Tuesday, June 01, 2010

On the Medical Uselessness of Massage

Let's be honest. I am in no doubt as to the therapeutic value of massage, but most of it is more spiritual or psychological than medical. The medical benefits solemnly listed by massage therapists are real enough, but they're mostly trivial. Yes, an hour of massage relieves stress and lowers blood pressure -- but not more than a ten-minute nap. It improves the circulation of blood and lymph -- but not more than a stroll around the block. It triggers an endorphin release – but not more than eating a bar of chocolate. It relieves muscle tension -- but not more than a hot bath. All these effects are real and measurable; they're just not very important, medically speaking, and they are not – quite obviously to me – why people really get massage. People get massage because they ache for the touch, for the physical communication, for the sensation of being physically cared for, physically attended to, physically heard. We dress it up as a medical intervention because that makes it respectable. It's justifiable to spend money on it, if it's medical. But it's no more medical really than a momma cat licking her kittens' tummies. Perhaps that does aid the kitten's digestion, but you and I and every cat knows that's not really the point.

The point is that we must love and be loved; we must touch and be touched. It's fundamental to our well-being. My favorite massage myth is that it “releases toxins.” This has been studied, and there's not a shred of evidence for it, but the myth marches on regardless, because it feels right. It feels like you're getting rid of something poisonous when you get a good massage, when you give your body over to someone and they treat it with interest and love and respect. But the poison isn't metabolic waste: the poison is the anxiety of loneliness, the ache for acceptance, the doubt whether we really belong to the tribe. Those are the toxins massage flushes from the system.

(Okay. An exception, here, is trigger point, which has serious therapeutic value for relieving chronic myofascial pain – what's commonly perceived as joint pain. But the most common “dosages” of massage – one hour once a month, or one hour once a week – are all but useless for trigger point, which typically needs ten minutes three or four times a day to be effective. I do trigger point on myself all the time, and so should you: but save your money. See a good trigger point therapist once or twice, get them to teach you how to work the points causing your pain, and do it yourself till the points resolve. That would be my advice, for all but the gnarliest and most entrenched trigger point systems.)

The thing about the pyschological benefit of massage is that it falls roughly under the rubric of placebo treatment, and from what we know about placebo, the more ritual and mystery surrounding it, and the more sense of its preciousness, the better it works. If I could talk a good line about releasing toxins or balancing energy, my massage would be more therapeutic. And if I charged more for it, it would be more effective. There's a serious case to be made for the therapeutic value of driveling, especially if you believe in the nonsense yourself. But I can't do it.

I can say this, in recompense: the love I feel for my clients is intense, and quite as real as any other kind of love. I'll stumble upon pockets of grief, I'll open up veins of lifelong loneliness, that will stagger me. Doing massage is no more soothing, ordinarily, than participating in a meditation retreat is relaxing. On the contrary, like a meditation retreat, it's most often, for me, a wild roller-coaster ride of emotions, waves of joy and sadness in quick succession, glimpses of rare colors and strange countries. The connection can be downright unnerving. You need either a thick skin or a certain amount of contemplative stability to ride it out. The end result may be – usually is – a profound sense of gratitude and well being: but it doesn't come cheap.

I suspect that if you studied people with a life history of getting regular massage, you'd find longevity benefits similar to – and as difficult to analyze as – those of marriage. But a study definitively establishing cause would be, under present funding conditions, prohibitively expensive. After all, people who get regular massage tend to be prosperous, tend to look after themselves, tend to be willing to expend resources on their own well-being, tend to be comfortable with touch and hence likely to be in healthy love relationships: you'd need to randomize your clientele, and track them over years, to avoid all that skew and get real results. A study like that is not going to happen while Big Pharma rules the medical roost.

The trouble is that if we keep making claims for short term medical effectiveness that we can't actually back up, sooner or later we're going to be discredited. Massage could go into another eclipse like that of the middle 20th Century, when it almost disappeared in America as a respectable profession. I'd hate to see that happen, because I do think we help people, profoundly and lastingly, and I do think we are the keepers of a traditional lore – of several traditional lores – that ought to be preserved. But I don't think we can compete with Big Pharma on its own ground of quick fixes and magical pain relief, and I don't think we should try.

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