blog post #399
Last Friday, June 15, Anatomy in Motion published this infographic, which quickly went a little viral with hundreds of likes and shares, as infographics do. (Click to embiggen.)
Comments were overwhelmingly positive, of course. Typical examples (with typical grammar and spelling):
Unsurprisingly, there are almost no comments questioning or challenging anything about the image. Julie Onofrio chimes in with the only genuine criticism so far: “a few of the things on there are not correct — massage has not been proven to increase endorphins or decrease cortisol.” Agreed: those are common scientific myths about massage.
Another commenter, Todd Bender, complains that the infographic makes massage sound too much like an “indulgence” and not enough like “health care.” It’s clear that he wants to make grander claims for massage, regardless of the evidence. Irony fail! If there was stronger evidence to cherry-pick in service of promoting massage as medicine, it would have ended up on this infographic.
Reader and colleague Tony Ingram, who writes the excellent therapy/dance Blog BBoy Science, gave me a heads up about the infographic and asked, “What do you think of this? Exaggerated claims, or about right?” My reply…
Yes, certainly it is a bit exaggerated.
It could be a lot worse — hey, at least it’s got references! But it could be a lot better. Citing single cherry-picked studies to support broad treatment claims is weak sauce, even if the picks are good (and clearly not all of these are). The evidence and claims here that are stronger are also less important … and those that are more clinically important are also less sound.
Example of strong-but-unimportant: it’s highly plausible and fairly confirmed that massage is relaxing, but paying $1+/min for relaxation is luxury wellness care, not “medicine.” Of course relaxation is a good thing and has some value, but it’s also disingenuous to pitch it as “health care.”
The constipation claim is another good example of something that’s probably as clinically trivial as it is certain. Who the hell thinks, “I haven’t had a crap in days: I guess I’d better buy a professional massage!” (I might rub my own belly.) In ten years working as an RMT, I think I did that kind of abdominal massage maybe a half dozen times — demand for the service was rather low. I’ve been writing about the science of massage even longer, and this is literally the first time the word “constipation” has ever appeared on this website — because who cares?
Perspective, people, perspective!
Flipping it the other way, there’s a particularly obvious example of an important-but-weakly-supported claim: boosting “athletic performance.”
No question: actually boosting performance would be a big deal, a humungous deal! But the cited evidence doesn’t remotely substantiate such a mighty claim. Even if we take that evidence at face value, it’s a huge and oversimplified reach to conclude that “a little increased range of motion” constitutes a meaningful effect on athletic performance as a whole. I can increase my ROM with a few seconds of stretching, too … and stretching does not enhance performance (look it up).
Now, think back to Caterina Caravello’s comment above, asserting that massage is a “necessity” for athletic performance. What would all the athletes who win medals without massage make of that?
So obviously (duh) this infographic was designed to score medical credibility points for massage, and research was cherry-picked to support that goal, and there wasn’t any chance that any discouraging words or science was going to make the cut! But it will get applause from almost everyone who sees it, because people love to love massage, because massage is a lovely experience for all kinds of reasons.
But whether or not it massage is good medicine is still an open question, and this infographic is really just a bit of mild-mannered propaganda. And amatereurish boosterism never does a profession any favours. Paying lip service to science for promotional purposes cheapens it and impedes progress and understanding.
If you want to actually understand massage science, start with my article — Does Massage Therapy Work? — and then graduate to this book, Massage therapy: Integrating Research And Practice.
There are also 247 more articles and eight big tutorials on the website, plus dozens more timely updates and “posts.” See the complete categorized index, or get some reading recommendations for patients or professionals.