pain (Chou et al., 2017; Qaseem et al., 2017). Another example is the Canadian Guideline for Opioid and Chronic Non-Cancer Pain now recommends a trial of massage therapy rather than a trial of opioids for a number of conditions including: back and neck pain, osteoarthritis of the knee and headaches (Busse et al., 2017). Internationally – The Global Spine Care Initiative also recognizes the value of non-pharmacological treatment options such as exercise, yoga, and massage therapy (Chou et al., 2018). Being a recognized treatment option for people in pain means the profession of massage therapy is moving into new formal settings. As this shift occurs, it is important that therapists adhere to evidence-based medicine and utilize critical thinking and research literacy skills. David Sackett and Gordon Guyatt first introduced evidence-based medicine (EBM) in 1996 as the conscientious use of current best evidence in making decisions about patient care. It is a process intended to reduce the risk of harm and optimize decision-making by emphasizing the use of evidence from well designed research. This includes the use of logical reasoning and the gathering of ideas and knowledge from many overlapping disciplines. • Patient Values – The needs and requests of your patient will influence your decision making. Therapists need to be able to hear the patient’s values and create a working relationship with the patient. Shared-decision making will include developing a plan of care based on individualized goals and needs of the patient. • Research Evidence – Research’s main role is to help guide clinical decisions and to warn of known harm, the higher the quality of the evidence the more confident we can be as a therapist making an informed decision. • Clinical Expertise – Clinical experience is used to create individualized treatment plans as patient presentation will vary on a case by case basis. Making sound decisions requires the clinician to expertly assess the patient’s personal, social, and clinical context and integrate this information with the values and preferences of the informed patient. The therapist will use his/her clinical expertise and allow the evidence to guide this process, rather than dictate it. Theories and Treatment Strategies For thousands of years, people with illnesses and disabilities were treated with various methods of massage, the history of which varies from country to country. Ancient Babylonia, Assyria, China, India, Greece and Rome all practiced some form of massage. One of the oldest accounts is in Egypt in the tomb of Akmanthor, in this tomb there is a painting dating back to 2330 BC that depicts two men having work done on their feet and hands. Another historical account is in Homer’s Iliad and the Odyssey where “massage with oils and aromatic substances is mentioned as a means to relax the tired limbs of warriors and a way to help the treatment of wounds”. The use of massage for therapeutic purposes originated in a pre-scientific era and some of the reasoning once used to explain the effects do not make sense in the light of what we know today. As such we should aim to update some of our explanations and align it with current medical practice. The contemporary practice of massage therapy is often practiced as a multi-modal approach that includes, but is not limited to classical massage, swedish massage, myofascial mobilization, instrument-assisted soft tissue mobilization (IASTM), cupping, joint mobilization, strain-counterstrain, neuromuscular therapy, muscle energy techniques, neural mobilizations, manual lymphatic drainage, and education. Treatment approaches in massage therapy may vary and despite being called different names, most of these techniques have similar effects and outcomes outlined in the chart below. Overview of Massage Therapy Techniques 28 | THEORIES AND TREATMENT STRATEGIES Commonly Used Techniques Swedish massage (effleurage, petrissage, percussion, vibration, friction), Joint mobilization (grades 1-4) Neural mobilization (nerve gliding, nerve flossing, sliders and tensioners) Neuromuscular therapy and muscle energy techniques Strain counterstrain and positional release Lymphatic drainage techniques Golgi tendon organ techniques Rocking and shaking Triggerpoint techniques Myofascial mobilization (muscle stripping, skin rolling) Safety Considerations Patient comfort: Always treat client within the agreed upon pain tolerance Treatment related adverse effects: discomfort, increase of pain aching muscles, headache, and tenderness; reports of increased pain Underlying pathologies: Varicosities, uncovered opening or recent incision, contagious skin lesion, hemophilia or anticoagulant medication, deep vein thrombosis, congestive heart failure, etc. Red flags: A referral will be given if a serious underlying pathology is suspected (e.g. cauda equina syndrome, spinal fracture, malignancy, and spinal infection). THEORIES AND TREATMENT STRATEGIES | 29 Effects & Outcomes Decrease pain perception Increase range of motion Decrease muscle spasm Increase local circulation Sensory motor integration (Wholebody integration) Stimulate the parasympathetic nervous system to promote relaxation & wellness Enhanced body and postural awareness Key Takeaways As the body of knowledge to support the use of massage therapy to help