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.
There are many types of research, each designed for a specific purpose, or to answer a particular type of questions. A few examples are exploratory, explanatory, qualitative, quantitative, descriptive (such as a case-study, observation, or survey), correlational (case-control study, observational study), semi-experimental (field experiment, quasi-experiment), experimental (experiment with random assignment), review (literature review, systematic review), meta-analytic (meta-analysis), and mixed methods research (such as the integration of quantitative and qualitative components). Any type of research that clearly shows empirical data relating to a research question, and answers that question in a clear and unbiased manner with evidence well designed to apply to the question at hand would be valid for massage therapy.
When determining if information found on a topic is valid and correct, it is important to make a few considerations. Who published the information? Where did they find it? If the information came from a research study, how was the study designed? How was the study performed? There have been cases, for example, where a research study was designed to produce an unbiased result; however, in the performance of the study, it became apparent that there was an inherent bias skewing the outcome. One way to test for bias is to replicate the study, something that often happens through peer review. For this reason, information is more often generally accepted as valid once it has been proven through a research study which has been published in a peer reviewed journal, and even more so if the study has been replicated, with those results also published. It is through this process of study, replication, and review that a body of work is built for s specific field of study.
Is research important in the massage profession? The importance of the research may vary, depending on the audience and the research topic in question. Let's consider a client that has been receiving massage therapy throughout their entire life, and, with each session, they experience an increased sense of well-being, incomparable to that achieved by other services that they may have received. This person very well may not be interested in the why and the how of the benefits of massage. Instead, they may be content with the proof of their own experience. On the other hand, we may also consider someone who is new to the massage profession, and who has had few or no massages. This person may not be sure about whether or not continuing to receive massage is worth the time and financial commitment massage sessions entail. In this case, it may be beneficial to be able to share scientifically objective information with this person, helping to paint a larger picture of what benefits they are likely to experience through undergoing massage therapy. It is also critical to have objective answers to questions about massage and disease, especially when it comes to contraindications or treatment for a condition.
Many people have heard the phrase "You should not massage the feet and ankles of a pregnant woman." It is something that comes up often on message boards and pregnancy blogs, with many women very concerned about the possibility of inducing preterm labor. Unsurprisingly, this idea inspires quite a bit of anxiety in someone who is, or may be, pregnant while seeking massage. This idea may have come from the fact, according to Pacific College of Oriental Medicine, that a small amount of oxytocin--a natural chemical involved in contracting the uterus--is produced by foot massage.
However, there is also a lot of contradictory information available. Livestrong.com actually contradicts themselves on this issue. In the article titled "Pressure Points to Avoid While Pregnant," author Erica Roth states that "according to the American Pregnancy Association, pressure points near the ankle are contraindicated during pregnancy, because, when manipulated, they can cause the pelvic muscles and uterus to contract. Contractions well before a woman's due date can lead to preterm labor, which is not safe for the child." Similarly, in the article "Foot Massage & Pregnancy," writer Jean Jenkins quotes a certified prenatal massage therapist, Rebecca Leary, as saying that "There are acupressure points in the legs, ankles and feet that correspond to the reproductive system. [Therapists are] trained to recognized and avoid these points on the feet of pregnant women, as they could send them into early, naturally induced labor." However, Jenkins also mentions the counter argument that "many professionals in the medical field disagree, not with foot massage in pregnancy per se, but with claims that massage and reflexology can be powerful enough to induce labor." Jenkins also states that "most obstetrician/gynecologists agree that foot massages, done gently, help to decompress agitation and anxiety and therefore, can make the experience of pregnancy more comfortbale and enjoyable, for both mom and baby."
In an article on the website for the Associated Bodywork & Massage Professionals trade organization, abmp.com, titled "Proceed with Caution: Foot/Ankle Massage for Pregnant Client," Leslie Stager writes that "despite the prevalence of this contraindication, there is no evidence that ankle massage is dangerous. The concern may have developed from specific information that was gradually altered through oral transmission, eventually becoming generic and essentially useless."
From the information presented, it would seem that the idea that acupressure points on the feet and ankles could inadvertently trigger contractions, and possible preterm labor, is more myth than fact. While based in small truth, it is a story that has been told, and retold, and become part of the fabric of common knowledge. However, common knowledge does not hold the same weight as empirical, fact-based, evidence and there is no evidence found to support the claim that massage and reflexology can be powerful enough to induce labor in pregnant women, at any stage of pregnancy.
As a massage therapist considering performing massage on pregnant clients, it is always best practice to be certified in prenatal massage, and make sure not to work outside your scope of practice. If you feel unsure, or unsafe about massaging a client, it is always best to err on the side of caution until you have acquired more and valid information of the subject. Take CEU classes on pregnancy massage, talk to certified prenatal massage therapists, and keep up with the latest research in respected research journals.
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.
There are many methods of research used in various fields of study, including basic, clinical, analytical, and descriptive research. Basic research simply increases the amount of knowledge on a particular topic, without necessarily coming up with a solution. Studying the complexity of touch is an example of basic research. Clinical research, also known as applied research, uses investigations or research studies to examine questions and investigate specific outcomes. Most research in massage therapy falls under this category. A good clinical research design includes a control group that is not treated, receives a pretend treatment, or an alternative therapy compared with a group receiving the treatment of interest. Analytical research utilizes in-depth investigation techniques to discover important facts about the complex issues being studies. It then uses critical thinking skills for evaluating the information relative to the research being conducted. Historical research, philosophical research, and research reviews land in this category. Descriptive research typically includes survey and interview studies and is used to describe characteristics of a population or phenomenon being studied. It does not answer questions about how/when/or why something has occurred. However, it does answer the "what" questions. Articles in journals, textbooks, reliable internet sources, blogs, and surveys are great ways to research. What is important is to choose the correct type of research study to accurately answer the question being asked.
Experimental research, surveys, and journal articles are valid types of research for the massage therapy field. Articles in peer-reviewed journals are written and reviewed by experts in the field before the article is published, which lends credibility to the source. Many articles have been published based on research conducted to prove or disprove various statements pertaining to massage therapy.
When researching, it is very important to make sure the information you are receiving is valid and correct. Publications from a peer-reviewed journal have validity, as previously mentioned. With any information from a website or a book, I look for an author listing with contact information, so I can then determine the author's qualifications, credentials, and connections to the subject. It may also be relevant to learn if the author has publications on the web or in hard copy, and if these publications have a complete list of works cited, which reference credible, authoritative sources. Cross-referencing with other sources known to be credible is an effective method of determining validity. Also, always check the date to determine how current the information is.
Research in important in many fields of study, and I believe massage therapy is no exception. Staying current with the latest research will provide you with more knowledge and credibility, which can reduce the risk of neglect, and help you grow into new areas of expertise. The massage profession has experienced tremendous growth in recent years, as more people are making massage a recurrent part of their health care regimen. More research into the effectiveness of massage can educate both the public and mainstream medicine, which can lead to more referrals and more business.1
The statement I researched was "You should not massage the feet or ankles of a pregnant 
woman." In a peer-reviewed journal article that researched the effects of massaging the feet of pregnant women, a study group had 20-minute foot massages daily for 5 days, which resulted in significantly smaller lower leg circumference. It showed that foot massage had a positive effect on decreasing hormonal physiological lower leg edema in late pregnancy.2 In an article written by Leslie Stager, an RN and LMT, she states that the 1990's brought increased research about pregnancy health and prenatal massage, which has since been recognized as beneficial. Research indicates it can decrease stress and the production of catecholamine, improving hormonal functions, speed labor, and reduce pain from contractions. In her article, Stager states that the dangers of massaging ankles due to induced labor are a myth. Uterine and ovarian reflexology zones located around the ankles and acupressure points near the ankles that may support labor are the foundation of such myths. This misinformation has permeated massage schools and the general public, making this a widely-accepted belief, although there is no real evidence to support it. The only technique that may have a relevant contraindication is acupressure. Dwight Byers, director of the Internation Institute of Reflexology says, "Massage cannot stimulate the uterine and ovarian reflexology preterm contractions." (Leslie Stager had personal communication with the author, January 2007). Suzanne Enzer, a midwife, nurse, reflexologist, and author of the Maternity Reflexology manual "Soul to Sole Reflexology" says that reflexology cannot, does not, and will not make the body do something unnatural. The balancing and harmonizing qualities of reflexology will enhance the woman's own self-regulating mechanisms. Reflexology may give a boost of energy and tip a women into labor if her body was already prepared to birth, but can not induce labor otherwise."3 Ultimately, the ankle-massage warning seems to refer to stimulation of acupoint Bladder 60 (the only point around the ankle referred to as contraindicated and has properties of drawing energy downward and is often used in combination with other points when attempting to induce labor). The other ankle points that pregnancy massage sources have labeled with concern do not have properties that bring on contractions. So what is the likelihood? Leslie Stager says it is remote because MT's typically do not repetitively massage one specific spot for extended periods; general effleurage does not have the same effects as acupressure. It seems the underlying fear is being sued if a woman miscarries4, although there is no research evidence to support a lawsuit accusing a therapist of causing a miscarriage by rubbing the ankles.5
Based on research, I have drawn the conclusion that massage is good for the ankles and feet of a pregnant woman. Massage helps with swelling and overall wellbeing. If rubbing over an area caused miscarriage, women wouldn't be able to put on body lotion while pregnant. Amanda Spencer is currently an LMT who has practiced prenatal massage for years. She stated in a Facebook forum that "in 9 years I've never sent a woman into labor." According to Massage Magazine, massage during pregnancy enhances the function of muscles and joints, improves general body tone, increases circulation and relieves mental/physical fatigue. Prenatal massage gives moms-to-be the ability to unwind and feel comforted.6
There is no evidence to support the claim "you should not massage the feet or ankles of a pregnant woman." There were no studies to prove this, but there were many articles about how massaging the ankles helps with lower leg edema. Due to my findings, I worry much less about causing premature labor in a pregnant woman. Prenatal massage is proved to be very beneficial and have many health benefits. I think it's important, as a massage therapist, to get the correct information to those who are misinformed.
Citations
1. Chirofind.com. Kathryn Feather, Senior Associate Editor
2. Coban, A. and Sirin, A. (2010), "Effect of foot massage to decrease physiological lower leg edema in late pregnancy; A randomized controlled trial in Turkey." International Journal of Nursing Practice, 16:454-460. Doi 10/1111/J.1440-172x.2010
3. Osborne-Sheets. Pre and Perinatal Massage Therapy, San Diego: Body Therapy Associates, 1998.
4. Pregnancy Massage Specialist and author of the textbook, Nurturing Massage for Pregnancy: A Practical Guide to Bodywork for the Perinatal Cycle. (Lippincott Williams and Wilkins, 2009) Leslie Stager, RN, LMT
5. ibid
6. Massage Magazine, July 31, 2015