EVIDENCE-BASED MASSAGE: PART 1

BY NICK DINSDALE, OSTEOPATH AND SPORTS MASSAGE PRACTITIONER

INTRODUCTION

Massage can be adapted to treat athletes and non-athletes, for purposes of athletic advancement (1,2) or to assist a treatment regime for soft-tissue injuries (3) and other conditions ranging from acute to chronic. Although relatively few robust randomised controlled studies exist, and much of the research is flawed, a strong belief remains that massage has significant therapeutic benefits. If massage failed to produce benefits, it is unlikely that experienced therapists would have continued its use throughout the decades. This rationale is supported by the growing demand for massage by elite athletes (4,5) across a wide range of sports. Nevertheless, massage must be safe, adopt best available contemporary research, and embrace the scientific principles underlying tissue healing.

WHAT THE RESEARCH LITERATURE SAYS Massage is not without its critics, and the lack of robust research on its benefits or otherwise leaves the discipline open to criticism. Research evidence is scarce (6) and, when it does exist, produces equivocal findings (7). In many studies, authors cite that the lack of positive findings is down to

This first part of a two-part article on evidence-based massage focuses on the current state of massage practice, its role in the treatment of soft-tissue injuries and the evidence for its use. Part 2 to be published in the next edition of sportEX dynamics will focus on the role of massage in athletic enhancement.

flawed methodology and poor design (6–8) or in some studies lack of therapist experience (9). Furthermore, within the literature, treatment styles and descriptions use conflicting or inconsistent terminology (10), which creates more confusion, further exacerbating the research dilemma.

IN SUPPORT OF THE CONTINUED USE OF MASSAGE Although massage is frowned upon by some professions for its poor evidence base, the lack of robust evidence is not confined to massage. Watson (11) reports that if one looks critically at the full range of physiotherapy treatments, then there is insufficient evidence to support or reject many of them in all known circumstances. Although we should strive for evidence-based practice, the lack of sound evidence does not necessarily mean that a treatment does not work in practice (12) or in fact should not be used. However, when sound evidence is lacking, treatment should be guided

AND EMBRACE THE SCIENTIFIC PRINCIPLES UNDERLYING TISSUE HEALING

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MASSAGE MUST BE SAFE, ADOPT BEST AVAILABLE CONTEMPORARY RESEARCH,

by experience and sound clinical reasoning (13). Crucially, treatment outcomes can be enhanced by taking opportunity of complementing”) massage with other suitable intervents, thereby adopting a multifactorial or multidisciplinary approach (4,12,14) or, ideally, an interdisciplinary approach. Modern therapy encourages a wider multidimensional and integrated approach.

CHARACTERISTICS OF A GOOD MASSAGE THERAPIST

A good massage therapist should be competent in manual therapy; should have a sound understanding of human anatomy, physiology and pathology; and should have the ability to apply this knowledge when practising massage (15). As frequently cited, therapists must acquire adequate knowledge of the pathophysiology of soft-tissue injury and the healing process (15–18). It is unequivocal that the phases of tissues healing should guide clinical reasoning and decision-making with respect to what, when and how to deliver safe and effective massage (3,15) – otherwise, massage may result in poor performance and cause further tissue damage, leading to prolonged recovery (19). Experience is an essential component in any profession, and

sportEX dynamics 2009;22(Oct):12-17