Massage Therapy: The Invisible Profession?

A Call to Action

By Diana L. Thompson
[Somatic Research]

Hello, everyone, and happy new year. This being a time for new beginnings and for my first column with Massage & Bodywork magazine, I want to introduce myself and prepare you for the year to come. In addition, I will provide a lay of the land of current massage and bodywork research and, because it is my nature, I will attempt to provoke some purposeful action from you.

As a licensed massage therapist for 26 years, with no related advanced degrees (I have a bachelor’s degree in anthropology) or impressive credentials after my name, I am fortunate to have so many years of research experience under my belt. Perhaps it was good timing or my crazy obsession with SOAP charting that convinced researchers I was approachable (a like-minded geek?). In 1997, Drs. Dan Cherkin and Karen Sherman invited me to the Group Health Center for Health Studies to ask me questions about massage therapy. They were embarking on what has become some of the most extensive randomized controlled trials (RCTs) on massage therapy to date. I was hired as a consultant and assisted in the selection and training of massage therapists for six massage research projects.

From there, I was drawn to volunteer with the Massage Therapy Foundation (MTF)—whose mission is to advance the knowledge and practice of massage therapy by supporting scientific research, education, and community service—and worked on such projects as the research curriculum kit, the case report contests, and the International Journal of Therapeutic Massage and Bodywork: Research, Education, and Practice (IJTMB). As the MTF president for the past four years, I’ve traveled to research conferences across the country and beyond, observing the world of academic debate and exploration into health care and integrative medicine (IM).

I share my background with you because I am no different than you: I practice, I teach, and I volunteer. Research is everyone’s responsibility. We all have an obligation to influence research and be influenced by research; organizations like the Institute of Medicine (IOM) and the National Center for Complementary and Alternative Medicine (NCCAM) profess it and other complementary and alternative medicine (CAM) professions have adopted it. To live up to the standards and expectations of other health and wellness professions and to be considered a part of integrative health care, it is important that we make research literacy and research capacity our standard of practice. Our innate curiosity can be the impetus to becoming research literate. It is imperative that we stop relying solely on those in other fields to do our research for us.

What Lies Ahead

Many of the strides we have made in becoming research literate have focused on our ability to find research articles and incorporate the data into our practices. This is a necessary first step to research literacy. In her Somatic Research columns for Massage & Bodywork the last couple of years, Ravensara Travillian did an excellent job of teaching you to think critically about research, analyzing which research articles passed muster for relevance, generalizability, and reproducibility. Many of you have gone to PubMed and BioMed Central and found information that assisted you in practice. Keep up the good work! I, too, will highlight articles relevant to the massage and bodywork profession and help you make sense of how the information revealed might impact your clinical decision making and treatment planning.

Research literacy is not just about translating research into clinical practice (bench-to-bedside). Translational research is equal parts bench-to-bedside and bedside-to-bench (practitioners relaying clinical experiences back to the researchers). The bench-to-bedside approach is only effective when the cycle is complete: researchers have access to clinical information and practitioners feed information back to the researchers on the clinical relevance of the discoveries (above).

My intention in this column is to provide you with equal parts bench-to-bedside and bedside-to-bench. I will be a resource for understanding the clinical implications of research and provide opportunities for you to engage with the academic world of research. As a profession, we have much to learn on how to influence research effectively. Until we do, we will be disappointed in the content of studies done without the consult of massage therapists or our trained hands providing the massage. We will continue to see headlines purporting that massage is bad for athletes, quoting research that claims “massage actually impairs blood flow to the muscle after exercise.”1

Keep in mind that rigorous studies representing massage as practiced exist. They are not the majority—yet. It is our responsibility to ensure that massage research involves massage therapists as consultants, practitioners, and principle investigators (PIs), one step at a time.

To become well rounded, we must influence research as much as research influences us. How do we reach out to researchers? I recommend a couple of approaches.

Write Case Reports

We all have stories to tell; we should start with simple cases explaining who we are, whom we treat, and what we commonly do. This includes everything from record keeping and interview questions to our assessment techniques and massage applications. Case reports do not have to be rare and exciting interactions where we “healed” someone in one or two sessions, though we all probably have a few of those stories to tell. It is important that we use the existing academic model and make a wide range of our stories accessible to researchers and health professionals by getting them published in peer-reviewed journals like the Journal of Bodywork and Movement Therapies (JBMT) and IJTMB.

Attend Research Conferences

There are many organized networking events that take place at research conferences. Researchers want to mingle with clinicians in the hopes that conversations and thoughtful debate might help them refine their hypotheses and protocols and tighten up their research designs. There are also opportunities for comment after each research presentation; attendees are encouraged to question researchers and offer suggestions for further study.

There are ground-level opportunities available to assist you in both of these endeavors through the MTF. has a complete guide to writing case reports, and you can win money and get published through the practitioner or student case report contests. Even if you don’t win with your first submission, you will receive valuable feedback that will help you gain experience and skills. The gold award winner for the 2008 Practitioner Case Report contest, Erika Larson, submitted a report in 2007 and received an honorable mention. She credits her initial involvement with the contest for boosting her confidence and skills.

Another opportunity is the second Highlighting Massage Therapy in Complementary and Integrative Medicine (CIM) Research conference, May 13-15, 2010, in Seattle. With an emphasis on massage and bodywork, you will feel right at home listening to researchers share information that directly impacts your business and your clients’ health and well-being. You will learn valuable information about low-back pain: how the fascia is involved from Dr. Helene Longevin, and how massage can improve low-back pain from Dr. Dan Cherkin. Experts will speak on public health and how to ensure massage is integrated into the new prevention and wellness paradigm for health care. Many opportunities are available for sharing your hypotheses about massage with researchers.

Lay of the Land

What is the status of massage research? How do massage and bodywork keep pace with the rise in public use of CAM? Is massage research funded and published at the same rates as other CAM professions?

A rigorous overview of massage research was published in IJTMB in June 2009.2 That article represents the mind meld of 37 conference attendees, including researchers, educators, practitioners, and other health professionals interested in massage research at the North American Research Conference on Complementary and Integrative Medicine (NARCCIM). The purpose of this workshop and summarizing article is to take stock of the current state of massage research, to explore approaches, directions, and strategies and to influence the future of massage research. We will explore it more fully in a future column.

For now, let’s take a quick look at some statistics from this and other articles. In the 2007 National Health Survey on Costs of Complementary and Alternative Medicine and Frequency of Visits to CAM Practitioners: United States, 83 million American adults spent $33.9 billion on CAM practitioners and CAM products.3 Massage was ranked number two for out-of-pocket expense, second only to natural products. This means that people paid more money out of pocket for massage therapy than chiropractic and osteopathic treatments, acupuncture, naturopathy, homeopathy, yoga, etc.

Even though we outranked all other practitioner visits for out-of-pocket expenses, the headlines never mentioned massage. The Los Angeles Times headline read, “Americans spend $34 billion a year for herbals, acupuncture, chiropractic, other alternative therapies.” The Boston Globe never mentioned massage, and The Washington Post mentioned massage in the third paragraph, after acknowledging acupuncture and chiropractic care.

Let’s turn to research publications. Many point to Dr. David Eisenberg’s study, “Trends in Alternative Medicine Use in the United States, 1990–1997,” published in Journal of the American Medical Association in 1998, as the pivotal shift in interest in CAM research,4 or perhaps it was his initial study, “Unconventional Medicine in the United States: Prevalence, Costs, and Patterns of Use,” published in The New England Journal of Medicine in 1993.5 Both are worth reading.

Here the numbers on the growth of CAM articles. From 1990–1999, PubMed indexed 147,668 articles on complementary medicine. From 2000–2009, this number increased to 292,505: nearly a 100 percent increase between decades. If we alter the search to specify massage research, the growth is similar: from 1990–1999 there were 1,740 articles indexed on PubMed, and between 2000–2009 PubMed indexed 3,375 (as of October 2009). However, massage is the number one out-of-pocket practitioner-related cost (vs. product cost), yet we only represent 1 percent of the research on CAM.

One more bit about the numbers: massage research presentations from the podium at IM and CAM conferences mirror the meager 1 percent representation or worse. In fact, at the IOM summit in February 2009, massage was addressed in two of the six pre-conference papers, was on one podium presentation slide, and the word massage was not uttered from a single presenter’s mouth.6 Although the NARCCIM did not shy away from speaking the word massage, there were a relatively small number of presentations related to research on massage therapy, and few of those presenters were massage practitioners.7

I am not whining. I am calling for action. I am not satisfied being the invisible practitioner in an invisible profession. Our clients are speaking out with their dollars. We must speak out with our presence at research conferences and with our voices by telling our stories. I hope I start hearing from you through your case reports and seeing you at research conferences.

 An LMP since 1984, Diana Thompson has created a varied and interesting career out of massage: from specializing in pre- and postsurgical lymph drainage to teaching, writing, consulting, and volunteering. Her consulting includes assisting insurance carriers on integrating massage into insurance plans, and educating researchers on massage therapy theory and practice to ensure research projects and protocols are designed to match how we practice. Contact her at


1. 090507164405.htm (accessed November 2009). The research project referenced in Science Daily has not yet been published but was presented as a poster at the American College of Sports Medicine conference in Seattle, May 2009. This was one of nearly 2,000 posters presented at this conference and unfortunately it was one of the few that made headlines. I will provide a critical assessment of it when it is published and accessible.

2. Christopher A. Moyer, PhD, Trish Dryden, RMT, MEd., and Stacey Shipwright, BA, RMT, “Directions and Dilemmas in Massage Therapy Research: A Workshop Report from the 2009 North American Research Conference on Complementary and Integrative Medicine,” International Journal of Therapeutic Massage & Bodywork 2, no. 2 (2009): 15–27. Available at (accessed November 2009).

3. National Center for Complementary and Alternative Medicine, press release dated July 30, 2009. Available at (accessed November 2009).

4. David Eisenberg, MD, et al, “Trends in Alternative Medicine Use in the United States, 1990-1997,” Journal of the American Medical Association 280, no. 18 (1998): 1569–1575.  Available at (accessed November 2009).

5. David Eisenberg, MD, et al, “Unconventional Medicine in the United States: Prevalence, Costs, and Patterns of Use,” New England Journal of Medicine 328 (1993): 246–252. Available at (accessed November 2009).

6. Vicki Weisfeld, “IOM Summit and Integrative Medicine and the Health of the Public: Issue Background and Overview,” Institute of Medicine of the National Academies, Commissioned Paper published February 2009.  Available at (accessed November 2009).

7. Martha Menard, “Letter to the Editor,” International Journal of Therapeutic Massage & Bodywork 2, no. 2 (2009): 28–29. Available at (accessed November 2009).