“When we place our hands on a patient and act/move in certain ways our patients improve.”

Social media receives a good deal of criticism from folks who feel it is the ultimate waste of time…though those same folks are usually posting these opinions on social media. Research “findings” are frequently posted on mass media sites, but end up being fluffy opinion pieces rather than accurate and objective articles. Even published papers can be misleading or poorly conducted, creating an impression of conclusive proof when none exists.

As an active member of a number of manual therapy groups on Facebook and LinkedIn, I read many posts that speak to the “proof” of specific manual therapy modalities and their effectiveness based on published findings, but occasionally am I able to watch as a paper is deconstructed.

The Skeptical Massage Therapist Facebook is a rather small group devoted to those who identify themselves as scientific skeptics, of which I include myself. (While their name would imply that I, as a physical therapist, would be excluded, they are liberal in allowing a wide range of manual therapists into their group) There was a recent post on the Group made by Nick Ng, a journalist for the TellUs News Digest, formerly of Guardian Liberty Voice and massage therapist, in response to an article he had written for the TellUs News Digest on CranioSacral Therapy. He posted to the Facebook Group, asking for feedback on a specific article titled “A randomized controlled trial investigating the effects of craniosacral therapy on pain and heart rate variability in fibromyalgia patients”(link)

Bryan Quesnelle provided some excellent observations and he graciously allowed me to share those observations here. Bryan runs the Clinic Wise Clinic Management Database and online CEU courses). I am not research literate, in comparison to many of my peers and when I read a paper published in a science journal I often make assumptions that there are stringent rules to assure the writers pass certain standards before the paper is published. While I am not casting any negative light on the writers of this study or the subject matter, Bryan had some very good observations:

“The “sham” group wasn’t receiving sham cranio treatments, they were attached to a disconnected magneto therapy machine… Basically, this was comparing CST to laying down without intervention. This doesn’t help at all to validate the premise of CST, just shows that attentive human touch can impact perceived pain levels. The controls necessary to isolate CST mechanisms from other non-specific therapeutic benefits were basically nonexistent here.“

“That also presents an issue for blinding, since the “sham” vs. real interventions were obvious, leading to a lot of bias and placebo influence.“

“The p values are all over the place for each measured tender spot over time, most going from 0.6 to 0.03 between measurement periods. Some variation is normal, but they’re pretty extreme jumps. That’s a lot of discrepancy in reliability of results of the same painful areas over time.“

I realize that my own modality, myofascial release, has similar problems, as do many of the hands-on approaches used by physical therapists, massage therapists, and chiropractors.

On the  Research Page of the Foundations Seminar website,  there are dozens of published papers showing myofascial release to be a successful modality in the treatment of various disorders.

But all of those papers, while stating the oft-used and outdated explanatory model, do nothing to prove how MFR affects the body. They show the hands-on aspect to be helpful, but do not prove how it works. This is an important distinction that many therapists miss. When therapists place their hands on patients and interact in a manner that they were taught in their myofascial release (and craniosacral) training, the outcome is often positive. If we could just keep our language more general and avoid explaining the outcome based on outdated or false models,  there would be less discourse when it comes to the claims of various modalities.

This does not diminish the effectiveness of MFR/CST, it simply should make you question the claims you were taught. If we spoke in more simple terms such as these, it would place most of the claims of many of the manual therapy modalities in question…which is not a bad thing!

As I increase my science and research awareness, I have allowed my language to be more accurate as well. Some might feel the opposite to be true, as I no longer sound so sure of myself and I no longer repeat inaccurate/outdated explanatory models using fascia as the primary source of pain, dysfunction, and “cure”.

MFR is effective, but I now know that the nervous system plays a much larger role than originally thought. The extent and manner in which the nervous system impacts my work has not been fully sorted, so I use a more broad explanatory model to explain my work to my patients and my students/therapists. I include past models of hypothetical fascial change as a frame of reference as well as a few different models of how the nervous system oversees all happenings. As some point, however, I will add:

When we place our hands on a patient and act/move in certain ways our patients improve.

If manual therapists and their teachers could be humble enough to speak in these terms I believe all of us would benefit. But this sentence is too simplistic for many. It doesn’t make the speaker sound informed. But it is bluntly honest and this is my goal.

So, challenge yourself to improve your research literacy. Question what you were taught and currently believe. I am doing the same. Accepting another person’s word at face value is rare, so why accept their explanatory model without questioning?

I should probably start off by saying that I am not actually fully registered as a Massage Therapist just yet- I have just graduated.

In general, studying massage therapy has been a wonderful experience. Even in my short time getting to know the profession, there are some really harmful messages I’ve already heard loads of times, often by people I admire and who surely mean well. I’m sure these phrases are probably all too familiar to just about any experienced therapist.

The good news is, we can do a lot to improve these messages just by recognizing them and giving them some discussion.

Here’s a list of the worst offenders I’ve heard so far. How about you?

1)Dismissing Or Denouncing A Person For Not Endorsing A Certain Modality

Maybe these harsh words have been said to you directly, or to other therapists you know: closed- minded, uncreative, unsupportive, negative, too literal, concrete, black-and-white, just can’t get it.

Surely we don’t have to let anyone call us less of a therapist or person just for wanting to ask questions, think critically, or voice meaningful concerns about different modalities.

This kind of silencing tactic comes from a real place of fear sometimes, often with good intentions behind it. A lot of us can probably remember having used it ourselves at some point. People have a lot invested emotionally in some of their approaches. But that doesn’t make this right. We need to think about modalities appropriately and honestly, and not just with unquestioning acceptance labelled as openness.

On a similar note…

2)Criticizing The Very Idea Of Questioning A Practice

Maybe it was said that questioning a certain method somehow equated to “dumping on” it or “demeaning” it in a way that was perceived as unfair. Again, many of us have probably made the mistake of doing this ourselves.

We don’t have to let anyone try to convince us it’s wrong to not automatically accept an idea or practice, or that a lack of approval is as simplistic as an unwarranted “dumping” on something.

Maybe we or someone we know has said this upon feeling attacked or threatened, but that doesn’t make it okay for a practice to go unquestioned, no matter who likes it or who feels like it works. It’s okay for us to express earnest doubts and make changes to ideas as needed.

3) This Is Just Part Of The Industry, It’s Tradition

We don’t have to let anyone try to force us to accept/adopt an idea with these suggestions.

None of us signed up for anything, except to learn about massage and work safely and effectively with our patients. We don’t have to think, feel, believe, or adopt anything in particular as long as we are properly following basic standards.

Tradition doesn’t make something universally appropriate. Traditions needn’t be imposed on us just because they are common somewhere. This does not necessarily make them right for everyone.

We have the right to question or let go of ideas when we need to.

Photo by: Fxq19910504

4)It’s Prejudiced To Question Using A Practice Associated With A Particular Place Or Region

Yikes! This idea is probably used with good intentions, but it’s often very misleading.

First off, we know that many “alternative” practices branded as, for example, “traditional eastern” or “traditional indigenous,” etc. are actually much newer, invented or re-invented practices that have been popularized in just the last few decades (or 1-2 centuries at most).

This is often done by people who have little to do with the cited culture, and frequently it’s in association with a “new-age” movement. There’s no real cultural prejudice in questioning these practices because, in reality, they’re not truly tied to a particular cultural tradition.

Second, even if something is traditional, that doesn’t automatically make it right to use it in absolutely any setting, especially a therapeutic setting that may also have nothing to do with the original culture.

It may even be a way to offensively misuse someone’s traditional practice.

Thirdly, when we keep associating the word “traditional” with certain cultures and/or associating certain cultures with mysticism or exotic practices, we diminish and oversimplify these cultures and may even wind up inaccurately insinuating that they are somehow “less modern” than other cultures, even when this is simply not true.

Now, all of this is prejudiced, and it allows us to harmfully overgeneralize about large and diverse groups of people.

This idea surely comes from a place of wanting to embrace multiple cultures, which is great, but we don’t need to exoticize or misappropriate anything from anyone in the process.

5) We Must Be Too Different As Therapists To Understand Each Other, Or Work Together

Ouch.

Of course, just because people disagree on something does not mean that they are necessarily all that different from one another, let alone that they can’t still have a productive relationship.

Our field has a long history of mixing evidence systems with belief systems, and this problem can make every conversation feel very personal. That doesn’t mean we have to let our professional culture pit us against one another over every disagreement.

We can do better, and we can recognize that we’re all basically in this for the same reasons and we all care just as much about helping people and helping our profession.

It seems that virtually everyone, whether a new student or a seasoned professional, wants the same basic things for the massage therapy profession: improved regulation, increased mainstream recognition, and more knowledge about how we can best serve the needs of clients and patients.

These things are hard to a achieve when we come from a history of conflating evidence systems and belief system or conflating fact and opinion. Our history and resulting professional culture can make conversations about therapeutic techniques and practices feel personally threatening, even when we are just trying to examine and improve our body of knowledge.

If we wish to exist and advance as an evidence-based profession, then we need to be able to commit to the critical thinking and constructive conversation that this entails. Although it can be hard, we need to be able to ask questions, have doubts, think critically, and share concerns, especially without having to fear such harsh and personal responses as the ones above that we so often see. This is the only way we can really hope to move forward and reach these collective goals.