Regression to the Mean and Massage

Regression to the Mean and Massage

Or “I’m not as good as I think I am”

As a massage therapist, you become aware that there are a multitude of different techniques, styles and modalities that are being taught.  There are proprietary names, three letter acronyms and jargon, jargon, jargon. 

There is a growing awareness that the narratives espoused by most of these courses are just plain wrong and that those teaching the courses could be argued are deluded about how their manual therapy techniques are affecting the body. 

Some therapists are happy to carry on doing what they’ve always been doing and believing everything that they have been taught.  And it is quite understandable because they often achieve good results for their clients and their clients keep returning.  If it ain’t broken, why fix it?

Other (and may I dare to say) more discerning and learned therapists can become challenged by the realisation that they are not changing soft tissue structures.  To quote from https://blog.amt.org.au/index.php/2018/02/07/a-massage-therapists-journey-through-a-career-crisis/

“You’re treating a person, not a skeleton with muscles, tendons, ligaments and fascia”

I had a fairly heated online discussion the other day with a couple of therapists who, tongue-in-cheek, wanted to change job title from “Massage Therapist” to “Muscle Therapist”.  Not sure that the discussion resolved anything as all parties stuck to their own biases – mine being that muscles are just living pieces of steak – how can we think that we are doing anything to change them by massage and manual therapy?  Instead we are interacting with the nervous system.

When it comes to treating people who are in chronic pain then there is a growing awareness that the strength of the therapeutic alliance between practitioner and therapist is more important than the actual techniques employed.  In addition, the phenomenon of Regression to the Mean suggests that therapists are probably overstating their importance in impacting on client’s chronic pain.

Now the title of this post “Regression to the Mean” sounds very mathematical with the strong possibility of statistics being involved.  Whilst it can be explained in mathematical and statistical language, it can ultimately just be considered common sense.  Maybe a better title would be “Get Better Anyway”.

People who are affected by chronic pain are likely to have fluctuations in how much pain they are experiencing.  Today might be better than yesterday, worse than yesterday or the same as yesterday.  Often any changes cannot be attributed to any activity of intervention that the sufferer has undertaken.  It just is and there will be bad days and not so bad days.  The pain may change on a daily basis or there may a few bad/good days in a row before pain levels modify.

Most people will attempt to take action when their pain is worsening or reaches a particular threshold, eg they will call a massage therapist on a bad day (or after a couple of bad days).  The therapist will do their magic and lo and behold the discomfort level may fall over the next few days.

And the therapist takes the credit for the improvement and it reinforces their bias that the specific treatment they provided was instrumental in the benefits that the client obtained. 

But the fact is that, very often, the pain levels would have dropped regardless of what interventions the sufferer took as natural variation in the client’s condition took hold.

For detailed explanation of this then I would suggest that you read the article at:

http://www.dcscience.net/2015/12/11/placebo-effects-are-weak-regression-to-the-mean-is-the-main-reason-ineffective-treatments-appear-to-work/

Now this post is not a reason not to book in for a massage if you are suffering from chronic pain.  Massage therapists can and do reduce pain and the results can be relatively quick, relieving and exactly what the client needs.  The change in pain is most likely the result of the “conversation” between the massage therapist’s touch and the client’s nervous system.  Calming and providing a different/interesting stimulus can impact on the brain’s interpretation of the pain.

These benefits though are likely to be the result of touch rather than specific techniques and tools that the therapist has used.  Now it is possible that the massage can impact on the psychosocial component of pain – for example if the client has better quality sleep post massage.  But the reality is that in the days post massage regression to the mean is likely to have more relevance.


Please do not hesitate to contact Richard if you have any questions to any information presented on this blog. Any information, advice, recommendations, statements or otherwise contained herein, or in any other communication made by or attributed to Richard Lane, whether oral or in writing, is not intended to replace or to be a substitute for medical advice trained by a trained physician or healthcare practitioner.

www.richardlanemassage.com.au
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