Knowledge Translation in Massage Therapy

I recently received an email from a practitioner concerned about a study he’d read about massage. The study reported that massage did not aid the removal of lactic acid from the body nor did it increase circulation, both commonly reported effects of massage. He was concerned that what he had learned in school wasn’t true and perhaps his work was not that helpful after all.

Are these issues true and do they mean that massage isn’t all it’s cracked up to be? Well, yes and no. Research has established for some time that massage does not speed the removal of lactic acid from the body. Does that mean massage isn’t useful in reducing soft-tissue pain and disability? Certainly not. On the contrary, this finding actually helps us better understand the physiological effects of massage.

What about massage not helping increase circulation? This one is a little trickier. Most of the studies investigating the effect of massage on increased circulation have focused on blood flow increases through major vessels. Massage does not increase blood circulation through these larger vessels. However, rarely do these studies investigate circulation through small capillaries in muscle tissue and skin. Increases in small capillary blood flow bring fresh oxygenated blood to muscle tissue and produce hyperemia (the characteristic redness) in the skin.

What this story illustrates is a need we currently have in all healthcare professions, including massage. This need is addressed by a discipline known as Knowledge Translation. Knowledge translation (KT) is the process of integrating research findings into clinical practice. A recent study investigating knowledge translation issues in medical practice noted that it takes about 20 years for advances in medical knowledge to be incorporated into clinical practice.¹  This lag time is one reason that myths like the role of massage in removing lactic acid from the blood persist.

How Does KT Fit with Massage

There is increasing emphasis on the importance of research in the massage profession. New findings allow massage professionals to refine clinical treatments so effective care can be provided. An example of how integrating science is relevant for massage comes from recent research into the pathology of overuse tendon disorders. It is now recognized that most overuse tendon disorders involve degeneration of the collagen matrix within the tendon structure (tendinosis) and not an inflammatory condition resulting from torn tendon fibers (tendinitis).

For years, the primary massage treatment strategy for overuse tendon disorders has been deep transverse friction. Treatment protocols emphasized friction applied in a transverse direction to re-align the scar tissue from torn tendon fibers. Today, it is known that the primary benefit of friction massage is actually the combination of pressure and movement in stimulating fibroblast production, thereby enhancing the tendon’s healing process.

This finding has important implications for treating problems such as bicipital tendinosis in the shoulder. Deep transverse friction treatments applied to the bicipital tendon run the risk of popping the muscle’s tendon out of the bicipital groove. It is now understood that tendinosis is effectively treated with longitudinal friction as pressure and movement are the key, not pressure direction.

Challenges to Implementing Research

There are reasons why research is not being integrated quicker into healthcare fields, including the massage profession. The volume of information currently being published is simply overwhelming. One study suggested that for physicians to keep abreast of current findings they would have to read 19 original articles each day.²

Another issue is the sheer complexity of the research; interpreting information from a study can be difficult. In other cases, such as the massage article mentioned above, the findings can be misinterpreted if the study’s design and methodology are not more closely analyzed.

Another challenge for integrating research into practice is long held beliefs or practices. This challenge is captured by a wonderful quote from the Canadian researcher Serge Gracovetsky. At a fascinating presentation at the 2007 Fascia Congress in Boston, he stated “Medicine is perhaps the only discipline in which an attractive idea can survive experimental annihilation.” In order to advance the health care professions, there needs to be adaptability and willingness to change practice patterns in response to new research findings.

Research Integration Barriers in MT

The problem of integrating scientific research into MT centers on several keys issues. The first is access. Either knowing how and where to access primary source websites and journal articles remains a barrier for many clinicians. It is also very difficult for full-time professionals to find the time required to look material up and read it.

A second barrier is the material itself, often written in difficult medical jargon, with methodologies unfamiliar to the massage professional. The answer to this problem lies with both the source and the recipient. First, the massage professional needs to develop clinical reasoning (see my MT column Mar 2009) and research literacy skills. Being capable of interpreting and evaluating research as well as analyzing methodology is critical. An individual must be able to read an article or research study, evaluate and critique aspects of it, and then conceive how its findings may relate to clinical practice.

On the other side of the equation, those scientists producing published materials must be able to write clearly and well (which is why many choose to use technical writers). They also need to find ways to get their materials out to relevant communities. The gap between scientist and clinician is fundamentally both a communication problem and a mechanism issue. What mechanism is being used to get material to the clinician (journal, newsletter, website, workshop)? What format and how accessible? Answering this dilemma is what KT is about.

Knowledge Translation as a Solution

The increasing complexity of our health care system and the volume of published literature require an increased emphasis on KT strategies. Finding ways to make research more accessible and improving research literacy among MT clinicians is critical to the profession.

Massage therapists have a wonderful resource today in the Massage Therapy Foundation, which is dedicated to improving access to and expanding resources for massage professionals. There are now two peer-reviewed publications available, Journal of Bodywork & Movement Therapies (published by Elsevier) and International Journal of Therapeutic Massage & Bodywork (an open access online journal from the Massage Therapy Foundation).

In addition, massage educators – both basic training and continuing education providers – have important roles in KT. Many CE educators already make current research an integral part of their programs, but many more could improve this aspect of their teachings. There is an increasing movement to make research literacy part of the initial training programs for massage students. As more people within the field develop research literacy, the move to bring research into clinical practice will grow.

The more clinicians incorporate the latest findings from quality clinical research, the more effective and successful they become in their practice. And with that, the more the profession can continue to develop as a legitimate and critical part of the healthcare industry.

1. Haynes RB. Using informatics principles and tools to harness research evidence for patient care: evidence-based informatics. Stud Health Technol Inform. 1998;52 Pt 1:suppl 33-36.
2. Choi BC. Understanding the basic principles of knowledge translation. J Epidemiol Community Health. Feb 2005;59(2):93.