INDIANAPOLIS — Research by a faculty member at the Indiana University School of Health and Rehabilitation Sciences is expected to support a movement to legitimize and integrate therapeutic massage and bodywork into the usual care for individuals.
“Massage is likely not the first thing one thinks of when considering higher education — at least not broader than a small component of nursing, physical therapy or occupational therapy,” said Niki Munk, a former massage practitioner and an assistant professor and director of research in the school’s Department of Health Sciences, at Indiana University-Purdue University Indianapolis. “But massage therapy is an emerging field with building research evidence as to its efficacy and effectiveness for various populations and symptomology.”
The field of massage therapy has many barriers to overcome in the research world, Munk said. “In the United States, massage therapy is not firmly established due to the lack of training standardization, regulation and oversight. In addition, practice and therapist requirements and competencies are not universal, agreed or transparent among the various practitioners and techniques included in what can be considered the umbrella term of therapeutic massage and bodywork.”
Nonetheless, there is growing acceptance within the general population and medical community of integrating massage therapy into health care and even perhaps primary care settings, she said. That trend has expanded the need for researchers like Munk to explore how massage can be used not only to rehabilitate but to preserve functioning and wellness.
Munk was a licensed massage therapist in Lexington, Ky., whose practice focused on successful aging and older adults. A decision to learn more about the elderly and the aging process led her to obtain a doctorate in gerontology from the University of Kentucky in 2011.
The study of gerontology was a natural fit with massage therapy, Munk said, because it looks at how the functioning of older adults is affected by events throughout their lives, starting from the prenatal stage. “It’s about the notion of working with people and keeping them functioning as well and as long as possible so that older adulthood is more meaningful.”
Munk’s plan had been to return to her massage therapy practice after obtaining her degree and to educate other massage therapists about older adults. Instead, Munk was bitten by the research bug.
She discovered that research done outside of academia was not done well, and research within academia was rarely conducted by individuals knowledgeable of massage therapy as practiced by massage therapists, nor informed by the therapeutic massage and bodywork field. Often, the research focused on or included massage treatments and interventions provided by professionals such as physical therapists, nurses, doctors of osteopathy and other health care providers.
Massage provided by such practitioners differs from a typical massage therapist, and such interventions are not reflective of the treatments provided in real-world massage practice settings, Munk said.
“What is frustrating is that the evidence, or lack of evidence, provided by previous studies has been inappropriately generalized to the massage therapy field in general. As I went through the doctoral program, I tried to identify where the research deficiencies lay in the massage therapy literature and determine how I could fill those,” she said.
Accordingly, Munk focused her training on research design, statistics, practice-based research and patient-centered outcome measures in addition to her gerontological course work.
After earning her doctorate, Munk worked in the University of Kentucky’s Department of Family and Community Medicine, first as a project manager/statistician and then as the department’s research protocol manager and investigator. She joined the School of Health and Rehabilitation Sciences in 2013 and continues her work as a co-investigator on the University of Kentucky research program examining real-world massage therapy for chronic low back pain patients in primary care.
At IUPUI, Munk’s research program seeks to examine massage therapy’s role in functional preservation and enhancement across the lifespan in addition to massage for chronic pain, integrative medicine within primary care, and the intersection of practice-informed massage therapy and research, and massage treatment application theory.
“I want to look at how massage can be applied throughout life so that it just isn’t being applied in a rehabilitative way, but in a wellness and a preventive way,” Munk said.
Massage therapy is cost prohibitive for most individuals because it is rarely covered by insurance, Munk said. This leads to significant accessibility issues for most U.S. residents and contributes to the notion that massage therapy is a luxury rather than a legitimate wellness or health care activity. Many aspects of Munk’s research directly consider these challenges and seek ways to overcome various accessibility issues for massage therapy utilization and integration.
“As the medical field becomes more patient centered and focused on patient outcomes, integrative practices like massage are of more interest and in demand,” she said. “Baby boomers are the highest utilizers of integrative practices (including massage therapy). They are demanding these things, they are expecting these things. People are listening to that, and you will see more and more massage therapy being offered.”
Munk intends to lend her massage research evidence to this movement towards integrative care in Indiana and the U.S.