In the past ten years Massage Therapy has exploded into mainstream healthcare, it is now a recognized treatment option for a wide range of injuries. This means the profession is moving into new formal clinical settings, these changes to the profession have led to a need to adapt to an evidence informed model of care - 'Evidence Informed Massage'.
Evidence Informed Massage: Moving The Profession Forward
Evidence informed massage is the synthesis of
- Therapist Expertise
- Patient Values
- Best Available Evidence
With the emergence of evidence informed massage it is important that therapists have the tools and resources to bridge the knowledge gap between scientific research and clinical practice. A 2015 survey of Registered Massage Therapists in Ontario concluded that there is room for improvement when it comes to research awareness in the profession. There are many ways that massage therapists can work together to improve their research literacy skills, one of my favorite ways is through social media sites like Facebook and Twitter.
Social media sites provides massage therapists with a digital meeting ground to bridge the knowledge gap between scientific research and clinical practice by exchanging ideas with their peers at the local, regional and global levels. Users beware – in this age of ‘new media’ it is important to be able to critically evaluate information. If you are evaluating information The CAARP method is a simple acronym will simplify the way you evaluate information.
The CAARP Method
- Currency - Is the information current or out of date for your topic?
- Authority - Who is the author and what are their qualifications?
- Accuracy - Where does that information come from and is it supported by evidence?
- Relevance - Does the information related to your topic or answer your question?
- Purpose - What is the purpose of the information? Are the author’s intentions clear?
What Resources are Available?
With the ‘CAARP’ method in mind, if you are looking for an authoritative opinion on a given topic, systematic reviews are considered the gold standard. The Cochrane database is the most well-known source of systematic reviews. To date there have been only a few large scale randomized control trials of massage therapy, this means systematic reviews of massage therapy can be hard to come by. So another way to inform your clinical practice is through peer-reviewed publications geared towards massage therapy.
Peer-Reviewed Publications for Massage Therapists
If you would like to read articles on a more broad range of topics, you can use a research database. PubMed is the largest medical database, and has many functions that will help you narrow down your search. One limitation with PubMed is that unless you are affiliated with an educational institution, many of these article are behind a paywall which may limit access to the entire article. You will still be able to read the abstract, this will give a brief summary of the key points of the article.
Open Access Research
There are alternatives- In the last ten years there has been a growth in the open access publishing model that provides immediate, barrier-free access to the full text of research articles. The RMT Education Project is an online resource where massage therapists can access a curated list of open access articles. This serves as a starting point in the development of a body of knowledge that massage therapists can use to guide an evidence informed practice.
Another way to access timely information is through grey literature, this category includes information or research produced by organizations, outside of commercial or academic publishing and distribution channels. It can include: magazines, articles, videos, emails, newsletters, blogs and even tweets. There is an abundance of grey literature available on the internet, this information requires a critical eye to evaluate the content - Think CAARP.
Why Research Matters
Evidence informed massage continues to be more common in new environments e.g. hospitals, sport medicine clinics and long term care facilities. These settings require massage therapists to work directly with physicians and allied health professions, this requires a sound understanding of the latest research findings. Evidence informed massage is important because over the last five years there have been major changes to the scientific knowledge about pain science, myofascial trigger points and myofascial release. This new knowledge may not revolutionize the way you practice, but it will change the way you communicate with other healthcare professionals. Massage therapists that are able to understand and incorporate research into their clinical practice will be well positioned to transition into these multi-disciplinary clinical settings. Here is a look at the latest research evidence and how it is changing clinical practice.
Scientific research has changed the way we view injuries, we now know the brain is a neuroplastic structure that is capable of changing over time. Long after the tissue has healed patients may feel pain due to changes that take place in the nervous system. This has important implications for assessment and treatments-essentially the experience of pain does not always correlate to severity of the injury.
"The experience of pain does not always correlate to severity of the injury"
Before reviewing the literature on myofascial release, I used a heavy handed approach to invoke a mechanical ‘tissue release’. Then I came across a research paper by Robert Schleip Fascial Plasticity - a New Neurobiological Explanation. In short, this paper suggests massage therapy stimulates fascial mechanoreceptors, which may, in turn, trigger tonus changes in connected skeletal muscle fibers. These muscle tonus changes might then be felt by the therapist. This paper was an easy to understand review of his research, complete with cartoon illustrations. This research paper helped me move from a mechanical mindset to one that is inclusive of the nervous system. For me Robert Schleip was a starting point, his papers cited other useful articles that were relevant to myofascial release, this ‘citation chaining’ lead me to Carla Stecco, Antonio Stecco and Leon Chaitow.
"This research paper helped me move from a mechanical mindset to one that is inclusive of the nervous system."
Myofascial Trigger Points
There has been a monumental shift in knowledge about the pathological entity that we call myofascial trigger points. In the March 2015 edition of Rheumatology A critical evaluation of the trigger point phenomenon was published, this article served to deconstruct the known etiology of myofascial trigger points. The authors suggest that researchers move their search for myofascial trigger points from muscles to nerves, or others structures. This was followed up in summer of 2015 by another paper on the topic of myofascial trigger points Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective, this was a narrative review that provide perspective on the topic of myofascial trigger points; however, It may surprise you to know, with over thirty plus years of research there is still no consensus to what these sore spots are, theories include: nerve inflammation, fascial densification and central sensitization.
"It may surprise you to know, with over thirty plus years of research there is still no consensus to what these sore spots are!"
Moving the Profession Forward
Evidence informed massage provides the profession with an opportunity for unprecedented growth, one of the best ways to facilitate this growth is by connecting with like-minded peers through social media. These sites provide a forum where massage therapists can work together to critically evaluate the contents of a research paper, teasing out the clinically relevant points - this is one of the best tools available to bridge the knowledge gap between scientific research and clinical practice. Whether you are new to the professional or have over 20 years of experience, there is someone out there that will benefit from your knowledge.
Join the online conversation and help move the profession forward!
Links For The Curious
The RMT Education Project attempts to simplify the complex- breaking down information dense research into manageable chunks. If you are looking for a somewhere to start, check out the ‘Curated Content’ page or browse through ‘The Research Countdown Series’.