Photo of a sign that says "evidence-based practice," to coordinate with an article about evidence-based massage therapy practice.

Evidence-based massage means using research studies to guide hands-on massage practices, approaches and principles. In this article, we will discuss the use of hands-on massage protocols found in research studies to create evidence-based massage practice.

There are three hyperlink urls at the end of this article to three massage-related, peer-reviewed research studies. All three studies provide step-by-step hands-on massage protocols used for specific populations, including:

• Two oncology massage hands-on protocols used during chemotherapy1

• Two hands-on massage protocols used for nonspecific chronic low back pain2

• A 30-minute, six-phase, hands-on massage protocol to treat headaches3

How to Practice Evidence-Based Massage

To establish an evidence-based massage practice, a massage therapist will literally apply a hands-on researched protocol to their clients. The objective is to simulate researched hands-on methods via protocols to provide beneficial outcomes, similar to what was achieved in the research study.

The National Library of Medicine, better known as the National Library of Medicine’s PubMed.gov, is one website where health care research is easily found. It includes thousands of massage-related research studies, and some of those studies will include hands-on massage protocols, such as those referenced in this article.

To practice evidence-based massage, it is recommended to seek research for massage modalities that you already know. Working within one’s own massage skill wheelhouse will be an easier start.

What’s the Evidence in Evidence-Based Massage?

Hands-on protocols are the evidenced method of how results are achieved within massage-related research studies.

Evidenced practice should be applied to similar populations that were used in the study, such as oncology groups or those suffering with chronic low-back pain or headaches. Study populations can also include detailed age groups, gender, disease severity and more.

In real-time, evidence-based practices, human variables can make it impossible to achieve identical massage protocol application. Massage therapists are not robots and neither are our clients. Evidence-based massage practice applies the researched hands-on protocol under similar conditions of the study, despite slight variables.

Basic Elements Provided in Massage Research

Most health care research studies will provide basic information, such as the number of people studied, who are also called subjects or participants. Methods used in the research might include a hands-on massage protocol. Often, studies summarize and conclude with results of studied methods.

Sometimes research is shared with abbreviated abstracts, and the publisher may charge a fee to view the entire literature. Unfortunately, there is no guarantee that paying for or viewing an entire research study will provide a step-by-step protocol. Sometimes hands-on massage protocols and methods published in research are disappointingly vague.

Some research studies are publicly available to view in full without having to pay, such as the three studies referenced at the end of this article. Sometimes studies are funded by government and tax-payer dollars, which could make the published research free and publicly available to everyone.

Researched Massage Protocol Use and Restrictions

When practicing massage from research, do not follow a protocol or method that is difficult to understand, or seems inappropriate or beyond your abilities or training. Never work outside of your licensed scope of practice.

This article’s three referenced studies include massage methods such as kneading the trapezius and trigger point work. If you are able to access researched protocols, they are often easy to follow if you can find them.

Sometimes researched massage protocols are basic. Some will be more advanced. And some will not provide concise directions or applications. Just use your best judgement and execute services to the best of your ability, while practicing in a manner to do no harm.

Using Research Studies to Provide Massage

While research studies are provided with a wide range of quality, that quality can be tested immediately once a protocol is applied in practice. The proof, as they say, is in the pudding.

Undoubtedly, the same hands-on protocol will not be effective with all clients; however, a researched protocol may be a great place to start when working with a particular client or condition, especially when the study has demonstrated efficacy in similar subjects.

A fine line is practiced in evidence-based work between following researched protocols and continually evaluating an individual to ensure the work is appropriate for them. Researched protocols should only be followed in their entirety when a client tolerates the work and positively responds to it. If a client is not tolerating or enjoying the protocol, it is recommended to change hands-on application until the client is satisfied, while maintaining treatment integrity.

To be clear, this article does not provide a green light to practice whatever is found in research, especially given some research demonstrates no changed observation or even negative results. Instead, practitioners must ensure the researched methods are sensible for each client.

Consider the Entire Study When Practicing Researched Methods

Massage therapists should read the entire study prior to emulating a researched protocol. The study in its entirety should provide valuable information, such as when the research subjects received their massage in relation to disease onset, or when associated with specific symptoms, or how many visits were standardly applied, and other factors that could affect hands-on work or appointment scheduling.

While study details can vary in quantity and quality, an abbreviated research abstract would have the least information of all.

In addition to learning who is an appropriate candidate for a researched protocol, sometimes studies will detail who is not an appropriate candidate. Studies can include parameters that disqualified subjects from participating due to various constraints or contraindications. This would all be relevant information to apply in your own evidence-based massage practice, which is why the entire study must be read and considered prior to real-time application or practice.

Learning More About Research Processes is Critical

Providing evidence-based massage practice requires a lot of reading and interpretation of the research literature, which becomes increasingly difficult when a study is of poor design or low quality.

Do not immediately discard a study based on perceived deficiencies. The massage industry does not have multi-billion-dollar corporations funding research, and health care studies rarely demonstrate 100% efficacies or absolutes, mainly due to human variables. Massage research should never be dismissed or disrespected due to limited financial constraints or unachievable standards.

There is a lot of valuable information already available in our current massage-related research studies.

Anyone wishing to work from research should spend time learning about the research process itself. A greater knowledge of the research industry will help practitioners better determine the objectives of a study, including which studies have the best evidential methods or are the strongest to cite or use.

Learning how to collect data and practice from research is a skill that takes time and training. Learning how to work from research can be an intensive and extensive process, but like anything else, is easily attainable with education and practice.

Using Research to Advance Your Massage Practice

It can be helpful to learn which researched massage methods or applications have shown poor or negative results beyond the benefits. This could create a more comprehensive understanding of massage efficacy, and collectively establish a partial list of massage dos and don’ts.

We hope massage therapists will learn more about research studies to provide stronger, evidence-based applications. An educated advancement is waiting for those who are able to use research to enhance their practice and results.

Footnotes

1. Mao, et. al., “Integrating Oncology Massage Into Chemoinfusion Suites: A Program Evaluation.” Journal of Oncology Practice.” Published online March 1, 2017.

2.  Cherkin, et. al., “Effectiveness of focused structural massage and relaxation massage for chronic low back pain: protocol for a randomized controlled trial.American College of Physicians Annals of Internal Medicine. Published online July 5, 2011. H

3. Quinn, et. al., “Massage Therapy and Frequency of Chronic Tension Headaches,” American Journal of Public Health.” Published online Oct 10, 2011.

Selena Belisle

About the Author

Selena Belisle is the founder of CE Institute LLC in Miami, Florida, where they teach massage, nursing and cosmetology industry CE courses. The school dedicates 12 hours in a CE course solely teaching massage therapists how to collect and use massage-related research data on their own. She has been practicing massage therapy and bodywork for over 30 years. She is approved as a continuing education provider by many industry state boards and the National Certification Board for Therapeutic Massage & Bodywork.