Massage Therapy Body of Knowledge

Comment

Comment by Christopher A. Moyer on October 20, 2009 at 11:05am

"Science does not always have the answers. And just because something can not be explained, does not make it untrue."

I agree with you on both of these statements, of course. But I believe there are questions that logically follow these statements. If we want the answer to something and we do not currently have it, how can we get it? I don't know of any method that works better than, or even as well as, science. Similarly, if there is an unexplained phenomena, how might we learn about it? Again, I don't know of any way but science. Other methods of knowing, such as subjective experience or tradition, are less reliable and are known to be misleading.

Regarding the remarks about "not very good evidence," we seem to be misunderstanding each other. To a scientist, a mountain of anecdotes are as good as a molehill. In other words, it does not matter how many observations or reports of a phenomena might have, if those reports are vulnerable to an alternate explanation. To use the present example, the thousands of people who would swear by energy medicine cannot be sure that what they experienced was in fact due to energy medicine. Other explanations - time, attention, placebo effects, regression to the mean, an altered state of consciousness due to suggestibility, et cetera - could be the cause of the phenomena even if there is no energy (or whatever is being posited) involved whatsoever.

I am not a licensed, or even an unlicensed, massage therapist in any state. My interest in this subject comes from being a scientist who researches massage therapy.

Not very good(?) evidence. I think it demands more study. But the fact people feel better to me, time after time, warrants mention as you seem "cloaked" in this science only mind-set.

In which state are you a licensed massage therapist, Christopher?

Comment by Keith Eric Grant on October 20, 2009 at 10:59am

Hi Noel,

Strikes me, on a quick skim, as part of an ongoing research dialog on understanding "placebo" effects. I also, however, believe that one has to be careful about what are truly placebo effects and what are effects of sensory input to a complex human body system with "state memory" Ron Wall brings out some of this in his phantom limb research leading to his proposing a neurological "analog body" or neuro-matrix. And, while it's somewhat difficult to find open access articles, there's an interesting and developing body of research in psychoneuroimmunology. Here's one accessible example on Pain and stress from a systems perspective.

So, conceivably, subtle alterations in bioelectric/biomagnetic fields at strategic locations could affect a "tipping point" change in a complex system without calling up the current regime of unscientific and unmeasurable "energies". The human brain and nervous system does a amazing job of integrating a diverse and overwhelming input of sensory information into our sense of having "a body". I would expect that there would be some types of "computational body" effects from this process tied to the chemical transmitter effects. I don't have more than abstract access, but I find the implications of this article by Blalock and Smith intriguing. The time-line noted by Besedovsky and del Ray is an indication of how recently the tools and understanding have come. I also don't discount the human nervous system and brain's ability to cross map information into the senses.

So, to take a line from Chris, it's quite possible that there are some quantifiable effects form heuristic protocols in use while, at the same time, the model of what is actually occurring is erroneous.

It is partly because I see opportunities for developing understanding consistent with scientific understanding, that I am adamantly opposed to inclusion as "knowledge" of mythologies or spiritual systems that contradict some fairly substantial knowledge of the universe. I do, clearly, see a substantial jump in criteria in going from informal practices based on personal "viewpoints" of the universe to a health care oriented formalization of the "knowledge" of a profession. I also am well aware that there are substantial psychological reasons for the maintenance of beliefs, supportable or not. Somewhere, however, one has to draw the line, and my own belief is that we reach than point in formally declaring "knowledge" as opposed to compiling a "body of beliefs".

Comment by Mike Hinkle on October 20, 2009 at 10:50am

Science does not always have the answers. And just because something can not be explained, does not make it untrue.

Not very good(?) evidence. I think it demands more study. But the fact people feel better to me, time after time, warrants mention as you seem "cloaked" in this science only mind-set.

In which state are you a licensed massage therapist, Christopher?

Comment by Mike Hinkle on October 20, 2009 at 10:30am

Keith,

Again, "seems minimal" is your opinion. 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.

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.

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

Medical procedures, manuals and all aspects were considered "quakery" and some of it was. Time is needed for research, which is on-going. You tout the advances in medicine. We too will advance, given time. In the meanwhile, documents such as the BOK will start us in these directions.

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.

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. It took a while to gain the acceptance it has now. Many theories help make it possible, but it is real.

Chiros weren't accepted, now they are and there are many other fields. People did not believe the moon's effect on ocean tides, etc. Research will or won't prove these methods effective. Until then, we stay as we are? Not!

I don't look at "feedback" as trying to block the BOK. I look at peoples own words, saying, "This is a AMTA effort to take control of the profession " and if we can split the group on modalities we can beat it" and "we need to contact our legislators to repudiate it". All these have been touted by those trying to quell the BOK, after just its' first draft.

This effort is NOT too quick. It should have been organized when licensing first started and we wouldn't be here. But those folks listened to the "scientists" and now we have a patchwork profession. We are going to create BOK, the Model Practice Act, Title Acts and Standards of Practice, as best we can and improve as we can, just like other professions. 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.

We have come too far and waited too long to do this. Improperly done? Again, your opinion. It was the first draft. NOW is the time and this will happen. Healthcare is still developing, we need to start our efforts to join in, and we are.

Comment by Noel Norwick on October 20, 2009 at 10:19am

Christopher: Since you ask for more specificity, I would appreciate your opinion re:
1. Could this study (that distinguishes placebo response as it relates to physical vs. biochemical outcome parameters) legitimately be used to provide a scientific explanation for "energy" based modalities?
2. Should the MTBOK promote inclusion, further study and conscious use of the placebo response at entry and/or more advanced levels of practice?

Comment by Christopher A. Moyer on October 20, 2009 at 9:58am

Hi Noel - My first thought is that this looks like an interesting study. I'm going to try to read it today. In the meantime, is there anything more specific you'd like to say about it, or ask about it? I'm wondering if you want to focus on anything more specific than merely 'what we think of it.'

Comment by Noel Norwick on October 20, 2009 at 9:52am

Keith & Christopher: What do you think of the following research report re placebo response as it relates to "evidence-based" practice?
http://www.biomedcentral.com/1741-7015/5/3

Comment by Keith Eric Grant on October 20, 2009 at 9:32am

Mike,

Again, this requires free registration with "Pulse" but I think Edzard Ernst's posts on The Value of Experience and The Reddest Herring in Town address some of your objections. As Ernst notes, the historical problems of non-effective treatments tied with placebo effects are why medicine and other areas of health care are currently moving toward evidence-based practice.

While there are things we still don't know about the universe, the likelihood that we don't understand the field of "energy" as it applies to every day life seems minimal. Science has come a long way from being purely mechanistic, including much greater appreciation for feedback effects and emergent systemic phenomena. It is still the best system we have for understanding the universe around us.

James Oschman has written a number of papers on electromagnetic fields. It is possible that a practitioner might be able to influence another's field and to some extent "tune" it, much like a piano tuner tunes a piano. It is also possible that some subtle detection of such a field could be mapped into the sensory realm by those having certain forms of synesthesia. But, that is still in the realm of research yet to be done (although with fmnr we have some tools) and far from what is likely to be taught. It is also not clear,however popular with massage practitioners, that energy work is logically part of massage and not its own area of practice.

I also don't think it is helpful to look at feedback as "trying to block a BOK". An improperly done BOK could easily be a long term detriment to the profession. Believing that the current effort is too fast and too little driven by science and knowledge management standards does not mean that a person is against a BOK. Believing that a BOK effort should draw far more on current standards and practices in health care informatics does not imply that the effort should not be done. It does mean that the massage profession needs to move past a snapshot of reality that was taken in the 1970's and come to grips with the tools and practices being used in the 21st century, including new disciplines of knowledge management and evidence-based practice that have their own standards.

I, for one, would rather see the effort done right in the beginning, then to see it having to be done over.

Comment by Christopher A. Moyer on October 20, 2009 at 9:31am

Hi Mike. Thanks for responding.

You've repeated the point that one could line up hundreds of people that have been helped by energy work, but I'm not sure what point you are trying to make by just repeating this, because that, by itself, is not very good evidence.

And yes, many medical practices have contributed to patient's demise, including practices that we have refined and continue to use, but what does that have to do with what we are discussing? Medicine has also rejected hundreds of practices because science found them ineffective or deleterious.

I'm also not sure what you mean by science for science's sake.

Comment by Mike Hinkle on October 20, 2009 at 8:24am

As I said, we can line up hundreds of people that have been helped by energy work.

Just because they have not been researched to the point you can "scientifically" pinpoint their effectiveness does not make them any less so. And it seems the medical "scientific" world has had a few corrections along the way of it's own as well.

Blood letting contributed to George Washington's demise. Yet leeches are still used in hospitals around the world today. We now understand them. Placebos are used by doctors and yet people are healed. Whether it is the mind or the willfullness of the individual to heal, it heals.

Science for science sake will not deter this effort. This will happen.

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