During the course of attending massage school at A New Beginning School of Massage, students are given a number of assignments that requiring research and writing. Some of these assignments result in very insightful and  well thought out information and  decision-making outcomes. I am happy to share some of their assignments for you to enjoy.

Using research in the arena of massage therapy to make decisions about treatment options for clients is a good idea. It can help address troubling theories such as the one that titles this paper. When making decisions that can significantly impact a client's well-being, it is certainly wise to look further afield for solid answers than just accepting an opinion of a fellow therapist or layman when not backed by solid evidence.

First, we should take a look at the question "What is valid research?" We need to look at what the types of research are currently found in the area of massage practices.
Research on massage therapy began to be published in the 1930's, with human and animal studies, on such topics as muscle atrophy and blood flow, although sample sizes were relatively small in these discussions. These studies  were also flawed in that control groups were frequently absent. In the subsequent years, scientific research has rectified many of the rough tactics of earlier researchers. There are increasing amounts of research becoming available through clinical studies of a serious nature and the results are being made available to those interested through the means of professional journals and associations.

What types of research are valid and why are they valid for the profession?

The gold standard for scientific research is to have a large sample tested using a control group in double blind testing. These studies should have as large of a sample group as is feasible in order to expect dependable results. While large samples have been arranged in the past, control groups often were given the alternate modality of a self-driven relaxation therapy. This would have to be considered single blind research, as the persons involved in conducting the experiment would be fully aware that massage was being compared to some other modality and could somehow skew the results. It is not such a simple situation as can be found in other treatment areas, where a blue pill might be given to everyone involved with the administrators being unaware of which blue pills had the actively tested ingredients.

This frequently caused problems for many reasons, including the fact that control clients needed to be actively involved in their alternate therapies and frequently did not follow through with their assigned parts. Since the discovery that moderate pressure is needed for most massage therapy to be effective (1), control groups are now often given light pressure massage. This allows the control group to expect some benefit from massage treatment and also allows a means of double-blind testing in that the participating therapist many not be familiar with the findings of the above-mentioned pressure studies. They likely surmise that only the effects of light massage vs massage with more pressure was being measured instead of the true test of if massage was a valid treatment at all for the condition being studied, thus making it as close to a double-blind study as is possible in this area.

What criteria do you use to determine if the information is valid or correct?

The internet is a big place where anyone can publish their ideas. The researcher has to use discernment in determining if the source of information that they are reading is valid or not. Beyond checking the date of publication to ensure that you are seeing recent findings, there are a few questions that you can ask yourself about whether or not the information that you are presented with is from a reputable source.

1. Who runs the website? A good health website will make it easy to learn who is responsible for the site and its information.
2. What is the purpose of the website? Is the purpose of the site to inform? Is it to sell a product? Is it to raise money? If you can tell who runs and pays for the site, this will help you evaluate its purpose. Be cautious about sites trying to sell a product or service.
3. What is the original source of the information on the website? Always pay close attention to where the information on the site comes from. Many health and medical websites simply re-post information collected from other website or sources.

Good sources of health information include:

• Sites that end in ".gov," sponsored by the federal government, like the U.S. Department of Health and Human Services, (www.hhs.gov), the FDA (www.fda.gov), the National Institutes of Health (www.nih.gov), the Centers for Disease Control and Prevention (www.cdc.gov), and the National Library of Medicine (www.nlm.nih.gov).
• Sites that end in .edu which are run by universities or medical schools, such as Johns Hopkin University School of Medicine and the University of California at Berkeley Hospital health system, and other health care facility sites, like the Mayo Clinic and Cleveland Clinic.

Is research important in the massage profession?

Because what we do as massage therapists can impact someone's health for better or worse, it is in everyone's best interest to make decisions on treatment based on solid scientific research whenever possible. It is true that a measure of massage falls into a general "feel good" category. Even so, research has overwhelmingly demonstrated that stress reduction is vital for continued good health and mental well-being.

Outside of that, there are many persons that come to massage therapists for relief from a wide range of physical ailments. Knowing which techniques and modalities help, which are ineffective, and which may even exacerbate a given complaint, with some certainty, is vital for a therapist to successfully treat these conditons.

Conditions may exist in a client that are not the reason for why they wanted a massage, such as in the case where they have a backache but also poison ivy. During assessment, these issues should be brought out and evaluated prior to formulating a treatment plan or even in deciding if it is advisable to offer treatment at all. There may be times when we, as the practitioner, should deny service to the client, in full or in part, either for their protection or that of ourselves. Knowledge is power and reliable research is key to gaining accurate knowledge in all of the above areas.

The reason why I chose to check into research on whether or not massage spreads cancer and if it should always be contraindicated is becuase I have a personal interest in this topic, since I have a close friend with cancer who is currently receiving regular massages.

Review of research

cancer cell

In a question found on the Breastcancer.org site from 2010 (1) titled "Does Massage Contribute to the Spread of Breast Cancer Cells to the Lymph Nodes?", the answer given by the staff expert, Tracy Walton, L.M.T., M.S., indicated that uncited research points to the fact that exercise and hot showers would pose more of a risk of spreading cancer cells than massage, if increasing blood and lymph flow were dangerous to the cancer patient.

Looking further, the American Massage Therapy Association site has a page where this topic is closely looked at in a well-cited article. (2) In it, the way cancer spreads, or metastasizes, is discussed. Four ways cancer can spread are brought out with focus given to the overwhelmingly prevalent way lethal cancers are found to metastasize, which involved blood circulation metastasis. Since massage therapy significantly impacts blood flow, concern is warranted in this area.

The three steps of the process of metastasization are looked at one by one. The first is when the original tumor sheds cancerous cells into the body. The conclusion made in the article was that if the tumor was close to the surface of the body, that vigorous massage or hydrotherapy should be avoided in that area to minimize risk of expediting this shedding of cells.

Next the cancer cells need to stay alive while moving through the blood or lymphatic system living off of whatever nutrients they carried until they could re-site. Their opinion was first that the more vigorous the flow, the less likely it would be for a cell to be able to root in a remote location before it ran out of nutrient. Also,because since more active patients tended to do better in the recovery process because of improved physiology, exercise, which inherently increased blood flow, is generally considered a positive influence.

Finally, the cells need to  latch onto tissue in the new spot to complete the migration. There appears to be no solid evidence, either for or against massage, as having an effect in this end stage of metastasizing. The article ends with summarizing that firm, vigorous and direct stimulation to superficial tumors should be avoided. This is best done through a careful pre-massage assessment which would include determining the exact location of any known tumors in the client.

Finally, continuing on to find some results of an actual double-blind study is information from the Journal of Pain and Symptom Management Report on a study conducted at the prestigious Sloan-Kettering Cancer Center (3).

The results indicated that massage should be applied to relieve symptoms in patients with cancer. This practice was, up until the time of this test, only supported by evidence from small trials and anecdotal evidence. No study had examined massage therapy outcomes in a large group of patients. In the Memorial Sloan-Kettering Cancer Center testing, patients reported symptom severity pre- and post- massage therapy using a 0-10 rating scale of pain, fatigue, stress/anxiety, nausea, depression and "other" categories.

Changes in symptom scores, and the modifying effects of patient status (inpatient or outpatient), and type of massage were analyzed. Over a three-year period, 1290 patients were treated. The findings? Symptom scores were reduced by approximately 50%, even for patients reporting high baseline scores. Outpatients improved about 10% more than inpatients. Benefits persisted, with patients experiencing no return toward baseline scores throughout the duration of 48-hour follow-up. These data indicate that massage therapy is associated with substantive improvement in cancer patients' symptom scores. See figures in original article.

Do research findings support the statement/treatment or not and in what way?

After reviewing the cited articles and research, the information that I found tends to refute the statement that massage spreads cancer and is always contraindicated. While there are aspects that the practitioner should be mindful of when treating a cancer patient, research supports a viewpoint that massage is actually helpful to cancer patients in the areas of relieving pain, fatigue, anxiety, nausea, depression and other side effects of treatment of the disease, while posing no significant risk of spreading the tumor(s). Any modality or treatment with that sort of success rate should not be put aside out of groundless fear, especially when there is no clinical proof that massage has caused any harm to these patients.

Local contraindications do exist however, and it appears to be prudent to take them into account. These boundaries include:

• Avoiding vigorous massage over the site of tumors or suspected tumors
• Avoiding surgery or radiation sites that have not completely healed by a hand's breadth margin
• Avoiding working over the areas of ports or other spots of possible tenderness because of medical treatments
• Positioning the client so as to not put pressure on tender sites

What implications does the knowledge have for you and your practice?

Based on what I discovered in the research, and articles that I have reviewed on this topic, I believe that massage is not globally contraindicated, but, in fact, is actually useful to the cancer patient. It reaps significant positive results so long as appropriate boundaries to the client's individual situation are maintained. Since the benefits to the cancer patient are well documented in reputable research findings, and include a wide range of physical and mental improvements for the client, I would be happy to include such treatments in my practice using caution.

Additionally, since the population in our country trends toward older as well as heavier individuals, which are more prone to cancer, it can be expected that the number of incidences massage therapists see in this area will also increase. I foresee an expanding market for these services and it could even be wise to consider specialization in providing relief for this group of clients.

Sources

(1) Massage spreads breast cancer cells? http://www.breastcancer.org/treatment/comp_med/ask_expert/2005_03/question_13  Tracy Walton, L.M.T., M.S.2010

(2) Could Massage Therapy Promote CANCER Metastasis? https://www.amtamassage.org/articles/3/MTJ/detail/1803 Debra Curties Sept. 21, 2000

(3) Massage Therapy for Symptom Control: Outcome Study at a Major Cancer Center http://www.jpsmjournal.com/article/S0885-3924(04)00262-3/pdf Barrie R Cassileth2004, Andrew J Vickers September 2004