Massage and Bodywork Magazine for the Visually Impaired - Q & A with Leon Chaitow and Antony Porcino

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September/October 2014 Issue

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Q & A with Leon Chaitow and Antony Porcino

The State of Massage Research

By Jerrilyn Cambron
[Somatic Research]

Journal editors review many research articles to determine the strongest and most appropriate research to publish. In this column, we will hear from two editors who oversee scientific journals that focus on massage and bodywork.
Leon Chaitow, ND, DO, is editor in chief of the Journal of Bodywork & Movement Therapies (JBMT, www.bodyworkmovement therapies.com), which he founded in 1995. An internationally known speaker and author, Chaitow has studied acupuncture, cranial osteopathy, naturopathy, orthomolecular nutrition, and osteopathy. Since 1983, he has been a visiting lecturer at numerous training institutions in Australia, Canada, Europe, and the United States. Chaitow, the author or editor of approximately 75 books covering many health-care topics, including breathing rehabilitation, chronic pain, and manual treatment methods, has a private practice in London.
Antony Porcino, PhD, is the executive editor of the International Journal of Therapeutic Massage and Bodywork (IJTMB, www.ijtmb.org). Porcino earned his bachelor’s degree in chemistry/biochemistry in 1994 and his doctorate in health services research in 2012. He has also studied manual and energetic therapies. His focus is to extend research capacity and literacy among complementary and alternative medicine (CAM) practitioners, as well as to ensure that current research in CAM manual therapies is rigorous and generalizable for the purpose of effectiveness studies and health policy recommendations. In addition to his work as an editor, Porcino is the project director of Complementary Medicine Education and Outcomes Program (CAMEO), a research project that provides complementary medicine education for patients, their supporters, and health-care providers in British Columbia.
We asked Chaitow and Porcino five questions about research, future directions, and how therapists can get involved. Here are their answers.

When did you get interested in research?
Chaitow: I became interested in research while working at a general medical practice in London, when we began to collate and audit the results of many years of collaborative work between MDs and CAM practitioners, including myself. The results of this work were published in 2002 as Integrating Complementary Therapies in Primary Care.1 The concept of mining the information recorded in case notes was a trigger for further efforts in that direction.

Porcino: It was during high school for me. Although I was in music and drama, I kept up with my sciences. In university, I did a double major in organic chemistry and biochemistry, and loved my minor in botany. I paid my way through university doing student research positions across Canada and in the United Kingdom. Once I started my training in Hellerwork Structural Integration, I started to look at the state of research in fascia and massage. I thought what I was seeing was deplorable, but it would be several years before I felt ready to take on therapeutic massage research.

What areas of research are most interesting to you?
Porcino: I love research methods—the theory behind how and why we do what we do in research. More specifically, I think practitioner-based and service-based research in complementary and alternative medicine, and in therapeutic massage, needs more refinement and advocacy. In practice, these treatments are usually individualized, while most classic research trials depend on nonindividualized protocols. Of course, this is a blanket statement, but it truly is a vexing issue, and research methods that allow for variability are only now gaining traction. I also like research that focuses on the practitioner, such as the development of expertise and competency, or treatment ethics. At the other end of the spectrum, my own practice was focused on chronic pain—I had a lot of thoracic outlet and fibromyalgia patients, along with car accident patients—and I would enjoy being involved in trials in these areas.

Chaitow: As editor of JBMT, I read a great many research submissions—and similarly, when I am working on a book, the amount of material that needs to be read is amazing. English essayist Samuel Johnson said, “A man will turn over half a library to make one book,” and obviously this process itself is research!
In your opinion, what article (or articles) has made the biggest impact on the massage and bodywork field?
Porcino: This is a tough one for me for two reasons: (1) I have my favorite articles that are relevant to me because of my interests, and (2) what do you mean by impact? Most therapeutic massage research has been for specific issues; so, for example, the work showing that massage is safe for cancer patients has been really important, as has all the research on massage and stress and depression—for those fields. These have indirect, far-reaching consequences, helping to move massage to the forefront of the public perception. But so have [David] Eisenberg’s work in the United States and that of his colleagues in other countries, which showed that massage was among the most common complementary and alternative medicines being used by the public. This helped focus the public’s awareness on therapeutic massage, as well as providing proof that more research money should be focused on massage research. Importantly, the 1999 Massage Therapy Research Agenda put therapist-led research on the map.2

Chaitow: I have no idea to what degree I’ve influenced the massage profession, despite being involved in teaching groups since the early ’80s. I hope I have encouraged the concept of working with innate self-regulating processes rather than simply prompting LMTs to use safe manual techniques that derive from my osteopathic background; although that seems pretty important to me, as does the importance of paying attention to the breathing patterns of clients.
Examples of my contributions to the field include:
• “Neuromuscular Techniques in Orthopedics,” published in Techniques in Orthopaedics.3
• “Breathing Pattern Disorders, Motor Control, and Low Back Pain,” published in the Journal of Osteopathic Medicine.4
• “Chronic Pelvic Pain: Pelvic Floor Problems, Sacroiliac Dysfunction and the Trigger Point Connection,” published in the Journal of Bodywork and Movement Therapies.5
• Recognizing and Treating Breathing Disorders, published by Elsevier.6

In your opinion, what areas or topics within massage and bodywork need the most research?
Chaitow: Demonstration of the mechanisms involved in achieving the obvious benefits deserves focused attention. What are the physical, circulatory, biochemical, and psychosocial effects of applying different degrees and models of massage to tissues in different states of functionality? One area that I am currently investigating relates to the fact that in massage, no single method, modality, or approach is used in a treatment session. Rather, a cocktail of approaches is used depending on patient need. This makes deciphering outcomes extremely difficult. It’s one thing to apply, say, a single modality in a particular setting and record the effects. But if that modality is followed or preceded by others, how can sense be made of the outcomes? It may be that we have to accept that selecting a variety of methods in any particular clinical setting is what “works”—even if that conclusion becomes unsatisfactory for other, more medically oriented researchers.

Porcino: I’m not a physiology person. However, I recently helped design an acupuncture trial, and studying pain and nerve physiology and how different types of acupuncture needling activate different physiological responses really helped me understand why massage physiology research is also critical. Massage has multiple styles, depths, and speeds. If we want to achieve specific effects, understanding the physiological mechanisms invoked by the different technique and therapy options available to us will help us refine our work, and perhaps make it more effective and efficient by allowing us to better understand when to use specific therapies or techniques.
The other area that I think needs more focus is education—how is tactile competency and expertise development taught? Back in the mid-1980s, in The Reflective Practitioner, Donald Schön talked about the “messy swamplands” of everyday practice compared to the theoretical ideal. He proposed the idea of a practice-based (swamplands) way of knowing the world, compared to a research-based (theoretical ideal) way of interpreting what was being seen.7 There is a dynamic tension between these two approaches, because one is experiential evidence, the other is “objective” research, and more work needs to be done to bridge the gap between these at the initial educational level of practitioners.
One area I personally want to see more research done is in somatics (Thomas Hanna’s original term, with an “s”), which is the subfield within therapeutic massage where the body-mind is conceived of as an integrated unit. It ranges from body-centered psychotherapy (psychotherapy using massage), to many forms of bodywork, including some deep-tissue work, but where the focus is integration of the experience of self and embodiment in the tissues. In 2007, Mary Koithan, PhD, in collaboration with other researchers, published an article on “unstuckness” and transformational healing. What struck me was how it was so similar to all the testimonials and writing of somatics colleagues in Rolfing, Rosen, Trager, Feldenkrais, and Aston Patterning. There is a rich wealth of knowledge and healing that is part of our therapeutic massage family where the research possibilities are still relatively untapped. Researchers need to catch up.

What suggestions do you have for therapists who want to get involved in research?
Chaitow: Record your work. Keep details of what you observe and what you do—use SOAP notes or other means of recording as much as possible. Write case reports or case studies or case series; enter competitions and try to get published. Spread knowledge, and as you do so, you will acquire knowledge.

Porcino: I immediately think of two things: First, what are you really learning from your practice? Are you reflecting on what you are learning, client by client? Do you see things that you would like to discuss with others or think others may need to know about or be able to add to? Find options for making this dialogue happen. The IJTMB offers several options, including letters to the editor, case reports and case series publication, and our new column, Trigger Points. Second, get your local massage organization to create a research discussion group, just like a book group. Challenge each other to contribute effective critiques about what you read. If you have an area of expertise, sign up as a reviewer for the IJTMB!

Thank you to Leon Chaitow and Antony Porcino for their insight and opinions. Both the Journal of Bodywork & Movement Therapies and the International Journal of Therapeutic Massage and Bodywork are indexed in PubMed
(www.pubmed.gov) and include a focus on bodywork and massage.
 
Notes
1. David Peters et al., Integrating Complementary Therapies in Primary Care (Elsevier, 2001).
2. Janet Kahn, Massage Therapy Research Agenda 1st ed., (Evanston, Illinois: American Massage Therapy Association, 2002), 1–17. The 1999 Massage Therapy Research Agenda is a list of five recommendations covering not only what kinds of research studies ought to be done, but also how they might best be done, and what conditions must be met in order to move the agenda forward. For more information, visit www.massagetherapyfoundation.org/clientuploads/Research%20Agenda/MRAW_Outcomes.pdf.
3. Leon Chaitow and Judith DeLany, “Neuromuscular Techniques in Orthopedics,” Techniques in Orthopaedics 18, no. 1 (2003): 74–86.
4. Leon Chaitow, “Breathing Pattern Disorders, Motor Control, and Low Back Pain,” Journal of Osteopathic Medicine 7, no. 1 (2004): 34–41.
5. Leon Chaitow, “Chronic Pelvic Pain: Pelvic Floor Problems, Sacroiliac Dysfunction and the Trigger Point Connection,” Journal of Bodywork and Movement Therapies 11 (2007): 327–39.
6. Leon Chaitow, Christopher Gilbert, and Dinah Bradley, Recognizing and Treating Breathing Disorders (Elsevier, 2014).
7. Donald Schon, The Reflective Practitioners: How Professionals Think in Action (Basic Books, 1984).

Jerrilyn Cambron, DC, PhD, MPH, LMT, is an educator at the National University of Health Sciences and president of the Massage Therapy Foundation. Contact her at jcambron@nuhs.edu.

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