Fantasy Physiology and the Post Hoc Fallacy

I have been around this field for three decades now. In many ways it has been quite astonishing to watch the tremendous progress in acceptance of massage therapy as a valid healthcare option. Obviously, we still have a long way to go but we have certainly come a long way in just a short period of time.

There are, however, a number of obstacles that continue to hinder us on our growth. One of the things that clearly distinguishes massage from other healthcare approaches is the academic environment that it springs from. Most other healthcare disciplines are firmly established in the traditional academic channels of university education and advanced degrees. Massage however has emerged, or perhaps we should say re-emerged, as a serious healthcare approach only in the last few decades in this country.

The early massage schools that sprang up and became the foundation for the explosive growth of this profession were generally started by practitioners who found themselves having success and wanted to share that success with others. Most had no background in education, curriculum, or the rigors of traditional academic programs. Because the educational requirements for massage therapists remain relatively low, practitioners can enter the field with a very limited education.

As a result of the limited education for entry-level practitioners, their more advanced training comes from continuing education courses. Like in a number of other fields, our continuing education offerings tend to be dominated by guru-style education. What that means is there is generally some individual or charismatic figure that teaches a particular approach and many people want to study with and emulate that approach. That teacher often has assistant instructors or students who then go out and also start teaching that same approach with their claim for validity being that they studied under so-and-so guru. This degree of inbreeding education is effective for maintaining some degree of consistency in the way something is taught, but it is notoriously difficult for standing up to the rigors of traditional academic debate and challenging processes to change and grow.

One of the more detrimental effects of this guru-style education is the vast proliferation of what I refer to as fantasy physiology. Far too often I will see some “new” technique or modality approach advocated by a charismatic teacher. Looking into the training further, I might watch videos or see live presentations and hear the instructor espouse explanations that completely defy our current understanding of physiology. Very rarely does anyone in the classroom actually question the instructor, because our initial training in this guru-style education does not teach us how to engage in academic debate and question authority effectively. As a result, erroneous and completely bogus physiological explanations are perpetuated from teacher to student and on and on.

Fantasy physiology pervades the massage therapy profession and many of the popular techniques you see advertised in our trade publications. You can usually pick up fantasy physiology in common catchphrases like “releasing ligaments” (which don’t contract to begin with), melting adhesions, or unwinding the torque in (fill in the tissue name___________).

So how does this come about? I don’t think most of these people are deliberately misleading their followers. I just think they are often operating from a limited understanding of the body and are getting caught by the post hoc fallacy. The post hoc fallacy comes from the Latin phrase post hoc ergo proctor hoc, which literally translates to “after this, therefore because of this”. Essentially this means if event B happened after event A, then A must have caused B. We see that in massage all the time by doing something like working on a particular area, perceiving that something has changed, and then making up a physiological explanation that we think caused the change (like magically released adhesions).

The reason this fantasy physiology is a problem is that it decreases our credibility and often leads us down erroneous paths of doing things to people that don’t really produce the results that we think we are producing. The only way out of this is to strengthen our academic rigor, and learn to challenge and debate ideas without considering those challenges to be personal attacks. Unfortunately, this means we’ll also have to give up many of the sacred cows we have been protecting for many years and acknowledge that maybe things don’t work the way we think they do. It is a challenge, but an important one if we are to grow as a healthcare profession.