MASSAGE Magazine spoke with Helene M. Langevin, M.D., the National Center for Complementary and Integrative Health (NCCIH) director, in a Zoom interview, to get her insights into and updates about how the NCCIH’s strategic plan is progressing, especially in terms of massage therapy-related research.
The field of massage therapy research has gotten a boost in recent years from the work of the NCCIH, a division of the National Institutes of Health (NIH). Founded in 1992 as the Office of Alternative Medicine, the NCCIH awarded its first project research grant in 1999 and has since funded many important projects.
The NCCIH Strategic Plan
In May 2021, the NCCIH released a new strategic plan, “NCCIH Strategic Plan FY 2021–2025: Mapping a Pathway to Research on Whole Person Health.” The 80-page document, available for free on the NCCIH’s website, centers on five objectives that focus heavily on research into natural health and wellness, including massage and other manual therapies:
• Advance Fundamental Science and Methods Development
• Advance Research on the Whole Person and on the Integration of Complementary and Conventional Care
• Foster Research on Health Promotion and Restoration, Resilience, Disease Prevention, and Symptom Management
• Enhance the Complementary and Integrative Health Research Workforce
• Provide Objective, Evidence-Based Information on Complementary and Integrative Health Interventions
In addition to describing their approach to tackling these five objectives over the four-year period from 2021 to 2025, in the document the NCCIH also reaffirms its commitment to being an “efficient and effective steward of public resources,” which includes supporting research into health disparities in women and minority groups, managing risk, and evaluating completed research to assure the effectiveness and progress of projects undertaken.
Research Funded by NCCIH
Since the release of the latest strategic plan, the NCCIH has already funded several research projects focusing on aspects of massage therapy, Langevin noted.
The NCCIH is holding an “investigator meeting” of the three force-based manipulation research networks— ForceNet, Neurons_MATTR and Spine-Work—on June 29, which will be an open online session that the public can view.
Langevin also talked about the NIH’s HEAL Initiative (Helping to End Addiction Long-Term), which focuses on myofascial pain, a key contributor to the opioid crisis, as many addicted individuals’ initial contact with opioid drugs occurs when they are prescribed for common issues such as chronic low-back pain.
HEAL is currently funding research into the development of objective biomarkers for pain in myofascial tissue, which could help improve manual therapies and decrease the need for pain-killing drugs.
Langevin points to the fact that manual therapists can often feel areas of pain and tightness in a client’s body, whether that means the tissues feel stuck, or resistant to palpation. The research HEAL has targeted would help quantify whatever therapists are palpating.
“We don’t know where to measure that right now. We don’t even know what the massage therapist is feeling with their hands in terms of the abnormalities,” Langevin said. “We know they feel it, but what is it? It could be relating to the muscles. There could be areas within the muscles that are either contracted or infiltrated with perhaps connective tissue. There could be areas within the fascia that are what we call densified.”
She explained that HEAL’s goal with research projects is to develop markers for these tissue abnormalities using techniques such as ultrasound, magnetic resonance elastography or magnetic resonance spectroscopy, techniques that can measure the abnormality and, importantly, whether that abnormality improves with treatment.
Whole Joint Health is another funded initiative; this research focuses on how to pinpoint the exact source of pain to help better target therapy, especially if the source of the pain makes complementary therapy more appropriate than a more invasive intervention. For example, knee pain could be myofascial in nature, or it could be coming from the cartilage inside. Identifying the precise source could help better guide treatment options.
“A lot of times people feel like if you have arthritis, the only thing you can do is take anti-inflammatories or even have the joint replaced eventually,” Langevin explained. “But there may be opportunities for restoring the health of the joint by doing noninvasive manual therapies of the tissues around the joint, including fascia, the ligaments, etc. So we need ways to measure that.”
A Whole Joint Health online workshop will take place July 25-26. The NCCIH anticipates a mixture of participants: researchers, health care practitioners and interested members of the public. All are encouraged to attend.
“This is going to be a very exciting workshop because it’s going to combine a lot of different people who look at joints from different perspectives,” she said. “One of the sessions is going to be on different types of therapies, including manual therapies for joints.”
Another of the NCCIH’s research efforts is the Pain Management Collaboratory, a collaboration with the Veterans Administration and the Department of Defense. “We funded this [initiative] on managing pain because military service members and veterans have disproportionate amounts of pain compared with the general population,” Langevin said.
How Well Does Massage Work on Pain?
Langevin said the evidence for massage therapy’s efficacy is positive and growing, but has been hampered by the inherent subjectivity of the practice.
“We have some evidence that massage can be effective for pain, but I think that research on massage has been slowed down by the fact that we really need some objective measurements of what the massage is doing,” she said, noting this is the exact knowledge gap that the HEAL initiative mentioned above is striving to fill. “Once we have ways to measure what’s going on in these tissues that the manual therapist can actually feel with their hands, then we can do research that has an objective component to it, which always helps a lot.”
Another aspect of massage that up until now has been difficult to quantify is the quality of the client’s relationship with the therapist, which can have a great effect on the quality of the manual therapy applied. Langevin points out that with the right research structure, that even something so seemingly subjective can be measured to an extent.
Past research has set up situations in which force is applied to the body via a robot with one group, versus with human contact in another group, she noted, but more sophisticated situations can be arranged.
“Dosage” of massage therapy also has to be considered and quantified for effective research. “What kind of force and how hard and how long and how many treatments would you give? Would you treat somebody once a day or once a week or once a month?
Types of force are also a factor; there are direct compression forces, “sheer” forces that slide in at an angle, and more.
Mechanosensation and Deeper Tissue
Langevin discussed the importance of the work of Ardem Patapoutian, PhD, who won the Nobel Prize in biology and medicine in 2021 for his discovery of mechanosensors, the sensory neurons we have that detect and respond to mechanical stimuli such as pressure and temperature. She noted that most of what we know about mechanosensation comes from the skin.
“We know a lot less about the deeper tissues. What are the sensations that we get from our deeper tissues, the fascia, the connective tissues, the subcutaneous tissues and the muscles?” she said. “We know very, very little about that, but that’s beginning to happen.
“A lot of that research has actually happened in the past, mostly in Europe, but we’re hoping that our force-based manipulation networks are going to really start picking up on this and doing more work on the innervation of these tissues and understanding how the mechanical signal gets transmitted to these mechanosensors and what effects this can have on pain, for example,” said Langevin.
The Second Annual Force-Based Investigator Meeting will be held June 29 and is open and free to the public.
Beyond the Physical
Manual therapy helps your physical well-being, but psychological well-being can also be affected by it, and the NCCIH’s planned initiatives, because of their focus on whole-person wellness, are striving to get a more complete picture of manual therapies by looking into other benefits besides the physical.
“We know that touch is such an important part of psychological well-being,” Langevin said. “There’s been research on massage in babies that showed that it slowed down their stress responses. We know that massage is very calming.”
She notes that an area of interest in massage research is exactly how this type of therapy exerts an effect on the autonomic nervous system.
The Toll of Pain
Research into manual therapy is especially important right now given the incredible amount of physical pain being experienced by so many in our world.
“There are so many areas where musculoskeletal pain is really depriving people of well-being,” Langevin said. “Pain can be really crippling and it can mean that people don’t get a good night’s sleep, and then as a result of that, they have no energy the next day. They don’t have energy to exercise or to eat well.
“We think that by helping people to both reduce their pain as well as decrease their stress, and helping them get a good night’s sleep, [we] can really help people to increase their healthy behaviors,” she continued.
“When you have a specific therapy, for example, massage, it’s not just like taking ibuprofen. It may have longer effects … not only with their immediate pain, but also help them to engage in healthy behaviors, in exercise, eating better,” Langevin said. “We know that these things are all related, so it’s a gateway treatment.”
About the Author
Allison M. Payne is an independent writer and editor based in northeast Florida. She has written many articles for MASSAGE Magazine, including “MTs Provide Massage for Low-Income Chronic Pain Clients” and “5 Reasons to Join the International Consortium on Manual Therapies.”