Evidence based massage therapy – what is it really and do we want to make sure that massage therapy that is done with clients/patients is evidence based? I have thought so for awhile, but a few weeks ago when an associate attended a presentation Healthier WA by the WA State Health Care Authority and heard that 40-60% of all medical procedures and prescriptions are NOT evidence based. I started researching just how much of medicine is evidence based and am still looking for more solid statistics
What is evidence based practice?
I always see these venn diagrams that have 3 circles that connect in a small area. When I see that I assume that all parts are equally considered….but no according to the skeptical massage therapists. The three cornerstones of evidence-based practice are:
1. Best available research evidence (as determined by critical appraisal)
2. Clinical experience, clinical reasoning
3. Practical, patient-centered application
A massage therapists is supposed to go through this process of assessing their clients condition, researching the evidence and then evaluating the research, and then supposedly integrate that evidence with clinical expertise, patient preferences and apply it to practice.
But when we do that based on things we see happen with people, it doesn’t seem to matter to the so called skeptical massage therapists. They seem to not consider that the patients values and preferences need to be considered as well as the experiences of the practitioner.
The evidenced based massage therapy movement right now is a double edged sword – one one side we want to gain respect from the public, legislators and healthcare professionals as well as health insurance companies so we look toward research and evidence….but there really isn’t much to go on right now. The book Massage Therapy: Integrating research with practice shows the current research up to it’s publishing date and says that at best the research looks promising for some conditions: headaches, back pain, anxiety and depression.
So what are the so-called evidenced based massage therapists doing in their practices? Since there isn’t any evidence why are they still even doing massage therapy?
They are so quick to throw many of the types of massage therapies under the bus – no reiki, no reflexology, no Mayan Abdominal massage for fertility, no triggerpoint therapy…. what’s next?
The Skeptics, the middle ground, the energy workers.
The ‘skeptical massage therapists’ say that things like Reiki, acupuncture and reflexology are not valid therapies and that there is no evidence that ‘energy’ actually exists. Then there are the middle ground supporters who say they are science and research based but they do find that there is enough evidence to show that these therapies work and there is evidence to support their practice.
No structural integration. No triggerpoint therapy. Fertility massage has been shown to be an unethical practice.
Part of the problem is it is more about the way these types of therapies are talked about. They may be doing something to help the client feel better, but it usually is not due to the reasons that are often sited such as:
- Massage gets the toxins out. (No toxins are released in massage/bodywork sessions.)
- Posture is the cause of pain. ( No the brain is the creator of pain.)
- Massage improves circulation. (No research on that.)
If massage therapy is going to jump on the evidence based practice bandwagon we need someone to interpret the evidence and to get it into massage therapists hands and heart. Most massage therapists are not trained in evaluating the evidence and don’t really care. ( I don’t!)
The problems with Evidence Based Practice
So we are supposed to use what evidence we have to create evidence based massage therapy practices…but with little to no evidence – what is everyone doing?
Where it the info/data from the clinical practice of each therapist? When does the client’s values and experience come into play? How do we allow clinicians to use the best evidence but also to apply it to each individuals needs/wants and use the professional experience of the therapist to use what they know and what they have seen in practice?
Most of regular medicine is not evidence based- otherwise how did we get into such a Opioid crisis?
It usually takes evidence 10 years to get into practice for physicians.
The process of evidence based practice is also based on millions of dollars of campaign contributions and lobbying for various products/procedures. The massage profession doesn’t have a Political Action Committee let alone a strong lobby nationally or even in states. The only PAC I am aware of is the one that I was involved with for a while here in WA that we had to shut down due to the dismal interest. (WA Massage Alliance for Health). We have raised usually about $5000 a year at best. That won’t get us anywhere.
Also in WA State, we have a few insurance companies who are requiring preauthorization of massage services and they use so called evidence based guidelines on whether to allow massage therapy or not. Their online system does not take into consideration the clients real condition or the doctors treatment recommended in the prescription. You put in the diagnosis code and clients insurance info and it spits out 4 sessions approved…no matter if they just fell down a ski slope and dislocated their elbow/shoulder or just pulled a hamstring running or are having neck/back pain from sitting at the computer all day.
Leave a Reply