Evidence based massage therapy group

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Comment by Taya Countryman LMT on November 9, 2010 at 9:55am

Thanks for your comments. I have been wanting to express my feelings but was hesitant. So I find that by believing what we are told is the attachment of a muscle and/or the action we can only see the problem from this perspective. Tom Meyers is starting to challenge what we have been taught about attachments (Thanks Tom!) and I would like to challenge the actions. Piriformis is a great example. Did you know that the actions of muscles that we memorize came from the electrical probing of the muscle and watching it contract then applying the logic of, "The fibers attach here and here so the action must be...?" Why do all muscles have to be movers? Can't some of them be stabilizers? If we accept the piriformis as an internal rotator of the hip, then using scientific logic we have to intellectually guess the antagonist. But if we look at it as a stabilizer then we can look and feel the stabilizing antagonist. (I think in men the antagonist is the abductors of the same leg and for women the abductors of the opposite leg) I can prove this over and over. But how can you change the already accepted science? Research is not even close to doing any studies of this type.
I have read many studies by Physical Therapists that are great and many of them are about functional actions of the muscles. But PT's have not accepted or applied much of this information because they are still using isolated contraction of a muscle to determine muscle "weakness".
I guess I am asking, when do we question the already acceptable "standards of practice'? How do I convince a PhD to do a study to that challenges a system that people have paid good money to memorize, learn, and apply. AND what about all the products that make money by supporting that system such as braces, weight lifting equipment, etc?
Ok, I am ranting again... Carl, I do want to team with traditional medicine and when I worked at the Everett Providence Hospital Pain Control Center in the 1980's I worked with a team of traditional practitioners like a neurologist, PT, OT, biofeedback techs, psychologists, & nurses. The patients were treated with traditional medicine and now in constant pain and it was our job to help them cope with this pain. I was so naive that I kept thinking that there must be something we missed so I kept searching and trying. I have been very successful with treating chronic and complex conditions. The doctors in my area call and ask me to look at patients. Am I using magic to help these people? No, I have been using questions. I have come to question the traditional way we look at the body, what the patients symptoms are telling us, and even the diagnosis the physician has given them.
I have asked Diana Thompson to do a two weekend class for us in Washington to teach us how to do case reports and to have a case report ready to submit to the MTF. She has encouraged me to write some of my outcomes in this format so I will learn how and start sharing. This class is the first and my hope is to help her design one that can be the blueprint to be taught around the country. Thanks for listening.

Comment by Carl W. Brown on November 9, 2010 at 9:00am

Taya, I agree 100%. Models by nature are limiting but when we go outside of the model we need EBP even more. We need to apply objective testing to guide us it insure that what we are doing is the right path. If we are truly going to complement traditional medicine by helping people who fall through the cracks we cannot work on faith based systems but need to apply objective testing even when we do not fully understand why what we do works.
When I started out in computers I learnd how the maching language instructions works from the circit diagrames, wrote my own operating system to run the programs and wrote my own code. Now softwre is so complicated that programmers have no idea of how the tools can pieces of code work that they use to create programs, yet they still test to results of what they create objectively. There is much of medicine that the doctors have no idea of how or why it works but they often lose sight of the fact that system only work when they are fairly simple. If I build a steel beam of certian dimentions I do not need to test is breaking point. But when things get more complex model based work starts to fall apart. Unfortunatly too many people throw out one model when it does not work and replace it with another. Western medicine does not work so tray Eastern medicine, etc.

Comment by Stephen Jeffrey on November 9, 2010 at 4:06am

Tanya
I can relate to every word you say especially when we are taught to regard osteo'schiro's physio's as "senior therapists" "research literate" "EBP"......then we find their evidence was flawed. But this goes all the way up the health chain eg surgeons are removing neck muscles and ribs in an attempt to resolve thoracic outlet syndrome but only 7 in 10 ops are sucessfull !!!

Like Sandy says my journey into research was a hell of an ego slam but having got over that, I've realized their are golden egg research articles that have empowered my work and thought process beyond anything I could have imagined. The best of which "Eyal Ledermans the fall of the postural biomechanical model in low back pain" explains why I work the way I do.
http://www.massageprofessionals.com/profiles/blogs/chronic-pain-you...

For many MT's researching the research will allways be a big challenge but the rewards are well worth it. :)

Comment by Taya Countryman LMT on November 9, 2010 at 1:51am

Listening to Leon Chaitow at the Massage Therapy Foundation research conference I was disappointed with how the straight leg test to determine if the patient had a structural or muscular problem was first created. But I was a further disappointed in how more research was built on the first assumptions. When we use the models from physicians, osteopaths, physical therapists, sports trainers, our results can only be as good as their model. So I hope massage therapy can continue to be the one modality that can approach a patient's body differently. To listen and watch how the body responds instead of imposing the intellectual knowledge of what and how we think the body should respond. Is the evidence in a research project or is the evidence in the decreased pain and increased function of our patients? I raise money for the MTF but I don't want our profession to become like physical therapy where I see every person with the same diagnosis is given the same exact treatment without any concern for the outcome of the patient. It is late maybe you have had this comment before. But what has happen over my 33+ years of experience is my patient's symptoms lead me to do something I have never done before and the results are amazing. Then I try this with a few more of my patients to see what results I get. If it is working, then I have to figure out why it is working because it doesn't fit the educational models we been taught. So my patients are my teachers and experience has shown me that just when we think we know how the body works, it shows us that there is so much more for us to learn.

Comment by Jason Erickson on November 9, 2010 at 1:21am

For those interested in orthopedic massage, Pam Latterell, one of James Waslaski's top pupils and TAs, is teaching a (free!) 2-hour workshop on Sunday, November 14, from 10am to 12pm. Participants will be eligible for exclusive discounts on a Waslaski orthopedic massage seminar and related products.

No CE hours will be ...granted, but it's FREE. Full details are available here: http://cstminnesota.com/8.html

Comment by Paula Nutting on August 14, 2010 at 4:15pm

Hi to one and all,
wow its great to see this site as an option and looking forward to getting to partake in some sound evidence based outcomes with this very worthy group of practitioners.
Cheers
Paula Nutting

Comment by Carl W. Brown on August 4, 2010 at 3:16pm

Jan, one of the problems is that parts of massage and bodywork can be explained scientifically and other parts cannot. What I find very discouraging is the parts that don’t fit into science are stuffed into some pseudoscientific drivel as accepted without proof.

Science is all about usefulness. If I have a steel beam of specific dimensions I can tell it breaking strength without actually breaking it. The disadvantage if science it that one has to take observations and fit them into a model. In the process, one loses information that does not fit. If we shift all of our thinking into the left brain we are operating half crippled.

It is easy to see how we can evidence based testing to validate rational thinking and the scientific hypothesis. But I believe that we can use that rational mind to establish objective tests for intuitive perceptions that cannot be rationally understood.

To start we need to acknowledge that science does not apply and setting of a predictive system is a false approach. However to throw out intuition just because it does not fit is limiting. Intuition, however can lead to false assumptions because it is untestable.

So what does one do? Firstly one has to use science to determine if the intuition is wrong what are the consequences. Will it cause harm? If not one can proceed. Ideally third party verification would be ideal but impractible with concepts that don’t communicate well.

When I feel problems like pinched nerves deep in the body and I release them and to problem goes away. I know in is scientifically impossible for me the physically fit the nerve but what am I to believe? What happens when I do something medically impossible but x-rays confirm what I have done?

Bodyworkers often see things that can not be explained by science and often adopt woo-woo explanations rather that try to develop objective evidence based testing to guide them to produce the best results. This is a far more difficult are to apply evidence based practices than scientifically proven areas.

Comment by Susan G. Salvo on August 3, 2010 at 5:25pm

Well said, Sandy.

Comment by Sandy Fritz on August 3, 2010 at 4:19pm

Very true to quote Jan"Many massage therapists "just know" that massage works and so even reading and analyzing the research becomes challenging because of that bias/opinion, particularly if it doesn't prove the bias/opinion." As a profession we really need to move beyond our beliefs. There will always be that intangible mystery of the energy exchange between two human beings. That being said, there are just so many myths about massage and as massage therapists we often don't want to know about the information that is not supporting of massage. Only reporting one side of an issue- typically yours and my opinions can be backed up by only selecting some of the research and avoiding or ignoring the rest. I have done this- I am human. However, if I am doing something like writing a textbook it is necessary to be very disciplined about looking for this kind of bias.I can be opinionated-and many of my peers agree with that statement. The first step in objectivity is knowing that I can believe and present my opinions as facts.That's why textbooks have reviewers or more objective journals are peer reviewed. Hopefully this type of process will catch the problem. We need as teachers to teach students to be critical thinkers and to question intelligently. When they accurately do this it can be quite an ego slam if you let it- or you can learn something.

Comment by Jan Schwartz on August 3, 2010 at 3:35pm

I should have tied this into massage better. The dots that need connecting have to do with biases. Many massage therapists "just know" that massage works and so even reading and analyzing the research becomes challenging because of that bias/opinion, particularly if it doesn't prove the bias/opinion.

Sandy is right, the entire series of deGrasse Tyson's short videos are helpful in understanding the phenomenon of bias as well as other issues in research. He's a scientist but doesn't overwhelm you with technical stuff. He is a really good and entertaining presenter that way.

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