Okay, Not Useless

I promise you, if I ever undertake seriously to argue that massage has no medical value, my paper will have footnotes and close argumentation and takedowns of several studies, and it will be longer than 500 words. I promise also that I will try to refrain from tweaking people with inflammatory and outrageous titles, although that will be a harder promise to keep. It's been part of my rhetorical strategy so long that it persists even when the ideology which formed it (essentially, that dull people are improved by being poked) has long since withered away. Habits die hard. I was given Strunk & White at a tender age, and encouraged to think that forcefulness was the prime virtue -- what all writing should aspire to all the time. I now have a middle-aged respect for accuracy and caveat, even when dull; but I still find myself fluttering the cape sometimes.

And anyway, I would never want to make that argument: it's untrue. When my essay was linked to for a group of people who work hard to do medical massage (and justify its use), they were understandably miffed. It was a nice lesson for me in how contexts can shift, on the internets. I can ordinarily assume that my audience here knows that I'm passionate about massage, that my much of my practice is what is called “relaxation massage,” rather than treatment-oriented massage (though I'm doing much more treatment nowadays.) So the “medical benefits of massage” that I was poking fun at are the ones that routinely show up on the web pages of practitioners like me -- not the pain relief, lymph drainage, and trigger point, and all the techniques that shade into physical therapy, but rather the stock list that you learn in Massage I – relieves stress, promotes circulation, lowers blood pressure -- all true, all verifiable, all temporary and trivial.

If massage were as effective as many of its practitioners claim, it would blow other therapies out of the water in comparative studies. In fact it comes out lackluster, most of the time. If some therapists have the extraordinary success rates they claim, that only makes the general picture worse: for every therapist two sigmas out on the right, there have to be a dozen or two whose work is completely worthless, to get the kind of distributions we see. Massage came out tops in treating low back pain, in a study a while back, but that was more because the other therapies were so ineffective, than because massage worked so well.

I started reading studies of massage back before I was in massage school, but I gave up pretty soon. What I saw then was mostly very small studies with inadequate controls documenting that massage could have a significant effect on this, that or the next thing. Which, if you're not a science person, might sound impressive. But “significant” doesn't mean “important,” in statistics: it just means “very unlikely to be a random result.” Aspirin significantly reduces low back pain, but we can be excused for not jumping up and down with delight about that fact, especially if we can't get out of bed. These studies were a start, and I'm not mocking the people who did them, who had next to no resources. They established that there's something to study, that the idea of treating various conditions with massage is not absurd. But they didn't take us much further than that.

I know. I have anecdotal evidence too. I have clients who swear that I fixed their necks, backs, hips, knees. I am confident that I've reduced a lot of pain. I even have people I think I really rehabilitated, got back on their feet again. Someone who couldn't go up and downstairs, who now runs up and down like a goat. Another who couldn't hold a pencil, whom I enabled to write again. Someone who thought it was only my work that allowed her still to stand upright, at the end of her pregnancy. That feels good, and I like believing in it, but I can hardly be classed as an unbiased observer. A scientific person has to ask: how many people were just going to get better anyway? Eighty percent of my appointments are with clients who think I'm terrific, but how much of that is because the people who didn't get any relief just didn't come back? How much of it is just because of the rapport and affection that any loving touch conveys? I like to think – be real, I do think – I'm a good therapist. I study and I think and I pay attention. If something doesn't seem to be working, I try something else. But I don't think the comparative studies are lying, and I don't think the majority of massage therapists are incompetent.

Having said that much – and possibly gotten myself in trouble again – I will also say: we don't know a damn thing. The study of massage is in its infancy. Chronic myofascial pain is very mysterious, and much of what we thought we knew about it is being daily disproven.

God, think what we could find out if we had the kind of money that gets spent researching drugs! Everything remains to be discovered. There may come a time when we can confidently tell someone with chronic back pain, “I'll have you on your feet again in a week, and after that you'll never need to come see me again.”

We are not there now, and claiming that we are only makes us look ridiculous. We want solutions that a workaday, non-brilliant, not particularly gifted therapist can execute and get reliable outcomes. The traditional lores are not going to get us there, not on their own, although they are full of hints. We need science. We need to understand how it really works. We need results that are verifiable and repeatable.

In the meantime, I'll do my best to help with the pain presented to me. But I don't have the confidence in the value of that part of my practice that I have in the supposedly vaguer, touchy-feely, cloth-mom-for-the-rhesus part of it. People need to be touched with love and understanding, and I know how to do it. The bottom is not going to drop out of that market if Methylene Blue turns out to fix discogenic back pain, or if someone builds a cool nerve-feedback acupuncture machine that fixes pseudosciatica every time. All that will do is take away one of the pretexts people have been depending on to get the touch they need. They'll find another.