Respectful Insolence

A study that oversells massage therapy

If there’s one form of so-called “complementary and alternative medicine” (CAM) that I find more tolerable than most, it’s massage therapy. The reason, of course, is that, whatever else anyone claims about massage, there’s no doubt that it feels good.

All too often, however, massage therapists ruin a perfectly good massage by imposing pseudoscientific and quack claims on it, such as claims that they are stimulating acupressure points or their adoption of the language of “energy healing.” So it was with a bit of trepidation (but also more than a bit of interest) that I took a look at some links that readers sent me about a week ago (too late, alas, for me to write about this last Monday). These links were to news stories with titles like Scientists Uncover Why Massage Heals Sore Muscles and Massage Reduces Inflammation And Promotes Growth Of New Mitochondria Following Strenuous Exercise, Study Finds. My first impression, actually, was that this was somewhat counterintuitive in that one might predict that deep kneading of muscles might actually cause a bit of inflammation and that it’s the counterirritation effect that leads to the perceived reduction in the amount of pain. Yet, according to the press release issued by McMasters University, whose contents were mirrored in many news stories, a study claiming state-of-the-art methods is concluding that massage is reducing inflammation:

Most athletes can testify to the pain-relieving, recovery-promoting effects of massage. Now there’s a scientific basis that supports booking a session with a massage therapist: On the cellular level massage reduces inflammation and promotes the growth of new mitochondria in skeletal muscle. The research, involving scientists from the Buck Institute for Research on Aging and McMaster University in Hamilton Ontario appears in the February 1st online edition of Science Translational Medicine.

The study involved the genetic analysis of muscle biopsies taken from the quadriceps of eleven young males after they had exercised to exhaustion on a stationary bicycle. One of their legs was randomly chosen to be massaged. Biopsies were taken from both legs prior to the exercise, immediately after 10 minutes of massage treatment and after a 2.5 hour period of recovery.


My first thought upon reading this press release was that this was rather interesting and I wanted to find out more. My second thought, which turned out to be correct, was that the investigators were totally overselling their preliminary results.

Unfortunately, my third thought was: Muscle biopsies? Really? Although it is possible to do a needle biopsy of the muscle, most of the time muscle biopsies are surgical procedures, and, although the description of how the muscle biopsies were done is maddeningly vague in this paper, they do not appear to have been needle biopsies, which could not have provided enough tissue to do all the tests the investigators ran. In any case, I’ve done muscle biopsies before. They involve making an incision, carrying it down to the fascia overlying the muscle, cutting into the fascia, and then taking a piece of muscle. Sure, muscle biopsies can be done under local anaesthesia, and they’re not big procedures, but they are surgical procedures, in this case, being done for no therapeutic intent on healthy volunteers. One wonders how the investigators got this study past the Institutional Review Board (IRB), because I know for sure that the IRBs at the two institutions where I’ve been on the faculty would probably have–shall we say?–challenged the investigators on their experimental design. Yet approved this study was by the McMaster University Research Ethics Board. Leaving aside the problems I have from an ethics standpoint of doing not one, not two, but five (!) unnecessary muscle biopsies on research subjects, the next question I have is whether this study actually shows what the investigators claim it shows. To do that, I went straight to the source, namely the study in Science Translational Research by Crane et al entitled Massage Therapy Attenuates Inflammatory Signaling After Exercise-Induced Muscle Damage. Here’s one of the investigators discussing the study:

When I first heard of this study, I couldn’t make up my mind whether it was good science, a fishing expedition that got lucky, or woo-omics. Then I got around to looking up the study, and I wondered if I was the only one disturbed by its design. Its big problem is that the investigators didn’t strike me as having a strong enough preclinical data base to justify doing a clinical trial in which medically unnecessary invasive procedures were carried out on healthy people and then whole genome mRNA expression profiling carried out. From my perspective, before going to doing five muscle biopsies on research subjects, there should be evidence from other less invasive (or preferably noninvasive) methods compelling enough to justify such an expensive study using invasive testing methods on humans. Yet, here is the authors’ justification:

Massage therapy is a well-known form of alternative medicine that consists of physical manipulation of muscle and connective tissue at a site of injury, inflexibility, or soreness to reduce pain and promote recovery (1, 2). Massage has been hypothesized to moderate inflammation, improve blood flow, and reduce tissue stiffness, resulting in a diminished sensation of pain. The potential benefits of massage could be useful to a broad spectrum of individuals including the elderly, those suffering from musculoskeletal injuries, and patients with chronic inflammatory conditions. About 18 million individuals undergo massage therapy annually in the United States, making it the fifth most widely used form of CAM (1). The functional benefits of massage remain contentious in humans (2-4), and experiments using massage therapy in animals may not properly mimic the human responses, limiting their usefulness. Despite several reports that long-term massage therapy reduces chronic pain and improves range of motion in clinical trials (5-7), the biological effects of massage on skeletal muscle tissue remain unclear.

After going on about various aspects of inflammation, which is what happens to muscle when it’s overworked because there are small tears in the myofibrillar structure of the muscle. So, basically, the authors’ hypothesis seems to be that massage somehow mediates inflammation and their rationale for choosing the study design they chose was that animal models may not mimic human responses, an assertion that, I note, the authors make without citing references to back it up. Is that enough to justify a clinical trial with this many muscle biopsies? I say no, but obviously the McMaster University Research Ethics Board did not agree. I also did not at all like how the authors bought into the language of “complementary and alternative medicine” (CAM), referring to massage therapy as “alternative medicine.” It is not, or, at least, it should not be considered so. The extent that massage is “alternative” depends directly on the amount of woo overlaid on it. It is, after all, physiological not implausible that manipulating muscles can do something to release cytokines or other factors that might either increase or decrease inflammation. Of course, this plausibility should have been explored in an appropriate animal model before moving straight to human studies.

There is little doubt that this particular study is the most “high tech” study ever done on massage therapy in that some fairly heavy duty genomic techniques were brought to bear on the question of what gene changes occur (1) after heavy exercise and (2) in response to massage therapy. It’s a small study (only 11 subjects), which means that there’s the potential for a lot of noise, which further means that the results had better be striking (i.e., at least a two-fold or better change in gene expression) to be suggestive or convincing. Let’s just say that they ain’t.

Now let’s take a look at the trial design itself, as shown in Figure 1 (click for full size):

i-e62932d3d335909ce91c83b01507f2da-massage figure 1-thumb-480x319-72556.jpg

As you can see, there are two visits and a total of five biopsies performed on each subject, one baseline and then two performed on each leg, before and after massage of one leg and before and after no massage on the opposite leg. Total RNA was isolated from these muscle biopsy samples, which were also subjected to additional testing, which will be discussed later. First, since it was the aspect of this study that caught my attention (and that of other scientists), I’m going to look at the results of the whole genome expression profiling. For those of you not familiar with this technique, it basically involves simultaneously measuring the levels of messenger RNAs (mRNAs) for every known gene in the genome. This is done by hybridizing the total mRNA isolated with probes designed to bind to each mRNA coded by the genome. These probes are housed on a chip, and the binding (or lack of binding) can be read by the machine. It’s all very complicated, with several probes designed for normalization, but when it’s done the results of each chip can be compared to other chips, and the results are usually reported as log2 results (i.e. “1” means a two-fold difference between control and experimental; “2” a four-fold difference, etc., with negative numbers meaning a decrease by the same factor). Ten years ago these cDNA microarrays, as they’re called, were state of the art. They aren’t now. Next generation sequencing (NGS) techniques, such as RNAseq, are, but that doesn’t mean cDNA microarrays aren’t still useful. NGS probably would have been overkill for this study–or at least prohibitively expensive.

One thing that I immediately noticed about this study is that it didn’t exactly use what is state-of-the-art analysis techniques on the data that were generated. Basically, they analyzed their data pretty much the same way I analyzed microarray data back in 2005, which was to look at single genes that had the most profound increase or decrease in expression compared to control. In this case, each subject served as his own control because these were muscle biopsies done before and after massage therapy or control intervention (i.e., no intervention). These days, more sophisticated analyses, known as network analyses, are usually done. These involve looking for groups of genes that are turned on and off in synchrony that indicate broader pathways that are being turned on and off. Single genes don’t actually mean all that much. It’s the groups of genes going up and down together as part of a pathway that truly indicate specific pathways being turned on and off. To get an idea of what these sorts of analyses look like, check out Figure 5 in this paper. Instead, what we get is a circa 2005 gene list not unlike the ones I produced (click for full size):

i-9f602b120b4c0ced6b413c632a6a3767-Table 1-thumb-480x210-72559.jpg

The first thing I noticed about this list is that it’s a short list, particularly compared to the number of genes that changed in response to exercise:

Independent of the massage treatment, the control leg muscle exhibited a change in 943 probes (representing 592 genes) at 0 hours after massage (30 min after exercise) and 2307 probes (representing 1309 genes) at 2.5 hours after massage (3 hours after exercise), significant changes that were induced by exercise alone (tables S1 and S2).

In other words, these five genes were a tiny subset of the genes altered by exercise to exhaustion. Less impressive is that none of the were particularly strongly turned on or turned off. The gene most turned on only reached a level 1.68 times control at time zero after massage and was not detectably different from control by 2.5 hours. The gene most turned off only decreased to 0.73 times control, a 27% decrease. Not impressive, at least not to me. Now, let’s see what the authors said about the identity of the genes whose mRNA levels changed:

One of the five genes whose expression was altered by massage immediately after the treatment was functionally related to actin dynamics (filamin B, b) (Table 1). One of the four genes induced by massage after recovery from treatment (2.5 hours) was related to NFκB nuclear trafficking (nucleoporin 88) (Table 1). Overall, this profile suggested that massage altered processes related to the cytoskeleton the former process being activated early after massage and the latter induced later in recovery.

I found this very questionable based on my own experience analyzing a cDNA microarray. The reason is that what I found my gene of interest to do was to decrease nuclear factor-κB (NF-κB) signaling. I’ve also done studies looking at the nuclear localization of NF-κB using confocal microscopy and NF-κB, and, quite frankly, when NF-κB is activated or turned off in my experience the changes seen in whole-genome expression profiling are not subtle and do not involve just a single gene, like nucleoporin, whose messenger RNA was elevated (but, it should be noted, whose protein was never verified to be also elevated after massage). NF-κB changes the activity of dozens of genes, and the increases are not subtle. I was looking at fold-changes that ranged from two-fold to over a hundred-fold. While it is true that I was studying cultured cells, which are an inherently less noisy system than tissue biopsies, I would have still expected to see a lot more genes altered if massage were truly impacting inflammation in general and the NF-κB signaling pathway in particular.

So how did Crane et al come to the conclusion that NF-κB was being affected? Basically, they observed that nucleoporin 88 was expressed at an increased level on the cDNA microarray. If that were truly related to NF-κB signaling in stressed muscle, we would expect that massage would increase, not decrease, NF-κB signaling because nucleoporin facilitates the entry of the NF-κB into the nucleus. Increased expression of nucleoporin 88 is associated with increased NF-κB activity, and depleting nucleoporin 88 results in decreased NF-κB signaling. Now, to be fair, the authors did follow up by measuring NF-κB level in the nucleus and found that nuclear NF-κB levels did appear to decrease at T=0 after massage but that by 2.5 hours there was no significant difference. This actually doesn’t really correlate with the changes in nucleoporin, which didn’t increase until 2.5 hours. To try to bolster their case, Crane et al also looked at heat shock proteins and saw a decrease at 2.5 hours. They also looked at another inflammatory cytokine and noted a truly unimpressive decrease that was statistically significant at 2.5 hours. Finally, they saw an even less impressive decrease in tumor necrosis factor (another inflammatory cytokine) at 0 hrs that was statistically significant but was not significant at 2.5 hr. In other words, the data are not entirely consistent, nor is the magnitude of the decrease in inflammatory factors impressive or persistent. The authors might be correct in their interpretation, but what I see more than anything else is probably either noise or a mild effect that is probably not clinically significant.

Interestingly, contrary to many of the other claims made by massage therapists, anabolic signaling and muscle metabolites, such as lactate, macroglycogen, proglycogen, and total glycogen were unaffected by massage. So much for the idea of “washing out toxins” that we sometimes hear.

Finally, the authors looked at another signaling molecule, nuclear peroxisome proliferator-activated receptor γ coactivator 1α (PGC-1α), because they found evidence that upstream signaling pathways that activates PGC-1α were turned on by massage (hmmm, I have to be more careful about how I phrase things). Sure enough PGC-1α levels were slightly increased (by maybe about 20% to my eyeballing the graphs) at 2.5 hours after massage. However, contrary to the way some news outlets reported this story, the number of mitochondria did not increase. Worse, this is a misstatement promoted by Dr. Melov himself:

Buck Institute faculty Simon Melov, PhD, was responsible for the genetic analysis of the tissue samples. “Our research showed that massage dampened the expression of inflammatory cytokines in the muscle cells and promoted biogenesis of mitochondria, which are the energy-producing units in the cells,” said Melov. He added that the pain reduction associated with massage may involve the same mechanism as those targeted by conventional anti-inflammatory drugs. “There’s general agreement that massage feels good, now we have a scientific basis for the experience,” said Melov.

Uh, not quite. This paper doesn’t show that massage promotes biogenesis of mitochondria, only that massage might–I repeat, might–increase the level of one molecule that promote the development of mitochondria by 20% at most. In fact, an actual skeptical massage therapist by the name of Paul Ingraham put it very well when he wrote:

What the authors actually reported is: “potentiated mitochondrial biogenesis signaling” and “promotes mitchondrial biogenesis.” In other words, they didn’t find more mitochondria … they found a mitochondrial growth signal. It’s the difference between finding bigger plants or just some bags of fertilizer.

Whether or not mitochondrial growth actually happens probably depends on many biological inputs, like everything else that our cells do. Inferring from one signal in a small sample that “massage increases mitochondria” is really just an enormous leap. Fortunately, the authors themselves didn’t make that leap — but lots of other people are making it.

Except that at least one of the investigators certainly is implying it very strongly–so much so that it’s a claim appearing in mainstream news articles about the study as though it were fact. As Paul also points out, the very design of this study indicates a lack of clinical insight into how massage therapy is actually used in the real world. What Crane et al were studying was acute muscle injury in response to exercise. Massage is rarely used for that, and, in fact, as he summarizes, we already know that massage has only at best modest effects on exercise recovery; i.e., there isn’t much of a clinical benefit to explain. Rather, massage tends to be used used for chronic soreness. In fact, it might well be that a vigorous massage after a workout to the point where one’s muscles are so exhausted that one can’t even pedal a bicycle anymore would actually be painful.

My quibbles about the ethics of this study aside (well, they’re more than quibbles), scientifically this is not a bad study. However, as is so often the case in CAM studies, it is in the interpretation of the results that the authors go astray. They try to make something out of a mere five genes compared to hundreds that are changed by exercise when there doesn’t appear to be much to see. They infer the wrong conclusion from the observation that nucleoporin 88 messenger RNA is elevated in muscle after massage. The correct inference would be to expect that NF-κB should be elevated after massage. Yet they found that it wasn’t but was rather decreased. Moreover, if the alterations in NF-κB signaling were significant, then there should have been a whole lot more than just a rather unremarkable change in the level of nucleoporin 88 messenger RNA. There wasn’t. The proper conclusion of this study is that there was little or no significant effect from massage, which would have been OK.

Yet that’s not what was concluded.

The authors concluded that they had found that massage was anti-inflammatory, and that that’s how it “works.” The concluded that it “promoted mitochondrial biogenesis” without any evidence for anything other than a small increase in one signaling protein that promotes mitochondrial formation. And the news media ate it up.

None of this is to say that massage is useless or that it might not have therapeutic benefit in some circumstances. What this is to say is that this study, contrary to how it’s being portrayed, is not slam-dunk evidence that massage is some sort of anti-inflammatory panacea that can replace non-steroidal anti-inflammatory drugs after exercise. Unfortunately, that’s how it was sold.

Comments

  1. #1 dt
    February 13, 2012

    “upstream signaling pathways… were turned on by massage (hmmm, I have to be more careful about how I phrase things)”

    Classic!

  2. #2 Erik
    February 13, 2012

    “the very design of this study indicates a lack of clinical insight into how massage therapy is actually used in the real world. What Crane et al were studying was acute muscle injury in response to exercise. Massage is rarely used for that, ”

    Sorry to bust your massage source, but this seems like a performance based investigation (testing until exhaustion, VO2max tests) and post exercise/recovery is mostly what elite athletes use massage for; sometimes for soreness or injury. Perhaps Paul’s insight is biased by a steady stream of sore “weekend warriors” in his clinic. No offense meant here- just want to point out the difference between general massage use and the elite athletes who may be the inspiration for this kind of study.

    Otherwise, great post. I have been eagerly waiting for someone to get their hands on this paper and talk about it.

  3. #3 Lawrence
    February 13, 2012

    I’m never quite understood (perhaps there isn’t anything to understand) how getting a good massage to relax morphed into some kind of “mystical healing process.”

  4. #4 Orac
    February 13, 2012

    @Erik

    If that’s true, then this study is actually pretty good evidence, along with the other evidence presented by Paul, that massage doesn’t work very well, if at all, for this particular indication. In any case, I took the word of a former massage therapist whom I know and who ultimately left massage therapy because he couldn’t stand the woo that had infiltrated it. Ah, well.

  5. #5 machintelligence
    February 13, 2012

    I am only moderately well versed in statistics, but when looking at hundreds or thousands of variables, isn’t it wise to set the significance level higher than .05 in order to eliminate the effects of random noise?

  6. #6 Orac
    February 13, 2012

    Yes. That’s the main problem with whole genome expression profiling. However, the mathematical algorithms used to analyze the data usually take multiple comparisons into account.

  7. #7 Ren
    February 13, 2012

    My wife and I had a couple’s massage session once. It was all fine and good until the person giving me the massage started just placing her hands over my back, not moving or, you know, massaging. I asked her if something was the matter, and she said she was balancing my energy.

    Talk about a buzz-kill.

    The rest of the time she was “balancing my energy”, I just laid there, rolling my eyes. Sometimes, or most of the time, a massage is just meant to be that, a massage. It feels good, but please don’t tell me that you’re balancing my energy or healing me through it. We know it not to be true.

  8. #8 JohnV
    February 13, 2012

    @machineintelligence

    There exist some statistical analyses developed for analyzing microarray data sets. The one I typically use, SAM (significance analysis of microarrays) takes into account your biological replicates and provides a false discovery rate which by the time the stats are done is just a little more robust p-value.

    What’s important to note, and the reason why new analysis protocols were developed, is that with a array having 20,000 transcripts (135,000 oligos) on it, a p value of 0.05 means that you might get 1000 false positives (Tusher et al, 2001).

    So you can imagine, a data set of like 10 genes with a p value of 0.05 is not the most confidence inspiring result I can envision. They did something more advanced then just a few t-tests, although I’m not familiar with the specific analyses mentioned in their paper I will assume that the reviewers were familiar enough with them to be ok with it.

  9. #9 Calli Arcale
    February 13, 2012

    Ren — if I was told she was balancing my energy, I might ask for a partial refund for the unused portion of the massage. After all, if I pay for half an hour of massage, I expect to get half an hour of massage. Then again, I’m a total wimp in person and would probably just roll my eyes and not go back.

  10. #10 Sesli Chat
    February 13, 2012

    It feels good, but please don’t tell me that you’re balancing my energy or healing me through it. We know it not to be true.

  11. #11 Sannica
    February 13, 2012

    As another quibble with the study, most of the array results that I see reported in papers and whatnot set an arbitrary threshhold of >2 or >5 -fold increase (or decrease) before they will even consider looking at a gene further, operating under the assumption that the rest is just noise. Maybe that’s just because most of my stuff is in cell culture, but it seems like a wise policy in this case, considering how extremely weak the changes are that these authors observed.
    Also, yes, there should be a crazy number of pro- or anti-inflammatory genes affected if NF-kB signalling is activated.

    On another note, I’ve been lurking for a few years on this blog – thanks for pounding out your frustrations for us, it’s been (and continues to be) educational!

  12. #12 Dangerous Bacon
    February 13, 2012

    Maybe my humble level of training explains this, but I’m confused as to why a possible increase in the number of mitochondria in muscle after massage should be taken as a positive thing.

    Is there compelling evidence that more mitochondria = less pain = faster recovery from strenuous exercise? Or could it be a sign of increased tissue damage which cells attempt to recover from by boosting their energy production?

    None of the questions Orac raises will matter in the least to athletes as a whole. When it comes to enthusiastic acceptance of woo, the gullibility of athletes has no equal. At least massage is far less likely to be harmful than the steroids, human growth hormone and handfuls of supplements that they imbibe in an attempt to gain a competitive advantage.

  13. #13 MikeMa
    February 13, 2012

    My family and my brother’s family meet often in New Hope, PA. The women & kids shop & my brother & I stop by the Chinese massage place. No healing, no expectations other than a relaxing half hour not shopping.

  14. #14 qetzal
    February 13, 2012

    I too worry about statistical significance in studies that look at this many genes. I know there are ways to adjust for that, but are they really robust enough in all situations? Especially after exercise to exhaustion, when I imagine lots of RNA levels are changing wildly.

    The control I’d like to see is this. Exercise another group of subjects to exhaustion, then randomly designate one leg as control and the other as mock. Don’t massage either leg, but look for gene expression changes in the mock leg anyway. My prediction: you’d see apparent differences between legs in a some genes, just like in the test group, even when neither leg was massaged. It might even be some of the same genes, if there’s something about their expression levels that makes them more likely to give spurious differences.

  15. #15 M
    February 13, 2012

    I was grateful to see some actual scientific study of massage. I have a twelve year old daughter with fibromyalgia, and we need real scientific research of what treatments are available whether they are called “alternative” or not. There is precious little that the conventional medical community has to offer us, other than “eat right and exercise”. What they do offer us is snake oil that costs $350/month, and makes her (and most other fibro patients) feel worse. There are so many children suffering great pain from this disease. When Stanford tried to run a trial of an off-label use of an APPROVED medication (naltrexone) in Fibromyalgia in children, after a successful trial in adults, the FDA would not approve the study. I could understand if it was a dangerous new drug, but this one is used all the time in teens at ten times the dosage.

    The FDA is rotten with corrupt influences. Scientific research is being choked and cut off at the knees. I celebrate anyone who is trying to actually do the research, even while I hope that they will incorporate your comments in future trials. But, most of all, I hope that someone, somewhere, will get a greater understanding of mitochondria, because that seems to be at the heart of the Fibromyalgia problem.

  16. #16 Denice Walter
    February 13, 2012

    While the authors may go over-board in interpretting the results, woo-meisters are apt to totally mis-read and mis-understand the study as they print or broadcast it as ‘more proof positive’ of alt med’s superiority to SBM ( and reason).

    To globally assess why woo loves massage: it involves no pharma and can be twisted into a way to balance energy ( see Ren’s above)- to liberate dammed-up chi or get the *elan vital* flowing ( perhaps when they say that they are really hinting at getting something *else* flowing, hm?)

    But there’s another woo-ful route of causality here as well: the idea that emotions can cause illness. So if you *feel* better you won’t be going about making yourself sick ( “stress causes cancer” etc). Of course, you may have heard those horrible so-called studies of “laughter being the best medicine” or suchlike ( “Anatomy of an Illness” anyone?)

    Yours truly was shanghaied into addressing/ interacting ( over a 2 year period) with a group of cancer survivors who were persuing various activities to assist in their recovery ( 2 different groups involved): while I did not formally study attitudes about CAM, there were certainly *interesting* ideas bandied about concerning massage, prayer, meditation, stress as illness-promoting, that fit right in with the woo-esphere’s standard memes ( healing power). Because these people *had* used SBM to deal with their illness, I did not cause a ruckus over the woo atmospherics, altho’ I did voice my opinions. However, I became very frustrated with the entire project and gracefully bowed out ( I was not paid but was given other valuable perks) I still get calls about this and feel slightly guilty: but I just had had enough.

  17. #17 Todd W.
    February 13, 2012

    @M

    While I understand your frustration at the lack of effective treatments for fibromyalgia, I’d hold off on going ballistic at the FDA. The drug you mention, naltrexone, is approved for alcohol dependence. It is not approved for the treatment of fibromyalgia in any population, and it carries a black box warning for potential liver damage. There are significant reasons to be wary of using the drug in a pediatric population, and, looking at ClinicalTrials.gov, it appears that the study to which you refer was halted because further testing was required before the drug could be allowed to be used in a pediatric population. My guess is that FDA did not feel that there was sufficient data to show that the drug was safe to be used in a pediatric population.

    It’s always interesting to see people castigate the FDA because drugs are not approved quickly enough, and yet throw blame their way when a drug is approved prematurely, leading to subsequent patient harm. They need to straddle a fine line between ensuring that good drugs get to patients in a timely manner while also ensuring that bad drugs don’t. The FDA has access to a lot more information than a layperson will, and often, the issue of drug approval is much more complex than we might assume.

  18. We’ve known about massage therapy and bodywork affecting gene expression for some time, born out of the study of fascia. Donald Ingber at Harvard has been talking about tensegrity and mechanotrandsduction for a good while now. The tensegrity architecture of the human body creates a kinetic link or mechanical transmission that translates to all size scales, including down to the cellular level. The integrins surrounding a cell kintetically link that cell to the entire tensegrity architecture. This cellular deformation leads to changes in cellular biochemistry and gene expression.

    I started talking about it in July of last year. http://firstofnine.wordpress.com/2011/07/16/tensegrity-got-rhythm/

    What’s clear is, we need more solid science in the massage therap field. We can do so much more than just help folks feel good. I appreciate the skeptical viewpoint.

  19. We’ve known about massage therapy and bodywork affecting gene expression for some time, born out of the study of fascia. Donald Ingber at Harvard has been talking about tensegrity and mechanotrandsduction for a good while now. The tensegrity architecture of the human body creates a kinetic link or mechanical transmission that translates to all size scales, including down to the cellular level. The integrins surrounding a cell kintetically link that cell to the entire tensegrity architecture. This cellular deformation leads to changes in cellular biochemistry and gene expression.

    I started talking about it in July of last year. http://firstofnine.wordpress.com/2011/07/16/tensegrity-got-rhythm/

    What’s clear is, we need more solid science in the massage therap field. We can do so much more than just help folks feel good. I appreciate the skeptical viewpoint.

  20. #20 Karl Withakay
    February 13, 2012

    Interesting. Is it a foregone conclusion that inflammation in this context is necessarily bad? I haven’t looked into it much, but I was under the impression that although the effects of inflammation are perceived as undesirable, in general, (non-chronic) inflammation was basically beneficial.

    Massage seems to be a practice which is really in no need of the woo, pseudoscience, and unvalidated scientific claims, but is nonetheless fairly steeped in all of it anyway.

    I have a friend who is a massage therapist and believes that manipulation of a specific area (an acupressure point) can stimulate labor, and since she doesn’t know where that point is, she won’t do any kind of massage on a woman in the third trimester of pregnancy. (I just bite my tongue and say nothing when she says this)

  21. #21 palindrom
    February 13, 2012

    If I remember correctly*, it was another Canadian, Marshall McCluhan, who famously said “The medium is the massage”.

    He later went on to a lucrative career of stepping out from behind movie posters to put pretentious windbags in their place.

    * (which I don’t)

  22. #22 Jim
    February 13, 2012

    Have you actually asked the research investigators on this study to comment on your review/ questions ? Especially about the technique and ethical questions about performing 5 biopsies per study subject ?

  23. #23 BigHeathenMike
    February 13, 2012

    As another skeptical massage therapist, I can confidently say that there are a TON of weirdy “energy” type RMTs all over the place who think reiki is real, recomment homopathy, and try to “balance” their client’s “energy”, wtf ever that means. It’s disheartening and I completely understand when a doctor or other health professional rolls their eyes when I tell them what I do.

    What is more disheartening is when one of those other health professionals try to talk me about “energy” or other woo woo because they think I’ll be sympathetic due to my job.

    I don’t have many friends in the field. Obviously. :)

  24. #24 lilady
    February 13, 2012

    @ Karl Withakay: Perhaps you could provide this link to your friend, the massage therapist, for on-line courses/Continuing Education Credits for LMTs (Licensed Massage Therapists):

    http://www.integrative-healthcare.org/programs/deep-vein-thrombosis–E412.html

    Oh look, there is a nine-page on-line manual and an on-line test for certifying a LMT’s “expertise” regarding Deep Vein Thrombosis…(“Display Certificate” available for $10 additional cost)

  25. #25 Bronze Dog
    February 13, 2012

    I remember a forum thread from my early days on the internet. A masseuse (sp?) was complaining about the atmosphere she dealt with while getting her training: There was a standardized test that involved a lot of “spiritual” bits. Passing the test was a requirement for a state-approved license or something. By itself, that’s pretty much an eye roll inducing argument from authority with First Amendment issues. When she brought up the topic at the school, she said she got a lot of guff from people there claiming that it’s not religion because The State approved of their test, which meant the school’s spiritual beliefs were factual science. It got into scarier ground when they moved the conversation into fascist-sounding ideology and rejection of the concept of individual autonomy.

    I suspected there was some exaggeration in her story, but given what I’ve seen of alties since becoming a skeptic, I’m even less confident that it was exaggerated.

  26. I myself became a massage therapist after growing up a dancer, gymnast and athlete found that receiving both relaxation and sports massage to be quite healing and restorative on a much quicker scale than co athletes that did not employ massage as part of their training. As for the spiritual side of massage therapy and energy healing well we are all made of energy and energies feed of one another, we as human are social creatures, vast studies show that infants and adults that receive regular massage thrive so much more that those that do not. In closing when a therapist is just putting his or her hands on you in any particular area, this is known as palpation the therapist is feeling where possible muscle tensions are and looking for hot, warm and cold spots; the cold spots would be the area that needs blood flow to it. The hot indicates inflammation while the warm area is in balance. This lets the therapist know which areas to work on more or areas that need less attention.

  27. #27 demandabanana
    February 13, 2012

    Re: muscle biopsies. This is actually something I know about. There are at least a few clinical studies looking at exercise and nutrition that require multiple muscle biopsies. They have full IRB, safety officers, and NIH funding. The UT-Galveston group is an example (eg http://www.ncbi.nlm.nih.gov/pubmed/21527663). If you really want to get into it, you should see the Dutch studies. I can’t find a pub right now. If I can remember the authors, I’ll post it.

    I’m curious about how your feel about it, though, Orac. Is it that biopsies are taken at all? The number? The study itself?

  28. #28 Todd W.
    February 13, 2012

    @demandabanana

    If I understand Orac correctly, the issue is that the subjects derive no direct benefit from the procedure, and that the procedure will be unlikely to result in significant advancement of medical knowledge that would be likely to benefit future patients. This is especially important if there are alternative, less invasive procedures available that can potentially provide the data the researchers want.

    An IRB generally wants to know that a) study subjects may derive some benefit from the study procedures and/or b) that the procedures are the least invasive/risky needed to get the job done.

    In this case, it could be that the number of biopsies is excessive (consider that with each biopsy, there are the risks from anesthesia, risk of infection, risk of complications, etc.) or that there may be non-invasive or less invasive means of obtaining the same information the researchers are measuring.

  29. #29 yellow
    February 13, 2012

    It is fine to take issue with this study, however, it is shameful to broaden it to a larger attack on massage therapy and to other practices that have been around much longer than western medicine. Why is it that we cannot each recognize our strengths and put them together to best serve our patients? This seems like the best practice for everyone. Closed minds close doors for our patients. If you don’t believe in energy therapy or massage therapy, that’s fine, maybe it’s not the best treatment for you. That doesn’t mean that it won’t help someone else. I don’t believe in taking an antibiotic every time my doctor can’t figure out what’s wrong with me, but that doesn’t mean I go around saying they never have any effect. There are many people who turn to massage therapy because western medicine has not provided them with answers. They are tired of downing pills that only mask their symptoms rather than get to the root of what is causing them. Why not work collaboratively to help these people? There is no reason to rule out possibilities.

    In hopes for a more collaborative future…

  30. #30 Todd W.
    February 13, 2012

    @yellow

    Not to sound cliché, here, but you know what they call alternative medicine that has been shown (scientifically) to work? Medicine.

    Here’s the problem with a lot of so-called “alternative” medicine: there is no evidence that it actually works as claimed. That means that patients may be wasting their time, money and emotion pursuing false hopes. In the best cases, that’s all they waste. In a worst case scenario, they pursue nonsense in place of conventional treatment, leading to a worsening of their condition. You may be interested in visiting What’s the Harm to get some idea of just why unproven modalities can be dangerous.

    If you think that energy medicine works, then prove it. Give us the well-designed studies showing that it works. All of us here are quite open to changing our thoughts on the subject. The main reason we have yet to accept that “energy healing” or other CAM work is because they have not yet been shown to work.

  31. #31 dreamer
    February 13, 2012

    Orac, your intro — massage has a low woo-quotient and might bring real benefits– was great to read, since that’s what my personal opinion has been. That includes the side of chiropractic that most resembles massage and dispenses with “subluxation.”

    It’s intriguing that someone is attempting to show how massage changes muscles, I’d be lost without Orac’s in depth- analysis. The media just picks up on the superficial results of a study, without analyzing the limitations/real strengths of the study methods themselves.

    But I need help with BASICS! Does anyone have a link to a basic intro in the differences between the Human Genome and the type of genetic changes Orac discusses above?

    HELP! I thought that Lamarck’s basic hypothesis has been disproven … our reproductive genes do not change as a result of exercise / exertion in a meaningful way (i.e. be transmitted to offspring). Yet there has been renewed talk about Lamarck just in the last month or so. Anyhow, so then we have these OTHER genetic changes — cancer, tumors.. do beneficial changes like our white cells “learning” to attack some cells (think Provenge) count? … I suppose these OTHER genetic changes like the ones discussed in the muscle/massage context do not affect reproducing, just like tumors do not get passed on yet they definitely change cells’ genes …

    Sorry I’m ignorant, but I never thought that exercise and inflammation/healing actually affects human genes. I get that our cells are actually clusters /collaborations of what eons ago were independent organisms, but the whole picture of which genes are “human” and which genes belong to the collaborators in our bodies eludes me. But somehow I didn’t picture inflammation as affecting “the” genes … (ok my only excuse is that if I miss basics, surely other readers might miss basics as well so I might as well ask for help!)

  32. #32 Calli Arcale
    February 13, 2012

    yellow — there is one major problem with the argument from antiquity, and it’s clear if you contemplate how different the world might be today if George Washington’s doctors hadn’t thought that since bloodletting had been done since the time of Galen and they always though it worked, they should use it on Washington. He might have survived, if not for their help.

    Orac didn’t say he doesn’t “believe” in massage therapy. Whether he does or not is immaterial; he wants what is best for his patients, and that means before he recommends something, he wants to know what a patient can expect to actually get out of it. Not just what someone believes, but what is actually true. People have believed an awful lot of things that weren’t true; it’s only by asking questions that we can find that out.

  33. #33 Erik
    February 13, 2012

    @Orac
    Yes, it seems that massage is not doing what the authors think it is. However, it is possible that massage could aid recovery in ways other than those studied here (e.g. morphologically). Maybe you can enlighten me, but the trouble I have with most massage studies is that they don’t really mimic how they are used in the sports world. Can massage affect measures of performance when used over the course of several months on athletes training 3-6 hours a day? Most of the studies I have been able to find are comprised of a few “average Joes” being exercised for a couple days. Is this really even comparable to real-world application? Although, I’m not sure you could even tease out the effects from massage from all the other factors in such a study.I am pretty skeptical of most massage claims but I’m still curious about this study design idea.

    @Dangerous Bacon
    Endurance training will increase mitochondrial density which improves performance. perhaps they are thinking that reducing the inflammation could speed up this process (although they didn’t prove either of those things, as claimed).

  34. #34 Ren
    February 13, 2012

    @Yellow

    “Western Medicine”. You keep calling it that, but I don’t think you understand. Artemisinin, an anti-malarial drug derived from a tree in China and used there as early as 200BC, has not been rejected by “western medicine”. It was tested over and over, using the scientific method, and it was found to work.

    Hippocrates used aspirin, derived from the bark of a willow tree, to relieve pains and fevers. It wasn’t rejected by “western medicine” either. It was tested over and over, using the scientific method, and it was found to work.

    And so on and so forth… Anything that you, the practitioners of “eastern medicine” (is it?), put forward as a treatment or remedy for a disease or condition will be tested over and over, using the scientific method. If it is found to work, hooray! We have a new treatment to use. If it doesn’t, we’ll focus our time and resources on other things.

    That’s the problem with energy healing or massage to balance chakrae (chakras?) and such. They have been tested, over and over, using the scientific method, and have been found to be no better than placebo. But, of course, those who stand to profit from using these “treatments” complain that everything from Big Pharma to the Government, to the Illuminati and our own Lord Draconis, have a hand in making trial after trial (randomized and otherwise) fail… And fail miserably.

    So excuse me if I have an issue with this animosity against the term “western” when it comes to medicine. The only “western” medicine I know not to work is eating rattlesnake soup to relieve symptoms of a rattlesnake bite. (True story.)

  35. #35 T.O.M.
    February 13, 2012

    yellow,
    The first problem I run into with pretty much every ‘energy’ based therapy is this: Where does the energy come from and no reasonable answer is given, most is handwaving to ‘mystical’ or ‘magical’ or ‘spiritual’ mumbo-jumbo jargon without a shred of evidence, dressing nonsense in pretty sounding words that still make no sense. (Chopra and his ‘quantum-crap’ anyone?)

    lilady
    The link you posted is awesome, my inner Teletubby had a field day there, it does have a sore throat from all the Uh-Ohs now though.

  36. #36 Science Mom
    February 13, 2012

    As for the spiritual side of massage therapy and energy healing well we are all made of energy and energies feed of one another, we as human are social creatures, vast studies show that infants and adults that receive regular massage thrive so much more that those that do not. In closing when a therapist is just putting his or her hands on you in any particular area, this is known as palpation the therapist is feeling where possible muscle tensions are and looking for hot, warm and cold spots; the cold spots would be the area that needs blood flow to it. The hot indicates inflammation while the warm area is in balance. This lets the therapist know which areas to work on more or areas that need less attention.

    Mrs. Tucker, there is no need to woo up therapeutic massage and there aren’t any valid studies demonstrating the “spiritual aspect” of massage is what makes it demonstrably beneficial for certain conditions. And that is key; massage therapy to manipulate musculature does relieve pain and is naturally going to have a helpful effect. Please don’t muck it up with bullshit energy balance and applications to conditions that massage therapy is not tested for. You want to believe a spiritual aspect to it? Fine, but don’t claim there is scientific validity to it.

  37. #37 JGC
    February 13, 2012

    Why is it that we cannot each recognize our strengths and put them together to best serve our patients?

    What strengths does alternative medicine bring to the table, exactly? To paraphrase a common trope, “strong” alternative medicine is readily identifiable (it’s seen to actually work) after which it’s simply called medicine.

  38. #38 Anton P. Nym
    February 13, 2012

    Before I get to my criticism of Mrs. Tucker’s post, I’d like to say that massage therapy does (in my highly-inexpert opinion) serve a role in health care. As Orac put it, at the very least it acts to mitigate the mental stresses of illness… and perhaps there is some circulatory stimulus from the massage that would help.

    As for the spiritual side of massage therapy and energy healing well we are all made of energy and energies feed of one another, we as human are social creatures, vast studies show that infants and adults that receive regular massage thrive so much more that those that do not.

    I agree with everything quoted above starting with “we are human”, but disagree vehemently with the part before it. We don’t need to invoke mysticism to explain why social attention (often called “grooming” when we refer to non-humans) is beneficial for social species… simple physiological mechanisms that we can observe can do the job quite well without seeking causes which we cannot.

    — Steve

  39. #39 Dangerous Bacon
    February 13, 2012

    yellow: “If you don’t believe in energy therapy or massage therapy, that’s fine, maybe it’s not the best treatment for you.”

    My idea of good medicine is stuff that works whether I believe in it or not.

    M: “I was grateful to see some actual scientific study of massage…The FDA is rotten with corrupt influences. Scientific research is being choked and cut off at the knees.”

    In this poster’s view, something is “actual scientific” research if it comes to conclusions concordant with her beliefs. It is “rotten” and “corrupt” if it doesn’t.

    Sounds like a familiar altie line: “Don’t believe the scientific establishment. Here’s a scientific study that proves it!

  40. #40 Narad
    February 13, 2012

    That’s the problem with energy healing or massage to balance chakrae (chakras?)

    Looks like the nominative, vocative, and accusative plurals are ‘chakrani’, in meatball romanization.

  41. #41 Ruth Werner
    February 13, 2012

    Thank you for this discussion– it is an important one, and I hope many MTs look at your dissection of the Crane article. That said, it isn’t massage therapists who are writing the misleading headlines. Media outlets looking for a quick attention-grabbers do that. MTs must become more discerning about the quality of the research that is referenced in these settings, certainly, but they are not responsible for having the headlines appear in major science outlets.

  42. #42 MarkH
    February 13, 2012

    Garbage in garbage out. This is why I hate microarray data and with few exceptions it really shouldn’t be the centerpiece of a paper. It should be a starting point in the lab, if anything, of intense molecular expression profiling that is confirmed with western and protein blotting and fits within a sensible scientific context.

    Without significant pre-test probability of an effect being meaningful or significant, it’s more likely that these effects are spurious than not. This is the classic “Why the majority of scientific research findings are false” stuff that Ioannidis talks about. Fishing expeditions with low pre-test odds will generate 50 false results for every true. I’d take this paper and put it in the circular file.

  43. #43 Narad
    February 13, 2012

    we are all made of energy and energies feed of[f] one another

    Define “energy.”

  44. #44 Alia
    February 13, 2012

    Don’t get me started on the topic of massage. My then husband-to-be once took some massage sessions to relieve stress. The message terapist was recommended by some friends. So far, so good. But as it turned out, the message terapist was not only message terapist but also a woo-meister, he gave my husband some herbal decoctions to drink before each massage. The result? Two weeks in hospital, infectious disease ward, because he got something that looked like stomach flu – only wasn’t. No viruses, bacteria or toxins found. The doctors there couldn’t really say what caused the illness but suspected that the “massage therapist” gave my husband something that caused electrolyte imbalance. So two weeks of vomiting, diarrhoea, drips, a month of diet – all thanks to some woo-meister who thought simple massage was not enought. And of course, don’t forget the money he charged, it was quite a lot.

  45. #45 lilady
    February 13, 2012

    @ Ren:

    “So excuse me if I have an issue with this animosity against the term “western” when it comes to medicine. The only “western” medicine I know not to work is eating rattlesnake soup to relieve symptoms of a rattlesnake bite. (True story.)”

    How about “prairie oysters” a.k.a. “Rocky Mountain Oysters” to enhance male virility?

    @ T.O.M. A Licensed Massage Therapist with a “Deep Vein Thrombosis Certification” has the ability to rule out DVTs. And, a consultation with someone credentialed in “Toothology” is a viable alternative to a consultation with a dentist.

  46. #46 MikeMa
    February 13, 2012

    @yellow,
    Minor quibble in addition to what Todd & Calli already pointed out: If you refer to science based/evidence based medicine as western medicine, you put it in opposition to eastern medicine. People most often do that when they want to use tradition in place of evidence.

  47. #47 Beamup
    February 13, 2012

    Adding to MikeMa’s comment, the supposed Eastern/Western dichotomy is also quite racist, since the implication is that “Eastern” people can’t do science.

  48. #48 Phoenix Woman
    February 13, 2012

    Muscle biopsies to test massage efficacy? Are they friggin’ nuts?

    Let’s set aside the questionable efficacy of poking holes in healthy muscle tissue for any reason but to treat an illness suffered by the owner of said muscle tissue. Are the words “post-surgical inflammation” meaningless to them?

  49. #49 Phoenix Woman
    February 13, 2012

    RE: the part of the massage where the therapist (if a woo-ee) doesn’t do anything for a few minutes —

    I suspect that’s the wooist version of what’s called a “rest hold” in professional wrestling. That’s where you get your opponent in a clinch that’s made to look intense to the punters (and is “sold” as such with the appropriate grunts and grimaces by the better class of wrestler) yet allows both you and the other wrestler to catch your breaths before moving on to the rest of the match. (Wrestling may be “fake” in that the match endings are pre-determined, but it’s not fake in terms of energy expenditure, or possibility of harm, as the long list of wrestlers who have died young shows.)

    Massage therapists typically do at least three to four one-hour (or longer) massages a day, and usually more. Dunno about you, but I’d seize on any excuse to give my hands a rest midway through — though I’d likely find another explanation for it. ;-)

  50. #50 Todd W.
    February 13, 2012

    @Phoenix Woman

    I think they’re attempting to account for that by taking a biopsy of both legs, one that received massage and one that did not. Now, there could be systemic effects of surgery/massage that could bias their results.

    My thoughts, though, were, “Getting a massage after biopsy? Umm, ouch?” But then I saw that the baseline biopsy was on a different day than the massage (which introduces another confounder, but that’s another story).

  51. #51 demandabanana
    February 13, 2012

    @Phoenix Woman and Todd W.

    But my point is that there are many ~basic~ science clinical studies that use muscle biopsies. I feel like the issue isn’t the biopsies, but the “woo-iness” of massage. While the study has some problems, I give them credit for trying to look for a biological, reality-based reason for the positive effects of massage. Muscle biopsies just aren’t uncommon among muscle biologists. I’ll concede that 5 is more than normal. It’s generally 3. That lateral leg control is unusual, and also confounding since there are likely to be systemic effects of massage.

  52. #52 dreamer
    February 13, 2012

    Can someone help me with basics? I would not have thought that either exercise, muscle tears from exertion, or massage would change genes .. how is that even possible?!

    Orac discusses RNA though, not DNA .. ?! .. also, I understand that cancers and tumors do involve DNA changes, unwanted ones (albeit not ones that can be passed to offspring?) I’m confused (lack basic knowledge) in how or what gene categories can possibly be affected by exertion, over-exertion, or massage ..”messengers” and other cell mechanisms involving many chemicals, glucose, etc, I can see . but the genes .. that sounds like Lamarkian evolution … ?!

  53. #53 PAMI
    February 13, 2012

    OK, So, I am not a scientist just a humble massage therapist most every day since 1994. I have no Woo Woo in my sessions. I am not a “healer”. All I know is that I get a massage every week and my regulars get one every week or two. Massage raises the quality of life. I believe this to be a fact. I don’t know how(maybe wish I did) But, it doesn’t matter to me as I will continue to help people one body at a time. Thank you to everyone that cares about massage.
    Your Partner in Wellness,
    PAMI
    http://www.pami.us
    p.s. I don’t believe I am alternative to anything.

  54. #54 Karl Withakay
    February 13, 2012

    @yellow

    “It is fine to take issue with this study, however, it is shameful to broaden it to a larger attack on massage therapy and to other practices that have been around much longer than western medicine”

    This is called argument from antiquity. It assumes that usage from ancient times somehow guarantees validity. Many beliefs and practices from antiquity have been shown to be invalid.

    What’s the obsession with ancient practices anyway? I prefer electricity and running water to candles and a bucket & well.

    “Closed minds close doors for our patients”

    There’s a difference between being open minded and being credulous or blindly accepting. There’s also a difference between being closed minded and forming provisional conclusions based on the best available scientific evidence.

    “If you don’t believe in energy therapy or massage therapy, that’s fine, maybe it’s not the best treatment for you. That doesn’t mean that it won’t help someone else”

    And believing in energy therapy doesn’t mean it will help anyone either. It’s probably not the best “treatment” for anyone for most things. It likely won’t make any objective difference to any aspect of anyone’s health at all. It won’t cure cancer, it won’t kill an infection, it won’t clear an obstructed artery, it won’t cure diabetes, etc.

    “I don’t believe in taking an antibiotic every time my doctor can’t figure out what’s wrong with me, but that doesn’t mean I go around saying they never have any effect.”

    Actually, if your doctor is prescribing an antibiotic any time they can’t figure out what’s wrong with you, they’re not practicing medicine correctly. If it’s not a bacterial infection (or fungal or protozoan, depending on how you define antibiotic), it shouldn’t have any objective effect. Anyway, that’s a false analogy. Antibiotics have been scientifically shown to work when used appropriately, and what’s more, the mechanism of effect are fairly well known. Energy therapy has not been scientifically shown to have any objective effect (nobody has even shown the ability to detect these energy fields under controlled conditions), and no plausible mechanism of possible action is known.

    “There are many people who turn to massage therapy because western medicine has not provided them with answers. ”

    If scientific medicine doesn’t have an answer, why must you assume someone else does have the answer? When science doesn’t have the answer for what exactly dark matter and dark energy are, I don’t look to see what the ancient Chinese or Greeks have to say about the nature of the universe to fill in the current gaps in our knowledge.

    Hey, as Kimball has said, a massage feels good, I’m just not sure it’s therapy. Lot’s of things are enjoyable and feel good and are worth doing or receiving if they don’t have significant downsides, but why must we label so many things as therapy?

    “There is no reason to rule out possibilities”

    I suppose that depends on how you define “possibilities”. If you completely disregard probability and plausibility when determining what is possible, then you may as well consult the science fiction/fantasy section of the library as much as your doctor and consider the nearly infinite number of possibilities. At some point, some things have to get ruled out. You seem to be under the impression that these things are being dismissed out of hand without consideration. The fact that the author of this post so carefully critiqued the paper in question shows he did not dismiss it without consideration.

    Adding to Beamup & MikeMa’s comments, the supposed Eastern/Western dichotomy is also racist because the implication is also that “western” people are too close minded or not enlightened enough to appreciate or understand “eastern medicine”.

  55. #55 JustaTech
    February 13, 2012

    @Dreamer: I know it sounds Lamarkian, but it’s really not. What they are looking at are not changes in what is written in the genome (DNA) but rather what parts of the genome are being used. So, what genes are being “turned on” or “turned off” (copied into mRNA or not). The mRNA/tRNA are what actually cause things to happen in the cell (make proteins, signal other genes on or off, that kind of thing.)

    So, it’s not that anyone thinks the instruction book (you genome) is being changed, but rather that the cells are reading from different parts.

    I hope that helps a little, I don’t have a good basic resource to explain it better.

  56. #56 dpryan
    February 13, 2012

    I’m too lazy at the moment, but I would imagine someone could download the microarray results from GEO and do pathway or even just GO analysis to see if some of their suppositions (e.g. “this profile suggested that massage altered processes related to the cytoskeleton”) have any statistical basis in reality.

    Also, they used Sybr green for RT-PCR? Firstly they showed some thoroughly unimpressive RT-PCR results of the two genes that they bothered to look at, but then they used the older known-less-reliable method. It’s not like TAQman kits are expensive or hard to use.

    Side note, the “statistics” section of the methods is humorous as you can tell that two separate people analyzed different parts of the experiments. The microarray results were analyzed in R, probably the token contribution of the fifth author, which is why nothing more interesting like pathway analysis was done. The remainder of the statistics were done in a software package released in 1993. I kid you not, they specifically mention using an almost 20 year old piece of statistical software. Odds are good both that something that old has serious bugs in it (or the computer used is giving off odd results due to the floating point errors that plagued some processors back then) and that anyone using it has no business doing even a simple T-test. They also suggest that sometimes data doesn’t conform to Gaussian assumptions (in which case the Wilcoxin was used), but I don’t see where in the text they mention using the Wilcoxon rather than a T-test. It’d be useful to know which datasets that applies to.

    Finally, maybe it’s because I’m originally an ion channel guy, but I hate it when people show a marginally significant change on a Western blot and assume that it’s a meaningfully/functionally significant change. I’d say that they’re lucky I wasn’t their reviewer. Though in reality I’d never agree to review something this crappy…and I’m just a post-doc.

  57. #57 MikeMa
    February 13, 2012

    @PAMI
    You seem to have a great attitude toward massage. Quality of life increases as a result of every massage I’ve ever had. Thank you and your brethren for the effort without the woo.

  58. #58 jrkrideau
    February 13, 2012

    @ 53 PAMI

    I have had many massages from an RMT or a therapist from a roughly equivalent Quèbec group whose actual name escapes me at the moment.

    No woo just a satisfactory relaxation of muscle tension and much improved, albeit temporary, flexibility in my neck, a-old injury problem.

    I had not even realised there was a woo problem in the field.

    However a quick google showed Humber Community College in Toronto with an, apparently, very sound program and the Royal Canadian College of Massage, also in Toronto apparently a bastion of 90% pure woo but promising an RMT designation at the end of the course.

    For non-Canadians the Registered Massage Therapist designation in Ontario is a protected term similar in concept to RN or Registered Dietitian though I am not sure of how rigourous the requirements are for RMT as compared to the very serious requirements for an RN or RD.

  59. #59 Todd W.
    February 13, 2012

    @demandabanana

    But my point is that there are many ~basic~ science clinical studies that use muscle biopsies.

    While that may be so, the context is very important. For example, a study looking at disorders involving muscle degeneration may call for a biopsy, while a biopsy may be inappropriate for a study looking at whether ice packs reduce recovery time following heavy exercise.

    Unfortunately, I can’t access the full paper text, let alone the protocol that the IRB reviewed, but the researchers would need to show proper justification for any procedure which is greater than no or minimal risk, which, from Orac’s description, this would be. They would need to show that the procedure would either result in direct benefit to the study participants or, barring that, that the risks of the procedure would not put the subject at increased risk and would result in an advancement of medical knowledge that would benefit future patients suffering from a particular disease, disorder or condition.

    The pertinent regulation is 45 CFR 46.111(a)(2):

    Risks to subjects are reasonable in relation to anticipated benefits, if any, to subjects, and the importance of the knowledge that may reasonably be expected to result. In evaluating risks and benefits, the IRB should consider only those risks and benefits that may result from the research (as distinguished from risks and benefits of therapies subjects would receive even if not participating in the research). The IRB should not consider possible long-range effects of applying knowledge gained in the research (for example, the possible effects of the research on public policy) as among those research risks that fall within the purview of its responsibility.

    It’s debatable whether the risks of the multiple biopsies are truly outweighed by any benefit derived from them. I can’t really adequately weigh in on the ethics, since I don’t have all the information, but based on what Orac reported regarding muscle biopsies, the IRB might have inappropriately approved the protocol.

  60. #60 Bodhi Haraldsson
    February 13, 2012

    As a massage therapist (MT) and director of a research department for a Canadian MT association I love seeing critical thinking around massage research. With out this kind of critique our research would not improve.

  61. #61 Glaxxon Terrabase DIA
    February 14, 2012

    MASSAGE BEGINS——————

    Shills and Minions,

    All this business about mitochondria is clearly nonsense. Now the effect on your midichlorians is another matter entirely. The increase in nuclear expression in the TVC-15 is also quite astonishing.

    Carry on shills and minions.

    Lord Draconis Zeneca VH7iL

    Glaxxon Cutter “Vengeful Catharsis”
    (coordinates undisclosed)

    00010111000101001011
    ——————————-MASSAGE ENDS (not happily)

  62. #62 Moderation
    February 14, 2012

    MikeMa: I suggest you check out PAMI’s website before you assume it to be a woo-free zone. The words don’t match the practice. Specifically, acupressure, reflexology, “energy work” and medicupping, which appears to be a variation on traditional “cupping” which uses a suction device instead of heating cups. And wow, the extensive list of things you can treat with medicupping. Including removing toxins, IBS, asthma, parkinsons, fibromyalgia, TMJ and cellulite, just to mention a few.

  63. #63 Dangerous Bacon
    February 14, 2012

    Speaking of overselling alternative medicine, here’s the most revoltingly credulous and unprofessional article I think I’ve ever seen, from the Hamilton-Wenham (Mass.) Chronicle:

    ht_p://www.wickedlocal.com/hamilton/features/x868512630/Beating-the-odds-Lois-Fischer-finds-success-using-alternative-medicine-to-treat-her-cancer#axzz1h4zH5YCK

    Apparently the “reporter” got the story of this patient’s odyssey through foreign clinic treatment employing such things as Laetrile, DMSO, juices, cleanses and Nicholas Gonzalez’s menu of supplements, and reports her “success” with absolutely no corroboration (of her diagnosis, treatment and current status) that I can see.

    This dreck makes Julie Deardorff look like Carl Bernstein.

  64. #64 E. B.
    February 14, 2012

    Being a skeptic AND a [state licensed] massage therapist, I cringed when I received the referenced article from my MT association. I was hopeful because it was SCIENCE as opposed to speculation. It was yet another let down, though perhaps a small step in the right direction. I strongly believe that only a fraction of MTs would even understand the study, considering it doesn’t involve rubbing crystals or glitter on the client’s body, or something equally asinine…
    We’re in dire need of scientific research — the saturation of woo in our industry is seriously hampering any progress we could be making in validating the body’s response to massage. The lack of critical thinking is maddening.

    I was fortunate enough to attend a school that was 99% woo-free (some individual instructors attempted to sneak in their own philosophies). Personally I would never make a claim that I could not provide valid references for – I’ve never mislead a client about “toxin flushing” or “energy balancing” or anything even remotely resembling metaphysics. I practice strictly based on my knowledge of human physiology. That said, in no way do I consider myself an “alternative” to traditional treatment. In fact, I refuse to work with those who do not have an established relationship with a (REAL) physician. Many of the MTs I know consider *me* the “nut-job”….well, so be it then! I’m a nut-job with a clear conscience anyway.

  65. #65 jrkrideau
    February 14, 2012

    @ 59 Todd W

    “The pertinent regulation is 45 CFR 46.111(a)(2)”

    I doubt it. In fact is is probably meaningless in the context.

    MacMaster University is not in the USA.

  66. #66 MikeMa
    February 14, 2012

    @Moderation.
    Just went by his/her words on the post. Greed and con over sense and science. Too bad.

  67. #67 Todd W.
    February 15, 2012

    @jrkrideau

    Forgot that point in all the back-and-forth. Thanks. At any rate, it is a representative example. One could also look at the Code of Nuremberg or the Belmont Report, which are internationally recognized guides to ethics in research. I’m not familiar enough with Canadian law to cite the regulations that govern human subjects research, but I’d be surprised if they did not have something similar.

  68. One of the first studies I found on massage affecting gene expression, I wrote about in December. Donal Ingber at Harvard talks about tensegrity architecture and mechanotransduction as the mechanical transmission that deformates cellular structure via the integrins surrounds the cell… so, mechanical activity on the gross translates to all size-scales in the human body, creating changes to biochemistry and gene expression down to the cellular level.

    http://firstofnine.wordpress.com/2011/12/20/tensegrity-principle-gene-expression/

  69. #69 Paul B.
    February 17, 2012

    As a massage therapist who believes that science is the best way to learn about the material world, I am glad you published this critique.

    Most of my work focuses around the work of Janet Travell and David Simons’ fabulous books on Myofascial Trigger Points, but more study about the effects of massage therapy is needed.

  70. #70 India Sanders
    February 23, 2012

    The statistics were interesting, but the basic info about massage was misleading in this article. To say that massage is not used often in injury treatment is untrue. I work full-time helping people with injuries, mostly sports related in a Chiropractic office. Lymphatic movement is the basis of swelling, and moving lymph will help in many cases of injury, pain, and inflammation. Deep tissue might further inflame an injury, so other techniques like PNF and isometric stretching would be better massage modalities. There are hundreds of studies done at the Touch Research Institute in Florida that provide scientific evidence why massage and acupuncture provided equal success with surgery in pain reduction. Why fight a non-invasive and inexpensive therapy that can be used in hospitals, clinics, offices and hospice settings?

  71. #71 Beamup
    February 23, 2012

    I work full-time … in a Chiropractic office.

    And any semblance of credibility or expertise just flies right out the window.

  72. Unknown to some that Touch Therapy or the Massage Therapy is one of best remedy in any way. It’s natural as can be. But other’s just neglect it since they say that massage is not medicinal. Yes it’s not in the scientific manner. But it still can heal.

  73. #73 Vicki
    April 26, 2012

    So, give us your evidence: if something is “one of the best remedies,” surely you can point us at the scientific studies showing that. They should include data on what is being healed, and on how massage compares to other therapies, and to doing nothing. Or is “not in the scientific manner” your way of saying “I can’t prove anything, and I’m a complete stranger selling this service, but take my word that it’s wonderful”?

  74. #74 Marc Stephens Is Insane
    April 26, 2012

    @LA Massage Therapist,

    I went to your website and noticed you offer reiki, reflexology and Cranio Sacral Therapy in addition to various massages. Which of your therapies work best on which ailments? Can you help me?

    Thank you!

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