What's Next is What's Now

By Ruth Werner
[Pathology Perspectives]

This column is usually devoted to a specific pathological condition or concept that is connected to the overall theme of the current issue of Massage & Bodywork. In this edition, however, we will take a moment to look at what’s next for massage in the context of pathology:
a different direction altogether.

I am a pathology wonk. I actually enjoy reading about diseases. I love the sense of how much medical writing I can understand, even when the jargon is highly technical and intimidating. (Here’s a secret: it’s not as hard as it looks.) More to the point, it is inspiring to learn about the amazing regenerative capacity of the human body and exciting to follow how our efforts can recruit and influence those innate healing energies.

References to massage therapy in most technical journals and medical website periodicals are typically few and far between. But a headline in a recent edition of Medscape, a medical journal that collects and distributes material for several different specialties, read this way: “Effectiveness of Massage Therapy for Chronic, Non-malignant Pain: A Review,” Jennie C.I. Tsao, Evid Based Complement Alternat Med. 4, no. 2 (2007): 165–179.1

This was on the same page with titles that included, “A Review of Biologic Treatments for Psoriasis with Emphasis on Infliximab” and “Common Causes of Nausea and Vomiting and Treatment Reviewed” (both fascinating articles—if you’re interested in that sort of thing).

The article about massage and nonmalignant pain was a meta-analysis: the author compiled findings from multiple projects about massage to look for predictable trends. Her findings were mixed. Results showed that bodywork is a good option for pain relief in some situations and only so-so for others. The article further found that most of the studies were done with small sample sizes and warranted further investigation.

In the best of all possible worlds, readers are now clamoring with more questions: what kinds of massage were investigated? Did massage therapists do the work or was it done by untrained clinicians? Were the studies blinded? How were participants selected? Was there a sham treatment for a comparison? Did the researchers who did the massage also collect the data? All these variables influence outcomes, and no individual study can be evaluated for accuracy and importance without answering these questions.

This kind of meta-analysis is not unique. It reflects an enormous body of knowledge that is being generated right this minute about the effectiveness of massage therapy. What makes this article special is where it appeared: not in a trade magazine marketed primarily to people in this profession, nor in an obscure academic journal; it was a headline in an open forum targeted toward many types of healthcare providers. Research about massage creates a bridge to the rest of the healthcare community: it provides a language that we can all speak and understand together.

And so we see that the discussion of massage in technical or research-based terms isn’t what’s next; it’s what’s now. Our profession is being studied and written about so that medical doctors of all disciplines, naturopaths, chiropractors, physical therapists, nurses, and others may be educated about what the evidence says regarding our work. 

So what is next for massage in this context? I identify three major areas that need leadership and development: massage therapist-generated knowledge, accessibility of information, and the establishment of some best practices protocols.

Problem: Massage
Therapist-Generated Knowledge

One concern is that the research being conducted is not always done by massage therapists, and the definition of massage is sometimes loosely used. Obviously, this can alter the results of any attempt to gather information. It is imperative that massage therapists participate in the research process. Even therapists who don’t work in clinical settings still work with clients who are dealing with acute and chronic conditions. Most of us have seen our work influence headaches, or muscle strains, or recovery time for injuries. Our clients live with diabetes, depression, anxiety disorders, fibromyalgia, Parkinson’s disease, and a host of other challenges, and they choose massage as part of their coping strategies. We should be the ones leading the way in testing and questioning the practice of massage. It is time for us to get serious about documenting our work in order to trigger large-scale research projects.

Problem: Accessibility of Information

Any reader who wants a taste of the
vast amount of research being
compiled about massage can visit PubMed at www.pubmed.gov or the Massage Therapy Research Database at
www.massagetherapyfoundation.org/researchdb.html. Enter massage and whatever variable interests you, and you may generate a list of dozens, or maybe hundreds of highly-credible, peer-reviewed published articles that include your keywords. Many of the articles have available abstracts (brief overviews of the scope and conclusions of the project), but most full texts are only available through the publishing journals or medical school libraries. Most scholarly articles of this nature are unavailable to the general public. This can be a frustrating and ultimately defeating roadblock to anyone outside the academic world who wants to gather important information.

Problem: Best Practices

Finally, while an avalanche of information is currently tumbling all around us, some key questions still await our attention. Most people now agree that massage therapy is an unusually positive intervention: when done with care and education the risks are relatively low, while the potential benefits are significant. This is important information, and as larger research projects are launched, we can all feel confident that carefully conducted studies will reinforce what we’ve known for generations: that loving, educated, nurturing touch supports health and improves the quality of life.

The benefit of knowing the why and how of massage is that it gives us tools to make choices and adjustments to reap the best possible benefits that bodywork can offer. This process is called developing a “best practices” protocol: based on the accumulated body of knowledge we can make some predictions about what kinds of massage might be most effective under what circumstances. Then we can choose what modalities, frequency, and duration may have the most positive outcomes.

Good News: Massage
Therapist-Generated Knowledge

By the time this issue of Massage & Bodywork publishes, the first annual Practitioner Case Report Contest
will have concluded. This event is conducted under the auspices of the Massage Therapy Foundation (MTF) and follows three successful years of Student Case Report Contests. The winner’s case report will first appear
in print in the Journal of Bodywork
and Movement Therapies, and then
will appear on the MTF website,

It is not too early for any interested readers to prepare for the 2008 Practitioner Case Report Contest. This is one avenue where our work to carefully document changes that massage brings about can come to fruition. In addition to doing the right thing for the profession, winners are also awarded cash prizes and other incentives. For details and a complete set of entry guidelines, visit www.massagetherapyfoundation.org/practitionercontest.html.

Good news: Accessibility of Information

Picture this: an electronic journal that focuses on current research in massage therapy that is instantly available and free of charge. This project is in the works. Also led by the MTF, the e?journal will be called the International Journal of Therapeutic Massage and Bodywork, and its launch is planned for fall 2008. It will have departments for research, education, and the practice of massage, and it will be available to anyone who is interested. The plan is that the journal will start slowly but eventually publish quarterly updates with an accessible archive.

Good News: Best Practices

The long-term goal for any healthcare modality is to establish a set of best practice protocols. This allows practitioners and professionals to continually hone their skills with an eye for creating the best possible outcomes for the people in their care. The MTF is now in the very beginning stages of creating a best practices discussion, which, if all goes according to plan,  the project will begin in 2009. This is a long-term project that will probably never be complete, because it provides a place for the accumulation of knowledge to turn into practical applications.

The common thread in all three of these projects is the Massage Therapy Foundation, a 501(c) (3) public charity. This is an organization with which I am proud to be associated, because it works specifically to identify needs in our profession, and to find ways to meet those needs. Its stated mission is to advance “the knowledge and practice of massage therapy by supporting scientific research, education, and community service.”2 

Through the Practitioner Case Report Contest, the International Journal of Therapeutic Massage and Bodywork, and the discussion of best practices, the MTF is helping to identify what’s next for massage therapists seeking the best they can do for themselves and their clients. I encourage every practicing therapist to support the foundation. This can be done financially, of course (www.massagetherapyfoundation.org/found_makedonation.html), but also through participation: enter the Practitioner Case Report Contest or support a colleague to do so. Watch for the launch of the International Journal of Therapeutic Massage and Bodywork and consider submitting material for publication. When the best practices discussion gets underway, watch how it develops, and answer calls for input. We’re all in this together. With a united effort, our future’s so bright we gotta wear shades. 

  Ruth Werner is a writer and educator who teaches several courses at the Myotherapy College of Utah and is approved by the NCTMB as a provider of continuing education. She wrote A Massage Therapist’s Guide to Pathology (Lippincott Williams & Wilkins, 2005), now in its third edition, which is used in massage schools worldwide. Werner is available at www.ruthwerner.com or wernerworkshops@ruthwerner.com. 


                             J. Tsao, “Effectiveness of Massage Therapy for Chronic, Non-malignant Pain: A Review,”
Evid Based Complement Alternat Med. 4, no 2 (2007): 165–79. 2007 Oxford University Press. Available at www.medscape.com/viewarticle/559775 (accessed July 2007).

Mission and History. Massage Therapy Foundation. www.massagetherapyfoundation.org/mission.html (accessed July 2007).