Massage therapy research has come a long way over the past 30-plus years, but there is still so much to do as the profession continues to move forward.
Three eminent researchers, Niki Munk, PhD, LMT, Martha Menard, PhD, LMT, and Jolie Haun, PhD, EdS, LMT, guide readers interested in learning more about research.
How have massage and massage research changed since you started your professional development?
Niki Munk: There have been more awareness and spoken emphasis on research, generally speaking. If the field wants sustainable career professionals (and there is a lot to those terms), education, standards and regulation practices should reflect those of other health-related professions.
Martha Menard: Massage and massage education have become commoditized. While educational standards have improved somewhat, other health care providers and researchers still do not see massage therapists as peers. There are very limited career paths for massage therapy researchers because massage therapy is not an academic field.
Jolie Haun: When I became a licensed massage therapist we were considered and licensed as non-health-related professionals such as cosmetology, e.g., hair stylists. Since that time, massage therapy has moved under licensure and regulatory statutes which identify us as health professionals.
When I became a massage therapist, massage therapy was rarely, if ever, covered under our health care insurance and it was not typically provided within the context of health care systems. Now massage therapy is covered by health insurance in some areas and has been a popular modality to be included in health care systems as a part of complementary and integrative health care programs.
What do you see as the major advances in the field of massage therapy research in the past 10 years?
Niki Munk: More research, in general, and by more and different people have been really important. There has also been a nice blend of bench-to-practice science allowing a better understanding of massage’s underlying mechanisms.
The past 10 years have brought more efforts in clinical research to reflect the field in its study designs; in other words, massage is being applied and potentially accessed as it would be in the real world. This is important because for the most part, those leading the large and funded studies are not massage professionals.
Martha Menard: Greater acceptance of individualized protocols that better reflect clinical practice; pragmatic trials; better understanding of massage’s biopsychosocial effects.
Jolie Haun: Established empirical evidence documenting the support for physical and psychological outcomes associated with massage therapy, particularly for symptoms associated with pain and pain management — which has informed guideline development for massage in the clinical setting and the integration of massage therapy into clinical care and health care systems.
What priorities do you see developing in research topics, professional development and education, and research literacy and dissemination?
• Research topics: Important research topics are barriers to massage integration and implementation as well as deimplementation with regard to practices that do not have an evidence base or, more importantly, for situations in which there is supportive evidence for the opposite of what may still be practiced in clinical care.
Also, massage self-care or partner delivered/assisted massage treatments may be instrumental in helping to bridge the accessibility gap for many with little access to therapist-applied massage treatments.
• Professional development and education: Approach to education more reflective of other health professions with career pathways into higher education and research careers.
• Research literacy and dissemination: Foundation and continuing education should incorporate more research literacy components, particularly at the level of supporting clinician research access, familiarity, and consumption for application into clinical practice. As massage education continues to strive for elevation, research literacy should be a key component, similar to other health professional programs.
• Research topics: What are the barriers to integration of massage therapy in health care?
• Professional development and education: There is a tremendous need for educational research in massage therapy.
• Research literacy and dissemination: There is more than enough research on massage therapy to justify its use in health care. Why isn’t it more widely known?
•Research topics — Massage for specific complex conditions such as PTSD.
Massage combined with other complementary and integrative health modalities (e.g. yoga) for multi-modal intervention effects associated with the implementation of complementary and integrative health care systems.
• Professional development and education: Continued developments in regulatory requirements across the United States for the purposes of educating and licensing massage therapy professionals.
The opportunity for massage therapists to work with full-time employment in the context of health care systems, such as hospitals and wellness centers.
Innovation and sustainable mechanisms for providing massage therapy to populations that otherwise might not have resources to access services, such as teaching partnered massage so that it can be provided in the home setting without need for professional services.
• Research literacy and dissemination: Advancing professionals in the field with opportunities to participate and lead research and publications in the field of massage therapy. For example, more opportunities for small funded projects and case studies.
What are the major gaps in the field of massage therapy research that need to be addressed as we advance the science?
Niki Munk: With regard to practice-based knowledge gaps, the massage field is similar to other applied health and function related professions. Specifically: What are the components (clinician derived, recipient derived, environment derived, society/policy derived) of effective and sustaining therapeutic encounters and how do these components intersect and impact each other?
Martha Menard: Implementation of existing research, for example, massage therapy for various types of pain. Systematic reviews show that massage is effective for reducing pain, and especially anxiety, which contributes to and exacerbates the perception of pain. So why is it not standard care? What is the barrier to implementation?
Jolie Haun: Without question, there is a call from the massage field to provide more rigorous research, often noted as a need for randomized controlled trials; however, there is also a need to establish rigorous protocols which can account for the personalized effects that we see as a result of massage therapy that are often not caught with traditional measures or traditional study designs. There is an established practice of providing case studies but one can also use nontraditional biofeedback measures to evaluate individualized massage effects.
If you had to give one piece of advice to people interested in conducting research in the field of massage therapy and bodywork, what would it be?
Niki Munk: Look to the long game, get a research-focused degree, and prepare for a life and career in the places in which research is conducted — most often an academy or large health-related agencies.
Martha Menard: Partner with an experienced team.
Jolie Haun: Start reading the literature. Gain proficiency in reading and critically evaluating massage therapy research study designs, methods and measures. Once you have studied the literature, find an interest area and seek a mentor that can support your development and participation in assisting the conduct of massage-related research.
It is important [to understand] that you do not have to lead the research in order to participate in the research. There are many roles that professionals can play in conducting and evaluating massage therapy.
Please provide an overview of your education, professional background and involvement in research.
Niki Munk: I am an associate professor of health sciences in Indiana University’s School of Health and Human Sciences, a non-practicing Kentucky licensed massage therapist, and a member of the Academic Collaboration for Academic Health research work group. I am also a co-investigator on the VA TOMCATT study and a Massage Therapy Foundation Trustee.
• 2002: Finished clinical training in massage therapy at Lexington Healing Arts Academy (2002) then associate and program director from 2002 to 2006.
• Developed practice focused on older adults (2002-2006). I ultimately didn’t feel my massage education prepared me well enough or to the depth that I wanted to understand massage impact on elders and age-related conditions, so I decided to pursue higher education related to aging.
• Earned doctorate in gerontology, University of Kentucky (2006-2011).
• Worked at the Department of Family and Community Medicine, University of Kentucky, on KYPROS (2011-2013).
• Began tenure track assistant professor position at Indiana University in the Department of Health Sciences (2013).
• Trial Outcomes for Massage: Caregiver-Assisted vs. Therapist-Treated (TOMCATT) study funded at VA; co-investigator on the $1.2 million randomized clinical trial led by Matt Bair, MD (2016).
• Affiliate VA investigator (2017–present).
• Visiting professor of health sciences, University of Technology Sydney & Massage and Myotherapy Fellow in Australian Research Centre in Complementary and Integrative Medicine’s International Complementary Medicine Research Leadership Program (2017–present).
• Associate professor of health science, Indiana University School of Health and Human Sciences (present).
Martha Menard: I am a clinician, researcher and educator who has served in multiple leadership positions with the massage therapy community. I’m the author of the widely used text on research literacy, Making Sense of Research, and an integrative pain leader who was previously guest faculty for the Samueli Institute Chronic Pain Breakthrough Collaborative.
• Massage practitioner and educator since 1982
• Master’s degree in psychology, University of Virginia (UVA)
• PhD in research, statistics and evaluation (UVA)
• Massage Therapy Foundation (MTF) grant recipient
• Former Board of Trustees member, MTF
• Former member and chair of MTF’s research grant review committee
Jolie Haun: I completed a National Institutes of Health, National Center for Complementary and Integrative Health post-doctoral fellowship in whole systems research at the University of Arizona’s College of Medicine in the Department of Family and Community Medicine. I am a research health scientist at the Veterans Health Administration, James A. Haley Veterans Hospital, in Research Service.
• Florida licensed massage therapist since 1995. Employed as a massage therapist in the clinical, chiropractic and spa setting.
• Conducted first research project in evaluating physical and psychological outcomes with children with cancer and blood diseases (published in IJTMB). Conducted post-doctoral studies, University of Arizona College of Medicine, in whole systems research, focusing on massage therapy as a system of care.
• Conducted a research project on evaluating gas discharge visualization to evaluate nontraditional biofeedback outcomes (JCIM). Also conducted a qualitative study on the universal constructs of healing by allopathic and complementary and integrative health care providers, including licensed massage therapists (publication pending).
• Currently funded to conduct a randomized controlled trial and evaluate the physical, psychological and social effects of a mobile app that uses partnered massage with veterans managing PTSD and chronic pain.
• Volunteer with the Massage Therapy Foundation for over a decade as chair and member of the Writing Group, now the Writing Committee, reviewing massage therapy-related research, and providing writing and editing skills to publish in trade journals for massage-related professionals.
About the Author
The Massage Therapy Foundation (MTF) has been tackling the challenges of research in the massage therapy profession for nearly 30 years, moving the needle to a higher level, both in the quantity and impact of the studies we fund. The core of our mission is to advance the profession forward through research; we have done this by previously funding research projects exploring such subjects as caregiver stress, cancer pain, and veterans and opioid use.
MTF encourages our colleagues to learn from the researchers in the field.
To that end, MTF disseminates research articles via a peer-reviewed, open access, quarterly publication, International Journal of Therapeutic Massage & Bodywork (IJTMB), which highlights research, education and practice, as well as via social media, newsletters, podcasts and visual abstracts. The information that is disseminated is derived from many funding agencies, not only our own.