MYTHOLOGY AND MASSAGE SCIENCE
This horrible infographic that I saw circulating on Facebook basically says that massage treatment can help anyone with anything:
Massage has been shown to help with anxiety and sadness, which is significant (much more on this below). These bullet points, on the other hand, range from “exaggerated” to “delusional.” This equally horrible blog article, which uncritically embraces and exaggerates the conclusions of a few dubious sources, boosterism clumsily masquerading as science blogging, and misleading everyone who wants to be deceived — which isn’t all massage therapists, but certainly a lot of them — inspired the image.
Massage treatment, unfortunately, has almost no established medical advantages and is plagued by an astonishing amount of fallacies and a history of sloppy research. Massage therapists aren’t alone in this: the area of musculoskeletal care as a whole is in need of scientific advancement and lags well behind the rest of evidence-based medicine (EBM). Physical therapy, for example, although having a far higher average level of scientific literacy, is plagued with misconceptions, junk science, and pseudo-quackery.
Medicine has had greater, scarier problems to deal with than simple aches and pains and injuries.
It continues to do so. Even with its tremendous resources, sports medicine is still remarkably basic. Massage research, on the other hand, is a gloomy backwater. I’ll debunk the myths and go over the science, if there is any. While there will be plenty of debunking to come, I’ll start with the good stuff: some of the actual reasons why massage research is so tough and limited — excuses, excuses! — and the finest scientific argument for massage treatment to date.
Excuses! The difficulty of studying massage
Massage can be researched: we don’t need to understand how something works to see if it works. When persons who are sick or broken are massaged, do they get better? Logistics, economics, and finicky minutiae, however, stand in the way. Massage therapists do not have scientific expertise, and few scientists are interested in studying it. Making time in a massage therapist’s job for research is an expensive and onerous endeavour – few do it, and even fewer have done it properly. Even when they do, it’s amazing how difficult it is to identify 100 people with the same problem, so studies of that magnitude are practically never done; instead, studies of 20 or 30 patients are more common, and aren’t usually enough to prove much. Another issue is that the term “massage” can refer to a variety of things, making it difficult to determine what is being investigated (lack of standardisation of treatment).
Massage research is afflicted by a “stark statistical mistake,” which is the error of declaring statistical significance of the incorrect object, or the wrong comparison. Dr. Christopher A. Moyer, a psychologist, is a rare example of a true scientist — someone who has been trained in and is an expert in research technique — who has decided to specialise on massage therapy:
I’ve been talking about this mistake for years, and I even wrote a paper about it. I discussed how the problem was widespread in massage therapy research after critiquing a single example of it. According to the Nieuwenhuis paper, it appears to be widespread elsewhere as well, which is sad. Understanding the distinction between a within-group and across-groups outcome is fundamental.
Massage research is particularly prone to this fallacy for the simple, hilarious reason that massage is so much “better than nothing” – patients are often satisfied with massage regardless of whether it has a medical benefit or contains a “active component.” This makes the outcomes of massage studies appear much more medically remarkable than they would be if all that satisfaction and other “nonspecific” effects were removed.
Because there is so much uncertainty, it is legitimate to wonder if we can truly say much about massage based on such limited and imprecise information. We certainly can, but we must do so with our eyes wide open and a slew of qualifications and bet hedging. We can’t be confident of anything, but the facts so far can certainly instruct us.
Massage therapy research is still in its early stages, owing to a lack of research infrastructure and a research tradition. As a result, most licenced massage therapists aren’t used to reading, evaluating, conducting, publishing case studies, or incorporating research into their own practise.
“Vision of Specialization for Registered Massage Therapists,” by Harriet Hall, RMT, PDP21
(Dr. Moyer thinks it’s worse than “infancy” – he calls massage therapy studies “stunted”!)
To date, the best scientific argument for massage treatment has been presented.
The most researched massage question is for low back pain, but it isn’t enough: the response is still “further research is needed.” Massage for trigger points is also thoroughly researched, but it isn’t enough: science has yet to prove that pressing on sensitive regions makes them less sore. Both of these topics are covered in depth in their respective sections further below.