Back in my days of practicing law, one of my escapes from reality was a good massage. It was a great treat, exchanging the high-octane atmosphere of the law office for the soothing music, subdued voices and pastel tones of the treatment room. I could have stayed on that table for hours.
Little did I know just how much an escape from reality massage therapy would soon become.
About 15 years ago, when I called to book an appointment with my favorite therapist, a recorded message offered something called “ray-kee” – at least, that is how it was pronounced. I assumed it was just a form of massage and didn’t think anything about it. Then, at one session, while my feet were being rubbed, my massage therapist – an RN, no less – suggested I would be surprised at how often a sore spot actually correlated with a medical problem. She was talking about reflexology, of course.
Fast forward a few years. A new massage therapist and a new location, this time a “health center” (actually, a gym) owned by a local hospital. The massage therapist inquired whether I’d like to try “cranial sacral therapy“. “What’s that?” I asked. “Oh,” she said, “it would be hard to explain.” (She got that right.) She then proceeded to inform me that she had actually used it in one of our sessions. This alerted me to the possibility that informed consent was not part of the massage therapy protocol.
A few more years went by. Another therapist (also an RN), another location. I was pleased with her because I thought she did a good job and she also taught me some simple stretching exercises. To my surprise, in one session, she started pressing on the space between my toes because, she said, it corresponded with the (something, something – I didn’t get this part) of my neck. Reflexology again. (Are they now teaching reflexology in nursing school? I am beginning to wonder.)
By this time, I was a fully committed SBM poster. I had little tolerance for nonsense. I left and never came back.
I moved on. Still another massage therapist and another location, a day spa. I was getting along fine with their therapists until I came upon one who announced (not asked me for permission, but announced) that we were “going to try some polarity therapy,” (which I had never heard of; more on this later) and put some arnica on my upper back. As I was already on the table, I submitted. If she ever did the polarity therapy, I didn’t realize it.
Same spa, different therapist. (I didn’t schedule with the “polarity therapist” again.) Finally! A massage therapist who does, well, massage. Thank you, Lisa!
Why was this so hard? Scheduling a massage, once a happy refuge from stress and pain, had become a pain. And stressful, if clients must interview each potential therapist to rule out quackery.
Or were my experiences an aberration? Did I just happen to come across a few who on the fringes? As it turns out, no. Sadly, it seems the whole profession has become infiltrated with pseudoscience. Its associations, its schools, its continuing education, and what appears to be a good percentage of its practitioners embrace quack treatments. We’ll get to a number of examples below. But first, a word about regulation.
Regulation: public protection?
In the U.S., massage therapy is a regulated practice in all but 5 states, according to the Federation of Massage Therapy Boards. It administers a national licensing exam, the MBLEx, which is accepted by most of the states where massage is regulated. Each state requires a certain amount of education to become licensed as well annual continuing education (CE). Some schools are accredited by the Commission on Massage Therapy Accreditation (COMTA), which is recognized by the U.S. Department of Education as a specialized accrediting agency. Graduation from a COMTA-accredited institution is not required in all states, but attendance at an accredited school or program gives students access to federal student aid. COMTA is made up of practitioners and school educators (including two chiropractors) and administrators, plus a public member.
Organizations like the American Massage Therapy Association (AMTA) and the National Certification Board for Therapeutic Massage & Bodywork (NCBTMB), which also offers a “Board Certification,” approve CE courses. These courses are, in turn, accepted by the states as fulfilling CE requirements.
Sound familiar? To regular SBM readers, it should. We’ve discussed various aspects of this same closed-loop, fox-guards-the-henhouse regulatory system before with regard to naturopathy, chiropractic, and pseudomedicine. (And, over on SfSBM, registered dietitians). From what I can tell, none of these professions does a particularly good job of protecting the public from quackery, and massage is no exception.
What’s the evidence?
SBM’s own Paul Ingraham, himself a former massage therapist, has some excellent articles on massage on his website, Pain Science. I particularly recommend “Does Massage Therapy Work?” The take-away message I got was that a plain, Swedish massage will do you as much good (or more) than the fancy techniques, the good being relaxation (including a reduction in blood pressure) and possibly more transcendent benefits plus maybe some short term pain relief. Which is pretty much what I concluded from my own experience. Paul includes a frank assessment of the pseudoscience problem in his former profession in an Appendix: “Powerful Bullshit: quackery pollution in massage therapy.”
According to NCCIH, massage therapy “may” benefit certain types of pain and improve quality of life, and it can be relaxing and improve mood, although overall the evidence is preliminary and conflicting. The effects, NCCIH says, are short term, so you have to keep getting massage to sustain any improvement. It’s not cheap, either. As Paul points out, it costs about a buck a minute.
Massage’s purported beneficial effect on back pain just took a big hit with the publication, this month, of a Cochrane Review, concluding:
We have very little confidence that massage is an effective treatment for low back pain.
Unfortunately, massage therapy has evolved (or, some might say, devolved) from a simple relaxation and short-term pain relief technique into a cornucopia of quackery that rivals naturopathy. There is no clear definition of what constitutes massage therapy and no taxonomy of practices. This creates a large tent under which many practices, unchallenged by science, can live harmoniously.
And they do.
(Here I’ll post a warning to my friend and colleague Mark Crislip: There’s a whole lot of loose talk about “energy” coming up next, and it could drive a physics major nuts.)
To illustrate just how deep into pseudoscience massage therapy has sunk, I’ve chosen a number of different practices from currently available continuing education courses, an accredited school and massage practitioners listed on the AMTA website. Note that none of these practices have any scientific plausibility whatsoever, yet a number make far-reaching claims about their ability to bestow actual therapeutic benefit on the client. (I apologize for the lengthy quotes, but I find it difficult to summarize gibberish. Plus, some are just laugh-out-loud funny.)
We begin with a course titled “Energy Introduction,” a sort of “Energy 101.” For reasons that will become obvious, I suggest that all massage therapists could benefit from learning the (alleged) differences between various “energy therapies.” It would also make a great Mitchell & Webb skit. [My comments are in brackets.]
Energy Introduction [CE course]
Unsure what the difference is between Reiki and crystal healing, or what chakras are all about? [I must confess that I am, indeed, confused about this very topic.] Maybe you struggle with how/when to best use your innate energy to help facilitate healing in others? Come discover how energy work may enlighten and simplify your practice by increasing revenue and minimizing your own fatigue as you introduce other service options (once properly trained in a specific energy modality). Note: This class will not include attunements of any kind [bummer!], but could involve chakra clearings or related exchanges.
The massage therapist can also learn, for school or continuing education credit:
It is simply amazing to see how the feet are a microcosm of the body! We will cover the history, mapping of the points, benefits, etc and of course correct technique to access the reflexology points.
Pranic Healing Level I [CE course]
Energetic anatomy: You will learn to work with the network of chakras, meridians and auras to accelerate the healing processes of your body.
Preventive healing: You will learn to remove the negative energetic patterns of a disease to prevent it from fully manifesting as a physical ailment.
- Step-by-step techniques for ailments related to your:
- respiratory system, e.g., asthma
- circulatory system, e.g., heart ailments
- gastrointestinal system, e.g., irritable bowel syndrome
- musculoskeletal system, e.g., arthritis and back pain
- reproductive system, e.g., menstrual problems
Cranial-Sacral Therapy Techniques [CE course]
CST works directly on the central nervous system to help speed healing to all parts of the body. . . It’s a great way to integrate your current tools and techniques with the [central nervous system], encouraging neuromuscular re-programming
Who can benefit from CST?
I’ve successfully used CST on kids with ADD, seniors with a variety of conditions, people of all ages with migraines and tension headaches, people at all stages of cancer, those suffering from anxiety or depression, infants with various disorders, people with back problems, people with advanced multiple sclerosis, professional athletes with pain or limited ROM, patients with brain injury, and much more – and I’ve seen dramatic, positive results!
Zero Balancing I & II [several CE courses; see, for example, here]
This was a new one on me, and a perfect example of how a promoter can fabricate a treatment and sell it to credulous clients and practitioners. Because there was only a brief description of the courses, I went to the website of the Zero Balancing Health Association (ZBHA). I learned there that ZBHA courses are not only approved in some states for massage therapists, but also for nurses, physical therapists, and acupuncturists.
Fritz Smith, MD created Zero Balancing in the early 1970s. It sounds to me like some sort of orthopedic energy therapy. Here’s how the ZBHA describes it:
. . . a powerful body-mind therapy that uses skilled touch to address the relationship between energy and structures of the body [using] finger pressure and gentle traction on areas of tension in the bones, joints and soft tissues to create fulcrums, or points of balance, around which the body can relax and reorganize . . . By addressing the deepest and densest tissues of the body along with soft tissue and energy fields . . . [it] helps to clear blocks in the body’s energy flow, amplify vitality and contribute to better postural alignment.
Ortho-Bionomy [500-hour course from the New Mexico Academy of Healing Arts, a COMTA-accredited school]
This was a new one to me also. For this, I had to go to the website of the Society for Ortho-Bionomy International. This technique, invented by a British osteopath,
. . . is a gentle, non-invasive, system of healing that reminds the body of its natural ability to restore balance. Its principles are based on a simple and profound philosophy: allow the body to correct itself . . . The body is stimulated using gentle movements, comfortable positioning, brief compression and subtle contact.
Polarity Therapy [CE course; polarity therapy also offered at New Mexico Academy of Healing Arts]
Developed by Dr. Randolph Stone, who had degrees in naturopathy, chiropractic and osteopathy.
The class introduces concepts of energy medicine through Polarity therapy theory and explores how to explain “energy work” in western terminology. Learn how to use affirmations and energy exercises from Polarity tradition . . . Polarity Therapy is a unique blend of bodywork, exercise and self-awareness that works with the human energy field. Polarity Therapy bodywork uses specific contact points to help balance and stimulate the body’s electromagnetic fields.
So far, we’ve covered energy, reflexology, Pranic healing, cranial-sacral therapy, zero balancing, ortho-bionomy and polarity therapy. Unfortunately, that’s not the end of it. Here are a few more treatments I found advertised by numerous practicing massage therapists listed on the AMTA website:
Amma Therapy [Yet another new one for me]. An “extremely specialized form of massage therapy rooted in a philosophy based on Taoism.” Instead of inserting acupuncture into “the energy pathway to stimulate and move the energy” the therapist uses her hands.
Acupressure: physical pressure applied to acupuncture points by the hand, elbow, or with various devices.
Reiki: a form of “energy healing,” “laying on of hands” that purports to transfer “life energy” to the client.
Structural integration: a/k/a “Rolfing.” Posits that muscles hold a memory of an incident in a particular part of the body. Therapist adjusts the massage technique when she detects “energy imbalance” to effect an “energetic release” which restores the flow of “vital energy.”
Oriental bodywork: “the treatment of the human body/mind/spirit, including the electromagnetic or energetic field which surrounds, infuses and brings that body to life, by using pressure and/or manipulation.”
Conclusion: Vitalism by any other name
As best I can tell, all of these practices boil down to pretty much the same thing: all are a variation on vitalism, the long-discredited, pre-scientific notion that there is some incorporeal force that governs your bodily functions. When this force is “unbalanced,” you get sick. When the therapist re-balances your force, you get well. The massage therapy profession has worked hard to escape its reputation as a cover for that oldest profession, prostitution. But I wonder if too many of them have simply transitioned to another form of prostitution: shilling for pseudoscience in the name of an improved bottom line.