A Map of Scientific Activity

By Ravensara S. Travillian
[Somatic Research]

Over the past two years in this column, we’ve covered a lot of ground, and we’ve added elements to our research repertoire. For the last article in this series, let’s zoom out and take a broader view of the entire field of massage research. Such a perspective allows us to cover a great deal of ground, to place studies in relation to each other, and to suggest niches for individuals with different interests to explore massage research capacity and literacy.

A few questions come to mind right away. How do we use this knowledge? What does any particular study mean in the larger context of massage? How does massage science fit into the larger scientific universe? How do we apply findings from research in our therapeutic encounters with clients? Many other questions will occur to you as you continue to become familiar with research study articles. Here, we’ll examine how we put those smaller, separate parts together into a bigger picture, each part of the process working back and forth to inform and influence the others. We’ll look at the field through several different lenses to suggest where your interests might open a natural starting point.

Anthropologist and educator Gary Witherspoon offers a useful way of thinking about relationships (part/whole, macro/micro) in the research articles we read. Although his immediate subject is Navajo art and cosmology, rather than biomedical research, the framework is useful. “Symmetry provides a succinct expression of the nature of the whole-to-part relationship,” he explains. “In symmetry, the whole consists of two or more complementary parts … All parts have their identity, their function, their efficacy, and their beauty in relationship to the whole. Any marring or disabling of any part of a symmetrical whole destroys the integrity of the whole. Therefore, symmetry is inherently interdependent and holistic.”1

This analogy helps frame several kinds of dynamic tension in science—between holism and reductionism; large scale and small scale; qualitative and quantitative; experimental and correlational; subjective and objective. In isolation, neither half is better than its opposite; the answer depends on the context. Think of the way each half of the yin-yang symbol contains a dot of the other color, indicating that they are not entirely separate from each other. Similarly, different research approaches are not polar opposites, but part of a continuous spectrum of scientific methods of investigation.

View 1. Qualitative and Quantitative Research

Qualitative studies (from quality) deals with descriptive or narrative aspects of research, while quantitative studies (from quantity) deal with numbers, i.e., all the things that can be counted and measured. We can learn about these methods by evaluating various research articles.

When A. Billhult and K. Dahlberg wanted to establish the idea of “meaning” of massage for cancer patients receiving treatment in a hospital, they took a qualitative approach. The researchers asked questions that focused on the experience of the study participant. Questions such as “How do you mean?” “Can you tell me more?” and instructions for the subjects to give examples led to responses about the quality of their massage care. Responses included a sense of feeling strong, empowered, and that “massage gives a meaningful relief also because it contributes to a balance between autonomy and dependence.”2

By contrast, when L.H. Craig’s team wanted to study the effects of neuromuscular therapy on people living with Parkinson’s disease, they looked at quantitative measures to establish how much improvement the participants showed in scores for motor function. They found significant improvements in scores for tremor, Clinical Global Impression scale (CGI-Change), and finger-tapping speed, as well as a “modest improvement in quality of life.”3

A mixture of methods, combining qualitative and quantitative approaches, can draw on the strengths and advantages of both while reducing the limitations of each.

View 2. Levels of Analysis

In a similar manner, being able to zoom in on various levels of analysis helps us focus on an issue at its proper scope. Does it close in tightly to examine effects at subcellular scale? Does the research take a high-level view, not of individuals but of averages across an entire population? Is the focus somewhere in between, or does it require examination of multiple levels at the same time? How can you get to the level you need and use it?

Below are brief examples of how research can be viewed at many different levels. For additional detail, I encourage you to read the studies cited.


Massage research at the subcellular level explores the effect of massage on the smallest components of cells. For example, F. Liu and L. Huang demonstrated that injected DNA could be delivered to the liver in mice for gene therapy to treat metabolic disease by massaging the liver after injection, a technique that is simple, repeatable, side-effect-free, and able to enhance the mice’s survival.4 Further, in a separate research article, Liu’s team showed that the pressure had an effect on the gene expression via the venous blood pressure; they propose that their “data suggest the mechanical massage produces transient membrane defects through which naked DNA can enter into the liver cells by simple diffusion.”5

While it will be a long time, if ever, before this technique is directly applicable in the clinic, it is important fundamental and translational knowledge. It provides insight into the most basic mechanisms of how massage operates on the body. Using those basic mechanisms as building blocks, we can begin to better understand how massage works at all of the levels of analysis we are examining, and to translate that understanding from one level to another.


Research at the cellular level explores effects of massage on the number and activity of entire cells and cell populations. M. Hernandez-Reif’s team examined the effects of 30-minute massages (with effleurage, petrissage, and stretching) three times per week for five weeks on (among other factors) the number of natural killer cells and lymphocytes in the blood of women living with breast cancer. They found that women in the massage treatment group showed increased numbers of those immune cells.6


At the tissue level, research examines the effect of massage on the tissues that make up organs and other anatomical structures. This affords an opportunity for truly translational work. D. Grimm, author of the article “Cell Biology Meets Rolfing,” reported on the first International Fascia Congress, which brought bench scientists and bodywork therapists together to explore interdisciplinary applications of the laboratory results and hypothesis generation based on clinical observations.7


Research at the organ level explores the effects of massage on discrete organs themselves. For example, in the study “Effects of Massage on the Mechanical Behaviour of Muscles in Adolescents with Spastic Diplegia,” R. MacGregor’s team evaluated the effects of two 14-minute stretching massages per week for five weeks in their subjects. They found that—while range of motion was not consistently increased—not only did the muscle require greater force to stretch than before the massage, but also the length of the muscle changed (as measured by the resting ankle angle). Subjects also improved functionality in motor skills, as measured by Gross Motor Function Classification System scores.8


Massage research at the systems level examines how massage affects larger systemic interactions between multiple organs and other anatomical structures. A. Moraska et al. reviewed the research literature to find and compare what various studies showed about outcomes in stress measurement after massage. They found there is some evidence for the effect of massage on diastolic blood pressure, but more studies, and more rigorous studies, need to be carried out in order to assess the effects of massage on stress hormones and specific organs as parts of a greater effect on physiological indicators of stress.9


Individual-level studies examine the effect of massage on clients themselves, including quantitative measurements and qualitative descriptions of experiences. B.S. Cronfalk’s team explored the experiences of terminally ill people dying at home with cancer, who received nine 20-minute hand or foot massages over two weeks as a palliative-care measure. As described in their 2009 research article, those who received massage reported that they appreciated the support and that it gave them a sense of temporary relief from their situation.10


At the population level of analysis, massage research explores the average effect that massage has on a group of people, rather than concentrating on an individual’s unique experience. Cronfalk led a different team to look at a related aspect of the palliative care study—the experiences and opinions of a population of palliative care nursing staff to a brief soft-tissue massage training session. Most of the nurses found the training to be a useful addition to their practice; some of them found it too basic or too intimate to be comfortable applying the training.11

The Development of a Massage Science

While knowing how to go back and forth among these levels of analysis is neither straightforward nor immediately obvious, it is necessary if you want to apply findings to an individual in your practice. For example, K.J. Sherman’s team has taken a step in the direction of translating research findings among levels and back and forth between the lab and the clinic by developing a taxonomy—a structured standardized vocabulary—for treatment goals, styles, and techniques of massage in the context of musculoskeletal pain.12

And of course, all of these views (and others) are guidelines, not an exact roadmap, for your journey in research literacy. There is something for everyone there; how you find it and what you do with it is up to you.

This will be my final column for Massage & Bodywork for a while; I’ll be focusing on other projects in the near future. I wish you all the best of luck with your journeys in massage research literacy and capacity.

  Ravensara S. Travillian is a massage practitioner and biomedical informatician in Seattle, Washington. She has practiced massage at the former Refugee Clinic at Harborview Medical Center and in private practice. In addition to teaching research methods in massage since 1996, she is the author of an upcoming book on research literacy in massage. Contact her at


1. G. Witherspoon and G. Peterson, “Dynamic Symmetry and Holistic Asymmetry in Navajo and Western Art and Cosmology,” American Indian Studies 5 (Peter Lang, 1995).

2. A. Billhult and K. Dahlberg, “A Meaningful Relief from Suffering Experiences of Massage in Cancer Care,” Cancer Nursing 24, no. 3 (2001): 180–4.

3. L.H. Craig et al., “Controlled Pilot Study of the Effects of Neuromuscular Therapy in Patients with Parkinson’s Disease,” Movement Disorders 21, no. 12 (2006): 2127–33.

4. F. Liu and L. Huang, “Noninvasive Gene Delivery to the Liver by Mechanical Massage,” Hepatology 35, no. 6 (2002): 1314–9.

5. F. Liu et al., “Mechanism of Liver Gene Transfer by Mechanical Massage,” Molecular Therapy 9, no. 3 (2004): 452–7.

6. M. Hernandez-Reif et al., “Breast Cancer Patients Have Improved Immune and Neuroendocrine Functions Following Massage Therapy,” Journal of Psychosomatic Research 57, no. 1 (2004): 45–52.

7. D. Grimm,“Biomedical Research: Cell Biology Meets Rolfing,” Science 318, no. 5854 (2007): 1234–5.

8. R. MacGregor et al., “Effects of Massage on the Mechanical Behaviour of Muscles in Adolescents with Spastic Diplegia: a Pilot Study,” Developmental Medicine and Child Neurology 49, no. 3 (2007): 187–91.

9. A. Moraska et al., “Physiological Adjustments to Stress Measures Following Massage Therapy: A Review of the Literature,” Evidence-Based Complementary and Alternative Medicine (May 7, 2008). Available at http://ecam.oxfordjournals.org/cgi/content/full/nen029 (accessed September 2009).

10. B.S. Cronfalk et al., “The Existential Experiences of Receiving Soft Tissue Massage in Palliative Home Care—An Intervention,” Supportive Care in Cancer (January 28, 2009): 1203–1211.

11. B.S. Cronfalk et al., “A One-Day Education in Soft Tissue Massage: Experiences and Opinions as Evaluated by Nursing Staff in Palliative Care,” Palliative & Supportive Care 6, no. 2 (2008): 141–8.

12. K.J. Sherman et al., “Development of a Taxonomy to Describe Massage Treatments for Musculoskeletal Pain,” BMC Complementary and Alternative Medicine 6 (June 26, 2006): 24.