We posed the following statement and question to two massage therapists for this post. We hope their responses spark a lively and interesting discussion in the comments below!

Some practitioners claim that individual experience and observation are enough evidence that massage and a variety of energy therapies are effective, even if we don't know exactly "how" it works. Others argue for controlled studies, scientific research, and hard evidence to understand how massage works and what conditions it can truly benefit.

What kinds of evidence should we require of energy therapy, massage, and bodywork?

Caution Necessary About the Claims We Make

by Jason Erickson, NCTMB, CMT, CPT, CES, CAIST, BBA, BA, AAJason_headshot_sm

Evidence is "the available body of facts or information indicating whether a belief or proposition is true or valid." Without evidence, we have no objective way to determine whether something is true or valid.

For example, it was once thought that massage would spread cancer. Despite a lack of supporting evidence, this belief was widely held until it was questioned and investigated; the evidence gathered provided an objective way of determining whether it was true or not. Since then, oncology massage has become commonplace, and the body of knowledge regarding how to safely work with clients that have various forms of cancer and treatments continues to grow. 

In my opinion, those who practice massage, bodywork, and/or energy work should continuously seek out the best evidence they can find. As the body of evidence changes, we should be willing to change with it. This will enable us to safely bring the benefits of massage to more people.

There are various types of evidence of varying reliability, from personal anecdotes (most subjective and least objectively reliable) to systematic reviews of randomized controlled trials (most objective and most objectively reliable). The key aspect here is that subjective evidence may be “true” only for the person(s) who participated at the time it was gathered, while objective evidence may be “true” for many people and can be replicated.

I have occasionally seen people claim that massage/bodywork professionals don’t need to worry about evidence, because “massage doesn’t hurt people”… but if that were always true, we wouldn’t have to worry about contraindications and there would be no massage professional liability insurance.

Unfortunately, there have been numerous incidents of serious injuries caused by professional therapists.

One of the great things about strong, objective evidence is that it is reliable enough to provide a reasonable level of confidence that we can trust when making important decisions. If a client has deep vein thrombosis, congestive heart failure, brittle bone disease, an acute injury, shingles, takes anticoagulant medications, or other possible contraindications… we need to make good decisions. Sometimes there is little room for error.

Professional Responsibility

Even when the stakes aren’t so high, we have a professional responsibility to represent what we do as accurately and honestly as possible.

“When consumers see or hear an advertisement, whether it’s on the Internet, radio or television, or anywhere else, federal law says that ad must be truthful, not misleading, and, when appropriate, backed by scientific evidence.  The Federal Trade Commission enforces these truth-in-advertising laws, and it applies the same standards no matter where an ad appears…”
~Federal Trade Commission, www.FTC.gov
When evidence is lacking, contradictory, or weak, we must be more cautious about the claims we make and the explanations we provide.

I don’t challenge the fact that people have some great experiences that seem to defy logic. What I challenge are the explanations provided for those experiences. To have an experience for which there is no readily available rational explanation is fine. It happens every day. It's okay to not know why/how something happened. Instead of claiming mechanisms that no one can detect nor prove as an explanation, why not just describe the experience and admit we don't yet know how to explain it?

Not having an explanation doesn't invalidate the experience, nor does it detract from the awe and wonder of it all. Admitting "I don't know yet" is completely honest and carries no baggage. It invites inquiry without prejudging what the outcome "should" be.

On the other hand, attributing what happened to specific mechanisms carries a certain burden of proof. If those mechanisms can't be proven to exist, or if they are disproven when scrutinized, the honest thing to do is admit the explanation was incorrect. We may not yet know the true explanation, but we should at least be willing to abandon explanations that lack merit.

In this situation, we may continue to do the work that seems to help our clients. It’s an opportunity to seek new ways to understand what we do. We may find clues in quality research generated by medical professions such as psychology or neuroscience, and this may help us work more closely with medical professionals.

About the contributor: Jason Erickson is a nationally certified massage therapist and personal trainer. He co-owns a large massage therapy practice, mentors massage therapists, teaches CE classes, and maintains a part-time personal training practice. Connect with Jason on LinkedIn.

What Is Energy Therapy?

by Michael Koplen, MT, DC, QME michael-k

I’m a massage therapist and a doctor of chiropractic. When recently asked my opinion about the “energy work” that manual therapists perform, my immediate response was that it’s a topic open for interpretation.

The term energy work has broad connotations. When online massage forum members try to define it, responses scatter like wild geese. Here’s a dictionary definition: “Energy can be transformed (converted) among a number of forms that may each manifest and be measurable in differing ways; the strength and vitality required for sustained physical or mental activity; a person's physical and mental powers; power derived from the utilization of physical or chemical resources, especially to provide light and heat.”

Doctors often perform tests to measure and monitor electrical energy fields, such as EEG’s, EKG’s, and EMG’s. In my practice, I work largely with the nervous system, which is a chemo-electrical energy system that controls and regulates virtually all bodily systems. When performing medical disability exams on injured workers, the worker comp. guidelines often required that I place NCV (nerve conduction velocity) tests before orthopedic and neurological exam findings.

Medical doctors, chiropractors, acupuncturists, and manual therapists all affect bodily energy systems in their line of work. Some healing modalities, such as infrared and laser therapy, don’t directly touch people but transmit healing energies through various means such as heat and light; others transmit sound waves, radiation, and electrical stimulation.

Manual therapists not only affect clients through pressure or stretching type forces, they also transmit electrical energy impulses, whether they are aware of it or not. Clients’ sensory nerves receive electrical impulses that transmit signals through the peripheral nervous system to the brain, which responds accordingly. Properly intentioned touch can send an energy signal telling the nervous system that “It’s okay to reduce a pain signal; it’s okay to reduce spasm.”

The energy of intention is important. We can sense if a pat on the back, tap on the head, or massage stroke should be interpreted as friendly and healing, or threatening. This phenomenon is explained in part by the Gate Theory, which has been expanded upon and renamed the Neuromatrix (mechanism).

Even if we’re not in direct tactile contact with another, and use more subtle forms of energy work, we’re still emitting electromagnetic frequencies that can have directed effects. We’ve all experienced the power of a glance, smile or wink of an eye sent across the room, and how it affects our emotional, electrical and biochemical energy fields. Likewise, the power of prayer and distance healing upon the human system has been validated by research studies at Stanford and other medical centers.

Miracle or Energy Healing

In India and elsewhere it’s common for rishis and saints to perform “miracle healings” by sending the ‘fire element” through their eyes like laser guided energy to “burn away” diseased areas, generate shaktipat healings by transmitting accelerated cosmic energies, or wash away deeply embedded emotional disturbances through water purification processes.

If humanity did not believe that such healing is possible without scientific validation, religions and spirituality would be regarded as a hoax. But millions of conservative scientists and doctors adhere to the healing powers of spirituality and attend religious ceremonies regularly. Most of humanity recognizes that there are energy forces that scientists have yet to discover, measure or control for their rational, reductionistic purposes, yet they do exist. Call them what you will, many such energy forces are used in the healing arts.

Unquestionably, energy comes in many forms, and various energy fields exist within humans. As health care practitioners, we work with various forms of energy – some more obvious and measurable, others more subtle. “Energy work” has many meanings, and all healing approaches should be acknowledged for their potential to affect energy fields, and respected for their complementary roles in helping patients and clients.

About the contributor: Michael Koplen, DC, MT, QME has been in practice for 20 years. He is a recipient of the National Chiropractor of the Year award and the former owner of the Denver Massage Clinic. He currently practices at the Capitola Health Center in Capitola, California. Connect with Michael on LinkedIn.

What's YOUR take on the statement and question we presented? What do you think about our contributor's responses? Join the conversation in the comments below!