Massage & Bodywork Assistant Editor Jed Heneberry talked to Ruth Werner, Thomas Findley, and Pamela Miles about their perspectives on research in their specialties of massage therapy, structural integration, and reiki. The following are excerpts from their discussions.
Massage & Bodywork: How do you feel about the state of current massage research and where do you see it progressing?
Ruth Werner (RW): My role is building support for increasing awareness of research on massage therapy. For me, that means my targets—the people I want to connect with—are not so much researchers, but massage therapists who have yet to discover how meaningful this work can be for them. For that reason I don’t have strong negative or positive feelings about the state of current research and where it’s progressing. My job is simply to create avenues of information flow.
M&B: What are some unique challenges that a personalized experience like a massage therapy session poses to researchers?
RW: In many ways, massage has more in common with psychotherapy than it has with traditional forms of physical medicine. The good news is that research that pays attention to qualitative experience, rather than quantitative measures, has become well accepted in the academic community, and when we ask questions about the nature of the therapeutic relationship between a client and a therapist, this research model is a good fit. The bad news is that qualitative research is much more complex and difficult to execute well then quantitative research.
Massage & Bodywork: How do you feel about the state of current research and where do you see it progressing?
Thomas Findley (TF): Research in structural integration is really just beginning to start. Structural integration claims to work on fascia, and there is a lot more information on fascia available. Without that, you can’t do much research into structural integration. So I see research progressing now that we have some ways to measure not just client outcomes—how they feel—but also some aspects of fascia and fascial structure. I see it progressing such that we can document structural changes in very detailed ways.
M&B: Is it unique in that there are still physiological studies that need to be done in order to advance the study of actual practice?
TF: That’s not unique. Every field of medicine and practice is that way. We need the underlying physiology. Then we need ways to measure underlying physiology so we can get back into the clinic and see what we do when we treat clients. Structural integration is no different than any other practice in that way.
M&B: In an interview with Massage & Bodywork [“Discovered Human Potential,” October/November 2003, page 84], Thomas Myers called Rolfing “halfway an art and halfway a science.” As a practitioner of Rolfing Structural Integration yourself, do you agree with that characterization?
TF: That applies to not just structural integration. Treatment is halfway an art and halfway a science, and that’s true across medicine, not just bodywork. I have one foot in the science and one foot in the art all the time I work with people, and I have one foot in the science and one foot in the art when I’m doing research. People forget that research is art and science also. There are too many things to research, there are too many things to observe, and the art is to figure out which ones I’m going to pick for a given project.
M&B: Is there an inherent distinction between conventional medical research and research into complementary and alternative (CAM) therapies, or should they be essentially the same?
TF: I don’t see much of a difference. Part of the difference is, and this is true in medicine also, for some therapies it’s a black box: it seems to work, we just don’t know why. And that’s true when you have a drug and you have an effect you didn’t expect. You say, “Oh! Let’s study that effect and figure out why it’s doing that.” It’s not that much different in bodywork and other CAM therapies. We try to come up with some hypotheses for what is going on in the middle, but the reality is that you have an input and a change in the client, and you’re trying to measure it. That’s the same with medical practice, also.
Massage & Bodywork: How do you feel about the state of current research and where do you see it progressing?
Pamela Miles (PM): Research into reiki is just beginning, and most of what has been done is not very good science. We need to look carefully at those studies and see how we can improve. We need to include seasoned reiki practitioners who have a basic understanding of research on the research team from the start.
The point of research is to investigate safety and efficacy. Since reiki recipients don’t ingest anything and reiki touch is nonmanipulative or off the body when needed, there is consensus in medicine that reiki practice is safe. That leaves us with the need to demonstrate efficacy.
Researchers focus on conditions and symptoms, but reiki practice doesn’t address conditions or symptoms directly; rather, it balances the system overall. We need more research showing that reiki treatment optimizes the body’s self-healing, such as documenting a shift from sympathetic nervous system dominance to parasympathetic nervous system dominance.
Qualitatively, the two benefits observed most often across various populations are reduced pain and anxiety. It would be useful to have more documentation, but this is an area where actual implementation is way ahead of the research.
As with other practices, the best research will come when seasoned reiki practitioners are part of every step of the research process: design, data collection, and interpretation.
M&B: Can you give an example of research that would support the effectiveness of reiki practice to optimize self-healing?
PM: I participated in a study at Yale medical school that was published in the Journal of the American College of Cardiology1 in which a 20-minute reiki treatment given to patients in the intensive care unit who had suffered a heart attack in the past 72 hours improved heart rate variability (HRV) as effectively as beta-blockers. (We also found benefit on all six qualitative measures included in the study.)
This is important because flat HRV is the leading predictor of death from another heart attack. However, beyond the cardiac population, flat HRV indicates a system in distress. HRV improves as the system heals and regains healthy resilience, so improving HRV is valuable in many situations.
How long do the benefits of reiki treatment last? Would we be able to see them with only five minutes of treatment? Would a one-hour session provide more benefits, or would it be better to have four, 10-minute sessions? These are questions we need to research.
M&B: How can reiki practitioners best balance the need for research, the unquantifiable aspects of their work, and the desire for it to be accepted by more conventional medical providers?
PM: It’s helpful for reiki practitioners to speak about the practice objectively, sharing commonly reported benefits such as reduced pain and anxiety, enhanced well-being and focus, and improved sleep and digestion, without making claims or requiring people to subscribe to a belief system. Even a few minutes of reiki practice can help people that conventional medicine has difficulty helping. A calmer patient is easier for staff to treat.
We don’t have to understand why reiki practice is effective, we just need to keep documenting the benefits. Nonresearchers often don’t realize that research doesn’t prove anything. Rather, research documents a change and assesses the likelihood that the change was due to chance.
M&B: What do you see as the greatest challenge facing research in your field?
RW: From my own relatively small point of view, the greatest challenge facing research on massage therapy is that not enough massage therapists know how to do it. And those people who want to learn and participate have extremely limited opportunities to do that.
The only long-term solution to this problem is the creation of educational opportunities for people who want to study massage in an academic setting. We won’t have a substantial body of massage therapy researchers in this country until we have something like a master’s degree or doctorate specifically in massage therapy. I would love to be proven wrong about this, but I don’t see it.
TF: The unique challenge of structural integration is that it tends to be a whole-body treatment, so you can’t bring out a microscope and analyze a 1-square-inch section of the body as you can with some techniques. You need whole-body techniques, and that’s a challenge.
The whole point of structural integration is that you can effect change at a distance in the body. It’s designed that way; it’s not just a by-product. And those long-distance connections don’t appear in any of the anatomy books.
PM: One challenge is that since medical research has until recently been primarily pharmaceutical research, the gold standard has been the randomized controlled trial, which is not well suited for reiki treatment. Drugs are unidirectional in action. How can we apply a unidirectional model to study practices like reiki that are multidirectional and expect to get meaningful data?
Another challenge is that academic medicine doesn’t know how to evaluate expertise that lies outside of its paradigm. For example, if researchers want to study Native-American healing practices, how would they find and identify a competent practitioner? If they want to study reiki, how would they identify an appropriate collaborator?
This is further complicated because reiki credentials are meaningless—some first-degree practitioners have more training than some reiki masters. This is difficult for academics to appreciate because they are so credential-based, but it is not an insurmountable hurdle. There are specific questions researchers can ask, such as how long the practitioner’s training took and how much experience he has, and especially if he practices daily reiki self-treatment. This is the most important question, the deal breaker. Practitioners who do not practice daily hands-on self-treatment will never have a deep understanding of reiki practice.
M&B: How important will conferences, like the upcoming Fascia Research Congress in Vancouver, be to advancing the state of research?
RW: I think it’s difficult to overstate how important conferences like the Fascia Research Congress in March 2012 or the International Research Congress, which will be in Portland in May 2012, are to research in the CAM professions in general. These are events where all kinds of CAM practitioners are sharing their experiences with each other, and it is critically important that massage therapists are recognized among that group.
I think one of the obstacles we have in the massage therapy profession to creating an environment where research literacy is simply part of the job description is that people feel research is abstract and distant from their day-to-day decision making. But when massage therapists attend conferences like the International Research Congress they have opportunities to speak directly to the people who are really trying hard to gather information about how these things work. Conferences like these are important ways to disseminate information, but they also serve to be the fertile ground where new seeds of ideas can sprout.
TF: I am an advocate of a gathering that combines researchers and clinicians, because the perspective of both is necessary to advance research in this field. Researchers can look around for a project forever and not come up with a critical issue, but if they listen to the clinicians and what the clinicians are observing, what they hear will guide them to more fruitful areas of investigation. I think a research congress is important, but you’ve got to have the clinicians there. One of the greatest challenges to research is forming teams of clinicians and scientists, and every year more and more of these teams come out of the Fascia Congress.
M&B: Why has research been such a passion for you?
RW: My relationship with research in the field of massage therapy changes daily. I am not a professional academic, so not too long ago I was exactly the kind of person to whom I try to reach out to today: someone who was curious, but who was unclear about the whys and the hows of research impacting my career.
I have two personal points of interest about massage therapy research. One has to do with the mechanisms of bodywork. I am fascinated to find out why things happen the way they happen because to me, that means we can use massage on purpose, instead of by happy accident.
My other interest has to do with the interaction of bodywork with mood and emotion. We have begun to put together a decent evidence base about massage in the context of anxiety and depression in lots of different populations, and it turns out to be a very effective way to help people deal with these kinds of difficulties. Well, that’s great, but it completely changes our scope of practice. But if that turns out to be a place our work is useful, and the risks are low and the benefits are big, then that’s where we should be working.
TF: I’ve been doing research for 60 years. According to my mother, I started when I was age 3. I stood with a honey jar in the window with the sun shining on it, and I stood still for 45 minutes. Finally she said, “Tommy, what are you doing?” and I responded, “I doing exerments.” Changing the viscosity of fluids is something I’m still doing today.
My latest work is really looking at the hyaluronic acid layer between the deep fascia and the muscles, and how we can facilitate that to allow movement in the body, how we can measure it, how we can affect it. It’s pretty exciting.
PM: I’ve always been a critical thinker looking to get to the facts and to discern truth. I began studying meditation and yoga as a kid, and the more I practiced, the more I realized that real spiritual practice and the scientific method have a lot in common. The main distinctions are the inner versus the outer focus, and where they draw the line for accepting evidence. The idea of parking the mind in neutral, observing, documenting, and then contemplating your observations, not jumping to conclusions, is important to both spiritual self-development and research.
M&B: What would you say to encourage others to better utilize research in their practices?
RW: It is unnecessary to reinvent the wheel. If you have a client with super-dense fascia, if you have a client with morning stiffness that he or she would like to resolve, if you have a client who is recovering from cancer treatment—people have gone before you to try out what appears to work and not to work. Why start over with each client? In other words, research, along with practitioner judgment and client desires, forms the basis of evidence-informed practice.
Another important application of research is in practice building. One of the most important things a massage therapist has to do is determine who his or her target market is. Once a person has figured that out, the chances are decent that some research has been developed that addresses issues that target market faces. For instance, if you want to work with elders, it’s not that difficult to do a search on PubMed Central or Google Scholar to see what information has been accumulated about massage in the context of that population group.
And finally, I would love to see massage therapists use the research that is available to them now to become inspired about what comes next. That might take the shape of individuals doing case reports, which is simply a careful documentation of the interaction between one therapist and one client in a format and a language that every scientist uses, or it might take the shape of massage therapists demanding the possibility of an advanced academic degree in their chosen field. I would certainly hope it would take the shape of massage therapists feeling the need to further grow research in their field, which essentially means supporting the work of the MTF.
TF: Every clinician does research every day. Your client comes in, you make your observations, you make your hypotheses, you design your treatments, you apply the intervention, and you evaluate. That’s research. It’s also clinical practice.
These concepts are not easy. Recently, I went through probably 2,000 research papers on fascia, and it took me two hours to really understand one diagram from one of the papers in a way that made sense to my clinical half. But now I can explain it clearly in just a few minutes. Clinicians might think some of it is too advanced, but you can do it and understand it just as well as anyone else; it just takes time. That’s one of our goals at the next Fascia Research Congress: to present and explain things in a way that clinicians can understand so that they can better observe the things that are happening in their practices.
PM: Research can help reiki practitioners feel better about what we do. Our work with clients is so subtle and the experience is very subjective, both of the reiki treatment itself and of the self-healing process that continues after the reiki hands have left the client’s body. It’s challenging to talk about reiki practice in a straightforward manner, especially because reiki practitioners are often not critical thinkers. This communication gap leaves many reiki practitioners feeling marginalized, and research helps bridge that gap.
Reiki practitioners have every reason to walk into a medical environment with pride—but not arrogance. It’s been my experience from the beginning of my foray into conventional health care 20 years ago that medicine wants the nondogmatic access to spirituality that reiki practice brings. This is perhaps the most common misconception among reiki practitioners, and it shows up in research—this sense of having to whitewash the spiritual roots of the practice. We don’t need to whitewash it—it’s probably the most important, most valuable, aspect of the practice. We’re literally handing people a meditative experience, through which they open to their own deeper resources and sense of well-being, and, through a mechanism that science does not yet understand, optimize their bodies’ self-healing mechanisms.
RW: As our attitudes about health care and health-care delivery systems evolve, people are more interested in prevention, wellness, and cost-effectiveness than ever before, and massage has a role to play here. I believe that our continued focus on good, quality research will enable us to coordinate with (not work against or in spite of) other health-care professionals, so that the most important outcome—the well-being of our clients—will improve.
Note
1. S.C. Friedman et al., “Effects of Reiki on Autonomic Activity Early After Acute Coronary Syndrome,” Journal of the American College of Cardiology 56 (2010): 995–96.
Jed Heneberry is assistant editor at ABMP. He can be reached at jed@abmp.com.