The Evidence Massage Therapy Needs

There’s a sentence in a peer-reviewed paper I co-authored a few years ago that I haven’t been able to stop thinking about.¹ My colleagues and I spent a year combing through a decade’s worth of massage therapy research in serious illness care, looking for evidence of what years in this work had already taught me: That a trained massage therapist brings something to the experience of a person living with serious illness that a well-meaning volunteer with good hands does not. But that’s not what we found.

Instead, we found that of the 10 clinical trials in our review, half didn’t use massage therapists to deliver “the intervention” at all. Studies used nurses, nursing assistants, physiotherapists, massage students, and others. Trained, practicing massage therapists provided the intervention less than half the time. And in the studies that did involve massage therapists, most locked them into strict, timed protocols (specific strokes, durations, sequences) in the name of scientific rigor. There were very few studies in which the kind of flexibility patients described as the thing that mattered most (the ability to adjust pressure, to read a room, to let a session become what a person needed) was retained in the study design.

In case there’s any question about what I’m saying: It keeps me up at night that the role and training of the person engaged in the person-to-person contact called “the intervention” was, in the overwhelming majority of this research, treated as incidental. Rather than an essential aspect of the work being highlighted, it was barely a footnote.

This approach to research has left our profession with a body of evidence which shows that “massage” (let’s call it “rubbing,” because that’s what so many of the studies were actually measuring) lessens pain and anxiety. Sometimes it impacts sleep and mood. Yet evidence for what a massage therapist—specifically trained and licensed in the practice of massage therapy, which is a deeply complex discipline shaped by skillful technical adaptation and person-centered psychosocial interaction—can contribute is almost entirely missing. 

A Significant Difference

“The evidence supports massage” and “the evidence supports massage therapists” are wildly different claims. 

We’ve continually allowed the first one to stand in for the second, and then we wonder why all these data haven’t translated into better jobs, more sustainable careers, and greater recognition of massage therapists as health-care providers.

In full transparency, the review my colleagues and I conducted focused on massage in seriously ill populations. I have not conducted a similarly deep dive into the broader massage therapy literature the way we did for this one field. That said, I’d be surprised if this pattern is unique to the study of massage in palliative care.

If we take just a moment to look at how we train people to do this work, we can see that our sense of what we do has shaped how we measure it and how we let others measure it. Hands-on technique gets the bulk of the focus. Communication skills, pathology, client-centered adaptation, the science of what’s actually happening in a body under stress, these get less, both in rigor and in approach. 

If we teach practitioners that the hands are the job, it stands to reason our research would go looking for evidence of what the hands do. And when that research is designed and executed by people who are not massage therapists, we find ourselves even further afield.

Never too Late to Start Anew

There’s no smoking gun, my friends. I’m certain that nobody set out to undersell the profession. It happened because most of the massage therapists who found their way into research projects were understandably glad to be there and reached for the tools mainstream medicine already trusted. It never occurred to us to ask whether those tools were built for measuring what we do. Rather than a failing of nerve or passion, it seems more likely that this is what happens when a young field is handed someone else’s rulebook and told this is how legitimacy works.

After 20 years of doing this work, I have formed some beliefs about what’s happening. There are times when a client’s body begins to trust me before the session “begins.” I’ve learned that there's a difference between the pressure someone asks for and the pressure that will benefit them, and there’s an art to finding the place where those meet. I understand some essential aspects of what helps people heal and find their own resources. 

Existing research has done very little to explore these aspects of the relationship you and I form with clients every day and how important that relationship is. Massage therapists know things about massage therapy that nobody else could possibly know. That knowledge is something that anyone with the power to bring massage therapy into its own as a health-care discipline should become very curious about understanding.

It’s time to believe that what we know, what we’ve learned, what we facilitate each day, each hour, in our treatment rooms, clinics, and at the bedside, is, in fact, the very kind of knowing anyone with power to change the field should be asking about, even if they don’t know it yet.

So, I’ll leave you with this: What have you seen and felt that supports your beliefs about why this work “works?” What questions could researchers be asking to surface those aspects of massage therapy to shift the narrative from one about hands to one about humans?

Notes

1. Cal Cates et al., “Massage Therapy in Palliative Care Populations: A Narrative Review of Literature from 2012 to 2022,” Annals of Palliative Medicine 12, no. 5 (2023): 963–75.