The Real Differences Between Science-Based and Outcome-Based Massage Practice - Massage...

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I find it frustrating when massage therapists blast other massage therapists on social media about their “unscientific techniques.”


They rant about how they only use evidence-based practices to justify their choice of treatments. If others question their evidence, they cite massage research that fits their model of proof.

Take Time with Massage Research


We rarely read the research, but instead we let others interpret it for us. Sadly, massage research has been exploited and interpreted to sell products, techniques or even medication.

Research or articles are posted on social media by therapists whom we respect, and we may like the post because the title looks interesting, but we seldom take the time to read the study or article, check its sources, notice when it was written—or understand it.

Massage research is the new mantra, or religion, being used to justify and sell us on massage techniques. This often means the creators or instructors of these techniques have selected research to “prove” that their technique is science-based.

Some technique developers have even done their own research to prove their claims, which taints their research because it has created the outcome they want.

My son the scientist says, “Manipulation of research happens because it is difficult to read and interpret.” The press and companies pick and choose research-related phrases to write their story or get people to buy what they are selling.

My son cites the research on Vitamin D that was used to convince health care professionals and the public they need to take this vitamin daily. The sample of people for this study was small, and if you read all of study, it also says that Vitamin D has very little influence on the immune system—but companies and health care providers are recommending we take Vitamin D for a variety of conditions.

Those who declare their practices are evidenced-based also look for articles and other posts to declare any other techniques as “fake,” undocumented or debunked practices.

The responses to these posts are either from true believers of science-based practices or therapists who try to defend these techniques that have been effective for their clients. However, any defense is met with the comment that client outcomes are only anecdotal.

Longtime massage therapists know that bodies present symptoms for many different reasons, and that the treatments that will help the client with these symptoms are as diverse as the clients themselves.

No one technique or protocol can help every person—but when we intellectually decide to apply only what we believe are evidence-based practices, we take the client, their symptoms, and how they are responding to treatment out of the equation.

Evidence-Based Practice


Evidence-based practices do not use what the client is reporting to ask why the client is not improving. So, why are massage therapists boasting about having evidenced-based practices when their clients are not improving with their current treatment choices?

I believe this comes from massage therapists’ personal need to be accepted by the Western model of medicine. (And perhaps they want to be accepted by this model to be able to bill insurance.)

In the 1980s, Western medicine professions began to notice that more clients were seeking complementary (then called alternative) therapies.

It was determined that clients were spending millions of dollars on these treatments and less on traditional Western medicine. studies also showed that clients felt complementary treatments had helped them with their symptoms.

These complementary treatments began to be investigated. In Washington State, massage therapists have been part of the health care field since 1984. We have been able to bill insurance companies for many years.

What we have learned is the insurance company has become our boss. It dictates what part of the body we can work on. It expects our chart notes to reflect gains in decreasing pain medication and symptoms and increasing range of motion and activity.

These gains need to be steady and permanent, and even after paying us the insurance company can demand the money back because it determined the client received only palliative care.

I believe the whole concept of evidence-based treatment came from the insurance companies because they were looking for ways to not pay for treatment in all forms of health care.

The Problem with Western Medicine


The danger of evidence-based practices is that a technique and protocol is chosen based on either the client’s symptoms or physical testing. It is applied only in the area of these symptoms to be consistent with the physician referral and the rules of the insurance company that is paying for the treatment.

This is the current model of Western medicine. Even if the evaluation of the client presents other areas of the body that are contributing to their symptoms, the therapist must only apply the accepted evidence-based practice protocol.

The client may not feel any relief or feel more pain or symptoms from this treatment, but this is ignored. This leaves clients frustrated with the Western model and sometimes leaves them in a state of suffering or seeking out alternative treatments.

This Western model also creates disconnect between the client and the therapist.

When clients report feeling more pain during or after their treatment, the therapist is trained to ignore the client. The therapists are told to expect complaints from the clients but to proceed with the current protocol.

Physical therapists, for example, are paid even if the client has not improved. If the client is not better, the therapist is instructed to send them back to their physician—but the documentation of the therapist does not explore why the client has not improved.

This leaves the doctor stuck with their protocol to offer different medications or procedures or surgery as a solution for this client.

Outcome-Based Practice


Outcome-based practice focuses on the client and their outcome. (However, when we report these client outcomes we are blasted because they are anecdotal.)

Outcome-based practice also focuses on the client’s goals toward restoration during and after treatment. During treatment, the therapist must notice how the body is responding and have the flexibility and diversity of treatment choices to immediately change what they are doing.

The therapist must use the results following the treatment to think and question what they have missed and how they will proceed with treatment or how they will refer the client. It is like being a detective.

I choose outcome-based practice.

From my years of doing treatment massage for complex and chronic conditions, I have learned to do an extensive intake and let the client tell their whole story while I ask questions, write responses and ideas, set goals, and evaluate visually and physically.

This helps me choose the types of treatments to use in the first treatment.

Next, I focus on how the client’s body is responding to the treatment and change treatment accordingly. When the client returns, I want to know how their body responded to the treatment.

Then the process starts over: evaluation, focus, and flexibility to choose further treatment or refer them for treatment by another professional who is proficient in other techniques or back to their physician.

Beware Bullies


New massage research helps us to better understand the body, but is conducted by scientists who only focus on very specific elements of the body, not for the possible use of treatment.

In our search for better treatments, we must not misinterpret massage research. And what is worse, we have started an intellectual conflict to justify that a treatment we might choose is better than the choices of other massage therapists, just because it’s been the subject of research.

The big difference between evidence-based or science-based practice and outcome-based practice is how much we focus on the client.

Evidence- or science-based practice dictates what treatment and protocol we apply verses focusing on the client’s goals and response to treatment.

Some people will argue that evidence and science-based practices do focus on the client; however, don’t let these therapists bully you into feeling you are not using best practices.

Most of my clients have been through the traditional Western model and have been injured or their symptoms have increased. This is why I choose outcome-based practice.

About the Author

Taya Countryman, L.M.T., has owned an active massage practice since 1977. She specializes in complex and chronic medical conditions, and is a Structural Relief Therapy continuing education instructor. She was awarded the American Massage Therapy Association Washington Chapter’s Service to the Profession 2003 award; the Service to the Chapter 2006 award; and the Chapter Meritorious 2010 award. She is a 2013 Massage Therapy Hall of Fame inductee. She is a regular contributor to MASSAGE Magazine, and wrote “The Client Who Couldn’t Feel Pain” for the December 2018 issue.

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