resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Balancing Spring Challenges
As the winter months come to a close and warmer spring weather appears, patients may begin to present with new challenging pattern presentations.
News in Brief
ACA Adopts New Governance Model; ACA 2017 Awards; CCA Helps Calif. DCs "Share the Love"; $1 Million to Help Advance the Profession; D'Youville Raises the Bar on Anatomy Education; ErRatum.
Women's Hormones: A Western & Eastern Perspective
Sometimes it may seem that you require a degree in medicine to understand hormones and how they function.
Creating Good Business Buzz
What do patients really think about working with you? Rarely do you hear the whole truth. Those who improve may be candid in their gratitude.
Why I Quit Doing House Calls
My father was a chiropractor who did house calls, so when I became a DC, I figured doing house calls was part of the job. My March article recalled my experience as a small boy, accompanying my dad while he went to patients' homes to treat them.
New Relationships, Old Trauma: AOM & Other Healing Strategies
Being in love is one the most beautiful and enjoyable experiences. Most of us are willing to pay almost any price to have that experience, and still often find it elusive or fleeting. Navigating the ups and downs of loving relationships are often challenging — even for the most psychologically balanced among us.
Clearing Blocks: A Way to Improve Cosmetic Acupuncture
As a Five Element acupuncturist who teaches facial acupuncture classes nationally, I was surprised to learn that one of the basic principles I was taught in school is unfamiliar to most acupuncturists.
Raditation & Your Smartphone: Is it Worth the Risk?
If radial arteries could talk (and in my experience they can to some extent), they would say, "Step away from the smartphone." At least that is the message I am receiving loud and clear as I feel the pulses of many patients.
Eczema & Acupuncture: A Sound Solution (Part 1)
Eczema affects approximately 3.5 percent of the global population and is one of the most common skin complaints seen by dermatologists.
Universal Design: Principles & Practice
In many respects, universal design serves as the core of ergonomics. It's also a good tool to use when designing a return-to-work program for injured and/or ill patients. Let's take a closer look at universal design and why it should matter to you and your patients.
Give Yourself the Digital Advantage
When you see this article in the print version of this issue and swear you read it already, don't be alarmed: you probably did. That's because by that time, the May issue will have been available online in digital format for three weeks.
A Major Role in Back Pain: The Multifidus
Back pain affects roughly 80 percent of the population at one time or another and is one of the leading causes of doctor visits.
Taking the Chiropractic Message to the Press
"There is no better place on earth to have a news event," the National Press Club boasts, and it's easy to understand why: Every year, the 108-year-old Washington, D.C.-based organization hosts countless press conferences on the hottest topics impacting America and often the world.
A Daily Strategy for Heavy-Metal Detox
In modern society, we are constantly exposed to heavy metals such as cadmium, lead and mercury. These heavy metals have no essential biochemical roles in our body, and conversely, can cause us a great deal of harm if they build up to toxic levels.
The Visual Error Scoring System: A Concussion Tool
Postural stability and oculomotor function are the most easily recognized physical indicators of neurologic motor dysfunction associated with concussions.
Is It Time to Rethink Mental Illness? (Pt. 1)
Invariably, patients will ask their chiropractor about depression or various mental illnesses. Some practitioners will reflexively offer a cervical adjustment, suggest St. John's wort or contemplate a referral to a specialist.
An Integrated Approach to Chronic Pain
Findings from a unique Medicaid pilot project in Rhode Island involving high-use Medicaid recipients from two health plans were recently presented to the state's Department of Health, demonstrating stellar outcomes with regard to medication use, ER visits, health care costs and patient satisfaction.
Is the New Medicare Reporting Exemption Right for You?
What you've heard is not a rumor – there will be exemptions for providers of Medicare patients, with no penalties assessed for offices that do not do Quality Payment Program (EHR, PQRS, MACRA and MIPS) reporting.
Bill With Confidence: Learn What to Collect
Q: I am trying to understand what I may collect from my patient when there is insurance. Do I have to accept the amount allowed by the plan or may I collect up to my billed amount? Please note, I am not a member of any insurance plan.
March, 2016, Vol. 16, Issue 03
Telling the Truth About Massage Therapy
By Tracy Walton, LMT, MS
Google "benefits of massage therapy," and you'll bring up 3.5 million web pages. Spend an afternoon checking out a bunch of them, and you'll find a few dozen benefits of massage therapy, along with a hundred or so conditions that massage is expected to help.
Among the many beneficial effects of massage, you might pick out a few focused on common cancer symptoms and side effects of treatment. In particular, you'll see references to the "Big Five" in cancer care: pain, nausea, fatigue, anxiety, and depression. These are compelling problems, familiar to oncology massage therapists and clients alike. Research has found growing support for effects on these symptoms and the strongest support is for easing pain and improving mood in people with cancer.
These claims are simple and fairly well documented. If we stopped there, with that last humble sentence about "growing support," we'd be on solid ground. But in the massage profession, we haven't stopped there, and some of our other claims are not so humble, and not solid at all. Go to some web sites, and you'll see long laundry lists of massage benefits. These don't apply to a specific population or problem. Instead, they are more generic. As we will see below, many of these generic claims are downright problematic.
All of us in massage therapy, not just those working with people with cancer, could do with a closer look at the generic list. I've whittled that list down to a short list of a few supposed massage benefits: claims of massage improving circulation, immunity, and endorphin levels. The likelihood of massage clearing out toxins or lowering cortisol levels.
You might have heard some of these claims repeated for years, starting with your first class in Swedish massage. They are mainstays in the massage therapy profession. Unfortunately, there are at least two problems with this short list.
Clients Don't Ask for These Benefits: Many of our claims about massage are focused on physiological effects, rather than clinical improvements. How many of your clients ask for an increase in circulation or endorphins? How many ask for detoxification or a smaller supply of cortisol coursing through their bloodstream? My guess is that, aside from an occasional request, most clients aren't focusing on these benefits. Our lists of benefits sound good, but they don't really address the primary reasons people come to us. People come to us in order to feel better.
Look back at the big five in cancer care vs. the generic lists of benefits and you'll find an important distinction: The Big Five focus on feeling better, improvements in pain, anxiety, and so on. In contrast, massage claims about endorphins and cortisol focus on complicated physiological explanations of how we might feel better. The former are clinical outcomes of massage therapy, the latter are mechanistic outcomes. Clinical outcomes are direct and relevant to the client. Mechanistic outcomes may not matter to a client at all. Many people take medications without questioning the way they work. In fact, many medications bring about positive clinical outcomes, while their mechanisms of action remain a mystery to consumers and medical providers alike.
This means that when our oncology clients (or really, any of our clients, regardless of health history) look for information about feeling better from massage, they are often met with a distracting list of mechanisms, focused mostly on cells or molecules in the blood going up, going down, or moving more swiftly through the body. These mechanistic claims might sound appealing, but they aren't usually related to the client's problem. And they come with other problems, too.
Our Claims Are Not Accurate: Many of the claims we've been making with such certainty are not at all certain. In most cases, we have no decent research to back what we are saying. For example, the claim about massage upping endorphins can be traced to only two tiny, primitive studies. Only one of those studies, fraught with design issues, reports an endorphin boost. Yet a Google search for "massage" and "endorphin" brings up tens of thousands of websites claiming massage will raise your endorphin levels.
Likewise, claims about improved circulation and immunity — mainstays of massage literature — have only a handful of studies behind them, with conflicting results. A body of research on cortisol has been analyzed and reported that massage does not lower cortisol. And there is no good evidence that I know of, anywhere in the English language, on the massage and toxin question at all.
The weakness in our claims about massage raises serious ethical issues for our profession. Health care providers have a recognized duty to tell the truth about their treatments. Even outside of health care, truth in advertising is a responsibility of anyone promoting a service or product.
When we offer massage therapy, people with cancer, health care providers and the public assume we are telling the truth about our services. In cancer care, patients may be especially vulnerable to false claims and oversold promises. They need to hear reasonable expectations about what massage will do for them. That's why the humble statement above, about "growing research support," for massage and cancer symptom relief is so important.
In particular, at least five of the generic claims we make about massage — effects on endorphins, circulation, immunity, cortisol, and detoxification — should be phased out of our literature, our websites, and our massage classrooms. Any time we tell someone, "massage does this," or "massage will help you with that," without good backing, we are making a false claim. Even with a few million websites repeating the same thing, we have a professional responsibility to question what we are told and what we tell our clients.
Telling the Truth, Discarding the Myths
To help MTs in this regard, the Massage Therapy Foundation has just released a free e-book, 5 Myths and Truths about Massage Therapy: Letting Go without Losing Heart (http://info.massagetherapyfoundation.org/5-myths-and-truths-about-massage-therapy).
In partnership with the Foundation, I wrote the e-book to help straighten out our stories about massage. I offer up a research summary of each claim about endorphins, immunity, cortisol, circulation, and detoxification. I also reference many of the small research studies behind each claim, such as the two tiny studies about endorphins, mentioned above. The results may be surprising, but will help all of us make fair, accurate, more defensible claims about our work.
Reporting the true benefits of massage therapy is just as important as discarding untrue claims. The Foundation offers free e-books on massage and pain research, pediatric massage, connecting with researchers, and even an e-book on connecting with physicians. These and other resources are referenced on the Foundation website www.massagetherapyfoundation.org/resources/general/. The e-books are just a sample of the many resources available at the Massage Therapy Foundation, which has funded research, education, and community service projects for 25 years.
In addition to the free e-book through the Foundation, I have listed 20+ highest-level massage research papers in a recent blog post, "One Massage Study Does Not Prove a Point, www.tracywalton.com/one-massage-study-does-not-prove-a-point/. Three of the papers listed are on massage and cancer. In that post, I also explain why a research review typically provides more useful and accurate information than the single massage studies we are told to promote.
All of our client populations deserve clear, accurate information about the benefits of massage therapy. Massage therapy is a wonderful intervention that is becoming more and more welcome in health care circles, and especially in cancer care. When we keep our claims true, humble and thoughtful, we strengthen the foundation of massage therapy for years to come.
Click here for more information about Tracy Walton, LMT, MS.
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