From the MTF
Highlighting CIM in Massage Therapy Research conference....
On May 12th through the 15th, the Massage Therapy Foundation held their second Highlighting Research in Complementary and Integrative Medicine conference.
Leaders in research, in practice, as well as many from our professional organizations, all came to a sunny Seattle, WA to take part in a truly excellent event.
The theme of the event was "translational research" - a name for research focused on the challenge of changing clinical practice based on more laboratory-centered work, and vice versa.
Crossing a broad range of disciplines, the conference helped attendees connect the dots between basic science, whole-body outcomes, practice & community-based research, and public health.
Presentations and discussions in each of these areas focused on the need to make those connections more often to create research that makes a difference in the real world.
And every session of the event was directly tied to massage therapy!
I was able to take myself to the conference to enrich my own practice and development, and also to enjoy sharing it with you.
You could not ask for a more impressive lineup of presenters and attendees, while still keeping the fun and friendly atmosphere of an event full of massage therapists.
Therapists with many years of experience (1 to at least 25) sat next to organization heads (at least 10) sitting next to the leading researchers touching massage therapy......
The evening of Wednesday the 12th featured a hosted presentation of video from the Amsterdam Fascia Research Conference last year.
Then, after welcoming remarks by the Foundation, the conference began Thursday morning in earnest.
We began straight away with one of the best-known researchers in basic science and manual therapies in the US.
Dr. Helene Langevin has been investigating possible mechanisms of action of manual therapy and acupuncture for several years at the University of Vermont.
She has focused on connective tissue at both the tissue and cellular level, and how external forces could lead to the effects we see in clinical practice.
This is an area of work that is difficult to make progress in, and it is not glamorous or popular in many research communities. The efforts of her lab are extremely valuable. The creative avenues she and her team develop and pursue are helping to lead the way in basic science that contributes to our field.
She shared some of their latest work that suggests how the living cells in connective tissue might make possible the softening and lengthening we see in practice - changes that are difficult to explain in a tissue that is strong and stable left to itself.
Dr. Daniel Cherkin followed to share his work designing and analyzing studies of the use of massage therapy. For more than 20 years, Dr. Cherkin has been a part of teams evaluating the use of complementary and alternative treatments.
He reviewed some of the findings they have developed regarding back and neck pain across that time.
They have learned a great deal about the challenges of developing research around providing massage therapy.
The challenges of defining - and implementing - a consistent massage therapy program are great just by themselves.
But even more challenging may be identifying and measuring the separate influences of touch itself, physical changes, and the patient-therapist relationship. All of them are probably very important. Some of the evidence from Dr. Cherkin's teams suggests the physical details are less important. Other researchers and practitioners may disagree.
In light of these complexities, we learned to continue to be skeptical consumers and practitioners of research. There is so much that we don't know yet.
A panel discussion followed where we discussed the role of massage therapy as a health profession and as a part of the public health system.
For many of us, including myself, this was a new idea.
Are we a part of a larger health system? Do individual therapists or clinics play a role in public health?
Are we really a profession, in the sense of a group in the world of health care, in the first place?
The panel articulated that by many definitions, we are a profession.
And as such, it is difficult to argue that we are not part of a larger public health system.
Should individual therapists or clinics more consciously play a role in public health? If, for example, obesity or heart disease is a primary concern of our public health system, should massage therapists collaborate with other agencies and take action? For example, should they look for opportunities to discuss body composition or blood pressure with every patient?
These are very interesting questions our profession could consider together.
On Thursday afternoon, we had a choice of breakout sessions and I attended the one named "Massage Therapy in Collaboration with Other Health Care Systems".
We were treated to five presentations by clinicians and researchers on their work.
Some of them worked in the labor academic office, some in the clinic.
We were shown an attempt to use an unusual instrument to try to develop new ways to measure how a body changes with massage therapy.
We heard a fascinating study of trying to implement a new massage therapy program in a women's substance abuse clinic. We learned about the challenges of that environment. We learned about what it takes to implement practice-based research with other teams, where you must give up some control and adapt to the situation. And we learned about a place where massage therapy had a positive impact.
We learned about the challenges of defining our profession when many of us have vastly different ideas of what we do.
We learned about trying to answer that challenge with a functional model of health problems and health solutions, using the WHO's already-available model.
And, in my favorite presentation, we learned about a program to train a family caregiver to use massage therapy at home with their loved-one with cancer. A small team developed a safe training program to empower caregivers at home to make a difference. This adds the benefit of regular massage therapy to the patient - and gives the spouse or other family member a way to contribute rather than feeling powerless when they most want to help.
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Friday morning began again with plenary sessions.
Dr. Christine Goertz came to us from the Palmer College of Chiropractic, where she is the Vice Chancellor of Research and Health Policy.
She shared more with us about where the scientific community is as a whole with translational research.
We talked more about the value of bridging the gap between laboratory-based work and clinical practice. And we talked about how research as a whole has and has not valued pursuing such translational work.
Basic research has indeed been a priority for a long time. This has included being the focus of the funding sources for research, including the NIH.
But the interest in translational work in the NIH and elsewhere is rapidly growing.
Now is the time to get involved in adding the real-world value of knowledge from clinical practice. She encourages working with the plans from NIH to support more translational and clinical research.
Julie Ann Day, a physical therapist from Italy, shared past and present research on Luigi Stecco's biomechanical model of the human fascial system.
His work contributed to the fascial models of musculoskeletal gaining increasing favor today.
For many years he has advocated a greater role of connective tissue in motor control.
His work is an excellent example of translational research. He used observations from his clinical practice to suggest anatomical research, and then information from anatomical research on animals furthered his theories and he used those theories in his practice.
A panel discussion followed where a striking group of leaders in the field shared their experience in translational research.
Leon Chaitow, Glenn Hymel, Geoffrey Bove, Daniel Cherkin, Willem Fourie, Helene Langevin, and Cynthia Price were assembled together for us.
They reminded us how much we have to contribute to research as the practitioners on the ground.
They reminded us of the challenges of designing research around procedural treatments like massage therapy.
And they reminded us how much we have to learn from others when we take the time to reach out and collaborate and find new information.
For my Friday afternoon breakout, I chose the session named "Massage Therapy in Hospital Settings/Acute Care".
We had a heart-warming afternoon hearing the success of several groups in large hospitals demonstrating the benefits of massage therapy.
The presenters shared research from the University of Virginia, the Mayo Clinic in Minnesota, from a set of several locations in Canada, and from Flagstaff Medical Center in Arizona.
All of them focused on adding massage therapy as a treatment to improve the quality of life of their patients. Most focused on pain or stress or anxiety, or simply looked for what value patients might report from it.
All of them reported patients improving (although in some cases not dramatically).
These groups are leading a trend of demonstrating the value of hospital- and clinic-based massage therapy. This promises to increase the opportunities for all of us.
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Saturday morning brought our last time together.
We spent the whole morning in plenary sessions hearing about new directions and getting ideas to challenge ourselves to keep learning.
The National Center for Complementary and Alternative Medicine, "NCCAM", is an NIH Center and the largest source of funding for research targeting CIM topics.
Dr. Josephine Briggs is the current head of NCCAM, and she came to speak to us about their current plans.
Dr. Briggs was happy to join us, because the NCCAM is recommitting to a focus on translational research.
The NCCAM was founded with a focus on clinical and translational research. This made sense because the public is already using the therapies, and the outcomes of their use are what we need to learn about right now. That is in contrast to developing new therapies from the ground up.
But the Center quickly became stuck in the standard practices of the NIH and spent most of its money on basic science.
Dr. Briggs and others are eager to return to the founding goals and make clinical and translational research a priority.
The MTBOK group also spoke briefly to encourage us to stay involved in their work.
Their first edition is now final, but the Body of Knowledge is not.
We should get involved and voice our thoughts on next steps for how to help it evolve, and what to do with it.
The Best Practices/Guidelines group also shared that they are moving forward. After more than a year of planning, they were finally able to hold their first intense working group on guidelines for back pain.
This group looks well organized, well led, and promises to offer a vital contribution to the profession.
Well-made guidelines for a condition such as back pain are something we can share with other health care providers to greatly improve collaboration.
Willem Fourie, a physical therapist from South Africa, gave a striking presentation on the process of mastectomy surgery, and how it correlates to symptoms we would see in a patient following the surgery. A very engaging speaker, Willem motivated us to learn more about the work of other caregivers because of the impact it has on our own work. The more we are able to collaborate and learn more from other providers and researchers, the more we can make each other more successful.
And finally, Whitney Lowe gave his suggestions for knowledge translation.
He reminded us how dynamic the knowledge of any field really is.
As time passes, when we all seek out and stay open to new ideas, the profession has a way to grow.
He suggested how we can enhance our own knowledge-gathering ability, and how teachers should make understanding research - at least for your own professional improvement - a priority for their students.