Massage Therapy Body of Knowledge

Comment

Comment by Christopher A. Moyer on October 20, 2009 at 1:51pm

I don't know the prevalence of acupuncture in China. I was only noting that the 6 week vs. 6 month recovery time was quite a claim. I would want more than someone's word on that.

Regarding the rest, I guess we disagree on what is convincing evidence. To a scientist, a million years of anecdotes, even in the form of SOAP notes, is not as convincing as a single well-controlled study. As scientists sometimes say, the plural of 'anecdote' is not 'data.'

Thousands, maybe millions, of people have faith in astrology, but that isn't evidence that it works. If we want to know if it works, we do an experiment. (They've been done, and astrology doesn't work.)

If we want to know if energy medicine works, it takes an experiment. Otherwise, we can't be sure. The thousands, or millions, or gazillions of successful cases (the number is unimportant) could be explained by other means. These includes attention effects, placebo effects, spontaneous remission, time, and statistical regression to the mean, to name a few. The only way that we know of to control for those validity threats is by experimentation.

Question - how many of you folks actively participating in this discussion plan on coming to the massage therapy research conference in Seattle this May? All of you, I hope! I'd like to meet you.

Comment by Mike Hinkle on October 20, 2009 at 1:30pm

My information came from an acupuncturist that spent years studying at the largest hospital in Beijing. Isn't acupuncture used instead of anesthesiology mostly in China? Why? Is theirs a better BOK?

The comparison: I was noting that even though anesthesiology works (there is no doubt about it - we have tons of scientific evidence to show that it works), we don't know how it works. With energy medicine, we do not know _if_ it works*. We have anecdotes, but no significant amount of convincing evidence.


I disagree with your premise. There are centuries of convincing evidence. Just because it hasn't been (S.O.A.P.) noted to the extent that scientists wish doesn't make it any less so. Therapists around the country are gathering information on a daily basis. We use it to help our clients. Because we don't do comparisons and follow up on research or have the funds needed to do these studies, we do not dismiss "our findings". And many of these are visual. We have not been trained to analyze more than improvement with our clients. Where are the scientists? If you really want to study massage. This is needed.

This push towards the medical profession is new to most therapists. Some still haven't and some won't ever accept this avenue. But it is ongoing. Money IS the largest factor. There IS a separation between East and West medicine and it exists to a large part even inside the massage profession. An example would be why so many therapists go to Thailand to learn Thai Massage. The AMA is a machine that will continue to do it their way. Many therapists are wary of joining this machine.

Healthcare is changing. And maybe massage will play a larger portion with that change. Can the West really believe it has in just over 100 years, gone from quacks and surpassed the East in knowledge? Will the West look to the East? That is where massage came from.

Comment by Christopher A. Moyer on October 20, 2009 at 1:12pm

Hi Bert. Thanks for taking the time to look at that article, and to respond.

I am well aware that the study authors included a 6th grader and Dr. Barrett. I have no problem with this at all. In science, ones credentials and authority do not matter; the work stands on its own. They carefully and accurately report what they did, why they did it, and what the results were.

Point taken about TT being but one form of energy medicine that may not apply to your practice or the practice of others here. I posted the Rosa study because I am very familiar with it, and because it represents a basic and scientifically sound attempt to measure one aspect of energy medicine.

In the Objective, the researchers clearly state what they aimed to investigate. could TTers detect a human energy field? It seems they could not.

In the Results, they remark on the statistical power of their test. This is unremarkable. You are correct that statistical power is not a substitute for validity, but they are not making this mistake, at least not in anything they have written. In other words, they are not conflating these concepts. I do agree with you that if the mechanism they are attempting to test is not important - that is, if detection of an energy field in this was is NOT germane to energy medicine - then they have not tested energy medicine. Some different test would have to be designed. (I think, though, that a fair number of energy workers do claim to be able to sense such a field.)

You take strong issue with their Conclusion. But to me, it looks like a pretty clear statement of fact. They report what they found, and what their conclusion is based on that. TTer's are no better than chance would predict at even locating a human hand. What do you want the researchers to say about bias? I think we know that their personal beliefs going into this were that it was nearly impossible they would find an effect, but so what? So long as they implemented a good design and report all the details to us transparently, that's all that matters. If we think that they somehow biased their results, we can replicate their study and see if we get different results.

You are right to be skeptical and critical when reviewing a study. But I'd like to add my opinion as a scientist that this study is certainly not drivel, as you suggest. The study is exactly what it claims to be (or, depending on deviations on our individual opinions, nearly what it claims to be) and reports the important details transparently. We can't ask for much more than that.

Your challenges to me:
1) Research the studies you rely on so you know if it is the brainchild of a 6th grader and 'quackwatch' or a valid scientific study.

It is both.

2) Find and present some energy studies that follow valid scientific method

This follows scientific method better than any energy study I have ever seen, and I've seen quite a few.

3) Regarding your challenge to energy workers to 'be scientifically tested', design and present an objective testing method.

I'd consider this. As an energy practitioner who has just critiqued the Rosa study, what are the details you would consider to be most important to have in such a study? (To avoid any possible misunderstanding, let me say this is a straightforward and honest question - what would need to be built into such a study for it to be convincing to you.)

Comment by Bert Davich on October 20, 2009 at 12:52pm

Hello Christopher,
I did check out the JAMA study and find it to be completely invalid for numerous reasons.

Considering "Ms E. Rosa designed and conducted the tests and tabulated her findings" and "Ms E. Rosa is a sixth-grade student at Loveland, Colo" and another one of the 'researchers' was Quackwatch Inc, Allentown, Pa (Dr Barrett), the lack of anything adhering to scientific method should anything but surprising.

I am not a TT practitioner so have no interest in defending any claims they may have made. Furthermore I don't agree with some of the claims the JAMA article attributes to TT practitioners (I have not heard these claims before). I am addressing the 'study' as blatantly fallacious. Also after reading it I am surprised that a psychologist who has declared to be 'researching' Massage Therapy did not see through the numerous fallacious assumptions in design, outcome measure, results and conclusions. You need to hone your research skills and objectivity.
1) CONTEXT: "Practitioners of TT claim to treat many medical conditions by using their hands to manipulate a "human energy field" perceptible above the patient's skin.
This 'claim' may be unique to TT practice and not reflective of most energy work modalities. None that I have trained in. Therefore the best that can be said is that it is a test of one of TT's claims.

2) OBJECTIVE: The objective states "To investigate whether TT practitioners can actually perceive a "human energy field." and (DESIGN) the testing method was "to determine whether they could correctly identify which of their hands was closest to the investigator's hand" and (Outcome measure) Practitioners of TT were asked to state whether the investigator's unseen hand hovered above their right hand or their left hand. To show the validity of TT theory, the practitioners should have been able to locate the investigator's hand 100% of the time. A score of 50% would be expected through chance alone"
The study ASSUMES that the inability to determine the presence of 'a human energy field in a contrived and arbitrarily chosen environment invalidates energy work. It also assumes that distance (5 to 10cm) of the hand would automatically increase the 'detectable' energy output as well as assume the energy field in each hand is identical in detectable energy.

3) RESULTS: "The statistical power of this experiment was sufficient to conclude that if TT practitioners could reliably detect a human energy field, the study would have demonstrated this"
Uses 'statistical power appeal' to validate results without having validated the web of assumptions used to obtain 'results'

4) CONCLUSION: "Twenty-one experienced TT practitioners were unable to detect the investigator's "energy field." Their failure to substantiate TT's most fundamental claim is unrefuted evidence that the claims of TT are groundless and that further professional use is unjustified.

Unrefuted evidence? What VALID evidence? Where is their statement on "bias". I guess they were so sure of the conclusion that was not necessary. This is such an obvious deviation from scientific method it would be laughable if it did not have the ability to influence those who are unable to see through the fallacious logic.
After this publication, my opinion of the scientific integrity of the JAMA (Journal of the American Medical Association) is right there with "Harry Potter". And shame on The television program "Scientific American Frontiers" who showed excerpts of this drivel.

Christopher, I lay down 2 challenges for you as a "researcher"
1) Research the studies you rely on so you know if it is the brainchild of a 6th grader and 'quackwatch' or a valid scientific study.
2) Find and present some energy studies that follow valid scientific method
3) Regarding your challenge to energy workers to 'be scientifically tested', design and present an objective testing method.

Comment by Christopher A. Moyer on October 20, 2009 at 12:51pm

"You hit the point on the head with anesthesiology. You learn it in class. You certify people's ability to perform it during operations, but it isn't understood. Sounds like the same groundwork for the energy work we have now."

I'm glad the example of anesthesiology helped us to understand each other's positions better, but I must add that I don't see it quite like you have indicated here. I was noting that even though anesthesiology works (there is no doubt about it - we have tons of scientific evidence to show that it works), we don't know how it works. With energy medicine, we do not know _if_ it works*. We have anecdotes, but no significant amount of convincing evidence.

"When it takes heart patients six months to heal after heart surgery in the West and six weeks in the East using acupuncture, I see the need for research."

I realize you're just making an example, but we should be clear. I don't know of any evidence that there is anything like that kind of difference (6 weeks vs. 6 months).

"Yet the West won't think of it. Money plays a huge factor in this issue as well."

Sure the "west" will think of it! Medicine will use _whatever_ works, even if they don't know how or why it works. This is _especially_ true if it is cost effective.


*Concerning energy medicine, the scientific case can be made that we do know if it works - that science knows it does not work. But I'm trying to be as moderate as possible here.

Comment by Noel Norwick on October 20, 2009 at 11:56am

Hi Keith: I appreciate knowing your perspective on this matter as it gives me some interesting new threads" to follow. FYI - I have found Eyal Lederman's The Science and Practice of Manual Therapy, David Butler's books, mostly The Sensitive Nervous System and Michael Shacklock's book Clinical Neurodynamics quite helpful when proposing mechanisms that might explain why massage works. Would appreciate any recommendations re other books you think might help me. Thanks

Comment by Mike Hinkle on October 20, 2009 at 11:47am

I'm glad you understand, now. BOK is what is now. It will improve, but it will also start. We will be progressive as well, but we start here.

Massage is only starting to be accepted and still has a long way to go.

You hit the point on the head with anesthesiology. You learn it in class. You certify people's ability to perform it during operations, but it isn't understood. Sounds like the same groundwork for the energy work we have now. Will it stay around as long? Who knows... back to research. But it still is used until on a daily basis until something better comes along. I already believe it has, in acupuncture. When it takes heart patients six months to heal after heart surgery in the West and six weeks in the East using acupuncture, I see the need for research. Yet the West won't think of it. Money plays a huge factor in this issue as well.

You can find a doctor to justify almost any point of view. I agree more study is needed, but we must continue down the road at the same time.

The BOK is to start that process. To these licensed therapists practicing energy work, they could care less if it is excepted by anyone other than their client. I understand the scientists point of view for proof, but therapists care about the result and "accept" powers to too do not always understand. Simple, maybe, but the BOK will be about who were are too. Some, will never accept these concepts. It doesn't matter to the working therapists. Only those looking for medical or scientific acceptance care about others understanding.

Comment by Christopher A. Moyer on October 20, 2009 at 11:34am

"That should make you happy as you will have more to research!"

Sure. :) But there really is no shortage of stuff to research, even if I limit myself just to massage therapy.

What makes me happier still is if the results of research improve the profession and its benefits to society. This can come about both by discovering the existence of something - say, that massage DOES lower anxiety - or by disproving something - for example, that massage therapy does not 'improve circulation' even though this was a belief that was passed down over and over.

Whether we are adding something or taking something away, so long as it moves us closer to the truth about nature, it is progress and it will have to be good. That's how I see it, anyway.

A question for Mike or anyone else who is an energy worker - would you ever permit your energy medicine skills or techniques to be scientifically tested? I'm just curious, as this relates to a discussion a student and I had recently.

Comment by Christopher A. Moyer on October 20, 2009 at 11:23am

I realize this message was directed to Keith, but I'd like to respond to some of the assertions in the hope that certain points might be made.

"Doctors, with science and evidence-based facts declare people "filled with cancer" and tell them to go home and die. They don't. Until they are "Masters", that are never wrong, they and science are to be questioned."

Absolutely. No one claims that science, or medicine, which is (usually and hopefully) a science-based practice, are always correct. But they often are, and just as importantly, they are progressive. They are constantly being improved thanks to scientific research. Cancer treatment is much better today than it was 20 years ago, and it will be much better again 20 years from now, and this is entirely thanks to science.

"Medical evidence was minimal until the University of Maryland started dissecting the human body when much was discovered and proven. This took years. The profession continued to function before then, during and afterwards. It improved and we shall as well."

Again, absolutely. One of the ways medicine improved was to reject practices and theories that were not supported by science. I am suggesting the same thing probably needs to happen with parts of massage therapy - there are theories and practices that need to be rejected, because scientific examination shows that they are almost certainly false (which is not the same as saying they are harmful, or that there is no phenomena occurring whatsoever, though in some cases these things may also be true).

"The end result of this effort will hopefully be acceptance by the medical profession. We are not now."

This statement is too absolute. Massage therapy is accepted by the medical profession in some ways and in some settings. This has come about largely due to scientific research on massage therapy which shows that it produces benefits. As massage therapy continues to do this, its acceptance by the medical profession will increase.

"The BOK being a "living document" will allow changes that will gain this acceptance. You are asking for a finished product from a profession that has just started it's first BOK draft. It will grow. It will improve."

I think this is probably all true. Isn't this very discussion an attempt to help it grow and improve? We could think of it as prenatal right now, and our efforts are an attempt to get it ready for the outside world.

"Medical procedures, manuals and all aspects were considered "quakery" and some of it was."

This is an excellent point, and one that many people are not aware of! The history of medicine is filled with nonsense. It is also true that there are modern-day practices which are common and effective, but that we do not understand! Ask an anesthesiologist how general anesthesia works - so far as I know, and I asked one recently, they do not know. Electroconvulsive therapy is an effective treatment for severe depression - how does it work? No one knows.

But, modern medicine (or the vast majority of it, at least) is not quackery. This, again, is thanks to scientific research. Instead of being based on hunches, tradition, untested theories, or anecdote, it is based on evidence from scientific inquiry.

"To me it is very clear that energy work is logically part of massage as it is a sanctioned modality, inside our profession. NCBTMB recognizes energy work as a massage modality. Do we get CE's for it? Then it is accepted."

I think I am understanding you better now - your position comes more (or entirely) from the profession as it is practiced. (I apologize if this should have been obvious to me all along.) But when you say it is accepted, I wonder "by whom?" Many in your profession do not accept it. Hardly anyone in the medical profession would accept it. Virtually no scientist would accept it based on current evidence."

"There will always be skeptics. Look at psychology, it is still not accepted by many. Yet it is by millions of people and many are doing well in that profession."

I am a psychologist by training. Sadly, there actually is a fair amount of quackery and nonsense in clinical psychology. Thankfully, there is also even more evidence-based practice. But you are right as well, professional psychology is a healthy profession.

"It will be done the best it can be, given the information and varibles we have. It will grow and change. That will not make our initial document wrong, it will just be improved upon."

Again, isn't this the process we are engaged in right now, by having this very discussion?

Comment by Mike Hinkle on October 20, 2009 at 11:15am

You are not a licensed therapist? So you are approaching everything from a scientific approach. Fine. Research takes time. We must continue. We will create the BOK. And continue research. That should make you happy as you will have more to research!

I'm sure doctors heard every aspect as they grew, but they proceeded and this will happen to massage therapists as well.

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