Takeaway

What we do and who we are as massage therapists needs to be more accurately reflected in massage therapy research.

I spent most of December and early January writing what’s called a narrative review for a peer-reviewed palliative medicine journal. In a nutshell, my task was to review the existing, published research about massage therapy in palliative care settings and populations. I chose to include settings and populations that would be considered “palliative eligible.” This means I included many studies about massage therapy and cancer, kidney disease, congestive heart failure, diabetes, and populations whose state of ill health would lend itself well to some improvement in their quality of life, which is the goal of palliative care. In order to achieve critical mass, it was necessary to include many studies in which the massage therapy was provided by people who are not massage therapists. 

I took many deep breaths. I don’t know of too many other disciplines with work that is covered by a garage band of “others” in the interest of science. For instance, you don’t have lay people or nurses offering physical therapy interventions to subjects in research studies and then calling it physical therapy research. I haven’t seen dermatologists being taught the basics of orthopedic surgery so they can, guided by a strict protocol, provide a knee replacement surgery for the sake of scientific research. 

The good news is that there is far too much research about “massage therapy” to go through the tens of thousands of studies to see how many of them involve interventions provided by trained, licensed massage therapists versus lay volunteers, nurses, or other non-massage therapists. I’m not sure I want to know how that comparison pans out, so it’s just as well. 

What I’m most curious about is what we hope to achieve with studies like these. Many of the studies I read, regardless of the provider of the hands-on intervention, were guided by strict protocols. These protocols offered very specific guidance not only about where to massage, for how long, and in what direction, but also about the amount and type of interpersonal interaction the research subject and the provider were permitted to have. 

It’s interesting to me that so many researchers choose to use such strict protocols given the unpredictability of the environments in which many of these studies took place (intensive care units, dialysis clinics, cancer centers) and of the health status of the people who were treated there. It’s even more curious that they would try to measure massage therapy by using it in a way that most practitioners of the discipline would not typically use it. 

Obviously, there is wide variability between what happens in a session I provide versus one you provide versus one provided by another person three counties over. This does present some problems when we’re trying to measure outcomes, but if we’re talking about autonomy and beneficence, two of the pillars of person-centered, ethical care, a strict protocol leaves both the provider and the receiver out in the cold. On top of that, we’re likely generating artificial “data” about an “intervention” that undermines the value of trained, licensed practitioners of massage therapy regardless of its success or failure. 

Certainly, in the case of something like craniosacral therapy, manual lymphatic drainage, or other hands-on interventions that specifically influence a directional system of pumps and vessels that work best in a certain sequence, a protocol is not only advisable, but also necessary for safety. But the studies I reviewed were measuring massage therapy’s effect on pain, anxiety, sleep, and other factors related to the experience of illness. How often are we using strict protocols in our practices? When we do use them, why do we do it, and what do we observe? Do any of those protocols require that we speak as little as possible with the person we are touching? When we say “protocol,” are we talking about five strokes this way, four strokes that way, wait 3 seconds, no return strokes, begin again? Or are we saying we begin by addressing this muscle group, then move on to that attachment or the area of that attachment, and then revisit the first group to assess, “deviating” as needed based on what we feel? 

We have to ask ourselves what we’re measuring and why. Do we want to measure the value of specific tissue manipulation, or do we want to measure the value of bringing the skill, insight, and humanity of an additional discipline into the experience? The latter holds much greater promise for the future of massage therapists in health care. Palliative massage therapy research will move our integration and practice forward when the studies we conduct about massage therapy’s effect on humans’ experiences reflect real-world situations mediated by practitioners of the discipline of massage therapy. 

We would be wise to look to social work and psychotherapy studies as well as nurse coaching interventions and other disciplines that recognize the inherent value in the interpersonal aspects of our work. Moving away from strict, mechanistic protocols will allow us to capture the ways we engage in real-time, evidence-based shifts in technique and approach when we come into contact with a person’s tissue and experience.

Thankfully, we are not machines. It’s time to stop trying to measure our value that way.