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No Appreciable Effect? A Deeper Look

Whenever I have a presentation to make, one of my favorite aspects is digging through the research literature to learn as much as I can about the subject. There is always so much to learn about any subject I am exploring. It's why I say yes to far too many projects- it forces me to set aside time to explore and learn.

There are, however, some glaring lessons along the way. Here is one- you must look a little deeper than the title and the abstract.

No Immediate Changes on Neural and Muscular Mechanosensitivity after First Rib Manipulation in Subjects with Cervical Whiplash: A Randomized Controlled Trial

M. Pena-Salinas, J Oliva-Pascual Vaca....

For a host of reasons, the first rib can be involved in multiple pain conditions of the upper extremity and the neck. With so many of the other studies showing positive connections, this study, a randomized controlled trial, did not.

Looking more closely, what the researchers explored was a one-time thrust manipulation of the first rib and then measured any changes in neural and mechanical sensitivity. While this is easy to execute (one quick intervention- immediately measure the effect), how close is this to real clinical practice? Hopefully, not even in the ballpark. Even though we, as massage therapists, don’t do thrust manipulations, I can’t imagine many practitioners that think that one manipulation is going to make any significant clinical difference. It would be akin to having a subject select a salad for lunch instead of a burger and then immediately having them jump on a scale to check for weight loss.

When looking at any study, consider several variables. What was done? Is the protocol described in detail? Just because that approach didn’t work, it doesn’t mean massage cannot be helpful. (That key didn’t unlock the door, therefore keys don’t unlock doors!) For how long was the session? Duration makes a difference. How often? (Hopefully more than once!) Who did the work? (In many early studies in massage, massage therapists were seldom the ones doing the work). Thankfully, that is changing.

Lastly, just like one session is unlikely to show any real appreciable clinical difference, the same might be said for studies in general. One study showing {fill in the blank} is just one study. We need a multitude of studies in any area to glean any real insight. The massage therapy research literature is clearly growing, but there is a long way to go. That’s why organizations like the Massage Therapy Foundation and the International Journal of Therapeutic Massage and Bodywork are so important and deserve our support.

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