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News in Brief
ACA Adopts New Governance Model; ACA 2017 Awards; CCA Helps Calif. DCs "Share the Love"; $1 Million to Help Advance the Profession; D'Youville Raises the Bar on Anatomy Education; ErRatum.
Clearing Blocks: A Way to Improve Cosmetic Acupuncture
As a Five Element acupuncturist who teaches facial acupuncture classes nationally, I was surprised to learn that one of the basic principles I was taught in school is unfamiliar to most acupuncturists.
Bill With Confidence: Learn What to Collect
Q: I am trying to understand what I may collect from my patient when there is insurance. Do I have to accept the amount allowed by the plan or may I collect up to my billed amount? Please note, I am not a member of any insurance plan.
An Integrated Approach to Chronic Pain
Findings from a unique Medicaid pilot project in Rhode Island involving high-use Medicaid recipients from two health plans were recently presented to the state's Department of Health, demonstrating stellar outcomes with regard to medication use, ER visits, health care costs and patient satisfaction.
Eczema & Acupuncture: A Sound Solution (Part 1)
Eczema affects approximately 3.5 percent of the global population and is one of the most common skin complaints seen by dermatologists.
The Visual Error Scoring System: A Concussion Tool
Postural stability and oculomotor function are the most easily recognized physical indicators of neurologic motor dysfunction associated with concussions.
Women's Hormones: A Western & Eastern Perspective
Sometimes it may seem that you require a degree in medicine to understand hormones and how they function.
New Relationships, Old Trauma: AOM & Other Healing Strategies
Being in love is one the most beautiful and enjoyable experiences. Most of us are willing to pay almost any price to have that experience, and still often find it elusive or fleeting. Navigating the ups and downs of loving relationships are often challenging — even for the most psychologically balanced among us.
Universal Design: Principles & Practice
In many respects, universal design serves as the core of ergonomics. It's also a good tool to use when designing a return-to-work program for injured and/or ill patients. Let's take a closer look at universal design and why it should matter to you and your patients.
Raditation & Your Smartphone: Is it Worth the Risk?
If radial arteries could talk (and in my experience they can to some extent), they would say, "Step away from the smartphone." At least that is the message I am receiving loud and clear as I feel the pulses of many patients.
Is It Time to Rethink Mental Illness? (Pt. 1)
Invariably, patients will ask their chiropractor about depression or various mental illnesses. Some practitioners will reflexively offer a cervical adjustment, suggest St. John's wort or contemplate a referral to a specialist.
Creating Good Business Buzz
What do patients really think about working with you? Rarely do you hear the whole truth. Those who improve may be candid in their gratitude.
An Unexpected Diagnosis: The Result of Lacking Communication
A couple years ago I had a case that showed me the importance of open communication between health practitioners. We need to show up with less fear, and let go of our judgments so we can do better for the patient.
Give Yourself the Digital Advantage
When you see this article in the print version of this issue and swear you read it already, don't be alarmed: you probably did. That's because by that time, the May issue will have been available online in digital format for three weeks.
Balancing Spring Challenges
As the winter months come to a close and warmer spring weather appears, patients may begin to present with new challenging pattern presentations.
A Major Role in Back Pain: The Multifidus
Back pain affects roughly 80 percent of the population at one time or another and is one of the leading causes of doctor visits.
Why I Quit Doing House Calls
My father was a chiropractor who did house calls, so when I became a DC, I figured doing house calls was part of the job. My March article recalled my experience as a small boy, accompanying my dad while he went to patients' homes to treat them.
Taking the Chiropractic Message to the Press
"There is no better place on earth to have a news event," the National Press Club boasts, and it's easy to understand why: Every year, the 108-year-old Washington, D.C.-based organization hosts countless press conferences on the hottest topics impacting America and often the world.
A Daily Strategy for Heavy-Metal Detox
In modern society, we are constantly exposed to heavy metals such as cadmium, lead and mercury. These heavy metals have no essential biochemical roles in our body, and conversely, can cause us a great deal of harm if they build up to toxic levels.
October, 2001, Vol. 01, Issue 10
Reflex Mechanisms of Massage Therapy, Part I
By Ross Turchaninov, MD
Editor's note: Dr. Ross Turchaninov graduated from Odessa Medical School in the Ukraine in 1983. He supervised the rehabilitation program at the Ministry of Public Health of Ukraine, and later served as chief scientific researcher at the Kiev Orthopedic Institute.Dr. Turchaninov is the author of more then 25 articles in Ukrainian, European and American medical and massage journals. He is also the author of two textbooks published in the USA: Medical Massage, Volume 1 and Therapeutic Massage: A Scientific Approach. Dr. Turchaninov currently resides in Phoenix, Arizona. In the past several years, massage therapy has developed with great speed in the United States as a form of alternative medicine. According to a statistical survey conducted by Eisenberg, et al. and published by the Journal of the American Medical Association in 1998, the probability of a patient visiting an alternative health practitioner increased from 36.3% in 1991 to 46.3% in 1998. Among these patients, massage therapy was second only to chiropractic care in terms of popularity.
The work of scientific institutions such as the Touch Research Institute in Florida has created a scientific background for the clinical application of massage therapy. More and more insurance companies cover the cost of massage therapy, and more and more doctors refer their patients to massage practitioners. Unfortunately, most insurance companies do not cover methods of preventive therapy; their major concern is the clinical effects of treatment. This is also a major expectation of patients and other health practitioners who recommended massage therapy. Consequently, it seems apparent that the further development of massage therapy may lead in the direction of its medical benefits.
Therapeutic massage alone does not necessarily deliver stable clinical results. This type of massage therapy was originally created for healthy people, to enhance their health and improve their well being. Some of the methods of medical massage therapy are already widely (e.g., lymph drainage massage) or partially (e.g., connective tissue massage) incorporated into the arsenal of American massage therapy; some methods remain to be rediscovered or more fully explored (e.g., segment-reflex massage or periostal massage).
The medical massage practitioner occupies a special place in massage therapy. What distinguishes a massage therapist from a medical massage practitioner? First of all, medical massage demands more education and, perhaps more importantly, a commitment to permanent self-improvement. Second, the massage therapist who studies and practices for example, lymph drainage massage, cannot be considered a medical massage practitioner, but rather a lymph drainage massage practitioner. The uniqueness of medical massage therapy is in its integrative approach. In other words, the medical massage therapist has to know all major methods of medical massage therapy, and be able to blend them together to create the unique treatment protocol of the treatment for each patient. Only in such a case can stable clinical results be achieved. We do not expect surgeons to conduct an operation by knife only; they utilize a wide set of different tools. The methods of medical massage therapy are tools massage therapists use for the health benefits of their patients. With such an integrative approach, the medical massage practitioner can treat different somatic or visceral disorders using the local and reflex mechanisms of massage therapy.
The local mechanisms of massage therapy are widely known -- they play an important role in the formation of the clinical effects of massage treatment. However, in this article I will discuss the theoretical foundation of reflex mechanisms of massage therapy. These mechanisms are key elements of the major methods of medical massage therapy: segment-reflex massage; connective tissue massage; periostal massage; and neuromuscular therapy.
The human body has two major anatomo-physiological components: soma and viscera. Soma includes skeletal system and all soft tissue structures: skin, fascia, muscles, etc. Viscera includes the inner organs and systems of our body. The soma provides our locomotion, interaction with environment and also serves as a protective envelope for the viscera. Somatic and visceral structures are perfectly united together by the nervous system. The different somatic structures also interconnect with each other through the nervous system. This interconnection can be seen between different visceral structures or systems of the body. These interconnections are possible because of several principal reflexes:
The medical massage practitioner is able to use soma-somatic, viscero-somatic and viscero-motor reflexes for the treatment of various somatic and visceral disorders. The reflex mechanism of massage therapy allows the practitioner to dramatically increase the results of the treatment of somatic abnormalities, and to participate in the treatment of visceral disorders. Soma-somatic, viscero-somatic and viscero-motor reflexes are responsible for the formation of local abnormalities in the areas of soft tissues, innervated by the same segment of the spinal cord as the original somatic or visceral disorder. These areas in the soft tissues are called reflex zones. The reflex zones do not form as soon as clinical picture of original disorder is established. In cases of somatic abnormalities, the formation of reflex zones may take an average of two-to-three weeks. In cases of visceral disorders, the reflex zones are formed after approximately three months. Thus, the reflex zones in the skin, connective tissue, skeletal muscles and periosteum are formed secondarily, as the body's response to chronic various somatic or visceral abnormalities.
The concept of reflex zones was first proposed by Prof. A. Sherbak, MD, in works published between 1910 and 1936. He developed one of the most effective methods of medical massage therapy: segment-reflex massage. The conception of reflex massage therapy continued to develop in different countries. In Austria, E. Dickle and Prof. W. Kohlrausch proposed connective tissue massage in the 1930s. In Germany, Dr. P. Vogler and Dr. H. Krauss developed the concept of periostal massage in 1950s. In 1955, Drs. O. Glezer and V.A. Dalicho reshaped segment-reflex massage by publishing maps of reflex zones in cases of different somatic and visceral disorders. In Russia, Prof. O.F. Kuznetsov developed asymmetric segment-reflex massage in 1977 for the treatment of patients with pulmonary disorders.
After World War II, reflex zones were intensively studied by American scientists (Beal, 1985). Experimental studies conducted by Prof. I. Korr in 1940s allowed scientists to more deeply understand the intimate mechanisms of reflex zone formation.
What mechanism is responsible for the formation of reflex zones in the skin, connective tissue (e.g. fascia, aponeurosis), skeletal muscles and periosteum (i.e., thin connective tissue membrane which covers bones and supports their metabolism)? Let's discuss this matter with the help of figure1.
Take as example a patient suffering from a chronic gastric ulcer. The patient complains of pain in the epigastric area, heartburn, gas, belching, etc. The symptoms worsen with stress and consumption of spicy or fatty foods. The flow of these pathological impulses (solid arrows in figure 1) travels from the peripheral receptors in the stomach, through the afferent sensory neurons, to the posterior horns of the spinal cord, where all sensory information arriving at the spinal cord is primarily processed. As soon as ascending sensory information reaches the spinal neurons in the corresponding segments of spinal cord, these neurons are stimulated. The posterior horns of the spinal cord act as a computer to analyze sensory input, then transfer it to the brain. Simultaneously, these sensory impulses from the stomach are conducted to the lower motor centers, located in the anterior horns of the spinal cord. As a result of stimulation of lower motor centers, the motor commands are sent to the area with original pathological processes in the stomach, causing changes in gastric function such as increased peristalsis, decreased gastric juice production, etc.
The stimulation of lower motor centers also produces the flow of motor impulses to the areas of the skin, connective tissue, skeletal muscles or periosteum, which are innervated by the same segments of the spinal cord as the stomach. Reflex zones start to form in these soft tissues, as a result of their permanent bombardment by motor impulses. However, these motor impulses were not produced originally by the stimulation of peripheral receptors in soft tissues. They are a radiation of sensory impulses from the stomach to somatic areas innervated by the same segment of the spinal cord as the stomach. The constant flow of unnecessary motor commands to the somatic areas causes the increased tension in these areas, and reflex zone formation.
Pathological changes in the reflex zones appear in different clinical forms. As soon as the reflex zones are formed, they start to emit their own pathological impulses through the afferent sensory neurons to the posterior horns of the spinal cord (dashed arrows in figure 1). These stimuli also activate the spinal neurons, which transfer sensory information up to the brain and stimulate the lower motor centers in the anterior horns of the spinal cord. Stimulation of the lower motor centers elicits the flow of motor stimuli back to the areas of reflex zones and, at the same time, the flow of motor stimuli to the stomach. This unnecessary flow of motor impulses to the stomach accelerates the original process of ulcer formation by increasing vasoconstriction, cellular edema, and abnormalities in the gastric secretion. Thus, a vicious circle is formed which supports further development of the chronic gastric ulcer.
Segmental-reflex massage, connective tissue massage, and periostal massage can interrupt this vicious circle - by eliminating local abnormalities in the areas of reflex zones, and by blocking a reverse flow of pathological impulses from the reflex zones to the spinal cord, brain and stomach. Essentially, this is the primary goal of medical massage therapy: to evaluate, then eliminate reflex zones.
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