This April, I celebrated my 38th anniversary of practicing massage therapy, a milestone that I never expected to accomplish. Looking back over this period, it is very clear that my career, and the nature of the work itself, has changed dramatically over the years. Part of the reason I am thinking about my career is that one of my clients asked me this question- Knowing what I know now, would I still have chosen this path? In the past, the answer was a quick “yes”. This time, I thought about his inquiry for a few moments before answering in the affirmative. His question caused me to both look backward to the past and also reassess what is important now with regard to the mission and the function of my chosen path. It is only natural and appropriate that time and experience has reshaped the fabric of my work. The result of such a long career is evolving clarity about the mission of this work, where it fits in the larger picture, and why that is important.
Looking back on those very early years, I was completely enamored with the novelty of massage therapy; it felt as though I was a pioneer down a new and important path. Years later, as I discovered neuromuscular therapy, it felt like a new chapter in my massage career had unfolded. The work required far more anatomical and technical skill than general massage and I was inspired by the challenge and the possibility of massage as a corrective and truly therapeutic modality.
During that time, it is also with a bit of embarrassment that I recall my overzealous assessment of the value of massage therapy in the treatment of musculoskeletal pain. There is an effect in psychology called the Dunning-Krueger Effect; the people who know the least are the most confident. That was certainly true for me during this time; I was unaware of that which I did not know.
As I dove ever deeper into the science of the work in the mid 1990’s, I became more and more deeply aware of the endless mysteries associated with this (and any field) of knowledge. The more I learned, the less sure I was about that which I had never previously questioned.
At the same time, a different kind of confidence began to emerge. Every client I saw became a learning experience. Research endeavors that had unexpected outcomes took me down previously unknown routes of exploration. Instead of being devastated and demoralized by research failures, I was rediscovering the same wonder for massage therapy that I had in the very beginning of my career. That sense of wonder continues to the present moment.
As many of you know, I don’t typically see people for general massage therapy for relaxation these days. Not because massage for relaxation isn’t valuable in its own right, but because I can best serve others by using my skills to solve very difficult problems. This is the interesting part with regard to my practice; as my skills have elevated, the complexity of the conditions I see has also increased. Each day is filled with deep challenges and complicated cases that push the limits of my ability.
Part of the reason that I share this background with you is that even though my career and type of massage I do has changed tremendously over the years, the mission, far clearer today, is still the same as it was in 1977. Hands-on therapy such as massage can play a vital role in health care. Far too many people suffer from musculoskeletal pain thinking that nothing can be done to help them or that the pain they experience is somehow “normal”. The development of Precision Neuromuscular Therapy (PNMT), the work that I teach, is based on effectiveness and efficiency.
As I travel and speak at conferences across the country, I have heard many presentations from researchers, health care providers, and educators from our top health care institutions and places like the National Institutes for Health. The picture they paint isn’t pretty; the data on the effectiveness and efficiency of standard approaches isn’t just underwhelming- it is a high cost that all of us are paying. This trend is not sustainable; we just cannot afford to waste money on approaches that don’t yield real benefits. As technology increases, the costs have gone up substantially. If the outcomes increased in proportion to the cost, then this increase may be justified. In fact however, our outcomes aren’t better at all. Only the cost has increased. In 2011, we Americans spent 13 Billion dollars on spinal fusions alone. The annual cost of back pain is estimated to be in the neighborhood of 90 Billion dollars! Is there a way that massage therapy, specifically Precision Neuromuscular Therapy, can fill gaps in the system and save both individuals and our health care system valuable resources?
This questions consumes my thoughts these days and demands that we clarify exactly what we are best at, especially targeting conditions that are not well served by traditional approaches. My goal for BWA is to keep better outcome data to help us know exactly that; did what we do work and how we can tweak it to be even more effective. A condition like TMJ (jaw pain) is a prime example of how we can be effective and efficient and save both the individual and the health care system substantial amounts of money and aggravation. Typically, with just three sessions, our success rate with pain in the jaw is very high. The total cost of these three sessions is a tiny fraction of what other more invasive approaches can cost. The science is also clear- more invasive approaches to TMJ pain are very expensive and do not produce favorable outcomes. My goal is to have a whole set of areas with which we are clear that we can help. On the flip side, it will also be clear that there are some conditions in which we have little to offer, therefore should refer to other disciplines who are more effective. We should know what we are good at, and what we are not.
More than ever, I believe that there is a place for our specific form of massage therapy called Precision Neuromuscular Therapy. While we have lots to do in the future, our track record with many common muscular ailments is one of effectiveness and minimal cost. Our commitment as an office is to continue to improve and refine our approaches to maximize results. You, our clients, deserve nothing less.