, as you note, definitely multifactorial! That's my very short answer to your good question.
Keep in mind that MT research is really in its infancy, as Dryden, Shipwright, and I have noted in a recent article:
http://www.ijtmb.org/index.php/ijtmb/article/view/51/64
If it seems that MT research has been kind of simplistic and limited its focus to one factor at a time, that's probably because it has. This is to be expected in the earliest stages of research. Once we pin some of those things down, then we can go on to more complicated research designs that examine multifactorial phenomena.
As for quant vs. qual - each have their place. I myself have done both types of research, sometimes within the same project. If it appears that there is a preference for quantitative research, that may be because the findings of quant research are easier to summarize briefly in news reports, announcements, and literature reviews.
MT needs both kinds of research, just as any clinical research field does. But I will add this opinion, which some might not share - when something is able to be reliably and meaningfully quantified, it should be, because that has a lot of scientific benefits. To conduct qual research in lieu of quant research, without a good rationale, is a practice that some lazy or poorly trained scientists sometimes engage in. Again, that's my opinion.
I hope I addressed your questions as they were written. Please let me know if I need to clarify any of what I've tried to say.
-CM
Noel Norwick said:Christopher: Delighted that you have joined the discussion as I wonder what your perspective is regarding what I perceive to be:
1. A "single factor" bias in current scientific research (that doesn't exist in what for the most part is a multifactorial reality) 2. A quantitative research vs. a qualitative research bias (as discussed in Working Minds, A Practitioner's Guide to Cognitive Task Analysis by Beth Crandall, Gary Klien & Robert Hoffman, The MIT Press, 2006).
Additionally, I would welcome your suggestions regarding what I (and possibly others) might do to overcome both of my above noted concerns.
Christopher A. Moyer said:Greetings everyone.
As someone who does massage therapy research, I've read this thread with interest. I'd like to comment on a few of the themes I have noticed here. I hope it will be O.K. to address several points in one message, as opposed to replying to many single posts individually. Money and Research: Yes, it takes money to do research. But it is not true that research is entirely guided by money, or that research will only be funded when it is in some person's or company's best interest to get a particular finding. I am glad to see that many of you are skeptical of scientific research such as drug research, and can recognize that drug-company funded research may be biased and suspect. But, I would encourage you to try and think of counterexamples to your concerns, too - are there not plenty of cases of research that was conducted merely to find something out, or to benefit humanity, without any profit motive? (Yes, there has been - there are thousands of examples.) When research is skewed by a profit motive, doesn't the self-corrective nature of science usually discover that and reveal it? (This usually happens - that's why you know about it! Also, scientists love nothing more than proving someone else wrong, so skewed results are vulnerable to being overturned.) I myself have done, and am doing, massage therapy research which I do not profit from, except indirectly as it bolsters my standing within a university.
MT isn't standardized: Some folks are often quick to conclude that MT cannot be studied scientifically because no two therapists will practice in the same way, no two patients are the same, no two massages are the same, etc. Yes, this makes our job as researchers more difficult. But it does not at all mean that we cannot do meaningful research. Many things that scientists study in nature have this quality. No two animals are exactly the same, but biology has been chugging along and making plenty of progress for hundreds of years! No human circulatory systems are exactly alike, but research into heart surgery advances every day. In fact, explaining some of the variability in MT is exactly what we need to do. WHY is this massage therapist especially good at X, and this one is better at Y? Why did John Doe give great massages yesterday, but can't seem to do so today? These questions can be difficult to answer, but they are not impossible, at least not in principle. Obtaining answers to them will be good for the profession and for the recipients.
"Holism" and "left-brain" thinking: Yes, I put scare quotes around those terms; please forgive me. I did so because I think these terms can be misleading and simplistic. Yes, it is true that certain important things can be more than the sum of their parts - "taking apart" a session of MT to understand it may not always work or may miss something critical. But again, this is not unique to massage - this is a problem that can be encountered in all the sciences. The solution is to do various forms of research that focus at different levels of the phenomenon. In MT research, sometimes it makes sense to focus on a single part of the anatomy, but at other times our unit of analysis may be the recipient-therapist dyad. In the first case we are focused on only a part of a single person, in the second we are focused on more than two entire organisms. Regarding "left-brain" phenomena, it seems to me that people use this to refer to that which is intuitive. Intuitive phenomena can be difficult to understand and to study, but that does not mean we just throw our hands in the air and declare them to be magic. Intuitive phenomena and other difficult to explain phenomena are what attract some of us scientists to massage therapy as a subject.
Alright, I'm not sure how articulate I've been, especially in that last part, but I think that's the best I can right now. I enjoy reading this discussion that combines many different viewpoints and hope I can make a meaningful contribution.
-CM
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Permalink Reply by Bert Davich on
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Dennis,
You hit the nail on the head.
Thank you.
Dennis Gibbons said:approximately three weeks ago I had a medical doctor on my table for back pain, he was asking many questions on how this technique worked. after I had explained many of the theories to him he said to me, "What scientific proof do you have of these statements?" My reply to him was, "What scientific proof do you have that refutes what I am telling you?" I further asked him, "Do you feel better?" His reply was, "Yes." I then replied, "What more proof do you need then how you feel." I do believe that it would be good to get this evidence based massage but in my 23 years of practice and having worked on thousands of individuals it would be difficult for me to set up a study of 100 people that have exactly the same issue. I do know that after talking to many of the researches at the Cleveland Clinic that it takes them a long time to come up with a satisfactory group to study. Their asset though is that the pharmaceutical companies are funding the research. I do believe it would be difficult to have comparable studies without that type of funding. If large enough grants were available I would be happy to compare the theory I developed, Muscle Release Therapy, MRTh(R) to many other modalites.
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