What Makes a Therapy Real? Part I: What Do We Know?
I belong to some discussion groups populated by massage therapists from all around the country (and even some international voices). Lately, a theme has cropped up among our various discussion threads. People seem to be asking what makes a given therapy or modality “real” or “valid.”
Almost everyone seems to accept that so called standard massage therapy is “real.” The results we see are readily connected to things we’ve studied in physiology and anatomy. And there is all sorts of scientific evidence (in the form studies published in “respected” journals) that supports the argument that manual manipulation of the tissues can relieve pain and reduce stress. But things get confusing beyond that point, and even that simple assumption has been called into question by at least one study.
This brings to light two issues: 1) What makes a study one that we can rely on? and 2) What about the many things we still don’t KNOW how work? Do we need scientific proof before we can accept something as valid?
The first question is trickier than you might think. Folks will tell you that for a scientific study ascertaining, proving, or disproving the effectiveness of any therapy to be valid, it must have controls, including “participants” who do not receive any treatment, and those who receive a similar treatment (whose efficacy I suppose ought to be known), along with those who receive the studied treatment. In addition, to be statistically significant, a study must be fairly large. It must not only be reproducible, it’s likely that it needs to have been reproduced before it’ll have any gravitas. Additionally, it’s unlikely that a study will be considered to be valid if the recipients only receive one session of anything… As you can well imagine, that costs money.
Looking into the fields of massage and body work, there’s not a lot of money to fund studies that the scientific community (including doctors and other health care providers and insurance companies) are likely to accept as valid and reliable. The Federal Government (bestower of many many grants for healthcare studies) is not out there offering millions to prove or disprove the efficacy of one type of massage for treating a specific problem, much less to prove or disprove the efficacy of any given modality over all.
What this boils down to is that there aren’t very many studies for us to lean on when we try to establish a given massage or bodywork modality as “real”.
It gets trickier when we realize that for a great deal of what we do as massage therapists, the medical scientists don’t have real answers either. We just aren’t there yet.
For example, we don’t REALLY know what causes muscle pain. Sure, there are theories, but nothing that has been studied well enough for us to be sure. For years, folks thought that lactic acid build up in the muscle fibers causes muscle pain; that’s since been proven to be false. It’s possible that muscle soreness stems from micro-tears in the muscle fibers; or perhaps its irritated nerve endings (there are nerve endings both in the belly of the muscle and at it’s ends); or maybe it’s really the fascia (tissue that surrounds all the muscles in your body) or nerves in the fascia. Those are all theories. They’re all worth study. But none have been studied well enough to let us be SURE.
Why? Because, quite frankly, the inner workings of muscles are almost as mysterious to us as the inner workings of the mind and brain. We’re still learning.
And this doesn’t get us into the thorny issues of things like trigger points, fibromyalgia, postural deviations, chronic pain, … etc. etc. It doesn’t even come close to why one person will find 5 pounds of pressure to be as if a gnat landed on them, while another will feel like you’re trying to push therm through the table.
If we don’t know the mechanics of muscle pain, how can we know whether a treatment is valid? (I guess that question applies as much to the pharmaceutical treatments as it does to “manual therapies). For some, the answer is quite simply “does it work for me?” The more we learn about the human body, and the infinite ways in which my body, for all our shared genes, is not the same as your body, the more I believe that is the right answer; part of what makes ANY treatment valid is how it actually affects EACH individual.