During the course of attending massage school at A New Beginning School of Massage, students are given a number of assignments that requiring research and writing. Some of these assignments result in very insightful and well thought out information and decision-making outcomes. I am happy to share some of their assignments for you to enjoy.
There are two main types of research in the massage therapy profession. Basic research is normally conducted in a lab setting and measures information at the molecular, cellular and tissue level in the body. This type of research is used to optimize protocols and develop both applied research questions and translational research programs. The other type of research is clinical, or applied, research, and most massage research falls under this category. This type of research uses investigations on a functional level to test a specific measurement of the effects of massage on the body. In clinical or applied research, experiments are carefully designed to include two groups; a control group does not receive any treatment or receives a "sham" treatment and a group that actually receives treatment. The researchers are careful to control or document independent variables and the data collected is carefully analyzed to produce correct results. Other types of research include analytical research which focuses on complex issues and mechanisms and descriptive research which is based on surveys and interview questions.
In my opinion, all types of research in the massage therapy profession are valid. Some effects of massage therapy can be easily measured and validated. For example, range of motion and density of scar tissue can both be objectively measured to determine if there have been improvements or not. Some effects of massage therapy are subjective and based on the subject's perception of improvement or lack of. For example, pain management, depression and anxiety can be measured on standardized surveys but the changes (or lack of) will be affected by the subject. Some of the issues that affect a subject's perception are the belief that the treatment will work and their overall opinion of massage therapy. There is still work to do to improve research in massage therapy and this is made more complicated by the mind-body connection of massage and the varied systems it affects. Continuing to improve methodology and finding new ways to measure results is important to the future of massage therapy research.
Massage therapists can benefit greatly from staying on top of new developments in their profession by reading research studies and thinking critically about the results before putting them into practice. They must understand the criteria that makes research valid and correct. The most important criteria is to consider the source of the information. There are an overwhelming number of website that have massage information and determining the credentials of the publisher is important. A peer-reviewed journal is the best source to review research articles. These articles have been reviewed by other professionals for experiment design, methodologies used, correct data analysis and repeatability of the study. Other good sources are professional association websites, such as ABMP or AMTA. With any information, the massage therapist must think critically about what is being said and do further investigations into any questions they may have.
In my opinion, research is very important to the massage profession today. Research allows massage therapists to gain knowledge for ourselves and for our clients. We can use new information from research to better treat our clients and to be able to answer the questions they have about the way a technique affects the area it is being applied to. Research gives massage therapy validity in the medical community. This allows massage therapists to talk to members in the medical community about massage and how it can assist their patients. It also opens a path for insurance reimbursement making massage more affordable to more clients. Research in massage therapy that is done by massage therapist helps us to define our profession and helps to change the attitude that massage is an activity of self-indulgence or as a cover for other activities.
The research statement I chose is "massage can spread cancer and is always contraindicated."
I chose this statement because I have a strong interest in this area. The information reviewed for this statement includes "Massage therapy for cancer patients: a reciprocal relationship between body and mind" (Sager, SM and R.K. Wong. Current Oncology, Volume 14, Number 2, pp 45-54). For background information, I also read through the article "Could Massage Therapy Promote Cancer Metastasis?" dated 21 September 2000 from the website www.amtamassage.org/articles/3/MT/detail/1803 .
The background article "Could Massage Therapy Promote Cancer Metastasis?" gives important information on how cancer metastasizes. The main ways cancer is spread is by direct contact to nearby structures, through body cavities, bloodstream (hematogenous metastasis) and through the lymphatic system (lymphogenous metastasis). It discusses the event cycle for both hematogenous and lymphogenous metastasis as massage directly influences the flow of these systems. The conclusion is that massage does not promote metastasis through these avenues as patients are also advised to exercise and stay active–both of which contribute to the same system flows as massage. The bigger concern is metastasis through cell shedding from the primary tumor. There is concern that direct pressure or other strong stimuli applied directly on the tumor or near it, with greater risk being involved if the tumor is near the surface of the skin. The solution in this case is for the massage therapist to get as much information as possible about the tumor's size, location and depth and to avoid deep pressure at the site. Overall, the article concludes that cancer is not spread by massage and that it is up to the therapist, physician and patient to determine the risks of massage on cancer patients.
The main article reviewed discussed several research studies done on cancer patients for symptom control. The symptoms that were measured in most of these studies included pain, fatigue, depression, stress and anxiety. The main focus of most of the studies seemed to be on depression and anxiety. The authors discussed the strengths and weaknesses of the studies reviewed, acknowledging both the strengths and weaknesses of each study. Overall, the studies reviewed showed conflicting results. And the authors acknowledged that the symptom improvements may be due to many factors including belief of benefit (placebo effect), verbal communication, background music and aromatherapy. The authors stated that a better understanding of the mechanics of therapeutic massage is necessary with focus on the physiologic pathways and the connection between myofascial manipulation, blood flow and central nervous system adaptations. The article goes on to describe massage techniques in the Western tradition and Eastern tradition. The next section discusses the safety of massage therapy and states that it is safe when administered by a licensed massage therapist and that complications are rare. Any adverse effects of massage were generally due to massages done by laypeople or if techniques other than Swedish massage were used. The article lists special situations that the massage therapist needs to be aware of in cancer patients and advises avoiding massage or lightening the touch over areas that pose risk.
The article goes on to discuss the qualifications of the massage therapist in both the US and in Canada. The typical standard in the US is 500 hours and 2200 hours in Canada. It points out that massage therapists working with cancer patients need to have special training and education. The article discusses the reasons most clients get a massage, including back symptoms, relaxation, neck symptoms, mood disorders and leg symptoms in addition to cancer related symptoms. The authors conclude that the evidence is sufficient that therapeutic massage relieves a variety of symptoms and that clinical trials need to have a better design to determine which techniques are most efficient. The article also states that studies are necessary to understand the psychophysiological effects of massage and how they influence clinical practice. The article discusses the relationship between the physical and mental effects of massage and poses the question of whether it is better measured in the realm of psychotherapy instead of a medical model. The authors acknowledge the connection between the physiologic and the subconscious effects of massage. The article concludes that the relationship between the mechanistic effects of massage and the relief it provides are inconclusive and acknowledges the connection between the body and mind. The authors determine that more studies are necessary to understand this connection in relation to symptom control in cancer patients.
The research findings do not support the statement that massage of cancer patients can spread cancer and is always contraindicated. Both articles support the use of massage therapy in relief of cancer symptoms by a trained massage therapist. The articles provide information on how cancer is spread and that there must be special training of the massage therapist with excellent communication between the massage therapist, physicians, and patient. Both articles provide information on special considerations of clients with cancer and solutions on how to safely massage those clients.
The implications of this knowledge for me and my practice are widespread. It removes the fear of harming a client with cancer and concern that massage therapy can contribute to metastasis of cancer. It also reinforces the need for special training in order to safely perform massage therapy on clients with cancer. There is a need for elevated communication with the client and physician in order to avoid tumors that are close to the skin. This knowledge reinforces the need to understand cancer and the many side effects of the treatments available including knowledge of drugs and their side effects. This knowledge reinforces the need for a deep understanding of what is a local contraindication and what is an absolute contraindication for clients with cancer. Most importantly, the article confirms the connection between the mind and the body and how this connection can relieve common symptoms of cancer. The article confirms that physical touch affects the mind and the body and touch is safe for all clients with the proper knowledge and training.
Here is some of the information I recently shared in my June newsletter. Each newsletter has a specific focus. This month is focused on fibromyalgia information. If you would be interested in receiving my newsletter, please head over to my contact page and sign up.
1. Medscape rheumatology published an interview, Fibromyalgia: The Latest in Diagnosis and Care, with Dr. Daniel Clauw and Dr. Philip Mease A summary of findings noted in the article:
a. …now in the 21st century, with the aid of sophisticated neuroimaging techniques; neurochemical studies of the CNS; genetic analyses; as well as family, developmental, and psychological studies, we are recognizing that FM results from a complex interplay of neurochemical and genetic dysregulation, perhaps in the context of psychological factors; it can occur either on its own or in association with many chronic diseases, especially chronic pain and inflammatory diseases.
b. With the change in thinking around Fibromyalgia, what is the approach to diagnosing the disorder?: We generally recommend that physicians learn to recognize the pattern of widespread pain accompanied by fatigue, sleep, memory, and mood problems and then use the FM label when that is the most likely explanation of those symptoms. … It is appropriate to remind ourselves about the difference between classification criteria, which the 1990 FM criteria are, and diagnostic criteria, which the 2010 preliminary American College of Rheumatology (ACR) criteria are intended to be. Classification criteria are intended to identify subjects with enough similar features that they can be considered reliably classified for the purposes of research on their condition…. The new criteria rely more on pattern recognition of the constellation of chronic widespread pain along with other characteristic features such as fatigue, sleep disturbance, cognitive dysfunction, and irritable bowel symptoms—symptoms that may occur either as an independent entity or in association with other chronic illnesses such as rheumatoid arthritis or osteoarthritis.
c. What is the most effective current treatment approach for fibromyalgia?: Both drug and nondrug therapies can be very effective in treating FM, and in fact, most experts believe that the best approach is to combine the two different types of therapies because they are probably working on different aspects of the disorder.
The three classes of drugs with the best evidence are tricyclics (TCAs—cyclobenzaprine, amitriptyline), serotonin-norepinephrine reuptake inhibitors (SNRIs— duloxetine and milnacipran), and gabapentinoids (gabapentin and pregabalin). Only about a third of individuals will have a meaningful improvement with any of these classes of drugs, probably because FM can be due to abnormalities in many different neurotransmitter systems that are known to regulate pain perception, sleep, mood, and alertness.
The nondrug treatments that have the best evidence for efficacy are education, exercise, and cognitive-behavioral therapy (CBT). Other treatments that can be effective include yoga, tai chi, acupuncture, and many other complementary and alternative medicine therapies.
2. FibroGuide is a free CBT program for FM patients that has been shown to be effective in a clinical trial and can give patients access to CBT treatments to which they might not otherwise have access
STUDIES AND ARTICLES
3. The University of Alabama at Birmingham (UAB) is investigating the connection between fibromyalgia and brain inflammation to fight chronic pain. The Neuroinflammation, Pain and Fatigue Laboratory at UAB will be involved in several studies, and Younger has shared details about the first one. Researchers will be exploring chemicals in the blood to see if they are affecting the immune system and making pain worse. At this time, they have found that leptin, a hormone that comes from fat cells, may be influencing pain levels and fatigue levels.
Here is some of the information I recently shared in my November newsletter. Each newsletter has a specific focus. This month is focused on rotator cuff and shoulder injury information. If you would be interested in receiving my newsletter, please head over to my contact page and sign up.
TIDBITS and UPDATES
I have been taking an in-depth anatomy of the upper limb class recently, and a couple of key points have really stuck out for me. These points might help understand some of your client/patient’s symptoms.
STUDIES, ARTICLES, and RESOURCES
I receive a weekly update on anything published anywhere on the internet that includes information about rotator cuffs and shoulders. Much of it is personal blogs, stories about athletes that are injured, etc., but some of the information can be helpful to practitioners. I try to glean the best of the information at provide a brief synopsis of the information and a link to find the full item yourself. If you have any problems with the links, please let me know, or if you come across any information that you think would be good to share, please also feel free to pass that information along to: email@example.com
1. Recently, the Moon Shoulder Group through Vanderbilt University Medical Center released the results of two studies on the Rotator Cuff.
a. The study focused on relieving shoulder pain in patients with rotator cuff tendon tears without surgery.
b. The study involved a specific exercise protocol provided by physical therapists with home work as well.
c. The specific exercises were compiled in a booklet available for download for free on the Moonshoulder website.
d. The study indicates that the protocol designed had an 85% success rate without surgery.
e. For a synopsis and discussion of the studies, check out the website Healthnewsdigest.com
2. A Number of booklets and small books with rehab protocols, exercises and lifestyle changes to heal and prevent shoulder injuries can be found on the GoBookee site
3. While there are some great stretches in the book you received in class, and more stretches in the Releasing the Rotator Cuff Book and DVD by Peggy Lamb, as well as the Stretch Your Clients book by Peggy Lamb, the Chron.com website has some excellent PNF stretches for the rotator cuff for those who might want a specific stretching routine.
4. For those working with athletes who are looking for fitness routines to help with rehab or strengthening, a great variation on routine exercises can be found at Stack.com
5. For those interested in providing some support, such as Kinesiotaping the shoulder, a great video of kinesiotape application to support the rotator cuff can be found on youtube.