January 18th: The Debut Session of the Massage Therapy Journal Club

Wednesday, January 18th 2017 at 6:30 EST / 3:30 PST will be the debut session of the Massage Therapy Journal Club. This is a new project which will attempt to present a seminar-style journal club on the internet.

I, along with seven participants from the massage therapy profession, will get together using Google Hangouts to discuss the seminal massage therapy research article entitled “Massage Therapy Effects” by Tiffany Field.  Our discussion will be broadcast live on my YouTube channel, and will also be posted for later viewing. The planned duration for the session is 90m.

I am in the process of creating the structure to have these regularly, with each session having a new set of participants and focusing on a different article. This first session is the real deal, but it is also going to be a test of the format. I plan to use what I learn from this session to tailor things going forward.  I can admit that I am both excited and a little nervous.

I prepared an outline from the article that will help me in hosting the session, but I expect the most important input, questions, and perspective will come from my esteemed participants. Nevertheless, I present the outline below in case it is of interest.

I hope you will either join us live, or view the session after it is completed.  I also hope that you may join us for one or more of the sessions I am planning for the future.


Field, T. (1998). Massage therapy effects. American Psychologist, 53, 1270-1281


Currently the most-cited massage therapy research article (506 citations in Google Scholar)

One of the earliest massage therapy research articles to appear in a major journal

Article type = narrative review

Article appeared when I was a college senior preparing for graduate school

Why choose this article to kick off the Journal Club?


Brief history of massage

Growing popularity is asserted and (casually) linked to the “alternative medicine movement”

Scant research – Medline database search yields only 200 articles across prior 30 years

That research suffers from “classic methodological problems” (p. 1270)

Few clinical trials

Studies often lack control groups, instead rely on within-group design

Studies often fail to use random assignment

Samples/groups often very small

Massage often part of a combination treatment

Failure to account for initial ‘level’ of symptom or clinical variable

“The use of inappropriate statistics” (p. 1270)

Likely publication bias in existing body of studies (positive results published, negative results go unpublished)

Asserts that these shortcomings motivated the Touch Research Institute (TRI) research program

TRI studies always used “deep tissue manipulation” (p. 1270) based on presumption that pressure receptors must be stimulated for there to be clinical effect

Effects organized into five categories: facilitating growth; reducing pain; increasing alertness; diminishing stress, anxiety, and depression; and enhancing immune function

Enhancing growth

Schanberg & colleagues finding that rat pups grow in response to stimulation that resembles mother rat’s licking, pinching, and carrying behaviors; results suggest a touch-growth relationship

Studies by Meaney et al. suggest handling modulates impact of the stress hormone cortisol

Weight gain in infants in response to massage across several studies

Hospital cost savings of $10,000 per premature infant

Norepinephrine and epinephrine levels increased compared with controls

Better performance on infant behavior assessment scale

Similar pattern of results reported for cocaine-exposed infants, HIV-exposed infants, and full-term infants

Pregnant women who received massage reported lower anxiety and depression, had lower stress hormone (cortisol, norepinephrine) levels, less pain, and fewer complications

Pain reduction

Positive results reported for childbirth labor, burn treatment, postoperative pain, juvenile rheumatoid arthritis, fibromyalgia, lower back pain, and migraine headache

Three ‘models’ for this set of effects are offered:

Gate theory, briefly explained as having a stimulus that competes with and overrides or interrupts a ‘pain stimulus’ (nociception)

Increase of the neurotransmitter serotonin, which may inhibit nociception

Promotion of sleep, because persons deprived of sleep show increased propensity for pain, possibly due to decreased somatostatin and increased substance P

Reduction of neuromuscular problems

Positive outcomes for multiple sclerosis

Positive outcomes for spinal cord injury

Enhancing attentiveness

Positive outcomes for autism

Positive outcomes for attention-deficit hyperactivity disorder

Enhanced alertness and better performance on a math task in medical school faculty and staff who received workplace massage – EEG patterns associated with this are mentioned but not detailed

Alleviation of stress, depression, and anxiety

Positive outcomes reported for/with:

Post-traumatic stress disorder

Child and adolescent psychiatric patients

Adolescent women with eating disorders

Chronic fatigue

Depressed elderly volunteers who massaged infants

Models offered for alleviation of stress, anxiety, and depression:

“Depressed mood was decreased, and anxiety levels and stress hormones (norepinephrine, epinephrine, cortisol) were reduced in all of the above studies” (p. 1276)

EEG shift

Increase in vagal activity: “The nucleus-ambiguous branch of the vagus (the “smart” vagus) stimulates facial expressions and vocalizations, which contribute to less depressed affect” (p. 1277)

Cardiovascular symptoms of stress – this section briefly highlights some findings that massage appears to lower blood pressure

Autoimmune disorders

Because vagal activity and insulin levels may be linked, a study of massage therapy for diabetic children was warranted

Anxiety and depressed mood lowered

Parents’ assessment of insulin and food regulation is improved

Children’s glucose levels decreased

Asthmatic children showed general (anxiety, mood) and specific (pulmonary measures) improvements in response to massage

Immune disorders

“Immune disorders might be expected to benefit from massage therapy because of the decrease in cortisol levels noted in several previous studies” (p. 1277)

Positive results reported for HIV+ men, and for women with breast cancer, are reported


In addition to condition-specific effects, “across studies, decreases were noted in anxiety, depression, stress hormones (cortisol), and catecholamines” (p. 1278)

“Increased parasympathetic activity may be the underlying activity for these changes” (p. 1278)

Asserts that pressure is critical (possibly to activate vagus) and that light stroking is “generally aversive” (p. 1278)

Among future directions: Are any particular massage therapy techniques more effective than others?

In relation to massage therapy effects in healthy individuals, some discussion of sports/athletic massage

A “mixed-results literature” (p. 1278)

Some discussion of whether massage should be expected to diminish inflammation, or not, with no clear consensus

Some discussion of mechanical vibration as a therapeutic intervention and whether massage therapy parallels this

Some discussion of effect of massage on blood flow

“In summary, these questions highlight the need for further research”

“There will need to be a shift in the social-political attitude toward touch [for massage therapy to be more widely used and benefitted from]”

“A larger body of methodologically sound research is needed”


Keynote speech at 2017 RMTAO Education Conference

I am pleased to announce that I have been invited to give a keynote speech at the Registered Massage Therapists Association of Ontario’s 2017 Education Conference. Here is the brief description:


Challenges in Massage Therapy Research

Christopher A. Moyer, Ph.D.

To conduct scientific research that examines massage therapy, and which has the potential to inform practice, is challenging. Of course, many of the challenges that are encountered when conducting massage therapy research are ones that also arise in other areas of clinical research (e.g., How does one get funding to conduct a study? Does a controlled study ever truly capture what happens in the real world?). At the same time, there are also challenges that are unique to conducting massage therapy research that relate to the culture of the profession and to the institutions that guide, oversee, and support scientific research. Using examples from his own scientific career, Dr. Moyer will outline these challenges in detail and offer his perspective on how they can be addressed to advance massage therapy research and practice.

Help me kick off the Online MT Journal Club

UPDATE:  It looks like we have a full roster for each of the first two sessions on 1/18 and 1/25.  But the plan is to keep doing these, so if this project interests you and you would like to stay informed – including opportunities to participate in one of those future sessions – send me an email at christopher.a.moyer@gmail.com and I will add you to the mailing list I am in the process of creating.  Also, if the Wednesday 3:30 PST / 6:30 EST does not work for you, please know that I plan on adding some variety to the schedule to accommodate as many people as possible.  -CM


Are you a massage therapist, massage therapy student, or massage therapy instructor with an interest in science and in massage therapy research?  If so you may be interested in a new project I am launching, including the opportunity to be involved with it from the very beginning.

The aim of the project is to create an online Journal Club focused on massage therapy research.  There is no requirement or expectation that participants will be researchers themselves or have specific scientific training or experience – all that is needed is an interest in massage therapy along with an open and interested perspective toward science.

The Journal Club will take place online, live and in real time, using Google Hangouts and will be modeled on a “seminar” college classroom format intended to foster discussion among a small number of students.  Each session, scheduled for 90m, will be led by myself and include five to eight participants.  The host and participants will prepare by carefully reading the specific assigned article and considering issues and questions that they would like to potentially bring to the discussion.  The host, who will provide an outline of the article, will use the first 15-20m of the session to provide some perspective on the article and offer some considerations for the discussion to follow.  The remainder of the session will give participants the opportunity to put forth their questions, perspectives, and viewpoints.

Each session will be broadcast on Google Hangouts, so that nonparticipant spectators can observe and learn from the session on the internet as it takes place.  In addition, each session will be recorded and uploaded to a dedicated YouTube channel for later viewing by anyone.  If the project succeeds it will steadily create an archive of sessions that examines and reviews the most important massage therapy research articles.

I am organizing two sessions of the Journal Club in January.  The aim of these first two sessions is to have successful Journal Club sessions, but also to test the format, timing, and technology for the project going forward.  Eventually, if this project is successful, active participation will require a modest registration fee, but because these first two sessions will serve as a test of the project participation in these sessions is being offered for free.  If you are interested in this project and able to commit to participating at one of the following times (which includes a careful reading of the assigned article ahead of the session, of course), I would love for you to be involved.  I currently have several openings for both of the following sessions.

The first session will take place on Wednesday evening January 18th at 3:30 PST / 4:30 MST / 5:30 CST /6:30 EST and will focus on the 1998 American Psychologist article by Tiffany Field entitled “Massage Therapy Effects.”  This is one of the most important and highly-cited articles in the massage therapy research literature and a critical examination of it, and how it has influenced the field across the last 18 years, is sure to be interesting.  There is no need for you to track down the article – you can download it here.

The second session will take place on Wednesday evening January 25th at 3:30 PST / 4:30 MST / 5:30 CST /6:30 EST and will focus on the 2013 article in The Journal of Manual and Manipulative Therapy by Albert Moraska and Clint Chandler entitled “Changes in Clinical Parameters in Patients with Tension-Type Headache Following Massage Therapy: A Pilot Study.”  Treatment of headache with massage therapy could have great clinical value, but also presents unique challenges to researchers, all of which is sure to lead to interesting discussion.  Again, here is no need for you to track down the article – you can download it here.

The only requirements are that you 1) have an interest in the project and in massage therapy research; 2) have a reliable internet connection and are able to use Google Hangouts to log in; 3) can commit to logging in a few minutes ahead of the scheduled start time and staying with the session for its scheduled 90m duration; 4) can commit to giving the assigned article a careful reading and to bringing one or more of your own questions, viewpoints, or perspectives to the discussion.

Interested?  I hope that you are.  Please let me know if you would like to reserve one of the participant slots for one of these first two sessions.  Finally, if you have any questions about Journal Club, my plans for it, or any of the details, be sure to let me know.  You can email me at christopher.a.moyer@gmail.com .  I look forward to hearing from you.


Christopher Moyer, Ph.D.

2017 Goals

This blog, and many of my projects and ideas, have languished in 2016.  I hope to soon write another post about 2016 and some of the events and circumstances that contributed to this, but presently I think it is more timely and important to make public my goals for 2017.  I’ve tried to be ambitious in generating this set of goals, and it is possible I will not accomplish them all.  But, as someone I admire recently tweeted, “it feels better to miss a tough goal than to reach an easy one.”

  1. I am going to launch an online journal club. I plan to test the idea in January with the goal of fully launching it in February. I will be providing more information on this in a separate post soon.
  2. I am going to submit four research articles to scientific journals.  I think this is a high number but I resisted the urge to dial that number back.
  3. I am going to publish an article in a popular press magazine.
  4. I am going to self-publish a book on Amazon.  It may be a book having something to do with massage therapy research and education, or it may be something entirely different.  I have at least two good ideas and probably cannot do them both, so I will decide later.
  5. I am going to give three in-person talks.  These are already in my schedule.  In February I will be part of a panel at the San Diego Pain Summit focused on Psychosocial Influences on Pain and Its Treatment.  The panel, which I organized, will also feature Leonie Koban and Beth Darnall and will be moderated by Jeffrey Mogil.  On March 31st I will give a talk on Massage, Anxiety, and the Autonomic Nervous System at the Registered Massage Therapists Association of British Columbia‘s symposium focused on Mental Health and the Body.  And in June I will give a talk at the Registered Massage Therapists Association of Ontario‘s 2017 Education Conference, for which I will provide additional information soon.
  6. I am going to submit a proposal to the Massage Therapy Foundation’s 2017 Research Grant competition.
  7. I am going to make substantive posts to this blog on a biweekly schedule.
  8. I am going to establish contact with a specific charitable organization that may have an interest in massage therapy research.
  9. I am going to establish contact with a specific business organization that may have an interest in massage therapy research.
  10. I am going to make a more systematic effort to stay informed of academic job opportunities here in the Denver region.
  11. I am going to strengthen my network connections with my colleagues in psychology.
  12. I am going to complete a Coursera online course related to computer programming.
  13. Finally, I am going to try to obtain some peer mentoring in support of achieving these goals.  I have a specific person in mind whom I think would be ideal for this and I am hopeful that they might consider doing this in trade for… well, I am not exactly sure.  But I am going to ask them.

Happy New Year.


Interviewed: Rajam Roose, massage therapist and founder of the San Diego Pain Summit

This is the fourth installment of an occasional interview series with notable people in massage therapy practice, education, research, and related fields.

Rajam business

Rajam Roose is an adventurer, author, massage therapist, business consultant, and the founder of the San Diego Pain Summit. With the 2016 edition of the San Diego Pain Summit about to happen in just a couple months (you are going, right?) I thought this would a perfect opportunity for us to learn a bit more about her.


Christopher Moyer:  How did you first get connected with massage therapy?

Rajam Roose:  That’s a long story. As a kid, I would maybe see massage represented on television or in a movie as something wealthy people indulged in while on vacation. It wasn’t something I considered as a career choice while I was growing up in North Alabama in the 1970s and 80s. Later, in 1993, I gave away my belongings and ‘hit the road’ for several years. In the winter, if I was in the U.S., I would camp out in Key West, Florida, where it was warm. While there I met a massage therapist from Virginia Beach who was vacationing with his wife. He gave me a full-body massage and told me how he had gone to massage school and such. I was surprised that there was actually a school one could attend to learn how to massage! At the time I didn’t think much of it except how interesting it was that someone could make a living doing massage and that there were actual educational requirements.

Several years later, I was hitchhiking around Venezuela with my dog and looking for a travel companion with whom I could explore the rest of South America and the world. I had almost no money, and what little I made came from selling crochet hats and bags that I made by hand. That was very difficult in Venezuela, as everyone assumed that I must be wealthy because I was white. People admired my handiwork, but thought I was standing out there on the sidewalk as a joke. Getting a job was nearly impossible. I walked into several hotels to ask for a job cleaning rooms and was laughed at. They couldn’t believe that a white woman wanted a job doing manual labor, which was really frustrating. Finally, I moved in with a woman who fed me and allowed me to sleep on her porch; in return, I did cleaning and helped take care of her kids. I had been considering trying to get a sailboat and it was then that I realized I wasn’t going to get a sailboat unless I had some sort of ‘real job.’ I didn’t find a travel companion, so when my visa expired, I returned to the U.S.

I returned to the States and my mom was adamant that I get some sort of training for a job. After living outside of society for almost five years, I found I wasn’t interested in working unless it was something I could put my heart into and be of some use to society. Also, I still wanted a sailboat to help me continue and extend my travels. I remembered the fellow from Virginia Beach and thought that massage would be my best choice. Not only did I have decades of experience working with my hands, from designing and building cabins as a teenager to creating fiber and stone arts in my early twenties, but I also had years of experience learning about using plants as medicine. So the idea of healing arts combined with manual labor seemed like it would be a great fit for me.

My mom wasn’t happy about my choice, but she conceded. A nurse from the local hospital recommended a massage school in Nashville and I remember I had to submit a paper describing why I was interested in massage. Upon acceptance, I had to have an in-person interview with the owner of the school. I passed that bit as well and then moved to Nashville where I worked full-time as wait staff in various restaurants and cleaning hotel rooms while also going to school full time for the two-year program. The school had a good base-level education. I was required to pass Kinesiology, Anatomy & Physiology, Pathology, and Pharmacology before being allowed to begin any hands-on work. Most of my classmates were nurses and there was even a heart surgeon enrolled in the program.

CM:  And you went into practice after that?

RR:  After I graduated in 1999, I moved back to Alabama to work. I had looked around in Nashville at some promising massage jobs but was tired of living there and felt like there would probably be less competition in a smaller city. In Alabama, I worked part time as a massage therapist and also part time as a grocery stock clerk. After about five months, I found another part time job in massage, so I quit the grocery store job and began working two part time massage jobs. Within a year, I was booked in both places and felt confident that I could support myself with this work.

However, something interesting happened. I began to lose my interest in purchasing a sailboat and instead became increasingly interested in the massage work itself. I realized that if I wanted to make a difference, I would have to be a part of society. I couldn’t make any kind of change living from the outside. I also realized that massage was helping me develop compassion for other people. Until then I generally felt that people were idiots, but I began to  realize that if I was going to have a job I ought to have one that would help me work on the worst parts of my own character.

I didn’t plan on starting my own business; that happened by accident when both places where I was working shut down at almost the same time. I was unable to find work and was griping about this to my new boyfriend (now my husband), and he offered to help me get a loan to open my own office. That was really touching because my own mother wouldn’t cosign a loan for me, but here was this guy I’d been dating for two months who offered to do it on his own. We went to my credit union and took out a $2000 loan. From there my business grew and did well until I had to close it to move to San Diego where I started another massage therapy business.

CM:  Interesting.  How did you like it, and how long did you pursue that as your main occupation?

RR:  I really enjoyed it. It combined several of my passions, which included creating things with my hands and learning about plant medicine. I also enjoyed massage because I felt that it helped me learn how to be less judgmental of people. In my youth I could be quick to judge people harshly, but as I got a little older I realized that was maybe not so healthy. If I was going to work at something for a while, I felt it should be something that contributed to my own self-improvement, and massage did that.

Later, as my career developed, I enjoyed massage because of the changes I saw in my regular clients. I was observing how people initially came in looking ‘pinched’ and stressed-out, and then over time their faces would become so much more open. Seeing that made me hope that the regular massage they were receiving was also having a positive influence on the people with whom they interacted as well. In the last half of my career was when my skill level had really increased, and being able to help people have less pain and to lead better lives was incredible. Seeing people who couldn’t do the things they enjoyed due to pain, and then watching them be able to return to those activities, was very rewarding.

I continued working full-time as a massage therapist until September 30th of this year, which is when I closed my business.

CM:  Why did you close it, and what are you working on now?

RR:  It took me a while to finally admit it, but I got burned out. Even though I took regular breaks and vacations, pursued continuing education, and had non-massage hobbies, I still burned out. I suppose it’s the right time; I didn’t plan on doing massage for the rest of my life. My hopes were to have something related to fall back on. Last year I organized the first annual San Diego Pain Summit with Professor Lorimer Moseley as the keynote speaker. I organized the entire event myself with no outside help. The event went really well, the 2016 event is filling up, and I’m lining up presenters for the third one to take place in 2017.

I’m also working on sharing the knowledge I acquired running my own business with other massage therapists and small business owners. I’d like to teach folks who are already in business, so I’ve started a consulting service. That project is moving at a slower pace because I spend more time working on the Summit. But I’m working on creating webinars and tutorials to help other small business owners. I’ve always loved marketing, and with advancing technology there are many things that business owners neglect because they can’t see or understand the relevance.

CM:  Should massage therapists consider attending the Pain Summit?  What do they stand to gain from it?

RR: Yes, definitely. Especially for those who are working on clients who are recovering from or dealing with chronic pain. Last year about a third of the attendees were massage therapists. If we want to be a part of a healthcare team, then it is important that we learn how to communicate within that team. One of the main goals I hope to accomplish is to help bring manual therapy forward when it comes to managing pain. Everything covered at the Summit is also within the scope of the massage practitioner.

Currently there is a lot of discussion and debate around psychological-based topics relevant to massage therapy and pain science, such as CBT (cognitive behavioral therapy), ACT (acceptance, awareness, and values in chronic pain), and similar approaches. However, these cover mostly ways to communicate with our clients and patients. It is not applying psychology per se. Three of the presenters at the 2016 Pain Summit will be covering these topics, which potentially clarify the importance and applicability of these important topics. In this way the Summit provides a place for education, interaction, and networking for massage therapists who want to advance their training and understanding.


The 2015 San Diego Pain Summit was a landmark event in massage and manual therapy education, and was very well received.


CM: How did the idea to create the Pain Summit come to you?  What motivated you to make it happen?

RR: In January 2013, I organized a continuing education course for manual therapists that included three days of dermoneuromodulation with Diane Jacobs followed by a two-day Simple Contact class with Barrett Dorko. Barrett asked the students what their physical therapy programs taught them about pain and whether they were familiar with the works of Patrick Wall, Louis Gifford, or David Butler. One of them said, “yeah, we learned about that pain science stuff but I don’t know how to apply that to my clinical work.” That’s when the light bulb came on – I had the idea and I was sure it could work. Very soon I drafted a list of potential speakers and discussed the idea with some trusted colleagues who encouraged me to go forward with it.

I knew I would need a well-known presenter to serve as a draw, which would help ensure the event’s success.  I contacted Professor Moseley, and he thought it was a great idea and agreed to give two presentations. Once he was in, I knew the event was actually going to happen, and after that I was able to get commitments numerous other respected presenters representing a range of related occupations and perspectives.

CM:  From your perspective as a massage therapist, conference organizer, and consultant, what are the biggest challenges that the U.S. massage therapy profession currently faces?

RR:  It is funny how that question seems so simple, yet it really is hugely multi-dimensional. It seems to me the massage profession is heavily fractured. There are those who want more critical thinking and clinical reasoning so that massage may be better utilized as part of valid healthcare. Others are anti-science and tend to apply magical thinking to their work. Then we have those who hate regulation, and others who find it important. And then there are those who just want to keep their heads down and be left alone to work, while others are a combination of some of the aforementioned types. Basically, our profession is heavily splintered such that, sometimes, nothing really seems to get done as a whole.

Overall, though, the biggest issue within the profession that I see is that we tend to be prone to huge egos and that can make it difficult for communicating with each other. I’ve experienced this at massage conferences and at the half dozen continuing education classes I’ve attended over the years. I’ve seen a lot of puffed-out chests and folks not wanting to share how they work, or during a class showing everyone the best way to do this or that with the client. I think this stems from the fact that our work really does help people feel better, and so here we are all day long in our offices hearing nothing but praise from our clients and seeing some really great results. No one is angry to see their massage therapist! This is what we typically deal with, and I think over time it affects our personalities and can give us an over-inflated sense of importance that makes it difficult to approach our profession, and our work, with a critical eye.

I think it’s an exciting time and I am interested to see where the massage profession ends up – it may be different than any of us can imagine. Really, the entire healthcare system needs an overhaul. A few years ago, I sat down and read the entire Patient Protection and Affordable Care Act and unless it has been changed, there is an amendment that is going to require all insurance companies to accept massage starting in 2016, so that will be interesting.

CM: Thank you, Rajam.

Following on from the successful 2015 San Diego Pain Summit, the 2016 edition is poised to be a great event and one that I expect will be viewed as a milestone in the advancement of massage therapy. Rajam Roose has assembled a most impressive line up of presenters headlined by Dr. Robert Sapolsky. You should not miss this, and I hope to see you there.

“Advancing Massage Therapy Education” – an invited presentation

On October 5th, 2015 I gave an invited presentation to the School of Health Education at Madison College. The topic was “Advancing Massage Therapy Education” and this talk included some ideas for integrating research into MT training programs.

Amy Nicholson and her colleagues at Madison College are making this presentation, which is about an hour long including some Q & A at the end, available to everyone. Have a look by clicking here.

Interviewed: Ravensara Travillian – massage therapist, research scientist, and educator

This is the third installment of an occasional interview series with notable people in massage therapy practice, education, research, and related fields.

Ravensara Travillian is a remarkable woman.  A licensed massage practitioner since 1992, she is also experienced in many other fields.  She has worked extensively with several refugee communities.  She has been a software programmer.  She earned a Ph.D. from University of Washington and has worked as a scientist for the European Bioinformatics Institute in Cambridgeshire, England.

She has studied the reproductive cycle of the sun bear, an endangered species.

She is a cancer survivor.

She has helped build the FaceBase knowledge repository of data on childhood craniofacial disorders such as cleft lip and palate.

Her Erdős number is 3, way lower than it needs to be to make me envious.

And, presently, she is working on some ambitious projects that integrate her work as a massage therapist with her knowledge and experience as a scientist and educator. Read on.

Christopher Moyer: Are you a scientist who also does massage therapy, or are you a massage therapist who also does science?

Ravensara Travillian: Based on time devoted to each pursuit, I used to be a scientist who also did massage therapy. Now that has changed, and I am a massage therapist who also does science.

CM: How did you choose to become a massage therapist?

RT:  I was working in the software industry, and seriously burning out on it. Two of my coworkers had started a night program in massage therapy. I had never heard of such a thing, but it clicked with me the moment I heard about it, and so I enrolled doing the same thing–working at my day job, and going to massage school at night, for a year.  Soon after that I took a position as the massage therapist at Harborview Medical Center’s Refugee Clinic, and got to work with survivors of war and genocide who dealt, daily, with the effects of post-traumatic stress disorder.  Those were seven of the most meaningful years of my life.  I also developed a private practice during that time.

My mother was a pioneer who challenged all the obstacles to attend medical school in Alabama in the 1950s, when medicine was considered an inappropriate career for women. She was truly passionate about her work. Being raised in a medical family by someone who lived and breathed that work ensured that I was never intimidated by hospitals or medical jargon, because it was so familiar. As a result, other healthcare professionals trusted me as someone who could be a bridge between their own work and massage therapy. I developed my practice treating clients with some very complex and serious conditions, such as high-risk pregnancies and cerebellar stroke.


Dr. Travillian has considerable experience providing massage therapy to persons with serious health concerns.

CM: But that trust was not simply because you had a familiarity with jargon – you’re a trained scientist.  Tell us more about that, please.

RS: I was a total science nerd as a kid – even before I started grade school, I could find the stars by name in the constellations, and tell you about their natural history. I grew up playing with zoology, chemistry, and math, as well as with balls and bicycles.

I’ve loved science my entire life – I can’t even remember a time when I wasn’t curious about the natural world and how it worked. And I was very fortunate that the grown-ups in my life encouraged that curiosity and supported it with reading, field trips, museum and planetarium visits, and more. Because they were so supportive, it lit the flame in me to pay that back, and now I mentor youth in the refugee community in support of their love of learning. This can help them build better careers and lives. But, also, to see that love of learning take root, to see their curiosity and enthusiasm for learning unfold, and to see them challenge ideas and support each other – nothing could make a teacher happier.

All of that earlier life work was amateur science, though – I actually focused on humanities as an undergraduate, getting a bachelor’s degree in French and German, and then on social sciences in graduate school, earning a master’s degree in Southeast Asian studies. My interest in other cultures really blossomed then, and I did a lot of work with Vietnamese and Cambodian communities in the U.S. That’s the connection that led to my becoming a massage therapist at the Refugee Clinic.

I loved my massage work, and at the same time, I saw so much more need than I could fill. Many of my immigrant clients saw me as their advocate in a system that they didn’t understand, and wanted my help in navigating it to get the care they need. They didn’t understand how massage is not an integral part of the healthcare system in the U.S., as it was in their own culture. And I also saw so many of my massage therapist colleagues – good, warm, deeply caring people who wanted nothing more than to help, and to be a force for good in changing the world for other people – getting trapped in dead-end rabbit holes of false explanations of the body and the natural world that didn’t match reality.

They truly wanted to understand, but were trapped by the explanations that they were taught by educators whom they trusted to get it right. And, worse, because of the beliefs that they subscribed to – and paid good money to learn – they were alienating healthcare professionals who were fearful that massage therapy’s connections to pseudoscience could undermine their patients’ medical care. So the massage therapists wanted credibility, legitimacy, referrals, and reimbursement for the valuable work they were capable of, but their education also trained them to do things that made those goals harder to achieve. Meanwhile clients wanted more massage therapy, and healthcare professionals wanted to refer to massage therapists, but not at the price of being forced to choose between healthcare grounded in reality versus a treatment that espoused obviously incorrect ideas about how biology, physics, and other sciences actually work.

As someone with a foot solidly in both camps, I thought I could see how they’re pinned. So I decided to use my grounding in science to build bridges between massage therapy and mainstream professional healthcare. I closed my practice (except for one woman living with a very complex condition; I stayed with her until the very end a few years later) and returned to school, completing a PhD in Biomedical and Health Informatics at the University of Washington School of Medicine. That’s when I made the transition from amateur to professional scientist.

sun bear

Dr. Travillian’s scientific background includes detailed study of sun bears, an endangered species.

Informatics is the science of information–how we find and collect it, how we organize and evaluate it, and how we share it with each other. My PhD is in an area where semantics intersects with technology. Another way to say that is that I study how we can use computers to collect, organize, and share meaningful biomedical knowledge. Now I am working to apply that research to support massage therapy in adapting to the massive social changes it is currently facing.

CM: And now you are involved in projects that integrate your training in massage therapy with your training as a scientist.

RS: Yes, I am starting the Pacific Northwest College of Allied Health Sciences (PNCAHS), a school to extend these practices in a sustainable way.

Grounding the humane and client-centered work that we massage therapists already do in a foundation of science is so important that it is reflected in the name of the school. We consider professional massage therapy to be an allied-health discipline, meaning we commit to the shared body of mainstream medical knowledge that other client-centered, biomedical healthcare professions are founded upon. We also emphasize science as the best way of correctly understanding how the natural world works, including the human body in health and in illness, and for translating that understanding into safe, effective, and cost-effective treatments for clients.

One of the PNCAHS programs will be a master’s degree in Advanced-Practice Professional Massage Therapy (APMT), which will integrate massage therapy and science.  Within that name, Massage – non-sexual touch with the intention of providing care, relief, comfort, solace, attention, and other positive outcomes – is central.  But further, Massage Therapy recognizes that we’ve specifically trained in the shared, structured body of knowledge, developed across many centuries and cultures, about how humans relate to one another through our natural inclination to use touch to help someone feel better. We are proud of our membership in the worldwide community of massage therapists.

Professional means that we actively participate in the shared body of scientific, biomedical, and biopsychosocial knowledge that is the foundation of all modern, mainstream, client-centered healthcare professions, and that we subscribe to the same ethical values and practices that those professions share: autonomy, beneficence, non-maleficence, dignity, and justice.  Practice emphasizes the crucial importance of putting theories and knowledge into active service and outreach for our clients, and Advanced is meant to reflect how hard we work to gain a rigorous and nuanced understanding of how our natural world works, and of how humans operate in relation to each other within that world.

This resembles the path some other healthcare professions have taken before us. Nursing and clinical psychology, for example, encountered challenges similar to the ones that massage therapy now faces. As a result, we actually have many potential allies who understand our struggles, and who can offer their experience in the hope that we can use it as a model to advance our own professional success.

The master’s program is in development, and we are aiming for program applications to be available this coming December or January and for classes to commence in September 2016.

In the meantime, we are integrating massage therapy and science by offering continuing education classes and workshops on science-based Trauma-Aware Massage Therapy, professional ethics, and other massage topics; live-blogging interdisciplinary workshops on an open-access, free-of-charge basis, with other evidence-based healthcare professionals who are eager to see us take a place at the decision-making table; developing technology tailored to the information needs of massage stakeholders; and conducting client appreciation events to raise awareness of our clients themselves and to heighten our visibility in those client communities.

CM: As scientists and as educators, you and I encourage people to think critically and to be skeptical.  With that in mind, what might you say to someone who is skeptical that you can make this ambitious goal a reality?  Or to someone who is skeptical that there is enough potential interest and support from the massage therapy profession to make an advanced degree program viable and sustainable?

RS: First of all, I would tell that person that they are right to raise such questions. Any time that someone is advocating for a cause, trying to sell you something, or attempting to persuade you to believe claims, you should investigate that information thoroughly. And after you investigate, if you are not satisfied with what you find, you should walk away. People deserve to settle for no less than honesty, integrity, transparency, and accountability. And it also needs to be valid – to match up with reality. If it isn’t, then you can’t rescue it, no matter how much you may personally like whoever is pitching the project. So you need to raise lots of questions like that, and to get transparent answers, to figure out whether the idea has a reasonable chance of succeeding.

With those aspects in mind, here is what I have to say. I agree that the goal is very ambitious. However, we know that professionalization is doable, because other healthcare professions have successfully traveled that path before us. We are no less capable of doing it than they were if we are committed.

Nevertheless, it is clear that the larger massage therapy industry is all over the map when it comes to attitudes about professionalization. Put yourself in their shoes for a moment – if half the people you are walking with want to take one trail, and the other half want to take a trail that goes in the opposite direction, then how do you ever get any further? If you choose one trail or the other, half of the people in your group are not going to get what they want, right from the start.

That situation is what our national organizations faced when the Affordable Care Act came into being. They were unable to seize that moment because factions of their membership, to whom they owed consideration, had entirely opposite goals about where they want massage therapy to end up. Meanwhile, time is passing us by, and clients who could really benefit from massage aren’t getting it because we haven’t taken a place at the table.

Advanced-Practice Massage Therapy is optional and self-selected. That means that our membership can all have the same goals, which are to integrate with mainstream healthcare professionals for the benefit of clients, and to let go of behaviors that prevent us from achieving that. Within APMT, we won’t have to be always at odds with each other over our foundation, and we don’t have to have the same arguments that the broader profession is so often engaged in, because we are all on the same page about the path we are on.

That is a huge part of accomplishing a mission together – to agree on what that mission is so we don’t get stuck at the very beginning. Once we have that agreement, then the rest of the plan becomes strategy, tactics, logistics, and resources. I’m not making light of those challenges, but those are all well-trodden paths. That’s where people asking about APMT’s viability should have some pointed and specific questions for me, and where I intend to do a solid job of connecting the dots.

For your second question – is there enough interest and support? – that is a very good question that we need to consider carefully before proceeding. The history of massage therapy is littered with enough well-intentioned but failed initiatives that we can’t afford yet another. There are many individual massage therapists who want to practice massage in a way that is compatible with reality and science; they have supported us wholeheartedly from the outset, and we are grateful for it. There are also potential clients who feel they might benefit from massage, but who hesitate because massage therapy’s alignment with alternative medicine is inconsistent with the information and treatment they get from their trusted healthcare providers. We offer them the opportunity for a true integrative team approach, and they support us.

There are potential colleagues in professional healthcare who feel that massage therapy might benefit their clients, but they also see massage therapists declaring publicly that massage is an alternative to the ‘slash, burn, and poison’ of modern medicine, and these potential colleagues see no basis for integration with a profession that lets such a viewpoint be expressed without challenge. We offer them the opportunity to trust us to work on a team with them, without undermining their relationship with their patients. Similarly, third-party reimbursers see the potential of massage therapy, though the low quality of much of massage research leaves them unsure which claims about massage therapy are true and which are just hype. For them, we will offer rigorous evaluations upon which they can make solid decisions regarding the safety, efficacy, effectiveness, and cost-effectiveness of massage therapy as a full-fledged component of mainstream healthcare.

To ensure sustainability, we are working with business mentors, including Irene Diamond and the Center for Inclusive Entrepreneurship, to ensure we are implementing best practices in business operations. One of those best practices is a lean launch. For example, instead of investing massive amounts of money on our own facilities at the outset, we rent small facilities that permit us to not only save money that we can re-invest in providing services, but also to take the workshops, clinics, and special events to the participants who might have difficulty traveling to us. In the last few months, PNCAHS has conducted two Trauma-Aware Massage Therapy workshops for massage therapy continuing education at the Seattle Crisis Center and at the Kent Regional Library, conducted twelve free veterans massage clinics at several other locations, held a Veterans Appreciation Brunch for our clients at the Bellevue Hilton, and held a chocolate-making class as a fundraiser. We are also leveraging open-access resources from other professions to build enduring resources that will, in turn, be available on an open-access basis to the entire massage therapy profession, so that anyone who wants it has access to the same knowledge sources as APMT has.

Viability and sustainability are so crucial to APMT that they are ‘baked in’ from the very start, and I encourage people to ask as many questions about these topics as necessary, until they get satisfactory answers that connect the dots with clarity and validity.

Raven Alice Jason

Alice Sanvito, Jason Erickson, and Ravensara Travillian at the 2015 San Diego Pain Summit. Dr. Travillian will also be a featured speaker at the 2016 San Diego Pain Summit.

CM: You’re very passionate about advancing massage therapy.  What is it about massage therapy that motivates you in this way – what is it that makes it so valuable, and worth this kind of effort?

RS: The rich, joyful meaningfulness of it all. I used to wonder if there was something wrong with me, because I would leave the Refugee Clinic feeling encouraged and empowered. I mean, what kind of person could listen to so many stories of the horrible things that had happened to these people, and not feel like bursting into tears? But with time, I realized that it wasn’t the content of the stories that was making me feel so positive, it was the trust that my clients showed by letting me get close enough to them to share their experiences, and the resilience, strength, and grace that they exhibited by being able to keep going without giving up.

Touch is a basic human need, and our society makes it hard to get that need met in healthy, constructive ways. Providing other people with caring, focused, attentive touch, and earning their trust as someone who will keep them safe in doing so, is the best job in the world. I’m very grateful that I get to do it.

CM: Thank you, Raven.